An Analysis of Memory Retrieval and Performances of Physiotherapy Exercises in Non-specific Low Back Pain Patients. Disha Jacob, Varoon c Jaiswal Srji Vol 3 Issue 2 Year 2014

ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

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AN ANALYSIS OF MEMORY RETRIEVAL AND PERFORMANCES OF

PHYSIOTHERAPY EXERCISES IN NON-SPECIFIC LOW BACK PA IN

PATIENTS

Disha Jacob*, Varoon C Jaiswal**

ABSTRACT

Objective-the goal of the current study was to analyze the memory retrieval and performance of exercises that

are prescribed in mechanical low back pain by using RATSALL scale (ten point exercise assessment scale).

Design-cross sectional study. Setting-JC Bamfordexcavators Ltd, talegaon, Pune. Method-60 subjects with the

problems of mechanical low back pain were selected and were divided into 3 groups, each group containing 20

subjects. Groups are: Group A-verbal instructions and self performance. Group B-written instructions and self

performance. GroupC-Human model demonstration and self performance. Exercises were prescribed to the

subjects as per above mentioned techniques and they were told to recall these exercises on 2nd and 5th day for

short term memory and long term memory respectively. Outcome was measured by RATSALL scale and points

were allotted. Result-Subjects in group A scored an average of 7.24 and 5.74(on 2nd and 5th day respectively)

out of 10 according to the rastsall scale. Subjects in group B scored an average on 5.32 and 3.74. Whereas,

Subjects in Group C scored an average of 9.45 and 39.17. Hence "demonstration by Human model and self

performance" has better memory retrieval of short term and long term memory in patients compared to other

two groups i.e. "Verbal Instructions and Self Performance & Pictorial Diagram / Written Material and Self

Performance". Conclusion-The study concluded that the best way of giving a home exercise program is by

demonstration on a Human model and then self performance, as in this way subject remembers most of the

exercises and hence will be effective.

Scientific Research Journal of India ● Volume: 3, Issue: 2, Year: 2014

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Keywords- retrieval, short term memory, long term memory, RATSALL scale.

INTRODUCTION

Therapeutic exercise intervention is considered

the core of physiotherapy practices. Physical

therapy and home exercise are two parts of a

whole. To support a therapy program, patients

are provided with instructions over the

exercises that they should continue to perform

at home known as home exercises. Home

exercise program (HEP) is unique to each

patient that facilitates the desired movements,

reduces pain and/or centralizes the symptoms,

performed exclusively by the patient. HEP is an

integral part of achieving success in physical

therapy. Physiotherapist prescribing HEP

should be aware that unsupervised exercise can

hinder the patient’s goal. So prescribing

exercises for home program is very

challenging. Exercise performance can be

enhanced by multiple ways. Typically, physical

therapy incorporates some re-training and

strengthening of specific muscles to perform

according to individual functions. In order to

activate the muscle and begin responding

appropriately, frequent and consistent practice

is necessary, and hence it is important for the

patients to perform some set of exercises even

at home. For maximum benefit, it is important

for the patients to take a active role in home

exercise program1.

Non-specific low back pain is tension, soreness

and/or stiffness in the lower back region for

which it is not possible to identify a specific

cause of the pain. Several structures in the

back, including the joints, discs and connective

tissues, may contribute to symptoms.The lower

back is commonly defined as the area between

the bottom of the rib cage and the buttock

creases. Some people with non-specific low

back pain may also feel pain in their upper legs,

but the low back pain usually predominates1.

Those patients who are good about

performing their home exercise program are the

same patients who feel better, stronger, and

more functional. Those patients who don’t

perform their home exercise program are often

not able to progress through therapy at the

expected rate2.

Background

When we look into the literature some of the

factors were elaborately used to prescribe a

home exercise program. Those factors are:

verbal cues3, written cues or pictorial

diagrams3, demonstration on a Human model4.

Pictorial diagrams are commonly used in the

clinics to teach exercises. The pictures usually

demonstrate the exercise in the start and finish

position. Arrow showing the direction of

movement with marks clearly indicating the

start and the end positions can be helpful. Often

pictures show positions midway through the

exercise and patient is unclear about the full

excursion of the movement1.

Practical demonstration is another one of

the most commonly used clinics to teach

exercises. In practical demonstration, there will


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be a Human modeling of an action either by

videotape or by the teacher performing the

action, it will help the learner to develop and

helps to understand the conceptual

representation of the action. By observation the

leaner can know the amplitude of movement,

appreciate the timing and fluency of the action

and relationship between the body parts2.

Lastly, Verbal instructions are most

commonly used for conveying information or

prescribing the exercises. Verbal instructions

mainly focus on kinematics description for

example angular displacement, oaths of the

body parts, which require an understanding by

the therapist of linked segment dynamics and

biomechanical necessities ofthe action to be

learned5.

Friedrich et al, (1996) concluded from the

study that exercises that are based only on

written instructions often are not performed

properly and therefore lead to poorer outcomes

compared with exercises learned under the

supervision of a physical therapist and hence

prescribing home exercises by written material

isn’t the best method of giving a home exercise

program, yet it is found that many hospitals

prescribe home exercises in this way.

Very few studies have compared the methods

of prescribing home exercise program and their

memory retrieval in non-specific low back

pain, since home program plays a vital role in

achieving physiotherapy success, it is an utmost

important for a physiotherapy for proper

prescription of home exercises program.

METHODOLOGY

Patient Selection

Inclusion Criteria

1. Younger adults of age group from 20 to 35.

2. Subjects with mechanical low back pain

3. With no memory deficits (subjects were

screened with mini-mental scale, those who

scored zero only those patients were selected).

Exclusion Criteria

1. Neurological deficits.

2. Visual impairments.

3. Hearing impairments.

4. Cognitive problems.

Material Used

1. Human model – To demonstrate the

exercises. The Human model was initially

trained to perform the given set of exercises for

each of the three conditions. When he was well

versed with all the exercises, he was asked to

demonstrate same for the subjects.

2. Plinth, Exercise instruction sheets.

3. Rastall scale.

Sample selection

Purposive sampling was done in this study.

Sample consists of 60 subjects in the age group

of 20-35 years. Subjects included in the study

were assessed for any impairment and/or

disabilities as per inclusion/exclusion criteria.

The total number of subjects in the study

design was 60. These 60 subjects were divided

into 3 groups with 20 subjects in each group.

Informed consent was obtained from the

subjects.


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Data collection

A qualified physiotherapist [1] was engaged in

diagnosing and prescribing the exercise to low

back pain subjects. Another physiotherapist [2]

was trained to rate them on Rastall scale on 2nd

& 5th day of exercise prescription.

Physiotherapist [2] was blinded to the

allocation. She jus calculated the mean and

standard deviation and the results were

obtained.

Outcome measure

Ten point exercise assessment scale6. This scale

was developed by Maggie Rastall el at 2000.

This scale measure primarily four components

of an exercise. They are

1) Correct starting position of the exercise.

2) Exercise body components moving in

correct plane

3) No compensation or cheat movements.

4) Movements performed within correct range.

Every exercise performance had a maximum

scoring of 10 points.

Correct starting position for

exercise

2

Exercising body component

moving in the correct plane

3

No compensations or cheat

movements

3

Movement performed within 2

the correct range

On exercise performance a score of 8 points or

more, was seemed to be correctly done they

were considered as number of exercises

correctly performed by the subject.

Procedure

Subjects with mechanical low back pain were

selected. A set of five exercises were given to

each subject. These set of exercises were

explained in all three medium of instructions.

These exercises were performed in three

different ways, they are-

1) Verbal Instructions and Self Performance.

2) Pictorial Diagram, Written Material and Self

Performance.

3) Demonstration by Human model and Self

Performance.

Methods for verbal instructions and self

performance-

In this group, exercises were explained to the

patient verbally and were asked to remember

them and do it. Patients were asked whether he

or she understood all the exercises properly.

The subjects were told to recall the same

exercises on 2nd and 5th day for both short term

and long term memory respectively.

Methods for written material/pictorial

diagram and self performance-

In this group, exercises were told to the patients

by the therapist in the form of pictorial

diagrams/written material. Subjects were asked

whether he or she understood it properly or not.

They were told to recall exercises on

Contains of Maggie Rastall exercise scoring table with points allotted.


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subsequent 2nd and 5th day for short term and

long term memory respectively.

Methods for demonstration by Human

model and self performance-

In this group, exercises were demonstrated to

the patient by the help Human model who

demonstrated the exercise to the subject, as told

by the therapist. Patients were told to remember

and do it and recall them on 2nd and 5th day for

both short term and long term memory

respectively.

Statistical Analysis- we have used descriptive

statistics to analyze the results. Mean and

standard deviation- measures of descriptive

statistics were used to analyze the result.

RESULTS

The study shows that subjects in group

C(Human model and self performance) scored

the maximum on 2nd and 5th day. Whereas,

subjects given oral instructions and self

performance scored less as compared to

subjects in group C.

Figure 1

Figure 2

DISCUSSION

The aim of the study was to analyze the

memory retrieval of HEP in mechanical low

back pain patients and which is the best method

of prescribing a home program. The result of

the study was, subjects in group C had an

average of 9.45(SD=±1) and 9.17(SD=±), on

2nd and 5th day respectively) out of 10

according to the Rastall scale, which suggest

that subjects in this group were able to

remember most of the exercise components as

well the exercises.When given an exercise

program by performance on a Human model

and then self performance, subject remembers

most of the exercises and has better memory

retrieval of exercise performance.However,

patients in group A i.e. verbal instructions

performed well as compared to group C , they

had an average of 7.24(SD=±1.7) and

5.74(SD=±.5) on 2nd and 5th day respectively as

they couldn't remember exercises components

and even some of the exercises.

When exercises were prescribed by

performance on a Human model and then self

performance, subjects got a visual feedback.

Eye is the main organ of processing memory,

and hence the better memory retrieval7. It has


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been found that vision also has an effect of

performance of a task8.

Also the subjects were more attentive when the

exercises were performed on the Human model.

It has been found that attention play a major

role in memory retrieval9.

Subjects in group B scored the least with an

average of 5.32(SD=±1.8) and 3.74(SD=±1.3)

on both 2nd and 5th day as they were not able to

recollect much of the exercises as compared to

subjects in the group A and C.

In most of the hospitals patients are given

handouts, and hence our study reveals that it

isn't the best method of giving a home exercise

program. Whereas, giving exercises by

performance on a Human model or oral

instructions are found to be more productive.

CONCLUSION

The study concluded that the best method of

giving a home exercise program is by Human

model and then self performance as in this way

patient remembers most of the exercises and

hence will be effective.

REFERENCES

1. Early management of persistent non-specific low back pain.NICE clinical guideline 88. Issued: May 2009.

2. Henchoz Y, de Goumoëns P, Norberg M, Paillex Role of physical exercise in low back pain rehabilitation: a

randomized controlled trial of a three-month exercise program in patients who have completed multidisciplinary

rehabilitation. May 20, 2010;35(12)

3. Friedrich et al, 1996, The Effect of Brochure Use Verses Therapist Teaching on Patients Performing Therapeutic

Exercises and on Changes in impairment Status, Physical Therapy, 76(10): 1082-1088, Oct 1996.

4. Carr and Shepard 1998, NEUROLOGICAL REHABILITATION: optimizing Motor Performance, Ch-2, 34-35.

5. Park K, 1997, Effect of Age event Based and time Based Prospective Memory, Psychological Aging, 12(2): 314 -

327, June 1997.

6. An Investigation into Younger and Older Adults' Memory for Physiotherapy Exercises-Maggie Rastall MCSP, Ten

point exercise assessment scale (Rastall, et al., 1999)

7. Berryhill, M.(2008, May 09). Visual memory and brain.

8. Bhatt, E., Catteneo, Z., Merabet, L.B., Pece,A.(2008).The influence of reduced visual acuity on age-related decline

in spatial working memory. Neuropsychology and cognition.

9. Exploring the role of attention during memory retrieval: effects of semantic encoding and divided attention. Mem

cognit.2006 jul;34(5):986-89.

10. Indian Journal of Physiotherapy and Occupational Therapy - An International Journal Year : 2012, Volume : 6,

Issue : 3

11. Alexander, N. B., Fry-Welch, D. K., Marshall, L. M., Chung, C. C., & Kowalski.

12. Guidelines for Exercise Testing and Prescription, DN. (1991)..Journal of Gerontology A Biological Science and

Medicine and Science, 46(3), M91-M98.

13. Kristin D Henry et al (1999), Effect of Number ofHome Exercises on Compliance and Performancein Adults Over

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14. Peggy MC Guire (2000), A Performance Frame Work for Teaching and Learning with Equipped for Future

Content Standards. Adventures In Assessment, Vol 12, 2000.


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15. Zimmer (2000), Pop Out Into Memory: A Retrieval Mechanism that is Enhanced with the Recall of Subject

Performed Tasks, Learning, Memory and Cognition, Vol 26(3), 658-670

CORRESPONDING AUTHOR:

*Intern, Maeers Physiotherapy College, Talegaon Dabhade Pune, Maharashtra, INDIA. Email:

[email protected]

**Asst. Professor, Maeers Physiotherapy College, Talegaon Dabhade Pune, Maharashtra, INDIA

Documents

An Analysis of Memory Retrieval and Performances of Physiotherapy Exercises in Non-specific Low Back Pain Patients. Disha Jacob, Varoon c Jaiswal Srji Vol 3 Issue 2 Year 2014