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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. Name o !"e Ca#$%$a!e A#$

A$$&e''

(%# )*o+ *e!!e&'-

TUSHAR KURADE

L/0, NE2 AIR INDIA COLONY, KALINA

SANTACRU3(EAST-,MUMBAI,MAHARASTRA

4. Name o !"e I#'!%!5!e LAXMI MEMORIAL COLLEGE OF

PHYSIOTHERAPY, MANGALORE.

0. Co5&'e o '!5$6 a#$ '5)7e+! MASTERS OF PHYSIOTHERAPY (MPT-

4 YEARS DEGREE COURSE

PHYSIOTHERAPY IN NEUROLOGICAL AN

PSYCHOSOMATIC DISORDERS

8. Da!e o A$m%''%o# !o Co5&'e APRIL 4919

:. T%!*e o !"e !o;%+

?. B&%e Re'5me o !"e I#!e#$e$ 2o&

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?.1 NEED FOR THE STUDY

Stroke also known as cerebrovascular accident, is define as rapidly developing clinical sign of

focal disturbance of cerebral function, lasting more than 24hrs. Or leading to death with no apparent

cause other than that of vascular origin.

C! can be divided into ischemic and hemorrhagic. "schemic stroke make up appro#imately $%&

of all stroke. 'van peppen et al 2%%4(. )he sign and symptoms of the stroke depends on location of

obstruction, the si*e of artery involved. Over half of the patients with upper limb paresis resulting from

stroke will suffer from long term impaired arm function and an enduring disability in daily life.

' kawakkel et al 2%%+(

-obath concept which was last published by -ertha and arl bobath '//%(. )he effect of bobath

approach on the e#citability of the spinal alpha motor neuron in stroke patient with muscle spasticity. 2

)he 01 approach was developed by 3erman kabat, 5 and argaret nott '/4%6/7%(.

01 is motor learning approach used in neuromotor development training to improve motor

function and facilitate ma#imal muscular contraction.

01 is dynamic approach to the evaluation and treatment of neuro6musculoskeletal dysfunction.

)he goal of the 01 approach is to facilited an optimal structural and neuro6muscular state. )his helps

to reduce the symptom to improve the distribution of forces through the symptomatic region and to

reduce the inherent functional stress cause by poor neuro6muscular control.

01 is effective to reduce tone in spasticity after stroke. )he techni8ues to reduce spasticity are

9hythmic movement initiation, movement reproduction, combinationof isotonic contraction.+

!bnormal tone which may be low or high than normal influences the patient:smovementpattern

adversely. 1ormali*ation of tone is seen as necessary for functional activities.

)his study will highlight the importance of bobath concept and its comparison with 01 in

concern with the abnormal tone.

)hus study can help us identify on which techni8ue is more effective in normali*ing tone.

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HYPOTHESIS

NULL HYPOTHESIS (HO-@

)here will not be significant difference between -obath and 01 techni8ue to normali*e tone in

spastic hemiplegic upper limb

ALTERNATE HYPOTHESIS(H1-

)here will be significant difference between -obath and 01 techni8ue to normali*e tone in

spastic hemiplegic upper limb.

?.4 REVIE2 OF LITERATURE

!nsari 1 1, 1aghdi S did a study to evaluate the efficacy of bobath approach on the e#citability

of the spinal alpha motor neuron in post stroke spasticity. )hey concluded that -obath therapy had

statistically significant effect of the e#citability of the alpha motor neuron in the affected side in the

stroke patient with muscle spasticity.4

5isa . Sommerfeld, !nna6arin Svenson, did a study on spasticity after stroke. )he use of

-obath approach focusing on normali*ing tone and movement patterns, is widespread and claims that

inhibition of spasticity should result in an improve motor function.7

Shelia ;enon, !) ) Southwestern medical center, an ?ao , studied on effect of 01 in spastic ankle after

stroke. !ccording to them 01 is effective to reduce spasticity around ankle @oint which helps to

improve tone and range of motion.A

Bang 9 did study on effect of 01 on gait of patient with hemiplegia of short and long

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duration.//4. they concluded that 01 helps to improve tone of muscle along with sub@ect with

hemiplegia of short duration demonstrated immediate improvement in gait speed and cadence. !nd

long duration had no improvement after one treatment but did improve with repeated treatment./

raft et al. did study on compared treatment to improve function of the arm and hand in

chronic hemiplegia. Conclusion was fugl6 eyer score improved 42& for D?6Stimulator, 27& for low

intensity stimulator, $& for 01 and negligible for notreatment.2

?regson

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INCLUSION CRITERIA

E !ge F 4% to =% years.

E 0atients of both gender.

E -runstorm stage +

E Subacute stroke

E 0atient who are medically stable.

EXCLUSION CRITERIA

E 0atients with cognition and perceptional disorder

E 1on co6operative patients

E 0atients with cardio6 respiratory disease.

MATERIALS

. 0illow

2. 0linth

+. Stool

TECHNI=UE OF APPLICATION

METHOD )wo groups G ?roup ! F 2% sub@ects

?roup - F 2% sub@ects

E ?roup ! G -obath techni8ue

obili*ation

Beight transfer

Selective upper limb movement

9eaching with affected arm

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9eaching with unaffected arm

9efle# inhibiting movement pattern'9"0(

9"0G )he palm acts as a peripheral refle#ogenic area. -y firmly grasping the area input is

provided to the nervous system. )he movement are done in the anatomical plane from distal to pro#imal

and in short leaver for upper limb.

E ?roup - G 01 techni8ue '0roproiceptive 1euromuscular acilitation(.

( 9hythmic movement initiation

2( ovement reproduction

+( Combination of isotonic contraction

5 le#ion patternG fle#ion, adduction, e#t. rotation

5 D#tension patternG D#tension, abduction, "nternal rotation.

5 2 le#ion patternG le#ion, abduction, intrnal rotation.

5 2 D#tension patternG D#tension, adduction, D#t, rotation.

E )reatment will be given for 47 min, = times per week for = week.

E 0re and 0ost evaluation of tone by using odified !shworth scale. )one assessment will do at

the end of each week

STUDY DURATION= onth.

OUTCOME MEASUREH odified !shworth ?rading Scale.

STATISTICAL ANALYSIS )o describe data various tables, diagram and graphs will be

represented. !ppropriate statistical test will be used.

Bilco#ons Signed )est for 0re and 0ost test within the group

enn Bhiteny )est for comparing between the groups.

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.0Doe' !"e '!5$6 &e5%&e a#6 %#e'!%a!%o#' o& %#!e&e#!%o#' !o )e +o#$5+!e$ o#

Pa!%e#!' o& o!"e& "5ma#' o& a#%ma*' I 'o, ;*ea'e $e'+&%)e )&%e*6.

DS. odified !shworth ?rading Scale will be used as an outcome measure. -obath techni8ue !nd

01 techni8ue will be used for the treatment.

Ha' e!"%+a* +*ea&a#+e )ee# o)!a%#e$ &om 6o5& %#'!%!5!%o#'

Dthical clearance obtained.

L%'! o Ree&e#+e'

. S!1 S.!5;D9, 5O"1"D -DCD9S, !)3 ->C 01 in practice. !ll illustrated

guide.)hird edition,with 27 figures in 7=4 separate illustrations.

4. !1S!9" 1 1, 1!?3!5" S ,)he effect of bobath approach on e#citability of the spinal alfa

motor neurons in stroke patients with muscle spasticity, Dlectromyogr clin 1europhysiol

2%%AG4A'(2/G+=.

7. 5"S! . SOD9D;5, D;S >, !11! !9"1 SD1 SO1, ;O))! B"5D1

3O;IB"S) !15 !?1>S,Spasticity after stroke its occurrence and association with motor

impairment and activity limitation , stroke @ournal of the !merican association sept 2%%/.

=. S3D;"! ;D11O1, ?ait re education based on the bobath concept in two patients with

hemiplegia following stroke. , physical therapy vol. $ no.+ march 2%%.

A. !1 ?!O,Dffect of 01 in spastic ankle after stroke, > ) Southwestern medical center )J

>S!.

$. >1"OS3" S3">9! !15 )!)S>!, Dffect of 01 on the initiation of voluntary

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movement and motor evoked potential in upper limb muscles, dpt of physical education and

health sciences unit, kitasalo university 676, sagamihrar 22$ @apan / oct 2%%.

/. B!1? 96, Dffect of 01 on gait patient with hemiplegia. 0hy )her //4,A4G%$67.

%. SKO1 0!S">), !9)! -!1!C3, 9S)1! ;O1?!B!,Stroke rehabilitation

conducted by 01 method with and without botulinium to#in, faculty of rehabilitation,institute

of neurology, @eigiellonian university medical college, cracow, 0oland 2%%7.

. 3 abat , .knott physical therapy /7+.

2. 9!) et.al, Compare treatment to improve function of arm and hand on chronic hemiplegia.

//2..

+. S>S!1 - O S>;;"!1, )3O!S < Schmit* physical rehabilitation and treatment, fifth

edition.pg 7267=.

4. ?9D?SO1

study on the inter6rater reliability of !shworth scale in assessment of spasticity. !cta medica

iramica 44'4(G 24=627%,2%%=.

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