Post-polio Residual Paralysis Research Articles

Profile of patients coming to the department of physical medicine and rehabilitation for locomotor disability certification: a 5-years observational study

Background: The persons with locomotor disability are eligible for various social welfare benefits from the Government under ‘The persons with disabilities (Equal opportunities, protection of rights and full participation) Act, 1995’ along with other causes of disabilities like blindness, hearing impairment etc. and recent enactment of the Rights of Persons with Disabilities (RPwD) Act, 2016. Understanding the utilization of services is crucial in enhancing assistance for individuals with certifiable disabilities. This study aimed to observe the clinico-demographic profile of patients coming to outpatient Department of Physical Medicine and Rehabilitations for locomotor disabilities certification and 5 years’ trend in the number of patients getting disability certificate. Methods: This retrospective study was based on the data taken at time of disability certification in a multispecialty tertiary care government medical college in Northern India. All persons with locomotor disability who were issued disability certificate between 2014 and 2018 were included in the study. Results: A total of 857 patients were issued disability certificates during the study period of 2014 to 2018. Among the 744 adult patients, only 149 (20%) were female. Most of them were urban residents. In locomotor disability, post-polio residual paralysis was the most common diagnosis encountered, followed by amputations and cerebral palsy. Most of the applicants were having a disability of 40-50%. Conclusions: Awareness has to be generated about the disability benefits and disability certification. Utilisation of services by females should be encouraged. Robust data and literature need to be built up for prevention and management of locomotor disability.

An integrated qualitative and quantitative study on sexual and reproductive health problems faced by women with disabilities in Chandigarh, India.

To estimate the prevalence of sexual and reproductive health (SRH) problems among women with disabilities (WWD) in Chandigarh, India, and to ascertain the difficulties experienced by WWD in accessing hospital services. This cross-sectional study was conducted during 2014 to 2017 in Chandigarh, India. The study participants were women 15 years and older with at least 40% disability. A pretested questionnaire and in-depth interview were used to determine sociodemographic profile, medical history, sexual and reproductive morbidity, treatment-seeking behavior, and the type, extent, and course of the disability. Verbatim responses of the participants were noted. Data were manually coded and collated into possible themes. Postpolio residual paralysis (80; 30.7%) was the main reported disability, followed by severe sight impairment (52; 19.9%). A majority (170; 65%) of participants were unmarried. Of them, 66 (39%) were not willing to get married. The prevalence of SRH problems was high (151; 57.9%) among WWD, and only 82 (54%) took treatment. Dysmenorrhea (47; 31.1%), irregular periods (36; 23.8%), and vaginal discharge (17; 11.3%) were the main problems reported. The WWD in this study were likely to hide their SRH problems from others out of shame or fear. Among WWD, the prevalence of SRH problems is high and obtaining relief is difficult.

Uncemented hemiarthroplasty in a case of post-polio residual paralysis patient with transcervical femur fracture with dysplastic femur: A surgical technical challenge

Introduction: Technical difficulties in managing a case of transcervical femur fracture in post-polio residual paralysis patient with dysplastic femur. Case Report: We present a case of a 66 year male with Post-Polio residual Paralysis walking with Hand to knee gait who sustained a transcervical Femur fracture. The difficulties faced in this case were narrow medullary canal, coxa valgus, dysplastic greater trochanter, hypoplastic lesser trochanter, Shallow acetabulum, inability to compare the length after insertion of trial implant with the opposite limb due to underdeveloped and shortened affected limb.Conclusion: We try to emphasise on the preoperative preparations that need to be done in terms of CT scan with pre operative estimation of canal diameter, keeping a back-up of an array of implants including CDH hip stems, technique of measuring the vertical and horizontal offset before neck osteotomy and extraction of the head and recreating the offset after implantation, increased anteversion of the hip to prevent dislocation due to shallow acetabulum, and proper closure of the capsule.

An algorithmic approach to total hip arthroplasty in patient with post-polio paralysis and fixed pelvic obliquity.

AimsTotal hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner wear, and early loosening.MethodsIn all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment.ResultsThe mean Harris Hip Score at the latest follow-up was 79.2 (68 to 90). There was significant improvement in the coronal pelvic obliquity from 16.6o (SD 7.9o) to 1.8o (SD 2.4o; p < 0.001). Radiographs of all ten hips showed stable prostheses with no signs of loosening or migration, regardless of whether paralytic or non-paralytic hip was replaced. No complications, including dislocation or infection related to the surgery, were observed in any patient. The subtrochanteric shortening osteotomy done in two patients had united by nine months.ConclusionSimultaneous correction of soft tissue contractures is necessary for obtaining a stable hip with balanced pelvis while treating hip arthritis by THA in patients with PPRP and fixed pelvic obliquity.Cite this article: Bone Jt Open 2021;2(9):696–704.

The Birth of first JIPMER “ICSI” Baby

Assisted reproductive techniques are becoming more and more essential for human life in the Society. Worldwide more than 5 million babies were born out of this technology after the birth of first baby Louis Brown and second Durga (India) in 1978. It is a boon for the couple in despair to have a child especially when it is provided by Govt Institutions for the less affordable people of the Society. It is essential to share provider’s experiences and expectations of the public in a fast growing biomedical field like ART. The techniques of IVF and ICSI have undergone a sea change since the initial technique of natural cycles to ovarian hyper stimulation and stem cell research. A 29 year old lady, Type I Diabetic with hirsutism, PCOS, failed IUI underwent ICSI following ovarian stimulation employing antagonist protocol after 8 years of married life. The husband is also diabetic for 13 years and suffered from post-polio residual paralysis and had asthenospermia. Frozen Embryo transfer of cleavage stage embryos was done on 31.7.2019 after endometrial preparation employing HRT. Her β HCG was HCG 387 on 14.8.2019 and intrauterine pregnancy was confirmed by transvaginal scan. Pregnancy and Diabetes were managed with progesterone support and Insulin therapy respectively. An alive male baby was delivered by emergency Caesarean section on 28.3.2020 at 12.34 PM for breech presentation in labour during lockdown for COVID 19. Both mother and baby were discharged home in healthy condition and the baby is one year old at the time of writing this report.

Total Hip Arthroplasty in Patients With Postpolio Residual Paralysis: A Systematic Review

BackgroundPatients with postpolio residual paralysis can develop disabling hip arthritis in paralytic as well as a nonparalytic limb, warranting total hip arthroplasty (THA). Limited literature is available on the results of THA among these patients in the form of small series or case reports. We have undertaken a systematic review to evaluate the clinical outcome of THA in patients with poliomyelitis with hip pathologies. MethodsA systematic search of electronic databases of PubMed, Scopus, and Web of Science pertaining to English literature was undertaken from 1945 to August 2020 to assess the results of THA in patients with poliomyelitis. Information was gathered about demographics, indication, clinical course, complications, functional outcome, survival, and need for any revision surgery in these patients. ResultsThe literature search revealed 81 articles. Finally, after deduplication and manual selection, 16 relevant articles (128 hips) were included for evaluation. There is a paucity of literature evaluating THA in patients with poliomyelitis over the last 2 decades. The principal reason for arthroplasty was osteoarthritis of the hip in the ipsilateral (paralyzed) limb. A combination of cemented, uncemented, and hybrid implant fixation system was found to be used by surgeons. Addressing instability and perioperative management of limb length discrepancy were found to be challenging propositions. ConclusionTHA remains an effective intervention to relieve pain and improve quality of life in patients of poliomyelitis afflicted with either primary or secondary arthritis of the hip. The use of uncemented nonconstrained hip implant designs appears to demonstrate better results than constrained implants.

Salvage procedures in post-polio residual paralysis (PPRP) with or without arthritis

Poliomyelitis is a rare disease at present, but presentation with its sequalae is not uncommon. In this study we are presenting 5 different cases with 5 different deformities in lower limb, who were managed with arthrodesis, tendon transfer, and osteotomies in combination. All the 5 patients were satisfied with their gait and pain relief after surgery compared with pre-operative status. All patients were followed for period of 2 years post operatively, no major complications were encountered. In conclusion, because of gross muscle power compromise replacement surgeries will not give good results in post residual paralysis patients, so salvage procedures definitely improve the performances of patients with painful unstable joints.

Role of Ilizarov external fixator in the treatment of long-standing knee flexion deformity in adults: A prospective cohort study

Background: One of the major disabilities of the lower limb is fixed knee flexion deformity. Post-polio residual paralysis is the main etiology, but there are others. This study evaluated the outcome of treatment of long-standing fixed knee flexion deformity with the Ilizarov external fixator without soft-tissue intervention or osteotomy in a certain age group. Methods: Thirty patients (33 knees) with knee flexion deformity were enrolled in this study. There were 11 women and 19 men. Three patients had bilateral lower limb affection. The etiology was post-polio residual paralysis in 11 patients (14 knees), four patients had brain insult, eight patients had post infectious etiology, and seven patients had failure of open reduction and internal fixation of tibial plateau fractures. An Ilizarov fixator was applied in all patients for deformity correction with no soft-tissue release or osteotomies. Results: The mean age of the patients was 28.7 yr (18-55 yr), the mean preoperative flexion knee angle was 77.87 degrees (50-130 degrees). The mean preoperative arc of motion was 17.1 degrees (0-50 degrees), the mean time since the deformity was well established was 9.4 yr (4-30 yr), the mean time needed for correction of the deformity was 49.2 days (27-120 days) at the end of the procedure. All patients achieved full correction of the deformity. Conclusions: The Ilizarov external fixator is an effective tool in the treatment of severe long-standing fixed knee flexion deformity in adults with minimal complications and good outcomes. Level of Evidence: Level II.

Osteosynthesis of Fracture Neck of Femur with High Valgus Angle in Young Adult with Post-polio Residual Paralysis: A Case Report and Review of Literature

Osteosynthesis of Fracture Neck of Femur with High Valgus Angle in Young Adult with Post-polio Residual Paralysis: A Case Report and Review of Literature

Outcome of Achilles tendon plication and transfer of peroneus longus to Achilles tendon for correction of dynamic calcaneo-valgus deformity of the foot in post-polio residual paralysis

Objective: Tendon transfers are indicated when dynamic muscle imbalance results in a deformity that interferes with ambulation or function of the extremities. Foot and ankle are the most dependent parts of the body and are subjected to greater strain than other parts. Calcaneo-valgus deformity is one of the common deformities seen in Post-Polio Residual Paralysis. A host of operative procedures have been described in the management of this deformity. We report the results of the study conducted in our institute where Achilles tendon plication and transfer of Peroneus Longus tendon to Achilles tendon has been done for dynamic calcaneo-valgus deformity of the foot in patients of post-polio residual paralysis. Methods: This is a prospective study of 37 patients with Calcaneovalgus deformity having Post-Polio Residual Paralysis presenting to Balaji Institute of Surgery, Research and Rehabilitation for the Disabled Hospital from December 2009 to December 2012. Informed consent was taken from the parents of all the patients. Ethical committee approval was also taken. Patients with age more than 7 years, ability to walk without support and Peroneal tendon having minimum motor power of grade 4 or 5 as per MRC classification are included in our study. Patients with fixed deformity at ankle joint or subtalar joint are excluded from the study. Pre-operative evaluation included detailed motor examination of the involved lower limbs as per MRC (Medical research council) classification, evaluation of deformity in the hip and knee and range of motion at ankle. AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating system was used to assess the patient pre-operatively and post-operatively. The aggregate score of the AOFAS ankle-hind foot clinical rating scale pre and post operatively were analyzed with use of chi-square analysis. The level of significance of < 0.05 was considered to be significant. The surgical procedure was done under spinal anesthesia with the patient in lateral position under pneumatic tourniquet. A longitudinal incision is made starting from the tip of lateral malleolus midway between the posterior border of lateral malleolus & Achilles tendon to about 8-10cm proximally. Skin flaps are mobilized without dissecting the subcutaneous fat. The two peroneal tendons are identified as they pass down the leg and around the back of the lateral malleolus. The peroneus longus tendon is divided as distally as possible and mobilized. Similarly the Achilles tendon is identified. Plication of the Achilles tendon is done in its middle third with nylon sutures and the peroneus longus tendon is transferred through it using Fish-Mouth (Pulvertaft) tendon suturing technique and is secured over itself proximally under tension providing the tenodesis effect. While this is done the ankle is kept in plantar flexion. The deep fascia is closed over the tendon. Pneumatic tourniquet was released, and the incision was closed in layers after hemostasis was achieved. Below knee cast is applied with the foot in plantar flexion. Movements of the toes are encouraged after recovery from anesthesia. Active toe movements were encouraged in the cast. After six weeks sutures are removed and ankle foot orthoses are provided for another six weeks. During this period supervised active exercises for strengthening the Tendoachilles (static cycling exercise) are started. Patient is reassessed after six weeks and the orthoses is discarded at this stage. Conclusion: Our experience concludes that Achilles tendon plication and transfer of peroneus longus tendon to Achilles tendon is an excellent procedure which improves the dynamic calcaneo-valgus deformity of foot in patients with post-polio residual paralysis. The advantage of the procedure being easy to do with very low complication rate and improves the quality of life in patients with post-polio residual paralysis. 37 patients with the dynamic calcaneo-valgus deformity of foot in patients with post-polio residual paralysis were analyzed with average follow up period of 12.5 months. Dynamic calcaneo-valgus deformity of the foot was corrected in 89.18% of patients. The study fared with 89 percent patients satisfied with the results. The patients showed improvement in their activity limitation, maximum walking distance, gait and stability.

Stride, energy expenditure, and user's satisfaction in person with postpolio residual paralysis: a comparative study between pneumatic control and drop-lock knee joint using knee-ankle-foot orthosis.

BACKGROUND: Persons with postpolio residual paralysis (PPRP) present gait abnormalities due to residual lower extremity pareses and joint deformities.[1,2] An increase in energy cost results from lower extremity muscle weakness. Lower extremity orthoses are prescribed to reduce gait abnormalities, to enable standing and walking, and to maintain or improve physical performance. The present study is to determine the effectiveness of the newly designed pneumatic control knee joint [Figure 2] with respect to stride parameter, energy expenditure, and user's satisfaction in comparison to drop-lock knee joint [Figure 1] in knee-ankle-foot orthosis (KAFO) in a patient with PPRP.{Figure 1}{Figure 2} METHODS: Purposive sampling was done for the study, and thirty patients were recruited. The stride parameter, energy expenditure, and user's satisfaction were measured between drop-lock knee joint KAFO and pneumatic control knee joint KAFO. An adaptation period of 1 h was provided with pneumatic control KAFO. RESULTS: A paired t-test was conducted for estimating step length and stride length for subjects using drop-lock KAFO and Pnuematic control KAFO. Pneumatic Control KAFO showed a higher significance in both step length with (t = −5.150, P = 0.000) and Stride length (t = −5.026, P = 0.000). A paired t-test conducted for cadence shows a signifi cant difference (t = 1.066, P = 0.295) in favor of drop-lock KAFO. The speed shows a signifi cant difference (t = −4.704, P = 0.000) in favor of pneumatic control KAFO. Physiological cost index while walking with pneumatic control KAFO was signifi cantly lower than those walking with drop-lock KAFO (t = −5.575, P value = 0.000). The user's satisfaction for the subjects using the drop-lock KAFO and the pneumatic control KAFO shows a significant difference (t = −9.798, P = 0.000) in favor of pneumatic control KAFO. CONCLUSION: The study concludes the pneumatic control KAFO to have significantly greater value as compared to drop-lock KAFO in terms of stride parameter and energy expenditure and user's satisfaction in subjects with PPRP.

Total Hip Arthroplasty in Patients of Post Polio Residual Paralysis: A Retrospective Case Series.

Background:Poliomyelitis is a viral, nervous system disease that affects both the upper and the lower extremities. The treatment of severe coxarthrosis in these patients with total hip arthroplasty (THA) has been widely questioned because of the high risk of subsequent complications. The aim of the present study was to describe both radiological and medium term clinical results in a series of patients with post polio residual paralysis that underwent THA.Materials and Methods:We report a retrospective review of a series of 5 five patients diagnosed with severe coxarthrosis secondary to post polio residual paralysis who were operated between 2008 and 2012. Uncemented THA was performed in all cases by the same surgeon. Clinical evaluation was carried out using the Harris Hip Score (HHS) at the preoperative visit, at 6 months, and annually after surgery.Results:The median age was 47 years, and the median followup was 55 months (interquartile range P25–P75: range 31–72 months). According to the HHS, a significant clinical improvement was observed in all patients with a median score of 81 points (interquartile range P25–P75: range 74–89) at 1 year of followup. A case of relapsing dislocation that required revision surgery of the implant was recorded. No cases of component loosening were found.Conclusion:THA surgery in patients with post polio residual paralysis is a complex procedure with a significant complication rate, but a predictable clinical improvement may encourage surgeons to perform in patients with severe coxarthrosis and moderate functional expectations.

Choice of implants in management of fractures in patients with post-polio residual paralysis

Introduction: Poliomyelitis is on the verge of eradication. Fractures in polio survivors present unique challenges; the bone is often small, deformed, osteoporotic and hypovascularized. Aim: Our aim was to assess the varied fracture patterns and the challenges faced in fixation of fractures in polio affected limbs and possible solutions to overcome them. Material & methods: All cases were managed at RMMCH, Annamalai University. Each and every case was unique in its own terms with variable clinical and radiological presentation. Varied challenges were managed in different manner with respect to implant choice for optimal outcome. Results: Fracture union and callus formation were evaluated on radiographs taken at each postoperative visit. Functional outcome assessments included range of motion and early return to activities of daily living. All fractures healed except for one nonunion due to conservative management. Conclusion: Anatomical locking plate may not be ideal for these patients as the plates may be larger and overhang the malformed bone. Hence nails with smaller diameter and locking compression plates designed for other skeletal regions may give better results than the conventional plates and nails. Fractures in the polio-affected limb are not a common entity and are difficult to manage using a common fracture management protocols and need to be customized for individual patients to suit their needs and bones with all implants ready for use.

Assessment of bone geometry and its considerations in implant selection for polio affected femoral fractures: An outcome analysis

Introduction: Fractures occurring in the femurs of polio affected limbs pose various challenges in their management since they have an altered anatomy. In this study, the bone geometry of femoral fractures in post-polio residual paralysis patients is analysed and compared with standard implants for proper implant selection to provide a stable fixation. Materials and methods: A total of 20 femoral fractures in adult post-polio residual paralysis patients were included in this study and their bone geometry was assessed. Based on the bone geometry in each case, appropriate implants were used. The mean age was 41.6 years (Range 26 to 58 years). 9 cases out of the 20 required the use of non-standard implants, including a custom-made femoral nail, a humerus nail, proximal humerus LCP, proximal tibial LCP and a modular bipolar hemiarthroplasty prosthesis with DDH stem. Mean duration of follow up was 34.5 months (Range 2 to 5 years). Results: The mean union time was 4.63 months. The mean duration of surgery was 81min (Range 65-145 mins). Intra-operative blood loss ranged from 80-250ml (Mean 130ml) with no case requiring blood transfusion. Mean hospital stay ranged from 7-9 days. All patients returned to their pre-operative function (assessed according to Vignos scale for lower extremities), except for two cases showing a deterioration of function post-operatively. Conclusion: No implant is unique for surgical management of femur fractures in post-polio residual paralysis patients. Proper pre-operative evaluation and planning should be individualised for each case according to the measured femoral geometry. The best implant should be chosen and a wide array of implants should be made available during surgery to achieve good results.

A rare case of postpoliomyelitis quadriparetic patient with severe kyphoscoliosis.

A rare case of postpoliomyelitis quadriparetic patient with severe kyphoscoliosis.

Massive pre-patellar bursitis – a case report

Pre-patellar bursitis is one of the common bursitis among all bursa affection. But massive Pre-patellar bursa is seen in patients who have repeated trauma to knee for long duration like patients ambulating on knees in post polio residual paralysis or cerebral diplegia and very few cases have been reported. Hence we report a case of 25 yr male patient with post polio residual paralysis presented who presented with massive pre-patellar bursitis. Bursa was excised along with the redundant skin leaving the anterior wall intact & scarification was done.

Quality of Life among Persons with Physical Disability in Udupi Taluk: A Cross Sectional Study.

Background:Disability is not just a health problem or attribute of individuals, but it reflects the problems individuals experience in their interaction with society and physical movements. Disabled persons remain neglected part of society and they also experience various barriers due to restriction of participation.Objectives:The aim was to assess the quality of life (QOL) of physically disabled persons, the impact of physical disability on activities of daily living (ADL) and to study the awareness about laws and facilities available for disabled persons.Materials and Methods:A cross-sectional community based study was conducted among 130 physical disabled persons who were selected using convenience sampling technique. The WHO BREF scale was used to assess QOL, while assessment of ADL was done using Barthel Index. Socio-demographic assessment was done using Udai Pareek scale. SPSS version 15.0 was used to analyze data. Categorical variables were expressed as frequencies and percentages. As per guidelines physical, psychological, social, and environmental domain scores for WHO BREF scale were calculated.Results:Among the study participants, 36.2% had a disability from birth that is, congenital. The second common cause of disability was found to be postpolio residual paralysis as it was found among 26.2% respondents. Other causes found were stroke/paralysis and accidents, in 19.2% and 18.5% respondents, respectively. Activities such as transfer, mobility, and stair climbing showed greater impact of physical disability. It was found that 11.5% respondents required help in one of the ADL. QOL score was found to be low under the psychological domain reflecting on negative feelings, bodily image, appearance, spirituality, and self-esteem of respondents.Conclusion:Physical disability had affected social participation as well as marriage of the respondents. However, it was found that very few of them are aware about facilities provided under persons with disability act.

Muscle Re-Education Following Free Muscle Transfers Using EMG Biofeedback Technique

Introduction: Indications for free muscle transfers (FMT) include Volkman’s Ischemic Contractures, Brachial Plexus Injuries, Post-polio residual paralysis or any other condition where muscle recovery is questionable due to significant trauma. Following injury, loss of extremity function is evident creating cortical changes. Primary function of the FMT is to provide patients with functional extremity and re-establish the cortical pathways. Different options are available for FMT. Upon detachment of muscle for transfers, a denervated muscle undergoes atrophic changes. This muscle atrophy is reversible as the muscle is re-innervated. However, initially, the reinnervating muscle has limited capacity to produce articular motion and thus muscle recovery goes un-noticed. An EMG Biofeedback technique is a useful adjunct in detecting and re-educating muscle recovery in early stages of muscle re-innervation. An EMG Biofeedback technique is a therapeutic procedure, which helps patients recognize muscle recovery and encourage greater voluntary control through auditory and visual signals enhancing cortical awareness of their extremity motion. In addition, an EMG triggered electrical stimulation further enhances muscle strength. The presentation illustrates the use of this technique in enhancing muscle recovery and function following FMT.

Hamstring transfer for quadriceps paralysis in post polio residual paralysis.

Context:Paralysis of quadriceps muscle leads to severe disability as the knee is unstable and cannot be fully extended and locked in extension, which results in giving way of the knee joint. Because of this, the patient tries to get stability of the knee by various means like hand to knee gait, extreme internal or external rotation of the affected limb to stabilize knee by support of medial or lateral collateral ligament, respectively, or by tilting pelvis. When there is concomitant weakness of gluteus maximus quadriceps and hamstrings (MRC muscle power less than grade III), patient may develop compensatory hyperlordosis of spine. Hamstring (H) transfer is a well-accepted procedure for patients with quadriceps (Q) weakness. For hamstring transfer, we have used a modified technique of anchoring of biceps femoris and semitendinosus tendon to patella. Instead of cutting the periosteum over the patella in an I-shaped manner, an osteoperisoteal flap was raised after two parallel incisions over the patella and both tendons were sutured under the flap with each other. We conducted a retrospective evaluation of the results of modified hamstring transfer in 267 patients of post polio residual paralysis with residual quadriceps paralysis.Materials and Methods:Two hundred and fifty young patients (100 male and 150 female patients) who had quadriceps paralysis due to polio were managed by hamstring transfer at a single center between 1984 and 1996 and were followed for a mean of 5 years (range 4–12 years). Age of patients ranged from 7 to 18 years in 238 patients and 12 patients were above the age of 18 years. All cases were followed periodically, and assessment of knee extension, extension lag, knee flexion, elimination of calliper, and avoidance of hand to knee gait was done.Results:One hundred and sixty two patients (65%) showed excellent results, 38 patients (15%) had good results, and 50 patients (20%) showed poor results. Ninety three patients had major complications like genu recurvatum, restricted knee flexion, and extension lag. Ten patients had minor complications like superficial infection and epidermal edge necrosis.Conclusions:H to Q transfer in the presence of quadriceps paralysis with good power in hamstring is a better alternative than supracondylar osteotomy because it is a dynamic correction and it produces some degree of recurvatum with increasing stability of knee in extension while walking. While inserting hamstring over patella the periosteum is not cut in an I-shaped fashion to create a flap which gives additional strength to new insertion and also patella act as a fulcrum during the extension of knee by producing the bowstring effect.

Clinical Utility of Electronic Balance Board and Treadmill Training in Pott’s Paraparesis: A Case Study

Abstract Background: Pott’s Paraparesis is one of the serious manifestations of Tuberculosis of Spine. The presence of Post Polio Residual Paralysis (PPRP) in one of the lower extremity adds to the seriousness of the sufferer. There is hardly any study about the electronic balance board and treadmill training in patients with Pott’s Paraparesis as well as PPRP. Therefore, the objective of this study was to find out the clinical utility of electronic balance board and treadmill training. Methods: A 33 years old male patient with a diagnosis of early onset grade 2 Pott’s Paraparesis for eight months along with right lower limb PPRP since childhood participated in this study. He was trained with Electronic Balance Board training for 15 minutes, Treadmill Training for 20 minutes and conventional physiotherapy for 45 minutes of 36 sessions over the period of six weeks and the outcome was assessed with Berg Balance Scale (BBS), Electronic Balance Board Score (EBBS), Spinal Cord Independence Measure (SCIM), Walking Index for Spinal Cord Injury (WISCI) and Computer Dyno Graphy (CDG)® system. Results: The results of this study showed 41.07% improvement in BBS, 50% in EBBS, 13% in SCIM, 30% in WISCI and in gait parameters such as Left/Right symmetry by 3.38%, single support time (left by 4.57%, right by 13.93%), double support time (left by 62.92%, right by 56.03%), single swing (left by 13.93%, right by 15.23%), distance (left by 49.16%, right by 47.64%) and step time (left by 45.14%, right by 43.20%). Conclusion: Electronic Balance Board and Treadmill Training may be used as an adjunct to Conventional Physiotherapeutic Rehabilitation of Pott’s Paraparesis along with PPRP patient.