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Seizures in cerebral palsy
Nagabhushana Rao Potharaju
January-June 2016, 2(1):3-21
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Journey of a child with spastic diplegic cerebral palsy from doldrums to hope
Divya Midha, Manisha Uttam, Megha Neb
July-December 2015, 1(2):127-130
This case study describes the physical therapy of a 9-year-old male child with spastic diplegic cerebral palsy with the aim to improve his gross motor function and social skills. The child had severe impairments across the full spectrum of developmental functions, especially affecting the gross motor and self-care functions at Stage V of gross motor function classification system (GMFCS) in spastic diplegic cerebral palsy. His body was completely stiff with marked asymmetrical spasticity in lower limbs, truncal dystonia, and chest deformity with cardio respiratory complications. The physical therapy was performed by giving sessions of Roods approach, sensory integration, and static weight-bearing exercise for a period of 9 months. Pre- and post-therapy evaluation of child was done using GMFCS. There was an improvement in the child with his social skills, transitional activities, activities of daily living, and gross motor skills, reaching to Stage IV with the 9 months physiotherapy intervention given by a neurological physical therapist.
  8,762 14 -
Physical profile of children with cerebral palsy in Jalandhar district of Punjab India
Raju Sharma, AGK Sinha
January-June 2015, 1(1):9-20
Introduction: Cerebral palsy (CP) has emerged as one of the major causes of childhood disability in India. Physical and functional status of children with CP and their relation with various sociodemographic variables in the Indian context are not widely reported. Objective: This report describes the physical and functional status of children with CP in Jalandhar district of Punjab and examines its association with biological and social factors. Methodology: A survey using physical examination of child and schedule interview of parents has been conducted on 248 children with CP of age group 3-13 years. Descriptive analysis has been conducted with probability level set at 0.05. Results: Spastic CP (83.46%) has been observed the most prevalent type of motor impairment. In spastic type diplegia has been major presentation (43.5%), followed by quadriplegia (34.3%), majority of children fall in level V (57.7%,) of Gross Motor Function Classification System (GMFCS). Mental retardation (MR) is (42.3%) the most frequent associated disability and epilepsy are the most prevalent co-morbidity. About 69% subjects have been found nonambulatory and dependent in their -self-care domains. More than 70% of children have been observed with deformities of more than four joints. GMFCS levels were significantly associated with topography, MR, age of diagnosis, time constraint of parent, difficulty in arranging physiotherapy, ignorance of parents about condition and rehab services required, poor belief in rehabilitation methods. Conclusion: Lack of comprehensive rehabilitation facilities for children with CP was reflected in the poor physical and functional status of the children. Beside the primary impairments, social factors have played an important role in determining the functional status of these children.
  5,539 13 1
Perinatal risk factors in cerebral palsy: A rehab center based study
Varidmala Jain, Jitendra Kumar Jain, Gyanendra Singh, Amit pandey
July-December 2015, 1(2):75-79
Introduction: The etiology of cerebral palsy (CP) is very diverse and multifactorial including prenatal, natal, and postnatal factors. Objective: This study is an attempt to describe the distribution of risk factors among children with cerebral palsy. Materials and Methods: This study was conducted to explore perinatal risk factors among 307 children having cerebral palsy. Results: Major risk factors found in this study were history of spontaneous abortions in 33 (10.7%), anemia during pregnancy in 53 (17.3%), hypertension in 26 (8.5%), and history of infection in 22 (6.2%) mothers. In total, 141 (45%) children were born preterm and 28 (9.1%) were born in multiple births. Further, it was also found that 12 (3.9%) deliveries were forceps delivery. Out of the total 307 respondents, 208 (67.8%) reported a history of delayed crying of their child at birth. Out of the available record of 278 children, 108 (38.8%) had birth weights of <1.5 kg. The most frequent risk factors in the postnatal period were high fever in 82 (26.7%), convulsion in 81 (26.4%), and jaundice in 99 (32.2%). Conclusions: In this study, factors related to poor antenatal care as well as other unavoidable risk factors were found; therefore, there is a need to prevent avoidable causes that lead to CP through strict standard practices, mass awareness programs, etc.
  5,292 19 -
Effect of dynamic sitting balance on upper extremity motor skills in children having spastic diplegia: A correlational study
Indira Brundavanam, Lakshmana Prasad Gadde, Naveen Kumar Balne, AK Purohit
July-December 2015, 1(2):70-74
Introduction: Children having spastic diplegic cerebral palsy also have some impairment in upper extremity functions; hence, they have difficulty in performing certain activities such as pulling up to stand, support themselves to sit, and participate in surrounding environment. Trunk control is proposed to be a major contributing factor for voluntary upper limb motor functions including motor control. Objective: To study the effect of dynamic sitting balance on upper extremity skill in children having spastic diplegia. Material and Methods: Study Design - Randomized control trial. Participants - The children were randomly divided into experimental (n = 15) and control group (n = 15). Experimental group received dynamic sitting balance training for a period of two weeks, whereas control group received conventional physiotherapy for a period of two weeks. Results: A significant improvement was noted in dynamic sitting balance and upper extremity skill, and a positive correlation was found between these two parameters. Conclusion: This study showed that, for this cohort of children having spastic diplegic cerebral palsy, short duration of dynamic sitting balance training resulted in improvement in upper extremity function with improvement in dynamic sitting balance.
  5,245 19 2
Comorbidities and their relationship to subtype of cerebral palsy in a tertiary care hospital in South India
Raghavendraswami Amoghimath, Vykuntaraju K Gowda, Asha Benakappa
July-December 2016, 2(2):90-93
Introduction: Comorbid conditions such as intellectual disability (ID), visual disability, epilepsy, and hearing impairment are associated with cerebral palsy (CP). For many children with cerebral palsy, it is these cooccurring conditions that may often have the greatest impact on the child and family from varying perspective. Aims: The aim of the current study was to provide data on the frequency and type of comorbidities in children with cerebral palsy and the burden of comorbidities among each motor subtypes of CP. In addition, we evaluated the causative agent of motor subtypes of CP. Methods: Two hundred consecutive children with cerebral palsy attending the pediatric neurology outpatient department with an age group from 3 months to 18 years were enrolled in the study. Information on neurologic subtype classified according to the topographic distribution of the motor impairment on neurologic examination and the presence of comorbidities: ID, visual impairment, hearing impairment, and coexisting afebrile seizures, was obtained. Demographic factors were also noted. Results: The mean age of the children was 55 months, with 120 boys and 80 girls. ID was seen in 91% (182/200) of children. Active afebrile seizure disorder was noted in 40% (80/200), severe auditory impairment was noted in 4% (8/200), and cortical visual impairment was noted in 19.5% (39/200) of children. Comorbidities were most frequent in children with spastic and dyskinetic cerebral palsy. The most common type of seizures was focal seizures in 47 individuals (23.5% of all the individuals), followed by generalized seizures in 23 individuals (11.5% of all the individuals) and myoclonic seizures in 11 individuals (5.5% of all the individuals). Conclusion: ID and seizures are more frequently associated comorbidities with CP. Bilateral spastic and dyskinetic CP are more likely to be associated with comorbidities.
  5,170 24 -
Efficacy of supracondylar knee ankle foot orthosis for hyperextended knee and heel rise in spastic cerebral palsy: A pilot clinical trial
Rajesh Kumar Mohanty, Ullas Chandra Sahoo, Smruti Prava Sahoo
January-June 2016, 2(1):22-26
Background: Guidelines to assist with decision making for orthotic management of gait dysfunction in individual with cerebral palsy (CP) is difficult to derive and remain controversial. The research question is whether supracondylar knee ankle foot orthosis (SKAFO) is one of best options for knee hyperextension and heel rise for spastic diaplegic Cerebral palsy. Aim: The purpose of this study was to check the efficacy of bilateral molded SKAFO for knee hyperextension and heel rise for Cerebral palsy in terms of gait parameters and energy expenditure. Materials and Methods: Five individuals (mean age 3.5 years) were diagnosed as spastic diplegic and one with hemiplegic (age 5 years old) Cerebral palsy with delayed milestone presented with knee hyperextension and heel rise during mid-stance and were fitted with bilateral molded SKAFO with pair of shoes. Observational gait analysis by video recording was performed and gait parameters by 10 m walk test and energy expenditure using physiological cost index was recorded in bracing and non-bracing conditions. Results: The orthosis controlled knee hyperextension by not allowing the knee to go beyond neutral position. The gait was more natural with proper heel strike and better push off. There was improvement in temporal-spatial gait parameters and gait was energy efficient. Conclusion: The SKAFO was found to be effective in controlling knee hyperextension and resulted in stable, natural, satisfactory and energy efficient gait in spastic Cerebral palsy with knee hyperextension and heel rise. Similar study involving case series can be used to set the prognosis of ambulation and the kind of orthotic interventions needed to optimize the walking ability.
  4,752 28 -
Does Q angle change in spastic diplegia children?
TU Jimshad, Sanam Mainali, KS Swethankh, Anil T John
July-December 2016, 2(2):85-89
Background: Spastic diplegia is a form of cerebral palsy that is a chronic neuromuscular condition of hypertonia and spasticity manifested as an especially high and constant tightness or stiffness in the muscles of the lower extremities of the human body, usually those of the legs, hips, and pelvis. Q angle is an angle formed by two imaginary lines, first line extending from anterior superior iliac spine to center point of patella and second line extending from tibial tuberosity to center point of patella. The abnormal twisting of patella is known as tibial torsion. Objectives: To find Q angle value in male children with spastic diplegia aged between 7 and 12 years and to compare the degree of Q angle between children with internal and external tibial torsion. Methodology and Procedure: A total of thirty male children aged between 7 and 12 years were divided into two groups based on their tibial torsion, and Q angle was assessed using standard goniometer. Results: Results were statistically analyzed. There was a significant change in Q angle of children with spastic cerebral palsy, and children with spastic diplegia with internal tibial torsion have decreased Q angle and children with external tibial torsion have a significant increase in their Q angle (P = 0.001). Conclusion: This study concludes that Q angle is a good outcome variable for assessing musculoskeletal problem related to lower limb and can be used as a major tool for prognosis during rehabilitation. This study also proves that children with spastic diplegia with internal tibial torsion have decreased Q angle and children with external tibial torsion have a significant increase in their Q angle.
  4,019 22 -
Feasibility of multisensory training and its effects on balance control in school going children with cerebral palsy
Bhakti Patel, S Karthikbabu, Nafeez Syed
July-December 2015, 1(2):101-107
Context: Involvement of sensory system affects the motor performance of children with cerebral palsy, and the literature on sensory-based balance training is scarce in such children. Aim: To test the feasibility of administering multisensory training in school going children with cerebral palsy and its effects on balance control as measured by Balance Evaluation - Systems Test (BESTest). Settings and Design: School setting and a baseline-pre-post feasibility trial. Subjects and Methods: Seventeen children with cerebral palsy (gross motor function classification system level 1-3) aged between 6 and 16 years participated in sensory-based balance training encompassing inputs from visual, vestibular, and proprioceptive systems. Children with mental delay, hearing, and visual impairments and those who underwent treatments such as BOTOX, tendon lengthening, derotation surgery, or selective rhizotomy in the past 6 months were excluded. Following 2 months run-in period, each child underwent 45 min of training per session; a total of 18 sessions over 2 months duration. Statistical Analysis and Results: Repeated measures ANOVA and post-hoc test was done to analyze within-subject changes and with respect to time. P < 0.05 was statistically significant. After training, all the components of BESTest showed statistically significant change (P < 0.05). Conclusion: Multisensory training is a feasible mode of practice in a school setting and is beneficial in improving balance control in children with cerebral palsy.
  4,000 12 1
Testicular characteristics of children with cerebral palsy: Our experience
Ibrahim Aliyu, Abdulsalam Mohammed, Raymond Belonwu, Zainab Fumilayo Ibrahim, Umar Isah Umar
July-December 2016, 2(2):79-84
Introduction: Cerebral palsy (CP) is a chronic neurologic disorder. The hallmark of CP is the abnormality of movement and posture, but there may be other associated abnormalities; however, association with absent testis is an area poorly studied. Materials and Methods: This was a case–control study. Pretested questionnaire was administered by the researchers, and testicular size was determined using an orchidometer. Results: Thirty-six (65.5%) of the caregivers in the cerebral palsy group had examined the testes of their wards while only 17 (30.9%) of those in the noncerebral palsy group had examined the testes of their wards. Absent testes were reported in 5 (13.9%) of the children in the cerebral palsy group while none was reported in the non-CP group. Three (60%) left testes were reported absent in the CP group, and two (40%) had both testes absent. Most caregivers (80%) could not remember the exact age at which the testes became nonpalpable, but one (20%) was reported at <1-year of life and none at birth. Only one caregiver (20%) complained of absent testes in the cerebral palsy group. A total of 8 (7.3%) testes were absent from the 110 testes (55 pairs); on the right side, 3 (5.5%) absent testes and 2 small testes were recorded among the CP group while only a single small testis was reported in the non-CP group. Conclusion: Absent testes were more common among the CP group; routine check of its presence and size should be a part of their evaluation.
  3,954 28 -
A study of audiological profile of children with cerebral palsy
Mohammad Shamim Ansari, MA Hafiz Ansari
July-December 2015, 1(2):80-83
Background: Hearing is critical for the full development of language skills. Even a mild hearing impairment can interfere with speech and language development. Hearing impairment has the highest incidence rate for any pediatric disability, since several risk factors in infants with cerebral palsy (CP) are the same risk factors to develop hearing impairment. Thus, it should come as no surprise that hearing impairment occurs more frequently among children with cerebral palsy than in the general population. Recent studies have shown that up to 25% of children with cerebral palsy also suffer from a hearing impairment. However, no data of hearing impairment in cerebral palsy is available in India. Objective: The goal of this study was to determine the frequency and profile of hearing impairment in children with cerebral palsy. Methodology: This was a retrospective study involving 117 children of 2-10 years of age of both genders who were diagnosed with cerebral palsy. The audiometry, tympanometry, otoacoustic emission, and auditory brain stem response hearing tests were employed to categorize the hearing impairment. Results: Hearing impairment was observed in 39% of children. Sensorineural, conductive, and mixed hearing impairment was present in 48%, 41%, and 31% of the children, respectively. Among them, there was mild, moderate, and severe degree of hearing impairment in 52%, 26%, and 22% of the children with cerebral palsy, respectively. Conclusions: Prevalence of hearing impairment in children with cerebral palsy is alarming. This warrants early identification and diagnosis of hearing impairment, especially for medically treatable forms of hearing impairment such as secretory otitis media, Eustachian tube dysfunction, and presence of wax. This early identification may facilitate better development of speech and language as well as positive outcomes. Therefore audiological assessment should be incorporated into the diagnostic and therapeutic plan of all children with cerebral palsy.
  3,601 16 -
A study on available support systems in inclusive setting for the students with mental retardation
Jayanti Pujari, M Annapurna
January-June 2015, 1(1):35-41
The present study is an exploratory study to find out the existing support system in the primary schools of two Districts of Telengana. The study primarily focused on identifying the available support system in the primary schools which facilitate the learning of children with mental retardation. The objective of the study was to find out the support system available for the students with mental retardation in terms of academic support, social support, emotional support and physical support in inclusive setting in the primary schools. A total number of 100 teachers (both regular and resource teacher), 50 students and 20 primary school were selected by purposive sampling procedure. The data was generated with the help of 4 type of questionnaire. The major findings of the study show that the academic and social support as perceived by regular teacher was in average level where as academic and social support perceived by resource teacher are in high level. The emotional support provided by peer is high level. The physical support was studied under three catogerise i.e. toilet and sanitation facilities, mobility and barrier free environment are in low level. The study concludes that adequate support system is key to the success of inclusive education.
  3,385 14 -
Interventions on hyperexcited motor circuits: Science or bias and confusion – what can be done?
Aniruddh Kumar Purohit
July-December 2016, 2(2):69-70
  3,373 22 -
Efficacy of task-oriented training on balance in children with cerebral palsy
Arjun Dutt, BN Prem Kumar
July-December 2016, 2(2):94-99
Background and Objective: Cerebral palsy (CP) is a well-recognized group of motor and postural neurodevelopmental disorders beginning in early childhood and persisting through the life span.[1] Prevalence estimates of CP ranged from 1.5 to more than 4 per 1000 live births. This single-group interventional study was conducted to know the effectiveness of task-oriented training on balance in children with cerebral palsy. Materials and Methods: Patients included for the study were children with spastic diplegic cerebral palsy, 6–14 years of age, both male and female children, Gross Motor Functional Classification Scale levels I, II and III, Motor Assessment Scale (sitting to standing item), and Modified Modified Ashworth Scale (MMAS) grade 1 and 2. Pediatric Balance Scale (PBS), Functional Reach Test (FRT), Five Times Sit to Stand Test (5STS), and Modified Modified Ashworth Scale (MMAS) were used as the tools of assessment. Task consisting included sitting reach outs activities, sit to stand activity, squatting, step up, stepping on one leg, and step on a small ball. Descriptive and inferential statistical analyses have been carried out in the present study, Student's t-test (two-tailed, independent) has been used for intergroup analysis, and Student's t-test (two-tailed, dependent) has been used to find the significance of study parameters on continuous scale within each group. Duration of the study lasted for 12 months and frequency was 1 h per session, 5 days a week. Results: Statistical analysis was performed using Student's t-test and significant improvement was observed in balance with task-oriented training with the mean improvement of 3.667 in PBS, 0.250 in 5STS, 0.25 in FRT, and 63% in MMAS. Conclusion: This study suggests that the task-oriented training is effective in improving the balance of children with cerebral palsy assessed using PBS, FRT, 5STS, and MMAS.
  3,234 21 -
One stage soft tissue release, open reduction, femoral shortening, osteotomy and peri acetabular augmentation for spastic dislocated hip-early results
Sakti Prasad Das, Sudhakar Pradhan, PK Sahoo, Shankar Ganesh, RN Mohanty, SK Das
January-June 2015, 1(1):28-34
Objectives: The goals of hip surgery in cerebral palsy are to maintain adequate reduction of the femoral head, prevent pain, improve sitting balance and maintain motion and the ambulatory status of the patient. It is now well accepted that soft tissue release, open reduction and femoral shortening were necessary for a stable hip along with some type of pelvic osteotomy. We evaluated the clinical and radiological results of one-stage correction of hip dislocation for cerebral palsy patients. Materials and Methods: We reviewed clinical outcomes and radiologic indices of 32 dislocated hips in 24 children with cerebral palsy (13 males, 11 females; mean age, 8.6 years). All 32 hips had dislocation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (2). The combined surgery included release of contracted muscles, (adductors, rectus femoris, iliopsoas) open reduction of the femoral head, femoral shortening varusderotation osteotomy and the modified Dega osteotomy along with shelf procedure. Hip range of motion, GMFCS level, acetabular index, center- edge angle, migration percentage, neck shaft angle, Sharp's angle was measured before and after surgery. The mean follow-up period was 38.1 months. Results: Hip abduction (median, 40°), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were no femoral head avascular necrosis, no infection or nonunion. There was no redislocation. All radiologic indices showed improvement after surgery. Conclusions: So, we believe that a combined approach of muscle releases, open reduction, femoral shortening varus-derotation osteotomy, Dega osteotomy and penicapsularacetabular augmentation was a highly effective method for the treatment of spastic dislocated hips in our patients.
  3,205 14 1
Results of selective motor fasciculotomy in spastic upper limbs due to cerebral palsy (a review of 30 children and adults)
Srikanth Reddy, Aneel Kumar Puligopu, Aniruddh Kumar Purohit
January-June 2015, 1(1):21-27
Objectives: To assess the outcome of selective motor fasciculotomy in relieving upper limb harmful resistant spasticity and thereby to improve motor functions in persons with cerebral palsy. Materials and Methods: Thirty people having cerebral palsy (16 males and 14 females) age ranging from 5-35 (mean age = 12.66) years with upper limb resistant spasticity were studied. The participants having spastic hemiplegia (N = 11), triplegia (N = 9) and quadriplegia (N = 10) were assessed using Modified Ashworth Scale (MAS), Selective Voluntary Control Grade (SVC), WeeFIM Scale and hand function evaluation. Selective motor fasciculotomy (SMF) was performed on musculocutaneous nerve (N = 15), median nerve (N = 35) and ulnar nerves (N = 3) for elbow flexors, pronators and radial wrist flexors and ulnar wrist flexors spasticity respectively. Pre and post op therapeutic exercises were performed. Results: Statistical analysis using Wilcoxon Signed Ranks test showed significant reduction in spasticity and improvement in selective voluntary control, hand functions (grasp to hold a rod) and WeeFIM self care domain. There was no recurrence in spasticity and no complications following surgery. Conclusions: The SMF of musculocutaneous, median and ulnar nerves significantly reduces spasticity in the affected muscle groups and thereby improves the self care (motor) functions in selected people with cerebral palsy who have harmful resistant spasticity without any organic shortening of the muscles. The procedure is safe and the spasticity does not recur.
  3,037 12 1

July-December 2016, 2(2):105-125
  2,951 40 -
Dr. PK Mullaferoze motivational biography (3 October 1910-24 November 2008)
Dhruv Mehta, Nadir Bharucha, GS Chawra, Rakesh R Bhansali, Ella D'Souza, PC Shastri, GS Shashikala, Asha Dangarwalla, Fatema Jetpurwalla, AK Purohit
January-June 2015, 1(1):54-60
  2,857 13 -
Neuronal apoptosis of the developing brain: Influence of anesthetics
Padmaja Durga
July-December 2016, 2(2):71-78
Surgeries and multiple procedures are undertaken on millions of children all over the world which involves exposure of these children to anesthetics during the stage of brain development. There is an increasing concern regarding the risk of anaesthetic neurotoxicity in children. Evidence has shown that exposure to all commonly used anaesthetics and sedatives can cause neurodegeneration in the developing brain with the possible exception of α2-adrenergic agonists. Anaesthetic effects on the brain during its growth spurt can initiate a cascade of alterations in neurodevelopment which have been detected structurally or functionally in preclinical experiments. The studies are ongoing to gather clinical evidence.
  2,837 30 -
Sanjad-Sakati syndrome: Beyond the Middle-East
Chetana Sen, Sandip Pal, Prasenjit Sengupta, Asutosh Pal, Jacky Ganguly, Chiranjib Das, Debasish Basu
January-June 2016, 2(1):54-57
Sanjad-Sakati syndrome (OMIM 241410), also known as hypoparathyroidism-retardation-dysmorphism (HRD) syndrome, is a rare autosomal recessive syndrome of congenital hypoparathyroidism, mental retardation, and facial dysmorphism, reported almost exclusively in the Middle-Eastern children of consanguineous parents. Here, we present a 20-year-old male child from India presenting with childhood-onset, recurrent generalized seizures, which were poorly controlled with multiple antiepileptics. Along with intrauterine growth retardation, the patient had short stature and typical facial dysmorphism. Investigations revealed extensive intracranial calcifications, with hypoparathyroidism and severe hypocalcemia. This is only the third reported patient of HRD phenotype in a non-Arab patient and the first to present with multifocal dystonia. Thus, it is important to keep in mind untreated hypocalcemia in a patient of refractory seizures, with HRD possibly being no longer an exclusively Middle-Eastern disease.
  2,824 24 -
Evaluation of functional performance assessment in preterm infants with Infant Neurological International Battery
G Shinde Krishna, S Ganvir Suvarna
July-December 2015, 1(2):84-87
Context: Many studies have found that there is an increased risk of neurodevelopmental impairments in preterm and low birth weight (LBW) infants, so it is desirable to make early predictions with regard to outcome. This is important for the family, for the researchers designing appropriate follow-up and intervention programs, and for the pediatric neurologist who has to give meaningful feedback to obstetricians and neonatologists. Several studies have tried to identify infants at particularly high risk of neurological damage. In 1972, Drillien described transitory dystonia of the LBW premature infant as a common developmental deviation of motor function during the 1 st year of life. Aims: To evaluate the functional performance (age specific motor development) in preterm infants using Infant Neurological International Battery (INFANIB). Settings and Design: Observational study design conducted at physiotherapy OPD. Subjects and Methods: An observational study was carried out in 100 infants who were born at 24-31 weeks gestation with age group from 4 to 9 months with a mean age of 4.3 months. The sample selection was based on convenient sampling method. The infants were evaluated according to their gestational age. The study was approved by Institutional Ethical Committee. The guardians signed an informed consent form allowing the infant's participation. INFANIB was administered on 100 preterm infants, and collected data were compared with standard values of INFANIB. Statistical Analysis Used: Unpaired t-test was used for between group comparisons. Results: The present study shows that premature infants have high risk of delayed pattern of motor development which is different from those infants born at term. Conclusions: The premature infants show delayed pattern of motor development that is different from those born at term.
  2,726 16 -
Single event multi level orthopedic surgery in a teenager having spastic triplegic cerebral palsy
Jitender Jain, Varidmala Jain, Vinai Shrivastav
January-June 2015, 1(1):45-48
An 18-year-old boy with spastic triplegic cerebral palsy was not able to stand or walk without support (GMF Score: Level-4) and even not able to hold things with his right hand. He had undergone orthopedic surgeries previously twice in both the lower limbs and right upper limb. He also underwent static magnetic field (SMF) of median nerve for pronator and wrist flexor spasticity in right upper limb. Single Event Multilevel Orthopedic Surgeries (SEMLOS) were performed in both the lower limbs and in right upper limb with derotational osteotomy on right proximal femur and fixation with DHS. On complete reassessment 1 month after the surgery it was found that he also had lots of trouble in sensory feedback. He was given first sensory integration followed by other therapeutic exercises. Now, he is fully independent and is able to walk with elbow crutches as well as two stick support for a long distance (GMF Score- level 3). Grip as well as release of fingers in right hand have also improved.
  2,683 14 -
Coupling effect of neuromuscular electrical stimulation on glutei and transcutaneous electrical nerve stimulation on hip adductors in scissoring gait
Khurshid Shaik, Lakshmana Prasad Gadde, Naveen Kumar Balne, Aniruddh Kumar Purohit
January-June 2016, 2(1):27-31
Introduction: Spasticity and weakness are the two most important factors effecting gait in children with spastic diplegia. Spasticity in hip adductors and associated weakness in hip extensors and abductors leads to scissoring gait pattern. Proximal muscle stability is essential for distal mobility; this study focuses more on proximal muscle group facilitation for correction of deviations in scissoring gait. Objective: The objective of this study was to study the coupled effect of neuromuscular electrical stimulation (NMES) on glutei and transcutaneous electrical nerve stimulation (TENS) on hip adductors in improving gait parameters. Materials and Methods: The experimental group received NMES to hip extensors and hip abductors followed by TENS to hip adductors as an adjunct to conventional therapy for a period of 3 weeks whereas the control group received only conventional therapy. In experimental group, NMES was applied to gluteus maximus and medius for 10 min each and were asked them to perform the muscle action voluntarily. Later, TENS was applied to hip adductors for 10 min with passive hip abduction (HAB). Both the group received home program for the next 2 months. Results: A significant improvement was noted in spasticity, active range of motion (AROM) to HAB, extension, and gait parameters with P < 0.05. Conclusion: The coupled effect of NMES on glutei and TENS on hip adductors in children with scissoring gait gives rise changes in muscle tone, AROM, and gait parameter. All these contribute in improving the gait. These gains persist atleast for 3 months compared to the individuals who receive only conventional therapy. The improvement is seen within a short period of 3 weeks time compared to conventional therapy alone group which takes longer period of 12 weeks time.
  2,611 24 -
My journey into the world of treating children with cerebral palsy
Warwick J Peacock
July-December 2015, 1(2):65-69
  2,480 18 -
Cerebral palsy field indeed needs scientific deeds
AK Purohit
January-June 2015, 1(1):1-3
  2,472 15 -