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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
Rehabilitation, cerebral palsy
ABCD is an assessment battery developed for children with DCD. It has been validated in India initially. We would like to develop normative values and validate in other countries
Saumen Gupta and Kavitha Raja
Disability and Rehabilitation, ISSN: 09638288, eISSN: 14645165, Published: 2019 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.
Jerin Mathew, Kavitha Raja, Febin P. Baby, and Basima Barikkal
Journal of Bodywork and Movement Therapies, ISSN: 13608592, eISSN: 15329283, Pages: 622-626, Published: July 2018 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
Journal of Pediatric Rehabilitation Medicine, ISSN: 18745393, eISSN: 18758894, Pages: 175-185, Published: 2018 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).
Road Traffic and Safety, Pages: 217-221, Published: 1 January 2017
Ashokan Arumugam, Kavitha Raja, Mahalakshmi Venugopalan, Baskaran Chandrasekaran, Kesava Kovanur Sampath, Hariraja Muthusamy, and Nagarani Shanmugam
Clinical Anatomy, ISSN: 08973806, eISSN: 10982353, Pages: 568-577, Published: 1 July 2016 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
Journal of Pediatric Rehabilitation Medicine, ISSN: 18745393, eISSN: 18758894, Pages: 107-116, Published: 31 May 2016 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
Disability, CBR and Inclusive Development, eISSN: 22115242, Pages: 72-86, Published: 2016 VU E-Publishing
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, Dr. Kavitha Raja, and Dr. Asha Kamath
Disability, CBR and Inclusive Development, eISSN: 22115242, Pages: 82-100, Published: 2016 VU E-Publishing
Amrita George, Annie Thomas, and Kavitha Raja
Disability, CBR and Inclusive Development, eISSN: 22115242, Pages: 92-102, Published: 2014 VU E-Publishing
Indian journal of medical ethics, ISSN: 09748466, Pages: 68-69, Published: 2013 Jan-Mar
Saumen Gupta and Kavitha Raja
American Journal of Physical Medicine and Rehabilitation, ISSN: 08949115, Pages: 761-767, Published: September 2012 Ovid Technologies (Wolters Kluwer Health)
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.
Wenwei Yu, Subhagata Chattopadhyay, Teik-Cheng Lim and Acharya Ur
Advances in Therapeutic Engineering, Pages: 267-280, Published: 1 January 2012 CRC Press
Kavitha Raja and Saumen Gupta
Asia Pacific Disability Rehabilitation Journal, eISSN: 22115242, Pages: 97-116, Published: 2012 VU E-Publishing
Nalina Gupta and Kavitha Raja
Journal of Neurosciences in Rural Practice, ISSN: 09763147, eISSN: 09763155, Pages: 207-209, Published: July 2011 Georg Thieme Verlag KG
N Gupta, J Solomon, and K Raja
Spinal Cord, ISSN: 13624393, eISSN: 14765624, Pages: 806-811, Published: July 2011 Springer Science and Business Media LLC
Study design:This study was carried out as a postal survey.Objectives:The aim of this study was to ascertain employment after paraplegia in India.Setting:This study was conducted in India.Methods:The study was conducted by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organisations. Data analysis was carried out by using descriptives.Results:The return rate was 46% (276/600) and the employment rate was 41% (114/276). Among 114 subjects who were employed, 68 (59.6%) were living in centres run by armed force and 46 (40.4%) were living in specialised centres or under the region of non-governmental organisations.Conclusions:Individuals who were employed were living either in centres run by armed force or in specialised centres. None of the individuals living in community was employed.
Ashokan Arumugam, Ramakrishnan Mani, and Kavitha Raja
Journal of Manipulative and Physiological Therapeutics, ISSN: 01614754, eISSN: 15326586, Pages: 247-253, Published: May 2011 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.
American Journal of Physical Medicine and Rehabilitation, ISSN: 08949115, Pages: 433, Published: May 2011 Ovid Technologies (Wolters Kluwer Health)
Kavitha Raja and Neha Dewan
American Journal of Physical Medicine and Rehabilitation, ISSN: 08949115, Pages: 247-262, Published: March 2011 Ovid Technologies (Wolters Kluwer Health)
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.
Anushree Narekuli, Kavitha Raja, and Senthil Kumaran
Asia Pacific Disability Rehabilitation Journal, eISSN: 22115242, Pages: 108-119, Published: 2011 VU E-Publishing
Eliza Annie Hillary Pereira, Kavitha Raja, and Ranganath Gangavalli
American Journal of Physical Medicine and Rehabilitation, ISSN: 08949115, Pages: 25-34, Published: January 2011 Ovid Technologies (Wolters Kluwer Health)
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.
N Gupta, J Solomon, and K Raja
Spinal Cord, ISSN: 13624393, eISSN: 14765624, Pages: 342-346, Published: April 2010 Springer Science and Business Media LLC
Study design:A postal survey.Objective:To ascertain the incidence of pain in individuals with paraplegia in India and to associate it with demographic characteristics.Setting:India.Method:The study was done by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organizations. Data analysis was done by using non-parametric tests of association.Results:The return rate was 46% (276/600). Fifty-seven percent of individuals complained of pain. Of this, pain in the back and chest ranked the highest (30.1%), followed by pain below the level of lesion (6.9%), pain in the shoulder and upper limb (4.7%) and neck (0.4%). Fifteen percent of individuals complained of pain at multiple sites. We found a significant association of pain with age, duration since injury and ambulation.Conclusion:More than half of the subjects complained of pain in the study. Pain was found to be associated with age, duration since injury and ambulation. As pain has a dramatic effect on a subjects' quality of life, there is a need to evaluate it in detail and treat accordingly with preventive, rehabilitative or surgical procedures.
Saumen Gupta, Kavitha Raja, and N Manikandan
International Journal of Diabetes in Developing Countries, ISSN: 09733930, eISSN: 19983832, Pages: 125-129, Published: 1 October 2008 Springer Science and Business Media LLC
CONTEXT Adhesive capsulitis (AC) is a common musculoskeletal manifestation in elderly having long standing history of diabetes. This hinders the function of shoulder which is crucial in many activities of daily living. This painful, functional deficit may decrease the quality of life in elderly. AIMS The purpose of this study was to evaluate the impact of AC on quality of life in diabetic elderly subjects. SETTINGS AND DESIGN District government Hospital, Udupi; Dr. T. M. A. Pai, Udupi, Kasturba Hospital, Manipal; and the study design is cross-sectional design. MATERIALS AND METHODS Two hundred and thirty-three diabetic elderly patients were recruited from the settings based on cluster sampling. They were evaluated for pain and restriction of range of motion in the shoulder joint and were. Severity of condition was classified on Oxford shoulder score and quality of life was calculated by SF- 36. STATISTICAL ANALYSIS USED Descriptive statistics and spearman's correlation coefficient done in SPSS. RESULTS Forty-nine percent of women had diabetic AC. Majority of the subjects without AC fell in average quality of life. Women with AC fell in unhealthy category, whereas men were clustered in the average category. CONCLUSIONS Adhesive capsulitis was an important factor in reducing the quality of life of the elderly with diabetes.
N Gupta, J Solomon, and K Raja
Spinal Cord, ISSN: 13624393, eISSN: 14765624, Pages: 664-670, Published: October 2007 Springer Science and Business Media LLC
Study design:Postal survey from August 2004 to May 2006.Objective:To ascertain the morbidity trends in individuals with paraplegia in India and to find its association with demographic characteristics.Settings:India.Methods:The questionnaire was mailed to the identified individuals (n=600) whose addresses were obtained from the medical records section of our hospital and by contacting non-government organizations (NGOs), working for individuals with paraplegia in various cities. The causes of morbidities surveyed were respiratory complications, use of catheter, pressure sores, spasticity, postural hypotension, pain and fractures. Data were analysed using nonparametric test of association (Goodman Kruskal Tau).Results:A total of 276 (46%) individuals responded. Of all the morbidities studied, pain was the leading cause (57.2%) followed by spasticity (39.1%), pressure sore (28.3%), postural hypotension (10.1%), respiratory complications, and fractures (5.8%). We found significant associations between various morbidities and demographics and between morbidities themselves.Conclusion:The most common cause for morbidity was pain. Ambulation reduced the incidence of secondary complications.Sponsorship:This study was funded in part by Indian Association of Physiotherapists.
P Agarwal, P Upadhyay, and K Raja
Spinal Cord, ISSN: 13624393, eISSN: 14765624, Pages: 597-602, Published: 7 September 2007 Springer Science and Business Media LLC
Study design and subjects:Retrospective descriptive analysis of data of patients with spinal injuries admitted to a tertiary referral medical center from January 1, 2003 to December 31, 2004.Objectives:To identify the demographic profile of patients with spinal injuries admitted in this hospital.Setting:Medical records department, Kasturba Hospital, Manipal, Karnataka, India.Methods:A total of 207 patients with traumatic and non-traumatic spinal injuries were included in the study. The patient characteristics that were included were age groups, neurologic status, mode and neurological level of injury, management and recovery pattern.Results:Ratio of men to women who sustained spinal injuries was 3.6:1. The maximum number of patients was in the age range of 20–39 years. The different levels of spine that sustained injuries were cervical spine (36.2%), thoracic spine (34.3%) and lumbar spine (29.5%). There were 118 patients with neurological deficit. Mechanisms of injury recorded were fall from height (58.9%), fall of weight (7.2%), motor vehicle accidents (21.3%) and non-traumatic causes (12.6%). Of these 207 spinal injury patients, 74.4% were managed conservatively, whereas 25.6% patients were managed surgically.Observation:This study gives a preliminary overview of the characteristics of patients with spinal injuries in this hospital.
Kavitha Raja, Benjamin Joseph, Susan Benjamin, Vineet Minocha, and Binay Rana
Journal of Pediatric Orthopaedics, ISSN: 02716798, Pages: 130-136, Published: March 2007 Ovid Technologies (Wolters Kluwer Health)
The study was undertaken to evaluate whether the Physiological Cost Index (PCI) can be used as a reliable index of efficiency of gait and as an outcome measure in cerebral palsy (CP). Physiological Cost Index was calculated in normal subjects by recording the heart rate manually and with electrocardiograph recording, and the values compared. In another group of subjects, PCI was calculated after they walked 3 different distances (50, 100, and 150 m). The PCI of normal children and children with CP was then estimated by manual recording of the pulse, with the children walking 50 m indoors and 50 m on an uneven surface outdoors. The reproducibility of calculation of PCI was evaluated. The PCI value of each patient was compared to the corresponding Functional Mobility Score. In a group of children with CP, PCI was calculated before and after therapeutic intervention. The PCI values were comparable with either method of heart rate measurement and for the 3 distances walked. The reproducibility of measurement of PCI was satisfactory (Intraclass Correlation Coefficients, 0.80-0.88). The PCI of normal children was 0.1 beats per meter, whereas children with CP had 6 times higher values of PCI, with the highest values in children with a crouch gait. In normal children, 10% greater PCI values were noted when they walked outdoors compared to a 100% increase in children with CP. The higher the PCI values, the lower the Functional Mobility Scores. Therapeutic interventions altered PCI values, and interventions that effectively reduced energy consumption could be identified. We conclude that PCI may be used as a reliable outcome measure of gait efficiency in children with CP.
Indian journal of medical ethics, Pages: 16-17, Published: January 2007
American Journal of Physical Medicine and Rehabilitation, ISSN: 08949115, Pages: 694-698, Published: August 2006 Ovid Technologies (Wolters Kluwer Health)
A 3-mo prospective descriptive study of 50 Indian ambulant children with cerebral palsy using different types of walkers or elbow crutches was done to determine compliance with use of the prescribed device. Children were between 6 and 16 yrs of age and of either sex. Data were collected by means of proxy log entries made by the child's caregivers throughout the day. The data collected consisted of the number of times and the distance the child walked each time with or without the prescribed walking aid. Compliance was taken as the number of times the child used the walking aid during ambulation. Overall mean compliance was 49.1%. Children using the reciprocal walker showed the greatest compliance (60.2%), whereas those using elbow crutches (34.9%) and walkers with gutter attachments (14.8%) showed the least. Compliance was greatest for distances of 50-100 m (57.5%), whereas it was the least for distances of >150 m (25.9%).