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ORIGINAL ARTICLE
Pallab Das, Manas K Dan

Comparative Study of the Effectiveness of Therapeutic Ultrasound vs Interferential Therapy to reduce Pain and improve Functional Ability in Osteoarthritis of Knee

[Year:2017] [Month:July-September] [Volumn:28 ] [Number:3] [Pages:25] [Pages No:100-105][No of Hits : 513]


Abstract

Many people develop functional limitation due to pain of osteoarthritis (OA) of the knee. Different physiotherapeutic modalities are commonly used to give treatment for patients with OA knee. This study aims to examine the efficacy of therapeutic ultrasound (UST) vs interferential therapy (IFT) to reduce pain and to improve functional ability in OA knee. Thirty subjects with a mean age of 62.55 ± 6.25 years having clinical diagnosis of OA of knee were randomly allocated to two study groups, namely groups I and II, each of 15 patients. Group I received UST and therapeutic exercise and group II received IFT and same therapeutic exercise designed for OA knee, conducted five times a week for 2 weeks. The outcome of this intervention was measured in terms of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, pain relief in terms of visual analog scale (VAS), and active range of motion (ROM). It was concluded that IFT could be the better choice of modality than UST in the management of OA of knee.

Clinical significance: This study helped us to formulate a better therapeutic approach of OA of knee.

Keywords: Interferential therapy Western Ontario and McMaster Universities Osteoarthritis Index, Knee, Osteoarthritis, Physiotherapeutic intervention, Therapeutic ultrasound, Visual analog scale.

How to cite this article: Das P, Dan MK. Comparative Study of the Effectiveness of Therapeutic Ultrasound vs Interferential Therapy to reduce Pain and improve Functional Ability in Osteoarthritis of Knee. Indian J Phy Med Rehab 2017;28(3):100-105.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rajesh K Mohanty, Sipra Lenka, Ritikesh Pattanaik, Srikanta Moharana, Patitapaban Mohanty, Sakti P Das

Comparison of Molded and Conventional Orthosis during Ambulation for Adolescent with Myelomeningocele

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:77-83][No of Hits : 405]


ABSTRACT

Varying diversities of involvement in adolescent with myelomeningocele make orthotic prescription, evaluation, and fitting highly challenging. A school-going 14-year-old boy presented with extensive weakness and kinematic alterations of both lower limbs and spine. Planovalgoid foot, calcaneal deformity of ankle, knee flexion, anterior pelvic tilt, rotation, and frequent hip dislocation of left side were noticed on examination. Gait comparisons were made between walking with bare foot and with conventional and molded orthosis with auxiliary crutches. Kinetic and kinematic parameters were studied in gait lab by force plate (BTS P-6000) and cameras with reflective markers (BTS SMART-DX 6000). Molded orthosis was found to improve all gait parameters except cadence and walking velocity; however, diversity in the results was observed. Though both variants were effective, a follow-up is necessary to finalize the best orthotic solution for the individual subject.

Keywords: Adolescent, Comparison, Gait, Myelomeningocele, Orthosis.

How to cite this article: Mohanty RK, Lenka S, Pattanaik R, Moharana S, Mohanty P, Das SP. Comparison of Molded and Conventional Orthosis during Ambulation for Adolescent with Myelomeningocele. Indian J Phy Med Rehab 2017;28(2):77-83.

Source of support: Nil

Conflict of interest: None

Date of receiving: 19-12-2016

Date of acceptance: 10-05-2017

Date of publication: July 2017


 
Case Report
Madhusree Sengupta, Ameed Equebal, Abhishek Biswas, Ambar Ballav

An Attempt to rehabilitate a Case of Rubinstein–Taybi Syndrome: A Rare Disorder

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:74-76][No of Hits : 285]


ABSTRACT

Rubinstein-Taybi syndrome (RSTS) is a genetically heterogeneous, rare, neurodevelopmental condition with the usual stigmata of facial dysmorphism, broad thumb and hallux, multisystem involvement, and developmental delay, which are themselves clinically diagnostic in the absence of standard criteria. Amidst all these physical features, the sensory, cognitive, behavioral, intellectual, and sometimes autistic features of the condition often escape attention. This case illustrates that the management of all these different aspects remains an integral part of rehabilitation.

Keywords: Autistic disorder, Intellectual disability, Occupational therapy, Rubinstein-Taybi syndrome.

How to cite this article: Sengupta M, Equebal A, Biswas A, Ballav A. An Attempt to rehabilitate a Case of Rubinstein-Taybi Syndrome: A Rare Disorder. Indian J Phy Med Rehab 2017;28(2):74-76.

Source of support: Nil

Conflict of interest: None

Date of receiving: 02-05-2016

Date of acceptance: 06-02-2017

Date of publication: July 2017


 
Original Article
Nonica Laisram, Sucheta Saha

Ambulatory Potential in Children with Cerebral Palsy

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:49-52][No of Hits : 270]


ABSTRACT

Ambulation is a major concern in cerebral palsy (CP) rehabilitation. The present study was carried out in 175 CP cases, belonging to the age group of 2 years and above. The aim of the article was to identify the independent ambulators in different types of CP, to study the age of achieving independent ambulation, and to determine some parameters that affect ambulatory outcome.
Among 175 cases, 69 (39.4%) cases were found to be able to walk independently. Of this, the maximum number of cases were children with spastic hemiplegia, 37 of 39 (94.9%), followed by children with spastic paraplegia, 7 of 18 (41.1%) and diplegia, 15 of 45 (33.1%). Majority of these children were found to have either normal intelligence or mild degree of mental retardation (MR). Degree of spasticity was mild in these cases. Majority of the children who were able to walk had achieved independent sitting by 2 years of age, i.e., in 54 of 69 (78.3%) cases.
The present study highlights that CP children with spastic hemiplegia had the highest potential for independent walking. Spasticity of mild degree in association with a normal intelligence or mild degree of MR and achievement of independent sitting by 2 years of age appear to be favorable for ambulation.

Keywords: Ambulation, Cerebral palsy, Potential.

How to cite this article: Laisram N, Saha S. Ambulatory Potential in Children with Cerebral Palsy. Indian J Phy Med Rehab 2017;28(2):49-52.

Source of support: Nil

Conflict of interest: None

Date of receiving: 08-11-2016

Date of acceptance: 03-01-2017

Date of publication: July 2017


 
Original Article
Kudremukh B Sumalatha, Ramita Sardana, Upinder P Singh, Gita Handa, Shiv L Yadav, Vishnu Sreenivas

Comparative Study of Effect of Diclofenac Alone vs Diclofenac with Ultrasound Therapy in Patients with Inferior Heel Pain using Pedography

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:53-58][No of Hits : 238]


ABSTRACT

Objectives: To study the additional benefits of ultrasonography in patients with inferior heel pain treated with diclofenac for foot pressure profile and pain.

Materials and methods: This was a randomized experimental trial. Comparison of the efficacy of two treatment modalities (diclofenac alone vs diclofenac with ultrasound therapy) with respect to pressure profiles using pedography and a visual analog scale (VAS) was carried out. Twenty-three patients with unilateral inferior heel pain were considered subjects. The main outcome measures were foot pressure profile using pedography and pain severity using VAS.

Results: In the diclofenac alone group, it was observed that there was significant decrease in pain score posttreatment. The rest of the parameters did not show any significant change. In the diclofenac and ultrasound group, a statistically significant increase in the rear foot pressure area and decrease in the VAS score posttreatment was observed. Changes in the rest of the parameters were not significant. Comparison of the difference between the two treatment modalities with respect to pressure areas and VAS scale for pain showed no significant change statistically.

Conclusion: Ultrasound therapy shows some increase in the ability to take more rear foot pressure while walking, but it does not have any other added benefit over diclofenac in treating inferior heel pain with respect to pressure profile and pain.

Keywords: Heel pain, Plantar fasciitis, Ultrasound therapy.

How to cite this article: Sumalatha KB, Sardana R, Singh UP, Handa G, Yadav SL, Sreenivas V. Comparative Study of Effect of Diclofenac Alone vs. Diclofenac with Ultrasound Therapy in Patients with Inferior Heel Pain using Pedography. Indian J Phy Med Rehab 2017;28(2):53-58.

Source of support: Nil

Conflict of interest: None

Date of receiving: 27-11-16

Date of acceptance: 03-01-2017

Date of publication: July 2017


 
Original Article
Ambar Konar, Rajesh Pramanik, Debayan Ghorai, Aniketa Banerjee

Effect of Infliximab Therapy in Functional Improvement in Patients with Ankylosing Spondylitis

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:59-63][No of Hits : 194]


ABSTRACT

Introduction: Ankylosing spondylitis (AS), one of the spondyloarthropathies predominantly affecting younger people, is notorious for morbidity with pain, functional impairment, and disability. Infliximab, a chimeric tumor necrosis factor (TNF) alpha inhibitor, has been proven as a safe and effective biologic in respect to improvement in clinical and radiological parameters in AS. This study is a humble attempt to look for disability limitations by infliximab therapy in patients with AS.

Aims and objectives: To look for functional improvement in AS patients treated with Infliximab in comparison with control group who were treated conservatively.

Materials and methods: A randomized controlled trial was done in the Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education & Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India, from December 2015 to May 2017, recruiting 20 AS patients who fulfilled the Assessment of SpondyloArthritis International Society (ASAS) criteria and had significant functional limitation. After Ethics Committee clearance, two groups were made randomly. Both groups I and II were included in the rehabilitation program. Group I, in addition, received injection infliximab on days 0, 14, and 42. Assessment by the Bath ankylosing spondylitis functional index (BASFI) and visual analog scale (VAS) for lower back pain was done before intervention and 2, 6, 12 weeks after initiation of treatment.

Results: Statistically significant positive outcome difference was seen in the first group in comparison with control group based on both outcome parameters.

Conclusion: Infliximab is a safe and highly efficacious biologic therapy in limiting disability in AS patients when treated early.

Keywords: Ankylosing spondylitis, Bath ankylosing spondylitis functional index, Disability, Visual analog scale.

How to cite this article: Konar A, Pramanik R, Ghorai D, Banerjee A. Effect of Infliximab Therapy in Functional Improvement in Patients with Ankylosing Spondylitis. Indian J Phy Med Rehab 2017;28(2):59-63.

Source of support: Nil

Conflict of interest: None

Date of receiving: 04-04-2017

Date of acceptance: 18-05-2017

Date of publication: July 2017


 
Case Report
Mohit K Srivastava, Anil K Gupta

Bilateral Lower Limb Amputee with Dhat Syndrome

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:71-73][No of Hits : 188]


ABSTRACT

Introduction: Dhat syndrome is a clinical entity mostly seen in Southeast Asia. The patient suffering from this syndrome commonly presents with features of depression, anxiety, multiple nonspecific somatic symptoms, and impairment of concentration, which are attributable to semen loss.

Case report: The case that we present here is of a 32-year-old patient with (right) transtibial and (left) transfemoral amputation. Patient presented with following complaints within 10 days of postamputation surgery. He complained of anxiety, low mood, anhedonia, decreased sleep, reduced appetite, and whitish discharge while passing urine. All the blood investigations and ultrasound of the whole abdomen were normal. The patient was prescribed sertraline 50 mg half H.S. for 3 days, followed by 50 mg one H.S. zolpidem (10 mg H.S.), and syrup cyproheptadine [2 teaspoonful (TSF) night time only (HS)] for a period of 2 weeks. Psychoeducation was also given on a daily basis during this duration. Significant improvement was seen in the above complaints after 1 week of medication.

Conclusion: Patients with lower limb amputation mostly suffer with depression, but development of features of Dhat syndrome along with this indicates the emotional and psychological impact of amputation on such patients, which often goes unnoticed. Every amputee should be given psychological rehabilitation after such an adverse episode of their life.

Keywords: Anxiety, Depression, Dhat syndrome, Lower limb amputee, Psychoeducation

How to cite this article: Srivastava MK, Gupta AK. Bilateral Lower Limb Amputee with Dhat Syndrome. Indian J Phy Med Rehab 2017;28(2):71-73.

Source of support: Nil

Conflict of interest: None

Date of receiving: 09-02-2017

Date of acceptance: 18-05-2017

Date of publication: July 2017


 
ORIGINAL ARTICLE
Jotin S Yengkhom, Romi S Nongmaithem, MS Chongreilen Chiru, Kaustav B Thakur, Utpalendu Debnath

Efficacy of Single-dose Intra-articular Injection of High-molecular-weight Hyaluronic Acid in Patients suffering from Primary Osteoarthritis of Knee

[Year:2017] [Month:July-September] [Volumn:28 ] [Number:3] [Pages:25] [Pages No:89-94][No of Hits : 177]


Abstract

Aim: To find the effectiveness of single-dose intra-articular (IA) injection of high-molecular-weight hyaluronic acid (HMWHA) in patients suffering from primary osteoarthritis (OA) of knee.

Study design: A randomized control trial.

Duration of the study: One-and-a-half years, commencing from October 2014.

Settings: Physical Medicine and Rehabilitation (PMR) Depart- ment, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India.

Study population: All patients suffering from OA knee, who fulfilled the American College of Rheumatology (ACR) criteria for classification of idiopathic OA knee and attending the department during the study period.

Materials and methods: Sixty-five patients were randomized to receive either visco-supplementation with single-dose IA injection of HMWHA (study group) or methylprednisolone (control group) and follow-up was done at 1, 3, and 6 months. Outcome measures were done with Western Ontario and McMaster University (WOMAC) and visual analog scale (VAS) for pain.

Results: Both the groups showed significant improvement in both WOMAC and VAS pain score at the end of 3 months. But at the end of 6 months, improvement in terms of WOMAC (p = 0.09) and VAS pain (p = 0.07) scores in control group was not significant, whereas the study group maintained statistically significant improvement.

Conclusion: single dose of IA HMWHA is effective in reducing pain and disability in patients with primary OA of knee.

Keywords: Disability, Hyaluronic acid, Primary osteoarthritis of knee, Visco-supplementation, Visual analog scale pain, Western Ontario and McMaster University score.

How to cite this article: Yengkhom JS, Nongmaithem RS, Chiru MSC, Thakur KB, Debnath U. Efficacy of Single-dose Intra-articular Injection of High-molecular-weight Hyaluronic Acid in Patients suffering from Primary Osteoarthritis of Knee. Indian J Phy Med Rehab 2017;28(3):89-94.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mohit Kataruka, Rajesh Pramanik, Pallab Das, Rathindranath Haldar

Electrophysiological Improvement Pattern in Patients with Carpal Tunnel Syndrome by Ultrasonic Therapy

[Year:2017] [Month:July-September] [Volumn:28 ] [Number:3] [Pages:25] [Pages No:106-109][No of Hits : 173]


Abstract

Introduction: Carpal tunnel syndrome (CTS) was effectively treated by lots of conservative management that includes splints, exercise, different types of heat modality like ultrasonic therapy (UST), etc. This is our humble attempt to explore and find out electrophysiological improvement pattern after treatment with UST in CTS. This analytical study was conducted at the Department of Physical Medicine and Rehabilitation (PMR), Institute of Post Graduate Medical Education and Research (IPGMER), SSKM Hospital, Kolkata, West Bengal, India, from January 15, 2012 to July 15, 2013.

Materials and methods: After getting Institutional Ethical Committee clearance, patients with symptoms of nerve compression at wrist were included in the study group according to inclusion and exclusion criteria. Ultrasound treatment was administered 15 minutes per session for 15 days to the palmar carpal tunnel area at a frequency of 1 MHz and intensity of 1.0 W/cm2, pulsed mode, with a transducer of 5 cm2 Professor and Head Department of Sports Medicine, Military Hospital, Khadakwasla NDA, Pune, Maharashtra, India 2-4 2 . The patients were examined after intervals of 2, 4, and 8 weeks postintervention.

Results: The results of our study suggest that there was marked improvement in all the clinical parameters. The same significant improvement was also found in electrophysiological parameter.

Conclusion: Ultrasonic therapy is one of the effective modalities of treatment for CTS.

Keywords: Carpal tunnel syndrome, Ultrasonic therapy, NCS.

How to cite this article: Kataruka M, Pramanik R, Das P, Haldar R. Electrophysiological Improvement Pattern in Patients with Carpal Tunnel Syndrome by Ultrasonic Therapy. Indian J Phy Med Rehab 2017;28(3):106-109.

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][No of Hits : 162]


ABSTRACT

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


 
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][No of Hits : 161]


ABSTRACT

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][No of Hits : 158]


ABSTRACT

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
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][No of Hits : 157]


ABSTRACT

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


 
Original Article
Chayanika Roy, Partha Roy

Comparative Evaluation of Awareness among Armed Forces Personnel in Respect of Special Provisions and Benefits Applicable to Children with Disabilities

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:64-68][No of Hits : 153]


ABSTRACT

Introduction: Mental retardation ranges from the borderline to mild to very severe. Fortunately, the majority (80%) are in the mild range that endows the individual the capacity to lead a simple, yet fruitful life once provided with a means that are conducive to their learning styles. Children with a more severe disorder can achieve remarkably if their unique talents are recognized and nurtured to the fullest.

Aim: We conducted a study among armed forces personnel in a large city in Maharashtra. This community has many peculiar and special features. They are from different ethnic, religious, and linguistic backgrounds and live together as a cohesive unit. The general socioeconomic and educational awareness toward facilities and concessions available for the differently abled children is assumed to be high.

Materials and methods: Detailed interaction with 27 parents having special children was conducted and further data were collected. Each parent was individually interviewed. This group was named parents having differently abled children (PHDAC). Group discussions consisting of 15 families in one group that had no special children in the family were conducted. A total of such eight groups (120 families) were, thus, interviewed. This group was named parents having normal children (PHNC). Each family was verbally questioned regarding the facilities available to special children thoroughly and responses were recorded.

Results and discussion: Overall, it was found that among the PHDAC, the awareness was much better, but some were circumspect of the facilities provided for their wards by the land of the law. Most of them felt that the benefits coming to them were due to their service with the Army. The PHNC were not aware of most of the provisions. However, during the interactions with the researcher, they evinced interest in the matter and were happy to know that special provisions are existent in various Government sectors for special children.

Keywords: Awareness, Differently abled, Special Provision.

How to cite this article: Roy C, Roy P. Comparative Evaluation of Awareness among Armed Forces Personnel in Respect of Special Provisions and Benefits Applicable to Children with Disabilities. Indian J Phy Med Rehab 2017;28(2):64-68.

Source of support: Nil

Conflict of interest: None

Date of receiving: 15-02-2016

Date of acceptance: 15-06-2017

Date of publication: July 2017


 
Case Report
Sebastian Meghaja

Tetraplegia: Beyond Neuromuscular Respiratory Dysfunction

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:69-70][No of Hits : 153]


ABSTRACT

In developing countries like India, tuberculosis (TB) is responsible for 30 to 80% of all pleural effusions encountered and may complicate TB in 31% of all cases. Among the extrapulmonary presentations, pleural TB is second in frequency after tubercular lymphadenitis. Here, we present the case of a 46-yearold lady with high-level spinal cord injury (SCI), who came to the outpatient department for regular follow-up. She had no specific complaints; however, respiratory system examination revealed decreased breath sounds and on further probing, patient revealed that she had mild breathlessness of 2-day duration. She had no history of contact with TB. On evaluation, she had left-sided pleural effusion; pleural tap was done, which showed increased number of cells with lymphocytosis and mildly elevated adenosine deaminase (ADA). The diagnosis of extrapulmonary TB was made and anti-TB therapy (ATT) (direct observation of drug intake (DOTS) category 1) was started.

Conclusion: Tuberculosis is a common infection in a developing country like India. All cases of breathlessness in a tetraplegic are not due to neuromuscular respiratory dysfunction.

Keywords: Spinal cord injury, Tetraplegia, Tuberculosis.

How to cite this article: Meghaja S. Tetraplegia: Beyond Neuromuscular Respiratory Dysfunction. Indian J Phy Med Rehab 2017;28(2):69-70.

Source of support: Nil

Conflict of interest: None

Date of receiving: 19-03-2017

Date of acceptance: 20-06-2017

Date of publication: July 2017


 
ORIGINAL ARTICLE
Pabitra K Sahoo, Mamata M Sahu, Tajuddin Chitapure, Sakti Prasad Das

Radiological Evaluation of Hip in Cerebral Palsy: A Randomized Cross-sectional Study

[Year:2017] [Month:July-September] [Volumn:28 ] [Number:3] [Pages:25] [Pages No:95-99][No of Hits : 151]


Abstract

Introduction: The incidence of hip abnormalities in cerebral palsy (CP) patients has been reported as low as 2.6% and as high as 28%. Hip displacement is the second most common deformity after equines. The objective of this study is to evaluate the radiological changes of hip in CP for detecting early features of hip instability.

Materials and methods: A total of 91 hips of 52 patients with CP who attended for rehabilitation management were randomly selected for the study. Hip surveillance was done in those cases where the clinical evaluation alone could not access stability. All the selected cases were evaluated radiologically with respect to acetabular angle, neck-shaft angles, degree of subluxation (migration percentage) and shape of femoral head.

Results: 38 hips showed grade I, 14 hips grade II, 6 hips grade III, and 2 hips grade IV stage of migration percentage. Flattening of femoral head was laterally seen in 16 cases, both medial and lateral flattening was seen in 8 cases of subluxated hip. Acetabular roof angle was increased in cases with grade III and IV migration percentage. Acetabular angle was within 12 to 75° with mean angle of 32°. The mean true neck-shaft angle was 145.5° ranging from 134° to 170°

Conclusion: Early detection of hip instability in Cerebral Palsy helps in timely intervention and that reduces or delays need for reconstructive surgery.

Keywords: Cerebral palsy, Diplegia, Hip, Migration percentage.

How to cite this article: Sahoo PK, Sahu MM, Chitapure T, Das SP. Radiological Evaluation of Hip in Cerebral Palsy: A Randomized Cross-sectional Study. Indian J Phy Med Rehab 2017;28(3):95-99.

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][No of Hits : 139]


ABSTRACT

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


 
Editorial
Rajesh Pramanik

Editorial

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:iv][No of Hits : 134]


ABSTRACT

Wish you a hearty thanks and gratitude from the new editorial board. June issue 2017 of Indian Journal of Physical Medicine and Rehabilitation marks the change of guard as I have taken the baton of Editorship from my predecessor on April 2017. After taking over the charge, I felt humbled by the huge responsibility and level of expectation for our prestigious journal.


 
MISCELLANEOUS
Nasir Mansoor Sahibzada, Ahmad Zaheer Qureshi

Pictorial Continuing Medical Education

[Year:2017] [Month:July-September] [Volumn:28 ] [Number:3] [Pages:25] [Pages No:110][No of Hits : 132]


Abstract

Pictorial Continuing Medical Education

A 32-year-old male presented to our clinic for second opinion regarding his right heel pain. He had two year history of right heel pain and a recent limp in gait for the past 3 months. There was no history of trauma or inflammatory joint disease. He had a thin body habitus. His work involved prolonged standing, which would aggravate his pain. Initially his heel pain was worse in the mornings and would gradually improve during the day, but he had no difficulty in walking. He never had similar symptoms in the left foot.


 
Editorial
Dr. Rajesh Pramanik

Rehabilitation in Chronic Kidney Disease (CKD) – Need of the Hour

[Year:2017] [Month:July-September] [Volumn:28 ] [Number:3] [Pages:25] [Pages No:v][No of Hits : 123]


Abstract

Rehabilitation in Chronic Kidney Disease (CKD) ? Need of the Hour

Chronic kidney disease is a fast growing health concern in our society as it is entwined with increasing lifestyle related morbidities such as diabetes, hypertension, etc. Living conditions of a patient diagnosed with chronic kidney disease starts degrading after the diagnosis and it falls further after commencement of dialysis due to various physical and social reasons. The overall prevalence and the untapped potential of a CKD patient to lead a normal life warrants adequate rehabilitative measures to bring them back to their normal life. Rehabilitation in ESRD patients should be an individualized comprehensive approach aimed at optimal social integration of the patient by increasing his functional potential along with reduction in the cardiovascular comorbidities.


 
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][No of Hits : 121]


ABSTRACT

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.


 
Miscellaneous

Postgraduate Forum

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:145-147][No of Hits : 117]


ABSTRACT

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


 
Miscellaneous

Medical Philately

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:85][No of Hits : 113]


ABSTRACT

Country          Uganda
Date               1979
Disability         Cerebral palsy|| Crutches|| Wheelchair


 
Miscellaneous

Medical Philately

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:144][No of Hits : 108]


ABSTRACT

Country       Malagasy

Date             1981

Disability      Amputee

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


 
Miscellaneous
Firdaus Kamal

Pictorial Continuing Medical Education

[Year:2017] [Month:October-December] [Volumn:28 ] [Number:4] [Pages:32] [Pages No:143][No of Hits : 104]


ABSTRACT

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

Postgraduate Forum

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:86-88][No of Hits : 97]


ABSTRACT

1. Physical Medicine and Rehabilitation Q & A Review, 2nd ed,by Lyn D., MD Weiss, Harry J., MD Lenaburg, Jay M., MD Weiss. Publisher: Demos Medical; May 2017.


 
Miscellaneous
Aniketa Banerjee

Pictorial Continuing Medical Education

[Year:2017] [Month:April-June] [Volumn:28 ] [Number:2] [Pages:39] [Pages No:84][No of Hits : 92]


ABSTRACT

A sixty seven year old right handed nondiabetic hypertensive housewife (Figure 1) from middle socioeconomic status presented with weakness of left half of the body with facial deviation to right side which was worsen in last six months. She was previously treated as a case of ischemic stroke for last eight years and recently became bed bound. Her family noticed her behavioural abnormality along with irrelevant talks and agitation being more marked in last three months with two episodes of convulsion.


 
Original Article
Tan YeowLeng, Lee Chooi Lynn, Saw Hay Mar, Ashfaq Ahmed Larck

Identifying factors predicting hospital length of stay and receiving prosthesis of lower limb amputee patients after amputation surgery - A Singapore perspective

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1-5][No of Hits : 104]


ABSTRACT

Ains: To identify predictors affecting total hospital length of stay(TLOS) and receiving lower limb prosthesis of amputees after surgery in a Singapore tertiary hospital.

Materials and Methods: A retrospective study of 96 patients was undertaken with various levels of lower limb amputation admitted to Singapore General Hospital (SGH) fromJanuary 2009 to December 2014.Patients were divided into two groups: 40-59 and 60 to 80 years old. We correlate clinical variables with TLOS and receiving prosthesis at 6 months from surgery.

Results: For the cohort of age 40-59, presence of IHD (B=22.4), wound infection (B=17.8) and those needing inpatient rehabilitation(B=36.8) correlate to increased TLOS. Premorbid independence (B=28.6) and presence of care-giver (B=23.3) led to a reduction of TLOS. For successful receiving of prosthesis at 6months from surgery, diabetes (B=0.69) and CRF (B=0.31)were negative predictors. In the older cohort, presence of care-giver (B=18.6) predicted shorter TLOS whereas those needing inpatient rehabilitation contributed to longer TLOS(B=25.61). Those who needed for inpatient rehabilitation had statistically significant higher chance of receiving prosthesis later(B=0.53).

Conclusion: IHD, wound infection and need for inpatient rehabilitation, premorbid independence and care-giver availability are important predictors of TLOS. For receiving of prosthesis at 6months, predictors include needing inpatient rehabilitation, diabetes and CRF.

Key words: Amputation, rehabilitation, length-of-stay.


 
Case Report
Mrinal Joshi, Mahima Agrawal

CRPS of lower extremity - A case report and review

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1-7][No of Hits : 98]


ABSTRACT

Complex regional pain syndrome (CRPS) of the lower limb is a relatively uncommon entity as compared to CRPS of the upper extremity. Literature search has revealed only 2 retrospective case series and a single case report of lower extremity CRPS type I from 1975 to 2014 on Pubmed, isolated cases of CRPS type I of lower extremity have also been reported following knee surgeries and arthroscopies. This report presents a case of lower limb CRPS type I following blunt trauma to right foot, treatment of which was directed towards management of allodynia, vasomotor symptoms and surgical correction of deformity which had developed because of the disease, coping mechanisms were also reinforced through counselling and relaxation training. The individual responded well to treatment with a reported 75% reduction in the disabling symptoms and improvement in ambulatory status.

Key words: Complex regional pain syndrome.


 
Case Report
SiddharthRai, Dileep Kumar, Anil Kumar Gupta, VijaiPrakash Sharma

Oculo-auriculovertebral spectrum with radial anomaly: a rare case report

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1-4][No of Hits : 96]


ABSTRACT

Oculo-auriculovertebral spectrum (OAVS) or the Goldenhar syndrome is a rare developmental disorder with plethora of congenital anomalies which mostly affects structures arising from the first and the second branchial arches. The affected structures include cheekbone, jaws, mouth eyes, ear and vertebrae. The case which we are presenting here had classical features such as microsomia, unilateral microtia, microphthalmia and facial nerve palsy along with vertebral anomalies with additional signs as unilateral hearing loss and radial limb anomalies. OAVS with radial defect and limb abnormalities is a rare presentation and thus reported..

Key words: Goldenhar syndrome, ear malformation, hemifacial microsomia, microphthalmia, radial defect, facial nerve palsy, vertebral anomalies.


 
Case Report
Poonekar PD, Mishra P

“VAC” Technique as a Physiatrist’s Bridge between Debridement and Surgery : Case Report of Filarial Leg Ulcer

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1-3][No of Hits : 77]


ABSTRACT

Difficult ulcers have differing aetiologies calling for varying strategies. For long, physiatrists have been treating diabetic foot and decubitus ulcers with great success. The “vacuum assisted therapy” (VAC) technique is proven to alter the local milieu to facilitate wound healing. A known case of filariasis for last 14-15 years, presented with elephantiasis of left leg with a large ulcer. The financial status of the patient prevented usage of the commercial VAC machine and so “in-house” VAC technique innovations were used at a fractional cost. She was successfully treated using the VAC technique and spontaneous complete healing was achieved in 8 weeks and resulted in early rehabilitation. It was very cost-effective.

Key words: Vacuum assisted closure (VAC), negative pressure wound therapy (NPWT), local negative pressure therapy (NPT), topical negative therapy (TNP), vacuum assisted therapy (VaT), subatmospheric therapy, filariasis, leg ulcer, rehabilitation, rural.


 
Original Article
CV Shendkar, Bikas K Arya, PK Lenka, Ratnesh Kumar, Ahbishek Biswas, Mahadevappa M.

Conception, development and clinical trial design of point of care technologies: a case of improved FES device development.

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1-8][No of Hits : 68]


ABSTRACT

Objective: This article presents a case study on the development of an indigenous stimulator device, including the design of its clinical trials and the process of its clinical trial registration in the newly launched clinical trial registry- India (CTRI). The ethical and regulatory issues involved in medical device clinical trials in India are also discussed.

Design and Methods: The entire development and trial cycle of a new medical device from ideation to technology transfer is explained in this case of a newly developed indigenous FES device. The primary emphasis is on how to systematically analyse the global trial registry databases to adequately frame a medical device trial. With this case study, we present how to shortlist relevant trials; we then compare them and explain the valid methods for registering a trial protocol in the CTRI.

Conclusions: Our work can act as a model or guide for rehabilitation researchers in India, facilitating there work in the medical device design and trial protocol development. Though our trial has been designed for and registered in the Indian CTRI trial registry, our work can be equally useful for researchers abroad who desire to conduct their medical device trials in India

Key words: Clinical Trial Registry-India (CTRI), functional electrical stimulation, stroke rehabilitation, medical device design, medical device clinical trial protocol design, neuromuscular electrical stimulation.


 
Case Report
PK Mandal, SourinBhuniya

Idiopathic scoliosis: a case report. Pampa De

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1-6][No of Hits : 66]


ABSTRACT

Introduction: Scoliosis is defined as a lateral curvature of spine greater than 10 degrees as measured by the Cobb method. Idiopathic scoliosis is the most common form of scoliosis and adolescent idiopathic scoliosis is the commonest presentation which is detected after 10 years but prior to skeletal maturity. The treatment depends on the measurement of Cobb’s angle and subsequent exercises, bracing and surgery.

Case report: A 13 years girl presented with idiopatic scoliosis, pes cavus and hand knee gait which incapacitated her ambulation.Her spine radiograph revealed thoracic scoliosis with apex T8. She was given Boston brace with corrective exercises for scoliosis both in and out brace and a pair of floor reaction AFO’s with modifications in footplate for pes cavus. There was significant improvement in the gait and posture of the girl and she started going to school after a few months.

Conclusion: Conservative management in the form of bracing can prevent curve progression and floor reaction AFO’s can indirectly affect the remote body segments and improve gait and posture.

Key words: Scoliosis; polypropylene brace, polypropylene floor reaction AFO’s, Cobb’s angle.


 
Original Article
Babeena Rachel Chandy, AhanaChatterjee, RohitBhide.

Prevalence of upper limb neuropathy in rehabilitated spinal cord injured patients in souh India

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1-7][No of Hits : 61]


ABSTRACT

Introduction: Paraplegics with spinal cord injury, independent in activities of daily living (ADL) are known to have upper limb neuropathy due to constant use for mobility and transfers. Additionally architectural barriers, disabled unfriendly public transport, difficult terrains and sociocultural barriers in a developing country like India, further adds strain on the upper limbs. Hence, it is important to know the effects of these increased demands in terms of prevalence of peripheral neuropathies in rehabilitated spinal cord injured population from developing countries. In this study we tried to find prevalence of upper limb neuropathy in SCI population in South India.

Methods: Patients with spinal cord injury with a neurological level T2 and below, not having any other associated complication of upper limb due to any other disease apart from SCI were recruited in the study. Total 51 patients (45 male and 6 female) out of 183 patients screened, met key inclusion criteria. All the subjects who were recruited in the study underwent electrodiagnostic studies for the median, ulnar and radial nerves (both sensory and motor). The baseline demographic parameters such as time since injury, age, sex, American Spinal Injury Association scale (AIS), vocation, comorbidities and current mode of indoor and outdoor mobility were recorded. The final diagnosis based on electrodiagnostic study of median/ulnar/radial nerve was graded in scale of 0-2 with 0 being normal, 1 being neuropathy of one hand and 2 being involvement of both the hands.

Results: The scores from demographic data and electrodiagnostic data were accessed and categorical comparison was made between different types of mobility aids and neuropathy (CTS/ulnar/radial). The study showed an overall prevalence of 80% for median neuropathy, 24% for ulnar neuropathy and 16% for radial neuropathy. However, no statistical correlation was found between the use of any particular mobility aid, time since injury, vocation and neuropathy.

Conclusions: We found high prevalence of upper limb compressive neuropathy in the spinal injured population studied, however, due to the small sample size, no statistical significance could be found. We also found carpal tunnel syndrome to be the commonest neuropathy amongst the population especially in the groups that use wheelchair and elbow crutches for mobility.

Key words: Upper limb neuropathy in spinal cord injury, prevalence, mobility aids versus neuropathy in spinal cord injury.


 
Original Article
Gupta Neeraj, Goenka Sunil, Verma Manoj

A Comparative Study of Local Ultrasound Therapy and Local Steroid Injection in Patients of Carpal Tunnel Syndrome

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1-6][No of Hits : 60]


ABSTRACT

Introduction: Carpal tunnel syndrome is the most common compressive neuropathy of upper extremity affecting predominantly females of middle age group. Symptoms include pain, paracsthesia, numbness in median nerve distribution of hand.

Study design: Comparative type of interventional study.

Study area: Department of Physical Medicine and Rehabilitation, SMS Medical College and attached group of hospitals, Jaipur.

Duration of study: One and a half years April 2014-October 2015.

Aims and objective: To compare the efficacy of local ultrasound therapy and local corticosteroid injection for carpal tunnel syndrome management.

Study population: A total of sixty patients with CTS (age ≥18 years) were randomly assigned to the steroid treatment plus splinting(group A) or ultrasound treatment plus splinting(group B).

Results: The mean age of study population was 45.47±12.24 years with males comprising 13.3% and females 86.6% of whole study. At baseline all outcome variables were comparable statistically in both the groups (p>0.05). In follow-up assessment at 8th week, statistically significant improvement was obtained in all clinical and electrophysiological parameters in group A: Grip strength, symptom severity score, functional status score, median DML, sensory nerve conduction velocity (p<0.001 for each). Also the group B showed improvement in all parameters except grip strength. At the end of 24th week all outcome variables showed decline in improvement as comparative to 8th week, but still they were better than baseline in both groups. There was no significant difference between the groups in outcome variables except for the grip strength.

Conclusion: Ultrasound treatment provided improvement comparable to steroid injection in all clinical and electrophysiological parameters in patients with CTS except grip strength. Overall steroid therapy is more effective than ultrasound therapy. Effectiveness of treatment persist for at least 6 months then it lessens, so long follow-up is required.

Key words: Carpal tunnel syndrome, steroid treatment, ultrasound treatment, splinting.


 
Original Article
Nonica Laisram, Vinay Goyal, Shikha Bhatnagar, Tufail Muzaffar.

Changing trends in clinical profile of cerebral palsy.

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1-4][No of Hits : 60]


ABSTRACT

Background : There may be change in clinical spectrum of cerebral palsy (CP) due to improvement in maternal and child care health service. The clinical profile, aetiological factors and comorbidities of children with CP attending Department of PMR,VMMC & Safdarjang Hospital during the years 1981- 1989 and 2008 - 2012 were therefore compared and analysis done.

Methods: Four hundred and ten (group B) children with CP registered in last 4 years (2008 - 2012 ) at PMR Department of VMMC & Safdarjang Hospital were compared with previous study of 544 ( group A) children during year 1981 - 1989 from same centre.

Results : Spastic CP remained most common in both the groups. Diplegia is commonest type of CP ( 38.78%) as compared to previous group where quadriplegia ( 34.9%) was most common. The mixed type showed a statistical significant increase in percentage (group A: 0.18 % versus group B: 3.7 %).

In aetiology, there is decrease in prenatal and postnatal causes and increase in natal causes which were statistically significant. Birth asphyxia ( 50.3 %) remains the main aetiological factor as earlier (24.5%). Speech problems (59.7%), mental retardation ( 31.7%) and seizures (26.8%) are common comorbidities as compared to previous studies where mental retardation (47.2 %) was found to be most common followed by speech impairment (37%), visual impairment (9%) and seizures (8.8%).

Conclusions : Clinical profile of CP has evolved with an increase in diplegic and a decrease in quadriplegic CP.

Key words: Cerebral palsy, clinical profile.


 
Original Article
Pabitra Kumar Sahu, Pramod Kumar Parida, SP Das.

Management of Sacral pressure sore by clinical isolated superior gluteal artery perforator based fasciocutaneus flap in patients with spinal cord injury

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1-5][No of Hits : 59]


ABSTRACT

Prolong confinement to bed in spinal injury patients imparts constant pressure on bony prominences resulting impairment of blood flow to local tissue.Constant pressure of 2 hours or more produces irreversible changes leading to tissue necrosis and development of pressure sore. Sacrum encounters highest pressure in supine position and is the commonest site of pressure sore in spinal cord injury patients followed by trochanter and heel.

Objective of the study: Observation on management of sacral pressure sore by superior gluteal arterial perforatorbased flap using anatomical land marks in the absence of facility of Doppler probe for isolation of superior gluteal arterial perforators.

Materials and methods: Thirteen patients of spinal cord injury presented with sacral pressure sore were managed surgically using superior gluteal artery perforator-based flap coverage. The location of the artery was identified using anatomical land marks. In 10 patients the flap was heeled uneventfully, one had significant complication with wound dehiscence.

Conclusions: Management of sacral pressure sore by superior gluteal arterial perforator-based flap using anatomical land marks is a simple and reliable procedure. The learning curve is not that stiff. Sophisticated instruments are not required for this procedure

Key words: Pressure sore, sacrum, fasciocutaneus flap, spinal cord injury, paraplegia.


 
PG Forum

Book News

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 57]


ABSTRACT

1. Atlas of Ultrasound Guided Musculoskeletal Injections (Musculoskeletal Medicine) Softcover reprint of the original 1st ed. (October 1, 2016)by David A. Spinner (Editor), Jonathan S. Kirschner (Editor), Joseph E. Herrera (Editor)


 
Review Article
A. Abdul Gafoor, Mohan Raj M

Upper extremity prosthesis - what is new in it?

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1-3][No of Hits : 54]


ABSTRACT

Over the past 40 years, technology has dramatically affected the field of upper limb prosthesis. With improvement in the electronics industry, along with advances in the miniaturisation and mass production of electronic components, myoelectrically controlled prosthesis has become reliable and widespread in their use. Compared to lower extremity amputees, the acceptance of prosthetic replacement is less in upper extremity amputees. This may be due to different factors like functional needs, cosmetic factors, motivation of the patient, inadequate training following conventional prosthetic fitment, etc. More and more developments are going on in upper limb extremity prosthesis which will fulfill the need of the upper limb amputees. Such developments ensure better rehabilitation though cost is a limiting factor. This article is an earnest attempt to review the recent trends in upper limb prosthetics.

Key words: Upper limb amputees, myoelectric prosthesis.


 
Original Article
Lt Col Sonu Singh, Brig. L C Pandey, Lt Col A S Kalra

Management of Myofascial Pain Syndrome in Armed Force Personnel: Two Novel Therapeutic Approach

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1-8][No of Hits : 53]


ABSTRACT

Background : Myofascial pain syndrome is one of the commonest pain syndromes now a days. Its pathophysiology is not fully documented or understood. Goal of treatment is to release the pain and discomfort of myofascial pain syndrome.

Methods: This was a multicentric prospective study comprising 70 patients who had been diagnosed clinically with myofascial pain syndrome in the neck, shoulder or back. Cases were randomly divided into two treatment groups. First group (36 cases) were treated with physiotherapy modalities (extracorporeal shock wave therapy and ultrasound therapy as combination therapy) and patients in second group (34 cases) were treated with trigger point injection. In both the groups patients were advised stretching exercises as soon as pain decreases.

Results : Pain was substantially decreased in both the treatment groups but results were early and comparatively better in patients treated by trigger point injection group. Stretching exercises were helpful in regaining strength and also helpful in decreasing recurrence of pain.

Key words: Myofascial pain, stretching exercises, treatment, trigger point, US therapy


 
Obituary
Dr KK Menon. Dr George Joseph

Obituary

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 48]


ABSTRACT

Nearly a year ago, on a casual meeting at National Hospital, Kozhikode, Dr. K. K. Menon told me that he gets breathing difficulty in closed rooms occasionally and that he is having mild interstitial lung disease. I took it lightly and never expected that he will leave us so early.


 
PG Forum

Book News

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1][No of Hits : 48]


ABSTRACT

1. Running Injuries,Michael Fredericson, Adam S. Tenforde Physical Medicine & Rehabilitation Clinics of North America. February 2016Volume 27, Issue 1, p1-372


 
Original Article
Ajit Singh Naorem, Jugindro Singh Nigthoujam, K Wangjam, RK Rajesh.

Does radiologic grading predict severity of osteo-arthritis knee

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1-5][No of Hits : 46]


ABSTRACT

Objective: Evaluation of association between pain and functional limitation of osteo-arthritis knee with radiographic features.

Methods: Total of 123 knee OA patients diagnosed on the basis of American College of Rheumatology Classification (ACR) Criteria for knee OA, attended in Physical Medicine and Rehabilitation (PMR) OPD, JNIMS, were included. Pain and disability were measured using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiological grading by Kellgren-Lawrence (KL) grading from x-ray of weight bearing antero-posterior and lateral views. Correlation between WOMAC score and KL grading analysed.

Results: Sex distribution M:F=9:32, mean age 59.48 ( + 9.8), mean disease duration 4.79 ( + 0.41) months. Correlations of WOMAC pain and KL grading and WOMAC disability and KL grading were insignificant (p > 0.05).

Conclusions: There is discordance between radiographic findings and clinical features of OA knee and we should not plan treatment on the basis of radiologic grading rather on the functional status and symptoms.

Key words: Osteo-arthritis knee, pain, disability, WOMAC score, KL grading.


 
Original Article
Annada Sankar Mohes, Aten Jongkey, L Darendtajit Singh,ThBidyarani, L Nilachandra Singh, Akoijam Joy Singh

Neuromuscular Electrical Stimulation for Early Recovery of Motor Control of Ankle along with Spasticity in Stroke Patients A Prospective Randomized Controlled Study

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1-7][No of Hits : 45]


ABSTRACT

Background and Purpose: Effect of neuromuscular electrical stimulation in acute stroke patients while stimulating only single muscle is not known. The purpose of the study is to find the influence of early neuromuscular electrical stimulation to the motor point of tibialis anterior muscle of the affected limb in achieving early motor control of the ankle with reduction in spasticity in poststroke patients.

Methods: One hundred and thirty-two subjects were selected between 45and 65 years of age and within 2 weeks of the first attack of stroke. They were randomly divided into study and control groups comprising 66 subjects in each group. Study group received neuromuscular electrical stimulation to tibialis anterior muscle of the affected limb, 15 minutes twice daily, 5 days a week up to 3 weeks along with conventional exercise therapy whereas control group received only exercise therapy for that period. Outcome measures include Modified Ashworth Scale for spasticity of ankle plantar flexors, motor power of ankle dorsiflexors and plantar flexors, motor control of ankle joint. They were recorded before starting treatment, after 3 weeks and at 7 weeks following starting the treatment.

Results: Significant improvement of spasticity was noticed after 7 weeks follow-up (p=0.014). Significant improvement also noticed in ankle dorsiflexor motor power (p<0.001), ankle motor control (p=0.007).

Conclusions: Neuromuscular electrical stimulation along with traditional exercise programme is superior to exercise alone for early recovery of ankle motor control, plantar-flexor spasticity and ankle dorsiflexor motor strength.

Key words: Stroke, spasticity, motor control, neuromuscular electrical stimulation, tibialis anterior.


 
PG Forum

Rehab Quiz

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1][No of Hits : 45]


ABSTRACT

1. Most common ligament to be injured in ankle sprain -
a) Anterior talofibular
b) Posterior talofibular
c) Calcaneofibular ligament
d) Calcaneonavicular ligament


 
Original Article
Pallab Das, Naorem Ajit Singh, Suresh R, Mahiuddin Araf, Sanjay Wadhwa, U. Singh

The Response of Rehabilitation Management in Patients Presenting with Locomotor Symptoms of Benign Joint Hypermobility Syndrome

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1-9][No of Hits : 43]


ABSTRACT

The benign joint hypermobility syndrome (BJHS) was first addressed by Kirk as a distinct pathology in 1967, as the presence of rheumatic symptoms with generalised joint laxity in the absence of any demonstrable systemic rheumatic disease.
In this prospective, longitudinal, analytical study, we tried to find out the response of rehabilitation therapy in patients presenting with locomotor symptoms of BJHS and selected 61 patients randomly. The rehabilitation protocol followed: Explanation and reassurance, teaching of joint protection techniques and work modification, isometric muscle strengthening exercise (both extensor and flexor muscles), endurance exercise. Clinically most of the patients showed significant overall response quantitatively, in all the parameters.
It can be concluded that the rehabilitation protocol prescribed here is very much suitable both quantitatively and qualitatively for the patients of BJHS.

Key words: Benign joint hypermobility syndrome, locomotor symptoms rehabilitation theropy.


 
Original Article
G Sonachand Sharma, Y Nandabir Singh, Ak Joy, Bimol Singh, Alex T Touthang, Tamphaleima Devi

Study of effectiveness of shoulder elbow wrist hand orthosis in the management of glenohumeral subluxation in post-stroke hemiplegic patients

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1-9][No of Hits : 42]


ABSTRACT

Objective: Study of effectiveness of shoulder elbow wrist hand orthosis in the management of glenohumeral subluxation in post-stroke hemiplegic patients.

Methods: Design: Randomised control trial.

Setting: Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences (RIMS), Imphal.

Participants: Post-stroke hemiplegic patients (n=120) having glenohumeral subluxation (GHS) as confirmed by x-ray.

Duration: One and half years (August 2010 to January 2012).

Intervention: Control group (n=60) received routine rehabilitation programme for hemiplegic practice in the Department of PMR, RIMS while the experiment group (n=60) received shoulder elbow wrist hand orthosis in addition to rehabilitation programme.

Outcomes: Grade of glenohumeral subluxation using x-ray.

Results: Experiment group showed reduction in the glenohumeral subluxation which is statistically significant when compared to control group (p<0.001).

Conclusions: Use of upper limb orthosis in addition to routine rehabilitation programme can effectively reduce glenohumeral subluxation in post-stroke hemiplegic patients.

Key words: Glenohumeral subluxation (GHS), shoulder elbow wrist hand orthosis (SEWHO), Post-stroke hemiplegic patients.


 
Editorial
R.N. Haldar

Beat Diabetes

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1][No of Hits : 42]


ABSTRACT

In 2008, an estimated 347 million people in the world had diabetes but in 2016, the number increased to 422 million. The prevalence is growing, particularly in low- and middle-income countries.
The disease is responsible for 1.5 million deaths every year, with more than 80% of those occurring in low- and middle-income countries. WHO projects that diabetes will be the 7th leading cause of death by 2030.


 
PG Forum

Medical Philately

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 41]


ABSTRACT

Issued by Sri Lanka on Dec. 3, 2009

Country / Post         Sri Lanka
Date of Issue           3 December 2009


 
PG Forum

Medical Philately

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1][No of Hits : 40]


ABSTRACT

Theme: Day of the Disabled
Country          Egypt
Date                December 15, 1990


 
Pictorial CME
Pramanik R

Hirayama Disease

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 39]


ABSTRACT

A young right handed male labourerby profession from lower socio economic status presented with gradually progressive right hand weakness and clawing of right ring and little fingers for 5 months duration without any history of pain, tingling or numbness; not associated with any systemic disorder or history of trauma etc.


 
Editorial
RN Haldar

International Day of Persons with Disabilities (IDPD)

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 38]


ABSTRACT

“Let us work together for the full and equal participation of persons with disabilities in an inclusive and sustainable world that embraces humanity in all its diversity.”


 
PG Forum

Rehab Challenges

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 37]


ABSTRACT

A 45 years old housewife, doing active household chores, presented with constant dull aching pain and gradual bowing of both knees for past 2 years, increasing in severity day by day. Knee pain is aggravated by working, squatting, climbing stairs and relieved partially with rest. On examination, there was joint line tenderness, crepitation , with varus deformity of knee.


 
PG Forum

Article News

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 36]


ABSTRACT

1. Electromyographic Changes in Trunk Muscles During Graded Lumbar Stabilization Exercises by Chung Reen Kim, Dae Kwon Park, Seok Tae Lee, Ju Seok Ryu. PM&R. October 2016 Volume 8, Issue 10, Pages 979-989


 
Original Article
Gupta Ajay, Kothari SY

Lower pole release in congenital muscular torticollis - retrospective analysis of outcomes in 15 cases

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1-3][No of Hits : 35]


ABSTRACT

Congenital muscular torticollis is a common congenital problem. It is considered to be amenable to treatment which may be conservative or surgical. There are as yet no fixed guidelines as to the methodology or the timing of treatment. It is certainly advised to be prudent in selecting the appropriate treatment which should neither be too conservative nor over-invasive. We are reporting a series of 15 cases in which we did a unipolar release of the sternocleidomastoid muscle at the lower attachment. Retrospective analysis of 15 consecutive patients is done. During the postoperative period the parents were advised to regularly continue with the stretching exercises, focus on activities on the opposite side of the face and use a semi-rigid cervical collar, specially designed for active correction of these cases. We got very satisfactory postoperative results in most of our patients except one who had resistant deformity due to advanced age. In conclusion we would like to bring the focus back to unipolar release which is shifting unduly in favour of a bipolar release. This would also reduce the chances of the complication of accessory nerve injury. We have used the scoring system developed by Cheng et al and modified by Shim in which the present cases showed improvement of 7 points with p-value of less than 0.0001

Key words: Torticollis, unipolar release, rehabilitation.


 
PG Forum

Rehab Quiz

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 34]


ABSTRACT

1. What is Panner’s disease?
a) Osteochondritis dessicans of trochlea
b) Traumatic elbow dislocation
c) Median nerve compression at elbow by lacertus fibrosis
d) Epiphyseal aseptic necrosis of capitellum


 
PG Forum

Rehab Challenges

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 32]


ABSTRACT

A 10 years old boy from urban area and middle socioeconomic status, born from non-consanguineous marriage with history of birth asphyxia and developmental delay presented in our OPD with right upper limb and bilateral lower limb deformity with difficulty in walking and ADL for last 4 years. Patient was previously diagnosed as triplegic CP and got two times botulinum toxin injection along with regular unsupervised physiotherapy. Six months ago he started using KAFO for deformity of lower limb while walking.


 
Case Report
Sunny Gupta, Mitesh patel, anupam Sinha, Charles Wow Karech.

Electrodiagnosis of medical pectoral nerve mononeuropathy

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1-3][No of Hits : 32]


ABSTRACT

With an increased awareness to maintain physical fitness, weight training has become increasingly popular. Neurologic injuries are one of many injuries which can occur accidentally or with improper technique. We present a case of an isolated right medial pectoral nerve mononeuropathy in a 48-year-old male weightlifter.

Key words: Electrodiagnosis, medial pectoral nerve, mononeuropathy.


 
Case Report
VK Sreekala

A rare indication for amputation

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1-3][No of Hits : 31]


ABSTRACT

A forty-two years old housewife came to the outpatient department. She met with a very bad road traffic accident in childhood resulting in a crush injury of left lower limb and a degloving injury on the right lower limb. She had undergone transtibial amputation on the left and skin grafting on the right lower limbs. The scar has been transformed into a large keloid. Now she is ambulant with patellar tendon bearing prosthesis on the left side and a rocky hard, heavy, insensate right lower limb with a grotesque appearance. She requests amputation and prosthetic fitting on the right side.

Key words: Crush injury, degloving injury, amputation, prosthesis, keloid.


 
PG Forum

Medical Philately

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 30]


ABSTRACT

The origin of the Paralympic Games are credited to Professor Ludwig Guttmann, a neurologist and Neurosurgeon. A new perspective on the issue of rehabilitation for persons with disabilities was influenced by World War II. In 1944, Professor Guttman founded a medical center in the Stoke- Mandeville Hospital (UK) for the treatment of the people with spinal cord disabilities.


 
PG Forum

Article News

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 30]


ABSTRACT

1. The Effect of Body Mass Index on Fluoroscopic Time and Radiation Dose during Sacroiliac Joint Injections Daniel Cushman, Alexandra Flis, Ben Jensen, Zachary McCormick. PM&R. August 2016 Volume 8, Issue 8, p767-72


 
Case Report
Anand Viswanathan, Subbian Esakkimuthu

When a safety valve became a ticking time-bomb: fractured tracheostomy tube as a tracheobronchial foreign body in a child

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1-3][No of Hits : 30]


ABSTRACT

Tracheostomy Tube care is a part of respiratory rehabilitation in acquired brain injury but just tracheostomy tube insertion is not enough. Checking for Pre-requisites including manufacturing details, and regular follow - up is important. Here we present a rare case of fracturing of the tracheostomy tube in a traumatic brain injury which was managed timely.

Key words: Acquired brain injury, Tracheostomy.


 
PG Forum

Book News

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1][No of Hits : 30]


ABSTRACT

1. Concussion in Sports. Edited by Scott R. Laker. Physical Medicine & Rehabilitation Clinics of North America. May 2016 Volume 27, Issue 2, p373-538


 
PG Forum

Article News

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1][No of Hits : 29]


ABSTRACT

1. Acute Responses of Functional Electrical Stimulation Cycling on the Ventilation-to-CO2 Production Ratio and Substrate Utilization After Spinal Cord Injury. Ashraf S. Gorgey, Justin Lawrence. PM&R. March 2016 Volume 8, Issue 3, p225-234


 
PG Forum

Rehab Quiz

[Year:2016] [Month:December] [Volumn:27 ] [Number:4] [Pages:38] [Pages No:1][No of Hits : 29]


ABSTRACT

1. According to Census 2011, what is the percentage of persons with disabilities

a) 2.21% of the total population
b) 2.68% of the total population
c) 1.56% of the total population
d) 3.12% of the total population


 
PG Forum

Medical Philately

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1][No of Hits : 28]


ABSTRACT

The Department of Posts, through this issue, based on a painting by special children extends its love to Our World of Special Children and pays a tribute to all the individuals and organizations


 
Editorial
Rajesh Pramanik

Miles to go

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1][No of Hits : 28]


ABSTRACT

In the era of twenty first century most of the medical specialities are trying their level best to deliver their expertise throughout the country. Since few decades after inception Physiatry is lagging behind not only by the number of experts but also the quantity and quality of the services delivered in India. In reality only few states of the country are getting any kind of PMR services till the present day.


 
PG Forum

Rehab Quiz

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1][No of Hits : 27]


ABSTRACT

1. Which ligament of spine resists extension?
a) Posterior longitudinal ligament
b) Ligamentum flavum
c) Anterior longitudinal ligament
d) Interspinous ligament


 
PG Forum

Article News

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1][No of Hits : 27]


ABSTRACT

1. Ultrasound-Based Detection of Low Muscle Mass for Diagnosis of Sarcopenia in Older Adults. Marco A. Minetto, Cristina Caresio, Tommaso Menapace, Arnel Hajdarevic, Andrea Marchini, Filippo Molinari, Nicola A. Maffiuletti. PM&R. May 2016Volume 8, Issue 5, p453-462


 
Editorial
Randall L Braddom

PMR in India: SWOT analysis and way forward

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 27]


ABSTRACT

Historical Perspective:

Globally PMR began in the fourth decade of the last century in the USA mainly on World War 2 veterans, primarily by Dr. Frank Krusen. In India, the movement started in 1960’s after the China war for the war disabled by Prof. Sant, AIPMR, Mumbai


 
PG Forum

Book News

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 26]


ABSTRACT

1. Outpatient Ultrasound-Guided Musculoskeletal Techniques Edited by Evan Peck. Physical Medicine & Rehabilitation Clinics of North America. August 2016 Volume 27, Issue 3, p539-764


 
Pictorial CME
Pramanik R

Absent radial artery in Cavanagh Syndrome

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1][No of Hits : 25]


ABSTRACT

An young male patient presented to PMR OPD with difficulty to perform his ADL and regular jobs due to weakness of both hands. He was also suffering from wasting of bilateral thenar muscles of his hand from his childhood days. The weakness was gradually increasing day by day. Now a day it is becoming very difficult for him to do his job as a manual laborer. That’s why he came to receive proper treatment in a tertiary rehabilitation center


 
PG Forum

Rehab Challenges

[Year:2016] [Month:June] [Volumn:27 ] [Number:2] [Pages:30] [Pages No:1][No of Hits : 25]


ABSTRACT

A 50 year male patient presented with severe non inflammatory low back pain with radiation to right lower limb which was not responded with conservative treatment. That’s why he attended PMR OPD for further management and his VAS was 9/10. He was also facing difficulty to perform his daily jobs even basic ADLs. At that time he had right L5 S1 sensory radiculopathy without any motor deficit.


 
Pictorial CME
Sahibzada Nasir Mansoor

Rise of the Smart Phone Thumb

[Year:2016] [Month:September] [Volumn:27 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 23]


ABSTRACT

The recent boom of touch screen smart phones has made the users vulnerable to new cumulative trauma disorder involving tenosynovitis of the flexor tendon sheaths.


 
PG Forum

Rehab Challenges

[Year:2016] [Month:March] [Volumn:27 ] [Number:1] [Pages:31] [Pages No:1][No of Hits : 23]


ABSTRACT

This 26 years old literate male patient from a low socioeconomic status presented to PMR OPD with congenital limb deficiency involving his left limb (Fig 1). He has been using this extension orthoprosthesis (Fig 2) for past few years. He has difficulties in sitting and the patient cannot kneel or squat with this prosthesis. At this moment he has mild hip joint and knee joint pain which is managed with analgesics. His left knee and hip ROM is full with Tendoachilles contracture. His left hip girdle muscle power is 4/5 and power of muscles around knee joint is 4/5. The power of the ankle joint muscles couldn’t be examined due to contracture. The left sided femur length is 60% as compared to right.He does not want to undergo any further surgical procedure.


 
Case Report
Shiva Prasad, Vijay Gururaj Bangari, Priyanka Patil, Spurti N Sagar

Ultrasound guided trigger point injections in myofascial pain syndrome

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1-3][No of Hits : 70]


ABSTRACT

Trigger points as a cause of musculoskeletal or myofascial pain syndrome is well documented. Trigger points (Tr Ps) are tender and hypersensitive nodules seen in skeletal muscles which develop as a result of sudden or repetitive trauma to the muscles. They cause contractile state of a muscle with local or radiating pain. Active trigger points cause intense pain with limitation of movements of the muscles. The treatment involves deactivating the trigger points, usually done by various methods. Most common practice is myotherapy which involves deep tissue massage which is painful and time consuming. Dry needling and needling with anaesthetic injaection have been successfully used by many. Recently, ultrasound guidance is used to locate the trigger points and to accurately place the needle in to them to deactivate, thus preventing complications of blind procedures.

Key words: Ultrasound, trigger point, needling, myofascial pain.


 
Case Report
Kumar D, Pebam S

Tibialis posterior tendon transfer in post injection common peroneal nerve palsy in a pediatric patient

[Year:2015] [Month:March] [Volumn:26 ] [Number:1] [Pages:23] [Pages No:1-3][No of Hits : 55]


ABSTRACT

Post injection foot drop is due to common peroneal nerve damage at site of injection (gluteal region) in which dorsiflexor of foot EHL, EDL and tibialis anterior are weakend or paralysed. It can be managed by reconstructive surgery; tibialis posterior tendon transfer to EHL, EDL and 2nd metatarsal. Here objective is rehabilitation of post injection common peroneal nerve palsy foot drop in a paeditaric patient. Our method and outcome measure as first rehabilitation programme for foot drop paediatric patient (common peroneal nerve palsy) thereafter reconstructive surgery of tibialis posterior transfer to EHL, EDL and 2nd metatarsal. Last we re-educate them to tibialis posterior contraction for dorsiflexion of foot. Our result was patient was able to walk similar as normal, able to elevate her toes and foot. Patient was happy and confident with her functional foot. But patient was advised to avoid heavy work, sprinting, and active aggressive game (like foot ball). Our conclusion is patient gets benefited by this procedure.

Key words: Foot drop, post injection nerve palsy, tibialis posterior tendon transfer.


 
Original Article
Laisram N. Goyal V

Grading of adductor spasticity in cerebral palsy - A new approach

[Year:2015] [Month:March] [Volumn:26 ] [Number:1] [Pages:23] [Pages No:1-4][No of Hits : 43]


ABSTRACT

Spastic cerebral palsy is the most common form of cerebral palsy. Spasticity in hip adductor causes discomfort, stiffness and difficulties in performing physical activities such as seating, transfers and walking. Grading of hip adductor spasticity is still a challenge in the field of rehabilitation. A simple method to assess hip adductor spasticity and use it as outcome measures of intervention is needed in general clinical practice.
We propose a visual method for grading hip adductor spasticity i.e grade 1= touch at ankle, grade 2 = crossing at ankle and grade 3 = crossing at knee in spastic cerebral palsy children. We followed 60 spastic cerebral palsy children over a period of three months on oral antispastic medication and found it very useful to assess response to drug. Intially hip adductor spasticity of grade 3 was observed in 10 %, grade 2- 8.33%, grade 1- 26.66% and 45% patients had no scissoring. After three months of drug therapy improvement was observed as grade 3 seen in 1 % , grade 2 - 7%, grade 1 - 23.33% and patients with no scissoring rose to 63.3%. These observations show that visual method for hip adductor spasticity is a simple and helpful method for grading response to therapeutic intervention.

Key words: Cerebral palsy, spasticity, hip adductors.


 
Original Article
Chandy BR, Betty M, Magimairaj HP, Thomas BP, Tharion G

Ultrasound: a screening tool for carpal tunnel syndrome

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1-7][No of Hits : 41]


ABSTRACT

Haemorrhage is responsible for around 11% of stroke syndrome. Haemorrhage usually occurs at a single site. However, it can be at multiple sites in some specific conditions i.e. coagulopathy, vascular malformation, malignancy etc. A 56-year-old male with left sided hemiplegia was admitted in the rehabilitation ward of RIMS, Imphal. He was hypertensive and was on irregular medication for that. He was also an alcoholic and chronic smoker for last 20 years. Patient was conscious and clinical examination revealed left 7th and 12th cranial nerve involvement with left hemiplegia. Non-contrast CT scan of brain revealed right thalamus and left basal ganglia haemorrhages. Thorough history and investigations did not reveal any aetiology for bilateral haemorrhage. Patient was treated with conservative management and improvement was noticed in serial follow-ups. There are very few case reports about bilateral spontaneous intracerebral haemorrhage associated with other diseases like migraine, Japanese encephalitis etc. Cause of bilateral haemorrhage in our case is doubtful.

Key words: Intracrebral haemorrhage, stroke syndrome, cranial nerve.


 
Original Article
Chaudhary S, Sharma R, Kothari SY, Thukral BB.

Effect of caudal epidural steroid injection in chronic low back pain due to prolapse intervertebral disc

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1-4][No of Hits : 39]


ABSTRACT

Background: Low back pain (LBP) due to disc herniation is a frequent cause of back pain. It is a debilitating condition having enormous medical and socio-economic effects. Epidural injection of steroids has been used to treat LBP for many decades. Despite widespread use and numerous publications there is significant controversy with regards to the medical necessity and indications for epidural injections, hence we planned this study.

Materials and methods: This was a prospective follow-up study. Forty-one patients of confirmed diagnosis of prolapse intervertebral disc (PIVD) were included. Caudal epidural steroid injection (CESI) of 80 mg methylprednisolone acetate diluted in 20 ml of 0.9% saline was given. Outcome was assessed by Numeric Pain Rating Scale (NRS), Oswestry Disability Index (ODI), Straight Leg Raise (SLR) and Modified Schober Test (MST) at baseline, one, three, six and twelve weeks follow-up.

Results: Thirty-seven patients completed the study. Significant improvement in patient’s status was observed after CESI, as measured with MST, SLR, NRS and ODI at one and three weeks post injection and the improvement were maintained till 12th week. Eighty-three per cent of patients were satisfied at the end of the study and side-effects reported were mild.

Conclusion: CESI is a simple, safe and cost effective intervention procedure for the treatment of chronic LBP due to PIVD. It provides rapid pain relief and improvement of physical function starting within a week of injection.

Key words: Epidural injection, herniated disc, low back pain, prolapsed disc.


 
Original Article
Kumar R, Wadhwa S, Singh U, Yadav SL

A study of effects of intervention of botulinum toxin A on lower limb in children with spastic cerebral palsy

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1-8][No of Hits : 38]


ABSTRACT

Background: Electrodiagnostic test is considered as the gold standard for diagnosis of carpal tunnel syndrome (CTS). Ultrasonography provides a simple non-invasive means of visualising peripheral nerve pathology.

Objective: The objective of the study was to assess the role of ultrasonography in CTS and its correlation with the present day gold standard of nerve conduction studies (NCS).

Materials and Methods: A prospective cohort size of 100 subjects was calculated based on a hypothesized sensitivity of 90% and a confidence interval of 85-95%. All 100 subjects, 64 controls and 36 patients underwent nerve conduction studies and USG. Transverse images of the median nerve were obtained at three levels: proximal to the carpal tunnel inlet, at the carpal tunnel inlet and at the carpal tunnel outlet. The flattening ratio was also assessed at the tunnel inlet and outlet. Statistical analysis was done to corelate the ultrasound findings at each level with nerve conduction studies and calculation of the positive and negative predictive values. The cut offs of the cross-sectional areas of the median nerve at the three anatomical levels on ultrasonography were taken at the best sensitivity and specificity according to the ROC curve.

Results: We found that at any one anatomical level, the sensitivity of ultrasound to detect carpal tunnel syndrome by increase in the cross-sectional area of median nerve as compared to the nerve conduction studies is 90%.

Conclusions: At 45% specificity, ultrasonography could be used as a non-invasive and easily available screening tool in carpal tunnel syndrome. Also, the best level to look for nerve compression is at the level of the carpal tunnel inlet.

Key words: Carpal tunnel syndrone, ultrasound, median nerve.


 
PG Forum

Medical Philately

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1][No of Hits : 37]


ABSTRACT

1981 International Year of Disabled People social integration

Country     Singapore
Date            1981


 
Case Report
Chethan C, Vinay Goyal, Diganta Borah, Rajendra Sharma, Nonica Laisram

Syndrome of inappropriate antidiuretic hormone (SIADH) in traumatic spinal cord injury

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1-3][No of Hits : 36]


ABSTRACT

Hyponatraemia is a known complication associated with neurosurgical conditions including acute spinal injury. The prevalence of hyponatraemia in acute spinal cord injury has been known to be much higher than in the general population. Hyponatraemia is a marker of different underlying diseases and it can be a cause of morbidity itself; this implies the importance of a correct approach to the problem. The syndrome of inappropriate antidiuretic hormone (SIADH) is one of the most common causes of hyponatraemia; it is a disorder of sodium and water balance characterised by urinary dilution impairment and euvolaemic/hypotonic hyponatraemia, in the absence of renal disease or any identifiable nonosmotic stimulus able to induce antidiuretic hormone (ADH) release. It is a diagnosis of exclusion. We are reporting a case of hyponatraemia in a patient with lumbar spinal cord injury who was initially managed as any other hyponatraemia and was later diagnosed as suffering from SIADH.

Key words: SIADH, Hyponatraemia, spinal cord injury.


 
Original Article
Kumar D, Gupta AK, Sharma VP, Srivastava RN, Ahmed J, Singh S.

Traumatic thoracolumbar spine injury - a demographic study

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1-4][No of Hits : 36]


ABSTRACT

Study design and subjects: Cross-sectional descriptive analysis of data of patients with thoracolumbar SCI admitted for rehabilitation at a tertiary care centre from January 2011 to September 2014.

Objectives: To identify the demographic pattern of TLSCI admitted to this centre.

Setting: Department of PM&R, King George’s Medical University, Lucknow.

Methods: One hundred and thirty-three consecutive patients of traumatic TLSCI admitted for rehabilitation were included in the study. Detailed demographic, clinical, neurological evaluation as per ASIA scale and radiological assessment done and analyzed.

Results: Mean age of our sample was 29.62±5 years. There were 21.05% females and 78.95% males. A significant percentage (36.84%) was farmers/labourers, followed by students 26.31%. Majority (67.67%) had fall from height followed by road traffic accidents (21%). Only 3.76% received ambulance for transport and majority (87.22%) of the cases transported by hired four wheelers. Only 18.78% cases came to tertiary center within 2 hours and majority (70%) came after 8 hours of injury. Ratio of complete and incomplete injuries being 1.7:1. Most common vertebral involvement in 58.64% cases were of T12 and L1.

Conclusions: Majority of Indian population live in rural areas which have minimal accessibility to even primary care. This disparity should be removed by even distribution of specialty hospital and trauma care centres in rural areas with better transportation with trained staff for trauma care. A national SCI registry system is needed and SCI case should be reported from all hospitals so that rehabilitation programme planning can be done accordingly.

Key words: Thoracolumbar spinal cord injury (TLSCI), American Spinal Injury Association (ASIA), paraplegia, demography.


 
Pictorial CME
Pramanik R

Normal pressure hydrocephalus presented with confusion and trtropulsion.

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1][No of Hits : 35]



 
Case Report
Patil S, Thomas R

Brainstem haemorrhage due to autonimicdysreflexia in a person with C6 tetraplegia.

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1-3][No of Hits : 35]


ABSTRACT

Isolated hand palsy also known as ‘pseudoperipheral palsy’ is a rare presentation of ischaemic stroke, often mistaken for peripheral nerve lesion. Here, we report a 13 years old young girl presented with sudden onset right hand palsy without any typical features of either upper motor lesion or lower motor lesion. Ischaemic stroke caused by embolic infarct of left precentral gyrus was the possible cause for her. She was managed with physiotherapy interventions including electrical stimulation, strengthening, grip exercise etc. Such an isolated hand palsy resulting from stroke is a rarely reported entity.

Key words: Isolated hand palsy, ischaemic stroke, pseudoperipheral palsy.


 
PG Forum

Medical Philately

[Year:2015] [Month:March] [Volumn:26 ] [Number:1] [Pages:23] [Pages No:1][No of Hits : 34]


ABSTRACT

2004 Indian Institute of Social Welfare and Business Management Kolkata

Country     India
Date           2004


 
Case Report
Sahibzada Nasir Mansoor, Ahmed Zaheer Qureshi

Acquired flat foot due to tibialis posterior rupture, a known yet missed cause

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1-3][No of Hits : 33]


ABSTRACT

Rupture of tibialis posterior tendon is a known cause of acquired flat foot but the diagnosis is missed or delayed in most of the cases. It may lead to significant morbidity. We present a case of 13 years old boy with history of blunt trauma to his left foot one year back and presented with pain medial aspect of right foot and difficulty in prolonged walking and running. Clinically he had a flat and hyperpronated foot. His x-rays were normal and MRI revealed partial tear of posterior tibial tendon. He was recommended medial arch support, shoe modification, NSAIDs and referred to orthopedic surgeon for repair. Posterior tibialis tendon dysfunction is one of the concealed injuries that require earliest diagnosis and immediate attention, failing which the outcomes can have debilitating effects on patient’s quality of life. This is important to prevent foot deformities and long term disability.

Key words: Acquired flat foot, tibialis posterior, diagnosis.


 
Original Article
Sahoo P, Sahu M, Singh DK, Das SP

Predicting factors for development of heterotopic ossification in spinal cord injury patients.

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1-4][No of Hits : 33]


ABSTRACT

Objective: Analysis of clinical gait pattern, change in spasticity and range of motion (ROM) in cerebral palsy patient (CP) with spastic lower limb muscle after injecting botulinum toxin- A.

Study Design: Prospective study

Methods: 28 children (18 male and 10 female) with spastic CP had problems in normal walking, aged 2–9 years (mean age 4.65 years), consecutively treated in the PMR department over a 2-year period, were prospectively followed-up and clinically assessed pre- and post-treatment (at 2 weeks and 2 months) both objectively and subjectively. Objective assessment included gait parameters -- stride length, cadence, velocity, step length, base of support; active and passive range of motion (ROM), (measured by goniometry) and spasticity on modified Ashworth scale. Subjective assessment was done by asking questionnaire in terms of comfort, ease of care, perineal hygiene, walking. Injections were given using clinical palpatory method on OPD basis. All patients received botulinum toxin-A injections, followed with exercises and activities and orthosis as needed.

Results: Significant improvement was achieved for spasticity reduction in gastrocnemius (p< 0.001), hamstring and adductor (p=0.050), ankle AROM & PROM (p< 0.001), active knee extension (p=0.009), popliteal angle (p=0.015) and percentage left and right foot contact (p< 0.001), whereas non-significant change was observed in step length, cadence, velocity, stride length, and base of support. Parents felt subjective improvement in most of the cases (>90%).

Conclusions: Botulinum toxin- A injection is effective in the treatment of spastic lower limb muscles for equinus/ crouching/scissoring gait in cerebral palsy children. The treatment was feasible and easily implemented. Botulinum toxin- A injections were well tolerated, yielded no serious treatment-related adverse events.

Key words: Botulinum toxin-A, spastic cerebral palsy.


 
Case Report
Mohes AS, Singh LD, Jongky A, BidyaraniTh, Singh LN, Singh Ak Joy

A rare case of bilateral spontaneous intracerebral haemorrhage presenting with left hemiplegia.

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1-2][No of Hits : 31]


ABSTRACT

A 40 years old female with generalised dystonia and chronic low back pain was injected with botulinum toxin injection to extensor hallucis longus(EHL) for management of Hitchhiker’s toe. The patient benefited functionally but later developed EHL and extensor digitorum (ED) weakness. Further workup revealed degenerative L4/5 disc lesion causing L5 root affection as the cause for the weakness. This coincidental occurrence of EHL and ED weakness due to L4/5 disc lesion in a patient with generalised dystonia , following botox injection to EHL for management of Hitch hiker’s toe, has not been reported before. Case Report

Key words: Dystonia, Hitch hiker’s toe, botulinum toxin injection.


 
Pictorial CME
Pramanik R

Missed opportunity for thrombolysis in a patient of massic MCA territory stroke

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 30]


ABSTRACT

A 45-year old male presented to PMR OPD with left sided complete hemiplegia (Day 3) due to stroke. Then he was admitted in PMR Indoor for neurorehabilitation. On initial evaluation he was haemodynamically stable. Motor power of his left upper limb and lower limb was 0/5. He was on catheter and IV fluid on the day of admission.


 
Review Article
Ramamoorthy Veyilmuthu

The role of physiatrist in the diabetes healthcare team

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1-6][No of Hits : 30]


ABSTRACT

The physiatrist is an important member of the diabetes healthcare team. His/her primary role is to provide physical activity counselling for the diabetics after thorough evaluation. Exercise is a primary component of diabetes management together with diet plan and antidiabetic drugs. The physiatrist, with his/her background knowledge in exercise physiology, is the most appropriate person for this job. Regular exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss and improve well being. Furthermore, regular exercise may prevent type 2 diabetes in high risk individuals. Thus physical activity plays a pivotal role in health promotion and diabetes control. People with diabetes should be advised to perform at least 150 minutes per week of moderate intensity aerobic physical activity using ’FITT Principle’. In the absence of contra-indications, people with type 2 diabetes should be encouraged to perform resistance training three times per week. DeLorme resistance exercise improves power, strength, endurance and burns more calories. Cross training is the term used to describe the use of a variety of activities during exercise. Interval training is the variation of intensity during one or more aerobic activities. Circuit training is the combination of aerobic exercise and weight training (anaerobic exercise). Before recommending a programme of physical activity, the physiatrist should assess diabetics for coronary artery disease and other complications of diabetes.

Key words: ’FITT Principle’, DeLorme resistance exercise, cross training, interval training, circuit training.


 
PG Forum

Medical Philately

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 30]


ABSTRACT

2007 Obligatory Tax Red Cross Week. Generations

Country     Slovenia
Date           2007


 
Editorial
Rajesh Pramanik

Can interventional physiatry overrule conventional physiatry?

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 30]


ABSTRACT

Over last one decade there is a boom of Interventional Physiatry all over India. Specially the younger generation of Indian Physiatry community is showing tremendous inclination towards different types of interventions either blind or guided (USG/ C arm etc) procedures in different centres of PMR or different workshops during CME or conferences. This is very healthy, specific bold approach to practise the subject. The question is that “Are we neglecting the strength of conventional approach at the same time?”


 
PG Forum

Book News

[Year:2015] [Month:March] [Volumn:26 ] [Number:1] [Pages:23] [Pages No:1][No of Hits : 30]


ABSTRACT

1. Dawn Forman, Dimity Pond Care of the Person with Dementia: Inter professional Practice and Education. November 30, 2015. ISBN-13: 978-1107678453


 
PG Forum

Rehab Challenges

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1][No of Hits : 29]


ABSTRACT

A 5-year-old boy from poor socio-economic status presented to PMR OPD with difficulty in standing and inability to walk since 2 years of his age due to spastic diplegic cerebral palsy. On assessment in indoor there was significant untreated lower limb spasticity which made him almost bed bound (Fig 1). Initial response with exercise therapy and antispasticity medications was very poor. That’s why phenol chemoneurolysis was done on bilateral post tibial nerve. Subsequently diagnostic followed by therapeutic motor point block of bilateral hamstring muscles were done.


 
PG Forum

Book News

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1][No of Hits : 28]


ABSTRACT

1. Karkucak Murat, Cilesizoglu Nurce , Capkin Erhan ,Can Ipek et al. Education and Visual Information Improves Effectiveness of Ultrasound-Guided Local Injections on Shoulder Pain and Associated Anxiety Level: A Randomized Controlled Study. American Journal of Physical Medicine & Rehabilitation; 95 (1): 9–14.


 
Original Article
Md Abdus Shakoor, Mohammad Tariqul Islam, Md Muhibbur Rahman, md Shahidur Rahman, Md Moyeenuzzsaman

Evaluation of the effects of lumbosacrac corset on the patients with chronic non-specific low back pain

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1-5][No of Hits : 28]


ABSTRACT

A randomised clinical trial was conducted in the Department of Physical Medicine & Rehabilitation (PMR), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 81 patients having chronic LBP were included according to the selection criteria. Out of them, 31 (38.3%) were male and 50 (61.7 %) were female in a ratio of 1: 1.61. The mean age of the patients in study was 41.65 ± 8.41years. Female persons were affected in their earlier ages (between 30 and 45 years) than male. Most of the patients were housewives (54.3%). The patients were divided randomly into two groups by the way of lottery for the clinical trial. Group-A patients were treated with NSAIDs, activities of daily living instructions (ADLs) and lumbosacral corset and group-B patients were treated with NSAIDs and ADLs. The patients were followed up weekly for five weeks and significant improvement was recorded after the treatment in both the groups (p=0.001). In comparison between two groups, it was found that there was no significant improvement in pre-treatment, after 1st week and after 3rd week. A little bit improvement was found in group-A patients than group-B after 4th week (p= 0.06). But finally, there was significant improvement in group-A than group-B patients after 5th week (p=0.005). So, it may be concluded that both the treatment is effective for the patients with chronic non-specific LBP. But the patient may be more benefited if lumbosacral corset is used as an adjunct to NSAIDs.

Key words: Low back pain, lumbosacral corset.


 
Original Article
Kumar D, Bansal P, Bhardwaj A.

A feasibility assessment of international classification of functioning, diability and health (ICF) tool for locomotion in rural community of northern India

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1-5][No of Hits : 28]


ABSTRACT

Background: ICF is a valid tool to assess the degree and extent of disability, functioning, and health among patients. Its use in population to assess the disability is often limited.

Aim: To assess the feasibility of ICF tool in community settings among patients with any signs and symptoms of locomotion.

Design: Community based survey was carried out to assess the disability.

Setting: The studied individuals were assessed during house to house survey in a rural area of Himachal Pradesh, India. Any individual with any signs and symptoms of disability associated to locomotion was interviewed by the trained medical social worker at their home.

Population: Total 82 individuals were interviewed to study the degree and extent of disability related to locomotion.

Methods: An ICF tool version 2.1a as recommended by World Health Organisation was used for assessment.

Results: A total 82 people whom 58.5% were assessed using ICF tool and 40.0% of males and 50.0% of females observed with no problem of impairment for locomotion. Among those who reported, moderate level of impairment related to joints was observed among 32.4% females and 31.3 % males. Mild impairment for muscle power was present among 31.3% males and 29.4% of females. Assessment of extent of impairment observed that the lower limb was most commonly (about 40.0%) involved in both males and females. Both males and females were mostly observed with restricted performance for daily activities like using transportation, lifting/carrying of objects, walking and moving around using assisted equipment. About 47.9% and 31.3% of males responded that the design of building and technology for public use, as mild and moderate barrier respectively. Design of building for public use was observed as severe barrier among 38.2% of females.

Conclusions: Disability related to locomotor system involving lower extremities is most common form of disability. Mild to moderate level of impairment was observed among individuals with locomotor disability to carry out day to day activities.

Rehabilitation impact: ICF tool can be used to study the degree and extent of disability. A standard pattern of analysis and reporting the results would help to assess the effect of rehabilitative interventions in community settings.

Key words: ICF, feasibility, locomotion, community.


 
Case Report
Baqer A, Jai Shanthini S, Gawad WA

Hitchhiker's toe and lumbar disc lesion: a strange coincidence in a patient with idiopathic dystonia treated with botulinum toxin injection

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1-3][No of Hits : 26]


ABSTRACT

Autonomic dysreflexia is an important clinical complication occurring in patients with high levels of spinal cord injury. If untreated, the acute rise in blood pressure can cause end organ damage, including intracerebral haemorrhage. Though unusual, it can be fatal with large haemorrhages causing brain herniation syndromes. Here we report the case of a patient with C6 complete tetraplegia patient who developed brainstem haemorrhage during an episode of autonomic dysreflexia. The pathophysiology and treatment methods of this condition are discussed, highlighting the importance of preventive measures to avoid the same.

Key words: Autonomic dysreflexia, spinal cord injury, cerebral haemorrhage, hypertensive encephalopathy.


 
Editorial
Haldar RN

International day of persons with disabilities, 3 December 2015.

[Year:2015] [Month:December] [Volumn:26 ] [Number:4] [Pages:32] [Pages No:1][No of Hits : 26]


ABSTRACT

Heterotopic ossification (HO) is a frequent complication in spinal cord injury (SCI) that is often difficult to treat. the incidence ranges from 16-35%. Association of certain complications in spinal cord injury increases the incidence of HO. This is a cross-sectional study conducted at SVNIRTAR, Cuttack, Odisha from January 2009 to December 2014. Out of 132 SCI patients attended to OPD or admitted to SCI ward, HO at different site was diagnosed in 86 patients. A close observation was done on these patients with respect to their associated complications and their relation to development of HO is discussed.

Key wards: Heterotopic ossification(HO), spinal cord injury (SCI), spasticity, pressure sore.


 
PG Forum

Book News

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1][No of Hits : 26]


ABSTRACT

1. Glen Gillen. Stroke Rehabilitation: A Function-Based Approach. Edition: 4th. August 26, 2015. ISBN- 13: 978-0323172813.


 
Original Article
Minggam Pertin, Romi Singh Nongmailthem, C Zonunsanga, Hminghanmawii, Chongreilen Chiru, Yongkhom Jotin Singh

Quality of life in postmenopausal women and its correlation with bone mineral density

[Year:2015] [Month:September] [Volumn:26 ] [Number:3] [Pages:30] [Pages No:1-7][No of Hits : 26]


ABSTRACT

Aim: To evaluate the quality of life in postmenopausal women and its correlation with bone mineral density.

Study design: Cross-sectional study.

Duration of the study: October 2012 to September 2014.

Settings: Physical Medicine and Rehabilitation Department, Regional Institute of Medical Sciences, Imphal.

Study population: Postmenopausal women who attended the department during the study period.

Materials and Methods: Quality of life was assessed using WHOQOL-BREF questionnaire, a validated brief version of the WHOQOL-100. Bone mineral density (BMD) in the lumbar spine, femoral neck and trochanter were measured using dual energy x-ray absorptiometry (DEXA) scan - GE Lunar model.

Results: A total of 125 patients were studied. The mean t-scores in lumbar spine, femoral neck and trochanter were -2.550 ± 1.209, -1.831 ± 0.921 and -1.621 ± 1.064 respectively. The mean BMD (g/cm2) in lumbar spine, femoral neck and trochanter were 0.867 ± 0.144, 0.789 ± 0.131 and 0.682 ± 0.139 respectively. The mean overall WHOQOL score was 57.68±10.07. There were statistically significant positive association of WHOQOL score with the BMDs in lumbar spine, femoral neck and trochanter (p < 0.05). Multivariate regression showed significant relation of overall WHOQOL score with BMD lumbar spine (b=0.229; R2=0.119), BMD femoral neck (b=0.285; R2=0.129), and BMD trochanter (b=0.245; R2=0.119).

Conclusion: BMDs in the lumbar spine, femoral neck and trochanter had a positive correlation with quality of life scores. BMD also had a good predictive value in determining the quality of life in postmenopausal women.

Key words: Quality of life, postmenopausal women, osteoporosis, WHOQOL-BREF, bone mineral density.


 
PG Forum

Rehab Quiz

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1][No of Hits : 26]


ABSTRACT

1. Which of the following micro processor knee uses artificial intelligence function?

a. Nabtesco hybrid knee
b. Ossur rheo knee
c. Ottobock C-Leg
d. All of the above


 
PG Forum

Rehab Quiz

[Year:2015] [Month:March] [Volumn:26 ] [Number:1] [Pages:23] [Pages No:1][No of Hits : 26]


ABSTRACT

1. After a meniscus repair, your patient should be non-weight bearing for
a) 7-10 days
b) 2-3 months
c) 4-6 weeks
d) 1-2 days


 
PG Forum

Rehab Challenges

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1][No of Hits : 25]


ABSTRACT

A 26 years old male patient presented to PMR OPD with spastic quadriplegia and immobility since last 2 years due to a compressive myelopathy after a road traffic accident. He was treated by neurosurgeons for initial few months and became haemodynamically stable within few days though there is no significant neurological recovery over the months. Thereafter patient was poorly managed mainly at home with little bit of unsupervised physiotherapy.


 
PG Forum

Article News

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1][No of Hits : 25]


ABSTRACT

1. Assis, Livia PhD; Almeida, Thais; Milares, Luiz Paulo MS; dos Passos, Nayara; Arañjo, Bruna; Bublitz, Caroline MS; Veronez, Suellen MS; Renno, Ana Claudia Muniz PhD. Musculoskeletal Atrophy in an Experimental Model of Knee Osteoarthritis: The Effects of Exercise Training and Low-Level Laser Therapy. American Journal of Physical Medicine & Rehabilitation; 94(8): p 609-616.


 
Original Article
Basak A, Pramanik R, Das P, Ballav A.

A comparative study on effectiveness of intra-articular injection of high molecular weight hyluronate, steroid and high molecular weight hyaluronate plus steroid in osteo arthritis knee

[Year:2015] [Month:June] [Volumn:26 ] [Number:2] [Pages:29] [Pages No:1-7][No of Hits : 25]


ABSTRACT

Background: Although primary osteo-arthritis is well known as a benign degenerative condition, the impact of this disease course is becoming terribly disabling day to day in our community possibly because of increasing life expectancy. After lots of search regarding the role of intra-articular hyaluronic acid plus steroid in osteo-arthritis knee it is noted that scarcity of literature regarding conclusive evidence for the above. There is a grey zone regarding the combined role of these two agents in patients with primary osteo-arthritis. This project is a humble sincere attempt to find out the role of high molecular weight hyaluronate plus steroid in osteo-arthritis knee and to compare the effectiveness of this with intra-articular steroid, and intraarticular HMW hyaluronic acid.

Methods and Design: This is a single blind randomised controlled parallel group study conducted in the department of physical medicine and rehabilitation, IPGME & R, SSKM Hospital, Kolkata for a period of 18 months taking 27 subjects in each group. All patients with primary osteo-arthritis knee with grade two or grade three were included in the study group. And those who did not want to get incorporated in the study, patients with secondary osteo-arthritis knee, grade one or grade four osteo-arthritis knee, with gross knee instability, patients with contra-indications of intra-articular injections or intra-articular injection of steroid or with history of allergy to a viscosupplementation solution and patients received intra-articular injection in knee within last one year were excluded from the study. WOMAC pain, stiffness and functional subscales, VAS pain, ROM of knee joint, 50 feet walk time, Patients global assessment scale, Physicians global assessment scale were the parameters studied. After taking clearance from the institutional ethical committee, patients were selected based on the inclusion and exclusion criteria, and baseline (visit-1) assessment was done on the parameters. The selected patients have been divided into three groups randomly. Written informed consent was taken from all patients before interventions. One group received intra-articular injection of methylprednisolone, second group received intra-articular injection of high molecular weight hyaluronoic acid , and third group received intra-articular injection of high molecular weight hyaluronate plus methylprednisolone in the knee joint. The injections administered under strict aseptic condition. After administering injections, the patients assessed at the interval of 6 weeks ( visit-2 ) and 12 weeks ( visit-3 ) using the parameters mentioned above. The results have been analysed according to the standard statistical methods to fulfill the aims and objectives of the study.

Discussion: Majority of patients were female and more than 50 years of age with K-L radiological grade of 3. At the baseline visit, the WOMAC pain was comparable in all the three groups. It has been seen that, there was statistically significant improvement in all the parameters at the 2nd visit ( 6 weeks ) from the baseline in all groups, and at the 3rd visit