Sanjay Wadhwa - Academia.edu (original) (raw)

Papers by Sanjay Wadhwa

World Journal of Virology

Cureus

The COVID-19 pandemic has posed numerous challenges in accessing adequate healthcare services, pa... more 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. 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. 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). 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.

Journal of Foot and Ankle Surgery (Asia Pacific)

Aim: Footwear modification with lateral elevation in the sole is considered an easy to administer... more Aim: Footwear modification with lateral elevation in the sole is considered an easy to administer and low-cost orthotic intervention for knee osteoarthritis, yet it is not routinely prescribed because of limited available data to prove its effectiveness. This study aimed to assess the effect of lateral wedging in footwear, quantitatively. Materials and methods: We used Zebris Foot pressure platforms integrated into Gait Analysis Laboratory for foot pressure assessment. A Prospective Pre-Post Interventional Study was conducted with 40 patients in the age-group 35-75 years who attended Physical Medicine and Rehabilitation (PMR) OPD with grade II and three osteoarthritis on Kellgren and Lawrence System affecting the medial compartment of the knee. Baseline evaluation was done without orthotic modification in footwear and then repeated after ¼ inches lateral wedge orthosis was given in footwear. Results and implications: Peak plantar pressures showed a trend of a shift toward the lateral zone of the foot after wearing lateral-wedged insoles in shoes, signifying the redistribution of pressure and change in the ground reaction forces in the patients with osteoarthritis knee after shoe modification. All patients reported relief in pain scores. Hence lateral wedging provides symptomatic benefits. Conclusion: In low-income nations, orthotic intervention has a lot of potential as a simple and economical treatment for knee osteoarthritis (KOA). Furthermore, our findings point toward the relevance of conservative management and its ability to slow disease progression, which could be extremely helpful for people with KOA who are not candidates for surgery.

Indian Journal of Physical Medicine & Rehabilitation

Frontiers in Neuroscience, 2020

Fibromyalgia is a multi-symptomatic disorder characterized by generalized pain. The pathophysiolo... more Fibromyalgia is a multi-symptomatic disorder characterized by generalized pain. The pathophysiology of fibromyalgia is supposedly an interplay between central nervous system hyper-responsiveness, autonomic dysfunction, and peripheral pain. In this cross-sectional study, the objective was to assess central sensitization and autonomic activity in patients with fibromyalgia compared with control. Fifty adults diagnosed with fibromyalgia by the modified American College of Rheumatology 2010 criteria and an equal number of age-and sex-matched controls participated in the study in an urban tertiary care hospital. Central sensitization was assessed by history and by evidence of increased prefrontal cortical activity as measured by cortical oxygenation using functional near-infrared spectroscopy. Autonomic activity was assessed by heart rate variability, electrodermal activity, and deep breathing test in three physiological states: rest, sympathetic stress (cold pressor test), and deep breathing. Mann-Whitney U-test, paired t-test, Wilcoxon test, and Friedman test with Bonferroni a priori were used to analyze the data. Cortical activity was significantly higher in the fibromyalgia group than control. There was no significant difference in autonomic activity between the fibromyalgia and control groups. In the fibromyalgia group, variable degrees of sympathetic hyperactivity and normal parasympathetic activity were observed. Central sensitization may be playing a primary role in the pathophysiology of generalized pain in fibromyalgia.

Title of the article: A Study of structured rehabilitation exercise program in Parkinson’s diseas... more Title of the article: A Study of structured rehabilitation exercise program in Parkinson’s disease Context: There is a growing need to address rehabilitation issues to supplement medical therapy. Aims: To assess the impact of rehabilitation intervention in the functional status and quality of life in patients with Parkinson’s disease. Settings and Design: Prospective follow-up study in a teaching hospital Materials and Methods: Twenty-eight cases with Parkinson’s Disease on a stable pharmacological regimen and moderately disabled participated in this study. All patients were given the same set of exercises. During the first month, patients performed exercises under supervision at the hospital and rest of the days at home. In the second and third month, patients continued the same exercises at home. During the fourth month, patients maintained their usual level of physical activity but discontinued the exercises. All patients were evaluated at 0, 1, 2, 3 and 4 months. Outcome measure...

Folia morphologica, 2008

We describe an unusual combination of unilateral upper limb variations, including an axillary arc... more We describe an unusual combination of unilateral upper limb variations, including an axillary arch, absence of a "typical" musculocutaneous nerve, direct lateral cord innervation of the muscles usually supplied by the musculocutaneous nerve, variant superficial brachial artery, a high anomalous origin of the common interosseous artery and a superficial ulnar artery noted during routine cadaver dissection. The embryological basis, recent molecular insights concerning such a constellation of anomalies and its clinical relevance are discussed.

Journal of Pediatric Neurosciences, 2013

Amiel-Tison method is a commonly used technique for assessing tone and neurological status of inf... more Amiel-Tison method is a commonly used technique for assessing tone and neurological status of infants. There is a paucity of data on the reliability of visual assessment of angles, a component of this method. We compared the visual and the goniometric assessment of adductor and popliteal angles in infants with hypertonia and neurologically normal controls. A total of 16 infants with hypertonia and 15 normal infants underwent blinded assessment of the adductor and popliteal angles. The mean and standard deviation for the difference between visual and goniometric measurements were calculated for popliteal and adductor angles. The mean differences between visual and goniometric measurements for the popliteal angle were 4.94 (SD3.40) and 8.73 (SD6.10) degrees for the cases and controls respectively. Similarly, the values for adductor angle measurements were 8.94 (SD8.23) and 14.47 (SD8.47) degrees respectively. The deviation of visual assessment from goniometric measurement was found to be less for popliteal angle measurement as compared to adductor angle measurements. It was note-worthy that the difference was less for the measurements of children with spasticity.

Between November 2014 and January 2016, 90 consecutive patients were included in this cross secti... more Between November 2014 and January 2016, 90 consecutive patients were included in this cross sectional survey of patients diagnosed with multiple myeloma. The study was approved by the Institute Ethics Committee and informed written consent was obtained. All patients (new and relapsed), irrespective of disease status and duration from diagnosis, underwent baseline evaluation following which they completed a scale exploring their functional status by Barthel mobility index scoring and QOL with the EORTC QOL scale with its myeloma module. The data was split into three subsets. First, newly diagnosed patients (naïve and on 1^st line treatment) and relapsed categories. Second, according to disease status; and third as per duration from diagnosis (<6 months, 6-12 months, 12-24 months and >24 months). Mean score and frequency (%) was calculated. Comparison of scores between different categories was analyzed.

Cureus, 2021

Background Achilles tendinopathy, a common cause of heel pain, is primarily considered mechanical... more Background Achilles tendinopathy, a common cause of heel pain, is primarily considered mechanical in origin, but its pathogenesis and treatment lack consensus. Molecules such as collagen peptide type-1, low molecular weight chondroitin sulphate, sodium hyaluronate and vitamin C have been shown to act as building blocks of tendon structure, and oral supplementation of these have promising results in Achilles tendinopathy. Methods This study was a prospective randomized control trial to compare the effectiveness of oral diclofenac sodium versus a nutraceutical combination of collagen peptide type-1, chondroitin sulphate, sodium hyaluronate, and vitamin C in the treatment of Achilles tendinopathy on pain and ultrasonographic structures. A total of 40 patients satisfying inclusion and exclusion criteria were randomly allocated into two groups and were given the nutraceutical combination in group A and diclofenac sodium in group B. The patient evaluation was done at baseline, six-week, and 12-week intervals in terms of VAS (Visual Analogue Scale) and tendo-Achilles thickness by ultrasound. Results Both nutraceutical combination and diclofenac reduced pain in persons with Achilles tendinopathy. The nutraceutical combination had a statistically significant better outcome in reducing pain at the end of 12 weeks. On ultrasound, both the interventions reduced Achilles tendon anteroposterior and mediolateral thickness by the end of 12 weeks. Although there was no absolute significant intergroup difference, the percentage change was more in the nutraceutical group in the case of anteroposterior thickness. Conclusion Combining collagen peptide type-1, low molecular weight chondroitin sulphate, sodium hyaluronate, and vitamin C is more effective than oral diclofenac in controlling pain in Achilles tendinopathy.

In-vivo proton MR spectroscopy carried out on post polio residual paralysis (PPRP) patients indic... more In-vivo proton MR spectroscopy carried out on post polio residual paralysis (PPRP) patients indicate that the presence or absence of intra-myocellular lipids (IMCL) is related to the severity of the paralysis. It is observed that mildly paralyzed patients are comparable (p > 0.05) with the control subjects in relation to the presence of IMCL, while moderate and severely paralysed patients are comparable (p > 0.05) in relation to the absence of IMCL. In addition, there is reduction or complete absence of creatine, carnitine and choline metabolites in severely paralyzed patients. The ability to detect noninvasively the subtle differences in in vivo, the lipid compartments of muscle may prove to be a valuable tool in understanding the pathogenesis of muscle diseases. This could open up the possibilities in designing effective rehabilitative exercise programs or development of new drug therapies.

Annals of Physical and Rehabilitation Medicine, 2018

Introduction/Background Chronic pain is common and significantly impacts on the lives of persons ... more Introduction/Background Chronic pain is common and significantly impacts on the lives of persons with multiple sclerosis (MS). Various types of non-pharmacological interventions are used to improve pain control in persons with MS (pwMS), however the effectiveness and safety of many modalities is still unknown. This review evaluated the effectiveness of currently used nonpharmacological interventions for chronic pain in pwMS. Material and method A literature search was performed using the Cochrane MS Group Trials Register which contains Cochrane CENTRAL, Medline, EMBASE, CINAHL, LILACUS, Clinical trials.gov and World Health Organisation International Clinical Trials Registry Platform in April 2017. Manual searching in the relevant journals and screening of reference lists of studies was done. Randomised controlled trials (RCTs), crossover studies and clinical controlled trials were included. All authors independently selected studies, extracted data and assessed the methodological quality. Pooling data for meta-analysis was not possible due to methodological/statistical heterogeneity of included studies. Results Overall, 12 RCTs (610 participants), which investigated different non-pharmacological interventions for the management of chronic pain in MS fulfilled the review inclusion criteria. The nonpharmacological interventions evaluated included: transcutaneous electrical nerve stimulation (TENS), psychotherapy (telephone selfmanagement, hypnosis and electroencephalogram biofeedback), transcranial random noise stimulation (tRNS), transcranial direct stimulation (tDCS), hydrotherapy (Ai Chi) and reflexology. The findings suggest that there is "low level" or limited evidence for the use of evaluated non-pharmacological management for chronic pain in MS. Though, there is improved changes in pain scores and secondary outcomes, these were not clinically or statistically significant for TENS for lower back pain and tRNS, hydrotherapy exercises, tDCS, reflexology and psychotherapy for overall pain. The evidence was limited for other interventions. Conclusion Despite the use of wide range of non-pharmacological interventions for the treatment of chronic pain in pwMS, the evidence for these interventions is still limited and/or insufficient. More robust studies are needed to justify the beneficial effect of these interventions.

American Journal of Physical Medicine & Rehabilitation, 2005

Cerebral palsy is a major severe childhood disability and its prevalence is increasing, particula... more Cerebral palsy is a major severe childhood disability and its prevalence is increasing, particularly among premature low birth weight newborns. Less attention is paid to dental health in these children. This study aimed to investigate various dental problems such as dental caries, plaque index, malocclusion and drooling in a group of 53 Indian cerebral palsy children. The results were compared with a control group of 53 age and sex matched normal children. Non-parametric statistical tests were used, with the level of significance set at p<0.05. The results showed a significant difference between cases and controls for caries. No significant difference was noted for malocclusion. One of the significant finding was that the children affected with drooling were not affected with caries teeth. Conclusion-Good oral hygiene, accompanied by early and regular dental examination and treatment will enhance good dental health in cerebral palsy children.

Indian Journal of Physical Medicine and Rehabilitation

The benign joint hypermobility syndrome (BJHS) was first addressed by Kirk as a distinct patholog... more The benign joint hypermobility syndrome (BJHS) was first addressed by Kirk as a distinct pathology in 1967, as the presence of rheumatic symptoms with generalised joint laxity in the absence of any demonstrable systemic rheumatic disease. In this prospective, longitudinal, analytical study, we tried to find out the response of rehabilitation therapy in patients presenting with locomotor symptoms of BJHS and selected 61 patients randomly. The rehabilitation protocol followed: Explanation and reassurance, teaching of joint protection techniques and work modification, isometric muscle strengthening exercise (both extensor and flexor muscles), endurance exercise. Clinically most of the patients showed significant overall response quantitatively, in all the parameters. It can be concluded that the rehabilitation protocol prescribed here is very much suitable both quantitatively and qualitatively for the patients of BJHS.

Indian Journal of Physical Medicine and Rehabilitation

Objective Analysis of clinical gait pattern, change in spasticity and range of motion (ROM) in ce... more Objective Analysis of clinical gait pattern, change in spasticity and range of motion (ROM) in cerebral palsy patient (CP) with spastic lower limb muscle after injecting botulinum toxin- A. Study Design Prospective study Methods 28 children (18 male and 10 female) with spastic CP had problems in normal walking, aged 2–9 years (mean age 4.65 years), consecutively treated in the PMR department over a 2-year period, were prospectively followed-up and clinically assessed pre- and post-treatment (at 2 weeks and 2 months) both objectively and subjectively. Objective assessment included gait parameters -- stride length, cadence, velocity, step length, base of support; active and passive range of motion (ROM), (measured by goniometry) and spasticity on modified Ashworth scale. Subjective assessment was done by asking questionnaire in terms of comfort, ease of care, perineal hygiene, walking. Injections were given using clinical palpatory method on OPD basis. All patients received botulinum ...

International Journal of Advances in Medicine

Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is de... more Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is dearth of studies relating to comparison of metabolic efficiency of A-AFO and P-AFO. Objective was to study the efficacy of A-AFO compared to P-AFO in foot drop patients, using gait and metabolic analysis.Methods: It was a cross over study, included foot drop patients who could walk with/ without orthosis. Patients having spasticity more than grade 2 (Modified Ashworth Scale) were excluded. The metabolic parameters measured were volume of Oxygen consumed at Standard Temperature and Pressure in l/min (VO2), Dry in l/min, Rate of Oxygen consumption (MET), Volume of Carbon dioxide produced in litre/min (VCO2). Along with various gait parameters, questionnaire about patient’s preference after 4 weeks was also incorporated.Results: A-AFO was significantly better than P-AFO in terms of VO2 and VCO2 (p value = 0.02 and 0.009 respectively) as well as in terms of subjective preference.Conclusions: ...

The Journal of Alternative and Complementary Medicine

The National Medical Journal of India

Journal of Family Medicine and Primary Care

Journal of clinical and diagnostic research : JCDR, 2017

Osteoarthritis (OA) of knee is a common joint disease. It is associated with reduced knee joint s... more Osteoarthritis (OA) of knee is a common joint disease. It is associated with reduced knee joint stability due to impaired quadriceps strength, pain, and an altered joint structure. There is altered muscle activation in knee OA patients, which interferes with normal load distribution around the knee and facilitates disease progression. Our primary aim was to determine activation patterns of the muscles i.e., quadriceps and hamstrings in knee OA patients during walking. We also studied co-activation of muscles around knee joint in primary OA knee patients including directed medial and lateral co-contractions. This observational study was done at Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India. Fourty-four patients with medial compartment primary knee OA were included in study after satisfying inclusion and exclusion criteria. All the patients were assessed for mean, peak and integrated Root Mean Square (RMS), EMG values, mu...

World Journal of Virology

Cureus

The COVID-19 pandemic has posed numerous challenges in accessing adequate healthcare services, pa... more 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. 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. 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). 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.

Journal of Foot and Ankle Surgery (Asia Pacific)

Aim: Footwear modification with lateral elevation in the sole is considered an easy to administer... more Aim: Footwear modification with lateral elevation in the sole is considered an easy to administer and low-cost orthotic intervention for knee osteoarthritis, yet it is not routinely prescribed because of limited available data to prove its effectiveness. This study aimed to assess the effect of lateral wedging in footwear, quantitatively. Materials and methods: We used Zebris Foot pressure platforms integrated into Gait Analysis Laboratory for foot pressure assessment. A Prospective Pre-Post Interventional Study was conducted with 40 patients in the age-group 35-75 years who attended Physical Medicine and Rehabilitation (PMR) OPD with grade II and three osteoarthritis on Kellgren and Lawrence System affecting the medial compartment of the knee. Baseline evaluation was done without orthotic modification in footwear and then repeated after ¼ inches lateral wedge orthosis was given in footwear. Results and implications: Peak plantar pressures showed a trend of a shift toward the lateral zone of the foot after wearing lateral-wedged insoles in shoes, signifying the redistribution of pressure and change in the ground reaction forces in the patients with osteoarthritis knee after shoe modification. All patients reported relief in pain scores. Hence lateral wedging provides symptomatic benefits. Conclusion: In low-income nations, orthotic intervention has a lot of potential as a simple and economical treatment for knee osteoarthritis (KOA). Furthermore, our findings point toward the relevance of conservative management and its ability to slow disease progression, which could be extremely helpful for people with KOA who are not candidates for surgery.

Indian Journal of Physical Medicine & Rehabilitation

Frontiers in Neuroscience, 2020

Fibromyalgia is a multi-symptomatic disorder characterized by generalized pain. The pathophysiolo... more Fibromyalgia is a multi-symptomatic disorder characterized by generalized pain. The pathophysiology of fibromyalgia is supposedly an interplay between central nervous system hyper-responsiveness, autonomic dysfunction, and peripheral pain. In this cross-sectional study, the objective was to assess central sensitization and autonomic activity in patients with fibromyalgia compared with control. Fifty adults diagnosed with fibromyalgia by the modified American College of Rheumatology 2010 criteria and an equal number of age-and sex-matched controls participated in the study in an urban tertiary care hospital. Central sensitization was assessed by history and by evidence of increased prefrontal cortical activity as measured by cortical oxygenation using functional near-infrared spectroscopy. Autonomic activity was assessed by heart rate variability, electrodermal activity, and deep breathing test in three physiological states: rest, sympathetic stress (cold pressor test), and deep breathing. Mann-Whitney U-test, paired t-test, Wilcoxon test, and Friedman test with Bonferroni a priori were used to analyze the data. Cortical activity was significantly higher in the fibromyalgia group than control. There was no significant difference in autonomic activity between the fibromyalgia and control groups. In the fibromyalgia group, variable degrees of sympathetic hyperactivity and normal parasympathetic activity were observed. Central sensitization may be playing a primary role in the pathophysiology of generalized pain in fibromyalgia.

Title of the article: A Study of structured rehabilitation exercise program in Parkinson’s diseas... more Title of the article: A Study of structured rehabilitation exercise program in Parkinson’s disease Context: There is a growing need to address rehabilitation issues to supplement medical therapy. Aims: To assess the impact of rehabilitation intervention in the functional status and quality of life in patients with Parkinson’s disease. Settings and Design: Prospective follow-up study in a teaching hospital Materials and Methods: Twenty-eight cases with Parkinson’s Disease on a stable pharmacological regimen and moderately disabled participated in this study. All patients were given the same set of exercises. During the first month, patients performed exercises under supervision at the hospital and rest of the days at home. In the second and third month, patients continued the same exercises at home. During the fourth month, patients maintained their usual level of physical activity but discontinued the exercises. All patients were evaluated at 0, 1, 2, 3 and 4 months. Outcome measure...

Folia morphologica, 2008

We describe an unusual combination of unilateral upper limb variations, including an axillary arc... more We describe an unusual combination of unilateral upper limb variations, including an axillary arch, absence of a "typical" musculocutaneous nerve, direct lateral cord innervation of the muscles usually supplied by the musculocutaneous nerve, variant superficial brachial artery, a high anomalous origin of the common interosseous artery and a superficial ulnar artery noted during routine cadaver dissection. The embryological basis, recent molecular insights concerning such a constellation of anomalies and its clinical relevance are discussed.

Journal of Pediatric Neurosciences, 2013

Amiel-Tison method is a commonly used technique for assessing tone and neurological status of inf... more Amiel-Tison method is a commonly used technique for assessing tone and neurological status of infants. There is a paucity of data on the reliability of visual assessment of angles, a component of this method. We compared the visual and the goniometric assessment of adductor and popliteal angles in infants with hypertonia and neurologically normal controls. A total of 16 infants with hypertonia and 15 normal infants underwent blinded assessment of the adductor and popliteal angles. The mean and standard deviation for the difference between visual and goniometric measurements were calculated for popliteal and adductor angles. The mean differences between visual and goniometric measurements for the popliteal angle were 4.94 (SD3.40) and 8.73 (SD6.10) degrees for the cases and controls respectively. Similarly, the values for adductor angle measurements were 8.94 (SD8.23) and 14.47 (SD8.47) degrees respectively. The deviation of visual assessment from goniometric measurement was found to be less for popliteal angle measurement as compared to adductor angle measurements. It was note-worthy that the difference was less for the measurements of children with spasticity.

Between November 2014 and January 2016, 90 consecutive patients were included in this cross secti... more Between November 2014 and January 2016, 90 consecutive patients were included in this cross sectional survey of patients diagnosed with multiple myeloma. The study was approved by the Institute Ethics Committee and informed written consent was obtained. All patients (new and relapsed), irrespective of disease status and duration from diagnosis, underwent baseline evaluation following which they completed a scale exploring their functional status by Barthel mobility index scoring and QOL with the EORTC QOL scale with its myeloma module. The data was split into three subsets. First, newly diagnosed patients (naïve and on 1^st line treatment) and relapsed categories. Second, according to disease status; and third as per duration from diagnosis (<6 months, 6-12 months, 12-24 months and >24 months). Mean score and frequency (%) was calculated. Comparison of scores between different categories was analyzed.

Cureus, 2021

Background Achilles tendinopathy, a common cause of heel pain, is primarily considered mechanical... more Background Achilles tendinopathy, a common cause of heel pain, is primarily considered mechanical in origin, but its pathogenesis and treatment lack consensus. Molecules such as collagen peptide type-1, low molecular weight chondroitin sulphate, sodium hyaluronate and vitamin C have been shown to act as building blocks of tendon structure, and oral supplementation of these have promising results in Achilles tendinopathy. Methods This study was a prospective randomized control trial to compare the effectiveness of oral diclofenac sodium versus a nutraceutical combination of collagen peptide type-1, chondroitin sulphate, sodium hyaluronate, and vitamin C in the treatment of Achilles tendinopathy on pain and ultrasonographic structures. A total of 40 patients satisfying inclusion and exclusion criteria were randomly allocated into two groups and were given the nutraceutical combination in group A and diclofenac sodium in group B. The patient evaluation was done at baseline, six-week, and 12-week intervals in terms of VAS (Visual Analogue Scale) and tendo-Achilles thickness by ultrasound. Results Both nutraceutical combination and diclofenac reduced pain in persons with Achilles tendinopathy. The nutraceutical combination had a statistically significant better outcome in reducing pain at the end of 12 weeks. On ultrasound, both the interventions reduced Achilles tendon anteroposterior and mediolateral thickness by the end of 12 weeks. Although there was no absolute significant intergroup difference, the percentage change was more in the nutraceutical group in the case of anteroposterior thickness. Conclusion Combining collagen peptide type-1, low molecular weight chondroitin sulphate, sodium hyaluronate, and vitamin C is more effective than oral diclofenac in controlling pain in Achilles tendinopathy.

In-vivo proton MR spectroscopy carried out on post polio residual paralysis (PPRP) patients indic... more In-vivo proton MR spectroscopy carried out on post polio residual paralysis (PPRP) patients indicate that the presence or absence of intra-myocellular lipids (IMCL) is related to the severity of the paralysis. It is observed that mildly paralyzed patients are comparable (p > 0.05) with the control subjects in relation to the presence of IMCL, while moderate and severely paralysed patients are comparable (p > 0.05) in relation to the absence of IMCL. In addition, there is reduction or complete absence of creatine, carnitine and choline metabolites in severely paralyzed patients. The ability to detect noninvasively the subtle differences in in vivo, the lipid compartments of muscle may prove to be a valuable tool in understanding the pathogenesis of muscle diseases. This could open up the possibilities in designing effective rehabilitative exercise programs or development of new drug therapies.

Annals of Physical and Rehabilitation Medicine, 2018

Introduction/Background Chronic pain is common and significantly impacts on the lives of persons ... more Introduction/Background Chronic pain is common and significantly impacts on the lives of persons with multiple sclerosis (MS). Various types of non-pharmacological interventions are used to improve pain control in persons with MS (pwMS), however the effectiveness and safety of many modalities is still unknown. This review evaluated the effectiveness of currently used nonpharmacological interventions for chronic pain in pwMS. Material and method A literature search was performed using the Cochrane MS Group Trials Register which contains Cochrane CENTRAL, Medline, EMBASE, CINAHL, LILACUS, Clinical trials.gov and World Health Organisation International Clinical Trials Registry Platform in April 2017. Manual searching in the relevant journals and screening of reference lists of studies was done. Randomised controlled trials (RCTs), crossover studies and clinical controlled trials were included. All authors independently selected studies, extracted data and assessed the methodological quality. Pooling data for meta-analysis was not possible due to methodological/statistical heterogeneity of included studies. Results Overall, 12 RCTs (610 participants), which investigated different non-pharmacological interventions for the management of chronic pain in MS fulfilled the review inclusion criteria. The nonpharmacological interventions evaluated included: transcutaneous electrical nerve stimulation (TENS), psychotherapy (telephone selfmanagement, hypnosis and electroencephalogram biofeedback), transcranial random noise stimulation (tRNS), transcranial direct stimulation (tDCS), hydrotherapy (Ai Chi) and reflexology. The findings suggest that there is "low level" or limited evidence for the use of evaluated non-pharmacological management for chronic pain in MS. Though, there is improved changes in pain scores and secondary outcomes, these were not clinically or statistically significant for TENS for lower back pain and tRNS, hydrotherapy exercises, tDCS, reflexology and psychotherapy for overall pain. The evidence was limited for other interventions. Conclusion Despite the use of wide range of non-pharmacological interventions for the treatment of chronic pain in pwMS, the evidence for these interventions is still limited and/or insufficient. More robust studies are needed to justify the beneficial effect of these interventions.

American Journal of Physical Medicine & Rehabilitation, 2005

Cerebral palsy is a major severe childhood disability and its prevalence is increasing, particula... more Cerebral palsy is a major severe childhood disability and its prevalence is increasing, particularly among premature low birth weight newborns. Less attention is paid to dental health in these children. This study aimed to investigate various dental problems such as dental caries, plaque index, malocclusion and drooling in a group of 53 Indian cerebral palsy children. The results were compared with a control group of 53 age and sex matched normal children. Non-parametric statistical tests were used, with the level of significance set at p<0.05. The results showed a significant difference between cases and controls for caries. No significant difference was noted for malocclusion. One of the significant finding was that the children affected with drooling were not affected with caries teeth. Conclusion-Good oral hygiene, accompanied by early and regular dental examination and treatment will enhance good dental health in cerebral palsy children.

Indian Journal of Physical Medicine and Rehabilitation

The benign joint hypermobility syndrome (BJHS) was first addressed by Kirk as a distinct patholog... more The benign joint hypermobility syndrome (BJHS) was first addressed by Kirk as a distinct pathology in 1967, as the presence of rheumatic symptoms with generalised joint laxity in the absence of any demonstrable systemic rheumatic disease. In this prospective, longitudinal, analytical study, we tried to find out the response of rehabilitation therapy in patients presenting with locomotor symptoms of BJHS and selected 61 patients randomly. The rehabilitation protocol followed: Explanation and reassurance, teaching of joint protection techniques and work modification, isometric muscle strengthening exercise (both extensor and flexor muscles), endurance exercise. Clinically most of the patients showed significant overall response quantitatively, in all the parameters. It can be concluded that the rehabilitation protocol prescribed here is very much suitable both quantitatively and qualitatively for the patients of BJHS.

Indian Journal of Physical Medicine and Rehabilitation

Objective Analysis of clinical gait pattern, change in spasticity and range of motion (ROM) in ce... more Objective Analysis of clinical gait pattern, change in spasticity and range of motion (ROM) in cerebral palsy patient (CP) with spastic lower limb muscle after injecting botulinum toxin- A. Study Design Prospective study Methods 28 children (18 male and 10 female) with spastic CP had problems in normal walking, aged 2–9 years (mean age 4.65 years), consecutively treated in the PMR department over a 2-year period, were prospectively followed-up and clinically assessed pre- and post-treatment (at 2 weeks and 2 months) both objectively and subjectively. Objective assessment included gait parameters -- stride length, cadence, velocity, step length, base of support; active and passive range of motion (ROM), (measured by goniometry) and spasticity on modified Ashworth scale. Subjective assessment was done by asking questionnaire in terms of comfort, ease of care, perineal hygiene, walking. Injections were given using clinical palpatory method on OPD basis. All patients received botulinum ...

International Journal of Advances in Medicine

Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is de... more Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is dearth of studies relating to comparison of metabolic efficiency of A-AFO and P-AFO. Objective was to study the efficacy of A-AFO compared to P-AFO in foot drop patients, using gait and metabolic analysis.Methods: It was a cross over study, included foot drop patients who could walk with/ without orthosis. Patients having spasticity more than grade 2 (Modified Ashworth Scale) were excluded. The metabolic parameters measured were volume of Oxygen consumed at Standard Temperature and Pressure in l/min (VO2), Dry in l/min, Rate of Oxygen consumption (MET), Volume of Carbon dioxide produced in litre/min (VCO2). Along with various gait parameters, questionnaire about patient’s preference after 4 weeks was also incorporated.Results: A-AFO was significantly better than P-AFO in terms of VO2 and VCO2 (p value = 0.02 and 0.009 respectively) as well as in terms of subjective preference.Conclusions: ...

The Journal of Alternative and Complementary Medicine

The National Medical Journal of India

Journal of Family Medicine and Primary Care

Journal of clinical and diagnostic research : JCDR, 2017

Osteoarthritis (OA) of knee is a common joint disease. It is associated with reduced knee joint s... more Osteoarthritis (OA) of knee is a common joint disease. It is associated with reduced knee joint stability due to impaired quadriceps strength, pain, and an altered joint structure. There is altered muscle activation in knee OA patients, which interferes with normal load distribution around the knee and facilitates disease progression. Our primary aim was to determine activation patterns of the muscles i.e., quadriceps and hamstrings in knee OA patients during walking. We also studied co-activation of muscles around knee joint in primary OA knee patients including directed medial and lateral co-contractions. This observational study was done at Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India. Fourty-four patients with medial compartment primary knee OA were included in study after satisfying inclusion and exclusion criteria. All the patients were assessed for mean, peak and integrated Root Mean Square (RMS), EMG values, mu...