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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
Muhammed Rashid, Jerin Mathew, Vijay Samuel Raj V, and Kavitha Raja
Journal of Bodywork and Movement Therapies, ISSN: 13608592, eISSN: 15329283, Pages: 174-182, Published: January 2021 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.
Mansoor Rahman, Kavitha Raja, Muhammed Rashid, and Jagadish Kumar
Games for Health Journal, ISSN: 2161783X, eISSN: 21617856, Pages: 453-460, Published: December 2020 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
Human Movement, ISSN: 17323991, eISSN: 18991955, Pages: 97-101, Published: 2020 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.
Disability, CBR and Inclusive Development, eISSN: 22115242, Pages: 164-178, Published: 2020
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 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
Disability, CBR and Inclusive Development, eISSN: 22115242, Pages: 82-100, Published: 2016 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
Disability, CBR and Inclusive Development, eISSN: 22115242, Pages: 92-102, Published: 2014 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.
Indian journal of medical ethics, ISSN: 09748466, Pages: 68-69, Published: 2013 Jan-Mar Forum for Medical Ethics Society
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)
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
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 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
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
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 D Senthil Kumaran
Asia Pacific Disability Rehabilitation Journal, eISSN: 22115242, Pages: 108-119, Published: 2011 Stichting Liliane Fonds
Advances in medical science have resulted in a concomitant increase in the life span of persons with disabilities. The prevalence of chronic disease, an aging population and the ongoing shift of the site of care from institutions to the community, have resulted in a significant increase in the informal care provided by family members and friends of those living with chronic illnesses. This in turn increases the burden on the family, by way of physical and psychological stressors.The objectives of this study were to identify the burden perceived by caregivers of individuals with functional disability, and to evaluate the effects of a tailored physical therapy intervention, or caregiver education, on the caregivers’ burden. Ninety seven persons were deliberately assigned, based on their accessibility, to the control group, caregiver education group and intervention group.Although there was no statistically significant difference between the groups, among caregivers of persons affected by moderate to severe disability, there were trends showing greater reduction in caregiver stress and burden in the intervention group.These trends and comments from individual participants point to an improvement in caregiver burden with physiotherapy intervention. Hence, it can be suggested that physiotherapy management of persons with disabilities must also include caregiver health. DOI 10.5463/DCID.v22i1.17
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.