Ganeswara Rao Melam

Background. Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. Aim. To determine the current standard of ICU PT practice, attitude, and barriers. Methods. A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. Results. The response rate was 28.1 (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n=111, 89) and stroke (n=102, 82.3) as compared to congestive heart failure (n=20, 16.1) and pulmonary infections (n=7, 5.6). The preferred treatment of choice among PTs was chest physiotherapy (n=102, 82.2) and positioning (n=73, 58.8), whereas functional electrical stimulation (n=12, 9.6) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n=89, 71.7) followed by inadequate training (n=53, 42.7), and the least quoted barrier was a communication gap between the critical care team members (n=8, 6.4). Conclusion. PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.

Background: The current study was done to assess the cross-cultural difference in physical activity and sedentary behavior among girls from culturally, environmentally, and geographically diverse countries residing in Saudi Arabia. Methods: This was a comparative cross-sectional study conducted among expatriate girls (N = 275), aged 9–16 years. Participants were from India (n = 65), Pakistan (n = 88), Egypt (n = 50), Sudan (n = 49), and other nationals (n = 23). They were randomly selected from different schools in Riyadh and their Body Mass Index (BMI) and screen time was assessed. Physical activity (PA) and leisure-time activity was assessed using Physical Activity Questionnaire for Older Children (PAQ-C) and the Godin-Shephard Leisure-Time Exercise Questionnaire (GSLTPAQ) respectively. Results: Out of 275, 65.8% were active and 34.2% were insufficiently active as per the GSLTPAQ, and half of them were moderately active and only 22.2% were extremely active as per PAQ-C. No statistical significant differences in their BMI status, screen time, or the levels of PA among expatriate girls. Conclusions: This study shows that the expatriate female school children in Saudi Arabia demonstrated a similar pattern in their BMI, sedentary time spent, and PA levels.

Zusammenfassung: Ziel Kinder mit Down-Syndrom zeigen körperliche und geistige Entwicklungsverzögerungen. Aus diesem Grund können sie möglicherweise die Empfehlungen für Bewegung nicht erfüllen. Hauptziel dieser Studie war es, das Maß der körperlichen Aktivität und die Gehleistung von Kindern mit Down-Syndrom zu beurteilen. Material und Methoden Querschnittsstudie. Es wurden Kinder mit Down-Syndrom und gesunde Kinder im Alter von 8 bis 12 Jahren untersucht. Die körperliche Aktivität wurde über 7 Tage mittels Pedometer gemessen und die Gehfähigkeit wurde mittels 6-Minuten Gehtest (6MWT) bewertet. Ergebnisse Kinder mit Down-Syndrom sind körperlich weniger aktiv als gesunde Kinder. Der Test der durchschnittlichen Gehfähigkeit ergab in allen Altersgruppen signifikante Unterschiede zwischen gesunden Kindern und Kindern mit Down-Syndrom. Es bestand ein enger Zusammenhang zwischen der täglichen Schrittzählung und der Gehfähigkeit. Schlussfolgerung In unserer Studie konnten wir feststellen, dass Kinder mit Down-Syndrom einen höheren BMI haben, weniger körperlich aktiv sind und im Vergleich zu normal entwickelten Kindern eine geringere Gehfähigkeit aufweisen.

Background: Early mobilization of patients in the intensive care unit (ICU) is associated with positive health benefits. The available literature does not provide insights into the current status of physical therapy practice in the ICU in the Kingdom of Saudi Arabia (KSA). To determine the current standard of ICU physical therapy practice, attitude, and barriers, an online survey was administered to KSA physiotherapists (PTs) working in the hospitals. Methods: A total of 124 PTs volunteered to participate, and the questionnaire consisted of closed-ended questions with regard to their experiences, qualifications, barriers, and most frequently encountered case scenarios in the ICU. Results: The most commonly referred cases were traumatic paraplegia (n=111, 89%) and stroke (n=102, 82.3%) compared to congestive road traffic accidents (n=20, 16.1%) and pulmonary infections (n=7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n=102, 82.2%) and positioning (n=73, 58.8%), whereas functional electrical stimulation (n=12, 9.6%) was the least preferred choice of physical therapy, irrespective of the condition. The perceived barriers in ICU physical therapy management was low confidence in managing cases (n=89, 71.7%), followed by inadequate training (n=53, 42.7%), and the least mentioned barrier was a communication gap among the critical care team members (n=8, 6.4%). Conclusion: PTs reported significant variation in the choice of treatment for different clinical case scenarios in the ICU. Several facilitators and barriers to physical therapy management should be taken into account to improve ICU recovery. Among the most important barriers are low confidence and inadequate training and strategies needed to overcome these barriers.

Purpose: To cross-culturally adapt the ABILHAND-Kids into Arabic and to examine its measurement properties in children with cerebral palsy. Materials and methods: The Cross-cultural adaption of the ABILHAND-Kids into Arabic language included forward translation, backward translation, expert committee followed by preliminary testing. Structural validity using Rasch analysis, internal consistency, test–retest reliability, measurement error, and construct validity of the Arabic ABILHAND-Kids were examined in children with cerebral palsy (N = 154; 54% male, mean age 7.4 years). Results: Rasch analysis did not support the structural validity of the Arabic ABILHAND-Kids mainly due to response dependency. Removal of two items addressed the issue of the response dependency and resulted in a unidimensional scale meeting the requirement of the Rasch model. The scale had excellent internal consistency (Person Separation Index = 0.93) and excellent test–retest reliability (intraclass correlation coefficient = 0.98). The results supported 86% of the predefined hypotheses regarding correlation of the Arabic ABILHAND-Kids with the manual ability classification system, gross motor function classification system and the functional independence measure for children. Conclusion: The Arabic ABILHAND-Kids demonstrated adequate evidence supporting its structural validity as a unidimensional measure along with evidence supporting its internal consistency, test–retest reliability and construct validity as a measure of manual ability in children with cerebral palsy.

Postpartum physical activity is important but is often neglected owing to conflicting priorities. Given the poor activity levels in the general Saudi population, women are especially likely to have poor postpartum activity levels. This study measured postpartum physical activity of Saudi working women and investigated the relationship between physical activity levels and sociodemographic factors. Study design: Cross-sectional study. This was a cross-sectional study conducted between January and June 2017. Working, postpartum Saudi women completed an online questionnaire including demographic information and the International Physical Activity Questionnaire (IPAQ)-short form. Of 486 women responding to the online invitation, 142 (29.2%) were eligible and participated. Based on IPAQ data, 23 (16.2%), 31 (21.8%), and 88 (62.0%) participants performed high, moderate or low levels of physical activity, respectively. No significant associations were found between the physical activity levels and sociodemographic factors. The most common factors discouraging physical activity were lack of time (21.2%) and childcare responsibilities (19.1%). The majority of participating working Saudi women had low postpartum physical activity levels. No sociodemographic factors were significantly associated with the level of physical activity. Measures may be required to promote postpartum physical activity among Saudi women.

Purpose: Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method used to reduce spasticity. It was also assumed that TENS reduces pain and therefore improves limb function. Most of the previous studies about the effect of TENS were done in the lower limb and in stroke patients. There is a lack of enough literature about the direct and indirect effects of TENS in the upper limb. Hence, our study aimed to determine whether TENS combined with therapeutic exercises helps to improves hand function by reducing spasticity in children with hemiplegic cerebral palsy (CP). Materials and methods: Twenty-nine children with hemiplegic CP were randomly assigned to the TENS group (n = 15) or the control group (n = 14). The TENS group received traditional physical therapy with the adjunct application of conventional TENS for 30 minutes (pulse duration, 250 µs; pulse rate, 100 Hz) on the wrist extensors, once daily, 3 days a week, for 8 weeks, while the control group received traditional physical therapy. Results: The results showed a significant intergroup difference in handgrip strength over the 8-week period. The time to accomplish the Jebsen Taylor Hand Function Test (JTHFT) task decreased by 48% and the ABILHAND-Kids questionnaire scores improved by 23% in the TENS group. Conclusions: The use of TENS in combination with therapeutic exercise may improve strength and hand function.

Purpose: Children with Down’s syndrome (DS) are considered sedentary and less engaged in recommended physical activity (PA) levels. This study compared the PA levels between children with DS and healthy children in Saudi Arabia. Methods: The study included 85 children divided into two groups. The DS group comprised 37 children with DS aged 8–12 years recruited from the Down Syndrome Charitable Association and Al-Nahda Schools for DS. The healthy group comprised 41 healthy children aged 8–12 years recruited from regular schools in the same region. PA levels were measured over 7 days using a pedometer. Results: The healthy group was more active than the DS group (p < 0.05). The total PA steps per minute had significant differences between the DS (M = 7.979, SD = 2.21) and healthy groups (M = 17.512, SD = 3.08; p < 0.05). The daily step count differed significantly on weekdays and weekends between the groups (p < 0.05). Conclusions: The DS group had a high body mass index and physical inactivity compared with the second group. Obesity and physical inactivity among Saudi Arabian children with and without DS are major health concerns. Therefore, concerted efforts are needed to combat childhood obesity, promote PA, improve patient quality of life, and reduce the sedentary lifestyle among Saudi children and adolescents.