Aim: To determine the effects of Hand-arm Bimanual Intensive Training on fine motor skills of chronic stroke patients. Methods: A randomized control trail was conducted at District Head Quarter Hospital Sargodha. Twenty-eight stroke patients were randomized into 2 groups. All patients were examined by using Questionnaire of Disabilities of Arm, Shoulder, and Hand (DASH), Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT). Control group was treated with Conventional Physical Therapy and experimental group with Hand Arm Bimanual Intensive Training. There were 3 sessions every week for a total of 12 sessions over the course of 4 weeks. At the beginning of the intervention, two weeks later, and four weeks later, all outcomes were evaluated. Data analysis was done with SPSS version 21. Results: Intra group analysis showed statistically significant results (p<0.001) in each group after 4 weeks of treatment indicating improvement in Disabilities of Arm, Shoulder, and Hand (DASH), Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT) of both groups. However, based on their mean differences, experimental group demonstrated greater progress across all outcome measures which is indicated through Inter group analysis that statistically significant difference was present between two groups in DASH, ARAT and WMFT with p-values 0.045, 0.046 and 0.043 respectively at end of treatment. Practical implications: HABIT pays attention to bimanual training which is highly related to most ADL tasks so there is need to evaluate the effectiveness of HABIT-related interventions. This will help to promote improvements in upper extremity functions and to enhance the level of independence among stroke patients. Conclusion: Study concluded that both conventional physical therapy and hand arm bimanual intensive training (HABIT) are helpful in improving upper extremity fine motor abilities in chronic stroke patients, but HABIT is more beneficial as compared to usual conventional and routine rehab treatments. Keywords: HABIT, fine motor skills, physical therapy, upper extremity, stroke.

Aim: To determine the effects of Muscle energy technique with and without Bowen therapy on pain, function, range of movement, and posture in Text neck syndrome. Methods: A randomized clinical trial was conducted in Fatima Hospital Sargodha. A total of 22 patients with text neck syndrome were included and randomly allocated to two groups. Assessment of pain, function, Cervical ROM, Craniovertebral angle, and Rounded shoulder angle was taken using a Numeric pain rating scale (NPRS), Neck disability index (NDI), Goniometer, and photogrammetry. Group A received treatment with hot packs and METs. Group B received a hot pack, Muscle energy technique (METs) and Bowen therapy. A total of 18 sessions were given in 6 weeks with 3 sessions per week. Both groups were reassessed after 3 weeks and 6 weeks of treatment with follow-up after 3 weeks of treatment completion. Data were analyzed by using SPSS 21. Results: Findings revealed that a statistically significant difference (p<0.05) was observed for both within a group and between-group analysis in NPRS, NDI, cervical range of motion (CROM), Craniovertebral angle (CVA), and Rounded shoulder angle (RSA). However, the Bowen group showed more improvement in terms of all outcome measures based on their mean differences. Conclusion: The combination of METs and Bowen therapy was more effective in decreasing pain, improving movement, regaining functional status, and correcting posture in individuals with Text neck syndrome rather than using METs alone. Keywords: Text neck, Muscle energy technique, Bowen technique, Pain, Range of motion

Background: Post-operative knee stiffness is caused by arthrofibrosis and functional limitation. Extensor lag is commonly prevalent after knee surgery. There are different approaches to treat this condition. Close kinetic chain exercises are hypothesized as one of effective treatment. DAPRE technique has remarked effects. Aim: To determine effects of DAPRE technique and close kinetic chain exercises on pain intensity, ROM, function, strength among post-operative knee stiffness. Study Design: Randomized control trial. Methodology: Total of 22 patients with post-operative knee stiffness were recruited and divided in two groups. One group received DAPRE technique and other group received close kinetic chain exercises were participated by using a Non-probability convenience sampling technique. Results: The result showed statistically significant difference in both groups in terms of NPRS, WOMAC index, ROM and strength with P-value less than 0.05. Conclusion: It was concluded that Close kinetic chain exercises was more effective than the Daily adjustable progressive resistance exercises on extensor lag for post-operative knee joint stiffness to improving the pain, physical function, range of motion and strength. Keywords: Knee Stiffness, Extensor Lag, Kinetic Chain Exercise, DAPRE and Resistance Exercises.

Background: Stroke is the leading cause of death and disability worldwide. It is a cerebrovascular disease, characterized by decreased blood supply to the brain tissues. It is known that patients with stroke have respiratory muscle weakness. Aim: To evaluate the effects of Resistive Diaphragmatic Breathing Exercises on the pulmonary functions in patients with chronic stroke. Method: A randomized controlled trial was conducted. 20 subjects were recruited based on inclusion and exclusion criteria and were allocated to Group A and B. Assessment of Pulmonary Functions was undertaken by Digital incentive Spirometer. Group A received treatment with Digital Incentive Spirometer. Group B received Digital Incentive Spirometer training and also inspiratory Muscle training (IMT), Diaphragmatic Breathing Exercises. 3 sessions per week for 4 weeks were given to each patient. The two groups were reassessed after 3 weeks of treatment. Follow up was taken 4 weeks after completion of treatment. Data was analyzed by using SPSS 21. Results: There was a statistically significant change within both groups in the VC, FVC, PEF, SPO2 and FEV1 and FEV1/FVC with p- value of < 0.05. Both were effective but using inspiratory Muscle training along with Digital incentive Spirometer training technique showed more improvement. Conclusion: Resistive Diaphragmatic breathing exercises found better than the simple spirometer training for improving the pulmonary functions. Resistance through Thera bands at the sternal and costal level have found the better results. Resistive Diaphragmatic breathing have better results in VC and FVC, FEV. These techniques if incorporated in early rehabilitation protocol of stroke patient helps in early discharge. Key words: Stroke, Inspiratory Muscle training, Spirometer training, diaphragmatic breathing

Background: Neck pain due to Forward Head Posture (FHP) caused by prolongs flexion of head and neck while using electronic gadgets. It causes different musculoskeletal complaints particularly affecting upper limb and neck region. Muscle Energy Technique is an efficient method to reduce the tightness and improve strength of muscles. Bruegger’s Relief Exercise is helpful in improving posture. Aim: To compare the effects of Muscle Energy Technique (MET) and Bruegger’s Relief Exercise on pain, range of motion and function in patients of cervicalgia due to FHP. Method: A pilot study was performed. 24 subjects were recruited according to sample selection criteria and were assigned to Group A and B. Assessment of pain, function, Cervical ROM and Craniovertebral angle was taken using NPRS, NDI, Goniometer and photogrammetry. Group A received treatment with hot pack and Muscle Energy Technique. Group B received hot pack and Bruegger’s Relief Exercise. Total 20 sessions were given to each patient in 4 weeks with 5 sessions per week. Both groups were reassessed after 4 weeks of treatment. Data was analyzed by using SPSS 23. Results: There was statistically significant changes within both groups in the NPRS, NDI, CROM and Craniovertebral angle with p- value of < 0.05 Both were effective but using Bruegger’s Relief Exercise showed more improvement. Conclusion: Both treatment strategies were effective in decreasing pain, improving movement, regaining functional status, and correcting posture but using Bruegger’s Relief Exercise is more efficient for treating neck pain due to FHP. Key words: Forward head posture, Muscle energy techniques, Bruegger’s relief exercise