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Year : 2021  |  Volume : 15  |  Issue : 3  |  Page : 1-76

AOCNR EPoster Abstract

Date of Web Publication16-Mar-2022

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How to cite this article:
. AOCNR EPoster Abstract. Physiother - J Indian Assoc Physiother 2021;15, Suppl S1:1-76

How to cite this URL:
. AOCNR EPoster Abstract. Physiother - J Indian Assoc Physiother [serial online] 2021 [cited 2023 Jun 5];15, Suppl S1:1-76. Available from: https://www.pjiap.org/text.asp?2021/15/3/1/339728

  Neurodegeneration with brain iron accumulation: A rare and unique challenge in neurorehabilitation Top

Sucheta Saha, Nonica Laisram

Consultant Rehabilitation Physician, Institute of Neurosciences Kolkata,Kolkata, India

E-mail: [email protected]

Introduction: Neurodegeneration with brain iron accumulation (NBIA) is a rare, heterogeneous group of neurologic disorders characterized by abnormal accumulation of iron in the basal ganglia. It is a relentlessly progressive neurodegenerative disorder, without any cure. Neurorehabilitation can play an important role in management of this rare disorder.

Case Description: An 18-year-old male patient presented to the Physical Medicine and Rehabilitation Outpatient Department of Vardhman Mahavir Medical College & Safdarjung Hospital with features of gradually increasing involuntary movement of neck, speech and swallowing difficulties. He was a diagnosed case of NBIA with characteristic 'Eye of the Tiger' appearance in MRI. Pharmacotherapy did not show any significant improvement. Injection Botulinum toxin was given for his cervical dystonia and he achieved remarkable improvement in the Fahn-Marsden dystonia scale scoring 2 weeks after the injection.

Discussion: Only a handful of cases are reported from India, who received mostly symptomatic treatment. Medications like Baclofen, Trihexyphenidyl has shown some effect. In this case, the effect of Botulinum toxin was noticeable and it improved the quality of life of the patient in conjunction with supportive rehabilitation care. It can be used as an effective adjunct to the pharmacotherapy in this rare neurological disorder.

  Therapeutic neural normalization for phonological judgment in developmental dyslexia Top

Sunita Gudwani, Manju Mehta, Rajesh Sagar, Madhuri Behari, Vaishna Narang, Sadanad Dwivedi, N.R. Jagannathan, S. Senthil Kumaran

Department of Neuro Rehab, Speech Therapy and Audiology, Escorts Heart Institute and Research Center, New Delhi, India.

E-mail: [email protected]

Background and Aims: Reading and writing has specialized cortical architecture. Children and adolescents with dyslexia have reading, spelling, writing problems and may involve phonological deficits. It's reported that neural deficits may not directly reflect in behavior, and evidence-based interventions are critically needed. Hence in this study therapy was tailored on neurobiological parameters and remedial gains were measured.

Methods: After ethical approval 30 participants were randomly allocated to two groups Group A (therapy, Rx) and Group B (wait-list, nonRx). Assessments were done at baseline and follow-up. Management for group A was tailored based on (baseline) potential parameters (negative and positive) evaluated with behavior and task evoked functional magnetic resonance imaging (task-fMRI). Final analysis of twenty-four participants' (Rx n=12; nonRx n=12) data was done with SPSS (behavioral performance) and SPM12 (fMRI).

Results: Significant improvement in reading, spelling, writing errors were observed in Rx group compared to nonRx. Cortical reorganization understood with fMRI (English meaningful-words and pseudowords paradigm) where the baseline activity observed in left postcentral gyrus, cingulate (BA 24), middle frontal (BA 6), and bilateral insula. Post therapy (follow-up) activity observed in bilateral fusiform (BA 37), left inferior occipital (BA 17), right inferior (BA 47), middle (BA 6) frontal gyri and anterior cingulate (BA 32). In group B (nonRx) follow-up activity was in right insula (123 parietal), precuneus (133 parietal, 12 occipital), cuneus (10 clusters) and bilateral frontal (right superior, middle frontal and left BA 46) and left superior temporal (BA 22).

Conclusions: Therapy induced neuralplastic normalization with significant improvement in performance.

  Gait comparisons during the timed up and go in elderly with and without benign paroxysmal positional vertigo: A preliminary study Top

Haziqah Nasruddin, Haidzir Manaf, Maria Justine

Department of Physiotherapy, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia.

E-mail: [email protected]

Background and Aims: Turning while walking is an important functional mobility task. While there is a considerable body of work on postural alteration in benign paroxysmal positional vertigo, rarely study on gait has been done, especially among the elderly. This study aims to compare the gait parameters during the Timed Up and Go Test (TUG) (time to complete TUG, steps taken to complete TUG, turning time during TUG, and turning steps during TUG) among elderly with BPPV (BPPV) and without BPPV(WBPPV).

Methods: Thirty-four aged-matched participants (17 BPPV and 17 WBPPV) underwent gait assessment while performing the TUG. Gait parameters 1) time to complete TUG 2) steps taken to complete TUG 3) time taken to complete turn during TUG, and 4) the number of steps taken during turning were recorded using a videotaped.

Results: A Mann-Whitney test indicated that time to complete TUG (22.0 vs 13.0, p= 0.008), steps taken to complete TUG (21.8 vs 13.2, P=0.04), turning time during TUG (22.3 vs 12.7, p= 0.005) and turning step (22.3 vs 12.7, p=0.01) were significantly greater in the BPPV than WBPPV.

Conclusions: The result shows that BPPV altered gait function, especially during turning. Furthermore, the elderly with BPPV is at risk of getting a fall while turning. All older people who presented with BPPV must be assessed and prescribed with gait training.

  Aphasia with apraxia secondary to arteriovenous malformation rupture – A case report Top

Gomathi Saravanan, Athira P. Gopi, Rakesh C. Veerabhadrappa, Usha A. Dalvi

Department of Audiology and Speech-Language Pathology, Aarupadai Veedu Medical College and Hospital, Puducherry, India.

E-mail: [email protected]

Arteriovenous Malformation (AVM) is one of the manifestations of vascular deformities in which normal separation of the arterial system from the venous system fails to occur. This kind of aberration could be fatal when a high-pressure arterial system is directly connected to the low-pressure venous system without an interposing capillary bed affecting the venous walls, which leads to hemorrhage. In younger adults, brain AVM is the primary cause of cerebral hemorrhage. The incidence of AVMs is between 1.12 and 1.42 per 1,00,000 person/year (Abecassis et al., 2014). However, brain AVM incidence and prevalence rate are still uncertain as 88% of cases are presented asymptomatically (Shaligram et al., 2019). Symptoms of hemorrhage can vary from severe headache to unconsciousness. Brain tissue damage in the hemorrhagic site can lead to sequelae such as seizures, hemiparesis, and language deficits. Data regarding the extent of language deficits and speech motor deficits in brain AVM cases is lacking. The current case report focuses on a 22-year-old male who primarily presented with speech and language impairment. Imaging tests revealed a left frontal AVM with a subacute hematoma. Post medical management, the patient was referred to the Department of Speech-Language Pathology for availing of rehabilitation services. A comprehensive evaluation was carried out, and profiling of speech and language characteristics was done with standardized test materials. With diffuse nature, the patient exhibited severe word retrieval deficit, articulatory groping, and oro-motor deficits. Provisionally, the patient was diagnosed with Broca's Aphasia with Apraxia of Speech and receiving therapy for the same.

  Preparedness in stroke caregiving among family caregivers Top

Mohd Amirul Aizad Binbaharudin, Muhammad Arif Razak, Farrah Wahida Sulaiman, Zulkanain Errie, Shamsulamri Mohd

Department of Physiotherapy, Training Institute of Ministry of Health of Malaysia, Sungai Buloh, Malaysia.

E-mail: [email protected]

Background and Purpose: The term cerebrovascular accident (CVA) is used to interchangeably with stroke to refer to the vascular condition of the brain. This scenario also has put the immediate family members to become the family caregivers without knowing whether they are well prepared or not. Moreover, it is important to ensure that family caregivers are ready to take care of stroke patients in order to increase their contribution to the rehabilitation of stroke patients. Therefore, this study is intended to highlight the preparedness in stroke caregiving among family caregivers.

Objective: To determine the preparedness in stroke caregiving among family caregivers.

Methods: A cross-sectional study was carried out with a convenience sampling of 85 family caregivers of stroke patients using self-administered questionnaires, demographic data and preparedness for caregiving scale (PCS) at Rehabilitation Medicine Department of Hospital Sungai Buloh, Selangor. Data analysis was based on Statistical Package for Social Sciences (SPSS) software version 21.0.

Results: There are significant associations between preparedness for caregiving scale (PCS) score with age (p < 0.001) and gender (p < 0.05) but no significant association between income and PCS score. The younger and female caregivers are more prepared than older and male family caregivers in stroke caregiving. PCS score are greater in higher income caregivers.

Conclusions: The findings of this study could improve the delivery of services in terms of patient education and motivation among stroke family caregivers.

  Dysarthria with oropharyngeal dysphagia secondary to gangliocapsular intraparenchymal haemorrhage - A case report Top

Gopika B. Kumar, Rakesh Chowkalli Veerabhadrappa

Department of Audiology and Speech Language Pathology, Aarupadai Veedu Medical College, Vinayaka Mission University, Kirumampakkam, Puducherry, India.

E-mail: [email protected]

Intraparenchymal haemorrhage (IPH) is intracerebral bleeding in which the bleeding is within the brain parenchyma. Capsulo-ganglionic haemorrhage is the most common form of intracerebral haemorrhage (ICH). A recent systematic review showed that the prevalence of cerebrovascular accident (CVA) in different parts of India ranged from 44.29 to 559/100,000 persons and its incidence ranged from 105 to 152/100,000 persons/year during the past two decades (Tangella, Iqbal, & Nayakar, 2020). ICH accounts for around 10%–20% of CVA.The most important risk factor for ICH ishypertension. Other risk factors include tumour, trauma, cavernous malformation, and CVA (Voelker, 1997). Clinical signs include hemiparesis, dysphagia, impaired speech and language skills, loss of balance and coordination, confusion, and delirium. The present case report focuses on a 52-year-oldmalepatientwho reported to the speech-language diagnostics department with slurred speech andswallowing difficulties for four months following the IPH. CT scan revealed ICH in the right Capsulo-ganglionic region. The clinical examination indicated inappropriate pauses and stress, imprecise consonants production, increased nasal airflow andspeech rate, reduced velocity and degree of velar movement during speech. Swallowing difficulties were more noticeable in liquids than solid or semi-solid foods. Also, increased latency for chewing and immediate aspiration for liquid foods were observed. The detailed case history revealed restricted speech and swallowing skills with intact language and cognitive functions. Standardized tests such as Western Aphasia Battery, Frenchay Dysarthria Assessment, and Swallowing Ability and Function Evaluation were administered.Based on the test results, the patient was clinically diagnosed with Hypokinetic Dysarthria with oropharyngeal dysphagia.

  Solat as a strategy to improve functional outcomes Top

Intan Sabrina

Department of Rehabilitation Medicine, Ministry of Health, Kuala PIlah, Malaysia.

E-mail: [email protected]

Introduction: Solat (Muslim prayer) has been recognised as a low to moderate intensity physical activity in recent publications. The ability to perform Solat successfully requires physical, cognitive, psychological and emotional abilities.

Objectives: To review the current literature on the health benefits of Solat and classify them using the International Classification of Functioning, Disability and Health (ICF) conceptual framework.

Methods: A scoping review was performed using keywords like “Solat” OR “Salat” OR “Muslim prayer” AND “health benefits” on Google and Pub Med search engines published until May 2021. Only full papers were included for the review. Duplicates, promotional brochures, blogs, news articles and religious commentaries were excluded. Selected papers were screened for health benefits and sub-divided into the ICF domains: body functions and structures; activity limitations; participation restriction; personal and environmental factors.

Results: Out of 11,300 and eight articles identified from Google and PubMed search engines respectively, only 17 articles fulfilled the selection criteria. Solat improves cardiovascular and respiratory fitness; cognition, musculoskeletal flexibility and strength; balance and coordination; and increased penile tumescence. Alpha wave amplitudes were increased in the parietal and occipital regions and heart rate was at its lowest during prostration (sujud), suggesting heightened relaxation state due to increased parasympathetic response. People who Solat regularly are more independent, mobile, less stressed and depressed.

Conclusions: Solat is a low to medium intensity activity. It improves body functions and structures; activities and participation; and have psychological benefits. Solat may be used as a strategy to improve functional outcomes.

  Delivering healthcare in rural areas Top

Intan Sabrina

Department of Rehabilitation Medicine, Ministry of Health, Kuala Pilah, Malaysia.

E-mail: [email protected]

There are many challenges in delivering healthcare in rural areas, especially when the information and communication technology (ICT) infrastructure is not as advanced compared with urban areas. Mobile health (mHealth) using mobile phones may be a solution for some population. Barriers to mHealth include poor network coverage, low smart phone and internet penetration, lack of awareness and/or expertise in telemedicine among healthcare providers and the community, preference for face-to-face consultation, lack of political will and competing health priorities. This paper will discuss on the challenges and solutions in delivering healthcare in rural areas. Healthcare providers need to adapt to the local culture and demands in order to improve access to quality and equitable healthcare.

  Effects of combining Botulinum toxin type A injection with Robotic Gait Training on gait performance in patients with stroke: A preliminary report Top

Shih-Ting, Huang, Simon Tang

Department of Rehabilitation Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan

E-mail: [email protected]

Introduction: Stroke often results in muscle over-activity which may cause deformity, gait disturbance and impaired motor control. Several studies focused on the therapeutic effects of intra-muscular (IM) Botulinum toxin type A (BTX-A) injection on lower limb spasticity and showed benefits in posture control and spasticity reduction. Additionally, several therapeutic benefits of robot-assisted gait training for stroke patients have been reported as improvements in walking independence, functional walking ability and gait speed. Therefore, the objectives of this study are to investigate whether the treatment of combining BTX-A injection with Robotic Gait Training can enhance the gait performance of the patients with stroke during ambulation or not.

Materials and Methods: In this prospective, case-controlled study, we recruited 19 patients with stroke, and they were divided into 3 groups for BTX-A Injection (n=5), Robotic Gait Training (n=10), and Combined Treatment (n=7). Each subject will undergo center of pressure measurement during ambulation before the initiation of the therapeutic program and after that for 4, 8, 12 weeks. The robotic gait training is for 30 minutes a day, 3 to 5 days a week, for 4 weeks. The dosage of the BTXA will be individualized according to the severity of muscle spasticity.

Outcome: Measures We use the L2ens-B (Free4act walk, Italy) to get gait parameter of speed, cadence and stride length during gait, and uses these parameters to calculate Symmetry index (SI). The repeated measurement analysis of variance (ANOVA) was used to compare the center of pressure data from center of pressure assessment among each group. The independent t test will be used to compare data among BTX-A injection, Robotic Gait Training and Combined Treatment group.

Result: In our study, all of groups improved in walking speed at the third follow-up assessment, the difference was statistically significant only in Robotic Gait Training group (p=0.012). Otherwise, combined treatment group have lowest symmetry index in the stance phase and swing phase at the third follow-up assessment, which means combined treatment improve balance and gait.

Conclusion: Robotic Gait Training might have a long-term effect in hemiplegic patients. In addition, combined with BTX-A injection, balance and gait were improved in stroke patients.

  Use of the Canadian occupational performance measure for a patient with Guillain Barre syndrome: A client-centered Occupational Therapy program Top

Aparna Rao

Department of Occupational Therapy, D Y Patil University, Navi Mumbai, Maharashtra, India.

E-mail: [email protected]

The Canadian Occupational Performance Measure (COPM) was used as a client-centred outcome measure in a client with Guillain Barre syndrome. The client was assessed using the COPM on admission, and his Occupational Therapy program incorporated activities that he identified as important for him to improve. Majority of the chosen activities were related to mobility, transfers and ambulation. The COPM was repeated at discharge. The results showed a statistically significant increase in the client ratings of performance and satisfaction. This study showed the effectiveness of the COPM as an outcome measure of Occupational Therapy in a long term rehabilitation setting.

  Efficacy of 'speech companion' app in facilitating oromotor strength in adult patients with flaccid dysarthria Top

Noorain Alam, Sanjay Munjal, Naresh Panda, Ramandeep Kaur, Gurmannat Kaur Shipra

Department of ENT, Speech and Hearing Unit, PGIMER, Chandigarh, India.

E-mail: [email protected]

Background and Aims: Dysarthria affects respiration, phonation, resonance and articulation. Speech Companion is downloadable Android app with a minimal cost that has a collection of short videos in which a speech therapist demonstrates an exercise.

Aim: To assess the efficacy of Speech Companion mobile app to improve the oromotor strength and range of motion of articulators in patients with Flaccid Dysarthria.

Methods: Total ten patients diagnosed with Flacccid Dysarthria were assessed by using the FDA which assesses the oro-motor parts in terms of structure, function and speech functions. They were divided into subject group and control group comprising of five participants each. Speech therapy program involved facilitation of normal respiratory, phonatory, resonatory and articulatory functions along with oromotor strengthening exercises. In Subject group participants were asked to install the Speech Companion app. The clinician demonstrated its use in the therapy session. The control group practised the exercises demonstrated without the use of any app. FDA was re-administered and the performance of the two groups were analysed after six months.

Results: On pre post therapy comparison between the two groups using Mann-Whitney U Test a significant improvement was found in both groups which could be seen by improvement of grade in the sub sections of Lips(In speech, at rest, spread, seal), Jaw (alternate), Tongue (In speech, at rest, protrusion, lateral and alternate) and Intelligibility(conversation) (p<.05). A significant more improvement was seen in the 'Speech Companion' group as compared to the control group.

Conclusions: Speech Companion facilitates improved Oromotor strength in Flaccid dysarthria.

  Brunnstrom stage as an independent factor affecting turn step in ischemic stroke patients Top

Kevin Triangto, Febrian Mulya Santausa, Widjajalaksmi Kusumaningsih, Salim Harris

Department of Physical Medicine and Rehabilitation, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.

E-mail: [email protected]

Introduction: Stroke patients are often classified to have high risk of fall. Timed Up and Go (TUG) test has been used as a screening test for balance in elderly people and the result is strongly associated with fall risk. Among the components of TUG, turn step – the number of steps taken to turn 180o – is one of the simplest component to observe. This study aims to evaluate TUG time in stroke patients, whether turn step is correlated with TUG time, and other factors affecting it.

Methods: Stroke (n=24) and non-stroke (n=35) patients were recruited from Neurology and Medical Rehabilitation Department outpatient clinic. TUG time and turn step were recorded on each subject.

Results: Mean TUG time was significantly higher in stroke patients (p=0.007). Among stroke patients, turn step was strongly correlated with TUG time (p=<0.001, r=0.746). By using linear regression test, it could be seen that besides age (p=0.009) and gender (p=0.031), Brunnstrom stage <5 was an independent factor (p=0.002) inversely related to turn step in stroke patients.

Discussion: This finding is parallel with the fact that higher Brunnstrom stage relates to better neuroplasticity.

Conclusion: Turn step can be used as a simple screening examination for balance in stroke patients, especially in patients with lower Brunnstrom stage (<5). Furthermore, the results of this study could seamlessly be used in a telerehabilitation setting for stroke patients.

  Effect of additional kinesiotaping in chronic stroke rehabilitation patients underwent weight shifting training on balance function Top

Ronni Untung Handayanto, Robby Tjandra, A. P. Rahmi Isma, Tanti Ajoe Kesoema

Department of Physical Medicine and Rehabilitation, Kariadi General Hospital, Semarang, Indonesia.

E-mail: [email protected]

Background: Approximately 75% stroke patients are suffering on longterm balance problem. Balance restoration still be a challenging in chronic stroke rehabilitation. In most cases conventional rehabilitation alone found insufficient to increase the balance function. Kinesiotaping has been given widely as an additional therapeutic on neuromuscular disorder. Kinesiotaping are effective to increase joint stabilization and strengthened the weak muscles, which can be applied to improve the balance of stroke patients.

Aim/Objective: To prove the effect of additional kinesiotaping on functional balance in chronic stroke rehabilitation patients underwent weight shifting training.

Methods: This is a research experimental with pre-post test group design. 18 subjects are divided into 2 separated groups with randomization. Control group received weight shifting training alone, while the intervention group received weight shifting training with additional of kinesiotaping. Balance function was measured using Berg Balance Scale before and after finished the intervention in 4 weeks.

Result: No significant difference on balance function between groups before intervention (p= 0,391). After finished the intervention there were a significant change on balance function on both groups with (p=0,006) and (p=0,007), with a significant difference on balance function improvement between groups (p=0,000).

Conclusion: Additional kinesiotaping are found effective to improve the balance function in chronic stroke patients underwent weight shifting training.

Keywords: Balance, kinesiotaping, stroke, weight shifting training

  Clinical practice guidelines for stroke rehabilitation from low and middle income countries Top

Ivy Anne Sebastian, I. A. Sebastian, D. B. C. Gandhi, S. K. Kamalakannan, A. Hombali, G. Urimubenshi, M. J. Solomon

Department of Neurology, St. Stephen's Hospital, Delhi, India.

E-mail: [email protected]

Background and Aims: Clinical practice guidelines (CPGs) provide an evidence-based foundation to build optimal services for people with stroke. In comparison to High Income Countries where many comprehensive stroke rehabilitation guidelines exist, identifying evidence-based guidelines specific to Low-and-Middle-Income Countries (LMICs) is challenging. This project aims to: 1. Evaluate the quality and content of existing CPGs for Stroke rehabilitation from LMICs 2. Develop LMIC-specific CPGs based on findings identified.

Methods: This project will be executed by a multi-disciplinary core team of stroke rehabilitation professionals, through a multi-phased process. An advisory board of global stroke and rehabilitation authorities with expertise in guideline development will provide periodic inputs wherever essential.

Phase I: A systematic review on the existing CPGs for stroke rehabilitation from LMICs will be conducted. Quality and methodological rigour of the CPGs will be assessed based on an identified cut-off on AGREE-II and AGREE-REX tools.

Phase II: CPGs meeting the essential criteria in Phase I will be compared for content with standardized WSO Global services guidelines and action plan, to identify existing gaps.

Phase III: LMIC-specific stroke rehabilitation CPGs will be developed informed by the merits and demerits identified in previous phases.

Results: Through this project we intend to study the quality and content of CPGs for stroke rehabilitation, identify the existing gaps and develop new evidence-based CPGs specific to LMICs.

Conclusions: This study is designed with the larger objective of identifying existing gaps in availability and implementation of CPGs, and to develop CPGs for stroke rehabilitation specifically tailored to LMICs.

  Translation and validation of the Malay version of quality of life after brain injury questionnaire Top

Maisarah Rafek

Department of Physiotherapy, Royal College of Medicine Perak, University Kuala Lumpur, Ipoh, Malaysia.

E-mail: [email protected]

Background and Aims: Traumatic Brain Injury (TBI) is the world-leading cause of death among children and young adult worldwide. Individuals with post-TBI will face many problems that lead to activity restriction and may reduce their quality of life. Quality of life after brain injury (QOLIBRI) is a questionnaire used to measure the level of health-related quality of life among TBI survivors. Therefore, the aim of this study is to translate and validate the Malay version of the QOLIBRI.

Methods: A total of 162 TBI patients were involved in this cross-sectional study design. The translation and validation process was conducted based on Beaton guideline for cross-cultural translation. The original version of QOLIBRI was translated into the Malay language. Then, factor analysis was used to check for the validity of the instrument.

Results: The Malay version of QOLIBRI (M-QOLIBRI) proved reliable, with an overall alpha value of 0.911. Overall, ICC for M-QOLIBRI also shows a good value (ICC = 1.00), making the translated version more reliable. No significant correlation shown between the M-QOLIBRI score with patients age (r = -.111, p > 0.05) and time since injury (r = -.117, p > 0.05).

Conclusion: This study shows that the M-QOLIBRI is reliable and can be implemented among the Malaysian population. The finding of this study can help in planning the proper and appropriate treatment plan for TBI patients.

  Functional assessment of the inspiratory muscles by ultrasound and electromyogram during maximal inspiratory load Top

Hiroyasu Iwatsuki, Toshihiro Haba, Toshiya Urushihata

Department of Physical Therapy, Aomori University of Health and Welfare, Aomori, Japan.

E-mail: [email protected]

Purpose: Because respiratory muscles are skeletal muscles, measurement of their muscle thickness by ultrasonic image and muscle activity by electromyography (EMG) can be used for quantitative evaluation methods. The purpose of this study was to clarify the relationship between muscle thickness, measured by ultrasound image, and muscle discharge of inspiratory muscles, measured using surface EMGs, during maximum forced inspiration.

Methods: The subjects were twelve health men who were laid down in the Fowler's position. Both muscles' thicknesses (right) and surface EMGs (left) in the sternocleidomastoid (SM), external intercostal muscle (EI), and diaphragm (DM) were recorded 5 times at the same point during maximum forced inspiration. Both the EI and DM were measured on the anterior axillary line of the eighth intercostal space. The discharges of each muscle were quantified by the root mean square (RMS).

Results: Both the muscle thicknesses and RMS in three muscles during maximal forced inspiration were significantly increased compared to during resting inspiration. As a result of the correlation analysis, the correlation coefficients were SM (0.42), EI (0.51) and DM (0.58), respectively, and a positive correlation was found between muscle thickness and RMS during maximum forced inspiration.

Conclusion: The associated increase in both the thicknesses of the three inspiratory muscles and RMS during maximal inspiration suggests that respiratory muscle activities during inspiration can be visualized in ultrasound images.

  The effects of additional radial shock wave therapy on spasticity of upper extermity muscle Top

Go Linda Sugiarto, K. Tanti Ajoe

Department of Neurorehabilitation, Dr. Moewardi Regional Public Hospital of Central Java, Surakarta, Indonesia.

E-mail: [email protected]

Background: Spasticity is one of the most common problems and greatly interfere with functional capacity of chronic stroke patients. The most treatment commonly used to deal with spasticity are infrared therapy and stretching exercise, but they have not been reducing spasticity effectively. The addition of Radial Shock Wave Therapy was expected to be more effective in reducing spasticity of chronic stroke patients.

Objective: The purpose of this study is to prove that the addition of RSWT is more effective in reducing spasticity of chronic stroke patients.

Materials and Methods: This study is a simple randomized controlled pre and post experimental design. Total sample of 30 chronic spastic stroke patients with a modified asworth scale 2-3, devided into 2 groups, study group and control group. RSWT provided once a week at muscle belly of flexor wist muscle on ventral aspect of forearm, intrinsic muscle of hand, and flexor digitorum tendon are added onto infrared therapy and stretching exercises in upper extremity which provide 3 times a week, 6 weeks consecutive. Level of spasticity is measured by Tardieu Scale which measures quality and angel of resistance at the beginning and end of study.

Result: Significantly greater reduction was obtained (p<0.05) from the level of spasticity measured by Tardieu Scale, both on the quality and angle of resistance in the study group.

Conclusion: The conclusion of this study is the addition of RSWT has been shown to have a greater reduction in spasticity of upper extremity muscle of chronic stroke patients.

  Survey on changes in neuro physiotherapy practice at a hospital\clinic and home- based settings in India during COVID-19 pandemic Top

Dorcas Gandhi, Komal Bhanot, Himani Khatter, Jeyaraj Pandian, Mridul Makkar

Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India.

E-mail: [email protected]

Background and Aims: Amidst COVID-19 pandemic, neuro-physiotherapy services have evolved due to various practical challenges in India. This survey aimed to analyse the quantitative and qualitative changes in neuro-physiotherapy practice during the pandemic.

Methods: A cross-sectional survey (validated and reliable) targeted to collect 100 responses from working physiotherapists across India who managed neurological cases during the current pandemic either at homes or in a hospital setting.

Results: The study records 141 responses representing near-equal participation from India. A majority of responders worked in hospital/private clinics (74.5%). This group of responders modified their practice by performing online assessment (52.1%), reducing manual contact (45.7%), reducing number (52.4%) & duration (41.9%) of sessions per patient. 67.6% of Physiotherapists (PTs) were not posted in COVID-19 wards. Home-based therapists (47% responders) experienced a decrease in the number of referrals. 61% of them did not visit containment zones, only 5.6% of responders used complete protective gear. Across both groups, the major change found was opting for caregiver education to reduce contact time and the use of telerehabilitation for prescription and supervision.

Conclusions: This study establishes need for development of practice-guidelines for rehabilitation providers in a hospital and home-based care to improve safety and process-flow. Need to actively include rehabilitation professionals in respiratory/sensory/motor rehabilitation during such pandemics is essential. Developing national policies towards this aim is necessary.

  Expert consensus for in-hospital rehabilitation for stroke during the COVID-19 pandemic in low and middle income countries Top

Dorcas Gandhi, S. Kamalakannan, M. Chockalingam, I. A. Sebastian, G. Urimubenshi, M. Alim, H. Khatter, S. Chakraborty, J. M. Solomon

Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India.

E-mail: [email protected]

Background and Aim: People with neurological dysfunction have been significantly impacted in receiving adequate, quality rehabilitation services due to the ongoing COVID-19 pandemic. The objective of this study was to systematically develop consensus-based expert recommendations for hospital-based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence.

Methods: A multidisciplinary group of experts in stroke rehabilitation (core group) initiated this task. A six-stage scoping review methodology was conducted using a comprehensive search strategy with MeSH terms related to the aim. Searches were run in MEDLINE and CINAHL on 12th September 2020. Specific statements with level 2b evidence from studies identified, were developed and circulated to 13 experts for consensus. The statements that received 80% agreement were grouped into relevant themes and recommendations were developed.

Results: The search yielded 51 relevant studies addressing aspects of neuro-rehabilitation. After data extraction, 75 recommendations were generated which were categorized under 5 themes: Recommendations relevant to Rehabilitation Providers, Tele-rehabilitation, Rehabilitation service/Administration/Management, Patients, Informal/Formal Caregivers Awareness/Education. Out of these, 72 recommendations received an agreement score of 3 by 80% or more of the expert participants27. These statements were compiled as the expert consensus statements.

Conclusion: Development of this consensus statement is of significance to stroke rehabilitation service providers and people living with disability resulting from stroke. Stakeholders involved in upholding standards for stroke rehabilitation practices in low- and middle-income countries must consider conversion of the consensus statement to minimum requirements within the context of the pandemic as well as for the future.

  Case report: Rare case of contralateral hemiplegia in stroke Top

Nirav Joshi, Akash Shridharani

Department of Physical Medicine and Rehabilitation, Amrita Hospital, Cochin, Kerala, India.

E-mail: [email protected]

The patient with sub-acute stroke and clinical history suggestive of Covid 19 infection, though RT-PCR was negative, came for evaluation of stroke. He had a right upper limb weakness and left lower limb weakness. This type of presentation is called contralateral hemiplegia. It is a very rare presentation of stroke. Horner's syndrome and cerebellar signs were positive. MRI was done and it showed right lower medullary and right cerebellar sub-acute infarcts. Rehabilitation was started for the patient. Stroke evaluation was done. Aim of this case presentation is to discuss how contralateral hemiplegia occurs in right lower medullary stroke and treatment guidance of rare case.

  Co-relation of axonal loss with duration and muscle weakness in patients with neuropathy: A retrospective study Top

Ashwini Mishra, Suvarna Ganvir1

Department of Neurophysiotherapy, Dr. Vitthalrao Vikhe Patil Foundation, College of Physiotherapy, 1Department of Neurophysiotherapy, DVVPF'S College of Physiotherapy, Ahmednagar, Maharashtra, India.

E-mail: [email protected]

Background: Electrodiagnostic test plays an important role in defining the presence of Neuropathy. Axon loss may also contribute to the weakness. However, it has not been extensively studied that to what extent axon loss occurs and to what extent it contributes to weakness.

Aim: To correlate the Axonal loss with duration and muscle weakness in patients with Neuropathy.

Methodology: In the present Retrospective Study, data analysed was of previous two years and 26 Patient with lowerlimb neuropathy, age ranging from 20- 80 years including both Gender. Nerve conduction study were performed using surface electrode and the axonal loss was calculated for Tibial and Peroneal nerves. Muscle strength was assessed using Manual muscle testing. And duration of the patient complaint were noted. Logistic Regression analysis was used to assess the axonal loss with the strength and the duration.

Result: The mean axonal loss for Tibial nerve and Peroneal nerve was 53.1% and 67.2%. The overall strength was 2.8 (Median) and mean duration of symptoms was 157 days. Univariate analysis revealed that axonal loss was extremely significantly associated with the strength of muscle (p<0.0001). Axonal loss of Tibial nerve was significantly positively associated with the duration of the symptoms (p<0.01) and that of peroneal nerve was very significantly associated with the duration of symptoms (p<0.007).

Conclusion: Axon loss occur in Neuropathy leading to the axonal degeneration and play an important role in affecting the strength of the muscle. And the axonal loss increases with the increase in the duration of the symptoms.

  Investigation of component wise affection in children with DCD in age group of 6 to 12 years Top

Eram Nizam Kazi, Suvarna Ganvir

Department of Neurophysiotherapy, D.V.V.P.F'S College of Physiotherapy, Ahmednagar, Maharashtra, India.

E-mail: [email protected]

Background: There are many evidences which shows that children with DCD have difficulties that has considerable impact on children's daily activities as they lack the ability to plan and organize themselves. There is a need for a component wise analysis of the DCD screening questionnaire in these children so as to frame a rehabilitative goals accordingly.

Methodology: 60 children in the age group of 6-12 years were screened for the presence of DCD, using DCD questionnaire in Ahmednagar. The Questionnaire consists of 15 questions, each of which is given maximum score is 5. Score of 15-46 indication of DCD (5 years-7 years 11 months), 15-55 indicated (8 years–9 years 11 months) and 15-57 indicated (10 years to 15 years). Component wise analysis was done in each age group along with gender specific evaluation.

Results: 11 children were found to be affected with DCD. The results shows that the scores of components like catching a ball, writing legibly, bull in a shop, learning new skills, quick and competent and does not fatigue was overall low in both genders among children in 6-12 years of age. On further age wise analysis, in addition to above components, jumping over, writing fast, cutting and likes sports were affected in age 6-7, running, efforts and pressure in age 8-9, throwing a ball, jumping, likes sports in age 10-12.

Conclusion: Children with DCD shows the affection of fine motor activities and general co-ordination which needs specific focus of therapeutic Physiotherapy intervention.

  Stressors in parents of school going children with ADHD aged 6–12 years and perceived barriers in Occupational Therapy program participation Top

Richa Deshmukh, Usha Kasar

Department of Occupational Therapy, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Parents of children with ADHD could experience some mental or physical exhaustion as they are required to be hypervigilant, always. During treatment sessions, families could experience barriers which could cause hindrance in regular participation, discontinuation, and dropouts from treatment. It is necessary to identify personal, economical, logistical barriers; determine stress levels in parents; and address them to prevent irregularities during therapy.

Aim: To study stress levels in parents of school going children with ADHD, aged 6-12 years and determine barriers in Occupational Therapy program participation.

Methods: After Institutional Ethical permission and parents' consent, 74 parents of children with ADHD participated. Demographic data was collected, parents were asked to mark responses on Kuppuswamy socioeconomic scale (2018), parental stress scale (PSS), Barriers to Treatment Participation Scale (BTPS)-parent version.

Results: On analysis following significant barriers were found: Competing life stressors: 35%, Relevance of treatment: 19%, Relationship with therapist- 11%, Treatment issues: 17%, Critical events: 18%. PSS- mean score was 63.837. (Total-90) Positive correlation was seen between BTPS 4 categories & PSS using Spearman's correlation coefficient. Negative correlation was seen between BTPS-relationship with therapist and parental stress score using ANOVA. In 7 categories according to order of child birth, highest level of stress was seen in 3rd/3 order of birth, least was seen in 2nd/2 order.

Conclusion: Findings of the study are suggestive of empowering &training parents, weekend training/treatment programs so families can participate as per their convenience, providing telerehabilitations, setting up mobile therapy vans, increasing the number of Government OT setups for easy availability & affordability of services.

  Intrathecal baclofen pump in post-stroke rehabilitation: Our experience Top

Ramnarayan Ramachandran, Raju Raman, P. Marimuthu

Department of Neurosurgery, New Hope Hospital, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background and Aims: About 30 to 40% of stroke survivors are chronically crippled. The main reason for this is the spasticity which appears after a stroke. The usual treatments for spasticity are not very useful in many patients. Here we describe our experience of intrathecal baclofen pump insertion for this problem.

Methods: This is a retrospective case note plot study of seventeen patients with post stroke spastic hemiplegia of more than one year. Of these eleven underwent intrathecal baclofen pump surgery after trail and six did not. Comparison is made among these two gropus on the quality of life at 1 year.

Results: Ten of them were men and nine had right hemiplegia. Eleven were ischaemic stroke and six haemorrhagic strokes. Modified Ashworth scale (MAS) 3 to 4 in all cases. Ten patients underwent intrathecal baclofen pump after positive trail. Follow up was upto an year. At one year the MAS scores and the Stroke specific QOL was much better in the operated group than in the non-operated group.

Conclusion: Intrathecal baclofen pump may be beneficial in selected cases of post stroke sever spastic hemiplegia.

  Long term effect of functional training on quality of life in patients with spinal cord injury hyphen pilot study Top

Rabina Sanjay Nayak, Maheshwari Harishchandre, Suvarna Ganvir

Department of Neurophysiotherapy, DVVPFS College of Physiotherapy, Ahmednagar, Maharashtra, India.

E-mail: [email protected]

Background: Spinal cord injury is a common source of chronic disability and is accompanied by a host of health-related issues, many of which are directly related to loss of muscle and related motor functions.

Objectives: 1. To find effect of 9 weeks rehabilitation training on NCV and QOL in patients with spinal cord injury. 2. To determine the changes in functional activity after 9 weeks of rehabilitation training in patients with SCI. 3. To find the association between functional activity, QOL and NCV after 9 weeks of rehabilitation training in patients with spinal cord injury.

Methods: The study included 10 participants with incomplete level of injury with traumatic and non – traumatic SCI participants aged between 18 to 55 years.

Study Design: Pre and Post study design. Inclusion and exclusion criteria were used for selection of patients with SCI.

Outcome Measures: SCIM-III, WHOQOL & MNCV, SNCV were assessed while the recruitment and after 9 weeks of functional training.

Result: A Paired – t- test concerning Pre and Post values: SCIM-III is statistically significant with P value is 0.0047, WHOQOL is statistically significant. A Pearson correlation for: SCIM-III with WHOQOL (Domain 1) r = 0.64 with P value (0.04), 95% confidence interval, considered significant. SCIM-III with WHOQOL (Domain-2, Domain–3, Domain-4) 95% confidence interval, considered not significant.

Conclusion: We found out that positive relationship exists among physical activity and QOL. So, physical activity improves the QOL and NCV of the patients with SCI.

  DBS of amygdala in Autism – A case report Top

Ramnarayan Ramachandran

Department of Neurosurgery, New Hope Hospital, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Aim: Autism spectrum disorders are becoming a big problem nowadays. Atleast 50% of the patients present with severe aggressive behaviour as they grow up.

Methods: We describe our experience of a 30 year old man with severe aggressive behaviour and autism. He underwent DBS surgery in March 2020.

Results: One year after surgery, patient had excellent reduction of the aggressive behaviour and also improved in some autistic features like speech and attention span.

Conclusion: DBS could be an option for selected patients with autism associated aggressive behaviour.

  Development and validation of Ahmednagar neuropathy screening instrument for diagnosing diabetic neuropathy Top

Aditi Hari Bhilwade, Suvarna Ganvir1

Department of Neurophysiotherapy, DVVPFS College of Physiotherapy, Ahmednagar, Maharashtra, India, 1Department of Neurophysiotherapy

E-mail: [email protected]

Background: Diabetic neuropathy is a leading cause for disability which leads to foot ulceration and amputation. There is a need for robust, comprehensive screening instrument which can cover all aspects related to clinical aspects of nerve dysfunction and hence a new screening tool was developed. The aim of the study is to report development and investigation of the psychometric properties i.e., Sensitivity and specificity of the newly developed screening instrument for diagnosing Diabetic Neuropathy.

Methodology: Thorough investigation of currently available screening instruments was done. Component wise analysis was done it was found that components like temperature, sensation, reflexes, muscle strength were missing, description are not properly given so there was difficulty in scoring the patient and after incorporating them ANSI was developed. The scale was reviewed by experts in the field of Neurophysiotherapy and after appropriate modifications the components of tool were finalized. The Ahmednagar Neuropathy Screening Instrument scale consist of 5 domains that are Muscle strength, Reflexes, Sensation, Symptoms and Appearance of feet which are further classified into components. We have analysed 100 patients using this screening tool, out of which 35 patients were diagnosed with diabetic neuropathy and also, we have compared with MNSI score.

Result: The total score of Ahmednagar Neuropathy Screening Instrument including all the component is 68 and the score of 45 shows 73% of Sensitivity and 50% of Specificity.

Conclusion: The accuracy of ANSI scoring makes it a useful screening test for diabetic neuropathy and further investigations on psychometric properties that is sensitivity, specificity & proper validation of the scale should be done.

  Effects of prefrontal cortex activity on language fluency tasks (VFT) during walking on a treadmill Top

Hiroyasu Iwatsuki, Toshihiro Haba, Toshiya Urushihata

Department of Physical Therapy, Aomori University of Health and welfare, Aomori, Japan.

E-mail: [email protected]

Purpose: Activation in the frontal cortex, including the premotor cortex and the supplementary motor areas, have been reported to increase during gait by studies using near-infrared spectroscopic imaging. The purpose of this study was to clarify the relationship with changes of gait parameters when some tasks are applied to the prefrontal cortex activation while walking on a treadmill.

Methods: 12 healthy young people with an accelerometer attached to the 3rd lumbar vertebra walked (2 km / h) for 60 seconds on a treadmill with a force plate. At same time prefrontal cortex activities were measured using a near-infrared photoimaging device. The tasks were no load, verbal fluency task (VFT), and recall of Japanese syllabary, and each task was performed twice with a break. A 16-channel probe was placed on both frontal regions to record changes in oxygenated hemoglobin (oxyHb). The analysis was divided into three regions: the central part, and the left and right parts. All participants in the experiment received an explanation of the experiment in advance from the researchers and signed the consent form.

Results: The OxyHb and lateral component of a force plate while walking were significantly increased in the both VFT and recall of Japanese syllabary tasks compared to no load. During the VFT, a positive correlation was found between oxyHb in bilateral sides parts and trunk sway, lateral component of a force plate.

Conclusion: These results indicated the walking performance changed even during constant-speed walking under the activities of the prefrontal cortex increased.

  Immediate effect of home made adaptive seating device on functional performance in children with cerebral palsy colon a case series Top

Prachi Sanjeev Bhagat, Suvarna Ganvir

Department of Neurophysiotherapy, DVVPFS College of Physiotherapy, Ahmednagar, Maharashtra, India.

E-mail: [email protected]

Background: Inability to continue face to face treatment due to lockdown resulted in poor functional performance at home in children with postural instability. Hence as an alternative, home made adaptive seating device (ASD) was proposed to enhance postural stability in these children.

Aim: To study the effect of Home made ASD on functional performance in children with cerebral palsy.

Methodology: In the present case series study, Parents and their children diagnosed as CP (n=6) mean age of 3 years participated. They required trunk support to maximize hand function when sitting on chair. Demonstration of ASD with anterior support to chest was given to parent through virtual platform and parents were asked to provide the same to their child. Canadian Occupational Performance Measure was used to evaluate immediate changes in activity performance and satisfaction through parent ratings with and without ASD.

Result: Parents identified 3-5 activity performance issues for their children. The mean performance scores was 4.04 and satisfaction scores was 4.64 without ASD. With ASD there was increase in performance and satisfaction scores by an average of 5.6 and 5.9 respectively. Data analyzed using paired t-test demonstrated significantly improved performance and satisfaction with p< 0.03 and p<0.04.

Conclusion: Parents reported that their children were more able to engage in self-care and play activities using ASD and activity performance and satisfaction improved when using adaptive seating devices at their home.

  Development and validation of the educational handout (parent-mediated early intervention) of caregivers in promoting 7 to 9 months baby's development Top

Manasa Kolibylu Raghupathy, Bhamini Krishna Rao, Leslie Edward Lewis

Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, Karnataka, India.

E-mail: [email protected]

Background and Aim: Preterm infants are at risk of global developmental delay in various domains. It is important to keep these babies under constant surveillance and refer them to early intervention services if needed. Educational handouts might empower/ motivate parents to deliver the intervention. Parents might act as a primary therapist while performing activities described in this handout and monitor the child's growth creating an enriched stimulated environment (parent-infant interaction/bonding) at home.

Aim: To develop and validate an educational handout as a guide for caregivers to promote their child's development during 7 to 9 months.

Methods: The initial content of the leaflet was formulated by literature review and clinical experience of authors. The framework consisted of an introduction, facilitation activities with pictorial representation, instructions, do's–don'ts, and disclaimer. The validation was conducted through a questionnaire (9 items): completeness, clarity, understandability, legibility of educational material for caregivers, and a section for comments. The handout with the enclosed questionnaire was distributed to 5 validators (1 Pediatrician, 3 Pediatric Physiotherapists, and 1 parent) to score based on a 4 points Likert scale.

Results: Responses from 5 validators were collected and analyzed. Item Level Content Validity Index (I-CVI) was calculated for individual items which ranged from 0.89- 1. Scale Level Content Validity Index (S-CVI) was calculated for 9 items, and it was found to be 0.98.

Conclusion: Handout for caregivers of 7-9 months infant's development has been developed and validated. It can be distributed in low resource/ clinical settings to encourage parent's active participation in their child's development

  Functional community ambulation and its correlates in previously rehabilitated participants with complete spinal cord injury t 12 and above Top

Annabelle Prithwini Kaunds, Henry Prakash, A. Elango, A. Augustin, T. Senthilvelkumar

Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India.

E-mail: [email protected]

Background and Aims: Functional ambulation is the ability to walk safely and sufficiently to carry out mobility related activities of daily living. In most Indian rehabilitation institutes, T8-T12 paraplegics are trained with KAFO (Knee Ankle Foot Orthosis) for therapeutic and functional ambulation, while also being given wheel chair skills training. There is lack of evidence at the community level for functional ambulation in complete paraplegia. The aim was to study the community ambulation in previously rehabilitated paraplegics T12 and above who were functionally ambulant at discharge and the factors associated with the outcome.

Materials and Methods: Participants fulfilling inclusion criteria were recruited after informed consent, through Spinal Cord Injury Melas, Mini Melas, home visit or in the Out-Patient Department and assessed using the SCIM, WISCI II and Proforma. Data was entered using EpiData and analysed with SPSS.

Results: Of the 90 participants studied, 9% were observed functional community ambulators. The causes for non- ambulation were that walking was inconvenient, tedious and fatiguing; uneven terrain, fear of fall, back or shoulder pain. There was a statistically significant decrease in percentage of ambulators with increasing age and duration since the injury and presence of co morbidities.

Conclusion: Most paraplegics trained in functional community ambulation discontinue walking after a few years due to various reasons. It is essential to include wheel chair training and achieve wheel chair independence for all complete thoracic level paraplegics. Ambulation training with focus on short distances or therapeutic standing a few times a week can be offered.

  Recurring seizures in epilepsy and cognitive impairment; successfully using “brainnext” tools for cognitive rehabilitation at epilepsy foundation, Mumbai India Top

Mangal Kardile, Nirmal Surya1

Department of Clinical Neuropsychology, Epilepsy Foundation, 1Founder, Epilepsy Foundation, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Epilepsy and Cognitive impairment have an important consideration in learning&memory. Mostly, Epilepsy population observed to be <45 years, compromising quality-of-life with longest-YLD. Recurring seizures cause sensory-information loss, taking brain backwards in learning. If these widespread-gaps not filled on-time, brain stagnates at its baseline-condition. The study aims at sensory-information loss with recurrent seizures having bilateral-epilepsy, involving corpus-callosum in A, B, C persons-with-Epilepsy causing global cognitive decline and using “BrainNext” program, based on Synaptic-plasticity, for successful memory, cognitive and behaviour rehabilitation, offline-online modes at Epilepsy Foundation, India.

Methods: With consent A, B, C Male, persons with uncontrolled-epilepsy, ages 11-17 years, tested offline with “BrainNext” tools for cognitive domain and given 15 days program. Three follow-ups with 15 days interval before Covid-19 and regular weekly-follow-ups conducted online for 5 months during Covid. Caregivers reported patient's progress online. On each follow-up previous exercises rehearsed, and new exercises added. Progress measured as 1 (10%), to 10 (100%) scale, 0% as baseline condition.

Results: A, B, C persons with severe epilepsy, showed >10% recovery in two weeks, improved visual stability, following simple instructions. Speech-Object recognition-facial expression, visual-motor-spatial coordination improved >25% normalizing behavioural responses in 2 months. Overall >60% improvement observed in 6 months from baseline condition with offline-online follow-ups.

Conclusions: Involvement of corpus-callosum with bilateral-cortical-deficit is unique, challenging hemispheric coordination in cognitive rehabilitation. Although uncontrolled seizures in patients A, B, C, having long term severe cognitive deficit, sensory-information gap could be retrieved > 60% from baseline condition with “BrainNext” rehab-program around 6 months.

  Botulinum toxin for post COVID-19 facial palsy with bogorad syndrome Top

Ayush Dubey, Shubham Dubey

Department of Medicine, GMC & Hamidia Hospital, Bhopal, Madhya Pradesh, India.

E-mail: [email protected]

Background and Aims: The current ongoing pandemic of Covid-19 infection has been responsible for a lot of morbidity as well as mortality in the world. Out of the many neurological complications of Covid-19, isolated facial palsy has also been seen and reported. Bogorad syndrome (gustatory lacrimation) is a rare complication of facial palsy. We describe such a case who was treated successfully with botulinum toxin.

Methods: A 42 year male was diagnosed to be having Covid-19 infection after having symptoms of fever, breathlessness and received treatment after hospitalization. Around 20 days after discharge, he developed facial deviation to left side with loss of wrinkles over right side of forehead and obliteration of right nasolabial fold. There was involuntary spillage of water from his right angle of mouth. It was diagnosed as LMN type of right facial palsy and he was given steroids as well as antivirals along with physiotherapy. He had almost complete recovery in his facial deviation but developed a new complaint of having tearing while eating after around 4 months of facial palsy. He was diagnosed to be having Bogorad syndrome/ gustatory lacrimation/ crocodile tears. When his symptoms did not get relieved after 15-20 days, we injected botulinum toxin 2.5 units transcutaneously in the parotid gland.

Results: There was substantial benefit in his lacrimation as ascertained by Schirmer's test after 1 week and 1 month after injection.

Conclusions: Post covid neurological complications include facial palsy. If gustatory hypersalivation occurs, transcutaneous botulinum toxin is an important tool for rehabilitation in such patients.

  Advances in orthotics and assistive technology in neuro rehabilitation Top

Lukeshkumar Rajendra Bhuyar, Ashok G. Indalkar, P. S. Dantala

Department of Orthotics and Posthetics, All India Institute of Physical Medicine & Rehabilitation, Mumbai, Maharashtra, India.

E-mail: [email protected]

According to the World Health Organization (WHO), neurological disorders and injuries account for the 6.3% of the global burden of disease (GBD). With more than 6% of DALY (disability-adjusted life years) in the world, neurological disorders represent one of the most widespread clinical condition. Among neurological disorders, more than half of the burden in DALYs is constituted by cerebral-vascular disease (55%), such as stroke. Stroke, together with spinal cord injury (SCI), accounts for 52% of the adult-onset disability and, over a billion people (i.e., about a 15% of the population worldwide) suffer from some form of disability. These numbers are likely to increase in the coming years due to the aging of the population, since disorders affecting people aged 60 years and older contribute to 23% of the total GBD. Standard physical rehabilitation favors the functional recovery after stroke, as compared to no treatment. However, the functional recovery is not always satisfactory as only 20% of patients fully resume their social life and job activities. Hence, the need of more effective and patient-tailored rehabilitative approaches to maximize the functional outcome of neurological injuries as well as patients' quality of life. Modern technological methodologies represent one of the most recent advances in Neuro Rehabilitation, and an increasing body of evidence supports their role in the recovery from brain and/or medullary insults. Orthoses and assistive devices are tools that assist in moving and performing tasks of daily activities. An Orthosis is a device that provides support to a weakened or paralyzed part of the body which includes static and dynamic splints. Assistive devices include walkers, wheelchairs, long-handled reachers, crutches, canes, and mobility aids. The assistive devices and Orthoses are generally used in combination with exercise. It helps to open and close things, transfer weight when shifting positions, hold objects or assist while walking.

Methods: Robots for Neuro Rehabilitation are designed to support the administration of physical exercises to the upper or lower extremities, with the purpose of promoting Neuro-motor recovery. This technology has a relatively long history, dating back to the early 1990s. Robotic devices for rehabilitation differ widely in terms of mechanical design, number of degrees of freedom, and control architectures. As regards the mechanical design, robots may have either a single point of interaction (i.e., end effector) with the user body (endpoint robots) or multiple points of interaction (exoskeletons and wearable robots) (A1) Endpoint robots: on the left the manipulandum, on the right the postural robot. A1 is a planar manipulandum developed at Geneva, Italy, with 2-DOF it is equipped with direct-drive brushless motors and is specially designed to minimize endpoint inertia. It uses the H3DAPI programming environment, which allows to share exercise protocol with other devices. A1 is a robotic device that permits full-body rehabilitation. It has two 2-DOF actuated and sensorized platforms located under the seat and on the floor level that allow it to rehabilitate several body districts, including lower limb, the core, and the back, using the platform located underneath the seat. Different patient categories (orthopedic, neurological, and geriatric) can be treated, and interact with the machine through a GUI based on serious games. (A2) Wearable device: the recent exoskeleton Twin. Twin is a fully modular device developed at IIT and co-funded by INAIL (the Italian National Institute for Insurance against Accidents at Work). The device can be easily assembled/disassembled by the patient/therapist. It provides total assistance to patients in the 5–95th percentile range with a weight up to 110kg. Its modularity is implemented by eight quick release connectors, each located at both mechanical ends of each motor that allow mechanical and electrical connection with the rest of the structure. It can implement three different walking patterns that can be fully customized according to the patient's needs via a GUI on mobile device, thus enabling personalization of the therapy. Steps can be triggered via an IMU-based machine state controller. (B1) Repetitive transcranial magnetic stimulation (rTMS) representation. rTMS refers to the application of magnetic pulses in a repetitive mode. Conventional rTMS applied at low frequency (0.2–1Hz) results in plastic inhibition of cortical excitability, whereas when it is applied at high frequency (5Hz), it leads to excitation. rTMS can also be applied in a “patterned mode.” Theta burst stimulation involves applying bursts of high frequency magnetic stimulation (three pulses at 50Hz) repeated at intervals of 200ms. Intermittent TBS increases cortical excitability for a period of 20–30min, whereas continuous TBS leads to a suppression of cortical activity for approximately the same amount of time. (B2) Transcranial current stimulation (tCS) representation. tCS uses ultra-low intensity current, to manipulate the membrane potential of neurons and modulate spontaneous firing rates, but is insufficient on its own to discharge resting neurons or axons. tCS is an umbrella term for a number of brain modulating paradigms, such as transcranial direct current stimulation, transcranial alternating current stimulation and transcranial random noise stimulation. (C) A typical BCI system. Five stages are represented: brain-signal acquisition, preprocessing, feature extraction/selection, classification, and application interface. In the first stage, brain-signal acquisition, suitable signals are acquired using an appropriate modality. Since the acquired signals are normally weak and contain noise (physiological and instrumental) and artifacts, preprocessing is needed, which is the second stage. In the third stage, some useful data or so-called “features” are extracted. These features, in the fourth stage, are classified using a suitable classifier. Finally, in the fifth stage, the classified signals are transmitted to a computer or other external devices for generating the desired control commands to the devices. In neurofeedback applications, the application interface is a real-time display of brain activity, which enables self-regulation of brain functions.

Results: Here we tried to overview the developments of advances in Orthotics and Assistive devices in Neuro Rehabilitation. We will describe more devices in final presentation.

Conclusions: The role of Orthoses and Assistive devices relates to the overall rehabilitation goal of eliminating, minimizing or helping patients to overcome the limitations imposed by their underlying Neurological disorders across areas of physical, cognitive, and psychosocial functions. While some Orthoses and Assistive devices allow a patient to achieve a degree of independence in a single area of function (such as mobility). Pediatric rehabilitation seeks to treat that patient as a whole person across his or her activities of daily living, learning, leisure and recreation, and/or vocational functions. Thus, the role of orthotic and assistive devices needs to be seen not just within the context of independence but also within the context of interdependence with others in a person's surroundings. The key to identifying the most appropriate Orthosis, augmentative communication or Assistive technology system is being creative and having a proper understanding of the anatomical, biomechanical, language and communication, and social networking needs of the patient and being sensitive to the patient's (or the parents') preferences and desires.

  Impact of cognitive deficits on fine motor skills and adaptive behaviour in autism spectrum disorders Top

Rajeswari Muthusamy, P. Ramachandran, Binu Ninan, Sailakshmi Ganesan

Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research. Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background: Children with Autism spectrum Disorders (ASD) have predominantly social impairment but significant physical features are also found which include hypotonia, motor apraxia, gross and fine motor delay. Smooth, targeted, and accurate movements require the harmonious functioning of sensory input, cognitive functioning for processing and coordination with cerebral functions. ASD children exhibit decreased cognitive functioning which is one of the basic component required for fine motor skills (FMS), but the impact of cognitive functioning on FMS and their level of Adaptive functioning is not clear.

Aim: The aim of this study is to explore the impact of cognitive functioning on FMS and level of Adaptive functioning in ASD.

Methods: This cross sectional study was carried out in 65 ASD children who met the inclusion criteria in the age group of 3-4 years of age. Subjects were recruited from Vidyasudha – School for children with special needs, Sri Ramachandra Institute of Higher Education and Research. Children diagnosed with ASD were quantified with Childhood Autism Rating Scale (CARS) and assessed for the level of FMS with Peabody developmental motor scale (PDMS2). Cognitive and Adaptive functioning was assessed using Developmental assessment for young children (DAYC 2).

Results: Pearson's correlation showed positive correlation between FMS and Cognition with r value of > 0.5. FMS showed a strong positive correlation with Adaptive functioning with r value of > 0.8 at p 0.05. The results convey that decreased coginition affects the FMS which in turn has an impact on the adaptive behavior of the ASD children.

Conclusion: The study concludes that cognitive deficits directly influence FMS and thereby the adaptive behavior of ASD children. The result of the study strongly emphasizes that Paediatric therapist should individualize treatment based on cognitive levels which should be considered and simultaneously addressed when training FMS and Activities of Daily Living in ASD children.

  Effectiveness of stroke step down care (SSDC): Post Stroke care transitional program - From Acute centre to community care Top

Nabilah Binti Abdul Rahman, Tan Hon Yin, Fikriah Abdullah

Department of Rehabilitation Medicine, Hospital Sultanah Bahiiyah, Alor Setar, Malaysia.

E-mail: [email protected]

Introduction: Stroke is the third commonest cause of disability worldwide. It is important to form a coordinated transitional post stroke care program from acute center to community. Stroke Step Down Care (SSDC) program is aimed to improve continuation of medical and rehabilitation management, achieving treatment goals and optimizing functional ability post stroke.

Methods: This is a prospective cohort study (2015 -2019) evaluating effectiveness of medical and rehabilitations management of stroke patients that were discharged from acute care, then directly followed up at the community health center near their locality. Patients undergo continuations of medical and rehabilitations management at the community health center; under the community doctors and therapists; with intermittent neurologist and physiatrist visits from acute hospital. The following parameters were monitored at the first appointment and six months follow up ie: appointment default rate, Modified Barthel Index (MBI), blood pressure control, lipid control, glycemic index (HbA1C), statin and antiplatelet usage.

Results: We compared data on the initiation year (2015) with subsequent year. There is reduction in default follow up cases from 23.5 % (2015) to 22.5% (2017), 20.6% (2018) and 20.0% in 2019. We also observed improvement in achieving target control in the following parameters after 6 months of follow up ie; Modified Barthel Index (MBI - achivement >75/100) from 60.8%(2015) to 74.6% (2017) 85.7 % (2018) 87.0% (2019); Diabetic control (HBA1C <6.5%) from 36.1% (2015) to 52.1% (2018) 59.1 % (2019); Lipid control (TC < 4.0mmol) from 31.6% (2015) to 37.0% (2017) to 56.0 % (2018) 64.9 % (2019); Blood pressure control (< 140/80mmHg) from 53.6 %(2015) to 65.3% (2017) 68.0% (2018) 71.4%(2019); prescriptions of antiplatelet from 85.0 % (2015) to 96.4% (2018) 99.5% (2019) and prescriptions of statin from 74.6 % (2015) to 75.1% (2017) 96.4% (2018) 100% (2019). All parameters monitored shown significant improvement throughout the years.

Conclusion: SSDC is able to improve medical and rehabilitation care post stroke by increasing the compliance of follow up, achieving treatment goals and optimizing functional post stroke.

  The effects of epilepsy on language development and cognition in children and its persistence with tele-therapy Top

Alifia Bharmal

Department of Speech Therapy, Epilepsy Foundation, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: The speed at which language and cognition is developing in children is truly remarkable. As the child is adding new language skills, the child's brain undergoes changes. On the other hand cognition involves memory, thought, learning problem solving, organization, and storage. The interplay of all these factors results in language development. Epilepsy and language are linked together as they both are generated in the brain. A connection exists between children with epilepsy also having language impairment. Seizures and any type of epilepsy diagnosed can cause such disturbance in the brain that can have lasting effects on language development and cognition in children.

Methods: This study aimed to produce online teaching material in Speech language Therapy suitable for children age range 5-15 years on the online material, record their performance when taught through this innovative method. It also explored the relationship between engagement with the module and performance. Patient evaluations of the online therapy were also recorded as was their engagement with the online module.

Results: Results revealed both telehealth made significant and similar improvements when treatment effects were measured. Findings showed there is limited but promising evidence to support telehealth for delivering speech-language pathology intervention services to school-age children with epilepsy.

Conclusions: Before beginning it is important to emphasize that treatment is considered to be essential for all children with speech and language disorders, but with few exceptions, it is most effective for less severe disorders. Nevertheless, even children with the most severe disorders can develop enhanced, functionally important communication skills that have a meaningful impact on their lives even though their speech and language disorders have not been completely resolved.

Keywords: Cognition, epilepsy, language, teletherapy

  The effect of placement tens electrode in agonist muscle compare with antagonist muscle in stroke ankle plantar flexor spasticity Top

Meisy Andriana, M. Andriana, Y. C. Suisan, R. Satyawati

Department of Physical Medicine and Rehabilitation, Medical Faculty, Academic General Hospital Dr Soetomo, Universitas Airlangga, Surabaya, Indonesia.

E-mail: [email protected]

Background: Spasticity in stroke especially in lower extremity result to pain, contractur, disturbance of postur control, mobilisation and increase of fall. Decrease spasticity in plantar flexor ankle connecting with stride length and walking speed and increase the quality of life in stroke.

Purpose: To determine the optimal location to placement TENS electrode to decrease spasticity in stroke ankle plantar flexor.

Methode: Ten subject were randomly allocated into two groups. Subject in group agonist was given TENS in Gastrocnemius muscle, and for group antagonist given TENS in Anterior tibialis muscle. After wash out period 1 week. 10 subject allocated in group opposite. TENS was applied over belly of Gastrocnemius muscle for 45 minute, rectangular monophasicwaveform at 100 Hz frequency, 125 ms pulse width, with intensity sensory threshold 2x.

Result: Group agonist show amplitudo sEMG significant decrease, group antagonist also show amplitudo sEMG significant decrease. Decreasing the spasticity until 30 minute after receive TENS. Group agonist show more decrease sEMG amplitude compare with group antagonist.

Conclution: This research show that placement TENS electrode in group agonist improve spasticity in stroke ankle plantar flexor more than in group antagonist.

Keywords: Agonist, antagonist, sEMG, spasticity, transcutaneous electrical nerve stimulation

  Effect of McConnell patellar taping for gait velocity, step length, and stride length in subacute stroke patient Top

Cokorda Gde Bayu Baskara Putra, Cokorda Baskara, Yudith D. Prawitri, Alit Pawana, Meisy Andriana

Departement of Physical Medicine and Rehabilitation, Faculty of Medicine, Dr Soetomo Academic General Hospital, Airlangga University, Surabaya, Indonesia.

E-mail: [email protected]

Background: Stroke: the most common cause of disability, with gait disturbance as one of its main problems The use of McConnell patellar taping for gait management in stroke is increasing and promising There is no data regarding use of McConnell Patellar taping in stroke patient in Indonesia.

Purpose: to investigate effect of McConnell patellar taping in gait velocity, step and stride length in subacute stroke patient.

Methode: 8 subacute stroke patient with inclusion criteria was applied McConnell patellar taping with medial patella attraction for 30 minute. Gait analysis performed before and after the application of McConnell patellar taping.

Result: These result showing McConnell patellar taping increase gait velocity in sub acute stroke patient. Increasing gait velocity without increase step length and stride length may be due to cadence. Gait velocity 0,80m/s is the velocity that suggested to do effective ambulation in community.

Conclusion: McConnell patellar taping increase gait velocity in sub acute stroke patient Further study with large sample size and longer intervention period are needed.

Keywords: Gait performance, McConnel patellar taping, subacute stroke

  Genetic influences on response to transcranial direct current stimulation in swallowing motor cortex Top

Sun Im, Hyemi Hwang, Hae-Yeon Park, Hyun-Mi Oh, Tae-Woo Kim, Geun-Young Park

Department of Rehabilitation Medicine, Catholic University of Korea, Seoul, South Korea.

E-mail: [email protected]

Twenty healthy participants (mean age: 22.45±3.26 years old; range: 19 29 years old; 12 males, 8 females) were recruited for the study. At the first visit, all participants underwent for genotype (COMT val158met) analysis. For each visit, participants underwent inhibition to 1-Hz repetitive transcranial magnetic stimulation (rTMS). After rTMS, anodal tDCS was performed at 1.5mA for 10 minutes in tDCS group. In the sham condition, 1mA stimulation lasted for only 30 seconds with the electrodes left in place for a further 10 minutes. For the primary outcome, mylohyoid resting motor–evoked potentials (MEP) were recorded at baseline, post rTMS inhibition and immediate and 30 minutes after tDCS. Regarding COMT genotype, 10 patients had the val/val allele (age: 21.00±1.56; 6 males, 4 females) and 10 were met carrier (age: 23.90±3.81; 6 males, 4 females). Patients treated with tDCS showed greater improvement in amplitude of mylohyoid MEP than the sham group in immediate and 30mininute follow up. In subgroup analysis, both val/val and met carrier group amplitude of mylohyoid MEP decreased significantly after rTMS inhibition (val/val group =-12.81(34.00) p=0.0052; met carrier group =-31.84 and 0.037). Significant associations were found between tDCS response and COMT polymorphism. Only val/val group showed significant increment of MEP amplitude in immediate and 30minute follow up (Immediate =30.42 (62.06) p=0.0020; 30minute =50.09 (65.88) p=0.0020). This study provides insight toward the understanding of response variability across COMT genes and highlights the need to create stratified approaches in tDCS treatments for dysphagia.

  Efficacy of ultrasound guided steroid injection in carpal tunnel syndrome - A prospective comparative study Top

Merrin Meria Mathew

Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

E-mail: [email protected]

Background: Though widely used, there is no guideline as to which corticosteroid injection has to be used as standard treatment in CTS. Triamcinolone (most commonly used) and Dexamethasone (least neurotoxic with better safety profile) are being compared for their efficacy in CTS.

Aim: To compare the efficacy of Dexamethasone and Triamcinolone injection in patients with CTS.

Methods: 69 patients who attended Out-patient clinic of PMR Department at AIIMS Jodhpur who were clinically diagnosed with CTS and confirmed by electrophysiological studies, received one-session of ultrasound-guided perineural injection by In-Plane Axial Ulnar Sided Approach with 4ml of either Dexamethasone [8mg (2ml) mixed with 2 ml 0.5% bupivacaine] or Triamcinolone [40mg/ml (1ml) mixed with 3ml 0.5% bupivacaine] and followed up with Visual Analog Scale (VAS) score at 0, 2, 4 months, Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score at 0, 2, 4 months and Nerve Conduction Study (NCS) changes of the median nerve - Sensory Nerve Conduction Velocity (SNCV) and Distal Motor Latency (DML) at 0,4 months. Data analysis was done using IBM SPSS version 26. Independent-Samples t-test was used for comparison between groups and paired t test for improvement within each group. A p value < 0.05 has been considered statistically significant.

Results: There was significant improvement in VAS and BCTQ scores after 2nd and 4th months and NCS changes at 4th month follow-up in both dexamethasone (P=0.00) and triamcinolone groups (P=0.00). But when comparing the two groups, there was no significant difference in VAS score at 2nd month (P=0.079), VAS at 4th month (P=0.319), BCTQ score at 2nd month (P=0.197), BCTQ score at 4th month (P=0.137), SNCV at 4th month (P=0.511) and DML at 4th month (P=0.753). No major side effects or complications were noted.

Conclusion: Dexamethasone is as effective as Triamcinolone in improving the symptoms of CTS and so can be preferred due its least neurotoxicity compared to Triamcinolone.

  Can virtual physiotherapy help in filling treatment gaps during COVID-19 pandemic in multiple sclerosis patients? Top

Darshpreet Kaur, Nidhi Billore, Gunjan Kumar, A. K. Singh

Department of Physiotherapy, Bihar Neurodiagnostic Centre, Patna, Bihar, India.

E-mail: [email protected]

Objective: To determine the efficacy of telerehabilitation in MS patients. The telerehabilitation was provided because of the COVID-19 pandemic.

Background: Published data demonstrate promising results of the rehabilitation in patients with multiple sclerosis (MS), including telerehabilitation technologies.

Design/Methods: A total number of 42 patients participated in the study out of which 24 followed up till the end of 6 weeks. The investigated group consisted: 15 females and 09 males, mean age was 42 ±10 years. The telerehabilitation was provided to the group for 6 weeks at a frequency of 3 classes per week. The patients used either laptops or mobile phones. Inclusion criteria was 6 minute walk test (with or without assistance). Motor function was evaluated using, Timed up and Go test, 30 second sit to stand test. Patients were required to fill two questionnaires also: 12 item MS walking Scale and Multiple Sclerosis Fatigue Impact Scale (MSFIS). All the patients data was examined by an independent physiotherapist before and after the intervention.

Results: Statistically significant improvement in motor performance and MSFIS and 12 item MS walking Scale. The following results were observed: statistically improved parameters of TUG, 30 STS, 12 item MSWS and MSFIS.

Conclusions: Based on the findings, it is reasonable to infer that the use of telemedicine in the rehabilitation of MS patients is very promising.

  Patient satisfaction with virtual consultation during COVID-19 pandemic: An experience from Malaysia Top

Law Boon Sia, Ng Mei Wei, Natasia Kaur, Norhayati Hussein, Azhari Nordin, Intan Sabrina

Department of Rehabilitation, Hospital Rehabilitasi Cheras, Cheras, Malaysia.

E-mail: [email protected]

Background and Aim: Virtual consultation (VC) is the use of information and communication technology (ICT) to conduct medical consultation without direct contact between healthcare providers and patients. VC is a useful medium to ensure access and continuity of care for neurorehabilitation patients during the Covid-19 pandemic. This study aims to determine the patient satisfaction with VC during the pandemic at neurology rehabilitation clinic, Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia.

Methods: A retrospective cross-sectional study was conducted at the neurology rehabilitation clinic in Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia from Jan 2021-May 2021. Feedback was asked for patients scheduled for VC during that period by using structured questionnaires after they completed their VC sessions via telephone, Zoom or Google Meet. The questionnaires assessed patient-satisfaction pertaining to the quality of the VC, technical issues, objectives and benefits of VC. Data were analyzed using Microsoft Excel Version 2016.

Results: A total of 30.8% (290/941) patients received VC during the study period. The response rate was 100%. All responders were satisfied with the quality of VC and understood the objectives of their VCs. Benefits of VC such as reducing cost, transport and time also scored 100%. The lowest satisfaction scores were reported in the technical components, whereby 1.4% of respondents experienced some form of technical issues during VC.

Conclusions: All neurorehabilitation patients were satisfied with the quality, objectives and benefits of VC. More resources should be invested in technical support to ensure the success of VC during and after the Covid-19 pandemic.

Keywords: COVID-19, neurorehabilitation, pandemic, virtual consultation

  Development of a comprehensive test for agrammatism in Kannada Top

Wasim Ahmed, Gopee Krishnan

Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Udupi, Karnataka, India.

E-mail: [email protected]

Background and Aims: Agrammatism, characterized by erroneous sentence production and poor grammar usage, is common in persons with non-fluent aphasia. A comprehensive test is desirable to assess the nuances of agrammatism in any language, which undoubtedly is a boon to clinicians and researchers. However, mere translation or adaptation of tests from another language is unfeasible. Considering the unavailability of such tools in Kannada, we aimed to develop one based on the framework of the Northwestern Assessment of Verbs and Sentences (NAVS) test.

Methods: This test contains six subtasks designed to assess comprehension and production of verbs, arguments and sentences. Further, four-sentences and three-interrogative types that Kannadigas colloquially use are included in a dialect neutral form. Test stimuli were adapted from a previously developed dataset in our lab. Thirty-six (18 females) adult participants (Mean age=45.38; SD=18.98) and seven male persons with aphasia (PWA: Mean age=64.57; SD=11.17 years) underwent this test along with Western Aphasia Battery in Kannada (WAB-K) and Syntax subtest of the Linguistic Profile Test (LPT) as the gold standard.

Results: An overall significant difference (U=0.0, p=0.00) was observed between the normative and PWA across all tests. The PWA performed better on comprehension tasks, especially verb comprehension, on par with the normative group (U=94.0, p=0.27). Yet, PWA demonstrated considerable difficulties in processing verb-argument structure and sentence types especially, subject and object clefts and interrogatives.

Conclusion: Preliminary findings from this ongoing study demonstrate the promising potential of this test to assess the intricacies of agrammatism in PWA and its possible utility in clinical and research domains.

  Uptake of virtual consultation in neurology rehabilitation clinic during the COVID-19 pandemic in Malaysia Top

Ng Mei Wei, Natasia Kaur, Law Boon Sia, Norhayati Hussein, Azhari Nordin, Intan Sabrina

Derpartment of Rehabilitation, Hospital Rehabilitasi Cheras, Cheras, Malaysia.

E-mail: [email protected]

Background and Aim: Covid-19 pandemic has transformed the landscape of healthcare delivery. Virtual consultation (VC) is no longer an option but a necessity to curb the spread of Covid-19. Healthcare providers, patients and their caregivers have to adjust to the new way of accessing healthcare. This study aims to determine the uptake of VC in Neurology Rehabilitation Clinic compared with face-to-face (F2F) consultations during the Covid-19 pandemic at Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia.

Methods: A retrospective cross sectional study was conducted from January-May 2021 during Covid-19 pandemic. Follow-up patients were screened for suitability of VC prior to their appointments. VC was conducted under the Government Integrated Telecommunications Network (GITN) using telephone, Google Meet or Zoom. Preference for VC or F2F consultation was asked at the end of the VC session. Data was analysed using Microsoft Excel 2016.

Results: A total of 30.8% (290/941) neurorehabilitation patients received VC during the study period. The response rate was 100%. From 290 neurorehabilitation patients, 165 (56.9%) preferred VC while 125 (43.1%) opted for F2F review. Out of total VC patients, 241 (83.1%) was conducted via telephone, 42 (14.5%) through Google Meet and 7 (2.4%) with Zoom.

Conclusion: Result shows that VC is still the preferred choice for consultation especially during the Movement Control Order (February and May 2021) imposed by the government. Most patients preferred telephone consultations due to technological barriers. We foresee that VC will play a vital role in the future as a method of improving access to health-care services.

Keywords: COVID-19, neurorehabilitation, pandemic, virtual consultation

  Study on predictive factors of the functional outcome in patients with “post COVID-19” residual disability after intensive rehabilitation Top

Valentina Barbieri, Paolo Rossi, Laura Perucca

Centro di Riabilitazione Brissago, Clinica Hildebrand, Brissago, Switzerland.

E-mail: [email protected]

Background and Aims: We hypothesize functional outcome predictors after moderate-to-severe COVID-19, using clinical and functional data on motor and cognitive skills.

Methods: 52 patients from Hildebrand and Novaggio Clinics (39M-13F, mean-age 67.2) were recruited between May and June 2020. Muscular deconditioning, nutrition and comorbidities were considered to establish recovery degree. Patients motor skills (Jamar-test, MRC-scale, Sit-to-Stand), nutritional state (Kondrup-index, BMI, albumin, electrolytes) and Cumulative Illness Rating Scale (CIRS) were evaluated at admission. These were related to outcomes, based on Functional Independence Measure (FIM), normalized for maximum potential improvement and length-of-stay, defined as Rehabilitation Effectiveness Score (REs-tot), divided in motor (REs-m), cognitive (REs-c), and duration (REs-d).

Results: 8 comorbidity profiles based on the first 13 CIRS items were described: differences between REs-m and comorbidity profiles were statistically meaningful. Psycho-behavioural CIRS was analysed separately, based on severity. REs-tot and REs-m were statistically different across profiles. Patient's age and REs-tot negatively correlate to length-of-stay. REs-m and REs-c show meaningful differences with respect to Kondrup-index. Regression models correlate motor tests with REs-tot, with Jamar-test having R=0.37.

Conclusions: Negative correlation suggests age as a predictor for outcome indexes. CIRS-profiles relate to outcome. Psycho-behavioural profile is predictive for REs-tot and REs-m, indicating possible involvement of “fatigue”. Nutrition is critical for improving REs-m and REs-c, and likely shortens length-of-stay. Jamar-test is a candidate predictor for REs-tot and REs-d, while MRC and sit-to-stand are possible REs-m predictors. Jamar-test is also a potential REs-c predictor, after regression analysis. We are conducting a follow-up with a wider population sample.

  Case series on the effects of Botulinum toxin-A injection for individuals with cervical dystonia Top

Farah Inaz Khairuzzaman, Ng Mei Wei, Norhayati Hussein

Department of Rehabilitation Medicine, Neurological Rehabilitation Unit, Hospital Rehabilitasi Cheras, Bandar Tun Razak, Kuala Lumpur, Malaysia.

E-mail: [email protected]

Background and Aim: Cervical dystonia is characterized by progressively worsening involuntary neck contraction causing the head to tilt to one side. This case series aims to highlight the clinical improvement in two individuals with cervical dystonia after chemodenervation with Botulinum toxin -A to reduce pain and improve neck and head positioning.

Methods: Single institution descriptive case series of two individuals with acquired cervical dystonia resulting from cerebral palsy and hypoxic insult.

Results: Case 1: A 23-years old gentleman with Cerebral Palsy (GMFCS V) was referred for neurorehabilitation at 21 years of age. He had kyphoscoliosis, bilateral hip subluxation, generalized spasticity, and cervical dystonia (characterized by torticollis). Collateral history from mother reported pain, difficulty in wheelchair positioning, and inadequate feeding due to inappropriate position. Chemodenervation with botulinum toxin-A injection resulted in reduced pain and improved positioning, which aids in feeding and non-verbal communication. Case 2: A 38-years old gentleman was referred for rehabilitation for hypoxic sequelae, sustained during surgical complications for total thyroidectomy for malignant thyroid carcinoma. He developed cervical dystonia (characterized by retrocollis and laterocollis), causing neck pain and difficulties in positioning. Multiple modalities were given to improve dystonia. Chemodenervation with botulinum toxin-A injection resulted in pain reduction, with improved neck and head posture.

Conclusion: Cervical dystonia can be a sequela in cerebral palsy and stroke. It can be amenable with Botulinum toxin-A injection; however, results are variable depending on the etiology. Careful selection of target muscles and evaluation of patients for chemodenervation is important to ensure a good outcome.

  Effect of platelet rich plasma injection as additional intervention to suprascapular nerve block in post stroke shoulder pain Top

Azhar Kalliyath, Abhishek Srivastava, Navita Vyas

Department of Physical Medicine and Rehabilitation, Kokilaben Hospitals, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Purpose: Stroke has a very high incidence of about 2.4% in general adult population and is one of the main causes of disability worldwide. Approximately 90% of stroke survivors have compromised functions including motor, sensory, cognitive and autonomic functions. Good shoulder function is a prerequisite for effective hand function, as well as for performing multiple tasks involving bed mobility, ambulation, and activities of daily living (ADL). A common sequel of stroke is Post Stroke Shoulder Pain (PSSP) which is often precipitated with movements of the joint. The pain can compromise the person's participation in therapy and in severe cases, patients stop therapy and mobilization all together due to pain. This can hamper the effective utilization of residual function, further training and subsequently lead to disability. It also prolongs rehabilitation of affected limbs and hospital stay thereby adding to the cost of rehabilitation. There are studies showing the effectiveness of Supra Scapular Nerve Block (SSNB) in Post Stroke Shoulder Pain (PSSP). There are studies showing the effectiveness of Platelet Rich Plasma (PRP) injections in Shoulder pathologies. There are very few studies on effect of PRP in Post Stroke Shoulder Pain. No study has been done comparing the benefits of giving Platelet Rich Plasma (PRP) for persisting shoulder pain even after Supra Scapular Nerve Block (SSNB).

Methods: Post Stroke patients with shoulder pain, who having pain score NRS>4/10 will be taken for shoulder Screening with Ultra sonography and will be assessed for any Rotator cuff pathology and will be given Supra Scapular Nerve Block. Patients will be assessed after 2 weeks for pain and range of motion. Patients having no marked change in pain score, no marked improvement in ROM, ultrasound screening showing shoulder pathology and are willing for PRP procedure will be given Freshly prepared PRP injection and will be reviewed after2 weeks, 1 month and then after 3 months. Those who are not willing for PRP injection will be considered as control.

Results: Patients who received Platelet Rich Plasma injection after receiving suprascapular nerve block (SSNB) consistently demonstrated superior and statistically significant pain reduction at all follow up time points. Mean NRS reduction, marked improvement in both active and passive ROM of shoulder, improvement in SF8 score in those who received both PRP and SSNB group when compared to the scores of those who received only SSNB injection. Significant differences were noted between groups in regards to function or quality of life. No adverse events associated with the intervention were reported.

Conclusion: Platelet Rich Plasma Injection as additional intervention to Suprascapular Nerve Block is safe and effective in Post Stroke Shoulder Pain.

  Surge of post covid neuromuscular involvement, influx of under investigation differential and role of physiatrists in scenario Top

Aradhana Shukla, Archana Ojha1, Jaydeep Nandi

Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 1Department of Neurology, MLN Medical College, Prayagraj, Allahabad, Uttar Pradesh, India.

E-mail: [email protected]

Introduction: The unprecedented rise of patients presenting in intensive care due to Covid-19 pneumonia is resulting in overwhelming rise in cases of intensive care unit-acquired weakness. After discharge, Intensive care unit (ICU)-acquired weakness is on the rise and diagnosis as post covid critical illness myopathy, critical illness neuropathy, critical illness polyneuromyopathy, Guillain-Barre syndrome have emerged as differentials in first examination.

Aims and Objective: To determine the presence of myopathy, neuropathy or both in ICU patients affected with Intensive care unit acquired weakness (ICUAW), in a tertiary care hospital with post covid complication patients and to discuss role of physiatrist in terms of examination, diagnostic work up and rehabilitation.

Methods: Data from patients reporting to PMR OPD for electrodiagnostic study for workup of post covid neuromuscular involvement and for rehabilitation.

Results: Muscle dysfunction is the primary cause of ICUAW although in most cases, both neuropathy and myopathy coexist. Muscle charting and NCV studies helped in establishing diagnosis by Physiatrist and Neurologists and in tailoring of individualized rehabilitation protocol.

Conclusion: Potential impact of CIM/CIP/CIPNM/GBS, and the need for robust efforts to detect these syndromes can be much more efficient with involvement in Physiatrist alongside Neurologist in holistic care. Thorough clinical knowledge and electrodiagnostic studies interpretation is must for better patient outcomes.

  Utilizing rehabilitation efficiency index (REI) as an outcome measure for inpatient neurological rehabilitation Top

Khaidatul Mohamed Zabidi, Aiman Dan Anuar, Norhayati Hussein

Department of Neurology Rehabilitation, Hospital Rehabilitasi Cheras, Kuala Lumpur, Malaysia.

E-mail: [email protected]

Background and Aims: Rehabilitation helps improve patient functional outcomes after an acute medical event, especially intensive inpatient rehabilitation. The Rehabilitation Effectiveness Index (REI) is a rehabilitation impact index which demonstrates rehabilitation efficiency by calculating the average functional increase per day. This paper's aim is to review the use of REI to gauge the outcome of individuals who completed inpatient neurorehabilitation.

Methods: This is a retrospective chart review of individuals with neurological conditions who received inpatient neurorehabilitation from 2017 to 2020 and completed intensive rehabilitation with admission and discharge Modified Barthel Index (MBI) scores. 737 patients were selected. REI is calculated based on MBI functional gain/length of stay, where 0-0.49= low efficiency, 0.5-1=moderate efficiency and >1 =high efficiency.

Results: Results showed an increase in the proportion of patients with REI>0.5 after 2017; from 50.0% (2017) to more than 70% from 2018-2020 [75.2% (2018), 76.1% (2019), 73.3% (2020)]. There was a reduced proportion of patients with low REI from 50.0% (2017) to 31.0% (2020). Conversely, there was a growth in the proportion of patients with high REI (>1) from 2017 to 2020; from 17.9% (2017), 41.2% (2018), 43.1% (2019) to 42.3% (2020), where scores ranged from 1.1 to 7.

Conclusions: Results show a higher proportion of patients with high REI throughout the study period. This demonstrates incremental success for the rehabilitation program. The REI trend is useful to identify the timeline which demonstrated outcome of inpatient rehabilitation. Further research is needed to specifically identify potential beneficial interventions and program effectiveness.

  Development of leisure-time physical activity and education program on level of physical activity, walking performance, exercise self-efficacy and quality of life among chronic stroke survivors Top

Fadia Razali, Haidzir Manaf, Maria Justine

Department of Physiotherapy, University Selangor, Shah Alam, Malaysia.

E-mail: [email protected]

Background and Aims: Stroke has become a significant public discussion about the health consequences, which will increase over the next decades and will be one of the top public health disability agenda in the 21st century. As a result, the number of stroke survivors living with consequences is increasing. Varieties types of physical activity (PA) among stroke patients had been stated to be effective such as treadmill training, aerobic training, circuit training, home-based type of exercise programmed, structural type of exercise with physiotherapist-monitored, prescription exercise with monitoring and without monitoring. Unfortunately, the studies unable to distinguish a proper dosage based on frequency, intensity, time, and type to suit PA's long-term commitment based on lifestyle after stroke. Therefore, it is suggested that the change of PA should influence and address conditions based on time and lifestyle after stroke, such as leisure leisure-time physical activity (LTPA).

Methods: This study design is integrating mixed methods between qualitative and quantitative study. The method includes Phase I: Identify issues and perspectives of physical activity among stroke chronic stroke using systematic review and interview, development of the intervention program (program and education material), and acceptability of the intervention based on the Delphi study. Phase II: Pilot study of the intervention.

Conclusion: Declination of PA among stroke populations is the main factor secondary to cardiovascular diseases and recurrent stroke. The ability to change PA into a lifestyle such as LTPA, which consists of freedom of choices and behaviour among stroke survivors, can help the stroke population increase physical activity in the long term.

Keywords: Home programme, leisure-type physical activity, physical activity

[TAG:2]Vestibular rehabilitation program: A holistic approach [/TAG:2]

Sheela Theivanthiran, N. Abdul Aziz

Department of Rehabilitation Medicine, Acquired Brain Injury Rehabilitation Unit, Hospital Rehabilitasi Cheras, Ministry of Health, Kuala Lumpur, Malaysia.

E-mail: [email protected]

Background and Aims: Vestibular rehabilitation program (VRP) advocated here, consists on a multi-disciplinary team to manage people with vertigo. The team members include the patient, rehabilitation medicine physicians, physiotherapists, audiologists, clinical psychologists and rehabilitation nurses. The goals of VRP are gaze stabilisation, postural stability, improvement in function and management of aggravating factors such as vestibular migraine, anxiety, fatigue, cervical muscle tension etc.

Methodology: Clients may present with symptoms arising from a central, peripheral or mixed cause. During the intake interview, clients are reviewed based on the inclusion criteria and medical stability. They are then assessed by the team members separately. The results of the assessments are discussed in the initial team meeting, to guide goal setting and allocation to the appropriate program. There are 2 options for VRP: An outpatient program (weekly therapy program for 8 weeks) or an inpatient program, daily review and therapy program for 3 weeks. In this series, we present 2 individuals with different central causes of vertigo.

Results: Ms SA, 48 year old, has a history of right acoustic neuroma, complained of worsening vertigo symptoms following tumour removal. She was unable to perform her activities of daily living (ADLs) and had vestibular migraine. Ms SA underwent inpatient VRP with a goal of return to work and pain management. She improved in her ability of self care, ambulation, reduced in vertigo symptoms and headaches. She was able return to work to her previous job with targeted breaks. Her initial assessment using Vestibular Nystagmogram (VNG): indicated vertigo of central pathology. Post program her outcome measurements results are as follows: Dizziness Handicap Index (DHI) pre 14/100 to post 4/100 minimal impairment; Berg Balance Scale (BBS) improved from 31/56 to 55/56 and Dynamic Gait Index (DGI) improved from 8/24 to 23/24 indicating low risk of falls and independent and stable gait. Mdm AR, 53 year old, lady with a pontine intra-parenchymal hemorrhage treated in a conservative manner. She had mild right sided hemiparesis, vertigo aggravated with positional change and pain in the left side of her neck. Her ADLs were limited due to dizziness. She required dry needling into the left trapezius group of muscles. This improved her neck range of motion, she participated better in VRP. VNG indicated vertigo of central cause. DHI improved from 22/100 to 16/100; BBS 50/56 to 56/56; DGI 18/24 to 22/24.

Conclusion: VRP in a multidisciplinary, goal orientated, individually tailored approach leads to functional improvements. It has a major role in enabling people with vertigo, even with a from central pathology.

  Resource of spirituality in rehabilitation towards integrative health Top

Vidya Shenoy

Centre for Alzheimer's and Dementia Therapy, Universe of Memory, Alzheimer's & Related Disorders Society of India, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim: To improve coping mechanism of rehabilitation with practice of Spirituality Therapy as complement to conventional medicine.

Method: One needs to be aware of the choice of belief that can be practiced. Best to start with Universal Prayer that relaxes the recipient giving focus leading them into the session. Thereafter, recitation of AUM and Gayatri with a singular thought of invoking the Universal Cosmic Energy to rehabilitate oneself followed by meditation and then by singing or listening to religious songs or using the mode of movement and music. Session can close with deep breathing or Three-Part Breathing followed by chanting of primordial, solar sound, AUM, three times to calm down once again.

Results: It lightens the mind, renews energy, builds confidence, helps in improvement on physical, emotional, mental, psychological planes and cognitive abilities, reduces stress, for some it calms and, some builds stamina, increases focus, concentration and balance.

Conclusion: Spirituality therapy works as a catalyst in the process of rehabilitation to offer untold catharsis. A win-win situation, spirituality therapy though less explored and applied, interconnects and builds a bond between the therapist (healer) and the subject (healed). Its impact is slow yet promisingly qualitative and is a special tool that gives a better coping mechanism of manage rehabilitation leading the giver and recipient on the therapeutic path towards inner peace and complete wellbeing.

  Mothers confidence regarding handling their neonatal intensive care unit infants following an education program a comparison of different delivery modes Top

Shruti Shantaram Kamath, Sumita Rege

Department of Occupational Therapy, MAHE, KMC Manipal Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Multiple programs are used in the Neonatal Intensive Care Unit (NICU) and all these programs have different purposes, however one common idea that links all these programs is inclusion of parents and family members in the intervention using education. Also, involvement of family members in the NICU infant handling and care during their NICU stay. The key technique being followed in the NICU is that of handling and it has a major role in all the interventions.

Aim and Objective: The primary aim of this study was to compare the modes for delivering on infant handling to primigravida mothers in the NICU and to develop and validate video of handling for mothers.

Methods: A pre and posttest study design was used for a sample size of 70 mothers. Using convenience sampling 35 mothers were allocated in Group 1 (Manual demonstration and booklet) and 35 in Group 2 (Manual demonstration and video). After baseline competency assessment using the Karitane Parenting Confidence Scale (KPCS), mothers received instruction according to their group. Two days before discharge KPCS was administered again to evaluate the confidence level of mothers.

Results: Using dependent sample t test, it was found that there was significant difference between the pre and post KPCS values within both the Group 1 and 2.Using independent sample t test it was found there was no significant differences found between the booklet and video group.

Conclusion: Booklet and video instructions are equally effective mode of teaching mothers to handle their infants in NICU.

  Post-operative pediatric spina bifida rehabilitative management: A case report Top

Ivan Triangto, Djoko Witjaksono, Eko Nugroho, Dwi Indriani, Gutama Arya Pringga

Department of Physical Medicine and Rehabilitation, RSUD Dr. Saiful Anwar Malang, Malang, Indonesia.

E-mail: [email protected]

Background: Spina bifida (SB), known as a common neural tube defect in children occurring 3.4 cases per 10,000 live births. Several frequently encountered complications include neuromuscular disorders, bowel & bladder dysfunction, and skin breakdowns. The following conditions could similarly occur post-operatively. Thus, post-operative rehabilitative management plays an important role to restore activity and participation in SB.

Case: A 14-year old boy was consulted to PM&R department with weakness of both lower extremities, accompanied with sensory deficit, bowel & bladder incontinence and sacral ulcer. Previously, patient underwent surgery for SB occulta Th12-L1 and aperta L2-3. Physical examination revealed functional MMT for right knee extensor and bilateral ankle plantar flexors, whereas left knee extensor, bilateral hip flexors, ankle dorsiflexors, and long toe extensors were nonfunctional. There was sensory & proprioceptive deficit of both lower extremities with sacral sparing, absence of VAC & DAP, and grade III sacral ulcer measuring 2x2 cm. Functional examination showed inability to accomplish most ADLs independently, including ambulation, transfer, bathing, toileting, and dressing. Preoperative radiological study confirms diagnosis SB with lipomyelocele at Th12-L3 and tethered cord at L2. Rehabilitative treatment was prescribed with ADL modifications, NMES & sensory stimulation of both lower extremities & sacral region, LLLT for sacral ulcer, and a tilt table test.

Conclusion: Post-operative ambulation requires caregiver assistance, but is then expected to be able to ambulate independently or with ambulatory aid. Thus, comprehensive rehabilitative management with education, ADL modifications, modalities & exercise, could help patient with SB to achieve return to activity and participation.

  The effects of closed kinetic chain and open kinetic chain exercise in the lower extremity on the chronic stroke patients balance, strength, and functional mobility Top

Lisa Nurhasanah

Department of Physical Medicine and Rehabilitation, Diponegoro University, Semaramg, Indonesia

E-mail: [email protected]

Background: Stroke is the third prevalent disease to cause disablement. Muscle weakness is can limits the recovery of physical functions such as balance, strength and functional mobility that interfere with activities of daily living. Closed Kinetic Chain (CKC) and Open Kinetic Chain (OKC) exercise as the progressive resistance training is one of the rehabilitation approaches to correct strength, balance disorders and funtional ability caused by paresis of the lower extremities of post-stroke patients.

Objective: The purpose of this study is to compare the effectivity of CKC and OKC exercise in the lower extremities to the balance, strength and functional mobility of the chronic stage post-stroke patients.

Materials and Methods: This study is a quasi-experimental pre and post controlled trial group design. Twenty chronic stage post-stroke patients divided into the CKC group and the OKC group had 6 weeks exercise. The assessment of balance, muscle strength and functional mobility is before and 1 day after the last session.

Result: It is found that the CKC group has a significant difference in balance compared to the OKC group (p<0.05). Meanwhile, the lower extremities muscle strength in the OKC group was has greater mean result than the CKC group.

Conclusion: The conclusion of this study is CKC and OKC exercises improve the balance, muscle strength and functional mobility of the chronic stage post-stroke patients. CKC exercise has been shown to have a better result in balance and functional mobility. While in the muscle strength, OKC is better than CKC exercise.

  Correlation between disability level of stroke patient and quality of life of informal caregiver Top

Ricky Gustian Halim, Widjajalaksmi Kusumaningsih, Wanarani Alwin,

V. S. Dhanasari

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia.

E-mail: [email protected]

Background and Aims: Stroke is a sudden and devastating condition for the patient and also for the family members that act as the caregiver. Giving care requires the caregiver physically and emotionally prepared due to the complexity of the stroke patient. This study aims to determine the correlation between the disability level of stroke patients and the quality of life of the informal caregiver.

Methods: The research design is a cross sectional study using Shah Modified Barthel Index to assess the disability level of stroke patient and SF-36 to assess quality of life of informal caregiver. Subjects of this study is 50 stroke patients and 50 informal caregivers. The interview was done by direct face to face setting (for 23 stroke patients and 23 informal caregivers) and indirect face to face setting using video call (for 27 stroke patients and 27 informal caregivers).

Results: The median score of disability level of stroke patient in this study is 82,5 (16 – 100) and mean score of quality of life of informal caregiver is 69,69 + 20,32. The score for the subscales of quality of life are 73,7 (20,63 – 97,5) for physical components and 69,8 + 21,93 for mental components. Spearman correlation test was done for disability level of stroke patient and quality of life of informal caregiver which resulted moderate positive correlation (r=0,6, p<0,001).

Conclusions: There is moderate positive correlation between disability level of stroke patient and quality of life of informal caregiver.

  Efficacy of dysphagia therapy in facilitating feeding and swallowing function in cerebral palsied childen Top

Jayasankar Panda

Department of Speech and Hearing, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India.

E-mail: [email protected]

Background: Presence of dysphagia has a profound impact on wellbeing and quality of life in children with cerebral Thus, management of feeding and swallowing difficulties in cerebral palsied children is critical for adequate development of speech, social, emotional, physical, and cognitive skills.

Aim: The current study explored the efficacy of a combination of three dysphagia therapy techniques (Non-Speech Oral-motor exercises, Langmore Ice chip Protocol, Mendelsohn manoeuvre) in improving feeding and swallowing function in cerebral palsied children.

Methodology: Participants were parents of 30 children with cerebral palsy between the age range of 2-7 years. The PediEAT (Thoyre et. al, 2018) checklist was used to measure the parental observations. The PediEat checklist was administered before initiation of therapy and after three months of post therapy. Descriptive statistics and total-item and inter-item correlations were calculated for each of the items across the pre and post therapy levels. Paired sample t-test was used to estimate significant differences between the pre and post therapy intervals.

Results: Results indicated strong inter-item correlation in the pre and post therapy intervals. Comparison of responses in the pre and post therapy intervals yielded weak correlation across most of the items with parents scoring positive scores indicating better swallow function in the cerebral palsied children using the combination therapy.

Conclusion: The results of the study strongly advocate inclusion of dysphagia therapy along with speech and language therapy in the treatment protocol for facilitating adequate feeding and swallowing function.

  The effect of kolintang instrumental music therapy on improvement of cognitive function in a subacute stroke patients with mild cognitive impairment: A randomized controlled trial Top

Liana Dewi

Department of Physical Medicine and Rehabilitation, Sam Ratulangi University, RSUP Prof. Dr. R. D. Kandou Manado, Manado, Indonesia

E-mail: [email protected]

Background and Aims: Stroke is second leading cause of death and third leading cause of disability. Cognitive impairment often occurs after stroke and as the determinants of poor long-term success of therapy. Mild Cognitive Impairment (MCI) often gets less attention even though it is a factor that affects recovery after a subacute stroke. Instrumental music therapy has been used as part of music therapy. Kolintang is the traditional musical instruments from North Sulawesi. This study aims to determine the effect of kolintang instrumental music therapy to improving cognitive functions in a subacute stroke patients with MCI.

Methods: Twenty subacute stroke patients with MCI, between 30 and 65 years of age, were enrolled in the study and randomly divided into 2 groups: the control group (CG; n=10) undergoing conventional therapy (CT) 3 times a week for 4 weeks, and the intervention group (IG; n=10) undergoing CT 3 times a week for 4 weeks plus listened to kolintang instrumental music therapy, played for 20 minutes, 6 times a week for 4 weeks. MoCA-Ina assessment was carried out initially and immediately after the end of intervention.

Results: In particular, the IG showed better improvement in cognitive function (p < 0.001), as compared to the CG. The mean increase of cognitive function score was higher in the IG than the CG (3.8 and 1.8 respectively) with t value from independent t test was 4.867; and p < 0.001. This increase of cognitive function was statistically significant different in IG compared to CG (p < 0.001).

Conclusions: Kolintang instrumental music therapy could be considered a complementary approach to enhance cognitive function in a subacute stroke patients with MCI.

Keywords: Cognitive function, kolintang, MoCA-Ina, subacute stroke

  A case series of patients of spinal cord injury with COVID 19 Top

Anyesha Saha, C. Chethan, Swapnil Sonune, S. Y. Kothari

Department of Physical Medicine and Rehabilitation, AIIMS, Bhopal, Madhya Pradesh, India.

E-mail: [email protected]

Introduction: Covid 19 had a varied presentation in different groups of population. Persons with Spinal Cord Injury (SCI) are potentially at risk for severe Covid 19 disease as many of them have associated co- morbidities like hypertension, diabetes, cardiovascular disease, obesity and often have decreased lung capacity.

Aims and Objectives: To observe the presentation of Covid 19 in patients of SCI.

Methods: 3 patients with SCI who tested positive for Covid 19 and were admitted in PMR ward were evaluated.

Results: One patient with acute traumatic SCI had mild symptoms and was managed conservatively while other two patients with chronic SCI had severe ARDS and developed cardiovascular complications for which they required ICU admission. One patient with chronic SCI recovered while other succumbed to death.

Conclusion: In our observation, the patient with acute SCI developed mild symptoms of Covid 19 while the patients with chronic SCI were prone to develop severe Covid 19 disease requiring medical attention.

  Preference of action observation training video parameters in acute stroke survivors Top

Arunima Biswas, Manikandan Natarajan, John M. Solomon

Department of Physiotherapy, Manipal Academy of Higher Education, Manipal, Karnataka, India.

E-mail: [email protected]

Background: The current trend in stroke rehabilitation is focused on different forms of motor priming like action observation training (AOT). It is based on the neurophysiology of activation of the same neural areas for observation and execution of movements. The specifications of constituent video parameters could play a key role in motor recovery. However, a uniform structuring of the content of videos used in AOT is lacking.

Aim: To determine the preference of acute stroke survivors in terms of recording and viewing parameters.

Methods: Various lower limb activities were recorded using normal individuals in various environments and different views. The clips were processed to adjust the background light and noise along with modulation of the speed of movements shown. The edited videos were then shown to ten acute stroke survivors. Videos were shown on laptops and mobiles, with different angles from eye level, varying distance from the eye and using allocentric and egocentric perspectives of movements.

Results: Self-held mobile devices were preferred over larger screens. A screen distance of less than 60 cm from the eye placed at an angle above eye level was found desirable. Video duration of five minutes in total was found suitable with every movement repeated thrice. Egocentric perspective of movements shown at normal speed were favoured over half speed.

Conclusion: Video parameters for efficient administration of AOT have been identified. Incorporation of these parameters in future trials may make the intervention program more robust.

  As far as the eye can see: Restoration of visual loss in neurological disorders, is neuroplasticity possible? Top

Muhamad Faizal Zainudin, Alicia Dixie Abraham Nurul Diyanah Zenian, Mohd Razali Hasim

Department of Rehabilitation Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia.

E-mail: [email protected]

Background: Visual loss following intracranial pathologies is not uncommon. The three approaches of visual rehabilitation are compensation (working with unaffected aspects of the visual system to make up for the damaged portions), substitution (environmental adaptations and low vision devices such as prism glasses), and restitution (attempt to restore lost function). We present two cases of severe visual impairment with visual recovery following the restorative approach.

Methods: Case A is a 58-year old lady who presented with left hemiparesis and blurry vision, four years after the first stroke. Urgent CT scan revealed acute right temporal and thalamic infarct with encephalomalacic left parieto-occipital lobe. Visually, she could only appreciate light and hand movement for both eyes. Case B is a 40-year old lady with parasagittal meningioma who presented with left hemiparesis and blurry vision. Post-operative CT brain revealed recent left occipital infarct. Visually, the left eye was completely blind while the right eye could only appreciate light. Both patients underwent low vision rehabilitation for four weeks with low-technology instruments: light awareness training, stimulation with bright colours, and contrast sensitivity training.

Results: In Case A, her vision evolved into left homonymous upper quadrantanopia. As for case 2, she could finger-count and read large fonts of one-inch size with her right eye while her left eye remained blind.

Conclusions: At present, there is still a lack of evidence for visual restitution following neurological disorders. We should attempt to restore the vision as visual recovery is possible with neuroplasticity.

  Aggravated neuroinflammation by traumatic brain injury after lipopolysaccharide microinjection into the mouse corpus callosum Top

Sekwang Lee, Won-Ki Kim

Department of Neuroscience, Korea University, Seoul, South Korea.

E-mail: [email protected]

Background and Aims: Activation of microglia and macrophages may be implicated in the pattern and degree of various brain injury types by producing various proinflammatory cytokines. The present study investigated the changes of neuroinflammatory responses that occur early after traumatic brain injury (TBI) by weight-drop in mice microinjected with lipopolysaccharide (LPS) into corpus callosum.

Methods: LPS was microinjected into the right side of the corpus callosum in the C57BL/6 mice. The next day after LPS injection, 50 g of metal weight was dropped vertically into the pipe at a height of 1.7 meters to induce weight drop damage to the head of mice. Mouse brains were harvested 5 and 48 hours after the TBI. Immunohistochemical studies were performed to examine the effects of LPS on microglia, macrophages, neutrophils, and astrocytes. Regions of interest (ROI) are as follows; medial prefrontal cortex, hippocampus, striatum, cortex.

Results: Intracorpus callosum injection of LPS increased microglial activation after 24 hours in all measured ROIs measured. TBI with LPS pre-injection group showed higher activation compared to LPS/Sham group at 5 and 24 h after TBI. The pattern of changes in neutrophils and macrophages infiltration was the same as above. In contrast, astrocytes showed increased activation by LPS and exacerbation by TBI only at 24 h after TBI, and not activated at 5 h after TBI.

Conclusions: Our results suggest that TBI augments neuroinflammatory responses of LPS-preactivated mice brain. Thus, in the brain inflamed for various reasons, such as an infection, TBI may exacerbate the inflammatory response.

  Pre-injection of lipopolysaccharide into the mouse corpus callosum exacerbates concussion TBI-induced sensorimotor decline Top

Sekwang Lee, Won-Ki Kim

Department of Neuroscience, Korea University, Seoul, South Korea.

E-mail: [email protected]

Background and Aims: Repetitive traumatic brain injury (TBI) is associated with impaired motor, cognitive and emotional functioning. It is known that in recurrent TBI, brain fragility is increased by the first TBI, resulting in increased damage by subsequent TBI. We evaluated whether activation of central immune cells via lipopolysaccharide (LPS) injection contributed to worsening sensorimotor function.

Methods: Male C57BL/6 mice were placed in a stereotaxic device under inhalation anesthesia. LPS (1 ug/1l) or saline was injected to both sides of the corpus callosum at a rate of 0.2 ml/min by a microinfusiom pump. The next day after injection, a 50 g of metal weight was dropped vertically into a height of 1.7 m high pipe to induce a weight-drop injury to the mouse's head. Post-injury assessments were performed 24 and 48 h after TBI.

Results: In the Rotarod test, LPS/TBI group showed a significantly decreased fall latencies compared to the Saline/TBI and LPS/sham group at 24 h after TBI. Although the LPS/TBI group had significantly lower fall latencies compared to the LPS/sham group at 48 h after TBI, there was a trend toward increased fall latency.

Conclusions: The results suggest that activation of central immune cells by LPS microinjection increases bain vulnerability to subsequent TBI. This finding suggests that suppression of the central immune response may be a potential therapeutic target to reduce functional impairment after TBI.

  SP-8356 alleviates repetitive traumatic brain injury in mouse via inhibition of matrix metalloproteinase-9 Top

Sekwang Lee, Won-Ki Kim

Department of Neuroscience, Korea University, Seoul, South Korea.

E-mail: [email protected]

Background and Aims: Recent studies have emphasized the importance of the brain extracellular matrix (ECM) in the remodeling process after traumatic brain injury (TBI). SP-8356, a (1S)-(–)-verbenone derivative, has an inhibitory effect on the major ECM enzymes, matrix metalloproteinases (MMP). We examined the effects of SP-8356 on a mouse model of repetitive weight-drop injury using quantitative real-time polymerase chain reaction (qRT-PCR).

Methods: C57BL/6 mice were anesthetized and placed on a floor made of Kimwipe. Weight-drop injuries were performed twice 24 h apart at a height of 1.7 m using a metal of 50 g. SP-8356 (50 mg/kg) or vehicle (normal saline) was administered intraperitoneally 2, 7, and 24 h after TBI. Brain harvesting was performed 6 h after the second weight-drop injury. The target genes of qRT-PCR were as follows; MMP-2, MMP-9, CD147, TGF-1, TNF-, TNFR1, TNFR2, IL-6, IL-1, CD11b.

Results: The TBI group had higher gene expression of TGF-1, TNF-, IL-6, and MMP-9 than the Sham group. MMP-9 was the only one with a significantly lowered gene expression in the SP-8356-treatet TBI group. CD11b expression was lower in the TBI group than in the Sham group, but there was no inhibitory effect by SP-8356 in the TBI group. The gene expression of other genes did not different between the Sham and TBI groups.

Conclusions: SP-8356 effectively reduced the MMP-9 gene expression increased by concussive TBIs. SP-8356 may be a potential therapeutic agent for repetitive concussive TBI by modulating the remodeling process after TBI.

  Rehabilitation in patients with stroke following COVID 19 pneumonia in a tertiary care center-case series Top

S. Kalyaanasundhary

Department of Physical Medicine and Rehabilitation, AIIMS, Bhopal, Madhya Pradesh, India.

E-mail: [email protected]

Introduction: There is a increased risk of stroke in patients presenting with COVID 19 pneumonia which is attributable to ACE2 receptor activation in the blood brain barrier by the virus leading to hypercoagulable state and also due to microglial activation.

Aims and Objectives: To study the presentation, clinical features, area of involvement, type of stroke and associated co morbidities among COVID 19 patients and their response to rehabilitation.

Methods: There were three patients admitted with COVID19 pneumonia among which two patients had recurrent stroke and one had primary stroke. First patient developed right sided weakness after five days of testing COVID positive and is a case of recurrent stroke. The patient was managed and acute rehabilitation started with range of motion exercises and is asked to review in stroke clinic for further rehabilitation. Second patient presented with weakness of right upper limb and lower limb after three days of testing COVID positive. The patient presented with septic shock and was admitted in ICU and was tracheostomized. Third patient is a case of primary stroke and the patient developed right sided limb weakness with altered sensorium after two days and was shifted to ICU.

Result: The above case series shows that there is increased risk of stroke in COVID 19 patients attributed to the hypercoagulation inducing mechanism of the virion.

Conclusion: This case series shows that there is increased risk of stroke in patients with COVID 19 and them requiring ICU admission hinders with providing good rehabilitation care to patient.

  A feasibility and effects of parafit program on physical activity, exercise self-efficacy, and physical fitness among individuals with spinal cord injury Top

Noor Hafifi Noor Hisham, Haidzir Manaf, Maria Justine

Department of Physiotherapy, Kuala Terengganu, Malaysia.

E-mail: [email protected]

Background and Aims: This study aims to determine the feasibility and the effects of Paraplegia Fitness Integrated Training with the Education Program (PARAFiT) on physical activity, exercise self-efficacy, physical fitness, and exercise adherence.

Methods: A total of 20 individuals with spinal cord injury participated in this non-randomized controlled feasibility trial. Participants were assigned to the intervention (PARAFiT combined with conventional physiotherapy) or control group (conventional physiotherapy alone) with 10 participants in each group. Both groups completed the 8-weeks program with exercise adherence was monitored throughout the program using an exercise diary. The outcomes of this study were measures using The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), Exercise Self-Efficacy Scale (ESES), 6 Minute Push Test (6-MPT) for cardiorespiratory fitness (CRF), BIODEX isokinetic machine for shoulder strength, and JAMAR® handheld dynamometer for handgrip strength. The PA and ESE were measured at baseline and 8th, week, while the measurement of CRF, shoulder, and handgrip strength was measured at baseline, 4th week, and 8th week.

Results: During the program, mean adherence rates in the PARAFiT group were 80% and the control group was 75%. The 2-way repeated measure mix ANOVA showed no significant differences in PA, ESES, and 6-MPT between both groups (all p > 0.05). There were significant differences between the right shoulder internal rotators and right adductors, left internal rotators between groups (all p < 0.05). However, there were no significant differences between groups of the right shoulder external rotators (p=0.084) and the right abductors, left shoulder external rotators, abductors, and adductors (all p > 0.05). In addition, there were significant differences between groups on the right (p = 0.029) and left (0.0548) handgrip strength.

Conclusions: Overall, the study was feasible and safe to conduct with no major injury complaints received from the subjects. A more longitudinal study should be conducted to investigate the effects of PARAFiT in a large sample and the long term effects

  Efficacy of non-speech oral motor exercises in facilitating articulation development in children with cerebral palsy Top

Bibhu Prasad Hota, Jayasankar Panda

Department of Speech and Hearing, Swami Vivekan and National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India.

E-mail: [email protected]

Background: Non-Speech Oral-motor exercises (NSOMEs) are used to strengthen and improve muscle coordination of the jaw, lips, tongue, soft palate, larynx, and respiratory muscles (Landis,1994).

Aim: The purpose of the present study was to investigate the efficacy of NSOMEs in facilitating articulation development in cerebral palsied children.

Methodology: Participants were 60 children with cerebral palsy with a mean age of 4.2 years and within age range of 2-6 years. The participants were studied across two homogenous groups. Non-Speech Oral Motor Exercises (NSOMEs) apart from motokinesthetic and sensorimotor therapy techniques were administered to group 1 participants. Performance scores of Comdeall-Assessment of Oromotor Skills in Toddlers and Photo Articulation Test in Odia were derived at 0, 3rd, 6th, and 9th month. Paired t-test was used to compare differences between therapy intervals in the two groups. Chi-square test was used to determine significant differences between scores of participants for each test across each interval.

Results: Results indicated statistically significant differences (p<0.05) between the interval scores of Comdeall-Assessment of Oromotor Skills in Toddlers and Odia Photo Articulation Test in group-1 participants. Intergroup comparison indicated significant differences between the final scores of Photo Articulation Test in Odia with Group-1 participants having better performance scores. No significant differences (p>0.05) were also found across the interval scores of Comdeall-Assessment of Oromotor Skills in Toddlers (Archana, 2008) in group 2 participants.

Conclusion: The results of the study stress the need of implementing NSOMEs in the speech and language treatment regime of cerebral palsied children.

  Inter-intra rater reliability of Tinneti Performance Oriented Mobility Scale and Dynamic Gait Index of balance and gait by virtual method in stroke Pt Top

Tejal Manohar Garud, Suvarna Shyam Ganvir

Department of Neurophysiothrapy, Dr. Vitthalrao Vikhe Patil Memorial Hospital, Ahmednagar, Nashik, Maharashtra, India.

E-mail: [email protected]

Background: With this pandemic era tele-rehabilitation has become a new normal in the treatment of patients with neurological dysfunction. So the tools used for assessment needs revalidation while being used virtually. The aim is to investigate Inter Rater and Intra Rater Reliability of Tinneti Performance Oriented Mobility scale and Dynamic Gait Index subscale and total score through virtual mode in patients with stroke.

Methods: This is the observational study conducted on patients with stroke using virtual medium. Patients with gait and balance impairment were assessed using Dynamic Gait Index and Performance Oriented Mobility Scale. A round of demo video incorporating the components of scale, description of each with instructions was done before the actual assessment was given to the patients and care takers. 2 independent raters of similar educational qualification scored the patients at the same time for inter rater reliability. First author scored the components on the next day for intrarater reliability.

Result: Agreement between Inter rater and Intra rater of POMA components wise was 71.47% it was from 52.94%- 88.23% Low to High. Inter rater and Intra rater reliability of individual items varied from poor to excellent. Agreement between Inter rater and intra rater of DGI was 58.9% and component wise it was from 47.05%- 70.58% Low to High. Conclusion: The Inter rater and Intra rater reliability of DGI and POMA is found to be good, when measured through virtual method.

Keywords: Inter rater and intra rater reliability, POMA and DGI assessment, stroke, tele-neurorehabilitation.

  Post stroke depression and its effect on functional outcomes during inpatient rehabilitation Top

B. P. Navin, G. S. Sonachand, Anupam Gupta

Department of Neurological Rehabiliation, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background and Aims: Neuropsychiatric disorders following stroke have been commonly reported, which adversely affect outcome. We aimed to observe the effect of post stroke depression on functional outcomes during inpatient rehabilitation.

Methods: Prospective observational study included first ever stroke patients with duration of 1 year. They were assessed at admission and after 14 days of inpatient rehabilitation using depression sub-scale of 'Hospital Anxiety and Depression Scale HADS-D' and Hamilton Depression Rating Scale (HDRS). The outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS) and Modified Rankin Scale (MRS).

Results: Thirty participants (18 males) with median age of 58 years and median stroke duration of 90 days were included. Seventeen participants (57%) had symptoms of depression (HADS-D>7). Participants in both groups (with and without depression) showed improvement in all the functional outcomes measures (BI, SSS, MRS) at the time of discharge as compare to admission. The difference in scores [median (Q3-Q1)] between discharge and admission in participants with depression for BI was 10 (20-5), SSS was 3 (7-0) and MRS was 0 (0,-1); in people without depression the difference in score for BI was 15 (25-15), SSS was 4 (8-2) and MRS was 0 (0,-1). The change in the outcome measures were statistically significant within groups (p< 0.05) but not significant between the groups (p>0.05).

Conclusion: Post stroke depression is common among stroke survivors. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program in the present study.

  Solo guidance of ultrasound for botulinum toxin injection in cricopharyngeus muscle: Successful treatment in a patient of chronic dysphagia following lateral medullary syndrome Top

Ayan Ghosal, Arindam Mitra, Rajesh Pramanik

Department of Physical Medicine and Rehabilitation, IPGMER and SSKMH, Kolkata, West Bengal, India.

E-mail: [email protected]

Background and Aims: Chronic dysphagia following lateral medullary syndrome is a concern for the physiatrists, and the cricopharyngeus muscle spasticity has been found as the main cause. Botulinum toxin injection is a widely used procedure for the treatment of the dysfunction of the upper oesophageal sphincter (UES). Although the injection can be guided by ultrasound, electromyography, or computed tomography, ultrasound guided injection is the easiest and least invasive method. There are only few studies that observed the effectiveness of ultrasound guided botulinum toxin (ONAbotulinum Toxin Type A, i.e. BTX-A) injection in cricophayngeus muscle in patients of dysphagia following lateral medullary syndrome. To our present knowledge no study has been done with solo guidance of ultrasonography. Our purpose is to report the effectiveness of BTX given under solo guidance of ultrasound in cricophayngeus muscle in a chronic dysphagia patient of Lateral Medullary Syndrome(LMS) and see the effect subjectively and objectively.

Methods: In a patient of right lateral medullary syndrome with chronic severe dysphagia, 50 U of BTX-A given in right cricopharyngeus muscle under guidance of ultrasound.

Results: There was both subjective and objective improvement with DOSS score improve from 1 to 6, FOIS score improved from 1 to 6 and PAS Score improvedfrom 7 to 2 at two months follow up and improvement sustained in up to 6 months of follow-up.

Conclusion: Solo ultrasound guided BTX-A injection may be an effective and cost-friendly way for patient with cricophayngeus muscle dysfunction following Lateral Medullary Syndrome.

  USG guided botulinum toxin for upper esophageal sphincter spasm in neurological dysphagia Top

Sabir Pottichi, Navita Vyas, Abishek Srivastava

Department of Physical Medicine and Rehabiliattion, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Cricopharyngeal Muscle (CP) or Upper Esophageal Sphincter (UES) spasm leading to Dysphagia and Aspiaration is very common problem in many neurologiacal diseases and can be treated by Botulinum toxin injection (BTX)in CP muscles. Injection can be given by EMG or Endoscopic guidance USG guidance is a new strategy to guide the injection.

  The efficacy of cognitive tele-rehabilitation in maintaining cognitive skills in neurodegenerative conditions: A pilot study Top

Karishma Jethmalani, Poonam Bajaj, Aashish Contractor

Department of Rehabilitation and Sports Medicine, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim: The aim of this study is to test the efficacy of cognitive tele-rehabilitation (CTR) in maintaining cognitive skills, and to further compare its effects with in-person cognitive rehabilitation (IPCR) in patients diagnosed with mild dementia.

Methodology: Twenty-two participants with mild dementia (Mini-mental state examination score 21-25; Clinical Dementia Rating score 1) were divided into two groups. Five patients received CTR, and seventeen patients received IPCR. The intervention consisted of two weekly sessions of CTR and IPCR, conducted over a span of three months. The main outcomes measures used were the Addenbroke's Cognitive Assessment (ACE-R) to assess cognitive functions, and the Hospital Anxiety and Depression Scale (HADS) and the Satisfaction with Life Scale (SWLS) to assess mood and satisfaction with life respectively.

Results: The mean global cognitive scores and satisfaction with life score showed improvement with both the CTR and IPCR group. However, there was a discrepancy between the subjective mood assessment scores, in that the IPCR group showed fewer depressive and anxious features as compared to the CTR group.

Conclusion: The present study provides preliminary evidence in support of cognitive tele-rehabilitation and its efficacy in maintaining cognitive skills in early dementia, and should pave the way for future studies aiming at designing treatment protocols for cognitive tele-rehabilitation for neurodegenerative conditions.

  Effectiveness of a comprehensive physical activity promotion program on physical activity and quality of life among people with stroke living in a south Asian country Top

Pradeepa Nayak, Senthil Kumaran, B. Unnikrishnan, M. John Solomon

Department of Physiotherapy, Manipal College of Health Professions, MAHE, Manipal, Karnataka, India.

E-mail: [email protected]

Background and Aims: Despite of proven health benefits of regular physical activity (PA), adults with stroke do not achieve recommended levels of PA. Therefore, we aimed to test the effectiveness of a comprehensive PA promotion program on PA levels measured with physical activity scale for individuals with physical disabilities (PASIPD) and accelerometers, and quality of life (QoL) measured with stroke specific quality of life (SSQoL) in adults with stroke.

Methods: In a cluster randomized controlled trial four community centers of Udupi district, Karnataka were randomly allocated to experimental and control groups. Participants in the experimental group received 7 intervention sessions in a period of 45 days. Sessions were focused on education, exercises, adaptive sports, and motivation to do PA. Control group participants received one session on education about stroke recovery. Participants' PA levels and QoL were assessed at baseline and 3 months post-intervention.

Results: Mean age of the participants was 60.03 ± 9.68 in the control group (n=35) and 56.60 ±9.92 in the experimental group (n=35). Repeated Measures ANOVA revealed a significant improvement in the PASIPD scores (F= 8.34; df = 1, 64; p=0.005), average kilocalories per day (F=4.93; df = 1, 58; p=0.030), step counts per day (F= 4.46; df = 1,58; p= 0.039) and SSQoL scores (F = 24.45; df = 1, 64; p<0.001) in the experimental group compared to the control group.

Conclusion: Comprehensive PA promotion program improves PA levels and QoL in community-dwelling adults with stroke.

  Using “brainnext” for acute, severe brain infection and profound global deficit; giving quality of life to a child with rabies encephalitis Top

Mangal Kardile

Department of Clinical Neuropsychology, Mental Health Aims, Nashik, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Rabies encephalitis is a rapidly-progressive-CNS-infection resulting from infection by a member of an RNA virus, mostly transmitted by infected animal vectors to humans via bite, resulting in rapid neurological deterioration, mostly progresses to death. The case of 17-years-old-young-boy “S”, had dog-bite when 10-years-old, until Normal development, but went almost into-vegetative-stage 1-and-half-month after acute-rabies encephalitis, with severe epilepsy. After trying all treatment-rehab options >7 years, started “BrainNext” rehab-program, recovered >55% in 14-months from baseline-condition, rehab continued by caregiver at home.

Methods: With caregiver's consent, the young boy “S” in vegetative state, supported at home after mother approached in the hospital OPD, author created special “BrainNext” tools rehab-program to alert sensory-systems, follow-up continued every 15 days revising and adding new exercises as applicable for 14 months before covid-19-March'20 at his residence. Rehab continued online during Covid-19, for 6-months. Recovery recorded on hard copy-audio-video. Measured progress,1 to 10 scale-(1-10%,10-100%), baseline as 0%.

Results: Sensory reflexes started >5% in 1st week, neuronal pathways alerted >15% in 1st-month, eyelids-movement, little speech, neck holding, neuromuscular flexibility improved>25% by 4 months, fine-motor grip, following-instructions subtly-facial-expressions-speech, chewing, visual-focus, spinal-stability improved >40% by 10 months, although having seizures, overall sensory-responses improved >55% by 14-months, “BrainNext”-rehab continued by caregiver at home.

Conclusions: “BrainNext” special rehab-tools developed for severe cognitive decline giving hope for caregivers with better quality of life for persons-with-rare-brain-infections, as rabies-encephalitis, improving >55% in 14 months recovering almost from vegetative-stage, besides severity and >7 years-lived-with-severe-disability, observed with increased responses to other therapies after “BrainNext” program.

  Medical complications among patients with severe traumatic brain injury admitted for inpatient rehabilitation in a tertiary care centre in South India Top

Saumya Susan Zacharia, Raji Thomas, Prashanth Chalageri

Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India.

E-mail: [email protected]

Background: Patients with Traumatic Brain Injury (TBI) admitted for inpatient rehabilitation have several preventable medical complications that delay rehabilitation. Awareness of these help in early diagnosis and timely intervention. There is scarcity of such studies in Indian literature and hence this study aims to identify medical complications during inpatient rehabilitation and to study associated factors.

Aims: To study medical complications during inpatient rehabilitation of patients with severe TBI and their association with age, extent and duration of injury, initial management and Ranchos Los Amigos (RLA) stage at admission.

Subjects and Methods: Severe TBI patients above 18 years of age, admitted during 2017-2019 were enrolled. Medical complications were retrospectively collected from records using questionnaire and association with different variables studied.

Results: 100 severe TBI patients, 81 males and 19 females, mean age 35 years were included. Duration since injury was </= 6 months in 39%, 6 months to 1 year in 19%, and >than a year in 42%. As per RLA staging, 17% were </= 2, 54% were within 3 to 4 and 29% were above 5. 81% patients had complications. Neurobehavioural issues (29%), genitourinary complications (18%), Heterotopic ossification (16%), dyselectrolytemia (11%), respiratory infections (11%), tracheostomy related complications (10%), seizures (8%), pressure ulcers (6%), contractures (6%), fractures (4%), paroxysmal sympathetic overactivity (3%), hydrocephalus (3%) and thromboembolic events (6%) were identified. Complications were more in 36-55years of age with RLA stage 3-4 and in those admitted within 6 months. Conclusion: Medical complications are very common during rehabilitation and are associated with age, duration since injury and level of consciousness.

  Transcutaneous tibial nerve stimulation for overactive bladder syndrome: A case study Top

Aastik Pankajkumar Bhatt, Sabir Pottichi, Navita Purohit, Abhishek Shrivastava

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Overactive bladder syndrome is defined as a symptom syndrome which includes urinary urgency, with or without urge incontinence, usually accompanied by frequency (>8 micturitions/24 h) and nocturia. Tibial nerve stimulation is a novel and non-invasive treatment option for overactive bladder syndrome.

Materials and Methods: A 71 years old male patient of recurrent meningioma was given Tibial Nerve Stimulation for overactive bladder syndrome. A set parameters of transcutaneous electrical nerve stimulation (TENS) current was given. The patient was assessed on Overactive Bladder Symptom Score (OABSS) developed by Yukio Homma et al and Overactive Bladder questionnaire (OAB-q) developed by Coyne K et al.

Result: OABSS (0-15) improved from 14/15 to 3/15. OAB-q (33-198) improved from 117/198 to 48/198.

Conclusion: These findings point towards transcutaneous electrical nerve stimulation (TENS) as an alternate treatment option for overactive bladder syndrome management.

  Step length asymmetry and walking performance in hemiplegic patients Top

Dhinla Sivadas, C. Ramesh, T. Jayakumar

Department of Neurorehabilitation, NIMHANS, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background and Aims: Gait asymmetry in stroke patients is well documented and asymmetry in spatiotemporal parameters has been used commonly in clinical practice. Hemiplegic patients may walk with either relatively longer paretic or non paretic step length. However, this asymmetry in step length and its effect on walking performance is less documented. So the aim of our study is to understand the relationship between step length asymmetry and hemiplegic walking performance.

Methods: This observational study includes 20 chronic stroke patients. Gait parameters such as step length asymmetry, paretic leg propulsion and mean velocity were assessed in 3 D Motion Gait analysis lab. Stroke severity was assessed by Brunnstrom stages of motor recovery scale.

Results: Significant negative correlation was revealed between step length asymmetry and propulsive force generation with paretic leg and it also shows a strong correlation with stroke severity and moderate negative correlation with walking speed.

Conclusion: Step length asymmetry is a promising tool to understand the walking performance of stroke patients.

  Sonographic evaluation of affected shoulder in patients with hemiplegia following stroke Top

Faiz Mohamed, Navita Vyas, Abhishek Srivastava

Department of Physical Medicine & Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.

E-mail: [email protected]

Objective: Hemiplegic shoulder pain is common in stroke. This study was performed to evaluate the sonoanatomy of affected shoulder in hemiplegia and to assess correlation between structural changes and Type of Stroke, Duration of stroke, Age of patient or Pain.

Materials and Methods: A Prospective study involving 70 patients was done in Department of PMR, Kokilaben Dhirubhai Ambani Hospital. Ultrasound evaluation of hemiplegic shoulder was performed to assess for structural changes. Type and duration of stroke, Age of patient and presence of pain was recorded. Statistical Analysis was done using SPSS V21. Chi-Square/Fisher's Exact test was used to find out non-random associations between two categorical variables.

Results: One or more structural abnormalities were found in all hemiplegic shoulders. 65 % had Ischemic stroke while 35 % had Haemorrhagic stroke. 34% were less than 3 months and 66 % were more than 3 months post stroke duration. 24% of patients were younger than 45 years, 76 % were older. 85% of them had pain in the shoulder while 15 % had no pain. The Sonographic evaluation showed: Supraspinatus tears in 87 %, Tenosynovitis of biceps tendon in 73%, SASD bursitis in 44%, Subscapularis tendinopathy in 38 %, Glenohumeral effusion in 20% and AC joint degeneration in 27%. There was no correlation between structural changes and Type of Stroke, Duration of stroke, Age of patient or presence of pain.

Conclusion: Hemiplegic patients have significant structural abnormalities in the affected shoulder irrespective of type, duration, age or presence of pain.

  Single session smart walker (SW) static standing intervention in cerebral palsy (CP) children – An observational study Top

Shristi Shakya, Nayan Prakash, S. Shamantha Madapura, Harikishan Balakrishna Shetty, Sivakumar Gopalakrishnan, Bhamini Krishna Rao, V. S. Venkatesan

Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.

E-mail: [email protected]

Background and Aims: Poor postural control interferes with independence in Activities of Daily Living and mobility in CP children. Improving balance and equilibrium during different postures and gait is important in rehabilitation. Most of the pediatric walkers are passive frames, which do not actively facilitate gait training. SW is an innovative interactive gait trainer. It aims to determine the feasibility of SW in postural training of CP children.

Methods: 2 typical and 3 CP children were enrolled after consent. Camera with mounting device captured anterior, lateral, and posterior view after the children were donned with SW at the ASIS level. Any one or combination of the walker's legs was extended to tilt SW. Postural adjustments were captured and analyzed using kinovea software.

Results: Postural adjustments, following anterior-posterior tilts of SW were recorded and analyzed. The typically developed (TD) children were quick to learn and adapt to the controlled imbalance compared to CP. The CP children were not able to remain stable/lost balance when the SW leg was raised beyond 3 cm compared to 9 cm of TD. The Lumbopelvic (LP) angle was 2.5 times higher in CP compared to TD children for anterior tilt and 2.25 times higher for posterior tilt.

Conclusion: Single session SW's static standing intervention was successful in triggering postural reactions and documented differences in LP angle in typical and CP children. However, the beneficial effects of short and long-term training with the SW in CP children are yet to be explored with EMG findings.

[TAG:2]Walking speed and cadence as predictors of fall risk in chronic neurological conditions [/TAG:2]

Poonam Bajaj, Shanaya Contractor

Department of Rehabilitation and Sports Medicine, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Fall risk is highest in most chronic neurological disorders. It can lead to a downward cascade that leads to significant morbidity and mortality. Whilst there are several standardized balance tests that can predict fall risk they are time consuming. This study seeks to analyse whether a quick and simple test of walking speed and cadence can screen for fall risk accurately.

Methods: 10 subjects within the age group of 55 to 75 years with a chronic neurological condition involving lower extremity weakness, such as stroke, Parkinsons Disease, traumatic brain and spinal cord injuries, were made to perform the 10 meter walk test. Their walking speed and cadence were measured over three trials. Their values were compared to 10 age matched normal controls.

Results: Statistical significance was calculated using a one-tailed t-test (using Social Science Statistics Calculator) for cadence (steps/ minute) and walking speed (metres/ second). Results were found to be significant for walking speed in individuals with chronic neurological conditions when compared to age matched normals (P 0.05). However results for cadence were found to be non-significant at P 0.05 in both groups.

Conclusion: Walking Speed is a reliable, valid, responsive, easy and safe, quick screening tool for fall risk prediction in the clinic. Cadence was not found to be as efficient a parameter for screening fall risk in chronic neurological conditions.

  Spectrum of COVID-19 in a tertiary care neuro rehabilitation centre Top

J. Jeyakhar, Navita Vyas, Abhishek Srivastava

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Introduction: The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged in Wuhan city, China and has since spread to 215 countries including India. India a developing nation and densely populated country too has been affected COVID-19 19 pandemic. As on March 3rd, 2020 nearly 10 million people were totally infected, death around 150 thousand dead and 9.9 million people recovered with Maharashtra state leading in the Number of cases. In Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute we have full-fledged Rehabilitation department and patient have the best opportunity for the maximum best outcome from covid-19 disease and Post covid-19 complication.

Aims and Objectives: The aim of the study is to present the demographic details, clinical features, severity of illness, radiological findings, management and rehabilitation for patients who were affected by COVID-19 and seen during July 2021 to February 2021 in the Centre of Physical Medicine & Rehabilitation in Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute.

Materials and Methods: It is a Cross Sectional Observational Retrospective study. All the patient with history of COVID-19 infection who attended/referred to Centre of Physical Medicine & Rehabilitation for Neuro Rehabilitation, Pain management and post COVID-19 Cardio - Respiratory rehabilitation for Inpatient, Outpatient and Day care management will be included in the study. Detailed history of the patient including the severity of the disease, reason for referral will be collected. The main disabling issues in the post COVID patients like Dyspnea, Deconditioning, Depression, Fatigue & Pain will be graded using standard scales.

Results: 97 patients were taken in the study out of which 75 (77%) were admitted due to covid/ with complications of covid, 10 (10%) had covid during hospital stay and remaining 12 (11%) had incidental finding of COVID. All the patients were evaluated by Rehabiliation Physician and Started on Comprehensive Rehabilitation for Covid as well as other Neurological aspects 18 (18%) were on ventilator support, 13(13%) required oxygen (3-15 lts), 12 (12%)were on Tracheostomy Tube. 12 (12%) succumbed to the virus in course of time. 38 (37%) had deconditioning due to the disease and 24 (24%) had severe fatigability; 80% had impaired mobility due to deconditioning, fatigability and pre covid neurological issues. All who survived were weaned off from ventilator within range of 5 to 60 days, were decannulated and all were sent home without oxygen except 1 (0.04%) who required 0.5-1 lt of oxygen while mobile; with Home rehabilitation Program.

Conclusion: The patients who required prolonged Ventilator support are the one who had severe Dyspnea, deconditioning, Depression, Fatigue, pain and cognitive impairments.

  Gait characteristics following stroke: A prospective crossover study among users of ankle-foot orthosis and functional electrical stimulation Top

Gourav Sannyasi, B. P. Navin, Rajdeep Ojha, George Tharion

Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background and Aims: Foot drop following stroke can be treated with ankle-foot orthosis (AFO) or functional electrical stimulation (FES) to peroneal nerve. There is limited evidence regarding the efficacy of FES as a substitute for a traditional ankle-foot orthosis. We aimed to compare the effect of FES with AFO on gait parameters in individuals with foot-drop following stroke.

Methods: Twenty individuals (ten per group) were enrolled in the prospective crossover trial. Participants in Group A received gait training with AFO for first week followed by FES during second week and vice-versa for group B. Outcome parameters included 10 meter and 6 minute walk test and spatiotemporal gait parameters. Assessment was done on day one (barefoot) and at the end of every week following AFO/FES training. In addition, the level of satisfaction was assessed using feedback questionnaire.

Results: Nineteen males and one female with mean (SD) age of 45.5 (9.45) years were recruited. Statistically significant (p<0.05) improvement was observed in 10-meter and 6-minute walk test, gait speed, TUG test, stance-swing ratio and single-limb support among users of FES as compared to AFO and barefoot. Physiological cost index (PCI) showed trend of improvement among FES users. Patient satisfaction scores were higher with FES.

Conclusions: Quantitative and qualitative results were in favour of walking with FES as compared to AFO and barefoot walking. Results highlighted the need for a low-cost FES device in the developing countries.

  Development and validation of FmAE device for hand function training Top

Salim Babulal Shaikh, Suvarna Ganvir

Department of Neurophysiotherapy, DVVPF'S College of Physiotherapy, Ahmednagar, Maharashtra, India.

E-mail: [email protected]

Background: Hand dysfunction due to any cause results in a significant impairment leading to functional inability. Very few devices are available to measure individual finger performance effectively, also the treatment devices that emphasize on individual finger activity are rare.

Objective: To describe the development of FmAE Device for hand function training in functional position. In addition, its intra- and inter-rater reliability was examined.

Methods: Thorough investigation of currently available grip measurement tools was done. Considering their limitations in terms of inability to provide immediate feedback, exact gradation of individual finger muscle strength, FmAE was devised. Application of this device was done on 10 healthy adults to figure out its reliability. Measurements of the Finger muscle strength were obtained by two examiners for 20 hands of 10 healthy adults at two time points, with a one-day interval between measurements, to determine the inter- and Intra-rater reliability.

Results: The reliability of the device was excellent for both intra- (intraclass correlation coefficients 0.94) and inter-rater (intraclass correlation coefficients 0.96) comparisons. No fixed or proportional bias was observed between the two examiners.

Conclusions: The results indicate the excellent reliability and responsiveness of our device. This reliable measurement tool used for assessment of individual finger strength which can be quantified objectively and hence can be recorded easily. It can be used for treatment purposes which will help to improve the muscle strength.

  Timed up and go test in chronic hemiplegic stroke patients: A comparison of turning direction Top

Satyanaya Widyaningrum, Widjajalaksmi Kusumaningsih,

Herdiman B. Purba, Dewi Friska

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Indonesia, DKI Jakarta, Indonesia.

E-mail: [email protected]

Background: The Timed Up and Go (TUG) Test is strongly correlated to level of functional mobility, to reflect the balance and gait maneuvers used in everday life. The most common disability in stroke patients is hemiparesis which affect the ability to complete safe turning. Instability in performing a turn can result in increasing risk of fall. Turning as performed during the TUG can indicate mobility difficulties, in addition to the motoric recovery. This study aims to investigate the effects of the turning direction according to the affected and unaffected sides of stroke on their TUG test.

Methods: Thirty chronic stroke patients with hemiparesis were asked to perform TUG test by turning two directions. Other parameters assessed were Functional independence (Barthel Index Shah Modification Indonesian version), Moc-Ina, and neuromuscular examinations.

Result: Longer Timed Up and Go (TUG) test duration time when turning with unaffected side (18.65±9.05 s) compared with the affected side (18.29±8.98 s). There were no significant differences in turning direction in Timed Up and Go test (p>0.05). Those who have reached Stage of recovery Brunnstrom 6 has shorter TUG time compare to Brunnstrom 5.

Conclusion: Neither turning in affected nor unaffected side of hemiparesis side seems to be safe in turning for daily activities. Brunnstrom stage of recovery has strong correlation in affecting TUG test.

  Comparison of activity levels between younger and elderly stroke survivors in hospital Top

Apoorva M. Shankaranarayana, Nikhil Hegde, Pattan Yakub Sameer Khan, John M. Solomon, N. Manikandan

Department of Physiotherapy, Manipal College of Health Professions, MAHE, India.

E-mail: [email protected]

Background and Aim: Stroke survivors exhibit sedentary behavior during hospital stay which could lead to development of complications, especially in older age groups. Aging can be a vital factor for reduced activity levels. Therefore, it is important to identify the difference in activity patterns between elderly and younger age group patients with stroke during hospitalization to plan the appropriate strategies. The aim of this study was to compare the level of activity in hospitalized stroke patients during acute and subacute stages between elderly and young to middle aged.

Methods: A cross-sectional study was carried among stroke survivors admitted in hospital. Stroke patients of either gender aged between 18 and 80 years were identified and monitored using an activity log chart from 8AM to 5PM. The observations were done every 15th minute and the various activities performed by the stroke patients were noted. Based on the age, participants were grouped either as elderly (>55 years) and young (<55 years).

Results: Seventeen patients were included in the study. There were 9 male and 8 female participants. 9 patients were aged >55years and 8 were <55years. On an average, stroke patients' in elderly group were active for 17.19% and sedentary for 75.28%. Patients <55 years were active for 41.55% and sedentary for 43.57% during the twelve hour period.

Conclusion: Age is an important factor affecting activity levels after stroke in hospital. Specific interventions and care towards elderly may help meet the required activity levels in this group and prevent complications.

  Interdisciplinary rehabilitation for complicated pressure injury in complete spinal cord injury due to neglected burst vertebral fracture: A case report Top

Nurrakhmanita Aziza, Indriati M. S. Tobing, Vitriana Biben

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hasan Sadikin National General Hospital, Padjadjaran University, Bandung, Indonesia.

E-mail: [email protected]

Background and Aims: Spinal cord injury (SCI)-associated pressure injuries are common, especially in a developing country. Interdisciplinary rehabilitation is mandatory to support the management of complicated pressure injuries.

Methods: A male, 31-years-old, diagnosed with SCI ASIA Impairment Scale (AIS) A with neurological level Thoracal 10 due to neglected vertebral burst fracture referred from the plastic surgeon with multiple pressure injury. The ulcers were unstageable at the sacrum and ischium tuberosity bilateral with the Pressure Ulcer Scale for Healing (PUSH) score was 17. It had multiple drug resistance (MDR) Acinnobacter baumannii infection that indicated unhygienic wound care. He also had malnutrition, catheter-associated urinary tract infection (CAUTI) by MDR Escherichia coli, and urinary leakage that could worsen the wound. Based on the resistance test, he got ampicillin-sulbactam to treat wound infection and CAUTI. The assessment of hemodynamic and cardiorespiratory endurance had been done to assess the patient tolerance in prone position. The patient was positioned prone and side-lying alternately every 2 hours and he got wound care. The patient also got high protein and calorie diet, iron supplement, and interdisciplinary program from the rehabilitation team to optimize his functional abilities for supporting the wound healing.

Results: After 3 weeks of hospitalization, the PUSH score became 13 and the caregiver could do the wound care with good hygiene. The CAUTI was healed, and he got an improvement in mobilization that will reduce the risk of worsening wound.

Conclusions: Comprehensive assessment, interdisciplinary approach of rehabilitation including family collaboration is needed to manage complicated pressure injury.

  Memory and cognitive rehab at Sancheti hospital (Sior), Pune, India; application of “brainnext” tools for varied neurology patient populations Top

Sonal Shah

Department of Physiotherapy, Ancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Other neurological disorders, excluding Alzheimer and Dementia show significant memory and cognitive impairment, observed in the research of standardized memory and cognitive screening tool “UMACE”-Universal-Memory-And-Cognitive-Exam. Sancheti Hospital, Pune, specializes in orthopedics rehabilitation and adding “BrainNext” rehab-model for neurology population, successfully achieves complete rehabilitation model. The study focuses on varied-neurological-population, children-to-elderly, in/out-patients given rehab sessions at Physio-dept., Sancheti Hospital using “BrainNext” program before and after Covid-19 emerged in India.

Methods: With consent and consulting with Clinical-Neuropsychologist, “BrainNext” rehab-program by trained-neurophysiotherapists for moderate-to-severe-patients, N=74, male-female, children to elderly with varied neurological conditions, developmental-disorders(comorbid-epilepsy)-rare brain-diseases-TBI-PostStroke-Parkinsons-Alzheimer's-dementia, given about 5-6 weeks, 2-weeks daily 1-hour, alternate-day-2weeks, then twice-thrice-a-week. 15-days-follow-ups with Clinical-Neuropsychologist, revised previous and added new cognitive exercises, rehab-program continued at home after 6-weeks with follow-ups every month. 2-severe-in-patients admitted, 1hour-2sessions-daily, observed for 15 days. Post-stroke and developmental-gross-motor-deficit supported with other rehab-therapies at hospital after “BrainNext” program. To measure progress 1 to 10 scale (1=10%,10=100%) used, baseline condition 0%.

Results: Patient-centered-memory-cognitive-rehab sessions by trained neurophysiotherapists at hospital showed >5% improvement in 1st week, orientation-visual focus-stability-following instructions-speech-memory-fine-motor developed >15% by 2 weeks, >50% improvement observed by 6 weeks, for in-out-patients. Severe-in-patients improved >30% in 15-days, discharged and home-support continued along with neurophysiotherapy.

Conclusions: “BrainNext”-rehab-sessions at Sancheti hospital by trained-neurophysiotherapists and regular-follow-ups by clinical neuropsychologist helped all-ages-varied-neurological-conditions, improving memory-cognitive-fine-motor deficit faster. Besides varied years-lived-with-disability, quality of life improved for all patients. Post-stoke and Developmental gross-motor deficit observed to be responded faster to neurophysiotherapy and occupational-therapy after “BrainNext” rehab, creating total rehab-support-model at Sancheti hospital, Pune.

  Effectiveness of therapy in aphasia using a combination of principles of deblocking and semantic naming – A single case study Top

Archita Kumari, Mereen Rose Babu, Aishwarya Dinesh, Anita Reddy

Department of Speech Language Studies, Dr. S.R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background and Aim: Severe comprehension impairments in Wernicke's aphasia (WA) are often seen to be associated with related auditory and phonological impairments, impairments in semantic and execution function. The present study aimed at understanding effectiveness of combining principles of deblocking and semantic naming treatment in a patient with acute infarct on left temporo-parietal lobe and chronic infarct with encephalomalacia involving left fronto-temporal lobe.

Materials and Methods: A 41 years old male diagnosed with Severe Wernicke's aphasia, attended 14 tele therapy sessions through Zoom platform. The therapy was focused on increasing his auditory comprehension, production of meaningful sentence formulation, and meaningful usage of words preserved in his vocabulary. The therapeutic strategies adopted for deblocking and semantic naming were reading and production of semantic attributes, respectively.

Results: The outcome of this approach is reflected with increase in the percentage of meaningful words from 57 % in the first session to 86 % for objects naming and 90% for action verbs after 14 sessions and an improvement in his auditory comprehension from50% to 80%. The percentage of production of meaningful sentences increased from 53.76 % to 86.04%.

Conclusion: The findings of this case study indicate the efficacy of combining the principles of deblocking and semantic naming treatment in improving the communication skills of individuals with Wernicke's Aphasia that can further enhance their quality of life.

  Impact of maternal stress on the motor functions of children with cerebral palsy Top

C. M. Radhika, Katuree Dutta, M. Rajeswari

Department of Faculty of Physiotherapy, SRI Ramachandra Institute of Higher Education & Research, Chennai,Tamil Nadu, India.

E-mail: [email protected]

Background and Aim: Mothers of children with cerebral palsy have showed increased level of stress as compared to mothers of normally developing children. Most of our rehabilitation in cerebral palsy revolves primarily around the child and less importance is given to reducing mental stress of the mothers. Reduced stress level will enhance the active participation of the mother which can have an impact on the motor function of the child. The aim of this study is to reduce the mental stress of the mothers of children with cerebral palsy and analyze the influence it could have on the motor function of the child.

Materials and Methods: 24 mother-child pairs were randomly divided into two groups. The mothers of experimental group received parental counseling, parental education and relaxation exercises. The mothers of the control group received parental counseling alone. The children of both the groups underwent regular physiotherapy. Parental stress scale was used to measure maternal stress and the Gross Motor Function Measure (GMFM-88) was used to measure the motor function of the child. The intervention period was for 4 weeks before and after which the stress and motor outcomes were measured.

Results: The mothers of the intervention group showed a decrease in the level of stress after the intervention period. The mean stress score of the mothers of the experimental group reduced from 47.92 ± SD 8.11 to 46.08 ± SD 8.6 (p 0.05).

Conclusion: Reducing the maternal stress through relaxation exercises and parental counseling will allow more active participation of the mother during therapy sessions and can be influential in improving the motor functions of children with cerebral palsy.

  Cauda Equina syndrome: An unusual presentation in chronic rheumatoid arthritis Top

Monica Moirangthem, A. K. Joy Singh, L. Nilachandra

Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India.

E-mail: [email protected]

Background and Aims: Rheumatoid arthritis (RA) is a symmetric inflammatory polyarticular arthritis that affects the small joints of hands and feet. Affection of the lumbar spine in chronic RA is very rare though it has been reported. It can cause chronic low back pain and even cauda equina syndrome (CES) which is uncommon but is a serious neurological condition affecting the bundle of nerve roots at the lower end of the spinal cord. This report is to emphasize that CES can possibly occur in longstanding cases of RA and must be kept in mind as a diagnosis in such patients.

Methods and Results: We report a case in a 65-year-old male who had history of seropositive RA for 13 years. He presented with weakness of both lower limb and difficulty in passing urine. Plain X-ray lumbosacral spine showed disc space reduction, poorly defined endplates erosion and sclerotic changes. MRI whole spine showed spinal canal stenosis at L3-L4, L4- L5 levels caused by facet joint hypertrophy most probably due to pannus. A diagnosis of CES was made based on the history and radiological findings. After neurosurgical consult, he was managed conservatively.

Conclusion: Although, rheumatoid arthritis presenting with CES is uncommon, such patients having complaints of backpain with progressive neurological deficit needs to properly be evaluated for further management and prevention of complications.

  Effect of combined low volume interval treadmill training and resistance exercise on gait speed and muscle strength among individuals with post-stroke Top

Nur Ainna Binti Adanan, Mohd Haidzir Bin Abd Manaf

Department of Physiotherapy, Hospital Selayang, Batu Caves, Malaysia.

E-mail: [email protected]

Background and Aims: Loss of walking ability is one of the major problems among individuals with post-stroke. They enter a vicious cycle of limited activity and deconditioning that limits functional recovery. Conventional gait training is an effective intervention to improve gait performance after stroke. A previous study has demonstrated that improves overground gait speed and stride length were improved following low volume interval treadmill training (LVITT). Therefore, this study aims to determine the effect of combined LVITT and resistance exercise training on gait speed and paretic lower limb muscle strength among individuals with post-stroke.

Methods: Thirty-nine chronic post-stroke participated. Participants performed the combined exercise program for 18 sessions (3x /week for 6 weeks). Gait speed was measured using 10-meter walk test and quadriceps muscle strength of paretic leg was measured using a handheld dynamometer (MicroFET 2). A repeated measure ANOVA within group analysis was used to determine the effects of baseline and after 3 and 6 weeks.

Results: A one-way repeated measure ANOVA revealed statistical significance for comfortable gait speed, fast gait speed and paretic leg quadriceps muscle strength (All p < 0.05). Post hoc analysis for gait speed and muscle strength revealed significant differences from PRE to POST-3 weeks (both, p= 0.001), PRE to POST-6 weeks (both, p= 0.001) and from POST-3 weeks to POST-6 weeks (both, p=0.001).

Conclusions: The findings show significant improvement in paretic leg quadriceps muscle strength, comfortable and fast gait speed in 6 weeks combined LVITT and resistance exercise program.

  Improvement in balance and gait after proximal control training in a patient with severe gullian barre syndrome – A case study Top

Shreya Gada, Poonam Bajaj, Aashish Contractor

Department of Rehabilitation and Sports Medicine, Sir H. N. Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Importance of proximal control training on balance and gait in a patient with severe Gullian Barre Syndrome (GBS).

Methodology: We present a case study of a 23 year old severe GBS male patient, who had lower limbs, upper limbs and bulbar weakness with prolonged hospital stay of 3 months. At 6 months, his upper limb strength was 3/5, lower limbs strength was 2++/5 except ankle muscles which were zero, abdominals grade 1+ and back extensors grade 2, plantar and ankle jerk were absent. He had difficulty in standing and walking, poor trunk control, hypersensitivity in feet. Thrice a week training for 2 ½ years included proximal control, strategy training, strengthening, proprioceptive training, desensitization, body weight support treadmill training, balance, gait training on challenging surfaces and stair climbing with bilateral crutches and AFOs.

Results: Initially, his Functional Index Measure (FIM) score was 91/126, 10 meter walk test (10MWT) was 30 secs with crutches and AFOs, 5 times sit to stand (5 times STS) and independent standing were not possible. Currently, trunk and proximal lower limb strength improved to 4/5, plantar flexors 1/5, but other ankle muscles strength remained near zero or flicker. FIM is 115/126, unsupported standing for 2 minutes without AFOs, 10MWT is 7 secs, 5 times STS is 44 secs independently.

Conclusion: Overall standing balance and gait improved due to improvement proximal control despite persistent poor ankle control.

  Awareness of post-stroke pelvic floor dysfunction in general adult population Top

Disha Padmaraja Hegde

Department of Rehabilitation and Sports Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aim: Pelvic floor dysfunction is a lesser-explored area of rehabilitation, more so in patient populations with stroke. The aim of this study to evaluate the awareness of the prevalence of post-stroke pelvic floor dysfunction among the general adult population, as increased awareness of the same would improve the quality of care provided to these individuals multi-fold.

Methods: 106 subjects above the age of 18 years were interviewed using an online questionnaire, consisting of multiple choice questions related to stroke, the pelvic floor and its dysfunction. 61.32 % of the subjects were females and 41.51% of the total subjects were health care professionals.

Results: 88.68% of the subjects knew what a stroke is, while 70.75% of them were aware of the pelvic floor. Of all the subjects, 63.21% agreed that chances of pelvic floor dysfunction increase post-stroke and 48.59% believed in the possible link between stroke & pelvic floor dysfunction. 79.25% of subjects agreed that post-stroke pelvic floor dysfunction is a significant issue, while 63.21% of subjects believed that not many in the general population are aware of these issues.

Conclusion: There is a lack of awareness among the general population regarding the functions of the pelvic floor, its likely dysfunction post-stroke and its implications on a person's activities of daily living. More research and proactive dissemination of relevant information by health care professionals is imperative to ensure better quality of care.

  Does somatosensory training have a significant effect on proprioception and balance in patients with diabetic neuropathy? Top

Shivangi Salian, Poonam Bajaj,

Aashish Contractor

Department of Rehabilitation and Sports Medicine, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Type 2 Diabetes mellitus is one of the leading metabolic disorders with several associated complications, causing multi-system involvement. Peripheral Neuropathy is the most common complication, which often causes balance impairments.

Aims: The aim of the study is to investigate the effect of somatosensory training on proprioception and balance in patients with diabetic neuropathy.

Methods: 15 patients (13 males & 2 females) in the age group 70-85 years with diabetic neuropathy and with impaired balance were included for the study. Subjects with other co morbidities & cognitive issues were excluded for the study. These patients underwent specific sensorimotor agility training targeted to improve proprioception 3 times a week for a month. MiniBEST scale (MCID value 4) was taken as the primary outcome measure. Pre and post values were calculated & compared.

Results: It was observed that there was significant difference in the pre and post scores of MiniBest scale after training (P value 0.0032).

Conclusion: Somatosensory training has significant effect on proprioception and balance in patients with diabetic neuropathy.

  Effect of cognitive activities on the functional mobility and reaction time in young adults Top

Bhagyashree Hajare, R. Lakshmiprabha

Department of Physiotherapy, Seth GS Medical College and General Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Cognitive Activities are mentally engaging activities that challenge a person's ability to think by enhancing attention, memory, executive function, language, speed of processing, visuospatial, perceptuomotor and reasoning skills. Functional mobility (including dual tasking) and Reaction time need intact cognitive processing, motor and sensory system, for optimal performance. Effect of physical activities/exercise on cognition is very well known. But the effect of cognitive activities on functional mobility and reaction time needs to be explored. Hence the Aim of the study is to examine the Immediate effect of Cognitive activities on Functional Mobility and Reaction time in healthy young adults.

Methodology: The present study is awaiting Institutional Ethics Committee approval very soon. Young adults in the age group of 18-25 years will be recruited by convenient sampling. Subjects with any history of medical, Psychiatric, acute musculoskeletal, cardiorespiratory, neurological conditions will be excluded. Pilot study will be conducted to calculate the sample size. In this Randomised Clinical Trial subjects will be allocated into three groups namely: Group A-Cognitive activities (15mins), Group B-Sham Cognitive activity (15mins) and Group C-No Activity (15mins). Functional Mobility (Including dual tasking) will be assessed using Timed Up and Go Test (TUG), TUG Manual, TUG Cognitive and Simple Reaction Time will be assessed using Deary-Liewald Reaction Time software pre and post in all three groups. Inter and Intra group comparison using appropriate statistical tools will be done. Results and conclusion will be shared later.

  Profile of dysarthria in persons with Wilson's disease (pWD) - A retrospective study in the on-medication group Top

Aditi Ravikumar, B. K. Yamini, D. V. Seshagiri, Mariamma Phillip, N. Madhu, S. Sinha

Department of Speech Language Pathology, National Institute of Mental Health and Neuroscience, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background: Dysarthria is reported in atleast 90 % of patients (Prashanth and others, 2004; Machado et al, 2006) with Neurologic form of WD and thus is a significant manifestation. In order to capture the details of non speech oro-vocal status and speech impairment in Persons with WD (pWD), the current preliminary retrospective study analysed the Frenchay Dysarthria Assessment - 2(FDA2) administered on confirmed pWD.

Aim: The aim was to delineate the dysarthria characteristics on FDA-2 in pWD (on-medication group).

Methods: Seventeen pWD(n=17; 11M, 6F; Mean age-22.18 yrs, SD-5.25) of a tertiary hospital, who were on regular medication for WD constituted the study group. The ratings of FDA-2 [(five best-fit descriptors from a (normal function) to e (no function)] on each of its seven sections were tabulated. The intelligibility rating was done for conversation task only, as the pWD spoke vernacular languages. Statistical analysis was done to describe dysarthria characteristics.

Results: The median duration of WD was 84 months(6-228) and speech impairment was 48 months (5-174). Speech impairment for two years or more was seen in 75.6% (n=12). The mean duration of medication was 84 months (12-168). Results of preliminary analysis of FDA-2 showed that 50-80 % of pWD had deficits of mild abnormality(b) and obvious abnormality(c) suggesting varied dysarthric presentation. The conversational speech showed an intelligibility deficit in 89 % of pWD.

Conclusion: Findings suggested continued use of management and compensatory strategies for dysarthria and in turn improving communication in this speech compromised population.

  Development of a qualitative outcome measure for sit to stand function Top

Sivakumar Ramachandran, Zainab Ali

Department of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background and Aim: Physical therapists clinically assess the quality and quantity of movement. Standing up from a sitting position, often termed sit to stand (STS), is a commonly assessed movement in patients with hemiplegia. A concise measure to assess the quality of STS is not available. The purpose of this study was to develop a measure to assess the quality of sit to stand in patients with hemiplegia.

Methods: The first phase consisted of a literature review for item generation. The second phase consisted of semi-structured interviews with 9 physiotherapy practitioners to understand the prevailing practice of qualitative assessment of sit to standSTS in patients with hemiplegia and a to know identify the need fora new measure for assessing the quality of sit to standSTS. The third phase comprised a Delphi technique involving 9 physical therapists to develop the components for the qualitative measure of sit to stand.

Results: All the participants in the semi-structured interview expressed a need for qualitative measure for sit to stand. Availability of a measure for qualitative assessment of sit to stand in patients with hemiplegia was not evident from the literature search. A total of 8 components were listed in the first round of Delphi for agreement. Based on the comments through the second round of Delphi, a measure with components to observe in the sagittal and frontal plane was developed. All the components reached 80% agreement from the Delphi experts.

Conclusion: A measure with additive scoring was developed, with a total score ranging from 0 to 7, higher scores indicating better quality of STS movement. The total score can be used for longitudinal evaluation. But, before the measure can be used in clinical practice its construct validity, reliability and responsiveness must be investigated.

  Importance of early versus late multimodal neurorehibilitation therapy in stroke Top

Pramod Virbhadra Dhonde, Mayura Dhonde, Ashwini Dhonde, Gayatri Khandale,

Varsha Gore

Department of Neurology, Dhonde Hospital and Shivansh Neurorehabilitation Centre, Nanded, Maharashtra, India.

E-mail: [email protected]

Background and Aims: We have studied effects of early neurorehabiltation including multimodality therapies in stroke patients results were observed retrospectively.

Materials and Methods: We studied retrospectively twenty two patients at Shivansh Neurorehabilitation centre with our standardized protocols for stroke patients between august 2020 to jun2021. We treated patients with conventional e.g. electrotherapy, exercise therapy and advansed therapies e.g. Hydrotherapy, Mirror box device andvirtual reality.

Results: Early neurorehabilitation with hydrotherapy and virtual reality shown good recovery.

Conclusions: 1. Early neurorehabilitation shown 90-95% recovery within 15-20 days of admission at our centre. 2.Patients who have taken lateneurorehabilitation required 2-3 months for 60-70% of recovery. 3. Patients treated with advansed modalities e.g. Hydrotherapy and Virtual reality have shown early and significant changes in recovery.

Keywords: Hydrotherapy, mirror box device, virtual reality

  Functional decline with progression in age in children with duchenne muscular dystrophy - A correlational study Top

Sakshi Desai, Hema Biju

Department of Occupational Therapy, Neurogen Brain and Spine Institute, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Duchenne Muscular Dystrophy (DMD), is an X-linked disorder resulting from a defect in the gene Dystrophin. There is progressive loss of skeletal muscle, decline in pulmonary capacity, loss of ambulation in early teen years and premature death due to cardiac and respiratory failure. Functional Independence Measure (FIM) is used to determine the level of functional participation in people with disabilities.

Aim: The aim of this study is to understand and determine the extent of correlation between the age of children with DMD and their FIM score to ascertain the changes in functional capacity as these children progress in age.

Methods: This study included 262 children diagnosed with DMD in an age range of 3-20 years. Their FIM scores were reviewed and a correlation between this score and age in these children was done to determine the relationship between the two variables. The software SPSS version 23 was used to find this correlation.

Result: After analysis, the bivariate correlation computed p<0.001 and r = -0.532, which depicts a moderate negative correlation i.e with an increase in the age of these children with DMD, there is a decrease in their functional capabilities.

Conclusion: As these children reach the age of 8-10 years, there is a decline in their ambulatory skills leading to increased dependency on others for their daily functional activities. Occupational Therapists focus on adapting the environment to optimize function, maintain and/or enhance residual skills and teach new skills to children with progressive disorders like muscular dystrophy.

  Tele- rehablitation: A new dimension to community based holistic rehabilitation Top

Neeraj Singh, A. K. Gupta

Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, Uttar Pradesh, India.

E-mail: [email protected]

Telerehabilitation refers specifically to clinical rehabilitation services with the focus of evaluation, diagnosis, and treatment. It is an emerging method of delivering rehabilitation services that uses technology to serve clients, clinicians, and systems by minimizing the barriers of distance, time, and cost. It make use of Information and Communication Technologies (ICT) to provide rehabilitation services to people remotely in their homes or other environments. The concept of telecare, when telerehabilitation is used to deliver services to helps to empower and enable individuals to take control of the management of their medical needs and interventions by enabling personalized care, choice and personal control. The driving force for telerehabilitation has been as an alternative to face-to-face rehabilitation approaches to reduce costs, increase geographic accessibility, or act as a mechanism to extend limited resources. A rationale for telerehabilitation is the potential to enhance outcomes beyond what may result from face-to-face interventions by enabling naturalistic, in vivo interventions. Some studies suggest that telerehabilitation can also reduce health care costs, improve treatment adherence, improve physical and mental function and quality of life, and be delivered in a manner that is satisfactory to patients. The tools of telerehabilitation help minimize the barrier of distance, both of patients to rehabilitative services and of researchers to subject populations. This enhanced access opens up new possibilities for discovering and implementing optimized intervention strategies across the continuum of care. This e-poster would thus be prepared with the rationale for how telerehabilitation can be used to promote client self-care and self-management.

  Long term functional outcomes in patients with hypoxic ischemic encephalopathy Top

Tanushree Bhat, Poonam Bajaj, Aashish Contractor

Department of Rehabilitation Medicine and Sports Sciences, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Hypoxic brain injury is commonly caused as a complication of cardiac arrest, poisoning such as drug overdose, drowning resulting a respiratory failure or head trauma. This can result in widespread neurological, behaviour and cognitive impairments.

Methods: This study included 6 patients with hypoxic brain injury whose data was retrospectively analysed. Clinical data, outcome measures including Glasgow Coma Scale (GCS), Functional Independence Measure (FIM) were recorded.

Results: Causes for the hypoxia were cardiac arrest (n=5), ARDS (n=1). 3 patients underwent PTCA after resuscitation. All the patients received intensive physical, speech and language and cognitive therapy throughout their hospital stay and one year post discharge on an outpatient basis. At discharge- Out of 6 patients, 3 patients had a GCS of 15, 2 had score of 8 and 1 had a score of 4 out of total score of 15. After one year follow up 5 patients had a GCS of 15 and 1 had 6.The FIM scores were analysed at discharge and one year follow up in which 4 patients improved significantly (with more than 50%) improvement in their scores. 2 patients FIM scores showed no change. Low scores of GCS and FIM scales at discharge were related to poor long term outcomes. Duration of hypoxia and resuscitation were also strong predictors of prognosis. Age and presence of seizure did not affect the physical outcomes.

Conclusion: GCS scores 8 at discharge showed better functional outcomes in long term in patients with hypoxic ischemic encephalopathy.

  Predictive analysis for anticipating spasticity after stroke: Findings from Sabah, Borneo Top

Fatimah Ahmedy, Syahiskandar Sybil Shah, Jamie Joseph, Khin Nyein Yin, Christina Eleanor Martin, Kamarul Hakim Hairudin, Nooralisa Mohd Tuah

Department of Rehabilitation Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Malaysia, Sabah, Kota Kinabalu, Malaysia.

E-mail: [email protected]

Background and Aims: Predictive analysis in healthcare can guide treating physicians on anticipating outcomes among patients presented with particular features. The study was to identify cluster of clinical features associated with spasticity development after stroke.

Methods: A cross-sectional study at a rehabilitation medicine specialist clinic in Kota Kinabalu, Sabah from June to October 2019. Those aged 18 years and above with stroke duration of more than four weeks were recruited while stroke survivors having concurrent conditions that may cause spasticity were excluded. Clinical features evaluated include age, gender, stroke duration (months), type of stroke (ischaemic or haemorrhagic), and severity of stroke (mild, moderate or severe). All patients were assessed for presence of spasticity using Modified Ashworth Scale (MAS). Univariate analysis was used to identify significant clinical features when comparing those with and without spasticity. Then, K-means clustering algorithm was implemented to identify cluster of clinical features among those with spasticity.

Results: A total of 150 individuals with stroke were recruited and 66 of them had developed spasticity. Three attributes showed significant associations with spasticity: duration after stroke (<0.001), type of stroke (p<0.05), and severity of stroke (p<0.05). The resultant predictive modelling demonstrated that spasticity is less likely to occur if an individual has a shorter duration after stroke (<20 months), ischaemic stroke type, and mild stroke severity.

Conclusion: Predictive analysis using clustering model can be applied for heterogeneous population such as stroke in order to anticipate spasticity outcomes for guiding rehabilitation management.

  Interdisciplinary rehabilitation management of Guillain Barre syndrome associated with COVID-19 infection in a Malaysian tertiary hospital Top

Sharifah Hanisah Wan Mohamad Akbar, Fazreen Nur Abdullah, Ahmad Fauzi Ahmad Termizi, Suhani Yacop

Department of Rehabilitation Medicine, Sultanah Bahiyah Hospital, Alor Setar, Malaysia.

E-mail: [email protected]

Background and Aims: Guillain Barre Syndrome (GBS) is an acute immune- mediated polyradiculoneuropathy resulting in varying degrees of sensorimotor impairment and is usually preceded by recent gastrointestinal or respiratory infections. The ongoing Coronavirus disease (COVID-19) worldwide pandemic has caused much morbidity, mortality and disruption to healthcare services. This case report highlights the importance of interdisciplinary neurorehabilitation approach in management of GBS associated with COVID-19.

Methods: A 46 year old male prisoner with background of active intravenous drug abuse and Hepatitis C presented with progressive ascending symmetrical lower limb weakness 2 weeks prior to admission leading to inability to walk, with rapid involvement of upper limbs. He experienced diarrhoea and vomiting episodes 2 weeks prior to this event. Despite claiming to have mild productive cough, he required oxygen supplementation. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was detected from naso- oropharyngeal swabs. Physical examination revealed sensorimotor quadriparesis sparing the cranial nerves, areflexia and limb hypotonia, clinically suggestive of GBS. Presence of autonomic dysfunction caused persistent tachycardia and disruption of bladder and bowel control. Lumbar puncture and electrodiagnostic studies were not done. Intravenous immunoglobulin and standard medical treatment for Category 4 COVID-19 pneumonia were initiated.

Results: He underwent intensive inpatient neurorehabilitation 3 weeks after admission and gained neurological and functional improvement in muscle strength, respiratory function, mobility, balance, self care and regained bladder and bowel control.

Conclusions: Early rehabilitation for patients with COVID-19 infection with associated extrapulmonary systemic manifestation including GBS is crucial to enhance functional capacity, preventing long-term complications and to improve quality of life in survivors.

  Delayed rehabilitation intervention of a chronic stroke with severe rheumatic mitral stenosis Top

Arya, Farida Arisanti, Sunaryo B. Sastradimaja

Department of Physical Medicine and Rehabilitation, Hasan Sadikin General Hospital, Bandung, Indonesia.

E-mail: [email protected]

Background and Aims: Severe rheumatic mitral stenosis is associated with a worse prognosis after stroke. Exercise and increased physical activity level (PAL) have been proven to reduce the risk of recurrent stroke in mitral stenosis patients. This case report presents a rehabilitation intervention for improving functional capacity and PAL in chronic stroke due to severe rheumatic mitral stenosis.

Methods: A-36 years old housewife, complaining of difficulty in walking and fatigue when performing activities after having an infarct stroke in right corona radiata and basal ganglia in December 2019. Her in-house activities were carried out with partial dependence due to those problems. The Berg Balance Scale (BBS) was 41/56, six minutes walking test (6MWT) showed low cardiorespiratory endurance fitness (METs 2.67), Barthel Index (BI) was 18/20 (mild disability), and the Functional Independence Measure (FIM) was 108/126. She started a late rehabilitation intervention in April 2021 that focused on cardiorespiratory endurance, balance, and functional task training twice a week.

Results: Despite delayed rehabilitation intervention, eight weeks after following the comprehensive rehabilitation intervention, the patients showed improvement of functional capacity (METs 3.18), balance functions (BBS 47), and independence of activities (BI 20/20 and FIM 121/126) regardless of the poor prognosis of motor function recovery.

Conclusions: A comprehensive rehabilitation intervention provides a beneficial result in the functional capacity of a chronic stroke patient due to severe mitral stenosis, which is expected to reduce the risk of recurrent stroke, even if it is done quite late.

[TAG:2]Importance of postural control training in chronic traumatic brain injury - Case series report [/TAG:2]

Shreya Shah, Mamta Vedak, Poonam Bajaj, Aashish Contractor

Department of Neuro Rehabilitation, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Neurorehabilitation is currently the most preferred treatment option for long-term improvement with chronic Traumatic Brain Injury (TBI). Recent advances have shown plasticity of neuronal connections as a key for successful recovery of motor functions, and great therapeutic potential is attributed to high-intensity training for motor deficits, including postural instability, which can affect their level of independence, causing risk of falls.

Methods: We present 3 case report of chronic TBI cases who have undergone therapy with us for 2 years or more.

Case 1: A case of 25 years old female with Quadriparesis for the past 8 years came to us 5 years post her injury.

Case 2: A case of 21 years old female with Ataxia for the past 7 years came to us 4 years post her injury.

Case 3: A case of 31 years old male with Ataxia for the past 3 years came to us 1 year post his injury.

Outcome Measure: World Health Organization Quality of Life questionnaire (WHOQOL-Bref) Functional independence measure (FIM), Goal attainment questionnaire.

Intervention: Patients underwent rehabilitation for Balance and Postural control training in which different components were targeted for static and dynamic stability by challenging visual, proprioceptive and vestibular system.

Result: All 3 patients who came to us after more than 1 year from the injury, showed significant improvement in outcome measure scores.

Conclusion: We conclude that even after more than one year post their injury, patients with TBI have shown promise in regaining postural control.

  Improving functional outcomes following spinal cord decompression sickness: A case report Top

Chamara Badrakumara Jayatunga, Duminda Abeysinghe1

Department of Spinal Injury Rehabilitation Unit, Rheumatology and Rehabilitation Hospital, Ragama, Sri Lanka, 1Rheumatology and Rehabilitation.

E-mail: [email protected]

Introduction: Decompression sickness is a serious condition associated with scuba diving which is caused by the liberation of dissolved gas in the form of bubbles inside the diver's tissues. Spinal cord is the most common site of neurological injury and management includes prompt hyperbaric oxygen therapy, supportive measures and a comprehensive rehabilitation programme.

Case Report: In February 2020, a 46-year-old previously healthy professional scuba diver from Kalpitiya, Sri Lanka with spinal cord decompression sickness (type 2) was transferred to our hospital after receiving hyperbaric oxygen therapy. Clinical evaluation revealed a complete thoracic spinal injury at T8 level. A comprehensive inward rehabilitation programme was carried out by a multidisciplinary team (MDT) based on the WHO international classification of functioning (ICF) model. Patient centred short term and long term goals were set and the MDT meetings were held every 4 weeks. These goals included management of pain, spasticity, neurogenic bladder and bowel, sexual function and prevention of complications associated with spinal cord injury. Health education, psychological support, recreational and vocational rehabilitation were provided throughout the stay.

Results: After a 7-month inward rehabilitation, patient was discharged with good hand function and the ability to walk indoors independently with bilateral elbow crutches and bilateral ankle foot orthoses. However, long distance mobility, required a wheelchair.

Conclusion: Patient centred comprehensive rehabilitation programme can improve functional outcomes in type 2 decompression sickness.

Keywords: Decompression sickness, rehabilitation, spinal cord injury

[TAG:2]Impact of obstructive sleep apnea on balance disorder in Parkinson patients [/TAG:2]

Shreya Shah, Shivangi Salian, Poonam Bajaj, Aashish Contractor

Department of Neuro Rehabilitation, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Parkinson's disease (PD) is the second most common chronic neurodegenerative disorder. In addition, patients with PD may suffer from different types of sleep disorders such as Obstructive Sleep Apnea (OSA) which occurs in 20 to 60 percent of patients. OSA is characterized by recurrent upper airway obstruction leading to periodic arrests of breathing during sleep, resulting in intermittent hypoxia and frequent arousal, which aggravates cognitive and motor manifestations in the early stages of PD.

Aim: We aim to assess the impact of OSA on Balance disorder in PD patients.

Methods: This study has included four PD patients between the age group of 60 to 75 years, out of which two patients have OSA, and two of them did not have any diagnosed sleep disorder. All the patients came within 2 years of their onset and had undergone similar medical and therapeutic management. Their initial evaluation was done with Unified Parkinson's disease rating scale (UPDRS), MiniBest Test, and Fall risk assessment as baseline outcome measures.

Result: We found PD patients with OSA had a higher UPRS score, increased risk of fall, and their baseline mini best scores were lower than those without any sleep disorder despite similar medical management possibly due to OSA as a co-morbid factor.

Conclusion: Our study lacks enough data to conclude that patients with OSA and PD have increased severity of symptoms. However, we see a trend that requires further studies to corroborate these findings and whether OSA can accelerate the neurodegenerative process.

  Effect of transcranial direct current stimulation (tDCS) on plantar flexor spasticity, balance and on gait in post stroke patients Top

Shilpa Khandare, Tushar Palekar

Department of Neuro Physiotherapy, Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune, Maharashtra, India.

E-mail: [email protected]

Background: This study aimed to compare the effects of cathodal, anodal, Bi-hemispheric and sham transcranial Direct Current Stimulation (tDCS) in the treatment of plantar flexor spasticity, balance and on gait in post stroke patients.

Materials and Methods: 60 patients with stroke were randomly divided into four groups using chit method of randomisation. The cathodal group (n = 15) received the cathodal tDCS on ipsilesional side, with intensity 1.5mA and duration of 20 minutes. The anodal group (n = 15) received the anodal tDCS ipsilesional, with intensity 1.5mA and duration of 20 minutes. The bi-hemispheric group (n = 15) received the tDCS application on both sides of the cortex,with intensity 1.5mA and duration of 20 minutes. The sham group (n = 15) received the sham tDCS, with intensity 0mA and duration of 20 minutes. All groups received the treatments for 4 weeks with alternate day session. The Modified Ashworth Scale (MAS), berg balance score (BBS), step Over (SO) test using balance master and the timed up and go (TUG) were assessed at baseline from day zero, 14th day, and on 28th day.

Results: The MAS Score, BBS score, SO and TUG showed significant improvement across all the groups. However, the BBS scores, and TUG improved significantly within groups. The results showed significant difference in cathodal tDCS group for all outcome measures when compared with other groups.

Conclusion: The cathodal, anodal, Bi-hemispheric and sham transcranial Direct Current Stimulation had similar effects, but the cathodal tDCS showed more effective in reducing ankle plantar flexor spasticity, balance and gait in post stroke patients.

  The effect of Bharatanatyam Mudra's to improve quality of fine motor skill in Downs syndrome children Top

Mudra Mahale, Sabah Thaver, Ali Irani

Department of Physiotherapy, Nanavati Max Super Speciality Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Down's Syndrome is a genetic disorder also known as Trisomy 21. It is the most common chromosomal abnormality in humans. Globally, almost 1 child out of 1000-1100 live birth has Down syndrome. In India alone, around 32,000 cases are observed annually. A child with Down syndrome will typically have some degree of slow mental growth, different facial feature, problems with vision, and various health related issues. While physical therapy helps in achieving the gross motor functions in these children but often the fine motor skills are not treated that readily. These fine motor skills hence become a point of worry when it comes to writing, wearing clothes or holding and manipulating objects. These children often have delayed milestones and hence most of the times confined to exercises and achieving those milestones. Bharatanatyam is an ancient form of dance based on Carnatic music. To introduce them to richer thing in life in the world of art along with aiming at improving there fine motor skills using Hasta Mudra's Of Bharatanatyam this study was done.

Aims and Objectives: To assess the effect of Bharatanatyam Mudra's to improve quality of fine motor skill in downs syndrome children. To improve the dexterity using various Bharatanatyam Mudra's (Hand gestures). To improve the time taken to complete the task that involves fine motor skill.

Methodology: 40 children with downs syndrome are recruited in the study. Total 10 sessions were conducted. In first 5 sessions, two Hasta Mudra's were taught every session and in next 5 sessions those leaned Mudra's were performed in speed (Slow, Medium, Fast) along with functional training. Pre and post intervention the functional outcome measures were noted.

Result: Comparison between the pre and post intervention on outcome measuresshowed that Bharatanatyam Hasta Mudra's are effective statistically as well as clinically in improving the fine motor skills in daily activities.

Conclusion: Bharatanatyam Hasta Mudra's are seen to be effective in improving the quality of fine motor skills. Also, its seen to be effective in improving the time required to carry out the activity in daily living.

  Physiotherapy interventions for motion sickness: A systematic review Top

Rasika Panse Kaluskar, Tushar Palekar, Saloni Gundecha

Department of Physiotherapy, TMVs Indutai College of Physiotherapy, Pune, Maharashtra, India.

E-mail: [email protected]

Background: Motion sickness is popularly known as travel sickness or seasickness. Motion sickness occurrence is dependent on the sensitivity of each individual and the ability of the vestibular system to adapt to continued exposure to the stimulus affecting activities of daily living and may lead to social isolation.

Aim: To systematically review physiotherapy interventions for motion sickness.

Materials and Methods: Data was extracted from PubMed, Pedro, Cochrane and Google scholar from the year 2000 to 2021 publication date using the following keywords: 'Motion sickness', 'exercise' 'physiotherapy' OR 'physical therapy' with language limitation in English.

Results: A total of 41789 articles were identified from 2 databases. After the first screening 41,767 articles were excluded and 18 articles were saved for secondary screening. After the investigators reviewed the remaining articles, at the end 7 articles were selected to be included in the review. These 7 studies included RCTs, case studies, experimental studies. Strong evidence was identified for 2 strategies used for individual having symptoms of motion sickness. These strategies included uses of breathing techniques (with or without the use of virtual reality) and the vestibular adaptation exercises. Along with these gaze stabilization exercises has shown to be less effective than vestibular adaptation exercises.

Conclusion: Physiotherapy interventions play an important role for individuals with motion sickness by alleviating the symptoms and improving the functional well-being.

Keywords: Motion sickness, physiotherapy, PRISMA

  Performance evaluation and application of postural stability assessment system for patients with balance disorders Top

Somya Saxena, M. S. Dhillon, Swapnil Bari, Neelesh Kuma

Department of Physical and Rehabilitation Medicine, PGIMER, Chandigarh, India.

E-mail: [email protected]

Introduction: Postural stability assessment is an important task that has found widespread medical and therapeutic applications. The quantitative score of postural balance is very important in determining improvement of patients suffering from balance disorder. Postural stability is highly dependent on the position of centre of pressure of the body.

Background: Injuries due to falls represent a major public health problem in patients with neurological disorders. There is an unmet need for simple, safe, portable and inexpensive device for assessment and training of these patients.

Aim: 1. To assess the performance and utility of Postural Stability Assessment System. 2. To assess quantitative changes in the postural stability of patients suffering from balance disorders after providing them biofeedback-based balance training.

Materials and Methods: We used Force Sensing Resistors to sense magnitude of forces acting at both feet. The COP was determined using the positions of various force points and magnitude of the force acting on them. The higher capability of the body to remain at that position implies higher postural stability and a lower power of sway. The repeated analysis shows the amount of change in patient's postural behaviour, before and after the training.

Results: Post intervention trials resulted in higher scores of postural performance. Hence, favourable results were obtained showing improvement in postural stability of the patients.

Conclusion: Our newly developed system is capable of estimating COP displacement and providing biofeedback-based balance training. Thus, it can be used to assess the postural performance of patients suffering from different postural disorders. Simple home-based balance training program and quantitative assessment of progress is feasible and is safe, effective, and reliable.

  Prospective analysis of pre-treatment quality of life, presenteeism and emotional health due to chronic neck pain in homemakers - An Indian tertiary care hospital perspective Top

Madhusree Sengupta, Jaydeep Nandi

Department of Neurorehabilitation, Institute of Neurosciences, Kolkata, West Bengal, India.

E-mail: [email protected]

Background: Chronic neck pain leads to neuromuscular and psychological disturbance, which may lead to a reduced quality of life, emotional health and productivity of a person. Absenteeism and presenteeism are both measure of work productivity. Homemakers are a neglected but an essential part of the society. In Central Indian cultural scenario, a homemaker rarely takes complete rest from her household chores. So presenteeism can be used as a marker for work productivity.

Aims and Objectives of the Study: To analyze the impact of chronic neck pain in the pre-treatment quality of life, presenteeism and emotional health in homemakers and to find the association of the findings with the cause of chronic neck pain.

Results: The causes of neck pain were divided into chronic primary pain, chronic neuropathic pain chronic musculoskeletal pain and others. The highest VAS score was found in chronic musculoskeletal pain. The psychological de arrangement was significantly high in the younger homemakers below 40 years of age and in those with primary or no education. The average score of presenteeism was 5.5, highest being for chronic musculoskeletal pain and significantly low for the 'Others' category. Medical disability score was found to be significantly high in the 'Others' category.

Conclusion: Chronic neck pain leads to a plethora of dysfunction. Homemakers are a neglected but an important population at risk for occupational hazard. The concept of presenteeism can be an important marker for work productivity in chronic health conditions.

Keywords: Homemakers, neck pain, presenteeism

  The effect of scapular kinesiotaping as an adjunct to dynamic neuromuscular stabilization exercises on upper limb functions in stroke patients Top

Shamla Wamanrao Pazare, Rutuja Jadhav1

Department of Neurophysiotherapy, CMF's College of Physiotherapy, 1St. Andrew's College of Physiotherapy, Pune, Maharashtra, India.

E-mail: [email protected]

Background and Aim: Stroke patients exhibit a combination of muscle weakness, spasticity, poor voluntary control and malalignment leading to reduction in functional use of upper limb. Postural changes secondary to stroke affects the ideal position of scapula and reduces the efficiency of the scapular muscles as stabilizers for upper limb functions. Scapular alignment remains a challenging issue in rehabilitation. This study was undertaken with the hypothesis that application of Kinesiotape may help improve scapular alignment and in combination with Dynamic Neuromuscular Stabilization Exercises will facilitate upper limb functions. The objective was to study the effect of scapular kinesiotaping as an adjunct to dynamic neuromuscular stabiization exercises (DNSE) on upper extremity functional index (UEFI), grip strength and scapular abduction.

Methods: This experimental study included 30 post stroke patients with Brunnstrom's grading for hand > 3 and free of cognitive involvemnt while presence of subluxation and contractures in upper limb and hypersensitivity to tape were excluded. Participants were divided into two groups, A (kinesiotaping & DNSE) and B (DNSE). Kinesiotape was applied to upper trapezius, Serratus Anterior and Rhomboids. Both the groups received DNSE intervention for 5 days/week for 4 weeks along with the conventional execises. Outcomes were assessed on 20 items of upper extremity functional index, grip strength measured with aneroid spygmomanometer and scapular abduction distance using MB ruler.

Results: On analyzing normal distribution, data was subjected to statistical tests. Group A and B showed significant difference in UEFI, grip strength and scapular abduction while comparison between the groups showed significant difference in UEFI and grip strength (0.0001) and not the scapular abduction (0.51).

Conclusions: Scapular kinesiotaping as an adjunct to dynamic neuromuscular stabiization exercises is significantly effective in improving upper extremity functions and grip strength in poststroke patients but not on scapular alignment of abduction.

  A case study of tendon transfer surgery in brachial plexus injury Top

N. K. Suvarna, Swapnil Sonune, Anuradha Shenoy, S. Y. Kothari

Department of Physical Medicine and Rehabilitation, AIIMS, Bhopal, Madhya Pradesh, India.

E-mail: [email protected]

Introduction: Brachial plexus injuries are usually due to high-speed motor vehicle accidents. These are devastating injuries which will cause a significant decrease in the quality of life. Apart from non-operative management, through which we can achieve reasonable mobility with help of rehabilitation and exercises therapy, we also have surgical options, such as neurolysis, nerve repair, use of nerve grafts and nerve transfer, tendon transfers and free muscle transplantation and arthrodesis. Tendon transfer surgery is one of the current surgical treatment to restore functional deficit of brachial plexus injury.

Aims and Objectives: To report a case of surgical rehabilitation in a patient with brachial plexus injury with major involvement of posterior cord for hand function improvement.

Methods: A 55-year-old male presented with right brachial plexus injury with major involvement of posterior cord secondary to trauma of 25yrs duration. To improve hand function flexor carpi ulnaris tendon transfer to extensor carpi radialis brevis, rerouting Extensor pollicis longus with palmaris longus, and extensor digitorum double plication was done. Hand function was assessed pre and post procedure.

Result: Hand function in terms of power and active range of motion, in 55-year-old male with right brachial plexus injury with major involvement of posterior cord has improved post tendon transfer surgery.

Conclusion: Brachial plexus injury in young patient can be challenging in terms of social and economic aspect. Therefore, any improvement in function through invasive procedure should also be considered to improve quality of life.

  A case study of hypoperfusion and dementia; using “brainnext” program for memory and cognitive rehabilitation at Sancheti hospital (SIOR), Pune, India Top

Mangal Kardile

Department of Clinical Neuropsychology, Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Dementia, broadly explained as progressive neurodegenerative disease and often ends-up in multiple functional disability. “UMACE” screening-tool, and “BrainNext”rehabilitation-research in cognitive-deficit in 18+ages neurology-patients, observed reasons for deficit and not just-age-related-atrophy. The case study-focuses on a-rare-brain-condition of hypoperfusion &history of major-depression, use of psychotropic medications >35 years. Person “Y” with dementia was extremely-intelligent with successful career-graph as a design engineer until his retirement-age-of 62years started developing dementia-like-symptoms. He was given “BrainNext” rehab-sessions at Sancheti Hospital before-Covid-19 and continued online-sessions during-Covid-19. His memory-retrieval was critically handled with special-sessions by the-author and successful-recall was achieved in 8 months.

Methods: With consent, “BrainNext” rehab-program at Sancheti-Hospital given to person “Y” clinically diagnosed with dementia, with online-offline sessions before-&-after Covid-19. Author developed new methods of memory recall, and strokes and shapes training using 3D acrylic material in “BrainNext” used, and alphabet&number-recognition critically managed with specially designed-person-centered-rehab-program. 2Rehab-sessions per week with follow-ups every 15 days for 2-months, 1 follow-up-each-month-for-6-months observed. Responses recorded by hardcopies-audio-video. Measured progress 1 to 10 scale-(1=10%, 10=100%), baseline as 0%.

Results: Person “Y” with dementia improved orientation-following-instructions-object recognition >5% in 1-week, short-term-memory (STM) improved>15% by 1month, objects-basic-shapes (monocolour) & strokes-recognition-word-formation-behaviour-improved >35% by 3-months. Word-recall-STM-alphabet&number recognition improved >50% by 8-months, rehab continued at home-by-caregiver.

Conclusion: Cognitive-decline after 55 years, without much interrogation often-diagnosed as Alzheimer's with-or-without dementia with age-related-atrophy, but cognitive decline has-a-reason and memory cannot-be-lost-forever. Hypoperfusion-for-brain challenges memory & cognitive rehab, using “BrainNext” special set for memory retrieval-person “Y”, achieved-STM-recall>48 hours(2days) in 8 months, improving quality of life, lessening little burden of caregiver.

  Therapeutic effects of lower limb cycling on selected motor performance variables among middle cerebral artery stroke patients with hemiplegia Top

A. Brammatha

Department of Stroke Rehabilitation, KMCH, Coimbatore, Tamil Nadu, India.

E-mail: [email protected]

Background: Stroke is the sudden loss of neurological function caused by an interruption of the blood flow to the brain The loss or difficulty with ambulation is one of the most devastating sequelae of stroke, so restoration of gait is often one of the primary goals of rehabilitation. Limitations in gait and gait-related activities are associated with an increase in fall risk. Cycling and walking has shared synergies of lower limb kinematics and kinetics. The reciprocal movements in cycling helps for functional range of motion of knee and hip joints required for walking, lower limb motor coordination and thereby it improves the ambulatory function in stroke patients.

Aim: To find out the therapeutic effectiveness of 3 weeks Lower limb Cycling on lower extremity motor performance variables among subacute stroke patients.

Methodology: A Pilot experimental study was conducted on 10 Inpatients who satisfied the selection criteria and assigned into two groups. Cycling Group received lower limb Cycling for 25 minutes along with standard therapeutic exercises for 40 minutes, 5 days /week, for Continuous 3 week for a total 15 sessions. Control Group received 60 minutes of standard therapeutic exercises. The Functional Ambulation Category (FAC), Fugl-Meyer Assessment (FMA) and Five Times Sit to Stand Test were used as outcome measures.

Results: There was a significant increase on all outcome measures (P < 0.05). The reciprocal and rhythmic nature of cycling motion improves the motor performance among patients with stroke. A. Brammatha [email protected] Professor/Kovai Medical Centre Hospital College of Physiotherapy Coimbatore.

  Effect of occupational therapy intervention on occupational performance and cognitive function in patients with obstructive sleep apnea syndrome (OSAS): A prospective analytical study Top

Vaishnavi Hiren Joshi

Department of Occupational Therapy, Government Medical College and Hospital, Nagpur, Maharashtra, India.

E-mail: [email protected]

Background and Aims: OSAS leads to significant cognitive impairment and the occupational health of the patients, which further leads to absenteeism from work, work disability and decreased productivity at work. Continuous Positive Airway Pressure (CPAP) is the conventional treatment in OSAS. It is known that restful and adequate sleep provides the foundation for optimal occupational performance, participation, and engagement in daily life. The impact of sleep on function and participation is incorporated into the repertoire of occupational therapy practitioners and addressed across the lifespan. Hence, the aim of this study was to compare the effect of Occupational Therapy Intervention along with CPAP; CPAP alone & Occupational Therapy alone on Occupational performance, and Cognitive function in OSAS patients.

Methods: A hospital based prospective comparative study was conducted in 57 eligible patients of OSAS over a period of 6 months. Convenient sampling method was used to categorize the patients in 3 groups viz. Group A with patients using CPAP alone, Group B with patients on Occupational Therapy alone who are not willing to buy and use CPAP Therapy or cannot afford CPAP, and Group C including patients on Occupational Therapy along with CPAP. The assessment of cognitive function and occupational performance was done on day 1, and at the end of 8 weeks.

Results: The overall difference in mean scores of Occupational Identity (p=0.814) and Occupational Settings (p=0.529) components of OPHI-II in the 3 treatment groups were statistically non-significant, while that of Occupational Competence (p=0.038) was found to be statistically significant. The overall difference in mean scores of total MoCA score (p<0.001) were statistically significant across the 3 treatment groups. However, the difference in difference analysis shows no statistical difference between the change in the mean scores of MoCA or OPHI II at the end of 8 weeks across the 3 treatment groups.

Conclusions: All the three treatment groups are equally effective in treatment of OSAS patients in terms of cognitive function and occupational performance.

  Correlation between perceived stress and dual tasking ability in young individuals Top

Bhakti T. Salgaonkar, R. Lakshmiprabha

Department of Physiotherapy, Physiotherapy School and Centre, Seth G.S.M.C and K.E.M Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Dual tasking implies the concurrent performance of two tasks performed independently with distinct, separate goals. One task requiring significant attentional demands while simultaneously performing an alternative task (motor or cognitive) which results in greater demands being imposed on the processing capacity of the brain than any one of the tasks individually. An individual's level of perceived stress can have a negative impact on the performance of tasks that require divided attention. The cognitive appraisal of a stressor plays a major role in the interaction of the person with his/her environment. This study aimed at finding the relationship between a young individual's perceived level of stress on their ability to dual task. Our study consisted of 70 young individuals between 18-30 years. All participants filled the 'Perceived Stress Stress-10' a self-reported measure of perceived stress and performed the 'Timed Up and Go Test' (TUG) and its two modifications (cognitive and motor). The Dual task costs were then calculated for both and correlated with their stress scores. The results showed a moderate correlation between perceived stress and cognitive dual task but no significant correlation with the motor modification. As the stress scores went on increasing, the time taken to perform the simple TUG, cognitive TUG went on increasing significantly, but not for the motor task. This implied that the attentional demands imposed by the cognitive task were more than that imposed by the motor task on the TUG. It was concluded that even in seemingly healthy, young individuals devoid of any known musculoskeletal, cardiovascular or neurological disorders, the time taken to perform a cognitive dual task increased significantly with an increase in perceived stress levels. This finding implies that one's subjective perception of stress warrants consideration while evaluating his or her performance in a dual task paradigm, especially if one of the imposed evaluation tasks is cognitive in nature.

  Development and clinical validation of cognitive linguistic assessment protocol in Odia Top

Bibhu Prasad Hota, Jayasankar Panda

Department of Speech and Hearing, Swami Vivekan and National Institute of Rehabilitation Training and Research, Cuttack, Odisha, India.

E-mail: [email protected]

Background: In order to assess the cognitive-linguistic abilities in Odia speaking adult aphasic population, it is needed to develop and standardize a test material and measure its clinical validity. Therefore, this study was undertaken to prepare and develop a tool to assess cognitive-linguistic abilities in Odia speaking normal and adult aphasic population.

Aim: The present study aimed to assess changes in the performance on cognitive-linguistic tasks in normal and aphasic adults.

Methodology: A total of 60 participants (30 aphasics and 30 normal) aged between 30–60 years were taken for the study. The persons having an aphasia quotient of less than 56 were considered. The study was carried out in three phases i) Transadaptation of CLAP from Kannada to Odia ii) Administering the test material on 60 participants iii) Checking reliability of the test material iv) Measuring clinical validity. To estimate age related changes, the response of the participants was studied across three age groups: group-I (30-40 years), group- II (40-50 years) and group-III (50-60 years) using the one-way analysis of variance (ANOVA) test. Comparison between the normal and aphasic population was done using independent sample “t” test.

Results: The results indicated significant difference observed among three age groups and also significant difference observed in performance among the normal and aphasic group.

Conclusion: Thus the study asserts that the development of Odia Cognitive- Linguistic Assessment Protocol is an effective, reliable, and valid tool to be used for assessing cognitive linguistic function in the aphasic population.

  Early intervention therapy for high risk infants - A scoping review Top

Tejas Borkar

Department of Pediatric Physiotherapy, Dr APJ Abdul Kalam College of Physiotherapy, PIMS, Ahmednagar, Maharashtra, India.

E-mail: [email protected]

Background and Aim: Infants born before 37 weeks are high risk infants who may need stay in NICU Various risk factors for preterm infants may result into a long term disability or developmental delay. Hence the early intervention programs for these infants are important. Aim of this scoping review was to access various aspects of early intervention therapy for high risk infants.

Methods: Recent literature was searched for various articles for early intervention therapy for high risk infants. Review was carried out by searching databases including google scholar, PubMed, Cochrane. Articles of last 5 years were included in study.

Results: Data was summarised using the articles Conclusion: Early intervention therapy is integral part of treatment for high risk infants. It plays key role in their development. It should start from birth as soon as possible. Also, the parental involvement in it is crucial.

  Effectiveness of multi-sensory balance training versus vision deprived balance training on balance and gait speed in stroke patients – A comparative study Top

Abhijit N. Satralkar, Rutuja Indapure

Department of Physiotherapy, P.E.S Modern College of Physiotherapy, Pune, Maharashtra, India.

E-mail: [email protected]

Background: Stroke is one of the leading causes of death and disability in India. Stroke patients usually show uneven weight distribution and increased postural sway in standing. Many studies have seen the effect of multi-sensory balance training and vision deprived balance training on balance and gait speed in stroke, but hardly any study is done on comparing these two effects.

Aim: The present study aimed at comparing the effects of multisensory balance training and vision deprived balance training on balance and gait speed when assessed using bergs balance scale and 10 meter walk test respectively at the end of 6 weeks of intervention.

Methods: 40 participants were selected based on the selection criteria. They were randomly assigned to two groups by chit method: Group A (n=20) received Multisensory Balance Training protocol and Group B (N=20) received Vision Deprived Balance Training protocol. Group A training included, 5 minutes of warm up followed by 30 minutes of multisensory balance training program and 5 minutes of rest post exercise. Group B training included 5 minutes of warm up followed by 30 minutes of balance training with deprivation of vision and 5 minutes of rest post exercise.

Results: There was no significant difference seen between both the groups for balance (p= 0.851) and gait speed (p=0.948).

Conclusion: Both the training program were effective in improving balance and gait speed in stroke patients(40-60years).But on comparison, both the training program showed equal effect on balance and gait speed in stroke patients.

  Effects of attentional focus during balance training on patients with Parkinsons Top

Preeti Gazbare, Manisha Rathi

Department of Neuro, Dr. D Y Patil College of Physiotherapy, Pune, Maharashtra, India.

E-mail: [email protected]

Background: Parkinson disease [PD] is degenerative neurological disorder characterised by rigidity, bradykinesia, tremor and postural instability leading to high risk of falls. PD patients in the use of [compensatory] movement strategies. Gait and balance disturbance is common in parkinson's disease and is a major contributor to increase disability and decrease health-related QOL and survival. Theorized strategy to improve balance in parkinsons is to give individuals attentional focus instructions while performing balance activities. This method either directs the persons attention towards the effect of the action (external focus) or the body movements (internal focus) need to be explored further.

Methods: An experimental study carried in Parkinson society in Pune after an institutional ethical approval, on 30 diagnosed Parkinson's patient, age- 40 to 80 years, Both gender, stage 2 & 3 on Hoehn & Yahr scale Exclusion other neurological impairment affecting balance & movement, surgical treatment for parkinson's, severe cognitive impairment, severe sensory deficits. Written consent was taken. Pre training scores of MS-UPDRS were taken. Patients were divided into Group A, B & C by chit method. Group A- Internal Focus- performed a listed task with focus on their own active limbs Group B- External focus: performed a listed task with focus on the external object (colourful plastic ball). The object moved at the subject eye contact level Group C- No focus: perform task without any focus. Intervention protocol included relaxation technique, flexibility exercise, listed task for Balance in standing & sitting performed for 4 days/ week for 2 weeks. Post Assessment taken.

Result: Data was analysed using anova test. All 3 group showed significant improvement with p= 0.0001. mean score of MS-UPDRS in external focus group is more as compared to group A (internal focus) & group C (no focus) with p=0.003. When Comparing of sub-activities in MS-UPDRS. group B showed better results in Q1. mentation, mood & behaviour. Q2. activities of daily living. Q3. motor examination& Q4. complication of therapy.

Conclusion: Thus external focus in balance training has a greater effect & has shown significant improvement in overall evaluation of MS-UPDRS.

  Water specific therapy and task type training in aquatic therapy combined with functional land based rehabilitation to improve activity and participation multiple sclerosis: Case report Top

Shraddha Pawar, Brinda Merchant

Department of Physiotherapy, Aquacentric, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Multiple Sclerosis (MS) is a progressive neurologic disease that affects the central nervous system leading to impairments of balance, muscle tone, strength and gait. Aquatic therapy is shown to be an effective adjunct to conventional therapy owing to unique properties of water which increase exercise compliance with less fatigue. Task type training approach (TTTA) is a restorative, therapeutic approach based on the system theory of motor control. TTTA is relevant to an individual and context, is randomly assigned, repetitive and involves massed practice. WST strategies include interventions to improve strength and postural control. Appropriate land based carryover helps the individual return to activity.

Purpose: Purpose of case report is to provide an overview of therapeutic benefits with combination of aquatic therapy and land based rehabilitation.

Methods: Case reported is of a 60 year old general surgeon with relapsing remitting Multiple Sclerosis. He underwent a 12 week program of aquatic and land based intervention (4 times/week). TUG, balance evaluation system test (BEST), Functional reach test were taken at baseline.

Results: At 12 weeks, BEST score improved from 54.62% to 71.29%. The FRT improved from 11 inches to 14 inches TUG improved from 43 seconds to 34 seconds.

Conclusion: WST and TTTA in aquatic therapy combined with functional land based rehabilitation may help improve activity and participation in adults with multiple sclerosis.

  Rehabilitation experience in a case of Klippel-Trenaunay-Weber syndrome presenting with Spastic Paraplegia Top

Vira Vaibhav Kalyanji, Amit Mhambre, Vinay Goyal

Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Haji Ali, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare limb overgrowth disorder with unknown etiology. Myelopathy in such cases is uncommon but has been reported in association with spinal hemangiomas, angiomyolipomas and A-V malformations. There is no literature documenting the rehabilitation in KTWS with spinal cord involvement. This case study presents a unique experience in rehabilitation of 24 years old male with KTWS with limb overgrowth of all the four limbs with intelligence quotient of 39 presented with spastic paraplegia (level D2) after embolization and laminectomy (D3-D4) done for epidural AV malformation.

Methods: He presented with difficulty in bed mobility, transfers and had attendant dependent wheelchair mobilization. He underwent comprehensive rehabilitation program with a weekly review. He was given Tab. Baclofen for spasticity management. Regular therapeutic exercise for maintenance of joint suppleness, improvement of endurance and prevention of edema progression and above knee night splint for prevention of deformity and therapeutic standing. Response over period of 4 months was monitored with the help of FIM® instrument (Uniform Data System for Medical Rehabilitation. 2018. The FIM System® Clinical Guide, Version 5.2.1. Buffalo: UDSMR) and The Barthel Index.

Results: At the end of 4 months, the FIM® ratings showed change from score of 34 to 51 with improvement in transfer and indoor mobility. The Barthel Index changed from 15 to 35 indicating achievement of rehabilitation.

Conclusion: In this study intellectual disability and limb overgrowth were limiting factors interfering the rehabilitation. Understanding of the disease pathology and the limiting factors with comprehensive approach will help in executing effective rehabilitation.

  Development and standardization of a novel verb picture corpus in Kannada Top

Wasim Ahmed, Gopee Krishnan

Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Udupi, Karnataka, India.

E-mail: [email protected]

Background and Aims: Clinicians and researchers engaged in rehabilitating persons with aphasia (PWA) often need standardized and language-specific pictorial stimuli that, in turn, are sparse in many Indian languages. Cross-culturally and cross-centrally appropriate picture stimuli have several advantages. Converse to noun-based picture corpora, verb picture sets are available only in a handful of languages, globally. In a multilingual country like India, it is crucial to develop such standardized stimulus sets, which are not a mere translation of the preexistent foreign corpora. Hence, we present a novel verb picture set based on argument structure categorization for the adult Kannadiga population.

Methods: Two hundred and sixty-nine picturable verb names were selected from a published database of 100,000 words and later developed into colored clipart images. This dataset is the first of its kind, as every verb picture was developed around individual model sentences, framed based on their respective argument structure. One hundred twenty clinically normal adult participants (Mean age=49.65±18.68, Females=60) were recruited to standardize these pictures across four psychometric tasks: the verb name & argument agreement, image agreement, concept familiarity, and visual complexity. The participants represented four major dialects of Kannada and diverse socio-economic and educational backgrounds.

Results: Overall, the verb corpus showed good name agreement, higher ratings, and strong correlations among the psychometric tasks, indicative of the quality, cultural and linguistic appropriateness of corpus.

Conclusion: Pictures and model sentences from this unique data set can be suitably adapted into experiments, diagnostic tools and therapy programs for PWA and persons/children with language impairment, in general.

  Use of hippotherapy in children with cerebral palsy Top

Disha Padmaraja Hegde

Department of Rehabilitation and Sports Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Hippotherapy is an innovative treatment method which uses the movement of a horse as part of a structured treatment protocol to achieve certain goals. The aim of this study is to evaluate the use of hippotherapy in children with cerebral palsy.

Methods: 33 studies published between 2011 and 2021 were searched using search words like “hippotherapy”, “cerebral palsy”, etc. and a literature review was conducted.

Results: Hippotherapy works on the principle that the movement of the equine pelvis shows a trial-axial pattern of movement during walking (about 6.98 degrees, 3.9 degrees and 9.1 degrees in the frontal, sagittal and transverse planes respectively), as is observed in the human pelvis. A common theme across these studies was the host of benefits of hippotherapy such as improvement in the gross motor skills, gait parameters, postural control, and balance, in addition to enhancing cognition, attention, psychosocial and sensory functions. There were several outcome measures used in these studies, including the Gross Motor Function Measure 66 and 88 (GMFM-66 and -88), Paediatric Evaluation of Disability Inventory-Functional Skills Scale (PEDI-FSS), Gross Motor Function Classification System (GMFCS), which showed significant improvement post-hippotherapy, conducted for a mean of 6-12 weeks. Some studies also used changes on electromyography (EMG) of various muscles as a measure of improvement.

Conclusion: Hippotherapy shows great promise to be used as an adjunct to conventional rehabilitation of children with cerebral palsy. Further research is needed to establish the long-term benefits and feasibility of hippotherapy in this population.

  Physiotherapeutic management of somatosensory tinnitus Poonam Bajaj, Raashi Khatri Punjabi, Aashish Contractor Top

Poonam Bajaj, Raashi Khatri Punjab, Aashish Contractor

Department of Rehabilitation and Sports Medicine, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aims: 65% of tinnitus arises from somatosensory causes. This is heavily underdiagnosed. Somatosensory tinnitus can arise from muscular contractions of the head, face, jaw, neck and upper extremities. Management for tinnitus mostly includes medication, white noise devices and psychotherapy. The aim of this study is to highlight physiotherapeutic management of somatosensory tinnitus in association with intra-oral device provided by a dentist.

Methods: Three individuals, who had been diagnosed with tinnitus for over one year with normal ENT examinations and no hearing loss, were considered for this study. Further evaluation was undertaken to check modulation of tinnitus with specific movements of the head, face, neck, jaw and changing postures of the cervical spine. One individual was found to have a history of soft tissue trauma around the cervical spine. All three were found to have significant trigger points in the head, face, neck and jaw region and poor cervical posture and mandibular derangement. All three had asymmetrical tinnitus which changed with movements and postures of the head, neck and jaw. The Tinnitus Handicap Inventory (THI) was used as an outcome measure. All three underwent physiotherapeutic measures for release of trigger points, postural and ergonomic correction, strengthening and biofeedback over three months.

Results: All three showed improvement in THI scores by more than 7 points which is the MCID (Minimal Clinically Important Difference) value for the scale.

Conclusion: Somatosensory tinnitus is a treatable entity and it is essential to distinguish it from other causes of tinnitus and treat it appropriately.

  High or low-frequency repetitive transcranial magnetic stimulation in cerebellar ataxia Top

Jong Hwa Lee, Won Wook Ha

Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, South Korea

E-mail: [email protected]

Background and Aims: Many researchers have demonstrated the effects repetitive transcranial magnetic stimulation (rTMS) over the cerebellum on patients with ataxia. The aim of this study is to compare the effect of low frequency rTMS and that of high frequency rTMS in ataxia after posterior circulation stroke (PCS).

Methods: We enrolled patients who were confirmed as acute PCS with symptoms of ataxia. All patients were randomly assigned to low (LG) or high frequency rTMS group (HG). Coil was placed 2cm below the inion and 2cm lateral to the midline on the cerebellar hemisphere. Both groups received a session of rTMS that comprised 900 stimuli for 10 days. The intensity of stimuli 100% of patient's resting motor threshold at both groups. The frequency of LG was 1Hz and that of HG was 10Hz. Before first and after last intervention, patients were evaluated using Berg Balance Scale (BBS), 10meter walk test (10MWT), Modified Rankin Scale (MRS), Functional Ambulation Category (FAC), Modified Barthel Index (MBI), and Sacale for the Assessment and Rating of Ataxia (SARA).

Results: Eighteen patients were recruited in each group. There were no significant differences in the baseline characteristics and initial measurements between two groups. After treatment, both groups showed significant improvements in BBS. 10MWT, FAC, SARA. MBI was improved only in HG. There were no significant differences in change of any measurements between the two groups.

Conclusions: We found therapeutic effectiveness of low and high frequency rTMS on PCS with ataxia. The result showed no superiority between two protocols.

  Effect of whole-body vibration therapy in subacute stroke patients Top

Jong Hwa Lee, Won Wook Ha

Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan South Korea.

E-mail: [email protected]

Background and Aims: The aim of this study was to investigate the effect of whole body vibration therapy on lower extremity function in subacute stroke patients.

Methods: Subacute stroke patients who were able to undergo gait training were randomly divided into a vibration therapy group and a control group. All patients attended 20-minute training sessions twice daily, five times a week for two weeks. Each session included 45 squats. The vibration group trained on a vibration platform and the control group trained on the ground. The degree of maximal isokinetic voluntary contraction torque was evaluated, and manual muscle tests of hip and knee flexion and extension were performed. The Berg Balance Scale, 10-meter walk test, Timed Up and Go Test, and Functional Ambulation Category were used.

Results: A total of 38 patients, 20 in the vibration group and 18 in the control group, were included in the analysis. After the two-week therapy, the vibration group showed significant improvements in lower extremity strength, balance, and gait performance. The vibration group showed significantly better performance on the Berg Balance Scale, 10-meter walk test, and Functional Ambulation Category than the control group. There were no significant differences in maximal isokinetic voluntary contraction torque or manual muscle tests between the groups.

Conclusions: Our results suggest that additional training with whole-body vibration may effectively improve the balance and gait performance of subacute stroke patients. Further studies on large populations are required to determine the therapy's clinical efficacy.

  Development and validation of a screening tool for detection of dysphagia in neonates Top

D. Seshasri

Integral Coach Factory Hospital, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background and Aim: Early detection of feeding and swallowing difficulties in neonates helps in reducing the associated developmental and medical complications. A look into the literature revealed limited screening tools to detect neonatal dysphagia. The existing tools have been developed for neonates with specific issues and some of them are not validated as well. Further since feeding practices vary with culture, there is a need to context specific tool. The present study aimed at developing a standardized screening tool for the detection of dysphagia in neonates. The objectives were a) To establish content and clinical validity and reliability of the tool and b) To establish its sensitivity and specificity.

Methods: A tool titled Neonatal Dysphagia Screening Tool (NDST) was constructed, which was validated for its contents by a multidisciplinary group of professionals. The final version of NDST comprised of 17 questions with a binary choice scoring system. To ascertain clinical validity, NDST was administered on 178 mothers of neonates in the age range of 1-5 days, who were divided into three groups based on the medical history such as typical group (TG), high risk group (HRG) and very high risk group (VHRG). In order to establish the sensitivity and specificity, the tool was administered on a different group of participants with and without dysphagia. The NDST was also assessed for its inter-rater reliability. The data was analysed using SPSS (version 20) statistical software.

Results: Mann Whitney test revealed a significant difference across groups. The feeding and swallowing difficulties were significantly higher in the VHRG, followed by HRG. Further, the tool had high sensitivity (89.12%), moderate specificity (55.59%) and a very good inter-rater reliability.

Conclusions: The outcome of the study was a highly sensitive, valid and reliable screening tool to identify dysphagia, which facilitates early identification along with quantification of extent of dysphagia in the high risk neonates.

  Diagnostic peripheral motor nerve block for management of upper limb and lower limb spasticity in physical medicine and rehabilitation setting Top

Mohd Hakim Bin Zenian, Chung Tze Yang, Chan Soo Chin

Department of Rehabilitation Medicine, University Malaya Medical Centre, Petaling Jaya, Malaysia.

E-mail: [email protected]

Objective: To assess the efficacy and practicality of peripheral motor nerve block in a local physical medicine and rehabilitation setting for management of post stroke spasticity.

Methodology: Three patients with post stroke spasticity (more than one year) involving either the upper or the lower limb were recruited. Two candidates received peripheral motor nerve block injection to the upper limb and one patient received it to the lower limb. One patient received exclusive peripheral motor nerve block only, while the other two received peripheral motor nerve block followed by botulinum toxin injection. All procedures were conducted in outpatient clinic settings. Lignocaine and Bupivacaine were the agent of choice, administered directly to perineural area under ultrasound guidance. Spasticity scoring is measured according to Modified Ashworth Scale and Modified Tardieu Scale at pre and post procedure, as well as on subsequent clinic follow up.

Result: All three candidates show positive improvement in spasticity immediately after the procedure. On subsequent assessment, the patient who received exclusive peripheral motor nerve block without botulinum toxin had lasting effect up to three months. While the other two patients who received both peripheral motor nerve block and botulinum toxin injection has potentially longer lasting effect. There was no reduction in motor strength related to the procedure.

Conclusion: Peripheral motor nerve block could be a viable option for post stroke spasticity management. On case to case basis, it could be considered as an alternative to botulinum toxin or could be administered together with potential synergistic effect. It might also serve as diagnostic tool for differentiating spasticity from contracture.

  CRPS among first ever stroke patient: A study from tertiary care centre in eastern India Top

Rezwana Parvin

Department of Physical Medicine and Rehabilitation, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.

E-mail: [email protected]

Background: CRPS is a common cause of upper limb pain in post stroke patient. It remains undiagnosed & untreated as it's a diagnosis of exclusion.

Inclusion Criteria: 1. Patient age> 18yrs 2. Patient with NIH score <20 3. Patient with ICH score < 3 4. Patient with MRS score < 4 5. Patient willing to regular follow up in opd.

Exclusion Criteria: 1. Previous history of stroke 2. Any history of brain injury 3. Any history of other neurological deficit 4. Any known orthopedic injury involving extremities.

Methodology: Patients are given questionnaire & data is collected upto 6 months post stroke.

Result: CRPS is more common in ischemic stroke with basal ganglia involvement with associated co morbidities with age distribution between 40-60 yrs.

  Effect of dry needling on spasticity and static balance in stroke survivors: A pilot study Top

Sanjivani Kamble, Gaurang Baxi, Tushar Palekar

Department of Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pune, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Dry needling (DN) is a therapeutic intervention used to treat myofascial trigger point and a variety of pain syndromes. Evidence for application of DN in neurological conditions with functional assessment is still lacking. This case series was conducted to explore the effects of DN on spastic soleus muscle in chronic stroke patients.

Methodology: 10 stroke survivors (>3 months onset) were included. Spasticity was assessed using the Modified Ashworth scale (MAS) and Modified Tardieu scale. Balance was assessed using the Berg balance scale (BBS). 6 sessions of DN were conducted for the spastic soleus muscle for a period of 2 week. Outcome measures were reassessed.

Results: A significant improvement was seen for all 3 outcome measures (p.0.05). MAS showed improvement from Grade 3 to 1+. Tardieu scale showed significant improvement for ankle ranges by 12 degrees. Berg balance scale score increased by 7.

Conclusion: After application of DN, a reduction in muscle tone of the spastic soleus was seen. Also, there was improvement in static balance. Discussion: DN was effective in decreasing the spasticity and improving balance, range of motion and accuracy of maintaining stability in stoke survivals. These initial results are promising, further research needs to be conducted to validate the findings.

Keywords: Berg balance scale, dry needling, modified ashworth scale, spasticity, stroke, Tardieu scale

  Role of wnt5a downregulation in promoting stroke recovery by 5-AZA-DC administration combined with a task specific training in rats Top

Inae Choi, Ji Hee Yu, Dong-Hee Choi,

Jongmin Lee

Center for Neuroscience Research, Konkuk University, Seoul, South Korea.

E-mail: [email protected]

Background and Aims: Stroke is a major cause of death and disability. Inflammation responses after stroke impede functional recovery. Epigenetic modulation promotes stroke recovery regulating gene expression. Inhibiting DNA methylation increases the expression of anti-inflammatory cytokines. To identify a therapeutic effect of modulating DNA methylation in stroke, this study investigated the effects of 5-aza-2'-deoxycytidine (5-Aza-dC), the DNA methyltransferase inhibitor, and task-specific training combination (TST) therapy on recovery and anti-inflammatory effects after stroke.

Methods: The experimental group consisted of control group, stroke group, post-stroke TST treatment group, post-stroke 5-Aza-dC treatment group, post-stroke TST and 5-Aza-dC combination treatment group. Systemic injection of 5-Aza-dC and TST were administered starting 5 days post-stroke for one week. Functional recovery was assessed using the staircase, and cylinder tests. Proinflammatory cytokines, Wnt family member 5A (Wnt5a)/Ca2+/calmodulin-dependent protein kinase II (CaMKII) signaling pathway, and localization of Wnt5a were determined.

Results: Combination therapy comprised 5-Aza-dC and TST promoted stroke recovery. The levels of proinflammatory cytokines and Wnt5a/CaMKII signaling pathway were suppressed by 5-Aza-dC and TST combination therapy. Increased Wnt5a expression in the astrocytes of the stroke group was significantly reduced in the 5-Aza-dC and TST combination therapy group. IL-10, a Wnt5a transcription suppressor, was significantly increased in the 5-Aza-dC and TST combination therapy group.

Conclusions: Our results suggest that 5-Aza-dC and TST combination therapy has an anti-inflammatory effect via the Wnt5a/CaMKII pathway, which aids stroke recovery.

Keywords: CaMKII, DNMT inhibitor, interleukin-10, proinflammatory cytokines, stroke, task-specific training, Wnt5a

  Language systems from lesion-symptom mapping in aphasia: A meta-analysis of voxel-based lesion mapping studies Top

Sung-Bom Pyun, Yoonhye Na, JeYoung Jung, Christopher Tench, Dorothee P. Auer

Department of Physical Medicine and Rehabilitation, Korea University Medical Center Anam Hospital, Korea Universiy, Seoul, South Korea.

E-mail: [email protected]

Background: Aphasia is one of the most common causes of post-stroke disabilities. As the symptoms and impact of post-stroke aphasia are heterogeneous, it is important to understand how topographical lesion heterogeneity in patients with aphasia is associated with different domains of language impairments. Here, we aim to provide a comprehensive overview of neuroanatomical basis in post-stroke aphasia through coordinate based meta-analysis of voxel-based lesion-symptom mapping studies.

Methods: We performed a meta-analysis of lesion-symptom mapping studies in post-stroke aphasia. We obtained coordinate-based functional neuroimaging data for 2,007 individuals with aphasia from 25 studies that met predefined inclusion criteria.

Results: Overall, our results revealed that the distinctive patterns of lesions in aphasia are associated with different language functions and tasks. Damage to the insular-motor areas impaired speech with preserved comprehension and a similar pattern was observed when the lesion covered the insular-motor and inferior parietal lobule. Lesions in the frontal area severely impaired speaking with relatively good comprehension. The repetition-selective deficits only arise from lesions involving the posterior superior temporal gyrus. Damage in the anterior-to-posterior temporal cortex was associated with semantic deficits.

Conclusion: The association patterns of lesion topography and specific language deficits provide key insights into the specific underlying language pathways. Our meta-analysis results strongly support the dual pathway model of language processing, capturing the link between the different symptom complexes of aphasias and the different underlying location of damage.

  Visual versus verbal feedback: Which is better in improving motor control in individuals with ambulatory stroke? Top

Sharvari Samant, Preeti Gazbare

Department of Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.

E-mail: [email protected]

Background and Aim: Patients with hemiplegia tend to support their body weight on unaffected side which disrupts the balance, symmetry, postural control and function. Feedback is important for effective skill learning. Hence this study aims to compare visual and verbal feedback on motor control in stroke patients.

Methods: Thirty ambulatory stroke patients, fulfilling the inclusion and exclusion criteria were selected. Patients were divided into 2 groups randomly, 15 in each group. Group A received visual feedback and Group B verbal feedback for functional training using the Balance Master along with conventional therapy. Duration was for 60 min. 3 times/week for 4 weeks. Pre-post outcome measures were Postural Assessment Scale for Stroke (PASS) and squatting, sit to stand, walk across using neurocom balance master equipment.

Results: Visual feedback (group A) was more effective than verbal feedback (group B) in improving time required for weight transfer in sit to stand. Within group analysis, both the groups showed improvement in PASS score, squatting at 0,30,60,90 of knee flexion - percentage of weight bearing on the affected side improved, mean step width in walk across also improved (p<0.05). In between group analysis sit to stand: weight transfer showed improvement. (p<0.05).

Conclusion: Visual and verbal feedback are equally effective in improving motor control, however visual feedback is more beneficial than verbal feedback in improving weight transfer time in sit to stand.

  Effect of extended duration of cortical stimulation in adults who stutter (AWS) - A preliminary study Top

Chanchal Chaudhary, Gopee Krishnan

Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.

E-mail: [email protected]

Background: Stuttering is a neurodevelopmental disorder characterized by excessive speech behaviors that disrupt the flow of speech. Neural markers in stuttering show impairments in speech motor-related brain regions and atypical brain activation patterns in areas involved in speech production.[1] The combined use of transcranial direct current stimulation (tDCS) and behavioral speech therapy shows promising results in enhancing fluency. However, the data is available only from short-term intervention (up to 6 sessions).[2],[3],[4]

Aim: We present preliminary evidence of benefit of extended duration of cortical stimulation (tDCS) clubbed with behavioral intervention (choral speech + metronome) on fluency in AWS.

Methods: Four AWS completed a three-week (5 days /week) intervention. In each of the 40-mins sessions, they received 1mA anodal stimulation over the left inferior frontal cortex for initial 20 minutes with behavioral fluency therapy. The latter continued for another 20 minutes and included temporary fluency enhancing conditions such as choral speech and metronome task. Fluency levels were assessed at baseline, 5th day, 10th day, and post-intervention (15th day) using %stuttered syllables, reading, and speaking tasks.

Result: Change in percentage of stuttering from baseline was observed at the end of week 1. Further reductions in dysfluencies were noted at the end of week 2. However, assessments on the 10th and 15th days did not show any notable differences.

Conclusion: This data shows the beneficial effect of extended duration of cortical stimulation in AWS. Thus, our findings support the assumption that extending the tDCS with concurrent speech therapy could optimize treatment outcomes in AWS.


Chesters J, Watkins KE, Möttönen R. Investigating the feasibility of using transcranial direct current stimulation to enhance fluency in people who stutter. Brain Lang 2017;164:68-76.

Chesters J, Möttönen R, Watkins KE. Transcranial direct current stimulation over left inferior frontal cortex improves speech fluency in adults who stutter. Brain 2018;141:1161-71.

Garnett EO, Chow HM, Choo AL, Chang SE. Stuttering severity modulates effects of non-invasive brain stimulation in adults who stutter. Front Hum Neurosci 2019;13:411.

Yada Y, Tomisato S, Hashimoto RI. Online cathodal transcranial direct current stimulation to the right homologue of Broca's area improves speech fluency in people who stutter. Psychiatry Clin Neurosci 2019;73:63-9.

  Effect of virtual reality on balance and gait in geriatric population Top

Sneha B Iyer

Department of Neurosciences, Dr D Y Patil College of Physiotherapy, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Falls result in injuries which account for 20%-30% of all injuries combined in age groups >60 years. Mild physical activity prevents falls, but due to low adherence to unsupervised exercises at home, improvements remain inconclusive. A multimodal home-based balance and gait training program, shows better outcomes. Nonetheless, virtual reality training (VRT) programs may potentially improve the effects on balance, gait and fall risk among geriatrics.

Aim: Study intends to compare the effect of virtual reality training (VRT) as compared to conventional physiotherapy exercises to improve balance, gait and fall risk.

Methods: An experimental study design conducted among 42 participants (aged 65 to 75 years), randomly divided into two groups namely VRT and conventional exercises using modified Otago Home Exercise program. Intervention was given for 4 weeks, with 3 sessions per week and pre-post assessment were done using Berg balance scale (BBS), Dynamic gait index (DGI) and Modified fall efficacy scale (MFES) to check balance, gait performance & fall risk respectively.

Result: Post 12 sessions of intervention, significant improvement seen on balance, gait and fall risk within both groups on BBS, DGI, MFES with (p<0.0001). On comparison, both groups showed equal effect on BBS (p=0.42), DGI (p=0.39), MFES (=0.53) with low statistical significance.

Conclusion: This study highlights both interventions are equally effective in improving Balance, gait and risk of fall, VRT has similar potential in preventing age-related fall. VRT showed more exercise adherence and positive feedback among individuals.

  Role of physical therapy for improving the functional independence of a child with SMA type 2 - Case report Top

Sharvani Chogle, Pradnya Gadgil, Abhishek Srivastava, Navita Purohit Vyas

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, North West, Maharashtra, India.

E-mail: [email protected]

Background: Spinal muscular atrophy (SMA) is a group of autosomal recessive genetic disorders characterized by loss of anterior horn cells of spinal cord. This leads to progressive muscle weakness and atrophy in muscles affecting the posture, movement etc. The disease is classified into 4 types based on severity, age of onset & highest attained milestone. SMA type1 is severe & life threatening, SMA type2 is intermediate, SMA type3 is mild & SMA type4 is adult onset.

Aim: Our aim is to describe outcomes of early & intensive neurorehabilitation for a child with SMA type2.Clinical presentation: Master X reported to us at 1yr 8m. Genetics and clinical examination confirmed SMA type2. At presentation, he was able to roll, sit when made to sit, but had complains of weakness in b/l upper & lower extremities, inability to independently come to sit, transition out of sitting, standing & walking. His baseline assessment was done for MMT, GMFM(35%)& HFMS(16/40).

Intervention: Goal directed therapy using following strategies was implemented:a) low intensity exercises with submaximal loading in weight bearing positions using muscle co-contractions to improve muscle endurance & postural stability.b) Balance training in various functional positions incorporating play activities.c) Respiratory exercises like blowing a balloon.d) supramalleolar orthosis given for foot planus, thereby improving foot alignment. Adequate rest periods were given to avoid fatigue. Progression was done in intensity & repetitions as tolerated. Exercises sessions were undertaken for 40 mins at a frequency of 3 times/week.

Results: With ongoing therapy, he started standing & walking independently, ride tricycle and was able to attend school. There have been no muscle contractures or respiratory complications.His latest assessment (at age 4 years) shows significant improvement from baseline scores for MMT,GMFM(58.44%), HFMS (28/40).

Conclusion: Thus we conclude that regular, goal directed physical therapy can improve functional independence and avoid respiratory & musculoskeletal complications that could arise from mobility restrictions in children with SMA type 2.

  Person-environment-occupation model-based occupational therapy intervention for functional recovery in a chronic case of multiple myeloma - A case study Top

Pooja P. Kamble

Department of Occupational Therapy, LTMMC & GH, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: A 50-year-old unknown male patient was brought to a tertiary care hospital in a state of severe pain, inability to sit or stand, and in an unkempt condition. On investigation and clinical correlation, this patient was diagnosed as a case of Multiple Myeloma.

Aim: To study the effect of Person-Environment-Occupation (PEO) model-based occupational therapy intervention on activity participation and functional recovery in chronic Multiple myeloma.

Methods: The PEO model was used where the patient's unique qualities and strengths were recognized, the environmental factors that promoted or demoted his functional independence were modified and thus, he was able to engage in the occupational roles that he wasn't able to independently engage in due to his condition. An interdisciplinary approach was used while formulating goals for the patient. The intervention was for 3 weeks and given in the ward. Standardized scales were used to measure pre-intervention and post-intervention functional status.

Result: Using PEO based occupational therapy intervention coupled with high motivation and participation of the patient, despite not having family or any other support, he was able to achieve all the short-term goals i.e., being able to sit independently and eat, wear his own splints, groom himself and independently propel a manual wheelchair. The patient was discharged to a charitable home after a long stay at the tertiary care hospital.

Conclusion: Individualized PEO-based occupational therapy intervention is effective in improving activity performance and functional recovery, thus improving the patient's self-esteem, self-image, and quality of life in chronic Multiple myeloma.

  Systematic evaluation and comprehensive management for traumatic brain injury - A case report Top

Sangeetha Ram

Department of Speech and Language, MERF-Institute of Speech and Hearing (P) Ltd, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background and Aims: Traumatic Brain Injury (TBI) is caused by a head injury leading to alterations in brain functioning and result in speech & Language disturbances, auditory processing deficit which in turn affects the quality of life. The aspect of assessment and rehabilitation following TBI is challenging because of many factors that. This study emphasizes on diverse assessment and rehabilitation procedure for a patient following TBI.

Case Description: A 39 year old male client was enrolled for assessment with the complaint of unclear speech and difficulty in perceiving auditory commands following road traffic accident on 20/12/2020. MRI results revealed diffuse axonal injury noted in left frontal and temporal cortices; focal contusions with edema in bilateral frontal lobes and mild subarachnoid haemorrhage seen in left parietal regions. VII and VIII nerve complexes appear normal.

Results: Audiological evaluation was done and it revealed no indication of cochlear pathology and retrocochlear pathology uptill brainstem in both sides. Cortical Auditory Evoked Potential revealed reduced P1 amplitude and absent P2 potential in left side. Temporal resolution- pitch patterning test and Gap detection test was administered and it revealed Central Auditory Processing Disorder. Speech and Language assessment was carried out which revealed non fluent aphasia, dysarthria and dysphagia. Comprehensive management goals for improving auditory processing deficit through temporal patterning task, swallowing through manuevres & postural modification; speech through articulatory drills and feedback.

Conclusions: Systematic approach using appropriate test tools are important for diagnosis and symptomatic therapy yield better prognosis for recovery.

  Systematic evaluation and comprehensive management for traumatic brain injury - A case report Top

Sangeetha Ram

Department of Speech and Language, MERF-Institute of Speech and Hearing (P) Ltd, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background and Aims: Traumatic Brain Injury (TBI) is caused by a head injury leading to alterations in brain functioning and result in speech & Language disturbances, auditory processing deficit which in turn affects the quality of life. The aspect of assessment and rehabilitation following TBI is challenging because of many factors that. This study emphasizes on diverse assessment and rehabilitation procedure for a patient following TBI.

Case Description: A 39 year old male client was enrolled for assessment with the complaint of unclear speech and difficulty in perceiving auditory commands following road traffic accident on 20/12/2020. MRI results revealed diffuse axonal injury noted in left frontal and temporal cortices; focal contusions with edema in bilateral frontal lobes and mild subarachnoid haemorrhage seen in left parietal regions. VII and VIII nerve complexes appear normal.

Results: Audiological evaluation was done and it revealed no indication of cochlear pathology and retrocochlear pathology uptill brainstem in both sides. Cortical Auditory Evoked Potential revealed reduced P1 amplitude and absent P2 potential in left side. Temporal resolution- pitch patterning test and Gap detection test was administered and it revealed Central Auditory Processing Disorder. Speech and Language assessment was carried out which revealed non fluent aphasia, dysarthria and dysphagia. Comprehensive management goals for improving auditory processing deficit through temporal patterning task, swallowing through manuevres & postural modification; speech through articulatory drills and feedback.

Conclusions: Systematic approach using appropriate test tools are important for diagnosis and symptomatic therapy yield better prognosis for recovery.

  Ataxia telangiectasia like disorder: Rare clinical profiles of siblings and its impact on caregiver Top

Subhiksha Murali, M. Suhada, P. C. Sooraj, N. Swapna

Department of Audiology and Speech Language Pathology, All India Institute of Speech and Hearing, Manasagangothri, Mysuru, Karnataka, India.

E-mail: [email protected]

Background and Aims: Ataxia Telangiectasia (AT) is a rare, progressive, autosomal recessive disorder characterized by cerebellar signs and telangiectasia. Atypical presentations, also called AT like Disorders (ATLD) have also been reported. This clinical case study aims to highlight the enigmatic speech, language, swallowing, psychological and motor profiles and supportive management in siblings with ATLD, along with the impact of ATLD on the kindred.

Methods: Two female siblings, 29.2 years and 25 years old, reported with the complaint of slurring and slow rate of speech, difficulty in eating and motor activities. The facets of communication, swallowing and motor faculties were assessed using performance based and subjective speech, language and cognition tests. Speech therapy focussing on programmed subsystem approach and physiotherapy focusing on amelioration of equilibrium and balance were provided as part of supportive management. The consequences of the disorder on the clients and custodian were assessed.

Results: The siblings showed features of ataxic dysarthria and motor signs of cerebellar lesion. Language and psychological status was intact. The elder sibling presented with greater speech difficulties and lesser motor problems compared to younger sibling who exhibited a reverse pattern, substantiating the claim that no two persons with AT have the same clinical presentation. The Quality of Life (QOL), which was moderately affected before treatment changed to mildly affected QOL with treatment. However, the impact of these problems was minimal on the custodian.

Conclusion: Considering variations in the presentation of ATLD is ineluctable to provide pertinent treatment. Supportive therapy and caregiver motivation are essential components of neurorehabilitation, which improves QOL.

  A case study on outcomes with cochlear implant in auditory neuropathy spectrum disorder Top

Gauri Singh, Ranjith Rajeswaran, Subhashini

Department of Audiology, MERF- Institute of Speech and Hearing, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background: Auditory neuropathy spectrum disorder (ANSD) is a rare disorder of auditory nerve, in which the person may have normal hearing or hearing loss ranging from mild to severe. Cochlear (CI) Implant isseldom performed in ANSD with normal hearing. Indication for CI in ANSD with normal hearing and outcomes are profiled in this case study.

Case Description: A 34 years old male came with complaint of difficulty in hearing and speech perception. The radiological evaluation revealed patent cochlea and auditory nerve. Audiological findings reveals minimal hearing loss in both ears with very poor speech perception abilities. He had normal middle ear with absent acoustic reflexes in both ears. Auditory brainstem responses were absent even at lower rate of stimulation, however his out hair cell functions were normal. Upon evaluation he was diagnosed with bilateral auditory neuropathy, Cortical potentials suggested right ear better than left ear. He underwent cochlear implantation in right ear followed by programming and rehabilitation.

Results: Post-operatively he had good electric stapedial reflex and his speech perception scores improved by 45% on open set and 55% on closed set. On non-implanted ear his hearing sensitivity deteoriated with absent outer hair cell functioning. The details of the functional outcomes will be discussed during the presentation.

Conclusion: Cochlear Implant is an option for patients with ANSD irrespective of degree of hearing loss. However early identification with systematic evidence-based diagnosis is crucial for decision making. Without detailed audiological test battery decision making for candidacy and rehabilitation is challenging.

  Utilization of post stroke rehabilitation services at a tertiary care center in the Northern Province Sri Lanka Top

Sivanesan Shivaram, R. Sampavi, R. Ghobika, L. Suvethini, B. Yathev, A. A. D. R. Amarasingha, S. Shiyananth, S. Shivaram, G. Sivakumar, A. A. A. Suramiya, A. Paherathy, S. Thivacaren, A. Arasalingam

Department of Medicine, University of Jaffna, Jaffna, Sri Lanka.

E-mail: [email protected]

Introduction: Stroke care is a comprehensive, inter-disciplinary process which comprises post-stroke rehabilitation as an integral component, involving the patient, family, healthcare staff, and therapists.

Objectives: To study the utilization of post-stroke rehabilitation from acute to home care.

Methods: Records of 792 patients extracted from the Sri Lanka Clinical Stroke Registry during the study period 1st April 2016 to 30th June 2017, were statistically analyzed. Variables include referrals to stroke rehabilitation services; inward and on discharge and are expressed as percentages.

Results: Of 792 patients 425 (53.4%) were male; 594 (75%) had ischemic stroke and 198 (25%) had intracerebral haemorrhage. On discharge, the number of referrals to post stroke rehabilitation services were physiotherapy 607/792 (76.6%), speech pathology 162/792 (20.5%), occupational therapy 27/792 (3.4%), counselling 1/792 (0.1%), and social services 1/792 (0.1%).

Conclusion: There is an overall underutilization of post stroke rehabilitation services, especially occupational therapy, counselling, and getting financial/social assistance from social services.

  Utilization of speech and language pathology services for stroke patients with dysphagia in the acute care setting at a tertiary care centre in the Northern Province of Sri Lanka Top

Sivanesan Shivaram, R. Sampavi, R. Ghobika, L. Suvethini, B. Yathev, A. A. D. R. Amarasingha, S. Shiyananth, S. Shivaram, G. Sivakumar, A. A. A. Suramiya, A. Paherathy, S. Thivacaren, A. Arasalingam

Department of Medicine, University of Jaffna, Jaffna, Sri Lanka.

E-mail: [email protected]

Introduction: Dysphagia, a common problem in acute stroke patients, is a frequent cause of complications particularly aspiration pneumonia. A speech pathologist conducts a formal assessment within 24-48 hours. A bed side swallow test is done on admission.

Objectives: To assess the utilization of speech and language pathology services in the management of dysphagia and assess the occurrence of aspiration pneumonia in the acute post stroke setting in a tertiary care centre in the Northern Province of Sri Lanka.

Methods: A retrospective study based on data extracted from the Sri Lanka Stroke Clinical Registry during the study period of 1st April 2016 to 30th June 2017.

Results: Of a total of 792 patients bedside swallow test was not done or documented in 729(91.8%); referral to speech and language pathologist was documented in 158/792(19.9%) and 152 (19.5%) had dysphagia. Sub analysis of the 152 patients with dysphagia - bed side swallow test was not documented in 149(98%) and 25(16.1%) were referred to the speech and language pathologist. 33/152 (21.3%) had aspiration pneumonia.

Conclusion: The documentation of bed side swallowing test was found to be lower than the optimal standards and there is a significant underutilization of speech and language pathology services in assessing dysphagia.

  An audit on the knowledge and utilization of stroke rehabilitation amongst intern medical officers and nursing officers attached to a tertiary care centre in Jaffna, Northern Province of Sri Lanka Top

Sivanesan Shivaram, R. Sampavi, R. Ghobika, L. Suvethini, B. Yathev, A. A. D. R. Amarasingha, S. Shiyananth, S. Shivaram, G. Sivakumar, M. Mithuriha, S. Thivacaren, A. A. A. Suramiya, A. Paherathy, A. Arasalingam

Department of Medicine, University of Jaffna, Jaffna, Sri Lanka.

E-mail: [email protected]

Introduction: With no designated neurorehabilitation centre, rehabilitation of neurology patients is covered by general rehabilitation centres. Knowledge and utilization of stroke rehabilitation services is paramount amongst the intern house officers and nursing officers who are the first contact points to a stroke patient and their relatives.

Objectives: We aimed to assess (1) the knowledge of rehabilitation and the concept of multidisciplinary teams; (2) the post stroke complications during the rehabilitation phase: and (3) the utilization of rehabilitation services amongst the intern house officers and nursing officers at the Teaching Hospital Jaffna, Sri Lanka. Randomly selected 100 subjects answered a self-administered questionnaire where 20 components were tested and knowledge scored out of 100.

Results: Of the 67 respondents, 43(64.1%) were intern medical officers; 52(77.6%) had worked in a medical ward; 5(7.5%) had undergone stroke rehabilitation training; 57(85%) knew the aims of stroke rehabilitation. Knowledge on the use of scales in stroke assessment varied from 11.9% to 56.7% based on the scales; 32(77.6%) made appropriate referrals to post stroke rehabilitation services; 58(91%) gave appropriate advice on discharge; and 40.3% knew the available rehabilitation centres in the Jaffna district. S4coring of knowledge 24(35.8%) were in the first quartile and 33(49.3%) in the second quartile.

Conclusion: Compared to an audit done in 2017 there has been a significant improvement in the utilization and knowledge with regard to stroke services. The knowledge on the use of scales was low probably due to the fact that these are not applied by the interns and nursing officers.

  Tinnitus as presenting symptom of arachnoid cyst of the anterior cranial fossa - A case report Top

Anusha Nagamalai, C. Pachaiappan, Dhulase Krithega

Department of Audiology and Speech-Language Pathology, MERF Institute of Speech and Hearing, MERF Institute of Speech and Hearing, Chennai,Tamil Nadu, India.

E-mail: [email protected]

Background and Aim: Arachnoid cysts are rare CSF collections which occur on the arachnoid membrane and sub arachnoid space. It is commonly seen in the middle cranial fossa, the suprasellar region, followed by the posterior cranial fossa. Localization in the anterior cranial fossa is an uncommon finding and it may remain asymptomatic or cause general symptoms. This study aims to report tinnitus as presenting symptom of arachnoid cyst of the anterior cranial fossa.

Case Description: A 34-year-old male, came to the department with the complaint of right-sided tinnitus occasionally accompanied by dizziness, headache and nausea. It was also subjected to a psychological overlay of depression and insomnia. These symptoms occurred at late age without any evident causative factors. Magnetic-Resonance Imaging showed an extra-axial CSF signal intensity lesion in the right anterior temporal region, suggestive of Arachnoid cyst.

Result: Audiological evaluation was carried out through Auditory Brainstem Responses, OtoacousticEmission, and Pure Tone Audiometry which revealed minimal hearing loss in both ears. Vestibular Evoked Myogenic Potential indicated normal vestibulocollic reflex pathway functioning. The impression of Tinnitus Handicap Inventory denoted a 'severe handicap'. Tinnitus matching and masking qualified him as a candidate for Tinnitus Retraining Therapy.

Conclusion: It is often difficult to interpret the relationship between intracranial arachnoid cysts and inner ear symptoms. Patients may be misdiagnosed due to varied range of symptoms. Test battery approach and symptomatic assessment is required for appropriate diagnosis and treatment.

  Kinect 360 based balance training improves postural stability kinematics among elderly during COVID 19 lockdown: A case series Top

Muhammad Ehab Azim, Muhammad Naveed Babur, Furqan Ahmed Siddiqi, Marwa Asim, Muhammad Furqan Hassan, Sana Khalid Mirza

Foundation University Institute of Rehabilitation Sciences, Foundation University Islamabad, Islamabad, Pakistan

E-mail: [email protected]

Background and Aim: Age-related deterioration in neuromuscular control of postural stability results in lowered mobility, increased risk of fall and trauma among the elderly. Balance training improves postural control but COVID 19 pandemic has impacted and reduced elderly rehabilitation care. Kinect-based Virtual reality balance training is a promising alternative to engage elderly in multidirectional balance training program. Current study aims to examine effects of Kinect based balance training on postural stability kinematics and control in elderly.

Methods: A pilot case series study was conducted on a convenience sample of 5 healthy elderly individuals. Participants were able to walk independently and stand for 10 sec without support with eyes open and eyes closed. Participants were provided Virtual reality-based balance training using commercially available XBOX Kinect 360 games on alternate days for 30-50 minutes for 6 weeks duration. postural stability system was used to evaluate postural stability and control via Fall risk Score, Postural stability Index, and Limits of Stability. Additionally timed up and go test was used to evaluate mobility. All assessments were done at baseline and end of training protocol.

Results: Gender distribution was observed as 40% (n=02) being Males and 60% (n=03) as females. Height, weight, and BMI were computed as 163.4±5.41 cm, 76.66±11.53 kg, and 28.73±4.17 Kg/m2 respectively. Results showed significant improvement (P<0.05) in Fall risk score, Limits of Stability, and timed up and go test duration. No significant change in Postural stability Index (P=0.104) was observed.

Conclusions: Kinect 360 based virtual reality balance training can improve balance, limits of stability, and mobility in elderly. The approach can be effectively incorporated as an alternate balance intervention to provide dynamic balance training during periods of lockdown and social distancing.

  Effect of progressive verticalization approach in treating COVID–19 critical illness polyneuromyopathy Top

Pon Raja Bharathi Raja Selvan,

Manisha D Hinduja, Abhishek Srivastav, Navita Vyas

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra. India.

E-mail: [email protected]

Aim: To find the effectiveness of progressive verticalization approach in treating COVID-19 critical illness polyneuromyopathy.

Background and Purpose: COVID-19 has a high incidence of ICU admittance due to Severe Acute Respiratory Syndrome which may require prolong artificial ventilation, neuromuscular blocking agents (paralytics), sedatives, steroids, which prolong the ICU stay leading to critical illness polyneuromyopathy. COVID-19 patients show mainly posterolateral basal lung involvements which affects perfusion in these areas leading to ventilation perfusion (V/Q) mismatch. This leads to hypoxia, increased work of breathing and low exercise tolerance in upright position. These difficulties can be overcome in supine position as patients show better oxygenation and reduced work of breathing in this position unlike other respiratory conditions like COPD, bronchitis which tolerate upright position better than supine position by Progressive verticalization approach. We can start strengthening program earlier during the course of rehabilitation, from supine position gradually progressing to vertical position depending on the patient's tolerance.

Methods: 1) Subjects- Study consists of 28 patients, age 50 to 65 years, from Kokilaben Dhirubhai Ambani Hospital, diagnosed with COVID-19 by RTPCR test, with a stay in ICU for more than 7 days, who were off sedation /paralysis for more than 48hrs, and had MRC sum score of less than 48/60. These patients had no previous neurological impairments and were independent in their ADLs prior to this hospitalization. 2) Assessment and Outcome measures: Medical Research Council (MRC) sum score was taken to assess Strength and integrity, Functional Status Score – ICU (FSS-ICU grading by FIM was taken to assess Functional mobility. Pre and post 4 weeks assessment scores of these measures were documented. 3) Intervention- Progressive Verticalization approach was used to strengthen the muscles from supine position, gradually progressing it into a vertical position.

Result: Pre and post 4 weeks assessment data of muscle strength and functional status will be compared statistically.

Conclusion: Progressive Verticalization approach can improve oxygenation, exercise tolerance to muscle strengthening program, thus achieving rehabilitation goals earlier in COVID-19 critical Illness Polyneuromyopathy.

  Effectiveness of cystoscopy guided intravesical injection of onabotulinum toxin (type a) in neurogenic overactive bladder due to traumatic spinal cord injury Top

Sudipto Haldar, Vasundhara Ghosal, Rajesh Pramanik

Department of Physical Medicine & Rehabilitation, IPGME&R, Kolkata, West Bengal, India.

E-mail: [email protected]

Background and Aims: Neurogenic Overactive bladder is a very common problem in suprasacral SCI. It is our humble attempt to study the effectiveness of cystoscopy guided intravesical injection of onabotulinum toxin type A injection in this kind of patients. In this study we tried to compare outcomes between patients treated with conservative therapy with anticholinergic medications only vs cystoscopy guided intravesical injection of onabotulinum toxin type A as add on. Not many studies have been done to compare these two standard methods in treatment of neurogenic overactive bladder.

Methods: This prospective randomized open label control trial was conducted in the Department of Physical Medicine and Rehabilitation, IPGME&R, India, between February 2019 and July 2020, after obtaining clearance from the Institutional Ethical Committee, Proper consent was taken from the patient. UDS confirmed cases of neurogenic overactive bladder due to traumatic SCI aged >18 yrs were included according to the inclusion and exclusion criteria and were being randomly subdivided into two groups. One group (group C) of patients received conservative therapy; and the other group of patients (group I) received Botulinum toxin injection in addition to conservative therapy.; and after initial visit, these patients were followed up on 2nd, 6th, 12th week, every time with respect to improvement in Maximum Cystometric Capacity(MCC), First Urge to Void(FDV), Frequency of incontinence and Post void residual urine volume(PVR) measurements.

Results: Statistically significant improvement (with p value less than 0.05) was observed in group C, and similar type of observation was also found while analyzing the improvement in MCC, FDV, Frequency of incontinence and PVR among group I patients. And the comparative analysis of the numerical variables of groups C and I showed statistically significant improvement in favour of group I.

Conclusion: Botulinum Toxin injection is quite effective in Neurogenic Overactive bladder due to traumatic spinal cord injury.

Keywords: Botulinum toxin injection, neurogenic overactive bladder, traumatic SCI

  Therapeutic effects of neuro muscular electrical stimulation, stretching, ice therapy, versus moist heat for ankle flexors in 5-15 years old spastic littles disease childrens Top

T. Karthikeyan

Department of Physiotherapy, NIMHANS (A Govt of India), Bengaluru, Karnataka, India.

E-mail: [email protected]

Background: Spastic little's disease is the most common type of little disease. To reduce spasticity and prevent contractures various interventions in physiotherapy are given. Neuro muscular Neuro muscular electrical stimulation, ice therapy, moist heat and stretching are also the treatment approaches in physiotherapy used to reduce spasticity in children with spastic little disease.

Methods: 60 little disease children's with the age group between 5-15 years were randomly divided into two groups: Group -A received neuro muscular electrical stimulation for tibialis anterior 30 min, ice therapy for 15 min, and stretching for planar flexors. Group-B received neuro muscular electrical stimulation for tibialis anterior, moist heat for 15 min, and stretching on spastic ankle flexors for 3 days in 4 weeks. Therapeutic effects of pre to post treatment assessed through Modified Ashworth scale and ROM measurement.

Result: The results shows a very highly significant increase in ROM in group A receiving neuro muscular electrical stimulation, ice, stretching which is compared to group B receiving neuro muscular electrical stimulation, moist heat, stretching which showed slight increase in ROM. The results of the study shown is highly significant in favour of neuro muscular electrical stimulation, ice, stretching.

Conclusion: The present study concludes that both the protocols reduce symptoms and increase the functional status. But neuro muscular electrical stimulation, ice, stretching (Group A) is more effective in reducing spasticity and increasing ROM than Neuro muscular electrical stimulation, moist heat, stretching (Group B).

Keywords: Moist heat, NMES, spastic littles disease, stretching

  Effectiveness of early intervention by ultrasound guided ona-botulinum toxin type a injection on shoulder pain due to post-stroke subscapularis spasticity Top

Panchatapa Bhattacharyya, Debayan Ghorai, Rajesh Pramanik

Department of Physical Medicine and Rehabilitation, IPGMER & SSKMH, Kolkata, West Bengal, India.

E-mail: [email protected]

Background and Aim: Post-stroke shoulder pain is one of the most common clinical condition leading to PMR OPD visit. This study is our humble attempt to put some light to assess the role of early intervention by ultrasound guided ona-botulinum toxin type A injection on shoulder pain due to post-stroke subscapularis spasticity.

Methods: This prospective randomized open label control trial was conducted in the Department of Physical Medicine and Rehabilitation, SSKM Hospital, A.J.C Bose road, Kolkata, West Bengal, India, between February 2019 and July 2020, after obtaining clearance from the Institutional Ethical Committee, Proper consent was taken from the patient. Confirmed cases of post-stroke shoulder pain due to subscapularis spasticity aged >18 yrs were included according to the inclusion and exclusion criteria and were being randomly subdivided into two groups. One group (group I) of patients received conservative therapy; and the other group of patients (group II) received Botulinum toxin injection in addition to conservative therapy.; and after initial visit, these patients were followed up on 2nd, 6th, 12th week, every time with respect to improvement in NRS,SPADI and MAS measurements.

Results: Statistically significant improvement (with p value less than 0.05) was observed in group I, and similar type of observation was also found while analyzing the improvement in NRS, SPADI and MAS among group II patients. And the comparative analysis by Student's unpaired t test of the numerical variables of groups I and II showed statistically significant improvement pattern of NRS, SPADI and MAS in favour of group II.

Conclusion: Botulinum Toxin injection is quite effective in early intervention of post-stroke shoulder pain due to subscapularis spasticity.

  Prevalence of painful diabetic peripheral neuropathy, a common yet underdiagnosed, undertreated condition: A review Top

Jorida Fernandes, Prashant Mukkannavar

Department of Physiotherapy, SDM College of Physiotherapy, Dharwad, Karnataka, India.

E-mail: [email protected]

Background and Aims: Pain as a direct consequence of abnormalities in the peripheral somatosensory system in people with diabetes is termed as painful diabetic peripheral neuropathy (PDPN). The intensity of pain has an impact on the function, levels of anxiety, kinesiophobia and fear of pain. Limited and variable published data on the prevalence of PDPN and its screening process is available. This review is undertaken to evaluate and summarize the data available on the prevalence and risk factors of PDPN to increase awareness among the decision makers of this underreported problem.

Methods: A computer based literature search from 2011- 2021 using PubMed, Google Scholar, CINAHL, Clinical Key and Medline was performed. Studies reporting the prevalence of PDPN among a cohort of Type 1 and Type 2 DM were included. Sample size varied from 100 to 15,000 recruited from different countries.

Results: The mean age ranged from 18- 80 years. The prevalence rates of PDPN ranged from 10% to 53%. Risk factors include longer duration of diabetes, poor glycemic control, obesity, history of smoking and elevated cholesterol levels.

Conclusion: Our findings suggest that the prevalence of PDPN is alarmingly high and goes undiagnosed and under treated most of the times. It is known to cause anxiety, depression and reduction in physical activity. Owing to the huge economic burden, a robust screening process and treatment strategies to tackle the physical as well as the mental components is the need of the hour.

Keywords: Diabetic neuropathy, pain, prevalence, risk factors

  Parents perspectives regarding teletherapy for children with special needs in a developing country Top

Amina Markar, Taral Nagda, Varsha Hooja, Mithu Alur

Department of Physiotherapy, Adapt, Formerly Spastic Society of India, Mumbai, Maharashtra, India.

E-mail: [email protected]

Introduction: Covid-19 pandemic pandemic resulted in suspension of institutional based and community based rehabilitation. A number of attempts were made globally to provide for this by way of teletherapy. In a systematic re,view of feasibility and effectiveness of home based therapy program (Beckers et al 2019) 92 studies were included but only 2 included parent related outcome measures. The current study analyses the limitations and effectiveness of a home based teletherapy rehabilitation program for children with cerebral palsy instituted by a national center in a developing country with resource challenged environment.

Materials and Methods: Under ADAPT Muskan teletherapy project, 531 teletherapy sessions were conducted for 61 patients by 7 therapists Number of sessions per child varied from 1 to 5 per month. Duration of sessions varied from 30 min to 60 min. 89 percent sessions were done on whatsapp video call, 3 percent on telephone and 8 percent on zoom. The sessions carried out in July (89) and August 2020 (205) were considered for the purpose of the study After the session the parents were contacted by a group of unbiased independent volunteers to assess the ease of teletherapy, its effectiveness and difficulties through a telephonic interview and responses were recorded on google form.

Results: Satisfaction level of sessions were graded as grade1 (not satisfactoey) 9.4%, grade 2 7.3 %, grade 3 18.5 5, grade 4 13%, grade 5 (highly satisfied) (51.9%) Therapist shared home program through oral instructions in 70.4, written instructions 3.7%, images 9.3 % and videos 37 %. 84 % parents felt that the instructions were simple and in language they could understand while 12 %felt that it could be improved upon and 4 % were not happy with instructions. Difficulties faced by the parents included Poor network 40 %, Inadequate video quality 20 %, inability to comprehend instructions 10 %, lack of suitable device 5 %, Timing issues 21 %, child being distracted and did not settle down 22 % 35.2 % felt online sessions were comparable to actual therapy sessions, 44.4 5 felt that they were not as good and 20.4 % felt that they were better than actual sessions. The parents felt in subjective assessment this was a great initiative and support by ADAPT and Muskan. List of issues faced as per therapist Network related; Poor connection Frequent breakdown Poor sound/ video Call got disconnected Child related Child was extremely distracted and took some time to settle down, Child was not cooperating Child was finding it very difficult to sit in one place and was interrupting the conversation with the parent quite frequently. Parent related Understanding of mother took longer time. Lack of focus of the patient during instructions Other issues It took longer time to complete the session. Camera fixation was not proper. hence got difficult for me to see the positioning clear.

Conclusion: The children were very happy to see the face and hear voice of their therapist. In the difficult time at least one of their problems about continued rehabilitation and apprehension about worsening of function was taken care of.

  Post stroke pusher's behavior in lying posture Top

Varidhi Vats, Abhishek Shrivastava, Navita Purohit Vyas

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aim: Stroke patients with contraversive pushing/pusher's behavior/ Lateropulsion, as per PM Davies, one of the first descriptions of Lateropulsion, have been found to push strongly towards their hemiplegic side in all positions and resist any attempts at passive correction of their subjective posture towards midline.These patients have been found to have disturbed postural responses with respect to gravity, i.e. there is an ipsiversive tilted perception of body orientation leading to contraversive pushing.Therapists dealing with stroke patients having contraversive pusher's behavior understand the challenges in the rehab, that includes increased time and physical assistance needed to perform interventions, these patients strongly resist efforts at righting thus making gait training extremely difficult. A systemic review examining the psychometric properties of clinical tools available to measure the degree of lateropulsion/pusher's syndrome suggested BLS as a useful tool in acute care settings where patients are more likely to show lateropulsion even in supine posture, as patients with pusher's actively resist postural change while rolling. The study aimed at identifying the pusher's behavior in a clinical setup in acute to subacute stroke patients.

Methods: A convenient sample of 12 patients with acute to sub-acute stroke were assessed for lateropulsion using BLS.Out of 12, 10 patients were confirmed of having post stroke “Contraversive pushing behaviour”, whereas the rest 2 patients showing “Ipsiversive lateropulsion” were excluded.The severity of pusher's behavior and the ability to maintain/change a given lying/sitting posture were assessed on BLS & PASS-TC respectively. Spearman's correlation was used to analyse the relation between subscales of BLS & PASS-TC with the total scale scores.

Results: There was a significant positive correlation b/w score for supine position with total BLS score, indicating that BLS subscale score of supine position is able to correlate positively with total BLS score, indicating the Pusher's syndrome may be identified in Supine position. There was a significant negative correlation of all subscales of BLS with total PASS-TC score indicating that sub-scale scores for BLS is increasing, total PASS-TC score decreases (p<0.05). This is also true for score for supine position indicating the BLS subscale for supine position is able to correlate negatively with total PASS-TC score, indicating that Pusher's syndrome may be identified in Supine position.

Conclusion: Based on the data analysis and interpretation, results conclude an association among post stroke pushing syndrome (Pusher's behaviour) and altered/impaired postural and balance control, which can be assessed in lying posture i.e., at the bedside during initial clinical assessments in acute /sub acute hospital care. -Submitted by Varidhi Vats, PMR deptt, kokilaben dhirubhai ambani hospital.

  Effect of task oriented functional training programme on indepndence in activities of daily living performance in elderly unknown patient - A case study Top

Shiksha Ramjeet Yadav, Shiksha R. Yadav, Anuradha V. Pai

Department of Occupational Therapy, LTMMC and General Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim: To study effectiveness of task oriented, functional training programme to improve performance of activities of daily living in elderly stroke patient.

Background: A 70 year old unknown male patient was found unconscious on road and was brought to tertiary care hospital. On investigations and clinical correlation, patient was diagnosed as a case of left hemiparesis secondary to acute middle cerebral artery infarct. Patient regained consciousness on next day. He was managed conservatively and was referred to occupational therapy department for further management.

Methods: Patient was evaluated by using uniform terminology. Modified Barthel index scale was administered. Patient was given intervention for 3 weeks. Enabling activities with self-care functional activities like brushing, eating, drinking milk, in bed mobility, transition from supine to sit, sit to stand and dressing were practised. Accident prevention, activity promotion, Compensatory strategies and environmental modifications were done. Scale was re administered post intervention and comparative data was obtained.

Result: Change of the Modified Barthel Index pre-intervention and post- intervention score indicates improvements in performing activities of daily living. There were significant improvement in activities like eating, drinking milk, in bed mobility dressing and coming to sit. Minimum to moderate improvement was seen in activities like toileting, walking, stair climbing and use of wheelchair. Despite his age and lack of family support, significant functional improvements were documented in this elderly stroke patient, and he was discharged to old age home.

Conclusion: Supplementing enabling activities with task oriented functional training is feasible and effective in improving independence for activity of daily living in elderly stroke.

  PLISSIT model in neurological conditions - An occupational therapy perspective Top

Kajol Poladia

Department of Occupational Therapy, LTMMC and Sion Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim: To study the effectiveness of PLISSIT model in sexual rehabilitation in neurological conditions through occupational therapy intervention.

Background: PLISSIT model was created in 1976 by Jack.Annon. The letters of the name refer to 4 different levels of intervention: permission,(P) limited information(LI).specific suggestions(SS) and intensive therapy (IT). We are going to review and know more about PLISSIT model, the extended EX PLISSIT model used in neurological conditions like MS,TBI, STROKE, SCI, progressive neurological conditions,etc. Sexuality is an activity of daily living that plays an important part in an individual's life and the most neglected ADL addressed by us as health care professionals. we are well equipped to address our clients but we are less equipped with evidences.

Methodology: Systematic literature search using the keywords “PLISSIT MODEL” AND “TBI” OR “STROKE” OR “SCI” OR “MS” OR “PROGESSIVE NEUROLOGICAL CONDITIONS” OR “NEUROLOGICAL CONDITIONS” was done. The studies included RCTs, observational studies and guideline statements.13 articles were reviewed.

Result: PLISSIT model was found to be very effective in sexual rehabilitation in neurological conditions. The results emphasized that sexuality should be integral part of rehabilitation for the professionals.

Conclusion: Very less literature on the extended model on PLISSIT (EX- PLISSIT) which emphasizes on permission is available. There is a continued need for research and program development that can validate the benefits of utilizing occupational therapy interventions to treat concerns with sexuality and sexual participation. Expertise and experience will come with practice. The first step is to open the door.

  Efficacy of cough-assist device in patients with neurological conditions Top

S. Shruthi Venugopalchari, Navita Vyas. Abhishek Srivastava

Department of Physical Medicine & Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.

E-mail: [email protected]

Objective: The aim of this study is to evaluate the effectiveness of Cough-Assist device in neurological conditions with weak cough effort/ reflex.

Background: People with neurological conditions exhibit weak cough, who are susceptible to recurrent chest infections and acute respiratory complications, contributing to frequent hospitalizations. Ineffective cough can be considered as a major underlying cause of treatment failure and increase mortality in these patients. Cough-Assist device also known as the Mechanical Insufflation- Exsufflation device uses a non invasive technique that increases inspiratory and expiratory flow to improve mucus clearance, thereby increasing the peak cough flow rate which facilitates the weaning of Mechanical ventilation in acute phase of Neuro- Rehabilitation.

Methods: Study was done in patients admitted in Kokilaben Dhirubhai Ambani Hospital from 2019 to 2020.20 patients with neurological conditions were selected who were been treated with Cough-Assist device along with conventional chest physiotherapy and their data before and after the commencement of therapy was analysed. The parameters taken into consideration are Spo2, Respiratory Rate, Peak Cough flow Rate, Quality and Quantity of secretions and number of days required to wean.

Results: We obtained significant changes in oxygen saturation, peak cough flow, respiratory rate, quantity of secretions leading to better bronchial hygiene which will be proved statistically further.

Conclusion: Cough-Assist device may improve bronchial hygiene, oxygen saturation, Peak Cough flow rate, reducing duration of mechanical ventilation and re-intubation rate, thereby helping in early Rehabilitation.

  Anticipatory and compensatory postural muscle work in sitting during reaching tasks varying in purpose of reach in typically developing children Top

Hemali Tanna, Navita Vyas. Abhishek Srivastava

Department of Physical Medicine & Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Anticipatory Postural Adjustments are unconscious muscular activities aiming to maintain the equilibrium of the body during voluntary motor performances, Compensatory Postural Adjustments serve to restore the body's position after a perturbation has occurred. Aim to determine effect of purpose of reach in sitting on anticipatory and compensatory postural activation in children. In this study 15 typically developing children between age group of 4 - 7 years were assessed for anticipatory and compensatory postural muscle activation in bilateral external oblique's and lower back extensors during four different reach conditions within based of support in sitting which differ in terms of purpose of reach and not in terms of motor demands. Here Condition 1 was reach to black dot on white paper, Condition 2 was reaching to get audio and visual feedback from virtual keyboard, Condition 3 was reaching to make a dot in order to complete painting previously made by child, and Condition 4 was reaching to complete a virtual painting.

Results: There was trend of correlation observed for APA's between the conditions which were relatively similar in terms of purpose of reach which was 2 dimensional construction. There is co-contraction of bilateral muscle groups rather than direction specific selective activation.

Keywords: Anticipatory postural adjustments, compensatory postural adjustments, typically developing children and 4 reach conditions

  Comparision between two quality of life questionnaire on individuals with dysphagia: Dysphagia Handicap Index and swallowing quality of life Top

Palak Vinod Devani, Nidhi Karkera, Safa Shaikh, Abhishek Srivastav, Navita Purohit

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Introduction: Patients are unanimous in their opinion that dysphagia has a huge impact on their lives. Therefore, assessing the quality of life (QoL) of patients is very difficult, due to the fact that each individual has their own subjective view on their physical, emotional and social well-being. This subjective opinion includes a cognitive element – satisfaction; as well as an emotional component – happiness. A declining QoL can strongly influence a patient's commitment towards controlling their disease. There are different tools for measuring the QoL. Hence the current study aims to compare two different questionnaires i.e. Dysphagia Handicap Index (DHI) and Swallowing Quality of Life (SWAL-QoL) to establish which one is more sensitive and which one gives an adequate assessment of the quality of life in individuals with dysphagia.

Methods: Setting: Neurorehabilitation department in Kokilaben Dhirubhai Ambani Hospital, Mumbai Participants: A total of 25 individuals who were diagnosed with oropharyngeal dysphagia using Mann Assessment Swallowing Ability (MASA).

Procedure: Mini- Mental State Examination will be conducted to assess the cognitive function in an individual. DHI and SWAL QoL will be administered only on an individuals with a score of 24 and above and who are diagnosed with oropharyngeal dysphagia.

Results and Conclusion: An appropriate statistical analysis will be conducted to establish if there was a statistically significant difference in the QoL. A correlation analysis will also be conducted to measure the strength of the correlation between different indices (Pearson correlation coefficient).

  Occupational therapy intervention, an integrated approach for West syndrome: A case study Top

Ankita Deepak Kamble

Department of Occupational Therapy, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: West Syndrome is a constellation of symptoms characterized by epileptic or infantile spasms, abnormal brain wave patterns called Hypsarrythmia and Intellectual disabilities. It causes functional and developmental delays, especially motor functions which include milestone development and reflex maturation along with tonal involvement.

Aim: To analyse the effect of Occupational Therapy Integrated Approach on Motor and Cognitive development of an infant with West Syndrome.

Methods: A 14 months old Male child, had seizures on 1st day of life with 40 days of stay in Neonatal Intensive Care Unit. Occupational Therapy intervention comprised of Neurodevelopmental and Model of Human Occupation approaches for handling & developmental stimulation. Handling techniques were demonstrated to mother. Therapy was given for development of Postural control & Psychosocial stimulations.

Result: Improvement was majorly seen in motor functions. Previously observed, strong Asymmetrical Tonic Neck Reflex was gradually integrated. Tonal improvement was observed on scores of Infant Neurological International Battery (Pre Score-57 and Post Score-64). Reduced scores were obtained on Parental stress scale. (Pre Score-66 and Post Score-59). Functional outcomes were achieved in the form of reduced drooling, cooing response to maternal voice and development of visual tracking for objects and family members.

Conclusion: Family centered Approach with comprehensive therapy can assist towards stimulating development of motor & social milestones in infants with West Syndrome and improve Parental perception regarding their child's Prognosis.

  Impact of dysphagia on the quality of life of post stroke survivor with subcortical lesions Top

Safa Salauddin Shaikh, Nidhi Karkera, Palak Devani, Abhishek Srivastava, Navita Purohit Vyas

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Dysphagia is the most common complication observed post stroke. Dysphagia and its related complications have negative impact on the quality of life in post stroke survivors. Prevalence of dysphagia in individuals with subcortical lesion might have long term adverse effect on swallowing functions as subcortical region plays important role in swallowing. Limited research has been conducted that recognizes the impact of dysphagia in post stroke survivors with subcortical lesion which may affect their quality of life.

Objective: The study aims to understand the impact dysphagia has on the quality of life in post stroke survivors with subcortical lesions. It also aims to assess the relation between various demographic details and domains of QOL.

Methods: The study will be conducted in Kokilaben Dhirubhai Ambani Hospital in the department of Physical Medicine and Rehabilitation in the year 2021. 20 individuals, diagnosed with subcortical lesions will participate in this study. Mini- Mental State Examination will be conducted to assess the cognitive function in an individual. Mann Assessment Swallowing Ability (MASA) will be used to evaluate the swallowing functions in these individuals. The Dysphagia Handicap Index (DHI) will be used to understand the impact of swallowing disorder on quality of life. The relationship between swallowing function and dysphagia will be calculated using Pearson (r) correlation coefficients on DHI and MASA.

Results and Conclusion: Data will be statistically analyzed using Pearson (r) correlation coefficients with P>0.05 with SPSS Software (Version 16.0).

Keywords: Dysphagia, Dysphagia Handicap Index, post stroke survivor, Mann assessment swallowing ability, subcortical lesion

  Discourse analysis in individuals with Parkinson's disease Top

J. Maria, N. Samyuktha, B. Yuva Yoga Shree, S. Divya

Department of Speech - Language Pathology, MERF-ISH, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background: Parkinson's disease (PD) is a degenerative disorder of the central nervous system. Though PD is primarily a motor speech disorder during the initial stages, as the disease progresses, a gradual decline in linguistic aspects is observed as well. The effects of disease (PD) on cognition, word retrieval, syntax, and speech/voice processes may act together to manifest uniquely in spoken language tasks. There is a dearth of studies focusing on the discourse abilities in PD, especially in Indian context.

Aim: The present study aims at investigating the micro and macrostructure discourse by using personal narrative task in Tamil speaking individuals with idiopathic PD and comparing it with the neuro-typical individuals.

Methods: Two groups comprising 5 Tamil-speaking individuals with idiopathic PD in the age range of 60–85 years and 5 neuro-typical individuals matched on age, gender, and language participated in the study. To assess their discourse skills, participants were engaged in a personal narrative task about 'an unforgettable incident in their life'. All the samples were transcribed orthographically and were divided into communication units. The communication units were analysed in terms of micro and macro structures of discourse. The raw scores were subjected to suitable statistical analysis. The scores were compared between both the groups.

Results: The individuals with Parkinson's disease underperformed neuro-typical individuals in most of the macro and micro structure processes.

Conclusion: As there is an evidence that there is an effect of the disease (PD) on the cognitive function and as a result of which is seen on the language aspects also, it is important to focus on the language aspects in such clients during the assessment and management process.

[TAG:2]Neuro-rehabilitation practice in tertiary hospital setting during the COVID-19 pandemic – A survey [/TAG:2]

Srikanth Laddhiperla, Abhishek Srivastava,

Navita Vyas

Department of Physical Medicine & Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim: To provide an overview of neuro-rehabilitation practice in tertiary hospital setting. Objective: To investigate neuro-rehabilitation team practice in neuro rehabilitation department during the COVID-19 pandemic.

Introduction: Corona virus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is recognized as a global pandemic by WHO 2020. People with neurological injuries and disease needed utmost neuro-rehabilitation service which support to achieve their maximum potential for physical, social and psychological function to participate in daily living, society and quality of life. The onset of the COVID-19 Pandemic and subsequent Indian Government Lock down presented multiple challenges.

Methods and Measures: 1. Design: prospective, observational, cross-sectional survey. 2. Setting: Neuro-rehabilitation department at Kokilaben Dhirubhai Ambani Hospital, Mumbai. 3. Subjects: Neuro-rehabilitation team which includes (Physiatrist, Physiotherapist, Occupational Therapist, Speech Therapist, Psychologist, Music Therapist, Special Educator and Customer Care Officer) working in hospital during the pandemic were taken 4. Survey: Gather relevant accurate information of service provided by neuro-rehabilitation department from March 2020 to August 2021, using self-developed questionnaire that randomly distribute paper based among neuro-rehabilitation team to identify knowledge, perception and safe practice regards to COVID-19, information on workforce planning, personal protective equipment's and training, psychological and emotional health of staff.

Results and Statistics: Interpretation of descriptive data will be taken and mean and standard deviation will be calculated using SPSS (Version 20.0). To understand the effect of pandemic on rehabilitation services in neuro-rehabilitation department.

  The review on use of infant positioning assessment tool for assessment and intervention in preterm infants Top

Sukanya Shelke

Department of Occupational Therapy, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Developmental Supportive Care (DSC) attempts to use methods such as positioning, swaddling, KMC, massage, NNS, breastfeeding, topical anesthetic in NICU. Therapeutic positioning in NICU influences neuromotor, musculoskeletal development, brain development, physiological function and stability.

Aim: The study was done to review the different uses of therapeutic positioning tool for preterm infants i.e Infant Positioning Assessment Tool (IPAT) and their results in research studies.

Methods: The review was conducted to analyze the use of IPAT. Keywords such as infant position assessment, assessment tool, therapeutic positioning, developmental care, IPAT were searched using portals such as PubMed, Google Scholar, Academia, Research Gate, Ajot. IPAT is used in most of NICU setting for improving infant positioning and is a pictorial tool used to evaluate the posture of infant. 30 articles were reviewed& 20 met the criterion.

Result: 12 used IPAT as intervention &outcome measures, others used it for educational purpose. IPAT is a simple tool and provides a better understanding of infant positioning to the NICU staff facilitating improvement in neuromotor and neurobehavioral functions. While IPAT was used as outcome measure it could be used to assess the outcomes in positioning. In some of the studies they have correlated the neurobehavioral status and pain levels in preterm infants.

Conclusion: IPAT been a valid and reliable tool can be used as a standardized tool for improving and assessing the proper developmental positioning practices in NICU under DSC program. There is scarce literature about its dual use hence more research is required.

  Effect of occupational therapy task oriented approach on impairment based recovery and occupational performance and satisfaction: An observational study Top

Shreya Kamath, Deepti Kamble, Navita Vyas, Abhishek Srivastava

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Introduction: Occupational therapy Task Oriented approach has shown to have an impact on occupational performance by improving the motor behaviour in patients with neurological conditions. Due to the emergence of client centered practice, understanding the client perceived changes in occupational performance and satisfaction post intervention is necessary.

Aim: The study aimed to observe the effect of Occupational therapy Task Oriented approach on recovery of impairment as well as patient-rated performance and satisfaction in post stroke survivors.

Methodology: Records of 15 stroke patients admitted to the inpatient neurorehabilitation unit of Kokilaben Dhirubhai Ambani Hospital with moderate to 'moderate to severe' NIHSS score were selected for the study. Analysis of Fugl meyer assessment, Barthel index and Canadian Occupational Performance Measure (COPM) scores were done which were recorded at admission and 6 weeks post intervention based on Occupational therapy Task Oriented approach.

Results: A total of 15 participants with mean age 48.40±6.895 years were included in the study. Out of these, 11 were male and 8 were with right side affectation. Analysis with Wilcoxon signed rank test showed statistically significant difference in all three scales with the 6 week of rehabilitation.

Conclusion: The study shows that Occupational therapy Task Oriented approach not only has an impact on the motor impairment affecting performance but also has positive effects on self perceived functional status of the post stroke patients in inpatient rehabilitation.

  Study of vitamin D3 levels in cerebral palsy patients in a multidisciplinary cerebral palsy clinic Top

Chaitrali Kale Kaprekar

Department of Paediatric Physiotherapist, Jupiter Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: The purpose of this study is to correlate levels of Vitamin D3 in different anatomical types of Cerebral Palsy (CP), their GMFCS levels and BMI.

Methods: A cross sectional data of 116 Cerebral Palsy patients who visited the Multidisciplinary Cerebral Palsy Clinic were evaluated for their type of CP, Serum vitamin D (25 (OH) D) levels, Body Mass Index (BMI), and functional levels (Gross Motor Function Classification System (GMFCS). We also studied various secondary problems such as deformities: Genu varum/Genu Valgum, pathological fractures and physeal slips.

Results: Out of the total 116 CP children. In age group below 10 years total 54 (94%) children had low levels of vitamin D whereas in age group above 10 years total 45(76%) children had low levels of vitamin D. On gender base male population total 63(79%) had low levels of vitamin D,in female population total 29(78%) had low levels of vitamin D.In Quadriplegics,diplegics and hemiplegics total 86 (81%) had low levels of vitamin D.In GMFCS category GMFCS 1,2& 3 total 65(79%) had low levels of vitamin D,GMFCS 4 and 5 total 32 (94%)children had low levels of vitamin D. When we consider the BMI index:out of 103 population underweight total were 35 in which 31 (88%) children had low levels of vitamin D,42 were healthy total 30 (71%) children had low levels of vitamin D, in 14 overweight children 13 (92%) children had low levels of vitamin D, in obese population 11 (91%)children had low levels of vitamin D.

Conclusions: Vitamin D deficiency is found across all Cerebral palsy (CP) patients irrespective of age, gender, GMFCS, BMI. Younger male patients. GMFCS 4 and 5, quadriplegics, overweight and obese children are more prone to have low levels of vitamin D.Based on this study all patients with CP should be investigated for vitamin D levels and should be treated accordingly.

Keywords: 25-hydroxyvitamin D, Body Mass Index, cerebral palsy, Gross Motor Function Classification System

  Neonatal feeding assessment as a predictor of neuromotor integrity and developmental outcomes: A scooping review Top

Deepa Gopal Awasthi, Shailaja Jaywant

Department of Occupational Therapy, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Sucking is a basic activity of neonates, controlled by the Bulbar central pattern generators in the brain. Nervous system development and maturity of sucking organization, occur in parallel. Assessment of infant's Oral-motor function, may provide an inexpensive measure of early neurological function.

Aim: To analyse Neonatal Feeding Assessment as an indicator of Neuromotor integrity and its associated developmental outcomes in infants.

Methods: Study Design: Scooping Review Computerized Scientific databases were searched from their inception to June, 2021. Search strategy included terms “neonate” AND “feeding” OR “sucking” OR “swallow” AND “assessment” AND “neuromotor” OR “developmental” AND “effect” OR “indicator”. Forty articles were screened and Ten most relevant studies were included in the review.

Results: Developmental delay on Bayley Scales of Infant Development (BSID) was observed in infants with poor scores on Neonatal Oro-Motor Assessment Scale (NOMAS). Nutritive Sucking pattern and Neurodevelopmental assessment at 18 months showed positive correlation. A Pilot study revealed specific sucking pattern, improved Neuronal activation. Studies concluded significant association between brain stem lesions, with feeding impairment. Researchers have deduced quantitative sucking assessment to potentially result in earlier diagnosis of diffuse white matter brain injuries.

Conclusion: Studies exhibited significant correlation between performance on Neonatal feeding assessment and developmental outcomes upto 18 months of age. Although, there is scarce evidence regarding the relation between early sucking, swallowing problems and neonatal brain injury. Further research regarding the clinical implication of Neonatal feeding examination as a marker for neuronal brain injury and its subsequent neurodevelopmental consequences, is recommended.

  Comparison of p300 between individuals with and without vestibular dysfunction Top

E. Anupriya, Kaushlendra Kumar, Mohan Kumar, D. Deviprasad

Department of Audiology and Speech Language Pathology, Manipal Academy of Higher Education, Mangalore, Maharashtra, India.

E-mail: [email protected]

Background and Aims: Vestibular dysfunction is mostly related to a sum of physical adverse outcomes, including postural instability, gait and falls. Evidence shows the loss of vestibular sensory information alters cognitive processing areas in the brain that coordinate spatial and non-spatial information (Smith, 1997). The P300 is an event-related potential that is used to evaluate the overlapping cognitive processing function in the context of various neurological conditions (Polich, 2007). This study aims to investigate the relationship between P300 latency and amplitude in individuals with and without vestibular dysfunction and to find the correlation of Dizziness Handicap Inventory score with P300 findings among individuals with vestibular dysfunction.

Methods: Based on study criteria 40 participants within the age range of 18 to 60 years were considered for this study. Participants divided into two groups: the experimental group, comprising 20 participants diagnosed with vestibular impairment; and the control group comprised of 20 age-matched normal healthy individuals. P300 recordings were conducted on all participants. The two components P3a and P3b were analysed from the Cz and Pz positions in both groups.

Results: The results showed significant reduction in the P3a and P3b amplitude in experimental group compared with control group. No significant difference observed in response latency at both electrode site. The reduced P300 amplitude among experimental group intend to represent the cognitive impairment, indicative of decline in attention and memory retrieval capability.

Conclusion: P300 testing can be used as a non-invasive clinical tool to assess the cognitive function in individuals following vestibular dysfunction. Which would be supportive for framing the symptomatic vestibular rehabilitation therapy for individuals with vestibular dysfunction.

  Evaluating the telerehabilitation program of Philippine general hospital during the COVID-19 pandemic: A cross-sectional study Top

Miguel Julio S. Valera, Carl Froilan D. Leochico, Sharon D. Ignacio, Jose Alvin P. Mojica

Department of Rehabiilitation Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines.

E-mail: [email protected]

Background: The Department of Rehabilitation Medicine at Philippine General Hospital had established its telerehabilitation service program in 2017. With the unprecedented coronavirus disease 2019 (COVID-19) pandemic, the program has expanded its service to outpatients who were previously managed face-to-face by the Department.

Objectives: This study aimed to evaluate the usability of the telerehabilitation service program at Philippine General Hospital when it was expanded during the pandemic, and to associate telerehabilitation usability ratings with the participant groups, demographic characteristics, and prior telemedicine knowledge and experience.

Methods: This cross-sectional study involved the doctors, physical therapists, occupational therapists, psychologists, patients, and patients' carers, who participated in at least one telerehabilitation session and consented to respond to a digital survey thereafter. Total enumeration sampling of all telerehabilitation participants was employed. The study outcome was the usability of the telerehabilitation program based on the System Usability Scale (SUS).

Results: The participants consisted of 19 doctors, 11 therapists, 37 patients, and 74 caregivers. There was a significant difference in the overall SUS scores between the lower mean scores of doctors (61.7) and higher mean score of patients (74.6), p<0.05. In terms of videoconferencing platform, participants reported significantly higher system usability for those who used either Zoom (mean: 75.0) or Viber (mean: 69.3), as compared to GoogleMeet (mean: 53.1), p<0.05.

Conclusion: Even though there were problems with Internet connectivity, the system run by Rehabilitation doctors and therapists has been working adequately in responding to the continued rehabilitation needs of patients in the midst of COVID-19 pandemic.

  Measuring the pre and post changes of gastrocsoleus using isokinetic dynamometer after administering balance exercises in stroke survivors: A report of three cases Top

Ankita Kasbekar, Abhishek Srivastava, Navita Vyas

Department of Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim of the Study: To determine the measurable quantitative changes in strength/force production of gastrocsoleus after starting balance exercises in stroke survivors using isokinetic dynamometer.

Methods: The report of three cases consists of 3 patients from Kokilaben Dhirubhai Ambani Hospital's department of physical medicine and rehabilitation from the in-patient and out-patient treatment settings. The patients included in the study were diagnosed with sub-acute to chronic hemiplegia and were cognitively sound to receive and follow commands. All participants in the study were voluntary participants.

Assesment/Outcome Measure: Measure of performance of gastrocsoleus muscle using pre and post values using isokinetic dynamometer.

Result and Conclusion: Direct effect of balance exercises on measurable muscle strength was obtained at the end of the study using comparison between pre and post values of plantar flexors in sub-acute and chronic stroke in rehabilitation sector.

Acknoweldgement: Mihir Shah, biomechanist, KDAH

  Standardization of gross motor function measure (GMFM-88) evaluation tool as parent administering - Occupational therapist observed tool for telerehabilitation services with a custom made Top

R. Sivagama Sundari

Department of Physical Medicine and Rehabilitation, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India.

E-mail: [email protected]

Background: COVID -19 Pandemic has affected Differently abled children severely from attending Regular therapy sessions by means of transportation & fear of contracting infection. As our hospital is the Nodal centre in treating COVID-19 disease & Mucormycosis infection, it made the parents & the children to refrain themselves from attending regular sessions & hence Telerehabilitation services started.

Aim: To find if GMFM - 88 tool can be done as a Parent administered - Therapist observation test for evaluation of progress in children with Cerebral Palsy.

Methods: 11 children with Cerebral Palsy of age 2-9 years were enrolled for tele rehabilitation services. Care was taken in selecting child's parents in respect to basic Educational qualification, Comprehension & Cognitive abilities. On Day 1 parents were explained about each item of the evaluation tool in detail & the same was demonstrated by the therapist in a Simulated manner using a custom made child Figurine (A Stuffed Toy/Doll) which the Parents followed. The tool items were administered by both child's father& mother individually in a gap of 1 day& documentation of scores done by two different therapists.

Results: Of all the 11 children,except 1 all others were able to follow the instructions carefully & the results were documented. Comparison of the scores obtained from the parents showed statistically, difference between both the scores is less than 1 i.e insignificant.

Conclusion: Overall GMFM-88 can be used as a Parent administered -OT observation standardized evaluation tool for children with Cerebral Palsy.

  Art therapy for the stroke patients: What can we do for them? Top

Mohd Azmarul A. Aziz, Norhayati Hussein

Department of Rehabilitation Medicine, Cheras Rehabilitation Hospital, Kuala Lumpur, Malaysia.

E-mail: [email protected]

Background and Aims: The Global Burden of Diseases 1990-2019 study showed that stroke is the second largest contributor of combined death and disability in Malaysia. Numerous activities were conducted for inpatients with stroke to improve their independent daily living skills and quality of life. Recently, art therapy was introduced and carried out to stroke patients. The activities aimed to provide the patients with the opportunity to communicate their thoughts and feelings through their artistic creations, in any kind of medium that works best for their needs.

Methods: The art therapy activities were conducted periodically during the weekend in an inpatient neurorehabilitation setting. The patients were provided with various art mediums, from drawing and sewing kits to musical instruments. Creative-art-based and expressive arts were tailored design based on the chosen themes and the rehabilitation team members were involved in facilitating the patients during the sessions. Context demands such as physical space, social, sequencing, and time, required body functions, actions, and performance skills were considered and analyzed for the activity.

Results: Narrative responses from patients suggest that they acquired many skills through art therapy activities especially motor, cognitive and social-communication skills. They reported fulfillment and satisfaction as they were able to create their artwork, hence increase self-confidence. They experienced improved concentration, emotion, social, and motivation post-art therapy activities.

Conclusions: Art therapy is beneficial to provide stimulation of different sensations, promote a safe environment for self-exploration, and encourage self-expression, creativity, and imagination through the use of arts.

  A pilot study on significance of evoked potentials in prognostic evaluation of neuro rehabilitation program in brain injury patients Top

Nithya, I. Vijayalakshmi

Department of Physical Medicine and Rehabilitation, Neurofoundation, Salem, Tamil Nadu, India.

E-mail: [email protected]

Background and Aim: NeuroRehabilitation is a mainstay of management in Brain injury patients. Determining the Outcomes and efficacy of a Neurorehabilitation is an unexplored and essential measure, given the amount of monetary and human resources needed for each person. Neuro physiological studies have been used earlier studies for diagnostic evaluation. But this is a Pilot study using the evoked potentials MEP and BAER for Prognostic evaluation of the efficacy and outcome of Rehabilitation.

Methods: This Pilot study is designed as a Prospective study for patients admitted at NeuroRehabilitation ward at NeuroFoundation, Salem. Evoked potentials- MEP and BAER is administered in the first week of admission and then repeated on 14th day & 28th day. The difference in the potentials is documented and analysed.

Results: It is an ongoing study with 30 patients. All 30 patients are enrolled and they are in various stages of the study. Study is scheduled to be complete on 10 July 2021. Hence statistical evaluation will be done in Final submission. But the evoked potentials done to date are promising a significant correlation with the clinical outcomes.

Conclusions: MEP represents prognostic marker of motor function recovery. BAER is useful to evaluate brain stem. MEP and BAER help us evaluate the ARAS (which lies between the corticospinal tract assessed by MEP and brainstem assessed by BAER) indicating recovery of Disorders of Consciousness. Evaluation of these parameters is critical in decisions pertaining to switching over or continuation of a certain rehabilitation protocol at the earliest.

  Art therapy for a patient with traumatic brain injury: A case study Top

Mohd Azmarul A. Aziz, Salini Manimaran, Norazlina Abdul Aziz

Department of Rehabilitation Medicine, Cheras Rehabilitation Hospital, Kuala Lumpur, Malaysia.

E-mail: [email protected]

Background and Aims: Art therapy is increasingly being acknowledged as a form of intervention in patients with stroke and psychiatric conditions. However, limited studies have reported the use of art therapy for TBI patients in Malaysia. This case study illustrates the therapeutic process through art therapy of a severe TBI patient. He had a diffuse axonal injury and was in a coma for six months. Upon recovery from the coma, he claimed that he was emotionally affected due to his condition. We investigated the efficacy of art therapy in exploring his past emotions, rebuilding his self-identity, and as a stress-coping mechanism.

Methods: Series of psychological assessments were conducted to determine the patient's psychological and emotional state such as the Malay version of Mindfulness Awareness & Attention Scale (MAAS) and Beck's Depression Inventory (BDI-II). Expressive art therapy was selected as an integrative approach for assessment and intervention. A systematic procedure was employed and the findings were determined by using activity analysis.

Results: Findings showed that he had minimal depression scores. However, through the therapist's observation and the patient's feedback, his emotions were severely affected in contrast with the item in the assessments. He had successfully expressed his emotions through art therapy. His mood, self-expression, and acceptance were improved. He was also able to identify strengths, potential, and capabilities to create a sense of empowerment and achievement for his life.

Conclusions: The findings highlighted the importance of art therapy focusing on the patients' emotional and psychosocial needs, in addition to conventional rehabilitation.

  To study the effectiveness of cognitive rehabilitation through occupational therapy interventions: A systematic review Top

Vijaya Bhau Tupsaundarya

Department of Occupational Therapy, LTMMC Sion Hospital, Airoli, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim: To analyze the role of occupational therapy in cognitive rehabilitation in patients with cognitive impairments by systematically reviewing published articles.

Background: Cognitive dysfunction is a significant disability that would affect performance of daily activities. The aim of occupational therapy interventions is to decrease activity limitations and enhance participation in everyday activities. Various assessments and intervention strategies are used. Cognitive rehabilitation includes models, approaches, and retraining programs. A combination of restorative/remedial approach along with techniques from compensatory/adaptive approach are used. Thus, the key to successful cognitive retraining is individualized occupational therapy assessment leading to a specific or unique occupational therapy intervention for an individual patient using either restorative/remedial or adaptive/compensatory or a combination of restorative/remedial and adaptive/compensatory approach.12 articles about cognitive rehabilitation strategies used in neurological conditions were reviewed.

Methodology: Systematic literature search using the keywords “Cognitive rehabilitation” “Cognitive models” “Cognitive approaches” “Occupational therapy” “Cognitive deficits” was done on PUBMED. The studies included RCTs, observational studies, systematic reviews.

Result: The unique feature of all occupational therapy models is the assumptions that treatment is based on purposeful activities which were analyzed and adapted to the patient's cognitive and functional ability. Cognitive models and approaches were found to be effective in making the patients functionally independent depending on his optimum cognitive abilities.

Conclusion: Review helped us in determining the degree of cognitive modifiability, thus formulating an intervention which is realistic, relevant, contextually and environmentally possible.

  Prevalence of cervicogenic headaches associated with dizziness and vertigo in post covid population Top

Namrata Kadam, Dipti Mehta, Navita Vyas, Abhishek Srivastava

Department of Physical Medical Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Research Centre, Mumbai, Maharashtra, India.

E-mail: [email protected]

Aim: To find out correlation between vertigo & headache with history of COVID.

Objective: To find the number of post COVID subjects reporting with - Dizziness - Vertigo - Cervical Pain - Headaches Using Dizziness Handicap Inventory Cervical.

Introduction: Vertigo is false sensation of movement especially of whirling, spinning, or being off balance. Cervical pain, headache, dizziness, nausea are all common symptoms of vertigo. Struggling with these disabling symptoms during corona virus pandemic might make you wonder, if it could be related to COVID-19. Physical Therapy concentrates on strengthening of impaired vestibular symptoms and engaging neuroplasticity to optimize other senses, to compensate for the brain's and inner ears inability to maintain proper sense of balance. Considering the relationship of these symptoms with history of COVID, will Prophylactic approach to optimize adaptation, habituation and sensory substitution get the dizzy patient back on their feet to function better.

Methodology: Total 40 subjects referred to PMR department for vestibular Rehabilitation, were participated in this observational study. Subjects were screened based on COVID history. The subjects with COVID history were given Dizziness Handicap Inventory Cervical. Data was analysed using descriptive statistics and confidence interval of mean.

Results: Out of 40 participants diagnosed with vertigo and Cervicogenic headache, 21 participants had a history of COVID. Rolling over in the bed & quick movements of the head reported to be most aggravating factors for the symptoms. Components related the spinning of surrounding were most affected involving lot of bending over & rolling movement of the neck.

Conclusion: This study is suggestive of stronger correlation between vertigo & headache with history of COVID.

  Has Covid 19 pandemic caused anxiety issues in persons with epilepsy? A survey study conducted by epilepsy foundation India Top

Nirmal Surya, Arti Sharma, Hitav Someshwer, Jhanvi Someshwer, Mangal Kardil, Divyansini Sharma, Alifia Bharmal

Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: The COVID-19 pandemic has had a major effect on our lives. Many of us are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. Public health actions, such as social distancing, are necessary to reduce the spread of COVID-19, but they can make us feel isolated and lonely and can increase stress and anxiety. Learning to cope with stress in a healthy way will make you, the people you care about, and those around you become more resilient.

Aims: We aimed to study the anxiety levels in persons with epilepsy due to the COVID 19 pandemic.

Methodology: We recruited persons with epilepsy who are registered at Epilepsy Foundation India. Corona Anxiety scale was used to assess the level of anxiety among them. The scale was translated in Hindi & Marathi. Electronic consent was obtained from them. The data was entered in excel and descriptive analysis was performed.

Results: 1118 patients were recruited in the study after giving their informed consent, 681 were residing in Mumbai and the others in rest of Maharashtra. 722 were females in the study. 31% never felt dizzy, lightheaded or fainted when they heard about the corona virus, 55.2% rarely felt the symptoms, 10.3% felt the symptoms on several days, 3.4 % felt the symptoms on all days of the week. 75.9% patients had no difficulties with sleep, 13.8% patients rarely had difficulties with sleep, 6.9% had issues on several days and 3.4% had issues with sleep every day. 72.4% never had abnormal appetite, 6.9% had appetite problems rarely where as 17.2% had issues on several days and 3.4% people had appetite issues every day.

Conclusion: Persons with epilepsy are prone to getting anxiety spells due to the COVID 19 pandemic, which makes them prone to getting seizures. Limited exposure to information on the virus, as well as maintaining a proper schedule and counseling are a key to reducing this anxiety.

  Physiotherapy management - An adult spastic quadriplegic, post intrathecal baclofen pump implant - A case study Top

S. Benedic Kingslin Suresh, K. Sridhar, N. V. Puratchirasan, C. R. Praveen Kumar

Department of Neuro Rehabilitation, MGM Healthcare, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Introduction: Spastic Quadriplegia usually refers to Cerebral Palsy, occurring in pediatric age groups. As of now, there is little evidence available regarding Physiotherapy management for Adult spastic quadriplegic due to a Cerebral insult. We report a patient adult patient who developed spastic quadriplegia following an Hypoxic-Ischemic insult. This study shares the information in improvement achieved in the prolonged bedridden patient, with a reduced sense of awareness and spastic quadriplegic with physiotherapy.

Case Description: The patient had an initial cardiac arrest and ROSC obtained after 30 minutes of CPR, which lead to Hypoxic-Ischemic Encephalopathy. Initially, the patient was managed at a local Hospital and later was admitted under us for further management of his disability. On Initial Assessment, muscle tone was carried out for the Biceps, Triceps, Long flexors of the wrist, Extensors of the wrist, Flexor Pollicis longus, Hamstrings, Quadriceps, Gastrocnemius, and Soleus. The score was 4 on Modified Ashworth Scale (MAS). The patient was unable to initiate voluntary movement, which was scored as 2 in Brunnstorm grading of voluntary control. The management he underwent was, Positioning, Passive Sustained Stretching, Electrical Stimulation, Tilt table standing, Graded weight transfer to joints, Early mobilization, Assisted Standing, and Ambulation with support. The outcome measures used were MAS, Brunnstorm Grading, and FIM, in which he scored MAS - 4, Brunnstorm Grading - 3 and FIM - 18 pre rehabilitation, post rehabilitation scores were MAS -2, Brunnstorm Grading – 5 and FIM 50.

Discussion: While there is little evidence available regarding Physiotherapy management for Adult spastic quadriplegic due to brain injury, we show with this case example that with aggressive rehabilitation and Intrathecal Baclofen, there can be considerable improvement in patient's condition.

  Anxiety issues in caregivers of persons with epilepsy due to COVID 19 pandemic - A survey study conducted by Epilepsy Foundation Top

Hitav Someshwar

Department of Neurophysiotherapy, Epilepsy Foundation India, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Fears about COVID-19 can take an emotional toll, especially if you're already living with an anxiety disorder.

Aims: We aimed to study the anxiety levels in caregivers of persons with epilepsy due to the COVID 19 pandemic. There's a lot of misinformation going around, as well as sensationalistic coverage that only feeds into fear.

Methodology: We recruited caregivers of persons with epilepsy who are registered at Epilepsy Foundation India. Corona Anxiety scale was used to assess the level of anxiety among them. The scale was translated in Hindi & Marathi. Electronic consent was obtained from them. The data was entered in excel and descriptive analysis was performed.

Results: 412 care givers were recruited in the study after giving their informed consent, 213 were residing in Mumbai and the others in rest of Maharashtra. 279 were females in the study. 28% never felt dizzy, lightheaded or fainted when they heard about the corona virus, 58.3% rarely felt the symptoms, 8.3% felt the symptoms on several days, and 5.4 % felt the symptoms on all days of the week. 65.9% patients had no difficulties with sleep, 15.8% patients rarely had difficulties with sleep, 13.8% had issues on several days and 4.2% had issues with sleep every day. 72.4% never had abnormal appetite, 6.9% had appetite problems rarely where as 17.2% had issues on several days and 3.4% people had appetite issues every day.

Conclusion: Care givers of Persons with epilepsy are prone to getting anxiety spells due to the COVID 19 pandemic. Limited exposure to information on the virus, as well as maintaining a proper schedule and counseling are a key to reducing this anxiety.

  Effect of yoga to reduce anxiety associated with corona virus pandemic in persons with epilepsy Top

Divya Sharma

Department of Social Worker, Epilepsy Foundation India, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: The COVID-19 pandemic and the resulting economic recession have negatively affected many people's mental health and created new barriers for people already suffering from Epilepsy. As the pandemic wears on, ongoing and necessary public health measures expose many people to experiencing situations linked to poor mental health outcomes, such as isolation and job loss.

Aims: We aimed to understand the effect of yoga on anxiety levels in persons with epilepsy.

Methodology: We recruited persons with epilepsy who were taking online yoga classes organized by epilepsy foundation during the COVID 19 pandemic. Electronic consent was taken from the participants. Pre anxiety was assessed before the yoga sessions & 4 weeks of yoga intervention was given and then post anxiety was assessed. Yoga intervention was given once a week for 4 weeks under supervision and 3 days per week by the participants themselves.

Results: 29 patients were recruited in the study after giving their informed consent, 18 were residing in Mumbai and the others in rest of Maharashtra. 19 were females in the study. There was a significant decrease in the anxiety scores pre and post yoga sessions (p>0.5).

Conclusion: Persons with epilepsy are prone to getting anxiety spells due to the COVID 19 pandemic, which leads to increase in seizure occurrence. Limited exposure to information on the virus, as well as maintaining a proper schedule and counseling are a key to reducing this anxiety. Yoga helps in reducing anxiety.

  Telemedicine and rehabilitation services during the COVID-19 pandemic for persons with epilepsy in India Top

Nirmal Surya

Department of Neurology, Epilepsy Foundation India, Mumbai, Maharashtra, India.

E-mail: [email protected]

In emergency situations, such as the current COVID-19 pandemic, telemedicine can be a feasible alternative to face-to-face outpatient rehabilitation services. In the current COVID-19 pandemic, outpatient services have been closed in many countries and patients left to self-manage their medical conditions. Using electronic tools, telemedicine can be used to deliver various services, including consultations and rehabilitation. This pandemic created a completely new normal for the world, and to face this new normal, we required a completely new armament to face challenge of pandemic. Epilepsy Foundation is NGO from Mumai India. From long time, Epilepsy Foundation dedicatedly worked for People with Epilepsy who are not able to get the comprehensive care. Now, in this Pandemic, Epilepsy Foundation created innovative model for comprehensive care of Epilepsy. This module not only provides the Pill and pill related services but, this module enables to provide a comprehensive care for patients which includes Yoga, Physical Therapy, Cognitive therapy and occupational therapy, music therapy, art therapy and Counseling to improve Quality of life of patient. This module designed by keeping in mind the social distancing aspects of Pandemic and new normal of world. This has helped in controlling seizures and reducing the morbidity associated with epilepsy.

[TAG:2]Aquatic therapy for idiopathic toe walkers: Review of literature [/TAG:2]

Shreya Shah, Poonam Bajaj

Department of Neuro Rehabilitation, Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Children with idiopathic toe-walking (ITW), a common pediatric condition, walk some or all of the time on their toes. There is no universally accepted treatment standard for idiopathic ITW in the current literature. In this study we reviewed our database to evaluate the scope of aquatic therapy for ITW. Aquatic therapy provides an alternate therapeutic environment that allows for the use of traditional therapeutic approaches as well as new intervention strategies. The water allows freedom of movement and weightlessness, and provides vestibular input. The water also provides assistance to the therapist through increased resistance, buoyancy, and neutral warmth.

Aim: To summarize the literature on the effects of aquatic therapy in Idiopathic toe walker.

Data Sources: MEDLINE, CINAHL, PUBMED, Journal Of Aquatic Physical therapy, Journal of human kinematics, Researchgate. Review Method The search included Systemic review, randomized controlled trials, quasi-experimental studies and case reports that investigated the use of aquatic therapy and its effect on improving the gait as a treatment options for Idiopathic toe walker.

Conclusion: Literature does not have enough evidence on effects of aquatic therapy as a treatment protocol for gait training in children with ITW. But there is good scope for further research as aquatic therapy shows to have good outcomes in other pediatric conditions. Despite the growing practice of aquatic therapy and the trend toward evidence-based practice, research on aquatic therapy in ITW is very limited.

  Telerehabilitation in the treatment of stroke: An ICF based case report Top

Hitav Someshwar

Department of Neurophysiotherapy, Surya Neuro Centre, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Objectives: Cerebrovascular accident is a common neurological condition. Telerehabilitation has seen emerging use in a variety of conditions. This case report aims to investigate the feasibility of adopting telerehabilitation in treating cerebrovascular accidents during the COVID 19 pandemic.

Case Presentation: A 73-year old female presented with stroke was assessed and rehabilitated using telerehabilitation. She underwent twelve sessions of physiotherapy. Results: The subject was compliant with all exercises prescribed during her rehabilitation and achieved all rehabilitation goals in twelve sessions.

Conclusion: Telerehabilitation is feasible in treating Stroke. One barrier to implementation of telerehabilitation includes the lack of technical skills and knowledge despite the high prevalence of technology in today's society. Telerehabilitation increases accessibility and ease of rehabilitation. Telerehabilitation can be considered for segments of the population that are most inclined to use technology.

  Effectiveness of prism adaptation therapy in unilateral neglect in stroke patients: A randomized control trial Top

Hitav Someshwar

Department of Neurophysiotherapy, KJ Somaiya College of Physiotherapy, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome.

Aim: The purpose of this study was to determine whether prism adaptation (PA) therapy improves USN and functional outcomes in stroke patients in the subacute stage.

Methods: A single center, Single blinded, randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN assessed with the Bells cancellation test,& the Catherine Bergego Scale (CBS), A total of 20 USN patients with right-brain damage were divided into prism (n =10) and control (n = 10) groups. The prism group performed repetitive pointing with prism glasses that induce rightward optical shift twice daily, 5 days per week, for 2 weeks, whereas the control group performed similar pointing training with neutral glasses.

Results: The CBS improved significantly more in the prism group. In mild USN patients, there was significantly greater improvement of CBS and Bells cancellation test in the prism group.

Conclusions: PA therapy can significantly improve ADL in patients with subacute stroke.

  Efficacy of lee silverman voice treatment (LSVT) in individuals with Parkinsonism: A preliminary study from India Top

Niharika Mahajan

Let's Talk Speech Therapy (Private Clinic), Mumbai, Maharashtra, India.

E-mail: [email protected]

Introduction: Individuals with Parkinsonism are known to have speech, swallowing and cognitive impairments involving multiple subsystems. The most common symptoms seen are reduced loudness, mono-pitch and unintelligible speech, affecting their quality of life. Traditional therapy as per nature of the problem involves a set of exercises for each subsystem, cumulatively increasing the exercise program. LSVT Loud is a 35-years researched and effective treatment protocol which has been known to have a 90% success rate especially in PD.

Aim: To compare and contrast efficacy of LSVT Loud vs traditional speech therapy mainly on 5 parameters (cognitive overload, duration, cost effectiveness, maintenance and quality of life).

Methodology: 25 participants with Parkinsonism, from across India were treated with LSVT Loud protocol. Their pre and post parameters as mentioned above, were assessed in terms of an effective communication. In contrast, 10-15 subjects who had undergone traditional therapy were assessed on these parameters as well.

Results: About 30-40% of patients with Parkinsonism present with cognitive and attention deficits as well, with increase in prevalence with advancing stages (Davis, A., & Racette, B., 2016). Patients had improvements in their vocal parameters such as increased loudness and wider pitch range, positively impacting their QOL. Hence, LSVT is a much simpler and time and cost-effective treatment approach.

Conclusion: We will be conducting a more extensive study further to assess LSVT efficacy in other populations such as Down's syndrome, CP, Dementia and other Neuro-communication disorders. Effective intervention can help arrest the deterioration to some extent.

  A backward walking training with virtual reality enhanced gait training in stroke patients: A pilot randomised control trial Top


Department of Neuro Rehabilitation, Neurofoundation Hospital, Salem, Tamil Nadu, India.

E-mail: [email protected]

Background and Purpose: As a strategy to address gait and balance deficits in stroke patients, the postural and motor control requirements of Backward Walking Training (BWT) with Virtual reality (VR) enhanced Gait training setup may prove to be beneficial to improve balance, walking speed and functional independence. This pilot study aims at 1. Determining the feasibility of administering BWT during inpatient rehabilitation with VT enhanced gait training and 2. Comparing the effectiveness of BWT and with VR enhanced Gait training to improve walking speed, balance, and balance-related efficacy in acute stroke.

Methods: 30 patients 1-week post stroke were randomized to test group of 15 patients who underwent eight, 30-minute sessions of BWT with VR enhanced gait training and 15 patients in regular gait training, balance and Coordination training. Five-Meter Walk Test, 3-Meter Backward Walk Test, Activities-Specific Balance Confidence Scale, Berg Balance Scale, and Function Independence Measure were assessed in both the group pre and post intervention.

Results: The improvement in Five meter walk test, 3-Meter Backward Walk Test and Berg Balance Scale was greater for test group with BWT with Virtual Reality enhanced training. But the most significant change was evident in Activities specific confidence scale and Function Independence Measure. (P<0.001).

Conclusion: This study shows that BWT with VR enhanced gait training has a very important impact on the translation of training to activities of daily living. Inclusion of 30 minutes sessions of this therapy in regular Stroke rehabilitation programme is very much feasible and it shall improve the overall independence of the patients.

  Association of education with cognitive-communicative skills in persons with dementia Top

Niharika Mahajan, Sonal Chitnis, Hemina Dawar, Sujit Jagtap, Poornima Karandikar, Sankar Prasad Gorthi

School of Audiology and Speech-Language Pathology (SASLP), Bharati Vidyapeeth (Deemed to be) University, Pune, Mumbai, Maharashtra, India.

E-mail: [email protected]

Introduction: There is mixed evidence available on effect of education and bilingualism on cognitive-communicative abilities in dementia across disease-progression stages. The Indian population is quite heterogeneous when considering their formal or functional literacy, bilingualism, socio-cultural cognitive morbidity and resilience post neuro-degenerative disorders.

Aim: To explore the relation of education and cognitive-communicative skills in persons with dementia.

Methodology: This cross-sectional study comprised of 25 Marathi-speaking individuals with irreversible dementia with a mean age of 69.52 years & with education in years (8–20). All participants were administered on the CDR scale, ACE-III in Marathi, Test of Cognitive-Linguistic Abilities in Marathi (TOCLA-M) and Instrument to Assess Communicative Effectiveness (IACE).

Results: Statistical analysis revealed a significant difference (p < 0.05) across individuals with mild and moderate dementia groups on communicative (on IACE tool) more than cognitive domains (on TOCLA-M test for attention & working memory domain) (Gupta & Chitnis, 2016). Further, there was a significant moderate to high association observed between education and cognitive-communicative skills of the mild dementia group (p < 0.05) (Alley et al., 2007).

Conclusion: The present study demonstrated a strong association between education and cognitive-communication abilities in persons with mild dementia. It revealed no significant similar association as the disease advances to moderate dementia. Bilingual socially and spiritually active Indian PWDs were better preserved in L2 than other PWDs on IACE. Vascular dementias were found more affected than the degenerative dementias. Both groups were observed to have significant impairments in their anterograde memories and expressive language abilities.

  Cognitive and communicative reserve in bilingual biliterate lady with Alzheimer's dementia: A case study Top

Niharika Mahajan, Abhishek Chaudhari, Sonal Chitnis, Priya Kapoor, Sujit Jagtap

School of Audiology and Speech-Language Pathology (SASLP), Bharati Vidyapeeth (Deemed to be) University, Pune, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Alzheimer's disease (AD) is a neuro-degenerative disorder which causes cognitive-behavioural-communicative dissolution cumulatively. Speech language pathology tele-rehabilitation service can facilitate overall ADL, ADI-cognition, communicative abilities where face-to-face rehabilitation is not feasible in current pandemic. There is need to explore and encourage tele-rehabilitation in dementia in India viewing bilingual, biodiverse aging population with heterogeneous cognitive reserve and profiles.

Aim: To profile cognitive-linguistic and communicative abilities and explore cognitive and communicative reserve in a bilingual biliterate lady with Alzheimer's disease, pre- and post-intervention.

Methods: A 65-year-old non-depressed healthy and active lady with recent memory loss, was evaluated at Memory clinic at BV(D)U, SASLP, Pune. A series of cognitive-communicative test batteries (CDR, ACE-III-M, IACE-M], Connected speech tasks, WHODAS 2.0) were administered and effective tailor-made neurorehabilitation was executed.

Results: Pre-intervention, mid-therapy (post one-year) and post-therapy (post 2-years) comparative profiling revealed that cognitive-communicative rehabilitation helped in her ADL, everyday memory skills and bilingual active work-up, hence showing a positive impact enhancing cognitive reserve and literacy in the MCI–moderate AD journey. Social communication and retrieval abilities in connected speech was markedly deteriorating with L2 proficiency. Everyday communication abilities remained less affected than extra-linguistic abilities post intervention. However, the progression of the disease and cognitive morbidity was quite slow, indicating a good cognitive reserve as cognitive activity strengthens the functioning and plasticity of neural circuits (Cheng, 2016).

Conclusion: Narrative abilities and cumulative cognitive-communicative performance can help understand cognitive reserve and the factors associated. Education and active bilingual cognitive-communicative rehabilitation with SLP services can be yielding.

  Neural basis of semantics revisited with a case study in a bilingual mixed aphasia post left temporo parietal ischemic infarction Top

Riyaz Memon

School of Audiology Speech Language Pathology, Pune, Maharashtra, India.

E-mail: [email protected]

Background: Semantics play a vital role in verbal and non-verbal communication across language modalities however its dynamism and neural basis is heterogenous. Majority of posterior disconnection syndromes exhibit fluent aphasia, constructional apraxia. However, their nonfluent speech praxis, poor repetition as well as fair ADL communication is not well correlated by aphasia quotient and structural imaging.

Aim of the Study: To explore and correlate neural basis of semantics and cognitive behavioral & imaging findings in person with aphasia post left temporo-parietal ischemic infarction.

Methods: We present 53 years Right handed accountant by profession, Marathi, Hindi and English bilingual with complaint of difficulty in all language modalities evaluated by test battery approach. MRI reveals acute nonhemorrhagic infarct in the left temporo-parieto-occipital lobe with minimal midline shift and uncal herniation SVD.

Results: Discordance on WAB, ADL communication mildly preserved ;however dysexecutive mixed fluent profile of cognitive, neurolinguistic, communicative and praxis skills on WAB, ACE, ISAT & ISB was observed. Findings of study with dominant hemisphere temporo-parietal infarction, impairment in language modalities, poor semantic memory and recognition across spoken and literacy skills backed by dual stream model & neural correlation. (Thompson-Schill et al, 1999; Fridriksson's et al, 2011).

Conclusion: Exploring recent Dual Stream Model based aphasia, apraxia dysexecutive profile (Ardilla, 2010) neural basis can help broaden the spectrum of understanding, assessing and diagnosing vascular cognitive linguistic impairment posterior disconnection syndrome. This can help build best practices in therapeutic intervention without getting biased as a pseudo-fluent aphasia on aphasia quotient.

  High dependency unit pulmonary rehabilitation: A visual monograph Top

Jaydeep Nandi

AIIMS, Raipur, Chhattisgarh, India.

E-mail: [email protected]

Background: Covid era has abruptly increased the pressure as well as importance of High Dependency Units. HDU referrals are often a challenging call for a Rehabilitation Professional. The unending lines, constantly beeping monitors and bee-like movement of skilled staffs uttering unfamiliar jargons can unnerve the newly inducted ones, more so as Residents are under exposed to HDU set ups in most teaching Hospitals.

Aims: A visual monograph on HDU Pulmonary Rehabilitation can help in avoiding errors and inculcate the right reflexes at right time, for Rehabilitation Professionals.

Methods: If we consider the journey of a patient through HDU, it is akin to a traveler negotiating treacherous mountainous path helped by his various mountain gears. If endotracheal intubation and tracheostomy are two summits, then that need to be quickly deescalated by weaning and decannulation to the normal plainland. To avoid scaling too much heights, a roundabout journey through valley can be planned like phrenic nerve pacing but that also possess limitations. Whatever be the route, it always is replete with dangers like acquired pneumonia or sleep disordered breathing. Under the supervision of his guide, the traveler have to appropriately use his assorted gears like medication, ventilator, non invasive ventilation, lung secretion management, assisted cough techniques, breathing retraining and life saving glossopharyngeal breathing, if he is really willing to reach his destiny.

Result: Rehabilitation Profession who is sure of his goals can decrease length of HDU stay.

Conclusion: There can be a role of a visual monograph based teaching to improve quality of care.

  A cross sectional study to evaluate the burden of care and quality of life among caregivers of persons with traumatic spinal cord injury Top

Shiv Lal Yadav, S. Arjun

Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India.

E-mail: [email protected]

Introduction: Caregivers who is living together with the Spinal cord injury (SCI) patients in thecommunity have to take over the roles and responsibilities of these people. In theprocess of care giving, many psychosocial issues and burdens arise, which can havea negative impact on the caregiver. The purpose of the study was to determinequality of life and burden of care among caregivers of traumatic spinal cord injuryand to investigate its association with different variables.MethodologyFamily burden interview schedule (FBIS) was used for obtaining the caregiversBurden and quality of life of the caregivers was assessed by The Short Form-36 (SF-36) questionnaire. Caregivers all traumatic spinal cord injury cases attending PMRdepartment, AIIMS, New Delhi during the study period, were asked to fill short form-36 (SF-36) health survey and family burden interview schedule.ResultsThe mean SF-36 Score of the study population was 57.07±15.084, whichindicates a major decrease in quality of life among the caregivers of spinal cordinjury. The mean FBIS Score of the study population was 29.02 ±7.94 whichindicates moderate to severe burden of care giving among the caregivers ofspinal cord injury. Duration of injury had an inverse relation with the quality of life ofthe caregiver which was statistically significant in this study. Pressure injury in SCIpatient was another significant factor which negatively affected QOL of thecaregivers (p value 0.001). Burden of care was more among care givers of the patientwith the presence of pressure injury (p value 0.0065).ConclusionModerate to severe burden of care giving and significant reduction inquality of life were found among the caregivers of spinal cord injury patients. Burdenof care was more among care givers of the patient with the presence of pressureinjury. Duration of injury had an inverse relation with the quality of life of thecaregiver.Presence of pressure injury was another significant factor which negativelyaffected QOL of the caregivers. Caregiver of the patient, who had injury at thelevel of D8 and above had significantly lower quality of life.

  Influence of myofacial release and stretching to relieve spasticity in patients with stroke - A systematic review Top

Maheshwari Harishchandre, Suvarna Ganvir1

Department of Neurophysiotherapy, Dr. Vikhe hospital, College of Physiotherapy, 1Department of Neurophysiotherapy, DVVPFS, College of Physiotherapy, Ahmednagar, Maharashtra, India.

E-mail: [email protected]

Background: Spasticity is a consequence of neuromuscular disorders, which affects quality of life in those who experience this phenomenon. The purpose of myofascial release is to release restrictions within the deeper layers of fascia. Stretching is widely used for individuals with spasticity in belief that tightness or contracture of soft tissues can be corrected and lengthened.

Objective: To investigate the literature evidence for the effect of Myofacial Release & stretching on spasticity in patients with stroke.

Methodology: Review contains latest literature, studies included within last 15 years. They were entered into PubMed, Google scholar and Ovid databases, which included Medline, CINAHL, and Journals at Ovid full text, EBM reviews. The population which was selected adults with spasticity developed after stroke. A systematic literature search was evaluated 74 articles related to effect of Myofacial Release & stretching.

Result: Out of 74 articles we selected, 10 articles which were found suitable for reviewing the effect of Myofacial Release & stretching. Out of 7 stretching studies 5 studies concluded that stretching is effective alone in stroke patients to relieve spasticity.

Conclusion: Myofascial release & Static stretching are expected to have an effect on the spasticity in stroke patients.

Keywords: Myafacial release, physiotherapy, spasticity, stretching, stroke

  Effect of transcranial direct current stimulation on early motor recovery in acute stroke - A Randomized controlled trial Top

Ashish Sharma

Department of Neurology, AIIMS, Bilaspur, Himachal Pradesh, India.

E-mail: [email protected]

Background: Transcranial direct current stimulation (tDCS) is a non-invasive, portable, easy to use and relatively inexpensive equipment to modulate cortical excitability. Neuromodulation by tDCS enhances synaptic plasticity. Use of tDCS in the acute period post stroke could improve brain plasticity and result in better motor recovery.

Objectives: Measure the effects of tDCS on functional and sensory outcomes throughout the first year post onset of stroke.

Methods: 40 acute stroke patients were randomized and placed into either the treatment or sham group. Anodal tDCS was applied (2 mA, 20 min) 5 times a week during the first month post stroke. Patients were evaluated with the Wolf Motor Function Test, the Semmes Weinstein Monofilament Test, the Upper Extremity section (UEFM), the Lower Extremity section (LEFM) and the Somatosensory section of the Fugl Meyer Test, the Tardieu Spasticity Scale, the Stroke Impact Scale (SIS), the Hospital Anxiety and Depression Scale (HADS) and the Barthel Index. Evaluations were held at 48 h post stroke, week 1, 2, 3, 4, 3 months, 6 months and 1 year.

Results: There were statistically and clinically significant improvements after tDCS in all functional motor outcomes, and somatosensory functions. Differences between both groups for the main outcome (WMFT time) were 51% (p = 0.04) at one month, and 57% (p = 0.02) at one year.

Conclusion: tDCS seems to be an effective adjuvant to conventional rehabilitation techniques. If applied in the acute stages of stroke, functional recovery is not only accelerated, but improved, and results are maintained up to one-year post stroke.

  Dementia application for diagnosis and tracking (DADT) Top

Soubhik Das, Akshay Sancheti, Pushkraj Marne

Department of Development, Manastik, Pune, Maharashtra, India.

E-mail: [email protected]

An online ecosystem that helps with neurological evaluations and cognitive testing for people suffering from dementia. Dementia Active Diagnosis and Tracking (DADT) enables a common platform for the doctors to make cognitive assessment for screening and tracking the progression of dementia by consulting the summarized history; as well as for the caregivers to stay connected with the doctors, and find helpers, etc. It further provides mechanism for the patients to take a test remotely and send the results for evaluations immediately for early detection and tracking efficiency. One of the ways in which we are getting this done is by leveraging advanced technologies such as Artificial Intelligence & Data Analytics. In parallel, research is being carried out to ensure that we are optimizing the parameters to be tracked and other test factors. This will go through a rigorous clinical trial after it's first version is out. Overall, catering to early detection, screening & progression tracking of dementia, a Teleneurology & Teleneurorehabilitation platform is being developed for effective treatment, rehabilitation and better quality of life for dementia patients.

  Effect of motor relearning programme on walking performances in post stroke individuals Top

Suraj Bhimarao Kanase

Department of Physiotherapy, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India.

E-mail: [email protected]

Background and Aim: Gait is a factor that affects majority of patients with stroke. Patients are able to walk independently but not efficiently. There is impaired swing at hip and knee with circumduction. Weakness in hip abductors, over activity of quadrates lumborum adds to circumductory gait. Patient's lack flexibility in their performances.Walking abnormallyincreases energy expenditure, decreases Biomechanical efficiency, reduces self-esteem and is not good esthetically. There is paucity in literature supporting overall improvement in gait parameters.

Objectives: 1. To find whether motor relearning programme is better to improve Walking performances 2.To find whether Conventional Training is better to improve walking performances 3.To find Effects of motor relearning programme and conventional training on walking performances.

Methods: 30 subjects were included according to inclusion and exclusion criteria. Informed consent was taken from each. They were divided into two groups. Group A: Motor relearning programme (9m+6f)and Group B: Conventional training (8m+7f). Interventions were given for 6 weeks and changes inspatial (stride length, step length), temporal (cadence, speed) and two Minute walk test were noted.

Results: Statistical measures such as mean, standard deviation (SD), paired and unpaired test were used for analysis. The results showed statistically significant improvement in spatial and temporal variables with motor relearning programme than conventional training.

Conclusion: The study concluded that motor relearning programme improved walking performances in terms of spatial and temporal variables. It enhances the quality of walking after stroke.

  Effects of craniocervical flexion exercises in relation to neck pain: A narrative review Top

Anushka Nanoo, Amal Clament, Ashuthosh U. Nayak

Department of Physiotherpy, MCHP, MAHE, North Goa, India.

E-mail: [email protected]

Objective: To narratively review the literature using the craniocervical flexion exercise in patients with neck pain to determine any evidence of its effectiveness in addressing pain, disablilty, strength, activation and ROM.

Methods: A comprehensive search was carried out to identify relevant articles written in.

Results: The thirteen studies considered in the review included neck pain population. Most of the articles reported significant reduction in neck pain and disability with deep cervical flexor exercises. Specific low load craniocervical flexion training enhanced deep cervical muscle strength and improved deep cervical flexors activation. Improvement in ROM of cervical spine is more significant in deep cervical flexor exercise than strength training. Deep cervical flexor exercises combined with thoracic manipulation shows more improvement. However a few studies also reported the absence of relationship between deep cervical flexor training and ROM. Clinicians need to consider the results of these studies while assessing and treating individuals with neck pain.

Conclusion and Significance: The findings of this review indicate that craniocervical flexion training can successfully address neck pain and disability and deep cervical muscle strength. The small number of studies investigating other physiological functions impacts on the interpretation and strength of the evidence. We can however suggest that a multimodal training regime is required when the aim of management of the patient with a neck pain disorder is to address the impaired physiological function associated with neck pain. Areas for further research are suggested to strengthen knowledge about specificity of effect of modes of training.

  The effects of two different type of ankle foot orthosis on gait and energy consumption with hemiplegic population Top

Priyadarsini Monalisha Dash, Manoj Kumar Tiwari

Department of Prosthetics and Orthotics, SVNIRTAR, Cuttack, Odisha, India.

E-mail: [email protected]

Background and Aims: Ankle foot orthosis (AFO) are most frequently used to provide a near to normal gait to the patients with foot drop in hemiplegic disorder. In this study two types of AFOs are used in same patient to review the efficacy of the both types AFOs in biomechanics parameters and to provide a clear prescription guideline.

Methods: The inclusion criteria includes randomize selection of hemiplegic patients (age group 20 to 70), AFO (solid AFO and articulated AFO)as an intervention, spatiotemporal gait parameters with 30m walk way test and the physiological cost index (PCI) is used as an intervention of gait performance. In this study both interventions are used with 15 to 20 days of interval and after proper training of the patient, data was collected with comfortable walking speed of the patient.

Results: Assessment of AFOs at the level of gait parameter and PCI are done by the student paired T-test statistically. Walking speed, step and stride length, cadence increased with dynamic AFO. By use of articulated one all rockers of the foot and ankle is restored during gait cycle. The articulated AFO had a positive effect on the patients overall gait which included improved temporospatial parameters because of decrease in energy cost of walking.

Conclusion: Outcome measures from the gait analysis in the specific criteria represents a shift towards normality and also can help for the confirm effectiveness of the AFO. The effect of articulated AFO on walking ability is statistically significant in comparison with solid AFO.

  Teletherapy: Creating a cost effective sustainable model of intervention for developing countries Top

Shabnam Rangwala, Dilip Rout

Department of Community Rehabilitation, Project Noor, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Project Noor works with the most marginalised of all populations which are the disabled children living in rural areas. We aim at developing sustainable partnerships with Community based organisations and supporting them to enhance their capacity to work with disabled children. The COVID 19 pandemic has seen transitioning of all activities to the online model and thus Project Noor took this opportunity to broaden the scope of its reach to serve more underserved communities in distant places. Project Noor's role is to bring in experts in the area of disability management through the use of technology with the aim of reaching their expertise to the rural and tribal communities of children with disabilities.

Objectives: 1. To provide direct professional support to families having children with neurodevelopmental disability in rural areas 2. To enhance the capacity of a community based organisation to create a cost effective model that is sustainable and replicable.

Methodology: Provide interventions to 35 children with neurodevelopmental disabilities by linking professionals via technology to use the medium of tele-therapy by partnering with a Community Based Organization (CBO). The health workers at the CBO are trained in evidence based family centric interventions to enhance their knowledge, attitude and skills effectively manage the children. This is being documented for replication and an audit on the same is planned. Professional assessments and thereafter weekly interventions are provided by Project Noor. Family centred goals have been set for each child that are being tracked through standardized outcome measures. Parent audits on their perspectives to the intervention will be conducted.

Results: The project is ongoing and is currently in its mid-term. Currently 32 children attend therapy regularly of which there are 18 girls and 16 boys. 22 children are below 5 years of age and fall in the early intervention category. Most of the enrolled families come from very low socioeconomic strata and come under the reserved communities. Preliminary findings reveal that 79% of the enrolled children have not been seen by an expert medical professional and do not have a formal medical diagnosis. After the professional assessments by therapists, 70% of the children received the diagnosis of cerebral palsy with 55% in the GMFCS level 4 and 5 level. Total of 40% had comorbid conditions like epilepsy, hearing difficulties, intellectual difficulties and behavioural challenges. Functional goal planning has been done for the children using the COPM and which will be tracked for progress at 6 months and then end of one year post intervention.

Conclusion: It is hoped that this project will use technology to its advantage to increase grassroot capacity for the management of children with neurodevelopmental disabilities in rural and remote regions. It will try to reduce the digital divide by partnering with CBO to help bridge the gap for the families. This will create a replicable and sustainable model of intervention using technology.

  Comprehensive approach to enhance qol in a person with right vestibular schwannoma with acute intracerebral hematoma left temporo parietal occipital lobe – An occupational therapy perspective Top

Rudra Narayan Samanta, Karthikeyan Ramachandra, Janet, Arul Jothi

Department of Occupational Therapy, Hamsa Spine and Brain Rehab, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background: Vestibular Schwannoma accounts for approximately 85% of tumours in the Cerebello-Pontine angle and often lead to brain insult. Along with its impact on the nervous system, the occurrence of intra cerebral hematoma remains uncommon. A 72 year old female, a known case of Right sided Vestibular Schwannoma diagnosed since 1year, underwent Cyberknife procedure and Left-sided Medium Pressure Dome Valve VP Shunt for hydrocephalus. On her quarantine due to COVID infection, the patient developed seizures. CT brain revealed Intracerebral Hematoma in the Left Temporal Parieto occipital lobe.

Aim: To improve the QOL with a timely coordinated multidisciplinary rehabilitation approach.

Methodology: Patient was assessed for Cognitive impairment, Motor Status and Functional ability. Patient was completely dependent for transfers and Activities of Daily Living (ADL). A Single Case Prospective Study Design with a multidisciplinary approach including Cognitive retaining, MOHO, Rehabilitation frame of reference, Task-oriented approach, Brunnstorm approach, Psychosocial frame of reference, Biomechanical approach.

Results: Rehabilitation program was given for 4 weeks and Improvements observed with following outcome measures Mini-Mental State Examination (0/30- 18/30), Manual Muscle Testing (0/5 -4/5) on right side limbs, DASH scale (700 to 300), Modified Barthel index scale (0/20 to 18/20), Berg balance scale (0/56 to 52/56).

Conclusion: This study highlights the importance of occupational therapy for improving the neurological deficits and functional abilities associated with coexisting Vestibular Schwannoma and Acute Intra cerebral hematoma.

Keywords: OT rehabilitation, QOL – quality of life, vestibular schwannoma

  A community based training program for para professionals to manage children with neurodevelopmental disabilities Top

Shabnam Rangwala

Department of Community Rehabilitaion, Project Noor, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: The pandemic has changed the world for most but the most impacted are the marginalized communities that include children with neurodevelopmental disabilities. Innovative ways need to be devised to help us expand our reach through manpower training.

Aims: 1. To create a cadre of para-professionals who can are equipped to manage disability at the field level. 2. To provide support to families with children with neurodevelopmental disabilities who are unable to reach tertiary care centres.

Methodology: Networking established with a grassroot organizations to empower their health workers through training to effectively manage children with neurodevelopmental disabilities. 25 participants working in different rural areas of India trained through a 10 day online training program. The areas of training included transdisciplinary management of children with neurodevelopmental disabilities. The resource material for training of the health workers as well as training material to be used by the health worker to support parents of children with neurodevelopmental disabilities has been based on training material developed in English by a UK based charity. The training material as well as the resource for parents has been translated into two Indian languages namely Hindi and Tamil.

Results: A total of 23 participants completed the training. The pre and post training assessment showed a change in areas of knowledge, confidence and skills of health workers to manage children with developmental disabilities. 80% felt they were more confident to use the knowledge gained to improve in their own work while 30% even said they would use the knowledge gained to teach other workers.

Conclusions: This type of community based training of semi-skilled professionals in management of neurodevelopmental disability is the need of the hour so that we can bridge the human resource gap that exists in developing countries.

[TAG:2]The prevalence of zoom fatigue in neurology residents in the covid pandemic times [/TAG:2]

Guhan Ramamurthy, Lakshmi Narasimhan Ranganathan, R. Shrivarthan

Department of Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background: The effect of the COVID 19 pandemic has caused an exponential increase in the use of online meeting platforms such as zoom by over 30 times in April 2020 compared to pre-Covid times and progressively more in 2021 that had enabled us to resume our routine during the lockdown. However, long hours at the online sessions cause increased stress resulting in fatigue both physical and cognitive.

Aim: To assess cognitive fatigue with clinical and electrophysiological measures in neurology residents who are at the maximum exposure to the online sessions following the sessions.

Materials and Methods: 20 Neurology residents from the Institute of Neurology, Madras Medical College in May 2021 were included in the study after excluding subjects with confounding factors. They were analysed for cognitive fatigue using clinical and electrophysiological measures before and after online class sessions. The clinical assessment was performed using modified versions of Stroop test (mST), symbol digit modality addition test (SDMAT), and three digit serial addition tests (3DSAT). Electrophysiological assessment was done using P300. The cognitive fatigue was measured as a change in the cognitive performance before and after the online classes. SDMAT is cognitively demanding test.

Results: The cognitive fatigue measured by mST, SDMAT, 3DSAT before the online session were 1.13±0.06, 1.05±0.11, 1.21±0.1 respectively and after the online session were 1.17±0.1, 1.16±0.13, 1.22±0.1 respectively. The cognitive fatigue was statistically significant for the SDMAT and insignificant for mST and 3DSAT performed before and after the online session. The cognitive fatigue was not evident electrophysiologically.

Conclusion: Cognitive fatigue is emerging with the increase in the online teaching sessions, the new normal, that is evident with cognitively demanding task. It is imperative to further study the effect of cognitive training on cognitive fatigue and further perform in larger sample sizes.

  Rehabilitation program for short stature lumbar scoliosis with multilevel stenosis with neurodeficit - A single case study Top

Aruljothi Gopalakrishnan, Karthikeyan, Rudra Narayan Samanta, Zainab, Vedhavalli

Department of Physiotherapy, HAMSA Spine and Brain Rehab, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background and Aim: Scoliosis commonly associated with a variety of neuromuscular disorders affecting upper and lower motor neurons. Neuromuscular disorders that have been associated with scoliosis and related to spinal deformities. Spinal stenosis is extremely common in achondroplasia, both at the lumbar and cervical areas. A 33years old male, a known case of lumbar scoliosis with multilevel stenosis with neurodeficit managed surgically T4-S1 Posterior instrumented deformity correction, T5-S1 posterior decompression, T4-S1 postero lateral fusion. He was admitted in a rehabilitation centre with symptoms of bilateral lower limb weakness and decreased sensation below T12 level, tightness of bilateral lower limb, poor trunk control and reduced bed mobility activities.

Methodology: Initial assessment was done by rehabilitation team members - Physiatrist, Physiotherapist and occupational therapist diagnosed as ASIA-B Paraparesis. Therapy program included Strengthening of upper and lower limb, stretching for bilateral lower limbs, trunk control training, bed mobility and balance training, respiratory training and endurance training, and Transfer training was encouraged.

Results: Intensive rehabilitation program given for 2 months and improvement was observed with the following outcome measures. ASIA scale B to C. Muscle Strength from Grade 1/5 to Grade 3/5 in the bilateral lower extremities. Modified Barthel index score from 1 to 14 out of 15.

Conclusion: We concluded that Post-Operative Lumbar scoliosis with neurological deficit need holistic approach during rehabilitation program to enhance his quality of life.

Keywords: Lumabr scoliosis, rehabilitation, short stature

  Development and validation of Oromotor Function Scale Top

Keerthi Prasanna, Deona Crasta, Shivam Singh, Preetie Shetty Akkunje, Prasanna Suresh Hegde

Department of Deglutology and Speech-Language Pathology, Bengaluru, Karnataka, India.

E-mail: [email protected]

Comprehensive assessments of oro-motor functions lack objectivity and are considered subjective in assessing functions like speech and swallow. In the present study, Oro-motor Function Scale (OFS) was developed and validated as an assessment measure of oral functions in neurological conditions and oral/oropharyngeal cancers. The scale was developed using the Delphi method by a panel of experts in Speech-Language Pathology. The scale was administered on 100 recorded videos of healthy individuals and ten each from clinical groups. Five Speech-Language Pathologists' scored 120 videos in the format that was familiarized. Forty healthy individuals and ten videos of the clinical groups were reassessed after two weeks for inter and intra rater reliability. The OFS scores were compared with the standard measures of speech and swallowing functions which are AYJNISHD Speech Intelligibility Rating Score, Percentage Consonant Correct, Substitution Omission Distortion Additional articulatory error scoring, triangular vowel space area, Functional Oral Intake Scale, Food Intake Level Scale, and Eating Assessment Tool 10. OFS subsection scores have shown different correlations to all the measures of speech and swallow functions indicating the role of individual structures, i.e., tongue, jaws, palate, and lips. Similarly, overall scoring and degree of OFS show varied correlations based on the dysfunction profile. The scale showed good inter-ratter and intra-ratter reliability. Although more studies have to be carried out to strengthen the scale psychometrically, it can currently be used with greater accuracy and objectivity to assess the oral motor functions in neurological disorders and oral/oropharyngeal carcinomas.

  Mindfulness-meditation based neurorehabilitation for patients with MCI and prodromal Alzheimer's disease - An open labeled intervention at crossroads of resting-state brain connectivity and neuropsychological analysis Top

P. G. Rajesh, Ramshekhar Menon, S. Krishnan, K. S. Meenu, K. Lekshmi, S. Krishnan, Bejoy Thomas, C. Kesavadas, Ramshekhar N. Menon

Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.

E-mail: [email protected]

Background/Objective: Studies focusing on the efficacy of Mindfulness-Meditation(MM) based Neurorehabilitation for neurological pathologies remain under-explored in the subcontinent. Graph-theory-based brain-connectivity analysis and Neuropsychology testing are prospective tools that can validate cognitive status. In the current study, we utilized both these techniques to demonstrate the effectiveness of MM in improving memory and cognition.

Methods: We customized a ten-week, group-based Mindfulness Unified Cognitive Behavior Therapy (MUCBT) training for older adults with MCI due to AD diagnosed as per Petersen's criteria and NINCDS–ADRDA criteria with a clinical dementia rating score of < 2. Neuropsychological testing and Resting-state fMRI (rs-fMRI) was performed on 14 patients (11-males & 3 females). A 3T GE-Discovery Studio MRI Scanner was used to acquire neuroimaging data. The graph-theory method was adopted to perform seed-based brain connectivity analysis with known rs-fMRI network nodes as regions of interest (ROI). The participants were recruited through the Memory & Neurobehavioral Disorders Clinic of SCTIMST, Trivandrum.

Result : rs-fMRI revealed notable differences in parameter degree (a measure of total number of edges at a particular node) for Pre-vs-Post meditation training at Anterior Cingulate Cortex at p < 0.03, FDR corrected with seed-based brain-connectivity. The neuropsychology score depicted improvement in memory performance with paired t-test demonstrating significance in scores of RAVLT-immediate with p<0.038, RAVLT-delayed p<0.035, RAVLT-recognition p<0.048, RAVLT-omission p<0.036.

Conclusion: Results signify that mindfulness meditation can be the holistic tool for neurorehabilitation and can activate neural correlates coupled with memory- recognition/recall and complex cognitive processes like emotion, impulse control, decision-making as well as assist in the relief of anxiety

  Mixed PPA - Case report in Indian context Top

Rajath Shenoy, K. Deepthi, Gopee Krishnan

Department of Speech and Hearing, Manipal College of Health Professions, Manipal academy of Higher Education, Manipal, Karnataka, India.

E-mial: [email protected]

Background and Aims: In India, number of elderly persons is expected to grow in the coming years. Communication changes are often reported in the old-age. Primary progressive aphasia is selective clinical deficit of language functions. Among other neurodegenerative conditions (such as dementia, Parkinson's disease etc.), patient has to meet basic criteria for PPA (Mesulam, 2001). Further, international consensus criteria (Gorno-Tempini et al., 2011) for PPA are highly used clinical diagnostic settings to differentially diagnose the 3 types of PPA. In India, using this criteria, there were previous reports on PPA, and among these the common subtype of PPA is PPA-Global (Prabhakar et al., 2018).

Methods and Results: We present the case of Mr. N, an 86-year-old man with primary complaint of language issues in his activities of daily living. The language and cognitive assessment provided clinical diagnosis of PPA and the underlying deficit met the PPA criteria (Mesulam, 2001). We then compared the clinical profile of Mr. N with the international consensus group criteria for PPA. The features exhibited by Mr. N did not meet the diagnostic representation of 3 variants. We present the overlapping and mixed clinical features of Mr. N.

Conclusion: We discuss the atypical clinical profile of Mr. N when compared with international consensus group criteria. Further we discuss the important clinical diagnostic features (i.e., Surface dyslexia or dysgraphia component) in the classification which could be questionable in the Indian context.


  1. Mesulam MM. Primary progressive aphasia. Ann Neurol 2001;49:425-32.
  2. Prabhakar AT, Mathew V, Sivadasan A, Aaron S, George A, Alexander M. Clinical profile of primary progressive aphasias in a tertiary care centre from India. Int J Speech Lang Pathol 2019;21:547-52.
  3. Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, et al. Classification of primary progressive aphasia and its variants. Neurology 2011;76:1006-14.

  The concept and application of integrated neuro-rehabilitation Top

K. V. Sriharsha, Sharan Srinivasan, Pratibha Sharan, Ahalya Sharma, Ranjani Deshpande

Department of AyurNewro- Integrated Rehab Services, PRS Neurosciences and Mechatronics Research Institute Pvt. Ltd, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background: INTEGRATED NEURO-REHABILITATION a unique approach catering to the holistic health of health seekers undergoing Advanced Neuro Rehab care, focusing on integrating contemporary systems of medicines and applications for ensuring the best possible outcomes of neurologically disabled patients undergoing Neuro- rehabilitation. This dimension dynamically chooses the best of Ayurveda, Modern Medicine and related evidence based systems for providing the best and most comprehensive treatment possible for persons affected with neurological conditions coupled with on-going evidence based research.

Methods: The integrated Neuro-rehabilitation process will include Therapies (External), Therapeutics (Rasayana), Herbal Nootropics, Panchakarma (Detoxification processes), Marma Chikitsa and Yoga to accomplish the Rehab Needs. Integrated Neuro rehab is a unique model effectively executed by a team of proficient Ayurveda Physicians, Expert Neurosurgeons, Expert Neuropsychologists, Advanced Neuro rehab therapists and Skilled Ayurveda therapists.

Results: Integrated Rehab shall focus to accomplish following goals in treatment including Strengthening immune system, efficient detoxification, improving inflammatory Responsiveness, Bringing Optimal metabolism, balancing the regulatory system, Enhancing the regenerative system and Harmonizing the life force.

Conclusion: Integrated Neuro-Rehab is based on the concept of Symbio Health-The combination of Defensive and Offensive strategies for providing the best results. The concept of Symbio-health in-turn leads to achieve the a Competent & culturally sensitive Holistic approach, Cost-effective Natural/ eco-friendly model, Minimal adverse effects Easily accessible treatment protocol, emphasising on prevention, Health promotion and Quality of life concerns especially in Chronic illness.

  Visual field restoration through tele-rehabilitation Top

Lakshmanan, V. Nandakumar,

V. Nithyanandam, N. Thamilpavai, Lakshmi Narasimhan Ranganathan

Department of Neurology, Madras Institute of Neurology, Madras Medical College, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background: Visual field deficit (VFD) is one of the most common symptoms to have a poor response to medications and complete recovery of vision is rare. Inspite of recent advances in biotechnology, there currently exists no consensus on rehabilitative therapy and treatment. Plenty of novel methods have been developed, all of them having one therapeutic principle in common; repeated practice of a specific visual task. Visual restorative therapy (VRT) is one such rehabilitation method.

Aim and Methods: The aim of the study is to 1. Identify the type of visual field defect. 2. Analyse the efficiency of the tele-rehabilitation therapy in visual field defects management. Patients presenting with visual field defects are examined thoroughly including automated perimetry. Patient is instructed to focus on an image (face) unveiling itself in a sectoral fashion by both clockwise and anticlockwise direction. The rate of unveiling the image was calibrated to 3 different time durations of 30, 90 and 180 seconds. The visual task is to be performed 1 hour a day with 2 sets of 30 minutes each for 6 times a week for 1 month and monitored through telecommunication. Patient visual field is reassessed periodically by perimetry every week.

Results and Conclusion: Patients assessed in the study were 10 in number. Patient visual field was observed to expand through visual restoration therapy. Its role as a tool for tele-rehabilitation therapy during the pandemic period was found effective. In future, VRT could be inculcated into routine rehabilitation therapy for visual field defect.

  Efficacy of telerehabilitation in improving receptive and expressive language skills in children with communication disorders Top

Kalyani Gholap, Namita Joshi, Neha Jamdhade, Neha Jose Mrunmayi Meshramkar

Department of Speech Language Pathology, Sampark Epolyclinic, Pune, Maharashtra, India.

E-mail: [email protected]

Background: Telerehabilitation has been proven to be the only choice for parents of children with communication disorders during the pandemic. However, problems were also observed more in preschoolers attending the school and therapy online due to their attention span. Hence most parents opted to wait for offline sessions than doing any therapy through online mode.

Aim: The current study evaluates the efficacy of improving preschoolers' receptive and expressive language skills through telerehabilitation mode.

Methods: Ten children with autism features within the age range 3-4Yrs, attending regular therapy through online (5 Children) and offline (5 children) mode were selected. The pre and post-therapy sessions (10 sessions) scores on receptive and expressive language skills were recorded on COMDEAL. Home Literacy questionnaire was administered where educational and general literacy environment was assessed.

Results: The Mann-Whitney U test showed that there was a significant difference in pre-post therapy scores on activities of daily leaving(z=95.00(1) P>0. 01), receptive (z=89.00(1)P>0.005), expressive language skills(z=87.00(1)P>0.005), social (z=87.00(1)P>0.003), emotional skills z=87.00(1)P>0.004) of children with communication disorders on online as well as offline mode. However, the rich home literacy environment contributed specifically to the improvement in receptive and expressive language skills of children with communication disorders.

Conclusion: A home literacy environment can make it possible for children with communication disorders to improvise their expressive and receptive language skills at the same extent through telerehabilitation mode as offline therapy.

Keywords: Autism, home-literacy, telerehabilitation

  Study of effectiveness of ankle turnbuckle splint in upper motor neuron lesion patients with ankle contracture Top

Sofia Hussain Azad, Khan Shariq, Chauhan Kirti

Department of Occupational Therapy, Government Medical College, Nagpur, Maharashtra, India.

E-mail: [email protected]

Introduction: Foot drop and ankle contractures are conditions commonly encountered in various upper motor neuron and lower motor neuron lesions in which dorsiflexion is restricted. This can further make walking and running difficult. Considering the various designs available in the market, this Ankle Turnbuckle splint was designed with an inbuilt mechanism to increase or decrease the foot angle as per the static progressive splint principle. This splint also provides low sustained stretch which is necessary to maintain the foot in a neutral position and may also help to reduce the TA tightness/spasticity in such patients. As this is a new design, a pilot study was done to ascertain its efficacy in upper motor neuron lesion with ankle contracture/tightness. Other objectives of the study were to improve the range of motion at ankle joint and to create a cost-effective splint to prevent ankle contracture/ tightness.

Methodology: 6 patients fitting in the inclusion criteria were selected and written consent was taken, followed by demographic data, PROM using goniometry and muscle tone using Modified Ashworth scale was evaluated for the ankle joint. Splint was given on the second day, donning-doffing and wearing schedule of the splint was explained. Progress was reviewed every alternate day for the duration of 4 weeks and necessary changes were made in the splint, whenever required.

Results and Conclusions: The mean pre and post splinting dorsiflexion ranges were -11.8° and 9.8° respectively. The mean improvement in the range of dorsiflexion PROM was 21.6°, with a range of 17°-25°, p=0.0001 which is considered as highly significant. Also, the Modified Ashworth Scale although subjectively showed a minimum change of one grade. Thus, it concludes that early application and following a proper splinting regime of the ankle turnbuckle splint can prevent the development of ankle contracture/ TA tightness.

  Disability assessment in patients with Guillian Barre syndrome and role of rehabilitation after discharge Top

Nirumal Khumar, Noel James, Shivaji, Mariam Jude Vijay, Jawahar, Balasubramanian, Lakshmi Narasimhan Ranganathan

Department of Neurology, Madras Medical College, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Background and Aims: Guillian barre syndrome is a immune mediated polyneuropathy that disables a person and contributes to morbidity as much as it contributes to mortality(1). The aim of this study is to assess various factors causing disability in patients with GBS and attempt to quantify the disability based on validated scales. Factors causing disability include pain, motor weakness and psychological factors including depression and anxiety.

Methods: We aim to assess the factors causing disability with the help of validated questionnaires concerning various domains causing disability. 30 GBS patients were included in the study, their baseline characteristics were recorded and disability assessment was done at 6 months. Kessler's psychological score(2) was used for grading psychological disability, pain disability index was used to assess pain disability(3) and modified hughes disability score was used for assessment of motor disability. The study also aspires to elucidate the role of telerehabilitation considering the pandemic situation. Statistical analysis of frequencies and correlation between different grades and domains of disability will be done using SPSS version 20.0.

Results and Conclusions: 30 Patients were assessed in the study. The major contributing factor to disability was motor weakness. questionnaire also yielder that pain was also an important factor especially in its contribution to occupational disability. Even those who were able to move around the house had occupational disability due to pain. Depression and anxiety contributed significantly to social disability. Of the 30 patients followed up, those who took professional motor rehabilitation at home (including those through virtual modes) had improvement in hughes disability score by more than 1 scale. Recognition of various aspects of disability and appropriate professional rehabilitation helps patients return to their baseline activity earlier.

  Community based living skills in youth with intellectual disabilities Top

Aishwarya Swaminathan, Anuradha Pai1

Department of School of Occupational Therapy, D Y Patil University, 1OT Training School and Centre, LTMMC, Sion, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aim: Community based living skills are affected in youth with intellectual disabilities, and there is dearth of research in this area. Therefore the aim of the study is to assess community based living skills in youth with intellectual disabilities.

Methods: 36 youth with moderate intellectual disabilities were assessed using community based living skills assessment.

Results: The mean percentage scores of level of independence of the 36 youth with intellectual disabilities in the community based living skills are as follows -career path and employment (43%), self-determination/advocacy (22%), health and safety (24%), peer relationships, socialization, social communication (35%), community participation and personal finance (27%), transportation (30%), leisure/recreation (40%) and home living (53%).

Conclusion: This study gives an insight into the present community based living skills of youth with intellectual disabilities. The future implications of this study are also discussed.

  COVID-19 and mental health: How is novel coronavirus spread affecting the mental health of patients with epilepsy? Top

Arti Sharma, Nirmal Surya

Department of Clinical Psychology, Epilepsy Foundation India, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: In January 2020 the World Health Organization (WHO) declared the outbreak of a new coronavirus disease, COVID-19, to be a Public Health Emergency of International Concern. The COVID-19 pandemic and the resulting economic recession have negatively affected many people's mental health and created new barriers for people already suffering from mental illness and substance use disorders.

Aim: We at epilepsy foundation India aimed to understand how is novel coronavirus spread affecting the mental health of patients with epilepsy.

Methodology: We recruited 40 persons with epilepsy who voluntarily participated in the study. A clinical psychologist consulted them over the telephone and noted down their demographics and the implications of COVID 19 on their mental health. The data was analysed and presented.

Results: The 40 participants belonged majorly in the age group of 25-44 years, 90% of them resided in urban areas, 60% were females. 40% were employed full time, 20% were unemployed and 5% were employed part time. Nearly 48% of the persons with epilepsy had mental health issues due to the novel coronavirus spread in India.

Conclusion: Mental Health repercussions of COVID 19 are serious, various NGOs and government body need to create policies to tackle these mental health issues.

  Unlocking gait rehabilitation strategies in locked-in syndrome: A review Top

Jennifer Valentina Dsouza, Pooja Gada, M. John Solomon

Department of Physiotherapy, St. John's Medical College Hospital, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background: Locked-In Syndrome (LIS) results from a brainstem lesion in the pons. Rehabilitation is a key requisite in the management of LIS. Existing literature on gait rehabilitation consists of treatment options that range from neuro-physiological principle-based approaches to high-end technology-based rehabilitation. Successful gait rehabilitation demands the exploration of different treatment options and their effectiveness.

Objectives: To explore and summarize the evidence for various management strategies targeting recovery of gait in people with locked-in syndrome.

Methods: Literature search updated to June 2021 was conducted resorting to the databases such as PubMed Central (PMC), MEDLINE, Scopus, Web of Science, and Embase using the keywords: Locked in Syndrome; gait training; physical recovery; functional training; motor control; locomotion; assistive technology.

Results: 253 records were identified from the databases, out of which 6 records were included for qualitative data synthesis. Interventions were inclusive of functional and neuromuscular electrical stimulation, body-weight support treadmill training, biofeedback, virtual reality, robot-assisted gait training, aquatic therapy, proprioceptive neuromuscular facilitation, and neurodevelopmental techniques. A wide variety of different outcomes were included in the studies that quantified the distance covered, gait velocity, functional independence achieved by people with LIS.

Conclusion: Rehabilitation strategies used for gait recovery have shown a positive trend in people with LIS. Improvements have been noted in terms of muscle tone, strength, walking ability in terms of velocity and endurance along with functional independence. However, it is difficult to quantify these benefits as the studies stand on the lower spectrum in terms of quality of evidence and do not use standardized outcome measures.

Keywords: Assistive technology, functional recovery, gait training, physical recovery, ventral pontine syndrome

  Documenting outcomes of neurorehabiliation of clients with non fluent aphasia in ICF framework Top

Namita Joshi, K. S. Gholap

Department of Speech Language Pathology, Sampark Epolylclinic, Pune, Maharashtra India.

E-mail: [email protected]

Background: Due to lack of awareness and non-availability of professionals, the crucial window period in neurorehabilitation in client with stroke is mostly spent with no rehabilitation. Moreover, there are no unique ways to assess and rehabilitate across borders. International classification of functioning, disability and Health (ICF) is proved to be the most successful form for documenting outcomes of neurorehabilitation.

Aim: To study the therapy outcome measures in clients with Non Fluent Aphasia in ICF framework.

Methods: The study included four clients (3M and 1F) who reported within two months duration of onset of stroke. The clients were mostly walking with support with speech characteristics of agrammatism, jargonophasia, and anomia. The clients were assessed on ACE III-R and recorded the functioning and disability along with contextual functions through pre- therapy, mid therapy (at three months) and post therapy (at five months).

Results: The results showed that ACE III R scores improvement could be marked in all four domains of ICF in first three months and gradually scoring nearly out of scores at end of five months. Kruscal- Wallis test showed a significant improvement in attention and orientation (p=0.007), memory (p=0.017), verbal fluency (0.017), Language (p=0.007), visio-spatial (0.009) across three and five months.

Conclusion: The present study highlights the importance of ICF framework in planning goals and documenting stepwise rehabilitation outcome measures in client with Aphasia.

Keywords: Aphasia, ICF, neurorehabiliation

  Occupational therapy using cognitive orientation to daily performance approach in a patient with lingustic memory affectation post excission of left temporal lobe abscess Top

Akanksha Manoj Mohite, Shriharsh Jahagirdar1

Department of Occupational Therapy, OT School and Centre, Topiwala National Medical College and B.Y.L. Nair ch. Hospital, 1TNMC and BYL Nair Ch Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Language is said to be an important tool of communication both in verbal and written form. Literature evidences depicts role of dominant temporal lobe in linguistic competence stored in long term memory. Thus, pathology of which impacts linguistic memory necessarily affecting communication as ADL which alters daily occupational performance and hence require addressing of these problems through research and evidences, to shed light on scope of functional rehabilitation for problems of linguistic memory by Occupational therapy.

Aim: To study the effect of Occupational therapy functional intervention using Cognitive Orientation to daily Occupational Performance approach in patient with linguistic memory affectation post excision of temporal lobe abscess in neuro surgery ICU.

Methods: A case study, Patient with right handed dominance was referred for OT intervention immediately after excision of temporal lobe abscess in Neurosurgery ICU. MOCA was used as screening tool and therapeutic observational activity analysis of linguistic memory was done. COPM was used to acquire 3 goals and assess occupational performance and satisfaction pre and post OT intervention based of CO-OP approach addressing problems in various language elements using different treatment strategies.

Results: The patient's MOCA score pre intervention was 26 post intervention of 10 days was 27 showing improvement in lexical fluency. On COPM occupational performance and satisfaction went on from 2 to 7 and 2 to 6 respectively.

Conclusion: Improvement in linguistic memory post OT intervention using CO-OP approach was achieved thus reflecting scope of early functional intervention in patient with linguistic memory deficits post excision of temporal lobe abscess.

  Changing paradigm of care of neuromuscular diseases in the COVID-19 pandemic: A scoping review Top

Isha Ganesh Tajane, Rucha Gadgil

K J Somaiya College of Physiotherapy, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background and Aim: In the current clinical scenario, people living with neuromuscular diseases (NMD) represent a vulnerable category with a high risk of severe course of COVID-19. Management of NMDs has become a challenge since most of them are chronic, disabling, progressive, and/or require immunosuppressive drugs. This scoping review aims to bring forth crucial queries for general neurologists and specialists dealing with NMD patients in the time of COVID-19 and highlight the research areas in a novel pandemic situation.

Methods: n= 18 articles Results: Currently, clinical data regarding the effects of COVID-19 on people with NMDs and their risk of contracting the infection or experiencing severe manifestations of COVID-19 is scarce. There are notable differences in responses to disruptions across the world. The existing care delivery model from medical and on a continuum to rehabilitation is inherently different. The technological services in developing countries seem to be potentially compromised and unexplored to a great extent.

Conclusion: COVID-19 has already caused reorganization of neuromuscular clinical care delivery and education, likely having a lasting impact on the field. This paradigm shift has impacted all sectors of clinical, rehabilitation and research avenues of patients with NMD. Evolving healthcare delivery models in neurology during the pandemic are promising. After the initial phase of rapid adjustments, countries are now coming up with practical recommendations addressing the care of NMD patients during the pandemic. With this, patients with neuromuscular conditions can continue high level medical and rehabilitation care to remain healthy and thrive,” during this pandemic.

  Feasibility of alternating voicing and swallowing water as a novel performance test for screening dysphagia Top

Jesel Dcosta, Sai Shruthhi, Mansi Jagtap, Prasanna S. Hegde

Department of Deglutology and Speech-Language Pathology, Bengaluru, Karnataka, India.

E-mail: [email protected]

Screening tests in dysphagia have been evolving in their objectivity as they are more feasible options to understanding swallow functions and dysfunctions in contrast to instrumental evaluations. The water swallow test (WST) has seen many modifications in the volume of water used, instructions, and interpretation of the results. The current study explores the feasibility of a novel performance test of alternating humming and swallowing water in screening dysphagia. 10 healthy adults in the age range of 18-35 years participated in the study who were instructed to hum for a brief period of one second soon after they completed one swallow during the 100 ml water swallow. Instances of cough, task difficulty, voice quality pre and post swallow were analyzed. 2 out of 10 participants were observed to have a cough during the performance of the task and the reported average difficulty of the task was 3.4/5. No correlation between the number of swallows in 100 ml WST and SwaVaaz. The mean number of swallows of 100ml WST and SwaVaaz were similar. Voice parameters in successive measurements pre and post swallow were significantly different similar to swallow sound parameter differences. The novel performance test of alternating humming and swallowing water is a feasible screening test that can be used with caution as the chances of instances of cough even if there is no reported dysphagia is 20%. Further exploration of utility may carry out to test the potential of the procedure to provide information on pathological swallow sounds and voice monitoring.

  The knowledge for all repository (K.A.R) promoting effective practice of neurorehabilitation in India Top

Sureshkumar Kamalakannan

Mumbai, Maharashtra, India.

E-mail: [email protected]

The Indian Federation of Neurorehabilitation (IFNR) is a multi-disciplinary organization in India that envisions empowerment of persons with neurological disabilities through continuous advancement in clinical practice, capacity building and research in the field of neurorehabilitation. As a strategic action towards its vision, IFNR launched a repository called “Knowledge for All Repository” (KAR) in September 2020. The KAR webpage has systematically organized information related to the globally standardised evaluation measures in neurorehabilitation that enable objective assessment and rehabilitation of neurological disability. The repository was developed with an objective to enable neurorehabilitation service providers and researchers to understand and implement appropriate evaluation measures for effective practice, research and training in neurorehabilitation, especially in an Indian context. The repository also aims to integrate the principles of International Classification of Functioning Disability and Health (ICF) from the WHO. A critical review of the content of the various measures was undertaken to understand which ICF domain they represented and based on this understanding the measure was linked to the relevant ICF codes. This feature would help clinicians select tools for a comprehensive evaluation within the ICF framework. There are several barriers to effectively identify an objective measure to evaluate neurological impairments and disabilities in an Indian context. There is also lack of skills among the neurorehabilitation providers to choose an appropriate evaluation measure and link it to the ICF framework. The KAR is expected to bridge these gaps in clinical practice and build skills among the neurorehabilitation providers in India to use appropriate evaluation measures. The repository is currently being utilised in India and is useful for service providers in Low and Middle-Income countries. Monitoring of its utilisation to understand its acceptability and benefits in India and other LMIC's is being carried out. The content is regularly upgraded and optimized so that the most appropriate measures are freely available for best practice in neurorehabilitation.

  Motor speech treatment for childhood ataxic dysarthria due to spinocerebellar ataxia type 29 (SCA29): A case study Top

Allison T. Streckenbein

Department of Communication Sciences and Disorders, East Stroudsburg University, East Stroudsburg, PA, USA

E-mail: [email protected]

Spinocerebellar ataxia type 29 (SCA29) is an autosomal dominant, non-progressive cerebellar ataxia characterized by infantile onset hypotonia, gross motor delay, speech motor delay and cognitive impairment. Owing to the cerebellar nature of involvement, children with SCA29 often present with signs and symptoms of predominant ataxic type of dysarthria characterized by deficits in control and coordination of speech movement patterns that disrupt articulation and prosody which in turn impacts verbal communication and social interaction. Limited research exists regarding the type of behavioral motor speech treatment and resultant communication outcomes for children with SCA29. This case study will discuss the effectiveness of a pediatric motor speech treatment that was developed based on the principles of motor learning and neuroplasticity and piloted to treat an 8-year-old male with ataxic dysarthria caused by SCA29. Treatment occurred in a university clinic for 50-minute duration, 2 times per week, for six weeks. Parent home training program was also provided. Outcome variables such as speech intelligibility, listener ratings, perceptual data and communication participation measures were assessed at baseline and at the end of six-week program. Results and effects of treatment on speech intelligibility and communication participation, and potential mechanisms underlying treatment gains will be discussed. Keywords: Ataxic dysarthria, childhood dysarthria, motor speech treatment, spinocerebellar ataxia.

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