bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation of the handicapped child - Who cares for the caregiver?
Authors: Amosun Seyi L. , Ikuesan Benson A. , Oloyede Lyabo J.
Published: July 2019

The mental health of caregivers of handicapped children (n=68), and of caregivers of children with minor ailments (n=40), was assessed using the General Health Questionnaire (GHQ). In the cross-sectional study, the caregivers of handicapped children had a significantly higher mean score which was above the threshold score. This suggests that the task of caring for disabled children may have a stressful impact on the caregivers which may contribute to psychiatric morbidity. There is a need to periodically assess the mental health of the caregiver, even as the rehabilitation of the handicapped child progresses. Addressing the psychological disturbances in the caregiver should form part of the treatment of the handicapped child.
An Ingested Foreign Body Presenting in Subcutaneous Plane on the Chest: A Rare Case
Authors: Shaikh Mohsin Ahmed Abdul Nabi , Mahuvakar Ankit Dilip , Gujrathi Atish Balajirao , Ambulgekar Vijayalaxmi Kishanrao
Published: July 2019

Migration of an ingested foreign body into subcutaneous plane is a very rare event. Most common migrating foreign bodies reported in literature are fish bones. We present a rare case of ingested foreign body, a ball point refill, which migrated and presented in the subcutaneous plane on the chest.
Schwannoma of Tonsillolingual Sulcus: First Case Report and Review of Literature
Authors: Verma Hitesh , Punia RPS
Published: July 2019

Schwannoma is a benign, encapsulated tumor that is derived from schwann's cells. The most common site is parapharyngeal space of the neck; oropharyngeal occurrence is extremely rare. Fourteen year male boy presented with a history of difficulty in swallowing, more for solids for the last 8 months. The patient also had a change of voice for the last 5 months and was muffled in character. Examination showed single lobulated mass having smooth surface, of the size of approximately 5 × 4 cm and was arising from the tonsillolingual sulcus. The fine needle aspiration cytology from the lesion, reported to be schwannoma. The mass was excised completely under general anesthesia with the help of bipolar cautery. We report first case of schwannoma of tonsillolingual sulcus and also review the literature of the rare entity.
Flap Selection in Head and Neck Cancer Reconstruction
Authors: Gupta Arunesh , Baliarsing Amresh S , Thorat Tushar S , Garg Sanchit , Bahat Uday , Bhattacharya Diptarka
Published: July 2019

Advances in head and neck reconstruction techniques have improved the results in function and the aesthetic outcome. Several flaps with different composition are available for specific reconstruction to achieve optimum result. Sensate free tissue transfer, dental rehabilitation and epiphyseal transfer for pediatric mandible are also now possible to achieve better function. The specific choice of the flap according to the region of defect and important keypoints in harvesting and reconstruction strategy for head and neck cancer are based on our experience in the last two decades.
Dorsal Approach Rhinoplasty
Authors: Dubeta Kenneth R
Published: July 2019

Direct dorsal excision of skin and subcutaneous tissue is employed in rhinoplasty cases characterized by thick rigid skin to achieve satisfactory esthetic results, in which attempted repair by more conventional means would most likely frustrate both surgeon and patient.

This historical review reminds us of the lesson: ‘History repeats itself.’ Built on a foundation of reconstructive rhinoplasty, modern cosmetic and corrective rhinoplasty have seen the parallel development of both open and closed techniques as ‘new’ methods are introduced and reintroduced again. It is from the perspective of constant evolution in the art of rhinoplasty surgery that the author presents, in Part II, his unique ‘eagle wing’ chevron incision technique of dorsal approach rhinoplasty, to overcome the problems posed by the rigid skin nose.
Invisible Orthodontics: Gen. Next!
Authors: Shivaprakash G.
Published: July 2019

The awareness about orthodontics has lead to drastic increase in many adult & adolescent seeking orthodontic treatment over the past decade. The two major setbacks for non acceptance include visibility of the appliance and the long duration of treatment. To overcome the aboveinvisible braces like - ceramic brackets, lingual brackets came into existence, but could not reduce the treatment time to a greater extent. Later surgical procedures like periodontal distraction, dentoalvelor distraction & inclusion of implant came to play. But involved surgical risk. To overcome these - the invisible braces so called clear aligners came into existence.

Clear aligners are a series of clear, removable teeth aligners that orthodontists use as an alternative to traditional metal/ceramic braces. They are more comfortable, kinder to tissues and used for minor orthodontic corrections.
ALL CERAMIC SYSTEMS - AN OVERVIEW
Authors: Shamnur Naveen , Shamnur Sunitha Naveen , Doddamani Santosh
Published: July 2019

In the search for alternative and esthetic restorative materials, many all-ceramic systems have been introduced for the general practitioner. They are used as veneers, inlays/onlays, crowns, and as enamel/dentin bonded partial or total coverage without macroretention. This article describes a classification of the different commercial all-ceramic systems and gives a review of their clinical durability. The primary changes in the field were the proliferation of zirconia-based frameworks and computer-aided fabrication of prostheses, as well as, a trend toward more clinically relevant in vitro test methods. Newer reinforced ceramics showed better durability then the earlier fired ceramic reconstructions. This report includes an overview of ceramic fabrication methods, suggestions for critical assessment of material property data.
Lasers in dentistry - Thinking ahead…
Authors: Priya NK , Sowmya NK , Ramakrishna Ashiwini
Published: July 2019

Laser technology was introduced in the field of dentistry with a novel idea of overcoming few problems or drawbacks posed by the conventional methods. Theodore Maiman in 1960 introduced the first solid state ruby laser. Since then lasers have gained its popularity in different fields of dentistry. Laser in dentistry is now in vogue and now becoming a part of the dentist's armamentarium. This article gives an insight to the basics of laser physics, types of laser, mechanism of action, their interactions with biologic tissues and their advantage and disadvantage.

How to cite this article

Priya NK, Sowmya NK, Ashwini R, Madhushankari GS, Lasers in Dentistry - Thinking ahead… CODS J Dent 2014;6;102-107
Aerosol and splatter in Dentistry - An Overview
Authors: Mehta Dhoom Singh , Pulluri Preetham , Karibasappa Sowmya Nagur
Published: July 2019

The environment in which we are surrounded is the sum total of living organisms like animals, plants and microorganisms and their actions which undergo constant changes, especially by human activity. It provides conditions for development and growth and also that of danger and damage. Aerosols are such products seen in the urban ecosystems in various forms. The presence of aerosols in earth's atmosphere can influence earth's climate, as well as human health. As they are omnipresent they form a universal challenge to all the dentists around the world to control their transmission and inhibit their action. Hence, in this article we have reviewed various properties of aerosols, methods of measurements, mode of transmission and standard precautions to be followed.

How to cite this article

Pulluri P, Karibasappa SN, Mehta DS, Aerosol and Splatter in Dentistry - An overview CODS J Dent 2015;7:28-32.
Comparative Evaluation of microhardness of type 2 Glass Ionomer Cement (restorative) and Zirconia based GIC - An In-Vitro Study
Authors: Lokhande Prakash
Published: July 2019

Aims

To evaluate the microhardness of type II glass-ionomer cement (GIC) (restorative) and zirconia based glass –ionomer cement.

Materials and Methods

Twenty cylindrical samples measuring 5mm (diameter) and 5mm in length were prepared with type II glass-ionomer cement that is restorative (n=10) and zirconia based glass-ionomer-cement (n=10). Finishing and polishing was made with coarse grit to fine grit. Then samples were subjected to Vickers hardness tester by using digital micro hardness tester (Zwick/Roell) under a load of 300 grams for 15 seconds. The data obtained was subjected to statistical analysis and unpaired‘t’ test was used to compare the micro hardness between two groups.

Result

Zirconia based glass-ionomer cements showed better micro hardness values as compared to that of type II glass-ionomer cement (restorative).

Conclusion

Better material with increased hardness like zirconia based GIC should be used in today's clinical practice. Further studies should be carried out to check other physical properties of zirconia based GIC.

How to cite this article

Lokhande P, Shivanna V. Comparative evaluation of micro hardness of type 2 Glass Ionomer cement (restorative) and Zirconia based GIC- An in vitro study. CODS J Dent 2015;7:4-7
Hypoplasia Management in permanent incisor caused by primary incisor intrusion- A case report
Authors: Ananthraj. A , Neena. I.E , Praveen. P
Published: July 2019

Orofacial trauma is a serious orodental and general health problem that may have medical, esthetic and psychological consequences for children and their parents. When the root of the primary tooth is close to the unerupted permanent tooth, primary tooth trauma may result in developmental disturbances and pulpal reaction in that permanent tooth. We report a case in which injury to the primary dentition resulted in developmental disturbances in the underlying permanent tooth. Localized malformation of the crown and enamel hypoplasia was treated with a light-cured composite resin restoration.

How to cite this article

Neena IE, Ananthraj A, Praveen P. Hypoplasia management in permanent incisor caused by primary incisor intrusion â€“A case report. CODS J Dent 2015;7:50-51
Unwanted Muscle Weakness following Botulinum Neurotoxin A Administration in Spinal Cord Injury with Literature Review
Authors: Joshi Tapan N
Published: July 2019

Botulinum neurotoxin A (BoNTA) is rapidly gaining acceptance for management of spasticity secondary to spinal cord injury (SCI). Due to its increased usage, more undesirable effects and complications have come in light. Unwanted distant and/or generalised muscle weakness is possible following BoNTA administration in SCI population causing temporary neurological and functional decline. Physicians should carefuly perform a clinical assessment of every patient individually for risks stratification. Additional studies for adult population evaluating adverse-effects of high dose of BoNTA treatment for spasticity management are indicated.
A Patient with Fixed Flexion Deformity of Hip and Knee
Authors: Das P , Basak A , Ghorai D , Pan P P , Khatua D K
Published: July 2019

A 17 years old female patient presented to PMR OPD with fixed flexion deformity of left hip and knee and cachexia. Five years back a severe pain was suddenly developed in her left knee and thigh which was investigated for juvenile inflammatory arthropathy and rheumatic arthritis. At that time all the serological markers (ANA, RF, ASO titre) and x-ray of knee were normal. Subsequently left hip pain and restricted ROM were developed which made it clear that the knee pain was actually referred from hip. A plain x-ray of hip was done to rule out Perthe's disease which was reported as avascular necrosis of femur.

When the patient was examined at PMR OPD, a CT scan of hip, routine hemogram, CXR, Manteux test was advised considering a provisional diagnosis of infective pathology like TB hip with a differential of neoplaia in or around hip keeping in mind about cachexia and weight loss. Surprisingly CT scan showed a big mass originating from glutei muscles evading back of the thigh and even left sphincter ani muscle. Fortunately patient was continent at that time. Interestingly the pathological report suggested a relatively rare diagnosis which practically made the patient bedridden with commonly featured fixed flexion deformity.
Effectiveness of Tolperisone Hydrochloride with Aceclofenac as Combined Therapy in Acute Low Back Pain.
Authors: Bhattacharjya B , Naser S Mohammad , Biswas A , Kamal F , Banerjee K
Published: July 2019

Objective

An open label, non-randomised, prospective study was conducted to evaluate the effectiveness of tolperisone hydrochloride 150mg thrice daily with aceclofenac 100mg twice daily compared to aceclofenac 100mg twice daily alone for the treatment of acute low back pain (LBP) for 14 days. total (n=242) patients recruited for the study were divided into two treatment groups. One of the group (n=124) received oral tolperisone plus aceclofenac and the other (n=118) Aceclofenac alone. The pain intensity was assessed by visual analogue scale. Patients were informed to report any adverse effect encountered during the study period. The overall effect of the drug (global assessment of the study medication) on pain and adverse effects were assessed by the patients at the end of the trial on a categorical scale. There was significant reduction in pain score in the tolperisone group than aceclofenac group with insignificant adverse effects which didn't require discontinuation of the study. Tolperisone when added with aceclofenac can be more effective than aceclofenac alone for relief of acute LBP with minimum adverse effects.
Prosthetic Fittings Limitations and Its Present Scenario in India and Abroad
Authors: Mathur M K
Published: July 2019

Dr. Mahendra Kishore Mathur currently working as Chief Consultant Research Development & Training, Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), Jaipur. After finishing his MS (Orthopaedics) from S.M.S Medical College Jaipur under guidence of Dr. P.K. Shethy on 1983 he worked as a teacher of PMR in same institute for two decades. He has several National and International level of publications. He also contributed chapters in Manuals of Fabrication of Jaipur Below Knee Systems, Fabrication of Jaipur Above Knee Systems, Fabrication of Jaipur Foot, “Jaipur Artificial Limbs” - First comprehensive Text Book on Jaipur Limb Technology. He is the first orator of Bengal oration of IAPMR on 2012 introduced by West Bengal Chapter of IAPMR.
Audit of Safety of Intramuscular Botulinum Toxin Injections among Patients Receiving Warfarin Anticoagulation Therapy
Authors: Jagatsinh Yogendra , George Jim
Published: July 2019

Background

Botulinum toxin (BTX) intramuscular injections are an effective treatment for spasticity in acquired brain injury. Despite use since the 1980s, issues concerning technique, dose and long-term side-effects remain unresolved. For example, the safety of BTX in warfarinised patients is unclear. There are two studies reporting the risk of intramuscular injections in patients receiving anticoagulant therapy with regard to possible local haematoma formation. There is no advice on this subject in the manufacturers’ summary of product characteristics for the original brand of warfarin, Dysport, BOTOX, Xeomin or in the British National Formulary.

Aim

To assess the safety of BTX injections in patients receiving oral anticoagulation.

Design

Prospective audit of safe practice.

Setting

Outpatient setting in a rehabilitation centre.

Population

Adult population affected with spasticity with acquired brain injury and receiving concurrent warfarin anticoagulant therapy.

Methods

Fourteen patients who were receiving anticoagulant therapy were given regular BTX (number of injection cycles or total mean no of injections each). Patients gave written informed consent before the injections. Injection technique did not differ from that used for un-anticoagulated patients. Patients were assessed by the injector for obvious haemorrhage in the first 15 minutes after the injection resulting in swelling, bruising, tenderness or haematoma. Patients were asked to watch for appearance of local reactions like swelling, bruising or haematoma and pain in the first week.

Results

There were no clinically detectable local complications after intramuscular injections and no major or minor bleeding episodes after BTX injections.

Conclusion

In our group, BTX injections were administered intramuscularly to patients who were receiving anticoagulant therapy without significant risk of local bleeding. However, injections must be used with caution in patients with an INR above the therapeutic range.

Clinical rehabilitation impact

BTX can be safely given in patients on anticoagulation therapy with safety checks in place.
Traumatic Cervical Spine Injury Pattern– A Snapshot
Authors: Joshi M , Agrawal Mahima
Published: July 2019

Study design and subjects

Cross-sectional descriptive study of pattern of cervical spine injury at a tertiary care rehabilitation centre in Rajasthan.

Objectives

To observe the socio demographic profile and injury pattern in cervical spinal cordinjury.

Methods

One hundred and forty-one clients of traumatic cervical spine injury (CSI) were admitted from 1st December 2010 to 15th October 2011 at the Department of Physical Medicine and Rehabilitation, S.M.S. Medical College and Hospital, Jaipur. Detailed clinical, neurological evaluation as per American Spinal Injury Association Classification (ASIA) and radiological assessment were done along with identification of mechanism of injury, mode of evacuation and presence of associated injuries. Data analysis was done in October 2011 and results were compiled and analysed.

Results

Mean age in our sample was 35.87 ± 14.38 years that comprised 11 females (7.8%) and 130 males (92.2%) of whom 78 (55.3%) fell in the age group of 25 to 55 years. Majority 64 (45.4%) were illiterate, 80 (56.8%) being farmers and labourers. Greater fraction had road traffic accidents i.e., 66 (46.81%) and fall from height 56 (39.72%) as the mechanism of trauma. Only 69 (49.8%) could arrange an ambulance for transport. Majority of the injured i.e., 84 (59.57%) presented with neurologically complete picture as per ASIA classification and the most common involvement being of 5th and 6th cervical segments i.e., 103 (73.15%).

Conclusion

This study evaluated the demographic variables of cervical spine injury for better understanding of impact that it has and further for better allocation of our health resources, distribution and planning
Pentazocine Induced Contractures: A Case Report of Drug Abuse
Authors: Agarwal A.K. , Gupta A.K , Sharma V.P. , Kumar Dileep
Published: July 2019

Contractures around the joints are seen due to multiple causes in our day to day practice where pathology can be superficial or deep. Further it can involve one joint or multiple joints. We are presenting a rare case of drug abuse due to pentazocine (fortwin) here in a 32 years old male, who had generalised and severe contractures of his hips, knees and ankles. In all such cases of myogenic generalised contractures around multiples joints, we must exclude the possibility of drug abuse.
Back Pack Palsy as an Unusual Cause of Shoulder Pain and Weakness–A Case Report
Authors: Mansoor S.N , Rathore F.A , Muhammad Fahim
Published: July 2019

Heavy back packs carried for prolonged durations can cause different musculoskeletal and neurological problems especially in the untrained and physically vulnerable individuals. They can cause postural disorders, gait abnormalities, muscular strains, pains and injuries to the brachial plexus and nerves resulting in significant morbidity and at times permanent disability. We report a case of brachial plexus injury in a young soldier wearing back pack for prolonged period. He developed weakness and pain in right shoulder which was not relieved with rest and analgesics. On examination he had weakness in deltoid, biceps and scapular muscles along with numbness in axillary nerve area. Brachial plexus injury (upper trunk) was suspected and confirmed by electrodiagnostic evaluation. His baseline investigations were normal. He was advised rest and avoidance to lift heavy weight. He was managed with electrical muscle stimulation for weak muscles, strengthening exercises and analgesics. He responded well to the treatment and had minimal residual weakness at the end of the six weeks’ treatment

Back pack palsy should be suspected in people carrying back packs and presenting with pain, weakness and numbness in the upper limbs. It can be prevented by education in the use of back packs, its weight limits, physical fitness and frequent breaks with changing positions.
Arnold Chiari Malformation with Holocord Syringomyelia Presenting as Unilateral Foot Drop: A Case Report
Authors: Krishnaprasad I.N , Soumya V , Abdulgafoor S
Published: July 2019

Foot drop is a common problem encountered in the clinical practice of a medical rehabilitation specialist. The aetiology of foot drop is usually lower motor neuron, either by the affection of peripheral nerve or the lower lumbar roots. However other rare differential diagnosis of foot drop should be borne in mind while evaluating such a patient. A detailed neurological evaluation along with supportive investigations like electrodiagnosis and magnetic resonance imaging often helps in differentiating such a cause. Here we report a case of holocord syringomyelia, secondary to Arnold Chiari malformation type 1, presented as unilateral foot drop.
Whistling-face Syndrome – A Case Report
Authors: Sahoo P K , Sahoo J , Das S P , Mohanty R N
Published: July 2019

The craniocarpotarsal, or “whistling face” syndrome was first described by Freeman and Sheldon in 1938. It's an extremely rare condition, comes under one type of distal arthrogryposis category. Prominent deformities include deformity of hand and foot with typical whistling face. Early diagnosis of the condition aware the clinician about resistance to different therapeutic manoeuvres and management is planned accordingly.
Profile of Traumatic Spinal Cord Injury Patients Admitted in Physical Medicine and Rehabilitation Department of a Tertiary Care Hospital: A North East India Experience
Authors: Chanu A R , Zonunsanga C , LNU Hmingthanmawii , Pertin M
Published: July 2019

Study Design

Retrospective Descriptive Study.

Setting

Physical Medicine and Rehabilitation (PMR) Department, Regional Institute of Medical Sciences (RIMS), Imphal, a tertiary care teaching hospital in North East India

Study Duration

1st November 2011 to 31st October 2012.

Study Duration

1st November 2011 to 31st October 2012.

Objective

To study the profile of traumatic spinal cord injury (SCI) patients admitted in PMR Department, RIMS.

Materials and Methods

Neurological profile of traumatic SCI patients admitted in PMR Department, RIMS was recorded using a structured proforma and analysed. Demographic profile of the patients, time since injury, functional status and complications were also recorded.

Results

Among all 22 patients, 16(72.7%) were tetraplegics with C5 (59.09%) as the most common neurological level involved. Twelve (54.5%) were American Spinal Injury Association (ASIA) grade A. The mean motor and sensory scores were 45±24.97 and 157.50±69.53 respectively. The mean FIM score (at admission) was 71.50±23.40 and FIM (at discharge) was 82.35±20.72. Spasticity was present in 16 cases (72.7%) with gastrosoleus as most common site. There were 14 patients (63.6%) who had urinary tract infection (UTI). Only 5(22.7%) underwent urodynamic study and all had hyperactive detrussor. The most common mode of bladder management was clean intermittent catheterisation (CIC) which was done in 16 patients (72.7%). Pressure sore was seen in 14(63.6%) of patients with sacrum (78.57%) as the most common site.

Conclusion

Majority of traumatic SCI inpatients were of ASIA grade A and tetraplegics were commoner. Fall from height was the comonest cause of injury. Spasticity, UTI and pressure sores were common complications.
Anatomic Reconstruction of the Distal Radio-ulnar Ligament for Distal Radio-ulnar Joint Instability : A Case Report
Authors: Sahoo Jagannatha
Published: July 2019

Stability of the distal radio-ulnar joint (DRUJ) is provided by bony architecture and by soft tissues such as the triangular fibrocartilage complex (TFCC), the joint capsule, and surrounding muscles. Many authors have made various attempts to restore DRUJ stability surgically following trauma. The objective of this study was to analyse clinical outcomes after anatomic reconstruction of the distal radio-ulnar ligaments in a 26 years male with post-traumatic chronic instability of the DRUJ. Anatomic reconstruction of the major structures responsible for joint stability is the most important principle for the treatment of instability of an injured joint with an intact articular surface by using a palmaris longus tendon graft whose ends were anchored in pre-drilled holes in the radius and the ulna. Anatomical reconstruction of the distal radioulnar ligaments is thought to be an effective procedure for treating post-traumatic DRUJ instability.
A Case Report of Hirayama Disease
Authors: Kumar Deepak , Singh Gogia Virinder
Published: July 2019

Hirayama disease is also known as juvenile muscular amyotrophy of distal upper limb. This type of condition is rare and difficult to differentiate this disease from other disease with similar symptoms such as motor neuron disease. Very few cases reported in Medical science and its management is not much proved. But in our case a 20-year-old male came to department with complaint of slowly progressive muscle atrophy and weakness in distal U/L of right side. This disease had confirmed by MRI of flexed cervical region. Patient was managed by similar protocol: Vitamin B12, exercise of hand, cervical collar and isometric neck muscle exercise. Got benefit to patient for cessation of progressive of disease. It is necessary to early diagnosis of Hirayama disease so that patient got early management. Surgical management is preserved to late stage. In case of similar symptoms of cold paresis, amyotrophy, weakness of distal upper limb then a flexion MRI study should be performed to confirm the diagnosis.
A Multidisciplinary Rehabilitation Approach for Writer's Cramp: A Case Study
Authors: Tripathi D R , Kumar Amod , Talele Mahesh , Singh Suryabhan
Published: July 2019

A 61 year-old male was referred from neurology to PMR department RML hospital, New Delhi, with difficulty in writing for 2 years prior to consultation. Initially difficulty in writing which is accompanied with pain after prolonged writing. Also he noticed tremor and stiffness while writing. Disability progressed and he was unable to write even a few words legibly and cannot hold object (spoon) which leads to anxiety and dependency.

When the patient was examined at PMR OPD, EMG/NCV study was advised, which showed normal sensory and motor nerve functions.

The present treatment involved the use of a multidisciplinary therapeutic approach with Physical Medicine and Rehabilitation Specialist, Clinical psychologist and Occupational Therapist which gave us satisfactory results within 6- 8 months. The findings in this case is very encouraging and studies with large sample sizes can be considered for further conclusive evidence on the treatment of writer's cramp.
Plexiform Neurofibromatosis with Abnormal Pachydermatocele: A Rare Case Report
Authors: Agarwal AK , Kumar Dileep , Gupta Anil Kumar , Yadav Ganesh
Published: July 2019

Plexiform neurofibromatosis, also known as pachydermatocele, is a rare type of neurofibromatosis, caused by excessive growth of the neural tissue in the subcutaneous fat. This condition is rare in Indian subcontinent but when it occurs, it causes cosmetic as well as functional disability. The optimal management of plexiform neurofibroma is not well defined and surgery is often delayed. We report a rare case of neurofibromatosis with pachydermatocele involving the nerves of the left thigh and leg with disfigurement and associated disability.
Spinal Cord Injury in Decompression Sickness: A Case Report
Authors: Henry Prakash M , Hariharan Ramaswamy , Chandy Bobeena
Published: July 2019

Study Design

Case report.

Objective

To describe an unusual case of deep diving followed by spinal cord injury due to decompression sickness (DCS).

Setting

Princess Royal Spinal Injuries Centre, Sheffield Teaching Hospitals NHS Foundation Trust, England.

Method

Description and observation of management and outcomes, of spinal decompression sickness (DCS).

Results

The patient's symptoms and signs developed after she surfaced after a deep sea diving event. She was managed and treated in a tertiary level care hospital. MRI performed within 24 hours, showed signs of increased signal intensity in the cervical and thoracolumbar regions. She was treated with hyperbaric oxygen which improved her pain symptoms but there was no immediate resolution in motor sensory deficits. Repeat MRI done after a week showed resolution if hyperintensity in the cervical region but not in the thoracolumbar region. Patient progressed to have significant neurological recovery in the next 6 months. She became ambulant with unilateral ankle foot orthotic and a pair of crutches, she continued to have bladder incontinence at 1 year follow-up interval.

Conclusion

Central nervous involvement is not uncommon in decompression sickness in divers. Early diagnosis and proper management can reduce acute symptoms and prevent further complications of permanent neurological disability. Primary prevention by education and adhering to standard diving guidelines is needed to reduce mortality and morbidity in decompression sickness.
Effectiveness of the Home-based Habilitation Programme for Children with Cerebral Palsy
Authors: Racic Maja , Kusmuk Srebrenka , Krstovic-Spremo Vesna
Published: July 2019

Objective

This study was undertaken with the aim to compare the effects of home-based habilitation programmes with the effects of hospital-based habilitation programme for children with cerebral palsy (CP) on motor performance and daily functioning.

Patients and methods

The study was conducted on a sample of 60 children with cerebral palsy. First group included 30 children, 5 to 12 years old, who had a continued physical home treatment and education in public/special school. The second group consisted of 30 children, from Banja Luka region, who continued inpatient habilitation programme and training. Habilitation outcomes were analysed by measuring muscle tone (using original Tardieu Scale), muscle strength, range of motion (ROM), gross motor functions (gross motor function measure-88) and the Barthel Index of activities of daily living (ADL).

Results

The proportion of clinically significant change in gross motor functions, ADLs, ROM and muscle strength didn't show major differences between the two groups.

Conclusion

There were no significant differences in effectiveness between home-based and hospital-based habilitation programmes according to the treatment outcomes. The effectiveness of home-based programme increases when supplemented by frequent consultations with the rehabilitation team members and occasional out-patient physical therapy treatment, education as well as counselling and support for parents.
Assessment of Autonomic Dysfunction in Chronic Complete Spinal Cord Injury by Heart Rate Variability
Authors: Navin BP , Dube Amitava
Published: July 2019

Objectives

Non-invasive assessment of cardiac autonomic dysfunction in spinal cord injury (SCI) by means of heart rate variability analysis (HRV). Also, to assess the effect of postural change on neural outflow.

Setting

Rehabilitation research center, Sawai Man Singh Hospital, Jaipur.

Participants

110 patients with SCI were screened, of whom, 12 patients aged between 20 and 30 years with chronic complete SCI and neurological level of T6 or above were included. An equal number of age and sex matched healthy individuals were the controls.

Interventions

Five minute ECG recording, first in supine position and then in sitting position was done.

Outcome measures

Frequency domain measures of heart rate variability.

Results

No significant differences were observed between both the groups in supine rest. On sitting, the absolute power of the low frequency (LF) and high frequency (HF) components were significantly less in the SCI patients than that in the controls. A significantly increased LF-to-HF ratio along with a higher mean heart rate (HR) was observed in the controls on postural change.

Conclusion

On change of posture, the controls showed a physiologically patterned response, which was not observed in the SCI patients. The loss of this homeostatic mechanism in the SCI subjects was observed, which may reflect a dysfunctional autonomic nervous system interplay in patients with complete SCI.
Tibialis Posterior Tendon Transfer in Post Injection Common Peroneal Nerve Palsy in a Paediatric Patient–A Case Report
Authors: Sudesh Pebam , Kumar Deepak
Published: July 2019

Post injection foot drop is due to common peroneal nerve damage at site of injection (gluteal region) in which dorsiflexor of foot EHL, EDL and tibialis anterior are weakend or paralysed. It can be managed by reconstructive surgery; tibialis posterior tendon transfer to EHL, EDL and 2nd metatarsal. Here objective is rehabilitation of post injection common peroneal nerve palsy foot drop in a paeditaric patient. Our method and outcome measure as first rehabilitation programme for foot drop paediatric patient (common peroneal nerve palsy) thereafter reconstructive surgery of tibialis posterior transfer to EHL, EDL and 2nd metatarsal. Last we re-educate them to tibialis posterior contraction for dorsiflexion of foot. Our result was patient was able to walk similar as normal, able to elevate her toes and foot. Patient was happy and confident with her functional foot. But patient was advised to avoid heavy work, sprinting, and active aggressive game (like foot ball). Our conclusion is patient gets benefited by this procedure.
Clinical and Imaging Evaluation of Efficacy of Viscosupplementation in Degenerative Osteo-arthritis Knee – A Prospective Interventional Study
Authors: Gupta Rohini , Kothari SY , Nandi Jaydeep , Borah Diganta , Thukral BB
Published: July 2019

In this study 30 patients with osteo-arthritis (OA) knee (total 55 knees) were given weekly injections of high molecular weight (HMW) hyaluronic acid (HA) for 3 weeks. The subjective parameter was Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) score which improved from 97.67±21.4 at baseline to 61.03±24.8 at six months follow-up (p=0.0001). Also the mean range of motion (ROM) of the involved knees was 125.73± 10.8 degrees at baseline and it increased to 132.64±5.2 degrees after six months (p=0.0001) of injection treatment. The objective parameter of disease modification was MRI based semi-quantitive Whole-organ Magnetic Resonence Imaging Score (WORMS) score. The mean of total WORMS score in medial femorotibial joint (MFTJ) and patellofemoral joint (PFJ) improved from baseline (28.382±10.446; 22.64±5.969) to final follow up (27.46±10.32; 21.76± 6.182) which was quite significant (p=0.0321; p=0.0294) and implies a reduced rate of cartilage destruction after injection HA though there is no regrowth of cartilage as such.
Concurrent and Discriminative Validity of the Mini Balance Evaluation Systems Test (miniBESTest) in People with Parkinson's Disease
Authors: Mak Margaret KY
Published: July 2019

Purpose

To examine the concurrent and discriminative validity of the miniBESTest in individuals with Parkinson's disease (PD).

Method

Thirty-four individuals with PD participated in study 1. Thirty-one healthy subjects and 127 individuals with PD completed study 2. All participants were assessed at the University Balance and motion analysis laboratory. Balance performance was assessed using the miniBESTest and Berg's balance scale (BBS). Self-perceived balance confidence level of subjects was measured by the activities-specific balance confidence (ABC) scale.

Results

In study 1, results of Pearson's correlation showed that the scores of the miniBESTest correlated well with BBS (r=0.765; p<0.001) and moderately well with ABC scores (r=0.587; p<0.001). For study 2, results of one-way analysis of variance demonstrated significant differences in miniBESTest scores among healthy subjects, PD non-fallers (PD-NF) and PD fallers (PD-F). Healthy subjects obtained the highest mini-BESTest score of 88.2 ± 8.9%, followed by PD-NF (73.6 ± 14.7%) and PDF (57.1 ± 17.0%) (all p<0.001). Significant differences were also observed among healthy subjects, PD-NF and PD-F for each miniBESTest domain score (all p<0.05).

Conclusion

The miniBESTest is a valid method to document balance performance in individuals with PD. Both total and domain miniBESTest scores could differentiate between healthy subjects, PD-NF and PD-F.
Evaluation of the Effects of Lumbosacral Corset on the Patients with Chronic Non-specific Low Back Pain
Authors: Shakoor Md. Abdus , Islam Mohammad Tariqul , Rahman Md. Muhibbur , Rahman Md. Shahidur , Moyeenuzzaman Md.
Published: July 2019

A randomised clinical trial was conducted in the Department of Physical Medicine & Rehabilitation (PMR), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. A total of 81 patients having chronic LBP were included according to the selection criteria. Out of them, 31 (38.3%) were male and 50 (61.7 %) were female in a ratio of 1: 1.61. The mean age of the patients in study was 41.65 ± 8.41years. Female persons were affected in their earlier ages (between 30 and 45 years) than male. Most of the patients were housewives (54.3%). The patients were divided randomly into two groups by the way of lottery for the clinical trial. Group-A patients were treated with NSAIDs, activities of daily living instructions (ADLs) and lumbosacral corset and group-B patients were treated with NSAIDs and ADLs. The patients were followed up weekly for five weeks and significant improvement was recorded after the treatment in both the groups (p=0.001). In comparison between two groups, it was found that there was no significant improvement in pre-treatment, after 1st week and after 3rd week. A little bit improvement was found in group-A patients than group-B after 4th week (p= 0.06). But finally, there was significant improvement in group-A than group-B patients after 5th week (p=0.005). So, it may be concluded that both the treatment is effective for the patients with chronic non-specific LBP. But the patient may be more benefited if lumbosacral corset is used as an adjunct to NSAIDs.
The Role of Physiatrist in the Diabetes Healthcare Team
Authors: Veyilmuthu Ramamoorthy
Published: July 2019

The physiatrist is an important member of the diabetes healthcare team. His/her primary role is to provide physical activity counselling for the diabetics after thorough evaluation. Exercise is a primary component of diabetes management together with diet plan and antidiabetic drugs. The physiatrist, with his/her background knowledge in exercise physiology, is the most appropriate person for this job. Regular exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss and improve well being. Furthermore, regular exercise may prevent type 2 diabetes in high risk individuals. Thus physical activity plays a pivotal role in health promotion and diabetes control. People with diabetes should be advised to perform at least 150 minutes per week of moderate intensity aerobic physical activity using ‘FITT Principle’. In the absence of contra-indications, people with type 2 diabetes should be encouraged to perform resistance training three times per week. DeLorme resistance exercise improves power, strength, endurance and burns more calories. Cross training is the term used to describe the use of a variety of activities during exercise. Interval training is the variation of intensity during one or more aerobic activities. Circuit training is the combination of aerobic exercise and weight training (anaerobic exercise). Before recommending a programme of physical activity, the physiatrist should assess diabetics for coronary artery disease and other complications of diabetes.
Hitchhiker's Toe and Lumbar Disc Lesion: A Strange Coincidence in a Patient with Idiopathic Dystonia Treated with Botulinum Toxin Injection
Authors: Baqer Ayyoub , Jai Shanthini S , Gawad Wael Abdul
Published: July 2019

A 40 years old female with generalised dystonia and chronic low back pain was injected with botulinum toxin injection to extensor hallucis longus(EHL) for management of Hitchhiker's toe. The patient benefited functionally but later developed EHL and extensor digitorum (ED) weakness. Further workup revealed degenerative L4/5 disc lesion causing L5 root affection as the cause for the weakness. This coincidental occurrence of EHL and ED weakness due to L4/5 disc lesion in a patient with generalised dystonia, following botox injection to EHL for management of Hitch hiker's toe, has not been reported before.
A Study of Effects of Intervention of Botulinum Toxin- A on Lower Limb in Children with Spastic Cerebral Palsy
Authors: Singh U , Kumar Raj , Wadhwa Sanjay , Yadav SL
Published: July 2019

Objective

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

Study Design

Prospective study

Methods

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

Results

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

Conclusions

Botulinum toxin- A injection is effective in the treatment of spastic lower limb muscles for equinus/ crouching/scissoring gait in cerebral palsy children. The treatment was feasible and easily implemented. Botulinum toxin- A injections were well tolerated, yielded no serious treatment-related adverse events.
Electrodiagnosis of Medial Pectoral Nerve Mononeuropathy
Authors: Gupta Sunny , Patel Mitesh , Sinha Anupam , Karech Charles Wow
Published: July 2019

With an increased awareness to maintain physical fitness, weight training has become increasingly popular. Neurologic injuries are one of many injuries which can occur accidentally or with improper technique. We present a case of an isolated right medial pectoral nerve mononeuropathy in a 48-year-old male weightlifter.
Idiopathic Scoliosis: A Case Report
Authors: Bhuniya Sourin , Pampa De , Mandal P K
Published: July 2019

Introduction

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

Case report

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

Conclusion

Conservative management in the form of bracing can prevent curve progression and floor reaction AFO's can indirectly affect the remote body segments and improve gait and posture.
Does Radiologic Grading Predict Severity of Osteo-arthritis Knee
Authors: Naorem Ajit Singh , Ningthoujam Jugindro Singh , Wangjam K , Rajesh RK
Published: July 2019

Objective

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

Methods

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

Results

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

Conclusions

There is discordance between radiographic findings and clinical features of OA knee and we should not plan treatment on the basis of radiologic grading rather on the functional status and symptoms.
Study of Effectiveness of Shoulder Elbow Wrist Hand Orthosis in the Management of Glenohumeral Subluxation in Post-stroke Hemiplegic Patients
Authors: Sharma G. Sonachand , Touthang Alex T , Singh Y. Nandabir , Joy Ak. , Singh Bimol , Devi Tamphaleima
Published: July 2019

Objective

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

Methods

Design: Randomised control trial.

Setting

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

Participants

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

Duration

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

Intervention

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

Outcomes

Grade of glenohumeral subluxation using x-ray.

Results

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

Conclusions

Use of upper limb orthosis in addition to routine rehabilitation programme can effectively reduce glenohumeral subluxation in post-stroke hemiplegic patients.
When a Safety-Valve Became a Ticking Time-Bomb: Fractured Tracheostomy Tube as a Tracheobronchial Foreign Body in a Child
Authors: Viswanathan Anand , Esakkimuthu Subbian
Published: July 2019

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