1. Customizing stroke rehabilitation using a 'Rehabilitation Problem-Solving Form' for a home-based therapy model in India
Abstract Category: Innovations in Health in Asia
Abstract Number: A
Name of the Author: Anirban Dutta1, Robins Kumar2, Bhawna Khattar2, Rajashekhar Reddi3, Alakananda Banerjee2
Institute: 1Univ. of Goettingen, Goettingen, Germany, 2Max Superspeciality Hospital Saket, Department of Physiotherapy and Rehabilitation, New Delhi, India, 3Max Superspeciality Hospital Saket, Department of Neurology, New Delhi, India
City: New Delhi
Country: India
Presentation Title:

2. Presentation Title: Customizing stroke rehabilitation using a 'Rehabilitation Problem-Solving Form' for a home-based therapy model in India
Name: Anirban Dutta, Robins Kumar, Bhawna Khattar, Rajashekhar Reddi, Alakananda Banerjee
CONTEXT: India-centered studies present a higher stroke-rate for younger individuals as compared to high-income nations. To overcome post-stroke gait disorders, functional electrical stimulation (FES) is a valuable orthotic tool. However the patient-specific FES dosing required for effecting therapeutic benefit needs to be customized.
AIM: We applied International Classification of Functioning, Disability and Health (ICF) for customizing FES therapy on 10 chronic stroke survivors in India.
STUDY DESIGN: A pilot study based on the inclusion and exclusion criteria listed at Clinical Trials Registry – India (
INTERVENTION: A multi-disciplinary rehabilitation team worked with each participant on a Rehab-CYCLE (or, dose) involving 6 sessions (3-times-a-week for 2-weeks) of 30 minutes of FES-assisted treadmill-walking. The Rehab-CYCLE involved, 1. Identify problem and needs, 2. Relate problems to modifiable and limiting factors, 3. Define target problems and target mediators, select appropriate measures, 4. Plan, implement, and coordinate interventions, 5. Assess effects, and then repeat the Rehab-CYCLE, if necessary.
DATA COLLECTION: Trained ICF coordinator completed the “Rehabilitation Problem-Solving Form” (RPS-Form) before and after Rehab-CYCLE, in consultations with patient/family and rehabilitation team. The Part 1 was scored as: 1=Mild-problem, 2=Moderate-difficulty, 3=Severe-difficulty, 4=Complete-difficulty, while Part2 was scored as: -1=Mild-barrier, -2=Moderate-barrier, -3=Severe-barrier, -4=Complete-barrier, +1=Mild-facilitator, +2=Moderate-facilitator, +3=Substantial-facilitator, +4=Complete-facilitator.
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3. Video-OGA (deviations)
Presentation Title: Customizing stroke rehabilitation using a 'Rehabilitation Problem-Solving Form' for a home-based therapy model in India
Name: Anirban Dutta, Robins Kumar, Bhawna Khattar, Rajashekhar Reddi, Alakananda Banerjee
FINDINGS: 2-weeks-long Rehab-CYCLE of short-duration, moderately-intensive movement therapy in clinic improved activities and participation of 4 out of 10 participants who consented to continuing the Rehab-CYCLE at their home, while 5 out of 10 participants consented to repeating the Rehab-CYCLE at clinic. Abbreviations - MMT: manual muscle test for tibialis-anterior (paretic), MAS: modified Ashworth scale for ankle (paretic), Video-OGA: observational gait analysis for deviations "present" at Ankle (A), Knee (K), Hip (H), Pelvis (P), Trunk (T)
Case
MMT
MAS
Video-OGA (deviations)
Part1:
Body
functions
and
structures
Activities
participation
Part2:
Environmental
factors
Personal
Pre-
Post-
Outcome 01 1+ 3
A,K,H H 2 1 +1 +3
Release 02 2- +2
Repeat 03 3-
A,K,H,P P 04
A,K,H,P,T 05 06 07 08 A 09 10
P,T
INTERPRETATION: Online RPS-Form encouraged the patient to play an active role in customizing his/her therapy - needs, length of intervention, intensity of intervention, functional outcome goals - in cooperation with his/her rehabilitation team. Because of the high therapy costs at rehabilitation clinics in India, a home-based therapy model may be preferable in chronic stroke following a short-duration Rehab-CYCLE at clinic. The home-based Rehab-CYCLE can be monitored with online RPS-Form which needs validation in a clinical study.
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