Indian Journal of Physical Medicine and Rehabilitation

Register      Login

Table of Content

2017 | October-December | Volume 28 | Issue 4

EDITORIAL

Transformation toward Sustainable and Resilient Society for All

[Year:2017] [Month:October-December] [Volume:28] [Number:4] [Pages:1]

   DOI: 10.5005/ijopmr-28-4-iv  |  Open Access |  How to cite  | 

Original Article

Kaustav B Thakur, N Romi Singh, 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] [Volume:28] [Number:4] [Pages:7] [Pages No:115 - 121]

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

   DOI: 10.5005/jp-journals-10066-0013  |  Open Access |  How to cite  | 

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.

Original Article

Mohit Kataruka, Rathindranath Haldar

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

[Year:2017] [Month:October-December] [Volume:28] [Number:4] [Pages:8] [Pages No:122 - 129]

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

   DOI: 10.5005/jp-journals-10066-0014  |  Open Access |  How to cite  | 

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.

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] [Volume:28] [Number:4] [Pages:6] [Pages No:130 - 135]

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

   DOI: 10.5005/jp-journals-10066-0015  |  Open Access |  How to cite  | 

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.

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] [Volume:28] [Number:4] [Pages:4] [Pages No:136 - 139]

Keywords: Amputee, Mobilization, Transtibial, Unhealed wound

   DOI: 10.5005/jp-journals-10066-0016  |  Open Access |  How to cite  | 

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.

CASE REPORT

Nitin A Menon, Dwarkadas K Baheti, A Menon Nitin

Management of Primary Hyperhidrosis with Sympathetic Block

[Year:2017] [Month:October-December] [Volume:28] [Number:4] [Pages:3] [Pages No:140 - 142]

Keywords: Epidural catheter, Hyperhidrosis, Sympathetic block

   DOI: 10.5005/jp-journals-10066-0017  |  Open Access |  How to cite  | 

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.

MISCELLANEOUS

Firdaus Kamal

Pictorial Continuing Medical Education

[Year:2017] [Month:October-December] [Volume:28] [Number:4] [Pages:1] [Pages No:143 - 143]

   DOI: 10.5005/ijopmr-28-4-143  |  Open Access |  How to cite  | 

MISCELLANEOUS

Medical Philately

[Year:2017] [Month:October-December] [Volume:28] [Number:4] [Pages:1] [Pages No:144 - 144]

   DOI: 10.5005/ijopmr-28-4-144  |  Open Access |  How to cite  | 

MISCELLANEOUS

Postgraduate Forum

[Year:2017] [Month:October-December] [Volume:28] [Number:4] [Pages:3] [Pages No:145 - 147]

   DOI: 10.5005/ijopmr-28-4-145  |  Open Access |  How to cite  | 

© Jaypee Brothers Medical Publishers (P) LTD.