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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 16
| Issue : 2 | Page : 77-80 |
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Awareness and attitude of first-aid seizure management among physiotherapy undergraduate students
Sanskruti Sehul Modi1, Dinesh Chavhan2, Rachana Dabadghav3, Ashok Shyam4, Parag Sancheti4
1 Department of Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
2 Department of Neuro Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
3 Department of Research Coordinator, Sancheti Institute, College of Physiotherapy, Pune, India
4 Department of MS Orthopaedics, Sancheti Institute of Orthopedics Rehabilitation, Pune, Maharashtra, India
| Date of Submission | 17-Jun-2022 |
| Date of Decision | 04-Dec-2022 |
| Date of Acceptance | 14-Dec-2022 |
| Date of Web Publication | 31-Jan-2023 |
Correspondence Address:
Dr. Dinesh Chavhan
Sancheti Healthcare Academy, 11/12 Thube Park, Shivajinagar, Pune - 411 005, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/pjiap.pjiap_26_22
BACKGROUND: Epilepsy is a chronic brain disorder. In Indian society, there are various misconceptions and practices performed while an individual is having an epileptic seizure and social acceptance is poor and stigmatized. As health-care professionals, physiotherapists need to know the first-aid management for seizures to prevent further harm caused by the episode. By increasing awareness, prompt treatment can be administered, which will subsequently lead to better survival rates.
AIMS: The aim of this study was to find out the awareness and attitude of first-aid seizure management among physiotherapy undergraduate students.
SUBJECTS AND METHODS: Approval from the institutional ethical committee was obtained for the study and validated by three experts in the field. Two hundred and five students in the age group of 20–24 years from 3rd year to 4th year and interns were included through convenience sampling. Subjects were recruited from various physiotherapy colleges through Google Forms. A Google Form link constituting the information and description of the study, and a self-made questionnaire were circulated to the subjects. Consent was taken before participating in the study. The responses were recorded, and descriptive analysis was done using SPSS software version 26.
RESULTS: Participants were in the age group of 20–24 years, of which awareness toward first-aid management is lacking as 35% agree to hold them and help to restrict movement during a seizure, and 27% agree to insert a spoon or metal into his mouth. Attitude is positive toward first-aid seizure management.
CONCLUSIONS: This study suggests that physiotherapy undergraduate students lack awareness of management and attitude positive toward first-aid seizure management.
Keywords: Epileptic seizure management, first-aid, physiotherapy
How to cite this article:
Modi SS, Chavhan D, Dabadghav R, Shyam A, Sancheti P. Awareness and attitude of first-aid seizure management among physiotherapy undergraduate students. Physiother - J Indian Assoc Physiother 2022;16:77-80 |
How to cite this URL:
Modi SS, Chavhan D, Dabadghav R, Shyam A, Sancheti P. Awareness and attitude of first-aid seizure management among physiotherapy undergraduate students. Physiother - J Indian Assoc Physiother [serial online] 2022 [cited 2023 Jun 5];16:77-80. Available from: https://www.pjiap.org/text.asp?2022/16/2/77/368875 |
| Introduction | |  |
Epilepsy is a chronic brain disorder with significant psychological and social consequences for everyday living.[1] In Indian society, various misconceptions and practices are performed, and social acceptance is poor and stigmatized. Due to no specific questionnaire available to test knowledge of epilepsy in physiotherapy undergraduate students, a self-made questionnaire was made and validated by three experts in the field. As physiotherapists, we come in contact with neurologically involved individuals who might experience seizures. The physiotherapist needs to know the first-aid management for the seizure to prevent further harm caused by the episode. Increasing awareness prompt treatment can be administered, leading to better survival rates. Knowledge and attitude toward patients with epilepsy would alter the extent of professional care and the social support they provide.
| Subjects and Methods | | |
Approval from the institutional ethical committee was obtained for the study and validated by three experts in the field for the analysis.
Two hundred and five students in the age group of 20–24 years from 3rd year to 4th year and interns were included through convenience sampling.
Subjects were recruited from physiotherapy colleges in Mumbai and Pune through Google Forms.
A Google Form link constituting the information and description of the study, and a self-made questionnaire were circulated to the subjects. The questionnaire had information on familiarity with epilepsy, awareness, and attitude toward first-aid seizure management. Consent was taken before participating in the study.
The responses were recorded, and a descriptive analysis was done.
| Results | | |
Final year 85 (41.46%), 3rd year 56 (27.31), and intern 64 (31.21%) took part in the current study.
Here are the results for knowledge and attitude of first-aid seizure management:
As per the statistical data analysis, considering the difference between the average of the answers given by interns and that of the 3rd and final year, the mean deviation comes out to 0.31 (6.28%) on a scale of 5, there is not much difference between the knowledge and attitude of first-aid seizure management between interns and 3rd- and 4th-year students.
Students were asked what can one do if the seizure lasted longer than 5 min, to which people replied to get immediate medical help, call an ambulance, or maintain breathing; 13 students mentioned drugs such as lorazepam and diazepam to be given. Majority of them correctly answered the need for emergency care and hospitalization post 5 min.
| Discussion | | |
The current study provides findings regarding physiotherapists' knowledge and attitude toward first-aid seizure management.
Knowledge about first-aid management
Knowledge about the characteristics of epilepsy is important in its management as it can give time to bring the person to a safer place, help identify the episode in time, and prevent further harm to the person. In the present study, students were aware of the characteristics. In a Goel et al. study, 53.7% did not know about the symptoms. Nearly 80% of students stated that persons with epilepsy could not sense seizures beforehand and 17% did not know about the types of seizures in persons with epilepsy.[2] More than three-fourths of respondents knew that foaming at the mouth and whole-body shaking are symptoms of seizures; however, almost half of the respondents ignored falling as a symptom of seizures in research by Abbasi Kangevari et al.[3]
In the present study, 35% of students wrongly agree to hold them during the seizure. In a survey by Goel, 47% wrongly held the arms and legs of a person with epilepsy tightly.[2] Another study by Basheikh (35.6%) followed by trying to hold the patient tight to prevent them from seizing (16.6%). This may cause injuries to the spine, ribs, and joints leading to fractures or dislocations, and such actions should be avoided.[4] About 40.7% tried to restrain them from stopping the seizure in research by Abbasi Kangevari et al.[3] Furthermore, only 41.8% answered with "disagree" to holding the patients on the floor and preventing them from moving during the seizure in Saudi Arabia.[5]
Twenty-five percentage wrongly agree to insert a metal or spoon into the mouth during a seizure. Study shows that placing a spoon or metal into the mouth to prevent them from biting their tongue is still commonly believed and practiced in sub-Saharan Africa.[6] Another study by Aragon et al. states a concerning one-fifth of respondents would place something in the patient's mouth (18.3%).[7] Due to a common misconception that placing an object, such as a spoon, in a seizing person's mouth prevents tongue biting, a variety of unusual items may also potentially be aspirated.[8] Basheikh states in his study that 14.7% reported that they would try to hold the patient's tongue to prevent tongue swallowing, which is one of the major myths in the subject of epilepsy and its emergencies, as tongue swallowing during a convulsion is considered to be impossible because the convulsive state is hypertonic not hypotonic.[4],[8] Unfortunately, 51.2% of the participants agreed to open the patient's mouth and insert an object during the seizure which is near to the result of Makkah's study by 55%. In comparison, only 17.7% reported that in a survey of Majmaah.[5] In another study conducted in Hong Kong, 52% of respondents believed that putting an object into a patient's mouth during a seizure to prevent injury was appropriate.[9]
Most of them answered hospitalization or emergency care, and few mentioned anti-epileptic drugs and benzodiazepines such as diazepam post 5 min of a seizure episode. In a study by Goel, nearly three-fourths of students in our research would call a doctor as a first-aid measure for a seizure in epilepsy. Similarly, two-thirds of students in Kerala reported that they would like to take a person to a hospital as a first-aid measure for a seizure in epilepsy.[2] (98.5%) participants stated that a person with epilepsy needs to go to a physician in a study by Abbasi Kangevari et al.[3] Ninety-two percentage answered to call the ambulance if the seizure lasts for more than 5 min. Only 7% will do that in a study of Makkah.[5] In a survey by Simy Mathew, 28.6% gave the correct response on how to care for a person with a seizure, as opposed to 61% of students from the Chandigarh study.[10]
The attitude of first-aid seizure management
In a study evaluating the stigma toward different chronic diseases such as epilepsy and diabetes, prejudgment toward epilepsy was reported to be higher compared to diabetes, and this was related to incorrect beliefs.[11] In our study, students were asked, "It is easier to treat patients with asthma and diabetes than epileptic seizures," 44% of students were neutral about the response, whereas 31% agreed with the statement. Eighty-seven (38.5) teachers also felt that it is not easier to teach children with diabetes, asthma, or sickle cell disease than those with epilepsy, while it is laudable for a teacher to express that the child with epilepsy can be taught in the same manner as a child with diabetes or asthma, this may not always be the case.[1]
In the current study, the majority of people agree to be involved with the management of seizures (48%), and (51%) agree that physiotherapists can intervene in the management of seizures showing a positive attitude toward the first aid of seizure management.
In a study by Christian N Eze, a significant increase in the number of respondents with good knowledge (29.6%), positive attitudes (16.4%), and good first-aid management skills (25.0%) of students with epilepsy 12 weeks postintervention.[1] A study in Sao Paulo, Brazil, showed positive knowledge of epilepsy in students in the health area.[12]
As physiotherapists, we deal with neurologically involved individuals who could risk experiencing a seizure. Therefore, there should be a good understanding of the condition and appropriate training to manage the seizure at the earliest. Fear of confronting an individual with a seizure should be eradicated. People tend to panic when they witness a person seizing. They are prone to physical injuries during seizures, and a lack of awareness about first-aid measures results in taking inappropriate first-aid measures.
Most children with cerebral palsy have a history of epileptic seizures and are prone to them. Epileptic attacks could be triggered by a flash of light, physical exertion, etc., These can be essential parts of an exercise intervention to treat several neurological conditions due to the fear of triggering an epileptic attack.
| Conclusions | | |
This study suggests that physiotherapy undergraduate students lack awareness of management and attitude positive toward first-aid seizure management. Hence, it is recommended that the awareness of first-aid management of seizures in epilepsy needs to be improved.
Clinical implication of the study
To improve the knowledge and confidence of students toward seizure in epilepsy mock drills, practical aspects should be focused on in the clinics and hospital setups. Thus, first-aid seizure management should be a part of the clinics and hospitals focusing more on the practical aspect, and mock drills can be arranged for students to experience such scenarios.
Future direction
A comparison of knowledge and attitude between physiotherapy undergraduates and postgraduates can be studied.
Acknowledgment
I would also like to thank the participants of my study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| Questionnaire and Responses | | |
1. Questionnaire
◻ Name
◻ Age
◻ Year
◻ Email
1. Seizure is defined as a sudden uncontrolled electrical disturbance of the brain
✓ Strongly agree
2. Seizure is characterized by loss of consciousness or fall, up rolling of eyes, staring at nothing/daydreaming, drooling of saliva, and tongue biting
✓ Strongly agree
3. All seizures are not all alike (generalized tonic-clonic seizures, absence seizures, focal seizures)
✓ Strongly agree
4. Would you want to be involved in the management of seizures?
✓ Strongly agree
5. It is easier to treat individuals with asthma, Diabetes than epileptic seizures
✓ Strongly disagree
6. Physiotherapist can involve the individual in strenuous activity during a seizure
✓ Strongly disagree
7. Do you think an epileptic child should attend a special school?
✓ Strongly disagree
8. Physiotherapists can intervene with individuals with seizure
✓ Strongly agree
9. Untie restricted clothing to allow breathing
✓ Strongly agree
10. Hold him or her and help to restrict movement
✓ Strongly disagree
11. Do nothing and wait for the convulsion to stop
✓ Strongly disagree
12. Insert a spoon or metal into his mouth
✓ Strongly disagree
13. Place something soft beneath the head
✓ Strongly agree
14. Remove sharp objects around
✓ Strongly agree
15. What should one do if the seizure lasts longer than 5 minutes?
| References | | |
| 1. | Eze CN, Ebuehi OM, Brigo F, Otte WM, Igwe SC. Effect of health education on trainee teachers' knowledge, attitudes, and first aid management of epilepsy: An interventional study. Seizure 2015;33:46-53.  |
| 2. | Goel S, Singh N, Lal V, Singh A. Knowledge, attitude and practices of students about first aid epilepsy seizures management in a Northern Indian City. Ann Indian Acad Neurol 2013;16:538-43. [ PUBMED] [Full text] |
| 3. | Abbasi Kangevari M, Kolahi AA, Farsar AR, Kermaniranjbar S. Public awareness, attitudes, and first-aid measures on epilepsy in tehran. Iran J Child Neurol 2019;13:91-106. |
| 4. | Basheikh M. Population-level investigation of the public awareness level toward witnessed seizures in Saudi Arabia. Middle East J Fam Med 2020;7:41. |
| 5. | Alshareef AH, Alnofaiey YH, Milibary AA, Sibyani AK, Alotaibi GH, Alshehri RA, et al. Effect of habits, traditions, and beliefs on seizure diagnosis and provide first aid in Taif city, KSA. J Family Med Prim Care 2021;10:3029-33. [Full text] |
| 6. | Rossi KC, Baumgartner AJ, Goldenholz SR, Goldenholz DM. Recognizing and refuting the myth of tongue swallowing during a seizure. Seizure 2020;83:32-7. |
| 7. | Aragon CE, Hess T, Burneo JG. Knowledge and attitudes about epilepsy: A survey of dentists in London, Ontario. J Can Dent Assoc 2009;75:450. |
| 8. | Redant D, Mahomed Z, Beringer C. Foreign body aspiration – A potentially life-threatening complication of seizures. Cureus 2020;12:e11349. |
| 9. | Fong CY, Hung A. Public awareness, attitude, and understanding of epilepsy in Hong Kong special administrative region, China. Epilepsia 2002;43:311-6. |
| 10. | Mathew S, Salman P, Khurshid S, Luke A. Awareness of first aid among undergraduate students in Ajman, UAE. J Dent Med Sci 2016;15:30-8. |
| 11. | Yeni K, Tülek Z, Bebek N, Çavuşoğlu A, Güven H, Şimşek N, et al. Knowledge and attitudes toward epilepsy among students of health occupations in a university. Epilepsi 2019;25:13-20. |
| 12. | Vancini RL, Benedito-Silva AA, Sousa BS, Gomes da Silva S, Souza-Vancini MI, Vancini-Campanharo CR, et al. Knowledge about epilepsy among health professionals: A cross-sectional survey in Sao Paulo, Brazil. BMJ Open 2012;2:e000919. |
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