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AN ANALYSIS OF MEMORY RETRIEVAL AND PERFORMANCES OF
PHYSIOTHERAPY EXERCISES IN NON-SPECIFIC LOW BACK PAIN
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 2
nd
and 5
th
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 2
nd
and 5
th
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
17
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 patients 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 program
1
.
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 predominates
1
.
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 dont
perform their home exercise program are often
not able to progress through therapy at the
expected rate
2
.

Background
When we look into the literature some of the
factors were elaborately used to prescribe a
home exercise program. Those factors are:
verbal cues
3
, written cues or pictorial
diagrams
3
, demonstration on a Human model
4
.
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 movement
1
.
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 parts
2.

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
learned
5
.
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
isnt 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.
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
19

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 2
nd

& 5
th
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 scale
6
.

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 2
nd
and 5
th
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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20
subsequent 2
nd
and 5
th
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 2
nd
and 5
th
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 2
nd
and 5
th
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
2
nd
and 5
th
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 2
nd
and 5
th
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 retrieval
7
. It has
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
21
been found that vision also has an effect of
performance of a task
8
.
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 retrieval
9
.
Subjects in group B scored the least with an
average of 5.32(SD=1.8) and 3.74(SD=1.3)
on both 2
nd
and 5
th
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.
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CORRESPONDING AUTHOR:
*Intern, Maeers Physiotherapy College, Talegaon Dabhade Pune, Maharashtra, INDIA. Email:
dishajacob@ymail.com
**Asst. Professor, Maeers Physiotherapy College, Talegaon Dabhade Pune, Maharashtra, INDIA