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Objective: To investigate the interrater reliability of the REEDCO postural score (RPS) between a physical therapist (PT) and a schoolteacher in healthy adolescents.
Methods: This study was a cross sectional study for interrater reliability evaluation. The standing posture of 86 adolescents were assessed using RPS scale. The schoolteacher and PT independently observed and scored 10 items of posture.  
Results: The Kappa coefficients of all items assessed were slight to fair. There was no significant agreement between assessors on seven items including the Head, Shoulders, Spine, and Hip in the posterior view, as well as the Upper back, Abdomen, and Lower back in the lateral view. Furthermore, there were significant differences in the grading between the two assessors for seven items including the Shoulders, Hips, and Ankles in the posterior view, as well as the Neck, Upper back, Trunk, and Abdomen in the lateral view. The total score of the RPS was also significantly different between a PT and a schoolteacher (p<0.001).
Discussion: The results from this study showed poor to fair level of agreements for posture screening by RPS between and schoolteacher. This might be due to the different observation skills between two assessors. The sequence of assessment might also influence the assessment results. The more comprehensive training sessions should be considered in posture school screening program to improve reliability between assessors.

Objectives: One of the most common and disabling complications that affects individuals with spinal cord injury is spasticity. The purpose of this study is to compare the effect of agonist and antagonist electrical stimulations on triceps surae muscle spasticity in patients with spinal cord injury.
Methods: A total of 30 subjects with spinal cord injury were considered for the study. They were divided into two groups randomly. Group 1 received agonist electrical stimulation (stimulation of triceps surae) and group 2 received antagonist electrical stimulation (stimulation of tibialis anterior) for 20 min, once daily, and 5 days per week for two weeks. To evaluate the therapeutic effect, modified Ashworth score, deep tendon reflex score and clonus score were tested before and after the treatment. Post treatment evaluation was made 24 h after the last treatment session.
Results: Both the groups showed significant reductions in the modified Ashworth scores and deep tendon reflex scores after the intervention, but these reductions were not found in the clonus score. Also, there was no significant difference in the post intervention scores of modified Ashworth scale, deep tendon reflex and clonus score between the two groups.
Discussion: This study provides evidence that both agonist electrical stimulation and antagonist electrical stimulations are equally effective in reducing spasticity in triceps surae muscle in patients with spinal cord injury.

Objectives: Clinical education is an important component of physiotherapy education. The students’ and clinical educators’ viewpoints about different aspects of education are being analyzed worldwide for the promotion of educational services. The aim of this study was to identify the challenges of clinical education based on the experiences of physiotherapy students and educators. 
Methods: A qualitative study was conducted using content analysis method. Data were collected through semi-structured interviews using a purposeful sampling method with a maximum variation based on some factors like first-hand experience, expertise, and their willingness to participate in this research. Data collection was continued until the point of data saturation was attained. The participants included 17 senior physiotherapy students and nine clinical educators with over three years of experience.
Results: After verbatim transcription of the interviews and data analysis, 360 initial or open codes were extracted. The related codes were derived from the students’ and clinical educators’ experiences and challenges and were categorized into three concepts: A. Personal and professional characteristics of physiotherapy students; B. Personal and professional characteristics of clinical educators; and C. Inefficient educational system.
Discussion: Clinical education efficiency requires a common understanding of the long –term complications involved in addressing the existing barriers. Understanding these challenges can equip the policy makers and educational planners of physiotherapy departments with valuable information for improvement in the quality of physiotherapy clinical education and preventing oversight of clinical education and programs. Thus, the study emphasized the need for comprehensive management for policy makers and educational planners and recommended further research.

Objectives: Clinical education in medical sciences is essential, because of its important role in the education of specialist skills. Physiotherapy specialization is among the main branches of medical sciences, which requires high academic and professional skills. One of the most important and effective methods to assess the quality of clinical education in physiotherapy is to review it from a student’s perspective. Therefore, this study attempted to recognize the barriers of clinical education in physiotherapy students from their own perspective. 
Methods: This qualitative study used content analysis method. Data were collected using semi-structured interviews and the samples were selected by purposeful sampling method. We have considered maximum variation (gender, semester, educational level, place of residence) of persons in the sample selection. The data collection continued until saturation was reached. Participants included 13 physiotherapy undergraduate students who had completed at least 6 clinical education units.
Results: We extracted 182 original codes from interviews analysis. By eliminating and matching the data, we finally developed 4 categories, as follows: 1. Personal and professional characteristics of clinical educators; 2. Personal characteristics of students; 3. Inadequate education system; 4. The inappropriate clinical education environment.
Discussion: Clinical incompetency, inadequate clinical skills, and failure to observe professional ethics are the most frequent problems of clinical supervisors. Moreover, student’s irresponsibility, inadequate participation, the lack of self-esteem in some students, and inappropriate planning and the implementation of clinical education of PT department and inappropriate interpersonal communication and facilities in clinical settings, can be considered as barriers for clinical education. Considering the obstacles and attempts to resolve them, reviewing the clinical education process can improve its quality. Reviewing the clinical education process seems to help recognize its barriers and attempt to resolving them. It seems to improve the quality of clinical education. 

Objectives: The primary study objective was to assess the effects of visuomotor training on grip strength and wrist movements in adults and the elderly to be efficiently used in rehabilitation. The secondary objective was to compare the post-training changes between the two groups.
Methods: This was a pre-test-post-test quasi-experimental study, including healthy individuals aged 25-44 (adults) and 65-79 (elderly) years. Individuals suffering from neuromuscular or musculoskeletal system disorders were excluded from the study. Grip strength (kg) and wrist movements (˚) were recorded by the equipment (Pablo system). Moreover, the scores of the Michigan Hand Outcome Questionnaire (MHQ) were recorded after interviewing the individuals. The study subjects were then provided with training (game-based) by Pablo system for 24 min/ d, thrice a week. Finally, post-test scores were recorded after 4 weeks of training. 
Results: Groups 1 and 2 had the Mean±SD age of 35.8±9 and 68.5±7.2 years, respectively. The obtained data were analyzed using the Analysis of Variance (ANOVA) and Tukey-Kramer multiple comparison test. The within-group analysis of group 1 demonstrated differences (pre-post) of 1.09 kg, 4.39°, and 3.7° in grip strength, wrist extension, and flexion, respectively, after the training. The differences between the different parameters of MHQ viz. function, work, pain, and satisfaction were 2.7, 1, 1.1, and 0.3, respectively. No change was observed in the Activities of Daily Living (ADLs) and satisfaction. The within-group analysis of group 2 indicated the mean score differences of 0.3 kg and 6.53° in grip strength and wrist extension, respectively. Wrist flexion revealed a decrease from pre-test to post-test phases. The difference in MHQ parameters; function, ADLs, work, pain, aesthetics, and satisfaction were 2.4, 1.2, 2.4, 4, 0.5, and 1.59, respectively. The between-group analysis suggested better improvement of grip strength, wrist flexion, and function in adults; while wrist extension, ADL, and work were better in the elderly. There was no significant difference in this area.
Discussion: Previous studies have explored the visuomotor training, using game-based rehabilitation, non-immersive virtual reality, or robotic therapy. They have suggested that it would provide neuroplasticity and cortical reorganization, and enhance brain reward system. The low scores obtained in some subjective parameters like satisfaction could be due to different perceptions in individuals. Degenerative changes like osteoarthritis could be a possible reason for the high score of pain in the elderly. Future studies are required with larger sample sizes, control groups, incorporating other factors, and so on. This study may be beneficial in overcoming the limitations of conventional protocols such as labor, compliance, and adherence. It could also play an important role in rehabilitation, especially neurorehabilitation, by providing a new perspective. 

Objectives: Knee osteoarthritis is one of the most common musculoskeletal problems that is associated with impaired balance. This study was conducted to determine the result of balance and strengthening training in static stability indices in females with knee osteoarthritis.
Methods: In this single-blind randomized controlled study, 13 patients were determined through the available sampling method and randomly assigned to strengthening exercises and balance exercises groups. Strengthening exercises were based on quadriceps strengthening and in the balance exercises group, it included balance exercises. Anterior-posterior, overall, and medial-lateral stability measures were performed by Biodex before and after the treatment in the static situation at the status of open and close eyes on one and two feet. The treatment was performed 15 sessions for 3 weeks. The data were analyzed by paired t-test and independent t-test.
Results: In strengthening exercises group, at the static status, overall and anterior-posterior stability index on two feet at the status of open eyes reduced from 1.26±0.82 to 0.76±0.48 (P=0.02) and from 0.87±0.53 to 0.56±0.37 (P=0.02), respectively. In the balance exercise group, in the static status, overall lateral stability index on the involved foot at the status of close eyes reduced from 9.15±3.18 to 7.53±2.81 (P=0.00) and from 8.27±3.32 to 6.77±2.95 (P=0.00), respectively. There was no significant difference between the groups (P>0.05).
Discussion: There was no difference between them regarding the impact on static stability indices. However, strengthening exercises caused improvement in the greater number of stability indices compared to those in the balance exercises group.

Objectives: Fear of falling (FoF) is a common complication after stroke affecting gait and balance performance in individuals with a history of stroke. The current study aimed at determining the influence of the level of FoF on gait and balance performance after chronic stroke.
Methods: A total of 76 persons with chronic stroke (including 41 women), who had no cognitive impairment and could walk at least 10 meters without walking aids, participated in this cross-sectional observational study. The participants walked at their preferred speed to calculate gait asymmetry ratios for stance time, swing time, and step length. The Asymmetry Index determined standing balance asymmetry measures of medial-lateral and Anterior-Posterior (AP) Center of Pressure (CoP) velocity. The Falls Efficacy Scale-International (FES-I) evaluated the severity of FoF. Thirty-one participants had no FoF, 25 had low FoF, and 20 had high FoF. A multivariate analysis of variance test was used to compare standing balance and gait parameters among 3 groups. The Pearson correlation test was also used to define the relationships between FES-I and gait and standing balance asymmetry measures in individuals with FoF.
Results: The Mean±SD age of the participants was 57.53±9.28 years. The Mean±SD time since stroke onset was 17.29±3.6 months. The participants with a high FoF had a significantly more asymmetrical swing time and step length and higher AP CoP asymmetry compared to those without FoF (P=0.02, P=0.007, P=0.03, respectively). Increased FES-I was related to increased swing time (r=0.65, P=0.001), step asymmetry (r=0.45, P=0.002), and AP CoP asymmetry (r=0.44, P=0.003).
Discussion: A high level of FoF affects gait and balance asymmetry after chronic stroke. Future research to develop therapeutic programs should consider the effects of FoF.

Objectives: The present research aimed to evaluate the relationship of supra patella effusion with pain and disability in patients with knee osteoarthritis by Ultrasonography (US).
Methods: In a cross-sectional study, 60 patients with knee OA (Mean±SD score of body mass index: 29.81±5.64 kg/m2 and age: 50.48±7.57 years) were selected by nonprobability sampling method. Supra patella effusion was evaluated using an US. All study subjects completed the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain and disability outcomes, respectively. To evaluate the relationship between effusion, disability, and pain, the Pearson’s correlation coefficient was employed. 
Results: There was a poor but significant relationship between the area of effusion (r=0.27, P=0.03), the thickness of effusion (r=0.32, P=0.01), with pain. No correlation was found between the trace of effusion (r=-0.08, P=0.5) and pain. The area of effusion (r=0.1, P=0.17), the thickness of effusion (r=0.08, P=0.51), and the trace of effusion (r=0.0, P=0.9) were not correlated with disability. 
Discussion: The effusion of supra patella was slightly correlated with pain. In contrast, the effusion of supra patella demonstrated no correlation with disability.

A 49-year-old male patient with type 2 diabetes mellitus and Diabetic Foot Syndrome (DFS) was evaluated by comprehensive diabetic foot assessment. A 10-session photobiomodulation therapy (low-level laser therapy) was prescribed for neuropathic pain and symptoms applying the scanning and probe method. Customized insoles were recommended for redistributing the plantar pressures and reducing stress on the diabetic foot’s plantar surface for 4 weeks. Dynamic plantar pressure distribution, lower limb kinematics, and postural sway were evaluated using WinTrack dynamic pressure platform. Photobiomodulation therapy with customized insoles is useful in the redistribution and treatment of plantar pressure and gait kinematics. This approach should be extensively used in DFS as preventive and treatment measures.

Objectives: Postoperative physiotherapy is routinely prescribed for patients after thoracic surgeries. There are no established guidelines for exercise prescription after pleural resection surgeries. The present study aimed to determine the effect of an individualized postoperative physiotherapy program on a patient who underwent pleurectomy.
Methods: A 19-year-old female patient was admitted to Kasturba Medical College, Mangalore in February 2019. She was diagnosed with right spontaneous pneumothorax; then, she underwent bullae repair and pleurectomy and was given a 7-day individualized postoperative physiotherapy. The severity of dyspnoea, chest expansion, and right shoulder range of motion was recorded on postoperative day 2 and the day of discharge; the six-minute walk distance was measured on postoperative day 4 and the day of discharge.
Results: Significant improvements in all the outcomes were found after the individualized post-operative physiotherapy program in the reported patient.
Discussion: The provided individualized 7-day physiotherapy program improved the chest expansion, shoulder range of motion, rating of perceived exertion scores, and functional capacity in the reported patient who underwent bullae repair and pleurectomy. 

Objectives: Computer usage has rapidly grown. This is because it helps to resolve problems, i.e., encountered in daily life by individuals. Various monitor screens that have been developed affect the user’s eyes. Screen size is one of the relevant impacts. Thus, this study compared the immediate effects of two computer screen sizes on visual fatigue in Video Display Terminal (VDT) users.
Methods: Twenty female VDT users participated in this study. Using a randomized block design for the study, the study participants randomly drew a ballot to determine the order of using an 18.5-inch and 23-inch computer screen size. The research participants were assessed by a visual fatigue score, critical flicker frequency, and dry eye score before and after using both computer screen sizes. They were tested in an ergonomic computer workstation for 2 hours. Besides, where they rested between each workstation for ≥30 minutes or until presetting no eye fatigue symptoms. The relevant data were compared between before and after using the computers and between the two different screen sizes. 
Results: The collected results suggested no significant difference in the visual fatigue score, critical flicker frequency, and dry eye score between using either computer screen sizes (P>0.05). However, there were significant differences in the visual fatigue score, critical flicker frequency, and dry eye score between before and after computer screen usage (P<0.05).
Discussion: Using both computer screen sizes resulted in increased visual fatigue, reduced critical flicker frequency, and increased dry eyes. The present study results can provide information in determining how to reduce risk factors and prevent visual fatigue from continuous computer use for a long time.