Stroke rehabilitation in pakistan: what we know and what we need to do?

Stroke is one of the leading causes of adult neurological disability all around the globe. There have been some remarkable improvements in the acute management of stroke. These include the use of thrombolysis, development of radiological investigations including computerized tomographic scan and magnetic resonance imaging and establishment of acute stroke units. There have been some promising advances the field of stroke rehabilitation as well in the last three decades

Guillain‐Barre Syndrome in Covid-19: A Literature Review

The novel coronavirus (COVID-19) can result in several neurological complications including Guillain-Barré Syndrome (GBS). It is an acute parainfectious paralytic neuropathy. This review summarizes the demographic features, clinical presentation, diagnostics workup, and management strategies of COVID-19 associated GBS reported in the literature. We searched Medline, PubMed Central, SCOPUS, and Google Scholar using pre-defined keywords. We included all kinds of manuscripts in the English language only. Demographics, clinical features, diagnostic workup, management, and outcomes were documented in the datasheet. We identified 24 cases of COVID-19 associated GBS. Most were reported from Italy, followed by the USA. The majority were males (18/24) and the age ranged from 23 -84 years. Clinical presentation was typical sensory-motor GBS in most. Nine patients had facial palsy of which five had bilateral involvement. Two patients had bilateral abducent nerve palsy while two presented as paraparetic GBS variant with autonomic dysfunction. Electrodiagnostics studies were conducted in 17 patients only and 12 had typical features of acute inflammatory demyelinating polyradiculoneuropathy. Intravenous immunoglobulin was the preferred mode of treatment in most of the patient. There was one death, and most were discharged to rehabilitation or home. GBS is an important neurological complication associated with COVID-19. More data are needed to establish a casualty. However, most cases have a post-infectious onset with male preponderance. Most of the cases have a typical presentation but some may present atypically. The prognosis is generally goo

Current situation and future recommendations For neurophysiology services in Pakistan

Clinical neurophysiology is defined as “a medical specialty that studies the central and peripheral nervous systems through the recording of bioelectrical activity, whether spontaneous or stimulated”.1 There are different models of practice for clinical neurophysiology around the world. In some countries it is considered to be an independent specialty, while in other countries it is integrated with neurology

An overview of pathophysiology, assessment and management strategies of post stroke shoulder subluxation

Shoulder subluxation is a common complication after stroke. It can result in soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain. An estimated 17-81 % of stroke patients have shoulder subluxation. It limits the use of affected extremity in addition to the weakness resulting from stroke itself. It can delay the neurological recovery in hemiplegic stroke patients. The etiology is multifactorial and the underlying mechanisms alongwith its association with shoulder pain are not clearly understood. This makes management of post stroke shoulder- subluxation a challenge for stroke management team. This review provides an overview of current concepts about the causes and prevention/management of post stroke shoulder subluxation. It suggests careful and regular assessments particularly the emerging role of musculoskeletal ultrasound in evaluating the prognosis of shoulder subluxation, and the importance of preempting the development of, and prevention of this distressing complication

The loose end: neurology without rehabilitation

In recent years, successive therapies for previously untreatable neurological conditions have been introduced in clinical practice and these advance interventions have remarkably changed the landscape of neurosciences1,2 .But, rehabilitation of the functional impairments caused by neurological diseases is often overlooked or sometimes even neglected. In other words, the role of a comprehensive and early multidisciplinary rehabilitation in neurological disease is unrecognized and poorly understood even among neurologists and neurosurgeons. Usually, lifesaving neurosurgical management or solving a diagnostic riddle in neurology is attributed to successful patient management; however in reality, this is the first step in establishing a care plan for improving quality of life of these patients. The outcomes of neurological disorders are often related with disability, psychological dysfunction and social incapacitations3. Comprehensive rehabilitation completes the management of patients with neurological disorders as it focuses on minimizing disability, maximizing functional independence, improving quality of life and decreasing the complications of prolonged immobility4. Unfortunately, the understanding of rehabilitation is usually limited to provision of physical therapy in many parts of the world5

The role of augmentative and alternative communication in speech and language therapy: a mini review

Augmentative and Alternative Communication is an aided or unaided means of communication which supports existing communication abilities of an individual or replaces natural speech due to any speech and language disorder. The deficit could be developmental or acquired such as autism spectrum disorder, cerebral palsy, learning difficulties, dysarthria, dyspraxia or due to any acquired neurological condition such as aphasia and other degenerative disorders. Furthermore, it may be due to surgical procedures such as laryngectomy. Alternate means of communication have also been successfully used with COVID-19 patients. These tools may include pictures, symbols, signs or voice output devices. Parents of children with special needs and medical professionals have been reluctant in implementing the approach due to certain misconceptions. The aim of this review is to summarize the current evidence for the use of Augmentative and Alternative Communication with a range of disorders in relation to in relation to Pakistan

South asian contributions to the international rehabilitation literature: an online literature survey of 10 years

Physical medicine and rehabilitation (PM & R) deals with management, rehabilitation and community reintegration persons with disabilities. It is an emerging medical specialty in the South-Asian region (Pakistan, India, Bangladesh, Nepal, Srilanka ,Afghanistan, Bhutan and Maldives,). The region comprises 24% of the world population with a huge burden of disability. The contributions of South Asian authors to the international rehabilitation medicine literature are unknown. The aim of this study was to document the contributions of south Asian authors in the international rehabilitation literature in the last decade

Technological advancements in stroke rehabilitation

Early, coordinated, and multidisciplinary rehabilitation plays a major part in motor recovery after stroke. The conventional stroke rehabilitation primarily includes physical therapy, occupational therapy, and speech therapy. However, with these conventional methods, many stroke survivors still have a residual functional disability which impairs their ability to perform activities of daily living. This could be attributed to the insufficient therapy dose, low engagement and motivation of the patient, and lack of objective feedback to achieve significant improvements in function. Various technology-based stroke rehabilitation interventions have been developed in the last few decades which have shown promising results in improving stroke patients' functional mobility and independence. The use of technology promotes repetitive, task-specific training, active engagement of patients, integrating constructive and concurrent feedback, and accurately measuring functional improvement. This review summarizes the important technological advances in stroke rehabilitation, including exergames, telerehabilitation, robotic-assisted systems, virtual and augmented reality, wearable sensors, and smartphone application