Heterotopic ossification (HO) is a frequent complication in spinal cord injury (SCI) that is often difficult to treat. the incidence ranges from 16-35%. Association of certain complications in spinal cord injury increases the incidence of HO. This is a cross-sectional study conducted at SVNIRTAR, Cuttack, Odisha from January 2009 to December 2014. Out of 132 SCI patients attended to OPD or admitted to SCI ward, HO at different site was diagnosed in 86 patients. A close observation was done on these patients with respect to their associated complications and their relation to development of HO is discussed.

Analysis of clinical gait pattern, change in spasticity and range of motion (ROM) in cerebral palsy patient (CP) with spastic lower limb muscle after injecting botulinum toxin- A.

Prospective study

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

Significant improvement was achieved for spasticity reduction in gastrocnemius (p< 0.001), hamstring and adductor (p=0.050), ankle AROM & PROM (p< 0.001), active knee extension (p=0.009), popliteal angle (p=0.015) and percentage left and right foot contact (p< 0.001), whereas non-significant change was observed in step length, cadence, velocity, stride length, and base of support. Parents felt subjective improvement in most of the cases (>90%).

Botulinum toxin- A injection is effective in the treatment of spastic lower limb muscles for equinus/ crouching/scissoring gait in cerebral palsy children. The treatment was feasible and easily implemented. Botulinum toxin- A injections were well tolerated, yielded no serious treatment-related adverse events.

Electrodiagnostic test is considered as the gold standard for diagnosis of carpal tunnel syndrome (CTS). Ultrasonography provides a simple non-invasive means of visualising peripheral nerve pathology.

The objective of the study was to assess the role of ultrasonography in CTS and its correlation with the present day gold standard of nerve conduction studies (NCS).

A prospective cohort size of 100 subjects was calculated based on a hypothesized sensitivity of 90% and a confidence interval of 85-95%. All 100 subjects, 64 controls and 36 patients underwent nerve conduction studies and USG. Transverse images of the median nerve were obtained at three levels: proximal to the carpal tunnel inlet, at the carpal tunnel inlet and at the carpal tunnel outlet. The flattening ratio was also assessed at the tunnel inlet and outlet. Statistical analysis was done to corelate the ultrasound findings at each level with nerve conduction studies and calculation of the positive and negative predictive values. The cut offs of the cross-sectional areas of the median nerve at the three anatomical levels on ultrasonography were taken at the best sensitivity and specificity according to the ROC curve.

We found that at any one anatomical level, the sensitivity of ultrasound to detect carpal tunnel syndrome by increase in the cross-sectional area of median nerve as compared to the nerve conduction studies is 90%.

At 45% specificity, ultrasonography could be used as a non-invasive and easily available screening tool in carpal tunnel syndrome. Also, the best level to look for nerve compression is at the level of the carpal tunnel inlet.

Haemorrhage is responsible for around 11% of stroke syndrome. Haemorrhage usually occurs at a single site. However, it can be at multiple sites in some specific conditions i.e. coagulopathy, vascular malformation, malignancy etc. A 56-year-old male with left sided hemiplegia was admitted in the rehabilitation ward of RIMS, Imphal. He was hypertensive and was on irregular medication for that. He was also an alcoholic and chronic smoker for last 20 years. Patient was conscious and clinical examination revealed left 7th and 12th cranial nerve involvement with left hemiplegia. Non-contrast CT scan of brain revealed right thalamus and left basal ganglia haemorrhages. Thorough history and investigations did not reveal any aetiology for bilateral haemorrhage. Patient was treated with conservative management and improvement was noticed in serial follow-ups. There are very few case reports about bilateral spontaneous intracerebral haemorrhage associated with other diseases like migraine, Japanese encephalitis etc. Cause of bilateral haemorrhage in our case is doubtful.

A 40 years old female with generalised dystonia and chronic low back pain was injected with botulinum toxin injection to extensor hallucis longus(EHL) for management of Hitchhiker's toe. The patient benefited functionally but later developed EHL and extensor digitorum (ED) weakness. Further workup revealed degenerative L4/5 disc lesion causing L5 root affection as the cause for the weakness. This coincidental occurrence of EHL and ED weakness due to L4/5 disc lesion in a patient with generalised dystonia, following botox injection to EHL for management of Hitch hiker's toe, has not been reported before.

Autonomic dysreflexia is an important clinical complication occurring in patients with high levels of spinal cord injury. If untreated, the acute rise in blood pressure can cause end organ damage, including intracerebral haemorrhage. Though unusual, it can be fatal with large haemorrhages causing brain herniation syndromes. Here we report the case of a patient with C6 complete tetraplegia patient who developed brainstem haemorrhage during an episode of autonomic dysreflexia. The pathophysiology and treatment methods of this condition are discussed, highlighting the importance of preventive measures to avoid the same.

Isolated hand palsy also known as ‘pseudoperipheral palsy’ is a rare presentation of ischaemic stroke, often mistaken for peripheral nerve lesion. Here, we report a 13 years old young girl presented with sudden onset right hand palsy without any typical features of either upper motor lesion or lower motor lesion. Ischaemic stroke caused by embolic infarct of left precentral gyrus was the possible cause for her. She was managed with physiotherapy interventions including electrical stimulation, strengthening, grip exercise etc. Such an isolated hand palsy resulting from stroke is a rarely reported entity.