Current Issue Volume 28, Number 4 , October-December 2017

EDITORIAL
Rajesh Pramanik

Transformation toward Sustainable and Resilient Society for All

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:iv]



The theme for the 2017 International Day of People with Disability is “Transformation toward sustainable and resilient society for all.” The overarching principle of this theme is to “leave no one behind” and empower people with disability to be active contributors of society. It is based on the transformative changes envisaged in the 2030 agenda for Sustainable Development. It aims to strengthen the resilience of people with disability by providing full access to justice, health care services, infrastructure, and accessible communities.


ORIGINAL ARTICLE
Kaustav B Thakur, Romi S Nongmaithem, Jotin S Yengkhom, Utpalendu Debnath, Lisham R Singh

Correlation of Radio-anatomic Site of Stroke with Motor Recovery and Functional Outcome in Ischemic Stroke Patients: A Hospital-based Prospective Cohort Study

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:115-121]



Introduction: Stroke is a global health problem and a leading cause of morbidity and mortality. The site of lesion in stroke is determined with either non contrast computed tomography or Magnetic resonance imaging (MRI) scan of brain. Clinical evidence suggests that the site of damage influences the pattern of motor deficits. Thus, motor recovery and functional outcome after stroke may vary according to the location and size of brain lesions. The relationship between the location of brain lesions and motor and functional outcomes in stroke patients still remains controversial. The present study was performed to find out such association, if any.

Materials and methods: A prospective cohort study was conducted in the department of physical medicine and rehabilitation (PMR), regional institute of medical sciences (RIMS) with 60 patients fulfilling the inclusion and exclusion criteria attending between September 2015 and August 2017. Valid informed consent from patients and ethical approval were taken. The outcome measures used were Functional Independence Measure (FIM) and Brunnstrom stages of recovery. Stroke severity was assessed by National Institutes of Health (NIH) Stroke Scale. Follow-up assessment was done at 3rd and 6th month post stroke. Data were entered and analyzed in SPSS version 21. A two-way mixed analysis of variance (ANOVA) was done to find out the effect of location of lesion on motor recovery and functional outcome; p-value < 0.05 was taken as statistically significant.

Results: A total of 60 patients were included in our study with a mean age of 58.47 ± 7.67 years. Male constituted 56.7% and female 43.3% in our study. Maximum patients were in the age group of 61 to 65 years (53.3%). Subcortical stroke was found to be the most common site of lesion (56.7%). Computed tomography (CT) scan was positive for ischemic features in 44 patients (73.33%). The rest of the 16 patients (26.67%) either showed normal study or location not correlating with the clinical features the patients presented with. Magnetic resonance imaging was advised for these patients and showed positive ischemic features confirming stroke or affecting other anatomical sites. Stroke in basal ganglia showed a statistically significant improvement in motor recovery (p = 0.0008) and functional outcome (p = 0.047). Similarly, minor stroke had the best motor recovery and functional outcome (p < 0.001).

Conclusion: The present study showed the relationship of radio-anatomic site of stroke with motor recovery and functional outcome. It also found that stroke in basal ganglia had a statistically significant improvement in motor recovery and functional outcome.

Keywords: Functional outcome, Ischemic stroke, Motor recovery, National Institutes of Health stroke scale, Stroke rehabilitation.

How to cite this article: Thakur KB, Nongmaithem RS, Yengkhom JS, Debnath U, Singh LR. Correlation of Radioanatomic Site of Stroke with Motor Recovery and Functional Outcome in Ischemic Stroke Patients: A Hospital-based Prospective Cohort Study. Indian J Phy Med Rehab 2017;28(4):115-121.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Mohit Kataruka, Rajesh Pramanik, Rathindranath Haldar

Comparative Study of Electrophysiological Improvement in Carpal Tunnel Syndrome by Local Infiltration of Steroid vs Ultrasonic Therapy.

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:122-129]



Introduction: Carpal Tunnel Syndrome (CTS) was effectively treated by lots of conservative management including splints, exercise, different types of heat modality like Ultrasound treatment (UST), steroid, etc. This is our humble attempt to explore and find out the electrophysiological improvement pattern after treatment with ultrasonic therapy and methylprednisolone injection in CTS. This analytical study was conducted at the Department of Physical Medicine and Rehabilitation (PMR), IPGME&R, SSKM Hospital, Kolkata from January 15, 2012 to July 15, 2013.

Materials and methods: After getting the institutional ethical committee clearance, patients with symptoms of nerve compression at wrist were included in the study group according to the inclusion and exclusion criteria and randomly divided into two groups. Group I received UST for 15 minutes per session for 15 days to the palmer carpal tunnel area at a frequency of 1 MHz and intensity of 1.0 W/cm2, pulsed mode, with a transducer of 5 cm2, and group II received 40 mg methylprednisolone injection. The patients were examined after intervals of 2, 4 and 8 weeks post intervention.

Results: The results of our study suggest that there was a marked improvement for all the clinical and electrophysiological parameters in both the groups, but there is no statistically significant difference between the groups.

Conclusion: Ultrasound treatment and intralesional steroid injection are both effective methods of treatment for CTS with clinical and electrophysiological improvement. This is one of the effective modalities of treatment for CTS.

Keywords: Carpal tunnel syndrome, Methyl prednisolone, Nerve conduction study, Ultrasound treatment.

How to cite this article: Kataruka M, Pramanik R, Haldar R. Comparative Study of Electrophysiological Improvement in Carpal Tunnel Syndrome by Local Infiltration of Steroid vs Ultrasonic Therapy. Indian J Phy Med Rehab 2017;28(4):122-129.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Krishnan P Sivaraman Nair, Ram P Hariharan

Is Functional Electrical Stimulation Effective in improving Gait in People with Multiple Sclerosis? A Systematic Review.

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:130-135]



Introduction: One of the reasons for difficulty with walking in people with multiple sclerosis (PwMS) is foot drop; the inability to dorsiflex the ankle during the swing phase of the gait. One approach to correct foot drop is to passively support the ankle joint with an ankle foot orthosis (AFO) or a foot up splint. Another approach is to use functional electrical stimulation (FES).

Objective: Is FES effective in improving gait in people with foot drop due to multiple sclerosis (MS)?

Materials and methods: AMED, EMBASE, BNI, MEDLINE, and CINAHL were searched. Meta-analysis, randomized control trials (RCTs) and non-RCTs, and case series involving investigating FES for foot drop in PwMS were reviewed. Conference abstracts, non-English articles, expert opinions, and FES for other indications were excluded. Full texts of the articles were reviewed by two authors independently using the Physiotherapy Evidence Database (PEDro) scale. The strength of evidence was graded from 1 to 5.

Results: Among the 172 results, we excluded 130 after reading the titles (duplicates, articles not in English, and articles on use of FES for indications other than foot drop). After reviewing the abstracts, we excluded further 27 (conference presentations, opinions, and reviews). The PEDro scores of the articles varied between 3 and 7. None of the studies blinded the participants and only one study used blinded assessors. Two RCTs and one meta-analysis found an orthotic effect of FES causing improvement in speed of walking by 0.05 to 0.08 m/s. Two RCTs reported 73 to 83% reduction in number of falls. There were no RCTs comparing effect of FES with AFO in this cohort.

Conclusion: There is level-1 evidence that the FES increases speed of walking through an orthotic effect. There is level-2 evidence that it reduces number of falls in PwMS. Further appropriately powered multicenter studies are required to assess the comparison of FES with AFO in this cohort.

Keywords: Falls, Functional electrical stimulation, Gait, Multiple sclerosis, Walking speed.

How to cite this article: Nair KPS, Hariharan RP. Is Functional Electrical Stimulation Effective in improving Gait in People with Multiple Sclerosis? A Systematic Review. Indian J Phy Med Rehab 2017;28(4):130-135.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Lin Cheng, Bhaskar Basu

The Effect of Early Mobilization in Transtibial Amputees with an Unhealed Residuum— Detrimental or Beneficial to Patients: A Review of Literatures

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:136-139]



Objective: To systematically identify and summarize literatures on early mobilization of transtibial patient with unhealed wound or ulcers.

Setting: Published literatures up to and including December 2017 where transtibial amputee with unhealed wound or ulcers and the effect of mobilization on wound healing and rehabilitation were reviewed.

Participants: Lower limb transtibial amputees with primary or secondary wounds were followed up to see if mobilization was detrimental or beneficial to wound healing.

Results: A total of 1,250 literatures were identified from search database of MEDLINE, PubMed, Google Scholar, and Ovid. Duplicates were removed and 12 abstracts were screen. Seven full-text articles were assessed for eligibility, and two literatures were felt to meet the prescribed criteria. Both literatures were from the United Kingdom, and both literatures showed that there was no detrimental effect of early mobilization in patient with large unhealed wound or ulcers. Strength and limitation of this study: Very few published literatures on the effect of early mobilization results in a small sample size. This highlights the need for more similar studies to be carried out. Only one reviewer performed the analysis, creating potential biasness.

Keywords: Amputee, Mobilization, Transtibial, Unhealed wound.

How to cite this article: Cheng L, Basu B. The Effect of Early Mobilization in Transtibial Amputees with an Unhealed Residuum—Detrimental or Beneficial to Patients: A Review of Literatures. Indian J Phy Med Rehab 2017;28(4):136-139.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Nitin A Menon, Dwarkadas K Baheti, Nitin N Dange

Management of Primary Hyperhidrosis with Sympathetic Block

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:140-142]



Hyperhidrosis is an unusual condition characterized by excessive sweating, which results in social embarrassment and work place impairment. Although a number of treatment options are available, the use of sympathetic block in certain patients is an important tool as a part of multimodal approach in the management of this condition.

Keywords: Epidural catheter, Hyperhidrosis, Sympathetic block.

How to cite this article: Menon NA, Baheti DK, Dange NN. Management of Primary Hyperhidrosis with Sympathetic Block. Indian J Phy Med Rehab 2017;28(4):140-142.

Source of support: Nil

Conflict of interest: None


MISCELLANEOUS
Firdaus Kamal

Pictorial Continuing Medical Education

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:143]



A 48 yrs female patient presented in PMR OPD with symmetrical polyarticular joint pain and deformity for last 2 years. She was facing lot of difficulties to perform her ADL due to hand deformities and restriction of joint movements. She is already on tab methotrexate , sulfasalazine and hydroxychloroquine and intermittent etoricoxib. Unfortunately she did not receive any other non-pharmacological management since the disease onset.


MISCELLANEOUS

Medical Philately

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:144]



Country       Malagasy

Date             1981

Disability      Amputee

Meta           Stamp, disability, outside centre, Malagasy, 1981 International Year of Disabled People IYDP, Amputee


MISCELLANEOUS

Postgraduate Forum

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:145-147]



1. Interventional Spine Procedures, An Issue of Physical Medicine and Rehabilitation Clinics of North America, by Carlos E. Rivera: Elsevier


© JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD.