Establishment of a post stroke dysphagia rehabilitation service in a lower middle income nation.

[Background and aims] From a preliminary six-month survey carried out amongst stroke patients in our center, dysphagia is a common complication affecting 57% of survivors and puts them at higher risk of morbidity and increased mortality. To date, there is no uniform approach for early post stroke dysphagia evaluation and management at our centre. Hereby, we describe our efforts in setting up a structured service for dysphagia rehabilitation in the acute hospital setting led by the rehabilitation physician. [Methods] The formation of a multidisciplinary team was tailored according to the limited human resources at our centre. Echoing the scenario throughout the country, scarcity of speech-language therapists (SLT) required delegation of responsibilities to the rehabilitation medicine team. Other key collaborators included nurses, visiting speech language therapists,otorhinolaryngologists, dentists and also dieticians. We seek to establish a post stroke dysphagia evaluation and rehabilitation protocol that may be applicable in establishments with similar resources. [Results] The multidisciplinary collaboration allowed a holistic approach in patient management ranging from good oral hygiene practice to routes of adjunctive enteral nutrition for patients who needed time for transition to full oral feeding. The involvement of a diverse group of healthcare professionals also allowed a wider dissemination of post stroke-dysphagia awareness amongst other clinicians. [Conclusions] In conclusion, countries with limited resources need to make necessary investments and pool resources to form a structured dysphagia rehabilitation team in the acute hospital setting to improve patient outcome

Orthosis for orthopaedic trauma of lower limb

Orthotic prescription and usage in severe lower limb trauma

Maggot debridement therapy for pressure injury management in a tetraplegic patient in Malaysia

Infected pressure injury is among life threatening complications in spinal cord injury (SCI) patients and mostly requires multifaceted management strategy. This case report illustrates wound healing progress of a 56-year-old man with incomplete tetraplegia from cervical spondylotic myelopathy complicated with infected bilateral ischial tuberosity pressure injury. Presence of multidrug-resistant organism infection, Pseudomonas aeruginosa, deemed wound management to be unsuccessful despite 14 days intravenous antibiotic therapy using polymyxin E, coupled with multiple intraoperative and bedside surgical debridement, with modern dressing throughout admission. Reduction of bacterial burden was seen after third intraoperative surgical debridement followed by Maggot Debridement Therapy (MDT). This case highlights MDT success in large unhealthy pressure injuries coupled with holistic wound care management specific to spinal cord injury community

A case report: atropine drops induced psychosis after sublingual administration for sialorrhea treatment in stroke patient.

Sialorrhea also known as drooling is defined as excessive saliva in the mouth or hypersalivation. The symptom causes discomfort for most stroke patients or other neurological disorders such as Parkinson's disease. Sialorrhea may affect physical, mental, self-esteem and social life because the patient needs to accommodate the excessive salivation in activity of daily living such as eating, talking, resting and sleeping in addition to psychosocial complications such as social stigma among families and friends. Advanced complications might also develop such as aspiration pneumonia. Even worse, the patient might suffocate with the excessive saliva in the throat. In view of sialorrhea affecting quality of life, the symptomatic treatment is very important. One of the drugs that can reduce salivary production is ophthalmic atropine drops; anticholinergic drops synonymously used for dilatation of pupils and treatment of iritis and uveitis. Utilising the side effect of atropine which is dryness of mouth, atropine eye drops are also used for symptomatic treatment of sialorrhea. Nevertheless, there is no consensus and limited research data regarding the use of sublingual atropine to manage sialorrhea. We describe a case of a 61 years old man with atropine-induced psychosis after a single dose of sublingual atropine 1%. We report the atropine outcomes and possible side effects of psychosis in administering ophthalmic atropine via sublingual route in a stroke patient

Control strategy forpowerassist upper limb rehabilitation robotwith the therapist’s motion intention prediction

Currently, fully automated rehabilitation robots can assisttherapists in providing rehabilitation therapy, hence the patients could get hurt. On the other hand, manual treatment may cause less patient injury but it is tiresome, and there are not enough therapists in most countries. Power assist rehabilitation robots can support the therapists in conducting the treatment and may help to alleviate this problem. The goal of this study is to develop a control strategy for the robot to assist the therapist’s movement in a power assist upper limb rehabilitation treatment. The system combines the advantages of robotic and manual rehabilitation therapy. Torque and position sensors fitted on the power assist upper limb rehabilitation robot arm are used for motion intention estimation. The amount of angular velocity necessary to be delivered to the feedback controller will be determined by predicting the therapist‘s motion intention using the impedance control method. The resulting velocity from the motion intention estimator is incorporated into the Sliding Mode Control -Function Approximation Technique (SMC-FAT) based adaptive controller. The SMC-FAT based adaptive controller in the feedback loop, overcomes theuncertain parameters in the combination of the robot and the human arm. The motion intention estimator forecasts the movement of therapists. The proposed controller is used to regulate elbow flexion and extension motion on a power assist upper limb rehabilitation robot with one degree of freedom (DOF). The proposed control system has been tested using MATLAB simulation and hardware experimental tests. The outcomes demonstrate the effectiveness of the proposed controller in directing the rehabilitation robot to follow the desired trajectory based on the therapist's motion intention, with maximum errors of 0.002rad/sec, 0.005rad/secand 0.02rad/secfor sinusoidal,constant torque values, and hardware experiment respectively

An experimental model of induction of osteoarthritis in New Zealand white rabbit

Introduction: Historically, animal models for osteoarthritis have been established to facilitate the study of the pathogenesis of osteoarthritis and the potential medical treatment. The anterior cruciate ligament transection (ACTL) and partial meniscal resection model in rabbits have been widely used. The aim of the study was to establish a more effective surgical approach to induce knee osteoarthritis in New Zealand White Rabbits. Materials and Methods: This descriptive study was approved by the Institutional Animal Care and Use Committee (I-ACUC) ethical committee. The surgical approach of induction of osteoarthritis was done in Advanced Orthopedics Research Laboratory, International Islamic University Malaysia. Eight rabbits underwent lateral and medial meniscectomies at bilateral foreleg knees to induce osteoarthritis. The models were examined through physical and radiographic analysis. Results: Physical exams showed that all model animal daily food and water intakes were normal. Animal model knee motion in passive range showed limitation and instability. Radiographic imaging analysis showed osteoarthritic changes in all models. Moreover, no mortality was recorded during the study. The approach requires less surgery time and easier access. The analgesia was more humane and showed faster recovery. Conclusion: These outcomes suggested an effective and feasible technique of inducing knee osteoarthritis in New Zealand White rabbit models

Surgical technique for knee osteoarthritis induction in New Zealand white rabbits

INTRODUCTION: Osteoarthritis (OA) is a degenerative joint disease that affects both humans and animals. It is characterized by the progressive deterioration of the cartilage an underlying bone. Surgical techniques are often used in animal models of OA to study the disease progression. MATERIALS & METHODS: Thirty-three New Zealand White rabbits (NZWR) weighing about 2.5 kg to 3.5 kg were chosen. Both foreleg knee joints were destabilized by anterior cruciate ligament transection (ACLT). Subsequently, medial and lateral partial meniscectomy and scraping both cartilage of tibial condyles was done. RESULTS: Osteoarthritis induction was successfully created in all 33 rabbits, evidenced by radiograph as early as 3 weeks. Radiographic images at 6 and 12 weeks showed consistent progression to moderate and severe osteoarthritis. Post surgical survival rate was 100%. DISCUSSIONS: NZWR are widely used in knee osteoarthritis studies because OA development in this species closely mimics the disease pathophysiology in humans. The combination of ACLT with partial meniscectomy ensures the formation of post traumatic osteoarthritis model by causing joint destabilization and inflammatory damage. As opposed to humans, rabbits have higher loading pressure in the lateral compartment of the knee joint. To imitate human knee OA which commonly involves the medial joint compartment, partial meniscectomy of the medial meniscus is important. Furthermore, as rabbit articular cartilage is known to be capable for regeneration, partial transection of both parts meniscus guarantees the formation of OA in the animal model. CONCLUSION: The surgical induction of knee osteoarthritis via ACLT combined with medial and lateral partial meniscectomy is a successful technique with a consistent result

COVID-19 : providing rehabilitation care in the time of pandemic

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Rehabilitation Post Major Trauma

Holistic rehabilitation consideration post major traum

Footcare, footwear and exercise in diabetic patients

Presentation on diabetic foot education for healthcare personnels involved in diabetic foot disease management