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.

Objective: Post stroke motor recovery is facilitated by the brain reorganization or the neuroplastic changes. The therapeutic approach mentioned in the current case is one of the approaches for enhancing motor recovery by stimulating the damaged neural networks directing the motor behaviour of a person. The aim of the present study was to establish the changes in the balance and gait pattern of an individual through multi target stimulation of areas of cerebral cortex by utilising multichannel trans cranial direct current stimulation (M-tDCS) in a sub-acute stroke survivor. Design: A Case Report Methods: The present patient was the participant of the trial (CTRI/2021/02/031044).The patient was intervened with M-tDCS (anodes over left primary motor cortex that is C3 point and left dorsolateral prefrontal cortex i.e., F3 point and cathodes over supraorbital areas, Intensity －1.2mA) for the duration of 20 minutes along with turbo med extern －an AFO to facilitate ankle dorsi flexion and conventional physiotherapy rehabilitation. The Fugl-Meyer assessment lower extremity (FMA-LE), Berg Balance Scale (BBS), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures were used for outcome assessment. Baseline assessment was done on day 0 followed by assessment on 10 and 20 post intervention. Results: Improvement was seen in all the tools i.e. (FMA -LE), BBS, SSQOL and WGS over the time period of 20 days. Conclusions: M-tDCS resulted in improvement in gait parameters, balance and motor functions of lower extremity of the patient.

Background: There has been rapid drift of rehabilitation professionals toward the clinical use of technology aided electrical interventions. Brain is a cortical hub of functionally related neural connections. Motor learning entails strong interaction with the cognitive domains. So better outcomes may be expected by optimally targeting functionally correlated areas simultaneously through tDCS. Aim: To determine the therapeutic effect of Multi Channel tDCS in combination with Functional electrical stimulation, SaeboFlex and conventional rehabilitation on recovery of Cognitive Domains, Motor Functions of Paretic Hand, and Gait in individuals with subacute Stroke. Methods: This is prospective, randomized, double blind controlled clinical trial. Subacute Stroke Survivors with the age Group (40- 75 years) will constitute the Population of the study. Participants will be randomly allocated to experimental or control group. Participants of the experimental group will receive Multi channel tDCS, Functional electrical stimulation, Saebo Flex Training and conventional rehabilitation. Participants of the group B will receive FES, training with SaeboFlex, conventional physiotherapy intervention similar to as given to the participants of group A and sham multi channel tDCS. Outcome Measures: The primary outcome measures of the study will be Fugl Meyer assessment, Electroencephalogram and secondary outcome measures of the study will be Grip strength, Pinch strength, Nine hole peg test( NHPT), Wisconsin gait scale, Montreal cognitive assessment, Electroencephaloraphy to observe the cortical changes and tDCS adverse effect questionnaire and stroke specific quality of Life scale. Statistical Analysis: The primary analysis of the study will be done at the end of 4weeks. Statistical analysis of data will be done using SPSS Version 22 with the help of a statistician. Conclusion: An insight into the therapeutic interventions augmenting, cognitive and motor domains simultaneously may yield better outcomes in the field of stroke rehabilitation thereby improving quality of life of stroke survivors

Purpose: Children with ADHD exhibit decrements in fitness levels, motor skill ability and attention. The purpose was to evaluate the benefits of a structured, school-based exercise program on motor skill, physical fitness and attention in children with ADHD. Method: Ten 8-12 year old school boys with ADHD and ten typically developing (TD) were recruited. They underwent a six week structured exercise program which included aerobics, resistance exercises, motor skills and attention training. Results: Following the 6 week, school -based exercise program significant improvements in physical fitness, motor skills and attention were observed in ADHD children compared to the TD children. Additionally, the exercise sessions were acceptable and enjoyable to all children. Conclusion: It is proposed that an exercise program be incorporated in school physical education curriculum. Exercises should be considered, in addition to other forms of intervention, as an essential treatment for improving problems associated with ADHD in school children.

INTRODUÇÃO: a propriocepção é essencial durante a implementação do movimento para atualizar os comandos de alimentação adiante resultantes da imagem visual e no planejamento e alteração de comandos motores gerados internamente. A escala integrada de rastreio da propriocepção (IPSS) avalia a propriocepção em vários domínios diferentes em pessoas com doença de Parkinson. OBJETIVOS: determinar as limitações da IPSS enfrentadas por fisioterapeuta neurológico e voluntários geriátricos em ambientes clínicos. MATERIAIS E MÉTODOS: Dez Neuro-fisioterapeutas e trinta voluntários geriátricos de cada terapeuta foram recrutados para este estudo de viabilidade de pesquisa transversal. Os participantes foram selecionados de acordo com os critérios de inclusão. Os questionários foram projetados e criados para avaliar as dificuldades enfrentadas pelos terapeutas e geriátrica voluntários em termos de tempo necessário para a administração da escala, do nível de compreensão da escala e seus subníveis, e o esforço físico experimentado pelo terapeuta e geriátrica voluntários. A IPSS foi administrada pelo terapeuta. Goniômetro Universal, fita métrica e dispositivo de rastreamento de movimento foram usados durante a administração da IPSS. Após a administração, os questionários foram distribuídos e preenchidos por Neuro-fisioterapeutas e voluntários geriátricos. O teste Shapiro-Wilk foi usado para testar a normalidade,pois os dados eram inferiores a 50. RESULTADOS: Dado que os dados não se seguem à distribuição normal, os dados foram expressos em mediana e intervalo. Skewness e Kurtosis também foram medidos. As variáveis foram expressas na forma de gráficos circulares. CONCLUSÃO: O estudo concluiu que o IPSS tem várias limitações como subjetivamente relatado pelos terapeutas e voluntários.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized primarily by either hyperactivity or inattention or both. Non-Invasive brain stimulation techniques including Transcranial direct current stimulation (tDCS) and Repetitive Transcranial magnetic stimulation (rTMS) act by altering brain activity and modulating neuronal networks. Both rTMS and tDCS have been previously used in pediatric population and now being used as an intervention for ADHD. The aim of this study was to review the existing literature on Non-Invasive stimulation in ADHD as a means of treatment. An English Language Literature search using Google Scholar, Scopus, PubMed and Pedro was done to identify the data. PRISMA guidelines were followed and those studies which fulfilled the specific requirements were selected. Methodological quality of these studies was assessed using PEDro scale. In accordance with the inclusion criteria; eight studies done between 2010 and 2019 were reviewed. Studies were grouped according to intervention given: rTMS and tDCS. Our findings reveal that both rTMS and tDCS have positive effects on improving inhibitory control, executive function as well as the impulsive symptoms in ADHD. It was concluded that Non-invasive stimulation is a promising and upcoming tool for improving executive functions and inhibitory control in ADHD. More number of high quality randomized control trials are required to strengthen the evidence and incorporation of these tools in clinical practice.

INTRODUÇÃO: A fibromialgia (FM) é uma dor musculoesquelética de longa duração, que continua a ser uma entidade clínica problemática a nível mundial, o manejo desta condição é um desafio para os profissionais de saúde. Numerosas opções de tratamento individual estão disponíveis para melhorar os sintomas da fibromialgia, mas ainda falta um tratamento individualizado. Assim, neste estudo testamos tanto os efeitos individuais das técnicas fisioterapêuticas, quanto a combinação das técnicas de terapia cognitiva-comportamental e as técnicas de fisioterapia, se trariam alguma alteração nos sintomas da fibromialgia. OBJECTIVO: Para determinar o efeito combinado de terapia cognitiva-comportamental associada as técnicas de fisioterapia no manejo dos sintomas de fibromialgia. MÉTODOS: Este estudo experimental recrutados 60 participantes com diagnóstico de FM, com idade compreendidas entre 18-50 anos, de Dehradun, Índia. Foram divididos aleatoriamente em dois grupos: Fisioterapia integrada apenas, fisioterapia integrada e terapia cognitiva-comportamental por 12 semanas. Escala analógica visual, questionário de impacto da fibromialgia revisado, Índice de Depressão Beck, inquéritos de saúde-36 versão resumida, algômetro de pressão de dor, transtorno de ansiedade geral -7. Foram registados na linha de base, quatro semanas, oito semanas e doze semanas. RESULTADOS: Após três meses, uma melhora significativa (p <0,05) foi observada em todas as medidas de resultados da fisioterapia integrada e do grupo de terapia cognitiva-comportamental. CONCLUSÃO: A terapia cognitiva comportamental combinada com o tratamento de fisioterapia teve um efeito na redução da depressão, na deficiência e a melhoria na qualidade de vida na fibromialgia.

Objective: Reacquisition of motor functions following stroke depends on interhemispheric neural connections. The intervention highlighted in the present case is an insight for augmenting motor recovery by stimulating the lesioned area and adjacent areas governing the motor behaviour of an individual. The purpose of this study was to determine the changes in the motor and cognitive outcomes through multi target stimulation of cortical areas by application of multichannel transcranial direct current stimulation (M-tDCS) in a stroke survivor. Methods: The patient was a participant of a trial registered with the clinical trial registry of India (CTRI/2020/01/022998). The patient was intervened with M-tDCS over the left primary motor cortex i.e. C3 point and left dorsolateral prefrontal cortex i.e. F3 point with 0.5-2 mA intensity for the period of 20 minutes. SaeboFlex-assisted task-oriented training, functional electrical stimulation over the lower extremity (LE) to elicit dorsiflexion at the ankle and eversion of the foot, and conventional physiotherapy rehabilitation including a tailored exercise program were performed. Outcome assessment was done using the Fugl-Meyer assessment scale (FMA) for the upper and lower extremity (UE and LE), Montreal Cognitive Assessment (MOCA), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures. Assessment was taken at Day 0, 15 and 30 post intervention. Results: Improvement was observed in all the outcome measures i.e FMA (UE and LE), MOCA, SSQOL and WGS across the span of 4 weeks. Conclusions: M-tDCS induced improvement in motor functions of the UE and LE, gait parameters and cognitive functions of the patient.

Background: Hemineglect is the inability to sense stimuli given on the paretic side. It is most frequently seen in individuals with left hemiplegia resulting from temporoparietal lobe damage. On the basis of duration poststroke, hemineglect can be acute (<3 months) or chronic (>6 months). The patients experience many challenges in rehabilitation of motor function, cognitive function, and in gaining functional independence. Aim: To identify the challenges faced by physiotherapists in rehabilitation of individuals with poststroke hemineglect. Methodology: Data Identification: An English language literature search using Google Scholar, Scopus, PubMed, and Pedro was done. Study Selection: Articles were identified and those which fulfilled the specific requirements were selected. Data Extraction: In accordance with the inclusion criteria, 9 studies done between 1997 and 2017 were reviewed. Results: In this study, we reviewed a number of studies on the treatment of hemineglect which show a variety of treatment options. The various interventions include robotic mirror therapy, repeated parietal theta-burst stimulation, low-frequency transcranial magnetic stimulation, trunk rotation and scanning training, forced use therapy, prism glass adaptation, movement detection bracelets, each of which have different effects. Conclusion: There are a limited number of studies on the different treatment methods that are currently available. Further research is needed on these treatment methods to prove their efficacy and find a suitable method to overcome the challenges that the patients with hemineglect face at present.

Context Reacquisition of hand motor function following stroke depends on inter hemispheric motor circuits in the brain. The challenge for obtaining good recovery in affected hand is to optimally utilize the broad spectrum intrinsic capacity of the brain in modulating viable neuronal networks by providing central & peripheral stimulation strategies to recover from the loss due to stroke. Aim & Objectives: Concurrent effect of (tDCS) along with (TASTT) on Motor retentions of Paretic Hand in Subacute Stroke survivors. Methodology: A Prospective, Randomized-Sham controlled trial was conducted on 40 Subacute survivors, selected based on the sample selection criteria and were randomly allocated into two groups i. e Experimental group (Bihemispheric -tDCS over Primary Motor cortex (M1) at C3/C4, based on (10-20 EEG International Classification System) along with TASTT) and Control group (TASTT +Sham tDCS ) with 1.2ma, 20minutes/session, 5days/week for 4 weeks. Outcome Measures: Quantitative Electroencephalogram (QEEG), Fugl meyer Assessment for Upper Extremity (FMA), Hand Dexterity (9Peg Hole Test), Pinch Strength (Lateral , Chuck and Pulp Pinch), Grip Strength & (tDCS) adverse effect questionnaire. Data analysis and Results Between group statistical analysis revealed significant findings in the Grip strength in the experimental Group (p<0.05) and Non significant Findings for other Outcome measures. Within group Statistical analysis revealed significant findings for FMA-UE (P<0.05) in the experimental and non significant findings with other Outcome measures with (p>0.05 ) in both groups. QEEG analysis revealed non significant findings with the alpha and Theta wave frequency and mean values changes, post intervention in both the groups. Conclusion and Study Suggestions Besides Non significant Findings, clinical improvement was seen in participants with the changes in the mean scores. There is strong need of large sample trials for establishing the synergic effect Central and peripheral stimulation strategies on paretic hand functions in stroke. Funding: DST- (SERB) Key words Transcranial direct current Stimulation, Stroke, Hand Dextrity.

BACKGROUND: “Stroke” is the second common cause of morbidity and long term disability. Upper limb neuromuscular weakness occurs frequently after stroke. So the present study to examine the combined effectiveness of upper limb tDCS along with FES compared to standard therapy in improving motor functional activities in subacute stroke survivors. METHODS : 20 subjects with subacute stroke were randomized to group A (tdcs +FES) N= 10 and Group B (tDCS+ conventional therapy )N=10. Outcome measures were FMA-UE, CAHAI ,Nine peg hole, Power grip strength and pinch grip strength were used before and after treatment. RESULTS: In Group A, the protocol was completed by all the subjects and showed significant improvements in scores of FMA-UE (t= -21.33 ,p < 0.05),CAHAI (t= -25.735 p < 0.05 ), NPH (t= 3.976 p < 0.05), PG (t=-9.992 p < 0.05),LPG (t= -6.708 p < 0.05), CPG (t=-8.143 p < 0.05), pp grip (t= -7.236 p> 0.05).The between group comparisons showed that a significant difference between Group A and Group B in terms of FMA-UE (t=5.730 ,p < 0.05),CAHAI (t= 7.45 p < 0.05 ) ,NPH (t= -1.798 p > 0.05), power grip (t= 3.547 p < 0.05),LPG (t= 3.070 p < 0.05).CPG (t=-4.530 p < 0.05), pulp to pulp grip (t= -0149 p> 0.05). CONCLUSION: The purposed protocol can facilitate recovery of upper limb activity in subacute stroke patients and is more beneficial than the protocol with tDCS alone. the results showed efficacy of the new paradigm with combined interventions. Key words: stroke, tDCS, FES,FMA-UE ,CAHAI

Background: Fibromyalgia (FM) is a ceaseless musculoskeletal torment, which remains a troublesome clinical entity worldwide and the administration of this condition is a challenge for the health providers. Various treatment options are available to improve the symptoms of fibromyalgia, but a specificity tailored to particular patient is still missing. Thus, in this study we tested the combination of cognitive behavioral therapy with physiotherapy techniques would bring any changes on the fibromyalgia symptoms. Method: A 21 year male reported to the psychiatry department with complaints of continuous pain at the back and neck area, with more than 8 months history of stiffness and functional disability. The patient met the 2010 fibromyalgia diagnostic criteria. Visual analogue scale, Pain pressure algometer, revised fibromyalgia impact questionnaire, general anxiety disorder(GAD-7) and shortform-36 health surveys were used as the outcome measures to document the changes. The patient was managed for a period of 3 months using cognitive behavioral therapy along with Physiotherapy techniques. Results: After three months we found positive results on the management of fibromyalgia. Conclusion: Cognitive behavioral therapy combined with integrated Physiotherapy techniques may have an effect to reduce the severity of pain, depression, anxiety, improvement on the pain pressure threshold and quality of life on fibromyalgia.

BACKGROUND: Individuals across every age, race or socioeconomic background are affected with stroke which is more prevalent in women than men. Stroke is the third leading cause of mortality worldwide and can cause significant disability, such as paralysis, speech difficulties, and emotional problems. A great percentile o stroke survivors land up into severe consequences as a result of persistent disability, who require more effective therapeutic strategies. The role of a physiotherapist is very crucial with respect to the rehabilitation point of view especially in the initial months in which there is maximum potential for recovery. However after which, this potential declines. A fully Functioned hand is vitally important for quality of everyday life. The acquisition of hand motor skills following stroke depends upon the cortical synchrony and the integrity of iplsilesional and contralesional motor circuits in the cerebral hemispheres.Stroke survivors can partially recover their motor function control from rehabilitation that involves task-specific and repetitive motor exercises.Advances in brain-computer interface (BCI) technology have enabled stroke survivors to interact with the environment using their brain signals.Since, Brain is an electrical organ and expends considerable energy maintaining a specific cellular resting potential. Not surprisingly therefor electrical intervention have potential to modify brain function to improve outcomes after stroke Hand repertoire exercises as the part of neurorehabilitation leads to partial recovery. Cortical motor map reorganization as a result of skilled arm and hand training suggests that neuroplasticity mechanisms are involved in motor learning. The challenge for improving stroke recovery is to understand how to optimally engage and modify surviving neuronal networks, to provide new response strategies that compensate for the loss due to injury in the brain. In general best recoveries are associated with greatest return towards normal state of brain functional organization, reorganization of central nervous system.Thus Enhancing stroke recovery by facilitating brain plasticity with the direct application of a physical modality to the cerebral cortex was the key motive for conducting the present study.

Comprehensive Neurological Assessment- Complete approach focused solely on the clinical performance of examination methods for a neurologically Ill patient for Physiotherapists.

Context The acquisition of hand motor skills following stroke depends upon the cortical synchrony and the integrity of iplsilesional and contralesional motor circuits in the cerebral hemispheres. With the aim to rebalance the cortical activity and optimize the motor learning, tDCS is reemerged as promising technique in the field of neurological rehabilitation. Objectives: To examine the effect of Simultaneous application of Bihemispheric (tDCS) & Therapist Assisted Sensory Motor Task Training (TASTT) on Paretic hand in patients with Subacute Stroke. Methodology: Study was Randomized sham controlled trial with two parallel Groups conducted in the OPD, Department of Physiotherapy, Punjabi University, Patiala. 08 Subacute Stroke patients were randomly allocated to both the groups. Experimental group received Bihemispheric (tdcs) i.e. anodal stimulation to ipsilesional and cathodal stimulation to contralesional motor cortex over C3/C4(1.2ma intensity, 20minutes/session, 5days/week for 4 weeks, based on (10-20 EEG International Classification System) plus TASTT and control group received sham tDCS and TASTT. Pre-Post Intervention assessment was done at 0day, 15 th and 30 th Day. Outcome Measures: Fugl meyer Assessment for Upper Extremity (FMA), Digital Dexterity (9PegHole Test), Pinch Strength (Lateral , Chuck and Pulp Pinch), and Grip Strength & (tDCS) adverse effect questionnaire. Data analysis and Results Within group, statistical analysis revealed significant results for the FMA (f=4.67, p=0.04) in the experimental Group .Non significant results were obtained for Digital Dextrity, Pinch and Grip Strength in both the groups with p>0.05.Between group comparison revealed Non significant findings for all the outcome variables except for Grip Strength with p=0.05). Conclusion and Study Suggestions Study concludes that, although results were statistically non significant but clinical improvement was seen in patients with the changes in the meanscore. Study suggests that large sample trial needs to be conducted for establishing the generalization of results. Funding: DST-Science Education and research Board (SERB) , Walnut Medicaid

Objective: To determine the effects of activity-based therapy (ABT) and surface spinal stimulation (SSS) on spinal cord integrity for locomotion and neurological recovery in people with incomplete spinal cord injury (SCI). Method: Sample of adults (n = 5, men, mean age 28.6 years) with motor-incomplete (American Spinal Injury Association Impairment Scale grade C or D) SCI injury. Interventions were conducted as thrice weekly sessions, total of 9 hours per week, consisting of non-invasive SSS and ABT for a period of 24 weeks including developmental sequences; resistance training; repetitive, patterned, rhythmic motor activity, task-specific activities, and locomotor training using body weight support treadmill training. Neurological function (International Standards for Neurological Classification of Spinal Cord Injury), the somatosensory evoked potential for tibial nerve, walking index for spinal cord injury, spinal cord injury functional ambulatory index (SCI-FAI), and spinal cord independence measure-III. Results: Significant improvements in neurologic function were noted for lower limb motor scores, pin prick, light touch sensations, gait parameter, 2-minute walk test, and the total score of SCI-FAI. Conclusions: ABT and surface spinal stimulation have the potential to influence the spinal cord integrity in individuals with chronic, motor-incomplete SCI. However, a larger sample size is required to be studied for further understanding and leads to gain insights into meaningful clinical benefits.

Introduction. Migraine is a public health problem of great impact on patients as well as society. Migraine prophylaxis requires daily administration of anti-migraine compounds whether or not migraine attack is occurring. All the drugs used for migraine prevention have potential and often relevant adverse effect or contraindications. The purpose of present study was to evaluate effi cacy of non-pharmacological management techniques like Cognitive Behavioral Therapy (CBT) and Transcranial Direct Current Stimulation (TDCS) on headache related disability and impact of headaches on life of patients suffering from migraine. Methodology. Sixty six subjects fulfi lling the selection criteria were recruited for the study. They were randomly allocated into three groups. Group one received TDCS, Group 2 received CBT , and Group 3 (Control group) did not receive any treatment. Participants were asked to fi ll HDI and HIT 6 prior to start of intervention, post intervention and at follow up. Collected data was analyzed for statistical signifi cance. Results. We found a signifi cant decrease in HDI and HIT 6 scores in TDCS and CBT Group as compared to Control Group. This improvement was maintained during follow up period. Conclusion. TDCS and CBT can be effective in decreasing headache related disability and impact of headache on daily life in patients suffering from Migraine.

Background Stroke being the third leading cause of death is considered as the primary cause of Long term disability. Dementia is likely to follow, specifically when cognitive impairment prevails. Post stroke dementia or vascular dementia affects full spectrum of cognitive domains like working memory, executive functions, poor understanding and concentration. This limitation affects their overall social well-being. As the early recognition of cognitive impairment in the acute phase of stroke, gives vital stability to the individuals with the start of cognitive rehabilitation preventing early fatality thus reducing the burden of cognitive decline and dementia after stroke. But Despite the availability and use of published guidelines for the early detection of cognitive deficits, the management and prognosis of a post stroke demented individual remains neglected. Aims: This paper aims to describe the clinical presentation of an individual with post stroke vascular dementia to facilitate better understanding of cognitive manifestations in post stroke dementia Case Description This Paper describes a case of 56 Year old Male, with hypertension and hypercholesterolemia along with history of tobacco use for 15 years 6 months back, His left side went numb; his face dropped and was incoherent when speaking to his wife. Within course of time, symptoms of forgetfulness, Difficulty in planning, executive functions along with additional emotional and personality fluctuations were also observed. Detailed cognitive, neurological and behavioral examination was done to elucidate cognitive manifestation in the course of present illness followed by application of Transcranial Direct current stimulation as an adjunct to cognitive rehabilitation therapy Key Words: Stroke, Cognition, Vascular Dementia,

Background: Cervical spine dysfunction is a common and broad condition represented by pain, limitation in the range of physiological movements, tenderness, and stiffness besides symptoms and information gathered from the patient history in decision‑making, and the diagnostic and prognostic accuracy can be done using magnetic resonance imaging (MRI), computed tomography (CT) scan, myelogram, discography, single photon emission CT, and X‑ray. Aims and Objectives: The aim of the present study was to find the X‑ray findings in cervical dysfunction and assess its psychometric properties through analyzing various articles. Methodology: Various articles from following databases such as Science Direct, Springer Link, EMBASE, PubMed, and Cochrane were gathered using terms such as “Cervical Dysfunction,” “Cervical Canal Diameter,” and “Radiological Findings.” A total of 12 articles based on the PICO format were included in the study, and based on their findings, a review was made. Discussion: MRI is the first line of choice to diagnose cervical disorders, but as we know, our India is developing country, so we need the cheap and easy diagnostic tool to assess. The reliability of the Torg ratio/Pavlov ratio, sagittal dimension of cervical canal, stress lines of the cervical spine, and cervical angle are different methods used to diagnose the cervical dysfunction using anteroposterior and lateral view of X‑ray. Conclusion: Radiographic measurements can be used to evaluate cervical spondylosis and cervical stenosis but cannot evaluate neurological outcomes. Keywords: Canal diameter, cervical dysfunction, X‑ray

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.

Background Understanding of Neurological Diseases have been expanded from Traditional “Lesion Approach” to the analysis of Psychosomatic manifestations associated with the Stroke to explore the cognitive domains affected as a consequence of altered neural activity in the Brain. Analysis of the mechanisms involved in the neural plasticity and Motor and Cognitive learning through cortical reorganization has lead the extensive use of (tDCS) in management of Stroke. Aim- To Ascertain the Synergistic effect of (tDCS) on psychosomatic manifestations in Stroke Methodology Data Identification- An English Language Literature Search using Pubmed, Pedro, MEDLINE, Google Scholar, Researchgate, Cocharne, and Bibliographic review of Textbooks & Articles. Study Selection- After Identification articles were selected that specifically addressed the stated purpose. Data Extraction: It was done using explicit methodological criteria for evaluating the quality of the articles. The databases were searched for the search terms: (tDCS), Stroke, Psychosomatic Illness, Depression, Anxiety. Results-The review gathered the literature regarding use of “modern” tDCS protocols in treatment of Psychiatric manifestations associated with Stroke. The Vast Majority of studies found strong and largely consistent evidence in alleviation of symptoms with improvement in cognitive performance of patients in Stroke lasting up to several weeks, when applied appropriately. Conclusion- (tDCS) is effective at modulating neural activity, However Refinement is required to expand the effectiveness of tDCS with their exact physiological mechanisms behind. Key Words- Transcranial Direct Current Stimulation (tDCS), Psychosomatic Symptoms, Stroke, Cognitive Impairments

Multi-directional reach test (MRT) emerged as a valid and reliable assessment tool for balance evaluation among elderly. The normative reference scores have been established in adults and elderly people, but they were not yet established for children. Hence, we aimed at establishing the normative reference scores of MRT among the school going children aged between 5 and 12 years. Children (N = 194; 124 males, 70 females) were recruited by the stratified random sampling for the normative study. MRT was performed by the custom made, multi-directional reach estimator. MRE device consists of three adjustable wooden frames with two metallic rulers each of 600 mm. Children were asked to reach maximum distance in forward reach (FR), backward reach (BR), right lateral reach (RLR) and left lateral reach (LLR) directions to obtain their maximum reaching ability. The mean of three readings were used to report the normative reference scores of MRT. Median age, height, weight and body mass index (BMI) were 8.5 years, 1240 mm, 27 kg and 17.24 kg/m2 respectively. The normative reference scores [median (95% confidence Interval, CI)] of MRT among the children aged 5-12 years old were FR [169.7 mm (CI, 166.1-183.3 mm)], BR [77.7 mm (CI, 78.0-85.5 mm)], RLR [122.0 mm (119.6-130.9 mm)] and LLR [107.0 (105.8-119.3 mm)] respectively.

Background: The shooter's performance was mainly depends on the accuracy of the target. Physical and psychological health (anxiety, irrational belief) helps to achieve target. There is no study to find the irrational belief among elite level shooter. Purpose: The aim of this study is to find the prevalence of irrational beliefs among the elite shooters. Methods: A cross-sectional survey was conducted among 21 professional shooters (14 female and 7 male), and data of irrational beliefs were collected by Short General Attitude Belief Scale was administrated among them. Results: The result shows that elite level shooter has irrational belief about their performance. In irrational belief, demand for the fairness of the performances (3.13 ± 0.89, 65%) and need for achievement (2.97 ± 0.93, 60%) were higher percentage than the other irrational belief. Conclusion: In irrational belief, demand for the fairness of the performances and need for achievement was higher percentage than the other irrational beliefs.

There has been Perennial Interest in neuroscience Community in expanding their Understanding of Neural Diseases from Traditional “Lesion Approach” to the analysis of Psychiatric manifestations associated with the Neurological Disorders to explore the Behavioral Phenomena associated with the brain dysfunction. The better understanding of neural plasticity and detailed analysis of the mechanisms involved in the motor control and motor learning through cortical reorganization has lead the exponential rise in the number of studies in application of tDCS as a means of modulating neural activity in the brain with aim to induce cognitive and motor learning in variety of Neural Disorders.

ROLE OF FUNCTIONAL ELECTRICAL STIMULATION (FES) ON GAIT PARAMETERS IN ACUTE STROKE SURVIVOR - A SINGLE CASE DESIGN Kritika Chawala, Narkeesh Arumugam, Shefali Gambhir ABSTRACT Purpose: The ability to walk independently is a prerequisite for most daily activities. Impairments resulting from stroke lead to persistent difficulties with walking and subsequently,improved walking ability is one of the highest priorities for people living with a stroke. So, the present study was conducted to determine the role of FES in gait rehabilitation among acute stroke survivor. Relevance: Muscle weakness and paralysis, poor motor control and soft tissue contracture are major contributors to walking. FES applied during walking is an effective gait rehabilitation strategy that can lead to improvements in gait performance, walking speed and endurance, balance, activity, and participation post-stroke dysfunction after stroke. Participant and Methodology: A 44 years male diagnosed with left basal ganglia infarct which leads to right hemiplegia, impaired balance and coordination, impaired transfer abilities, equinus deformity and abnormal gait pattern was included in the present study. A total 20 treatment sessions (5 days per week/ 40 mins each session) was given to the patient which consisted of conventional post-stroke gait rehabilitation patients along with the application of FES on both exercise and walk mode. The kinetic and kinematic variables of gait were used as a prognostic indicator by using videographic analysis & Wisconsin Gait Scale at Baseline and Post-intervention after10 th and 20 th treatment sessions. Analysis and Results- The data obtained was analyzed by using MS-excel and tables & graphs were made. Conclusion and Implications- The participant showed reduced circumduction with initiation of swing phase and early development of knee flexion after 20 days of treatment. Keywords: FES, gait parameters, cerebro-vascular accident, gait rehabilitation, conventional physiotherapy.

The purpose of present case study was to explore the efficacy of osteopathic manipulative treatment (OMT) on post mastectomy lymphedema (PML) induced disabilities. 55 year old female who presented with the chief complaint of swelling in the right upper extremity along with pain in the neck, arm and thoracic spine hindering her activities of daily living (ADL). The OMT sessions were planned as 2 sessions per week for 5 weeks. The OMT resulted in the reduction in the volume of the lymph, modified truncated cone method (1878ml to 564ml), pain level, visual analogue scale (VAS) (7.8 to 3.4), disability of the upper limb, Disabilities of the Arm, Shoulder and Hand (DASH) Score (33.56 to 5.04) and improvement in quality of life, European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23) (31.28 to 34.22). The OMT might be an effective treatment option in the management of patients with PML.

Objective: To determine from a societal perspective the cost-effectiveness and cost-utility of telephone-based support for management of pressure ulcers. Study design: Cost-effectiveness and cost-utility analysis of a randomised clinical trial. Setting: Tertiary centre in India and Bangladesh. Methods: An economic evaluation was conducted alongside a randomised clinical trial comparing 12 weeks of telephone-based support (intervention group) with usual care (control group). The analyses evaluated costs and health outcomes in terms of cm(2) reduction of pressure ulcers size and quality-adjusted life years (QALYs) gained. All costs were in Indian Rupees (INR) and then converted to US dollars (USD). Results: The mean (95% confidence interval) between-group difference for the reduction in size of pressure ulcers was 0.53 (-3.12 to 4.32) cm(2), favouring the intervention group. The corresponding QALYs were 0.027 (0.004-0.051), favouring the intervention group. The mean total cost per participant in the intervention group was INR 43 781 (USD 2460) compared to INR 42 561 (USD 2391) for the control group. The per participant cost of delivering the intervention was INR 2110 (USD 119). The incremental cost-effectiveness ratio was INR 2306 (USD 130) per additional cm(2) reduction in the size of the pressure ulcer and INR 44 915 (USD 2523) per QALY gained. Conclusion: In terms of QALYs, telephone-based support to help people manage pressure ulcers at home provides good value for money and has an 87% probability of being cost-effective, based on 3 times gross domestic product. Sensitivity analyses were performed using the overall cost data with and without productivity costs, and did not alter this conclusion.Spinal Cord advance online publication, 15 August 2017; doi:10.1038/sc.2017.87.

Background: Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that can produce low back pain, leg pain, and weakness. Many treatment approaches are used for its treatment. An integrated exercise approach has been employed in this case, and its effects pre and post treatment has been compared. Case Summary: A 48-year-old female presenting with a complaint of pain in the lower back region which was radiating to both lower limbs. She also had difficulty to perform household work like bending, sitting and standing. After taking medicine for two months, the patient didn't get any relief and then she comes in Physiotherapy OPD. After the complete physical examination and assessment, secondary lumbar spinal stenosis was diagnosed. The benefits of integrated exercise protocol on LSS were reported, and treatment protocol was planned according to the identified problem areas of the patient. An intervention of 21 days (20-40 minutes per day, five days per week for three weeks) was given to the patient and improvement was taken on baseline evaluation and 11th day and 22nd day of post-intervention. Outcome measures: The Oswestry Disability Questionnaire observed the recovery of the patient, Modified Schober Test, Numeric Pain Rating Scale, SLR and Slump test. Conclusion: Considerable improvement was seen in Pain intensity, neural flexibility, ROM and Quality of life after the rehabilitation. It was observed that the integrated exercise protocol has helped in improving the patient with LSS.

• Conference: 14th World Congress on Neurology and Neurological Disorders
• At: Chicago, USA

The purpose of the present case study was to explore the efficacy of osteopathic manipulative treatment (OMT) in patient with pulmonary fibrosis (PF) in the critical care outpatient department. Here, we present a 48‑year‑old male case with breathlessness, increased frequency of defecation, and pain in and around the nape of neck with diagnosed pulmonary fibrosis. He scored 3 on a patient‑reported modified Medical Research Council (mMRC) dyspnea scale. Osteopathic examination reveals multiple somatic findings across the chest and abdominal region and treated by OMT. Pre‑ and post‑intervention changes were assessed by the 13‑item shortness of breath with daily activities (13iSOBDA). 27.2, 22, 16.4, and 11.8 were noted at the end of 1st, 2nd, 3rd, and 4th week of intervention, respectively, on 13iSOBDA while mMRC decreased from 3 to 1. OMT may be a feasible option in decreasing the symptoms of the PPF in the critical care outpatient department.

Background: The Acquired Dyke-Davidoff Masson Syndrome (ADDMS) or cerebral hemiatrophy is rarely encoun-

Modulation of Neuronal Wiring through Transcranial Direct Current Stimulation(tDCS) in Paretic Hand after Subacute Stroke- a Case Series Shefali Gambhir1, Narkeesh Arumugam2 1Research Scholar, 2Professor Department of Physiotherapy, Punjabi University, Patiala gambhir.shefali@gmail.com, narkeesh@gmail.com Abstract Introduction- The loss of hand function after stroke results in a severe compromise of the ability to feed and care for oneself and limits one’s participation in work, social and family life. It has been reported that the cortical mechanisms of interhemispheric competition as well as interhemispheric inhibition post stroke does lead to considerable deficits in hand functions. So, in the present study the concurrent application of bihemishperic tDCS which induces cortical excitability and altered the neural networks with the adjuvant use of task specific training which encourage the better functional recovery of paretic hand among stroke survivors was incorporated. Methodology- Bihemispheric Direct Current at 2mA intensity was administered via a pair of sponge electrodes moistened with NaCl solution on C3,C4 area of scalp of international 10-20 EEG electrode system for 40 minutes with simulatneously doing the task specific activities. The anode electrode was placed on the lesioned motor cortex and cathode on the contralesional cortex. A total 30 treatment sessions was given to each patient. Outcome Variables- Modified Ashworth Scale(MAS), Fugl Meyer Assessment Scale- Upper Extremity Component (FMA-UE), Stroke Impact Scale (SIS), Grip Dynamometer, Pinch Dynamometer, Jebsen Taylor Hand Function Test(JTHFT) and Nine hole peg test (NHPT) were used as an outcome measures to determine the efficacy of an intervention at baseline and after 15th and 30th treatment sessions. Discussion and Conclusion- tDCS modulates the neuronal membrane potential through polarizing currents by weak constant direct current, thereby influencing the levels of excitability and modulating the spontaneous firing rate of neurons. Considerable improvement was seen in fine motor skills, strength, and dexterity of paretic hand after stroke. It was concluded that tDCS only modulates but does not induce neuronal firing, so, performing a behavioural task concurrently would enhance the stimulation-induced differences in cortical excitability. Keywords- tDCS, Task Specific Training, Cortical Excitability, neural plasticity.

Objectives: Motor cognitive processing speed (MCPS) is often reported in terms of reaction time. In spite of being a significant indicator of function, behavior, and performance, MCPS is rarely used in clinics and schools to identify kids with slowed motor cognitive processing. The reason behind this is the lack of availability of convenient formula to estimate MCPS. Thereby, the aim of this study is to estimate the MCPS in the primary schoolchildren. Materials and Methods: Two hundred and four primary schoolchildren, aged 6–12 years, were recruited by the cluster sampling method for this cross‑sectional study. MCPS was estimated by the ruler drop method (RDM). By this method, a metallic stainless steel ruler was suspended vertically such that 5 cm graduation of the lower was aligned between the web space of the child’s hand, and the child was asked to catch the moving ruler as quickly as possible, once released from the examiner’s hand. Distance the ruler traveled was recorded and converted into time, which is the MCPS. Multiple regression analysis of variables was performed to determine the influence of independent variables on MCPS. Results: Mean MCPS of the entire sample of 204 primary schoolchildren is 230.01 ms ± 26.5 standard deviation (95% confidence interval; 226.4–233.7 ms) that ranged from 162.9 to 321.6 ms. By stepwise regression analysis, we derived the regression equation, MCPS (ms) = 279.625–5.495 × age, with 41.3% (R = 0.413) predictability and 17.1% (R2 = 0.171 and adjusted R2 = 0.166) variability. Conclusion: MCPS prediction formula through RDM in the primary schoolchildren has been established.

VR-based interventions offer instantaneous feedback on patient performance and then adjust the difficulty level to suit patient needs. 20,21 In addition, VR-based interventions incorporate the latest real-time graphics and imaging technology, allowing patients to experience numerous visual and auditory stimuli in a computer-generated virtual environment for their rehabilitative needs. 21 Most of the recent studies included in this meta-analysis applied VR-based interventions to patients in an acute stage of cancer care. ..

Background context: Lumbar Spinal Stenosis (LSS) is one of the most common spinal pathologies in India. Spinal stenosis is narrowing of the spinal canal with encroachment on the neural structures by surrounding bone and soft tissue. While it is widely held that conservative management should be the first line of approach in patients with LSS, little is known about the efficacy of non-surgical treatments for this condition. Purpose: To compare the specific integrated exercise program with conventional physical therapy programs for patients with LSS. Study design: Experimental study. Method: 30 patients (experimental group, n=15; control group, n=15) with lumbar spinal stenosis were randomized to one of two 3 week physical therapy programs. One program included exercise program (Flexibility exercise, Specific experimental canal enlargement exercise, strengthening exercise, functional/recreational activities), while the other included electrotherapy and exercise program (Hot fomentation, IFT, Flexion Exercises). Outcome measures: Perceived recovery was assessed with an Oswestry Disability Questionnaire (ODQ). Secondary outcomes included: Numeric Pain Rating Scale (NPRS), Straight Leg Raise, Slump test and Modified Schober Test (MST). Results: Result shows that the significant improvement in Quality of life, intensity of pain, lumbar ROM and Neural Flexibility was seen in Group A but it was not showing significant results in Group B. This signifies that group A has more significant improvement than Group B. Conclusion: From the result analysis we found that the integrated exercise approach has a significant effect then a conventional physiotherapy treatment.

ABSTRACT Background: Migraine is a common disabling headache disorder. It has been ranked among the disease causing greatest degree of handicap together with conditions such as quadriplegia, dementia and active psychosis. Purpose: Objective of present study was to evaluate the efficacy of Trans Cranial Direct Current Stimulation (tDCS) and Cognitive Behavioral therapy (CBT) in Management of Migraine. Materials and methods: Subjects fulfilling selection criteria were randomly allocated into three groups. Subjects in group one were given tDCS, three sessions per week for six weeks duration. Subjects in group two were given CBT sessions, one session per week, of approximately one hour duration for six weeks along with Sham tDCS. Control group did not receive any treatment. Subjects were asked to record their Headaches in Headache Diary for Baseline and Post Intervention Data. Results: Results showed a significant decrease in Headache frequency, Pain Intensity and Duration of headache in both tDCS and CBT groups as compared to control group. There was significant difference in headache frequency and pain intensity between tDCS and CBT group. Conclusion: tDCS and CBT can decrease headache frequency, pain intensity and headache duration in patients of Migraine. tDCS may be more effective in decreasing Headache frequency and in intensity as compared to CBT. Keywords: Migraine, Headache, Trans cranial Direct Current Stimulation, Cognitive Behavioral Therapy.

This paper reports the benefits of therapist assisted sensorimotor task specific training (TASTT) and electrical stimulation in the rehabilitation of Wrist drop. Wrist drop is caused by damage to the radial nerve, which travels down the arm and controls the movement of the triceps muscle at the back of the upper arm, because of several conditions. An intervention of 20 days (5 days per week for 4 weeks) was given to the patient & prognosis was observed on various outcome variables like Chedoke arm and hand inventory scale and strength and duration (SD) curve before & after the intervention. A poor prognosis was seen in both the variables which may be because of Neurolysis. PDF file:

Study design: A multicentre, prospective, assessor-blinded, parallel randomised controlled trial. Objectives: The objective of the trial was to determine the effectiveness of telephone-based management of pressure ulcers in people with spinal cord injury (SCI) in low- and middle-income countries. Methods: One hundred and twenty people with SCI living in the community were recruited through three hospitals in India and Bangladesh between November 2013 and March 2016. Participants had sustained an SCI >3 months prior and had a pressure ulcer. Participants were randomly allocated (1:1) to a control or intervention group. Participants in the control group received no intervention. Participants in the intervention group received weekly advice by telephone for 12 weeks about the management of their pressure ulcers from a trained health-care professional. Outcomes were measured by a blinded assessor at baseline and 12 weeks. There was one primary outcome, namely, the size of the pressure ulcer and 13 secondary outcomes. Results: The mean between-group difference for the size of the pressure ulcer at 12 weeks was 2.3 cm(2) (95% confidence interval -0.3 to 4.9; favouring the intervention group). Eight of the 13 secondary outcomes were statistically significant. Conclusion: The results of our primary outcome (that is, size of pressure ulcer) do not provide conclusive evidence that people with SCI can be supported at home to manage their pressure ulcers through regular telephone-based advice. However, the results from the secondary outcomes are sufficiently positive to provide hope that this simple intervention may provide some relief from this insidious problem in the future.Spinal Cord advance online publication, 20 December 2016; doi:10.1038/sc.2016.163.

This study aimed to estimate normative range for reaction time using ruler drop method for school-going South Asian children between 6 and 12 years of age. A cross-sectional study was used to evaluate the reaction time for 204 children. Normal values for each age group were obtained. The results of multiple linear regressions showed a decrease in the reaction time values with age, and a significant change occurring between six and eight years of age. No difference in reaction time was obtained between boys and girls. Ruler drop method is an easy to use test and the results of this study provide a normative data for age groups 6–12 years ranging from 214.2 ms to 248.8 ms. These values can serve as a reference to screen children with delayed reaction time.

Objectives Motor cognitive processing speed (MCPS) is often reported in terms of reaction time. In spite of being a significant indicator of function, behavior, and performance, MCPS is rarely used in clinics and schools to identify kids with slowed motor cognitive processing. The reason behind this is the lack of availability of convenient formula to estimate MCPS. Thereby, the aim of this study is to estimate the MCPS in the primary schoolchildren. Materials and Methods Two hundred and four primary schoolchildren, aged 6–12 years, were recruited by the cluster sampling method for this cross-sectional study. MCPS was estimated by the ruler drop method (RDM). By this method, a metallic stainless steel ruler was suspended vertically such that 5 cm graduation of the lower was aligned between the web space of the child's hand, and the child was asked to catch the moving ruler as quickly as possible, once released from the examiner's hand. Distance the ruler traveled was recorded and converted into time, which is the MCPS. Multiple regression analysis of variables was performed to determine the influence of independent variables on MCPS. Results Mean MCPS of the entire sample of 204 primary schoolchildren is 230.01 ms ± 26.5 standard deviation (95% confidence interval; 226.4–233.7 ms) that ranged from 162.9 to 321.6 ms. By stepwise regression analysis, we derived the regression equation, MCPS (ms) = 279.625–5.495 × age, with 41.3% (R = 0.413) predictability and 17.1% (R² = 0.171 and adjusted R² = 0.166) variability. Conclusion MCPS prediction formula through RDM in the primary schoolchildren has been established.

A new intervention (TASTT) for hand rehabilitation was proposed in this report which was based on the principle of somatosensory input, mirror neurons, learned non use phenomenon and neuroplasticity. An intervention of 45 days (1 hour per day, 5 days per week for 9 weeks) was given to the patient & prognosis was observed on various outcome variables like CAHAI, ABHILHAND, Brunnstrom stage of hand recovery and Sollerman Hand Function test before & after the intervention. It was concluded that a combination of sensiromotor with task specific training may be a successful strategy for the treatment of paretic hand.

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.

Background: Shoulder subluxation is a frequent occurrence in individuals following a stroke. Although various methods of treatment are available, none of them address all possible consequences of the subluxation pain, limited range of motion, the subluxation, and decreased functional use of the arm. Aims: The purpose of this study was to evaluate the effectiveness of California tri-pull taping (CTPT) method on shoulder subluxation, pain, active shoulder flexion, and upper limb functional recovery after stroke. Materials and methods: This was a randomized control study on 30 participants. All participants received conventional neurorehabilitation 5 days a week over 6 weeks. Half of the participants also received the CTPT. Pre- and post-assessment scores were taken on all participants for the amount of shoulder subluxation, pain, active shoulder flexion, and functional recovery. Results: The CTPT method demonstrated a significant reduction of pain in the treatment group from baseline, a significant improvement in active shoulder flexion and a significant improvement in proximal arm function as measured on the proximal subscale on the Fugl-Meyer upper extremity functional Scale but not the distal or total Fugl-Meyer subscales. Shoulder subluxation was not statistically significant. Conclusions: The CTPT method is an effective treatment for the hemiplegic subluxed shoulder.

Effect of Cathodal Transcranial Direct Current (tDCS) Stimulation on Pain and Handwriting Skills among patient with Writer’s Cramp- a case report Shefali Gambhir1, Narkeesh Arumugam2 1Research Scholar, 2Professor Department of Physiotherapy, Punjabi University, Patiala gambhir.shefali@gmail.com, narkeesh@gmail.com Abstract Introduction- Writer’s Cramp is primary adult-onset task-specific focal dystonia characterized by abnormal movements or posturing of the upper limb, because of inappropriate muscle contractions that interfere with writing movement. A disordered neuroplastic changes has been seen in patients with writer’s cramp and transcranial direct current stimulation helps in modulating cortical excitability and use as a therapeutic adjuvant. So, in the present study, the effect of Cathodal trancranial direct current stimulation (tDCS) on the rehabilitation of Writer’s cramp was evaluated. Case Description- Cathodal trancranial direct current at 2mA intensity was administered via a pair of sponge electrodes moistened with NaCl solution on C3,C4 area of scalp of international 10-20 EEG electrode system for 40 minutes. The anode electrode was placed on the Forehead as a refernce electrode and cathode on the ipsiesional cortex (Left side) . An intervention of 30 days(1 hour per day, 5 days per week) was given to the patient. Outcome Variables- Prognosis was observed on various outcome variables like Burke-Fahn-Marsden scale, global dystonia scale, Jedynak’s protocol and unified dystonia rating scale before & after the intervention. Conclusion- The incorporation of Cathodal tDCS that alter the cortical physiology has been helpful in improving writing and fine motor skills in patient with writer’s cramp. So, Cathodal tDCS can be used as a conservative intervention strategy in writer’s cramp for the improvement of somatosensory structure and clinical function. Keywords- tDCS, Writer’s Cramp, Focal Hand Dystonia

The purpose of present case study was to explore the efficacy of osteopathic manipulative treatment (OMT) on post-mastectomy lymphedema (PML) induced disabilities. 55 years old female who presented with the chief complaint of swelling in the right upper extremity along with pain in the neck, arm and thoracic spine hindering her activities of daily living (ADL). The OMT sessions were planned as 2 sessions per week for 5 weeks. The OMT resulted in the reduction in the volume of the lymph, modified truncated cone method (1878ml–564ml), pain level, visual analogue scale (VAS) (7.8–3.4), disability of the upper limb, Disabilities of the Arm, Shoulder and Hand (DASH) Score (33.56–5.04) and improvement in the quality of life, European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23) (31.28–34.22). The OMT might be effective in the management of PML.

Background of Study: Archery is a game of precision and focus. Pre-competition anxiety and stress decreases the focus as well as concentration in archers. Furthermore, the irregularities in shoulder strength training program during training sessions will influence their performance. Thus, the purpose of the present study is to determine the effect of Psychological Skill Training program along with Strength Training of shoulder stabilizers in enhancing the performance in elite archers. Method: Elite archers (n=30) were screened on the basis of inclusion and exclusion criteria. The subjects were allocated using Simple Random Sampling Method into Experimental and Control Group. The treatment protocol was administered on experimental group which consists of psychological skill training along with strength training of shoulder stabilizers and in Control group only conventional training program given by their coaches were administered.

Objective:The primary objective of the study was to evaluate the effect of California tri-pull taping (CTPT) method on post stroke shoulder subluxation, pain, active range of motion and upper limb functional recovery. Design: Pretest post test design. Setting: Study was conducted ininpatient and outpatient department of MM hospital Mullana- Ambala. Participants: 10 subjects with post stroke shoulder subluxation were included into the study. (7 male , 3 female). Intervention: For taping, two types of tape was used, cotton pre-tape and rigid post-tape. Tape was applied to subjects for thrice a week, for six weeks and conventional neuro rehabilitation programmewas also given to the subjects, five days a week for six weeks. Main outcome measures: Pre, and post assessment scores were taken from each subject by using, Digital Vernier caliper, visual analogue scale (VAS), Goniometer, and Fuglmeyer scale (FUG). Results: The CTPT method produced significant reduction on inferior subluxation from pre intervention to post intervention, pain. There was also significant improvement of AROM, and FUG. Conclusion: This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder. The main limitation of the study was, small sample size and no control group was used.

Objective:The primary objective of the study was to evaluate the effect of California tri-pull taping (CTPT) method on post stroke shoulder subluxation, pain, active range of motion and upper limb functional recovery. Design: Pretest post test design. Setting: Study was conducted ininpatient and outpatient department of MM hospital Mullana-Ambala. Participants: 10 subjects with post stroke shoulder subluxation were included into the study. (7 male , 3 female). Intervention: For taping, two types of tape was used, cotton pre-tape and rigid post-tape. Tape was applied to subjects for thrice a week, for six weeks and conventional neuro rehabilitation programmewas also given to the subjects, five days a week for six weeks. Main outcome measures: Pre, and post assessment scores were taken from each subject by using, Digital Vernier caliper, visual analogue scale (VAS), Goniometer, and Fuglmeyer scale (FUG). Results: The CTPT method produced significant reduction on inferior subluxation from pre intervention to post intervention, pain. There was also significant improvement of AROM, and FUG. Conclusion: This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder. The main limitation of the study was, small sample size and no control group was used.

Activity based therapy and surface spinal stimulation for recovery of walking in individual with traumatic incomplete spinal cord injury: a case report Objective: To examine the effects of Activity Based Therapy (ABT) and Surface Spinal Stimulation on neurologic function, walking ability and functional independence. Design: Single Subject Case Study. Setting: Outpatient Private Physiotherapy and Rehabilitation Clinic. Participant: Volunteer subject with Spinal Cord Injury, Motor Incomplete ASIA grade C. Interventions: A total of 12 hours/week of ABT for 24 weeks including developmental sequencing, resistance training, repetitive patterned motor activity and task specific loco motor training. This was accompanied with thrice weekly, 45minutes session of Surface Spinal Stimulation. Main outcome measures: Neurologic function ASIA (International standards for Neurological Classification of Spinal Cord Injury), Hoffmans Reflex, Somato Sensory Evoked Potential (SSEP), Walking Index for Spinal Cord Injury –II, SCI-FAI, Spinal Cord Injury Independence Measure (SCIMIII). Results: Some observable changes in the neural pathways, improvement in ASIA score of lower limb by 2 points on right side and by 1 point on left side. There was no change in level of WISCI-II and improvement of 5 points on SCI-FAI and of 9 points on SCIM-III. Conclusion: Both SSS and ABT have a positive effect on the neurologic function; walking ability and functional independence of the individual with Motor Incomplete ASIA grade C SCI. However, there must be further investigations into this field to determine a specific protocol of ABT and a particular spectrum of SSS optimal for individuals with SCI

Introduction: Pressure ulcers are a common and severe complication of spinal cord injury, particularly in low-income and middle-income countries where people often need to manage pressure ulcers alone and at home. Telephone-based support may help people in these situations to manage their pressure ulcers. The aim of this study is to determine the effectiveness and cost-effectiveness of telephone-based support to help people with spinal cord injury manage pressure ulcers at home in India and Bangladesh. Methods and analysis: A multicentre (3 sites), prospective, assessor-blinded, parallel, randomised controlled trial will be undertaken. 120 participants with pressure ulcers on the sacrum, ischial tuberosity or greater trochanter of the femur secondary to spinal cord injury will be randomly assigned to a Control or Intervention group. Participants in the Control group will receive usual community care. That is, they will manage their pressure ulcers on their own at home but will be free to access whatever healthcare support they can. Participants in the Intervention group will also manage their pressure ulcers at home and will also be free to access whatever healthcare support they can, but in addition they will receive weekly telephone-based support and advice for 12 weeks (15-25 min/week). The primary outcome is the size of the pressure ulcer at 12 weeks. 13 secondary outcomes will be measured reflecting other aspects of pressure ulcer resolution, depression, quality of life, participation and satisfaction with healthcare provision. An economic evaluation will be run in parallel and will include a cost-effectiveness and a cost-utility analysis. Ethics and dissemination: Ethical approval was obtained from the Institutional Ethics Committee at each site. The results of this study will be disseminated through publications and presented at national and international conferences. Trial registration number: ACTRN12613001225707.

Background: Walking recovery is one of the main goals of patients after SCI. Walking is rated as primary goal and desire (together with bladder and bowel function) irrespective of the level of lesion. Past literature terms walking as long-term outcome or as a primary means of mobility after SCI.In patients with SCI clinical and electrophysiological examinations are directed towards predicting functional recovery. Methods: A systematic research of all papers was made by the authors using the PRISMA 2009 guidelines. Using the various search engines 56 articles was found and 22 were selected for the present study. Out of these 17 were included for the final stage Result: Electrophysiological measures can provide information that complements clinical assessments such as the American Spinal Injury Association sensory and motor scores in the evaluation of outcomes after spinal cord injury (SCI). Conclusion: The authors review and summarize the literature regarding tests that are most relevant to the study of SCI recovery—in particular, motor evoked potentials and somatosensory evoked potentials (SSEPs). Both SSEP and MEP provide data clinically significant as a prognostic indicator.

Background and Purpose: Myofascial pain syndrome (MPS) is a syndrome presenting with acute or chronic regional pain originating from trigger points (TPs) localized in the muscles or the fascia. TPs are local points showing high irritability, sensitivity to finger pressure and causing characteristic referred pain. The aim of this case study is to assess the effectiveness of cranio-cervical training on neck disability, endurance of deep cervical muscles and pressure pain threshold in a patient with cervical myofascial pain syndrome. Case description: A 36 year old female who was diagnosed with myofascial pain syndrome. She received cranio cervical training, a low load endurance exercises in order to train and/or to regain muscle control of the cervicoscapular and craniocervical regions. The patient received the treatment program for 10 to 15 minutes. The frequency of treatment is five days in a week for a period of 3 weeks. Outcome: The outcome measures were neck disability index, pressure pain threshold and deep cervical endurance test, which were measured prior to treatment and at the end of third week. Conclusion: The craniocervical training programme for a patient with myofascial pain syndrome found to be effective in reducing neck disability, improving the pressure pain threshold and deep cervical flexor muscle endurance.

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.

OBJECTIVES: To find out the effect of GMI and conventional treatment on upper limb motor impairment and in enhancing the quality of life of patients with stroke. MATERIALS/METHODS: 26 subjects consisting of 15 males and 11 females were randomly allocated to the GMI group (n=13) and to the Conventional group (n=13) by using sealed red and blue colored chits containing the treatment allocation for each participant. Conventional group received conventional treatment containing Task oriented upper extremity functional exercises. GMI group received GMI consisted of two weeks each of left right discrimination training, explicit motor imagery and mirror therapy. Primary outcome measure upper limb motor function was assessed by Fugl meyer assessment scale (FMA) and Chedoke arm and hand activity inventory scale (CAHAI) and Secondary outcome measure quality of life was assessed by Stroke specific quality of life (SS-QOL) were recorded at baseline and after 6 weeks. RESULTS: Paired t test was used to determine the difference between the pre and post treatment score within the group A and B and Unpaired t test was used to analyze the baseline scores and pre-post mean difference between the group A and B. The results suggested that there was improvement in mean change scores of FMA, CAHAI and SS-QOL after treatment in GMI group and Conventional group. But statistical analysis reveals that there was more significant improvement in GMI group (p value ≤0.05). Between group effect sizes were calculated by using Cohen's d coefficient which was large for all three outcome measures (d>1.6). CONCLUSION: GMI group along with conventional treatment shows more significant improvement than conventional group alone in improving upper limb motor functions and quality of life in patients with Stroke.

Objective: To review the researches on the effectiveness of non-invasive brain stimulation in the form of transcranial direct current stimulation on rehabilitation of individuals suffering from stroke. Design: A computerized search of CINAHL, EMBASE, COCHRANE central register of controlled trials, PEDro, PUBMED, SCIENTECH, and OT SEEKER from January 1996 to December 2013 was conducted. Participants: The study considered patients suffering from stroke of age 18 years and above of both genders and of all duration. Intervention: tDCS in association with physiotherapy or occupational therapy was included. Different modes of application such as unihemispheric and bihemispheric stimulations of tDCS were also included. Outcome Measure: Functional scales that measured motor functions, motor control, hand functions, Gait or Activities of daily living were included. Results: Seven studies met the inclusion criteriawere included and reviewed for their methodological quality. The average score of these studies was 8.57 ± 1.72 with a minimum score of 2 and a maximum score of 10. Conclusion: The review of all the seven studies on the effectiveness of the application of tDCS post stroke shows better recovery in the upper limb motor recovery and no significant difference in the lower limb motor recovery.

Background: The occurrence of inferior glenohumeral subluxation is very high when the patient is in initial flaccid stage. The available treatment approaches for subluxation is very limited and has many disadvantages. Purpose: The main purpose of the study is to evaluate the efficacy of California tri-pull taping (CTPT) method on shoulder subluxation, pain, active flexion range of motion (AFLXN), and upper limb functional recovery after stroke. Relevance: The result of the study may help the physiotherapist to effectively use the CTPT method to treat post stroke shoulder subluxation patient and promote better recovery of the upper limb. Participants: 30 subjects with post stroke shoulder subluxation were included into the study; they were randomly allocated into conventional and experimental group. Method: Pre and post assessment scores were taken from each subject by using, Digital Vernier caliper, visual analogue scale (VAS), Goniometer, and Fugl-Meyer scale (FMS). For taping, two types of tape was used, cotton pre-tape and rigid post-tape. Tape was applied to subjects for thrice a week, for six weeks and conventional neurorehabilitation treatment was also given to the subjects, five days a week for six weeks. In conventional group we gave only conventional neurorehabilitation treatment. Analysis: Pre-and post-test scores were analyzed using paired t-test for within group variables and unpaired t test for between group variables, at 95% confidence interval in SPSS version 22.0 for Windows. Results: Both the group showed statistically significant result in all clinical parameters (p ≤0.000). When we compared the change score result between the groups, experimental group showed more improvement than conventional group in all the parameters. Mean difference of change score for subluxation reduction was 0.70(p=0.000), for pain reduction was 1.33(p=0.000), for AFLXN range improvement it was 0.14(p=0.000), for motor performance it was 1.73 (p = 0.000). Conclusion: This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder. Implications: The CTPT method offers an effective intervention for addressing subluxation, which is quick and easy to apply and allows for functional use of subluxed shoulder. Key words: Stroke, shoulder subluxation, CTPT.

The need of research pertaining to the epidemiological studies on management of SCI emerged from the western countries where the resources and protocols of SCI management are harmonized. The individual with SCI after the rehabilitation are re enabled to realize his potential and join the mainstream population as early as possible. Such a harmony is found to be lacking in the developing countries due to many factors. This paper is an attempt to highlight the need for adequate and accurate data required for optimal planning and allocation of resources for SCI population in order to make the resources available, affordable and accessible.

Background:Joint mobilisations in the spine are used as an integral part of the treatment and rehabilitation toalleviate pain and reduce stiffness. Mobilisation has also been used to improve muscle strength as described inthe literature. However, there is dearth of data exploring the effect of mobilisation on muscle strength in CLBP.Purpose:To investigate the effects of lumbar mobilisation on pain, range of motion and back strength chronicmechanical low back pain patients.Materials and Methods:Thirty subjects with chronic back pain partici-pated in the randomized clinical trial. The effects of lumbar mobilisation & exercises were comparedwith theexercises alone. Pain levels were measured using visual analog scale, lumbar extension range of motion usingmodified Schobers test and strength by back-leg-chest dynamometer. Measurements were done before & after2 and 4 weeks respectively.Results:A significantly greater improvement in pain (p=0.001); ROM (p=0.002);strength (p=0.001) after 4 weeks in experimental group than the control group.Conclusion:This study there-fore provides experimental evidence to support the use of lumbar mobilization along with the exercises for themanagement of patients with chronic mechanical low back pain, who responded favourably to the interven-tion.

Background: Fibromyalgia (FM) is exemplified by chronic pervasive musculoskeletal pain, which remains a difficult clinical entity worldwide and the management of this condition is a challenge for the health providers. Numerous treatment options are available to improve the symptoms of fibromyalgia, but a specificity tailored to particular patient is still missing. Thus, in this study we tested the combination of pregabalin with physiotherapy techniques would bring any changes on the fibromyalgia symptoms. Method: A 36 year female reported to the psychiatry department with complaints of continuous pain all over the body, with more than 4 year history of stiffness and functional disability. The patient met the 2010 fibromyalgia diagnostic criteria. Visual analogue scale, Pain pressure algometer, revised fibromyalgia impact questionnaire and shortform-36 health surveys were used as the outcome measures to document the changes. The patient was managed for a period of 3 months using pregabalin along with Physiotherapy techniques. Results: After three months we found positive results on the management of fibromyalgia. Conclusion: Pregabalin combined with Physiotherapy may be synergistic in the treatment of FM had an effect to reduce the severity of pain and improve the pressure threshold and quality of life on fibromyalgia.

Spasticity forms one of the major complications after a spinal cord injury. Various treatment approaches are used for its reduction. Surface spinal stimulation has been used in this case and its effect pre- and post-treatment have been compared. A 27-year-old male suffered a spinal cord injury of the level C4-C5 due to a bus accident, in which the bus had overturned. The patient is a follow-up case of C4-C5 discoligamentous injury with quadriparesis with bowel and bladder involvement. The patient developed spasticity in his upper and lower limbs owing to the spinal cord injury. He has been taking physiotherapy treatment for the same. Due to the spasticity, he is suffering from problems in maintaining a comfortable posture and complains of spasms. When assessed with modified Ashworth scale for spasticity, the patient scored 4 for both left and right dorsiflexors of the lower limb. The patient was given surface spinal stimulation for reduction in spasticity and at the end of 15 days, the spasticity rating was 1 and 2 for left and right limbs respectively. Surface spinal stimulation has proved to be an effective tool for reducing spasticity after spinal cord injury. It helped the patient in being more comfortable and he was able to participate in his exercises more actively. The patient was given a session for 45 minutes each day for five days a week for fifteen days and MAS and functional outcomes of spinal cord injury measure, adductor tone rating scale, spasm frequency were recorded on day 0, day 8, and day 15. The treatment session consisted of application of two pad electrodes (5 × 9 cm) at paravertebral region at the level of T10-L2 vertebrae. There was significant reduction in the score of MAS in the individual and, therefore, it can be said that spasticity was reduced. Keywords: Spinal cord injury, spasticity, modified Ashworth scale (MAS), surface spinal stimulation

Background and Introduction: Cervicogenic headache is a very common condition which leads to significant disability. Cervicogenic headache was first introduced by Sjaastad in 1983 and is defined by the World Cervicogenic Headache Society as referred pain perceived in any part of the head caused by a primary nociceptive source in the musculoskeletal tissues innervated by cervical nerves. A number of studies have been conducted to find the effects of various therapeutic techniques on cervicogenic headache. In this study, comparison has been done between Cervical Therapeutic Exercise Programme for cervicogenic headache and Myofascial Release Techniques to find out the technique more effective in reducing cervicogenic headache parameters. Method: 30 subjects selected according to the inclusion and exclusion criteria were randomly divided into 3 groups: Conventional group, Exercise group and MFR group to which Conventional treatment for Cervicogenic Headache, Cervical Therapeutic Exercise Programme and Myofascial Release Techniques respectively are administered. Pre and post treatment readings were recorded for Neck Disability Index score, Visual Analog Scale score, Headache Duration, Headache Frequency. Results: After one week of treatment it was found that all the three treatment approaches were effective in reducing the Cervicogenic headache parameters. However on comparing three treatment approaches, Myofascial Release Techniques were the most effective in reducing the above parameters. (p<0.05) Conclusion: Myofascial Release Techniques are more effective than Cervical Therapeutic Exercise Programme in reducing Cervicogenic Headache symptoms.

Learning Disabilities are heterogeneous group of disorders characterized by the unexpected failure of an individual to acquire, retrieve, and use information competently. It is estimated that around 15 million children suffer from this ‘invisible handicap’, thus average class in schools has about five students with learning disabilities. In order to encounter the problem, education authorities have issued some guidelines which are compensatory in nature and they lack a curative approach to the problem till date the proper intervention is missing. Present study tries to interpret all the academic, therapeutic and psychological aspect through formulation of structured protocol in the form of intervention technique called Combined Integrated Learning Programme (CILP) and also finds efficacy along with guidelines of Punjab School Education Board (PSEB) on 30 subjects. The mean, standard deviation, t- value F-value and post hoc analysis for all the variables were calculated. It was concluded that CILP has significant effect on the learning outcomes of children with learning disabilities.