Indian Association of Physiotherapist

["[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration dysfunction.[10,11] Furthermore, studies from our laboratory have 7.\t Fanciulli A, Strano S, Colosimo C, Caltagirone C, Spalletta G, shown that alternative medicines and therapies like Ayurveda Pontieri FE. The potential prognostic role of cardiovascular and Yoga could modulate cardiac autonomic dysfunction, tilting autonomic failure in \u03b1\u2011synucleinopathies. Eur J Neurol the balance favoring vagal influence.[12\u201114] 2013;20:231\u20115. Yoga, an ancient Indian technique of restoring homeostasis of body\u2011mind functioning, helps maintain good health and 8.\t Palma JA, Benarroch EE. Neural control of the heart: Recent manage diverse disease conditions. Various clinical conditions concepts and clinical correlations. Neurology 2014;83:261\u201171. associated with autonomic dysfunction, such as hypertension, diabetes, anxiety, depression, migraine, epilepsy, and pain, 9.\t Bermeo\u2011Ovalle AC, Kennedy JD, Schuele SU. Cardiac improve with regular yoga practice. Such positive effects and autonomic mechanisms contributing to SUDEP. J\u00a0 Clin may help to manage or avert secondary cardiac morbidities Neurophysiol 2015;32:21\u20119. in neurological diseases. With this background, the current presentation will deal with cardiovascular autonomic 10.\t Sathyaprabha TN, Koot LA, Hermans BH, Adoor M, Sinha S, dysfunction in neurological disorders, understanding the Kramer BW, et\u00a0al. Effects of chronic carbamazepine treatment interaction between neurological and cardiovascular control. It on the ECG in patients with focal seizures. Clin Drug Investig will also look at the possible effect of specific medication and 2018;38:845\u201151. alternative therapies like Yoga in the modulation of cardiac autonomic dysfunction in selective neurological illnesses. 11.\t Sriranjini SJ, Ganesan M, Datta K, Pal PK, Sathyaprabha TN. Conclusion Effect of a single dose of standard levodopa on cardiac autonomic Cardiac autonomic dysfunction in majority of neurological function in Parkinson\u2019s disease. Neurol India 2011;59:659\u201163. disorders are associated with increased sympathetic and decreased parasympathetic activity. However, the mechanisms 12.\t Sathyaprabha TN, Satishchandra P, Pradhan C, Sinha S, Kaveri responsible for these changes are poorly understood. This B, Thennarasu K, et\u00a0al. Modulation of cardiac autonomic balance presentation is unique to comprehensively understand with adjuvant yoga therapy in patients with refractory epilepsy. the role of the autonomic nervous system in neurological Epilepsy Behav 2008;12:245\u201152. disorders and understand the possible influence of drugs and therapy on this autonomic dysfunction. Our studies at 13.\t Kishore RK, Abhishekh HA, Udupa K, Thirthalli J, Lavekar NIMHANS have demonstrated that cardiovascular autonomic GS, Gangadhar BN, et\u00a0al. Evaluation of the influence of function is disturbed in neurological disorders, including ayurvedic formulation\u00a0(Ayushman\u201115) on psychopathology, epilepsy, spinocerebellar ataxias, and Parkinson\u2019s disease. heart rate variability and stress hormonal level in major This change in cardiac autonomic function was found in drug depression\u00a0(Vishada). Asian J Psychiatr 2014;12:100\u20117. na\u00efve epilepsy and chronic refractory epilepsy. We have also demonstrated the effect of certain medications on AD and 14.\t Jaideep SS, Nagaraja D, Pal PK, Sudhakara D, Talakad SN. the use of alternative therapies like Yoga in the modulation of Modulation of cardiac autonomic dysfunction in ischemic stroke cardiac autonomic dysfunction in select neurological illnesses. following ayurveda\u00a0(Indian System of Medicine) treatment. Evid All these outcomes obtained from our study at NIMHANS have Based Complement Alternat Med 2014;2014:634695. shown that the autonomic nervous system has an immense role in maintaining normal homeostasis and the initiation and Symposium on Neuromuscular Disorders prognosis of different neurological conditions. Hence identifying this cardiac autonomic dysfunction at an early phase of the Managing chronic fatigue disease helps to understand the disease in a better way and to design a proper treatment protocol. This ANS assessment also Shiv Lal Yadav can be used as a prognostic tool for various health ailments. Professor, AIIMS, New Delhi, India References The term \u201cneurasthenia\u201d, first used in 1869 means \u201clack of nerve force\u201d. Neurasthenia, a diagnosis characterized by 1.\t Bassi A, Bozzali M. Potential interactions between the autonomic chronic fatigue, was defined by George Beard inthe best\u2011selling nervous system and higher level functions in neurological and book American Nervousness.Chronic fatigue is one of the neuropsychiatric conditions. Front Neurol 2015;6:182. most underestimated yet debilitating symptoms inneuromuscular disease. Chronic fatigue is mostly seen in various neurological 2.\t Li DP, Li YL, Li J, Wang S. Neural mechanisms of autonomic disorders likepost stroke, post\u2011poliomyelitis, multiple sclerosis, dysfunction in neurological diseases. Neural Plast in chronic fatigue syndrome, in manyneuromuscular junction 2017;2017:2050191. diseases etc., Chronic fatigue is defined when fatigue lasts for morethan six months. In central, peripheral, and autonomic 3.\t Mativo P, Anjum J, Pradhan C, Sathyaprabha TN, Raju TR, nervous systems diseases centralfatigue is seen and Satishchandra P. Study of cardiac autonomic function in peripheral fatigue is seen in many neuromuscular junction drug\u2011na\u00efve, newly diagnosed epilepsy patients. Epileptic Disord disorders andmetabolic diseases leading to failure to maintain 2010;12:212\u20116. the force of muscle contraction. In NMDscause of fatigue development are cardiopulmonary impairments, deconditioning, 4.\t Pascoe MK, Low PA, Windebank AJ, Litchy WJ. Subacute diabetic loss ofmobility, pain, depression and others co\u2011morbidities proximal neuropathy. Mayo Clin Proc 1997;72:1123\u201132. etc., Apart from neuromuscular disorders\u00a0(NMD), currently chronic fatigue related to cancer and post\u2011COVID 5.\t Stevens SL, Wood S, Koshiaris C, Law K, Glasziou P, Stevens syndromes\u00a0(\u2018longCOVID\u2019) are topics of interest. Post\u2011COVID\u201119 RJ, et\u00a0al. Blood pressure variability and cardiovascular disease: fatigue is defined as the decrease in physicaland\/or mental Systematic review and meta\u2011analysis. BMJ 2016;354:i4098. performance that results from changes in central, psychological, and\/orperipheral factors due to the COVID\u201119. Management 6.\t La Rovere MT, Pinna GD, Maestri R, Sleight P. Clinical value of of chronic fatigue is mainly symptomatic and rehabilitative.The baroreflex sensitivity. Neth Heart J 2013;21:61\u20113. chronic fatigue syndrome\u00a0(CFS) is characterized by intense permanent fatigueof unknown cause, and limits the patient\u2019s functional capacity, producing various degrees of disability. There are multiple theories exist in causation of CFS like Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S101","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration genetics, infections, neuro\u2011inflammation, alteration in immunity are advised for many myopathies like Duchenne Muscular etc., Diagnostic Criteria for CFS\u00a0(2015) states that it requires Dystrophy\u00a0(DMD).During the CBT sessions, the therapist the presence of thefollowing three symptoms for more than emphasizes the role of thought process and itsimpact on the six months as well as the intensity of the symptomsshould be patient\u2019s actions and feelings, as well as recognizes behaviours moderate or severe for at least 50% of the time. The three that cause themto feel more tired and hence minimize them. main symptoms include:\u00a0 Fatigue: A\u00a0 noticeable decrease or Multiple trials, as well as Cochrane reviews, showed the impairment in a patient\u2019s ability to engage in activities thatthey positive benefits of CBT on improving fatigue, mood, and would enjoy before the onset of the illness. This impairment post\u2011exertional malaisein both adolescent and adult patients. continues for more than sixmonths and is associated with GET involves a supervised, gradual increase of physicalactivity new\u2011onset severe fatigue unrelated to exertion and not intensity and duration. Pharmacological options are pain relievedby rest. Post\u2011exertional malaise: Patients experience medication\u00a0(NSAIDS), Tricyclic Antidepressants, Selective worsening symptoms and function afterexposure to physical Serotonin Reuptake Inhibitors\u00a0(SSRI) and or cognitive stressors, which they previously well tolerated. Serotonin\u2011Norepinephrine ReuptakeInhibitors\u00a0(SNRI), antiviral Unrefreshing sleep: patients feel that they are tired after a therapy\u00a0(nucleotide analogue inhibitors) mainly in cases of night\u2019s sleep.Criterion fulfilment for diagnosis requires the three viralcausation, immunoglobulins, and corticosteroids. There above\u2011stated symptoms, plus one of theadditional are few complementary andalternative medicines like essential below\u2011mentioned symptoms. Cognitive impairment: Problems fatty acids, magnesium, acetyl\u2011l\u2011carnitine, vitamin B12, and with the thought or executive function worsened by exertion, antioxidants also being used. Some newer agents are in effort, stress, or time pressure. Orthostatic intolerance: research like Rintatolimod, Rituximab, and Faecal Microbiota Worsening of symptoms upon assuming and maintaining an Transplantation. For TCAs it takes mostly 3\u20114\u00a0weeks for upright posture. Symptoms are improved, although not symptoms relief. Shorter acting benzodiazepines could also necessarily abolished, by lying back down orelevating the feet. be effective for nocturnal myoclonus and periodic Diagnosis of chronic fatigue is of utmost importance because limbmovements during sleep in central fatigue. chronic fatigue can be related to psychiatric and functional Aminopyridines\u00a0(also used for treatment of Lambert\u2011Eaton disorder or it may be due organic cause primarily due to brain myasthenic syndrome) are effective in fatigue associated with or other system involvement There are numerous scales to multiplesclerosis. Amantadine, originally developed as an measure fatigue. An example of a well known fatigue measure antiviral for the influenza virus, is probably the most effective is the Fatigue Severity Scale\u00a0(FSS); it is composed of nine pharmacological treatment for fatigue with multiple sclerosis. items. There is also a 14\u2011item Fatigue Scale\u00a0(Chalder, 1993). Pemoline, acentrally active sympathomimetic, has been A\u00a054\u2011item Profile of Fatigue\u2011Related Symptoms\u00a0(PFRS) was recommended for fatigue in multiple sclerosis.Methylphenidate developed to measure CFS symptomatology. A\u00a0recently has been used occasionally in fatigued patients with multiple developed one is ME\/CFS Fatigue Types Questionnaire\u00a0(MFTQ), sclerosis andmultiple system atrophy. Modafinil is a central a 22\u2011item scale designed to measure the duration, severity stimulant drug and is the first line of treatmentfor excessive and frequency of different fatigue\u2011related sensations and daytime sleepiness and in narcolepsy. Many of the NMDs, symptoms. Short Form\u201136(SF\u201136), Multidimensional particularly the mitochondrial myopathies, share similar final Assessment of Fatigue\u00a0(MAF) scales, Multidimensional Fatigue common pathways of cellular dysfunction that may be Inventory\u00a0(MFI), Piper Fatigue Scale\u00a0(PFS), and the Visual favourably influenced by Creatine Monohydrate\u00a0(CrM) Analog Scale\u00a0(VAS) of fatigueare also used to measure fatigue. supplementation.Apart from this treatment options, especially Management broadly includes non\u2011pharmacological and in NMDs, specific areas should bead dressed for proper pharmacological approaches. Non\u2011pharmacological management. In NMDs cardiopulmonary impairments must approaches include Cognitive\u2011Behavioural Therapy\u00a0(CBT), be treated adequately since such impairments itself cause Graded Exercise Therapy\u00a0(GET), Adaptive Pacing chronic fatigue. Chronic fatigue substantially impairs the quality Therapy\u00a0 (APT), activitymodifications, programmed physical of life of a person; hence fruitful rehabilitative approaches are exercise, control and coping with disease\u2011associatedstress, essential to minimize the disability. Future research should and cognitive restructuring etc., A\u00a0regular pattern of activity is focus on better understanding of the pathophysiological generally encouraged in all patients: the amountundertaken pathways of fatigue in NMD, with agoal of planning better should be modest, spread throughout the day, with greater treatment options that will alleviate symptoms, improve quality emphasis on regularitynot on level of performance. Aerobic of lifeand maximize physical and psychological functioning. exercise\u00a0(gentle and low\u2011impact) especially helps tomaintain cardiorespiratory fitness and also it has a beneficial effect on Symposium on Stroke Rehab mood, psychological well\u2011being, appetite, and sleep, in addition, it lowers the risk of metabolic syndrome. Pool therapy Dysphagia rehabilitation after stroke is often an ideal way for patients with NMD to do aerobic exercise, as simple aswalking in the water, with the water at Akila Rajappa mid\u2011chest height. This is best done in a therapy poolwith a flat, uniform depth floor that is heated to 92F to 95F. The warmth Department of Communication Sciences and Disorders, College of of the water willhelp reduce spasticity and facilitate movement. Health Sciences, East Stroudsburg University of Pennsylvania, East Excessive physical activity has a detrimental effect on fatigue Stroudsburg, Pennsylvania, USA and level of physicalendurance, probably because of an Presentation Format: WILL PRESENT LIVE accelerated rate of decline in function of the surviving motor Swallowing disorders known as dysphagia affects millions units which is seen in post\u2011poliomyelitis patients. This is the worldwide can be caused due to many disease conditions. reason why many a times submaximal non\u2011fatigable exercises Stroke is a common cause of dysphagia that can result in S102\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration devastating consequences such as malnutrition, dehydration, performed by the Nazi physicians during world war II.[1] aspiration pneumonia, decreased rehabilitation potential, However, at that time there was no formal mechanism for any increased health care costs, and decreased quality of institutional oversight, safeguard for the research participants or life. Early identification and intervention of post stroke concept of an informed consent. This resulted in many events dysphagia is a medical priority to prevent these adversities. which would today be classified as breach of human research Dysphagia treatment for many years has relied on utilization ethics, research misconduct or violation of basic human rights. of compensatory approaches. Compensatory dysphagia Some of them include the pre\u2011World War II eugenics movement management approaches such as provision of mechanically supported by many prominent scientist and physicians of that altered diets, feeding tubes and management strategies and\/ time,[4] U.S. government\u2011sponsored radiation research on or maneuvers are frequently used in dysphagia treatment humans\u00a0(1945\u20111975),[5,6] Japan\u2019s medical experimentations on as it allows for immediate reduction in risks and is good for prisoners of war\u00a0(POW) and medical field testing on Chinese short term. However, compensatory management strategies civilians\u00a0(1941\u20111943)[7,8] German Nazi\u2019s human experimentation reinforce underlying swallowing impairment. Clinical on Jews and other POW resulting in the death of a large number research data demonstrate that although compensatory of the research subjects,[9,10] Tuskegee Syphilis study,[11] and management strategies are effective at limiting aspiration but Milgram obedience experiments.[12] not at improving swallowing. Feeding tubes do not reduce Over the years, clinical research has become more formal aspiration nor occurrence of aspiration pneumonia. Feeding and organized. Human research ethics principles have been strategies\u00a0(i.e., feeding tubes, diet modifications etc.) do not identified and many guidelines published across the globe. improve hydration\u00a0(Langmore et\u00a0al. 1998; Martin et\u00a0al., 1994). There is an emphasis on the increased transparency, ethical Dysphagia treatment should be directed at the physiological conduct of research, protection for the participants and or anatomical disorder, rather than at the symptoms alone. institutional oversight. Some remarkable work in the field of Current research demonstrates that dysphagia rehabilitation research ethics has been done in the last five decades.[\u200a13] The improves the sensorimotor control systems that are involved foundations for ethics concerning human research were laid in swallowing and are designed to change\/improve swallowing down in the 1947 Nuremberg Code and the 1964\u00a0Declaration physiology through neuromuscular underpinnings serving of Helsinki.[14] Nuremberg code for the first time stressed the oropharynx. This talk will address the pathophysiology on the importance of voluntary participation in research. of dysphagia caused due to stroke, diagnostic accuracy and The declaration of Helsinki is based on the report \u201cEthical specificity for post stroke dysphagia and discuss in detail the Principles for Medical Research Involving Human Subjects\u201d. evidence\u2011based practice and upcoming trends pertaining It has undergone multiple and extensive revisions with the last to dysphagia rehabilitation post stroke. Emphasis will be revision being in 2013.[15] In 1979, The National Commission for on utilization of foundation principles underlying dysphagia the Protection of Human Subjects in Biomedical and Behavioral rehabilitation such as neuroplasticity, motor learning, exercise Research, USA published The Belmont Report: Principles of physiology and strength\/skill\u2011based approaches. Discussion Ethical Research on Human Subjects. The Report provides the about peripheral and central stimulation treatment paradigms conceptual foundation for a major revision of the U.S. research for dysphagia rehabilitation post stroke will also be covered. regulations in 1981.[13] It discusses the issue of informed consent for patient recruitment in research, assessment of Clinical Trial governance and risks and benefits for the research participants and ensuring conduct\u00a0\u2013\u00a0Ethics, guidelines, trial reasonable, non\u2011exploitative, and well\u2011considered procedures are administered fairly. registration and reporting Nowadays a full\u2011informed consent without any coercion or exploitation is a mandatory requirement to conduct a clinical Farooq Azam Rathore1,2 trial involving human subjects. Other ethical aspects that need attention are use of placebo, risk analysis, post\u2011trial care and 1Department of Rehabilitation Medicine, PNS Shifa Hospital, the issue of compensation. Karachi, Pakistan, 2Orthotist & Prosthetist, Department of Prospective registration of a clinical trial particularly it is a Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan randomized controlled trial\u00a0(RCT) is a mandatory requirement \u201cTo maximise the benefit to society, you need to not just do for publication as outlined by the International Committee research, but do it well\u201d.[1] of Medical Journal Editors\u00a0(ICMJE).[16] There are at present Doug Altman\u00a0(1948\u20112018), statistician, researcher more than 20 clinical trial registries from different parts The World Health Organization\u00a0 (WHO) defines clinical trial of the world. Some of them include the United States\u2019 as \u2018any research study that prospectively assigns human ClinicalTrials.gov, United\u00a0Kingdoms\u2019 ISRCTN registry, participants or groups of humans to one or more health\u2011related Australia and New\u00a0Zealand\u2019s\u00a0(ANZCTR), Chinese Clinical interventions to evaluate the effects on health outcomes. Trial Registry\u00a0(ChiCTR), Clinical Trials Registry\u00a0\u2011\u00a0India\u00a0(CTRI), Interventions include but are not restricted to drugs, cells and EU Clinical Trials Register\u00a0(EU\u2011CTR), German Clinical Trials other biological products, surgical procedures, radiological Register\u00a0(DRKS), Iranian Registry of Clinical Trials\u00a0(IRCT) and procedures, devices, behavioural treatments, process\u2011of\u2011care Pan African Clinical Trial Registry\u00a0(PACTR). changes, preventive care, etc.\u201d[2] The reporting of the clinical trial should follow certain guidelines The history of human research is thousands of years old.[3] It called reporting guidelines. A\u00a0reporting guideline is defined as has progressed from dietary therapy of legumes and lemons \u201ca checklist, flow diagram, or structured text to guide authors in in the Roman era to scurvy trials of James Lind and battle reporting a specific type of research, developed using explicit filed experiments of Ambroise Par\u00e8 to the human experiments methodology.\u201d[17] A reporting guideline is a simple, structured Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S103","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration tool for health researchers to use while writing manuscripts. medical\u2011ethics\/declaration\u2011of\u2011helsinki\/.\u00a0[Last accessed on A\u00a0reporting guideline provides a minimum list of information 2021\u00a0Jul\u00a024]. needed to ensure a manuscript can be understood by a 15.\t World Medical Association. Medical Research Involving Human reader, replicated by a researcher, used by a doctor to make Subjects. Available from: https:\/\/www.unlv.edu\/research\/ a clinical decision, and included in a systematic review. The ORI\u2011HSR\/history\u2011ethics.\u00a0[Last accessed on 2021\u00a0Jul\u00a024]. recommended reporting guideline for an RCT is Consolidated 16.\t 16ICMJE. Available from: http:\/\/www.icmje.org\/about\u2011icmje\/ Standards of Reporting Trials\u00a0(CONSORT). CONSORT is faqs\/clinical\u2011trials\u2011registration\/.\u00a0[Last accessed on 2021\u00a0Jul\u00a024]. an evidence\u2011based, minimum set of recommendations for 17.\t EQUATOR Network. What is a Reporting Guideline? reporting randomized trials. It offers a standard way for authors Available from: https:\/\/www.equator\u2011network.org\/about\u2011us\/ to prepare reports of trial findings, facilitating their complete what\u2011is\u2011a\u2011reporting\u2011guideline\/.\u00a0[Last accessed on 2021\u00a0Jul\u00a025]. and transparent reporting, and aiding their critical appraisal and interpretation. The CONSORT Statement comprises a Rehabilitation in the home: An Australian 25\u2011item checklist and a flow diagram. The checklist items prespective focus on reporting how the trial was designed, analyzed, and interpreted; the flow diagram displays the progress of all Fary Khan, Bhasker Amatya1 participants through the trial. Department of Rehabilitation, Royal Melbourne Hospital, It is important that clinical trial should be conducted in a 1Department of Medicine, University of Melbourne, Parkville, transparent manner with an appropriate administrative and Victoria, Australia ethical review committee oversight. In addition, emphasis Rehabilitation is an essential component across all levels should be made on following the ethical principles and adhering of the healthcare system. It is a pillar for sustainable to the appropriate guidelines and standards of reporting. This development, contributing to health, economic and social will ensure that the research is ethical and beneficial both to development.[1] Rehabilitation needs have grown significantly the society and the participants resulting in data that can be worldwide, due to current global health and demographic used to make a positive difference in patients\u2019 lives. trends, and the high prevalence of disability in the world population.[2] An estimated 2.41\u00a0billion individuals globally References have conditions that would benefit from rehabilitation input, this equates to at least one in every three people requiring 1.\t Bahor Z. Remembering Doug Altman. Available from: https:\/\/ rehabilitation at some point during their disease trajectory blogs.bmj.com\/openscience\/2018\/07\/09\/remembering\u2011 or injury course.[3] Further, the current COVID\u201119 pandemic doug\u2011altman\/. [Last accessed on 2021\u00a0Jul\u00a025]. has created a range of additional challenges testing resilience of many healthcare systems and vulnerabilities 2.\t University of California. San Francisco. Available from: https:\/\/ at all levels\u00a0(acute, sub\u2011acute, community, individuals) on hub.ucsf.edu\/clinicaltrialsgov\u2011definition\u2011clinical\u2011trial.\u00a0[Last the global stage.[4] This brings numerous operational and accessed on 2021\u00a0Jul\u00a020]. organizational challenges to the rehabilitation services, specifically on inpatient caseload management, signifying 3.\t Baron JH. Evolution of clinical research: A\u00a0history before and the need for new patient care models and reshaping of beyond James Lind. Perspect Clin Res 2012;3:149. services to deliver comprehensive care effectively. Various alternative sustainable methods of service delivery have 4.\t Spiegel AM. The Jeremiah Metzger lecture: A\u00a0brief history of been considered including, tele\u2011rehabilitation, rehabilitation eugenics in America: Implications for medicine in the 21ST in home, community rehabilitation, etc. century. Trans Am Clin Climatol Assoc 2019;130:216\u201134. The Rehabilitation Medicine Department at the Royal Melbourne Hospital in Victoria, Australia is one of the 5.\t McCally M, Cassel C, Kimball DG. U.S. government\u2011sponsored leading organizations to initiate the \u2018Rehabilitation in the radiation research on humans 1945\u20111975. Med Glob Surviv Home\u00a0(RITH)\u2019 program since 2017. The program is led by a 1994;1:4\u201117. treating rehabilitation physician. It is a bed\u2011\u00a0substitution model of service delivery, providing evidence\u2011based rehabilitation 6.\t Schneider K. Secret nuclear research on people comes to light. practice in the comfort of a person\u2019s own home, or other N\u00a0Y Times Web 1993;\u200aA1, B11. suitable environment. Standard care is delivered at home to patients who are medically stable enough to be at home and 7.\t Strous RD, Zivotofsky AZ. Looking to the future from the past: therefore do not require frequent monitoring. The rehabilitation Take home lessons from Japanese World War II medical atrocities. treatment is patient\u2011focused, taking into consideration the Am J Bioeth 2015;15:59\u201161. psychological, physical and environmental needs of the patient and not influenced by the funding models. It is voluntary, 8.\t Dahlby T. Japan\u2019s germ warriors: Plumbing the horrors of \u2018Devil\u2019s provided free of charge under Medicare in Australia for Brigade.\u2019 Washington Post 1983;A1, A25. permanent residents and citizens. Patients are regarded as inpatients and receive similar comprehensive treatment 9.\t Oehler\u2011Klein S, Preuss D, Roelcke V. The use of executed that they would have received had they been in an inpatient Nazi victims in anatomy: Findings from the institute of hospital bed. anatomy at Gie\u00dfen University, pre\u2011\u00a0and post\u20111945. Ann Anat The service delivery is coordinated with primary care 2012;194:293\u20117. and community based services. In June 2019, \u2018RMH@ 10.\t Miles SH. The diptych: Nazi and Japanese bioscience war crimes. Am J Bioeth 2015;15:52\u20114. 11.\t Katz RV, Warren RC Eds. The search for the legacy of the USPHS syphilis study at Tuskegee. Lexington 2011. J\u00a0Natl Med Assoc Summer 2014;106:73\u20114. 12.\t Cave E, Holm S. Milgram and Tuskegee\u00a0 \u2013\u00a0 Paradigm research projects in bioethics. Health Care Anal 2003;11:27\u201140. 13.\t Resnik DB. Research Ethics Timeline. Available from: https:\/\/ www.niehs.nih.gov\/research\/resources\/bioethics\/timeline\/ index.cfm.\u00a0[Last accessed on 2021\u00a0Jul\u00a024]. 14.\t University of Nevada, Los Vegas. History of Research Ethics. Available from: https:\/\/www.wma.net\/what\u2011we\u2011do\/ S104\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration Home Subacute care\u2019, which included the RITH combined Table 1: Continued Weaknesses with the \u2018RMH@Home Acute care\u2019 service under a single Strengths banner\u00a0\u2013\u00a0\u2018RMH@Home\u2019 to provide both acute and subacute care for patients in their home environment.[5] The RMH@Home Increasing catchment population Reduced consumer knowledge team works closely with the referring patient\u2019s medical unit, Increasing ageing population of service patient\u00a0(carers\/family), and community healthcare providers to Partnerships with GP networks Inappropriate referrals develop a realistic plan of treatment in the patient\u2019s home. The and community organizations Lack of GP engagement RMH@Home Subacute has admitted 300\u00a0patients in a year since its launch in 2019 and now has expanded to 15 beds.[6] Support from hospital Skills of community partners The service includes: executives Staff safety \u2022\t review by a multidisciplinary team including physician, A better and broader range of Brokerage availability from in-house skills preferred providers nursing, physiotherapy, occupational therapy, dietician, Integration of telehealth and social worker and speech therapy as required other technology into care \u2022\t daily home based visits over a 2 to 3\u00a0weeks length of stay \u2022\t patient centered, goal\u2011based therapy Engagement of the broader \u2022\t Geriatric Evaluation and Management\u00a0(GEM) organization and departments \u2022\t rehabilitation following fracture, orthopedic surgery or acute medical illness\/event Rebranding the service to \u2022\t falls assessment and management create a more cohesive \u201cbrand\u201d \u2022\t reconditioning following an acute exacerbation of a chronic and structure illness Adapted from RMH@Home Improvement Summary, SAN: 5, 2020 (6)] The service delivers safe, timely, effective, person\u2011centered References care using technology and innovative models of care. It aims to: \u2011\t increase capacity for the most acutely unwell and complex 1.\t Cieza A. Rehabilitation the health strategy of the 21st\u00a0century, really? Arch Phys Med Rehabil 2019;100:2212\u20114. patients to be treated within the hospital walls \u2011\t Improves outcomes and recovery at home against a 2.\t Stucki G, Bickenbach J, Gutenbrunner C, Melvin J. Rehabilitation: The health strategy of the 21st\u00a0century. J\u00a0Rehabil Med 2018;50:309\u201116. range of clinical markers including symptoms, function, psychological issues, etc. 3.\t Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. \u2011\t maximizes patient safety and support efficient care delivery Global estimates of the need for rehabilitation based on the global \u2011\t improves efficient utilization of patient and\/or carer\u2019s time, burden of disease study 2019: A\u00a0systematic analysis for the global traveling costs burden of disease study 2019. Lancet 2021;396:2006\u201117. \u2011\t prevents unnecessary admission\/readmission and more efficient utilization of beds within hospitals 4.\t Amatya B, Khan F. Rehabilitation response in pandemics. Am J \u2011\t more capacity building for staff Phys Med Rehabil 2020;99:663\u20118. \u2011\t improve patient satisfaction \u2011\t reduce the cost to the hospital\u00a0(lower cost than inpatient 5.\t Royal Melbourne Hospital. RMH@Home; 2021. Available rehabilitation care) from: https:\/\/www.thermh.org.au\/health\u2011professionals\/ \u2011\t reduce waitlists to improve patient transition and experience clinical\u2011services\/community\u2011services\/rmh\u2011at\u2011home.\u00a0[Last \u2011\t better networks and collaboration in the community accessed on 2021\u00a0Jul\u00a006]. Details of the evaluation of the RMH@Home service using a 6.\t Island L. RMH@Home Improvement Summary\u00a0(Standard Action Strength, Weakness, Opportunity, and Threat\u00a0(SWOT) analysis No.: 5). Melbourne: Royal Melbourne Hospital; 2020. are tabulated below in Table\u00a01. \u200aImmersive virtual reality for memory Medical led service Lack of marketing experience in rehabilitation: Is it the way forward? Located in a large metropolitan the team hospital Working within the constraints of Furqan Ahmed Siddiqi Good staff satisfaction the financial health climate Experienced senior staff Staff not always in the right place Orthotist & Prosthetist, Foundation University Institute of Staffing (very passionate, for best patient care (program Rehabilitation Sciences\u00a0(FUIRS), Foundation University Islamabad, engaged and dedicated) alignment) Defense Avenue, DHA Phase\u2011I, Rawalpindi, Islamabad, Pakistan Already have strong links with Connectivity between programs E\u2011mail:\[email protected] some community providers Staff training and education Already delivering care at home IT issues Virtual reality\u00a0(VR) is defined by Lombard & Ditton, 1997, as, Current hospital in the home Wide range in clinical conditions \u201cdigitally rendered complex 3D representation of the virtual model with shared governance treated at home \u2013requires staff world enabling interaction with computing environment and across different units assists in to be trained in a wide range associated with the feeling of being present in the virtual engagement with other units of management of acute and environments\u201d.[1] Currently, virtual reality is used in for the subacute medical and surgical purpose of diagnosis as well as treatment in persons with conditions cognitive impairments.[2] The clinical utilization of virtual reality presents recreations of real life situations and setting Small service size that decreases to discern and amend the behavior and conduct of the patient flexibility in delivery in environmentally valid settings.[3] Memory impairments are a common occurrence, associated with numerous conditions and Opportunities Threats disorders, comprising a broad spectrum of diseases as well, including but not limited to schizophrenia, depression, bipolar disorder, obsessive\u2011compulsive disorder, Alzheimer disease Parkinson disease, Huntington disease, multiple sclerosis, Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S105","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration stroke and even conditions such as acquired immunodeficiency regular neuropsychological measures.[13] syndrome\u00a0(AIDS), making memory rehabilitation an integral The most commonly used \u201cimmersive\u201d technology to present and import part of the management and rehabilitation of such a virtual environment is via the use of head mounted patients.[3] Evidence has shown, that in addition to pathological displays.[3] Moreover, interaction with virtual environment is changes, memory deterioration and decay is also associated usually enabled with special controllers or hand trackers.[13] It with the normal healthy aging processes,[4] further signifying is reasoned that both immersive and non\u2011immersive VR have the importance of memory rehabilitation.[3] Moreover, memory certain advantages and disadvantages for their use in cognitive decline and impairments may symbolize an important objective rehabilitation. Regarding the advantages of immersive over non for cognitive training in the geriatric rehabilitation as well as immersive virtual reality, despite the theoretical advantages of cognitive rehabilitation in the aforementioned mental and immersive virtual reality and its growing practice in cognitive neurological disorders.[3] rehabilitation, very little is known about its benefits over the As mentioned, cognitive training is an important part of the more affordable desktop applications with lower levels of management of mental and neurological disorders and immersion.[12] The potential of immersive virtual environments characterizes the process of recurrent cognitive exercises and has been described by numerous studies[14] and also in a interventions envisioned to augment the cognitive functions meta\u2011analysis conducted by by Hill et\u00a0al.[8] Up to now there of the patients[5] based on neuroplasticity principles.[6] The are only 2 studies that have compared the effectiveness of expression \u2018cognitive rehabilitation\u2019 is used in the clinical immersive and non\u2011immersive virtual reality approaches in setting to define training and management focused at the terms of cognitive rehabilitation.[15,16] both of which were not restoration of impaired cognitive functions.[3] Currently, found to be conclusive. Furthermore, it is has been described modern technology is being used for the purpose of memory that the application of immersive virtual reality in memory rehabilitation in the form of computerized cognitive training. assessment can result in worse performance, which is perhaps Numerous studies have been published investigating the the because of the augmented cognitive load.[3] effectiveness of computerized cognitive training in different The existing research has shown only a minor additional mental and neurological disorders.[6] Computerized cognitive effect of the complex virtual reality environments on memory training allows the specific and repetitive exhibition of the rehabilitation in contrast to the standard.[3] Plechata A et\u00a0al. in a stimuli and characteristically applies straightforward tasks systematic review, debates that a few studies using immersive concentrating on one cognitive domain. Recent meta\u2011analyses\u2019 virtual reality does not permit an evaluation of the possible published, have focused on the effectiveness of computer advantageous value of immersive virtual environments in assisted rehabilitation\u00a0[7\u20119] demonstrating a minor to modest memory rehabilitation.[3] Despite the assumption that immersive effect on memory function, endorsing equivalent efficacy to virtual reality can increase patients\u2019 motivation towards the conventional paper\u2011pencil approach.[3] Regarding complex monotonous recurring tasks as it was formerly connected three dimensional virtual environments, existing systematic to amplified amusement, there is no data to endorse this reviews have summarized research studies focusing on and upcoming studies are required to address this subject.[3] cognitive rehabilitation in patients of traumatic brain injury, Regarding the very inadequate number of studies that directly stroke, and multiple sclerosis demonstrating improvement compare non\u2011immersive and immersive virtual environment in in balance, upper limb functions and in cognitive function.[3] memory training, it is not likely to conclude if immersive virtual Furthermore, recent systematic reviews have also supported reality training is superior. the utility of virtual environment in cognitive rehabilitation in both healthy and pathological aging.[9] The advantage of virtual References environment in contrast to the traditional motor or cognitive interventions has been found to be associated with an added 1.\t Lombard M, Ditton T. At the heart of it all: The concept of encouraging and affirmative attitude along with augmented presence. J\u00a0Comput Mediat Commun 1997;3:JCMC321. motivation towards training.[8] La Corte et\u00a0al. arguments that the results of rehabilitation carried out via virtual reality training 2.\t Laamarti F, Eid M, El Saddik A. An overview of serious games. stay preliminary and provide data regarding feasibility but not Int J Comput Games Technol 2014;2014\u200a. enough data about the effectiveness.[10] Regarding immersion in virtual reality, immersion is defined 3.\t Plechat\u00e1 A, Nekov\u00e1\u0159ov\u00e1 T, Fajnerov\u00e1 I. What is the future for as the ability of the virtual system to support sensorimotor immersive virtual reality in memory rehabilitation? A systematic contingencies. Immersion is a constituent of the technology review. NeuroRehabilitation 2021;48:389\u2011412. used and is an integral factor in the application of virtual reality systems.[11] Higher quality of the system results in a greater 4.\t Harada CN, Natelson Love MC, Triebel KL. Normal cognitive level of immersion, and higher immersion has been found to aging. Clin Geriatr Med 2013;29:737\u201152. be linked with an increased level sensation of being within the virtual environment.[12] The experience of immersion during 5.\t Medalia A, Choi J. Cognitive remediation in schizophrenia. cognitive training can assist the transference of learned abilities Neuropsychol Rev 2009;19:353\u201164. to real life circumstances, and also incorporates real world situations and encounters in virtual reality while preserving 6.\t Rohling ML, Faust ME, Beverly B, Demakis G. Effectiveness control over offered stimulus, leading to the ecological validity of cognitive rehabilitation following acquired brain injury: of cognitive rehabilitation.[3] This is further supported by findings A\u00a0meta\u2011analytic re\u2011examination of Cicerone et\u00a0al.\u2019s\u00a0(2000, 2005) of previous studies suggesting that virtual simulations of daily systematic reviews. Neuropsychology 2009;23:20\u201139. life activities can better forecast real world functioning than 7.\t Grynszpan O, Perbal S, Pelissolo A, Fossati P, Jouvent R, Dubal S, et\u00a0al. Efficacy and specificity of computer\u2011assisted cognitive remediation in schizophrenia: A\u00a0meta\u2011analytical study. Psychol Med 2011;41:163\u201173. 8.\t Hill NT, Mowszowski L, Naismith SL, Chadwick VL, Valenzuela M, Lampit A. Computerized cognitive training in older adults with mild cognitive impairment or dementia: A\u00a0systematic review and meta\u2011analysis. Am J Psychiatry 2017;174:329\u201140. 9.\t Motter JN, Pimontel MA, Rindskopf D, Devanand DP, S106\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration Doraiswamy PM, Sneed JR. Computerized cognitive training and Rehabilitation in Sri Lanka was taking place both as inpatient functional recovery in major depressive disorder: A\u00a0meta\u2011analysis. and as outpatient. We do not have community rehabilitation J\u00a0Affect Disord 2016;189:184\u201191. programmes or teams. Inpatient rehabilitation takes place by 10.\t La Corte V, Sperduti M, Abichou K, Piolino P. Episodic memory the rehabilitation teams usually headed by the neurologists assessment and remediation in normal and pathological aging and we conduct weekly team meetings to discuss progress using virtual reality: A\u00a0mini review. Front Psychol 2019;10:173. and to plan activities. Outpatient rehabilitation takes place as 11.\t Slater M, Sanchez\u2011Vives MV. Enhancing our lives with immersive patients visit rehab facilities. Such home\u2011based rehabilitation virtual reality. Front Robot AI 2016;3:74. was supported by family members being trained to carry out 12.\t Cummings JJ, Bailenson JN. How immersive is enough? A the exercise programmes. State sector does not provide meta\u2011analysis of the effect of immersive technology on user \u2018therapist visiting home service\u2019. This service is available presence. Media Psychol 2016;19:272\u2011309. through the private sector where certain patients are being 13.\t Greenwood KE, Morris R, Smith V, Jones AM, Pearman D, Wykes visited mostly by physiotherapists. As far as COVID 19 infection T. Virtual shopping: A\u00a0viable alternative to direct assessment of is concerned. We had our first COVID case reported in a real life function? Schizophr Res 2016;172:206\u201110. Chinese tourist from Hubei on 27th\u00a0January 2020. Since then, 14.\t Maggio MG, De Luca R, Molonia F, Porcari B, Destro M, Casella we experienced 3 waves of the pandemic comparable with C, et\u00a0al. Cognitive rehabilitation in patients with traumatic brain most other countries. We were able to manage the first and injury: A\u00a0narrative review on the emerging use of virtual reality. second waves efficiently. Now with the third wave Sri Lanka is J\u00a0Clin Neurosci 2019;61:1\u20114. in a partial lock down continuing for the second month at the 15.\t Dehn LB, Kater L, Piefke M, Botsch M, Driessen M, Beblo T. time of writing. Health staff are given approval to travel to the Training in a comprehensive everyday\u2011like virtual reality workplace to run hospital services with minimum capacity. We environment compared to computerized cognitive training for experience that there is reluctance in stroke patients arriving patients with depression. Comput Human Behav 2018;79:40\u201152. at hospitals both for acute treatment as well as rehabilitation. 16.\t Gamito P, Oliveira J, Santos N, Pacheco J, Morais D, Saraiva T, Patients and families prefer to do rehabilitation from home et\u00a0al. Virtual exercises to promote cognitive recovery in stroke where the rehab team sees them in the outpatient department. patients: The comparison between head mounted displays versus Despite such reluctance most needy patients are still being screen exposure methods. Int J Disabil Hum Dev 2014;13:337\u201142. rehabilitated within stroke units. Rehabilitation was a challenge during the lockdown period. Patients were tested for COVID \u200aExperience of COVID 19 and 19 when admitted to the stroke rehabilitation unit. Therapists Neurorehabilitation Symposium were carrying out their therapy sessions in Personal protective Equipment\u00a0(PPE). visitors were not allowed into the stroke unit. Rehabilitation in COVID19 Sri Lankan A\u00a0family member who could help patient therapy activities was experience allowed to stay with the patient after being tested and negative for COVID 19. Interviewing and examining rehab patients by Gamini Karapitiya Pathirana doctors and therapists was done in the ward. Our doctors, therapists were in full PPE while interviewing and carrying Neurologist, Sri Lanka out close examination, therapy sessions. Team discussions Neuro rehabilitation in COVID 19\u00a0\u2013\u00a0Sri Lankan experience Sri were done in a room while maintaining social distance. Some Lanka is an island nation situated within Indian ocean. It has patients were reluctant to accept in center rehabilitation when 48 neurologists serving a population of 20.2 million at present. offered. More patients were diverted to either outpatient rehab Stroke is the sixth leading cause of death and fifth leading or home\u2011based rehabilitation whenever possible especially cause of disability in the country. It has a stroke prevalence of where there was a particularly good family participation. close to 10 per 1000. Sri Lanka runs 10 stroke units throughout Others who need inpatient rehabilitation were offered such the country. State sector provides 95% of stroke care within services in the same way it had been in the past, while taking hospitals. Most stroke patients still do not receive rehabilitation precautions to prevent the spread of the disease. Those who due to inadequate availability of such services in the state had COVID 19 infection complicated with stroke were looked sector. Contribution for stroke rehabilitation in the private after in a separate isolation ward together with other COVID sector is negligible where only a small percentage of stroke positive patients. Such patients too were offered rehabilitation patients are being rehabilitated. Physiotherapy, occupational while being treated for COVID19. For a significant number of therapy, speech therapy and social services were available in rehab patients, close family members were extremely useful most hospitals. Dedicated rehabilitation teams serving stroke regarding carrying out rehab sessions during COVID 19 era. patients are seen only in 3 teaching level hospitals. Such Dr\u00a0Gamini Pathirana Neurologist with interest in stroke care teams are usually headed by neurologists. Sri Lanka has no National Hospital of Sri Lanka President\u00a0\u2013\u00a0Association of Sri stroke physicians with formal stroke training or accreditation Lankan Neurologists. for stroke care Majority of stroke patients are managed by general physicians in internal medicine. Post graduate institute Hyperbaric oxygen and carbon dioxide, of Sri Lanka\u00a0(PGIM) is in the process of producing specialists therapies, as\u00a0\u2013\u00a0including physiatric\/ in medical rehabilitation who may contribute for rehabilitation needs in the country very soon. Sri Lanka does not have rehabilitation\u00a0\u2013\u00a0interventions in spinal cord separate neuro rehabilitation hospitals as such. At present injury: Systematic and synthetic literature neurologists look after neuro rehabilitation needs within their ward setting with the support from available therapists within review such hospitals. Stroke rehabilitation too is done to a limited capacity within stroke units which again are run by neurologists. Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S107","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration Gelu Onose1,2,3,4,5, Constantin Munteanu2,3,5,6,7 to preserving muscle functionality\u00a0(\u201dfiber type switching\u201d and endurance enhancement), and also trophycity, based on 1Department of Physical and Rehabilitation Medicine, Faculty angiogenesis and vasodilatation with more oxygen input, of Medicine, Carol Davila University of Medicine and Pharmacy, and consequent improved blood supply to the muscles, too, 2Neuromuscular Rehabilitation Clinic Division, The Teaching in the territories exposed to CO2 therapy. Thus, this type Emergency Hospital Bagdasar\u2011Arseni, 3Romanian Spinal of pyshiatric intervention might be an alternative treatment Cord Society, 4\u200aRomanian Society for NeuroRehabilitation, of contractures\u00a0\u2013\u00a0a major complication in patients with SCI, 5\u200aRomanian Society of Physical and Rehabilitation Medicine preceding and associating to spasticity\u00a0\u2013\u00a0thereby resulting and Balneoclimatology, 7\u200aRomanian Association of Balneology, in related segmental range of motion enhancement, as well. Bucharest, 6Faculty of Medical Bioengineering, The University of Methods: We have documented this work based on an Medicine and Pharmacy\u00a0\u2011\u00a0Grigore T. Popa, Ia\u0219i, Romania inspired by Preferred Reporting Items for Systematic Reviews Background and Aims: Spinal cord injury\u00a0(SCI) is a severe and Meta\u2011Analyses\u00a0(PRISMA) method. Thereby, we quested neurological sufferance, yet without efficacious treatment, by for open access articles, published in English during the last now. SCI often results in tetra\u2011\u00a0or para\u2011plegia, associated with five years, through interrogating the following international vegetative disturbances\u00a0\u2013\u00a0affecting also micturition and\/or medical databases: Cochrane, Elsevier, National Center for defecation and or sexual\/reproductive, functions\u00a0\u2013\u00a0thus often Biotechnology Information\u00a0(NCBI)\/PubMed, NCBI\/PubMed severely jeopardizing the quality of life\u00a0(QOL) in such patients. Central\u00a0(PMC), Physiotherapy Evidence Database\u00a0(PEDro), At tissue level, SCI usually causes neuronal death and axonal and Institute for Scientific Information\u00a0(ISI) Web of Knowledge\/ damage, ischemia, oxidative stress, neuroinflammation\u00a0(involving Science\u00a0(the latter was used to identify articles published in the activation of microglia and astrocytes by related mediators), ISI indexed journals, as only such ones have been considered glial fibrous scar, and possibly cyst\/syringomyelia formation, eligible). For this purpose, we have contextually searched by interruption of nerve communication mechanisms, all keywords combinations\/syntaxes\u00a0(\u201cSpinal Cord Injury\/SCI AND within a consequent local microenvironment hostile to Hyperbaric oxygen therapy\/HBOT\u201d; \u201cSpinal Cord Injury\/SCI AND neuroregeneration\/re\u2011connection. Recently, some advances Carbon dioxide\/CO2\u201d), in the title and abstract of the articles. have been made towards understanding the role of autophagy, Results: Our search identified, initially 123 articles. After fulfilling too\u00a0\u2013\u00a0a very efficient and subtle intimate biologic mechanism, the steps of the PRISMA\u2011inspired selection methodology, acting in both: physiological and pathological conditions and including with the application of the PEDro inspired indirect also, pending on complex circumstances, being pro\u2011apoptotic qualitative filtering classification scoring, there remained 15 but as well conversely: favoring cells survival, by being involved papers that have been carefully full\u2011text analysed. including in cytoplasmic organelles\u2019 refurbishment and thus, Conclusions: HBOT has been shown in experimental studies, by sorting the rescuable ones, saving energy and biological to exert neuroprotective actions in SCI, mainly: improving material\u00a0\u2013\u00a0in the central nervous system\u00a0(CNS) injuries, including spinal cord oxygen tension, decreasing apoptosis, reducing in SCI; promoting removal of such damaged subcellular\/cellular inflammation, attenuating oxidative stress\u00a0 \u2013\u00a0 the \u201dhallmark\u201d of moieties, autophagy may contribute to endogenous resilience the intimate damages mechanisms of the \u201dsecondary lesions\u201d, and recovery. including in SCI\u00a0\u2013\u00a0and promoting angiogenesis and autophagy. At least in the last half\u2011decade, some studies found that However, only a few clinical reports have been performed, Hyperbaric Oxygen Therapy\u00a0(HBOT) significantly protected of in this respect, and they have shown conflicting outcomes, embitterment, after SCI, also through stimulating autophagy, thereby warranting further studies to elucidate the optimal HBOT in animal experimental models, supporting cell repair. It paradigm and to determine if the respective schemata should has served as a non\u2011invasive medical intervention for more depend on the specific type of SCI. CO2 may improve muscular than 100\u00a0years. In the literature it is shown that HBOT can fibrosis because of the reduced gene expression of Type \u2160 significantly improve spinal cord tissue oxygen tension and collagen, thereby boosting the muscular injury repair\u00a0\u2013\u00a0including oxygen diffusing capacity, reduce oedema and haemorrhage, through the mitochondrial energetics link\u00a0\u2013\u00a0in post SCI statuses. support the recovery of nerve tract functions, and as well, reverse various path\u2011physiological processes and\/or promote Aqua Therapy reparative ones, after SCI. More recent papers confirmed that the application of HBOT\u00a0(combined for instance with drugs and Aquatic Therapy as \u201ca Game surgery), after SCI, can reduce neurological deficits\u00a0\u2013\u00a0including Changer\u201d\u00a0\u2013\u00a0Experience and Learning with the improvement of motor functions and thereby, the functioning of the affected patients\u2019 QOL. So, although its Gerda Joubert potential effects and underlining mechanisms remain, at least partially, unknown, HBOT seems to be a possible therapy \u200aPrivate Practitioner for SCI, and hence worth to be further approached, in this 2021-08-06 respect, too. Introduction: Aquatic Therapy is an essential part to the Carbon dioxide\u00a0(CO2) is more recently reported to have some idea of life through movement. The support of the water beneficial actions in acute SCI experimental animal models, creates \u201ca dare to fall\u201d environment that offers patients a including similar effects with those of physical exercise in wider range of possibilities to correct their movement for post\u2011SCI conditions. Specifically, administered transcutaneous, themselves. The case study used for the \u201cAquatic Therapy as it would operate at nuclear, cellular, muscle tissue and articular, a Game Changer\u00a0\u2013\u00a0Experience and Learning\u201d workshop was levels\u00a0(mitigating the gene expression of the Type \u2160 collagen documented in 2013\u20112014. This was before COVID\u201119. The mRNA and respectively, of the TGF\u2011\u03b21\u00a0\u2013\u00a0both connected current pandemic has created extra challenges that should be with fibrosis\u00a0(including\u00a0\u2013\u00a0precocious\u00a0\u2013\u00a0in joint capsules) development\u00a0\u2013, stimulating mitochondrial energetics\u00a0\u2013\u00a0prone S108\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration taken in consideration within the aquatic environment and to Thermodynamic) would have on her already compromised be addressed in future aquatic therapy case studies. The Case body structure and functions. The patient also had to be study\u2019s ICD\u201110 codes include: B91 Sequelae poliomyelitis mentally prepared for the effect that the water would have on G81.04 Flaccid hemiplegia affecting the left nondominant her body. The treatment of a patient follows a pattern where, a side I69.351 Hemiplegia and hemiparesis following cerebral successful cognitive phase will lead the way to the associative infarct of right dominant side This workshop focuses on Aquatic phase, followed by a successful autonomic phase. Postural therapy as \u201ca game changer\u201d in the physical therapy regime control precedes movement control and the patient had to received by a 73\u2011\u00a0year\u2011old female patient. The patient had be re\u2011educated in postural control. A\u00a0multi\u2011disciplinary team contracted Poliomyelitis in her childhood years, which affected approach is essential for the holistic success of a patient\u2019s her left non\u2011dominant side. Although both her left upper and therapy process. Therefore, communication with the other lower extremities were affected, she was still able to walk professionals involved had to be maintained and feedback independently, with an adapted walking pattern, and take incorporated where possible into the treatment schedule of care of everyday necessities without assistance. However, at the day. The patient\u2019s treatment plan included the use of the age of 73 she suffered a stroke which affected her right land\u2011based activities more familiar to the patient and then dominant upper and lower extremities. The stroke caused her progression into introducing more advanced aquatic therapy to be wheelchair bound. It is important to note that at the time techniques. Attention was given to activities focusing on fall aquatic therapy intervention took place her medical condition prevention and crossing of midline activities. During water was stable. The patient was referred for physical therapy therapy a safe and successful entry to and exit from the pool 8\u00a0months after she had suffered the stoke. Furthermore, for was crucial. These two phases can be seen as a \u201cmake or the first 5\u00a0 months following the stroke she was completely break\u201d situation. The trust of the patient in the therapist and wheelchair bound. The last 3\u00a0months before aquatic therapy the aquatic environment can be heavily impacted during these commenced, she was able to stand up from her wheelchair and two phases of therapy. move from and to a chair or bed. However, this was all done Findings: While using aquatic therapy, the patient\u2019s mental with assistance. As a result of her increased sedentary lifestyle adaptation took longer than expected. The cause of this was her body weight increased significantly. The patient\u2019s referring because she was completely unfamiliar with the effects of the physician as well as her family mentioned noticing signs of water properties. This influenced the introductory phase to the depression. The patient however denied having depression. pool and therefore it took longer than expected to progress The family was part of a small but close\u2011knit farming community and reach the aim of her walking independently in the pool. and since the stroke her socialization became limited. The same situation was found with the implementation of During consultation with the patient, she reported a fear of the disengagement phase of the therapist from the patient falling that prevented her from attempting to walk aided and in the pool. Later, during therapy the effort to introduce more unaided. The patient\u2019s fear of falling is one of the factors that advance aquatic therapy techniques was unsuccessful and in prompted the decision to suggest the use of aquatic therapy fact had a more negative impact on her balance and general as treatment modality. At this point it should be noted that the body awareness. Especially when going into supine positions. patient had no previous experience in a pool and had a fear The readiness of the patient needs to be carefully considered of drowning because of her limited movement abilities. The when introducing the next or new phase in a treatment plan. introduction of aquatic therapy as part of the patient\u2019s treatment Progression in a treatment plan however cannot be delayed regime needed to be accepted and approved of by both the but only slowed; this is important for preventing stagnation patient and her supporting family. A\u00a0patient\u2019s acceptance in a patient\u2019s progress. While treating this patient it was also and approval of any treatment is paramount. The patient\u2019s noticed that despite having a supportive and caring family, main aim for participating in the treatment was prompted by their presence in the pool area was found to have had both a her need to become independent from her caretaker and positive and negative effect on the patient\u2019s performance of the family members for every\u2011day living activities and to walk day. The emotional pressure for improvement was felt by both independently.[2] The diagram below represents the patient\u2019s parties. As therapy progressed and mutual trust established, International Classification of Functioning, Disability and the patient\u2019s mischievous and fun personality surfaced making Health\u00a0(ICF)\u00a0(Adapted from: World Health Organization. 2001. it easier towards the end of the therapy period to introduce ICF). Health Condition Poliomyelitis & Stroke Body Function some fun and games during therapy sessions. and Structure Functions: muscle strength and tone, joint Conclusion: In conclusion, thinking outside the box of the motion, voluntary movement pattern, sensation Structures: conventional aquatic therapy process is important. Optimize unilaterally arms and legs, trunk Cognition cardiovascular that which the patient is willingly offering you to work with. fitness spasticity sensation Activities Mobility: walking and The element of fun in the water adds value to a session. moving around, walking speed and endurance Execution of a Movement restricted patients should be guided to find their task: reaching and grasping ADL Participation Return to normal own balance and movement patterns. Aquatic therapy was \u201ca domestic life Independent eating and dressing Community game changer\u201d in this patient\u2019s life as it assisted her in finding integration and recreation Environmental Factors Wheelchair\/ her new balance point, creating her own new adaptive waking walker\/cane Accessibility and safety Living situation, support pattern, and become independent to the maximum degree from structure, available services Personal Factors Age, marital her caretaker and family\u2019s assistance.[4] status, selfmotivation and self\u2011efficacy, readiness to change, coping mechanism, socioeconomic status Falls.[3] The \u200aReferences Treatment Plan: The treatment plan designed for the patient mentioned in the case study had to consider the effect that the 1.\t Campion MR. Hydrotherapy\u2011Principles and Practice. Oxford: fundamental principles of water\u00a0(Hydrostatics, Hydrodynamics, Butterworth Heinemann; 1997. Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S109","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration 2.\t Carse D. Aqua\u2011Rhythmics\u00a0\u2013\u00a0Everybody\u2019s Guide to Safe and management is often provided by a few disciplines namely Efficient Water Exercising. Johannesburg: Human and Rousseau; physicians, physiotherapists and nurses. Hence, they are 1991. required to multitask for care normally provided by other members of the team. 3.\t Kourney JM. Aquatic Therapy Programming\u2011Guidelines for Aspects of care like sexuality and fertility counseling, Orthopedic Rehabilitation. USA: Human Kinetics; 1996. occupational therapy, assistive technology, educational classes, vocational counseling, pre\u2011discharge home visits 4.\t Lambeck JF, Gamper PT. The halliwick concept. In: Becker and follow up home care services are especially deficient. BE, Cole AJ, editors. Comprehensive Aquatic Therapy. USA: Community inclusion and lifelong follow up also pose a Washington State University Publishing; 2011. p.\u00a077\u2011107. significant challenge. Prevention programs are quite inadequate and need a major boost. 5.\t Morris DM. Aquatic rehabilitation for the treatment of neurological Knowledge about evaluation procedures for bladder disorders. J\u00a0Back Musculoskelet Rehabil 1994;4:297\u2011308. management and access to them is limited. Many patients are not initiated on CIC and continue to be on indwelling 6.\t L e o n a r d i M , F h e o d o r o f K . G o a l s e t t i n g w i t h catheter, condom catheter, reflex voiding or even voiding ICF\u00a0(international classification of functioning, disability through Crede\u2019s maneuver. Paucity of disposable catheters and health) and multidisciplinary team approach in stroke further adds to the challenges in management of the neurogenic rehabilitation. In: Thomas P, editor. Clinical Pathways in bladder. Guidelines are available for use, processing, and Stroke Rehabilitation\u00a0 \u2013\u00a0 Evidence\u2011Based Clinical Practice storage of reusable catheters, but knowledge in this regard is Recommendations. Switzerland AG: Springer Nature; 2021. not adequately disseminated. p.\u00a035\u201156. The delay in initiation of bowel training predisposes patients to fecaliths, impacted bowel, and associated complications 7.\t Ruoti RG, Morris DM, Cole AJ. Aquatic Rehabilitation. NY: like hemorrhoids as well as pressure sores and autonomic Lippincott; 1997. dysreflexia. Sexual counseling and management is one of the most Spinal cord injury management\u00a0\u2013\u00a0Strengths, neglected aspects of SCI in the less developed countries. weaknesses and challenges in the Indian The prominent cause for this is lack of awareness and cultural scenario taboos. Fertility counseling and management is also not given adequate importance. H. S. Chabbra Complications are similar to those seen in developed countries India had been very slow in responding to the revolutionisation but there is a higher incidence, probably due to inadequate of spinal injury management which took place almost seven and inappropriate management as well as delay in its initiation. decades ago. The needs of the Indian Society have been The rate of genito\u2011urinary and renal complications in people different because of relative paucity of resources, differences in with spinal cord injury in less developed countries continues epidemiology and substantial rural concentration of population. to be quite high. Pressure ulcers and preventable secondary It has been only in the last three decades that attention has infections pose another major challenge in the management of been focused on setting up services for SCI management. spinal cord injuries. There is increased incidence of spasticity A\u00a0few centers of excellence emerged. However, the services and secondary contractures. available are largely inadequate to meet the needs of the Home care services are almost negligible and nonexistent in second largest population of the world. In addition, there less developed countries. Follow\u2011up poses a big challenge and are numerous challenges like inadequate awareness, late the follow\u2011up rates are low. presentation to definitive institution, financial barriers and A significant percentage of SCI do not get appropriate assistive paucity of trained manpower, which prevent spinal cord injured devices. Accessibility, both within the community and at home, in India to get the benefits of optimum management as per the poses a major challenge for persons with spinal cord injury in established standards. less developed countries. Architectural barriers like improper Despite its established importance in improving outcome, roads, infrastructure, and nonwheelchair friendly houses as well pre\u2011hospital care is grossly deficient and one of the most as the rough terrains are all barriers to community inclusion. neglected components of spinal cord injury management There are very low rates of return to vocation in less developed resulting in significantly higher morbidity and mortality. Lack of countries. There is insufficient data on prevalence and formal prehospital care systems and adequate equipment as incidence of SCI in the less developed nations which poses well as long transport times to the nearest health facility pose a challenge for formulation of effective prevention programs. a big challenge. Implementation and enforcement of prevention programs is Spinal cord injured patients often present quite late to the also inadequate. definite center in less developed countries. They have However, there are a number of strengths in the India system had either inadequate or no treatment and there is often which help the spinal injured to overcome the challenges. an unsupervised period at home. Delay in initiation of The strong family and community support has perhaps comprehensive management of SCI leads to higher incidence the most important positive influence on outcome. Strong of complications and compromised outcomes. religious beliefs and especially facets like \u201cDoctrine of Karma\u201d Acute in\u2011hospital management is not as neglected as the other help them cope with the disability and face the challenge aspects of SCI management. However, a significant percentage successfully. of patients are sent back home after acute management. Anticoagulant prophylaxis is often not administered in the Asian setting due to the belief that the incidence of DVT is much lower than in the West. The multidisciplinary comprehensive care required for SCI S110\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration The challenges also perhaps stimulate the health professionals intensity with which it acts. The ANS basically innervates the to come out with innovative ideas to help the spinal cord heart muscle, smooth muscles of blood vessels, gut and the injured to get back to the mainstream of the society. Reusable genitourinary systems, glands\u00a0\u2013\u00a0mostly exocrine but some catheters, clean cotton cloth bag for storing catheters, floor endocrine glands and adipose tissue. mobility device, training attendants for care giving even in acute It is well known that the autonomic motor pathways consist phase and honey\/vinegar for pressure sore dressings are some of two neurons separated by a ganglion which is actually a of the examples of the innovative mind. The relatively cheap conglomerate of nerve cell bodies acting as a relay station. and abundant availability of manpower further helps the spinal The ganglion in the case of the sympathetic nervous system injured, especially tetraplegics, to freely avail the services of is situated close to the central nervous system whereas, in the a caregiver. case of the parasympathetic nervous system it is situated very All stakeholders including the Government, Healthcare close to the target organ, hence the name \u2018parasympathetic\u2019 to providers, professional orgnaisations like AOCNR, Consumers indicate \u2018next to\u2019 or \u2018close to\u2019 the target organ. and the Society need to fulfill their roles and responsibilities Most organs have dual innervation by the two subdivisions of inorder to overcome the challenge posed by Spinal Cord Injury. the autonomic nervous system. The neurotransmitters secreted Thus, even though the spinal injured face a lot of challenges by the nerve endings and the receptors present at the target in the Indian scenario, the strengths of the system are helping tissue are diverse producing a wide variety of effects in the a progressively increasing number to get back into the body. Irrespective of whether it is the sympathetic division or mainstream of the Society. the parasympathetic division, the preganglionic nerve cells secrete acetylcholine and the receptor in the postganglionic Experience of COVID 19 and cell body is a nicotinic type cholinergic receptor. They belong Neurorehabilitation Symposium to type\u00a02 nicotinic receptors which are different to what is found in the skeletal muscles at the neuromuscular junction\u00a0(which View Point from Taiwan belongs to type\u00a01 nicotinic receptors). In the case of the target organs in relation to the parasympathetic nervous system the Hung\u2011Chou Chen post ganglionic cells are cholinergic and the target organs carry muscarinic acetylcholine receptors. In fact, the target Assistant Professor, School of Medicine, College of Medicine Taipei rcceeecllllessp)e,txooprrsre.MsM3s\u2011otMysp1t\u2011es(\u00a0sy(asmlmivpaoarotyhthegtlimacnupdsoscs,lestgt,oammngaalncioyhn)gi,clMann2e\u2011d\u00a0(uscr)aomrndsuiasrcecnaleoraidnsaiecl Medical University, Taiwan norepinephrine from their terminals and hence the target Neurological Involvement after COVID\u201119:\u00a0\u20117.8% to 36.4% of organs carry alpha or beta receptors. The exceptions being Covid\u201119\u00a0patients suffered from varies kinds of neurological the sympathetic efferents that innervate eccrine sweat glands, symptoms, with a higher rate in patients with severe which release acetylcholine at their terminals and act through infection.\u00a0\u20111.4% to 3.0% patients suffered from acute an M3\u2011type acetylcholine receptors. cerebrovascular diseases, with a higher rate in Asia The only nerves that do not have a ganglion before reaching patients.\u00a0\u2011Up to 9.8% of post\u2011critical care Covid\u201119\u00a0patients the target organ are the sympathetic nerves travelling to the suffered from Critical illness\u2011associated weakness.\u00a0\u2011Early adrenal medulla, where the preganglionic nerves end on the evaluation and treatment of these neurological symptoms are adrenal medullary secretory cells and the adrenal medullary important. cells act as the post ganglionic nerve secreting epinephrine and a small amount of norepinephrine. Introduction to the Autonomic Nervous Although it is said that there is dual innervation of organs, there System are a few exceptions. One of them is the systemic blood vessels. They are innervated entirely by sympathetics adrenergic nerves Indu Nanayakkara and the receptors are alpha one adrenergic. Sweat glands are also lacking in parasympathetic innervation with eccrine glands Department of Physiology, Faculty of Medicine, University of being innervated by sympathetic cholinergic while the apocrine Peradeniya, Kandy, Sri Lanka sweat glands being innervated by adrenergics acting on alpha\u20111 2021-08-06 adrenergic receptor. When it comes to receptor subtypes Autonomic nervous system is responsible for maintaining although several subtypes will be present in any given tissue, homeostasis of the internal environment. It is anatomically one subtype will predominate and that would be taken as the not well defined and its distribution is diffused. However, the receptor type present in the given organ. Receptors at the post autonomic nervous system\u00a0(ANS) controls some of the very synaptic membrane are generally either G\u2011protein coupled important functions of the body including heart rate and blood receptors or ligand\u2011gated channels. Therefore, activation of pressure, respiration, digestion, storing and voiding of urine these receptors would either activate or inactivate intracellular and sexual functions. Conventionally, the ANS is divided into enzymes or increase the permeability to some ion. two sub divisions the sympathetic nervous system and the If one were to look at the general organization of the parasympathetic nervous system. However, more recently sympathetic nervous system, the preganglionic fibers come there is a third division identifies separately, which is the enteric out from 1st\u00a0thoracic to the 2nd\u00a0lumbar segments of the spinal nervous system. The enteric nervous system is involuntary cord. Once they exit the spinal cord they may take one of in its activity, acts independently but is influenced by the several pathways. The small white myelinated fibers enter sympathetics and parasympathetics. the paravertebral sympathetic chain of ganglia where they The remarkable feature of the ANS is the rapidity and the Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S111","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration may synapse with the post ganglionic neuron in the ganglion technology, including the exchange of information on they enter or one or two ganglia above or below. Alternatively, diagnosis, treatment, prevention of disease and injury, they may go through the chain and synapse in one of the research and evaluation, and continuing education of health prevertebral ganglia\u00a0(coeliac, aorticorenal, superior mesenteric service providers for the benefit of improving individual and or inferior mesenteric). Some fibers travelling to the adrenal community health.[2] medulla may not synapse until they reach the adrenal medullary Telerehabilitation is the application of telecommunication cells. The unmyelinated grey fibers that exit the sympathetic technology to provide distance support, assessment, and chain join with somatic spinal nerves to reach its target organs. intervention to individuals with disabilities.[3] In the case of the parasympathetic nervous system, 90% of Telemedicine Guideline in South East Asian\u00a0(SEA) the fibers are carried in the two vagus nerves. In addition Countries to the vagus nerve, the other cranial nerves involved with By knowing development of telemedicine in SEA countries, we parasympathetic fibers are the cranial nerves III, V, VII, IX. can related with developing tele\u2011rehabilitation in rural area. In The cranial part of the parasympathetic fibres supply the general, most SEA countries have telemedicine guidelines of entire body\u2019s parasympathetic innervation except for the varying breadth and depth. The majority of the SEA guidelines supply to the pelvic organs. The pelvis organs such as the concentrated on telemedicine\u2019s ethical and clinical aspects, with urinary bladder, lower parts of the ureter, urethra, reproductive less emphasis on the technology or platform used to provide organs, the gut from below the splenic flexure is supplied by the the service\u00a0[Table\u00a01].[4] parasympathetic components from the sacral segments S1\u2011S3. Implementation Challenges of Tele\u2011Rehabilitation Services As mentioned previously, the current trend is to consider the Eight aspects affect the implementation challenges of enteric nervous system in the myenteric and meissner plexus as a telerehabilitation services in a rural area, including policy, separate entity from the sympathetics and parasympathetics. They organization, accreditation, service, infrastructure, team, legal, control the digestive functions of muscle contraction\/relaxation, financial, and social\u00a0[Figure\u00a01]. In policy aspect including secretion\/absorption, and blood flow in the gastrointestinal tract guidelines, there is a big gap between policy and regulation for through a multitude of reflexes. The enteric nerve functions are telerehabilitation implementation. In the organization aspect, no highly influenced by the sympathetics and the parasympathetics. government or academic organization takes care of this service Autonomic nervous system is a complex and dynamic to take advantage of this service. And no specific foundation nervous system that helps in keeping the stability of the or organization can assess whether telerehabilitation is done internal environment and through the hypothalamus it helps in properly and correctly. This is needed to make telerehabilitation integrating nervous signals with endocrine activity in the body. is equal to other telehealth services or ordinary health services. Technology aspect, divided into two major aspects, which are Symposium on Telerehabilitation services and infrastructure. To improve the telerehabilitation service, a solid development team is required. This includes Developing telerehabilitation in rural area the doctor itself, application developer, and project owner who understands IT and data transactions. The legal aspect is needed Irma Ruslina Deli if legal disputes arise or malpractice, electronic prescription dispute, telerehabilitation provider license. In the financial aspect, Physiatrist, Indonesia developing a telerehabilitation service needs high cost, but on Introduction the other hand, the results of these services cannot be gained What are Telemedicine and Virtual Care quickly and are questionable. In the social aspect, we are facing The term telemedicine refers specifically to the treatment the rural population who has poor IT literation. They still feel not of various medical conditions without seeing the patient in comfortable with technology, for example, they prefer to see the person. Healthcare providers may use telehealth platforms like doctor offline, so they feel being treated.[5] live video, audio, or instant messaging to address a patient\u2019s concerns and diagnose their condition remotely, functioning Figure\u00a01: Cycle aspects of telemedicine barrier as a stand\u2011alone service parallel to\u2011face consultations. And virtual care is a broad term that encompasses all the ways healthcare providers remotely interact with their patients. In addition to treating patients via telemedicine, providers may use live video, audio, and instant messaging to communicate with their patients remotely.[1] Both telemedicine and virtual care have the same functions: connecting providers and patients to provide health care services when they are not in the same location; information delivery method: synchronous or asynchronous; using information and communication technology to exchange valid information for the diagnosis, treatment, and prevention of disease and injury in the interest of advancing individual health. Definition and Scope Telemedicine is the provision of remote health services by health professionals using information and communication S112\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration Tele\u2011Rehabilitation Service Development Approach Figure\u00a06: Developing telemedicine implementation using waterfall model in 2002\u00a0\u2013\u00a02005 Tele\u2011rehabilitation service development approach can be implemented to set up telerehabilitation services. There are two objectives in tele\u2011rehabilitation service development, cost reduction or revenue generation. If we choose cost reduction, we can develop the waterfall model using a sequencing process\u00a0[Figure\u00a02]. And if we focus on revenue generation, we can use the agile model and lean validation to develop the application\u00a0[Figure\u00a03]. The combination between the waterfall model and agile model is possible because, in the agile model, a task has a short timeline and very clear scope, so a small project with a waterfall model can be implemented\u00a0[Figure\u00a04]. Figure\u00a02: Waterfall model[6] Figure\u00a07: Developing telemedicine implementation using waterfall model in 2009\u00a0\u2013\u00a02014 Figure\u00a03: Agile model and lean validation[7] The Approach of Tele\u2011Rehabilitation Technology Figure\u00a04: Combination agile model and waterfall model[6] A technology review was done to ensure the availability of Figure\u00a05: Tele\u2011rehabilitation technology review infrastructure capable of delivering a service. To develop telerehabilitation services, we must understand what technology can be used to develop those services. What is needed is not only exchanging data information through mobile applications but there are other technologies required, for example, specifically serving users in rural areas where mobile connectivity does not exist. It is divided into three layers,\u00a0(1) ecosystem service layer,\u00a0(2) platform layer,\u00a0(3) connectivity layer\u00a0[Figure\u00a05]. There is a lot of choice in the connectivity layer, but we focus on the most relevant telerehabilitation: fiber optic, mobile, and satellite. These choices depend on the objective of the digital product. There is a lot of alternative technology in the platform layer, for example, IoT, data center, cloud, big data, security, and artificial intelligence. This choice and roadmap are depended on the target to develop the product. Telemedicine Implementation The example of telemedicine implementation using the waterfall method developed 20\u00a0years ago. At that time, no internet network was as easy to manage as it is today, so to transmit data in the form of images and sound, voice, telecommunication, and radio networks were used\u00a0[Figure\u00a06].[8] Ten years ago, a waterfall method was used to measure how a transaction transfers data from a disaster location using a Low Altitude Platform for Emergency Medical Comm and also digitalization of maternal and post\u2011natal care system.[9] The technology used at that time was WiFi and WMAX\u00a0[Figure\u00a07]. An example of an agile and lean implementation is related to the COVID\u201119 tracing, tracking, and vaccine application\u00a0[Figure\u00a08]. The development process is preceded by finalizing the user candidate\u2019s experience research Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S113","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration Figure\u00a08: Telemedicine implementation using the agile model Table 1: The domain contained in the telemedicine guideline of South East Asian countries[4] Domains Singapore Malaysia Indonesia Thailand Vietnam Clinical Definition of telemedicine Yes Yes Yes Yes Yes Clinical governance Yes Yes Yes Yes Yes Restrictions Yes Yes Yes No No International service Yes Yes Yes No Yes Ethical and legal Medical ethics Yes Yes Yes Yes Yes Legislation Yes Yes No No No Consent from users Yes Yes Yes No No Confidentiality and privacy Yes Yes Yes Yes Yes Identification\/authentication (providers, patients) Yes Yes Yes No No Operational and technical Data security and stewardship Yes Yes Yes Yes Yes Record keeping and data storage Yes Yes Yes Yes Yes Licensing of healthcare practitioners Yes Yes Yes No Yes Licensing of healthcare facilities Yes Yes Yes No Yes Licensing of telehealth products (mHealth, Apps) Yes Yes Yes Yes No Licensing of traditional and complementary medicine No No Yes No No ICT infrastructure Yes Yes Yes Yes Yes Internet speed requirement No No Yes No Yes Human resource Yes Yes Yes Yes Yes Cost of ICT infrastructure, training, human resource Yes Yes Yes Yes Yes Reimbursement\/service fee Yes No Yes No Yes Feedback from users Yes No No No No Choices offered to users Yes No No No No ICT=Information and communication technology, EMR=Electronic medical records, HIMS=Health information management system, mHealth=Mobile health, Apps, phone applications journey, then the connectivity and infrastructure of the platform access. The challenges of service technologies are\u00a0(1) Slow are carried out. Everything starts from the smallest thing and will service maturity\u00a0(2) Unclear orientation of market and industry grow every day to be evaluated and immediately redeveloped needs. Even with regularly updating technology developments, the when needed. Hence, there is no need to finish everything first, availability of infrastructure needed for Tele\u2011rehabilitation services like in the waterfall method. If some things are not clearly related has not reached all remote areas. The technical architecture to the user\u2019s needs, we will first validate whether this is really for telerehabilitation can use a combination of connectivity what the user needs. and platform technologies based on service configuration Conclusion specifications. The challenges of infrastructure for Tele\u2011rehabilitation services are\u00a0(1) Very fast technology development;\u00a0(2) Inequality in ICT References infrastructure;\u00a0(3) Expensive investment; and\u00a0(4) Slow internet 1.\t Jones M, Craft L. Hype cycle for digital care delivery including S114\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration telemedicine and virtual care. In: Gartner Research. \u200a\u00a02018. Available comprehensive evaluation for planning a patient\u2011tailored from: \u200ahttps:\/\/www.gartner.com\/en\/documents\/3882881\/ approach to management. hype\u2011cycle\u2011for\u2011digital\u2011care\u2011delivery\u2011 including\u2011 telemedic. 2.\t Moeloek NF, Ekatjahjana W. Permenkes No.\u00a0 20 Tahun 2019 Research Methdology in Tentang Penyelenggaraan Telemedicine Antar Fasilitas Pelayanan Neurorehab Kesehatan. \u200a\u00a0Ministry of Health; 2019. Available from: \u200a\u00a0https:\/\/ www.researchgate.net\/publication\/338428993. Pragmatic and implementation trials for low 3.\t Ricker JH, Rosenthal M, Garay E, DeLuca J, Germain A, and middle\u2011income countries Abraham\u2011Fuchs K, et\u00a0al. Telerehabilitation needs: A\u00a0survey of persons with acquired brain injury. J\u00a0 Head Trauma Rehabil Jeyaraj D. Pandian 2002;17:242\u201150. 4.\t Intan Sabrina M, Defi IR. Telemedicine guidelines in South East Principal and Professor of Neurology, Christian Medical College and Asia\u00a0\u2013\u00a0A scoping review. Front Neurol 2020;11:581649. Hospital, Ludhiana, India 5.\t Bali S. Barriers to development of telemedicine in developing There are several challenges in delivering stroke rehabilitation countries. In: Telehealth. \u00a02018.\u00a0[doi: 10.5772\/intechopen. 81723]. in LMICs. Even though there are many evidence based 6.\t Kukhnavets P. Agile vs Waterfall Defining the Difference Between stroke rehabilitation strategies available whether they are Two Powerful Methodologies. Available from: \u200a\u00a0https:\/\/hygger. effective in LMICs is unclear. Hence there is a need for io\/guides\/agile\/agile\u2011vs\u2011waterfall\/. pragmatic stroke implementation trials. The Family led stroke 7.\t Okeke N. Agile Methodology: Meaning, Advantages, rehabilitation trial\u00a0(ATTEND) was one such pragmatic stroke Disadvantages & More. Available from: \u200a\u00a0https:\/\/targettrend.com\/ rehabilitation trial done in India. The caregivers were trained agile\u2011methodology\u2011 meaning\u2011advantages\u2011disadvantages\u2011more\/. by the physiotherapists and the stroke rehabilitation was 8.\t Sutiono AB, Qiantori A, Prasetio S, Santoso H, Suwa H, Ohta monitored in their homes. The study was neutral in primary T, et\u00a0al. Designing an emergency medical information system outcome however the lessons learnt from this trial will pave for the early stages of disasters in developing countries: The way for better home based stroke rehabilitation programs. The human interface advantage, simplicity and efficiency. J\u00a0Med Syst RECOVER trial was a simple pragmatic trial which tested the 2010;34:667\u201175. effectiveness of nurse driven stroke rehabilitation in China. 9.\t Qiantori A, Sutiono AB, Hariyanto H, Suwa H, Ohta T. An The trial did not improve the patients outcome however the emergency medical communications system by low altitude model was feasible in delivering rehabilitation. There are platform at the early stages of a natural disaster in Indonesia. several small stroke rehabilitation trials which address specific J\u00a0Med Syst 2012;36:41\u201152. functional disability. The assessment tools, outcome measures and culturally relevant therapies need to be considered when Urological and sexual autonomic pragmatic stroke rehabilitation trials are designed. dysfunction in neurological disorders Symposium on Gait Disorder Jalesh N. Panicker Rehabilitation Department of Uro\u2011Neurology, Reader in Uro\u2011Neurology and Clinical Gait rehab in Ataxia Neurology, The National Hospital for Neurology and Neurosurgery and UCL, Institute of Neurology, Queen Square, London, John M. Solomon1,2 United\u00a0Kingdom Lower urinary tract\u00a0(LUT) and sexual dysfunction are 1Department of Physiotherapy, Manipal College Health Professions, commonly reported sequelae of neurological disease and Manipal Academy Higher Education, 2Centre for Comprehensive have a significant impact on quality of life. Neurologists are Stroke Rehabilitation and Research, MAHE, Manipal, Karnataka, increasingly enquiring are increasingly becoming involved in India the management of these complaints. Gait training in cerebellar ataxia The pattern of LUT dysfunction is influenced by the site of Introduction: Cerebellar Ataxias are a group of gait disorders neurological lesion. The risk for developing upper urinary caused due to the dysfunction of the cerebellum due to tract damage is considerably lower in patients with slowly inherited and acquired causes, manifesting as problems with progressive non\u2011traumatic neurological disorders, compared balance and walking leading to considerable disability.[1] The to patients with spinal cord injury or spina bifida. History cerebellar vermis\u00a0[lays a significant part in controlling the gait taking forms the cornerstone of assessment, and urinalysis, by regulating extensor tone, sustaining upright stance and ultrasonography and urodynamics provide information about dynamic balance control, and modulating rhythmic flexor and the cause and nature of LUT dysfunction. Antimuscarinic extensor muscle activity.[2] But there seems to be contribution agents are the first line management of urinary incontinence, from the intermediate and lateral portions of the cerebellum in however the side effect profile and anticholinergic burden controlling precision and adjustments during novel situations should be considered when prescribing these medications. respectively.[3] Hence lesion in any of these areas could lead Beta\u20113 receptor agonists are a promising alternative to Ataxic gait. Traditional training methods: Gait training for oral medication. Tibial and sacral neuromodulation have cerebellar ataxia has been traditionally implemented along with been shown to be effective for managing neurogenic Frenkel\u2019s exercise. Which follows the principles of precision, incontinence. Intradetrusor injections of onabotulinumtoxinA concentration and repetition. It involves, drawing foot print on have revolutionised the management of neurogenic detrusor the ground and training patients to place the feet on the marking overactivity. Phosphodiesterase\u20115 inhibitors are the first line management for managing neurogenic sexual dysfunction. Neurological patients reporting LUT symptoms require a Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S115","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration and train them to control the foot placements. It has shown to 2018;2018:7172686. improve functional balance and gait in patients with cerebellar 9.\t Fonteyn EM, Heeren A, Engels JJ, Boer JJ, van de Warrenburg disorders. Though it is widely practiced, it is often stereotypical, non\u2011contextual and low of repetition in clinical setup based BP, Weerdesteyn V. Gait adaptability training improves obstacle training. Here we look at other possible options to train patients avoidance and dynamic stability in patients with cerebellar with cerebellar ataxia. System based approaches: Affected degeneration. Gait Posture 2014;40:247\u201151. anticipatory control while walking has been identified as one 10.\t Ilg W, Synofzik M, Br\u00f6tz D, Burkard S, Giese MA, Sch\u00f6ls L. of the dysfunctions of cerebellar ataxia. Repeated waist pull Intensive coordinative training improves motor performance in perturbations[5] and use of obstacles could be used to control degenerative cerebellar disease. Neurology 2009;73:1823\u201130. while walking. Trunk stabilization exercises to improve truncal 11.\t Stephan MA, Krattinger S, Pasquier J, Bashir S, Fournier T, Ruegg stability has also been tried to reduce the ataxic component.[6] DG, et\u00a0al. Effect of long\u2011term climbing training on cerebellar ataxia: Task specific training: Task specific training in the form of Body A\u00a0case series. Rehabil Res Pract 2011;2011:525879. Weight Support Treadmill training and Overground walking 12.\t Keller JL, Bastian AJ. A\u00a0home balance exercise program improves training has been used for improving gait parameters.[7,8] walking in people with cerebellar ataxia. Neurorehabil Neural Additional methods focus on use of various surfaces and walking Repair 2014;28:770\u20118. environment. Gait adaptability training in these patients seem to 13.\t Wang RY, Huang FY, Soong BW, Huang SF, Yang YR. improve their ability to avoid obstacles and gain more stability.[9] A\u00a0randomized controlled pilot trial of game\u2011based training in For any of these treatment to have an effect intensive training individuals with spinocerebellar ataxia type\u00a03. Sci Rep 2018;8:7816. seems to be the key[10] There has also been trials looking at tasks 14.\t Belas Dos Santos M, Barros de Oliveira C, Dos Santos A, that might transfer its benefit to walking, like climbing.[11] All these Garabello Pires C, Dylewski V, Arida RM. A\u00a0comparative study of interventions are done under a trained therapists. But, would conventional physiotherapy versus robot\u00a0\u2013\u00a0Assisted gait training a homebased program work in these patients. Improvements associated to physiotherapy in individuals with ataxia after stroke. in gait were noted in a study with a six week individualized Behav Neurol 2018;2018:2892065. home based balance exercise program for cerebellar ataxia.[12] 15.\t Kim HY, Shin JH, Yang SP, Shin MA, Lee SH. Robot\u2011assisted gait Technology based interventions: VR\/Game based rehabilitation training for balance and lower extremity function in patients with and Robotics has gained popularity in improving balance and infratentorial stroke: A\u00a0single\u2011blinded randomized controlled gait in patients with neurological disorders. Though studies trial. J\u00a0Neuroeng Rehabil 2019;16:99. seem to show some positive effects, these seem to be from 16.\t Fonteyn EM, Keus SH, Verstappen CC, Sch\u00f6ls L, de Groot IJ, the additional training received rather than a direct effect. More van de Warrenburg BP. The effectiveness of allied health care in studies are needed before converting this into clinical practice patients with ataxia: A\u00a0systematic review. J\u00a0Neurol 2014;261:251\u20118. for patients with ataxia.[13\u201115] Conclusion: Patients with cerebellar ataxia improve with Electromechanical\u2010assisted training for training implemented through physical and occupational walking after stroke therapy.[16] Individualized, intensive, context specific task based gait training seems to appropriate for improving gait in patients Julia Patrick Engkasan with cerebellar ataxia. There is a need to conduct more RCTs to derive define conclusion to identify evidence and implement it. Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, Malaysia \u200aReferences The aim of this lecture is to provide a summary and commentary on the published Cochrane Review titled: 1.\t Buckley E, Mazz\u00e0 C, McNeill A. A\u00a0systematic review of the gait Electromechanical\u2011assisted training for walking after by characteristics associated with cerebellar ataxia. Gait Posture Mehrholz et\u00a0al.[1] which was published in Cochrane Database 2018;60:154\u201163. of Systematic Reviews\u00a0(2020). Approximately 20% and 70% of stroke survivors remains in a wheelchair and had difficulty 2.\t Ilg W, Timmann D. Gait ataxia\u00a0\u2013\u00a0 Specific cerebellar influences walking respectively. Thus improving walking ability is one of the and their rehabilitation. Mov Disord 2013;28:1566\u201175. top priorities for people who have impaired walking. In the past decade, electromechanical assisted gait training has gained 3.\t Kelly G, Shanley J. Rehabilitation of ataxic gait following cerebellar popularity. Electromechanical gait training enables repetitive lesions: Applying theory to practice. Physiother Theory Pract gait cycles and requires less effort from physiotherapists. 2016;32:430\u20117. This Cochrane systematic review by Mehrholz et\u00a0al. aims to determine whether electromechanical\u2011\u00a0and robot\u2011assisted gait 4.\t He M, Zhang HN, Tang ZC, Gao SG. Balance and coordination training versus normal care improves walking after stroke. training for patients with genetic degenerative ataxia: A\u00a0systematic They also aim to determine whether electromechanical\u2011\u00a0and review. J\u00a0Neurol 2020;\u00a0[doi: 10.1007\/s00415\u2011020\u201109938\u20116]. robot\u2011assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and 5.\t Aprigliano F, Martelli D, Kang J, Kuo SH, Kang UJ, Monaco V, death from all causes until the end of the intervention phase. et\u00a0al. Effects of repeated waist\u2011pull perturbations on gait stability This review addressed participants of any gender over\u00a018\u00a0years in subjects with cerebellar ataxia. J\u00a0Neuroeng Rehabil 2019;16:50. of age after stroke. The interventions studied evaluated electromechanical\u2011\u00a0and robot\u2011\u00a0assisted gait training plus 6.\t Freund JE, Stetts DM. Use of trunk stabilization and locomotor physiotherapy versus physiotherapy\u00a0(or usual care) for regaining training in an adult with cerebellar ataxia: A\u00a0single system design. and improving walking after stroke. The intervention included Physiother Theory Pract 2010;26:447\u201158. were all types of electromechanical\u2011\u00a0and robot\u2011assisted gait training, which is compared to conventional gait therapy. The 7.\t Im SJ, Kim YH, Kim KH, Han JW, Yoon SJ, Park JH. The effect primary outcome measure was the ability to walk independently. of a task\u2011specific locomotor training strategy on gait stability in patients with cerebellar disease: A\u00a0feasibility study. Disabil Rehabil 2017;39:1002\u20118. 8.\t de Oliveira LA, Martins CP, Horsczaruk CH, da Silva DC, Vasconcellos LF, Lopes AJ, et\u00a0al. Partial body weight\u2011supported treadmill training in spinocerebellar ataxia. Rehabil Res Pract S116\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration The secondary outcomes were walking speed\u00a0(in metres per recovery and neurorehabilitation Cambridge University Press second; Hornby 2020), walking capacity\u00a0(metres walked in 2010 Serafin Beer, Fary Khan, J\u00fcrg Kesselring Rehabilitation 6\u00a0minutes; interventions in Multiple Sclerosis An overview J Neurol This review included 62 trials involving a total of 2440 2012 DOI 10.1007\/s00415\u2011012\u20116577\u20114 Kesselring J, Beer participants. In general, electromechanical\u2011assisted gait S Symptomatic therapy and Neurorehabilitation in multiple training in combination with physiotherapy increased the sclerosis The Lancet Neurology 2005; 4\u00a0(10); 643\u2011652 Fary odds of participants becoming independent in walking and Khan, Bhasker Amatya, Mary P. Galea, Roman Gonzenbach, increased mean walking velocity but did not improve mean J\u00fcrg Kesselring Neurorehabilitation\u00a0\u2011\u00a0Applied Neuroplasticity walking capacity. The speaker will further describe the concept J Neurol 2016\u00a0(online 18.10.2016) Meyer\u2011Heim A, Rothmaier of sensitive and subgroup analysis used in this review. The M, Weder M, Kool J, Kesselring J Advanced cooling\u00a0\u2011\u00a0garment lecture ends with describing how the evidence obtained from technology: functional improvements in thermosensitive this systematic review could be put into clinical practice. patients with Multiple Sclerosis 2006; 12:\u00a01\u00a0\u2013\u00a06 Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G References Developing the ICF Core Sets for Multiple Sclerosis to specify functioning Multiple Sclerosis 2008;14:\u00a0252\u20114 Holper, Coenen 1.\t Mehrholz J, Thomas S, Kugler J, Pohl M, Elsner B. M, Weise A, Stucki G, Cieza A, Kesselring J Characterizing Electromechanical\u2011assisted training for walking after stroke. functioning in MS using the ICF J Neurol 2010; 257:\u00a0103\u00a0\u2013\u00a0113 Cochrane Database Syst Rev 2020;10:CD006185. Prof. Dr.\u00a0J\u00fcrg Kesselring is Head emeritus of Department of Neurology & Neurorehabilitation at the Rehabilitation Centre Symposium on Multiple Sclerosis in Valens, Switzerland and Professor of Clinical Neurology and Neurorehabilitation, University of Bern, Lecturer in Clinical Neurorehabilitation in multiple Neuroscience at the Center of Neuroscience, University sclerosis\u00a0\u2013\u00a0Building resilience based on and ETH Z\u00fcrich, Chair of neurorehabilitation, San Raffaele University, Milano, Italy and at Danube University, Krems, neuroplasticity Austria. He is a Member of the Assembly of the International Committee of the Red Cross, and former President\u00a0 (now: J\u00fcrg Kesselring Honorary President) of the Swiss Multiple Sclerosis Society and former Chairman of the International Medical and Scientific Rehabilitation Centre, 7317 Valens, Switzerland Board of Multiple Sclerosis International Federation\u00a0(MSIF) Neurorehabilitation\u00a0\u2013\u00a0applied neuroplasticity. Re\u2011organisation of and of the Resarch Committee on Demyelination of the World structures and functions in the brain are the basis of learning. Federation of Neurology\u00a0(WFN), Chairman of the WHO Working Plastic changes occur in normal as well as in diseased Group on Multiple Sclerosis\u00a0(\u20112005), former President of the brains and can be enhanced by task\u2011specific therapeutic European Committee on Treatment and Research in Multiple interventions\u00a0(Neurorehabilitation). Due to the variety of Sclerosis\u00a0(ECTRIMS). Author of 250 Originalpublications and symptoms and functional deficits Multiple Sclerosis\u00a0(MS) Editor or Co\u2011Author of 15 books, mainly related to Multiple can lead to a broad range of functional impairments and Sclerosis, Neurorehabilitation, Magnetic Resonance. handicap. Even with newer immunomudulating therapies, the course remains progressive. The symptoms themselves, COVID\u201119 and acute neurorehabilitation: loss of independence and participation in social activities are An early mobilization program responsible for the progressive decline of quality of life. The main objective of a comprehensive rehabilitation program is Karin Disrens to ease the burden of disease by improving self performance and independence. Restoration of function is not the key Department of Clinical Neurosciences, Acute Heurorehabilitation effect of rehabilitation in MS. As rehabilitation measures Unit, University Hospital of Lausanne, Lausanne, Switzerland have no direct influence on the ongoing disease process Coronavirus disease 2019\u00a0(COVID\u201119) requires admission and progression of the disease, compensation of functional to the intensive care\u00a0(ICU) for the management of acute deficits, adaptation and reconditioning together with other respiratory distress syndrome in about 5% of cases. Although nonspecific effects\u00a0 (management of specific symptoms and our understanding of COVID\u201119 is still incomplete, a growing impairments, emotional coping, self estimation) is more body of evidence is indicating potential direct deleterious effects important in the longterm. Several of the many symptoms of on the central and peripheral nervous systems. Indeed, complex MS are amenable to drug therapies which have been proven in and long\u2011lasting physical, cognitive, and functional impairments careful evidence\u2011based analyses to be effective\u00a0(e.g.\u00a0fatigue, have often been observed after COVID\u201119. Early\u00a0(defined as spasticity, bladder, bowel and sexual disturbances, pain, during and immediately after ICU discharge) rehabilitative cognitive dysfunctions etc). Newer studies in MS patients show, interventions are fundamental for reducing the neurological that despite the ongoing progression of the disease process, burden of a disease that already heavily affects lung function rehabilitation is effective by improving personal activities and with pulmonary fibrosis as a possible long\u2011term consequence. participation in social activities leading to better quality of life. In addition, ameliorating neuromuscular weakness, with early After comprehensive inpatient rehabilitation, improvement rehabilitation would improve the efficiency of respiratory function overlasts the treatment period for several months. Quality of life as respiratory muscle atrophy worsens lung capacity. In this is correlated more with disability and handicap rather than with respect, we propose a neurosensory approach of verticalization functional deficits and progression of the disease. Kesselring using robotic devices associated with repetitive movements J, Comi G, Thompson AJ Multiple Sclerosis\u00a0\u2013\u00a0functional Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S117","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration of the legs, allowing coma patients to improve awakening Lakshmi Narasimhan Ranganathan, Guhan and re\u2011afferentation. The benefits of early multidisciplinary Ramamurthy, R. Shrivarthan rehabilitation after an ICU stay have been shown in several clinical conditions making an early rehabilitative approach Neurologist, Consultant Neurologist, Madras Medical College, generalizable and desirable to physicians from a wide range Tamil Nadu, India of different specialties and especially now for the polymorphic Introduction manifestations of COVID\u201119. The neurological disorders constitute a significant proportion of global disease burden and disability\u2011adjusted life years, Pitfalls of coma diagnosis: An interactive the majority of which is contributed by stroke and trauma in learning tutorial adults. Despite conventional rehabilitation, a vast majority of these patients fail to resume social and economic activities Karin Diserens and lack of financial freedom. The emerging technologies can help to bridge the gap in enabling the effective functioning of Department of Clinical Neurosciences, Division of Neurology, Acute the affected patient. It is brought about by augmented clinical Neurorehabilitation Unit, University Hospital, Lausanne, Switzerland improvement or replacing the function with substitution devices thereby negating the disability. In the following discussion, Bedside assessment of consciousness or awareness after cutting edge treatment and rehabilitation with the following are a severe brain injury might be hampered by confounding discussed Figure\u00a01: clinical factors\u00a0(i.e., pitfalls) interfering with the production of behavioral or motor responses to external stimuli. Despite Figure\u00a01: Digital devices and cyberspace in neurorehabilitation the use of validated clinical scales, a high misdiagnosis rate \u2022\t Neuromodulation is indeed observed in severe brain injury patients admitted \u2022\t Sensory substitution devices to an acute neuro\u2011rehabilitation program. In this interactive \u2022\t Cyberspace learning tutorial, the main pitfalls are presented including \u2022\t Wearables polyneuropathy and\/or myopathy and\/or myelopathy, major \u2022\t Neuromodulation cranial nerve palsies, non\u2011convulsive status epilepticus, The techniques in neuromodulation result in modulation aphasia\u00a0(expressive or comprehensive), cortical blindness, of the neurons causing alterations in the excitability of the thalamic involvement and frontal akinetic syndrome. As all cortex, neuroplasticity and thereby brings about change in of these pitfalls could compromise the motor efference and network behaviour. Neuroplasticity improves the adaptability verbal responses, which are mainly evaluated by the current of the brain to the pathological state resulting in improved clinical scales. In order to avoid confusing unresponsiveness function. This results from improved structural and functional with disorders of consciousness, the validated scales have efficiency of the neuronal process and remapping of the cortical to be complemented by observing the motor behavior and maps following the insult. Neuromodulation is invasive or detecting subtle clues or conscious perception as signs of non\u2011invasive. The invasive neuromodulation includes deep clinical \u2018Cognitive Motor Dissociation\u2019\u00a0(cCMD). We present a brain stimulation, invasive vagal nerve stimulation and epidural validated methodology called the Motor Behavior Tool\u00a0(MBT) motor cortex stimulation. The non\u2011invasive neuromodulation to detect cCMD using videos of clinical cases, and a treatment includes transcranial direct current stimulation\u00a0(tDCS), program using a neurosensorial approach in the very acute transcranial magnetic stimulation\u00a0(TMS), and paired associative phase of these patients. We discuss the results of the outcomes stimulation\u00a0(PAS).[1] of this particular subset of CMD patients. Invasive brain stimulation is useful in the management of various neurological disorders such as the use of deep brain Gastrointestinal autonomic dysfunction in stimulation in movement disorders, invasive vagal nerve neurological disorders\u200b stimulation in the management of drug\u2011refractory epilepsy and epidural motor cortex stimulation in the management Katarina Ivana Tudor of pain. Non\u2011invasive brain stimulation is based on the correction of interhemispheric imbalance following insult in Department of Neurology, Unit for Headaches, Neurogenic Pain and one hemisphere. This is accomplished by stimulating the Spinal Disorders, University Hospital Center Zagreb, Zagreb, Croatia injured cortex or inhibiting the healthy cortex and resuming the balance between the two hemispheres. The stimulation of the Bowel dysfunction is frequent among patients with neurological disease, e.g.,\u00a0spinal cord injury, multiple sclerosis, spina bifida, Parkinson\u2019s disease and stroke. These symptoms are among the most physically, socially and emotionally disabling. They have a major negative effect on the quality of life, ability to socially integrate and the ability to live independently. The aim of this talk is to review the pathophysiology underpinning gastrointestinal autonomic dysfunction in neurological disorders, assessment and management. \u200aDigital devices and cyberspace in neurorehabilitation S118\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration ipsilesional cortex is performed using high\u2011frequency repetitive decipher the whereabouts of the objects and the properties of TMS\u00a0>\u00a03Hz, anodal tDCS or PAS with an interstimulus interval the surface encountered. The use of the SSDs has been based of 25ms. Inhibiting the contralesional cortex is performed using on the hypothesis that the brain is a task\u2011specific structure and low\u2011frequency repetitive TMS\u00a0<\u00a01\u00a0Hz, cathodal tDCS or PAS not modality\u2011specific. The hypothesis is exemplified by the with an interstimulus interval of 10ms, Figure\u00a02.[1] following scenarios. In a congenitally blind individual, an attempt to read using the braille system activates the visual word form Figure\u00a02: The interhemispheric imbalance is corrected by area\u00a0(VWFA) in the cortex similar to that would be activated in stimulating the injured cortex or inhibiting the healthy cortex subjects reading through vision. Hence, VWFA is activated in and resuming the balance between the two hemispheres. The the cortex for reading words regardless of the modality used. stimulation of the ipsilesional cortex is performed using high Similarly in subjects using echolocation, the visual cortex is frequency repetitive transcranial magnetic stimulation\u00a0(TMS) activated as opposed to the activation of the auditory cortex >3Hz, anodal transcranial direct current stimulation\u00a0(tDCS) for other sounds.[12] or Paired associative stimulus\u00a0(PAS) with an interstimulus The sensory substitution devices have been upgraded with interval\u00a0(ISI) of 25ms. Inhibiting the contralesional cortex is the evolution of technology and are now available in mobile performed using low\u2011frequency repetitive TMS\u00a0<\u00a01\u00a0Hz, cathodal phones. For example, \u2018the vOICe\u2019 SSD application is useful tDCS or PAS with an interstimulus interval of 10ms in the conversion of visual information\u00a0(using the camera) The tDCS is performed by delivery of a constant and into auditory information\u00a0(conveyed using the earphones to low\u2011intensity galvanic current to the target area of interest. the subject). As the computer algorithms advance, the salient Anodal tDCS is stimulatory and cathodal tDCS is inhibitory. The features from the scene can be filtered and converted into audio evidence for the efficacy of the non\u2011invasive brain stimulation information. Following the training of individuals using the SSD, has been mixed owing to the heterogenous methodology in congenitally blind individuals and blindfolded normal sighted various studies. Various evidence suggests the role of tDCS in individuals were able to identify the location, size and texture the rehabilitation of motor and language deficits, hemineglect of the objects in front, identify the movement of the objects and and post\u2011traumatic disorders of consciousness\u00a0[2\u20116]. The were able to navigate avoiding the obstacles. These results are repetitive TMS\u00a0(rTMS), using repetitive pulses of magnetic promising in restoring the virtual sight in visually challenged stimulation is useful in the rehabilitation of motor deficit, individuals and encouraging the development of newer devices language deficit and hemineglect\u00a0 .[7\u20119] In PAS, a peripheral with easy interpretation of the stimuli and compact design of site of stimulation such as a median nerve is performed in the device that can fit into the daily routine. The combination conjunction with the central cortical stimulation performed using of retinal prosthesis and SSDs in restoring vision needs to be rTMS. When the interstimulus interval is\u00a0>\u00a025ms, it is excitatory evaluated.[12,13] and when the interstimulus interval is\u00a0<\u00a010ms, it is inhibitory. Cyberspace PAS, in the preliminary stages, was found to be useful in Cyberspace or the virtual space created by the cyber brain is motor rehabilitation following stroke and spinal cord injury.[10,11] an emerging tool in the armamentarium of neurorehabilitation. Additional studies are required to establish the various target The virtual environment with a wide spectrum of interactions sites and dosages in motor and language rehabilitation. provides a tailored situation for the rehabilitation sessions. Virtual Sensory Substitution Devices reality\u00a0(VR) is immersive, semi\u2011immersive or non\u2011immersive. In Vision is a major sensory system that helps a subject navigate. non\u2011immersive VR, the interaction is with a computer screen The loss of sight results in significant disability to the patient. using a mouse and keyboard. In immersive VR, the patient is The use of several methods in visual restoration such as placed in a virtual environment using a head\u2011mounted display. transplantation of photoreceptors, bionic eyes have proved The various devices that are required to provide a completely futile. The emergence of sensory substitution devices has immersive experience include a head\u2011mounted display\u00a0(at offered promise to the visually challenged. The sensory least 15 frames per second), omnidirectional treadmills, spatial substitution device\u00a0(SSD) functions by homing the visual sound, sensory vests and gloves for haptic input and interaction information through auditory or tactile tracts and directs it to with surroundings respectively. The devices are used to place the visual cortex. The information is used to create mental the patient in a suitable virtual environment with challenges images of the scene rather than a \u2018true vision\u2019. The subjects can relevant to the disability of the patient and training is initiated.[14] Several studies are available on the use of virtual reality in various aspects of neurorehabilitation such as gait and balance, arm rehabilitation, cognitive rehabilitation and pain management. The studies have confirmed the feasibility and safety of the use of virtual reality in the patient population. The balance and gait training using virtual reality was found to reduce falls and improves balance scores in Parkinson\u2019s disease, improves balance scores in patients with multiple sclerosis and strengthens balance and gait speed in stroke patients. When VR is combined with treadmill training in Parkinson disease patients, it enhances biofeedback and reduces falls.[15] VR in arm rehabilitation using task\u2011specific game\u2011based rehabilitation has shown improved functional outcomes in post\u2011stroke patients. The visual amplification of the arm Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S119","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration movement in the virtual reality platform that is oriented towards Rev 2013;11:CD009645. the goal, akin to mirror therapy, provides visual and motor 3.\t Monti A, Cogiamanian F, Marceglia S, Ferrucci R, Mameli F, feedback. This enhances motor recovery in stroke patients with hemiparetic arm.[16,17] Mrakic\u2011Sposta S, et\u00a0al. Improved naming after transcranial direct The advantage of virtual reality in neurorehabilitation includes current stimulation in aphasia. J\u00a0Neurol Neurosurg Psychiatry providing a safe environment, motivation to the patient and 2008;79:451\u20113. confidence, absent physical consequences from errors. 4.\t Vestito L, Rosellini S, Mantero M, Bandini F. Long\u2011term effects Quantitative measurement of the improvement may be of transcranial direct\u2011current stimulation in chronic post\u2011stroke performed, and biofeedback can be provided to the patient aphasia: A\u00a0pilot study. Front Hum Neurosci 2014;8:785. that augments the recovery process. However, the available 5.\t Sunwoo H, Kim YH, Chang WH, Noh S, Kim EJ, Ko MH. Effects evidence has been focusing more on non\u2011immersive VR. More of dual transcranial direct current stimulation on post\u2011stroke studies using immersive VR, dosing and duration is the need unilateral visuospatial neglect. Neurosci Lett 2013;554:94\u20118. of the hour.[14] 6.\t Angelakis E, Liouta E, Andreadis N, Korfias S, Ktonas P, Stranjalis Wearables G, et\u00a0al. Transcranial direct current stimulation effects in disorders Wearables are digital devices worn on the patient body of consciousness. Arch Phys Med Rehabil 2014;95:283\u20119. that helps collect the required information using sensors in 7.\t Hsu WY, Cheng CH, Liao KK, Lee IH, Lin YY. Effects of repetitive monitoring the patient and provides feedback to the physician transcranial magnetic stimulation on motor functions in patients and the patient. It enables the continuous monitoring extending with stroke: A\u00a0meta\u2011analysis. Stroke 2012;43:1849\u201157. from the clinics to the home of the patient and ensures an 8.\t Ren CL, Zhang GF, Xia N, Jin CH, Zhang XH, Hao JF, et\u00a0al. objective measure rather than subjective description by the Effect of low\u2011frequency rTMS on aphasia in stroke patients: patient and thereby tailor the rehabilitative therapy to the A\u00a0 meta\u2011analysis of randomized controlled trials. PLoS One patient.[18] 2014;9:e102557. Inertial measurement units\u00a0(IMU) measure the movement 9.\t Kim BR, Chun MH, Kim DY, Lee SJ. Effect of high\u2011\u00a0and of limbs. The linear movement is measured using linear low\u2011frequency repetitive transcranial magnetic stimulation on accelerometers and angular acceleration using a gyroscope. visuospatial neglect in patients with acute stroke: A\u00a0double\u2011blind, It provides an objective measure of the motor function during sham\u2011controlled trial. Arch Phys Med Rehabil 2013;94:803\u20117. the activities of daily living at home. It records the movement 10.\t Castel\u2011Lacanal E, Marque P, Tardy J, de Boissezon X, Guiraud V, intensity, amplitude and frequency that provide clinical Chollet F, et\u00a0al. Induction of cortical plastic changes in wrist information to the physician and feedback to the patient. The muscles by paired associative stimulation in the recovery phase potentiometers are used to measure the angular displacement of stroke patients. Neurorehabil Neural Repair 2009;23:366\u201172. and hence detects the movement range of the joint. Encoders 11.\t Bunday KL, Perez MA. Motor recovery after spinal cord injury are digital versions of potentiometers.[18] enhanced by strengthening corticospinal synaptic transmission. Surface Electromyography\u00a0(sEMG) sensors are useful in Curr Biol 2012;22:2355\u201161. recording the muscle activity and pattern of muscle activation 12.\t Reich L, Maidenbaum S, Amedi A. The brain as a flexible task involved in the movement. It complements the data collected by machine: Implications for visual rehabilitation using noninvasive the IMU in the assessment of motor activity. The data collected vs. invasive approaches. Curr Opin Neurol 2012;25:86\u201195. include recording the strength of contraction of the involved 13.\t Jicol C, Lloyd\u2011Esenkaya T, Proulx MJ, Lange\u2011Smith S, Scheller M, muscles and the fine movements involved in the handling of O\u2019Neill E, et\u00a0al. Efficiency of sensory substitution devices alone objects. A\u00a0device setup with the use of the above sensors helps and in combination with self\u2011motion for spatial navigation in collect data in making clinical decisions. These sensors are sighted and visually impaired. Front Psychol 2020;11:1443. being studied in the rehabilitation of stroke patients.[18] 14.\t Schiza E, Matsangidou M, Neokleous K, Pattichis CS. Virtual Conclusion reality applications for neurological disease: A\u00a0review. Front The use of digital devices including neuromodulation, SSD Robot AI 2019;6:100. and wearables are set to revolutionize the assessment and 15.\t Cano Porras D, Siemonsma P, Inzelberg R, Zeilig G, Plotnik M. rehabilitation of patients with motor and cognitive deficits. Advantages of virtual reality in the rehabilitation of balance and Cyberspace can provide a safe environment and fabulous gait: Systematic review. Neurology 2018;90:1017\u201125. platform for the rehabilitation of patients. With the evolution 16.\t Shin JH, Ryu H, Jang SH. A\u00a0task\u2011specific interactive game\u2011based and digitalization of the world, these devices will become virtual reality rehabilitation system for patients with stroke: more affordable and widely used. However, the literature A\u00a0usability test and two clinical experiments. J\u00a0Neuroeng Rehabil studies and data on these technologies is far from adequate. 2014;11:32. A\u00a0uniform protocol for studies is required to compare devices 17.\t Ballester BR, Nirme J, Duarte E, Cuxart A, Rodriguez S, Verschure across studies and to establish the dosing and duration of the P, et\u00a0al. The visual amplification of goal\u2011oriented movements rehabilitation. counteracts acquired non\u2011use in hemiparetic stroke patients. J\u00a0Neuroeng Rehabil 2015;12:50. References 18.\t Maceira\u2011Elvira P, Popa T, Schmid AC, Hummel FC. Wearable technology in stroke rehabilitation: Towards improved diagnosis 1.\t Castel\u2011Lacanal E. Sites of electrical stimulation used in neurology. and treatment of upper\u2011limb motor impairment. J\u00a0Neuroeng Ann Phys Rehabil Med 2015;58:201\u20117. Rehabil 2019;16:142. 2.\t Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct Symposium on Holistic Rehabilitation current stimulation\u00a0(tDCS) for improving function and activities of daily living in patients after stroke. Cochrane Database Syst Eight weeks of high\u2011intensity interval static strength training improves skeletal muscle atrophy and motor function in aged rats Lei Fang S120\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration Associate professor of School of Rehabilitation Science, Shanghai Lijuan Ao University of Traditional Chinese Medicine Background: Sarcopenia is a syndrome characterized by Professor & Dean of School of Rehabilitation, Kunming Medical the loss of skeletal muscle mass and strength. Most studies University, Yunnan, 650500 have focused on dynamic resistance exercises for preventing 1. Brief introduction of focused ultrasound\u00a0(FUS) Human can muscular decline and maintaining the muscle strength of older hear sounds within frequency from 20\u00a0Hz to 20,000\u00a0Hz. The individuals. However, this training mode is impractical for older frequency of ultrasound is above 20,000\u00a0Hz so that cannot be people with osteoarthritis and a limited range of motion. The perceived by human and has long been widely used in clinical static strength training mode is more suitable for older people. practice as imaging methodology and physiotherapy. Focused Therefore, a determination of the effect and mechanism of ultrasound is namely ultrasound that works in a focused way. static strength training on sarcopenia is critical. The most frequently used analogy of FUS is a magnifying glass Methods: In this study, we developed a training device which can focus sun rays into a point. Under this condition, designed to collect training data and evaluate the effects of combustible can be fired easier within the focused point rather static training on the upper limbs of rats. The expression of than other regions. Since the discovery that sound could interact PGC\u20111 was locally blocked by injecting a siRNA at the midpoint with biological organ as well as tissue more than 100\u00a0years of the biceps to determine whether PGC\u20111 signal transduction ago, researchers devoted into biophysical effects of sound and participates in the effects of high\u2011intensity interval static FUS has aroused researchers\u2019 interests in neuromodulation training on muscle strength. Then, the rat\u2019s motor capacity was for the past decades. It has been well known that under certain measured after static strength training. Immunohistochemistry parameters, if the focus of high\u2011intensity focused and Western blotting were applied to determine PGC\u20111 \/ ultrasound\u00a0(HIFU) is put at deep biological tissue, thermal FNDC5\/UCP1 expression levels in the muscle and adipose ablation occurs in the focused region while the surrounding tissue. The serum irisin level was also detected using an tissue remains unaffected. In the year of 2016, the U.S. Food enzyme\u2011linked immunosorbent assay\u00a0(ELISA). and Drug Administration approved the first focused ultrasound Results: Increased levels of serum irisin and local expression device to treat drug non\u2011responsive essential tremor via thermal of FNDC5, PGC\u20111, and UCP1 were observed in the biceps ablation. Apart from thermal ablation, the blood\u2011brain brachii and surrounding fatty tissue after static strength training. barrier\u00a0(BBB) could be reliably, transiently and locally opened Static strength training showed an advantage in reducing via low\u2011intensity focused ultrasound\u00a0(LIFU) with the appearance body weight and white fat accumulation while increasing the of microbubbles. The blood\u2011brain barrier exists between blood muscle fiber volume, which resulted in a longer training time circulation and brain tissue, and is responsible for protecting and shorter rest time. the brain from toxins, which on the other hand hinders Conclusion: Overall, these results indicated that high\u2011intensity therapeutic agents into the brain, becoming an obstacle of CNS interval static training prevents skeletal muscle atrophy and disease treatment. BBB opening via FUS and microbubbles improves the motor function of aged rats through the PGC\u20111\/ creates conditions for neuromodulations such as delivery of FNDC5\/UCP1 signaling pathway. anticancer drugs, genes and other therapeutic agents. LIFU alone, however, has exerted its potential of modulating neuro Invited Guest Lecture activities in numerous researches. LIFU has been reported to excite and inhibit neuros reversibly, which may benefit for Setting goals in neurorehabilitation with diseases such as Parkinson\u2019s disease and neuropathic pain. ICF and WHODAS 2.0 2. Biophysical effects of FUS How FUS interacts with neuros is of great significance to understand the principle behind Leonardi Matilde neuromodulation via FUS, but it\u2019s far to get an acknowledged biophysical mechanism theory. The biophysical effects of FUS Orthotist & Prosthetist, Director,Fondazione IRCCS Istituto can be conventionally categorized into thermal effects and Neurologico C. Besta non\u2011thermal effects. At high intensities, FUS is able to locally Whenever a patient\u2019s problems are sufficiently complex to increase temperatures as to denature proteins and coagulation require the involvement of a two or more service providers necrosis occur eventually\u00a0(>56). So far HIFU ablation has been from different professions and\/or the process is continued for reported promising benefits for fibroids, essential tremor, more than a few days, then a formal goal\u2011setting process may Parkinson\u2019s disease, obsessive\u2011compulsive disorder, major be needed to derive a set of goals that motivate the patient; depression and even chronic neuropathic pain. At low ensure that individual team members work\u00a0towards the same intensities, thermal effect of FUS becomes subordinate, the goals; ensure that important actions are not overlooked; temperature changes is minimal within physiological range, and allow monitoring of change to abort ineffective activities and non\u2011thermal effects play a leading role. Non\u2011thermal effects quickly. ICF and WHODAS 2.0 are the instruments that can of FUS include mechanical pressure, radiation force, and help professional to set goals for neurorehabilitation of patients cavitation, among which cavitation plays an important role in all over the world. A\u00a0common language is what is needed and BBB opening via LIFU. When microbubbles circulate through ICF can provide it. the focused region, FUS activates microbubbles to grow, oscillate\u00a0(stable cavitation) and even collapse\u00a0(inertial Symposium on Holistic Rehabilitation cavitation), affecting cellular structure and leading to the open of tight junctions of BBB, which facilitates drugs delivery into Focused ultrasound and neuromodulation the brain. When the pressure is reduced by ultrasound or under negative pressure, sub\u2011micron gas particles in body fluids may separate from hydrophobic substances and expand to form gas microbubbles. Stable cavitation is theorized to move bilayer Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S121","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration membrane without pre\u2011injunction microbubbles and affect model. A\u00a0subsequent study further proved the value of BBB cellular membrane potentials via mechanosensitive proteins. opening via FUS in AD. In this study, transcranial FUS BBB What\u2019s more, study has demonstrated that local application of opening was carried out on TgCRND8 mouse model of AD, a FUS radiation force causes tissue replacement, which in theory reduction of plaque pathology was also observed without will affect mechanosensitive ion channels and eventually additional therapeutic agents administered. Endogenous change activity state of neuros. 3. Applications of FUS antibodies are found bound to A plaques and glia activation neuromodulation At present, the commonly used was enhanced, which may contribute to internalization of A. neuromodulation methods include deep brain stimulation\u00a0(DBS), Apart from disorders mentioned above, other diseases such transcranial direct current stimulation\u00a0(tDCS) and transcranial as brain tumor, obsessive\u2011compulsive disorder, major magnetic stimulation\u00a0(TMS). Deep brain stimulation\u00a0(DBS) is depression and even neuropathic pain also benefit from FUS a surgical neuromodulation procedure that need electrode ablation and opening of the BBB in various degree. 4. Our implanted into certain regain to block abnormal neural activities. practice We are fascinated by the \u201cmagical\u201d biophysical effects One of disadvantages of DBS is its invasive nature, which of FUS and have been working hard for years in therapeutic accordingly increases the risk of inflammation. TMS as well as effects and the mechanism behind. Our published or on\u2011going tDCS are noninvasive. TMS can effect at the surface of the studies involve:\u00a0(1) the effect and mechanisms of BBB opening brain with centimeter\u2011level, while FUS can achieve millimeter with FUS.\u00a0(2) lipid PLGA hybrid bubbles manufacturing.\u00a0(3) or even submillimeter resolution. The same as TMS, tDCS treating diseases such as AD, PD and neuropathic pain via possesses unsatisfied anatomical resolution. FUS is emerging FUS. Our latest work demonstrated that LIFU is effective at as an innovative neuromodulation methodology. The alleviating neuropathic pain by increasing the expression of advantages of FUS neuromodulation are attractive: noninvasive, KCC2 and inhibiting of CaMKIV\u2013KCC2 pathway in L4\u2013 high resolution, the compatibility with other imaging methodology L5\u00a0section of rats with peripheral nerve injury. We have been such as MRI which facilitates real\u2011time location and monitoring paying much endeavor seeking evidence about effectiveness during FUS procedure. These advantages are driving FUS of FUS in the treatment of interested disorders and will go for toward disease\u2011treating researches and clinical practice. As it continuously. 5. Conclusions FUS is becoming a candidate one of the most common movement disorders, essential tremor of cerebral surgery. thermal ablation of targeted nuclei may is a highly disabling disease, with incidence estimated at normalize brain activities so as to improve motor function such 0.3\u20115.6%, and the incidence increases with age. For patients as essential tremor and Parkinson\u2019s disease. FUS induced with essential tremor who have not respond to medications, BBB opening provides possibilities to delivery drugs which surgical treatment, usually thalamotomy may be consider and cannot easily access into the brain under physiological FUS is one of the alternative choices. Studies have conditions. Increased permeability of BBB is a low\u2011cost choice demonstrated the effectiveness as well as feasibility of because of high utilization rate of therapeutic agents when transcranial FUS ablation in treating essential tremor. Elias dealing with cerebral tumors. The potential of stimulating and et\u00a0al. carried out MRI\u2011guided FUS thalamotomy on 57\u00a0patients inhibiting neural activities makes FUS a possible candidate for with other 19\u00a0patients treated sham procedure. The mean score movement disorders or even psychiatric illness. Overall, FUS for hand tremor improved by 47% at 3\u00a0months. With the is an innovative neuromodulation methodology. It is noninvasive, promising effect of FUS ablation on essential tremor, low\u2011cost and precise. The improvement of FUS technics will MRI\u2011guided FUS ablation has been approved by U.S. Food move us further to understand mechanisms behind FUS and and Drug Administration to treat essential tremor and the may revolutionize the way that people deal with neurological approval to treat Parkinson\u2019s disease is pending. Parkinson\u2019s and psychiatric diseases. disease\u00a0(PD) is a progressive neurodegenerative disease. Tremor, bradykinesia, stiffness and postural instability are Paediatric rehabilitation common symptoms of PD. The symptoms can be alleviated by medications while the neurodegeneration progress cannot be Luh Karunia Wahyuni stopped. Studies of dealing PD with FUS involve ablation, BBB opening and the stimulation of brain circuits. Thalamotomy of Physiatrist, Head of PMR, RSCM\u2011University of Indonesia the ventral intermediate nucleus via MRI\u2011guided FUS ablation Children with disabilities are experiencing significant challenges significantly reduced PD patients\u2019 tremor and increased the to service access due to suspension of in\u2011person medical quality of life. BBB opening can serve as an effective gene rehabilitation management during the current COVID\u201119 therapy strategy. Delivery of glial cell line\u2011derived neurotrophic pandemic. Access to routine but essential services for child factor\u00a0(GDNF) gene exerted neuroprotective effect and health and development, such as developmental monitoring improved motor\u2011related behavioral abnormalities in a muse and support services, are very limited in this pandemic era. model of PD. Recently a study reveals that noninvasive deep The impact of these service changes was compounded by brain stimulation of the subthalamic nucleus or the globus the closure of services that provide therapeutic interventions, pallidus via FUS improves motor function of PD mice and education, formal and informal supports. Simultaneously, protects the dopamine neurons. As the most common families were dealing with additional stressors such as neurodegenerative disorder, Alzheimer\u2019s disease\u00a0(AD) posts self\u2011isolation\/quarantine, fear of transmission, financial loss, great challenge to modern medicine. The situation of AD is inadequate food and medical supplies, relationship stress similar to PD, that is there are symptom\u2011relief medications but and stigma. Children are also experiencing loss of routines, no curative approach exists. In 2010, a study of Jord\u00e3o et\u00a0al. frustration, boredom, lack of contact with close family provided evidence that BBB opening via MRI\u2011guided FUS members\u00a0(e.g.\u00a0grandparents) or friends. Even though enhanced delivery of intravenously\u2011administered antibodies restrictions are loosening, families are still reluctant to take and amyloid A plaque pathology was reduced in AD mouse their children to health facilities for non\u2011urgent issues due S122\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration to concern about viral exposure or in effort to minimise the In order to establish an effective telemedicine system that burden of healthcare services. This is further exacerbating the can provide medical rehabilitation services while still ensuring \u2018inverse care law\u2019 that existed prior to the pandemic, in which the quality and standards of care for children with disability, those children from the most disadvantaged backgrounds including the education and training of the staff. and most at risk of disability are the ones least engaging and Keywords: Children with disabilities, COVID 19, telemedicine accessing the prevention and health promotion programmes. The COVID\u201119 pandemic represents a transformative shock Symposium on Dementia to our health\u2011care system. Understandably the initial focus has been on developing readiness for worst case infection burden Dementia evaluation and rehabilitation in and intensive care. There is now an urgent need to establish Japan: A\u00a0neuropsychology perspective alternate support and intervention systems for vulnerable groups, with a recent report suggesting that children with Maiko Sakamoto Pomeroy disability are experiencing significant employment stress in the family. In accordance with the WHO call for \u2018keeping each Orthotist & Prosthetist, Japan other safe and connected\u2019, we need to examine the potential Overview of Dementia in Japan It is well known that Japan has opportunities to build a service system so that children with one of the longest life expectancies\u00a0\u2013\u00a0the average life span for disabilities, and their families, are not left behind. Innovative women is 87.45\u00a0years and men is 81.41\u00a0years.[1] The average care delivery models must therefore be a focus of medical life span of both men and women has extended more than five rehabilitation care services and policy initiatives during and years in 30\u00a0years due to improvement in medical technologies following this COVID\u201119 pandemic. We must create true as well as increased health awareness. As Japan is a partnerships between parents and medical rehabilitation care super\u2011aging society, dementia is an immensely serious issue services that focus primarily on improving access to medical including diagnosis, treatment, and care. As of 2020, six million rehabilitation care by reducing barriers of time and expense people are living with dementia and is expected to increase to associated with travel and at the same time adhere to current seven million by 2025, which indicates that one out of five health protocols. Telemedicine has become one of viable elders\u00a0(over\u00a065) will be diagnosed with dementia.[1] Alzheimer\u2019s solutions to address the medical rehabilitation team shortages disease\u00a0(AD) and vascular dementia\u00a0(VaD) are the two most and geographic barriers that rural residents face and has been prominent dementia subtypes in Japan, and it was reported implemented successfully to provide specialist consultation for that VaD was more prevalent than AD until the 1990\u2019s. children with disabilities. However, the number of AD is increasing whereas that of VaD There are a few published reports describing the use is decreasing.[2] In 2019, approximately 68% of dementia of telemedicine for children with disabilities. The use of patients were diagnosed with AD, 20% with VaD, 4.3% with telemedicine has been reported to be particularly attractive Lewy body dementia, and 1% with frontotemporal dementia.[1] and equally effective as in\u2011person visits with a high satisfaction It is not uncommon to see that the family members who bring level. The reason being was because of\u00a0(a) reduced travel patients to the hospital are also elderly. This phenomenon is costs and reduced time lost from work,\u00a0(b) avoiding the need called, which means \u201colder people looking after very old for special equipment or staff during travel,\u00a0(c) decreasing people.\u201d It is a part of Japanese tradition to take care of aging stress for the child and parents,\u00a0(d) increasing the likelihood parents, and we now see sons and daughters of patients who of a successful examination and treatment by receiving care are over\u00a065 and need their own medical care. In fact, I had a in a familiar environment with less disruption to their routine. 98\u2011year\u2011old mother and 70\u2011year\u2011old daughter who both suffered Indonesia, as the largest archipelago country in the world, has from dementia. Thus, early diagnosis and early intervention is always had significant challenges in providing equal healthcare crucial for not only patients but also their families to maintain for the whole population of 276 million people spread across current cognitive and everyday functions. Dementia Evaluation thousands of islands. Therefore, the use of telemedicine can in Japan Like most countries, we use a multidisciplinary be one of the answers for this problem. The government approach to diagnose dementia. In general, patients undergo also showed support for telemedicine by the passing of The physical checkups, blood drawing and urine tests, Indonesian Ministry of Health Regulation No.\u00a020 of 2019 on neuropsychological tests, and imaging tests. The family Implementation of Telemedicine between Health Service members will be asked various questions including chief Facilities. Based on the data from the Indonesian Ministry of complaints\u00a0(i.e., memory problems, dysexecutive functions, Communications in 2020, approximately 150 million people behavioral and psychological symptoms of dementia\u00a0(BPSD) in Indonesia are daily internet users\u00a0(around 56% of the etc.) and patient\u2019s activities of daily living\u00a0(ADL)\/instrumental population). The fact that more than half of the population are activities of daily living\u00a0(IADL). Regarding neuropsychological using the internet, the use of telemedicine system is indeed tests, Mini\u2011Mental Sate Examination\u00a0(MMSE), Hasegawa promising. Dementia Scale\u2011\u00a0Revised\u00a0(HDS\u2011R), and Montreal Cognitive Telemedicine has already been used in Indonesia to bridge Assessment\u00a0(MoCA) are widely used as a screening tool in some gaps in healthcare delivery for those who live outside Japan; however, they cannot localize cerebral lesions or the metropolitan areas, or in remote and rural areas. In recent differentiate subtypes of dementia.[3] Frontal Assessment of years, online health care has also been growing, but many of Bedside\u00a0(FAB), Trail Making Test\u00a0(TMT), Clock Drawing the programmes are not yet optimized or targeted to children Test\u00a0(CDT), animal naming test, cube drawing, and Geriatric with a disability. Depression Scale\u00a0(GDS) are the examples added to assist In conclusion, Indonesia need to learn from other countries\u2019 differentiating subtypes of dementia. The Alzheimer\u2019s Disease experiences and researches about their telemedicine system. Assessment Scale\u00a0\u2013\u00a0Cognitive\u00a0(ADAS\u2011Cog) and Repeated Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S123","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration Battery for the Assessment of Neuropsychological and happy memories help the patients reduce confusion and Status\u00a0(RBANS) have been also used for both clinical and anxiety. Cognitive Simulation Therapy\u00a0(CST), Cognitive research settings. It is important to note that many Training\u00a0(CT), and Cognitive Rehabilitation\u00a0(CR) are newer and neuropsychological assessments do not have standardized seen at nursing homes and adult day services.[8] For example, norms developed based on a large pool of the Japanese Japanese dementia patients participated in CST sessions twice population; therefore, choice of tests is limited.[4] Evaluating a week for seven weeks and demonstrated significant IADL is challenging in Japan. It is ideal to conduct actual IADL improvement in cognitive function, mood, and Quality of assessments, such as Naturalistic Action Test\u00a0(NAT); however, Life\u00a0(QOL).[10] Sudoku, Kumon, cross\u2011word puzzles, and Wii we lack examiners, time, and space within clinical settings.[4] are also often used at adult day services. Occupational therapy As a result, we must rely on questionnaires, such as has been also used for dementia rehabilitation.[8] It targets Lawton\u2011Brody IADL scale, Functional Status improvements in IADL, QOL, BPSD, and caregivers\u2019 burden. Questionnaire\u00a0(FSQ), and Clinical Dementia Rating\u00a0(CDR). Music therapy and animal therapy help dementia patients While it is easy to gather information in a relatively short time, reduce anxiety and irritation, relax, and reminisce. Light these questionnaires tend to include subjective opinions. In exercise and nutrition therapy are also effective to improve addition, it is part of our culture that wives do most of the house patients\u2019 apathy, physical strength, and sleep dysfunction.[8] chores, and as a result, it is not uncommon to see male patients Nursing homes and adult day services in Japan combine these who have never cooked, grocery shopped, did laundry, or even approaches and techniques based on the patients\u2019 cognitive prepared their own clothes. This situation makes it difficult to and physical conditions as well as personal goals. Challenges compare their current IADL level to baseline\u00a0(pre\u2011dementia). for Dementia Care in Japan Due to the aging and decreasing Many Japanese men often focus on work; however, they are birth rate, we are facing financial and elderly care crisis, and usually retired when they come to memory clinics, so we must therefore, the elders\u2019 well\u2011being and independence is important. evaluate based on limited information regarding IADL. One In Saga prefecture, public halls invite local elders to activities, other factor that makes early diagnosis and early intervention such as mahjong, Shogi, dance, swimming, and so forth for challenging is our cultural aspect of overconfidence about the prevention of dementia and frail. In 2012 and 2015, the elders\u2019 cognitive function as well as a cultural stigma of mental Japanese government proposed seven core plans to prevent and cognitive disorders.[4] Even if grown children recognize and treat dementia, including training dementia supporters and their parents\u2019 cognitive decline, they may not take the parents care managers, developing local support teams, and opening to memory clinics if they refuse to go. While it is recommended \u201cDementia Caf\u00e9s\u201d as a gathering place for patients and their starting drug treatment and rehabilitation when the patient families to provide useful information and psychological exhibits Mild Cognitive Impairment\u00a0(MCI), it is not uncommon support.[1] There are approximately 8,000 dementia cafes to see patients whose cognitive and IADL functions have operating and expanding throughout Japan. Developing already declined to a moderate level of dementia. Therefore, rehabilitation models and providing the services are among the within the Japanese tradition of respecting and looking after seven plans; however, any rehabilitation approach requires the elderly, it ironically becomes an obstacle for dementia care. professionals. For example, trained clinical psychologists or Rehabilitation for Japanese Dementia patients and Family clinicians should conduct CST, CT, CR or Reminiscence Having personal goals in life can drastically reduce incidents because the sessions could be not only ineffective but of developing not only dementia but also MCI.[5] Thinking about dangerous, and the patient might have a traumatic experience. the future and setting personal goals may increase their health Thus, training dementia care professionals is one of the biggest awareness. Creating personal goals is one of the most challenges. New medication, Lecanemab, for AD was granted important aspects in dementia rehabilitation. For example, Aid by the FDA, and this news gives us hope that AD may be cured for Decision Making in Occupation Choice\u00a0(ADOC) is an iPad one day. However, it is our common understanding that society application invented to help patients develop their personal will continue to cope with dementia. It is essential to facilitate goals.[6] The ADOC consists of 95 questions with pictures, and dementia research, respect patients and their families, provide generally therapists help patients to work through ADOC. Given quality support and educate society as a whole on dementia. that the cut off score for the use of ADOC is seven points on MMSE, even moderately or severely impaired patients may be References able to use this tool.[7] When making goals, it is important to make goals personable. Respecting the patient\u2019s opinions and 1.\t Minister of Health, Labour and Welfare. Comprehensive focusing on 5W1H\u00a0(who, why, what, when, where, and how) Promotion for Dementia Care; 2019. Available from: \u200a\u00a0 https:\/\/ allows to develop customized and achievable goals.[8] The other www.mhlw.go.jp\/content\/12300000\/000519620.pdf. important aspect in dementia rehabilitation is to assess relationships between cognition, IADL, BPSD, and other factors 2.\t Nakamura S, \u200a\u00a0et al. Prevalence and predominance of Alzheimer and evaluate them routinely. Problems tend to occur when the type dementia in rural Japan. Psychogeriatrics 2003;3:97\u2011103. balance between cognitive and physical functions and living environment becomes disrupted.[8] These problems are usually 3.\t Matsuda H, Asada T, editors. Diagnostic Imaging for Dementia. not singular but intertwined; therefore, it is important to prioritize Osaka, Japan: Nagai Syoten; 2004. issues based on personal goals as well as emergency. Many approaches and techniques are used for dementia rehabilitation 4.\t Sakamoto M. Neuropsychology in Japan: History, current in Japan. Life Review\/Reminiscence developed by Robert challenges, and future prospects. Clin Neuropsychol Butler[9] is one of the oldest techniques used in Japan. As many 2016;30:1278\u201195. Japanese elders survived World War II and achieved economic development post\u2011war successes, sharing painful experiences 5.\t Boyle PA, Buchman AS, Wilson RS, Yu L, Schneider JA, Bennett DA. Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age. Arch Gen Psychiatry 2012;69:499\u2011505. 6.\t Tomori K, Uezu S, Kinjo S, Ogahara K, Nagatani R, Higashi T. Utilization of the iPad application: Aid for Decision\u2011making in Occupation Choice. Occup Ther Int 2012;19:88\u201197. S124\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration 7.\t Tomori K, Nagayama H, Saito Y, Ohno K, Nagatani R, Higashi T. intervention of speech and swallow functions. The presentation Examination of a cut\u2011off score to express the meaningful activity will focus on highlighting the salient features pertaining to of people with dementia using iPad application\u00a0(ADOC). Disabil speech and swallowing problems in individuals with MND and Rehabil Assist Technol 2015;10:126\u201131. will touch upon intervention strategies for the same. 8.\t Tahira T, Tanaka H, editprs. Dementia Rehabilitation Based on Rehabilitation in Intensive Care Unit Evidence. Tokyo, Japan: Igaku Shoin; 2020. Follow\u2011up of patients with post\u2011acute covid 9.\t Butler RN. The life review: An interpretation of reminiscence in syndrome through online telerehabilitation the aged. Psychiatry 1963;26:65\u201176. and non\u2011immersive virtual reality 10.\t Yamanaka K, Kawano Y, Noguchi D, Nakaaki S, Watanabe N, Amano T, et\u00a0al. Effects of cognitive stimulation therapy Japanese Marcos Maldonado, Josefina Garc\u00eda Huidobro, version\u00a0(CST\u2011J) for people with dementia: A\u00a0single\u2011blind, Ricardo Vasquez controlled clinical trial. Aging Ment Health 2013;17:579\u201186. Department of Physical Medicine and Rehabilitation, Outpatient Symposium on Motor Neurone Disease Neurorehabilitation Unit, Clinica Alemana\u00a0\u2011\u00a0Universidad del Desarrollo. Santiago, Chile E\u2011mail:\[email protected] Speech and swallowing disorders in MND Background: Covid\u201119 survivors, especially those who required ICU ventilatory support and with prolonged length of Mansi Jagtap stay in ICU may develop residual deficits such as neuropathies, myopathies, and deconditioning critically illness seen as part Assistant Professor, Bharati Vidyapeeth Deemed University, Pune, of critical care episodes. Therefore, they are more likely to Maharashtra, India need ongoing rehabilitation. A\u00a0classification was established Motor neuron disease is a group of conditions affecting the by Nalbandian et\u00a0al. that those patients whose symptoms motor neurons which play a vital role in gross and fine motor were persistent, generating late or long\u2011term complications. skills. Speech and swallowing are complex functions which It was divided into two categories:\u00a0 (1) subacute or ongoing are governed by these neurons, and hence, can be impaired symptomatic COVID\u201119, which includes symptoms and in individuals with MND affecting the bulbar region\u00a0(head abnormalities present 4 to 12\u00a0weeks after acute COVID\u201119; and neck region). Research reveals that 25% of patients and\u00a0(2) chronic or post\u2011COVID\u201119 syndrome, which includes with MND present with affected speech\u00a0(dysarthria) and\/or symptoms and abnormalities that persist or are present swallowing\u00a0(dysphagia) skills at time of disease onset. These beyond 12\u00a0weeks from the onset of acute COVID\u201119 and not primarily stem due to affected oromotor structures\u00a0(atrophy and attributable to alternative diagnoses. There is concern regarding wasting) and function\u00a0(weakness, spasticity, reduced range the effectiveness of rehabilitation, particularly if systematic of motion) like tongue, jaw, palate, lips as well as pharyngeal evaluations are not carried out that will make it possible to know and laryngeal area. Mixed dysarthria of flaccid\u00a0\u2013\u00a0spastic origin the evolution of recovery objectively. Therefore, the evaluation is frequently encountered due to involvement of upper and of functional capacity in these patients has become an important lower motor neurons. These involve multiple subsystems like issue to estimate functional consequences, disability and respiration, phonation, resonance, articulation and prosody, desaturation during physical exertion. Although there are leading to poor speech intelligibility. Oropharyngeal dysphagia national and international guidelines that recommend specific poses health risks among patients with MND. Reduced speech evaluations and treatments, the evidence is still scant on how intelligibility and oropharyngeal dysphagia affect the quality of to perform virtual evaluations and treatments\u00a0(including stress life of these individuals. As MND is a progressive degenerative tests) in patients with cardiopulmonary disease. However, condition, a deterioration in the severity of dysarthria and a recent systematic review concluded that many functional dysphagia is commonly noted. Those patients who revealed exercise tests can be performed virtually at home with minimal normal speech and swallowing skills at disease onset may show equipment\u00a0(for example, 1\u00a0minute sit\u2011and\u2011stand\u00a0(1\u2011MSTST) bulbar symptoms as disease spreads and progresses to the tests, 4\u2011meter walking speed\u00a0(4MGS), battery Short Physical head and neck region. Since the rate of progression is variable Performance Test\u00a0(SPPB) and various step tests. It was among patients, Speech language pathologists play a vital role determined that the 1\u2011MSTST could be a practical, reliable, in detailed and regular assessment of speech and swallowing valid and responsive alternative to measure physical capacity, functions so as to identify early signs of deterioration and plan and has shown a significant correlation with clinical outcomes appropriate intervention. Universally used scales like ALS in subjects with lung disease and chronic obstructive disease. functional rating scale, Norris scale provide valuable information To carry out this therapy, tele\u2011rehabilitation programs use on disease progression, however, should be cautiously appropriate technology that has the potential to help in interpreted with respect to bulbar functions as these are situations like this. Patients must be offered a fast and easily weighed more to evaluate overall motor functioning with lesser accessible therapeutic method. This can be delivered in a focus on speech and swallowing problems alone. Detailed number of ways, either synchronously or asynchronously, assessment of speech sub systems, speech intelligibility and using non\u2011immersive virtual reality\u00a0(NIVR). The latter is swallowing skills using standardized protocols are helpful in less well known, but has proven to be effective as it meets charting these functions more specifically. Intervention depends several criteria: it provides cognitive\u2011motor training, follows on various factors, especially the stage of disease. It could evidence\u2011based neuroscience principles, offers motivational either aim to improve the function or facilitate compensation. activities and empowerment techniques. This helps promote In end stage cases however, palliative care in form of enteral feeding and alternative modes of communication are preferred when no meaningful speech and safe swallow is possible. SLP play an important role in determining candidacy for adequate Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S125","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] IFNR Oration self\u2011confidence, self\u2011management, self\u2011efficacy and, therefore, Reality\u00a0(NIVR): The median days of training were 18\u00a0(IR 12\u201140), independence, promoting recovery and a higher quality of while the median days of NIMV and IMV were 11\u00a0(IR 3\u201111) life for patients. Thus, the purpose of this study is to describe and 10\u00a0(9\u201115) respectively. The initial gait speed test\u00a0(4MGS) the experience of the home hospital rehabilitation care model reported a median of 0.55\u00a0(IR 0.50\u20110.95) and a final median for patients with post\u2011acute covid syndrome, carried out of 1.20\u00a0(IR 1.10\u20111.60). The initial median MOCA score was through evaluation, intervention and follow\u2011up through online 27\u00a0(IR 27\u00a0\u201128) and final 28\u00a0(IR 28\u201128). The Minibestest showed tele\u2011rehabilitation\u00a0(OTR) and a non\u2011immersive virtual reality an initial median of 20\u00a0(IR 20\u201123) and final 27\u00a0(IR 26\u201128). The program\u00a0(NIVR) level of difficulty of the LLR and the SST presented a median Methods: This was a descriptive, retrospective study of 57\u00a0(IR 50\u201157) and 20\u00a0(IR 18\u201125) respectively, while the conducted in a private clinic in Santiago de Chile, with all performance showed a median of 90\u00a0(IR 45\u201191). Finally, the patients with post\u2011acute covid syndrome between March functional evaluations of the initial and final gait were 27\u00a0(IR and May 2021. All were evaluated by a physiatrist prior to 21\u201127) and 29\u00a0(IR 28\u201130), respectively. discharge, if met the rehabilitation objectives and the inclusion Discussion: The most important finding of this study was that criteria\u00a0(without ventilatory support, stable hemodynamics, 49\u2011year\u2011old adults with post\u2011acute covid syndrome achieved FSS\u2011ICU\u00a0>\u00a033, Medical Research Council\u00a0(MRC) 4 or 5 in each good results on the 1\u2011MSTST after 5 sessions or 150\u00a0minutes muscle group), they were proposed to participate in the study of training, which implied no functional limitations at the end of and after the signed informed consent, both training modalities treatment. These results are also appreciated in VR training. were offered. If the patient had impaired balance, according According to the evidence, the mean number of 1\u2011MSTST to the Minibestest\u00a0(MBT) training with NIVR was suggested. repetitions reported in the literature achieved ranged from Suggested training data for patients with synchronous OTR and 8.1\u00a0(patients with stroke) to 50.0\u00a0(young men). Therefore, the asynchronous telerehabilitation were analyzed through NIVR. results obtained in this study are within these ranges. The 4MGS A\u00a0formal sample size calculation was not performed; therefore, had the best correlation with exercise tests; however, it may be the type of sampling was non\u2011probabilistic consecutive. difficult to standardize in a home environment during a virtual The data evaluated in the case of OTR were: Non\u2011\u00a0Invasive assessment. In the case of training with NIVR, changes were Mechanical Ventilation; Invasive Mechanical Ventilation; observed, which could be associated with a better functional Treatment in the prone position; Length of stay in ICU. The state, according to the PFCS. NIVR would have an advantage following clinical parameters were considered: Heart rate; The over OTR, since it favors the patient\u2019s self\u2011efficacy and could oxygen saturation; Sit to Stand test in one minute\u00a0(1\u2011MSTST); accelerate the acquisition of autonomy, directly influencing The Short Physical Performance Battery\u00a0(SPPB); The its functionality. In turn, the quantification of training allowed Post\u00a0\u2011\u00a0COVID\u201119 Functional Status Scale\u00a0(PCFS) survey; the to identify parameters related precisely to training, such as: number of sessions performed and adherence to rehabilitation. training time, level of difficulty, performance, response time In the case of NIVR, the following parameters were evaluated: and these data can be correlated with clinical data. In contrast, Non\u2011\u00a0Invasive Mechanical Ventilation; Invasive Mechanical OTR preserves the classic paradigm of care directed by the Ventilation; The length of stay in ICU; Functional Status physiotherapist in face\u2011to\u2011face rehabilitation and the black Score for the Intensive Care Unit\u00a0(FSSICU) at discharge; box of non\u2011training time. A\u00a0limitation of this study is the size of Montreal Cognitive Assessment; Minibestest; Functional the sample and the challenge for a future study is to measure Gait Assessment; 4\u2011meter walking speed\u00a0(4MGS); The the same clinical parameters, before and after treatment, Post\u00a0\u2011\u00a0COVID\u201119 Functional Status Scale\u00a0(PCFS) survey. regardless of the therapeutic alternative used. A\u00a0strength was The total training time, the level of difficulty, the performance, that the institutional service previously had a measurement and the level of adherence to the sessions were identified, and treatment system for cardiovascular and neurological patients, in parameters related to the response time achieved against low addition to training with OTR and NIVR, which made it possible limb resistance\u00a0(LLR) and sitting\u2011standing exercises\u00a0(SST) were to unify criteria and gradually add strategies for more efficient evaluated. A\u00a0descriptive analysis of the data was carried out, rehabilitation. In conclusion, as that in other studies it seems the means and deviations or medians and interquartile ranges that the virtual evaluations and treatments responsive and then were obtained for the quantitative variables depending on the are a reliable and valid tool to assess the physical capacity in distribution of each variable and for the qualitative variables the older adults and chronic obstructive pulmonary disease\u00a0(COPD) absolute frequencies with their respective relative frequencies patients. Additional to, this study is a first approach to the were calculated. evaluation and treatment of these patients in these very adverse Results: The average age of the 45\u00a0patients assigned to conditions given the pandemic. It\u00a0\u00d7\u00a0s hope that the future OTR was 49.7\u00a0years\u00a0(SD 10.3), while the average age of the studies to have a larger sample of patients and a more rigorous 5\u00a0patients assigned to NIVR was 62.4\u00a0(SD 4.6), in both groups systematization of information, which serves as input and support the percentage of male participants exceeded the 70%. Online to improve, propose and evaluate a training process. telerehabilitation\u00a0(OTR): The median in minutes of training was 150\u00a0(IR 30\u2011300), while the median of the days of NIMV and Experience of neurorehabilitation in Latin IMV were 7\u00a0(IR 5\u20119) and 6\u00a0(4\u201111) respectively, the correlation America during COVID\u201119 between the days of training and heart rate was\u00a0\u20110.44\u00a0(p value\u00a0=\u00a00.05). The median of 1\u2011MSTST was 29\u00a0(IR 24\u00a0\u2013\u00a035). Marcos Maldonado\u2011D\u00edaz The median values of the PCFS scale in the initial evaluation were 1\u00a0(IR 0\u20113) and in the final evaluation they were 0\u00a0(IR 0\u20110) Orthotist & Prosthetist, Outpatient Neurorehabilitation Unit, Physical showing statistically significant differences\u00a0(p value\u00a0<\u00a00.001). Medicine and Rehabilitation Service of Clinica Alemana, Universidad Finally, adherence to training was 51%. Non\u2011\u00a0Immersive Virtual del Desarrollo, Santiago, Chile E\u2011mail:\[email protected] S126\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Invited Lecture Summaries Title what can we learn from the dysphagia on August 19\u201133. of Wallenberg syndrome: Disruption Under the pandemic of COVID\u201119, rehabilitation for our dysphagia patients is faced with many challenges. To of the obligatory swallowing sequence, successfully treat these patients, it is essential to go back to factors affect the severity, and effective the basics and choose a rehabilitation program that is based on the physiology of swallowing. rehabilitation? In addition, to provide care sustainably with limited medical resources, it is necessary to consider how to discharge Mari Nakao patients from the hospital to the community or home safely. Good cooperation and information sharing between community Physiatrist, Japan professionals and hospital professionals are required now Invited guest lecture: 7th\u00a0August 12:00\u00a0\u2013\u00a012:30 IST more than ever. We have created a tool called the \u201cNiigata Dysphagia is disorder with swallowing. In Europe 30\u201140% in dysphagia management diary\u201d to share information between independent older people, in United States 6\u201110 millions people, community care workers, families, patients themselves, and and in Japan more than one million people is estimated to their physicians. This tool can be used as an example of suffer with dysphagia. To find out the clue for the treatment of multidisciplinary team approach not only in hospitals but also dysphagia, understanding swallowing physiology is important. in the whole community to realize \u201cHolistic rehabilitation from Wallenberg syndrome is a specific series of symptoms hospital to home\u201d. We hope that you will find this tool useful. including dysphagia caused by lateral medullary infarction. To understand swallowing physiology, role of medulla and it\u2019s Autism and Aquatics disorder supply important information because central pattern generator\u00a0(CPG) for swallowing, which produce rhythmic motor Meredith Morig pattern of swallowing movement, is situated. We studied and published in 2019 about the differences in Pediatric Occupational Therapist & Clinical Instructor, PremaPlay, swallowing dynamics between 35\u00a0patients with Wallenberg Sanford, USA syndrome and normal subjects on the previously published Autism Spectrum Disorder is a developmental disability that articles. In this study, we found that the majority of the can cause significant social, communication and behavioral patients with Wallenberg syndrome had a reversal of the challenges. The learning, thinking and problem solving abilities swallowing dynamic sequence that always occurs in normal of people with autism can range from gifted to severely subjects\u00a0(obligatory sequence). In this lecture, we will report challenged. In addition, many people with autism demonstrate on this study in detail. difficulty processing sensory stimuli, have trouble understating In addition, subsequent studies have shown that the severity other people\u2019s feelings or talking about their own feelings, of dysphagia in Wallenberg syndrome is related to the vertical appear to be unaware when people talk to them, repeat or extent of the lesion rather than the horizontal extent of the echo words or phrases to them and have trouble expressing lesion on the MRI. their needs using typical words or motions. The water provides We present a rehabilitation program that is indicated for the 30\u00a0times more proprioceptive input than land, giving people dysphagia of Wallenberg syndrome. In Wallenberg syndrome, with autism, constant deep pressure and input throughout the the inability to open the upper esophageal sphincter\u00a0(UES) on entire body. This can organize a person\u2019s sensory system, the affected side\u00a0(sometimes bilaterally) has been the focus of improve attention and processing and ultimately improve body much attention, and rehabilitation has been applied clinically to awareness. With increased body awareness, skills requiring address this problem. For example, the head lifting exercise, coordination will improve. The water challenges a person\u2019s also known as the Shaker exercise, is known to strengthen the ability to multi task by requiring use of bilateral coordination, muscles that tract UES on the opening, such as the Geniohyoid trunk strength and visual spatial awareness simultaneously. muscle. In addition, balloon dilatation exercise of the UES is In addition, the water is very motivating and provides also a clinically used technique. Postural adjustment\u00a0(reclining many opportunities for functional communication. Although method) to control the flow of bolus by gravity, head rotation communication for people with autism can appear challenging, to open the UES on the unaffected side is also clinically it is important for them to feel heard and understood, even if it performed. means communicating a little differently. There are many ways If we focus on the sequential disorder of Wallenberg syndrome, that communication, activities and exercises can be adapted other rehabilitation options may be considered in addition to to benefit from the properties of water and ultimately improve these. Here, we report our training experience. We have studied functional skills. When working with people with autism, it is six cases of brain stem stroke\u00a0(five cases of lateral medulla, important to embrace any differences and support them. The one case of pons). We performed exercise\u2011based rehabilitation water provides us the perfect environment to do just that. in six cases of brain stem stroke patients\u00a0(five cases of lateral medulla, one case of pons) for three weeks. The program was Music therapy in neurorehabilitation the McNeil Dysphagia Therapy Program\u00a0(MDTP) developed by Carnaby\u2011Mann and Crary. All patients started training with Michael Thaut a Functional Oral Intake Scale\u00a0(FOIS) Lv. 5 and improved to a FOIS Lv. 7 within 3\u00a0weeks. This result suggests that motor \u200aProfessor of Music at the University of Toronto\u00a0with cross- learning through repeated swallowing exercises can improve appointments in Rehabilitation Science and Neuroscience, Director sequential disorder. A\u00a0detailed analysis of this study will be of the University\u2019s Music and Health Science Research Center presented at the World Dysphagia Summit @ Nagoya, Japan (MAHRC) \u00a9 2022 Physiotherapy - The Journal of Indian Association of Physiotherapists | Published by Wolters Kluwer - Medknow\t S129","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Invited Lecture Summaries A summary of new data in clinical music neuroscience research and land based therapies: 1] 2\u00a0 month old Spastic Dystonic and translations to Neurologic Music Therapy. Cerebral Palsy[PVL\u2011grade\u00a04] We worked on him through tele rehab where Mother worked with him in pool almost 4 to5\u00a0days Aqua Therapy a week in small pool and we made significant changes in terms of helping him come out of severe extension and move his body Paediatric aquatic therapy, application in and extremities freely as well as better Head control, achieved early intervention rolling and ability to sit with support in a period of 5\u00a0months. 2]A child with multiple issues and Global development Delay, how Mona Patel he achieved all his milestones from head control to independent \u200aPaediatric Physiotherapist, & Paediatric Aquatic Therapist, SPARSH walking in period of one and half year[starting when he was Paediatric Rehabilitation Clinic 3\u00a0month old till 2\u00a0years] 3]A 3\u00a0year old with Lt Hemiparesis\u00a0\u2013\u00a0I Summary: I\u00a0 will be discussing why early intervention is will be sharing gains we achieved at all the levels of ICF. important and how aquatic therapy helps in early intervention Research References for Aquatic therapy in Early Intervention: and will be supporting it with my case studies and references 1] The effect of aquatic therapy on functional mobility of infants from research. Why early intervention is important: As Karen and toddlers in early intervention\u00a0[Beth M McManus, Milton Pape\u00a0[Neonatologist] explains in her book, Baby brain if suffers Kotelchuck] 2] Effect of aquatic physical therapy on pain and damage has 2 task at hand 1) To grow 2) To recover from state of sleep and wakefulness among stable preterm newborns damage Baby brain gets double in weight by 6\u00a0months and in neonatal intensive care units[Carine Moraes Vignochi 1, 75% by 2\u00a0years and 90% by 4\u00a0years So it is very important Patr\u00edcia P Teixeira, Silvana S Nader] 3] Aquatic therapy for a to start early as synaptogenesis hits its peak at 2\u20113yrs of age child with type\u00a0III spinal muscular atrophy: a case report\u00a0[Yasser so we have to start treating early so that we can: 1) Maximize Salem 1, Stacy Jaffee Gropack]. neuroplasticity 2) Minimize maladaptive habits HOW DO WE DO IT By providing stimulation through enriched environment. Symposium on Movement Disorder Water has a very rich sensory motor environment. How Aquatic therapy has an edge as a therapeutic tool for Early intervention Post stroke movement disorders and for kids with neuro motor challenges: 1]Better self\u2011regulation management and better sleep 2]Better Participation 3]Better postural control\u00a0(anticipatory and reactive control) 4]Pain free elongation Muhammad Umar of spastic and tight muscles 5]Helps reduce hyperreflexia and hypertonicity[spastics] 6]Better core activation\u00a0(both inner Orthotist & Prosthetist, Pakistan and outer core) 7]Better medium for easy and efficient fascial Post stroke movement disorders could be many and have release 8]Better sensory feedback both somatosensory and different time frame for their development. The lecture will vestibular[For Hypotonics as well as for Kids with ASD and highlight both the hypokinetic and hyperkinetic post stroke ADHD] 8]Helps to reduce involuntary movements\u00a0(dystonia movement disorders and their management. and athetosis) 9]Helps to improve balance as gives patient more time for problem solving and Balance restoration. Less Experience of COVID 19 and risk of falling 10]Lots of opportunities for rotations which Neurorehabilitation Symposium further helps reduce spasticity 11]Lots of opportunities for dissociation and selective muscle facilitation 12]Advantage of View Point from Pakistan changing environmental context\u00a0(land and water) as a result skill that develops can be easily generalized which in turn Muhammad Naveed Babur helps facilitating motor problem solving ability 13]Easy and quick changes between varied range of functional training Physiotherapist, Pakistan options 14]Better speed and endurance 15]Reaction time Severe acute respiratory syndrome coronavirus 2 or more reduces and performance in sequential motor task improves commonly known as COVID 19 has caused devastation 16]Brain plasticity\u00a0\u2011\u00a0physical exercise with some kind of quality\/ throughout the world since its first discovery in December 2019. intensity and environmental enrichment 17]Environment Since then this historical pandemic has spread across globe Enrichment\u2011\u00a0enhanced Sensory, motor, cognitive and social wreaking havoc and effecting all countries alike. The World stimulation, easily possible with water 18] Infant seek lot of Health Organization\u00a0 (WHO) has classified the coronavirus sensory motor stimulation, water provides ideal environment epidemic as a global public health emergency of international 19]Evidences on immersion causing increase in attention and concern. Like other countries Pakistan has also been severely memory as well as improvement in executive function 20] Better affected by this pandemic and since report of first in late brain blood flow We use Water specific therapy as primary tool February 2020 the cases have been continuously on the rise. for treating our infants and toddlers in pool but also as part of my Following this there was a significant surge in positivity due to diversified practice, I combined principles of lot of approaches influx of infected pilgrims from Iran. In addition to this only within like Total motion Release toddler and teens\u00a0[TMRTOTs], in 15\u00a0days of report of first case the cases plummeted to 202 Neuro Development Treatment[NDT] as well as using different infected patients. Such situation was expected considering the approaching primarily focusing on facilitating postural control low literacy rate, general lack of awareness regarding COVID and motor control along with Water Specific Therapy in My leading to non\u2011serious behavior of people towards the adoption Aquatic Practice. I\u00a0will be presenting 3\u00a0case studies where how of social distancing, hand hygiene and other COVID SOPs. we made significant changes with combined use of aquatic Like other lower middle income countries Pakistan is has scarce S130\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Invited Lecture Summaries hi end medical facilities and have inadequate health strategies. rehabilitation were converted to COVID beds and inpatient This along with high population density in major cities with Neuro rehabilitation services were halted. This resulted in public having unresponsive attitude of towards general disruption of care for Non COVID Patients requiring continuous protective measures contributed to increase in number of cases. support and care such as, Stroke patients, SCI patient, Children Since Feb 2020 Pakistan is continuously struggling to flatten with Cerebral palsy and elderly etc., for some time but was the curve but has seen 3 Waves of COVID 19 and is now somewhat catered for by provision of tele rehab services, home preparing for delta wave. The Govt has been trying its best to health services and outpatient services. Similar to this at some tackle this challenge considering all ways of life to prevent any places specialized Rehabilitation Hospitals were also converted major setback with major focus on healthcare provision. The to COVID hospital and isolation Centers. This is evident from country minister and Chair of National command and operation the fact that the country\u2019s largest dedicated tertiary care center managing all COVID related issues said \u201cThe target is Physical rehabilitation hospital with more than 100 bed facility to prevent healthcare system from getting choked besides providing a range of comprehensive and multidisciplinary reducing hunger, poverty, unemployment due to COVID\u201119\u201d. services to people with disabilities was converted to 130 bedded For said purposes number of steps have been taken including quarantine and Isolation facility. Limited services in some complete lockdown on march 23rd\u00a02020 including closure of all facilities and closure of other neuro rehabilitation facilities educational institutes, recreational centers, wedding halls etc., resulted in overwhelming patient presence and intake in other However, the struggling economy of the country forced the neuro rehabilitation centers of the regions. This resulting in government to lift the lockdown on May 9, 2020. As COVID increased demand of admission in neuro rehabilitation services significantly impacted countries economy as evident from the having limited work personal eventually exhausting resources fact that National Poverty rate increased by 33 Percentage including human resources. While some facilities were points during the Lockdown and closure of different sectors completely shut down access to others was difficult. To curb resulted in drop in GDP and loss of Rs. 1.3 trillion to counties the increasing number of cases the govt instituted suspension economy, the counties focus shifted from complete lockdown of all trains and inter district Passenger transit including urban to selective smart lockdowns of hot spots with relation to passenger transit. This was in addition to imposition of ban on infection rate. Current stats show that since Feb 2020 Pakistan movement of elderly, children and people with health issue. has seen over\u00a01.03 Million Confirmed cases of COVID 19 with Considering the fact that almost 70% of counties population currently having over\u00a070 thousand active cases. Majority of live in peripheries the individuals with specialized neuro cases being reported are from Sindh and Punjab, two provinces rehabilitation needs were unable to access care. Due to difficult with major population chunk. COVID\u201119 posed unprecedented of in some cases complete lack to any transportation. Similar challenges to states and communities across the globe. Like to people, neuro rehabilitation professional also faced difficulty in many other countries, the health sector in Pakistan has Putin accessing patient receiving care in home based setting. massive efforts to control the spread of this pandemic in Considering the restrictions imposed by the healthcare Pakistan and to care of the ill presenting in any health setting. authorities in the movement of people to prevent the spreading The pandemic has put healthcare professionals working in of the infection. This situation had a significant negative impact ERs, ICUs, Laboratories, and other departments in an in the short term, mainly for those patients at higher risk of unprecedented situation, with difficult decision options and deterioration of their functional abilities due to lack of intense pressure for maneuvers. This significantly impacted rehabilitation care. In addition to this Physical distancing and the healthcare system resulting in. \u2022 Hindrance to elective isolation measures implied the suspension of physiotherapy healthcare services \u2022 Limited patients\u2019 access to accident and services, which impacted negatively on patient\u2019s quality of life emergency departments \u2022 Changes in patient administration and health and impaired physiotherapists ability to manage the systems such as shift to telephone consultations instead of continuum of care for patients with chronic neurological face to face consultations resulting in Surge towards the use conditions such as Stroke, SCI, Parkinson\u2019s etc., COVID 19 of telemedicine \u2022 Increased need for multidisciplinary team also resulted in reappropriation of not only physical resources collaboration to manage covid patients \u2022 Need for increased but also human resources from specialized neuro rehabilitation heath care capacity including increase in intensive care units units to intensive care units to care for COVID 19\u00a0patients. This beds, staff and supplies such as PPEs, Masks, Ventilators etc) predominantly due to significant patient intake of COVID but \u2022 Special emphasis being put on Physical and psychological also due to non\u2011availability of staff as a result of COVID infection pressures in health care workers in Pakistan due high risk of or isolation. In addition to this manpower from orthotics and infection, inadequate equipment for safety from contagion, prosthesis sector was also shifted from developing orthotics isolation, exhaustion, and lack of contact with family Similar to and prosthesis to development and production of Masks and all aspect of Health care Rehabilitation care especially Neuro PPEs to cater for the limited supply and increased demand of Rehabilitation has also been impacted due to COVID 19. masks and PPEs. This resulted in significant delays in COVID 19 has increased the need for rehabilitation services development of Orthosis and prosthesis from neuro rehabilitation in Intensive care rehab and for patient with post COVID long patient requiring some form of support orthotics etc., Physical term complications. For such purpose in country like Pakistan and mental health of the work staff and health professionals where health facilities had limited capacity, special measures was also one of the issues faced during the recent COVID 19 were taken for conversion of different departmental wards into pandemic. Long working hours with increased physical work COVID isolation units, High dependency units and ICUs to demand resulted in health professional with significant physical have more beds for COVID patient to cater for increasing patient and mental exhaustion and fatigue. Mental health was further inflow. In addition to this to ensure the care of patients affected challenges in by additional emotional challenge due to by other medical conditions whose admission cannot be managing COVID patient not having contact with family postponed numerous Inpatient beds of Neurological members due to risk of virus transmission, fear of infection and Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S131","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Invited Lecture Summaries transmission. This emotional stress was in addition to stress T10 level Tightness of pectoral muscles Reduced ROM OF left resulting from witnessing deaths of COVID patients and forced shoulder. Immature weight bearing and weight shifts in sitting self\u2011isolation and monitoring at home as a result of suspected and standing Difficulty in activation and initiation of lower limb infection. All these highlighted the need for mental health care muscles Based on assessment and client expectation following for rehab and health professionals. While significant challenges goals were set: She should be able to sit independently for were identified some opportunities also raised in wake of 1 hour without support on wheel chair with appropriate neck COVID. The country lack significant barriers to tele medicine and trunk alignment Client should be able to independently and rehabilitation with lack of infrastruction, internet access, turn from supine to side lying She should be able to come awareness. COVID 19 promoted the incorporation of from side to sitting and transfer with minimal assistance telerehabilitation services to tackle the issues of limited access Client should be able to walk 10m with walker and calipers arising suspension or delay in outpatient services, ceased home independently. Her rehabilitation spanned over\u00a05\u00a0months based rehabilitation services, lack of access to health care with aquatic therapy frequency of 3\u00a0times\/week. Duration facility. In addition to this having better telehealth services in of each session was 45\u00a0mins. SCIM\u00a0\u2011III, WISCI\u2011II and FRT 3rd\u00a0world countries; International hospitals offered aid inform of were taken at baseline. Aquatic intervention were carried free online multidisciplinary rehabilitation programs, consultation out in an indoor temperature controlled pool. Therapeutic and online health scans and tailored treatment regimes for aquatic strategies that were used are Bad\u00a0\u2013Ragaz Ring patients in Pakistan, COVID also provided opportunity for health method, Water specific Therapy to improve trunk control and professional to Up skilling rehab care services provided to alignment. Other activities like upper limb strengthening with patients under infectious control protocols for such professionals equipment\u2019s, functional activities like sit to stand and walking were provided trainings related to barrier protocols and effective in water using underwater treadmill were incorporated. Results and judicious use of PPE and provision of rehab care to COVID obtained at the end of 100 sessions showed changes in the patients. All in all COVID 19 is far from over in Pakistan and following outcome measure. At baseline SCIM\u2011III was 24\/100 future policies and reforms can be carried out considering all and post therapy was 65\/100, there is also improvement in aspects of neurological rehabilitation care and current situation WISCI\u2011II which at baseline was level 0 and post intervention of COVID 19. was level 6. There is improvement in Functional reach test Acknowledgement: Dr\u00a0Muhammad Ehab Chaudhry, PhD which at baseline was 14\u00a0cm and post therapy was 35cm These scholar for acquisition of data. changes indicated there has been improvement trunk control, inter limb dissociation for walking, improved weight bearing Aqua Therapy: Case Discussion and weight shifts in sitting and standing, improved upper limb strength, improved body alignment and reduced energy Application of aquatic therapy in a young expenditure. Thus, in conclusion aquatic therapy is shown adult with spinal cord injury to be a useful tool in rehabilitation of spinal cord injury. The strategies suggested may be effective adjuncts to conventional Nidhi Agarwal, Anjali Shetty land based neurorehabilitation techniques popularly used in management of SCI. Department of Neurological Rehabilitation Aquacentric Therapy, Mumbai, Maharashtra, India AOCNR 2021 Symposium: Neuromuscular Every year 250000\u2011500000 people suffer from spinal cord Disorder injury\u00a0(SCI) globally. Majority of these cases are seen in young adults between 18\u201135\u00a0years due to preventable causes such Up\u2011close with Guillain\u2013Barr\u00e9 syndrome: as road traffic accident, falls, and violence. In India, most Variants, mimics and chameleons in the common cause is fall from height. SCI resulting in paralysis has devastating physical, mental, social, economic, sexual neurorehabilitation setting and vocational consequence for the youths with SCI. Many studies have shown benefits of aqua therapy to enhance Norhayati Hussein aerobic capacity, improve strength, endurance, improve range of motion, reduce pain and enhance sense of mobility Physiatrist, Malaysia and independence in water in SCI. People with SCI lead Guillain\u2013Barr\u00e9 syndrome\u00a0 (GBS) is an inflammatory disease sedentary lifestyles, experiencing poor quality of life and of the peripheral nervous system and is the leading global medical challenges. Aqua therapy as an adjunct to land cause of acute flaccid paralysis. The prevalence of GBS is therapy may alleviate boredom and enhance compliance. This estimated to be 1\u20133 per 100,000 worldwide, and the disease case study discusses the assessment and management with is more common in males than in females. The GBS incidence aquatic therapy of a 28\u00a0year old with spinal cord injury\u00a0(T9\u2011T10) increases with age, although all age groups can be affected. classified as grade\u00a0 A on ASIA scale, complete injury. Her The diagnosis of Guillain\u2013Barr\u00e9 syndrome is largely based on Chief complains are: Difficulty to sit independently without clinical features and supported by serological, electrodiagnostic, support Difficulty with bed mobility and dependence on all and immunological investigations. Key features are weakness, ADLS of self\u2011care and transfers. Early fatigue with upper hyporeflexia\/areflexia and raised CSF protein concentrations limb activities Difficulty in walking Based on her assessment, without pleocytosis. major impairments that were identified are as follows: Poor Patients with GBS classically presents with features of sustenance and co activation of abdominal and back extensor symmetrical sensori\u2011motor signs in the lower extremities muscles. Autonomic dysfunction Motor and sensory loss below which gradually ascends to upper extremities and may involve S132\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Invited Lecture Summaries the cranial nerves. Although this symmetrical paralysis of Nationwide health\u2011care facilities especially inpatient wards the extremities forms the classic presentation, the clinical were repurposed to treat COVID\u201119\u00a0patients. The COVID\u201119 presentation of the disease is heterogeneous, and several hybrid hospital status affects timely access to inpatient distinct clinical variants exist. There are several presentations of neurorehabilitation. Outpatient neurorehabilitation services GBS variants depending on topographical involvement. The GBS were redesigned to ensure early access to collaborative variants include classic sensorimotor, pure motor, paraparetic, interdisciplinary neurorehabilitation care via Integrated pharyngeal\u2011cervical\u2011brachial\u00a0(PCB), bilateral facial palsy with Neurorehabilitation Clinic Consultation. Specific inpatient paraesthesias, pure sensory, Miller\u2011Fisher Syndrome\u00a0(MFS) service routines were omitted to ensure reduction of and Bickerstaff brainstem encephalitis. These variants may infection risk. Neurorehabilitation routines and practices be distinct; yet often overlap and forms a continuous spectrum incorporating the \u2018Environmental Enrichment\u2019 concept; so of discrete and overlapping syndromes. The differential crucial for neurological patients were inadvertently restricted, diagnoses\u00a0(mimics) for GBS can be broadly divided into those in addition to imposing restrictions in communal activities presenting with symmetrical extremities weakness and those and visitations. Tele\u2011neurorehabilitation was swiftly adopted presenting with brainstem signs. Miller\u2011Fisher Syndrome\u00a0(MFS) to enable virtual clinic consultations and monitoring, speech and the pharyngeal\u2011cervical\u2011brachial\u00a0(PCB) variant of GBS therapy & audiological intervention, neuropsychological are frequently mistaken for brainstem stroke, botulism or assessment & treatment and promoting therapeutic exercises. myasthenia gravis. Bickerstaff\u2019s brainstem encephalitis may Interdisciplinary conferences and educational training be mistakenly diagnosed as Wernicke\u2019s encephalopathy and sessions were conducted via online platforms. To date, it has other encephalitis\u2011related disorders. been a period of continual improvements, adjustments and Atypical presentations\u00a0(chameleons) of GBS\u2011related disorders adaptations. The COVID\u201119 pandemic resulted in a multitude include paraparetic GBS, bifacial weakness with paraesthesias, of challenges at different levels. This forces a pivotal shift acute ataxic neuropathy, acute ophthalmoparesis, acute ptosis out of the comfort\u2011zone; yet potentially creating opportunities and acute mydriasis. Though GBS affects the peripheral for neurorehabilitation service transformation and future nervous system, clinicians may be unaware that deep tendon preparedness. reflexes remain present and may even appear brisk in up to 10% of patients with GBS. Unmet rehabilitation needs among This lecture will review the spectrum of GBS variants, the community\u2011dwelling stroke survivors important differential diagnoses\u00a0(mimics) for patients presenting and implementation of early supported with acute flaccid paralysis and brain stem signs; and highlights the atypical presentation\u00a0(chameleons) of GBS\u2011related discharge program in Korea disorders which may be encountered in the neurorehabilitation setting. A\u00a0good appreciation of GBS variants and the common Nam\u2011Jong Paik GBS mimics and chameleons is necessary for the accurate diagnosis and treatment of GBS. This will assist in realistic Department of Rehabilitation Medicine, Seoul National University recovery prognostication and enable accurate planning of College of Medicine, Seoul National University Bundang Hospital, neurorehabilitation management. Seongnam, South\u00a0Korea Community\u2011dwelling stroke survivors have various long\u2011term Experience of COVID\u201119 and problems. These problems are often not properly managed, Neurorehabilitation Symposium remaining as unmet rehabilitation needs. Among those unmet needs, identifying the \u201cintervenable\u201d unmet rehabilitation needs View point from Malaysia is important because it can lead to the appropriate rehabilitative service. We have conducted a survey on unmet rehabilitation Norhayati Hussein needs of eight domains, namely spasticity, dysphagia, communication, cognition, ambulation, pain\/discomfort, Physiatrist, Malaysia anxiety\/depression, and self\u2011care. The most frequently Malaysia is experiencing the ongoing fourth wave of COVID\u201119 reported unmet needs\u00a0were anxiety\/depression\u00a0(74.6%), pandemic, which crucially impact the overall nationwide communication\u00a0(61.9%), and cognition\u00a0(59.7%), and the health\u2011care services. This viewpoint is based on the experience total number of unmet needs significantly correlated with a in the context of COVID\u201119 pandemic\u00a0\u2011\u00a0with special reference lower EQ\u20115D index. These findings imply that non\u2011physical to a neurorehabilitation setting within a free\u2011standing needs are more likely to be unmet, requiring attention for rehabilitation hospital in Malaysia. This is complemented by appropriate management. Early supported discharge\u00a0(ESD) collective experience gleaned from other rehabilitation services is a transitional care model aimed to accelerate the home nationwide. discharge of post\u2011acute stroke patients. By providing a Due to the current pandemic, neurorehabilitation services in well\u2011organized home\u2011based rehabilitation service, ESD has Malaysia are affected and require aggressive adaptations; both been proven to reduce the length of hospital stay as well as in the overall organization and in the operational process and long\u2011term dependency. A\u00a0multicenter randomized controlled methods to maintain safety of patients and clinical personnel study is under investigation to examine the feasibility of in a seamless manner. The monumental challenge relates to ESD in Korea. The results will include various impacts of finding the balance between provision of timely and effective ESD including functional outcomes, cost\u2011effectiveness, and neurorehabilitation services despite resources limitations; and sociocultural aspects. The study will be able to prove evidence minimizing the risk of spreading COVID\u201119. of the applicability of ESD in Korea. Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S133","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Invited Lecture Summaries Long COVID 19 syndrome: A\u00a0rehabilitation Davies et\u00a0al. revealed the probability of having prolonged perspective symptoms of moderate, severe and very severe category in 37%, 15% and 5% in the long Covid 19\u00a0patients six months after As the Covid pandemic slowly comes under control about the onset of the acute illness. Hence the numbers are significant 4 million people worldwide have succumbed to it and about potentially which will challenge healthcare resources unless we one 180 million have recovered. Recent classifications by have effective resource allocation and a clear understanding the National Institute for Health and Care Excellence\u00a0(NICE), of the syndrome and the rehabilitation strategies that need to Scottish Intercollegiate Guidelines Network\u00a0(SIGN) and the be in place to initiate early recovery and prevent prolonged Royal College of General practitioners\u00a0(RCGP) have divided morbidity and societal burden. The increasing awareness of the Covid\u2011\u00a019 infection into i) acute Covid 19 infection up to condition and treatment interventions by medical professionals 4\u00a0weeks, ii) ongoing symptomatic Covid\u2011\u00a019 from four weeks and allied health professionals, patients, members of the public up to 12\u00a0weeks and iii) post Covid 19 syndrome beyond and lawmakers will help to prepare and maximise the healthcare 12\u00a0weeks when symptoms and signs persist. \u201cLong Covid 19 facilities in recovered subjects through a holistic care approach. syndrome\u201d includes both \u201congoing symptomatic\u201d and \u201cpost Rehabilitation management: Pulmonary rehabilitation of Covid 19 syndrome\u201d. interstitial lung disease following Covid in patients presenting This evolving syndrome involves multiple organ systems\u00a0\u2013\u00a0brain, with long\u2011term shortness of breath and cough long after lung, heart, skin and in addition manifests as generalised the acute illness has subsided is now being defined. non\u2011localising symptoms of fatigue, post exertional malaise, Cardiac rehabilitation in patients suffering from myocarditis, cognitive abnormalities\u00a0(brain fog), sleep disorders, impairment decompensated heart failure cardiac arrhythmias and acute of concentration, and joint pains among many others. All of coronary syndrome in addition to thromboembolic events is these which evolves and persists after the acute Covid 19 and being realised as well. Various cutaneous manifestations as many last beyond 12\u00a0weeks lead to morbidity and limitation of a consequence of immune activation and micro thrombi and activities of daily living and consequent inability to get back to altered microvascular haemodynamics secondary to potential work and normal livelihood. autonomic dysfunction are also being recognised by internists, The pathogenesis of this new illness\/syndrome is yet poorly dermatologists and rheumatologists. understood. Since the long Covid 19 syndrome is seen Neurological, psychiatric and neuromuscular rehabilitation: in patients with severe initial illness requiring critical care The neurological manifestations are seen in half of the support and prolonged stay with higher incidence of comorbid hospitalised patients and in a high proportion in critically ill conditions including diabetes, cardiovascular disease, cancers, subjects requiring ITU care. Persistent symptoms of headache, pre\u2011existing lung conditions and underlying psychiatric myalgia, weakness, vertigo, loss of smell and taste to more conditions and obesity, several hypotheses for long Covid 19 intrusive symptoms of ongoing seizures, encephalopathy syndrome have been put forward. Dissemination of the virus and burdensome stroke need a multi\u2011disciplinary approach through blood circulation into every organ system, widespread to optimise rehabilitation. \u201cBrain fog\u201d, an umbrella term to endothelium inflammation and micro thrombi formation, the describe a constellation of cognitive dysfunction manifesting subsequent immune hyperstimulation syndrome leading to as confusion, short\u2011term memory loss, dizziness and inability cytokine storm in severe cases with associated mast cell to concentrate is a common manifestation of the long Covid activation syndrome leads to an excessive inflammatory syndrome thought to be due to hypoxia and mitochondrial response from which the consequent tissue damage takes dysfunction leading to micro structural brain vascular damage. much longer to recover. Persistent immune\u2011mediated tissue The psychiatric burden of stress on survivors particularly from injury due to the formation of antigen\u2011antibody complexes critical care units has unmasked the entity of post\u2011traumatic in the second and third weeks when the humoral immunity stress disorder, anxiety and depressive symptoms in nearly gets activated may be a cofactor. Activation of autoantibodies 35% of subjects in each cohort studied. Impaired cognition results in lung injury and lung fibrosis in addition to the initial attention and concentration and sleep disturbances manifesting hypoxaemia and the effects of oxygen therapy causing as reduced attention span, mental processing speed reduction, superoxide\/reactive oxygen species induced lung inflammation, impaired concentration and memory one year later following fibrosis and injury. the acute Covid syndrome has already been identified in nearly Unfortunately, there is no wide awareness of the long Covid one third of that specific cohort. The generalised weakness 19 syndrome even among health\u2011care workers. This is a new that patients report particularly in patients receiving invasive disease entity and the complex immune response that has ventilation for a prolonged period with coadministration of been varied between and within various geographical regions high\u2011dose steroids, neuromuscular blocking agents and of the world and the speed with which millions of people have immunomodulators are extremely prone to critical illness been afflicted by this novel coronavirus has indeed caught us neuro myopathy who then suffered from prolonged immobility unawares in the management of the acute illness affecting so and consequent disability. The comorbidities of diabetes, many at any one time and thereby stretching and overwhelming chronic alcoholism, chronic smoking, hypertension, morbid the health care resource of every country and particularly obesity and the metabolic syndrome contribute towards the lower\u2011\u00a0and middle\u2011income countries. The subsequent the microangiopathy and dysimmune\/persistent immune development of the long Covid 19 syndrome has been a dysfunction with associated endocrine\/hormonal imbalance further blow to society and to the already stretched healthcare that contributes towards a persistent and prolonged multi\u2011organ resources as the expected recovery of moderately and severely chronic dysfunction. affected individuals by this new syndrome was not anticipated. In lower\u2011\u00a0and middle\u2011income countries\u00a0(LMIC) in the Asia and Oceania region where 60% of the world\u2019s population live the S134\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Invited Lecture Summaries availability of trained health care providers is at a premium. capacity improved. 6\u2011Minute walk distance increased by 199\u00a0m, Neurologists managing the neurological complications equating to 80% of their age\u2011predicted distance. Quality of life of acute Covid 19 are few and far between and neuro and PTSD scores did not improve. At evaluation after physical rehabilitationists are even less on ground. Our allied health therapy, the patient was still experiencing migraines, dyspnoea, professional colleagues who are the real providers of the fatigue, and cognitive dysfunction. service for the long Covid syndrome affected patients are In another comprehensive survey to assess functional limitations critically low in numbers across the world and severely so and rehabilitation needs during and after infection with COVID\u201119, in the LMIC countries. In relation to the potential numbers The COVID\u201119 Rehabilitation Needs Survey\u00a0(C19\u2011RehabNeS) of patients ideally requiring the services of physiotherapists, consisting of the established 36\u2011item Short Form Survey\u00a0(SF\u201136) occupational therapists, clinical psychologists, speech together with the newly developed COVID\u201119\u2011Rehabilitation and language specialists and social workers and many Needs Questionnaire\u00a0(C19\u2011RehabNeQ) enables collection other colleagues depending on the alternative\/local health of systematic information on patients with post\u2011COVID\u201119 practitioners\/practices\u00a0(e.g.\u00a0In India AYUSH\u00a0\u2011\u00a0Ayurveda, syndrome\u00a0(Long\u2011COVID\u201119). The strength of this survey is Yoga & Naturopathy, Unani, Siddha and Homeopathy) in the that it combines the assessment of important rehabilitation LMIC countries it is anticipated that the combined help of all needs with assessment of satisfaction with the health services, specialists will help provide universal coverage to all afflicted treatment and therapy during the pandemic\u00a0(C19\u2011RehabNeQ) in Long COVID syndrome. The use of Teleneurology, group and assessment of patients\u2019 quality of life\u00a0(SF\u201136). therapy, self\u2011support therapy modules and empowerment of Thus, Long COVID Syndrome is a new disease\/syndromic societal networks will ensure that no one is left behind or out entity and potentially will affect large numbers of people in the and everyone is looked after. The fact that this Long COVID most populated parts of the globe and if newer variants create syndrome has an eventual good prognosis in most and does more havoc and the virus with its peculiar pathogenesis stays not merit anxiety and distress cannot be overemphasised. The in circulation for next few years we are better off getting out knowledge base of this illness as it increases in the scientific act together to ensure that all of us are prepared to face its and medical community will result in a better outcome of menace and provide good care to our respective populations therapy planning. in our region. A PubMed search of Long Covid and Physiotherapy showed For that our people and respective governments will be approximately 50 publications in 2020\/2021. These focus on grateful to us. This crisis response will help pave the way the cognitive and emotional wellbeing as outcomes. Single for better health for the future in our Asia Oceania region case reports show a patient participating in biweekly physical and new methods of health care delivery like digital health, therapist sessions for 8\u00a0weeks, which included aerobic training, Teleneurology and Indigenous medicine will flourish in the strengthening exercises, diaphragmatic breathing techniques, future and chronic underfunding of health care in our regions will and mindfulness training with metabolic equivalent for task potentially improve with better patient advocacy and lawmaker levels increasing with variability over the course of the program. understanding and input into healthcare. The patient\u2019s muscle strength, physical function, and exercise Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S135","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts Conference Title: Holistic rehabilitation: Thus, we need to think developmentally about the ages, stages Hospital to home and tasks of children\u2019s learning and skill development, provide opportunities for achievement and success, and look beyond Title of this talk: GETTING \u2018There\u2019 from targeting impairments \u2018within\u2011the\u2011child\u2019 in order to recognize \u2018here\u2019: Using an F\u2011words Roadmap how else we can be helpful to the children and their families, as outlined next. The field of childhood disability is in a state of dramatic Theme 2: How are we thinking, talking and acting in 2021 transformation. I\u00a0welcome the chance to share some ideas Where is \u2018THERE\u2019 about this evolution. My talk provides an opportunity to address There have been profound shifts and expansions in our three related themes relevant to childhood disability and ways of conceptualizing our work. The World Health \u2018holistic rehabilitation\u2019\u00a0\u2013\u00a0ideas that I hope will be useful both to Organization\u00a0(WHO)\u2019s International Classification of Functioning, colleagues who work with children and youth with impairments, Disability and Health\u00a0(ICF) framework for health[1] includes, but and to people in adult rehabilitation who meet \u2018former\u2019 children moves well beyond, our traditional emphasis on biomedicine with child\u2011onset impairments. I\u00a0have framed my ideas around to promote functioning and participation\u00a0(engagement in the overall title of the conference, which conceptualizes the life)\u00a0[Figure\u00a01]. This integrated biopsychosocial framework move of our work from \u2018Hospital to Home\u2019. If such a move is to includes our traditional biomedical thinking and models of happen, we need to be aware of\u00a0(i) where we have been and diagnosis and intervention; however, it widens the scope usually still are\u00a0(the \u2018HERE\u2019 of my title);\u00a0(ii) where we want to considerably by formally reminding us of the potential go\u00a0(the \u2018THERE\u2019), and why; and\u00a0(iii) how we can use current consequences of an impairment in \u2018body structure and function\u2019 thinking to guide the journey\u00a0(the F\u2011Words Roadmap). on functioning, including on \u2018activities\u2019\u00a0(e.g., of daily life), and on Theme 1: Where are we now \u2018participation\u2019\u00a0(engagement in life in ways that are meaningful In child health, we usually refer to our field of developmental to that individual). The contextual elements of our lives include disability as \u2018Paediatric Rehabilitation\u2019. This is inaccurate! The \u2018personal factors\u2019 that make each person\u2019s condition unique concept of rehabilitation is extremely important\u00a0\u2013\u00a0when the goal to them, and \u2018environmental factors\u2019 that exert a profound is restoration of function. However, in children with early\u2011onset influence on us but are often ignored or thought to be outside impairments, in whom there has been limited achievement our scope of responsibility. Discussion of these contextual ideas of function, we need to think differently about our goals and often elicits a roll of the eyes, because they are thought to be not roles. If we think first about the \u2018child\u2019\u00a0(and family) aspect of our new: they are readily recognizable and make sense to people. focus, we will acknowledge that we are, or should be, promoting However, unless they are actively factored into our discussions child\u00a0(and family) development rather than thinking that we can with families and the planning of interventions, it is too easy for \u2018return people to previous functioning\u2019. This is fundamentally interventions to default to treating impairments and expecting important for several reasons. that changes in body structures and functions will translate into When we work with people\u00a0(mostly adults) requiring better functioning. Alas, that is seldom the case.[2] However, rehabilitation, we usually know a lot from them and about them. there are other ways to conceptualize what we are trying to What were they able to do before needing rehab How, and how accomplish, and the roadmap we have created\u00a0\u2013\u00a0outlined well That information provides considerable guidance regarding next\u00a0\u2013\u00a0provides conceptual guidance to get \u2018there\u2019. setting realistic expectations. What goals do they have that can direct our intervention efforts People may have several Figure\u00a01: The ICF framework for health impairments, not necessarily equally important and impactful Theme 3: A\u00a0roadmap to guide families and practitioners to them. The ones on which they want to focus should become on our shared journey primary targets of our rehabilitation work. As shown here, these modern ICF concepts have been brought On the other hand, such information is not available about young to life for families, young people and clinicians by a whimsical children with early\u2011onset impairments. As a consequence, our adaptation of the ICF framework known as the \u2018F\u2011words for intervention goals default to \u2018normal\u2019 development, relying on Child Development\u2019\u00a0(or \u2018My Favourite Words\u2019).[3] Huber and milestones and typical functioning. However, there can be considerable tyranny in this thinking. For one thing, \u2018normal\u2019 is a strange and confining idea, and leaves little room for people to accept and tolerate variation and difference in ways of doing things. Second, children with early\u2011onset impairments can learn to adapt and do things their own ways\u00a0\u2013\u00a0often becoming creative in accomplishing task idiosyncratically but effectively. Because we don\u2019t expect such adaptations and successes, these successful young people are often the focus of heroic YouTube videos and other celebrations when, with a little imagination, we might recognize opportunities for the young people with whom we work to have similar achievements. If this were more commonly being promoted and achieved, we would no longer find these successes so unusual. S136\t \u00a9 2022 Physiotherapy - The Journal of Indian Association of Physiotherapists | Published by Wolters Kluwer - Medknow","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts colleagues\u00a0(2011)[4] proposed that health is \u2018the ability to adapt of the \u2018being, belonging and becoming\u2019 that characterize and self\u2011manage in the face of social, physical and emotional child development. challenges\u2019. In other words, functioning\u00a0(however it is done, regardless of ability) can be understood as evidence of health. As the F\u2011words began to be used, adopted and adapted, Building on this idea, and on the ICF\u2019s expanded notion of our research centre created both an F\u2011words Knowledge health as an integrated biopsychosocial experience that brings Hub[5]\u00a0(www.canchild.ca\/f\u2011words) to promote these ideas, and together the biomedical and social dimensions of health, an F\u2011words Research Program to evaluate their impact. There we wanted to help people see that these concepts can be is an ever\u2011increasing array of creative ways that people are operationalized in a way that is both accessible and memorable. bringing these ideas to life, and all are shared for free, with Figures\u00a02 and 3 illustrate the \u2018F\u2011words\u2019 and their connection attribution to the parents and colleagues who develop them. to the ICF framework for health onto which they are grafted. In addition to parents and service providers who use these tools, entire clinical programs and services are reshaping their Figure\u00a02: The F\u2011words\u00a0\u2013\u00a0children\u2019s version thinking, their clinical tools and their philosophies around this ICF\/F\u2011words view of the world of childhood disabilities. Figure\u00a03: The F\u2011words\u00a0\u2013\u00a0adult version Our goal has been to help people appreciate health as broader The F\u2011words have captured people\u2019s imagination around the than just the impairments than might constrain functioning. world. There have been\u00a0>\u00a045,000 downloads of the original While in no way dismissing or limiting the best of our biomedical paper, >66,000 unique visitors have come to the F\u2011words interventions, these ideas build on the WHO\u2019s expanded ICF Knowledge hub\u00a0>\u00a075,000\u00a0times, >30 translations, and almost framework, and encourage people to think more inclusively. 360 citations in the literature. There is considerable evidence The ICF framework was co\u2011created by professionals around of the impact of these ideas on families, who have reported the world with the input of people with \u2018disabilities\u2019. We believe finding them transformative and empowering. As this paper is that the F\u2011words challenge people to think more broadly: being submitted in mid\u20112021, two other research submissions \u2022\t about \u2018functioning\u2019, beyond what are usually considered are under review, reporting additional aspects of this story. \u2018nice\u2019 or \u2018normal\u2019 ways of doing things; Our research group has been challenged about our ideas: \u2022\t about \u2018fitness\u2019 as including both body and mind, and an we appear to have neglected f\u2011words others feel are important\u00a0(examples are \u2018faith\u2019 and \u2018funding\u2019); the ideas seem to important element of wellbeing; be about \u2018physical\u2019 disability but ignore issues of mental health; \u2022\t about \u2018friends\u2019 as an important component of children\u2019s \u2018we don\u2019t need more tests and assessments\u2019. This group of ideas has been collated and addressed, and is available as a participation and engagement in life; \u2018Lessons Learned\u2019 document on the F\u2011words Knowledge Hub.[5] \u2022\t about \u2018fun\u2019, a personal factor around which to build therapies We hope it is apparent that we welcome people\u2019s comments, questions, critiques and creativity to be able to promote these that are likely to engage children; ideas as widely and effectively as possible. \u2022\t about \u2018family\u2019 as the essential environmental force in the In summary lives of children; and \u2022\t about \u2018future\u2019, which, while not part of the ICF\u2019s slice\u2011in\u2011time Fundamental changes are underway in the field of childhood disability. Parents want to be more involved in decision\u2011making picture of people\u2019s current realities, is an essential aspect about their child and family. We are more open to variations in how things are done, and are focusing less on the futile task of \u2018fixing\u2019 neurodisabilities. The ICF\u2019s framework for health, and our F\u2011words ideas, offer families, service providers and program managers a new way to look at \u2018childhood disability\u2019 and to plot a course from \u2018there\u2019 to \u2018here\u2019. I\u00a0hope these ideas are helpful to people. References 1.\t World Health Organization. The International Classification of Functioning, Disability and Health. Geneva, Switzerland: World Health Organization; 2001. 2.\t Wright FV, Rosenbaum PL, Goldsmith CH, Law M, Fehlings DL. How do changes in body functions and structures, activity, and participation relate in children with cerebral palsy? Dev Med Child Neurol 2008;50:283\u20119. 3.\t Rosenbaum P, Gorter JW. The \u2018F\u2011words\u2019 in childhood disability: I\u00a0swear this is how we should think! Child Care Health Dev 2012;38:457\u201163. 4.\t Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et\u00a0al. How should we define health? BMJ 2011;343:d4163. 5.\t CanChild. F\u2011Words Knowledge Hub; 2021. Available from: https:\/\/www.canchild.ca\/en\/research\u2011in\u2011practice\/ f\u2011words\u2011in\u2011childhood\u2011disability.\u00a0[Last accessed on 2021\u00a0Jul\u00a030]. Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S137","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts Symposium on Parkinsonism for PD with a focus on the impairments and the neural basis underlying the same as detailed above. Those impairments that Physical therapy in Parkinsons\u2019 disease are refractory to dopamine supplements are addressed with these exercises and should form the basis of physiotherapy Poonam Bajaj programs that are meted out to individuals with PD in an attempt to delay mobility problems that are an inevitable part Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India of this progressive neurodegenerative disease. Most studies Parkinson\u2019s Disease\u00a0(PD) is a mixed degenerative disease that examine the role of physiotherapy in PD are done on consisting of motor and non\u2011motor symptoms. The main motor individuals with PD in Hoehn and Yahr Stages 1 to 3, whilst symptoms are tremor, rigidity\u2011\u00a0axial and peripheral, postural they are still ambulatory. The most commonly prescribed instability, bradykinesia and gait dysfunction. These further exercises are stretching and strengthening. Stretching of lead to secondary motor symptoms such as freezing of gait rigid axial and limb muscles. Active stretching especially of and imbalance\u00a0(and falls) during turns. Balance dysfunction axial muscles is known to improve, reach and sit to stand and in PD is responsible for a large part of the motor disability and rolling transitions in individuals with PD. It has been proved to the severity of this only increases with disease progression. improve functional reach\u00a0(Schenkmann et\u00a0al. 2000). Various Whilst it is standard of care that physical exercise should be strengthening protocols have been found to improve balance prescribed with dopamine supplementation at even the early and gait and reduce falls\u00a0(Hirsch 2003). Strengthening should phases of the disease, most individuals with PD do not see essentially focus on plantar flexor, quadriceps and hip flexor a physiotherapist until they have obvious mobility problems. strengthening. A\u00a0sensori\u2011motor agility program\u00a0(King and Amongst the motor dysfunctions in PD, bradykinesia and rigidity Horak 2009) focused at addressing impairments of rigidity, are dopamine sensitive. However several problems seen in PD bradykinesia, freezing, inflexible sequencing and impaired such as impaired sensory integration\u00a0(kinesthesia), inflexibility sensory integration\u2011\u00a0includes agility training, tai\u2011chi, kayaking of sequential co\u2011ordination\u00a0(example\u2011\u00a0transitions such as sitting and boxing. Seensory cueing such as auditory cues with to standing and rolling in bed) and executive dysfunction are rhythmic auditory inputs in the form of metronome beats are not dopamine sensitive and do not get corrected by dopamine known to help with freezing, step length and gait speed and supplementation medication\u00a0(King and Horak 2009). These initiation of gait in individuals with PD. Visual cueing such as dysfunctions can specifically be addressed by an individualized laser beam emitting canes are proven to help with step initiation, exercise program to maintain mobility and sensori\u2011motor freezing of gait and stride length. Balance training on unsteady agility\u00a0(Park, Horak et\u00a0al. 2015). Rigidity is responsible for the surfaces such as foam pads, wobble boards and inclines are stooped posture with the forward center of mass, because known to improve kinesthetic awareness in individuals with PD of which there is an impaired response to external backward The HiBalance program\u00a0(Logfren and Franzen et\u00a0al) helped perturbations\u00a0(this also forms the basis of the \u201cretropulsive pull with gait speed and balance in PD Treadmill training with virtual test\u201d which is often used as a clinical diagnostic tool for PD). reality environments is known to help with gait speed and step Axial rigidity is not responsive to syndopa\u00a0(J Argue, 2000) length in individuals with PD. This can be quite an expensive and hence continues to impair the ability for individuals with and an inaccessible option for most people afflicted with PD. PD to turn whilst walking or roll in bed. Bradykinesia causes The Lee Silverman BIG technique is a well\u2011\u00a0known standardized a slower and smaller amplitude postural reaction to any protocol for PD. Cycling regularly in PD is proved to improve external perturbation and also decreases anticipatory postural overall motor function, reduce tremor, reduce bradykinesia, adjustments. Anticipatory postural adjustments are necessary reduce rigidity, improve aerobic capacity, mood and cognitive in voluntary self\u00a0\u2013initiated movements such as gait wherein the function. It has been known to improve the UPDRS scores center of mass has to shift laterally towards the stance limb for in individuals with PD. A\u00a0very recent award winning study by the unweighing of the swing limb in preparation of the swing Suzanne O\u2019Neal PT\u00a0(July 2021) proves that the backward phase. A\u00a0decrease in lateral direction anticipatory postural static cycling is effective in improving posterior protective adjustments causes decreased weight shifting and hence responses in individuals with PD. This may be an important initially a shuffling gait and with progression of the disease, factor in preventing backward falls from external perturbations. freezing of gait in the later stages. Contrary to popular belief, In addition to exercises there are numerous assistive devices levodopa in actuality weakens postural responses\u00a0(Horak that are used in preventing falls and helping prolong mobility. and Nutt, 1996) The process of sensory reweighting slows Aside from the standard walkers and canes, there are specially down in PD. There is impaired proprioception. Proprioception designed walkers such as the U\u2011step walker. This is designed usually forms 70% of the afferent information about the body to prevent falls and is equipped with auditory cues like the schema in space. This impairment is a large contributory metronome and also a laser light beam to help with freezing of factor to imbalance. Diabetic individuals with PD have this gait. Home modifications form a large part of making the life of compounded due to diabetic sensory neuropathy being present. an individual with PD safer whilst maintaining independence. This is commonly seen in India, which is the diabetic capital of Yoga has been found to improve motor function, balance the world. Falls occur due to impaired proprioception, which and gait\u00a0(Colgrove et\u00a0al. 2012). Various eastern cultures contribute to the morbidity and mortality of PD. That exercise have investigated the effect of specific traditional types of can bring about neuroplasticity and offset neurodegeneration exercises on PD\u2011for instance Wing Chun, a type of martial art is a well\u2011\u00a0known fact. There are several types of exercise helps with balance and gait speed in PD. WuQinxi exercises programs that are carried out for individuals with PD. Some of have been found effective for stretching and improvement of them are the product of randomized controlled trials and others hand function in individuals with PD\u00a0(Tian Wang et\u00a0al., 2020). are untested. The rest of this summary will attempt to bring To conclude, the above mentioned interventions are by no forward some of the evidence based exercise principles used means the only interventions suggested for individuals with PD. S138\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts Physical exercises have been found to have a neuro protective disorders and the debilitating effects of such problems on effect. Physical therapy has been proved to delay mobility overall health and quality of life. The traditional care focused on decline in individuals with PD, reduce fall risk and improve symptom centric approach to alleviate the problems identified the quality of life. Physiotherapists should hence customize clinically while more recent paradigm shift to patient centric the exercise program based on the predominant impairment approach to better response to patient needs. being experienced by the individual with PD. Several of these The treatment of dysphagia is a challenging activity of daily impairments are not dopamine sensitive and hence do not professional practice as there are still places where instrumental respond to medication or dopamine supplementation. Hence evaluations are not readily available. Decision making largely physical exercise should be intelligently used to address the depends on clinical swallow evaluation and seldom depends impairment and enhance the efficacy of dopamine supplements on the standard assessment strategies followed in the west. and improve the quality of life for the individual with PD. However, service delivery has to occur with highest efficacy possible in any scenarios of clinical practice. Symposium on Dance, Art and Music The treatment of dysphagia begins with counselling the patients Therapy based on their medical, surgical or any relevant history for or due to which the dysphagia may occur. It is of utmost important Art therapy and neuro\u2011resilience to explain the patient about degree, type and its impact on the quality of life. This allows patients to understand the time line of Poornima Gauri care and incline the expectations with the clinical possibilities. This document discusses general strategies that are involved Department of Neurology, Bharati Vidyapeeth\u00a0(DTU) Medical in improving swallowing functions in patients post stroke. College, Pune, Maharashtra, India Facilitatory strategies: These strategies help in improving the Background: Art is a natural expression of a human being. functions by facilitating normal physiology and are not usually The neurobiology of visual art has been identified to several involving food. regions in the brain. The brain of artists is found to be different Strengthening of Lips: Lip plays an important part for initiation from other individuals. With training art\u2011based skills can be of peristaltic movements and pressure with which the food refined. These skills can be used for exploring neuroplasticity is propelled towards pharynx and followed through till the and rehabilitation. stomach. It is also important to bolus hold within the oral cavity. Observations: Visual art is a time intensive process. It is Usual problems associated with it are anterior spillage and an immersive sensory, cognitive and motor experience with may implicate in delay in swallow initiation. Muscle exercises possibilities of cognitive, emotive and spiritual engagement. targeting the upper lip scoop, lower lip scoop, and lip closure Due to its time and attention engaging nature, art can be used through the event of swallow. for enhancing neuro\u2011resilience. Once created, the art work can Strengthening Buccinators: In addition to lips, buccinator continue to convey deep messages silently. Art can be used muscles, casually called as buccal mucosa, assists in creating as an excellent communication tool to teach new concepts and the positive pressure assisting the posterior movement of bolus. convey advocacy messages. The process of creating visual art It also helps in maintaining the bolus within the masticatory is a complex, multi\u2011step motor and cognitive process. Artists space during chewing. Also, the buccinator muscles may are found to have more neural networks in areas dedicated assist in clearing bolus form the buccal cavity. Activities such to fine motor activities and visual imagery.\u00a0 The process of as sucking, lollipop swallowing, voluntary residue clearance, interpreting art is sensory, cognitive and equally multifaceted. sipping may help in increasing the strength of the muscle. It is found to involve multiple areas: precuneus, cingulate cortex Strengthening of Muscles of Tongue: Isometric and Isotonic and temporoparietal junction. A\u00a0lot of further research needs exercises can be carried out to strengthen the tongue muscles to be done in this field to be able to use this important tool in a to improve the bolus hold, lateral and medial movements in systematic manner. We need to harness this powerful tool for the oral cavity and posterior propulsion of food. The isometric rehabilitation of specific areas and deficits in an efficient way. exercises can be assisted by devices such as tongue Significance: Thus Visual\u2011Art can be used in several possible depressors, Iowa Oral Performance Instrument or any other ways in Brain and Mind health: Preventive tool to develop assistive devices. Isotonic can be done by simple stretching Neuro\u2011resilience\u00a0 Rehabilitation tool for cognitive disorders, exercises in all the planes. Speech stimuli may also assist in stroke, Parkinson\u2019s disease, post traumatic neurodeficits, strengthening muscles which in return help the swallowing Neuro\u2011psychiatric disorders.\u00a0 Advocacy tool: to convey during oral phase dysphagia. Although not studies, constraint messages for awareness and orientation. induced therapy for challenging the tongue reach farer targets Conclusion: Visual Art remains an untapped tool in the field of to improve the overall function of the tongue. Strengthening of Advocacy, Neuro\u2011rehabilitation and self development. It needs soft palate: soft palate completely shuts the nasopharynx from to be explored further in a systematic manner. participation in the movement of bolus and nasal regurgitation is the usual complains implicating the dysfunction of soft palate. Management of dysphagia post stroke Puffing cheeks, blowing balloon, wind instruments of therapy and straws can be used to facilitate stronger closure of soft Prasanna Suresh Hegde palate for swallow. Speech may also be used to facilitate the soft palate elevation in general. Speech Therapist, India Strengthening Pharynx: Exercises that are focused on Management of Dysphagia is an essential part of rehabilitation pharyngeal strengthening may focus on one or of the swallowing post stroke considering the prevalence of difficulty in swallowing Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S139","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts physiology which are pharyngal squeeze, efficiency swallow in the pharynx. This technique may be avoided when there is and pharyngeal clearance. Similar to oromotor exercises, aspiration risk. This increases overall pressure in the pharynx, the exercises may be isometric to engage the muscles of longer laryngeal vestibule closure, longer upper esophageal pharynx. Effortful swallow which is a technique where the sphincter opening to clear the pharyngeal residue. person pretends to swallow a golf ball. Yawn sigh which is Chin Tuck and Chin Down: Chin tuck is usually carried out exaggerations of yawn for a particular time. Masako manuveur with head position backwards in which the larynx slightly is a constraint induced strategy to restrict the participation of moves away from the line of food entry. This also reduces base of tongue to facilitate posterior pharyngeal wall movement. the pharyngeal space there by increasing the pharyngeal This may also increase pharyngeal residue hence not advised pressure for bolus clearance. This can not be used with severe during food trials. It may also need validation of efficacy using dysphagia. In chin down, the chin touches the chest to help the instrumental evaluation. patient to control the bolus within the mouth before the person Strengthening Airway Safety: Airway safety is facilitated performs swallow action. by complete closure of airway during the swallow event and Head Tilt and Head Rotation: Head tilt is usually carried out complete clearance of the food from the pharynx without if there is unilateral oral and\/or pharyngeal problems. Tilting spillage or residue. This is primarily facilitated by hyolaryngeal to the stronger side will allow the food to avoid the weaker excursion in synchronous to pharyngeal squeeze, vocal and side. However, head rotation towards weak or damaged side false vocal folds and epiglottis. The pressure and the upward closes the weak side and increases the upper esophageal movement open the upper esophageal sphincter to allow the sphincter relaxation. This may be used in fixation of hemi\u2011larynx bolus to clear the pharyngeal area. Mendelsohn\u2019s Manoeuvre, due paralysis. This is of special interest in lateral medullary voluntary prolongation of laryngeal excursion at the midpoint syndrome. of swallow. This leads to better laryngeal elevation, timing, Head Back: This technique uses gravity and it is indicated in coordination at swallow, reduces pharyngeal residue due to patients who can not push the bolus back. This technique can better phsryngeal squeeze, better and longer upper esophageal be combined with other airway safety measures as well. sphincter opening. It may difficult to carryout Mendelsohn\u2019s Manual Support: Use of external support to close mouth or manuvouer in children. Hence, hyoid lift maneuver can be lip competency is always used as a compensatory strategy in done using straw to transfer small objects. Expiratory muscle cases of labial incompetence, inability to close the mouth. It strength training can also be used in cases where there is reduces anterior spillage, improves swallow coordination and higher risk of silent aspiration and recued strength of cough. It improves immediate success and satisfaction. improves expiratory driving pressure and activates submental Assistive Devices: There are a variety of devices available to and suprahyoid complex. Neuomuscular Electrical Stimulation assist patients with problem of oral cavity. Some of the devices is also a well known treatment strategy which provides an extra control the speed, volume and consistency. Some by pass non \u201coomph\u201d by facilitating and stimulating active effort of exercise. functionals parts such as tongue. They are modified spoons, This may be of great assistance where the swallow events are straw, cut up glasses. Sometimes, a prosthondontist may help diminished. fabricating as required. At an early stage, syringe or dropper Strengthening of Upper Esophageal Sphincter: Timely can be used for the same. relaxation of cricopharyngeal muscles and adequate time for the Consistency Modification: In the beginning or on a regular food to pass through upper esophageal sphincter is crucial for patient care, diet modification has made the swallow trial safe efficiency of swallow. Upper esophageal sphincter movement and provided possibility for immediate success for the patient. is facilitated by hyolaryngeal excursion and temperature of the Following the IDDSI guidelines of consistency modification, bolus. Shakers exercises can carried out in supine position. the patients are catered with various consistencies within Modified Shakers exercises is carried out in a sitting position the cleared food items. This does not affect the nutritional and provided resistance for chin down. It is also similar to chin value a patient may need. Decision on the usage of individual tuck against resistance. Exaggerated jaw opening is also seen technique or combination are by clinical practice and developed to inflict upon the upper esophageal movements. clinical wisdom over period of time. Although an instrumental Rehabilitative Strategies: These techniques provide immediate evaluation is necessary to see the validated, patient reports relief to the patients by alleviating the swallow problems. may let us understand the physiology better and make a However, some these does not have normal swallow mindful decision. physiology. These techniques are used when food is given. Breath Hold Swallow: It is mimicking the normal physiology Perception of rehabilitation professionals to reduce immediate entry of bolus below the vocal folds and towards multidisciplinary\/interdisciplinary to provide a negative pressure for hyolaryngeal excursion. Supraglottic swallow: In cases of during and immediate post approach working in neurorehabilitation swallow aspiration, supraglottic swallow helps clear out the residue in the supraglottis and vocal folds. This includes Muhammad Naveed Babur inhalation, breath hold, swallow and cough. A\u00a0variant of this is to bear down to increase arytenoid movements and false vocal Islamabad, Pakistan fold closure to increase the airway closure during swallow. This An\u00a0interdisciplinary\/multidisciplinary team\u00a0refers to a number of is called as Super Supraglottic Swallow. health care providers associated with different specialties, each Effortful Swallow: This is carried out with patient pretending to providing specific service to the patient focusing on detailed swallow a golf ball with effort which reduces the overall residue assessment and treatment. Interdisciplinary teams\u00a0provide S140\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts numerous\u00a0benefits\u00a0to patients and its team members. the academic public healthcare institutions, are being deployed Researches on the said topic are indicative that multidisciplinary\/ to help cover COVID\u201119 isolation and general medicine wards. Interdisciplinary team approach leads to improved health In addition, we also continue to run our inpatient medical outcomes and patients and attendants satisfaction levels. rehabilitation units with Neurorehabilitation conditions such as The appropriate and effective use of available equipment and strokes, brain and spinal cord injuries, and neurodegenerative modalities results in improved efficacy of services and staff diseases. Singapore physiatrists go through a regular Internal satisfaction at job. medicine residency before entry into another 3\u00a0years of Although multidisciplinary\/Interdisciplinary teams delivers Rehabilitation Medicine training. As such, our physiatrists services based on various skills and experiences as compare did not have any significant difficulties with managing acute, to single health care provider but it requires co\u2011ordination medically complicated, and post COVID\u201119\u00a0patients. It is among members and appropriate handing over taking over of also important to have steady leadership, protocols and case load. Effective multidisciplinary\/Interdisciplinary team will procedures for COVID\u201119\u00a0patients, frequent communications need good leadership and relations based on respect and trust and updates, ready availability of PPE from stockpiles, and a among team members. well\u2011developed medical infrastructure. With increased pressure Conventionally, care of the patient in a rehabilitation unit utilizes from the acute services to transfer COVID\u201119\u00a0patients to team approach involving various health care specialists like Rehabilitation Medicine units to decongest, our units have physicians, physical therapists, occupational therapists, social been busy. Admissions include the usual rehabilitation \u201cclean\u201d workers, psychologists, nurses, speech pathologists, dietitians cases, but also those post COVID\u201119. Protocols for patients and others. The key proposition is that, functioning together in include infection prevention measures such as hand\u2011washing, a team is greater than the sum of its individualized parts. Team disinfection of rehabilitation equipment, frequent symptom work becomes a holistic approach to enhance assessment and checking, mask wearing, and staff safe distancing. Patients supervision of the patient by the various members working require two negative RT\u2011PCR swab tests for COVID\u201119, and together instead of working separately. This approach also absence of fever and respiratory symptoms before coming to provides improved time management, resulting in many cost the rehabilitation units. Outpatient, home\u2011based, and community benefits. It is a general belief in the inpatient rehabilitation day rehabilitation services however have been curtailed and setting that complicated situations or patients can be better telecommunication used instead to follow\u2011up. Importantly, managed through a multidisciplinary\/Interdisciplinary team Rehabilitation Medicine doctors make a significant difference in approach. the early functional assessment and interventions for patients Benefits of multidisciplinary\/Interdisciplinary team in health with severe COVID\u201119 as deployment to the acute care facilities care setups cannot be denied. If effectively developed and allows concurrent addressing of rehabilitative needs, hence implemented patients and team members both gets immense improving outcomes both physically and psychologically. advantage from it. Unfortunately in developing countries due to other constraints this part of health care is still neglected. Disability assessment as per guidelines There are multiple reasons behind it which include lack of clear vision; organizations are not sure what they want from Rajendra Sharma a multidisciplinary\/Interdisciplinary team. Benefits although know but are not crystal clear to administration resulting Department of Physical Medicine and Rehabilitation, Abvims and in neglect from there end in facilitation for development of RML Hospital, New\u00a0Delhi, India multidisciplinary\/Interdisciplinary team. Lack of appropriate Why assess curriculum, at degree level. Professional entering the field lack \u2022\t To satisfy the legal requirement of the RPwD Act for basic knowledge regarding multidisciplinary\/Interdisciplinary team approach. Limited research facilities and rigid mind set quantifying benchmark disability leads to a group of professionals who are in field to practice in \u2022\t To prioritize resource allocation a traditional way. Lack of continuous teaching and training is \u2022\t To give graded benefit and opportunity for participation observed, employs are reported to be so busy that attending \u2022\t For deciding compensations in various laws refreshers and relevant workshops is not possible for them. \u2022\t To eventually understand the functional ability of each There is absence of staff to provide cover for employs attending workshops or seminars. Frequent political shifts and security individual based on the biological & environmental factors. concerns never let policy makers focus on emerging trends Indian practice and rules in health care. GDP allocated to health care restrain teaching \u2022\t RPWD act received the assent of the President on the and training of professionals and advent of multidisciplinary team in long run. Lack of Skill mix is another issue, services 27th\u00a0December, 2016 of allied health professionals are scarce and professionals are \u2022\t Act to give effect to the United\u00a0Nations Convention on the reluctant to perform duties in far off areas or less privileged areas of country. Rights of Persons with Disabilities signed by India in 2006 Experience of COVID 19 and Neurorehabilitation Symposium \u2022\t MINISTRY OF SOCIAL JUSTICE AND EMPOWERMENT View point from Singapore Peter Lim notified disability assessment guidelines on the 4th\u00a0January, Society of Rehabilitation Medicine, Singapore 2018 Physiatrists across Singapore, a vast majority of whom work in \u2022\t Section 56 of the Rights of Persons with Disabilities Act, 2016\u00a0(49 of 2016). Specified disabilities I.\t Locomotor disability II.\t Blindness and low\u2011vision III.\tDeaf and hard of hearing and speech and language disability Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S141","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts IV.\tIntellectual disability and specific learning disabilities Bladder involvement Percentage V.\t Mental illness of permanent VI.\tChronic neurological conditions Mild (hesitancy\/frequency) impairment VII.\tHaemophilia, thalassemia and sickle cell disease Moderate (precipitancy) 25 VIII.\t Multiple disabilities. Severe (occasional but recurrent Incontinence) 50 Very severe (retention\/total incontinence) 75 I. LOCOMOTOR DISABILITY 100 \u2022\t Inability to execute distinctive activities \u2022\t Associated with movement of self and objects Ataxia\u00a0(Sensory or Cerebellar) due to neurogenic \u2022\t Musculoskeletal or nervous system or both. Involvement Locomotor Disability various sections as per RPWD Act Severity of ataxia Percentage of permanent impairment Section A Permanent PPI of extremities Section B PPI of the spine Mild (detected on examination) <40 Section C PPI in persons with amputation (amputees) Moderate 40\u201360 Section D PPI in persons with clubfoot and other conditions Severe More than 60 Section E Locomotor disability due to chronic neurological conditions Sensory deficit due to neurogenic Involvement Section F Spinal cord injuries Extent of sensory deficit Percentage of permanent impairment Section G Acid attack victims Anaesthesia Up to 10% for each limb Section H Cerebral palsy affected persons with disabilities Hypoaesthesia Depending upon % of loss of sensation Section I Leprosy cured persons with disabilities Paraesthesia Up to 30% depending upon loss of Section J PPI in cases of short stature\/dwarfism sensation Section K Muscular dystrophy Hands\/feet sensory loss Depending upon % of loss of sensation SECTION A: Assessment to be used in LMN disorders\u00a0\u2013 SECTION F: Spinal Cord Injuries Upper Limb The individuals with SCI shall be categorized into one of the four main diagnostic categories for the purpose of disability Arm component (90%) Hand component (90%) evaluation and certification\u00a0\u2013\u00a0a) Tetraplegia\u00a0\u2013\u00a0up to 90%, b) Range of motion (90%) Sensation (30%) paraplegia\u00a0\u2013\u00a0up to 75%, c) Cauda equina without bowel & bladder dysfunction\u00a0\u2013\u00a0up to 40%, Cauda equine\u2011like syndrome Muscle strength (90%) Strength (30%) with bowel or bladder impairment such as lumbosacral plexopathies\u00a0\u2013\u00a0up to 60%. Coordinated activities (90%) Prehension (30%) Additional weightage of up to 20% is given for presence Combining formula is used *Added directly for of significant neuropathic pain, spinal deformity, spasticity, for calculating total disability calculating total disability contracture, heterotopic ossification, pressure ulcer etc., depending on severity, and added to the permanent physical impairment % Additional weightage is given for presence of any of the and computed. Total disability % will not exceed 100%. following complications\u00a0\u2013\u00a0Deformity, Pain, Loss of sensation, SECTION H: Cerebral Palsy affected Persons with Shortening and if dominant hand is involved additional disabilities percentage is added. \u2022\t Non\u2011progressive neurological condition \u2022\t Damage to one or more specific areas of the brain Combining formula: a+(b\u00a0(90\u2011a))\/90)\u00a0[a\u00a0=\u00a0higher value, \u2022\t Movements and muscle coordination impairments. b\u00a0=\u00a0lower value] Gross Motor Function Classification System\u00a0 (GMFCS): self\u2011initiated movement, with emphasis on sitting, transfers, Mobility component (90%) Stability component (90%) and mobility. Manual Ability Classification System\u00a0(MACS): use Range of motion (90%) of hands to handle objects in daily activities. Other disabilities assessed separately\u00a0\u2011\u00a0visual impairment, hearing impairment, Muscle strength (90%) speech impairment, mental sub\u2011normality\u00a0(low IQ) etc., Final Combining formula is used for calculating total disability disability is calculated by using the combining formula. Disability is certified in relation to the whole body. SECTION A: to be used in LMN disorders\u00a0\u2013\u00a0Lower Limb SECTION K: Muscular Dystrophy Disability is to be expressed in relation to the whole body, to Additional weightage is given for presence of any of the account for\u00a0\u2011\u00a0Weakness, Contractures, Scoliosis and Cardiac following complications\u00a0\u2013\u00a0Deformity, Pain, Loss of sensation, or pulmonary involvement. Complications & Shortening. Chronic neurological conditions In Chronic neurological conditions\u00a0(Multiple Sclerosis, SECTION E: Locomotor Disability due to chronic Parkinson\u2019s) the disability is multidimensional involving Neurological conditions manifestation in Musculo\u2011skeleton system and psychosocial behaviour. Stroke: The modified Rankin Scale\u00a0(mRS) is used for measuring the degree of disability or dependence in the daily activities. For those who have suffered a stroke or other causes of neurological disability. 0 (nil) 3 (51%\u201360%) 1 (<40%) 4 (61%\u201380%) 2 (40%\u201350%) 5 (>80%) Bladder disability due to neurogenic Involvement S142\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts Disability assessment: Do principles of motor learning help to \u2022\t Musculo\u2011skeletal component: assessed in terms of remediate speech deficits? Examination of guidelines relating to assessment of locomotor disability available evidence due to chronic neurological conditions \u2022\t The psychosocial disability assessed by using the IDEAS Ramesh Kaipa and Intellectual disability as per IQ \u2022\t To be assessed individually and added by combining \u200aDepartment of Communication Sciences and Disorder s, Stillwater, formula. Oklahoma, USA Behavioural interventions like speech therapy are known Indian Disability Evaluation and Assessment Scale\u00a0(IDEAS) to promote brain reorganization and plasticity, and this can is a scale for measuring and quantifying disability in mental best be achieved through the systematic application of disorders, to be used for assessment of disability related to principles of motor learning\u00a0(PMLs) during the rehabilitation mental illness, as given below. regimen. PMLs refer to a set of principles which facilitate the \u2022\t Self\u2011care process of motor learning\u00a0(Mass et\u00a0al., 2008). PMLs can be \u2022\t Inter Personal Activities broadly grouped into principles based on:\u00a0(1) the structure of \u2022\t Communication and Understanding practice\/treatment and\u00a0(2) the nature of feedback provided \u2022\t Work. during practice\/treatment. PMLs have largely emerged from studies involving nonspeech motor tasks\u00a0(e.g., finger tapping, TOTAL SCORE: Add scores of the above 4 items\u00a0(self\u2011care, keyboard entry, and lever positioning tasks). However, over interpersonal activities, communication and understanding, and the past two decades there have been several attempts to work) and obtain a total score explore, validate, and incorporate PMLs in treatment of speech deficits\u00a0(e.g.\u00a0Kaipa, Jones, & Robb, 2016). The different Global Disability is assessed by combining Total Disability PMLs and its relation to non\u2011speech and speech activities score\u00a0+\u00a0Duration of illness\u00a0(DOI) score. Score Percentages are indicated in Tables\u00a01 and 2. While the aforementioned ranges from No Disability\u00a0(0 Score) to Profund Disability\u00a0(20 studies have definitely turned our attention to the application Score). of PMLs in clinical practice, it is worth pondering what do these studies inform us about PMLs This issue is especially Total % of Permanent Physical Impairment\u00a0(PPI) will not exceed important when considering treatment strategies for individuals 100% in any case. with motor\u2011based communication disorders. From the time, the first paper on application of PMLs in speech motor learning Challenges in Disability assessment was published in 2000\u00a0(Adams & Page, 2000), there have I.\t Large number of conditions been several studies that have published positive or at times II.\t Low Awareness equivocal findings on outcomes of PMLs in learning\/relearning III.\tAgreement\/Consensus speech motor tasks. While the consensus is PMLs aid in the IV.\tNeed of orientation and training treatment of speech deficits, it is unclear to what extent and V.\t Limited resources. more specifically, what PMLs need to be applied In order to address this limitation, the author draws on his \u200aReferences decade long experience in conducting a narrative review on the studies that have investigated the outcomes of PMLs in treating 1.\t The Rights of Persons with Disabilities Act, 2016, Gazette of speech disorders. Through this narrative review, the author India\u00a0(Extra\u2011Ordinary); December 28, 2016. attempts to answer two important research questions \u00a0\u2013\u00a0(1) Do PMLs help in retention of speech skills that were acquired 2.\t Guidelines for the Purpose of Assessing the Extent of during speech therapy, and\u00a0(2) What PMLs are considered to Specified Disability in a Person Included under the Rights be effective in remediating speech deficits. of Persons with Disabilities Act, 2016\u00a0 (49 of 2016), Gazette of India\u00a0(Extra\u2011Ordinary); January 04, 2018. 3.\t The UN Convention on the Rights of Persons with Disabilities; 2006. Table 1: Practice conditions with appropriate examples for application in nonspeech and speech tasks (adapted from Mass et al., 2008) Practice Options Relationship to nonspeech (learning to play Relationship to speech (learning to say condition volleyball) \u201cbubble\u201d) Amount Small versus Large Practicing a serve 10 times versus 100 times Practicing saying \u201cbubble\u201d 10 times versus 1000 times Distribution Massed versus Practicing 100 serves in 10 min versus 100 Practicing saying \u201cbubble\u201d 100 times in 5 min distributed serves in 50 min versus 50 times in 10 min Variability Constant versus variable Practicing the serve in the same spot versus Practicing the word \u201cbubble\u201d at a constant speech practicing in different spots rate versus saying it at different speech rates Schedule Random versus blocked Practicing underhand and overhand serves Practicing the words \u201cbubble\u201d and \u201ctreat\u201d randomly versus practising underhand serve 50 randomly versus practising \u201cbubble\u201d 50 times and times and then proceeding to overhand serve then proceeding to \u201ctreat\u201d Focus Internal versus external Focusing on the dominant hand versus Focusing on the lips versus trying to hear the watching the ball as it tossed up in air word while saying it Complexity Simple versus complex Practicing a simple overserve versus a topspin Practicing individual syllables in the word \u201cbubble\u201d versus the whole word Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S143","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts Table 2: Feedback conditions with appropriate examples for application in non-speech and speech tasks (adapted from mass et al., 2008) Feedback Options Relationship to nonspeech (learning to play Relationship to speech (learning to say Conditions volleyball) \u201cbubble\u201d) Type Knowledge of performance versus How did I hit the ball versus did the ball land How did the lips move versus was it said on the correct spot correctly Knowledge of results Frequency High versus low Feedback after every serve versus feedback Feedback after every attempt versus after every 50 serves feedback after every 50 attempts Timing Immediate versus delayed Providing feedback immediately after the serve Providing feedback immediately after versus delaying by 5 s production versus delaying by 5 s Methods screening 3. To cite the evolution of Nociplastic Pain and the As this is a narrative review, the author manually conducted difference from Neuropathic Pain From the IASP definition in a hand search of all the relevant articles that examined the 1994, a lot of ambiguities in this definition led IASP to propose outcomes of application of PMLs to treat speech disorders. a new definition which states that it is an aversive sensory This involved perusing the relevant pages of key journals, and emotional experience typically caused by or resembling conferences, and other sources as well as checking reference actual or potential tissue damage. There is the change of the lists of identified articles and documents. At the end of the word unpleasant to aversive and instead of actual the word narrative review, the author identified articles that specifically resembling was added. This is important because some examined the outcomes of different PMLs in treating speech pains do not rise from actual damage but only from those that deficits. These PMLs included practice variability, practice resembles the actual damage. This definition is still being schedule, practice intensity, and feedback timing. Although finalized Another proposed definition captures the psycho there were articles that examined the outcomes of other PMLs social aspect as important in the pathogenesis of pain Pain in learning speech motor tasks, these articles did not include Is a multimodal experience. There is Peripheral sensitization clinical population. where there is decrease in threshold leading to increase in Results and Discussion nerve excitability mostly found at the site of tissue damage, The Among the four PMLs that were identified to have a solid role exaggerated response leads to hyperalgesia which spreads in treating speech deficits, practice intensity was maximally beyond the site of injury leading to secondary hyperalgesia beneficial in retaining the speech skills that were acquired and central sensitization. The Peripheral maintains the central during speech therapy. Practice schedule presented with the sensitization which is defined by the IASP as increased most equivocal findings as the outcomes varied depending on responsiveness of the sensory neurons in the CNS to their the population that were involved and also between children and subthreshold afferent input. The Descending pathways are adults. Furthermore, the author found that the research designs also important because pain can be modulated by Central used in these studies varied from phase I\u00a0(where phase I is the Disinhibition Pain has several stages both ascending and first step for identifying a treatment effect) to phase III\u00a0(during descending which are the following: Transduction\u00a0\u2013\u00a0translation this phase clinical trial\u00a0(s) are conducted to assess the efficacy of the noxious stimulus into electrical activity at the peripheral of the treatment through parallel\u2011groups design). nociceptor Transmission\u00a0\u2013\u00a0the propagation of nerve impulses through the nervous system Modulation\u00a0 \u2013\u00a0 modification of \u200aReferences nociceptive transmission by inhibition of the spinal dorsal horn cells by endorphins Perception\u00a0 \u2013\u00a0 the final conscious 1.\t Adams SG, Page AD. Effects of selected practice and feedback subjective and emotional experience of pain Inflammatory variables on speech motor learning. J\u00a0Med Speech Lang Pathol mediators\u00a0(eg bradykinin, serotonin, prostaglandins, cytokines, 2000;8:215\u201120. and H+) are released from damaged tissue and can stimulate nociceptors directly. This process is called primary or peripheral 2.\t Kaipa R, Jones RD, Robb MP. Are individuals with Parkinson\u2019s sensitization. Continuous activation of muscle nociceptors leads disease capable of speech\u2011motor learning?\u00a0 \u2013\u00a0 A preliminary to the co\u2011release of L\u2011glutamate and SP at the pre\u2011synaptic evaluation. Parkinsonism Relat Disord 2016;28:141\u20115. terminals of the dorsal horn. In addition to activation of alpha\u2011amino\u20113\u2011hydroxy\u20115\u2011methyl\u20114\u2011isoxazolepropionic 3.\t Maas E, Robin DA, Austermann Hula SN, Freedman SE, Wulf G, acid\u00a0(AMPA) receptors by L\u2011\u00a0glutamate at the post\u2011synaptic Ballard KJ, et\u00a0al. Principles of motor learning in treatment of motor terminal, Substance P facilitates activation of previously speech disorders. Am J Speech Lang Pathol 2008;17:277\u201198. dormant N\u2011\u00a0methyl\u2011D\u2011aspartate\u00a0(NMDA) receptors. This leads to maximal opening of calcium\u2011permeable ion channels, Symposium on Pain Management which hyper excites nociceptive neurons and causes apoptosis of inhibitory interneurons. There are then carried The Evolution of Neuropathic to Nociplastic by two main pathways tha to higher centres in the brain Pain through the spinothalamic tract and the Spinoreticular tract. Pain then is perceived. Pain is complex and subjective, Reynaldo Rey\u2011Matias and is affected by factors such as cognition\u00a0(eg distraction or catastrophising), mood, beliefs and genetics and this is \u200aChairman and Associate Professor, St Luke's College of Medicine - often called the \u2018pain matrix\u2019. In this study, they induced Department of Physical and Rehabilitation Medicine colitis in a rat. After 24\u201172 hours it showed inflammation in The lecture has the following objectives: 1. To report the updates in the definition of pain according to IASP.\u00a02. To discuss Neuropathic pain as to epidemiology, causes, symptoms, S144\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts the bladder triggered by Central sensitization with increased describe a pathological perception or sensation of pain not inflammatory response and mast cell infiltration. The primary generated by injury \u2022 \u201cNocipathic\u201d\u00a0\u2011\u00a0to denote a pathological pathology orthodromically sensitizes the dorsal horn\u00a0\u2013\u00a0there is state of nociception. primary afferent depolarization which releases anttidromically neuropeptides in the somatic and visceral tissues or any Characteristics and outcomes of spinal cord tissues linked segmentally to the primary pathology The primary injury following spondylitis tuberculosis pathology orthodromically sensitizes the dorsal horn\u00a0\u2013\u00a0there is primary afferent depolarization which releases anttidromically Ronald Pakasi neuropeptides in the somatic and visceral tissues or any tissues linked segmentally to the primary pathology Along Orthotist & Prosthetist, Fatmawati General Hospital, Jakarta, with Substance P, Proteinase Activated Receptor 2 enhances Indonesia expression of proinflammatory cytokines\u00a0 (bradykinin, TNF\u2019s and Interleukin) so Substance P\u00a0and PAR 2 can be potent Spondylitis tuberculosis\u00a0(STB) also known as Pott disease biomarkers of Neurogenic Inflammation and Sensitization So occurs in 1% of all tuberculosis worldwide. It is a dangerous we can say that the primary pathology resides in the region of type of extra pulmonary tuberculosis as it can cause spinal cord the primary hyperalgesia as the cause while the neurogenic injury\u00a0(SCI), and consequently paralysis on the extremities. inflammatory response resides in the region of the secondary hyperalgesia which Is more of the effect A continuous barrage In Fatmawati General Hospital, Jakarta, STB is the most of noxious input into the dorsal horn\u00a0(a process termed afferent common case of non traumatic SCI admitted in the rehabilitation bombardment) results in the co\u2011release of L\u2011glutamate and ward. From 2017 STB cases has exceed the number of substance P\u00a0(SP). Released together, these two substances traumatic case. In 2018, there are 42% case of STB compared can lower thresholds for synaptic activation and open previously to 18% cases of traumatic SCI. From 2017 to 2020 we recorded ineffective synaptic connections in wide dynamic range\u00a0(WDR) 107\u00a0cases of STB, with 40\u00a0male subjects and 67\u00a0female neurons, thus inducing central sensitization Furthermore, subjects. Based on the ASIA Impairment Scale\u00a0(AIS), 42.06% afferent fibers have the ability to sprout new spinal terminals were AIS D, and 33.64% were classified as AIS C.The thoracic that broaden synaptic contacts at the dorsal horn and may also level has the most neurological involvement with 42.06% in the contribute to expanded pain receptive fields. So we can say low thoracic level\u00a0(below T6 level), and 28.93% in high thoracic that the primary pathology resides in the region of the primary level\u00a0(T6 and above). Most common symptoms were sensory hyperalgesia as the cause while the neurogenic inflammatory dysfunction, including sensory loss and paresthesia\u00a0(94.54%), response resides in the region of the secondary hyperalgesia followed by limb weakness\u00a0(91.81%), and spinal pain\u00a0(71.96%). which Is more of the effect. Neuropathic Pain\u00a0(NeP) has the Spasticity occurred in 33\u00a0cases\u00a0(30.84%), while palpable old and the new definition. \u2022 Old: \u201cpain initiated or caused mass on the back was only observed in 8\u00a0cases. Eighteen by a primary lesion, dysfunction, or transitory perturbation subjects has concomitant pulmonary tuberculosis. The majority of the peripheral or central nervous system\u201d\u00a0(International of cases had bladder and bowel dysfunction in 72 and 71 Association for the Study of Pain\u00a0(IASP) 1 \u2022 New: \u201ccaused by a subjects respectively. However in most cases, bladder and lesion or disease of the somatosensory system\u201d\u00a0(International bowel sensations were still intact. Normal micturition was Association for the Study of Pain\u00a0(IASP), Among the Central observed in 35 subjects\u00a0(32.71%), while 36 subjects\u00a0(33.64%) NeP are: \u2022 Cerebrovascular disease \u2022 Neurodegenerative still retain normal defecation. From the radiological findings, diseases\u00a0(notably Parkinson disease) \u2022 Spinal cord lesions \u2022 vertebral bodies destruction accounts for 65.42% occurences, Demyelinating diseases The Peripheral NeP are the following: followed by cold abscesses\u00a0(62.62%), and compression \u2022 Lumbar and cervical painful radiculopathies are the most fracture\u00a0(57.94%). Severe spinal cord compression was frequent cause of chronic neuropathic pain. \u2022 Diabetes mellitus, observed in 46.73% of cases. prediabetes and other metabolic dysfunctions, infectious diseases\u00a0(mainly HIV infection and leprosy), chemotherapy, The inpatient rehabilitation program may run up to 8\u00a0weeks or immune and inflammatory dis orders, inherited neuropathies more. However the majority of subjects only needs 2\u00a0weeks and channelopathies This original taxonomy was problematic, or less\u00a0(40.19%), or 3\u20114\u00a0weeks\u00a0(28.97%) to achieve functional positing a framework of pain neurobiology in which there independence. Most of the subjects achieved functional is either pain experienced with a normally functioning walking after rehabilitation program\u00a0(52.72%), while 14 somatosensory nervous system\u00a0(i.e.\u00a0Nociceptive pain) or pain subjects\u00a0(13.08%) can only walk short distance using gait experienced when the somatosensory nervous system exhibits aids and still need wheelchair for longer distance. Forty four any kind of abnormal function\u00a0(i.e.\u00a0Neuropathic pain). This strict subjects\u00a0(41.12%) still need wheelchair after the rehabilitation binary classification of pain leq a sizeable proportion of patients program. Functional independence in activity of daily unclassified, specifically:\u00a0 (1) patients who present clinically living\u00a0(ADL) was achieved in the majority of cases\u00a0(70.09%), with a substantial overlap of Nociceptive and Neuropathic while 31 subjects\u00a0(28.97%) need caregiver assistance. symptoms;\u00a0(2) patients who do not exhibit signs or symptoms of any actual or threatened tissue damage, nor evidence of a Conclusion: early management of spondylitis tuberculosis lesion or disease of the somatosensory system. This ends up seemed to show better outcome\u00a0(i.e.\u00a0reducing the neurological to the definition of Nociplastic Pain Nociplastic pain \u2022 Pain that deficit impact, better prognosis, better walking ability, better arises from altered nociception despite no clear evidence of ADL outcome). Management strategies are combinations actual or threatened tissue damage causing the activation of of medication, surgical interventions\u00a0(if necessary), and peripheral nociceptors or evidence for disease or lesion of the rehabilitation strategies.Early rehabilitation should be started somatosensory system causing the pain. \u2022 \u201cAlgopathic\u201d\u00a0\u2011\u00a0 to as soon as possible, including pre operative phase for better preparation in setting the rehabilitation strategies. Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S145","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts Implementation of the PREP protocol to factors to consider while building capacity for implementation promote participation and inclusion of of models like the PREP in low resource settings. Learning Objectives: children with disabilities in India Participants will\u2011 1.\t Learn philosophy and key principles of the PREP approach Roopa Srinivasan1,2 with the help of case scenarios 1\u200aPaediatrician,\u00a0Fellowship in Developmental Pediatrics, CMC, 2.\t Learn about PREP implementation lessons through Vellore, Tamil Nadu, 2Ummeed Child Development Center, Mumbai, Maharashtra, India examples from disability service delivery organizations Participation in everyday activities that one desires\/or is expected within India. to be engaged in is accepted as one of the most important outcomes of rehabilitation interventions.[1] The International References Classification of Functioning, Disability, and Health\u00a0 (ICF) framework, endorsed by the World Health Organization, 1.\t Law M. Participation in the occupations of everyday life. Am J emphasizes the role of environmental factors in positively or Occup Ther 2002;56:640\u20119. negatively affecting an individual\u2019s participation.[2] Participation is known to be dependent on environmental factors such 2.\t World Health Organization. How to Use the ICF: A\u00a0 Practical as the physical\u00a0(e.g., built environment), social\u00a0(e.g., family Manual for Using the International Classification of Functioning, and peer support), cultural\u00a0(e.g., attitudes and values), and Disability, and Health\u00a0(ICF). Exposure Draft for Comment. institutional\u00a0(e.g., availability of program, services, and inclusive Geneva, Switzerland: WHO; 2013. policies) aspects of the environment.[3] Participation of children with disabilities is now known to be 3.\t Imms C, Adair B, Keen D, Ullenhag A, Rosenbaum P, Granlund lower in home, school, and community settings when compared M. \u201cParticipation\u201d: A\u00a0systematic review of language, definitions, to their non\u2011disabled counterparts in a low\u2011resource setting like and constructs used in intervention research with children with India.[4] Implementation of participation\u2011based approaches in disabilities. Dev Med Child Neurol 2016;58:29\u201138. disability services within a low\u2011resource setting is challenging in such contexts for several reasons.[4] 4.\t Srinivasan R, Kulkarni V, Smriti S, Teplicky R, Anaby D. The demand for services far exceeds the supply of trained Cross\u2011cultural adaptation and evaluation of the participation physicians and rehabilitation professionals given that India has and environment measure for children and youth to the indian one of the highest prevalence rates for childhood disabilities. context\u00a0\u2013\u00a0A mixed\u2011methods study. Int J Environ Res Public Health The few who are available have been trained to view disability 2021;18:1514. from a biomedical perspective, with little or no emphasis on psychosocial factors and their influence on a person with a 5.\t Anaby D, Law M, Teplicky R, Turner L. Focusing on the disability or their family. Limited access to information, pay for environment to improve youth participation: Experiences and service model and the complexity of the health care systems perspectives of occupational therapists. Int J Environ Res Public deter caregivers from accessing available services and turn to Health 2015;12:13388\u201198. alternative medicine practitioners and faith healers. Societal stigma and cultural beliefs may often force caregivers to seek 6.\t Morris ZS, Wooding S, Grant J. The answer is 17\u00a0years, what is \u201cfixes\u201d and cures for their child\u2019s disability. the question: Understanding time lags in translational research. Systematic capacity building among providers for the adoption of J\u00a0R Soc Med 2011;104:510\u201120. the biopsychosocial approach will aid in a better understanding of various psychosocial factors that influence the well\u2011being Evidence\u2011Based Medicine and Cochrane of persons with disabilities and their families. Evidence\u2011based Reviews for Neurorehabilitation: intervention models based on the ICF\u2011CY like Pathways and Resources for Engagement and Participation\u00a0(PREP)\u00a0(www. A\u00a0Workshop Organized by the WFNR prepintervention.ca) enable providers to use a family\u2011centered Jointly with Cochrane Rehabilitation approach to mitigate physical, social, attitudinal barriers while building supports to enhance participation in any type Organised inpatient care for stroke of activity.[5] Mitigation of environmental barriers and building of local context\u2011specific supports can play a critical role in Samantha Ramachandra promoting inclusion of children with disabilities in all contexts. However, the implementation of an approach that focuses on Acting Director, District General Hospital, Embilipitiya, Sri Lanka environmental barriers is challenging in a context where the The Asia Oceanian Congress of Neurorehabilitation biopsychosocial approach to disability is not usually adopted.[4] 2021\u00a0(AOCNR 2021) Summary on Organised inpatient care It is well known that on average it takes 17\u00a0years for research for stroke By Dr\u00a0Samantha Ramachandra. The presentation on and knowledge to translate into practice and that over\u00a075% Organised inpatient care for stroke comes as the 1st\u00a0component of change efforts fail because organizations are not ready for of part\u00a0B under the theme of \u201cEvidence\u2011Based Medicine and change.[6] Barriers and challenges faced when research findings Cochrane Reviews for Neurorehabilitation\u201d. Participants are are implemented in socioeconomically and culturally diverse now knowledgeable on what evidence\u2011based medicine is, the sites are yet unknown. This preconference session describes study designs that generate evidence to the field of medicine, the PREP model and will provide some early insights about and the vital role of Cochrane Reviews in generating evidence in the field of medicine. As the conference is focused on \u201cHolistic Rehabilitation: Hospital to home\u201d, we will be focusing on preparing the patient for home care following an attack of stroke. The Cochrane Review on \u201cOrganised inpatient care for stroke\u201d will be used as an example that had generated evidence on advantages. Stroke and stroke care Stroke is the second leading cause of mortality and the third leading cause of disability\u00a0(Murray et\u00a0al., 2012)\u00a0(Lozano et\u00a0al., 2012). While the mortality trend is reducing in the developed world, South S146\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts East Asia shows a rising trend of mortality and morbidity with at different care settings No. of trials No. of participants Poor some contribution factors\u00a0(WHO, 2021). The current projections outcome Odds Level of evidence Stroke wards Vs General estimate the number of deaths worldwide will rise to 6.5 million Wards 15\u00a03523 Pairwise comparison OR 0.78, 95% CI 0.68 to in 2015 and 7.8 million in 2030: most of them will be from South 0.91 Moderate quality evidence NMA OR 0.74, 95% CI 0.62 Wast Asia\u00a0(Strong, Mathers and Bonita, 2007). It is a very timely to 0.89 Moderate quality evidence Mobile Stroke team Vs, effort to identify strengthening strategies on neuro\u2011rehabilitation General wards 2\u00a0438 Pairwise comparison OR 0.80, 95% CI by South East Asian countries to minimise the economic 0.52 to 1.22 Low\u2011quality evidence NMA\u00a0\u2011\u00a0OR 0.88, 95% CI 0.58 impact of this long disabling condition. The review taken as to 1.34 Low\u2011quality evidence Mixed rehab, ward Vs. General the example focused on finding new evidence on the impact wards 6\u00a0630 Pairwise comparison OR 0.65, 95% CI 0.47 to of stroke outcome at stroke unit, which is the specific setting 0.90 Moderate quality evidence NMA OR 0.70, 95% CI 0.52 to compared to treating stroke patients at general medical ward. 0.95 Low\u2011quality evidence The subgroup analyses indicate that The whole world is practising unique settings for stroke care organised inpatient\u00a0(stroke unit) care based in a dedicated stroke for decades now. There was evidence that patients who were ward is likely to be most effective. Further, that organised stroke initially managed at these unique settings benefited from better unit care is of benefit in both acute and rehabilitation phases health outcomes. The current review added new evidence to of care. Costs and benefits Stroke units appear to improve the medical literature proving that the settings are beneficial. outcomes, but at what cost. In cost terms, length of stay is likely The article is available at https:\/\/www.ncbi.nlm.nih.gov\/ to dominate any individual component of acute patient care pmc\/articles\/PMC7197653\/pdf\/CD000197.pdf for reference. and rehabilitation. Longer\u2011term costs are likely to be dominated Background: Organised inpatient\u00a0(stroke unit) care is the by the need for nursing care. Studies from several developed term used to describe focused care for people with stroke in a countries have shown that fixed costs\u00a0(particularly nursing staff hospital under a multi\u2011disciplinary team\u00a0(nurses, doctors, and salaries) account for over\u00a090% of spending on acute stroke therapists) of individuals who specialise in stroke management. patients\u00a0(Warlow et\u00a0al., 2008). Remedial therapy represents They aim to work as a co\u2011ordinated team to provide the most only a small proportion of the total cost of hospitalisation. More appropriate care tailored to the needs of individual people with research is required to elucidate the cost implications of stroke stroke. This concept is not new, and its value has been debated units. Agreements and disagreements with other studies or for more than 30\u00a0years. A\u00a0debate has been created whether reviews This systematic review has been updated multiple more people survive and make a good recovery as a result of times over the last 25\u00a0years with broadly similar conclusions; organised inpatient\u00a0(stroke unit) care the overall conclusion about the organised inpatient\u00a0(stroke unit) Review Question: Does organised inpatient\u00a0(stroke unit) care has remained as \u201ceffective\u201d. Conclusion Moderate\u2011quality care improve the recovery of people with stroke in hospitals evidence shows that people with acute stroke are more likely to compared with conventional care in general wards survive, return home, and regain independence if they receive Outcome Variables: Alive after stroke, independent, and living at organised inpatient\u00a0(stroke unit) care. This is typically provided home one year after the stroke Method The review was conducted by a co\u2011ordinated multi\u2011disciplinary team operating within a according to the Cochrane review protocols. We included all discrete stroke ward that can over a substantial rehabilitation randomised controlled clinical trials that compared an organised period if required. There are no firm grounds for restricting access inpatient\u00a0(stroke unit) care system with an alternative form of according to a person\u2019s age, sex, stroke severity, or pathological inpatient care. Patients compatible with the clinical definition stroke type\u00a0(i.e.\u00a0ischaemic or haemorrhagic). Stroke unit care of stroke: \u201cfocal neurological deficit due to cerebrovascular provided in a dedicated stroke ward seems to be most effective. disease, excluding subarachnoid haemorrhage and subdural Therefore, providing a \u201cHolistic Rehabilitation: Hospital to home\u201d haematoma\u201d were taken as eligible subjects to be included in the for stroke patients recommends a multi\u2011disciplinary team\u2019s care trial. Organised inpatient care was categorised according to how at the stroke unit. organised the settings were. The transitivity\u00a0(similarity) of trials were considered for the Network Meta\u2011Analysis\u00a0(NMA) eligibility References assessment. While the Cochrane specialist group stroke register being the primary source of information, several other electronic 1.\t Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans databases were searched for randomised clinical trials on stroke V, et\u00a0al. Global and regional mortality from 235 causes of death care. Twenty\u2011nine trials\u00a0(5902 participants) were included in for 20 age groups in 1990 and 2010: A\u00a0systematic analysis for the the review. Data analysis and results The analysis of different global burden of disease study 2010. Lancet 2012;380:2095\u2011128. types of organised\u00a0(stroke unit) care used both direct pairwise comparisons and NMA. Direct comparison of stroke ward versus 2.\t Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud general ward: 15 trials\u00a0(3523 participants) care in a stroke ward C, et\u00a0al. Disability\u2011adjusted life years\u00a0(DALYs) for 291 diseases compared with the care in general wards. Stroke ward care and injuries in 21 regions, 1990\u20112010: A\u00a0systematic analysis for the showed a reduction in the odds of a poor outcome at the end global burden of disease study 2010. Lancet 2012;380:2197\u2011223. of follow\u2011up\u00a0(OR 0.78, 95% CI 0.68 to 0.91; moderate\u2011quality evidence). The following table\u00a0[Table\u00a001] discusses the general 3.\t Strong K, Mathers C, Bonita R. Preventing stroke: Saving lives outcome of stroke patients in different settings, and the use of around the world. Lancet Neurol 2007;6:182\u20117. both analysis methods has demonstrated almost similar results. The benefits were independent of the patient\u2019s age, sex, initial 4.\t Warlow C, \u200a\u00a0et al. \u00a0Stroke: Practical Management, Third Edition. stroke severity, or stroke type and were most apparent in special 1st\u00a0ed. \u00a02008.\u00a0[doi: 10.1002\/9780470696361]. stroke care settings compared to the general rehabilitation ward. Table\u00a01\u00a0\u2011\u00a0Odd\u2019s of poor outcome following Stroke after one year 5.\t WHO. Global, Regional and National Burdens of Ischemic Heart Disease and Stroke Attributable to Exposure to Long Working Hours for 194 Countries, 2000\u20112016; 2021. Available from: https:\/\/www.who.int\/news\u2011room\/ q\u2011a\u2011detail\/global\u2011regional\u2011and\u2011national\u2011burdens\u2011of\u2011ischemic\u2011 heart\u2011disease\u2011and\u2011stroke\u2011attributable\u2011to\u2011exposure\u2011to\u2011 long\u2011working\u2011hours\u2011for\u2011194\u2011countries\u20112000\u20112016.\u00a0[Last accessed on 2021\u00a0Jul\u00a021]. Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S147","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts Symposium on Stroke\u00a0(2) muscle testing\u00a0(MMT) score of at least 3\u00a0(anti\u2011gravity on the Medical Research Council scale), were walking with minimal to Effectiveness of adjunct robotic therapy moderate assistance\u00a0(FAC 1\u20132) on transfer to the rehabilitation with a patient\u2011guided suspension unit, and met manufacturer guidelines. Of the eligible patients, there were 50\u00a0patients in the robotic therapy group and 50 in system for stroke rehabilitation using a the conventional therapy group. The patients in the conventional 7\u2011days\u2011a\u2011week model of care: A\u00a0comparison therapy group received 6\u2011days\u2011a\u2011week therapy. The patients in the robotic group received robotic therapy 7\u2011days\u2011a\u2011week with conventional rehabilitation in addition to conventional therapy. The demographics\u00a0(age, gender, type, and location of strokes) and baseline scores\u00a0(FIM, San San Tay, Christine Alejandro Visperas, Abbas FAC, mRS, BBS, and NIHSS at admission) were similar, Bin Zainul Abideen, Mark Min Jian Tan, Ei Mon with no significant intergroup differences between the robotic Zaw, Hsuan Lai, Edmund Jin Rui Neo therapy and the conventional therapy groups. The mean BBS significantly improved in both groups and met the criteria for Physiatrist, Chief and Senior Consultant, Department of minimal detectable change. The robotic group had greater Rehabilitation Medicine at Changi General Hospital (CGH), improvement in mean BBS but this did not achieve statistical Singapore significance\u00a0(p\u00a0=\u00a00.244). The improvement in FAC was greater Objective: To determine and compare the effectiveness of in the robotic group than in the control group, with a mean gain adjunct robotic therapy with a patient\u2011guided suspension of 1.24\u00a0\u00b1\u00a00.89 versus 0.78\u00a0\u00b1\u00a00.76\u00a0(p\u00a0=\u00a00.007). There were no system for stroke rehabilitation using a 7\u2011days\u2011a\u2011week model significant differences found in the improvement in mRS scores of care with that of conventional rehabilitation. between the control and robotic groups\u00a0(p\u00a0=\u00a00.232) as well as in Design: Retrospective cohort study Setting: Inpatient rehabilitation the NIHSS scores\u00a0(p\u00a0=\u00a00.355). The average FIM score in both unit of an acute general hospital Participants: A\u00a0 total of 100 groups were within the moderate stroke category at admission. consecutive stroke patients admitted within a 7\u2011month period The FIM gain in the robotic group was 1.4 points higher, but who fulfilled the criteria to undergo robotic therapy with a did not reach statistical significance\u00a0(p\u00a0=\u00a00.525). The median patient\u2011guided suspension system were enrolled in this study. FIM efficiency was 1.29\u00a0(IQR: 0.71\u20132.29) in the robotic group Interventions: Patients either underwent robotic therapy in and 0.86\u00a0(IQR: 0.27\u20131.86) in the control group\u00a0(p\u00a0=\u00a00.162). The addition to conventional therapy\u00a0(robotic group) or conventional majority of patients tolerated robotic therapy well and were either therapy only\u00a0(control group). There were 50\u00a0patients in each satisfied or very satisfied with it. Most preferred robotic therapy cohort. Main Outcome Measures: Functional independence as an adjunct to conventional therapy rather than conventional measure\u00a0(FIM) and its derivatives\u00a0(FIM gain and FIM therapy alone. In summary, the robotic group demonstrated a efficiency); Berg Balance Scale\u00a0(BBS), functional ambulation significant greater improvement in FAC. There were greater category\u00a0(FAC); modified Rankin Scale\u00a0(mRS); and National improvements in FIM Efficiency, Berg Balance, mRS scores Institutes of Health Stroke Scale. although these did not achieve statistical significance. Newer Results: The average FIM gains in both groups were statistically studies have shown that high\u2011intensity stepping training during significant\u00a0(p\u00a0<\u00a00.01). The robotic group had greater improvement inpatient stroke rehabilitation improves outcomes.[6] Specificity, in FAC scores\u00a0(1.24 versus 0.78, P\u00a0=\u00a00.007). However, other amount, and intensity of locomotor training are other important measurements such as FIM efficiency, BBS, and mRS were factors.[7,8] Robotic therapy was solely dedicated to gait training not significantly different between the two groups. The robotics and increases the number of gait cycles\u00a0(average distance group reported high patient satisfaction rates, with the majority ambulated per session was 368\u00a0m) which may have made a of patients finding the intervention both beneficial and desirable. difference in the improvement of the FAC scores. The limitations Conclusions: Adjunct robotic therapy has the potential to of this study, other than the restricted sample size, included the increase the efficacy of stroke rehabilitation. However, further lack of longitudinal follow\u2011up at three months or longer. This studies are needed to strengthen the evidence. Studies have was also not a head\u2011to\u2011head comparison of robotic versus shown that greater intensity of stroke rehabilitation leads to better conventional therapy as the robotic group still underwent outcomes[1\u20113] and a positive relationship between lower limb conventional therapy, hence the significant improvement in FAC exercise dose and improved walking speed.[4] It is challenging to may be attributed by an increased exercise dose as well. Using achieve 3 hours of therapy per day. One possible way to increase a patient\u2011guided suspension system robotic device for selected efficiency could be to provide 7\u2011days\u2011a\u2011week rehabilitation.[5] The groups of stroke patients with FAC 1\u20132 in a 7\u2011days\u2011a\u2011week hypothesis was that providing adjunct robotic therapy using a model had the potential to increase rehabilitation efficiency and 7\u2011days\u2011a week model of care improves rehabilitation outcomes. improve FAC scores in our study. However, further studies are A\u00a0new robotic therapy service was implemented in our inpatient needed to strengthen the evidence. rehabilitation unit in June 2019. The robotic device used is categorized as a patient\u2011guided suspension system. It allows for References partial weight support and the selection of gait speed via a remote control. It has sensors and algorithms that assist the device with 1.\t Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee propulsion, maneuvering of frame and directional adjustments S, Richards C, Ashburn A, et\u00a0al. Effects of augmented exercise for patient safety. Safety features include auto\u2011brakes as well as therapy time after stroke: A\u00a0meta\u2011analysis. Stroke 2004;35:2529\u201139. a harness system. Service evaluation was performed through a retrospective cohort study. A\u00a0total of 282 electronic medical 2.\t Kwakkel G. Impact of intensity of practice after stroke: Issues for records were reviewed for the period between March to October consideration. Disabil Rehabil 2006;28:823\u201130. 2019. The study included 100\u00a0patients who had a manual 3.\t French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, et\u00a0al. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev 2016;11:CD006073. S148\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts 4.\t Scrivener K, Sherrington C, Schurr K. Amount of exercise in the CAREPa\u2011Re\u00ae\u00a0\u2013\u00a0the 360 degree matrix! first week after stroke predicts walking speed and unassisted 1.\t What is this CAREPa\u2011Re all about It is a part of our guiding walking. Neurorehabil Neural Repair 2012;26:932\u20118. principle\u00a0\u2013\u00a0called the CAREPa\u2011Re principle. 5.\t Sonoda S, Saitoh E, Nagai S, Kawakita M, Kanada Y. Full\u2011time \t The components of the CAREPa\u2011Re principle are: integrated treatment program, a new system for stroke rehabilitation in Japan: Comparison with conventional \u2011\tClinical rehabilitation. Am J Phys Med Rehabil 2004;83:88\u201193. \u2011\tAnatomical \u2011\tRadiological 6.\t Moore JL, Nordvik JE, Erichsen A, Rosseland I, B\u00f8 E, Hornby TG, \u2011\tEtio et\u00a0al. Implementation of high\u2011intensity stepping training during \u2011\t Pathological inpatient stroke rehabilitation improves functional outcomes. \u2011\tRehabilitation. Stroke 2020;51:563\u201170. Objective: I\u00a0realised over\u00a02 decades ago that the reason why some patients with neurological disabilities do much better\u00a0(or 7.\t Hornby TG, Holleran CL, Leddy AL, Hennessy P, Leech KA, worse) than many others was due to the CAREPa. Connolly M, et\u00a0al. Feasibility of focused stepping practice during I hypothesised that with \u2018all variables remaining constant\u2019, inpatient rehabilitation poststroke and potential contributions to this was \u2018the\u2019 one factor that really influenced the eventual mobility outcomes. Neurorehabil Neural Repair 2015;29:923\u201132. outcomes. But the BIGGEST FACTOR is this: even in the most advanced 8.\t Hornby TG, Straube DS, Kinnaird CR, Holleran CL, Echauz hospitals in the world, there is no connection made between AJ, Rodriguez KS, et\u00a0al. Importance of specificity, amount, and the CAREPa\u00a0(managed by the acute care neuro specialists) intensity of locomotor training to improve ambulatory function and the Re\u00a0(Rehabilitation\u00a0\u2013\u00a0managed predominantly by the in patients poststroke. Top Stroke Rehabil 2011;18:293\u2011307. therapists) For most \u2018Re\u2019 professionals\u00a0\u2013\u00a0hemiplegia is a hemiplegia Neurorehabilitation 360 degrees, A is a hemiplegia. They don\u2019t really care if it was caused functional neurosurgeon\u2019s perspective by a TBI\u00a0(traumatic brain injury), ischemic stroke\u00a0(whether thrombolysed or not), hemorrhagic stroke, CVT\u00a0(cortical Sharan Srinivasan venous thrombosis), brain tumor, brain infection, secondary to brain herniation, brainstem stroke, etc., they treat all of them Neurosurgeon, \u00a0Jain Institute of Movement Disorders and Functional the same way. But the same \u2018C\u2019 \u2018hemiplegia\u2019, caused due to Neurosurgery, CMD\u00a0\u2013\u00a0PRS Neurosciences different \u2018EPa\u2019s and in different \u2018A\u2019s and confirmed by serial Areas of interest & expertise: Neuro modulation & neuro \u2018R\u2019s will demonstrate different variations in initial presentation, rehabilitation different progression and different PPP!. THE IMPACT of brain & spinal cord injuries! This is the essence that the CAREPa\u2011Re principle \u2022\t Together these\u00a0(TBI, dementia & stroke) will potentially add captures very effectively and is able to do \u2018targeted rehab\u2019\u00a0\u2013\u00a0rebuilding damaged brain circuits. over\u00a035 lakh people to the disabled population every year, 2.\t Is it new Or Is it building on previous work which is almost equal to the population of a metropolitan \t Though all the elements of the CAPEPa have been used city like Nagpur or Lucknow! in some combination or the other for centuries, they were \u2022\t World Health Organization notes that between 250\u00a0000 and mainly used for diagnosis and care of the acute patient. This 500\u00a0000 people suffer a spinal cord injury\u00a0(SCI) every year, is probably the first time that someone has systematically around the world. Furthermore, people with a spinal cord formatted the use of CAREPa in the neuro rehabilitation injury are two to five times more likely to die prematurely space and in this way. than people without a spinal cord injury, with worse survival 3.\t How does it help with the intended outcome rates in low\u2011\u00a0and middle\u2011income countries \tRationale: these are the different ways CAREPa helps us: \u2022\t Statistically, every minute 7 new people are acquiring a \u2022\t a) understanding the areas of the brain affected and hence neurological disability in India\u00a0\u2011\u00a0amounting to nearly 11,000 the brain circuits that could be damaged is critical for new patients\/day!. prognosticating the future progress and hence to predicting THE IMPACT of brain & spinal cord injuries! eventual \u2018functional\u2019 outcomes \u2022\t Together these\u00a0(TBI, dementia & stroke) will potentially add \u2022\t b) By dynamically tracking the initial CAREPa to the over\u00a035 lakh people to the disabled population every year, subsequent CAREPa findings, we can predict even bette which is almost equal to the population of a metropolitan \u2022\t c) As the patient improves, the CAREPa will help city like Nagpur or Lucknow! anticipate and uncover more advanced yet subtle and \u2022\t World Health Organization notes that between 250\u00a0000 and complex neurological disabilities\u00a0(like apraxias, agnosias, 500\u00a0000 people suffer a spinal cord injury\u00a0(SCI) every year, visuo\u2011spatial issues, etc) all of which can impact the PPP. around the world. Furthermore, people with a spinal cord Based on this possible anticipatory problems, we initiate injury are two to five times more likely to die prematurely early and focussed rehab for such deficits also\u00a0\u2013\u00a0a concept than people without a spinal cord injury, with worse survival we call in NewRo\u00a0\u2013\u00a0keeping the brain \u2018future ready\u2019! rates in low\u2011\u00a0and middle\u2011income countries \u2022\t d) By mapping these initial CAREPa to the subsequent Re \u2022\t Statistically, every minute 7 new people are acquiring a and fMRI findings, we will be even more confident in the PPP neurological disability in India\u00a0\u2011\u00a0amounting to nearly 11,000 \u2022\t e) It also helps us to plan the appropriate \u2018neuro modulation new patients\/day!. strategies\u2019 required to improve the eventual \u2018functional\u2019 The mental shift I had to make from being predominantly a outcomes!. \u2018structural\u2019 neurosurgeon to a \u2018functional\u2019 neurosurgeon was quite dramatic and had a lasting impact on the way I even evaluated & treated my patients initially\u00a0(both medical & surgical). Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S149","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts 4.\t How does it work no evidence of either re\u2011perfusion hemorrhage or significant \t The CAREPa tree is designed to effectively capture relevant midline shift\/brain herniation. EPa\u00a0\u2013\u00a0being a hypertensive and diabetic and with dyslipidemia data as per this pattern and poor drug compliance and control, the current thrombotic \u2011\tClinical occlusion of the MCA\u00a0(most probably M1) are as a direct result \u2011\tAnatomical of these co\u2011morbidities. \u2011\tRadiological CAREPa Conclusion: since he came into the emergency in \u2011\t EtioPathological. the window period and we were able to thrombolyse him within It captures the initial clinical findings at ictus, the subsequent 3 hours of ictus and with the subsequent findings as above, he worsening due to the progress of the disease, related and has a good chance of a near total recovery provided intensive unrelated complications\u00a0(like raised ICP, brain surgery, neurorehabilitation and other supportive care is provided. electrolyte disturbances, effective control of hypertension and What are the patient\u2019s\/family\u2019s expectations diabetes, infections, etc), speed of improvement, areas of the \u2022\t Will my patient improve brain affected, the type of etio\u2011pathology, etc. \u2022\t Will he\/she become normal again 1.\t What are the MAJOR subsections \u2022\t How long will it take \u2022\t What all do we need to do for that 2.\t How does each subsection work Each sub\u2011section \u2022\t Is there hope Meaning \u2026is this patient rehabable addresses certain key aspects. The below snapshots \t To answer these questions, we need to know\u2026 give us the glimpse of the next level of detailing in each \u2022\t What was the reason for this situation of the patient Ie sub\u2011section. stroke, head injury, brain infection, spinal cord problems, 3.\t How do they combine to help with the intended outcome degenerative diseases, etc. They help in the following ways: a) they let us know the \u2022\t What is the current level of functioning of the patient depth & severity of the problem. b) They let us know how \u2022\t What are all the different disabilities that the patient is having the various neurological symptoms that the patient has currently, that is stopping them from functioning well connects to the various areas of the brain. c) In case \u2022\t What are the expectations of the patient\/family Is it realistic it is a stroke, they let us know the anatomical areas of Can all that be achieved the brain that have been affected as well as the various \u2022\t Do we know what all abilities that the patient needs to have possible complications that may have occurred. In a for this outcome majority of cases, these complications have a direct \u2022\t How do we know if the patient is improving\/progressing in bearing on the quality of outcome. d) They also help us the right direction Can we measure the progress to identify which \u2018functional\u2019 areas of the cerebral cortex \u2022\t How can all these be communicated to the patient\/family lies where\u00a0(surface anatomy) and how we can plan \u2022\t Can\/do we issue reports to the patient\/family \u2018non\u2011invasive\u2019 brain stimulation and how this may alter \t \u2018SMART\u2019 Neuro Rehab\u00a0=\u00a0newro logix\u00ae the functional outcomes. \t (ROS\u00a0=\u00a0Rehab Operating System) A comprehensive clini\u2011tech neuro rehab process 4.\t Relevant examples of the products with data and \u2022\t S\u00a0\u2011\u00a0Specialised, outcomes. Actual examples of the product with data and \u2022\t M\u00a0\u2011\u00a0Measurable Methodologies outcomes\u00a0\u2011\u00a0Experiment, Data, Analysis, Conclusions. \u2022\t A\u00a0\u2011\u00a0Assessments, Analytics, AI \u2022\t R\u00a0\u2013\u00a0Rehabilitation CAREPa report: \u2022\t T\u00a0\u2011\u00a0Techniques & Technologies C\u00a0\u2013\u00a0patient is in altered sensorium and with a right hemiparesis. This model is a proprietary software tool It uses the principles He was brought to the emergency within the window period\u00a0(<2 & paradigms of \u201cBrain, Computation & Learning\u201d All the above hours) and hence qualified and underwent IV thrombolysis. His have been embedded into the \u2018newro logix\u2019 software that we are NIHSS was 25 initially and improved to 20 over next 10\u00a0days. building. With its own clinical algorithms embedded. And this A\u00a0\u2013\u00a0the anatomical substrates involved are\u00a0\u2013\u00a0the dominant left is the starting point for the AI and ML. Our proprietary Patient cerebral hemisphere, brainstem structures. Management Software with analytics is called \u2018newro logix\u00ae. R\u00a0\u2013\u00a0the initial MRI stroke protocol was consistent of an evolving This \u2018newro logix\u2019 has been built using Team newro\u2019s original MCA territory infarct\u00a0(only seen on DWI). The subsequent \u2018logics\u2019 and uses proprietary algorithms, artificial intelligence, CT scans showed patchy MCA territory infarcts. And with machine learning. (through the establishment of artificial neural networks) and critical analysis pathways to help Making \u2018feedback\u2019 the mainstay in assessments, course corrections and therapy planning It acquires multi\u2011dimensional data via \u2018high touch and high tech\u2019 strategies & innovative & patented equipments with software and hence assists the user to obtain a 360\u2011degree view of both the functions and dysfunctions of the various different parts\u00a0(both hardware & software) of the human nervous system. It begins with the neuroscientists\u00a0(neurologists, neurosurgeons, rehab physicians, therapists and support staff) and their patients S150\t Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts at one end and the computational and analytical engineers\u00a0(with 1.\t C2C\u00ae BIR for brain injuries and expertise in AI, ML, big data analyses, building artificial neural 2.\t C2C\u00ae SCIR for spinal cord injuries. networks, robotics, etc) at the other end. 1.\t What is SEFA\u00ae about And using a robust and repetitive \u2018prospective\u2011retrospective\u2019 SEFA\u00a0=\u00a0Self Evaluation of Functional Abilities in neurological process, we will be able to establish artificial neural networks patients. and fine\u2011tune the process strategies as well as to come up with Objective: an online, self\u2011explanatory, interactive \u2018screening newer \u2018cutting\u2011edge\u2019 technologies and therapies. tool\u2019 that helps the neurologically disabled patients\u2019 or their families\/caregivers to self \u2018identify\u2019 the various, subtle yet Protocols and processes for progress and complex \u2018functional disabilities\u2019 that they have because of the prognosis prediction disease\u00a0(ex: stroke, TBI, ABI, SCI, etc) they suffer from. We have 2 parts to the SEFA: Sharan Srinivasan a) SEFA for brain injured patients\u00a0(like traumatic brain injury, acquired brain injury, stroke, brain tumors, demyelination, brain Neurosurgeon,\u200aJain Institute of Movement Disorders and Functional infections like encephalitis, hypoxic brain injury, etc) Neurosurgery, CMD\u00a0\u2013\u00a0PRS Neurosciences.\u00a0 b) SEFA for spinal cord injured patients\u00a0(like those after trauma, E\u2011mail:\[email protected] infections, tumors, demyelination, etc). Areas of interest & expertise: Neuro modulation & neuro 2.\t How is this concept different Two reasons: rehabilitation a) these disabilities usually need multiple experts in The world Cannot afford Disability multispecialty hospitals to begin the screening process. \u2022\t The direct and indirect costs on the GDP is huge! This \u2018screening tool\u2019 helps in self\u2011identifying these complex \u2022\t Disability attenuates India\u2019s population dividend \u2018functional disabilities\u2019. \u2022\t Physical healing must necessarily restore functional abilities b) there is no such self\u2011screening tool existing today that \u2022\t Restoration of functional abilities requires one to \u201creboot is agnostic to the disease\u00a0(brain, spine or peripheral nerve related) that a non\u2011healthcare person\u00a0(usually the patient the brain\u201d themselves or their caregivers) is able to answer and navigate \u2022\t Assessments of functional ability must be easy for patients through \u2022\t Measurements of functional ability must be objective and c) They also automatically receive a \u2018pre\u2011prepared report\u2019 based on their answers. cannot be vague 3.\t What are the advantages of SEFA. \u2022\t There are both visible and hidden patterns in the process a) The SEFA can be answered by any lay person with no medical or rehab knowledge. Hence it can be deployed online of functional restoration; prudent usage of technology can and in a massive scale. uncover hidden and camouflaged patterns. b) It can also be translated into any language since it is agnostic The predictive and treatment\u2011guiding processes of our to race, religion, ethnicity, cultures. curriculum is based on principles that are concordant to the 4.\t How does it help with the intended outcome well\u2011established principle of \u201cfunction follows form\u201d. This Rationale: every neurologically disabled patient has the same principle is concordant with the physical and mathematical simple questions: will\/can I get better Will I be normal When principles of form\u2011function interconnectedness for defining and can I get back to my life Will I ever be able to walk Use by right describing functional abilities\u00a0(or the lack of it) in patients with hand to eat Etc, etc. neural tissue injuries. To be able to answer their questions, we must have structured Furthermore, the process helps to objectively: and concrete data that helps us to: 1.\t assess the current \u2018functioning level\u2019 of a neurologically a) Objectively assess the current level of functioning & how far disabled patient, it is from their \u2018normal\u2019 2.\t the rehab potential he\/she has, b) Which are all the functional brain circuits that have got 3.\t help to map the progress and impacted. 4.\t to try and predict the eventual possible outcomes. 5.\t How do the various aspects combine to help with the This product uses the C2C\u00ae BIR and C2C\u00ae SCIR levels to help categorize patients with neurological\/functional disabilities intended outcome arising from brain, spinal cord and peripheral nerve injuries SEFA uses data obtained from simple day\u2011to\u2011day movements into 4 stages and 10 levels, respectively. C2C\u00ae levels are and activities of the patient to arrive at the C2C level of that computed in 2 ways: patient. This is done using a complex and innovative logic. 1.\t SEFA\u00a0\u2013\u00a0a web\u2011based self\u2011assessment tool REHABABILITY INDEX\u00a0(RI) 2.\t CEFA\u00a0\u2011\u00a0from a C2C calculator\u00a0\u2013\u00a0to be done by the clinician. 1.\t What is this Rehabability Index\u00ae\u00a0(RI) all about Each level has a set of unique clinical data has then been Rationale: every neurologically disabled patient has the same transcribed into a set of reports\u00a0(one for each level). Though simple questions: will\/can I get better Will I be normal When the reports have been pre\u2011written, the accuracy and precision can I get back to my life Will I ever be able to walk Use by right has been anywhere between 70\u201190%!. hand to eat Also, how long will it take How much will it cost C2C\u00ae levels Is it worth it All these questions are critical in an economically We have created this unique concept to objectively describe each patients\u2019 level of functional ability\u00a0(and disability) following any kind of brain or spinal cord injuries. The C2C levels are of 2 types: Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021\t S151","[Downloaded from http:\/\/www.pjiap.org on Saturday, July 29, 2023, IP: 43.246.243.196] Reflections from Experts challenged economy like India where a majority of patients still Symposium on Speech and Swallowing make out\u2011of\u2011pocket payments of their hospital bills. Rehabilitation Objective: RI is a prediction tool, wherein each C2C\u00ae level is linked to a predictive value termed as the REHABABILITY Assessment and neurorehabilitation of INDEX, which estimates the dynamic relationships of functional primary progressive aphasias outcomes with the nature and duration of the neurorehabilitation processes & protocols. Sonal Vijay Chitnis This is probably the first time in the world that such an index has been created for this purpose. We intend to Speech Language Pathology, Bharati Vidyapeeth\u00a0(DT) University, continuously refine the index and it\u2019s accuracy\u00a0 \u2013\u00a0 using School of Audiology and Speech Language Pathology, Pune, ML & AI. Maharashtra, India E\u2011mail:\[email protected] The RI helps everyone\u00a0 (the clinicians, the front office, the Diagnosing dementia and its clinical classification have caregiver and the patient) understand these usual questions always been a challenging topic for medical and healthcare everyone wants to know: professionals. Medical work up, clinical correlation of cognitive a.\t Is the patient really \u2018rehabable\u2019 behavioural characteristics and neuroimaging is mainstay of the b.\t What is the best possible outcome we can expect clinical assessment 1. Progressive aphasia are typical language c.\t How long will it take approximately onset clinical dementia syndromes which are often intricate to d.\t Where does he\/she have to stay identify, diagnose and intervene. Primary Progressive Aphasia e.\t How many sessions of therapy\/day is needed is language based dementia or more common as a language f.\t How much will it cost. variant of Fronto temporal dementia where there is gradual, insidious dissolution of language & communication skills Figure\u00a02: Bir\u00a0\u2013\u00a0brain injury rehabilitation. Section 1: recovered with preserved memory and other cognitive abilities in very patients initial phase. Speech language pathologists play a significant role in memory clinic, neurocognitive evaluation, disease diagnostic differential process and Neurorehabilitation for PPAs. Multidimentional PPA has varied profiles and it has direct influenc based on underlying Neuropathology which determines Praxis, Progression and PreRESERVE vs Lost abilities across PPA individuals. Clinical correlation of Speech verbal praxis, receptive and expressive communication, cognitive behavioural characteristics and neuroimaging is mainstay of the clinical assessment of PPA. Nonfluent PPA have better auditory comprehension abilities with comparatively preserved posterior receptive and receptive cognitive abilities that of semantic dementia\/fluent variant of PPA and Logopenic PPA\/AD pathology associated mixed PPA. Careful tailor made speech, language and cognitive communication rehabilitation can make definite difference towards quality of life in persons with neurodegenerative disorders following PPA. Safe swallowing and maintained functional communication along with mindful conversational partner training is essential part of speech language therapeutic services in PPA Neurorehabilitation. Present talk will brief on SAI\u00a0\u2013\u00a0preliminary research and clinical practice oriented Neurorehabilitation in PPA by author in Indian bilingual persons with PPA. Author acknowledges all the kind support, encouragement and mentorship in field of Cognitive neuroscience and Neurorehabilitation by Professor Dr\u00a0Suvarna Alladi, Dr\u00a0Jaydip Ray Chaudhury, Dr\u00a0Sujit Jagtap. Author also appreciates kind guidance and all the support in neurolinguistics and PPA research as a primary guide during her post graduate dissertation by Dr\u00a0Sudheer Bhan, Osmania University AYJNIHH SRC. Symposium on IT and Neurorehabilitation The future of AI in neurorehabilitation S152\t Soubhik Das Social Worker, Manastik, Pune, India With the advent of technology, especially smartphones, we are looking at a billion people, whose lives can be touched upon Physiotherapy - The Journal of Indian Association of Physiotherapists - Volume 15, Supplement 1, December 2021"]