Vol.1 ● No.

2 ● 2012 Scientific Research Journal of India 1

Index

Editorial Dr. Parismita Bordoloi 3

Growth in Cerebral Palsy Children
Parmar Sanjay T,
between 3-13 years in Urban Dharwad, 5
Nayana A. Khobre
India
Correlation of Balance Tests Scores With
Sunita Yadav, Physiotherapy
Modified Physical Performance Test In 12
Deepti Dhar
Indian Community-Dwelling Older Adults
Safety Positions for Healthy Sex Following
B.Arun 31
Back Pain
Reduced Instruction Set Computer (RISC) Thanigaivel.V,
Computer
32bit Processor on Field Programmable V. Subramanian, 36
Science
Gate Arrays (FPGAs) Implementation K. Priyadharsan

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 3

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 syndromes secondary to causes are congenital, genetic,
lesions or anomalies of the brain arising in inflammatory, infectious, anoxic, traumatic
the early stages of its development”. and metabolic. The injury to the
Cerebral palsy is in variably associated developing brain may be prenatal, natal or
with many deficits such as mental postnatal1. The incidence of cerebral palsy
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
is 2-2.5 cases in every 1000 live births.
There are an estimated 4-5 million children
and people in India with cerebral palsy2.
The incidence of malnutrition in
individuals with cerebral palsy is a
combination of factors, which directly or
indirectly result in reduced food and
nutrient intake3. Feeding problems are not
easily recognizable in children and in order
to optimally utilize the impaired feeding
potential in these children, early
identification of the incidence of
malnutrition in individuals with cerebral
palsy is necessary. It also requires regular
assessment of feeding and nutritional
status and appropriate nutritional
4
rehabilitation .
While the prevalence of growth
disorders among these children is
unknown, certain observations have been
made. Growth failure has been related to
the type of cp-spastic or athetoid and to
topographical distribution, and oral-motor
dysfunction also has been associated with
5
poorer growth
A study done on percent body fat,
muscle area and oral motor functions are
important factors for weight gain and
linear growth of children with cerebral
palsy. The identification of the nutritional
problem has a great potential to help
improve weight, muscle mass, decrease
irritability and circulation in order to halt
6
the incidence of malnutrition in children
with cerebral palsy6.
A study done on incidence of
malnutrition in children with cerebral
palsy tells about feeding problem are
usually complicated by the lack of
awareness of parents of incidence of
malnutrition in cerebral palsy children.
The main reasons for lack of awareness in
parents were illiteracy, misconception
about the disease and associated
complications in cerebral palsy. The
psychological impact of having child with
severe chronic neurological disease is so
deep that parents do not appreciate the
feeding problems to the extent they should.
The study done on Growth and
nutrition disorders is common secondary
health conditions in children with cerebral
palsy (CP). Poor growth and malnutrition
in CP merit study because of their impact
on health, including psychological and
physiological function, healthcare
utilization, societal participation, motor
function, and survival. Understanding the
etiology of poor growth has led to a variety
of interventions to improve growth.
Increased recognition and understanding of
neurological, endocrinal, and
environmental factors have begun to shape
care for children with CP, as well. The
investigation of these factors relies on
advances made in the assessment methods
available to address the challenges
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
inherent in measuring growth in children
with CP. Descriptive growth charts and
norms of body composition provide
information that may help clinicians to
interpret growth and intervene to improve
growth and nutrition in children with CP.
Linking growth to measures of health will
be necessary to develop growth standards
for children with CP in order to optimize
health and well-being.
METHOD
A sample size of 100 children with
cerebral palsy with either gender from 3-
13 years of age was assessed for body
mass index. The study was conducted for 1
year in Physiotherapy OPD of SDM
medical hospital Dharwad Karnataka
India. Ethical clearance is obtained from
the Institutional Ethical Committee, Shri
Dharmasthala Manjunatheshwara College
of Medical Sciences and Hospital, prior to
the commencement of the study. The
children included in the study were
diagnosed cerebral palsy cases, who were
able to stand on stadiometer and weighing
machine. Children who were un-conscious,
unco-operative, who were not able to stand
and unstable Patients were excluded.
Parents of the subjects willing to
participate were briefed about the study
and how the study would help their
children.A written consent was obtained
from the parents of the children.
7
Children diagnosed with cerebral
palsy were assessed for BMI by taking the
height and weight of the children. The
child was made to stand on the
Stediometer with the consideration of
physical disabilities to measure the height
and Weight was measured by making the
children stand on weighing machine.
The outcome measures was
CDC/NHCS growth charts. The growth
was assessed by height in meters and
weight in kilograms and BMI (Body Mass
Index) is calculated in weight (in kgs) by
height square (in meters). And BMI
percentiles were calculated on CDC/NHCS
growth charts.
DATA ANALYSIS
Statistical analysis was done with
statistical software (n Master 1.0).
descriptive analysis was carried out using
mean and standard deviation of mean age,
height, weight, BMI, BMI percentile.
Comparison between variables is done
using unpaired t-test. The p-value is
0.5693 which shows that there is no
significant difference between boys and
girls.
RESULTS
The table1 depicts the distribution
of study subjects according to gender and
different types of cerebral palsy children.
It shows mainly spastic cerebral palsy
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cases more in the present study which
includes 3-13years of age group. The table
2 depicts the mean and standard deviation
age of both boys and girls.
The table 3, 4, 5 depicts that the
mean and standard deviation (SD) values
of height, weight, BMI and BMI percentile
for different diagnosis of cerebral palsy in
which dystonic and diplegic type have less
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
8
than girls which was not significant. The
table 5 depicts the children in our study are
underweight with 86%.
The table 6 shows that comparison
of boys and girl children with respect to
BMI scores by t-test with mean and
standard deviation where there was no
significant difference between boys and
girls.

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 Std.Dev.
Diagnosis
Ataxic CP 18.1857 4.9878 63.8571 36.0159
Dystonic CP 14.3333 3.2629 35.1667 47.2035
Hemiplegic CP 15.5706 2.0784 41.0000 34.6717
Hypotonic CP 16.0500 4.2646 42.1667 46.2100
Diplegic CP 15.5429 3.0375 30.5357 35.6282
Quadri CP 16.7615 4.2477 48.6154 39.3732
Triplegic CP 17.3800 2.8197 65.5000 32.2154
All Grps 16.1910 3.5160 43.8200 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 Std.Dev.
Ataxic CP 18.1857 4.9878 63.8571 36.0159
Dystonic CP 14.3333 3.2629 35.1667 47.2035
Hemiplegic CP 15.5706 2.0784 41.0000 34.6717
Hypotonic CP 16.0500 4.2646 42.1667 46.2100
Diplegic CP 15.5429 3.0375 30.5357 35.6282
Quadri CP 16.7615 4.2477 48.6154 39.3732
Triplegic CP 17.3800 2.8197 65.5000 32.2154
All Grps 16.1910 3.5160 43.8200 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 Total
Height Means 97.0000 115.7500 130.1481 145.1250 119.6500
Std.Dev. 10.1612 7.6031 10.5492 7.0887 18.6917
Weight Means 13.2120 21.5031 28.5185 41.5563 24.5330
Std.Dev. 3.2447 5.2859 8.3176 12.2666 11.7800
BMI Means 13.7760 16.1719 16.5222 19.4438 16.1910
Std.Dev. 2.0765 3.0619 2.6963 4.6381 3.5160
The above table depicts Mean and SD of Wt, Ht and BMI by age groups

Table 5: Distribution of samples by BMI category and gender

BMI Male % Female % Total %
Under weight 61 70.93 25 29.07 86 86.00
Normal 9 90.00 1 10.00 10 10.00
Over weight 3 75.00 1 25.00 4 4.00
Total 73 73.00 27 27.00 100 100.00
The above depicts that Distribution of samples by BMI category and gender

DISCUSSION children more in 9-11yrs group mean

In our study the mean age group of
boys population is 7.794 and of girls
population is 8.266 out of the total score
which showed the mean value more in age
group of 9-11years in total score which
depicts there is no significant difference in
BMI in both male and female population.
As in 9-11yrs age group 30 children were
there and in 12+yrs age group were 15
children may be because of number of
value was more as comparative to other
groups.
The mean values in the different
variable of our study show different mean
values of each type of cerebral palsy
relatively quadriplegic and hypotonic
having lower mean as compared to others
due to smaller sample size in them for
which no statistical analysis was been
carried out.

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Studies 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 percentiles where explained,
among patients who are non-ambulatory undernourished children with CP have
Poor growth in children with CP changes in body composition and
may be related to nutritional factors, proportion compared with normally
physical factors or factors related to the developing peers. Alterations include
brain lesion itself. Nutritional factors increased total body water, severely
include inadequate dietary intake, depleted fat stores, minimally depleted
secondary to impaired oral motor and muscle stores, severe short stature, and
swallowing competence and poor decreased bone density.
nutritional status and may impact directly
on growth. Physical factors result in CONCLUSION
decreased mechanical stress on bones due All the children with cerebral palsy
to immobility or lack of weight bearing. had lower growth than other peer groups,
Bone growth studies 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 suppresses certain 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.
indirectly (via the endocrine system).
Growth differences between impaired and
unimpaired limbs in children with

References
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 11

1. Bax 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 State, Number 314
295-297. December4, 2000 (Revised). U.S
2. Chitra Sankar, Nandini Mundkar. Department of Health and Human
Cerebral Palsy- Definition, 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. 6. Incidence of malnutrition in
3. Bell et al. A prospective, individuals with cerebral palsy.
longitudinal study of growth, Available 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. 7. Okeke IB, Ojinnaka NC.
4. Bruce K. Shapiro, Pauline Green, Nutritional status of children with
Jackie Krick, Darlene Allen, cerebral palsy in enugu Nigeria.
Arnold J. Capute. Growth of European journal of scientific
severely impaired children: research 2010; 39: 505-513.
neurological verse nutritional
factors. Dev Med 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 (Group-
A), 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% of total
in India. India is the second most populous population. Recurrent falls are an
country in the world has 76.6 million important cause of morbidity and mortality
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 13
in the elderly and are a marker of poor their likelihood of falls and to enhance
2
physical and cognitive status. 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 interaction of neural and the patient voluntary postural control.
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 the physical activities and and fall risk in older people. In this study
physical function also decreases due to balance subscale of Tinetti assessment is
11
decreased muscular power and strength. used to assess the balance of older adults.15
Both balance problems and physical Brown, M, Sinacore, D.R.
inactivity affect the quality of life of older developed the modified physical
adults. Therefore the assessment of both performance test in 2005 to provide more
balance and physical function is necessary focus on gross motor function by
for older adults in order to help establish substituting a chair rise task and a balance
appropriate treatment goals, increase task for the writing and stimulated eating
awareness of fall risk and assign tasks described in the original PPT. The
appropriate assistive device and to tool was more useful in identifying deficits
decrease the disability. Several such in physical function than the self- report
instrument have shown satisfactory comparison measure, the functional status
reliability and validity in identifying older questionnaire. The authors concluded that
people with balance and 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
for the patients.16

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Several researchers found that
balancing exercises improve physical
function and previous studies also found
significant correlation between balance
scales and other functional tests.17,18,13,19
Therefore it is clear that there is a
relationship between balance and physical
function.
Yet there is no study to show
relationship between these scales or tests
in different age groups. Therefore the main
purpose of my study is to find out the
relationship between balance tests and
Modified physical performance test.
Second purpose is, the Modified physical
performance test assesses both balance and
physical function in older adults no other
tool is required because it measure the
both static and dynamic balance and also
physical function. It tells about fall risk,
need of assistance device and functional
limitations; additionally it takes less time
to administer as compared to other scale.
METHODOLOGY
This observational study recruited
58 subjects from old age homes and local
community of Delhi and Dehradun
meeting the inclusion criteria. Inclusion
Criteria: Age - 60 to 89 year old healthy
subjects; Gender- Both male and female;
Ability to abduct and flex the shoulder up
to 90 degrees; Ability to stand for
minimum 10 min. without any assistance;
14
Ability to walk at least 50 feet before
sitting to rest; Minimal use of rail or cane
while climbing. Exclusion Criteria: Use
of any assistive prosthetic device; History
of any cardiac problem confirmed by
physician; Any history of fainting spells or
extended dizziness due to unknown
reasons History of neurological; vestibular
or auditory deficit confirmed by physician;
History of any visual disorder which will
not be corrected by optical glasses as
confirmed by physician; MMSE score
below 23; History of postural hypotension;
History of recent fractures and severe
arthritic conditions; History of any major
surgeries during last 6 month; History of
any previous balance training; Moderate to
severe hypertensions
Measurement Tools
Berg Balance Scale (BBS)
The BBS was developed to measure
balance among older people with
impairment in balance function by
assessing the performance of 14 functional
tasks. The results are based on how long it
takes to complete specific tasks and how
well the tasks are performed. Each task is
measured on a five point ordinal scale
ranging from 0 to 4 (0 = unable to
perform, 4 = independent) so that the
aggregate score ranges from 0 to 56.
Multidirectional Reach Test (MDRT)
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
The MDRT is an inexpensive, reliable and
valid screening tool to measure the limits
of postural stability in four directions
(forward, backward, right & left) during
standing. The distance of each reach is
measured in centimetres or inches.
Balance Performance Oriented Mobility
Assessment (BPOMA)
The Tinetti assessment is a physical task-
oriented scale which measures the gait and
balance activities of older adults. In this
study BPOMA was used to assess the
balance of the community dwelling older
adults; it consists 9 tasks. 6 tasks are
measured on a three point ordinal scale
ranging from 0 to 2 and remaining three
tasks are measured on a two point ordinal
scale ranging from 0 to 1 ( 0 = unable to
perform, 1 & 2 = independent). The
maximum score is 16.
Physical Performance Test (Modified-
PPT)
An objective evaluation of overall physical
function was obtained by using modified
PPT. The severity of physical frailty in
physical functioning was assessed using a
modified PPT. It consists of 9 tasks; each
task is measured on a five point ordinal
scale ranging from 0 to 4 ( 0 = unable to
perform, 4 = independent) except 7th task
(turning 360 degrees) which ranges from 0
to 1 (0 = unsteady, 1 = steady). The
maximum score is 36.
15
Procedure
The subjects were recruited based on
inclusion and exclusion criteria the
subjects of different age groups 60 to 69
years of age (Group- A), 70 to 79 years of
age (Group- B), and 80 to 89 years of age
(Group- C). Subjects in each group
performed the tests in a sequence i.e. BBS,
MDRT, Modified-PPT, POMA. The whole
procedure was explained to each subject
and the subject signed a consent form
before performing the study. Description
data was collected which included age,
gender, height, weight and number of falls
in the past 6 months. MMSE score was
also assessed. All subjects were assessed
by all four scales or tests in the following
order BBS, MDRT, Modified-PPT and
BPOMA. All components of each scale
were demonstrated to all the subjects and
one practice session was done for all the
components of four scales by all the
subjects, after that reading was taken. Each
test or scale was administered by myself.
All subjects were offered rest breaks and
water during the session and completed the
approximately 60 minute testing protocol
without complaint of fatigue or
discomfort. The resting period of 5 to 10
minute was given after performing each
scale. As a precautionary measure, blood
pressure was checked prior to beginning of
the test session and it was again taken at
the end of the last test performed. One
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 16
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 [Table 4], was calculated. The
standard deviation of age, height and correlation values of balance tests with
weight in demographic data 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) among elderly 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 in demographic data 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).
between balance tests (BBS, MDRT &
POMA) with physical performance test Table 1: Mean and standard deviation of
demographic data
(modified) among elderly people.
Statistical significance level was set at < Group – A
N Mean
0.05.
Age 20 65.3±3.0
Height 20 161.4±5.6
Weight 20 68.4±4.8
RESULT AND INTERPRETATION
A sample of 58 subjects were selected on Group – B
N Mean
the basis of inclusion and exclusion Age 20 73.7±2.4
criteria. Each group of older adults had 20 Height 20 164.9±10.2
Weight 20 72.7±6.9
subjects except Group – C (81-89 years of
age) which has only 18 subjects due to Group – C
N Mean
unavailability of the subjects. The mean Age 20 82.6±1.4
Height 20 160.3±5.9
and standard deviation of age weight and Weight 20 63.6±7.7
height of three Groups A, B and C [Table 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 Figure 1: Mean and standard deviation of
age) & Group – C ( 80 – 89 years of age). balance tests (BBS, MDRT, & BPOMA)
with modified physical performance test
Table 2: (Group – A) Mean and standard
(modified) of Group A, B and C.
deviation (SD) of balance tests (BBS,
MDRT & BPOMA) and Physical
Performance Test (Modified).

Tests N Mean and SD

BBS 20 54±2.4
FR (MDRT) 20 13.6±2.6
BR (MDRT) 20 11.8±2.6
RR (MDRT) 20 12.5±2.5
LR (MDRT) 20 12.2±3.0
BPOMA 20 14.9±1.9
PPT (modified) 20 31.1±2.5

Table 2 shows mean and standard deviation of

balance tests and modified physical performance Table 5: (Group A) Correlations of
test of Group-A (60-69 Years of age). balance tests (BBS, MDRT, & POMA)
with Physical Performance Test
Table 3: (Group – B) Mean and standard (Modified)
deviation (SD) of balance tests (BBS,
MDRT & BPOMA) and Physical Balance Tests r P
Performance Test (Modified). value value
BBS Vs PPT (modified) .759 .000
Tests N Mean and SD FR( MDRT) Vs PPT (modified) .592 .006
BBS 20 27.7±5.3 BR (MDRT) Vs PPT (modified) .671 .001
FR (MDRT) 20 12.0±3.4 RR (MDRT) Vs PPT (modified) .541 .014
BR (MDRT) 20 9.9±3.9 LR (MDRT) Vs PPT (modified) .518 .019
RR (MDRT) 20 11.2±3.3 BPOMA Vs PPT (modified) .826 .000
LR (MDRT) 20 11.4±4.3
BPOMA 20 12.9±2.2 Table 5 shows correlation of balance tests with
PPT (Modified) 20 27.7±5.3 physical performance test (modified), all the
balance tests show significant correlation except
Table 3 shows mean and standard deviation of right and left reaches which show moderately
balance tests and physical performance test significant correlations with physical performance
(modified) of Group-A (70-79 Years of age). test (modified) of Group – A (60 – 69 years of age).

Table 4: (Group – C) Mean and standard

deviation (SD) of balance tests (BBS, Figure 2: Correlation Graph of Berg
MDRT & BPOMA) and Physical Balance Scale (BBS) and Physical
Performance Test (Modified). Performance Test (Modified) of Group –
A.
Tests N Mean and SD
BBS 20 42.6±3.6
FR (MDRT) 20 5.5±2.2
BR (MDRT) 20 3.2±1.9
RR (MDRT) 20 4.9±2.3
LR (MDRT) 20 4.4±2.2
BPOMA 20 10.5±1.4
PPT (modified) 20 18.0±3.5
Figure 2 depicts correlation between BBS and
Table 4 shows mean and standard deviation of modified PPT. It shows positive significant
balance tests and Modified physical performance correlation in 60-69 years of age group i.e. Group –
test of Group A (80-89 Years of age). A.

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Vol.1 ● No.2 ● 2012
Figure 3: Correlation Graph Of Forward
Reach (FR) of MDRT and Physical
Performance Test (Modified) Of Group –
A.
Scientific Research Journal of India 18
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

Figure 3 depicts correlation between FR of MDRT and PPT (modified). It shows positive significant
and PPT (modified). It shows positive significant correlation in 60-69 years of age group i.e. Group –
correlation in 60-69 years of age group i.e. Group – A.
A.
Figure 7: Correlation Graph of Balance
Figure 4: Correlation Graph of Backward Performance Oriented Mobility
Reach (BR) of MDRT and Physical Assessment (BPOMA) with Physical
Performance Test (Modified) Of Group – Performance Test (Modified) of Group –
A. 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 7 depicts correlation between BPOMA and
Modified PPT (modified). It shows positive
Figure 5: Correlation Graph of Right significant correlation in 60-69 years of age group
Reach (RR) of MDRT and Physical i.e. Group – A.
Performance Test (Modified) of Group -
A. Table 6: Correlations of balance tests
(BBS, MDRT, & BPOMA) with Physical
Performance Test (modified) of Group - B.
Balance Tests r P
value value
BBS Vs PPT (modified) .944 < .01
FR( MDRT) Vs PPT (modified) .874 < .01
BR (MDRT) Vs PPT (modified) .893 < .01
RR (MDRT) Vs PPT (modified) .826 < .01
LR (MDRT) Vs PPT (modified) .710 < .01
Figure 5 depicts correlation between RR of MDRT BPOMA Vs PPT (modified) .856 < .01
and PPT (modified). It shows positive significant
correlation in 60-69 years of age group i.e. Group – Table 6 shows significant correlation between
A. balance tests (BBS, MDRT & BPOMA) and

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
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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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
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 i.e. Group – C.
Table 7: Correlations of balance tests
(BBS, MDRT, & BPOMA) with Physical
Performance Test (Modified) – 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.
20
Figure 15 depicts correlation between FR of
MDRT and PPT (modified). It shows positive
significant correlation in 81-89 years of age group
Figure 16: Correlation graph of Backward
Reach (BR) 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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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
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.
Figure 19: Correlation graph of Balance
Performance Oriented Mobility
Assessment (BPOMA) with Physical
Performance Test (Modified) of Group –
C.
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.
DISCUSSION
Assessing balance and physical
abilities as they relate to falls in older
adults is complex due to many social and
health related issues that may be involved.
The geriatric population above 80 years
adults presents a more complicated
situation due to a sedentary life style, a
lower level of function, and the dynamics
of their physical and emotional
environments. Any one or combination of
these factors may lead to a falls at any time
because the level of the older adult’s
performance may not meet the demands of
the environment or task at hand. The need
to reduce this functional decline is an
important health care issue. It is important
to identify those factors that contribute to
21
the functional decline. Balance instability
and physical inactivity in older adults
contribute to this decline in ADLs
(activities of daily living). Therefore,
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
documented validity and reliability to
assess balance abilities. As well as
physical performance test (modified) has
also documented validity and reliability to
assess functional abilities in community
dwelling older adults. Previous researchers
found significant relationship between
balance scales (BBS, MDRT & BPOMA)
with other functional performance tests;
Barthel mobility subscale, Time up and go
Test and Physical Performance Test
respectively 13, 25, 26. But there is little to no
documentation of relationship between
three balance scales with PPT (modified).
Thus this study was done to find out the
relationship of these three balance scales
with physical performance test (modified).
The clinical trial studied the correlation
between balance tests (BBS, MDRT, &
BPOMA) and physical performance test
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
(modified) among elderly people who
were divided into three age categories.
Berg Balance Scale (BBS)
The last two items of the Berg Balance
Test are considered the most difficult to
perform. These tasks are: item no. 13 & 14
(stand with feet in tandem for 30 seconds,
stand on one leg respectively), One study
found that item numbers 12, 13, & 14 are
25
the most difficult tasks to perform, but in
the current study only 6 subjects (Group B
& C) found difficulty to perform the 12th
task. All the subjects got grade 4 for the
1st, 2nd, 3rd, & 4th components of the
BBS. Not one subject reached up to 25cm
for the 8th component (Reaching forward
with outstretched arm while standing) of
the BBS.
In the current study the mean values (54,
49 & 42, as shown in tables 2, 3 & 4) of
BBS in different age groups are lower
from the findings (55,55; 53,52; & 52,48
for male and female respectively) of one
study in 3 age groups (60-69, 70-79, &
34
80+ years). This difference may be due
to age difference. They have given the
average mean of age (69); they did not
mention the mean value of age for
individual groups so the subjects of the
this study may be slightly younger than my
study; in this study the mean values for
females in each age group have lower than
males and in the current study the scores of
the tests for the females also lower and the
22
number of female subjects are more than
males so it could be the reason for lowest
values. Another study found mean values
of BBS in fallers (36.5) and nonfallers
(35.7) older adults;25 these values are very
low as compared to the current study. The
reasons could be one that the mean age of
this study population is 83±8.8 years
which shows very older subjects. Secondly
they examined community dwelling older
adults who were home bound and have a
neurological or musculoskeletal diagnosis
that may disturb the balance and contribute
to falls . In another study the mean value
of BBS is 48.6 and the mean age of this
study is 74.1± 7.9 years which is
approximately similar to Group-B of the
current study. The mean value of BBS of
the current study is 49.65 which is slightly
more, the reason could be the age
difference because the mean age of the
Group-B is 73.70 ± 2.4 which shows that
the subjects were mostly between 71 to 75
years and the subjects of the above said
study were mostly between 68 to 81 years,
so this could be the reason for the lowest
value of BBS among 254 community-
dwelling older adults.13
A study done by Patricia S. Smith found
significant relationship between BBS and
forward reach in post acute stroke patients
(r = 0.78).27 The BBS has also been
shown to correlate with both the Tinetti
mobility index (r = 0.91) and the “get up &
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
go test” (r = - 0.76).28 A correlation greater
than 0.70 between total BBS and total
Fugl-Mayer-Scale (FMS) scores have been
18
reported in older adults. The above
studies shows correlations between BBS
and other functional tests. This current
study also shows significant correlation
between BBS and physical performance
test (modified), [r = 0.759, P = <0.01
(Group - A); r = 0.944, P = <0.01 (Group -
B); ); r = 0.789, P = <0.01 (Group - C); as
shown in tables 5, 6, 7 & figures 2, 8, and
14 respectively]. The reason of significant
correlation between BBS and physical
performance test (modified) could be one
that the five components are similar
between BBS and PPT (modified) and
secondly both BBS and PPT (modified)
assess static and dynamic balance and also
physical activity.
Multi-directional Reach Test (MDRT)
In MDRT backward reach is the most
difficult task to perform because most of
the subjects of the Group-C used to take a
step behind while performing this reach.
MDRT is considered the more time taking
test and most difficult to understand by the
subjects because the mostly older adults
use the spine not the ankle for the reaches.
This current study shows there is a
significant relationship between
components (FR, BR, RR & LR) of
MDRT and physical performance test
(modified) in older adults of different age
23
groups. It also indicates that there is a
relationship between age and height with
performance on the lateral reach test.
These results similar to the study who
reported that, similar to functional reach
performance is positively correlated with
height and negatively correlated with
age.22 The four heighted persons were
present in the current study, the values of
all the components of MDRT were greater
to these heighted persons as compared to
other subjects. Mean scores on
performance of the functional and lateral
reach tests in the present study are lower
than mean scores reported elsewhere.13,29,
30
In a sample of 14 community dwelling
elderly females (age, 70-87 years), a study
reported a mean functional reach of
26.7±8.9cm.30 In another research, with a
larger sample of 254 elderly community-
dwelling adults (mean age = 74.1±7.9
years), It was reported a mean forward,
backward, right and left reach tests scores
of 22.6±8.6cm, 11.5±7.8cm,17.5±7.6 &
16.8±7.4cm respectively.13 Yet another
study reported mean left and right lateral
reach test scores of 21.0±2.5cm and
20.0±0.5cm respectively, from 60 healthy
females over the age of 65 (mean age =
72.5±5.0 years).29 In each of the above
mentioned studies scores were defined as
the mean multiple trials which may reflect
score inflation due to learning over
multiple trials. In contrast, scores in
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
present study were recorded from a single
trial. Additionally, subjects used the ankle
movements rather than spine movements
which reflects the negative correlation
between age and ankle muscle strength,
sensation and ability to generate large
amounts of force at the ankle joint.31
One of studies in past have revealed that
MDRT demonstrated significant inverse
relationships with scores on the time up &
go test (TUG): [FR (r = -0.442) BR (r = -
0.333), RR (r = - 0.260), LR (r = - 0.310)
which is a functional performance test.13
Similarly current study showed significant
correlation between MDRT and modified
physical performance test which is again a
functional performance test with high
validity and reliability. Hence it can be
said that MDRT also shows good
correlation with different functional
performance tests.
Tinetti Balance Subscale
During the performance of this test, the
subjects did not find any difficulty with
any of the tasks in the balance of
performance-oriented mobility assessment
(BPOMA) of Tinetti.
One study found a mean among the
community dwelling older women with no
health problems on the balance subset of
32
12.6±1.7 (mean age = 74.7±6.0 years),
which is similar to mean value (12.9±2.1,
as shown in table- 3) of Group-B of the
current study (mean age = 73.7±2.4 years,
24
as shown in table- 1). Another study found
mean value of 13±2.9 among females
(mean age = 83.8±7.7 years),33 which is
more as compared to mean value
(10.5±1.4, as shown in table- 4 ) of Group-
C of the current study, in fact mean age
was similar (82.6±1.3 years, as shown in
table- 1 ). The subjects for Group-C were
all above 80 and physical frailty
component was more among the subjects
of the current study while in the above said
study where mean value was 83.8±7.7
years, many subjects less than may 80
years. Hence the balance scores were
better for them.
Physical Performance Test (Modified-
PPT)
In modified physical performance test, the
Ist & 2nd tasks were considered the most
difficult task to perform by the subjects
mainly for the Groups B & C. Seven
subjects were using the assistive devices
for the 8th & 9th components (climb one
flight of stairs and climb stairs) of the
physical performance test (modified) and
four subjects climbed the stairs by holding
the one sided railing.
In one study it was found that the mean
value of the PPT (modified) score among
27 frail obese older volunteers after
treatment was 29.4±2.2 and for control
group it was 29.8±2.0.34 Mean age was
71.1±5.1for treatment group which
matched the current age of Group – B but
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
the mean value is lower i.e. 27.6±5.2 as
shown in table- 3, this difference is may be
due to age because in my study the mean
age for the Group - B is 73.7±2.4, which
shows that the subjects were slightly older
which reflects the negative correlation
between age and physical function.35 The
mean age of group-A of current study is
65.2±3.0 which is slightly younger than
the control group (69±4.6) of the above
study, therefore the mean value for this
group of my study is more and second
reason could be that the subjects were
obese which also reflects the negative
correlation between obesity and physical
35
function.
Another study found the mean values of
physical performance test (modified) in
community dwelling older adults. The
mean values of three groups [obese
elderly, nonobese frail, and nonobese
nonfrail] were 34.4±0.5, 29.3±0.7 and
15
27.8±0.8 respectively. The second group
of above study matched with Group - B of
the current study in respect similar age,
weight and condition but the mean value
of physical performance test (modified) is
more than the current study, the reason
could be that the subjects of my study may
be more frail and reason could be the
larger number of female subject in the
current study compared to this study, there
both genders were in equal proportion
while in the current study out of 20
25
subjects 16 were female. It has been well
established that in females balance
component is affected due to larger body
mass in the upper segment the of body.
The age is an important factor that affects
both balance and physical function of older
adults. Declines in standing balance have
been attributed to sensory, musculoskeletal
and cognitive changes, typically in some
combination as multiple systems fall
below minimal functional thresholds.36
The results of the balance tests and
physical performance test (modified) are
different in different age groups of older
adults, which proved that the disturbance
in balance and physical function also differ
in severity (mild, moderate and severe for
group A, B & C respectively) among
different age groups of older adults. Thus
assessment and treatment also differ to
provide effective evaluation and treatment
in different age groups. Additionally safety
measures are necessary for the Group – C
(80-89 years of age) in the assessment and
treatment also to prevent fall.
CONCLUSION
There is a significant relationship between
balance tests and physical performance test
(modified) and physical performance test
(modified) is an 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 the these balance
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Vol.1 ● No.2 ● 2012
tests used in the study, MDRT was the
most difficult to understand and perform
for people above 70 years and subjects
above 80 years found it really hard to
understand the procedure. According to
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.
Scientific Research Journal of India 26
functional level as well as the balance
issues in an elderly person rather than
giving other tests which are time taking,
separately for balance and functional
performance.
Limitations
In the present study, the sample size was
small. The sample size of age Group – 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
Future Research
As the Indian population over the age of
Future study can be done with larger
60 years continues to grow, there will be
sample size to see the results. Future
rise in the level of functional disability and
research is needed to find out the
prolonging health. It is therefore
reliability and validity of modified
imperative that appropriate screening
physical performance test with balance
methods are developed to identify
scales (PPT, MDRT & BPOMA) in
community dwelling elderly individuals
elderly. In my study the value of the left
with functional impairment who should be
lateral reach is more than right lateral
referred for a detailed physical therapy
reach for the heighted person. Future study
evaluation. As we have seen that PPT
can be done to identify that why this
(modified) incorporates all important
difference has come and this difference is
entities of balance and function hence,
significant or not.
simply administering modified physical
performance testing can well define the
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24. Jennifer S Brach, Jessie
Vanswearingen, Anne B Newman,
Andrea M Kriska. Identifying early
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: performance-based and self report
measures. J American Phys Ther
Association. 2001 Sept 10.
25. Teresa Steffen, Megan Seney.
Test-retest reliability and minimal
detectable change on balance and
ambulation tests, the 36-item short
form health survey and the unified
Parkinson disease rating scale in
people with parkinsonism. J Phys
Ther. 2008 june;88(16):733-746.
26. Mary Thompson, Ann Medley.
Forward and lateral
functional reach in
middle-aged and older adults. J of
geriatric Phys Ther. 30(2):07.
27. Hui-Fen Mao, Fing Hsueh, Fei-
Fang Tang, Ching-Fan
Analysis and comparison of the
psychometric properties of three
balance measures for
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28. Sabrina E., Trader, Roberta A.
Newton, RonitaL., Cromwell.
Balance abilities of homebound
older adults classified as fallers and
M nonfallers. J of geriatric Phys Ther.
26(3):03.
29. Duncan PW, Weiner DK, Chandler
J, Studenskis S. Functional reach: a
new clinical measure of balance. J
Gerontol Med Sd. 1990;45:M192-
M197.
30. DeWaard B, Bentrup B, Hollman J,
Brasseur J. Relationship of the
functional reach and lateral reach
tests in elderly females. J Geriatr
Phys Ther. 2002; 25:4-9
31. Sadashiv Ram Aggarwal, Deepak
kumar. Lower extremity muscle
strength and balance performance
in Indian community-dwelling
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sitting above. Indian J of Phys Ther and
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Sullivan. Balance and ankle range
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Phys Ther Association. 2000 May Physical activity and

30; dehydroepiandrosterone sulphate,
33. Dennist , Villareal, Marian Banks, insulin-like growth 1 and
David R, Sinacare, Catherine testosterone in healthy active
Siener, Sarmuel Klein. Effect of elderly people. J Ageing oxford
weight loss and exercise on frailty journals. 1998;27:745-751.
in obese older adults. Arch Intern 36. Dr. Sandra Brauer, Y Voner Burns,
Med. 2006;166:860-866. Prudence Galley. Lateral reach: a
34. Karen W, Hayes, Marjorie E. clinical measure of medio-lateral
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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

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 31

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
interpersonal relationship between the
partners brings a firm emotional bond.
Sexual activity has not only produced by
physical, emotional aspects but also
biological aspects in human. The strong
union between the partners may be
wrecked due to a variety of causes. One of
the major causes for the breakage is
unhappiness or dissatisfaction. Pain may
produce disappointments during sexual
activity for both the partners. Pain in the
back is one of the major causes of it.1
Sexuality is an integral part of
normal and healthy relationships. It need
not be the first thing abandoned when you
are bothered by a flare-up of Back pain.2
Though it is chronic it should not prevent
one from enjoying this part of the
relationship.
Low back pain is the most common
musculoskeletal problem encountered by
most adult population around the world.
Four out of five adults will experience
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 32
significant back pain sometime during Literatures supports that the physical
their life. After the common 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
In the Indian 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 job task ect.. Very few back result in pain.
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 activity is frequently more stress in the lumbar region which can
inhibited by acute pain. Sexual prevent active participation of the
dysfunctions following back pain is the individual and most of the time back pain
common complaint but 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.
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? arthritis, & Sacroiliac joint dysfunctions
During the sexual activity between need modification of the positions. 7
the partners there are number of Fear of pain may ruin the sexual
musculoskeletal activity happens. life between the partners. Back pain

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 33
doesn’t stop the sexual relationship Apart from it the modified positions will
between the partners. In fact it tells to 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
HOW TO ASSESS IT? managing for the problem. Having a good
Various Back disability scale has communication and developing a positive
an inclusion of sexual 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
HOW TO MANAGE IT? an atmosphere that is very romantic and
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 RECOMMENDED POSITIONS
and they usually avoid such positions or No single position is good for all.
1
movements. 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 staff. Generally
cure pain, there are variety of treatment recommendations include positions like
measures in physiotherapy, no single the Missionary position for both men and
treatment is best for all patients. women. 1
Combination of various 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
lie at the side of woman either on the front

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
or at the back. If a female partner
complains, she can be at the top with
variety of positions like in bed or sitting in
5
a chair.
Depending on the type of back
pain, the position alters. For example,
patients with annular bulge will have an
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.
34
General advice given to partners are
placing a towel at the back reduce the
lumbar curvature which helps to prevent
pain. People with back pain can be advised
on good sex through illustration described
by Fahrni in 1976. These illustrations give
guidelines to people with back pain.

ILLUSTRATIONS FOR DIFFERENT POSITIONS

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 35

References
1. Danielle Kloeck, “Sex and Back and treatments”.
pain” Webb Physiotherapists Inc, healthynewage.com, 2011.
http://www.physionline.co.za., 6. Kamiah A Walkier, “Tips for
2010, www.spine-dr.com Better sex....even with back pain”
2. Anthony delitto et al., “exercise www.spineuniverse.com, 2008.
based therapy for Low back pain” 7. Grieves.P, “Common vertebral
Sep 2010, uptodate.com. 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.

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 36

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 of components in the used for the hardware implementation. The
implementation domain. Reduced Web pack from Xilinx and ModelSim has
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 using VHDL, and some (CPU) has 17 instructions. In the following
components have been implemented and sections we will describe the design of the
4, 5, 6, 7
tested on Xilinx FPGA. Spartan 2E three main components of the processor.

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
Figure .1 System constructions
Plan of the ROM
The central processing unit has a
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
Ready for reading
CLK : clock signal
Reset : Initial reset signal
Plan of the Control Unit
The control unit plan is based on
allows each state to run at one clock cycle,
the first state is the reset which is
initializes the central processing unit
internal registers and variables. The
machine goes to the reset state by enabling
the reset signal for a certain number of
clocks. Following the reset state would be
the instruction fetching and decoding
states which will enable the suitable
signals for reading order data from the
37
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
control unit.
Figure 2: control unit Design
Design of the Data Path
The Data Path consists of subunits
that are necessary for performing all of
arithmetic and logic operations. A Data
path is a hardware that performs data
processing operations.8, 9, 10, and 11 It is one
of two types of modules used to represent
a digital system, the other being a control
unit. The Data path model we designed
consists of the units necessary to perform
all the operations on the data selected by
the control unit. The components include a
Register File, Arithmetic/Logic Unit,
Memory Interface and Branching Unit as
shown in Figure 3.The Register File holds
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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 38
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
Figure 3: Data Path
Memory Interface was designed to
RESULTS
accommodate simple load/store operations
There are 5 main signals that are
with the 16x32 memory. The effective
viewed in throughout the simulation. The
address is calculated by adding the content
sim_clock signal is the clock generated for
of the address register and the immediate
the simulation and runs at 50Mhz,
data. The Branch Unit calculates a given
instruction fetch signal shows when the
condition by the control unit and raises a
control unit requests data from the ROM,
branch flag whether the condition is met or
the instruction address 32bit bus is the
not, and if the flag is raised, it sends the
address of the instruction being fetched,
branch address back to the control unit in
the instruction data 32bit bus is the data
order to replace the program counter. The
sent out from the ROM, and the reset state
control lines coming from the control unit
is enabled for 3.5 cycle to give enough
operate all the units in the data path. The
time for all units to reset and initialize,
path starts from the register file that has
after that we can see the first instruction
two output ports which are connected to all
beginning at address 0 is executed
the other units, after that the processing is
followed by all the proceeding instructions
done by one of the other units then finally
until the instruction at address 40 Which is
returned back to the register files input
the shift half word “SHW”.
port using the multiplexer. The signals
used in the data path are forwarded from CONCLUSION
the control unit to each subcomponent as 32bit RISC Process has been
needed. design and implemented in hardware on
Xilinx Spartan 2E FPGA. The design has

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India
been achieved using VHDL and simulated
with ModelSim. Digilent Spartan 2E
progress board has been used for the
hardware part. Most of the goals were
achieve and simulation shows that the
processor is working perfectly, but the
Spartan 2E FPGA was not sufficient for
implementing the whole design into a real
hardware, since the total accessible logic
39
gate in Spartan 2E is 200K Logic Gate,
which was not enough for implementing
the whole processor, but parts of the
processor have been implemented and test
in a real hardware. Future work will be
added by increasing the number of
instructions and make a pipelined plan
with fewer clocks cycles per instruction.

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. Proceedings, PRIME, 2006, p
Jordan, “Computer Systems Design 229232.
and Architecture”, 2nd Edition, 6. Rainer Ohlendorf, Thomas Wild,
2003. Michael Meitinger, Holm
3. Wayne Wolf, FPGA Based System Rauchfuss, Andreas Herkersdorf,
Design, Prentice Hall, 2005. “Simulated and measured
4. Dal Poz, Marco Antonio Simon, performance evaluation of
Cobo, Jose Edinson Aedo, Van RISCbased SoC platforms in
Noije, Wilhelmus Adrianus Maria, network processing applications”,
Zuffo, Marcelo Knorich, “Simple Journal of Systems Architecture 53
Risc microprocessor core designed (2007) 703–718.
for digital settopbox applications”, 7. Luker, Jarrod D., Prasad, Vinod B.,
Proceedings of the International “RISC system design in an FPGA”,
Conference on Application MWSCAS 2001, v2, 2001,
Specific Systems, Architectures p532536.
and Processors, 2000, p 3544. 8. Jiang, Hongtu; “FPGA
5. Brunelli Claudio, Cinelli Federico, implementation of controller data
Rossi Davide, Nurmi Jari, “A path pair in custom image
VHDL model and implementation processor design”; IEEE

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Vol.1 ● No.2 ● 2012 Scientific Research Journal of India 40

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, G. ASIC, 2005, Proceedings, v 2, p
Konstantoulakis, J.A. SanchezP., 906909.
“Design and performance 11. Jiang Hongtu, Owall Viktor,
evaluation of a Programmable “FPGA 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 Symposium on
and Microsystems 31, 2007, p Circuits and Systems, Proceedings
188–199. v 5, p V141V144.

CORRESPONDENCE
*Centre for Research and Development, PRIST University, Vallam, Thanjavur–613403, Tamilnadu, India. E-
Mail: 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

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Sciences, Agricultural Sciences,
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