Background: Stroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial. Objective: The aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke. Methods: It was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22. Results: The trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted. Conclusions: VR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability. Trial Registration: Iranian Registry of Clinical Trials RCT20190715044216N1; https://www.irct.ir/user/trial/40898/view

Study Design. Prospective randomized clinical trial. The trial is registered in the Chinese registry of clinical trials with a trial number of ChiCTR1800019908. Background. Median nerve mobilization is a relatively new technique that can be used to treat carpal tunnel syndrome. But literature about additional effects of neuromobilization for the management of carpal tunnel syndrome is scarce. Objective. To examine and compare the role of median nerve neuromobilization at the wrist as compared to routine physical therapy in improving pain numeric pain rating scale (NPRS), range of motion (Ballestero‐Pérez et al., 2017), muscle strength, and functional status. Methods. A sample size of 66 patients was recruited using convenient sampling and distributed randomly in two groups. After assessing both groups using ROM, manual muscle strength, pain at NPRS, and functional status on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), which consists of two further scales (the symptom severity scale (SSS) and the functional status scale (FSS)), Group 1 received conservative treatment including ultrasound therapy two days a week for six weeks, using a pulsed mode 0.8 W/cm² and frequency 1 MHz, wrist splinting, and tendon gliding exercises, while Group 2 received both conservative treatments including ultrasound, splinting, and tendon gliding exercises as well as a neuromobilization technique. Treatment was given for 6 weeks, 2 sessions/week, and patients were reassessed at the end of the 3^rd and 6^th weeks. Results. Although both groups improved significantly in terms of all the outcome measures used, the neuromobilization groups showed a statistically more significant increase in flexion, extension, decrease in pain, decrease in SSS, decrease in FSS, and BCTQ as compared to the routine physical therapy group. Conclusions. The addition of neuromobilization in the rehabilitation program of carpal tunnel syndrome has better effects on treatment outcomes.

Stroke patients suffer impairments including sensory, motor, visual, and cognitive areas, as well as gait and balance manifestations making activities of daily living difficult. In such conditions, virtual reality training can be a potential rehabilitation tool in comparison to conventional physical therapy to cater to the burden of this disability; hence, this randomized clinical trial compared the effects of virtual reality training and conventional physical therapy on balance and lower extremity function in stroke patients. The sample of 68 poststroke participants from Kanaan Physical Therapy and Spine Clinic, Lahore, Pakistan, were divided into N = 34 cases each using the lottery method with one group given virtual reality training and the other received conventional physical therapy. Each group received 60 minutes intervention, 3 days per week for 6 weeks. The Berg balance scale and the Fugl-Meyer assessment-lower extremity scale were employed for data collection preintervention, immediate postintervention, and 6 weeks postintervention. The statistically significant differences between virtual reality and conventional physical therapy groups for the Berg Balance score ( ), Fugl-Meyer assessment (FMA)-lower extremity domains of FMA-motor function ( ), FMA-joint pain, and joint range ( ); however, there is no significant difference for time vs. group interaction and significant ( ) for the time main effect for FMA sensation. Hence, virtual reality training is more effective to restore balance and lower extremity function compared to conventional physical therapy in stroke patients. The results of the study have significant implications for the clinicians with better case management enhancing quality of life of patients along with the dearth of local literature, thus providing base for future research from a developing country’s perspective.

Objective: To measure additional benefits of neuromobilisation along with conventional treatment in improving the functional status in patients having carpal tunnel syndrome. Method: The prospective, double-blind randomised controlled trial was conducted from August 2018 to June 2019 at the Physiotherapy outdoor clinic of Mayo Hospital, Lahore, Pakistan, and comprised patients of either gender aged 20-45 years with <3-month history of carpal tunnel syndrome. The patients were randomised into control group 1 and experimental group 2. Group 1 received conservative treatment including ultrasound therapy, wrist splinting, and tendon-gliding exercises, while Group 2 additionally received neuromobilisation. Functional limitation was measured using the Functional Status Scale and the Symptom Severity Scale of the Boston Carpal Tunnel Syndrome Questionnaire. Patients had 2 sessions per week for 6 weeks. Clinical data was noted at baseline, after 3 weeks of treatment and finally at the end of the 6-week intervention. Data was analysed using SPSS 21. Results: Of the 66 patients, there were 33(50%) in Group 1; 3(9.1%) males, 30(90.9%) females, overall mean age 37.79 ±5.91 years. The remaining 33(50%) were in Group 2; 2(6.1%) males, 31(93.9%) females, overall mean age 35.58 ±7.15 years. Both the groups showed significant improvement (p <0.05), but the addition of neuromobilisation in Group 2 showed better results compared to Group 1(p<0.05). Conclusion: The addition of neuromobilisation to routine physical therapy was found to have significantly decreased the symptoms of carpal tunnel syndrome and improved the functional status of the patients. Key Words: Functional status, Carpal tunnel syndrome, Neuromobilisation.

Background: Pain in the sacroiliac joint is the most prevalent and often overlooked. The sacroiliac joints are thought to be sources of pain in roughly 10% to 25% of patients with chronic lower back pain. Due to the biomechanical nature of the joint, muscle imbalance is the most important cause of sacroiliac joint dysfunction. The hamstring and gluteus medius are the primary muscles involved in postural dysfunction-related muscle imbalance; however, the quadratus lumborum’s role in the compensatory mechanism is becoming more apparent, and its potential for treatment in conjunction with gluteus medius strengthening has not yet been investigated. Gluteus medius exercises, along with conventional treatment, are routinely given to patients with sacroiliac joint dysfunction; however, the aim of this study is to explore the additional effects of the muscle energy technique (MET) on the quadratus lumborum along with strengthening of the gluteus medius on pain, disability and quality of life of patients with sacroiliac joint dysfunction. Methods: Using a computer-generated random number table, seventy patients with unilateral sacroiliac joint pain were divided equally and randomly into two groups. Prior to initiating treatment, baseline measurements were taken using a hand-held dynamometer, visual analog scale (VAS), Oswestry Disability Index (ODI-U) and short form 36-item survey (SF-36v2) to assess strength, pain, functional disability and quality of life, respectively. Over the course of four weeks, all patients received twelve sessions, and both the pre- and post-intervention outcome measures were documented. Results: After 4 weeks of treatment, both groups showed statistically significant (p < 0.005) mean improvements in muscle strength, pain, disability and quality of life before and after intervention. However, the mean improvements in post-intervention on a dynamometer, VAS, ODI and SF-36 were better in the MET with exercise group (METGME) as compared to the conventional group with exercise (CTGME), with a larger effect size. Conclusions: The muscle energy technique, applied to the quadratus lumborum in combination with gluteus medius strengthening, is more effective clinically and significantly in improving pain, disability and quality of life in comparison to conventional treatment of sacroiliac joints with gluteus medius exercises.