ABSTRACT
Objective: This pilot study aimed to assess the safety and feasibility of robotic gait training and its' effects on gait parameters in individuals with incomplete motor spinal cord injury-SCI (AIS C and AIS D). Methods: The study was conducted in a tertiary research center with indigenously developed Robotic Exoskeleton Assisted Rehabilitation Systems (REARS). Primary outcome measures used were the ten-meter walk test (10MWT), two-minute walk test (2MWT), six-minute walk test (6MWT), the timed up and go test (TUG), the walking index for spinal cord injury II (WISCI II), and the spinal cord independence measure version III (SCIM III) at baseline, 12 sessions, and after 24 sessions (endpoint) of training. At baseline, individuals who could not perform 10MWT, TUG, and 6MWT were grouped in G1 for analysis. Participants in G2 were able to perform all the tests at baseline. Results: The median (interquartile range [IQR]) age and duration of illness was 41 (24) years and 167 (147) days, respectively. Five out of seven participants had non-traumatic etiology and five were males. After completing training, participants in G1 were able to complete the 10MWT, 6MWT, and TUG, and the mean (SD) scores were 0.2 m/s (0.2), 66.3 m (61.2) and 113.3 s (117.4), respectively. Participants in G2 could perform the TUG test 13.5 s faster at the end of the study (11.9 s vs 25.4 s). The minimum clinically important difference (MCID) for TUG was 10.8 s. In G2, the pre-post training change in mean score of 10MWT and 6MWT was 0.11 m/s and 42 m, respectively; these values approached the MCID for these measures. None of the participants had any injury during training. Conclusions: Robotic gait training with REARS is safe and feasible. Such training may lead to an improvement in balance and walking capacity.
ABSTRACT
Objective: With COVID-19 vaccination campaign worldwide, associated Guillain-Barre syndrome (GBS) is being increasingly reported from different countries. The objectives of the study were to observe the clinical profile and rehabilitation outcomes in patients with post-COVID-19 vaccine-associated GBS. Material and Method: This prospective study was conducted in neurological rehabilitation unit with in-patients. A detailed customized rehabilitation program was formulated based on the clinical status and associated complications. Outcome measures were documented on the day of admission and at discharge and compared. Results: The study included 16 patients (eight males) of which 15 (93.75%) received the CoviShield (AstraZeneca) and 1 Covaxin (Bharat Biotech) vaccine. The median (IQR) duration of first symptom was 9 (18.25) days and for motor symptoms 18 (12.75) days. Functional improvement was observed in patients using Barthel index scores and Hughes disability scores and overall neuropathy limitation scale. All rehabilitation outcomes showed a statistically significant improvement (P < 0.05) from the time of admission to discharge. At discharge, complete independence in activities of daily living was achieved in 4 (25%) patients and 5 (31.25%) were minimally dependent. Three (18.75%) patients were walking independently, seven (43.75%) with minimal support, and four with walker (25%). Nine (56.25%) patients needed bilateral ankle-foot orthosis and two bilateral knee gaiters for locomotion. Conclusion: Comprehensive inpatient rehabilitation interventions in patients with post-COVID-19 vaccine-associated GBS result in significant functional recovery.
ABSTRACT
Dementia is an eurodegenerative disorder, which causes significant disability, especially among the elderly population worldwide. The affected person shows a progressive cognitive decline, which interferes with the independence in performing the activities of daily living. Other than the cognitive domain, the patient tends to have neuropsychiatric, behavioral, sensorimotor, speech, and language-related issues. It is expected that the global burden of the disease will rise with more people entering the geriatric age group. By 2050 close, to 140 million people will be living with one or the other type of dementia. Alzheimer's disease contributes to more than 60% of cases worldwide, followed by vascular dementia. Pharmacotherapy has a limited role to play in the treatment, and at present, no drug is available, which can halt or reverse the progress of the disease. World Health Organization has mandated rehabilitation as a core recommendation in the global action plan on the public health response to dementia. Rehabilitation services are widely recognized as a practical framework to maximize independence and community participation in dementia care. The rehabilitation program is customized to achieve the desired goals, as each person has different experiences, preferences, motivations, strengths, and requirements based on type, course, and severity of the illness. It is an interdisciplinary-team approach with the involvement of several health care professionals. This article reviews the existing literature and outlines the effective rehabilitation strategies concisely in dementia care.
ABSTRACT
STUDY DESIGN: Prospective observational study. PURPOSE: To evaluate bone turnover markers (BTMs) in individuals with acute spinal cord injury (SCI) and to compare the results with those of healthy controls and postmenopausal females. OVERVIEW OF LITERATURE: SCI significantly impacts bone health. Change in bone mineral density appears 6 months after SCI and rapid bone loss during the acute phase is often underestimated, resulting in osteoporosis and a high risk of sublesional fractures. However, few studies have evaluated BTMs in the Indian SCI population. Despite a high risk of fracture, there are no guidelines for the diagnosis, monitoring, and management of SCI-induced osteoporosis. METHODS: Twenty patients within 1 month of traumatic SCI who had been admitted to a tertiary care rehabilitation center were included in this study. Serum BTMs, C telopeptide (CTX) as a bone resorption marker, and osteocalcin as a bone formation marker, were serially measured at baseline, and 3 and 6 months after SCI. BTMs of SCI patients were compared with those of a control group of age-matched healthy males, premenopausal females, and a vulnerable group of postmenopausal females. RESULTS: BTMs were significantly elevated in patients with SCI, with maximum levels observed at the 3rd month of injury. At baseline, the bone resorption marker CTX was approximately 3 times higher in SCI patients than in the control male population and premenopausal females, and about double that of postmenopausal females. The rise in the bone formation marker was marginal in comparison to that of the bone resorption marker. BTMs were persistently elevated and did not reach the normative range until the 6th month of SCI. CONCLUSIONS: Raised bone resorption markers in comparison to bone formation markers indicate hyper-resorption-related bone loss following acute SCI. Markedly elevated bone resorption markers in the SCI population, compared with those in control and vulnerable groups, emphasize the need for early bone health monitoring and management.
