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   Table of Contents - Current issue
Coverpage
January-June 2016
Volume 2 | Issue 1
Page Nos. 1-61

Online since Wednesday, August 10, 2016

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EDITORIAL  

Medical publication - A minimum must to progress p. 1
Aniruddh Kumar Purohit
DOI:10.4103/2395-4264.188149  
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ANNOTATION Top

Seizures in cerebral palsy Highly accessed article p. 3
Nagabhushana Rao Potharaju
DOI:10.4103/2395-4264.188150  
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ORIGINAL ARTICLES Top

Efficacy of supracondylar knee ankle foot orthosis for hyperextended knee and heel rise in spastic cerebral palsy: A pilot clinical trial p. 22
Rajesh Kumar Mohanty, Ullas Chandra Sahoo, Smruti Prava Sahoo
DOI:10.4103/2395-4264.188151  
Background: Guidelines to assist with decision making for orthotic management of gait dysfunction in individual with cerebral palsy (CP) is difficult to derive and remain controversial. The research question is whether supracondylar knee ankle foot orthosis (SKAFO) is one of best options for knee hyperextension and heel rise for spastic diaplegic Cerebral palsy. Aim: The purpose of this study was to check the efficacy of bilateral molded SKAFO for knee hyperextension and heel rise for Cerebral palsy in terms of gait parameters and energy expenditure. Materials and Methods: Five individuals (mean age 3.5 years) were diagnosed as spastic diplegic and one with hemiplegic (age 5 years old) Cerebral palsy with delayed milestone presented with knee hyperextension and heel rise during mid-stance and were fitted with bilateral molded SKAFO with pair of shoes. Observational gait analysis by video recording was performed and gait parameters by 10 m walk test and energy expenditure using physiological cost index was recorded in bracing and non-bracing conditions. Results: The orthosis controlled knee hyperextension by not allowing the knee to go beyond neutral position. The gait was more natural with proper heel strike and better push off. There was improvement in temporal-spatial gait parameters and gait was energy efficient. Conclusion: The SKAFO was found to be effective in controlling knee hyperextension and resulted in stable, natural, satisfactory and energy efficient gait in spastic Cerebral palsy with knee hyperextension and heel rise. Similar study involving case series can be used to set the prognosis of ambulation and the kind of orthotic interventions needed to optimize the walking ability.
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Coupling effect of neuromuscular electrical stimulation on glutei and transcutaneous electrical nerve stimulation on hip adductors in scissoring gait p. 27
Khurshid Shaik, Lakshmana Prasad Gadde, Naveen Kumar Balne, Aniruddh Kumar Purohit
DOI:10.4103/2395-4264.188154  
Introduction: Spasticity and weakness are the two most important factors effecting gait in children with spastic diplegia. Spasticity in hip adductors and associated weakness in hip extensors and abductors leads to scissoring gait pattern. Proximal muscle stability is essential for distal mobility; this study focuses more on proximal muscle group facilitation for correction of deviations in scissoring gait. Objective: The objective of this study was to study the coupled effect of neuromuscular electrical stimulation (NMES) on glutei and transcutaneous electrical nerve stimulation (TENS) on hip adductors in improving gait parameters. Materials and Methods: The experimental group received NMES to hip extensors and hip abductors followed by TENS to hip adductors as an adjunct to conventional therapy for a period of 3 weeks whereas the control group received only conventional therapy. In experimental group, NMES was applied to gluteus maximus and medius for 10 min each and were asked them to perform the muscle action voluntarily. Later, TENS was applied to hip adductors for 10 min with passive hip abduction (HAB). Both the group received home program for the next 2 months. Results: A significant improvement was noted in spasticity, active range of motion (AROM) to HAB, extension, and gait parameters with P < 0.05. Conclusion: The coupled effect of NMES on glutei and TENS on hip adductors in children with scissoring gait gives rise changes in muscle tone, AROM, and gait parameter. All these contribute in improving the gait. These gains persist atleast for 3 months compared to the individuals who receive only conventional therapy. The improvement is seen within a short period of 3 weeks time compared to conventional therapy alone group which takes longer period of 12 weeks time.
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Comparison of self-concept of children with cerebral palsy and children without impairments p. 32
Sharwari Mutsaddi, Ravinder Kaur Mahapatra
DOI:10.4103/2395-4264.188157  
Introduction: Self-esteem or self-concept is a feeling of self-appreciation. A positive self-concept is essential to maintain normal psychological health. Cerebral palsy results in functional impairments that limit the individual's activities. This could lead to a negative self-concept among these children. Aim: To compare the self-concept of children having cerebral palsy with the children having no impairment. Material and Methods: The study was an observational case-control type of study with n = 56 (28 in each group). The self-concept of the children (age 10-16 years) was assessed using Harter's Self Perception Profile for Children. The mean of each subscale was compared between the two groups using the Mann-Whitney U-test on SPSS version 20. The males and females were compared in each group. Results: There was a significant difference in the two graphs with respect to the aspects of physical appearance (P = 0.000), behavioral conduct (P = 0.024), social competence (P = 0.001), and athletic competence (P = 0.000). Males with cerebral palsy showed a lower sense of self-concept in the field of social competence (P = 0.002), athletic competence (P = 0.00), and physical appearance (P = 0.016). On the other hand, females with cerebral palsy showed comparatively lower self-concept in the fields of athletic competence (P = 0.000) and physical appearance (P = 0.000). Conclusion: Children having cerebral palsy showed reduced self-concept in the domains of social competence, behavioral conduct, physical appearance, and athletic competence. Gender-based differences were observed in the two groups.
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Awareness among primary caregivers of the differently abled children on Indian legislation: A cross-sectional study p. 37
Deepa Chanbasappa Metgud, Lecrissa Hyacinta Fernandes, Shruti Nagesh Naik
DOI:10.4103/2395-4264.188158  
Aim: The present study was undertaken to assess the level of awareness on Indian legislation among the primary caregivers of the differently abled children. Methods: A sample of 120 respondents from various centers attending services of day care centers, clinical setups, and educational institutes for their children was administered a thirty-item questionnaire, categorized into awareness of legislations, awareness of rights, concessions and benefits, and life cycle needs. Results: The results showed a significant level of awareness on Indian legislation among the primary caregivers depending on the age group of the respondents, gender, and the educational levels with P < 0.05. The educated male respondents were better aware than the females in the category of ≤10 th standard and Pre-university college (PUC) educated. Based on the age, respondents in the older age group were adequately aware compared to the respondents in the younger age group. Conclusions: There is a need to promote awareness among the primary caregivers of the differently abled children to enable them to receive optimum benefits. Different modes of communication should be explored to overcome the barriers and reach the illiterate. Limitations: The study included children with multiple disabilities. The children were unevenly distributed as well as drawn from different centers.
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CASE REPORTS Top

Dual static encephalopathies - cerebral palsy with arrested hydrocephalus: A challenging spasticity management p. 40
Pavan Kumar Pelluru, Aniruddh Kumar Purohit
DOI:10.4103/2395-4264.188160  
Cerebral palsy associated with arrested hydrocephalus is an uncommon occurrence posing management challenge in the treatment of spasticity. We present a 14 year old male who was having spastic diplegia and arrested hydrocephalus due to congenital aqueductal stenosis. He was having spasticity of MAS 1-3 in the lower limbs. We haven't found such a type of dual static encephalopathies in the literature. In such a challenging scenario Selective Posterior Rhizotomy (SPR) may lead to alteration in the CSF dynamics, so Selective Motor Fasciculotomies (SMF) were performed to relieve spasticity.
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Effect of vibrotactile stimulation on motor performance in a child with cerebral palsy: A case study p. 43
Chetana Ashok Kunde, Suvarna Shyam Ganvir, Mayuri Mahaveer Agrawal
DOI:10.4103/2395-4264.188161  
The purpose of this study is to report unexpected quick and highly effective result of vibrotactile stimulation on gross motor ability in a child with cerebral palsy. This is a 9-year-old male child with sensory motor disorder. Gross motor function classification system level classified as V. On somatosensory examination and sensory profile caregiver questionnaire, the child had tactile hypersensitivity. Outcomes were assessed using gross motor function measure (GMFM). For the first 4 weeks, child was given sensory stimulation with different texture (soft to hard) + neurodevelopmental therapy (NDT). For another 4 weeks, sensory stimulation was added with vibration + soft to hard texture + NDT. Vibration of 50-60 Hz was given for 10 min for 6 days/week on the sole of foot, ankle, and knee joint. There was minimal motor improvement in the first 4 weeks of hard and soft texture stimulation combined with NDT. Following this, an another 4 weeks of vibrotactile stimulation showed appreciable improvement in the dimensions A, B, C, and D, of GMFM (pre: 28.97%, post: 33.20%). Vibrotactile stimulation helps to decrease tactile hypersensitivity in children with cerebral palsy and thus improves gross motor function abilities in 4-week period.
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Generalized spastic dystonic cerebral palsy with regression of motor milestones due to congenital atlantoaxial dislocation: A diagnostic dilemma and rare association p. 48
Pavan Kumar Pelluru, Aniruddh Kumar Purohit
DOI:10.4103/2395-4264.188163  
In spastic cerebral palsy cervical dystonia with congenital AAD is a rare association. The combination of these and regression of milestones produces clinical dilemma. We present a case of generalized spastic dystonic cerebral palsy with AAD. The child had regression of the milestones following a trivial fall due to compression at the cervicomedullary junction. One has to differentiate the regression of milestones caused by untreatable herditary or treatable mechanical etiologies. This might make significant difference in management, prognosis and may have financial implications.
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Joubert syndrome misdiagnosed as hypotonic cerebral palsy: Confirmation by magnetic resonance imaging p. 51
Ghanshyam Dev, Mohd Ilyas, Sonali Sharma
DOI:10.4103/2395-4264.188165  
Joubert syndrome is a rare autosomal recessive condition characterized by hypotonia, ataxia, psychomotor delay, and variable occurrence of oculomotor apraxia and neonatal breathing abnormalities. We report a 7-year-old female child who was referred to our department as a case developmental delay and hypotonia due to hypotonic cerebral palsy for magnetic resonance imaging (MRI) of the brain. MRI of the brain revealed typical molar tooth sign, bat wing appearance of the fourth ventricle, and dysgenesis of the superior cerebellar vermis. Determination of the symptoms, early diagnosis, and genetic consultation are the goals for decision-making to begin treatment and rehabilitation programs.
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Sanjad-Sakati syndrome: Beyond the Middle-East p. 54
Chetana Sen, Sandip Pal, Prasenjit Sengupta, Asutosh Pal, Jacky Ganguly, Chiranjib Das, Debasish Basu
DOI:10.4103/2395-4264.188166  
Sanjad-Sakati syndrome (OMIM 241410), also known as hypoparathyroidism-retardation-dysmorphism (HRD) syndrome, is a rare autosomal recessive syndrome of congenital hypoparathyroidism, mental retardation, and facial dysmorphism, reported almost exclusively in the Middle-Eastern children of consanguineous parents. Here, we present a 20-year-old male child from India presenting with childhood-onset, recurrent generalized seizures, which were poorly controlled with multiple antiepileptics. Along with intrauterine growth retardation, the patient had short stature and typical facial dysmorphism. Investigations revealed extensive intracranial calcifications, with hypoparathyroidism and severe hypocalcemia. This is only the third reported patient of HRD phenotype in a non-Arab patient and the first to present with multifocal dystonia. Thus, it is important to keep in mind untreated hypocalcemia in a patient of refractory seizures, with HRD possibly being no longer an exclusively Middle-Eastern disease.
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LETTERS TO THE EDITOR Top

Developmental delay in children with septo-optic dysplasia-plus p. 58
Paramdeep Singh, Rupinderjeet Kaur, Chaitanya Tapasvi, Rashmeet Kaur
DOI:10.4103/2395-4264.188168  
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Anomalous anterior and posterior nerve root openings p. 60
Pavan Kumar Pelluru, Aniruddh Kumar Purohit
DOI:10.4103/2395-4264.188169  
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