Efficacy of exercises in early-stage Parkinson's disease (PARK-EASE trial): single-blind, randomised, controlled trial.

Objectives: To assess the efficacy of exercises in early-stage Parkinson's disease (PD). Design: Single-blind, randomised controlled trial. Setting: Tertiary rehabilitation care centre. Participants: Forty individuals (≥18 years, either gender) with newly diagnosed PD (Hoehn and Yahr stage ≤2) on a stable dose of PD medications were randomised (1:1) to the intervention group (IG) and control group (CG). Interventions: The IG received strengthening (30 min/day, 2 days/week), aerobic (30 min/day, 3 days/week) and agility (30 min/day, 2 days/week) exercises in a structured format for 12 weeks. CG received stretching exercises for 12 weeks. Main outcome measures: Unified PD Rating Scale (UPDRS) III (motor) at week 12 (primary), UPDRS I (mentation, behaviour and mood), UPDRS II and VI (Schwab and England Activities of daily living Scale) and Parkinson's Disease Quality of Life (PDQL) at week 12 (secondary). Results: 36 participants completed 12-week study period. UPDRS III (lesser scores reflect improvement) at 12 weeks showed a significant between-group difference (-5.05 points (95% CI: -9.38 to -0.71), p=0.02). At 4 and 8 weeks, UPDRS III did not show a statistically significant between-group difference (-2.15 points (95% CI: -6.77 to 2.47) and -4.1 points (95% CI: -8.54 to 0.34), respectively). From baseline to 12 weeks, UPDRS III in the IG showed a 6.5-point (95% CI (4.85 to 8.14)) reduction, and the CG showed a 0.8-point increase (95% CI (-3.06 to 1.46)), PDQL (higher scores reflect improvement) in the IG showed a 8.45-point (95% CI (-12.78 to -4.11)) increase and CG showed a 2.75-point (95% CI (0.16 to 5.33)) reduction. Conclusions: Structured exercises improve motor symptoms and quality of life in early-stage PD. Consistent adherence for at least 12 weeks is crucial for clinical improvement. Early initiation of exercises as neurorehabilitation is recommended. Further research on specific types, dosing and intensity of exercises with a larger sample size is warranted in early-stage PD. Trial registration number: CTRI/2018/05/014241.

Lower limb amputation rehabilitation status in India: A review.

Rehabilitation of lower limb amputation in developing countries is quite challenging. Though there are basic to highly advanced prostheses available in India, the set-up is still facing difficulties in developing countries. Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations. In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India. Currently, India is advancing well in the rehabilitation field, but further studies are required to provide more evidence and recommendation.

Artificial intelligence and machine learning in motor recovery: A rehabilitation medicine perspective.

Artificial intelligence (AI) and machine learning (ML) are powerful technologies with the potential to revolutionize motor recovery in rehabilitation medicine. This perspective explores how AI and ML are harnessed to assess, diagnose, and design personalized treatment plans for patients with motor impairments. The integration of wearable sensors, virtual reality, augmented reality, and robotic devices allows for precise movement analysis and adaptive neurorehabilitation approaches. Moreover, AI-driven telerehabilitation enables remote monitoring and consultation. Although these applications show promise, healthcare professionals must interpret AI-generated insights and ensure patient safety. While AI and ML are in their early stages, ongoing research will determine their effectiveness in rehabilitation medicine.

Effectiveness of Telerehabilitation in Persons With Spinal Cord Injury During the COVID-19 Pandemic (TELE-SCOPE): A Single-Center, Double-Blind, Randomized Controlled Trial.

Introduction The COVID-19 pandemic has posed numerous challenges in accessing adequate healthcare services, particularly for individuals with spinal cord injury (SCI). On the other hand, telerehabilitation has emerged as a promising solution to address healthcare needs. Since there was no study during the pandemic, we started this study with the aim of assessing the efficacy of telerehabilitation for individuals with SCI during the COVID-19 pandemic. Methods This is a prospective double-blind, randomized, controlled trial conducted in a tertiary rehabilitation care center hospital. Thirty participants with traumatic spinal cord injuries (age 18 years or more, either gender) were equally randomized to the telerehabilitation or control group (1:1). Biweekly telerehabilitation sessions (each session: 30 minutes) were provided. Participants in the control group were advised to continue standard usual care as advised previously during outpatient or inpatient rehabilitation. The Spinal Cord Independence Measure (SCIM III) (primary outcome measure) and Coronavirus Anxiety Scale (CAS) (secondary outcome measure) were evaluated at baseline, four weeks, and eight weeks. Results The mean age of the intervention group was 28.2±6.9 years, and the mean age of the control group was 26.3±7.7 years. The self-care (P = 0.03) and mobility domains (P=0.01) of the SCIM III in the intervention group compared to the control group, as determined through a between-group analysis, showed statistically significant differences. CAS also showed improvement in the intervention group compared to the control group. Within-group analysis showed a mean difference of 6.3 points in the intervention group compared to the control group (1.3 points). Conclusion Telerehabilitation intervention is safe, feasible, and effective in improving self-care and mobility domains in persons with spinal cord injuries during the pandemic. It is also effective in reducing the anxiety related to the coronavirus in this population. Further research with a larger sample size and a longer duration is needed to evaluate long-term effectiveness during such crises.

Sexual function history taking in medicine.

Sexual history taking is important for the proper diagnosis and treatment of sexual dysfunction. It is often neglected in a clinical setting and it is also underreported by patients due to stigma and hesitation. Here we have described how we should take sexual function history taking during any sexual dysfunction.

Effect of the pandemic on rehabilitation healthcare services in India: Breaking barriers.

We would like to highlight the rehabilitation medicine perspective from India. Difficulties are impacted by the pandemic during this time, especially for people with disabilities. Awareness building among the public regarding the need for rehabilitation along with improvement in infrastructure is the key unmet need.

Musculoskeletal complications in long COVID-19: A systematic review.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has crippled humanity since early 2020. Various sequelae of COVID-19 have been reported in different body systems. Musculoskeletal symptoms are widely reported during COVID-19 infection, but musculoskeletal complications in long COVID-19 are underreported. However, post-COVID-19 survivors have reported complaints of persisting or new-onset fatigue, myalgia, arthralgia, arthritis, muscle weakness, etc in clinical practice. The well-known detrimental effects of steroids on the musculoskeletal system coupled with their over-the-counter availability can also be anticipated since they were the cornerstone of life-saving management in this pandemic. AIM: To determine the musculoskeletal complications in long COVID. METHODS: We performed a systematic review of 'systematic reviews and meta-analyses'. RESULTS: Of the 63 articles screened, 24 articles were included. Two articles specifically discussed children and adolescents. One article discussed rehabilitation intervention. No article addressed rehabilitation of musculoskeletal issues in long COVID-19 in particular. Fatigue was the most common musculoskeletal complication. CONCLUSION: Fatigue is found to be very common along with myalgia and arthralgia. There were no studies on rehabilitation intervention in musculoskeletal complications specifically. Considering the lacuna in literature and the needs of the current situation, further studies are warranted to standardize effective rehabilitation interventions in musculoskeletal complications. More homogenous studies are needed. Studies on functional impairment due to musculoskeletal involvement are essential.

Can hydroxychloroquine be used for COVID-19-induced arthritis? A debatable hypothesis.

Hydroxychloroquine (HCQ) is a known disease-modifying antirheumatic drug for rheumatoid arthritis. It is also being used in viral arthritis on many occasions. HCQ is also being used to treat coronavirus disease 2019, but the results are not satisfactory. HCQ has been shown to have antiviral effects. In this context, we have a hypothesis that HCQ may be used as a treatment option in post-coronavirus disease 2019 arthritis.

"Helicobacter pylori treatment guideline: An Indian perspective": Letter to the editor.

Treatment guidelines in many countries for Helicobacter pylori (H. pylori) may differ. Owing to the various characteristics of bacteria, clinical manifestations, resistance to antibiotics and recurrence rate, treatment regimens may change. In this letter, we would like to give an Indian perspective on H. pylori treatment guidelines.

Communicable to Non-communicable Disease Pandemic in the Making: An Urgent Call for Post-COVID-19 Preparedness.

We have entered the third year of the coronavirus disease 2019 (COVID-19) pandemic. If we look back, we can see how this pandemic caused a wide spectrum of disabilities and death worldwide. Moreover, COVID-19 is notorious for affecting multiple systems of our body leading to what we call "long-COVID". Many people are still suffering from persistent symptoms of long-COVID. Apart from respiratory complications, it is causing cardiac issues, renal failure, stroke, etc. Due to such multiple complications, the rate of disability and functional impairments has increased in the past two years following the beginning of this pandemic. Thus, an infectious disease/communicable disease such as COVID-19 is indirectly leading to increased incidence of several non-communicable diseases (cardiac, renal, neurological, etc.). In this scenario, urgent preparedness in all aspects is warranted to control such a situation.

Rehabilitation in long COVID-19: A mini-review.

We have been experiencing multiple waves of the coronavirus disease 2019 (COVID-19) pandemic. With these unprecedented waves, we have entered into an era of 'new normal'. This pandemic has enforced us to rethink the very basics of childhood learning: Habits, health etiquette, and hygiene. Rehabilitation has immense importance during this pandemic considering a few aspects. Multidisciplinary COVID-19 rehabilitation clinics are essential to address the demand. The equitable distribution of COVID-19 rehabilitation services for differently-abled individuals during the pandemic is an important aspect. Rehabilitation needs identification and further studies on various rehabilitation interventions are among the key unmet future research needs.

"Platelet-Rich Fibrin Membrane-as a novel biomaterial for pressure injury healing in a person with spinal cord injury: A case report".

INTRODUCTION: Pressure injury (PI) impacts the quality of life, and socioeconomic and psychological well-being negatively in persons with Spinal Cord Injury (SCI). Autologous Platelet Rich Plasma (PRP) and Platelet Rich Fibrin (PRF) showed promising roles in wound healing. PRF is considered a second-generation PRP, contains more growth factors and is more biocompatible than PRP. It possesses an additional favourable impact on wound healing due to its three-dimensional fibrin architecture, and antimicrobial property. There are no studies on PRF membrane use for PI healing in SCI. CASE PRESENTATION: A 25-year-old male with operated traumatic T10 American Spinal Injury Association Impairment Scale grade A paraplegia with neurogenic bowel, and bladder and a stage II PI over the left greater trochanter, was admitted for inpatient rehabilitation. The chronic non-healing PI which did not show any improvement following normal saline (0.9%) dressing for the past 3 months, was treated with autologous PRF membrane weekly for four weeks. The PI healed completely and no adverse events were noted. Weekly total scores of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool and Pressure Ulcer Scale for Healing were 6, 6, 5, 2, 0 and 12, 10, 10, 3, and 0 respectively. DISCUSSION: To the best of our knowledge, this is the first case report on the healing of PI in SCI with the use of PRF. This novel biomaterial is a safe and effective promising agent for PI management in SCI. But further randomized trials are needed to establish stronger evidence regarding feasibility and effectiveness.

Barriers to personal hygiene in persons with spinal cord injury during the COVID-19 pandemic and lockdown: A rehabilitation perspective of two cases.

Personal hygiene is the most important measure to prevent coronavirus disease 19 (COVID-19). The pandemic has put persons with disabilities into various challenges. People with spinal cord injury (SCI) are facing these obstacles more because of their altered physiology and increased susceptibility to COVID-19. Through telerehabilitation, hurdles were identified in two paraplegic individuals, such as safe water sources, concerns regarding self-catheterization, increased dependence on care partner, hygiene of assistive aids/wheelchairs, availability of dressing materials for pressure injury dressing, and sanitary pads for menstrual hygiene. To the best of our knowledge, these are the first cases to describe hygiene concerns of SCI people during the COVID-19 pandemic and its rehabilitation implications. Considering the population with disabilities, we should improve access to primary care at the community level regarding personal hygiene. For a large population with disabilities such as SCI who are at risk, simple health education, awareness, and economic ways of hygienic practices can be a saviour.

Vitamin C Deficiency as a Risk Factor for Bell's Palsy: A New Association.

A 28-year-old female developed gum hypertrophy after five months of Bell's palsy (BP). The vitamin C level was severely low. After vitamin C supplementation for one month, gingival hypertrophy was completely resolved. Facial deviation also improved following rehabilitation. Vitamin C is commonly considered as an antioxidant, anti-inflammatory, and immunomodulator, and it hastens recovery of neuritis caused by herpes (cause of BP). BP too has an immune-inflammatory background. To the best of our knowledge, for the first time, vitamin C deficiency has been reported as a cause or triggering/risk factor for Bell's palsy and at the same time immune-inflammation triggered in BP also may lead to vitamin C deficiency as existing vitamin C in the body starts scavenging free radicals to prevent oxidative damage. Vitamin C levels must be checked in all cases of BP, and intake of vitamin C-rich food should be encouraged in people who are at risk of developing BP.

Precautions before starting tofacitinib in persons with rheumatoid arthritis.

Tofacitinib is an immunosuppressive and disease-modifying therapy in rheumatoid arthritis. It may result in many infections flaring up. It is important to take precautions of all kinds (cardiovascular, malignancy, infections etc.) before starting tofacitinib. In this article, we have highlighted important steps where we need to take precautions before starting tofacitinib.

Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection: A Narrative Review.

ABSTRACT: The objective of this review was to analyze the existing data on acute inflammatory myelopathies associated with coronavirus disease 2019 infection, which were reported globally in 2020. PubMed, CENTRAL, MEDLINE, and online publication databases were searched. Thirty-three acute inflammatory myelopathy cases (among them, seven cases had associated brain lesions) associated with coronavirus disease 2019 infection were reported. Demyelinating change was seen in cervical and thoracic regions (27.3% each, separately). Simultaneous involvement of both regions, cervical and thoracic, was seen in 45.4% of the patients. Most acute inflammatory myelopathy disorders reported sensory motor and bowel bladder dysfunctions. On cerebrospinal fluid analysis, pleocytosis and increased protein were reported in 56.7% and 76.7% of the patients, respectively. Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction was positive in five patients. On T2-weighted imaging, longitudinally extensive transverse myelitis and short-segment demyelinating lesions were reported in 76% and 21%, respectively. Among the patients with longitudinally extensive transverse myelitis, 61% reported "moderate to significant" improvement and 26% demonstrated "no improvement" in the motor function of lower limbs. Demyelinating changes in the entire spinal cord were observed in three patients. Most of the patients with acute inflammatory myelopathy (including brain lesions) were treated with methylprednisolone (81.8%) and plasma-exchange therapy (42.4%). An early treatment, especially with intravenous methylprednisolone with or without immunoglobulin and plasma-exchange therapy, helped improve motor recovery in the patients with acute inflammatory myelopathy associated with coronavirus disease 2019.