Effectiveness of Activity-Based Therapy in Comparison with Surface Spinal Stimulation in People with Traumatic Incomplete Spinal Cord Injury for Activation of Central Pattern Generator for Locomotion: Study Protocol for a 24-Week Randomized Controlled Trial

Study Design A multi-centric randomized controlled trial to be conducted at two sites, department of phyhysiotherapypy, Punjabi University, Patiala and rehabilitation department, Indian Spinal Injury Centre, New Delhi, India. Purpose To determine the effectiveness of activity-based therapy in comparison with surface spinal stimulation (SSS) in traumatic incomplete spinal cord injury (SCI) with special reference to locomotion—a central pattern generator controlled function. Overview of Literature A major goal for many patients after SCI is to regain the function of locomotion. It is crucial that rehabilitation strives to maximize locomotor ability and functional recovery after SCI. Experimental evidence of improvement in stepping and motor control after activity-based training in animal models and human SCI has been translated into clinical neuro-rehabilitation. Methods Control group participants will undertake an intensive 24-week duration thrice weekly program of activity-based therapy. In addition to this the participants in experimental group will also receive a session of 45 minutes of SSS on thrice weekly basis. The primary analysis for our study will be at 24 weeks. Linear regression will be used to determine the mean between-group differences and 95% confidence interval for all continuous outcomes using baseline scores and group allocation as covariates. Results The primary outcome measure is improvement in the level of walking index for SCI-II. The secondary outcome measures are modified Ashworth scale, Penn spasm frequency score, spinal cord independence measure-III, SCI functional ambulation inventory, Hoffman’s reflex, somatosensory evoked potential, and American Spinal Injury Association Impairment Scale scores. Conclusions An insight into training-induced mechanisms will be of great importance to fine tune such combined treatments and vindicate their efficacy in restoration of locomotion and functional activities in individuals with SCI

Effect of surface spinal stimulation on autonomic nervous system in the patients with spinal cord injury

Background: The Autonomic Nervous System (ANS) plays a key role in the regulation of many physiological processes, mediated by supraspinal control from centers in the central nervous system. Spinal cord injury (SCI) decreases the ability to sympathetically control blood pressure and to regulate body temperature. Bladder dysfunction has been reported as a serious medical complication following SCI. The purpose of study is to find the effect of surface spinal stimulation on autonomic nervous system i.e., bladder function, skin resistance, and skin temperature. Materials and Methods: Five traumatic spinal cord injury subjects were selected for experimental pilot study; surface spinal stimulation for 45 minute period applied to the skin in T11-L2 area, with a carrier frequency of 2500Hz and modulated to beats frequency of 20Hz. Stimulation amplitude was raised to cause sensory stimulation. The pre- and post-stimulation values using the values of urodynamics testing, galvanic skin response, and infra-red thermometer compared in same patients and results were obtained. Results: Result of the present study indicates that four of five subjects demonstrate a decrease in the infused fluid volume, improved bladder sensation, but shown no effect over the bladder capacity. The skin resistance of the right lower limb was increased post-stimulation, but the improvement was not significant, and skin temperature of thigh and foreleg improved significantly. Conclusion: According to our results, surface spinal stimulation was effective to improve non-reflexive bladder, skin resistance and skin temperature, but further research is needed

EFFECT OF ELECTRICAL MUSCLE STIMULATION WITH SENSIROMOTOR TRAINING IN FOCAL HAND DYSTONIA - A CASE REPORT

Background: Focal hand Dystonia is shown by involuntary muscle contractions in the arm or hand while writing with a disordered neuroplastic changes in the brain. Symptoms can include lack of co-ordination, cramping and tremor and tend to be specific for each individual. So, the present study evaluates the effect of an integrated approach that is employed to improve functional independence in a patient suffering from focal hand dystonia. Case Description: The benefits of sensorimotor task specific training along with electrical muscle stimulation in the rehabilitation of focal hand dystonia is reported in this study. The treatment protocol is planned according to the problem list of the patient and an intervention of 20 days (1 hour per day, 5 days per week for 4 weeks) is given to the patient. Outcome Variables: Prognosis is observed in Burke-Fahn-Marsden scale, global dystonia scale, Jedynak’s protocol and unified dystonia rating scale before & after the intervention. A Depression anxiety stress scale is also used to assess the psychological status of the patient. Conclusion: Considerable improvement is seen in writing and fine motor skills after the rehabilitation. It is observed that the electrical muscle stimulation in conjunction with sensiromostor task specific training induces excitability in the muscles and improve the clinical function in patient with focal hand dystonia

EFFECT OF LOCOMOTOR TRAINING WITH BODY WEIGHT SUPPORT ON GAIT AND LOWER LIMB STRENGTH IN INCOMPLETE SPINAL CORD INJURY-A CASE REPORT

Background: Irrespective of the severity of the spinal injury, time after lesion and age at time of injury, the restoration of walking is given high priority by subjects with SCI. There is ample amount of literature with gait training methods for restoration of locomotion from other parts of the world. Rehabilitative training is currently one of the most thriving treatments to promote functional recovery following SCI. Many strategies exist to enhance locomotion, such as treadmill training with and without body weight support, robotic-assisted gait training, functional electrical stimulation, epidural stimulation and surface spinal stimulation. Pertaining to developing countries, this case study is an attempt to determine the effect of Locomotor Training with Body Weight Support on Gait and Muscle Strength in Incomplete Spinal Cord Injury. Methods: Single case design, Body weight support treadmill training for over a period of 12 months for an Individual with SCI (ASIA C) in a private clinic set up for SCI rehabilitation. ASIA lower extremity muscle strength, Spinal Cord Injury Functional Ambulation Inventory and Walking Index for Spinal Cord Injury –II. Results: Significant change in lower extremity muscle strength, gait parameters and temporal parameters of SCI-FAI. Though, no change was observed in score of assistive devices and similarly WISCI-II scoring. Conclusion: Single participant case study provided us with vital evidence for locomotor training with Body weight support in incomplete SCI. Further research in to the field shall yield valuable clinical findings

Review Article CONTEXT AND TASK RELATED APPROACH IN REHABILITATION AFTER STROKE: A SYSTEMATIC REVIEW

Background: Stroke is one of the leading causes of death and disability in both the developing and developed nations of the world. Stroke rehabilitation is an organized endeavor to help patients to maximize all opportunities for returning to an active lifestyle1. Neuro-rehabilitation is a method for relearning a previously learned task in a different way, either by compensatory strategies or by adaptively recruiting alternative pathways. There are several different approaches to physiotherapy treatment after stroke. These can broadly be divided into approaches that are based on neurophysiological, motor learning, or orthopedic principles. Some physiotherapists base their treatment on a single approach, whereas others use a mixture of components from a number of different approaches10. Neurological rehabilitation and the contribution of physical therapy have changed considerably over the past decades as scientific and technological developments have enabled greater understanding of brain reorganization and the mechanisms of motor control, motor performance, impairments and adaptations. Aim: This paper is a report of a review conducted to provide an overview of the evidence in the literature on the effect of Context and Task related approach in management stroke survivors. Data Sources: A range of databases was searched to identify papers addressing Context and Task related approac

Efficacy of cranial electrical stimulation and rational emotive behavior therapy in improving psychological illness among chronic stroke survivors: A pilot randomized controlled trial

Background: Stroke survivors suffer from significant neuropsychiatric disturbances and these disturbances act as barrier in the motor recovery. Medication is the common treatment but it has adverse effects. Hence, there is a need to find out effective treatments with or without minimal side effects for gross motor recovery of the patient. Objectives: Cranial electrical stimulation (CES) and rational emotive behavior therapy (REBT) are used as treatment approaches for depression, anxiety, stress, and irrational beliefs in the general population. In the present study, the efficacy of two psycho-therapeutic modalities (CES and REBT) along with conventional physiotherapy management was evaluated on psychological illness, motor recovery, and quality of life among chronic stroke (CS) survivors. Materials and Methods: A total of 18 patients with CS who scored >10 on Beck Depression Inventory Scale, scored >23 on Mini–Mental state examination scale, and having stroke of duration >6 months–2 years were included in the study. They were divided into two groups, A and B. Group A received CES while Group B received REBT. Both the interventions were given 5 days in a week for 4 weeks. Conventional physiotherapy for 30 min was added to both groups as common intervention. Depression, Anxiety, Stress scale (DASS-42), Pittsburgh Sleep Quality Index (PSQI), and Shortened General Attitude and Belief Scale (SGABS) were used for measuring depression, anxiety, and stress, sleep, attitude and beliefs, respectively, 4 weeks postintervention. Results: Patients with CS in Group A demonstrated significant improvement, P< 0.05, in Depression, Anxiety, Stress scale-24, PSQI, and MSSI when compared to those of Group B. Conclusion: CES has the potential to improve psychological illness such as depression, anxiety, stress, attitudes, belief, and thereby quality of life among CS survivors than REBT

RELATIONSHIP BETWEEN MODIFIED ASHWORTH SCALE AND ALPHA MOTONEURON EXCITABILITY IN SPINAL CORD LESIONS

Background: Spasticity is one of the major neurological complications occurring in people with Spinal Cord Lesions due to loss of supra-spinal and spinal control over alpha motor neuron activity. Its accurate assessment is necessary for tailoring patient specific rehabilitation program. Clinical assessment is commonly done through Modified Ashworth Scale where in the examiner subjectively judges resistance to passive range of motion whereas, electrophysiological quantification of spasticity can be done through Hoffman’s Reflex which is an estimate of alpha motor neuron activity. Methods: This co-relational study establishes an association between MAS and H reflex in a sample of both traumatic and non-traumatic Spinal Cord lesion patients. A sample of 22 patients was obtained who were rated for MAS grades 0,1,1+,2 and 3 in bilateral gastro soleus and consequent H reflex elicitation was done. Results: Karl Pearson Correlation coefficient was calculated between MAS and H amplitude (r = 0.342, p0.05) ; MAS and H/M ratio (r=0.190 ,p>0.05). Conclusion: It was concluded that there exists a weak but significant correlation between MAS and H amplitude but non-significant relationship between MAS and H latency; MAS and H/M ratio

Transcranial Direct Current Stimulation as an Effective Treatment Compared to Video Games on Executive Functions in Children With Attention Deficit Hyperactivity Disorder

Objectives: This study aims to determine the effectiveness of transcranial direct current stimulation (tDCS) compared to video games on executive functions in children with attention deficit hyperactivity children (ADHD). Methods: This was an unblinded randomized control trial study with ADHD participants recruited from various schools in Patiala District in Punjab, India. The participants were screened for ADHD using the NICHQ Vanderbilt assessment scale and then they were assessed for eligibility. The random allocation method was done for 61 participants and they were divided into two groups: the control group (video game only) and the intervention group (tDCS along with video game). tDCS was applied at the F3 (anode) and Fp2 (cathode) positions with 1 mA intensity for 20 min 3 times a week for 4 weeks. Pre-, mid-, and post- (day 0, 15, 30) intervention scores for the Raven progressive matrices, the Stroop test, and the trail making test were evaluated for all the participants. Results: The present study had 61 participants in the age range of 10 to 16 years. They were randomly allocated to control and intervention groups. One-way analysis of variance was used to evaluate within-group differences and an unpaired t test was utilized for between-group analyses on different parameters with P<0.05 as the level of significance. Our analysis revealed that tDCS along with video games has a statistically significant effect on components of executive functions as evaluated via the Raven progressive matrices (t=2.483, P=0.01), the Stroop test (t=3.507, P=0.001) and the trail making test (TMT Part A: t=3.238, P=0.02; TMT Part B: t=4.064, P=0.000) compared to the control group. Discussion: When compared with video games, tDCS is effective in improving executive functions in children with ADHD. A randomized control trial with a larger sample size is needed to strengthen the findings of this study and overcome its limitations