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Vol.1 ● No.2 ● 2012

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Scientific Research Journal of India

Index

Editorial Growth in Cerebral Palsy Children between 3-13 years in Urban Dharwad, India Correlation of Balance Tests Scores With Modified Physical Performance Test In Indian Community-Dwelling Older Adults Safety Positions for Healthy Sex Following Back Pain

3

Dr. Parismita Bordoloi Parmar Sanjay T,

5

Nayana A. Khobre

Sunita Yadav,

Physiotherapy

Deepti Dhar

31

B.Arun

Reduced Instruction Set Computer (RISC)

Thanigaivel.V,

32bit Processor on Field Programmable

V. Subramanian,

Gate Arrays (FPGAs) Implementation

K. Priyadharsan

12

Computer Science

36

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Editorial Dear Readers, I am very pleased to present the second issue of the Scientific Research Journal of India (SRJI). This multidisciplinary and open access Journal of science is the official organ of Dr. L. Sharma Medical Care and Educational Development Society. The previous issue had covered three disciplines of science Agriculture, Anthropology and Physiotherapy. In this current issue we are covering two branches of science- Physiotherapy and Computer Science with total 4 papers. I would like to mention that this journal is intended to publish selected original research articles, reviews, short communications and book reviews etc. in the various fields of science like Botany, Zoology, Medical Sciences, Agricultural Sciences, Environmental Sciences, Natural Sciences, Anthropology and any other branch of related sciences and we’ll be more than happy to recognize any of your works in these field too. Wish you a happy reading.

Regards, Dr. Popiha Pordoloi. Ph.D. Email: popiha@gmail.com

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Growth in Cerebral Palsy Children between 3-13 years in Urban Dharwad, India Parmar Sanjay T.*. MPT (Paediatrics). Nayana A. Khobre**. MPT (Paediatrics).

Abstract: Background & Objective- Cerebral palsy is defined as a group of non-progressive disorders of movement or posture due to a defect or lesion of the immature brain. The incidence of cerebral palsy is 2-2.5 cases in every 1000 live births. Cerebral palsy is frequently associated with poor growth and children with cerebral palsy tend to be shorter and lighter than their normal counterparts. Our objective of the study is to find out growth in cerebral palsy children. Method - A sample size of 100 children with cerebral palsy of either gender from 3-13 years were assessed for body mass index, growth of children with cerebral palsy was found out. The outcome measures Child Developmental Care/National Health Center Statistics growth charts (CDC/NHCS). Results - Statistical analysis was done with statistical software (n Master 1.0). Data analysis and results showed no statistical significance growth found in children with cerebral palsy. The study showed that clinically all the children with cerebral palsy had low growth when assessed on CDC/NHCS growth charts. Interpretation and conclusion - The children with cerebral palsy had low growth compared with the other counterparts of same age group.

Key words- Growth, Cerebral Palsy.

INTRODUCTION Cerebral palsy (CP) is defined as

retardation, speech and language and oral-

“umbrella term covering a group of non-

motor problems. The etiology of CP is

progressive, but often changing, motor

very diverse and multi-factorial. The

impairment

causes

syndromes

secondary

to

are

congenital,

genetic,

lesions or anomalies of the brain arising in

inflammatory, infectious, anoxic, traumatic

the early stages of its development”.

and

Cerebral palsy is in variably associated

developing brain may be prenatal, natal or

with many

postnatal1. The incidence of cerebral palsy http://www.srji.co.cc

deficits such

as mental

metabolic.

The

injury

to

the


Vol.1 â—? No.2 â—? 2012

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is 2-2.5 cases in every 1000 live births.

the incidence of malnutrition in children

There are an estimated 4-5 million children

with cerebral palsy6.

and people in India with cerebral palsy2.

A study done on incidence of

The incidence of malnutrition in

malnutrition in children with cerebral

individuals with cerebral palsy is a

palsy tells about feeding problem are

combination of factors, which directly or

usually complicated by the lack of

indirectly result in reduced food and

awareness of parents of incidence of

nutrient intake3. Feeding problems are not

malnutrition in cerebral palsy children.

easily recognizable in children and in order

The main reasons for lack of awareness in

to optimally utilize the impaired feeding

parents were illiteracy, misconception

potential

about

in

these

identification

of

children, incidence

the

disease

and

associated

of

complications in cerebral palsy. The

malnutrition in individuals with cerebral

psychological impact of having child with

palsy is necessary. It also requires regular

severe chronic neurological disease is so

assessment of feeding and nutritional

deep that parents do not appreciate the

status

feeding problems to the extent they should.

and

the

early

appropriate

nutritional

4

rehabilitation .

The study done on Growth and

While the prevalence of growth disorders

among

these

children

nutrition disorders is common secondary

is

health conditions in children with cerebral

unknown, certain observations have been

palsy (CP). Poor growth and malnutrition

made. Growth failure has been related to

in CP merit study because of their impact

the type of cp-spastic or athetoid and to

on health, including psychological and

topographical distribution, and oral-motor

physiological

dysfunction also has been associated with

utilization, societal participation, motor

5

poorer growth

A study done on percent body fat,

function,

healthcare

function, and survival. Understanding the etiology of poor growth has led to a variety

muscle area and oral motor functions are

of

important factors for weight gain and

Increased recognition and understanding of

linear growth of children with cerebral

neurological,

palsy. The identification of the nutritional

environmental factors have begun to shape

problem has a great potential to help

care for children with CP, as well. The

improve weight, muscle mass, decrease

investigation of these factors relies on

irritability and circulation in order to halt

advances made in the assessment methods

interventions

available

to

to

improve

endocrinal,

address

the

growth. and

challenges

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Vol.1 â—? No.2 â—? 2012

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inherent in measuring growth in children

Children diagnosed with cerebral

with CP. Descriptive growth charts and

palsy were assessed for BMI by taking the

norms of

height and weight of the children. The

body composition

provide

information that may help clinicians to

child

interpret growth and intervene to improve

Stediometer with the consideration of

growth and nutrition in children with CP.

physical disabilities to measure the height

Linking growth to measures of health will

and Weight was measured by making the

be necessary to develop growth standards

children stand on weighing machine.

for children with CP in order to optimize health and well-being.

was

made

The

to

outcome

stand

on

measures

the

was

CDC/NHCS growth charts. The growth was assessed by height in meters and weight in kilograms and BMI (Body Mass

METHOD A sample size of 100 children with

Index) is calculated in weight (in kgs) by

cerebral palsy with either gender from 3-

height square (in meters). And BMI

13 years of age was assessed for body

percentiles were calculated on CDC/NHCS

mass index. The study was conducted for 1

growth charts.

year in Physiotherapy OPD of SDM medical

hospital

Dharwad

Karnataka

DATA ANALYSIS Statistical analysis was done with

India. Ethical clearance is obtained from the Institutional Ethical Committee, Shri

statistical

software

(n

Master

1.0).

Dharmasthala Manjunatheshwara College

descriptive analysis was carried out using

of Medical Sciences and Hospital, prior to

mean and standard deviation of mean age,

the commencement of the study. The

height, weight, BMI, BMI percentile.

children included in the study were

Comparison between variables is done

diagnosed cerebral palsy cases, who were

using unpaired t-test. The p-value is

able to stand on stadiometer and weighing

0.5693 which shows that there is no

machine. Children who were un-conscious,

significant difference between boys and

unco-operative, who were not able to stand

girls.

and unstable Patients were excluded. Parents of the subjects willing to

RESULTS

participate were briefed about the study

The table1 depicts the distribution

and how the study would help their

of study subjects according to gender and

children.A written consent was obtained

different types of cerebral palsy children.

from the parents of the children.

It shows mainly spastic cerebral palsy http://www.srji.co.cc


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cases more in the present study which

than girls which was not significant. The

includes 3-13years of age group. The table

table 5 depicts the children in our study are

2 depicts the mean and standard deviation

underweight with 86%.

age of both boys and girls.

The table 6 shows that comparison

The table 3, 4, 5 depicts that the

of boys and girl children with respect to

mean and standard deviation (SD) values

BMI scores by t-test with mean and

of height, weight, BMI and BMI percentile

standard deviation where there was no

for different diagnosis of cerebral palsy in

significant difference between boys and

which dystonic and diplegic type have less

girls.

mean values. And by different age groups of 3-5years, 6-8 years, 9-11 years, and 12+ years have increasing mean values as per the age increases. The mean values of height, weight and BMI is less in boys

ILLUSTRATIONS FOR DIFFERENT POSITIONS Table 1: Distribution of study subjects according to gender by different diagnosis Diagnosis Boys % Girls % Total Ataxic CP 5 71.43 2 28.57 7 Dystonic CP 5 83.33 1 16.67 6 Hemiplegic CP 11 64.71 6 35.29 17 Hypotonic CP 6 100.00 0 0.00 6 Diplegic CP 17 60.71 11 39.29 28 Quadri CP 21 80.77 5 19.23 26 Triplegic CP 8 80.00 2 20.00 10 Total 73 73.00 27 27.00 100 The above table depicts Distribution of study subjects according to gender by different diagnosis Table2: Mean and SD total oral motor scores and its dimensions by diagnosis BMI BMI% Means Std.Dev. Means Diagnosis Ataxic CP 18.1857 4.9878 63.8571 Dystonic CP 14.3333 3.2629 35.1667 Hemiplegic CP 15.5706 2.0784 41.0000 Hypotonic CP 16.0500 4.2646 42.1667 Diplegic CP 15.5429 3.0375 30.5357 Quadri CP 16.7615 4.2477 48.6154 Triplegic CP 17.3800 2.8197 65.5000 All Grps 16.1910 3.5160 43.8200

Std.Dev. 36.0159 47.2035 34.6717 46.2100 35.6282 39.3732 32.2154 38.2515

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Table 3: Mean and SD total oral motor scores and its dimensions by diagnosis BMI BMI% Diagnosis Means Std.Dev. Means Ataxic CP 18.1857 4.9878 63.8571 Dystonic CP 14.3333 3.2629 35.1667 Hemiplegic CP 15.5706 2.0784 41.0000 Hypotonic CP 16.0500 4.2646 42.1667 Diplegic CP 15.5429 3.0375 30.5357 Quadri CP 16.7615 4.2477 48.6154 Triplegic CP 17.3800 2.8197 65.5000 All Grps 16.1910 3.5160 43.8200

Std.Dev. 36.0159 47.2035 34.6717 46.2100 35.6282 39.3732 32.2154 38.2515

Table 4: Mean and SD of Wt, Ht and BMI by age groups Variables Summary 3-5yrs 6-8yrs 9-11yrs 12+yrs Height Means 97.0000 115.7500 130.1481 145.1250 Std.Dev. 10.1612 7.6031 10.5492 7.0887 Weight Means 13.2120 21.5031 28.5185 41.5563 Std.Dev. 3.2447 5.2859 8.3176 12.2666 BMI Means 13.7760 16.1719 16.5222 19.4438 Std.Dev. 2.0765 3.0619 2.6963 4.6381 The above table depicts Mean and SD of Wt, Ht and BMI by age groups

Total 119.6500 18.6917 24.5330 11.7800 16.1910 3.5160

Table 5: Distribution of samples by BMI category and gender BMI Male % Female % Total Under weight 61 70.93 25 29.07 86 Normal 9 90.00 1 10.00 10 Over weight 3 75.00 1 25.00 4 Total 73 73.00 27 27.00 100 The above depicts that Distribution of samples by BMI category and gender

% 86.00 10.00 4.00 100.00

DISCUSSION In our study the mean age group of boys population is 7.794 and of girls

children more in 9-11yrs group mean value was more as comparative to other groups.

population is 8.266 out of the total score

The mean values in the different

which showed the mean value more in age

variable of our study show different mean

group of 9-11years in total score which

values of each type of cerebral palsy

depicts there is no significant difference in

relatively

BMI in both male and female population.

having lower mean as compared to others

As in 9-11yrs age group 30 children were

due to smaller sample size in them for

there and in 12+yrs age group were 15

which no statistical analysis was been

children may be because of number of

carried out.

quadriplegic

and

hypotonic

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Vol.1 â—? No.2 â—? 2012 Studies

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Scientific Research Journal of India

have

documented

that

hemiplegic, support the hypothesis that

growth patterns for patients with cerebral

non-nutritional factors play a significant

palsy (CP) are different from those in the

role in reducing growth in children with

general population. Patients with CP have

CP.

below average weight, linear growth, and

A study done on Identification of

muscle mass and fat stores compared with

malnutrition in children with cerebral

their peers in the general population. Bone

palsy: poor performance of weight-for-

mass density is also reduced, especially

height

among patients who are non-ambulatory

undernourished children with CP have

Poor growth in children with CP

percentiles

changes

in

where

body

explained,

composition

and

may be related to nutritional factors,

proportion

compared

physical factors or factors related to the

developing

peers.

brain lesion itself. Nutritional factors

increased

include

intake,

depleted fat stores, minimally depleted

secondary to impaired oral motor and

muscle stores, severe short stature, and

swallowing

decreased bone density.

inadequate

dietary

competence

and

poor

with

Alterations

normally include

total body water, severely

nutritional status and may impact directly on growth. Physical factors result in decreased mechanical stress on bones due to immobility or lack of weight bearing.

CONCLUSION All the children with cerebral palsy had lower growth than other peer groups,

have

when they were assessed on CDC/NHCS

suggested that immobilization decreases

growth charts, which may be due to oral

bone formation and longitudinal bone

motor dysfunction and other factors such

growth and increases bone resorption,

as neurological factors and the further

which

growth-

studies can be carried out by considering

stimulating hormones. Factors related to

different types of cerebral palsy with

the brain lesion itself may impact on

various other scales and their growth

growth either directly (via a negative

pattern to find out what oral motor

neurotrophic effect on linear growth) or

dysfunction has effect on growth.

Bone

growth

suppresses

studies

certain

indirectly (via the endocrine system). Growth differences between impaired and unimpaired

limbs

in

children

with

References http://www.srji.co.cc


Vol.1 â—? No.2 â—? 2012 1. Bax

11

Scientific Research Journal of India

MCO.

Terminology

and

5. Kuczmarski R J, Ogdan C L et al.

classification of cerebral palsy.

Advance Data CDC Growth Chart:

Dev Med Child Neurol. 1964; 39;

United

295-297.

December4, 2000 (Revised). U.S

2. Chitra Sankar, Nandini Mundkar. Cerebral

Palsy-

Definition,

State,

Number

314

Department of Health and Human Services,

Centers

for

Disease

Classification, Etiology, and Early

Control and Prevention/ National

Diagnosis. Indian J Pediatr .2005;

Center for Health Statistics.

72 (10) : 865-868. 3. Bell

et

al.

longitudinal

6. Incidence A

study

of

malnutrition

in

prospective,

individuals with cerebral palsy.

of

Available

growth,

from:

http.//

nutrition and sedentary behavior in

www.cerebralpalsysource.com/mal

young children with cerebral palsy.

nutrition/index.html

BMC Public Health 2010, 10:176. 4. Bruce K. Shapiro, Pauline Green, Jackie

Krick,

Darlene

Allen,

7. Okeke

IB,

Ojinnaka

Nutritional status of children with cerebral palsy in enugu Nigeria.

Arnold J. Capute. Growth of

European

severely

research 2010; 39: 505-513.

impaired

children:

verse

nutritional

neurological factors.

Dev

Med

NC.

journal

of

scientific

Child

Neurol.1986, 28, 729-733.

CORRESPONDENCE *Assistant Prof, SDM College of Physiotherapy Dharwad India. **Post graduate student, SDM College of Physiotherapy, Dharwad India.

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Correlation of Balance Tests Scores with Modified Physical Performance Test in Indian Community-Dwelling Older Adults Sunita Yadav* MPT (Neuro), Deepti Dhar** MPT (Paediatrics)

Abstract: Background and Objective: There is sufficient evidence which shows significant relationship between balance tests and other functional tests but there is lack of literature regarding the relationship between balance tests (BBS, MDRT, BPOMA) and Modified Physical Performance Test in different age groups of older adults. Design: An Observational Study Subjects: 58 subjects were divided into three different age groups, having the mean age of 65.3±3.0 (Group-A), 73.7±2.4 (Group-B), 82.6±1.4 (Group-C), mean height of 161.4±5.6 (Group-A), 164.9±10.2 (Group-B), 160.3±5.9 (Group-C) & mean weight of 68.4±4.8 (GroupA), 72.7±6.9 (Group-B), 63.6±7.7 (Group-C) were recruited in this study from old age home and local community. Methods: Subjects in each group performed the tests in the following sequence: BBS (Berg Balance Scale), MDRT (Multi-Directional Reach Test), Modified-PPT (Physical Performance Test) & BPOMA (Balance Performance-Oriented Mobility Assessment of Tinetti) with rest period of 5-10 minutes between each scale. Result: The results suggested that there was a significant positive correlation between balance tests and Modified Physical Performance Test in different age groups of older adults. Conclusion: The current study concluded that Modified physical performance test is a efficient tool to assess static and dynamic balance and also physical function and ambulation in different age groups of older adults. It was also observed that out of these balance tests used in the study, MDRT was the most difficult to understand and perform by subjects above 70 years and the subjects above 80 years found it really hard to understand the procedure. Keywords: BBS, MDRT, BPOMA, Modified PPT, Balance, Physical Function.

INTRODUCTION The number of persons above the

people at or over the age of 60,

age of 60 years is fast growing, especially

constituting

above

7.7%

in India. India is the second most populous

population.

country in the world has 76.6 million

important cause of morbidity and mortality

Recurrent

falls

of are

total an

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Vol.1 â—? No.2 â—? 2012

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Scientific Research Journal of India

in the elderly and are a marker of poor 2

physical and cognitive status.

their likelihood of falls and to enhance physical function.

Impaired balance and physical

The Berg Balance Scale was

function are the main causes of fall among

developed by Kathy Berg (a Canadian

the older adults. Stability and orientation

physical therapist) in1993, as a means of

are to distinct goals of the postural control

measuring balance in the elderly.

system. Postural control for stability and

Multi-directional

Reach

Test

orientation requires both perception and

(MDRT) is developed by Roberta A.

action. Thus, postural control requires the

Newton in 2001. It allows for analysis of

complex

the patient voluntary postural control.

interaction

of

neural

and

4

musculoskeletal systems.

The

Performance

Oriented

Several researchers show that as

Mobility Assessment (POMA) scale was

the age increases, the changes in the neural

originally developed by Dr. Mary E.

and musculoskeletal systems disturb the

Tinetti and first published in 1986, is a

balance and physical activities.6 As age

widely used tool for assessing mobility

increases

and

and fall risk in older people. In this study

physical function also decreases due to

balance subscale of Tinetti assessment is

11

used to assess the balance of older adults.15

the

physical activities

decreased muscular power and strength.

Both balance problems and physical

Brown,

Sinacore,

developed

adults. Therefore the assessment of both

performance test in 2005 to provide more

balance and physical function is necessary

focus

for older adults in order to help establish

substituting a chair rise task and a balance

appropriate

increase

task for the writing and stimulated eating

assign

tasks described in the original PPT. The

awareness appropriate

treatment of

fall

goals, risk

assistive

and

function

by

tool was more useful in identifying deficits

decrease the disability. Several such

in physical function than the self- report

instrument

satisfactory

comparison measure, the functional status

reliability and validity in identifying older

questionnaire. The authors concluded that

people

physical

the performance based measure could

functional problems, discriminating older

assist in early identification of minor

adults by their needs for different assistive

problems in physical functioning, and

device to maintain balance or predicting

allow for opportunity for early intervention

with

shown

balance

and

and

motor

physical

to

have

device

gross

modified

D.R.

inactivity affect the quality of life of older

on

the

M,

for the patients.16 http://www.srji.co.cc


Vol.1 â—? No.2 â—? 2012 Several

14

Scientific Research Journal of India

researchers

found that

Ability to walk at least 50 feet before

physical

sitting to rest; Minimal use of rail or cane

function and previous studies also found

while climbing. Exclusion Criteria: Use

significant correlation between balance

of any assistive prosthetic device; History

scales and other functional tests.17,18,13,19

of any cardiac problem confirmed by

Therefore it is clear that there is a

physician; Any history of fainting spells or

relationship between balance and physical

extended

function.

reasons History of neurological; vestibular

balancing

exercises

improve

dizziness

due

to

unknown

Yet there is no study to show

or auditory deficit confirmed by physician;

relationship between these scales or tests

History of any visual disorder which will

in different age groups. Therefore the main

not be corrected by optical glasses as

purpose of my study is to find out the

confirmed by physician; MMSE score

relationship between balance tests and

below 23; History of postural hypotension;

Modified

test.

History of recent fractures and severe

Second purpose is, the Modified physical

arthritic conditions; History of any major

performance test assesses both balance and

surgeries during last 6 month; History of

physical function in older adults no other

any previous balance training; Moderate to

tool is required because it measure the

severe hypertensions

physical

performance

both static and dynamic balance and also physical function. It tells about fall risk,

Measurement Tools

need of assistance device and functional

Berg Balance Scale (BBS)

limitations; additionally it takes less time

The BBS was developed to measure

to administer as compared to other scale.

balance

among

impairment

in

older balance

people

with

function

by

assessing the performance of 14 functional

METHODOLOGY This observational study recruited

tasks. The results are based on how long it

58 subjects from old age homes and local

takes to complete specific tasks and how

community

Dehradun

well the tasks are performed. Each task is

meeting the inclusion criteria. Inclusion

measured on a five point ordinal scale

Criteria: Age - 60 to 89 year old healthy

ranging from 0 to 4 (0 = unable to

subjects; Gender- Both male and female;

perform, 4 = independent) so that the

Ability to abduct and flex the shoulder up

aggregate score ranges from 0 to 56.

to 90 degrees; Ability to stand for

Multidirectional Reach Test (MDRT)

of

Delhi

and

minimum 10 min. without any assistance; http://www.srji.co.cc


Vol.1 â—? No.2 â—? 2012

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Scientific Research Journal of India

The MDRT is an inexpensive, reliable and

Procedure

valid screening tool to measure the limits

The subjects were recruited based on

of postural stability in four directions

inclusion

(forward, backward, right & left) during

subjects of different age groups 60 to 69

standing. The distance of each reach is

years of age (Group- A), 70 to 79 years of

measured in centimetres or inches.

age (Group- B), and 80 to 89 years of age

Balance Performance Oriented Mobility

(Group- C). Subjects in each group

Assessment (BPOMA)

performed the tests in a sequence i.e. BBS,

The Tinetti assessment is a physical task-

MDRT, Modified-PPT, POMA. The whole

oriented scale which measures the gait and

procedure was explained to each subject

balance activities of older adults. In this

and the subject signed a consent form

study BPOMA was used to assess the

before performing the study. Description

balance of the community dwelling older

data was collected which included age,

adults; it consists 9 tasks. 6 tasks are

gender, height, weight and number of falls

measured on a three point ordinal scale

in the past 6 months. MMSE score was

ranging from 0 to 2 and remaining three

also assessed. All subjects were assessed

tasks are measured on a two point ordinal

by all four scales or tests in the following

scale ranging from 0 to 1 ( 0 = unable to

order BBS, MDRT, Modified-PPT and

perform, 1 & 2 = independent). The

BPOMA. All components of each scale

maximum score is 16.

were demonstrated to all the subjects and

Physical Performance Test (Modified-

one practice session was done for all the

PPT)

components of four scales by all the

An objective evaluation of overall physical

subjects, after that reading was taken. Each

function was obtained by using modified

test or scale was administered by myself.

PPT. The severity of physical frailty in

All subjects were offered rest breaks and

physical functioning was assessed using a

water during the session and completed the

modified PPT. It consists of 9 tasks; each

approximately 60 minute testing protocol

task is measured on a five point ordinal

without

scale ranging from 0 to 4 ( 0 = unable to

discomfort. The resting period of 5 to 10

perform, 4 = independent) except 7th task

minute was given after performing each

(turning 360 degrees) which ranges from 0

scale. As a precautionary measure, blood

to 1 (0 = unsteady, 1 = steady). The

pressure was checked prior to beginning of

maximum score is 36.

the test session and it was again taken at

and

exclusion

complaint

of

criteria

fatigue

the

or

the end of the last test performed. One http://www.srji.co.cc


Vol.1 ● No.2 ● 2012

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person was always nearby vicinity of the

1] was calculated. The mean and standard

subject.

deviation of balance tests and physical Data Analysis

performance test (modified) of Group – A

The data analysis was done on SPSS 11.5

[Table 2], Group – B [Table 3], & Group –

software. The arithmetical mean and

C

standard deviation of age, height and

correlation values of balance tests with

weight

were

modified physical performance test of

evaluated. Karl pearson’s correlation test

Group – A [Table 5], Group – B [Table 6],

was done to analyse the correlation

& Group – C [Table 7], were calculated.

between balance tests (BBS, MDRT &

Karl pearson’s correlation test was used to

POMA) with physical performance test

find out the correlation between BBS,

(modified)

people.

MDRT & BPOMA with PPT (modified) in

Statistical significance level was set at <

different age groups of older adults, Group

0.05. The data analysis was done on SPSS

– A (60 – 69 years of age), Group – B (70

11.5 software. The arithmetical mean and

– 79 years of age), and Group – C (80 - 89

standard deviation of age, height and

years of age); these three groups showed

weight

were

significant positive correlation between

evaluated. Karl pearson’s correlation test

balance tests (BBS, MDRT & BPOMA)

was done to analyse the correlation

with physical performance test (modified).

in

in

demographic

among

data

elderly

demographic

data

[Table

4],

was

calculated.

The

between balance tests (BBS, MDRT & POMA) with physical performance test (modified)

among

elderly

people.

Table 1: Mean and standard deviation of demographic data

Statistical significance level was set at < 0.05.

RESULT AND INTERPRETATION

Group – A Age Height Weight

N 20 20 20

Age Height Weight

N 20 20 20

Group – B

A sample of 58 subjects were selected on the basis of inclusion and exclusion criteria. Each group of older adults had 20 subjects except Group – C (81-89 years of age) which has only 18 subjects due to unavailability of the subjects. The mean and standard deviation of age weight and height of three Groups A, B and C [Table

Mean 65.3±3.0 161.4±5.6 68.4±4.8

Mean 73.7±2.4 164.9±10.2 72.7±6.9

Group – C N Mean Age 20 82.6±1.4 Height 20 160.3±5.9 Weight 20 63.6±7.7 Table 1 shows mean and standard deviation of demographic data of different age groups. Group –

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(60 – 69 years of age), Group –B (70 – 79 years of age) & Group – C ( 80 – 89 years of age).

Table 2: (Group – A) Mean and standard deviation (SD) of balance tests (BBS, MDRT & BPOMA) and Physical Performance Test (Modified). Tests BBS FR (MDRT) BR (MDRT) RR (MDRT) LR (MDRT) BPOMA PPT (modified)

N 20 20 20 20 20 20 20

Table 3: (Group – B) Mean and standard deviation (SD) of balance tests (BBS, MDRT & BPOMA) and Physical Performance Test (Modified). N 20 20 20 20 20 20 20

Mean and SD 27.7±5.3 12.0±3.4 9.9±3.9 11.2±3.3 11.4±4.3 12.9±2.2 27.7±5.3

Table 3 shows mean and standard deviation of balance tests and physical performance test (modified) of Group-A (70-79 Years of age).

Table 4: (Group – C) Mean and standard deviation (SD) of balance tests (BBS, MDRT & BPOMA) and Physical Performance Test (Modified). Tests BBS FR (MDRT) BR (MDRT) RR (MDRT) LR (MDRT) BPOMA PPT (modified)

N 20 20 20 20 20 20 20

Figure 1: Mean and standard deviation of balance tests (BBS, MDRT, & BPOMA) with modified physical performance test (modified) of Group A, B and C.

Mean and SD 54±2.4 13.6±2.6 11.8±2.6 12.5±2.5 12.2±3.0 14.9±1.9 31.1±2.5

Table 2 shows mean and standard deviation of balance tests and modified physical performance test of Group-A (60-69 Years of age).

Tests BBS FR (MDRT) BR (MDRT) RR (MDRT) LR (MDRT) BPOMA PPT (Modified)

17

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Mean and SD 42.6±3.6 5.5±2.2 3.2±1.9 4.9±2.3 4.4±2.2 10.5±1.4 18.0±3.5

Table 4 shows mean and standard deviation of balance tests and Modified physical performance test of Group A (80-89 Years of age).

Table 5: (Group A) Correlations of balance tests (BBS, MDRT, & POMA) with Physical Performance Test (Modified) Balance Tests BBS Vs PPT (modified) FR( MDRT) Vs PPT (modified) BR (MDRT) Vs PPT (modified) RR (MDRT) Vs PPT (modified) LR (MDRT) Vs PPT (modified) BPOMA Vs PPT (modified)

r value .759 .592 .671 .541 .518 .826

P value .000 .006 .001 .014 .019 .000

Table 5 shows correlation of balance tests with physical performance test (modified), all the balance tests show significant correlation except right and left reaches which show moderately significant correlations with physical performance test (modified) of Group – A (60 – 69 years of age).

Figure 2: Correlation Graph of Berg Balance Scale (BBS) and Physical Performance Test (Modified) of Group – A.

Figure 2 depicts correlation between BBS and modified PPT. It shows positive significant correlation in 60-69 years of age group i.e. Group – A.

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Figure 3: Correlation Graph Of Forward Reach (FR) of MDRT and Physical Performance Test (Modified) Of Group – A.

Figure 3 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group – A.

Figure 4: Correlation Graph of Backward Reach (BR) of MDRT and Physical Performance Test (Modified) Of Group – A.

Figure 4 depicts correlation between BR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group – A.

Figure 5: Correlation Graph of Right Reach (RR) of MDRT and Physical Performance Test (Modified) of Group A.

Figure 6: Correlation Graph Of Lateral Reach (LR) of MDRT and Physical Performance Test (Modified) of Group – A.

Figure 6 depicts correlation between LR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group – A.

Figure 7: Correlation Graph of Balance Performance Oriented Mobility Assessment (BPOMA) with Physical Performance Test (Modified) of Group – A.

Figure 7 depicts correlation between BPOMA and Modified PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group – A.

Table 6: Correlations of balance tests (BBS, MDRT, & BPOMA) with Physical Performance Test (modified) of Group - B. Balance Tests

Figure 5 depicts correlation between RR of MDRT and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group – A.

BBS Vs PPT (modified) FR( MDRT) Vs PPT (modified) BR (MDRT) Vs PPT (modified) RR (MDRT) Vs PPT (modified) LR (MDRT) Vs PPT (modified) BPOMA Vs PPT (modified)

r value .944 .874 .893 .826 .710 .856

P value < .01 < .01 < .01 < .01 < .01 < .01

Table 6 shows significant correlation between balance tests (BBS, MDRT & BPOMA) and

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modified physical performance test in older adults [Group – B (70 – 79 years of age)].

Figure 8: Correlation graph of Berg Balance Test (BBS) with Physical Performance Test (Modified) Of Group – B.

Figure 8 depicts correlation between BBS and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group – B.

Figure 9: Correlation graph of Forward Reach of MDRT with Physical Performance Test (Modified) of Group B.

Figure 9 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group – B.

Figure 10: Correlation graph of Backward Reach (BR) of MDRT with Physical Performance Test (Modified) Of Group – B.

19

Figure 10 depicts correlation between BR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group – B.

Figure 11: Correlation graph of Right Reach (RR) of MDRT with Physical Performance Test (Modified) of Group B.

Figure 11 depicts correlation between RR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group – B.

Figure 12: Correlation graph of Left Reach (LR) of MDRT with Physical Performance Test (Modified) Of Group B.

Figure 12 depicts correlation between LR of MDRT and PPT (modified). It shows positive significant correlation in 70-79 years of age group i.e. Group – B.

Figure 13: Correlation graph of Balance Performance Oriented Mobility Assessment (BPOMA) with Physical Performance Test (Modified) Of Group B.

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20

Figure 13 depicts correlation between POMA and PPT (modified). It shows positive significant correlation in 71-79 years of age group i.e. Group – B

Figure 15 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group – C.

Table 7: Correlations of balance tests (BBS, MDRT, & BPOMA) with Physical Performance Test (Modified) – Group-C.

Figure 16: Correlation graph of Backward Reach (BR) of MDRT with Physical Performance Test (Modified) of Group C.

Balance Tests

r P value value BBS Vs PPT (modified) .789 < .01 FR( MDRT) Vs PPT (modified) .822 < .01 BR (MDRT) Vs PPT (modified) .852 < .01 RR (MDRT) Vs PPT (modified) .770 < .01 LR (MDRT) Vs PPT (modified) .752 < .01 B POMA Vs PPT (modified) .651 < .01 Table 7: also shows significant correlation between balance tests ( BBS, MDRT & BPOMA) and physical performance test (modified) in older adults [Group – C ( 80 – 89 years of age)].

Figure 14: Correlation graph of Berg Balance Scale (BBS) with Physical Performance Test (Modified ) Of Group C.

Figure 14 depicts correlation between BBS and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group – C.

Figure 15: Correlation graph Of Forward Reach (FR) of MDRT with Physical Performance Test (Modified) Of Group C.

Figure 16 depicts correlation between BR of MDRT and PPT. It shows positive significant correlation in 81-89 years of age group i.e. Group – C.

Figure 17: Correlation graph of Right Reach (RR) of MDRT with Physical Performance Test (Modified) of Group C.

Figure 17 depicts correlation between RR of MDRT and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group – C.

Figure 18: Correlation graph of Left Reach (LR) of MDRT with Physical Performance Test (Modified) of Group – C.

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Figure 18 depicts correlation between LR of MDRT and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group – C.

the functional decline. Balance instability

Figure 19: Correlation graph of Balance Performance Oriented Mobility Assessment (BPOMA) with Physical Performance Test (Modified) of Group – C.

(activities of daily living). Therefore,

and physical inactivity in older adults contribute to this decline in ADLs effective

balance

and

functional

assessments are needed to document balance and functional abilities and in this segment of the older adult population. This information is critical to the design of all prevention/reduction

programs

and

to

maintain or improve the quality of life for these individuals.25 The BBS, MDRT, & BPOMA have Figure 19 depicts correlation between BPOMA and PPT (modified). It shows positive significant correlation in 81-89 years of age group i.e. Group – C.

documented validity and reliability to

DISCUSSION

also documented validity and reliability to

assess balance abilities. As well as physical performance test (modified) has

Assessing balance and physical

assess functional abilities in community

abilities as they relate to falls in older

dwelling older adults. Previous researchers

adults is complex due to many social and

found significant relationship between

health related issues that may be involved.

balance scales (BBS, MDRT & BPOMA)

The geriatric population above 80 years

with other functional performance tests;

adults

complicated

Barthel mobility subscale, Time up and go

situation due to a sedentary life style, a

Test and Physical Performance Test

lower level of function, and the dynamics

respectively 13, 25, 26. But there is little to no

of

emotional

documentation of relationship between

environments. Any one or combination of

three balance scales with PPT (modified).

these factors may lead to a falls at any time

Thus this study was done to find out the

because the level of the older adult’s

relationship of these three balance scales

performance may not meet the demands of

with physical performance test (modified).

the environment or task at hand. The need

The clinical trial studied the correlation

to reduce this functional decline is an

between balance tests (BBS, MDRT, &

important health care issue. It is important

BPOMA) and physical performance test

presents

their

a

physical

more

and

to identify those factors that contribute to http://www.srji.co.cc


Vol.1 ● No.2 ● 2012

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(modified) among elderly people who

number of female subjects are more than

were divided into three age categories.

males so it could be the reason for lowest

Berg Balance Scale (BBS)

values. Another study found mean values

The last two items of the Berg Balance

of BBS in fallers (36.5) and nonfallers

Test are considered the most difficult to

(35.7) older adults;25 these values are very

perform. These tasks are: item no. 13 & 14

low as compared to the current study. The

(stand with feet in tandem for 30 seconds,

reasons could be one that the mean age of

stand on one leg respectively), One study

this study population is 83±8.8 years

found that item numbers 12, 13, & 14 are

which shows very older subjects. Secondly

25

the most difficult tasks to perform, but in

they examined community dwelling older

the current study only 6 subjects (Group B

adults who were home bound and have a

& C) found difficulty to perform the 12th

neurological or musculoskeletal diagnosis

task. All the subjects got grade 4 for the

that may disturb the balance and contribute

1st, 2nd, 3rd, & 4th components of the

to falls . In another study the mean value

BBS. Not one subject reached up to 25cm

of BBS is 48.6 and the mean age of this

for the 8th component (Reaching forward

study is 74.1± 7.9 years which is

with outstretched arm while standing) of

approximately similar to Group-B of the

the BBS.

current study. The mean value of BBS of

In the current study the mean values (54,

the current study is 49.65 which is slightly

49 & 42, as shown in tables 2, 3 & 4) of

more, the reason could be the age

BBS in different age groups are lower

difference because the mean age of the

from the findings (55,55; 53,52; & 52,48

Group-B is 73.70 ± 2.4 which shows that

for male and female respectively) of one

the subjects were mostly between 71 to 75

study in 3 age groups (60-69, 70-79, &

years and the subjects of the above said

34

This difference may be due

study were mostly between 68 to 81 years,

to age difference. They have given the

so this could be the reason for the lowest

average mean of age (69); they did not

value of BBS among 254 community-

mention the mean value of age for

dwelling older adults.13

individual groups so the subjects of the

A study done by Patricia S. Smith found

this study may be slightly younger than my

significant relationship between BBS and

study; in this study the mean values for

forward reach in post acute stroke patients

females in each age group have lower than

(r = 0.78).27 The BBS has also been

males and in the current study the scores of

shown to correlate with both the Tinetti

the tests for the females also lower and the

mobility index (r = 0.91) and the “get up &

80+ years).

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Vol.1 ● No.2 ● 2012

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Scientific Research Journal of India

go test” (r = - 0.76).28 A correlation greater

groups. It also indicates that there is a

than 0.70 between total BBS and total

relationship between age and height with

Fugl-Mayer-Scale (FMS) scores have been

performance on the lateral reach test.

reported in older adults.

18

The above

These results similar to the study who

studies shows correlations between BBS

reported that, similar to functional reach

and other functional tests. This current

performance is positively correlated with

study also shows significant correlation

height and negatively correlated with

between BBS and physical performance

age.22 The four heighted persons were

test (modified), [r = 0.759, P = <0.01

present in the current study, the values of

(Group - A); r = 0.944, P = <0.01 (Group -

all the components of MDRT were greater

B); ); r = 0.789, P = <0.01 (Group - C); as

to these heighted persons as compared to

shown in tables 5, 6, 7 & figures 2, 8, and

other

14 respectively]. The reason of significant

performance of the functional and lateral

correlation between BBS and physical

reach tests in the present study are lower

performance test (modified) could be one

than mean scores reported elsewhere.13,29,

that the five components are similar

30

between BBS and PPT (modified) and

elderly females (age, 70-87 years), a study

secondly both BBS and PPT (modified)

reported a mean functional reach of

assess static and dynamic balance and also

26.7±8.9cm.30 In another research, with a

physical activity.

larger sample of 254 elderly community-

Multi-directional Reach Test (MDRT)

dwelling adults (mean age = 74.1±7.9

In MDRT backward reach is the most

years), It was reported a mean forward,

difficult task to perform because most of

backward, right and left reach tests scores

the subjects of the Group-C used to take a

of 22.6±8.6cm, 11.5±7.8cm,17.5±7.6 &

step behind while performing this reach.

16.8±7.4cm respectively.13 Yet another

MDRT is considered the more time taking

study reported mean left and right lateral

test and most difficult to understand by the

reach test scores of 21.0±2.5cm and

subjects because the mostly older adults

20.0±0.5cm respectively, from 60 healthy

use the spine not the ankle for the reaches.

females over the age of 65 (mean age =

This current study shows there is a

72.5±5.0 years).29 In each of the above

significant

between

mentioned studies scores were defined as

components (FR, BR, RR & LR) of

the mean multiple trials which may reflect

MDRT and physical performance test

score inflation due to learning over

(modified) in older adults of different age

multiple trials. In contrast, scores in

relationship

subjects.

Mean

scores

on

In a sample of 14 community dwelling

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present study were recorded from a single

as shown in table- 1). Another study found

trial. Additionally, subjects used the ankle

mean value of 13±2.9 among females

movements rather than spine movements

(mean age = 83.8±7.7 years),33 which is

which reflects the negative correlation

more

between age and ankle muscle strength,

(10.5±1.4, as shown in table- 4 ) of Group-

sensation and ability to generate large

C of the current study, in fact mean age

amounts of force at the ankle joint.31

was similar (82.6±1.3 years, as shown in

One of studies in past have revealed that

table- 1 ). The subjects for Group-C were

MDRT demonstrated significant inverse

all

relationships with scores on the time up &

component was more among the subjects

go test (TUG): [FR (r = -0.442) BR (r = -

of the current study while in the above said

0.333), RR (r = - 0.260), LR (r = - 0.310)

study where mean value was 83.8±7.7

which is a functional performance test.13

years, many subjects less than may 80

Similarly current study showed significant

years. Hence the balance scores were

correlation between MDRT and modified

better for them.

physical performance test which is again a

Physical Performance Test (Modified-

functional performance test with high

PPT)

validity and reliability. Hence it can be

In modified physical performance test, the

said

good

Ist & 2nd tasks were considered the most

functional

difficult task to perform by the subjects

that

correlation

MDRT with

also

shows

different

as

above

compared

80

and

to

mean

physical

value

frailty

performance tests.

mainly for the Groups B & C. Seven

Tinetti Balance Subscale

subjects were using the assistive devices

During the performance of this test, the

for the 8th & 9th components (climb one

subjects did not find any difficulty with

flight of stairs and climb stairs) of the

any of the tasks in the balance of

physical performance test (modified) and

performance-oriented mobility assessment

four subjects climbed the stairs by holding

(BPOMA) of Tinetti.

the one sided railing.

One study found a mean among the

In one study it was found that the mean

community dwelling older women with no

value of the PPT (modified) score among

health problems on the balance subset of

27 frail obese older volunteers after

32

12.6±1.7 (mean age = 74.7±6.0 years),

treatment was 29.4±2.2 and for control

which is similar to mean value (12.9±2.1,

group it was 29.8±2.0.34 Mean age was

as shown in table- 3) of Group-B of the

71.1±5.1for

current study (mean age = 73.7±2.4 years,

matched the current age of Group – B but

treatment

group

which

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Vol.1 ● No.2 ● 2012

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the mean value is lower i.e. 27.6±5.2 as

subjects 16 were female. It has been well

shown in table- 3, this difference is may be

established

due to age because in my study the mean

component is affected due to larger body

age for the Group - B is 73.7±2.4, which

mass in the upper segment the of body.

shows that the subjects were slightly older

The age is an important factor that affects

which reflects the negative correlation

both balance and physical function of older

between age and physical function.35 The

adults. Declines in standing balance have

mean age of group-A of current study is

been attributed to sensory, musculoskeletal

65.2±3.0 which is slightly younger than

and cognitive changes, typically in some

the control group (69±4.6) of the above

combination as multiple systems fall

study, therefore the mean value for this

below minimal functional thresholds.36

group of my study is more and second

The results of the balance tests and

reason could be that the subjects were

physical performance test (modified) are

obese which also reflects the negative

different in different age groups of older

correlation between obesity and physical

adults, which proved that the disturbance

function.

35

that

in

females

balance

in balance and physical function also differ

Another study found the mean values of

in severity (mild, moderate and severe for

physical performance test (modified) in

group A, B & C respectively) among

community dwelling older adults. The

different age groups of older adults. Thus

mean values of three groups [obese

assessment and treatment also differ to

elderly, nonobese frail, and nonobese

provide effective evaluation and treatment

nonfrail] were 34.4±0.5, 29.3±0.7 and

in different age groups. Additionally safety

15

27.8±0.8 respectively. The second group

measures are necessary for the Group – C

of above study matched with Group - B of

(80-89 years of age) in the assessment and

the current study in respect similar age,

treatment also to prevent fall.

weight and condition but the mean value of physical performance test (modified) is

CONCLUSION There is a significant relationship between

more than the current study, the reason

balance tests and physical performance test

could be that the subjects of my study may

(modified) and physical performance test

be more frail and reason could be the

(modified) is an efficient tool to assess

larger number of female subject in the

static and dynamic balance and also

current study compared to this study, there

physical function and ambulation in

both genders were in equal proportion

different age groups of older adults. It was

while in the current study out of 20

also observed that out of the these balance http://www.srji.co.cc


Vol.1 â&#x2014;? No.2 â&#x2014;? 2012

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tests used in the study, MDRT was the

functional level as well as the balance

most difficult to understand and perform

issues in an elderly person rather than

for people above 70 years and subjects

giving other tests which are time taking,

above 80 years found it really hard to

separately for balance and functional

understand the procedure. According to

performance.

this test the subject was supposed to perform movement at the ankle joint but more of trunkal mobility was seen in people above 80 years while performing this test. Hence it can be said that MDRT is not a very feasible test for cheeking balance in subjects above 80 years.

60 years continues to grow, there will be rise in the level of functional disability and health.

imperative methods

that are

It

is

therefore

appropriate

screening

developed

to

identify

community dwelling elderly individuals with functional impairment who should be referred for a detailed physical therapy evaluation. As we have seen that PPT (modified)

incorporates

all

small. The sample size of age Group â&#x20AC;&#x201C; C (81-89 years of age) was relatively smaller as compared to other groups. Gait subscale of

performance

oriented

mobility

assessment is not included in this study.

Clinical significance As the Indian population over the age of

prolonging

Limitations In the present study, the sample size was

important

entities of balance and function hence,

Future Research Future study can be done with larger sample size to see the results. Future research is needed to find out the reliability

and

validity

of

modified

physical performance test with balance scales (PPT, MDRT & BPOMA) in elderly. In my study the value of the left lateral reach is more than right lateral reach for the heighted person. Future study can be done to identify that why this difference has come and this difference is significant or not.

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affordable technique reduction De

15. Kathryn D. Mitchell, Roberta A. Newton. mobility

Performance-oriented assessment

(POMA)

L’ equilibre après un accident vasculaire cerebral grace a une technique

simple,

efficace

et

balance scale indicates need for

accessible.

assistive

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189.

20. Ganvir

16. Dennis T. Villareal, Marian banks,

J

SD.

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American

Assessment

capacity

in

of

elderly

Catheraian Siener, David R. Sina

population by elderly mobility

Core,

scale in wardha. Indian academy of

Samuel

Klein.

Physical

frailty and body composition in obese elderly men and women. J Obesity

A

Research

J.

2004;12:913-920. 17. Angela

Conrad

21. Tm steffen, LA Mollinger. Agegender related test performance in community-dwelling adults. J of

Wooton.

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integrative review of Tai Chi research: An alternative form of physical

geriatrics. 2008;4:89-97.

to

Phys

Ther.

2005;29(4):181-188. 22. Patricia

S

Smith,

Judith

A

improve

Hombree, Mary E Thompson. Berg

balance and prevent falls in older

balance scale and functional reach:

adults. J Orthopaedic Nursing.

determining the best clinical tool

2010 April; 29(2): 108-116.

for individuals post acute stroke. J

18. Matsuda,

activity

neurological

Patricia

Shumway-Cook,Anne,

Noritake, Ciol,

Clinical

rehablilitation.

2004;18(7):811-818.

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K,

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S,

Williams J, Gayton D. Measuring balance in the elderly: preliminary

patients.

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American

Heart

Association. 2002;33:1022. 28. Sabrina E., Trader, Roberta A.

development of an instrument. J

Newton,

Phys Ther association. 2001 sept

Balance abilities of homebound

10.

older adults classified as fallers and

24. Jennifer

S

Brach,

Jessie

M

Vanswearingen, Anne B Newman,

RonitaL.,

Cromwell.

nonfallers. J of geriatric Phys Ther. 26(3):03.

Andrea M Kriska. Identifying early

29. Duncan PW, Weiner DK, Chandler

decline of physical function in

J, Studenskis S. Functional reach: a

community-dwelling older womem

new clinical measure of balance. J

: performance-based and self report

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measures. J American Phys Ther

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Steffen,

30. DeWaard B, Bentrup B, Hollman J,

Megan Seney.

Brasseur J. Relationship of the

Test-retest reliability and minimal

functional reach and lateral reach

detectable change on balance and

tests in elderly females. J Geriatr

ambulation tests, the 36-item short

Phys Ther. 2002; 25:4-9

form health survey and the unified

31. Sadashiv Ram Aggarwal, Deepak

Parkinson disease rating scale in

kumar. Lower extremity muscle

people with parkinsonism. J Phys

strength and balance performance

Ther. 2008 june;88(16):733-746.

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26. Mary Thompson, Ann Medley. Forward functional

and

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reach

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sitting younger,

middle-aged and older adults. J of geriatric Phys Ther. 30(2):07. Tang,

Ching-Fan

community-dwelling

elderly men aged 50 years and above. Indian J of Phys Ther and occupational therapy. 2007;1(2). 32. Chiara

Mecagni,

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Pullin

Smith, Kay E Roberts, Susan B O’

27. Hui-Fen Mao, Fing Hsueh, FeiFang

Indian

Sheu.

Sullivan. Balance and ankle range of motion in community-dwelling

Analysis and comparison of the

aged

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balance

measures

for

64

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87

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:

A

stroke

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Phys Ther Association. 2000 May

Physical

activity

and

30;

dehydroepiandrosterone

sulphate,

insulin-like

growth

1

testosterone

in

33. Dennist , Villareal, Marian Banks, David

R,

Sinacare,

Catherine

healthy

Siener, Sarmuel Klein. Effect of

elderly people. J

weight loss and exercise on frailty

journals. 1998;27:745-751.

in obese older adults. Arch Intern Med. 2006;166:860-866.

and active

Ageing oxford

36. Dr. Sandra Brauer, Y Voner Burns, Prudence Galley. Lateral reach: a

34. Karen W, Hayes, Marjorie E.

clinical measure of medio-lateral

Johnson. Measures of adult general

postural stability. J Phys Ther Res

performance tests. Arthritis care

Int. 1990;4:81-88.

and

research.

2003

Oct

15;49(55):S28-S42. 35. Marc Bonnefoy, Tomasz Kostka, Marie

C. Patricol,

Sophic E,

Bethouze, Brono Mathian et al.

CORRESPONDENCE *Student, Dolphin Institute, Dehradun affiliated to H.N.B Garhwal University, Uttarakhand, India Mob: 08882590557. **Lecturer, Dolphin Institute, Uttarakhand. India

http://www.srji.co.cc


Vol.1 ● No.2 ● 2012

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Scientific Research Journal of India

Safety Positions for Healthy Sex Following Back Pain B.Arun.* MPT, CMPT

Abstract: Sexual rehabilitation is never a part of low back rehabilitation in India. Sex is enjoyment, which should be liked by both the partners, around the world about eight out of every 10 people has experiencing back pain at some time in their lives, Back pain could cause difficulty in day-to-day activities. Crisis on partner’s relationship may occur due to unsatisfactory sex. India a Cultural Rich & Religious country will posse’s mysterious side on sex and people live in India have closed mouth attitude on sex. Fear about pain during sex is the first thing which produces fear on sex. The partners should understand the facts on pain and accommodate the new positions for happy and healthy sex. Variety of recommended positions is there which help to alleviate pain and gives good support and satisfaction to both partners.

Key words: Sexual Rehabilitation, Sex, Low Back Pain, Physiotherapy

INTRODUCTION Sex is pleasure, it is a wonderful feeling experienced by both partners. The

activity for both the partners. Pain in the back is one of the major causes of it.1

interpersonal relationship between the

Sexuality is an integral part of

partners brings a firm emotional bond.

normal and healthy relationships. It need

Sexual activity has not only produced by

not be the first thing abandoned when you

physical,

emotional aspects but also

are bothered by a flare-up of Back pain.2

biological aspects in human. The strong

Though it is chronic it should not prevent

union between the partners may be

one from enjoying this part of the

wrecked due to a variety of causes. One of

relationship.

the major causes for the breakage is

Low back pain is the most common

unhappiness or dissatisfaction. Pain may

musculoskeletal problem encountered by

produce disappointments during sexual

most adult population around the world. Four out of five adults will experience http://www.srji.co.cc


Vol.1 â&#x2014;? No.2 â&#x2014;? 2012

32

Scientific Research Journal of India

significant back pain sometime during

Literatures supports that the physical

their

cold,

activity during sex produce similar stress

problems caused by the back are the most

to back same like lifting, pulling ect.. On

frequent cause of lost work days in adults

while performing a vigorous movement in

under the age of forty-five. 3, 7

the pelvic region there is an increased

life.

After

the

common

scenario,

stress at the back. During anterior tilting of

rehabilitation of back pain concludes when

pelvis, the back muscles get compressed

a patient has significant reduction of pain

with ligaments and other soft tissues. The

or he has got ability to do all ADL

repetitive activity produces more stress to

activities, like day to day activities or

the muscles, fascia and bones around the

handling

back result in pain.

In

the

job

Indian

task

ect..

Very

few

rehabilitation protocols followed in India

People with back pain are usually

focuses on the other parts of rehabilitation.

aware which positions could cause pain

Mostly sexual rehabilitation is not the

and they are able to find out which

choice of treatment for patient living in

positions tend to increase or provoke pain.

India.

During vigorous sexual activity there is Sexual

inhibited

by

activity acute

is

frequently

pain.

Sexual

more stress in the lumbar region which can prevent

active

participation

of

the

dysfunctions following back pain is the

individual and most of the time back pain

common

infrequently

ruins their intercourse. A good scheme to

discussed with the therapist. The reasons

keep enjoying sex is to choose sensuality

for this closed mouth attitude are multiple.

over sexuality.

complaint

but

People who are suffering with it feel that

Back pain may ruin sexual life and

they may be the only ones having the

may wreck the relationship between the

problem and therefore embarrassed to talk

partners. So finding the positions which

about it, even with the doctor or to the

help to reduce or minimize pain is

therapist. Some doctors do not feel

important for a successful sexual life.

comfortable with the subject, or may not

Modified positions are there to reduce

even recognize it as a problem.4

stress in the back and help in safe sex. Conditions like herniated disk, spinal

WHY PAIN OCCURS DURING SEX? During the sexual activity between the

partners

musculoskeletal

there

are

activity

arthritis, & Sacroiliac joint dysfunctions need modification of the positions. 7

of

Fear of pain may ruin the sexual

happens.

life between the partners. Back pain

number

http://www.srji.co.cc


Vol.1 ● No.2 ● 2012 doesn’t

stop

the

33

Scientific Research Journal of India sexual

relationship

between the partners. In fact it tells to

Apart from it the modified positions will also help to ease pain.

accommodate the position to get rid of

Physical fitness doesn’t mean that

pain. Back pain is more of psychological

the partner is able to handle the pain.

than physical. The most part of pain

Mental fitness is as important as physical

depends on mental status of the person.

fitness.

Understanding

the

problem

between the partners is very important for managing for the problem. Having a good

HOW TO ASSESS IT? Various Back disability scale has an

inclusion

of

sexual

communication and developing a positive

relationship

attitude can reduce the anxiety and

questionnaire. Like, Oswestry has one part

apprehension between the partners. Sexual

which focuses on sexual relationship. The

intercourse provides a natural pelvic tilt

scale by Laumann et al., 2005, has come

movement which is to be encouraged to

up with a scale to find out sexual

relieve lower back pain. Partners must

dysfunction in males. The scale will be

create and use of other sexual techniques

helpful in evaluating the dysfunction.

that can spare the back, like touching, atmosphere creation and oral sex. Create an atmosphere that is very romantic and

HOW TO MANAGE IT? Learning up a new posture or pain

not be rushed, relaxed and peaceful. Begin

relieving methods like massage or ice prior

with oral method and followed with

to the sex helps in reducing pain and

recommended potions.

stress. Usually people with back pain are aware of which positions those cause pain and they usually avoid such positions or movements.

1

RECOMMENDED POSITIONS No single position is good for all. Positions depend on the type and cause of

People with Back pain should take

back pain and are best consulted with the

a proper rehabilitation measures so that to

rehabilitation

cure pain, there are variety of treatment

recommendations include positions like

measures in physiotherapy, no single

the Missionary position for both men and

treatment

women. 1

is

best

for

all

patients.

staff.

Generally

treatment

If a male partner complains of back

approaches help in regaining the function

pain, he can be at the top of women will

as well as reducing the pain in patients.

help to reduce stress at back, or man can

Combination

of

various

lie at the side of woman either on the front http://www.srji.co.cc


Vol.1 â&#x2014;? No.2 â&#x2014;? 2012

34

Scientific Research Journal of India

or at the back. If a female partner

General advice given to partners are

complains, she can be at the top with

placing a towel at the back reduce the

variety of positions like in bed or sitting in

lumbar curvature which helps to prevent

a chair.

5

pain. People with back pain can be advised

Depending on the type of back

on good sex through illustration described

pain, the position alters. For example,

by Fahrni in 1976. These illustrations give

patients with annular bulge will have an

guidelines to people with back pain.

increase in pain during flexion whereas for a patient with facet problem pain will increase with extension movements. There are no hard and fast rules in dealing pain.

ILLUSTRATIONS FOR DIFFERENT POSITIONS

http://www.srji.co.cc


Vol.1 ● No.2 ● 2012

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Scientific Research Journal of India

References 1. Danielle Kloeck, “Sex and Back pain” Webb Physiotherapists Inc, http://www.physionline.co.za., 2010, www.spine-dr.com

and

treatments”.

healthynewage.com, 2011. 6. Kamiah A Walkier, “Tips for Better sex....even with back pain”

2. Anthony delitto et al., “exercise based therapy for Low back pain” Sep 2010, uptodate.com.

www.spineuniverse.com, 2008. 7. Grieves.P,

“Common

vertebral

joint problems, Elsevier, 2003.

3. Jerry corners, MD. “ Sex and Back pain”

Healthy

back

institute,

www.losethebackpain.com. 2010 4. Dr.Kraus. Back and neck pain, www. Lowback - pain .com 2008. 5. Louise F. Lynch “Sex and back pain information-causes, Diagnosis

CORRESPONDENCE *Vice principal, K.G.College of Physiotherapy, Coimbatore 35. Email: barunmpt@gmail.com, Mob: 09994576111.

http://www.srji.co.cc


Vol.1 â&#x2014;? No.2 â&#x2014;? 2012

36

Scientific Research Journal of India

Reduced Instruction Set Computer (RISC) 32bit Processor on Field Programmable Gate Arrays (FPGAs) Implementation Thanigaivel.V*, V. Subramanian**, K. Priyadharsan***

Abstract: This paper concerned with the Reduced Instruction Set Computer (RISC) processor on a Field Programmable Gate Arrays (FPGAs). The processor has been designed with VHDL, synthesized using Xilinx ISE 9.1i Web pack, with ModelSim simulator, and then implement on Xilinx Spartan 2E FPGA that has 143 presented Input/ Output pins and 50MHz clock oscillator. The test bench waveforms for the different parts of the processor are obtainable and the system architecture is established.

Key words- Processor, HDL,FPGA, RISC, CPU.

INTRODUCTION The Computer Engineering is very

development board, DIO1, and DIO2

much concerned with the cost and

extension boards from Digilent have been

performance

the

used for the hardware implementation. The

Reduced

Web pack from Xilinx and ModelSim has

of

implementation

components domain.

in

Instruction Set Computer (RISC) focuses

been used for synthesis and simulation.

on reducing the number and complexity of instructions in the machine.1,

2

Field

System Construction

Programmable Gate Arrays (FPGAs) are

The RISC processor presented in

growing fast with cost reduction compared

this paper consists of three components as

3

to ASIC design. In this paper a low cost

shown in Figure .1, these Components are

32bit RISC Processor has been designed

the Control Unit (CU), the Data Path, and

and synthesized, the design has been

the ROM. The Central Processing Unit

described

some

(CPU) has 17 instructions. In the following

components have been implemented and

sections we will describe the design of the

using

VHDL, 4, 5, 6, 7

tested on Xilinx FPGA.

and

Spartan 2E

three main components of the processor. http://www.srji.co.cc


Vol.1 â&#x2014;? No.2 â&#x2014;? 2012

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Scientific Research Journal of India

ROM then decoding the parts of the order. The decoding state will also select the next state depending on the order; the control unit will jump to the correct state based on the order given. After all states of a running order are finished, the last one will return to the fetch state which will allow us to process the next order in the program. Figure .2 shows the state diagram for the

Figure .1 System constructions

Plan of the ROM The central processing unit has a

control unit.

built in ROM which enables us to program simple code and execute it. It is a basic 16x32 ROM and it is 32bit allied. The List of signals in the ROM list. Address: address sent by the control unit Data out : data that is contained the given address Read

: signal to enable reading from the ROM

Ready

: signal to indicate when the ROM is

Design of the Data Path

Ready for reading CLK

: clock signal

Reset

: Initial reset signal

Figure 2: control unit Design

The Data Path consists of subunits that are necessary for performing all of arithmetic and logic operations. A Data

Plan of the Control Unit

path is a hardware that performs data

The control unit plan is based on

processing operations.8, 9, 10, and 11 It is one

allows each state to run at one clock cycle,

of two types of modules used to represent

the first state is the reset which is

a digital system, the other being a control

initializes the central processing unit

unit. The Data path model we designed

internal

The

consists of the units necessary to perform

machine goes to the reset state by enabling

all the operations on the data selected by

the reset signal for a certain number of

the control unit. The components include a

clocks. Following the reset state would be

Register

the instruction fetching and decoding

Memory Interface and Branching Unit as

states which will enable the suitable

shown in Figure 3.The Register File holds

registers and

variables.

File,

Arithmetic/Logic

Unit,

signals for reading order data from the http://www.srji.co.cc


Vol.1 ● No.2 ● 2012

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Scientific Research Journal of India

the table of the 32 general purpose registers available to the CPU, it has two output ports (output1, outpu2) and one input port, also it has a 16 bit bus connected directly to the Control Unit to pass immediate data. The ALU design consists of two input ports and one output port which mainly performs operations on two operands. It has a design similar to the control unit which selects an operation based on a code given by the ALUCL. The Memory

Interface

was

designed

accommodate simple load/store operations with the 16x32 memory. The effective address is calculated by adding the content of the address register and the immediate data. The Branch Unit calculates a given condition by the control unit and raises a branch flag whether the condition is met or not, and if the flag is raised, it sends the branch address back to the control unit in order to replace the program counter. The control lines coming from the control unit operate all the units in the data path. The path starts from the register file that has two output ports which are connected to all the other units, after that the processing is done by one of the other units then finally returned back to the register files input port using the multiplexer. The signals used in the data path are forwarded from the control unit to each subcomponent as needed.

Figure 3: Data Path

to RESULTS

There are 5 main signals that are viewed in throughout the simulation. The sim_clock signal is the clock generated for the simulation and runs at 50Mhz, instruction fetch signal shows when the control unit requests data from the ROM, the instruction address 32bit bus is the address of the instruction being fetched, the instruction data 32bit bus is the data sent out from the ROM, and the reset state is enabled for 3.5 cycle to give enough time for all units to reset and initialize, after that we can see the first instruction beginning at address 0 is executed followed by all the proceeding instructions until the instruction at address 40 Which is the shift half word “SHW”. CONCLUSION 32bit RISC Process has been design and implemented in hardware on Xilinx Spartan 2E FPGA. The design has http://www.srji.co.cc


Vol.1 ● No.2 ● 2012

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Scientific Research Journal of India

been achieved using VHDL and simulated

gate in Spartan 2E is 200K Logic Gate,

with ModelSim. Digilent Spartan 2E

which was not enough for implementing

progress board has been used for the

the whole processor, but parts of the

hardware part. Most of the goals were

processor have been implemented and test

achieve and simulation shows that the

in a real hardware. Future work will be

processor is working perfectly, but the

added by increasing the number of

Spartan 2E FPGA was not sufficient for

instructions and make a pipelined plan

implementing the whole design into a real

with fewer clocks cycles per instruction.

hardware, since the total accessible logic

References 1. John L. Hennessy, and David A.

of a coarsegrain reconfigurable

Patterson, “Computer Architecture

coprocessor for a RISC core”, 2nd

A Quantitative Approach”, 4th

Conference on Ph.D. Research in

Edition; 2006.

Micro Electronics and Electronics

2. Vincent P. Heuring, and Harry F. Jordan, “Computer Systems Design and Architecture”, 2nd Edition, 2003.

Proceedings,

Design, Prentice Hall, 2005. 4. Dal Poz, Marco Antonio Simon,

2006,

p

229232. 6. Rainer Ohlendorf, Thomas Wild, Michael

3. Wayne Wolf, FPGA Based System

PRIME,

Meitinger,

Holm

Rauchfuss, Andreas Herkersdorf, “Simulated

and

performance

measured

evaluation

of

Cobo, Jose Edinson Aedo, Van

RISCbased

Noije, Wilhelmus Adrianus Maria,

network processing applications”,

Zuffo, Marcelo Knorich, “Simple

Journal of Systems Architecture 53

Risc microprocessor core designed

(2007) 703–718.

SoC

platforms

in

for digital settopbox applications”,

7. Luker, Jarrod D., Prasad, Vinod B.,

Proceedings of the International

“RISC system design in an FPGA”,

Conference

MWSCAS

Specific

on

Application

Systems,

Architectures

and Processors, 2000, p 3544. 5. Brunelli Claudio, Cinelli Federico,

2001,

v2,

2001,

p532536. 8. Jiang,

Hongtu;

“FPGA

implementation of controller data

Rossi Davide, Nurmi Jari, “A

path

pair

VHDL model and implementation

processor

in

custom

design”;

image IEEE

http://www.srji.co.cc


Vol.1 ● No.2 ● 2012

40

Scientific Research Journal of India

International

Symposium

on

10. Lou Dongjun, Yuan Jingkun, Li

Circuits and Systems Proceedings;

Daguang, Jacobs Chris, “Data path

2004, p V141V144.

verification

with

System

C

9. K.Vlachos, T. Orphanoudakis, Y.

reference model”, ASICON 2005,

Papaeftathiou, N. Nikolaou, D.

6th International Conference on

Pnevmatikatos,

ASIC, 2005, Proceedings, v 2, p

G.

Konstantoulakis, J.A. SanchezP., “Design evaluation

and

performance

of a Programmable

906909. 11. Jiang “FPGA

Hongtu,

Owall

Viktor,

implementation

of

Packet Processing Engine (PPE)

controller data path Pair in custom

suitable for high speed network

image processor design”, IEEE

processors units”, Microprocessors

International

and Microsystems 31, 2007, p

Circuits and Systems, Proceedings

188–199.

v 5, p V141V144.

Symposium

on

CORRESPONDENCE *Centre for Research and Development, PRIST University, Vallam, Thanjavur–613403, Tamilnadu, India. EMail: svthanigaivel@gmail.com. **Centre for Research and Development, PRIST University, Vallam, Thanjavur–613403, Tamilnadu, India. E-Mail: subramaniancrd.prist@gmail.com. ***Centre for Research and Development,

PRIST

University,

Vallam,

Thanjavur–613403,

Tamilnadu,

India.

E-Mail:

kvpriyadharshan@gmail.com

http://www.srji.co.cc


Vol.1 â&#x2014;? No.2 â&#x2014;? 2012

Scientific Research Journal of India

41

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Scientific Research Journal of India (SRJI): Volume: 1 Issue: 2 Year: 2012