Dr. Abhijit Diwate, Ph.D.
1. Professor and Head: Physiotherapy in Cardiovascular and Respiratory Sciences, DVVPF, COPT, Ahmednagar
2. Member: Board of Studies, Maharashtra University of Health Sciences, Nashik
3.Member: Board of Studies, Dr D. Y. Patil University, Pune
4. Director: District Disability Rehabilitation Centre, Ahmednagar
Address: Dr Vitthalrao Vikhe Patil Foundation's College of Physiotherapy
Vadgaon Gupta, MIDC, Ahmednagar - 414111
Maharashtra, India
2. Member: Board of Studies, Maharashtra University of Health Sciences, Nashik
3.Member: Board of Studies, Dr D. Y. Patil University, Pune
4. Director: District Disability Rehabilitation Centre, Ahmednagar
Address: Dr Vitthalrao Vikhe Patil Foundation's College of Physiotherapy
Vadgaon Gupta, MIDC, Ahmednagar - 414111
Maharashtra, India
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is a leading cause of death globally. According to the World Health Organization (WHO), 41 million people
die due to noncommunicable diseases which is equal to 71% of all death globally in which cardiovascular
diseases are the most common cause for death. The International Institute of Population Sciences stated that
from 1990 to 2016, the contribution rate of mortality of cardiovascular diseases is increased by 34.3% in India.
The more common leading cause of cardiovascular diseases are Coronary Artery Disease (CAD) and Stroke,
also WHO says in 2017, CAD is the leading cause of death and which is 15.6%. To treat these critical
conditions of coronary artery disease patients should undergo cardiac surgery which is known as Coronary
Artery Bypass Grafting Surgery (CABG). According to the A.H.A., Cardiac Rehabilitation is a
comprehensive exercise, education and behavioural modification program design to improve the physical and
emotional condition of patients with heart disease. Early mobilization includes an active range of motion,
thoracic mobility, bedside sitting, chair sitting, hall ambulation (chair sitting). With all these techniques, there
are mechanical devices available to improve oxygenation they known as positive pressure devices such as
Acapella, Flutter, Bubble-PEP, RC-Cornet. Bubble P.E.P. also used to prevent pulmonary complications in
postoperative open-heart surgery patient. On the other hand, the therapist-made bubble-PEP device which is
made from inexpensive and easily accessible materials consisting of a container (e.g. bottle) and tubing.
Therefore, the bubble P.E.P. is relatively cheaper and readily accessible.
Aim: To compare the effect of BBPEP Device and Acapella on Oxygenation and PEFR among patients with
open-heart surgery.
Objectives:
1. To compare the effect of BBPEP Device and Acapella on FiO2 and SpO2 among patients with openheart surgery.
2. To compare the effect of BBPEP Device and Acapella on PEFR among patients with open-heart
surgery.
Methodology: The study done on 54 samples. Samples were randomly divided into two groups, i.e. BBPEP
and Acapella group. Both the group received intervention from P.O.D. 1 to 3 twice a day. FiO2, SpO2 and
PEFR were taken pre- and post-treatment in every session. Data were collected and analysis was done.
Statistical analysis: normality was checked by using Kolomogrov-Smirnov Test. Data did not pass the
normality test, so a non-parametric test was used for data analysis.
Result: There was no significant difference between both groups.
Conclusion: The BBPEP and Acapella is equally effective in improving oxygenation and PEFR in the patient
who undergo open-heart surgery.
Keywords: BBPEP, Acapella, PEFR, FiO2, SpO2, Open Heart Surgery
changes and this can be measured using peak expiratory flow rate (PEFR). That force of expiration is less in
multipara women than uniparous or nulliparous women since abdominal muscle are responsible for it. To evaluate
the presence of abdominal muscle weakness in multipara woman by measuring peak expiratory flow rate. 100
participants were selected who were multipara women from 18-45 years of age and with postpartum period of at
least one year women who were known case of hernia, stress incontinence, musculoskeletal disorder of spine,
respiratory disorder or facial palsy. Material-Airflow® Peak flow meter, Peak flow meter measurement and Manual
Muscle testing of abdominal muscle were done and then the results were co related. By the acquired statistics it was
concluded that there is no co-relation between the measurement of PEFR and prediction of abdominal weakness
in multipara women. In future PEFR can be used as a test to detect abdominal weakness and further preventive
measures can be taken.
in a loss of adaptive response to a stress & in a growing risk of age-associated diseases. New
alveoli are formed until about age 20. After that, the lungs begin to lose some of their tissue.
The number of alveoli decreases, and there is a corresponding decrease in lung capillaries.
The maximal force that can be generated while inspiration and expiration decreases with age,
as the diaphragm and intercostals muscles become weaker. The chest is less able to stretch to
breathe, and the pattern of breathing may change slightly to compensate for this decreased
ability to expand the chest. Maximum lung function decreases with age. Changes in Lung
function is seen in elderly with age group of 60 – 75 years compared with other age groups of
20 – 39 years and 40 -59 years. There are significant changes in following parameters: FEV1,
FEV1/FVC, PEFR, Chest Expansion but no difference in FVC in elderly group. There is no
significant changes in lung function between predicted and subjects value in all the three
groups. This study concludes that there are significant changes in lung function in Age group
60 – 75 years and no significant changes between predicted and subjects value.
Keywords: Pulmonary Function Testing Unit (RMS Helios), Baseline Respiratory Symptom
Questionnaire
Abnormal posture creates a strain on ligaments and muscles that indirectly affects the curvature of the lumbar spine.Low
back pain can be because of muscle overuse, muscle strain, and /or injuries to the muscles, ligaments, and discs that support
the spine.The lumbosacral angle is the angle formed between the long axis of the lumbar vertebrae and the sacrum
Lumbosacral angle may be one of the contributing factors in producing low back pain (LBP) and disability.
Method- The Institutional Ethical Committee was obtained for the study. All the subjects had signed written informed
consent before participating in the study. Study design was cross sectional study.Using lateral view of radiographs
lumbosacral angle was calculated on the PACS .Core muscle endurance subject was tested by using prone double SLR test.
Result- Core muscle endurance was reduced in patients with chronic low back pain. There was negative correlation (r was–
0.1912) present between core muscle endurance and lumbosacral angle.
Conclusion-Muscle endurance is found to be reduced in patients having chronic low back pain, where as endurance is found to be more in males as compared to females; and also negative correlation is present between core muscle endurance and Lumbosacral angle, in patients with chronic low back pain
Key words -Low back pain, Lumbosacral angle, Endurance, Prone double SLR
Conference Presentations
Methodology: 50 young healthy non-obese subjects (29 females and 21 males) between are group 18-30 years were selected and Pulmonary Function Tests were done in six different positions (sitting upright, reclined sitting (crook), supine, prone, right and left side lying) in a Cardiorespiratory Laboratory of a Superspeciality Hospital. FVC, FEV, PEER, PIFR, FEV1, FVC, FEF 25-75%, SVC, VE, Vt, Vt/Ti and MVV were measured in six different positions. All the data was statistically analyzed and results were documented.
Result: There was statistical significant reduction in PFT parameters in all recumbent positions compared to upright positions (p<0.0033). Further, prone position showed significantly higher flow rates and lung volumes when compared with supine position.
Conclusion: Hence we conclude that reference standard position of upright sitting was the best position among all other positions. Subsequently, prone position was found to be more physiological than supine position.
Books
Aim and Objectives: To find out the effect of different body positions on maximum expiratory pressure, To assess the expiratory muscle strength by using the positive expiratory pressure gauge and To check MEP in standing, sitting and semi-fowlers position and comparison of MEP in three positions.
Effect of preoperative risk stratification on phase 1 Cardiac Rehabilitation: An observational study
is a leading cause of death globally. According to the World Health Organization (WHO), 41 million people
die due to noncommunicable diseases which is equal to 71% of all death globally in which cardiovascular
diseases are the most common cause for death. The International Institute of Population Sciences stated that
from 1990 to 2016, the contribution rate of mortality of cardiovascular diseases is increased by 34.3% in India.
The more common leading cause of cardiovascular diseases are Coronary Artery Disease (CAD) and Stroke,
also WHO says in 2017, CAD is the leading cause of death and which is 15.6%. To treat these critical
conditions of coronary artery disease patients should undergo cardiac surgery which is known as Coronary
Artery Bypass Grafting Surgery (CABG). According to the A.H.A., Cardiac Rehabilitation is a
comprehensive exercise, education and behavioural modification program design to improve the physical and
emotional condition of patients with heart disease. Early mobilization includes an active range of motion,
thoracic mobility, bedside sitting, chair sitting, hall ambulation (chair sitting). With all these techniques, there
are mechanical devices available to improve oxygenation they known as positive pressure devices such as
Acapella, Flutter, Bubble-PEP, RC-Cornet. Bubble P.E.P. also used to prevent pulmonary complications in
postoperative open-heart surgery patient. On the other hand, the therapist-made bubble-PEP device which is
made from inexpensive and easily accessible materials consisting of a container (e.g. bottle) and tubing.
Therefore, the bubble P.E.P. is relatively cheaper and readily accessible.
Aim: To compare the effect of BBPEP Device and Acapella on Oxygenation and PEFR among patients with
open-heart surgery.
Objectives:
1. To compare the effect of BBPEP Device and Acapella on FiO2 and SpO2 among patients with openheart surgery.
2. To compare the effect of BBPEP Device and Acapella on PEFR among patients with open-heart
surgery.
Methodology: The study done on 54 samples. Samples were randomly divided into two groups, i.e. BBPEP
and Acapella group. Both the group received intervention from P.O.D. 1 to 3 twice a day. FiO2, SpO2 and
PEFR were taken pre- and post-treatment in every session. Data were collected and analysis was done.
Statistical analysis: normality was checked by using Kolomogrov-Smirnov Test. Data did not pass the
normality test, so a non-parametric test was used for data analysis.
Result: There was no significant difference between both groups.
Conclusion: The BBPEP and Acapella is equally effective in improving oxygenation and PEFR in the patient
who undergo open-heart surgery.
Keywords: BBPEP, Acapella, PEFR, FiO2, SpO2, Open Heart Surgery
changes and this can be measured using peak expiratory flow rate (PEFR). That force of expiration is less in
multipara women than uniparous or nulliparous women since abdominal muscle are responsible for it. To evaluate
the presence of abdominal muscle weakness in multipara woman by measuring peak expiratory flow rate. 100
participants were selected who were multipara women from 18-45 years of age and with postpartum period of at
least one year women who were known case of hernia, stress incontinence, musculoskeletal disorder of spine,
respiratory disorder or facial palsy. Material-Airflow® Peak flow meter, Peak flow meter measurement and Manual
Muscle testing of abdominal muscle were done and then the results were co related. By the acquired statistics it was
concluded that there is no co-relation between the measurement of PEFR and prediction of abdominal weakness
in multipara women. In future PEFR can be used as a test to detect abdominal weakness and further preventive
measures can be taken.
in a loss of adaptive response to a stress & in a growing risk of age-associated diseases. New
alveoli are formed until about age 20. After that, the lungs begin to lose some of their tissue.
The number of alveoli decreases, and there is a corresponding decrease in lung capillaries.
The maximal force that can be generated while inspiration and expiration decreases with age,
as the diaphragm and intercostals muscles become weaker. The chest is less able to stretch to
breathe, and the pattern of breathing may change slightly to compensate for this decreased
ability to expand the chest. Maximum lung function decreases with age. Changes in Lung
function is seen in elderly with age group of 60 – 75 years compared with other age groups of
20 – 39 years and 40 -59 years. There are significant changes in following parameters: FEV1,
FEV1/FVC, PEFR, Chest Expansion but no difference in FVC in elderly group. There is no
significant changes in lung function between predicted and subjects value in all the three
groups. This study concludes that there are significant changes in lung function in Age group
60 – 75 years and no significant changes between predicted and subjects value.
Keywords: Pulmonary Function Testing Unit (RMS Helios), Baseline Respiratory Symptom
Questionnaire
Abnormal posture creates a strain on ligaments and muscles that indirectly affects the curvature of the lumbar spine.Low
back pain can be because of muscle overuse, muscle strain, and /or injuries to the muscles, ligaments, and discs that support
the spine.The lumbosacral angle is the angle formed between the long axis of the lumbar vertebrae and the sacrum
Lumbosacral angle may be one of the contributing factors in producing low back pain (LBP) and disability.
Method- The Institutional Ethical Committee was obtained for the study. All the subjects had signed written informed
consent before participating in the study. Study design was cross sectional study.Using lateral view of radiographs
lumbosacral angle was calculated on the PACS .Core muscle endurance subject was tested by using prone double SLR test.
Result- Core muscle endurance was reduced in patients with chronic low back pain. There was negative correlation (r was–
0.1912) present between core muscle endurance and lumbosacral angle.
Conclusion-Muscle endurance is found to be reduced in patients having chronic low back pain, where as endurance is found to be more in males as compared to females; and also negative correlation is present between core muscle endurance and Lumbosacral angle, in patients with chronic low back pain
Key words -Low back pain, Lumbosacral angle, Endurance, Prone double SLR
Methodology: 50 young healthy non-obese subjects (29 females and 21 males) between are group 18-30 years were selected and Pulmonary Function Tests were done in six different positions (sitting upright, reclined sitting (crook), supine, prone, right and left side lying) in a Cardiorespiratory Laboratory of a Superspeciality Hospital. FVC, FEV, PEER, PIFR, FEV1, FVC, FEF 25-75%, SVC, VE, Vt, Vt/Ti and MVV were measured in six different positions. All the data was statistically analyzed and results were documented.
Result: There was statistical significant reduction in PFT parameters in all recumbent positions compared to upright positions (p<0.0033). Further, prone position showed significantly higher flow rates and lung volumes when compared with supine position.
Conclusion: Hence we conclude that reference standard position of upright sitting was the best position among all other positions. Subsequently, prone position was found to be more physiological than supine position.
Aim and Objectives: To find out the effect of different body positions on maximum expiratory pressure, To assess the expiratory muscle strength by using the positive expiratory pressure gauge and To check MEP in standing, sitting and semi-fowlers position and comparison of MEP in three positions.
Effect of preoperative risk stratification on phase 1 Cardiac Rehabilitation: An observational study