Indian Journal of Physical Medicine and Rehabilitation

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2012 | March | Volume 23 | Issue 1

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[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijopmr-23-1-39a  |  Open Access |  How to cite  | 



Nonica Laisram, Tufail Muzaffar, S Y Kothari

Correlation of Gross Motor Function with Topographical Diagnosis in Children with Cerebral Palsy

[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:5] [Pages No:10 - 14]

   DOI: 10.5005/ijopmr-23-1-10  |  Open Access |  How to cite  | 


There is a need for appropriate classification to describe gross motor function status in a child with cerebral palsy (CP). It was hypothesised that: greater the number of limbs involved, higher would be the Gross Motor Function Classification System (GMFCS) level; and, there would be spectrum of GMFCS level for each of the topographical types of the cerebral palsy.

A cross-sectional study of 182 children of both sexes in the age group of 7 months to 30 years having spastic CP who attended CP clinic from 2008 to 2009 in tertiary care hospital were assessed for topographical diagnosis and GMFCS levels. Topographical distribution showed diplegia (42%), quadriplegia (30%), hemiplegia (23%), triplegia (4%) and monoplegia (1%). GMFCS levels were almost evenly distributed, level II (26%) was most common followed by level V (23%). Statistical analysis was done using Cramer's ratio and Pearson's Chi-square test.

Cramer's ratio of 0.277 showed fairly weak correlation between GMFCS levels and topographical CP types. Pearson's Chi-square (12) =41.7, p=0.000 indicates that there is significant difference between expected and observed values of number of limbs involved in GMFCS levels, further substantiating the weak correlation.

These results mean that GMFCS in different topographical groups have different distributions. It was also observed that GMFCS had weak correlation with the number of limbs involved, thus reflecting that the GMFCS is a better indicator of gross motor function impairment than the traditional topographical categorisation of CP that specifies the number of limbs involved.



AK Joy, I Ozukum, L Nilachandra, Th Khelendro, Y Nandabir, W Kunjabasi

Prevalence of Hemiplegic Shoulder Pain in Post-stroke Patients – A Hospital Based Study

[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:5] [Pages No:15 - 19]

   DOI: 10.5005/ijopmr-23-1-15  |  Open Access |  How to cite  | 



To study the prevalence of hemiplegic shoulder pain (HSP) and its association with other factors like age, sex, side of paralysis, type of brain lesion, muscle tone, degree of functional recovery in upper limb and glenohumeral subluxation (GHS).


Prospective study based on all the hemiplegic 140 patients admitted in the physical medicine and rehabilitation ward in two consecutive years.


Assessment of HSP was done by using a structured questionnaire known as “Shoulder Q”. Modified Ashworth scale (MAS) was used for spasticity assessment and functional independence measure (FIM) to document the severity of disability. Follow-up at intervals of 1, 3 and 6 months from the date of discharge for all cases were attempted and even cases with at least one follow-up around 3 months were also included in the study. Analysis was done on 109 patients as 31 patients lost to follow-up.


Out of the 109 patients, 61.5% were males with a mean age of 58.9 ± 10.9 years. Cerebral infarct represents 53.2% of patients. HSP was present in 47.7% (n= 52) of patients. The prevalence of HSP on left and right sides was comparable though involvement was more on the left side (58.8%). Glenohumeral subluxation was present in 32.7% (n=17) of 52 cases with HSP and 33.3% (n=19) of 57 cases without HSP. Mean FIM score at admission for patients with HSP was 54.5 ± 17.6 and 56.6 ± 19.5 among cases without HSP. Again, mean FIM scores at last follow-up were 80.0 ± 16.4 and 79.9 ± 18.9 respectively for both cases with HSP and without it. Among the compliers, patients with tone more than MAS=1 were more likely to develop HSP.


Prevalence rate of HSP among post-stroke hemiplegic patients admitted during two years was 47.7%. There was no association of HSP with factors like age, sex, side of paralysis, type of lesion and GHS. Correlation between HSP and muscle tone or degree of functional recovery was significant.



Tapan N Joshi

Unwanted Muscle Weakness following Botulinum Neurotoxin A Administration in Spinal Cord Injury with Literature Review

[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:5] [Pages No:20 - 24]

   DOI: 10.5005/ijopmr-23-1-20  |  Open Access |  How to cite  | 


Botulinum neurotoxin A (BoNTA) is rapidly gaining acceptance for management of spasticity secondary to spinal cord injury (SCI). Due to its increased usage, more undesirable effects and complications have come in light. Unwanted distant and/or generalised muscle weakness is possible following BoNTA administration in SCI population causing temporary neurological and functional decline. Physicians should carefuly perform a clinical assessment of every patient individually for risks stratification. Additional studies for adult population evaluating adverse-effects of high dose of BoNTA treatment for spasticity management are indicated.



P Das, A Basak, D Ghorai, P P Pan, D K Khatua

A Patient with Fixed Flexion Deformity of Hip and Knee

[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:4] [Pages No:25 - 28]

   DOI: 10.5005/ijopmr-23-1-25  |  Open Access |  How to cite  | 


A 17 years old female patient presented to PMR OPD with fixed flexion deformity of left hip and knee and cachexia. Five years back a severe pain was suddenly developed in her left knee and thigh which was investigated for juvenile inflammatory arthropathy and rheumatic arthritis. At that time all the serological markers (ANA, RF, ASO titre) and x-ray of knee were normal. Subsequently left hip pain and restricted ROM were developed which made it clear that the knee pain was actually referred from hip. A plain x-ray of hip was done to rule out Perthe's disease which was reported as avascular necrosis of femur.

When the patient was examined at PMR OPD, a CT scan of hip, routine hemogram, CXR, Manteux test was advised considering a provisional diagnosis of infective pathology like TB hip with a differential of neoplaia in or around hip keeping in mind about cachexia and weight loss. Surprisingly CT scan showed a big mass originating from glutei muscles evading back of the thigh and even left sphincter ani muscle. Fortunately patient was continent at that time. Interestingly the pathological report suggested a relatively rare diagnosis which practically made the patient bedridden with commonly featured fixed flexion deformity.



Jagannatha Sahoo, P Hemanta Kumar, G Jagadeesh

An Interesting Form of Osteochondrodystrophy–A Case Report of a Family

[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:3] [Pages No:29 - 31]

   DOI: 10.5005/ijopmr-23-1-29  |  Open Access |  How to cite  | 


A 12-year-old boy presented with progressive increasing deformity of both knee joints since last 10 years. The radiograph of femor, tibia and phalanges showed different dysplastic changes of epiphysis. It showed a different skeletal dysplastic nature to multiple epiphysial dysplasias. Silfverskiöld described similar types of skeletal dysplasia.



Manoj Sivan, James Brown

Role of Platelet-Rich Plasma (PRP) in Chronic Tendinopathy

[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:4] [Pages No:32 - 35]

   DOI: 10.5005/ijopmr-23-1-32  |  Open Access |  How to cite  | 


Platelet-rich plasma (PRP) is increasingly being used in the treatment of chronic tendinopathy in both sporting and sedentary population. It is rich source of various growth factors and is believed to stimulate and enhance the tissue repair process in tendinopathy. The current literature has six clinical studies (excluding single case studies) which have investigated the effect of PRP in tendinopathy of various tendons. The evidence so far is inconclusive in demonstrating the superiority of PRP over placebo injection or eccentric loading exercises. Future research should focus on conducting randomised controlled studies to establish the clinical effect and support or refute the current widespread use of PRP in chronic tendinopathy.



D K Khatua, R Pramanik

Synovial Chondromatosis Misdiagnosed As OA Knee

[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:2] [Pages No:36 - 37]

   DOI: 10.5005/ijopmr-23-1-36  |  Open Access |  How to cite  | 




[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:1] [Pages No:38 - 38]

   DOI: 10.5005/ijopmr-23-1-38  |  Open Access |  How to cite  | 




[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:1] [Pages No:39 - 39]

   DOI: 10.5005/ijopmr-23-1-39  |  Open Access |  How to cite  | 




[Year:2012] [Month:March] [Volume:23] [Number:1] [Pages:2] [Pages No:40 - 41]

   DOI: 10.5005/ijopmr-23-1-40  |  Open Access |  How to cite  | 


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