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   Table of Contents - Current issue
October-December 2018
Volume 50 | Issue 4
Page Nos. 107-146

Online since Wednesday, February 6, 2019

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Allied and Healthcare Central Council Bill 2018 and inclusion of Occupational Therapists as an official signatory in medical board for issuance of disability certificate: The updates on recent Government policy p. 107
Anil K Srivastava
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Guest Editorial: Neurorehabilitation and functional ability: Opportunities for occupational therapy in transferring evidence from clinic to community p. 109
Kinsuk Maitra, Emily Buchman
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Outcome measures used in stroke rehabilitation in India: A scoping review Highly accessed article p. 111
Karthik Mani, Savitha Sundar
Background: Stroke is one of the prevalent noncommunicable diseases in India. In stroke rehabilitation, valid and reliable outcome measurements help in evaluating treatment effectiveness, systematic program evaluation, and justifying reimbursement. Measuring outcomes is construed as a good practice in the field of rehabilitation. Objectives: The purpose of this scoping review was to identify and review the outcome measures used in stroke rehabilitation in India to provide an up-to-date understanding of the nature of outcome measures used, their cultural relevance, linguistic relevance, and validity. Study Design: This is a descriptive scoping review. Methods: The scoping review framework proposed by Arksey and O'Malley in 2005 was used in this review. Following the development of review questions, relevant studies were identified, suitable studies were selected and critically reviewed, and the data were charted, collated, and summarized to generate themes. Results: Thirty-three studies identified 46 outcome measures. Most of the outcome measures used in stroke rehabilitation research in India were ordinal scales and body structure/function assessments. Reliability and validity scores of the identified scales ranged from 0.37–1.00 to 0.65–0.96, respectively. Modified Rankin Scale and Barthel Index were the most used outcome measures. Only two of the identified measures were developed in India. Conclusion: There is a dearth of culturally sensitive stroke-related outcome measures in India in all domains. The authors suggest that researchers in India exert caution when selecting and using outcome measures developed in foreign countries as the review identified only two translated and validated cognitive scales and one performance measure specific to the Indian population.
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The phenomenon of bicycling ability in Parkinson's disease: A brief review report p. 119
Alok Sunil Patil
Background: People with Parkinson's disease (PD) may suffer from reduced mobility and resulting secondary issues. Participation in therapeutic exercise program may help ameliorate the undesired effects of decreased mobility as well as help augment optimal functional outcomes. The physical as well as cognitive benefits of aerobic exercise such as bicycling have been well documented in healthy population. Limited references to literature suggest preserved ability of bicycling, even in the face of freezing of mobility, namely gait. However, this role or ability of bicycling in PD has yet not been adequately represented in research. Objectives: The objective of the study is to assess and explore the relevance of the phenomenon of bicycling ability in PD through a review of literature. Study Design: This study was a brief review report. Methods: Articles published in indexed journals in PubMed over a period of 10 years from 2007 to 2016 were accessed and collected from their online database and were reviewed for their underlying neurophysiological mechanisms, their content, level of evidence, and study design. Results: Ten articles that included case report, single group cohort, and comparative studies were chosen in the study. The articles included were found pertaining to the phenomenon of bicycling and its relation to the freezing of gait episodes. The phenomenon of imagining cycling to reduce freezing episodes along with the preserved ability to cycle aiding in the diagnosis of typical and atypical parkinsonism was also explored. Conclusion: There is a definitive relevance of the phenomenon of bicycling in the assessment, treatment, and measuring outcome in both typical and atypical parkinsonism. Further research is required to establish a consensus on the exact role of bicycling ability and identify novel avenues for its implementation in the care of people with PD.
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Effect of hand splinting versus stretching exercises for reducing spasticity and improving hand function in poststroke hemiplegia: A comparative interventional study p. 125
Mokhtar Ahmad Khan, Pragyan Singh
Background: Hand splints are used to prevent muscular hyperactivity in adult poststroke patients. Reflex inhibitory splints may be used as an integrative treatment of poststroke upperlimb spasticity. Hand splints are used by occupational therapists as a method of reducing the increased muscle tone of the upper extremity following stroke. Muscle stretching is becoming a very common practice in the rehabilitative management of spasticity. It includes several types of muscle stretching such as passive stretching, active stretching and prolonged stretching, isotonic stretching, and isokinetic stretching. Objectives: The objective of this study was to study the difference between the effects of splinting and stretching in reducing spasticity and improving hand function in poststroke hemiplegia. Study Design: This was a two-arm comparative interventional study. Methods: A total of 30 poststroke hemiplegic patients fulfilling the inclusion criteria which mainly include patients having tone of the affected upper extremity at wrist and fingers ≥2, according to the Modified Modified Ashworth Scale (MMAS), having score ≥25 on Mini-Mental State Examination and having age between the age group of 35 and 65 years are enrolled for the study. Consecutive sampling was done by putting all odd number patients in the splinting group and all even number patients in the stretching group. Assessment tools and outcome measures were B and C subscales of Fugl-Meyer Assessment of Physical Performance for Upper Extremity and MMAS. The patients of the splinting group were given a resting hand splint to wear for 10–12 h continuously per day for 6 weeks. Stretching exercise using a prolonged slow stretch technique was carried out to patients of the stretching group. Results: The patients of splinting group showed more improvement in spasticity and hand function than stretching group with mean difference of 1, P= 0.695, and 95% confidence interval (CI) = −26.41–−22.39 for wrist flexor spasticity, for finger flexor spasticity mean difference was 4, P= 0.143, and 95% CI = −8.28–−5.42 and for hand function mean difference was 4, P= 0.13, and 95% CI = 14.62–20.47. Conclusion: There was the statistically nonsignificant difference between the efficacy of hand splinting and stretching exercises, in reducing spasticity and improving hand functions in poststroke hemiplegia. However, clinically, hand splinting is more beneficial than stretching exercises for the desired outcomes.
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Effect of the spacing technique to improve balance and gait in stroke survivor: An experimental study p. 130
Neelima, Rama Kumar Sahu
Background: Spacing effect is the observation that information presented using spaced repetitions is better remembered than information presented via massed repetitions (Challis, 1993). Many studies of spacing effect reported positive effect on motor learning, but there is a limited application of spacing strategies for the people with stroke which could potentially result in a significant improvement in balance and gait training for everyday functioning. The aim of this study was to determine whether spaced learning improves motor learning as regards balance and gait in people with stroke. Objectives: The aim of this study is to study the effect of spacing technique in improving balance and gait in patients with stroke. Study Design: This study is in pretest–posttest experimental study design. Methods: Thirty patients with stroke were selected and randomly assigned to Experimental and Control groups. Experimental group consists of 15 patients with 9 males and 6 females patients who received conventional therapy along with spaced exercise protocol thrice a week for 8 weeks. Control group consists of 15 patients with 12 male and 3 female patients who received conventional therapy. Tinetti Performance-Oriented Mobility Assessment (TPOMA) was used as an outcome measure. Results: Statistical analysis showed that there was significant improvement in the Experimental group, measured with TPOMA on Mann–Whitney U-test where the result shows U = 14 which corresponds to P= 0.000 along with 95% confidence interval (0.000, 0.095). Conclusions: The study concluded that application of the spacing technique program with conventional therapy improves balance and gait more effectively than only with the conventional therapy. Thus, spacing effect or spaced interval practice along with conventional therapy should be considered during the management of stroke population to improve balance and gait.
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Dual task training, fall, and functional independence in patients with Parkinson's disease: A longitudinal study p. 134
Soumyakanta Sahu, Padmalaya Jali, Arpita Srivastava
Background: Most of the daily living activities (ADL) require dual-task (DT) performance so as to efficiently accomplish different tasks in everyday life like shifting objects from one place to other, monitoring the environment, and judging the threats and balancing efficiently to transfer self, etc. Due to disruption of the motor function of basal ganglia, patients with Parkinson's disease (PD) demonstrate noticeable problems while performing DT with a significant amount of gait and balance impairments which are also known as fall risk factors. Objectives: In this study, we evaluated the long-term effect of a DT training program applied with basic principles of motor learning on falling and ADL in patients with PD. Study Design: Pre-test and post-test experimental study design. Methods: Fifty-four patients with PD were allocated into two groups by simple randomization. Outcomes were recorded for fear of fall (FOF) by Tinetti Fall Efficacy Scale, ADL by functional independence measure and a number of falls within the last 6 months. Both the groups received occupational therapy services, whereas the patients of the experimental group received a 4 weeks program of one-on-one training program including walking while performing several motor and cognitive tasks. Data for all outcomes were measured before training and posttraining. Follow-up scores were recorded till 2 years after completion of the training program. Results: Both the groups showed significant improvements in FOF and ADL scores. Between the group, analyses showed experimental group had a significant difference in the improvements than the control group. There was a significant difference noted between posttraining and follow-up scores for both the groups. The number of falls in both groups reduced significantly. The experimental group showed a significant reduction in some falls as compared to the control group. Conclusion: The result of this study showed feasibility as well as the efficacy of DT training program to minimize falls and FOF thus resulting in improvement of functional independence with its strong retention effect till 2 years after posttraining.
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Effects of specially designed early self-mobility chair on functional independence in a child with myelomeningocele p. 139
Suhas Sudam Bongade, Shailaja Sandeep Jaywant, Rashmi Sudhakar Yeradkar
Myelomeningocele (MMC) which is the most common neural tube defect not only significantly limits mobility and further exploration of environment but also remarkably limits social, perceptive, and cognitive development of the child. Furthermore, it makes the child dependent for activities of daily living and subsequently affects quality of life of the child and caregiver. This is a case report of 2½-year-old child diagnosed with L1 level MMC, with significant motor impairment but good cognitive skills and fair upper extremity functions. No further milestones were achieved due to inactivity, disuse, and prolonged hours of lying down postures, despite nil neurological deficits in the upper body. The child was intervened for improving his upper extremity and upper trunk strength and endurance. Thereafter, a specially designed mobility chair was fabricated and introduced to him with organized and structured in-hospital training. The chair advantageously instilled upper extremities' functional mobility and cognition functional activities and thus made it possible for him to explore the surroundings as freely as other children of his own age. The objective of the intervention was to improve his mobility and to find out its significance on independence using the International Classification of Functioning, Disability, and Health model and its effect on parental stress level. The child's mobility improved significantly, social interaction became evident, and thereby, independence was achieved at the end of 1 year of therapy. For this child, the chair proved to be beneficial as an early mobility aid. A research study on suitable sample size to prove the hypothesis generated in the case report as statistically significant is suggested.
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News and Information p. 145

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