Sailakshmi Ganesan

Comparison of physio ball and plinth trunk exercises regimens on trunk control and functional balance in patients with acute stroke: a pilot randomized controlled trial

Objective: To examine the effects of trunk exercises performed using the physio ball as against the plinth, on trunk control and functional balance in patients with acute stroke. Design: An observer-blinded pilot randomized controlled trial. Subjects: Thirty patients with acute stroke (mean post-stroke duration 12 (95% confidence interval (CI) 2–34) days) who had the first onset of unilateral haemorrhagic or ischaemic lesion and an independent ability to sit for 30 seconds. Setting: Inpatient stroke rehabilitation centre. Interventions: The experimental group performed task-specific trunk exercises on an unstable surface (physio ball) while the control group performed them on a stable surface (plinth). In addition to regular acute physiotherapy, both the groups underwent 1 hour of trunk exercises a day, four days a week for three weeks. Main measures: Trunk Impairment Scale and Brunel Balance Assessment. Results: The difference between the baseline characteristics of the patients belonging to both groups was not statistically significant. Post-intervention, both the groups improved on trunk control and functional balance but the experimental group improved more significantly than the control group (change scores of between-group comparison for the total Trunk Impairment Scale 3.06 (1.43), dynamic sitting balance 1.47 (1.36) and coordination 1.3 (0.67) subscales of Trunk Impairment Scale; the total Brunel Balance Assessment 1.8 (1.4) and stepping 1.87 (1.6) component of Brunel Balance Assessment). The level of significance was set at P < 0.05. Conclusions: The trunk exercises performed on the physio ball are more effective than those performed on the plinth in improving both trunk control and functional balance in acute stroke patients, suggesting a task-specific effect and also a carry-over effect.

Pelvic alignment in standing, and its relationship with trunk control and motor recovery of lower limb after stroke

The pelvis is not stable after stroke, and poor trunk recovery might be the foremost contributor to altered pelvic alignment in sitting, standing and during walking.

Inter-rater reliability of the Top Down Motor Milestone Test: a cross-sectional study

Objective: To assess the inter-rater reliability of the Top Down Motor Milestone Test, which is the first step of the Mobility Opportunities Via Education programme in children with motor disabilities. Design: A cross-sectional study. Setting: Neurosensory Developmental Unit of a tertiary hospital. Subjects: Parents of 21 children with motor disabilities were interviewed and scored on the Top Down Motor Milestone Test. Methods: The subjects were interviewed by one therapist while two other therapists observed the interview procedure. All three therapists were blinded to each others scores. Results: Inter-rater reliability was analysed for all the 16 subtests using the inter-rater kappa. The pooled kappa was done for the three raters. The standard error and the P-value were also calculated. The value of inter-rater kappa for individual subtests ranged from 0.74 to 0.96. Pooled kappa for the Top Down Motor Milestone Test was 0.88 with standard error 0.06 and P-value50.01. Conclusion: The inter-rater reliability of the Top Down Motor Milestone Test proved to be good for each subtest and for the whole test.

Relationship between pelvic alignment and weight-bearing asymmetry in community-dwelling chronic stroke survivors

Background and Purpose: Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors. Materials and Methods: This cross-sectional study was conducted in tertiary care rehabilitation centers. In standing, the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation (PALM™) meter device. The percentage of WBA was measured with two standard weighing scales. Pearson correlation coefficient (r) was used to study the correlation between pelvic tilt and WBA. Results: Of 112 study participants, the mean (standard deviation) age was 54.7 (11.7) years and the poststroke duration was 14 (11) months. The lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 (1.8) and 4.4 (1.8) degree, respectively. The percentage of WBA was 23.2 (18.94). There was a high correlation of lateral pelvic tilt with WBA (r = 0.631; P< 0.001) than anterior pelvic tilt (r = 0.44; P< 0.001). Conclusion: Excessive lateral pelvic tilt toward the most affected side in standing may influence the weight-bearing ability of the ipsilateral lower extremity in community-dwelling chronic stroke survivors.

Provocative Poliomyelitis Causing Postpolio Residual Paralysis among Select Communities of Two Remote Villages of North Karnataka in India: A Community Survey

Intramuscular injections can provoke muscular paralysis especially, if the child has had exposure to polio virus. The purpose of the study was to determine the association with known risk factors for motor disabilities in two remote villages of North Karnataka (India), where an increased number of disabled people among select communities had been reported. A community based survey was conducted. The selection of study subjects was done through screening, history related with occurrence of musculoskeletal disability, screening and general examination of the affected joints and muscles. Data analysis was done by estimation of percentages. Among the physical disabilities identified, the most common was post-polio residual paralysis. 35.65% (n = 41) subjects had developed paralysis following the administration of an intramuscular injection when they had acute viremia in childhood, indicating that (probably) muscle paralysis would have been provoked by intramuscular injections, resulting in provocative poliomyelitis. Unnecessary injection must be avoided in children during acute viremia state and use of oral polio vaccine should be encouraged.