George Tharion

Psychological wellbeing among carers of people with spinal cord injury: a preliminary investigation from South India

Study design: A cross-sectional study that assessed people with spinal cord injury (SCI) and their carers who attended the 3-day health care program.Objectives: The study examined the nature and prevalence of the factors associated with psychological morbidity among carers of people with SCI.Setting: A community reintegrated population of persons with SCI and their carers attended the 3-day program in the Department of Physical Medicine and Rehabilitation, Christian Medical College Hospitals, Vellore, South India.Methods: Thirty-eight people with SCI and their carers participated in this cross-sectional study.Results: Thirty (78.9%) carers of people with SCI were psychologically distressed. While carers were distressed, they were not significantly depressed. Educational level of carers and suicidal behavior of people with SCI were significantly associated with psychological distress.Conclusion: The findings of this study suggest that health care workers should have a high index of suspicion of psychological morbidity, in carers of people with SCI. Identification of risk factors may lead to useful target interventions.Sponsorship: Nil.

Malignant secondary deposit in the iliac crest masquerading as meralgia paresthetica

Meralgia paresthetica is an entrapment neuropathy from compression of lateral femoral cutaneous nerve of the thigh as it passes under the inguinal ligament. The entrapment produces pain, paresthesia, and sensory loss over the anterolateral aspect of the thigh, without motor loss. The etiology of this condition is often obscure and the pathogenesis is thought to be an entrapment of this nerve at the inguinal ligament where it pierces the fascia to reach the skin. Rarely, retroperitoneal lymphomas or other neoplasms can mimic symptoms of meralgia paresthetica. We report a case of a 60-year-old man who presented with clinical features of meralgia paresthetica. On investigation, he was found to have a secondary malignant deposit in the iliac crest from an adenocarcinoma of the lung. This neuropathy, although often caused by a benign lesion, can at times be the presenting symptom of a malignancy.

Motor recovery following olfactory ensheathing cell transplantation in rats with spinal cord injury

BACKGROUND Olfactory ensheathing cells (OEC) are considered to be the most suitable cells for transplantation therapy in the central nervous system (CNS) because of their unique ability to help axonal regrowth and remyelination in the CNS. However, there are conflicting reports about the success rates with OEC. AIM This study was undertaken to evaluate the therapeutic effect of OEC in rat models using different cell dosages. MATERIAL AND METHODS OECs harvested from the olfactory mucosa of adult white Albino rats were cultured. Spinal cord injury (SCI) was inflicted at the lower thoracic segment in a control and test group of rats. Two weeks later, OECs were delivered in and around the injured spinal cord segment of the test group of the rats. The outcome in terms of locomotor recovery of limb muscles was assessed on a standard rating scale and by recording the motor-evoked potentials from the muscles during transcranial electrical stimulation. Finally, the animals were sacrificed to assess the structural repair by light microscopy. STATISTICAL ANALYSIS Wilcoxon signed rank test and Mann-Whitney U-test were used to compare the data in the control and the test group of animals. A P value of <0.05 was considered significant. RESULTS The study showed a moderate but significant recovery of the injured rats after OEC transplantation (P=0.005). CONCLUSION Transplantation of OECs along with olfactory nerve fibroblasts improved the motor recovery in rat models with SCI.

Re-examining the psychology of spinal cord injury: a meaning centered approach from a cultural perspective

Objectives: To examine the impact of SCI from a non-Western cultural perspective.Setting: India.Methods: A philosophical approach.Conclusion: Management of the individual with spinal cord injury needs to take in to account the individuals beliefs and cultural context.Spinal Cord (2001) 39, 323–326.

‘Mirror Therapy and Transcutaneous Electrical Nerve Stimulation for Management of Phantom Limb Pain in Amputees — A Single Blinded Randomized Controlled Trial’

BACKGROUND AND PURPOSE Phantom limb pain (PLP) can be disabling for nearly two thirds of amputees. Hence, there is a need to find an effective and inexpensive treatment that can be self administered. Among the non-pharmacological treatment for PLP, transcutaneous electrical nerve stimulation (TENS) applied to the contralateral extremity and mirror therapy are two promising options. However, there are no studies to compare the two treatments. The purpose of this study is to evaluate and compare mirror therapy and TENS in the management of PLP in subjects with amputation. METHODS The study was an assessor blinded randomized controlled trial conducted at Physiotherapy Gymnasium of Physical Medicine and Rehabilitation Department, Christian Medical College, Vellore. Twenty-six subjects with PLP consented to participate. An initial assessment of pain using visual analogue scale (VAS) and universal pain score (UPS) was performed by a therapist blinded to the treatment given. Random allocation into Group I-mirror therapy and Group II-TENS was carried out. After 4 days of treatment, pain was re-assessed by the same therapist. The mean difference in Pre and Post values were compared among the groups. The change in pre-post score was analyzed using the paired t test. RESULTS Participants of Group I had significant decrease in pain [VAS ( p = 0.003) and UPS ( p = 0.001)]. Group II also showed a significant reduction in pain [VAS ( p = 0.003) and UPS ( p = 0.002)]. However, no difference was observed between the two groups [VAS ( p = 0.223 and UPS ( p = 0.956)]. DISCUSSION Both Mirror Therapy and TENS were found to be effective in pain reduction on a short-term basis. However, no difference between the two groups was found. Substantiation with long-term follow-up is essential to find its long-term effectiveness. Copyright

Glucose intolerance and dyslipidaemias in persons with paraplegia and tetraplegia in South India

Glucose intolerance and dyslipidaemias have been reported among paraplegics and tetraplegics. In this study we determined the lipid profiles and the glucose tolerance in a group of 48 persons with spinal cord lesions who had been rehabilitated in our Department of Physical Medicine and Rehabilitation. This non-randomised, descriptive study was conducted as part of the annual medical follow-up of these individuals. Hypertension was observed in only 6% of the subjects. Fasting hyperglycemia was observed in 19% and glucose intolerance in 23% of the subjects. Total cholesterol was abnormal in 2%, but 58% had low levels of high density lipoprotein (HDL). 10% of the subjects had raised low density lipoprotein (LDL) levels. The cardioprotective HDL fraction may remain very low even while the total cholesterol level is within normal limits, and unless a lipid profile estimation is done, this group of individuals who are at cardiovascular risk may remain undetected. We conclude that glucose intolerance and dyslipidaemias are common among paraplegic and tetraplegic individuals, and these metabolic derangements may contribute to increased cardiovascular morbidity.

Comparison of body weight-supported treadmill training versus body weight-supported overground training in people with incomplete tetraplegia: a pilot randomized trial:

Objective: To compare the effectiveness of body weight-supported treadmill training and body weight-supported overground training for improving gait and strength in people with traumatic incomplete tetraplegia. Design: Assessor blinded randomized trial. Setting: Rehabilitation institute of a tertiary care teaching hospital in India. Participants: Sixteen participants with traumatic motor incomplete tetraplegia and within two years of injury. Interventions: Participants were randomised to one of two groups: body weight-supported overground training on level ground and body weight-supported treadmill training. Both groups received 30 minutes of gait training per day, five days a week for eight weeks. In addition, both groups received regular rehabilitation which included flexibility, strength, balance, self care and functional training. Outcome measures: The primary outcome measure was the Walking Index for Spinal Cord Injury (/20 points) and the secondary outcome was the Lower Extremity Muscle Score (/50 points). Results: There was no statistically significant between group differences in the Walking Index for Spinal Cord Injury [mean difference=0.3points; 95% CI (-4.8 to 5.4); p=0.748] or the Lower Extremity Muscle Score [mean difference=0.2 points; 95% CI (-3.8 to 5.1); p=0.749]. Conclusions: Gait training with body weight-supported overground training is comparable to treadmill training for improving locomotion in people with traumatic incomplete tetraplegia.

The Effectiveness of Intravesical Oxybutynin, Propantheline, and Capsaicin in the Management of Neuropathic Bladder following Spinal Cord Injury

The objective of this study was to compare the therapeutic response of intravesical oxybutynin, propantheline, and capsaicin in the treatment of neurogenic detrusor overactivity. Carried out in the Department of Physical Medicine and Rehabilitation at a university teaching hospital in India, patients acted as their own controls. Oxybutynin 5 mg in solution or propantheline 15 mg in solution and capsaicin were instilled intravesically in each patient. Urodynamic studies were done before and after the intravesical instillation of each drug. The nonparametric tests were used for statistical analysis. The efficacy of intravesical capsaicin in the treatment of neurogenic detrusor overactivity was statistically significant for reflex volume (RV) (p = 0.018), cystometric capacity (CC) (p = 0.0440), leak volume (LV) (p = 0.000), and leak frequency (LF) (p = 0.009). The Kruskal-Wallis test for paired sample comparing pre- and post-LV and LF for intravesical capsaicin was significant at 2nd week (p = 0.002 and 0.054, respectively). There was a significant difference in therapeutic response between intravesical oxybutynin, propantheline, and capsaicin in the treatment of detrusor overactivity for LV and LF at 2nd week (p = 0.017 and 0.003, respectively). When comparing responses of oxybutynin and propantheline, more subjects demonstrated improvement with intravesical propantheline than oxybutynin for RV, detrusor leak point pressure (LPP), clean intermittent catheterization volume (CICV), and LV. This study suggests that intravesical agents may be used as effective adjuvants in the management of incontinence due to neurogenic detrusor overactivity following spinal cord injury.

Investigation of controllable multi electrode based FES (functional electrical stimulation) system for restoration of grasp-preliminary study on healthy individuals

Functional electrical stimulation applied via surface electrode can be used for hand rehabilitation particularly for enabling grasp in patients with stroke or spinal cord injury. The use of multi-pad electrode and multi-channel electrical stimulator based improve the effectiveness of conventional FES. Such a system consists of a multi-pad surface electrode and a matching multi-channel stimulator. This system will allow the targeting of motor neurons which activate muscle groups to produce corresponding functional movements of the hand. This paper presents our study on normal subjects to quantify the movement resulting from stimulation of electrodes spatially distributed around the forearm. The device was tested on four healthy subjects and the results show that multi-pad electrode provide desired amount of selectivity and can be used for generating functional grasp. The results also show that the effect of stimulation varies from person to person reflecting inters subject anatomical variability.

A Sensorized Glove and Ball for Monitoring Hand Rehabilitation Therapy in Stroke Patients

Stroke is the principal cause of adult disabilities in India and the third leading cause of death worldwide. Hemiparesis/ Hemiplegia is the common outcome of stroke, and as a result the survivor loses the control of skills that are necessary for activities of daily living (ADL). Planning of a rehabilitation treatment to regain the skills that the patient has lost is necessary to quantify the hand movements that he/she is able to perform. For the same, a sensorized glove has been designed using flex sensors, optical linear encoder (OLE) and a 3-axis accelerometer to measure finger flexion, wrist flexion/extension and forearm movement. A sensorized ball has also been devised to exercise the hand and is used to measure the grasp force. The complete system hardware and test software have been assembled and tested on two healthy individuals. The proposed system is able to detect finger flexion, forearm movement and grasp force. The user software has to be developed in future.