Comprehensive rehabilitation outcome measurement scale (CROMS): development and preliminary validation of an interdisciplinary measure for rehabilitation outcomes.

INTRODUCTION: Comprehensive and interdisciplinary measurement of rehabilitation outcome is an essential part of the assessment and prognosis of a patient. Thus, this requires substantial contributions from the patient, their family and the rehabilitation professional working with them. Moreover, the measurement tool should be comprehensive and must consider the cultural compatibility, cost efficiency and contextual factors of the region. METHODS: The Comprehensive Rehabilitation Outcome Measurement Scale (CROMS) was developed through consensus and followed the Delphi process incorporating inputs from various rehabilitation professionals. The domains and items were finalized using Principal Component Analysis (PCA). The tool was validated in two native languages and back-translated considering the semantic equivalence of the scale. Intra-class correlation coefficient was performed to determine the agreement between the therapist and patient-reported scales. RESULTS: The final CROMS carries 32 comprehensive items that can be completed by the person with disability and the professional team. CROMS compares well to similar items on FIM (l ICC of 0.93) and has good internal consistency with a Cronbach's Alpha of 0.92 for both patient and therapist reported measures. CONCLUSIONS: The 32 item CROMS is a tool that can potentially be used to evaluate the functional independence of various patient populations, predominantly patients with neurological disabilities.

Down syndrome-A narrative review with a focus on anatomical features.

Down syndrome (DS) is the most common aneuploidy of chromosome 21, characterized by the presence of an extra copy of that chromosome (trisomy 21). Children with DS present with an abnormal phenotype, which is attributed to a loss of genetic balance or an excess dose of chromosome 21 genes. In recent years, advances in prenatal screening and diagnostic tests have aided in the early diagnosis and appropriate management of fetuses with DS. A myriad of clinical symptoms resulting from cognitive, physical, and physiological impairments caused by aberrations in various systems of the body occur in DS. However, despite these impairments, which range from trivial to fatal manifestations, the survival rate of individuals with DS has increased dramatically from less than 50% during the mid-1990s to 95% in the early 2000s, with a median life expectancy of 60 years reported recently. The aim of this narrative review is to review and summarize the etiopathology, prenatal screening and diagnostic tests, prognosis, clinical manifestations in various body systems, and comorbidities associated with DS. Clin. Anat. 29:568-577, 2016. © 2015 Wiley Periodicals, Inc.

Chemotherapeutic and Antiproliferative Effect of Purified Protein from Marine Catfish Tachysurus Dussumieri on Human Colon Cancer Cell Line.

The present study aimed to investigate the purified protein from the epidermal mucus of marine catfish Tachysurus dussumieri on the human colon cancer cell line. The bioactive protein was purified with the Anion exchange chromatography and the collected fractions were then tested to assess cell viability in HT 29 cells through the MTT assay. The most responding active purified protein fraction (PPF III) was characterized with the MALDI-TOF/MS it shared a similar homology and sequence with 90% of antimicrobial peptides from external secretions of amphibians. Typical morphological changes of apoptotic cells, including cell shrinkage and detachment, DNA damage, and nuclear condensation were observed after the treatment of bioactive protein. PPF III triggered ROS, increasing the LDH activity, disruption of mitochondrial membrane potential, and upregulation of Cleaved caspase 3/9, Cytochrome-c, Bax, and downregulation of Bcl-2 protein and gene expression on HT 29 cells.

Comparison of sway meter and Kinovea software as a tool of measurement for the sway parameters during quiet standing: An observational study.

BACKGROUND: Several attempts have been made to quantify postural sway, from simple observational techniques to advanced computer technology. Measuring sway using commercial motion tracking devices and force plates are expensive and not feasible in evaluation on non-standardised surfaces. Video cameras can be used as an affordable alternative to perform human motion capturing, and this data can be analysed using motion tracking software like Kinovea; a free, reliable software that provides valid data, and an acceptable level of accuracy in angular and linear measurements. This study evaluated the reliability of Kinovea software to measure the sway amplitude in comparison with sway meter. METHODS: Thirty-six young women were recruited by convenience to this prospective observational study. Sway amplitude of the participants were measured using a sway meter on three different surfaces, with eyes opened and closed conditions, using modified Lords sway meter and videography. Videos were later analysed using Kinovea motion analysing software. The quantitative data of sway parameters were analysed for reliability using intraclass-correlation co-efficient and Bland Altman plot. RESULTS: There was an excellent correlation (>0.90) between the sway measurement values obtained from both methods irrespective of the surfaces. But the reliability was greater for the medio-lateral sway on the pebbled surfaces (0.981), and least for the anterior posterior sway on the same surface. CONCLUSION: This study concludes that, there is an excellent reliability for the video based sway analysis using Kinovea software. Hence this method can be used as an affordable alternative to measure the sway parameters.

Interrater reliability of the craniocervical flexion test in asymptomatic individuals--a cross-sectional study.

OBJECTIVE: The objective of this study was to evaluate interrater reliability of the craniocervical flexion test (CCFT) on asymptomatic subjects. METHODS: A cross-sectional repeated-measures study design was used. Thirty asymptomatic subjects (15 men and 15 women; mean age, 33.7 years; range, 22-48 years) were recruited for the study. Subjects were positioned in supine lying with a pneumatic pressure sensor of the pressure biofeedback unit placed under the neck. Subjects performed 3 trials of craniocervical flexion with each trial consisting of 5 incremental stages (22, 24, 26, 28, and 30 mm Hg) guided through feedback from the pressure dial of the pressure biofeedback unit. All the trials were scored simultaneously by 2 raters. The outcome measure was the activation score-the maximum pressure (above baseline 20 mm Hg) that was achieved and held in a steady manner for 10 seconds. Intraclass correlation coefficient (ICC 3,1) was analyzed using the 2 repeated scores out of 3 trials for either rater. RESULTS: Interrater reliability (ICC) for the CCFT was 0.91 (95% confidence interval, 0.83-0.96). There was a reasonable agreement on the Bland-Altman plot confirming high reliability of the test. CONCLUSION: The study has shown high interrater reliability when 2 raters simultaneously scored the CCFT trials in asymptomatic individuals.

Energy Expenditure Index as a measure of efficiency of walking on outdoor uneven surface in individuals with cerebral palsy.

Purpose: This study aims to validate and report responsiveness of Energy Expenditure Index (EEI) during walking on outdoor uneven surface in individuals with cerebral palsy (CP).Methods: Eighty ambulant children with spastic diplegia (Gross Motor Function Classification System II & III) aged between six and 18 years and 58 age matched typically developing children were recruited for ascertaining reliability and validation of EEI during outdoor walking. Responsiveness of EEI was ascertained using anchor-based approach using Functional Mobility Scale in 29 children with CP who were recruited for surgical intervention.Results: EEI had acceptable test-retest reliability and agreement in both typically developing and children with CP. Friedman's analysis of variance of 29 children with CP showed a significant difference in EEI (χ2 = 10.15, p = 0.006), Functional Mobility Scale - 50 m (χ2=18.77, p = 0.000) and 500 m (χ2 = 40.19, p = 0.000) scores at 6 and 12 months when compared with baseline. The minimal clinical important difference of EEI during walking on uneven outdoor surface with a concomitant change in functional mobility scale (500 m) at 6 and 12 months was 0.29 and 0.37 beats/m, respectively.Conclusions: EEI during walking on outdoor uneven surface is a stable, valid and reliable measure of energy efficiency in individuals with CP and is responsive to orthopedic intervention in CP.IMPLICATIONS FOR REHABILITATIONEnergy Expenditure Index during outdoor walking on uneven surface is a valid, reliable and responsive outcome measure for documenting changes in walking efficiency to post-surgical interventions employed to improve walking in individuals with cerebral palsy.Rehabilitation professionals should document the efficiency during outdoor walking on all the post-operative visits.Energy Expenditure Index during outdoor walking can serve as surveillance tool for deterioration in outdoor walking ability.

Antiproliferative and antioxidant properties of nematocysts crude venom from jellyfish Acromitus flagellatus against human cancer cell lines.

This study aimed to investigate the antiproliferative and antioxidant properties of crude venom from the nematocyst of Jellyfish Acromitus flagellates on human lung cancer (A549) and liver cancer (HepG2) cell lines. The prepared crude venom was subjected to analyses of the biochemical constituents, protein profiles, antioxidant and anticancer activities by standard methods. The extracted venom was pale-yellow in color and viscous/sticky. The biochemical composition such as, protein (1.547 mg/ml), lipid (0.039 mg/ml) and carbohydrate (0.028 mg/ml) was estimated. Protein profiles were determined by SDS PAGE, the result revealed that the molecular weight range from 205 - 3.5 kDa. The free radical scavenging activity was analyzed by the reducing potential (56.36%), DPPH (72.47%), hydroxyl (68.50%), superoxide anion (65.75%), and nitric oxide (33.04%). The cell viability was observed by using different concentrations (20 to 100 µg/ml) of crude venom on A549 and HepG2 cancer cell lines and the IC50 values were recorded in (60 µg/ml and 40 µg/ml) respectively, while it had none cytotoxic effects on Vero cell line up to the concentration of 90 µg/ml. These results suggest that crude venom from nematocyst of A. flagellatus possesses anti-cancer activity and able to develop novel drugs on marine-derived compounds.

Andrographolide as a potential inhibitor of SARS-CoV-2 main protease: an in silico approach.

SARS-CoV-2 virus which caused the global pandemic the Coronavirus Disease- 2019 (COVID-2019) has infected about 1,203,959 patients and brought forth death rate about 64,788 among 206 countries as mentioned by WHO in the month of April 2020. The clinical trials are underway for Remdesivir, an investigational anti-viral drug from Gilead Sciences. Antimalarial drugs such as Chloroquine and Hydroxychloroquine derivatives are being used in emergency cases; however, they are not suitable for patients with conditions like diabetes, hypertension and cardiac issues. The lack of availability of approved treatment for this disease calls forth the scientific community to find novel compounds with the ability to treat it. This paper evaluates the compound Andrographolide from Andrographis paniculata as a potential inhibitor of the main protease of SARS-COV-2 (Mpro) through in silico studies such as molecular docking, target analysis, toxicity prediction and ADME prediction. Andrographolide was docked successfully in the binding site of SARS-CoV-2 Mpro. Computational approaches also predicts this molecule to have good solubility, pharmacodynamics property and target accuracy. This molecule also obeys Lipinski's rule, which makes it a promising compound to pursue further biochemical and cell based assays to explore its potential for use against COVID-19.Communicated by Ramaswamy H. Sarma.

Optimization of backpack loads using gait parameters in school boys.

BACKGROUND: Backpacks are an efficient way of manual carriage used by people of all ages, and is commonly used by schoolchildren. Carrying heavy backpacks may result in cumulative trauma later in life due to biomechanical adaptations during gait. Gait parameters are known to be sensitive to force vectors, which can be altered by load carrying. This study attempts to find the most favorable backpack weight using gait changes as an indicator. METHODS: This was an observational study conducted on twenty typically developing boys aged between 9 and 14 years. Gait analysis was done using standard recommendations, with increasing backpack loads with respect to their body weights. Gait cycles were captured using video cameras and analyzed using Kinovea0.8.25 motion analyzing software. RESULTS: As the backpack load increased, significant kinematic changes were noted in the child's ankle, knee, and hip joints. These changes were evident when the backpack load increased beyond 15% of their body weight. CONCLUSIONS: This study concludes that the optimum weight that can be carried without having an impact on dynamic posture will be less than 15% of the body weight.

Listing of Indian Folk Games for Potential Therapeutic Benefits in Children with Neurodevelopmental Disability.

Background: India has a diverse cultural heritage, with a wealth of indigenous folk games that are culturally ingrained. Due to the ease of acquisition, low costs, and widespread acceptability, this form of games can be incorporated to facilitate and improve physical fitness among children with neurodevelopmental disabilities. Hence this study focuses on the analysis of the therapeutic benefits of traditional Indian folk games. Objective: To explore the therapeutic benefits of traditional Indian folk games. Methodology: Ten traditional Indian folk games were selected through purposive sampling and videotaped on skilled players. Each game was analyzed by two observers based on an operationalized conceptual model by using a six-point Likert scale. Results: Functional domains of the game have been identified and listed by using the operationalized conceptual model. Conclusion: Folk games encompass a variety of functions and can potentially be used for therapeutic purposes in children with neurodevelopmental disabilities.

Anticancer effect of purified polysaccharide from marine clam Donax variabilis on A549 cells.

The marine invertebrates are one of the main leads to the derivation of anticancer compounds. The present investigation was to explore the anticancer effect of a potentially active polysaccharide fraction from marine clam Donax variabilis on human lung cancer cells (A549). A polysaccharide was purified from the whole tissue of D. variabilis by GFC and characterized by FT-IR and NMR spectroscopy. Subsequently, fraction 2.1 (F2.1) showed a significant inhibitory effect on A549 cells (p < .001) with cellular, nuclear, and apoptotic morphological changes along with DNA damage. Although, F2.1 treatment exhibit the cell cycle arrest in S-phase through the downregulation of cell cycle regulators such as Cyclin A and cdk2 and regulate ROS-induced mitochondrial-mediated apoptosis in A549 cells by an increased level of proapoptotic molecules such as Bax, Cyt-c, Cleaved caspase-3 and 9, and decreased the level of Bcl-2. All data were statistically evaluated by one-way ANOVA and a post hoc analysis with Dunnett testing. Together, purified polysaccharide fraction from marine clam could be a new source of the natural anticancer agent against lung cancer. PRACTICAL APPLICATIONS: Over the decades, a lot of anticancer drugs were designed from plant sources for therapies against various diseases. This was an attempt to isolate a novel anticancer agent from animal sources. Most of the marine mollusks are nutritionally rich and with some potent bioactive compounds. Donax variabilis is an edible marine clam, which was consumed as food among people where live in coastal regions. In the present investigation, the D. variabilis was chosen to isolate active polysaccharide fraction against lung cancer cells. Based on our findings, the purified polysaccharide fraction may be utilized as sources of natural bioactive agents in cancer prevention.

Pharmacist Medication Management of Adults with Attention Deficit: An Alternative Clinical Structure.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric conditions in youth. This disorder can persist into adulthood, with an estimated prevalence of 4.4% to 5.2% in the US. OBJECTIVE: To review adult ADHD diagnostic criteria, adult clinical presentation, and resulting impairments in function and to describe our adult psychiatry clinic's pharmacist-comanaged ADHD medication management program as a model to provide safe and effective care that is accessible, efficient, and well monitored. METHODS: The program consists of 1) screening (urine toxicology, diagnostic evaluation, data collection) by physicians, 2) program participation and treatment agreement with establishment of care goals, and 3) patient maintenance and monitoring. Pharmacists in the Department of Psychiatry manage refills, distributing the clinical caseload among a broader clinician base. RESULTS: This program created a standardized protocol for assessment, referral, and follow-up of adult patients with ADHD, with close monitoring and titration of controlled medications, systematic use of screening measures, and a stimulant treatment contract. DISCUSSION: Development of this program and workflow model could increase care delivery efficiency, potentially improving patient satisfaction and outcomes. There is a great need to use alternative patient management strategies such as this to maintain access to high-quality care while there is a nationwide need for more psychiatric clinicians. CONCLUSION: We believe this program offers a solution to a component of this growing problem, and other clinical sites would benefit from such a program. Next steps include analysis and publication of results of implementation, including patient outcomes, engagement in treatment, and satisfaction.

Energy efficiency of ambulation-A comparison of various orthopaedic possibilities.

BACKGROUND: In most developing countries, accessibility for people using walking aids is limited due to architectural and environmental barriers. As observed from anecdotal accounts, even a minor orthopaedic injury/disorder may restrict a person's ambulation due to fatigue associated with using walking aids. Hence this study was undertaken with the following objective. OBJECTIVE: to estimate the magnitude of energy consumption using energy expenditure index (EEI) during gait under different conditions. DESIGN: Repeated measures design (within subjects study). SETTING: School. PARTICIPANTS: Ten healthy, typical young adults between 17 and 25 years of age. OUTCOME MEASURE: Energy Expenditure Index (EEI) was estimated for each of the conditions of the study using consistent measurement procedures. RESULTS: Energy consumption with immobilization is greater (ankle-16.2%, knee-36.7% and ankle and knee-49.2%) than typical self-selected ambulation. During on ground ambulation the energy cost was greatest for an axillary crutches than a standard walker with ankle and knee immobilized being the highest in relation to typical ambulation (78.2% greater). Axillary crutches were more efficient than a walker during stair climbing. CONCLUSION: For young adults a standard walker may be the right option for over-ground ambulation, when a lower limb joint in immobilized; with an axillary crutch used during stair climbing.

Assessment Battery for Children with Developmental Coordination Disorder (ABCD): Preliminary report of tool development and clinical application.

PURPOSE: Development of an easy to use tool for the assessment of Developmental Coordination Disorder that is applicable to Indian children. METHODS: The steps for instrument development were followed stringently. In order to ensure the robustness of the tool, psychometric properties were determined with 127 children attending various schools. The Winsteps program was used to analyze data for a Rasch model analysis. RESULTS: The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) analysis showed an acceptable limit. The real item separation reliability of 4.84 demonstrates that the items of this tool create a well-defined variable. CONCLUSION: This study met the objectives that it attempted to. The final tool consists of two versions- the Assessment Battery for Children with coordination Disorder-Short Version (ABCD-SV) consisting of 12 items, and the ABCD-FV consisting of 20 items. ABCD fulfills criterion A and B of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria for Developmental Coordination Disorder (DCD).

Expectations of persons with paraplegia regarding their care in India: a qualitative study.

STUDY DESIGN: A qualitative study. OBJECTIVE: The aim of this study was to understand expectations of persons with paraplegia in India regarding their care. SETTING: India. METHODS: This study used a qualitative methodology to have a focus group interview of persons with paraplegia in India. Focus group consisted of two to four participants with paraplegia. Adults with level T6 and below, complete injury, duration of at least 6 months post injury and those living in the community were included. Online focus group interviews were conducted using ZOOM online software for online discussions/meetings. Data were collected till data saturation. Recorded videos were transcribed into texts, and the transcribed documents were analysed using the ATLASti.8 software for qualitative data analysis. RESULTS: Forty-eight codes were retrieved under fourteen code groups. These code groups were acceptance, accessibility, advanced technology, assistive devices, basic skills, employment, expectations, experiences, functional independence, government policies, knowledge, psychological make-up, physiotherapy and rural area. CONCLUSION: Because of lack of awareness, knowledge and education provided to persons with paraplegia, their expectations were often unrealistic. Patient education and education of the health professionals are two of the most important aspects in spinal cord injury rehabilitation that must be taken into consideration in India.

Prevalence of developmental coordination disorder among mainstream school children in India.

OBJECTIVE: To estimate the prevalence of DCD in children between ages of 6-15 years attending mainstream schools in a school district in southern India using criteria of Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5). METHODS: A total of 2282 children, were screened with Kannada version of DCDQ'07. All the children who were identified as probable. DCD cases were defined by using inclusion (Criteria A, B and C) and exclusion criteria (D) of DSM-5 which are ascertained by specific tests. RESULTS: Nineteen (0.8%) children were identified as DCD with girls (1.1%) affected more than boys (0.5%) at confidence interval of 95%. CONCLUSION: The prevalence of DCD using DSM-5 criteria is found to be 0.8% in Southern India. Girls were twice affected than boys.

Responsiveness of Edinburgh Visual Gait Score to orthopedic surgical intervention of the lower limbs in children with cerebral palsy.

OBJECTIVE: The aim of this study was to report the responsiveness and minimal clinically important difference of the Edinburgh Visual Gait Score (EVGS), used to measure gait deviations in children with cerebral palsy. DESIGN: Fifty ambulant children with spastic diplegia (Gross Motor Function Classification System levels II and III) aged between 6 and 19 yrs were recruited for this longitudinal study. The participants were evaluated before surgery and at 6 and 12 mos after surgery. The change in EVGS at these time points was used to calculate effect sizes and minimal clinically important differences. RESULTS: Friedman analysis of variance showed a significant difference (χ2 = 60.69, P = 0.000) in the EVGS scores at 6 and 12 mos when compared with baseline. Effect sizes at 6 and 12 mos were large (1.19 and 1.22, respectively), indicating a visible difference in gait .The minimal clinically important differences of EVGS at 6 and 12 mos were 11 and 15, respectively. CONCLUSIONS: The EVGS is an outcome measure that can be used to evaluate the effect of orthopedic surgical intervention in children with cerebral palsy. Differences of 11 and 15 points on the EVGS are required to suggest that changes in gait are attributable to intervention when group means are considered.

Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review.

A systematic analysis was conducted on the effectiveness of knee braces and foot orthoses in conservative management of knee osteoarthritis. The methodologic quality of the randomized clinical trials, controlled clinical trials, and observational studies were systematically reviewed using the Structured Effectiveness Quality Evaluation Scale. Twenty-five studies met the inclusion criteria. The orthoses used in the studies included Generation II osteoarthritis knee brace, valgus knee braces, functional off-loading knee braces, knee sleeves, lateral-wedged insoles with subtalar strapping, medial-wedged insoles, and specialized footwear. Results suggest that knee braces and foot orthoses are effective in decreasing pain, joint stiffness, and drug dosage. They also improve proprioception, balance, Kellgren/Lawrence grading, and physical function scores in subjects with varus and valgus knee osteoarthritis. Knee braces and foot orthoses could be cautiously considered as conservative management for relief of pain and stiffness and improving physical function for persons with knee osteoarthritis. The conclusions of this review are limited by methodologic considerations like poor quality of trials and heterogeneity of interventions.

Effect of training on interlimb transfer of dexterity skills in healthy adults.

OBJECTIVE: To examine transference of dexterity skills to the contralateral hand after ipsilateral hand training, retention of skills at 1 mo, and the influence of hand dominance, sex, and age on interlimb transfer of these skills. DESIGN: This is an interventional study involving 200 healthy adults in the age group of 20-30 yrs and >30 yrs, who were block randomized into experimental and control groups. Experimental group was further subdivided into dominant and nondominant hand training group and participants underwent 5 days unsupervised training on tasks aimed at improving precision and dexterity. Jebsen-Taylor hand function test was administered at baseline, postintervention, and 1-mo follow-up. Analysis was done by nonparametric tests of comparison. RESULTS: One hundred sixty-nine subjects completed the study. Transfer effect was noted from the dominant to the nondominant hand (P ≤ 0.001) and vice versa (P = 0.003) on the total test scores. This effect was retained at 1-mo follow-up. CONCLUSIONS: Dexterity skills are not consistently transferred to the contralateral hand after ipsilateral hand training. However, transference of gross motor skills of hand function does occur with retention effects up to 1 mo. Transfer of skills differs based on the hand trained and age of the individual.