Kavitha Raja

Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review.

A systematic analysis was conducted on the effectiveness of knee braces and foot orthoses in conservative management of knee osteoarthritis. The methodologic quality of the randomized clinical trials, controlled clinical trials, and observational studies were systematically reviewed using the Structured Effectiveness Quality Evaluation Scale. Twenty-five studies met the inclusion criteria. The orthoses used in the studies included Generation II osteoarthritis knee brace, valgus knee braces, functional off-loading knee braces, knee sleeves, lateral-wedged insoles with subtalar strapping, medial-wedged insoles, and specialized footwear. Results suggest that knee braces and foot orthoses are effective in decreasing pain, joint stiffness, and drug dosage. They also improve proprioception, balance, Kellgren/Lawrence grading, and physical function scores in subjects with varus and valgus knee osteoarthritis. Knee braces and foot orthoses could be cautiously considered as conservative management for relief of pain and stiffness and improving physical function for persons with knee osteoarthritis. The conclusions of this review are limited by methodologic considerations like poor quality of trials and heterogeneity of interventions.

Effect of Training on Interlimb Transfer of Dexterity Skills in Healthy Adults

Objective: To examine transference of dexterity skills to the contralateral hand after ipsilateral hand training, retention of skills at 1 mo, and the influence of hand dominance, sex, and age on interlimb transfer of these skills. Design: This is an interventional study involving 200 healthy adults in the age group of 20-30 yrs and >30 yrs, who were block randomized into experimental and control groups. Experimental group was further subdivided into dominant and nondominant hand training group and participants underwent 5 days unsupervised training on tasks aimed at improving precision and dexterity. Jebsen-Taylor hand function test was administered at baseline, postintervention, and 1-mo follow-up. Analysis was done by nonparametric tests of comparison. Results: One hundred sixty-nine subjects completed the study. Transfer effect was noted from the dominant to the nondominant hand (P ≤ 0.001) and vice versa (P = 0.003) on the total test scores. This effect was retained at 1-mo follow-up. Conclusions: Dexterity skills are not consistently transferred to the contralateral hand after ipsilateral hand training. However, transference of gross motor skills of hand function does occur with retention effects up to 1 mo. Transfer of skills differs based on the hand trained and age of the individual.

Interrater reliability of the craniocervical flexion test in asymptomatic individuals--a cross-sectional study.

OBJECTIVE The objective of this study was to evaluate interrater reliability of the craniocervical flexion test (CCFT) on asymptomatic subjects. METHODS A cross-sectional repeated-measures study design was used. Thirty asymptomatic subjects (15 men and 15 women; mean age, 33.7 years; range, 22-48 years) were recruited for the study. Subjects were positioned in supine lying with a pneumatic pressure sensor of the pressure biofeedback unit placed under the neck. Subjects performed 3 trials of craniocervical flexion with each trial consisting of 5 incremental stages (22, 24, 26, 28, and 30 mm Hg) guided through feedback from the pressure dial of the pressure biofeedback unit. All the trials were scored simultaneously by 2 raters. The outcome measure was the activation score-the maximum pressure (above baseline 20 mm Hg) that was achieved and held in a steady manner for 10 seconds. Intraclass correlation coefficient (ICC 3,1) was analyzed using the 2 repeated scores out of 3 trials for either rater. RESULTS Interrater reliability (ICC) for the CCFT was 0.91 (95% confidence interval, 0.83-0.96). There was a reasonable agreement on the Bland-Altman plot confirming high reliability of the test. CONCLUSION The study has shown high interrater reliability when 2 raters simultaneously scored the CCFT trials in asymptomatic individuals.

Down syndrome—A narrative review with a focus on anatomical features

Down syndrome (DS) is the most common aneuploidy of chromosome 21, characterized by the presence of an extra copy of that chromosome (trisomy 21). Children with DS present with an abnormal phenotype, which is attributed to a loss of genetic balance or an excess dose of chromosome 21 genes. In recent years, advances in prenatal screening and diagnostic tests have aided in the early diagnosis and appropriate management of fetuses with DS. A myriad of clinical symptoms resulting from cognitive, physical, and physiological impairments caused by aberrations in various systems of the body occur in DS. However, despite these impairments, which range from trivial to fatal manifestations, the survival rate of individuals with DS has increased dramatically from less than 50% during the mid‐1990s to 95% in the early 2000s, with a median life expectancy of 60 years reported recently. The aim of this narrative review is to review and summarize the etiopathology, prenatal screening and diagnostic tests, prognosis, clinical manifestations in various body systems, and comorbidities associated with DS. Clin. Anat. 29:568–577, 2016.

Down syndrome – A Narrative Review

Down syndrome (DS) is the most common aneuploidy of chromosome 21, characterized by the presence of an extra copy of that chromosome (trisomy 21). Children with DS present with an abnormal phenotype, which is attributed to a loss of genetic balance or an excess dose of chromosome 21 genes. In recent years, advances in prenatal screening and diagnostic tests have aided in the early diagnosis and appropriate management of fetuses with DS. A myriad of clinical symptoms resulting from cognitive, physical, and physiological impairments caused by aberrations in various systems of the body occur in DS. However, despite these impairments, which range from trivial to fatal manifestations, the survival rate of individuals with DS has increased dramatically from less than 50% during the mid‐1990s to 95% in the early 2000s, with a median life expectancy of 60 years reported recently. The aim of this narrative review is to review and summarize the etiopathology, prenatal screening and diagnostic tests, prognosis, clinical manifestations in various body systems, and comorbidities associated with DS. Clin. Anat. 29:568–577, 2016.

Impact of adhesive capsulitis on quality of life in elderly subjects with diabetes: A cross sectional study.

CONTEXT: Adhesive capsulitis (AC) is a common musculoskeletal manifestation in elderly having long standing history of diabetes. This hinders the function of shoulder which is crucial in many activities of daily living. This painful, functional deficit may decrease the quality of life in elderly. AIMS: The purpose of this study was to evaluate the impact of AC on quality of life in diabetic elderly subjects. SETTINGS AND DESIGN: District government Hospital, Udupi; Dr. T. M. A. Pai, Udupi, Kasturba Hospital, Manipal; and the study design is cross-sectional design. MATERIALS AND METHODS: Two hundred and thirty-three diabetic elderly patients were recruited from the settings based on cluster sampling. They were evaluated for pain and restriction of range of motion in the shoulder joint and were. Severity of condition was classified on Oxford shoulder score and quality of life was calculated by SF- 36. Statistical analysis used: Descriptive statistics and spearmans correlation coefficient done in SPSS. RESULTS: Forty-nine percent of women had diabetic AC. Majority of the subjects without AC fell in average quality of life. Women with AC fell in unhealthy category, whereas men were clustered in the average category. CONCLUSIONS: Adhesive capsulitis was an important factor in reducing the quality of life of the elderly with diabetes.

Responsiveness of Edinburgh Visual Gait Score to Orthopedic Surgical Intervention of the Lower Limbs in Children with Cerebral Palsy

ObjectiveThe aim of this study was to report the responsiveness and minimal clinically important difference of the Edinburgh Visual Gait Score (EVGS), used to measure gait deviations in children with cerebral palsy. DesignFifty ambulant children with spastic diplegia (Gross Motor Function Classification System levels II and III) aged between 6 and 19 yrs were recruited for this longitudinal study. The participants were evaluated before surgery and at 6 and 12 mos after surgery. The change in EVGS at these time points was used to calculate effect sizes and minimal clinically important differences. ResultsFriedman analysis of variance showed a significant difference (&khgr;22 = 60.69, P = 0.000) in the EVGS scores at 6 and 12 mos when compared with baseline. Effect sizes at 6 and 12 mos were large (1.19 and 1.22, respectively), indicating a visible difference in gait .The minimal clinically important differences of EVGS at 6 and 12 mos were 11 and 15, respectively. ConclusionsThe EVGS is an outcome measure that can be used to evaluate the effect of orthopedic surgical intervention in children with cerebral palsy. Differences of 11 and 15 points on the EVGS are required to suggest that changes in gait are attributable to intervention when group means are considered.

Employment after paraplegia in India: a postal survey

Study design:This study was carried out as a postal survey.Objectives:The aim of this study was to ascertain employment after paraplegia in India.Setting:This study was conducted in India.Methods:The study was conducted by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organisations. Data analysis was carried out by using descriptives.Results:The return rate was 46% (276/600) and the employment rate was 41% (114/276). Among 114 subjects who were employed, 68 (59.6%) were living in centres run by armed force and 46 (40.4%) were living in specialised centres or under the region of non-governmental organisations.Conclusions:Individuals who were employed were living either in centres run by armed force or in specialised centres. None of the individuals living in community was employed.

Compliance with walking aid use in children with cerebral palsy in India.

Raja K: Compliance with walking aid use in children with cerebral palsy in India. Am J Phys Med Rehabil 2006;85:694–698. A 3-mo prospective descriptive study of 50 Indian ambulant children with cerebral palsy using different types of walkers or elbow crutches was done to determine compliance with use of the prescribed device. Children were between 6 and 16 yrs of age and of either sex. Data were collected by means of proxy log entries made by the child’s caregivers throughout the day. The data collected consisted of the number of times and the distance the child walked each time with or without the prescribed walking aid. Compliance was taken as the number of times the child used the walking aid during ambulation. Overall mean compliance was 49.1%. Children using the reciprocal walker showed the greatest compliance (60.2%), whereas those using elbow crutches (34.9%) and walkers with gutter attachments (14.8%) showed the least. Compliance was greatest for distances of 50–100 m (57.5%), whereas it was the least for distances of >150 m (25.9%).

Effect of Box Taping as an Adjunct to Stretching-Strengthening Exercise Program in Correction of Scapular Alignment in People with Forward Shoulder Posture: A Randomised Trial

Objective. The objective of this study was to provide preliminary estimates of effects of box taping as an adjunct to stretching-strengthening exercise program on scapular alignment in healthy subjects with forward shoulder posture (FSP). Methods. Sixty subjects were screened and 38 asymptomatic subjects with FSP were allocated into box taping and standard treatment group using block randomization. Both groups received a supervised stretching-strengthening exercise program and postural advice for 15 sessions over 3 weeks. In addition, box taping was applied to the intervention group. Static and dynamic scapular alignment was recorded at baseline, 7th and 15th sessions. Differences over time and between the treatment groups were determined using repeated measures of analysis of variance (ANOVA). Results. Twenty subjects completed the study. Both interventions were well tolerated and resulted in improvements in static and dynamic postural indicators over time in both groups () except for dynamic scapular alignment by the 15th session. We were under powered to detect differences between the groups (). Conclusions. This study suggests postural exercises improve scapular alignment; but a large RCT is required to determine whether the addition of box taping is indicated, and whether this preventative approach reduces the incidence of upper quarter musculoskeletal disorders. This trial is registered with CTRI/2013/10/004095.