Prosthetics and orthotics for persons with movement disabilities in India in the postpandemic milieu.

The SARS-CoV-2 disease had a severe impact on global socioeconomic growth, and its harmful effects continue with virus mutation. Over the past 3 years, the pandemic has caused isolation, mental trauma, stress, financial losses, and various health complications in individuals. Recent reports have stressed the sufferings of the physically abled population. However, we should not neglect the challenges faced by the disabled population, which were more severe in many ways due to their dependency on others at various levels. The strategies implemented to contain the virus have further aggravated their sufferings and made it even worse because health care priorities were skewed toward public-centered care. As a result, it is difficult to determine the extent of care the disabled population received during the pandemic. Moreover, a single-centered study reports that amputations in India increased by 54.1% compared with those during the prepandemic era. This indicates the need for special attention to the physically disabled community, especially persons with movement disabilities. These individuals are partially dependent and have the potential to make significant contributions to the gross domestic product if included in the human resources pool. The Indian government had launched various initiatives to improve their living status. But delays in policy implementation, reduction in budget allocation, and the ongoing pandemic have derailed the efforts. For these reasons, this article emphasizes several challenges in movement disability care. In addition, it makes recommendations for improving the quality of life of persons with movement disabilities. These include collaboration, creating start-up businesses, applying state-of-the-art logistics, establishing a technological ecosystem, raising public awareness, accessing high-quality care, and using contemporary medical devices.

Imaging & neuropsychological changes in brain with spiritual practice: A pilot study.

BACKGROUND & OBJECTIVES: Some studies have systematically assessed the effects of spiritual practice (SP) on the brain using combined neuropsychological testing and functional imaging. The objective of the present study was to compare imaging and neuropsychological changes in healthy individuals after SP and those with only physical exercise. METHODS: Healthy adult male volunteers, aged 25-45 yr were randomized into two groups. Group 1 (SP group) underwent the SP and group 2 (controls) did brisk walk for 30 min daily. Detailed neuropsychological evaluation, resting-state functional magnetic resonance imaging (fMRI) and brain 99mTc ethyl cysteinate dimer single-photon emission computed tomography (SPECT) were carried out for both groups before and three months after intervention. RESULTS: Post-intervention, resting state fMRI showed increased connections of left precuneus (in the posterior cingulate cortex area of default mode network) in group 1 and increased left frontal connections in group 2. The neuropsychological tests showed significant improvement in 'Speed of Processing' (Digit Symbol Test) in group 1 and in Focused Attention (Trail Making A) in group 2. The SPECT data in group 1 showed significant improvement in perfusion of the frontal areas, with relatively lesser improvement in parietal areas. Group 2 showed significant improvement in perfusion predominantly in parietal areas, as compared to frontal areas. In addition, significantly improved mood was reported by group 1 and not by group 2. INTERPRETATION & CONCLUSIONS: This pilot study shows important functional imaging and neuropsychological changes in the brain with SP.

A Single Session of rTMS Enhances Small-Worldness in Writer's Cramp: Evidence from Simultaneous EEG-fMRI Multi-Modal Brain Graph.

Background and Purpose: Repetitive transcranial magnetic stimulation (rTMS) induces widespread changes in brain connectivity. As the network topology differences induced by a single session of rTMS are less known we undertook this study to ascertain whether the network alterations had a small-world morphology using multi-modal graph theory analysis of simultaneous EEG-fMRI. Method: Simultaneous EEG-fMRI was acquired in duplicate before (R1) and after (R2) a single session of rTMS in 14 patients with Writer's Cramp (WC). Whole brain neuronal and hemodynamic network connectivity were explored using the graph theory measures and clustering coefficient, path length and small-world index were calculated for EEG and resting state fMRI (rsfMRI). Multi-modal graph theory analysis was used to evaluate the correlation of EEG and fMRI clustering coefficients. Result: A single session of rTMS was found to increase the clustering coefficient and small-worldness significantly in both EEG and fMRI (p < 0.05). Multi-modal graph theory analysis revealed significant modulations in the fronto-parietal regions immediately after rTMS. The rsfMRI revealed additional modulations in several deep brain regions including cerebellum, insula and medial frontal lobe. Conclusion: Multi-modal graph theory analysis of simultaneous EEG-fMRI can supplement motor physiology methods in understanding the neurobiology of rTMS in vivo. Coinciding evidence from EEG and rsfMRI reports small-world morphology for the acute phase network hyper-connectivity indicating changes ensuing low-frequency rTMS is probably not "noise".

Freezing of gait in Parkinson's disease is associated with altered functional brain connectivity.

BACKGROUND: Patients with Parkinson's disease (PD) may develop several gait disturbances during the course of illness and Freezing of gait (FOG) is one of them. Several neuroimaging studies have been conducted to identify the neural correlates of FOG but results have not been uniform. Resting state functional MRI (rs-fMRI) is relatively less explored in PD patients with FOG. This study aims to compare the whole brain resting state connectivity of PD patients with and without FOG using rs-fMRI. METHODS: rs-fMRI was obtained for 28 PD patients (15 with and 13 patients without FOG) who were matched for various demographic and clinical characteristics. Seed to voxel analysis was performed at whole brain level and compared between the two groups. RESULTS: When compared to patients without FOG, the patients with FOG had reduced functional connectivity across multiple seeds. Major finding was reduced inter-hemispheric connectivity of left parietal opercular cortex with multiple regions of the brain primarily involving the primary somatosensory and auditory areas, which also negatively correlated with the FOGQ scores. CONCLUSION: Our findings suggest that alterations in the resting state functional connectivity of the opercular parietal cortex may be one of the substrates of FOG. Reduced interhemispheric connectivity probably is the reason for impairment of control and coordination in bilateral leg movements while walking.