Kavitha Raja
@jssphysiotherapy.edu.in
Professor Physiotherapy
JSS College of Physiotherapy
Graduated from Christian Medical College Vellore, masters from Texas Womans University and PhD from Manipal University. Working as academic since 1999
RESEARCH INTERESTS
Rehabilitation, cerebral palsy
Scopus Publications
Scopus Publications
Muhammed Rashid, Sherin Siby, Jerin Mathew, Sayed Asif Basha, and Kavitha Raja
Elsevier BV
Muhammed Rashid, Sandeep Padantaya Harish, Jerin Mathew, Akshaiya Kalidas, and Kavitha Raja
Springer Science and Business Media LLC
Abstract 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.
Muhammed Rashid, Sherin Siby, Sandeep P. H., Anoop Joy, Arun Gopi, Jerin Mathew, and Kavitha Raja
SAGE Publications
Introduction: Comparison of sway parameters of visually impaired participants to that of the sighted population may give insight into the intrinsic risk of falls relative to the surface. Sway is a natural mechanism to adjust the posture and maintain balance. But the sway characteristics on uneven surfaces are ill explored. There is a paucity of evidence on baseline values of sway amplitude in visually impaired women in comparison to sighted women, which underpins the importance of this study. Methods: Eighteen visually impaired young women and an equal number of age-matched sighted peers 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 videography and analyzed using Kinovea motion analyzing software. Demographics and participant characteristics were summarized using descriptive statistics. The comparison were performed using independent sample t-test. Results: Visually impaired women demonstrated lower amplitude of sway than sighted young women, irrespective of the surface. Discussion: There was a gradual increase in sway amplitude as the standing surfaces changed from even to sand and pebbles, respectively, for both groups. Implications for Practitioners: Contrary to the existing evidence, the results of this study indicate that visually impaired young individuals may not be not at higher intrinsic risk of falls on various terrains than their sighted peers. The authors hypothesize that the lower sway among visually impaired participants can be attributed to the learned strategy for safety from exposure to real-life pragmatic environments during everyday activities, which enabled them to adopt postural strategies as a safety measure. Hence, this strategy can potentially be used in dynamic situations to decrease the propensity for falls during ambulation in visually impaired individuals.
Kavitha Raja, Saumen Gupta, and Priyanka Shirsath
Stichting Liliane Fonds
Muhammed Rashid, Jerin Mathew, Vijay Samuel Raj V, and Kavitha Raja
Elsevier BV
ABSTRACT 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 09 to 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.
Saumen Gupta and Kavitha Raja
Informa UK Limited
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 REHABILITATION Energy 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.
Mansoor Rahman, Kavitha Raja, Muhammed Rashid, and Jagadish Kumar
Mary Ann Liebert Inc
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.
Mansoor Rahman and Kavitha Raja
Termedia Sp. z.o.o.
Background. Monitoring body movements in neonates can have important clinical implications, as these are early predictors of neurodevelopmental disability. the most valid analysis method applied for this purpose is general movement assessment (GMA). Purpose. Performing GMA requires special training, which is often inaccessible to healthcare providers in lowand middleincome countries. Hence, this prospective exploratory study was proposed to profile movement in typical neonates to distinguish it from abnormal movements using Laban/bartenieff Movement Studies (LbMS) framework, which has been widely used to analyse movement in a variety of situations. Methods. Overall, 8 typical neonates were videotaped and 10 cycles of movements were sampled, which resulted in 80 units. Data saturation occurred at 5 children. Results. the results obtained are consistent when described using LbMS language. Conclusions. LbMS may be a feasible and viable method to interpret and document movement patterns in neonates as an alternative to other, more resource-intensive methods.
Jerin Mathew, Kavitha Raja, Febin P. Baby, and Basima Barikkal
Elsevier BV
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.
Kavitha Raja, Srilatha Girish, Saumen Gupta, Jerin Mathew, and V. Ganasan
IOS Press
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).
Ashokan Arumugam, Kavitha Raja, Mahalakshmi Venugopalan, Baskaran Chandrasekaran, Kesava Kovanur Sampath, Hariraja Muthusamy, and Nagarani Shanmugam
Wiley
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.
Srilatha Girish, Kavitha Raja, and Asha Kamath
IOS Press
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.
Nalina Gupta and Kavitha Raja
Stichting Liliane Fonds
Purpose: This review aimed to identify the practice guidelines/ recommendations for physiotherapy management in acute /post-acute/ chronic/long-term phase of rehabilitation of clients with paraplegia due to traumatic causes. Methods : Of the 120 articles retrieved, 26 met the inclusion criteria. After quality appraisal, 16 articles were included in the study. Data were extracted under the sub-headings: physiotherapy care in acute, chronic and long-term community stage; expected outcomes; effect of physical interventions; morbidities; wheelchair characteristics and standing. Results: There is strong evidence in support of strength and fitness training, and gait training. Parameters of strength training (frequency, duration and intensity) vary. There is lack of evidence on passive movements, stretching, bed mobility, transfers and wheelchair propulsion. Preservation of upper limb functions is an important consideration in caring for clients with paraplegia. Conclusion: Many areas of rehabilitation interventions remain inadequately explored and there is a need for high quality studies on rehabilitation protocols. Client preferences and feasibility are other areas that should be explored. Limitations: The search criteria of articles in the English language or articles translated in English is a reason for this limitation. Articles related to advanced therapeutic interventions such as robot-assisted training, and transcranial electrical and magnetic stimulation were excluded from the study.
Srilatha Girish, Kavitha Raja, and Asha Kamath
Stichting Liliane Fonds
Purpose: The revised version of Developmental Coordination Disorder Questionnaire (DCDQ’07) is a widely used parent-reported screening tool for DCD. The tool is not available in any Indian language. This article reports on the results of the cross-cultural validation of DCDQ’07 into Kannada, a South Indian language. Methods: The questionnaire was first translated into Indian English to overcome differences in phraseology between Canadian and Indian English (DCDQ’07-IE). Following this, forward translation, synthesis, back translation, expert committee review, and pre-testing of the translated version were conducted to obtain the Kannada version of the questionnaire (DCDQ’07-K). Minor examples, in keeping with local usage, were added.160 parents were recruited, among whom 80 were parents of children with motor difficulties and 80 were parents of children without motor difficulties. They rated their children on DCDQ’07-IE. After a washout period of 2 weeks, the same parents once again rated their children on DCDQ’07-K.Statistical analysis for reliability, construct validity, and Rasch diagnostics (person and item reliability, fit statistics, category functioning of scores and person-item map) were conducted. Results: Internal consistency (Cronbach’s Alpha>0.8), parallel form test-retest reliability (ICC=0.95 at 95% CI) and floor and ceiling were acceptable. Principal component analysis (PCA) showed three factors accounting for total variance of 59.29% and 58.80% in DCDQ’07-IE and DCDQ’07-K respectively. Item reliability (<0.8) and separation index (<2) were poor in both versions. Category functioning was effective. Person-item map represented inconsistency in spread of items in difficulty and person’s abilities. Qualitative review of the parents revealed that they were unfamiliar with the performance of their children on sports-related items and hence scored their child on the basis of conjecture. Conclusion: Translation into Kannada was fairly successful. Although traditional tool properties produced satisfactory results, Rasch analysis demonstrated problems with the tool. This could be due to cultural reasons. Hence DCDQ’07-K should be interpreted with caution when rated by parents in the local context.
Amrita George, Annie Thomas, and Kavitha Raja
Stichting Liliane Fonds
Purpose: This study attempted to profile the prevalence of childhood health conditions and the factors that contribute to the disablement process leading to disability among children who visit a tertiary referral hospital in Mysore, India. Method: A mixed methods approach was adopted. Phase 1 of the study delineated the profile of cases being referred for physiotherapy treatment. Cases of Cerebral Palsy were reported to be the highest (46%). Phase 2 of the study identified 4 major themes based on the mothers’ experiences with their children. Result: The findings revealed the need to create awareness among paediatricians about the importance of early intervention in childhood disorders and optimal referral to physiotherapy. The other themes which emerged included various attitudes of family and society,lack of cooperation from school as well as the presence physical barriers in school and community and frustration experienced by caregivers due to lack of help and facilities. Conclusion: There is a need to educate parents and society at large that disability should not be associated with “abnormal”. It is rather an interrelated phenomenon where the health issues of an individual and the outlook of society both play an important part.
Kavitha Raja
Forum for Medical Ethics Society
Saumen Gupta and Kavitha Raja
Ovid Technologies (Wolters Kluwer Health)
ObjectiveThe 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. DesignFifty 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. ResultsFriedman analysis of variance showed a significant difference (&khgr;22 = 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. ConclusionsThe 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.
Wenwei Yu, Subhagata Chattopadhyay, T. Lim and Acharya Ur
CRC Press
Kavitha Raja and Saumen Gupta
Stichting Liliane Fonds
Purpose: To devise a viable programme of intervention for older people with Cerebral Palsy (CP). Methods: Using focus group interviews, a ‘top down’ model of intervention was devised among older children and adolescents with CP. Ten participants volunteered and a custom tailored approach was employed, in keeping with the participants’ goals. Results: The outcomes are described qualitatively. Conclusions: There are preliminary indications that the programme is versatile and feasible. Further trials must be conducted before conclusive comments can be made. doi 10.5463/DCID.v23i4.161
Nalina Gupta and Kavitha Raja
Georg Thieme Verlag KG
N Gupta, J Solomon, and K Raja
Springer Science and Business Media LLC
Ashokan Arumugam, Ramakrishnan Mani, and Kavitha Raja
Elsevier BV
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.
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Ovid Technologies (Wolters Kluwer Health)