Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMAupper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity func-* Corresponding author. D. Sethy et al. 2 tioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001); while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.

Objective: To investigate the effect of token economy-a behaviour therapy technique for controlling drooling in children with cerebral palsy associated with mild intellectual disability. Methodology: A total number of 25 children with cerebral palsy associated with mild intellectual disability attending the occupational therapy department of Swami Vivekanand National Institute of Rehabilitation Training and Research (SVNIRTAR), Orissa, India, participated in a single blind randomized pre-and post-test control group training study. Subjects were randomly allocated to group A (experimental n=12) and group B (control n=13). Baseline frequency of drooling was observed by two independent raters for 20 minutes for both the groups. After the baseline data collection, subjects in group A received conventional therapy along with behaviour therapy (token economy) and group B received conventional therapy alone. Results: The result showed that there was a significant decrease in frequency of drooling after application of token economy as a behaviour modification technique in the experimental group (P=0.001) as compared to the control group (P=0.070). Conclusion: The result of the study demonstrated that the token economy program was effective in controlling drooling in children with cerebral palsy associated with mild intellectual disability.

ABSTRACT

Objective: To investigate the effectiveness of task related circuit training on walking ability in a Multiple Sclerosis subject. Design: Single case study of a man diagnosed with moderate primary progressive type of multiple sclerosis. Method: Baseline measurement of lower limb muscle strength, speed test, Timed "Up and Go" test and 6-minute walk test, Modified fatigue impact scale and Expanded Disability Status Score were taken. After baseline measurement, subject was explained the sequence of tasks to be used in circuit training and the subject was given task related circuit training for 12 weeks. Post training measurements for all the outcome measures were taken. Setting: Department of Occupational Therapy, NIOH, Kolkata, West Bengal, India. Participant: A 34 -year -old male. Intervention: Task related Circuit training for a session of 45 minutes, 3 days per week for 12 weeks. Results: The subject showed improvement in speed test, step test, 6-minute Walk Test. Also, fatigue was reduced. The walking ability of the subject improved, with increase in muscle strength, endurance, and physical fitness. Conclusion: Task-related circuit training is effective in improving muscle strength and endurance, and in decreasing the fatigue of the subject thereby improving the subject's ability to walk.

Background: There is a direct relationship exists between hemiplegic walking speed and functional limitations, both in household and community ambulation. Walking after stroke is characterized by slow gait speed, poor endurance, and change in the quality and adaptability of walking patterns. Side stability, symmetrical weight-bearing, and backward motor control ability are required to improve walking function. Objective: To investigate whether a combination of backward and side walking training is effective in improving walking speed and walking endurance in patients with poststroke hemiparesis. Study Design: An experimental randomized controlled study design. Methods: A total of 56 patients with poststroke hemiparesis fulfilling inclusion criteria were recruited for the study. Patients in the experimental group received 30 min of backward and side walking training of 15 min each. The patients in the control group received conventional occupational therapy for 30 min. Walking speed was assessed by walking endurance was evaluated by 10-m walk test (MWT) (and walking endurance was evaluated by 6MWT. Follow-up assessment was performed after 6 weeks of intervention. Results: In the within-group comparisons, both experimental and control groups showed significant differences postintervention (P < 0.05). In the between-group comparison, patients in the experimental group showed more improvement than the control group for walking speed (P = 0.001, 95% confidence interval [CI]: 7.86 to 9.73) and walking endurance (P = 0.004, 95% CI: 8.32 to 9.47) after 6-weeks of intervention. Conclusions: This study concluded that combined backward and side walking training has a better effect on walking speed and endurance than conventional therapy.