Comparison of Submental Surface Electromyography during Dry Swallow between Irradiated Head and Neck Cancer Survivors and Normal Individuals.

INTRODUCTION: This study compared the submental surface electromyography (sEMG) duration and amplitude during dry swallowing between irradiated head and neck cancer (HNC) survivors and age-matched normal individuals. Further, the relationship between submental and infrahyoid sEMG in the irradiated HNC group was explored. METHOD: Forty participants (20 HNC survivors and 20 age-matched normal individuals) participated in this study. The HNC survivors had completed organ preservation cancer treatment (at least 1-month post-treatment). They were on a complete oral diet without enteral supplementation (FOIS score> 4). Submental and infrahyoid sEMG activity was calculated for three trials of saliva swallow for each participant using sEMG. The duration and amplitude parameters considered were: onset duration - duration from the onset of swallowing to the maximum amplitude, offset duration - duration from the maximum amplitude to the end of the swallowing activity, total duration, and maximum amplitude. RESULTS: The study found that irradiated HNC survivors exhibited prolonged temporal measures, particularly in the offset duration, which suggested a delayed descent of the hyolaryngeal complex during swallowing. Additionally, the HNC group showed a positive correlation between submental and infrahyoid sEMG. Furthermore, it was observed that the rate of increase in the duration of submental sEMG during subsequent swallowing was greater in HNC survivors which could be due to reduced salivation. CONCLUSION: Compared to age-matched normal individuals, irradiated HNC survivors manifest alterations in the submental muscle activities during dry swallowing as measured using sEMG. The temporal and amplitude changes are likely to have arisen as a consequence of postradiation changes.

Do kinematic measures, added to clinical measures, better predict upper extremity motor impairments at three months post-stroke?

OBJECTIVE: Predicting post-stroke recovery through prediction models is crucial for choosing appropriate treatment options. However, the existing models predominantly incorporate clinical measures although measurement of movement quality using kinematic measures is essential for distinguishing various types of recovery. Thus, this study aimed at determining if, by considering varied aspects of recovery, adding kinematic measurements over clinical measures would better predict upper extremity (UE) motor impairments at three months post-stroke. MATERIALS AND METHODS: Eighty-nine stroke survivors (58.9 ± 11.8 years) were assessed for clinical predictors between 4 and 7 days, kinematic predictors within 1 month, and the impairment outcome of the Fugl Meyer Assessment of the UE (FM-UE) at three months post-stroke. Significant predictors (p<0.05) with a variation inflation factor (VIF) <10 were selected for model development. After performing further step-wise selection, three models incorporating clinical outcomes, kinematic measurements, and a combination of these two, respectively, were formulated. RESULTS: The clinical model (R2 = 0.70) included shoulder abduction finger extension (SAFE) scores, the National Institutes of Health Stroke Scale (NIHSS), and the Montreal Cognitive Assessment (MoCA). The kinematic model (R2 = 0.34) included total displacement, total time, and reaction time. The combined model (R2 = 0.72) comprised of SAFE score and shoulder flexion. All the models had a minimal mean squared error on cross validation, which indicated a good validity. CONCLUSION: The performance of clinical and combined prediction models for predicting three-month post-stroke UE motor recovery was nearly similar. However, in order to detect minimal changes over time and to understand all aspects of motor recovery, there is a need to add instrument-based kinematic measures.

Kannada Translation and Validation of the ESAS-r Renal for Symptom Burden Survey in Patients with End-Stage Kidney Disease.

Objectives: End-stage kidney disease (ESKD) is a life-limiting illness that leads to significant health-related suffering for the patients and their caregivers. Moreover, disease-directed options such as dialysis and renal transplant might not be universally accessible. Inadequate assessment and management of symptoms often lead to diminished quality of life. For evaluating symptoms and their associated distress, various tools have been identified. However, these are not available for the native Kannada-speaking population for assessing ESKD symptom burden. In this study, we determined the reliability and validity of the Edmonton Symptom Assessment System Revised Renal (ESAS-r: Renal) in Kannada-speaking ESKD patients. Materials and Methods: ESAS-r: Renal English version was translated into Kannada using the forward and backward method. The translated version was endorsed by Nephrology, Palliative care, Dialysis technology and Nursing experts. As a pilot study, 12 ESKD patients evaluated the content of the questionnaires for appropriateness and relevance. The ESAS-r: Renal Kannada version was validated by administering this tool to 45 patients twice a fortnight. Result: The translated ESAS-r: Renal Kannada version questionnaire had an acceptable face and content validity. Experts' opinion was assessed by content validity ratio (CVR), and the value of CVR of ESAS-r: Renal Kannada version was-'1'-. Internal consistency of the tool was assessed among Kannada-speaking ESKD patients; its Cronbach's α was 0.785, and test-retest validity was 0.896. Conclusion: The validated Kannada version of ESAS-r: Renal was reliable and valid for assessing symptom burden in ESKD patients.

Radiologic Outcomes of Bilateral and Unilateral Perthes Disease: A Comparative Cohort Study.

INTRODUCTION: This study was undertaken to compare the radiologic outcomes of bilateral and unilateral Perthes disease and also to evaluate the outcome of synchronous and metachronous bilateral Perthes disease. METHODS: Of 353 children with Perthes disease followed up from presentation to healing during the last 10 years, 37 had bilateral involvement (11 synchronous and 26 metachronous onset). The radiologic outcomes of each hip of children with bilateral disease were compared with outcomes of 148 children with unilateral disease who were matched for age, sex, and treatment. Children with unilateral or bilateral diseases were treated with a proximal femoral varus derotation osteotomy if they fulfilled the criteria for surgery. The primary outcome measure was the shape of the femoral head at healing assessed by the Sphericity Deviation Score (SDS). RESULTS: The children with bilateral disease were younger than those with unilateral disease (6.2 vs. 7.03 y; P<0.001), and they had a longer duration of the disease. All other characteristics of bilateral and unilateral cases were similar. The SDS values of unilateral and bilateral disease were comparable, as were the SDS of synchronous and metachronous bilateral disease. The effect of early surgery on the evolution of the disease in bilateral cases was similar to that reported in unilateral disease. The age of onset of the disease alone influenced the SDS in bilateral cases. CONCLUSION: The age at onset of the bilateral disease is lower, the duration of the disease longer than that of unilateral disease, but the disease outcome is similar.

Characteristics of musculoskeletal pain among employees of fish processing factory in Udupi City, Karnataka.

Fish processing employees are exposed to various occupational risk factors that result in musculoskeletal pain (MSP). The objective of the study was to determine the characteristics of MSP among them and its association with the nature of the job and work condition. A cross-sectional study was conducted among 364 employees of five fish processing factories using standard questionnaires. Descriptive analysis and Chi-square test were performed using SPSS software version 15.0. The prevalence of MSP was 77.7% affecting more of the upper extremities (43.8%). Mild and moderate types of pain were more (37.6%) that resulted due to repeated work (30.2%) and work method (35.4%) that include extreme temperature and work posture. The mean numeric pain severity score was 3.02 ± 2.14. Global self-rated health was reported as predominantly good (57.7%). To conclude, the study revealed a higher prevalence of MSP and its various characteristics in detail which help in designing intervention programs.

Comparison of Pharyngoesophageal Segment Biomechanics Between Persons with Total Laryngectomy With and Without Dysphagia Using sEMG: A Multicentric Swallow Study.

Total laryngectomy (TL) is the surgical treatment option for advanced stage of laryngeal cancer, involving the removal of larynx along with several muscles attached to it. Several anatomical changes occur following the surgery which will in turn affect the swallowing mechanism. The severing of the cricopharyngeus muscle, which is an important muscle of the pharyngoesophageal segment (PES), may lead to dysphagia. Several other causes have also been explained in the literature. Several invasive instruments have been used to identify dysphagia in this population. The present study aimed to identify the differences in the biomechanics of the PES during dry and wet swallow tasks in persons with TL with and without dysphagia. Amplitude and duration of movement of PES was analysed using a non-invasive instrumental method surface electromyography. The results indicate that amplitude of PES movement was significantly higher in dysphagic group for solids and semisolids. A significantly longer duration was observed for solid consistency for dysphagic group when compared to non-dysphagic group. sEMG evidences suggestive of differences in amplitude and duration between the TL with and without dysphagia groups. Findings also revealed that TL with dysphagia group require more effort to swallow solids and semisolid consistencies when compared to the effort exerted by them during liquid and dry swallow.

Use of Vitamin D Supplements in Osteoarthritis: An Observational Study in a Tertiary Health Care Facility.

OBJECTIVE: The purpose of the study was to assess impact of vitamin D supplements on the disease progression and overall health of osteoarthritis (OA) patients. METHODOLOGY: A cohort study was carried out for 8 months (August 2017-March 2018) in the Orthopedics Department of Kasturba Hospital, Manipal, India, a tertiary care hospital. One hundred and forty-two patients who were diagnosed with OA (grades 1-3) with low serum 25(OH)D levels (severely deficient, deficient, or insufficient) were selected for the study. These patients were categorized into two cohorts: a control cohort (CC) and a study cohort (SC). CC members were patients (n = 71) who had not received vitamin D supplements, and SC members were patients (n = 71) who had received vitamin D supplements. Severity grading of OA, pain score, and health assessment were performed using the Kellgren-Laurence grading score, visual analogue scale (VAS), and WOMAC, respectively, at baseline and after 3 months of follow-up. RESULTS: Subjects in the both CC and SC reported no statistically significant difference (similar in both group) in severity grade (p = 0.303), pain score (p = 0.099), parathyroid hormone (PTH) (p = 0.083), and health status (p = 0.76) at baseline. After 3 months of follow-up (post vitamin D supplementation), OA patients have shown statistically significant difference in severity grades, serum 25(OH)D status, PTH level (p < 0.001), and overall health status (p = 0.001) in the SC with respect to baseline. Likewise, percentage distribution of positive changes was significantly higher in severity grade, pain score, serum 25(OH)D level, overall health status (p < 0.001), and PTH (p = 0.040) of SC as compared to CC at follow-up. CONCLUSION: Vitamin D supplements have significantly improved serum 25(OH)D levels, PTH, severity grade, and pain score of OA patients. Most importantly, vitamin D supplements have shown improvement in the overall health of OA patients, emphasizing the place of vitamin D supplements in the management of OA. Clinical Trial Registry-India (CTRI) registration no: CTRI/2017/12/011031.

Effectiveness of exercise-based rehabilitation on functional capacity and quality of life in head and neck cancer patients receiving chemo-radiotherapy.

PURPOSE: Fatigue, decreased functionality, and impaired quality of life are some of the most common adverse outcomes of chemo-radiotherapy (CRT). Head and neck cancers (HNC) affect more than half a million individuals globally and its treatment takes a heavy toll on the patient, often affecting their speech, swallowing, and respiratory functions, and as a result they often develop fatigue, depression, and physical inactivity. The purpose of this study was to evaluate the effectiveness of exercise-based rehabilitation on functional capacity, quality of life, fatigue, hemoglobin, and platelet counts in patients with HNC on CRT. PATIENTS AND METHODS: A randomized controlled trial was conducted on 148 patients with head and neck cancer undergoing CRT to evaluate the effectiveness of exercise on functional capacity measured by the 6-min walk test, quality of life measured by the Medical Outcomes Survey Short Form 36 v2 questionnaire, fatigue by the NCCN (0-10) scale, hemoglobin, and platelets. The control group received standard physical activity recommendations while the exercise group received a structured exercise program of aerobic and active resistance exercises for a period of 11 weeks. RESULTS: There was a significant improvement in the functional capacity (p < 0.001), quality of life (p < 0.001), and prevention of worsening of fatigue (p < 0.001) in the exercise group. The blood parameters did not show a significant difference between the control group and the exercise group. CONCLUSION: Our results elucidate that an 11-week structured exercise program for HNC patients receiving CRT helps in improving their functional capacity and quality of life. It also prevents deterioration of fatigue levels in the exercise group.

Response abilities of children with Down Syndrome and other intellectual developmental disorders.

Efficiency with which a task is performed results from the precise timing and force with which the task is executed. We aimed at assessing the influence of change in task constructs on the response abilities of children who are known to have impaired perceptual motor control. To answer this question, we assessed the response abilities in terms of response time(RT) and response force(RF) among children with Down Syndrome(DS), intellectual developmental disorders(IDD) and those who are typically developing. A response analyzer was used to assess their response abilities across a variety of task constructs namely while performing a simple response task, dual task (i.e. passive and active dual tasks), force modulation task and choice response task. Across all tasks, it was seen that their RT increased while RF decreased as the tasks became more complex in nature. The number of participants in the DS and IDD group diminished as the task complexity increased, reflecting their inherent difficulty in learning new tasks and executing a common expected response under different task conditions. The response abilities of the DS and IDD group was comparable across tasks and varied significantly from the TDC group. The study enables us to understand the influence of task difficulties on the response abilities and participation across groups of children with and without disabilities. The results of the study necessitate the need to evaluate and find methods to train the response abilities of children with DS and IDD, which has considerable implications towards the performance of their daily life skills.

Elucidating the role of Cyclooxygenase-2 in the pathogenesis of oral lichen planus - an immunohistochemical study with supportive histochemical analysis.

OBJECTIVE: Oral lichen planus (OLP) is a chronic, inflammatory disorder that affects the oral mucous membrane. During an inflammatory response, several chemokines and cytokines are released by the cells of the immune system. Activation of MMPs, along with mast cell-derived chymase and tryptase, degrades the basement membrane structural proteins, resulting in basement membrane breaks. AIM: To investigate the association between the COX-2 expressions, presence of intact or degranulating mast cells within the connective tissue and the extent of basement membrane discontinuity in OLP cases. METHODS: This study included a total of 50 formalin-fixed paraffin-embedded specimens (FFPE) of histologically confirmed cases of idiopathic oral lichen planus. A retrospective cross-sectional analysis was carried out by immunohistochemistry to study the epithelial expression of COX-2 and by the use of special stains such as toluidine blue and periodic acid-Schiff (PAS) to study the mast cell count and basement membrane changes in the oral mucosal tissue, respectively. RESULTS: There was a significant (P = 0.03) association between the COX-2 expressions and mast cell count. As the intensity of COX-2 expression increased from mild to moderate or severe, the number of mast cell count almost doubled. CONCLUSION: Interaction between upregulation of COX-2, mast cell and basement membrane sets a vicious cycle which relates to the chronic nature of the disease. Inhibitors of COX-2 may reduce the inflammatory process preceding the immune dysregulation in OLP.

High prevalence of dental fluorosis among adolescents is a growing concern: a school based cross-sectional study from Southern India.

BACKGROUND: Fluorosis, caused by ingestion of excessive amount of fluoride through food or water, is a major public health problem in India. This study was undertaken to quantify the dental fluorosis burden among school going adolescents and to find factors associated with dental fluorosis in Kolar taluka, Karnataka, India. METHODS: A total of 1026 high school adolescents (12-17 years) were enrolled from different schools selected by stratified sampling method. Dental examination was done to record Dean's fluorosis index, and socio-demographic, food consumption and oral hygiene data were recorded using a pre-tested structured questionnaire. Fluoride content was measured using Orion apparatus, and Community Fluorosis Index (CFI) was calculated from drinking water samples from various drinking sources. Multivariable analysis with generalized estimating equation (GEE) regression model was used to explore the factors associated with dental fluorosis. RESULT: Among 1026 enrolled students, 64.3% of adolescents were detected with dental fluorosis; more than 50% had either severe or moderate fluorosis according to the Dean's Fluorosis Index and Community Fluorosis Index (CFI). The majority of affected students were from government schools. The significantly associated factors with dental fluorosis were living in study area for more than 5 years and studying in government school. A strong positive correlation between the amount of fluoride content in drinking water sample collected and CFI was observed (rho = 0.570). CONCLUSION: Prevalence of dental fluorosis was considerably high, affecting nearly two-thirds of the students, and mainly in government schools and long-term residents of the area. Health education and community awareness for preventing fluorosis, apart from setting-up defluoridation plants or training for home based defluoridation techniques in study villages, should be considered.

Therapeutic Assessment of Primaquine for Radical Cure of Plasmodium vivax Malaria at Primary and Tertiary Care Centres in Southwestern India.

Acquaintance is scanty on primaquine (PQ) efficacy and Plasmodium vivax recurrence in Udupi district, Karnataka, India. We assessed the efficacy of 14 days PQ regimen (0.25 mg/kg/day) to prevent P. vivax recurrence. Microscopically, aparasitemic adults (≥18 years) after acute vivax malaria on day 28 were re-enrolled into 15 months' long follow-up study. A peripheral blood smear examination was performed with participants at every 1-2 month interval. A nested PCR test was performed to confirm the mono-infection with P. vivax. Of 114 participants, 28 (24.6%) recurred subsequently. The median (IQR) duration of the first recurrence was 3.1 (2.2-5.8) months which ranged from 1.2 to 15.1 months, including initial 28 days. Participants with history of vivax malaria had significantly higher risk of recurrence, with hazard ratio (HR) (95% CI) of 2.62 (1.24-5.54) (P=0.012). Severity of disease (11.4%, 13/114) was not associated (P=1.00) with recurrence. Of 28 recurrence cases, the nPCR proved that P. vivax mono-infection recurrence rate was at least 72.7% (16/22) at first recurrence. In Udupi district, PQ dose of 0.25 mg/kg/day over 14 days seems inadequate to prevent recurrence in substantial proportion of vivax malaria. Patients with a history of vivax malaria are at high risk of recurrences.

Postural sway in diabetic peripheral neuropathy among Indian elderly.

BACKGROUND & OBJECTIVES: Diabetic peripheral neuropathy (DPN) is a major complication of type 2 diabetes and have long term complications on the postural control of the affected population. The objectives of this study were to evaluate postural stability in patients with DPN and to examine correlation of Michigan Neuropathy Screening Instrument (MNSI) with duration of diabetes, age and postural stability measures. METHODS: Participants were included if they had clinical neuropathy which was defined by MNSI. Sixty one patients gave their consent to participate in the study and were evaluated on posturography for postural stability measures in four conditions. Repeated measures of analysis of variance (RANOVA) was used to analyze the changes in postural stability measures in different conditions. RESULTS: An increase in mean value of postural stability measures was observed for velocity moment 20.4±1.3, 24.3±2.2, 42.3±20.7, 59±43.03, mediolateral displacement 0.21±0.10, 0.22±0.18, 0.03±0.11, 0.34±0.18, and anteroposterior displacement 0.39 ± 0.09, 0.45±0.12, 0.47±0.13, 0.51±0.20 from EO to EC, EOF, and ECF, respectively. There was a significant difference (P<0.05) in participants with DPN, with greater sway amplitude on firm and foam surface in all the conditions. Moderate correlation of MNSI with age (r=0.43) and postural stability measures were also observed. INTERPRETATION & CONCLUSIONS: Evaluation of postural stability in Indian DPN population suggests balance impairments on either firm and foam surfaces, with greater likelihood of fall being on foam or deformable surfaces among elderly adults with neuropathy (CTRI/2011/07/001884).

Acoustic Analysis of Madhya and Taar Saptak/Sthayi in Indian Classical Singers.

OBJECTIVES: We aimed to compare the acoustic parameters of voice between Madhya Saptak/Sthayi (MS) and Taar Saptak/Sthayi (TS) in trained Indian classical singers and between males and females. PARTICIPANTS AND METHOD: Sixty-five adult trained Indian classical singers were instructed to produce MS and TS; the acoustic parameters were analyzed with the Multidimensional Voice Program. Descriptive statistics were used for analysis across tasks and gender. Two-way random-effects ANOVA was used to test the effect of gender and task. RESULTS: Male participants had a restricted range of fundamental frequency (F0), especially at high pitches. The acoustic analysis showed a statistically significant difference for F0 measures, range of F0, jitter and pitch perturbation quotient between males and females during MS and TS. CONCLUSION: The use of TS, that is, high-pitch phonation, during the clinical evaluation of singers enables an understanding of their vocal behavior in the higher scales of singing.

Test-retest reliability of a portable gas analysis system under free living conditions.

INTRODUCTION: K4b2 (COSMED Srl Italy) is a portable device that is considered valid and reliable for measuring oxygen uptake (VO2) and carbon dioxide production (VCO2) under laboratory conditions. OBJECTIVES: Evaluate the test-retest reliability of K4b2 during walking, stair climbing and descending stairs under free living conditions. METHODS: Twelve participants completed two self-selected comfortable paced walking tests and 20 participants completed two self-selected comfortable paced stair climbing and descending tests. VO2 and VCO2 were measured during the tests using K4b2. RESULTS: ICCs for VO2 (ICC & 95% Cl: 0.91, 0.72-0.97) and VCO2 (0.91, 0.72-0.97) of walking demonstrated high reliability whereas reliability was moderate for stair climbing (VO2: 0.82, 0.6-0.93; VCO2: 0.73, 0.44 - 0.88) and low for descending stairs (VO2: 0.67, 0.33-0.85; VCO2: 0.51, 0.1-0.77). CONCLUSION: K4b2 is a highly reliable device for VO2 and VCO2 measurement during self-paced walking in free living environment.

Awareness of chronic disease related health benefits of physical activity among residents of a rural South Indian region: a cross-sectional study.

BACKGROUND: Physical activity trends for a lower-middle income country like India suggest a gradual decline in work related physical activity and no concomitant increase in leisure time physical activity. Perceived health benefits of physical activity and intention to increase physical activity have been established as independent correlates of physical activity status. In India, not much is known about peoples' perceptions of health benefits of physical activity and their intention to increase physical activity levels. This study was performed to understand peoples' perceptions and awareness about health benefits of physical activity in a rural South Indian region. METHODS: This cross-sectional study was conducted using a multistage cluster sampling design. A content validated, field tested questionnaire was administered in person by a trained interviewer in the participants' native language. The questionnaire assessed the participants' perceptions about their lifestyle (active or sedentary), health benefits of physical activity and need for increasing their physical activity. In addition, the participant's physical activity was assessed using version 2 of global physical activity questionnaire. Frequencies and percentages were used to summarise perceived health benefits of physical activity and other categorical variables. Age and body mass index were summarised using mean ± SD, whereas physical activity (MET.min.wk -1) was summarised using median and interquartile range. RESULTS: Four hundred fifty members from 125 randomly selected households were included in the study, of which 409 members participated. 89% (364) of participants felt they lead an active lifestyle and 83.1% (340) of participants did not feel a need to increase their physical activity level. 86.1%, (352) of the participants were physically active. Though 92.4% (378) of participants felt there were health benefits of physical activity, majority of them (75.1%) did not report any benefit related to chronic diseases. None mentioned health benefits related to heart disease or stroke. CONCLUSION: There is low awareness of chronic disease related benefits of physical activity and participants do not see a need to increase their physical activity level. Public health awareness programs on importance and health benefits of physical activity would be useful to counter the anticipated decline in physical activity.

Effect of Structured Exercise-Based Intervention on Upper Quadrant Dysfunction among Fish Processing Workers with Work-Related Musculoskeletal Disorders.

Background: Musculoskeletal disorders (MSDs) are one of the major causes of morbidity, which affect particularly the upper quadrant in industrial settings and so upset the quality of life (QoL). The influence of the protocol of exercise-based programs at the workplace on the well-being of the worker is contradictory. The objective of the study was to find the effect of the structured exercise-based intervention on upper quadrant dysfunction among fish processing workers with work-related MSDs. Methods: The intervention group (n = 91) participated in an individually tailored structured exercise-based intervention (SEBI) program for three months, which consisted of stretching, strengthening, and active exercises. The control group (n = 93) was instructed to continue routine daily activities. The outcome measures of the cluster-randomized controlled trial were Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), Visual Analog Scale (VAS), and Short Form-36, used to evaluate at baseline, eighth, and twelfth week. The data were analyzed by repeated analysis of variance and Student's t-tests. Results: The results for the overall perception of upper quadrant dysfunction showed statistically significant differences (P < 0.0001) for NDI, DASH, and VAS. Further, we obtained a significant difference in QoL between the intervention and control groups for physical and psychological health sub-domains. Conclusion: SEBI effectively enhanced the general health of fish processing workers by showing improvements in the measures of NDI, DASH, VAS, and QoL. Hence, SEBI can be recommended in the fish processing industries to achieve potential impact on upper quadrant dysfunction and improve the QoL.

Effect of high-definition transcranial direct current stimulation among late-subacute and chronic stroke survivors with fatigue: A randomized-controlled crossover trial protocol.

Post-stroke fatigue (PSF) is a commonly overlooked symptom that impacts daily functioning and quality of life. It is caused by altered functional connectivity within the brain networks, which can potentially be influenced by neuromodulation. Multiple cortical regions have been targeted to reduce PSF, but the most efficient ones remain uncertain. Therefore, we aim to identify the most appropriate cortical stimulation site to reduce PSF. Twenty participants with PSF will be included in this cross-over trial. Each participant will receive one session of active anodal high definition- transcranial direct current stimulation (HD-tDCS) over three different cortical areas and one session of sham tDCS in a cross-over manner, with a two-week of washout period in between. Pre- and post- fatigue will be assessed using Fatigue Severity Scale and fatigability using electromyography by determining the time to task failure. Resting-state electroencephalography will be performed before and after each stimulation session to determine the functional connectivity of the cortical areas stimulated.

Effectiveness of an Intensive, Functional, and Gamified Rehabilitation Program on Upper Limb Function in People With Stroke (EnteRtain): A Multicenter Randomized Clinical Trial.

BACKGROUND1: Despite a growing interest in gaming rehabilitation for upper limb (UL) recovery post-stroke, studies investigating the effects of game-based rehabilitation incorporating functional games are lacking. OBJECTIVE: To investigate the efficacy of an intensive, functional, gamified rehabilitation program compared to task-based training on UL motor function in acute/sub-acute stroke survivors. METHODS: This randomized, multicenter, single-blind, clinical trial comprises 120 participants with unilateral stroke who were randomized to receive either gamified training (n = 64) using the ArmAble™ [experimental group (EG)] or task-based training (n = 56) in conjunction with conventional therapy for 2 hours per day, 6 days per week for 2 weeks, followed by UL rehabilitation for another 4 weeks at home. Primary outcomes evaluated by a blinded assessor included the Fugl-Meyer Assessment-Upper Extremity (FM-UE), and Action Research Arm Test (ARAT). Data were analyzed using a linear mixed-effect regression model. RESULTS: The mean (standard deviation) age of the participants was 54.4 ± 11.7 years (78.1% men) in the EG and 57.7 ± 10.9 years (73.2% men) in the comparator group (CG). The median (interquartile range) time since stroke was 30.0 (54.0) days in the EG and 22.5 (45.0) days in the CG. Following the 2-week intervention, a statistically significant improvement was observed in the EG for the FM-UE [between-group mean differences (95% confidence interval): -3.9 (-6.5, -1.3); P = .003]; but not for the ARAT [-2.9 (-5.8, 0.0); P = .051]. Gains at 6 weeks were significantly greater in the EG for both FM-UE [-3.9 (-6.5, -1.3); P = .003]; and ARAT [-3.0 (-5.9, -0.0); P = .046]. CONCLUSION: Gamified rehabilitation using the ArmAble™ device has shown immediate and short-term improvement in UL function after acute/sub-acute stroke. CLINICAL TRIALS REGISTRY NUMBER: CTRI/2020/09/027651.

Non-pharmacological interventions to reduce anxiety among children undergoing surgery: A systematic review.

A hospitalized child experiences anxiety more frequently as compared to non-hospitalized children. Surgery can be emotionally distressing for children, and subsequently their parents and caregivers, this distress can cause profound adverse impacts on children. We aimed to identify the effect of non-pharmacological interventions on children's (1-18 years) anxiety undergoing surgery. The following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Proquest, Web" of Science, and Cochrane Central Register of Controlled Trials were systematically searched for full-text articles. The review included 15 randomized controlled trials. The risk of bias was assessed using Cochrane Risk of Bias tool. The interventions included in the study were preoperative education, puppet play, therapeutic play, distraction activities, parental presence, and clown therapy. The review presents a narrative reporting of the findings. This review identifies that non-pharmacological interventions are effective in reducing anxiety among children undergoing surgery. There are a limited number of studies from developing countries. Further research is required to underpin the use of these interventions with children before surgery.