Physical Therapy Journal of Indonesia

Effect of halliwick aquatic therapy and a land-based homologous program on postural control in children with cerebral palsy

Julio E Pérez-Parra — 2026-06-19

Background: This study explores whether the effectiveness of Halliwick aquatic therapy is attributable to the mechanical properties of water, to the therapeutic exercise program developed during the sessions, or to a combination of both. This study aimed to determine the effect of Halliwick Aquatic Therapy and a homologous land-based program on postural control in children with cerebral palsy aged 5 to 15 years classified as GMFCS levels I, II, and III.

Methods: A controlled clinical trial with a crossover design was conducted. Seventeen children participated, with a mean age of 9 years, most of them with hemiparesis. Each child received both interventions: Halliwick aquatic therapy and a land-based homologous program. The initial intervention was randomized. Postural control was assessed using the Pediatric Berg Scale and dimension E of the Gross Motor Function Measure. Analyses included intra- and inter-sample differences, as well as repeated measures ANOVA.

Results: Balance improved significantly with both interventions (p<0.01). Gross motor function improved with both interventions but only reached significance on land (p<0.001). Significant differences were found in the improvement of balance between the interventions. (p=0.017), with greater improvement on land. The sequential application of both interventions significantly improved both balance (p<0.001) and gross motor function (p=0.013).

Conclusions: The land-based program homologous to Halliwick Aquatic Therapy significantly improves gross motor function and balance in children with CP. A combined approach of consecutive therapies is recommended to optimize outcomes.

Rehabilitation approaches for visual disorders post-stroke: A systematic review in neurological physiotherapy

Jovita Jutamulia — 2026-06-23

Introduction: Visual disorders after stroke are common and may substantially impair reading, mobility, spatial orientation, activities of daily living, and quality of life. Although various rehabilitation strategies have been developed, the evidence remains heterogeneous across impairment subtypes and intervention modalities. This systematic review aimed to examine rehabilitation approaches for post-stroke visual disorders, identify the types of interventions used, and summarize findings relevant to neurological physiotherapy practice.

Methods: A systematic review was conducted following PRISMA principles. Literature searches were performed in PubMed/MEDLINE, ScienceDirect, ProQuest, and Google Scholar from inception to March 2026. Eligible studies involved patients with stroke presenting with visual disorders, including hemianopia, diplopia, visual neglect, and visual perceptual deficits, and evaluated neurological physiotherapy-based rehabilitation interventions. Due to heterogeneity in interventions, outcome measures, and study designs, the findings were synthesized narratively.

Results: A total of 1,022 records were identified, and 15 studies were included in the final review. Most included studies were randomized controlled trials published between 2008 and 2025, with sample sizes ranging from 12 to 158 participants. The most common disorder was homonymous hemianopia, while the main interventions included visual scanning training, visual exploration training, smooth pursuit training, vision restoration training, virtual reality-based rehabilitation, and stimulation-based approaches such as tDCS and TENS. Overall, rehabilitation interventions were generally associated with improvements in functional outcomes, including visual search, reading performance, neglect measures, activities of daily living, and vision-related quality of life. Although some multimodal interventions combining visual training with sensory or electrical stimulation showed promising results, the findings varied across studies and should be interpreted cautiously.

Conclusion: Rehabilitation approaches for post-stroke visual disorders may support improvements in functional performance and quality of life; however, the evidence remains heterogeneous across visual impairment subtypes, intervention modalities, and outcome measures. Early identification, accurate phenotyping, and individualized rehabilitation planning may help optimize neurological physiotherapy management, but further well-designed studies are needed to determine the most effective intervention strategies.

Immediate effects on plantar pressure time integral with thermoplastic polyurethane versus plastazote insoles in type 2 diabetes with peripheral neuropathy: A randomized comparative study

Nyoman Chandra Adidharma — 2026-07-13

Background: The prevalence of diabetes continues to rise worldwide, and diabetic foot ulcers remain a serious complication caused by repeated pressure on the tissue of the sole of the foot due to neuropathy. This study aimed to compare the immediate changes in the plantar pressure time integral (PTI) following the use of Plastazote shoe insoles versus thermoplastic polyurethane (TPU) shoe insoles in adults with type 2 diabetes and peripheral neuropathy.

Methods: This study was a randomized, two-group pre-post design study. A total of 24 subjects with type 2 diabetes mellitus were divided into two groups of Plastazote insole group (n = 12) and the TPU insole group (n = 12). PTI was measured using a dynamic plantar pressure measurement system that divided the foot into five regions (heel, midfoot, forefoot, big toe, and toes) before and after insole use. Analyses were performed within groups (pre-post comparison) and between groups (ΔPTI comparison). Safety and user perception were evaluated using a pain VAS during insole use.

Results: TPU resulted in a greater reduction in PTI compared to Plastazote in the rear and middle sections of the foot (p ≤ 0.043) as well as in total PTI (p = 0.019), while Plastazote increased PTI in the front section of the foot and total PTI (p ≤ 0.047; p < 0.001). The between-group difference favored TPU (p ≤ 0.024), with no effect on the big toe or other toes (p ≥ 0.721).

Conclusion: In patients with type 2 diabetes, the highest plantar pressure is found in the heel and forefoot. The distribution of plantar pressure in type 2 diabetes is influenced more by dynamic factors and neuropathy than by static foot position. Therefore, screening for diabetic foot complications should incorporate static, dynamic, and sensorimotor assessments.

Implementing the international exercise guidelines to improve the functional independence among the chronic spinal cord injury patients: A randomized controlled trial

Nurul Hanifah — 2026-07-13

Background: This research investigated the effectiveness of a modified exercise program in accordance with international spinal cord injury (SCI) exercise guidelines for improving functional independence in individuals with chronic SCI.

Methods: A randomized controlled trial with a pre–post assessment design. Chronic SCI patients were allocated to either the intervention or control group. The intervention group participated in a 12-week combined aerobic and resistance training program. Functional independence was measured using the Spinal Cord Independence Measure (SCIM-III) at baseline and post-intervention.

Results: Participants of intervention showed statistically significant improvement in functional independence (SCIM-III scores 79.25 ±19.6 to 86.0±17,8 p=0.018; effect size d = 0,84). The control group showed no meaningful change (56.38 ± 24.48 to 56.88 ± 23.73, p=0.848). Between-group comparison confirmed a significantly greater gain in the intervention group (Δ6.75 ± 6.79 vs. 0.5 ± 7.09, p=0.014; effect size 0.9). No severe adverse events were reported.

Conclusion: A working translation of the International SCI Exercise Guidelines has been tested in Indonesia, showing clear gains in daily living skills. Because these results match global findings, adding planned physical activity to spinal cord injury recovery may work well even where resources are limited.

Heart rate variability responses to neuromuscular electrical stimulation in intensive care unit-acquired weakness patients: A pre–post observational study

Grace Juillet Samosir — 2026-07-13

Background: Intensive care unit-acquired weakness (ICU-AW) is common in critically ill patients, occurring in roughly 25–50% of mechanically ventilated ICU patients and limiting early mobilization. Neuromuscular electrical stimulation (NMES) may provide adjunctive rehabilitation and potentially modulate autonomic function. This study evaluated short-term changes in heart rate variability (HRV) after a five-day NMES course in ICU-AW patients.

Methods: One-group pre–post observational study in a tertiary ICU. Bilateral quadriceps NMES was delivered once daily for five consecutive days. Five-minute HRV recordings were obtained before the first session and after the intervention period and were analyzed using Kubios. Outcomes were the root mean square of successive differences (RMSSD), the standard deviation of normal-to-normal intervals (SDNN), and the low-frequency/high-frequency ratio (LF/HF); comparisons used Wilcoxon signed-rank tests.

Results: Seventeen patients completed the protocol, and no clinically significant NMES-related adverse events occurred. RMSSD increased from 22.49 ms (4.22–93.10) to 51.63 ms (3.81–92.88) (p = 0.010), and SDNN increased from 28.85 ms (11.03–93.54) to 47.70 ms (9.52–137.70) (p = 0.040). The LF/HF ratio showed no significant change (0.65 [0.19–8.24] vs 0.98 [0.18–7.71]; p = 0.190).

Conclusion: In ICU-AW patients, a five-day bilateral quadriceps NMES protocol was feasible and well-tolerated. The intervention period was accompanied by higher RMSSD and SDNN, indicating increased beat-to-beat and overall HRV that may reflect greater short-term autonomic adaptability during critical illness.

Effect of the Indonesian scientific exercise guidelines for adults with spinal cord injury on quality of life in patients with chronic spinal cord injury

Ega Rahman Evsya — 2026-07-21

Background: Spinal cord injury (SCI) impairs motor and autonomic function and is often associated with reduced quality of life (QOL). Although the Scientific Exercise Guidelines for Adults with Spinal Cord Injury (SEG-SCI) have been shown to improve fitness and QOL, their effectiveness has not been evaluated in Indonesia. This study examined the effect of implementing the Indonesian adaptation of SEG-SCI on QOL in individuals with chronic SCI.

Methods: A randomized controlled trial with a pre–post design was conducted in seventeen individuals with chronic SCI. Participants were randomly allocated to the control group (n= 9) and intervention group (n= 8). The intervention group completed a 12-week exercise program based on the Indonesian version of SEG-SCI in addition to usual care, and control group underwent observation at the start and at the end of the study. QOL was assessed using the SF-36 before and after the intervention.

Results: Five people (45%) in the control group and six people (55%) in the intervention group said they did moderate amounts of physical activity every day, according to activity diary records. Participants in the intervention group showed a significant improvement in QOL, with a mean increase of 13.12 ± 6.7 points on the SF-36 (p = 0.001, d = 1.19), whereas the control group showed negative change of -7.5 ± 4.71 after a 12-week intervention period (p = 0.001, d = 0.44).

Conclusion: A 12-week exercise program based on the Indonesian adaptation of SEG-SCI safely improves quality of life in individuals with chronic SCI. Participants who followed the guideline-based program showed clinically relevant improvements, whereas those in the control group, who did not receive structured exercise, experienced a decline in quality of life over the same period.

Integrative sport medicine rehabilitation for early-onset knee osteoarthritis in overweight young adults: Evidence from meta-analytic reviews

Moch. Yunus — 2026-07-21

Background: Early-onset and early-stage knee osteoarthritis (KOA) is increasingly reported in overweight young adults and is associated with pain, functional limitations, and reduced quality of life. This umbrella review aims to map the domains of Sports Medicine-Oriented Holistic Rehabilitation (SMOHR) interventions, defined as exercise-based therapy combined with at least one additional domain, and to summarize the reported effects and certainty of evidence for pain, physical function, psychosocial outcomes, and quality of life.

Methods: A PRISMA 2020-guided search of PubMed, Scopus, Web of Science, and SPORTDiscus identified English-language systematic reviews with meta-analyses and network meta-analyses published between 2021 and 2025. Two reviewers independently screened abstracts and full texts; disagreements were resolved through discussion and review by a third reviewer. Review quality was assessed using AMSTAR-2, and GRADE ratings were summarized according to those reported in the included reviews without repeating assessments.

Results: Fifteen meta-analyses were included. Exercise-based rehabilitation was consistently associated with improvements in pain and physical function, although effect estimates varied depending on the comparison and outcome measured. Network meta-analyses also showed favorable comparative performance of knee braces and hydrotherapy for WOMAC-related outcomes; however, subgroup estimates specific to young adults with overweight were rarely reported. Self-management and psychosocial interventions showed more variable effects, with some evidence of benefits for physical activity, pain, and kinesiophobia in specific contexts.

Conclusion: SMOHR may be a useful framework for organizing multiple conservative treatments for KOA, but heterogeneity and limited evidence based on age and BMI limit conclusions for young adults with overweight and early-stage disease. stages.