Botulinum toxin as adjuvant therapy for hypertonic dysfunction in a neuro-rehabilitation cohort

Purpose: Botulinum toxin (BTX) is a neurotoxin produced by the bacterium Clostridium botulinum, in recent decades, BTX has become an important adjunct treatment to neurological or rehabilitative strategies.We aimed to describe the clinical aspects of patients admitted to a rehabilitation hospital who were treated with BTX for spasticity and dystonia. Methods: This was a historical cohort; data was collected from the electronic charts of all outpatients treated with BTX between 2014 and 2016 in the spasticity and movement disorders service of a quaternary, open access, rehabilitation hospital. The inclusion criteria were limb spasticity due to traumatic brain injury (TBI), and stroke; limb tremor; cervical dystonia; and generalized limb dystonia from any cause in addition to pain that limits rehabilitation. We used relatively lower doses than those generally published in the literature. Therapeutic response was determined by the Goal attainment scale (GAS), pain (graded by visual analogue scale ), independence for daily living activities, target joint range of motion (pre- and post-application), and gait analysis (only for walkers patients). Results: A total of 63 patients were enrolled in this study with a mean follow-up of 2 years. There was significant improvement in joint restriction ) with 66.7% of patients reporting improvement in the GAS scale, best improvement occurred with ortheses and limb adjustments. Conclusions: Most patients have improved functionality on the GAS scale after treatment with BTX, which is used as an adjunct therapy in subjects already in rehabilitation programs. The main rehabilitation objectives with the GAS scale were achieved in most patients.

The novel isoindigo compound with aggregation-induced emission: Br–Br bonding joint restriction of intramolecular motion and for cell imaging property

6, 6’ Dibromided tert-butyloxycarbonyl Isoindigo (Br-TBOCII) possess intense fluorescence for solid state under excitation with Aggregation-Induced Emission (AIE) property, contrary to the classic heavy-atom effect. The unique AIE mechanism is...

THE COMPARATIVE EFFECTS OF VRUDDHADARVADI UPANAHA AND WAX THERAPY IN THE PAIN MANAGEMENT OF JANU SANDHIGATAVATA W.S.R. TO OSTEOARTHRITIS OF KNEE JOINT

A clinical trial was conducted to evaluate the efficacy of different treatment modalities in Janu Sandhigatavata. The Lakshanas of Janu Sandhigatavata as per classics are Shotha, Shoola, Prasaranaa kunchanayovedana, and Atopa are like the symptoms of Osteoarthritis of knee joint i.e., pain, swelling, crepitation and joint restriction. 30 patients suffering from Janu Sandhigatavata (single or both knees), who fulfilled the inclusion and exclusion criteria were selected for the study. 30 Patients were randomly allocated equally into two groups, Group A and Group B. Group A patients received Vruddhadarvadi Upanaha sweda for 1 Hour and Group B patients received Wax therapy for 20min, for 7 days. Both the groups received Placebos (capsules filled with rice flour) for 14 days during the follow-up period. The data of both the groups were analysed using Wilcoxon Signed Rank Test and Mann- Whitney U Test. The efficacy was statistically significant in both the Groups as p value <0.001 in most of the symptoms. Upanaha Sweda and Wax therapy, both the treatments shown equal effectiveness in relieving the pain, swelling, joint restriction and difficulty in walking. While comparison between the Groups, Group A i.e. Upanaha group showed marked reduction in symptoms. The final evaluation proved that the efficacy of Group A was moderately significant as compared to Group B.

Interrater Reliability of Motion Palpation in the Thoracic Spine

Introduction. Manual therapists commonly use assessments of intervertebral motion to determine the need for spinal manipulation, but the reliability of these procedures demonstrates conflicting results. The objectives of this study were to investigate the interrater reliability of thoracic spine motion palpation for perceived joint restriction and pain.Methods. Twenty-five participants between the ages of 18 and 70, with or without mid-back pain, were enrolled. Two raters motion palpated marked T5–T12 levels using two methods (standardised and pragmatic) and noted any restricted or painful segments. We calculated agreement between two raters by generating raw agreement percentages and Kappa coefficients with 95% confidence intervals.Results. There was poor to low level of agreement between the raters for both joint stiffness and pain localization using both pragmatic and standardized approaches. The results did not improve significantly when we conducted a post hoc analysis where three spinal levels were collapsed as one and right and left sides were also combined.Conclusions. The results for interrater reliability were poor for motion restriction and pain. These findings may have unfavourable implications for all manual therapists who use motion palpation to select patients appropriate for spinal manipulation.

Extensive heterotopic ossification in patient with tubercular meningitis

ABSTRACTTubercular meningitis is a severe form of central nervous system tuberculosis with high morbidity and mortality. Apart from neurological deficits, musculoskeletal involvement is also seen in very few cases in the form of heterotopic ossification around immobile joints. A 35-year-old male case of tubercular meningitis with left hemiparesis presented with multiple joint restriction of range of motion. On clinical examination, palpable firm masses around multiple joints with painful restriction of movements were seen. X-ray films of multiple joints revealed heterotopic ossification over left shoulder, hip and knee joint with bony ankylosis of left hip and soft tissue contractures. Very few reports have been published in the literature for association of heterotopic ossification with tubercular meningitis with such extensive joint involvement which compels us to report this clinical association of tubercular meningitis. This report is intended to create caution among physicians and other caregivers for this debilitating complication of tubercular meningitis and in face of high prevalence of tuberculosis and tubercular meningitis, employ methods to prevent and treat.