Ratnesh Kumar

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.

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.

Therapeutic Management of the Hallux Rigidus

Background. Hallux rigidus is a chronic, disabling condition of foot characterized by reduced great toe extension. The manual therapy approaches are described theoretically however their practical published evidence has not been analyzed well. Objective. Aim of the present paper was to systematically review the literature available for therapeutic management of the hallux rigidus by identifying and evaluating the randomized controlled trials (RCTs) and non-RCTs. Methods. To view the hallux rigidus and its rehabilitation, a webbased published literature search of Pubmed, Ovid Medline, Science direct, Cochrane Database, PEDro database, CINAHL was conducted for last 35 years in August 2010 using 4 specific keywords “hallux rigidus, physical therapy, chiropractic, and manual therapy” typed in exactly same manner in the search column of the databases. Result. the review finds that there is acute need of the quality studies and RCTs for the manual therapy, chiropractic, or physiotherapeutic management of the hallux rigidus. Conclusion. Review conclude that conservative programs for hallux rigidus consists of comprehensive intervention program that includes great toe mobilization, toe flexor strengthening, sesamoid bones mobilization and long MTP joint. The clinician should put an emphasis on the mobilization program with proper follow up along with comparative studies for rehabilitation of hallux rigidus.

Effectiveness of Maitland Techniques in Idiopathic Shoulder Adhesive Capsulitis

Objective. To study the effectiveness of Maitland techniques in the treatment of idiopathic shoulder adhesive capsulitis. Methods. total of 40 patients diagnosed with idiopathic shoulder adhesive capsulitis were recruited and randomly allocated into two groups. In Group A () subjects were treated with Maitland mobilization technique and common supervised exercises, whereas subjects in Group B () only received common supervised exercises. Variables. Shoulder pain and disability index (SPADI), VAS and shoulder ROM (external rotation and abduction) were variables of the study. These were recorded before and after the session of the training. Total duration of the study was four weeks. Result. Statistical analysis of the data revealed that within-group comparison both groups showed significant improvement for all the parameters, whereas between-group comparison revealed higher improvement in Group A compared to the Group B. Conclusion. The study confirmed that addition of the Maitland mobilization technique with the combination of exercises have proved their efficacy in relieving pain and improving R.O.M. and shoulder function and hence should form a part of the treatment plan.

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.

RELATIONSHIP AMONG DIFFERENT TESTS OF EVALUATING LOW BACK CORE STABILITY

Purpose: This study aims to determine the relation among the commonly used different tests of evaluating core stability performance. Establishing this relationship is important as different authors have used different types of tests for evaluating core stabilization in their study yet relation among these tests and the individual importance of each of these tests is not clearly established so far. Methods: Among 40 recreationally active subjects the core stability performance was evaluated using variety of different tests reported in the previous literatures. Results: Results show that there was no