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   2015| January-June  | Volume 1 | Issue 1  
    Online since April 21, 2015

 
 
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CLINICAL ARTICLES
Physical profile of children with cerebral palsy in Jalandhar district of Punjab India
Raju Sharma, AGK Sinha
January-June 2015, 1(1):9-20
DOI:10.4103/2395-4264.153557  
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.
  6,321 13 2
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
DOI:10.4103/2395-4264.153559  
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.
  4,138 12 1
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
DOI:10.4103/2395-4264.153567  
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.
  3,983 14 -
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
DOI:10.4103/2395-4264.153562  
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.
  3,834 14 1
BIOGRAPHY
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
DOI:10.4103/2395-4264.153580  
  3,546 13 -
CASE REPORTS
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
DOI:10.4103/2395-4264.153575  
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.
  3,296 14 -
EDITORIAL
Cerebral palsy field indeed needs scientific deeds
AK Purohit
January-June 2015, 1(1):1-3
DOI:10.4103/2395-4264.153553  
  2,942 15 -
CASE REPORTS
Participation restrictions in a teenager with down syndrome: A nine year follow up case study
Asha Chitnis, Reena Mody, Gajanan Vithalrao Bhalerao, Sujata Noronha, Madhavi Kelapure, Kruti Shah
January-June 2015, 1(1):49-53
DOI:10.4103/2395-4264.153579  
This is a case report of Aadyant, a child with Down syndrome, [1] across his life so far from age 8-17 years. Although Aadyant (name changed) had a sound immediate postnatal period, he was diagnosed with Down syndrome at birth. He suffered from convulsions at the age of 6 months. He had subluxation of the right hip joint. Sensory motor cognitive developmental therapies with perseverance and participation by the family do improve the condition of the person.
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Acquired cryptorchidism with spastic cerebral palsy
Ibrahim Aliyu
January-June 2015, 1(1):42-44
DOI:10.4103/2395-4264.153571  
Cryptorchidism may have significant impact on the psycho-social wellbeing of a child that if not detected could result in low self-esteem and poor scholastic achievement. It may be congenital or acquired; in acquired cryptorchidism the testes would have descended into the scrotum and then subsequently ascended into the inguinal canal or abdomen. Although congenital cryptorchidism is commonly associated with prematurity and diseases such as prune-belly syndrome, Smith-Lemli-Opitz syndrome, Laurence-Moon-Biedl syndromes; acquired cryptorchidism (unlike retractile testes) is rare. Therefore, the case of an 11-year-old boy with acquired cryptorchidism associated with spastic cerebral palsy, which was omitted, is reported. This affected his relationship with his peers and also resulted in poor school attendance.
  2,913 12 -
ANNOTATION
Developmental disability in the 21 st century: New ideas for a new millennium
Peter Rosenbaum
January-June 2015, 1(1):4-8
DOI:10.4103/2395-4264.153555  
  2,857 13 -