Pallavi Harjpal

Introduction: A common, but frequently misdiagnosed, condition known as Cervicogenic Headache (CGH) is characterised by pain radiating from the cervical spine to the head. CGH can significantly impact quality of life, leading to disability and reduced productivity. It also provides information regarding the nature of CGH. External pressure on the neck and movements of the neck, such as extension, rotation, or lateral flexion, may trigger the headache, which may then spread to the ipsilateral orbito-frontal-temporal or facial regions. Pain is referred from cervical structures due to the convergence of sensory pathways in the trigeminal-cervical complex. Dysfunction or irritation of cervical joints, muscles, or nerves can contribute to CGH symptoms. Physical therapy targets the cervical spine, which is often involved in CGHs. Techniques aim to improve joint function, reduce muscle tension, and enhance cervical stability. Therapy helps to restore normal cervical function, improve posture, and enhance overall quality of life. Patients also learn about self-management strategies, ergonomic adjustments, and lifestyle modifications to prevent exacerbation. This structured background provides a comprehensive overview of CGHs and the role of physical therapy in their management and effectiveness. Aim: This article aims to provide a thorough overview of CGHs, covering a range of physical therapy treatments. Materials and Methods: In the present systematic review, a literature search was conducted to find pertinent studies and reviews on cervicogenic headache, using the PubMed database. Key search terms included “cervicogenic headache” and “physiotherapy.” Only English-language research published between 2005 and 2024 were included in the search. The platform “RAYYAN” was used for the screening of articles and provides information regarding duplicate and unresolved articles. Results: In the identification phase, a search of databases and registers yielded 40 potentially relevant records. During the screening process, two duplicates were removed, leaving 38 records for further evaluation. Of these, 21 were excluded for reasons such as irrelevance to the research question or differing study types. The remaining 17 records underwent assessment based on predefined inclusion and exclusion criteria. Ultimately, 11 studies met the eligibility requirements and were included in the systematic review. Articles with titles related to CGH and physiotherapy were included. The subjects were children, as well as male and female adults. A Clinical Trial (CT) and Randomised Controlled Trial (RCT) study design including 13 various interventions published from 2005 to 2024 were selected. All studies were written in English and had free fulltext availability. Conclusion: Given the complexity of cervicogenic headache, multiple modalities must be used in diagnosis and treatment. To improve patient outcomes and optimise therapeutic techniques, further research is required.

Introduction: Following a stroke, the resultant injury causes hyperexcitability of the contralesional hemisphere, leading to an interhemispheric imbalance and contralateral motor dysfunction. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non invasive brain stimulation technique that has been investigated for its ability to hasten stroke recovery by stimulating the ipsilesional motor cortex or inhibiting the contralesional hemisphere. Need of the study: Stroke is a major cause of impairment, with a significant number of survivors experiencing motor impairments that affect their quality of life and independence. rTMS modulates cortical excitability and plasticity and has been shown to improve motor recovery after stroke. However, the exact parameters, timing and targets of rTMS remain undefined, which contributes to its variable clinical evidence. Some research focusing on the unaffected hemisphere suggests that ipsilateral cortical stimulation may be one means to decrease interhemispheric inhibition and promote recovery. A better understanding of the mechanisms underlying these phenomena might be useful in improving stroke treatment and intervention strategies. Aim: The present research aims to determine the effectiveness of a standard physiotherapy protocol for the contralateral side combined with rTMS of the ipsilateral (contralesional) cortex in improving tone and function in subacute stroke survivors. Materials and Methods: A randomised controlled trial involving 60 subacute stroke patients will be conducted, in which the patients will be divided into two groups: Group A (experimental) and Group B (control), using a random number sequence with a 1:1 allocation ratio. The experimental group will receive rTMS along with standard physiotherapy, while the control group will receive placebo rTMS alongside standard physiotherapy. This study will take place in the outpatient department of Ravi Nair Physiotherapy College and Acharya Vinobha Bhave Rural Hospital from April 2024 to March 2025. Each group will receive five intervention sessions per week for four weeks. The Modified Ashworth Scale (MAS), Stroke Rehabilitation Assessment of Movement (STREAM), Functional Reach Test (FRT) and 10-Metre Walk Test (10-MWT) will be used to assess each patient before and after therapy. The paired t-test will be employed to test the outcome variables for the pre-post results. The Kolmogorov-Smirnov test will be used to assess the normality of the data. If the data are normally distributed, a parametric test will be performed; if normality is violated, a non parametric test will be carried out, with a significance level set at p-value <0.05.

Background and aim: Cervicogenic headache (CGH) is a complicated and common headache disorder that may present itself with cervical spine dysfunction, irritation of the nerves, central sensitization, and muscular tension. Theoretically, this diagnosis should be an exclusionary diagnosis, considering the fact that it requires extended clinical assessment of the cervical spine and an evaluation for other primary headache types. CGH represents a clinical challenge as they habitually present with an array of nonspecific manifestations highly variable among patients. Management of CGHs is properly based on accurate diagnosis and sound understanding of the complaints of the individual. The development of CGH still carries with it a palpable gap in meaningful literature related to really effective assessment tools for the condition. The aim of the current study was to develop and investigate the validity of the content of the Cervicogenic Headache Patient Questionnaire. This questionnaire is designed especially to measure pain intensity, its impact on daily activities, disturbance in sleep, and the overall quality of life in subjects with CGHs. Methodology and results: The content validity ratio (CVR) and Content Validity Index (CVI) have been used to thoroughly examine the content validity. Each item was rated by 10 experts for relevance and clarity. The scale consists of two main parts: demographic information and symptoms. Under the demographic section, the patient is asked for their age, sex, occupation, and any relevant medical history. The Symptom Checklist contains 10 questions concerning headache frequency, intensity, duration, location, and contributing factors, as well as how headaches affect daily activities, sleep, and quality of life. Item-CVI scores ranged from 0.60 to 1.00, and Scale-CVI/Ave was 0.95, which indicates strong overall content validity. The ScaleCVI/Universal Agreement was 0.83, meaning that most items are of high relevance. The clarity assessments resulted in I-CVI ratings of 1.00 for the majority of items. Using CVR analysis, items 1, 2, 5, 6, 7, and 10 all had a CVR of 1.00, whereas all the rest ranged from 0.40 to 0.80, suggesting unanimous agreement among the experts. Conclusion: The results underline the strength of the questionnaire in covering all the critical dimensions of cervicogenic headaches, such as pain, daily functioning, sleep, and quality of life. The scores provided by experts for content validity and clarity were high; hence, it is suitable for use as a comprehensive tool both in clinical and research applications.

Atlantoaxial dislocations (AAD) are a diverse set of C1-C2 rotatory subluxations that include the inferior and superior axial facet articulations. C1-C2 segments are both covered by cranial-cervical ligaments, indicating that AAD would damage both joints. Whenever the posterior elements are missing or impaired, lateral mass screw fixation has replaced alternative posterior cervical fixation procedures as the preferred treatment for securing the sub-axial cervical spine. An increase in muscle tone, hyperreflexia, pathological reflexes, digit/hand clumsiness, and gait deviations caused by spinal cord compression at the cervical level are the most common clinical features. A 23-year-old female patient came with the chief complaint of weakness, tingling sensation, and numbness in both upper and lower limbs along with imbalance while walking. She had a history of falls which was managed conservatively. As the symptoms progressed, an MRI, a CT scan, and an X-ray of the neck were done to rule out the level of injury which revealed AAD, and the patient was operated on for C1-C2 lateral mass fixation. Post-operatively, the patient was referred to the physiotherapy department for further management. The patient's quality of life and daily functioning were positively affected after undergoing early intervention as measured by the Functional Independence Measure, Neck Disability Index, Berg Balance Scale, and Dynamic Gait Index.

The internal capsule (IC) is a vital brain structure housing descending and ascending fiber tracts, with traditional assumptions about the corticobulbar and corticospinal tracts descending through the genu and anterior third of the posterior limb of internal capsule (PLIC), respectively. However, observations of IC infarctions reveal that symptoms often deviate from the expected fiber pattern, prompting a deeper exploration of these complexities. The posterior limb of the IC receives its blood supply from the lenticulostriate branches of the middle cerebral artery and the anterior choroidal artery (AChA). AChA infarctions present a diverse array of symptoms beyond the classic triad, reflecting the intricate vascular supply and lesion patterns within this region. We present a case of a 74-year-old male farmer with righthand dominance, who experienced a fall resulting in head and right lower limb injuries. Subsequently, he developed weakness in his left upper and lower limbs, facial deviation, slurred speech, and swelling in the right lower limb. Following these symptoms, his family promptly brought him to the hospital on November 30, 2023. Extensive investigations, including magnetic resonance imaging (MRI), revealed a hyper-acute infarct in the posterior limb of the left IC. The patient was admitted to the intensive care unit (ICU) for three days and later shifted to the neurology ward where medical management was commenced, including physiotherapy protocol that was started on December 2, 2023. Physiotherapy interventions were designed to address the patient's weakness, altered sensation, and diminished reflexes. Therapeutic goals focused on preventing complications, improving posture, enhancing range of motion (ROM), and mitigating breathing difficulties and mobility issues. The physiotherapy aimed to enhance the patient's overall physical and mental well-being, emphasizing independence and improved quality of life. Regular assessments and adjustments to the therapeutic interventions were made based on the patient's progress. This case underscores the importance of tailored physiotherapy interventions in addressing the diverse manifestations of IC infarctions, contributing to a comprehensive understanding of rehabilitation strategies in neurologically compromised individuals.

One of the most prevalent degenerative musculoskeletal conditions is lumbar spinal canal stenosis (LSS), which is characterized by narrowing of the lumbar spinal canal that pressures the nerve roots and cauda equine. LSS, when treated surgically, usually presents with foot drop as its major complication. Foot drop is a common presentation of several clinical diseases, traditionally characterized as severe weakening of ankle and toe dorsiflexion. Foot drop has a great impact on patients' lives, lowering their quality of life and affecting their activities of daily living. Ankle dorsiflexion weakness leads to foot drop and a high-stepping gait, which can cause multiple falls and accidents. This case study aimed to assess the efficacy of a customized physiotherapy program in a 50-year-old woman with paraparesis along with left foot drop and post-surgery complications following lumbar decompression and spinal fusion at L3-S1 (lumbar-sacral) level after a jerk experienced by her while working out in the gym. The objective was to determine the impact of individualized exercises on the patient's strength, gait, balance, and pelvic floor function over a 12-week rehabilitation period. The interventions included lower limb exercises (stretching exercises, strengthening exercises, and weight-bearing exercises), pelvic floor exercises, and core stability training. The findings demonstrated significant improvements in the patient's functional outcomes, as evidenced by enhanced scores in the Berg Balance Scale, Manual Muscle Testing, Dynamic Gait Index, Barthel Index, and Stanmore Assessment Questionnaire. Notable progress was observed in the strength, balance, gait, and pelvic floor function, highlighting the positive influence of targeted physiotherapeutic interventions. This case underscores the importance of tailored exercise plans in addressing the complexities of post-surgery challenges, emphasizing the potential for comprehensive recovery and improved overall quality of life through personalized physiotherapy.

Shoulder pain is a common complaint among gym-going individuals, particularly those engaged in upper limb workouts. The rotator cuff, comprising four muscles, plays a crucial role in stabilizing the shoulder joint during movements and supporting its mobility. Imbalances or weaknesses in these muscles can lead to shoulder injuries, affecting performance and overall well-being. The main aim of this review is to explore the benefit of one of the approaches in preventing shoulder pain and improving performance among gymgoing individuals. Specific rotator cuff stretching exercises target the entire shoulder complex to enhance the mobility, control, and stabilization of the joint. The dynamic warm-up routine will actively engage the relevant muscles in various planes of motion, promoting the increased range of motion and reduced inflammation. Ultimately, the results from this review can serve as important knowledge for gym-going individuals, trainers, and fitness enthusiasts, guiding them in incorporating evidence-based warm-up strategies to optimize their workouts. Empowering individuals to take proactive measures in caring for their shoulder health can lead to improved overall performance and a better training experience in the gym.