Ameed Equebal

Effect of Locomotor Training on Motor Recovery and Walking Ability in Patients with Incomplete Spinal Cord Injury: A Case Series

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.

Comparison of energy cost in transtibial amputees using "prosthesis" and "crutches without prosthesis" for walking activities.

BACKGROUND In a survey of 100 transtibial amputees (TTA) in the study place, it was noticed that nearly 30% of total activities performed by crutches. It was recorded nearly 52% of the amputees were totally independent, 39% had to use a crutch or cane and only 9% need not used any devices simply because they are unaware of current technology or availability. Out of 39 TTA, nine used crutches only for performing daily activities while 30 used both prosthesis and crutch. Walking is a major activity in lower limb amputees and therefore it is imperative to know the energy cost in both the mobility devices (prosthesis and crutches without prosthesis) for walking activities. OBJECTIVES The purpose of this study was to quantify and compare the difference in energy cost between the two most commonly used assistive devices (prosthesis and axillary crutches) in adults with Transtibial amputation by indirect calorimetric method at the self-selected speed in plane surface walking. METHODS Thirty adults who had a unilateral transtibial amputation participated in this study. Oxygen consumption was measured with a Cosmed K4 b(2) oxygen analysis telemetry unit (Rome, Italy) as the participants walked over level ground for 30 meters at a self-selected speed. The variables that were analyzed were VO(2) rate (mL/min), VO(2) cost (mL/kg/m), heart rate (bpm), self-selected walking velocity (m/min) and energy expenditure per minute (Kcal/min). RESULTS It was observed that VO(2) uptake rate and EE comparisons were highly significant for both prosthesis and crutches without prosthesis walking in adults with transtibial amputation (P<0.025). There was significant difference between prosthesis walking and crutches without prosthesis walking in terms of VO(2) uptake rate (P<0.005) and EE/min (P<0.00001). It was noticed the adults with transtibial amputation using prosthesis walked with 21% more efficient in terms of VO(2) uptake rate and 92% more efficient in terms of EE/min as compared to crutches without prosthesis. CONCLUSIONS The data on energy cost indicates that all below knee amputee groups walk with less effort by using prosthesis. It may be concluded that crutches without prosthesis may not be used as a permanent rehabilitative measure in transtibial amputations.

EFFICACY OF PRESSURE-BIOFEEDBACK GUIDED DEEP CERVICAL FLEXOR TRAINING ON NECK PAIN AND MUSCLE PERFORMANCE IN VISUAL DISPLAY TERMINAL OPERATORS

Purpose: This randomized trial study compared the efficacy of pressure-biofeedback guided deep cervical flexor training as an adjunct with conventional exercise on pain and muscle performance in visually displayed terminal operators. Methods: A total of 50 (22 men and 28 women) patients with neck pain participated in the study. Patients were randomly placed into two groups: a biofeedback group (n = 25) and a control group (n = 25). The biofeedback group received pressure-biofeedback guided deep cervical flexor training program for 5 days a week for 6 weeks, whereas the control group received an exercise program only. Results: On intergroup comparisons, the deep cervical flexor performance in biofeedback group, at the end of 6th week was significantly higher than those of control group (p < 0.01). Pain intensity was also significantly reduced in biofeedback group when compared to control group at the end of trial (p < 0.004). Conclusion: The addition of pressure-biofeedback to a 6-week conventional program appeared to increase deep cervical flexor muscle performance, compared to the exercise program alone for people with reduced muscle performance.

Effect of gender on strength gains after isometric exercise coupled with electromyographic biofeedback in knee osteoarthritis: a preliminary study.

OBJECTIVE The objective of this trial was to evaluate the effect of gender on strength gains after five week training programme that consisted of isometric exercise coupled with electromyographic biofeedback to the quadriceps muscle. MATERIALS AND METHODS Forty-three (20 men and 23 women) patients with knee osteoarthritis (OA), were placed into two groups based on their gender. Both groups performed isometric exercise coupled with electromyographic biofeedback for five days a week for five weeks. RESULTS Both groups reported gains in muscle strength after five week training. However, the difference was found to be statistically insignificant between the two groups (P=0.224). CONCLUSION The results suggest that gender did not affect gains in muscle strength by isometric exercise coupled with electromyographic biofeedback in patients with knee OA.

The prevalence and impact of age and gender on rehabilitation outcomes in spinal cord injury in India: a retrospective pilot study.

Study design:Retrospective, 1 year case series.Objectives:To analyze the relationship between gender, age, injury-related variables and rehabilitation outcomes in patients with spinal cord injury (SCI).Setting:Tertiary Rehabilitation Center, Inpatient rehabilitation unit, India.Methods:The data from a series of SCI cases were analyzed. Each case was followed from admission into the hospital until their discharge. Patients were described according to age, gender, etiology of SCI, neurological classification, medical complications, American spinal injury association (ASIA) classification, length of rehabilitation stay and spinal cord independence measure (SCIM).Results:Forty-seven new SCI cases, 37 (78.7%) male and 10 (21.3%) female patients, were reported over a 1-year period during 2009–2010. Male patients were younger than the female ones, but the difference was not statistically significant. There was no statistically significant relationship between age or gender, and the following SCI variables: ASIA classification, neurological classification, SCI complications and length of stay (P>0.05). Traumatic etiology and Pott’s disease was found be related with gender (P<0.05). There was no statistically significant relationship between age or gender and SCIM score at admission or discharge (P>0.05).Conclusion:Age and gender are not significantly related to outcomes of rehabilitation or characteristics of SCI in this sample. Further research is needed to confirm the generalizability of these findings and to identify which factors contribute more strongly to SCI rehabilitation outcomes.

Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization

Objective: To observe changes in cystometric parameters in individuals with spinal cord injury (SCI) with neurogenic bladder practicing clean intermittent self-catheterization (CIC) and incidence of urinary tract infection (UTI) in such patients. Design: Prospective, observational study. Setting: Tertiary Urban Rehabilitation Hospital. Participants: Persons with neurogenic bladder caused by traumatic SCI and practicing CIC. Interventions: Clinical evaluation, complete urine analysis, urine culture and sensitivity, ultrasonography of the abdomen and urodynamic study were evaluated at baseline and at follow-up (6 months to 1 year). Outcome Measures: Detrusor pattern, cystometric capacity, detrusor compliance, detrusor leak point pressure, residual urine, incidence of UTI. Results: Thirty-one participants were included in the study. The baseline cystometric study showed that 15 had overactive detrusor and 16 had detrusor areflexia. The mean cystometric capacity decreased significantly between baseline and follow-up in both the groups but remained within the normal threshold limit, decline being more marked in the overactive detrusor group, who also had more marked decrease in compliance. Mean detrusor leak point pressure was below 40 cm H2O in all participants in both groups at baseline and follow-up. Mean residual urine improved at follow-up in both groups. Incidence of UTI was 2.29 episodes per patient per year, and more frequent in the overactive detrusor group. Escherichia coli was the causative agent in 45%. Conclusion: The cystometric capacity and compliance decreased significantly though patients were doing regular CIC and managed on antimuscarinics for detrusor overactivity (DO). UTI is more common in individuals with SCI with DO and E. coli is the most common cause of UTI.

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

1Post Doctoral Fellow, 2Assistant Professor, 3Director, 4Professor and Consultant 1Department of Neurorehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India 2-4Department of Physical medicine and Rehabilitation National Institute for Locomotor Disabilities (Divyangjan) Kolkata, West Bengal, India Corresponding Author: Madhusree Sengupta, Post Doctoral Fellow, Department of Neurorehabilitation, National Institute of Mental Health and Neurosciences, Room No. 131 Kabani Hostel Complex, Hosur Road, Bengaluru, Karnataka, India, e-mail: drmadhusreesengupta3@gmail.com ABSTRACT

The effect of a spinal orthosis on posture and cardio-respiratory functions in progressive myopathic scoliosis

Background: Historically, the orthotic treatment in progressive myopathic scoliosis has not been as effective as expected. The purpose of this study was to investigate the effect of a spinal orthosis on scoliotic curve correction, alignment of altered posture and cardio-respiratory functions. Case Description and Methods: An 11 year-old girl diagnosed with myopathy was fitted with a custom molded thoraco-lumbo-sacral orthosis to enhance the sitting ability. The cardio-respiratory tests were performed by a COSMED K4 b2; metabolic analyzer. The anterior posterior radiographs were analyzed for measuring Cobb angle and Ferguson angle. A plumb line test was used to assess the postural improvements. Findings and Outcomes: No significant difference was observed for variables such as O2 consumption level, PaO2, tidal volume, heart rate and energy expenditure/min. The improved posture was evident by shifting of the plumb line 18 mm towards the mid line with the use of orthosis. Very minor improvements in both angles were observed with the use of the brace. Conclusion: The brace treatment cannot be expected to have a lasting corrective effect although it can be used as a sitting support and for maintaining posture Clinical relevance This case study provides an objective prescription of thoraco-lumbo-sacral orthosis as a sitting support and for improving posture in progressive myopathic scoliosis if suitably designed and properly fitted.