Background: Diabetes mellitus is a chronic metabolic disorder characterized by impaired glucose regulation. Exercise is a key non-pharmacological strategy to improve insulin sensitivity and metabolic control. Emerging evidence indicates that the timing of exercise, especially in the afternoon, may optimize glycemic outcomes. Objective: To analyze the effect of exercise timing on glycemic markers in individuals with metabolic diseases like diabetes. Methodology: For this review, two authors performed literature searches in numerous databases. For quality assessment Modified Downs and Black Checklist has been used. After a comprehensive analysis, seven studies met the inclusion criteria. Results: Afternoon timing results had favorable outcomes, showing a decline in their glucose parameters. Unlike morning timing also showed considerable results in a decrease of glycemic factors. Studies reported statistically significant findings in favor of afternoon exercise. For example, Savikj et al. (2018) reported reduced blood glucose levels based on CGM in the afternoon group (6.1 ± 0.4 mmol/l) compared to the morning group (6.6 ± 0.4 mmol/l; p < 0.05). Mancilla et al. (2020) showed a decline in fasting plasma glucose in the afternoon group (−0.3 ± 1.0 mmol/l) versus an increase in the morning group (+0.5 ± 0.8 mmol/l), with a significant intergroup difference (p = 0.02). VO₂ max improvements were significant in both groups with p-values of 0.003 (morning) and 0.001 (afternoon). Additionally, Gomez et al. (2015) found that hypoglycemic events were significantly lower following morning exercise sessions compared to afternoon (p < 0.001). Conclusion: Afternoon timing plays a pivotal role in reducing the glycemic parameters. Future research endeavors should focus on incorporating larger sample sizes, and more randomized control trials should be conducted on the female population Keywords: Circadian Rhythm; Diabetes; Exercise Timing; Muscle Clocks; Morning Exercise; Afternoon Exercise
Cerebral palsy is characterized by abnormal tone, posture and movement with multisystem involvement leading to limitation of activity. In the given case, a female patient was reported with hypotonic Cerebral palsy with complaints of floppiness and muscular weakness predominantly affecting right side of body. She was also having poor head and neck control along with instability of trunk. The patient received Pulsed Electromagnetic Field (PEMF) therapy (25–35 Hz, 412 µs, 10 min) followed by Electrical muscle stimulation (EMS) (20–35 Hz, synchronous mode, 10 min), both applied five times weekly. This was followed by physical therapy exercises targeting the affected extremity. Data collection was done at the baseline, 12 and 24 weeks of intervention. Marked improvements in motor function were observed over 24 weeks, as evidenced by higher scores on the GMFM and advancement to GMFCS Level III, indicating enhanced mobility and postural control. Thus, it can be concluded that combination of PEMF with EMS is an effective intervention for improving Muscle Tone and enhancing Motor Function in Hypotonic Cerebral Palsy Keywords: Cerebral Palsy, Magnetic Field Therapy, Muscle Hypotonic, Postural Balance.
Background: Protracted shoulders are common musculoskeletal condition in young population which has impact on thoracic expansion and interscapular distance. The main contributors to protracted shoulders are poor ergonomics, sedentary lifestyle and excessive use of gadgets. In this study frequency of protracted shoulders and its relationship with interscapular distance and thoracic expansion has been evaluated. Objective: To determine the frequency of protracted shoulders in healthy young adults and its relationship with interscapular distance and thoracic expansion at axillary and T4 level. Methodology: The study design was a cross-sectional analytical study, conducted among students from Foundation University Islamabad. A total of 357 subjects were selected using convenience sampling based on inclusion and exclusion criteria, and all participants provided written informed consent. Outcome Measures: Plumb line was used to access protracted shoulders and measuring tape was used to measure interscapular distance and thoracic expansion at axillary and T4 level. Results: The study showed that there is moderately positive correlation between protracted shoulders (PS) and Interscapular Distance. (p=0.436, rs = 0.41). Furthermore, the correlation between PS and Thoracic expansion at axillary level was strongly positive (p=0.162, rs = 0.74) while a strongly negative correlation (p=0.225, rs = - 0.64) was observed at T4 level. 2 Conclusion: The study's findings concluded that the frequency of protracted shoulders is high among healthy young adults. The study showed that there’s a relationship of protracted shoulders with thoracic expansion at the axillary level while no relationship established at T4 level and with interscapular distance among healthy young adults. Keywords: Posture, Protracted Shoulder, Thoracic expansion
Background: Urinary incontinence (UI) is widely recognized as a debilitating condition. Regardless of its type, UI can significantly affect an individual’s quality of life across multiple domains, including emotional well-being, functional capacity, and social participation. A comprehensive physical rehabilitation program has been shown to offer beneficial effects in the management of urinary incontinence. Objective: To determine the role of self-managed, semi-supervised physical therapy in urinary incontinence rehabilitation. Methodology: This was a quasi-experimental clinical trial, conducted at Lady Reading Hospital, Peshawar, involving patients diagnosed with urinary incontinence. Based on predefined inclusion criteria, a total of 31 participants were recruited through a convenience sampling technique. The sample comprised 9 male and 22 female patients, with a mean age of 40.93 ± 13.9 years. All participants underwent a comprehensive, self-managed, semi-supervised rehabilitation program over a period of four weeks. Bladder behavior—including the severity, frequency, and volume of urine leakage—was recorded. The effectiveness of the intervention was evaluated using the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF). Results: The results of this study show that 45.16 % participants were suffering from Stress Urinary Incontinence (SUI); 25.80% complained of Urge Urinary Incontinence (UUI) and 29.03% were having symptoms of both SUI and UUI so they were classified as Mixed Urinary Incontinence (MUI). The paired t-test for the comparison of bladder-related quality of life at baseline (ICIQF initial =12.37 + 3.64) and at the end of the treatment (ICIQF final =5.44 + 3.61) shows clinically and statistically significant results. (p=0.01). Conclusion: This study determines that a self-managed and semi-supervised physical rehabilitation protocol can be effectively implemented in patients with any type of urinary incontinence to improve bladder related quality of life. Keywords: Physical Therapy, Urinary Incontinence, Quality of Life
Background: The present study analyzed the effectiveness of Narrative Therapy in developing narrative proficiency in Children with Intellectual Disabilities. Objective: To determine the effect of story retelling and narrative comprehension with Narrative Therapy in children with Intellectual Disability Methodology: The study employed a within-subjects design. The study sample included participants diagnosed with a mild level of Intellectual Disability. The study involved ten participants (N = 10), comprising five males and five females, whose mental age ranged from four to six years. The sample was recruited using a nonprobability purposive sampling technique from Amin Maktab and Rising Angel's institutes in Lahore from January 2023 to January 2024. Multilingual Assessment Intervention for Narratives (MAIN) assessed story retelling and comprehension. The therapy lasted for eight weeks. Each participant had twenty-four sessions of intervention. Results: The data were analyzed using the Wilcoxon signed rank test to report the pre- and post-evaluation scores. The results, which included macrostructural and microstructural analyses, showed a marked improvement in narrative abilities post-intervention, with p < 0.05. Conclusion: The study's findings, which revealed a significant increase in story retelling and comprehension scores of narratives after the intervention, underscore the effectiveness of narrative therapy in developing narration abilities in children with Intellectual Disability. Keywords: Narrative Therapy, Intellectual Disability, Microstructure, Macrostructure
Background: Low back pain is a global health issue and leading cause of disability. It is frequently treated by using manual treatments in physiotherapy clinics including mobilizations and spinal traction. Objective: To determine and compare the effects of joint mobilizations and manual spinal traction on pain, disablity and joint range of motion in mechanical low back pain Methodology: In the Physiotherapy Department of Aziz Bhatti Hospital, Gujrat, 34 participants with the complaint of diagnosed and confirmed cases of mechanical low back pain, aged 25 to 65 years were split into two equal groups for a randomized clinical trial. Group A received Passive Translatoric Intervertebral Glides while Group B received Manual Lumbar Traction (MLT) and both received conventional core stability exercises. Data was gathered using Numeric Pain Rating Scale (NPRS), Modified Oswestry Diability Index (MODI), and a universal goniometer at baseline, 2nd week and 4th week using Non-probability convenient sampling technique. SPSS version 22 was used for data analysis. (Clinical Trial Registry Number: NCT05522543) Results: A significant improvement in pain, disability and range of motion was seen in both groups at the 4th week of intervention (p< 0.001). However, Group B (MLT) showed more improvement in NPRS compared with Group A (PTIG). Both the treatment groups including PTIG (p< 0.001) and MLT (p< 0.001) showed significant reduction in disability scores however no statistically significant difference was found in inter-group analysis for disability score (p=0.274), Flexion(p=0.610) or Extension (p=0.170). Conclusion: The study concluded that both treatments are effective in lowering the pain, disability and improving lumbar range of motion. However, significant improvement was found in group B in reducing pain, while overall no significant group differences were observed. Keywords: Joint range of motion, Mechanical low back pain, Mobilizations, Traction
Background: Piriformis syndrome is considered as painful musculoskeletal condition resembling sciatica. It is responsible for 6% of cases of low back pain and is frequently unrecognized in clinical setting. Objective: To compare the effects of neural mobilization of Sciatic nerve versus stretching of piriformis muscle in patients with piriformis syndrome. Methodology: All patients coming to Physiotherapy OPD complained about radiating pain in back and legs were screened for sciatica and piriformis syndrome. A total of 40 patients were selected. They were randomly divided into 2 groups; each group contained 20 patients. Group A received neural mobilization of sciatic nerves while Group B received stretching of piriformis muscle. Both groups received treatment for 3 days a week for 2 weeks. Visual analogue Scale (VAS), hip range of motion (ROM) (flexion, abduction and external rotation) and FAIR test were performed pre and post intervention and results were compared for any improvements. SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for Statistical analyses. Paired t-tests were applied for within-group comparisons, and independent t-tests for between-group comparisons. Effect sizes (Cohen’s d) and 95% confidence intervals were also calculated. (Clinical Trial Registry Number: NCT06808659) Results: The difference in means for all the assessment parameters pre and post treatment showed significant improvement in both groups. Hip flexion ROM, Hip external rotation, Hip abduction ROM, FAIR test, and VAS showed no significant difference when both groups were compared. Conclusion: This study concluded that both neural mobilization of the sciatic nerve and piriformis stretching significantly improved pain and hip function, but neither technique was superior. These findings suggest that both approaches are effective and may be considered equally viable treatment options for piriformis syndrome. Keywords: Visual analogue scale, physiotherapy, pain management, Piriformis syndrome, FAIR test, Range of motion.
Background: Physiotherapists play an important role in the rehabilitation of post-operative Anterior Cruciate Ligament Reconstruction (ACLR). Return to Sport after ACLR is one of the primaries aims of the patients. Objective: This survey aimed to define the present clinical treatment approach of Pakistani physiotherapists for treating ACLR patients and find out the standards used for return to sports after ACLR. Methodology: An online questionnaire consisting of four separate sections, demographic data, and medical practice about ACLR post-operative therapy comprising the parameters for return to sports was used to survey Pakistani physiotherapists. Descriptive analysis was performed for demographic and professional characteristics of the physiotherapists. Results: Out of 1375, 710 physiotherapists responded to the questionnaire. The response rate was 51.6%. Two-hundred and eighteen (40.4%) physical therapists showed that post-ACLR rehabilitation should be started lower than one-week post-surgery, 48.1% recommended that therapy be initiated between one and two weeks and 11.5% said beginning it later three or more weeks. The standards used for return to sports allowance standards were associated to physical aspects such as quadriceps strength (76.5%), hamstring strength (69.1), hip muscle strength (66.3%), and knee ROM (65.1%). A few therapists used functional (17%) and psychological (18.1%) characteristics of their clients to support return to sports choice. Conclusion: The study showed that the majority of the physiotherapists focused on the parameters related to physical factors for return to sports and a small number worked on the self-reported functional scale and psychological parameters. Keywords: Anterior Cruciate Ligament, Physiotherapists, return to sports
Background: Obese vehicle drivers are predisposed to piriformis syndrome due to prolonged sitting, poor posture, and increased mechanical stress. Excess body weight may intensify piriformis muscle tightness and compress the sciatic nerve, resulting in chronic pain and functional limitations. Objective: To determine the associations between obesity, piriformis muscle dysfunction, and pain severity among professional drivers. Methodology: This cross-sectional study was conducted over six months in District Lahore among 113 male online vehicle drivers (Uber, Careem, Foodpanda) aged 18–60 years, selected through convenient sampling. Participants with prolonged sitting time and elevated BMI were included. Data were collected using a self-designed questionnaire, the Piriformis Stretch Test, and the Visual Analog Scale (VAS) for pain assessment. Ethical approval was obtained, and informed consent was secured from all participants. Statistical analysis was performed using SPSS version 24.0, applying descriptive and Pearson’s correlation tests to evaluate relationships among BMI, Piriformis Stretch Test outcomes, and pain severity. Results: A significant positive correlation was found between BMI and the Piriformis Stretch Test (r = 0.681, p < 0.001), indicating that drivers with higher BMI were more likely to exhibit piriformis tightness. Piriformis Stretch Test results also showed a strong correlation with pain intensity (r = 0.833, p < 0.001), while BMI correlated significantly with pain severity (r = 0.681, p < 0.001). Approximately 72% of participants reported moderate-to-severe pain (VAS > 5). Longer driving hours (>8 hours/day) and increasing age further amplified pain levels (p < 0.05). Conclusion: Higher BMI, prolonged driving duration, and piriformis muscle dysfunction were significantly associated with increased pain severity among vehicle drivers. These findings highlight the importance of implementing targeted interventions such as weight management, ergonomic adjustments, and regular stretching programs to reduce musculoskeletal pain in this population. Keywords: Correlation, Drivers, Obese, Occupational health, Piriformis dysfunction
Background: One-sided, recurring headache that generally comes with neck pain and stiffness are associated with cervicogenic headache. These headaches have frequent episodes lately, and they alter people’s day to day routines and quality of work. It’s impossible to stay productive or focused while your head and neck is hurting continuously, and for healthcare professionals, it can even effect care services given to patients. Objective: To assess the impact of cervicogenic headache on job performance among the office workers. Methodology: Cross-sectional survey was implemented by the researchers, involving the Cervicogenic Headache International Study Group criteria to spot cases of cervicogenic headache. Two hundred and ninty volunteers were selected using convenience sampling and focus on the Work Productivity and Activity Impairment Questionnaire (WPAI) to assess them. The researchers evaluated the data with SPSS version 22. Everyone who took part gave their informed consent. Results: Age group selected in this study was among 27 - 40 years old. The results showed that the more hours of work each day causes the higher pain scores and shows elevation. Productivity and activity impairment scores also raise with pain. Absenteeism and presenteeism had somehow moderate association with pain (r = 0.408 and r = 0.519), but by giving a thorough look to work and activity impairment, the correlation was even stronger (r = 0.704 for both). Individuals having chronic CGH felt the strongest decline in their productivity, and the difference between all the stages of CGH it was clear that chronic cases had major worst impact (p < 0.001). Conclusion: This study shows a significant correlation between cervicogenic headaches and lower work productivity. When the pain gets worse or lasts longer, job performance really takes a hit. But it’s not just about the pain itself Keywords: Absenteeism, Cervicogenic headache, Neck pain headache, Presenteeism, Work productivity, Working population
Abstract: Background: Effective teaching is crucial in medical education, where instructor’s performance and personality attributes significantly impact student learning. Objective: The objective of the study was to identify the perception of students of Khyber Medical University (KMU) regarding teachers' most and least effective attributes. Methodology: A cross-sectional survey of 288 undergraduate students was conducted in constituent institutes of KMU, Peshawar. Undergraduate students of any gender from the 2nd year to the final year were allowed in this survey after taking their written informed consent. One-way ANOVA and Tukey test were used to identify the differences among institutes. Results: Performance attributes (M=4.39 ± 0.48) were more important than personality attributes (M=4.29 ± 0.53) to the students. The top 3 performance items were: Expert on the subject, facilitation of students’ learning and desire to promote students’ learning. The top 3 personality items were: Helpful, punctual and good communication skills. Uniform marking and not being strict/showing leniency were the least valued. Conclusion: Performance attributes were found to be more important than personality. However, there were some highly endorsed personality attributes, which show that students want their learning needs to be met and desire some personality attributes which make a teacher effective. Keywords: Perception, Clinical Competence, Students, Faculty, Teaching, Personality
Abstract: Background: Cervicogenic headache is a common condition caused by issue in the cervical spine, leading to chronic head pain. Various treatments exist, including kinesiology Taping and Instrument Assisted Soft Tissue Mobilization, but there is limited evidence comparing their effectiveness. Objective: In this study, the effects of instrument-assisted soft tissue mobilization and kinesiology taping on pain severity, range of motion, and functional status in individuals with cervicogenic headache were compared. Methodology: In the physiotherapy department of Healing Hands Institute, Mega Medical Complex, Rawalpindi, 36 participants with clinically diagnosed cervicogenic headache, headache, and stiffness in the neck, positive flexion rotation test with restriction of 6-10 degrees unilateral headache, aged 30-44 years, were divided into two equal groups for a clinical experiment that was randomized. While Group B received conventional therapy together with Instrument Assisted Soft Tissue Mobilizations (IASTM), Group A received conventional treatment along with Kinesiology Taping. Using a non-probability purposeful sampling approach, data was gathered at baseline and the fourth week to measure the indicator using the Numeric Pain Rating Scale, Neck Disability Index, and Bubble Inclinometer. SPSS version 22 was used for data analysis. (CTR : NCT05474612) Results: At 4 weeks of intervention, both groups A and B saw substantial improvements in disability, range of motion, and discomfort (p < 0.05). Although there were no statistically significant differences in cervical flexion, extension, left lateral flexion, or left rotation (p > 0.05), between-group analysis revealed statistically significant differences in NPRS, NDI, cervical right rotation, and cervical right lateral flexion (p < 0.05). In the case of within-group comparisons, all measures showed statistically significant changes (p < 0.05). Conclusion: The study concludes that the use of both instrument-assisted soft tissue mobilization and kinesiology taping has been successful in improving range of motion and lowering pain and impairment. However, Group B (Instrument Assisted Soft Tissue Mobilization) had a more notable improvement. Keywords: Cervical Atlas, Cervicogenic Headache, Headache Unilateral, Mobilization, Range of Motion.
Abstract: Background: Proprioception is the body's ability of sensing the position, movement, and alignment of its joints and limbs. The ACL is rich in proprioceptive fibers, an injury to this ligament, impairs knee function and neuromuscular control, leading to poor coordination. Incorporating proprioception assessment and training in ACL rehabilitation is essential for restoring function and preventing future injuries. Objective: To determine knee joint proprioception in loaded and unloaded position among patients after arthroscopically assisted anterior cruciate ligament (ACL) reconstruction. Methodology: A descriptive cross-sectional study was conducted at Ghurki Trust and Teaching Hospital (GTTH), targeting patients who had undergone surgical reconstruction of anterior cruciate ligament. The total study duration was six months, covering the period from June 2023 to December 2023. Using a non-probability purposive sampling technique, a total of 74 participants meeting the inclusion criteria were selected. A goniometer was utilized to evaluate joint position sense in both loaded and unloaded positions. The data was entered and analyzed using SPSS version 22. Results: The result showed that the mean age of participants was 27.79 ± 5.03. Knee flexion in weight bearing position was 30 degrees and maximum range was 44 degree with mean of 34.89 ± 4.21 whereas minimum knee flexion in non-weight bearing was 30 degree and maximum was 45 degree with mean of 33.68 ± 4.35. Conclusion: Statistically significant difference was found in knee joint proprioception between loaded and unloaded position among patient of ACL reconstruction. Keywords: Anterior Cruciate Ligament, Knee Joint, Proprioception, Weight-Bearing
Abstract: Background: With increased use of smartphones, extended screen time is associated with musculoskeletal disorders such as cervicogenic headaches. Poor postures and forward head posture can cause cervical spine dysfunction and result in headache. Young adults, especially students, are highly susceptible because of overuse of smartphones. The prevalence and severity of cervicogenic headaches in this population need to be identified for early treatment and prevention. Objective: To determine the association between smartphone screen time and cervicogenic headache severity in young adults. Methodology: This cross-sectional study was conducted on Doctor of Physical Therapy (DPT) students (n=175) using a non-probability convenience sampling technique. Participants included both male and female DPT students aged 18–25 years with more than three hours of daily smartphone screen time, while individuals with systemic diseases, whiplash injuries, psychiatric illnesses, or a history of cervical spine tumors were excluded. Cervicogenic headache severity was assessed using the Numeric Pain Rating Scale (NPRS), and cervical spine dysfunction was evaluated through the Cervical Flexion-Rotation Test (FRT). Results: Of the 175 participants, 137 tested positive and 39 tested negatives on the Flexion Rotation Test (FRT). According to the NPRS (Numeric Pain Rating Scale), 35.4% of participants reported mild pain, 55.4% had moderate pain, and 9.1% experienced severe pain. Screen time and Cervicogenic Headache CGH pain severity were statistically significantly correlated, with a chi-square test value of 63.742 and a p-value of <0.001. Conclusion: The majority of students experienced cervicogenic headaches associated with excessive smartphone use. Moreover, a statistically significant association was found between increased screen time and higher cervicogenic headache severity (χ² = 63.742, p <0.001), indicating that prolonged smartphone use may contribute to increased headache intensity in young adults. Keywords: Cervicogenic Headache, Smartphone Addiction, Screen Time, Young Adult
Introduction: The most common and widely recognized impairment caused by a stroke is motor and sensory impairment. This can be defined as a loss or limitation of muscle control, movement, mobility or sensual control. Motor and sensorial impairments after a stroke typically affect the control of movement in the arm and leg on one side of the body, and is seen in about 80% of patients. Approximately two-thirds of stroke survivors have initial mobility deficits, and more than 30% of survivors cannot walk independently six months after a stroke. After a stroke, a person may experience complete or partial damage to their senses, including those responsible for light touch, pain, temperature, proprioception, vibration, foot pressure, stereognosis, and two-point discrimination. Among patients with gait disturbances evaluated for stroke, most experience proprioception loss. Approximately 36-54% of stroke patients experience varying degrees of loss of joint position sense. Additionally, disturbances in touch, vision, and hearing are also observed. Loss of superficial sensation in the forefoot and loss of plantar pressure sensation can affect patients' ability to bear weight on their forefoot and cause problems with activities such as sitting up and walking.1, 2 Therefore, much of the focus of stroke rehabilitation, particularly the work of physiotherapists, is on recovering physical independence and functional ability during activities of daily living. The ultimate goal of therapy is commonly to improve sensorial integration, walking function and balance. During the rehabilitation process, therapeutic exercises and neurophysiological approaches are used to help patients regain motor function. For many years, fundamental neurophysiological approaches such as the Bobath Concept, Margaret Johnstone Approach, and Brunnstrom Technique have long been used in stroke rehabilitation to help patients achieve functional gains. In recent years, contemporary approaches such as Constraint-Induced Movement Therapy (CIMT), Virtual Rehabilitation (VR), robotic-assisted rehabilitation, task-focused training, Mirror Therapy, and PANat (Pro-Active Neurorehabilitation approach integrating air splints and other tools) have increasingly been preferred by physical therapists due to their evidence-based outcomes and adaptability to individual patient needs. 3, 4 Parallel to these developments, motor imagery strategies has also been preferred to accelerate neuroplasticity. Motor imagery (MI) is an increasingly popular and widely studied technique in stroke rehabilitation, particularly for improving motor function in patients with impaired movement. MI (motor imagery) is a technique that uses imagination to teach movement to individuals who have suffered a stroke. Based on the principles of mental practice, MI has also begun to be used in stroke rehabilitation in recent years. Two concepts frequently emerge when examining mental exercises. The first is movement observation (MO), and the second is motor imagery (MI). MI is defined as imagining a task without performing it. Movement observation (MO) is based on an individual watching a specific movement performed by a third person or played back from a video recording. Motor imagery (MI) is the conscious mental representation of a movement without physically performing it. MI is defined as the mental rehearsal or simulation of movement and is considered a dynamic cognitive process. Research using advanced brain imaging techniques has revealed that brain regions responsible for planning, executing, and regulating movement become active during both physical movement and motor imagery. These structures include the premotor area, parietal lobe, basal ganglia, anterior cingulate cortex, and cerebellum. Motor imagery has several clinical applications in stroke rehabilitation, particularly in enhancing motor recovery. One of its most notable effects is improving motor function, particularly in recovering upper limb movements, which are often impaired after a stroke. When combined with physical therapy, motor imagery can also increase muscle strength by reinforcing the neural activation patterns associated with movement. It also supports brain reorganization by stimulating motor-related areas of the brain and promoting neuroplasticity, which is essential for recovery. After a stroke, the areas of the brain responsible for movement may be damaged. However, studies have shown that imagining movements activates the same brain regions as performing them. As a therapeutic approach, motor imagery is safe and cost-effective, making it accessible to a wide range of patients. Furthermore, it can be self-administered or guided by therapists and can be enhanced through the use of technology, enabling flexible, individualized rehabilitation programs. Systematic reviews and randomized controlled trials (RCTs) provide moderate evidence that motor imagery (MI) is effective in improving upper limb function, particularly in individuals recovering from subacute or chronic stroke. The therapeutic benefits are significantly enhanced when MI is combined with physical practice, as this integrated approach proves more effective than physical training alone. Optimal outcomes are typically achieved through regular and consistent practice, with sessions conducted three to five times per week, each lasting approximately 20 to 30 minutes. This structured routine supports the reinforcement of neural pathways involved in motor control and facilitates more meaningful functional recovery. The effectiveness of motor imagery in stroke rehabilitation largely depends on the patient's ability to accurately imagine movements, a skill that not all individuals possess or can easily develop. To ensure its success, proper training and assessment are necessary, often involving tools such as the Kinesthetic and Visual Imagery Questionnaire to evaluate a patient's imagery capabilities. It is also important to recognize that motor imagery is not a replacement for physical therapy; rather, it serves as a complementary approach that enhances the overall rehabilitation process when used alongside conventional therapeutic interventions.5,6,7 Therefore, motor imagery (MI) may facilitate the reorganization of motor networks in patients who have had a stroke by enhancing neural activation in specific cortical and subcortical regions, as well as modulating functional connectivity within motor-related pathways. It is thought that these neurophysiological changes contribute to improvements in motor function and overall recovery. 8, 9 Conclusion: In summary, motor and sensory impairments are among the most common consequences of stroke, significantly affecting patients' mobility, independence, and quality of life. Traditional neurophysiological rehabilitation approaches have long aimed to restore functional movement, and recent advancements have introduced more dynamic and cognitively engaging strategies such as motor imagery (MI). MI offers a promising adjunct to conventional therapy by engaging the brain's motor networks through mental simulation of movement, thereby promoting neuroplasticity and functional recovery. Evidence from clinical research, including systematic reviews and randomized controlled trials, supports the use of MI—particularly when combined with physical practice—for improving upper limb function in individuals with subacute or chronic stroke. While the effectiveness of MI may vary depending on a patient's ability to mentally visualize movement, its accessibility, low cost, and adaptability make it a valuable tool in modern stroke rehabilitation. As part of a comprehensive, individualized rehabilitation plan, motor imagery has the potential to enhance recovery outcomes and contribute meaningfully to restoring patients' independence in daily activities. Motor imagery can be incorporated into the standard rehabilitation programme to enhance cognitive processes and target motor function in appropriate stroke cases. In this context, it is recommended that physical therapists increase their experience in this area and use this technique. References: • Comino-Suárez, Comino-Suárez J, et al. Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: A systematic review and meta-analysis of randomized control trials. J Neuroeng Rehabil. 2021;18(1):148. • Tanamachi K, Kuwahara W, Okawada M, Sasaki S, Kaneko F. Relationship between resting-state functional connectivity and change in motor function after motor imagery intervention in patients with stroke: A scoping review. J Neuroeng Rehabil. 2023;20(1):159. • Mehrholz J, Thomas S, Kugler J, Pohl M. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2018;10:CD006185. • PANat Concept. PRO-Active Neurorehabilitation integrating air splints and therapy tools. 2022. Available from: https://www.panat.info/ • Prasomsri J, Sakai K, Ikeda Y. Effectiveness of motor imagery on physical function in patients with stroke: A systematic review. Mot Control. 2024;28(4):442–63. • Taube W, Gruber M, Beck S, Faist M, Gollhofer A, Leukel C. Cortical and spinal adaptations induced by balance training: Correlation between stance stability and corticospinal excitability. Acta Physiol (Oxf). 2015;213(1):1–12. • Kho ME, Duffett M, Willison DJ, Cook DJ, Brouwers MC. The CONSORT statement: A guideline for reporting randomized trials in rehabilitation research. Arch Phys Med Rehabil. 2014;95(8):1451–8. • Zhang W, Li W, Liu X, Zhao Q, Gao M, Li Z, et al. Examining the effectiveness of motor imagery combined with non-invasive brain stimulation for upper limb recovery in stroke patients: A systematic review and meta-analysis of randomized clinical trials. J Neuroeng Rehabil. 2024;21(1):209. • Yazgan EA, Kara Kaya B, Tiryaki P, Atlı E, Cavlak U. Effectiveness of motor imagery and action observation in parameters of sport performance: A systematic review. Percept Mot Skills. 2025 Jul 14.
Abstract: Background: In sports that involve overhead movements, the overuse injuries occurs due to the repetitive exertion of force in an arc overhead exerts significant stress on the shoulder and elbow joints. Objective: To find out the frequency of shoulder and elbow overuse injuries among overhead athletes and the association of frequency with associated factors such as age, gender, sport, years of experience and weekly playing hours. Methodology: This cross-sectional study was conducted at Peshawar Sports Complex and Hayatabad Sports Complex, Peshawar from July to October 2024. A total of 132 athletes of ages between 18-40 years were included in this study. Data was collected through Oslo Sports Trauma Centre Overuse Injury Questionnaire from the athletes. Data was analyzed using Statistical Package for Social Sciences version 27.0 to create graphs and tables. Chi square test was used for statistical analysis to find the association between overuse injuries and its risk factors. Results: A total of 132 athletes were part of this study. The frequency of shoulder overuse injuries was 17.4% while the frequency of elbow overuse injuries was 5.3%. Most of the affected athletes were between the ages of 18-25 years. There was no significant association between the frequency of shoulder and elbow overuse injuries and its risk factors. Conclusion: This study concluded that statistically, the overuse injuries do not show significant association with the factors such as age, gender, sport, years of experience and weekly training hours. Keywords: Elbow Injuries, Overhead Athletes, Overuse Injuries, Shoulder Injuries
Abstract: Background: Menstrual pain often caused by prostaglandins, triggering uterine contractions is named as Primary Dysmenorrhea. Perceived stress is stated as an individual’s subjective assessment of the degree to which they feel overwhelmed or unable to cope with the demands of life. Objective: To determine the level of perceived stress among undergraduate physiotherapy female students with primary dysmenorrhea in Sialkot, Pakistan. Methodology: This Cross-sectional study included 232 females with primary dysmenorrhea, selected using Simple non-random sampling technique. Inclusion criteria was age (18-25 years), women with normal menstrual cycle lasting between 21 to 35 days, low back pain that begins one day before the menstrual cycle and lasts for 6-12 hours after the start of menstrual cycle, and leads to 3 days of bleeding in last 3 menstrual cycles whereas polycystic ovarian syndrome (PCOS), amenorrhea, use of oral contraceptives, use of intrauterine devices, pregnancy and secondary dysmenorrhea were excluded from the study. The outcome measuring tool was Perceived Stress Scale (PSS-10). The data was analyzed using SPSS software 22 and interpreted as frequencies and percentages. Results: Out of 232 participants the mean age was (21.34± S.D 1.49 years). The majority of the participants were unmarried (N=206, 88.8%). Most of the participants (N=138, 59.5%) had normal Body Mass Index, (N=131, 56.5%) had healthy diet with maximum sleep duration of 12 hours. Most of the participants had 3-5 days of menstrual bleeding (N=188, 81.0%), moderate menstrual flow (N=182, 78.4%), 21-35 days of menstrual cycle length (N=169, 72.8%) and menarche at the age of 13 years (N=57, 24.6%). The Participant’s mean score of perceived stress scale was (22.10± S.D 5.92). Conclusion: The study concluded that students with primary dysmenorrhea had moderate level of perceived stress. Keywords: Menarche, Primary Dysmenorrhea, Perceived Stress
