• Neuro Rehabilitation Department

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    Neurorehabilitation is a multifaceted treatment process which offers innovation, dedicated and reliable rehabilitation services from nervous system injuries and long term neurologic care. It generally deals with the managment and functional recovery of major nervous system injuries such as stroke, multiple sclerosis, Alzheimer's disease, spinal cord injuries and peripheral nerve injuries. Brain injuries due to accidents, tumors, Developmental delay in kids.

    Clinical Programs

    Stroke Rehabilitation Brain Injury Rehabilitation Orthopaedic Rehabilitation Pediatric Rehabilitation Child Development Clinic Learning Disability Clinic Coma Arousal Program Cardio Pulmonary Rehabilitation Parkinsons Disease Rehabilitation Geriatric Rehabilitation Tele Rehabilitation

    Rehabilitation Medicine

    • Advanced Medical management of complications and secondary changes in Neurological illness, Trauma and Childhood developmental disabilities
    • Regaining functions in
    • CVA, TBI, SCI, movement disorders, Development disorders.

    Aims to avoid,reduce,treat & overcome disability.
    • Addresses Spasticity, Weakness , Functional, Mobility , Communication and Cognitive problems.
    • Motor point blocks,
    • Botulinum toxin Injections,
    • intrathecal Baclofen,
    • Structured Rehabilitation therapies,
    • Neurogenic bladder management
    • Advanced mobility orthotics like SUYAM, ARGO, REWALK etc
    • Rehabilitation Robotics
    • Virtual Rehabilitation
    • Comprehensive Services
    • Promise of Independence and Dignity delivered with state of Art technology

    Components of Neuro Rehabilitation

    Neurorehabilitation is a multifaceted treatment process which offers innovation, dedicated and reliable rehabilitation services from nervous system injuries and long term neurologic care. It generally deals with the managment and functional recovery of major nervous system injuries such as stroke, multiple sclerosis, Alzheimer's disease, spinal cord injuries and peripheral nerve injuries. Brain injuries due to accidents, tumors, Developmental delay in kids.

    The major components in Neuro Rehabilitation are

    • Developmental nerurorehabilitation
    • Behavioural cognitive rehabilitation
    • Clinical neruorehabilitation
    • Neuropsychological rehabilitation
    • Communication rehabilitation
    • Nutritional counselling
    • Ethical aspects of neurorehabilitation
    • Rehabilitation Sociovacational

    The major rehabilitation techniques developed and implemented are one of the long term Neurolgic care and requires time for the patient to overcome properly.
    Mild traumatic brain injury may cause temporary dysfunction of cells. More serious Spine or brain injury can result in bruising, torn tissues, bleeding and other physical damage that can result in long term complications like memory disturbance, speech difficulty, swallowing difficulty, no walking, depression etc...

    Traumatic Brain Injury

    Recovering from brain injuries can be excruciating. It takes a long time to adjust to the changes and the complex nature of treatment.

    Usually, individuals affected by these conditions can have a number of symptoms directly related to the brain injury like paralysis and other related functional disability. Brain Injury rehabilitation focuses on bringing back the functional ability for day-to-day activities. Other such brain injury symptoms include

    • One-sided or both sided weakness and numbness of the arms and legs
    • Pain and tightness of the arms and legs
    • Difficulty with speech
    • Cognitive impairment such as memory problems, slow thinking skills, problems with attention
    • Changes in their behavior such as aggression
    • Changes in their mood such as depression and anxiety
    • Difficulty in swallowing
    • Bladder and bowel incontinence
    • Visual problem
    • Hearing problem

    Our Neuro Rehabilitation Team includes a Rehabilitation Physician, Experienced Physiotherapists, Occupational Therapists, Clinical Neuropsychologists & Remedial Trainers. TBI patients receive an individualized rehabilitation program based upon the patient's strengths and capacities and that rehabilitation services should be modified over time to adapt to the patient's changing needs. This involves individually tailored treatment programs in the areas of Physical medicine & Rehabilitation, Physical therapy, Occupational therapy, Speech/language therapy, Clinical Psychology, and social support. The overall goal of rehabilitation after a TBI is to improve the patient's ability to function at home and in society. Therapists help the patient adapt to disabilities or change the patient's living space, called environmental modification, to make everyday activities easier.

    There are medical complications that needs to be taken care of by Rehabilitation Physicians a few weeks or months after a brain injury. Some common ones include

    • Pneumonia
    • Urinary tract infection
    • Deep vein thrombosis – blood clot in the veins of your arms and legs
    • Pressure ulcers
    • Heterotopic ossification – a condition which causes stiffness of your joints
    • Seizures
    • Post-stroke shoulder pain – shoulder pain in the weak arm
    • Spasticity – tightness of the muscles of the affected arm and leg
    • Paroxysmal sympathetic hyperactivity – a condition which causes fluctuations in your blood pressure, heart rate, and also causes abnormal stiffness of the arms and legs
    • Headache
    • Hydrocephalus – a condition where fluid builds up in your brains

    Spinal Cord Injury

    An injury to the spinal cord is a nightmare and the Spinal cord injury treatment process is even scarier and difficult to comprehend. Post the surgery, spinal cord injury rehabilitation process is supported by us in a best possible way, with an active support from our expert team, during the recovery period. Our paralysis treatment plays an important role in nursing the individual back to good health. We have some of the best neuro rehab services for treating complications of spinal injury.

    • Traumatic spinal cord injury
    • Ischemic spinal cord injury
    • Tumors and metastasis to the spinal cord
    • Vascular malformations such as Arteriovenous malformation, aneurysm
    • Spinal cord infections
    • Auto-immune conditions such as multiple sclerosis, transverse myelitis
    • Spondylitic myelopathy (degeneration of the vertebral column)
    • Toxic/metabolic causes such as sub-acute combined degeneration of the spinal cord, radiation- induced spinal cord damage, chemotherapy-induced spinal cord damage

    The commonly seen spinal injury symptoms in the individuals affected by these conditions are

    • Weakness and numbness of the arms and/or legs
    • Bladder and bowel dysfunction
    • Swallow dysfunction
    • Breathing difficulty

    Treatment of patients with spinal cord injury treatment is an ongoing process for many years and starts shortly after the injury with acute care and early surgical interventions; thereafter, sensory, motor and autonomic dysfunction treatment in the chronic phase and finally, lifelong treatment in the home environment.

    Acute and SubAcute Rehabilitation in the SCI

    This period begins with admission to hospital and stabilization of the patient’s neurological state and is a 6-12 wk bed period. The aim of rehabilitation in this period is to prevent complications that may occur long term. Passive exercises should be done intensively to resolve contractures, muscle atrophy and pain during the acute period of hospitalization in patients with complete injury. Positioning of the joints is important in order to protect the articulary structure and maintain the optimal muscle tonus. Sand bags and pillows can be useful in positioning. If the pillows and sandbags are not able to provide positioning, it can be achieved with plaster splints or more rigid orthotics. Ankle foot orthosis, knee-ankle foot orthosis or static ankle foot orthosis, etc. are mainly used for this purpose. he most important point is strengthening of the upper extremities to the maximal level in the acute period of rehabilitation in patients with complete paraplegia. Enpowering exercises for shoulder rotation are proposed for using crutches, swimming, electric bicycles and walking[ 34 ]. At the end of the acute phase, strong upper extremities are needed for the independent transfer from bed. For this purpose, active and resistance exercises to strengthen the muscles of the upper extremity should be initiated at the earliest possible period. Weight and resistance exercises can be applied with dumbbells in bed depending on the patient’s muscle strength. Electrical stimulation may be a useful alternative if extreme fatigue occurs while strengthening the muscles.

    Corsets are used for fixation and supporting the spine while moving on to a sitting position after the end of the bed interval. Hyperextension corsets or plaster plastic body jackets are used in treatment of thoracic and upper lumbar region fractures. A knight-type corset would be more appropriate to support the fractures at the lower of L2 vertebrae. Knight- Taylor type corsets restrict flexion and extension of the trunk but have no restriction on rotation. Plaster or plastic body jacket corsets should be used to restrict movements in all directions.

    Orthostatic hypotension is likely to be found in patients with a long period of lying in bed. Syncope can be seen in these patients while sitting and being lifted up due to low blood pressure. A tilt table may be useful for patients with this condition, starting from 45 degrees for 30 min a day. The degree is increased according to the patient’s complaints or state. Standing upright stimulates the blood pressure reflexly to a sufficient and persistent limit. The patients adapt to sit and stand and are prepared to transfer and balance. When the patient comes to the upright position with a tilt table, the patient should be in a sitting position on the edge of the bed 3-4 times a day and balance exercises should be done to maintain this position. Independent sitting on the edge of the bed is very important for wheelchair use, enabling wheelchair transfer. The purpose of this rehabilitation period should focus on stability and strength education for sitting and transportation. Functional goals must prepare the patient for movements such sitting up in bed or a wheelchair, dressing and transfers. Initially, the goal is for successful bed movements. ROM and stretching exercises are used for functional activities. Exercises for sitting, balance and strengthening of the upper extremities should be done at the beginning. Patients who can tolerate sitting can begin to push up, with static and dynamic balance training to transfer to the wheelchair.

    Wheelchairs, walkers and crutches are used for out of bed transferring of patients. The wheelchair is the most important tool for SCI patients to be mobile and participate in social life. Ideally, wheelchairs must allow for optimal mobility, protect skin integrity and maintain the normal anatomical posture. A battery assisted wheelchair is appropriate for injuries at the upper segments, whereas a manual wheelchair is preferred at lower levels. Wheelchair dimensions such as the height, pelvic width, seat length, backrest, seat and arm support should be specifically prescribed for each patient.

    The success of splints or other attempts for functional ambulation depends on whether the injury is complete or incomplete and the injury level. An incomplete SCI patient has the potential to walk, irrespective of level. The beginning of functional ambulation level is considered to be T12. Truncal and pelvic stabilization must be provided to stand and mobilize in the parallel bars. Mobilization in the parallel bars, standing and balance training exercises should be started and the patient could be supported by a posterior shell in the parallel bars during this period. A long and locked knee joint walking device is utilized, ensuring the integrity and stability of the lower extremity joints in patients after the upright standing with a posterior shell. The benefits of standing are a reduction in spasticity and the risk of DVT, bowel and bladder function recovery, prevention of pressure ulcers and osteoporosis, and reduction in depression. Functional neuromuscular stimulation (FNS) is based on innervating nerve fibers of intact muscles. If the muscles are denervated, FNS stimulates the muscle fibers. A study suggests that suitable activation to specific muscles of the trunk and lower extremity can enable patients with SCI to alter their standing postures with minimal upper body effort and subsequently increase the muscle volume.

    Chronic Rehabilitation Of Spinal Cord Injury

    The most important goal is realization of the independent mobilization for both complete and incomplete paraplegic patients during the chronic period. Ambulation can be social, domestic and aimed at exercise. The patient must be able to walk 50 m unaided or with assistive devices for social ambulation. Those who ambulate domestically can walk independently or with partial assistance and need a little help or can be independent at home. Those who ambulate for exercise need advanced help for walking or transferring. Factors such as injury level, age, weight, general health status, motivation and spasticity affect the ambulation potential. Generally, patients with an injury of T10 and above can be ambulated for exercise. Patients with T11-L2 injuries can ambulate in the home (domestic) and the patients of more distal injuries can ambulate socially.

    Walkers, crutches and orthoses are important to provide chronic stage ambulation. Patients with pelvic control can walk with an orthosis or crutches outside the parallel bars. If the muscle strength of quadriceps femoris is normal, patients can walk with elbow crutches and orthosis without needing a wheelchair. In patients with complete injury of C8-T12, ambulation can be achieved by a parawalker (hip guidance orthosis), both in the house and outside. Walking devices used in spinal cord injury are becoming more and more lightweight and easy to move. However, the devices with advanced technological features are also more expensive. Oxygen consumption, energy expenditure and walking speed can vary significantly depending on the shape, type and weight of material of devices used by the patients. One of them is the RGO (Reciprocating Gait orthosis). For effective use, patient’s excess weight reduction and increased aerobic capacity must be maintained and muscle mass must be increased. RGO has been further developed and is more complicated and more expensive than ARGO. ARGO also leads to an excessive waste of energy like RGO. Hybrid walking devices were created by adding Functional Electrical Stimulation to orthosis. Walking is becoming better within the hybrid devices. Robotic training is a new approach and is developing day by day. A case report showed that upper extremity function has been improved by robotic assistance over four weeks. After training, manual muscle test scores of wrist extensor, finger flexor and finger abductor are significantly increased. Another study demonstrated that the robotic-assisted gait training using the locomat system improved the functional outcome of subacute SCI patients.

    The most important expectations in the chronic phase or phase to return home are ensuring the maximum independence related to the level of the patient’s injury, integration of the patient to society and teaching the importance of the family’s role.

    In addition, house modifications are important for patients with SCI in order to have independent activities of daily living. Door width should be 81.5 cm for manual wheelchair access and 86.5 cm for battery assisted wheelchairs. The height of electric switches should be 91.5 cm. Adequate insulation and heat must be provided at home. Door handles must be the “leverage shaped” type and the height of the door sills should not impede the passage of a wheelchair for tetraplegic patients. Carpets should be removed and the surface should be hard in order to maneuver the wheelchair. Bath tubs should be mounted on the wall and must have handles. The height of kitchen apparatuses should be accessible to the patient. There must be a ramp at the entrance to the house.

    One of the important features of this period is restoring the patient’s psychological and emotional state again because of the high incidence of depression in patients (the incidence is about 1/3 in the first six months). Depression is not a natural process experienced after SCI but is a complication that needs to be treated. Suicide is the most common cause of death after SCI among patients under the age of 55. Frequency of posttraumatic stress disorder is 17% and usually occurs in the first 5 years. Consultation with a psychiatrist is needed if there is psychotic behavior and depression. Occupational therapy and finding the patient’s role in society are most important factors in restoring the psychological state. Social and psychological problems in the absence of daily activities have been reported. Suicide attempts have been reported due to a lack of daily activity, depression, alcohol dependence and emotional distress. Occupational therapy allows SCI patients to be more social, to use their own functions for creative jobs and to deal with psychological problems like depression.

    Occupational therapy is an important part of the rehabilitation process. In developed countries, occupational therapy is carried out by the occupational therapist in the rehabilitation team. Occupational therapists assess the patient’s limitations and plan the occupational activities. Occupational therapy is planned and implemented depending on the social and cultural characteristics of individuals, level of education, personality traits, interests, values, attitudes and behaviors before and after the injury. Pictures, music, crafts, ceramic work and a variety of activities (for example, sports) and entertainment are implemented and planned to focus on the purpose in the occupational treatment.

    Pediatric Conditions

    It is the dream of every parent to see their newborn evolve into a successful being. Our expertise in pediatric rehabilitation includes

    • Child Development Clinic : High Risk Children with Birth Asphyxia, Neonatal Seizures, Neonatal ICU care are taken Care of even before there is any Developmental Delay in our Child Development Clinic.
    • Cerebral palsy – A non-progressive brain disorder that predominantly affects arm and leg movement, but can also affect speaking, swallowing and thinking skills.
    • Dyslexia is one of the most common forms of learning disability that affects reading, writing, spelling, and often handwriting. Although letter or word reversals may be a concern for children with dyslexia, they are not the primary markers for dyslexia.
    • Orthopedic and Musculoskeletal Conditions like clubfoot, scoliosis, kyphosis, bowlegs, knock knees, hip dysplasia causing pain and deformities of the affected joints.
    • Pediatric limb deficiencies – congenital limb deficiencies such as transradial (forearm) or transhumeral (arm) limb deficiencies, transfibular (leg), transtibial (leg) or transfemoral (thigh) are the most common and occurs due to a variety of reasons such as certain medications and maternal diabetes during pregnancy.
    • Spina bifida – A developmental disorder causing a defect in the vertebral column and if severe, can damage the spinal cord.
    • Peripheral neuromuscular disorders - These are conditions that affect either your muscles, or nerves, or the junction between muscles and nerves. Symptoms that are seen are progressive weakness in the arms and legs muscle, difficulty with speech, difficulty with swallow, and intellectual disability.
    • Children with Speech and Language Delay associated with other conditions such as Autism spectrum Disorder, Mental Retardation, seizures, Apraxia .

    NeuroDegenerative Conditions

    Special fall prevention program, flexibility training and Cognitive Retraining for Independence in Mobility and Activities of Daily Living helps Patients with

    • Parkinson's disease
    • Parkinson-plus syndromes
    • Alzheimer’s / Dementia
    • Multiple system atrophy
    • Hereditary and non-hereditary ataxias

    Usually individuals affected by these conditions can have a number of symptoms such as

    • Impaired walking and balance, leading to frequent falls and fractures
    • Memory impairment
    • Swallow impairment especially as silent aspiration of food and liquids
    • Abnormal coordination of movements of the arms and legs
    • Difficulty initiating a particular movement - slow in performing a task
    • Weakness of the muscles of the arms and legs

    Scientific Basis of Neuro Rehabilitation

    Neuromodulation and Nuroplasticity

    The field of Neurorehabilitation is relatively new, and some cutting edge therapies including neuromodulation may be potentially beneficial to patients with CNS injuries or other disorders. The advances in the understanding of brain circuit together with the development of neurostimulation technologies have prompted us to explore the potential of electrical stimulation of the nervous system to promote functional recovery in patients who are the sufferers of the CNS disorders

    Neuromodulation also offers new therapeutic interventions for patients with stroke, traumatic brain injury, spinal cord injury and epilepsy by counteract and abnormal network in the brain.

    • Neural prosthesis
    • Neuromodulation, Visual and Auditory perception
    • Unconstrained unconscious cognition
    • Peripheral Nerve Stimulation
    • Spinal Cord Stimulation
    • Cortical reorganization




    Neural and Musculoskeletal Modeling

    Interventions like

    • Muscle - driven simulations
    • Muscle - tendon activation
    • Model calibration and validation
    • Neuromuscular synergies help patients to stand, walk to be independent
    • Helps in musculoskeletal modeling for neuro muscular recovery

    Tightness of Arm/Leg

    The Neurological disorders in general have residual impairments whuch needs to be treated in the rehabilitation phase. Management of all these like tightness, weakness,speech & cognitive distrabance are explained below.
    All the advanced medical treatment for reducing the tightness and jerks which are common in neuro patients. The Botox* An Injection Which Relaxes The Muscr.E.-5 foundation.

    Weakness of muscles

    Neuro rehab proposes new models to reduce the abnormal brain functioning of motor weaknesses.

    The human motor system attains adaptability through acquired immunological actions. Motor learning is a loosely defined term that emcompasses motor adaptation,skill acquisition and decision-making. Motor learning can be catagorized into kinematic and dynamic components. Advance technological approaches, using animal models and functional imaging in humans show that the mature can undergo plastic changes during both learning and recovery as they have the tendency to undergo differentiation upon receiving signals.

    Quantitative motor control approaches allow differentiation between compensation and true recovery although both improve with practice. Several promising new rehabilitation approaches are based on theories of motor learning.
    • Modular motor therapies
    • Constraint - induced movement therapy (CIMT)
    • Electromvogram - triggered neuromuscular stimulation
    • Neuro motor control

    First Time in South India

    These treatments aim at strengthening of the weak muscles to make them strong enough for next stage - walking and other activities.

    Independent Walking

    The Brain tries to repair itself after any damage with a priority on functions most needed. Hence early mobiliization is the key for better outcome in walking. This is made possible by technologies which takes up weight of the patient from legs, so he can use his weak legs to move. Also the walking style is corrected of maintained to avoid the usual circumduction or dragging gait

    Cyclic muscle strengthener

    The field of Neurorehabilitation is relatively- new, and some cutting edge therapies including neuromodulation may be potentially beneficial to patients with CNS injuries or other disorders. The advances int the understanding of brain circuitry, together with the development of neurostimulation technologies have prompted us to explore the potential of electrical stumilation of the nervous system to promote functional recovery in patients who are the suffers of the CNS disorders. It offers therapeutic intervention to counteract the a bnormal network in brain.

    Speech and communication training

    The first and basic need of a person is to interact and communicate what he wants to the other person. Speech and language pathologies are taken care by the speech therapist.

    Functional Training

    The improvements in strength gained by the rehab team is latter transformed into meaningful functional activities like brushing, dressing, toileting eating by occupational therapy.
    Children with special needs are also trained for head holding, sitting, crawling and them made to walk.

    Paediatric Neurorehabilitation

    Paediatric Rehabilitation provides comprehensive rehabilitation Care to children suffering from range of Neurological difficulties.
    It is dedicated to treating children, teens and their families to promote recovery form and adaptation to changes resulting from brain injury or significant neurological disease. Combining the family's knowledge of their child with the team expertise in brain injury rehabilitation, working together to achieve the goal of returning the child to participation in home, school and community based activities.

    The main aims of the paediatric neurorehabilitation service are :
    • Enable children and young people to reach their optimum physical potential.
    • Maximise function and independence.
    • Reduce the risk of developing contractors and deformity.
    • Improve quality of life in children with
    • Traumatic brain injury
    • Encephalitis
    • Child developmental disorders
    • Epilepsy in children
    • Hypoxia
    • Paediatric assistive technology

    Specialized devices individualized for each patient

    Orthosis are mechanical devices used to support a weak part or to reduce tightness of a muscle. This is not an off the shelf product but custom made to each patient according to their needs and problems.

    Coma / cognitive Disturbance

    Coma Arousal Program

    To bring back memories / cognitive or thinking abilities of brain damaged individuals.
    We, at Neuro Foundation, have an advanced comprehensive multimodal stimulation, the CAP - Coma arousal Program, given to brains injured patients once their medical condition is stable.
    This treatment brings back Remote, recent memories of the patient and also improves the thinking skills of the patient.

    Rehababilitation Nursing

    Nursing as an integral part of the health care system, encompasses the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages, in all health care and other community settings. Neuro rehabilitaion nursing comprises not only of individuals taking care of the patient but also the way to nurse and eradicate the disorders in long term neurologic care.
    It comprises of both small and big approaches to improve the health standards of a patient and ensure a better way of living by rendering him complete care via machines and personal care.



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"Dr. Nithya Manoj MD.,DPMR Senior Consultant"

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Dr. Nithya Manoj MD.,DPMR

Senior Consultant