Department of Physical Medicine and Rehabilitation

1. To assess, evaluate, pre op planning, pre op counseling and corrective surgery of the patients with disability.
2. To extend assessment and rehabilitation surgery service to the periphery through surgery camps.
3. To assess and distribute rehabilitation aids and appliances in remote areas of our country.
4. To undertake surveys, investigations and research concerning the cause of occurrence of disabilities, preventive methods and innovative corrective surgery.
5. To train the candidates of National Board of Examinations, New Delhi in  the subject of physical medicine and rehabilitation.
6. To train and conduct CME programme for physiatrists, orthopedic, Surgeons, Nurses, health workers, teachers and parents of disabled children.
7. To train the students of physiotherapy, occupational therapy and prosthetic orthotic engineering in the subject of PMR and Orthopedics.

Patient facilities

Profile

Department of physical medicine and rehabilitation adopts a holistic approach in patient assessment, pre op evaluation, proper patient counseling, corrective and reconstructive surgery for patients with musculoskeletal disability and their post op rehabilitation.
It provides ample services in the specialty of

• • Pediatric orthopedics
  • Rehabilitation surgery
  • Ankle and foot surgery
  • Hand surgery
  • Illizarov reconstructive surgery
  • Arthroscopy
  • Arthroplasty
  • Neglected trauma
  • Basic spine surgery.

Units
Department of physical medicine and rehabilitation provides service in out patient’s department, in patient department and emergency department.
It has fully dedicated units of

• • Pediatric ward
  • Spinal cord injury ward
  • Female ward
  • Male ward
  • Amputee ward

Working pattern

• Patient evaluation and assessment in outpatient department.
• Pre op evaluation in OPD for treatment plan, admission and surgery.
• Corrective surgery after proper evaluation
• Post op rehabilitation in ward.
• Referral for therapy, fitment and vocational training to respective departments
• Proper counseling and postop advice before discharge with a well formulated plan for post op rehabilitation and follow up.
• Conducting emergency service
• Conducting peripheral camps for surgical correction and distribution of rehabilitation aids.

Infrastructure

1. Fully functioning 100 bedded barrier free hospitals
2. State of the art Operation Theater for rehabilitation and corrective surgery
3. Minor OT and corrective plaster facility
4. Well maintained Dietary service
5. Dedicated Pharmacy service
6. Supportive Laboratory and ‘X’ Ray facility
7. 24 x 7 Ambulance service

Department conducts:

1. Post graduation degree course in physical medicine and Rehabilitation under national board of examinations, New Delhi.
2. CME programme to train physiatrists, orthopedic surgeons in the field of rehabilitation surgery.
3. Teaching of Physiotherapy, Occupational therapy and Prosthetic Engineering students in PMR and Orthopedics.
4. Awareness programme for Nurses, health workers, teachers and parents of disabled children.

Selection Procedure for DNB PMR Degree Course.

1. National board of examinations, New Delhi conducts CET examinations for broad specialties in the month of May and November each year. The opting selected candidates may join against accredited two primary DNB PMR seats and two DNB PMR secondary seats each year in the January session.

After successful completion of 3 yrs. of training and submission of thesis they can appear in their final theory and practical examination.

Scientific research works :

1. Correction of angular deformities of knee by flexible figure of 8 plate Hemiepiphysiodesis.
2. One stage release of congenital constriction band in lower limb from new born to   3 years.
3. Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsy.
4. Conjoined legs – Sirenomelia or caudal regression syndrome.
5. Metacarpal lengthening by distraction histiogenesis in adults.
6. Lower limb alignment in cerebral palsy.
7. Outcome of 8 plate hemiepiphysiodesis on genu valgum and height correction in  B/L fibular hemimelia.
8. Illizarov method in CTEV.
9. Flat feet – clinical presentation.
10. Management of plantar ulcer in leprosy.
11. Primary malignant tumor of foot.
12. Dorsiflexor palsy tendon transfer.
13. Management of severe burn contracture of wrist by illizarov method.
14. Tendon transfers around foot in paralytic deformity.
15. Management of giant cell tumor around knee.
16. Management of congenital absence of radius.
17. Management of congenital absence of tibia.
18. Management of CTEV by UMEX.
19. Illizarov in complex ankle and foot deformities.
20. Calcaneal lengthening in flat foot.
21. Congenital absence of fibula.
22. Congenital vertical talus.
23. Congenital constriction band.
24. Flat feet with special reference to CVT.
25. Growth modulation by 8 plates in congenital absence of fibula.
26. Habitual dislocation of patella in children.
27. Melorrheostosis – case report.
28. Assessment criteria for disability, handicap rehabilitation.
29. Management of congenital pseudarthrosis of tibia by illizarov method.
30. Therapeutic management of pain in orthopedic practice.
31. UMEX for relapsed and neglected CTEV.
32. Hip disarticulation and trans pelvic amputation – medical and surgical aspect.
33. Cleft foot.
34. Locomotor disability and rehabilitation.
35. Post traumatic rehabilitation of extremity.
36. Tibial agenesis.
37. Cafey Silverman disease – case report.
38. Treatment of neglected CTEV with minimum soft tissue release combined with Unconstrained illizarov method.
39. Amputation surgery – prospective study.
40. Medical and surgical rehabilitation of cerebral palsy.
41. Early open reduction of DDH .
42. Prescription of crutches, crutch gait and care.
43. Role of orthosis in ambulation in spastic CP.
44. Surgical management of congenital genu recurvatum.
45. Gene therapy for spinal disorder.
46. Management of VIC – late presentation.
47. Early surgical intervention to facilitate ambulatory potential in rehabilitation of spastic diplegia.
48. Surgical procedure to improve hand function in CP.
49. Exostosis of talus – case report.
50. Evaluation of treatment of Dupuytren contracture by partial fasciectomy.
51. Study of surgical exposure by hemicincinati incision vs Turco incision for PMSTR in club foot.
52. Rigid knee deformity correction in arthritis by illizarov method

Future Research Projects:

1. Management of Cerebral Palsy with Botulinum –A Toxin : Preliminary InvestigationBotulinum A Toxin has been used widely for the treatment of spasticity in children with Cerebral Palsy(CP) since the 1990s. It acts at the neuromuscular junction by inhibiting the release of the neurotransmitter acetylcholine and selectively reduces muscle activity for 12 to 16 weeks. Benefits reported include a reduction in muscle tone, an increased joint range of motion, improvement in gait and an increased muscle length. A number of systematic reviews have demonstrated that injection of Botulinum toxin A are effecting in reducing spasticity in children with CP and they have proposed guideline of using Botulinum toxin A injection. In this preliminary open study, the effectiveness of intramuscularly injected Botox on the muscular imbalances of Cerebral Palsy will be assessed.
2. Long-Term Outcome evaluation in Club foot patients after plaster technique and surgical release and comparison of results.Congenital Talipes Equinovarus (CTEV ) or Club foot is a deformity affecting approximately 1 in 1000 births. Most infants are initially treated with manipulation and serial casting , the goal of intervention is a pain-free functional foot. The most commonly carried out procedure to treat infants with residual foot deformity after casting was a comprehensive club foot release, a technique described and modified by several investigators. Posteromedial release was used in all releases to obtain a full correction of the foot deformity in three dimensions. The current standard of care utilizes the ponseti casting technique. The purpose of this study is to analyse the long term effects of surgical correction for patients with CTEV. The study is designed to improve our understanding of club foot during adulthood and to provide comparison with normal foot function by quantifying segmental foot motion during gait, lower extremity strength & range of motion(ROM ). We also want to study the outcome variability of club foot pathology using measures of patients satisfaction, self perception and outcome measures.
3. Long Term follow up of a patient with Legg- Calve – Perthes DiseaseThe objective in treatment in Legg- Calve – Perthes Disease (LCPD) is to create a congruent hip joint with out deformity at the time of skeletal maturity to gain normal function and in the long term , to reduce the risk of secondary osteoarthritis and total hip replacement. This treatment for the patients with LCPD aims to achieve containment of femoral head and include physical therapy, bracing/ casting, adductor tenotomy and femoral and / or pelvic osteotomy. Decision with regard to when and how to treat relies on a classification that is related to an accurate long term prognosis. As most of the literature consists of studies in which inclusion criteria, classification of the disease and treatment of the patients varied considerably, it is difficult to draw firm conclusions with regards to the prognostic factors and the natural course of the disease. The purpose of the study was to evaluate whether severity of the disease, age at onset, sex and presence of head at risk signs were risk factors for poor outcome.
4. Pressure Ulcers : Prevention and Management :A pressure ulcer is a localized injury to the skin or the underlying tissue, usually over a bony prominence, as result of unrelieved pressure. Predisposing factors are classified as intrinsic ( e.g,  limited mobility, poor nutrition, comorbidities, aging skin) or extrinsic (e.g, pressure, friction,shear,moisture). Prevention includes identifying at risk persons and implementing specific prevention measures such as following a patient repositioning schedule, keeping the head of the bed at the lowest safe elevation to prevent shear ; using pressure reducing surfaces and assessing nutrition and providing supplementation if needed. Treatment involves management of local and distance infections, removal of necrotic tissues, maintenance of a most environment for wound healing & surgery. We have got 24 beds for spinal cord injured patients who usually develops pressure sore / get admitted with pressure sore. We want to study the incidence, site of occurrence, various methods of preventions and management of pressure sore in our patients.

TO ESTABLISH SPECIAL CLINICS:

1. Congenital Deformity Clinic:A lot of patients with congenital deformity are coming to the Institute from various parts of Orissa including Tribal District of Koraput, Bolangir and Kalahandi (KBK) and other neighboring states like WB, Bihar, MP, UP, Chhatisgarh, Andhra Pradesh etc. The deformity like CTEV, AGMC, Syndactaly, Genu valgum and Genu varum etc. are referred to this Institute from various parts of the Country. The modality of treatment includes casting to bracing to surgical intervention including Illizarov method.Therefore, it is proposed to start a separate Congenital Deformity Clinic to cater to the needs of these patients.
2. Geriatric Clinic:With the improvement in quality of life and medical facilities the mortality and morbidity rate has reduced and the life span of human beings has increased. There is increasing incidence of old age musculoskeletal problem such as Osteoarthitis, Osteoporosis Fracture, Periarthritis, Spondylosis etc. and impaired functional ability. It requires medical, surgical, therapy, psychological and recreational activities to keep them fit both mentally as well as physically.
   Therefore, it is proposed to start a Geriatric Clinic also at SVNIRTAR.
3. Ankle and Foot Clinic:With increase incidence of road traffic accident and congenital deformities, patients with foot and ankle deformities forming a major part in outpatient department daily. Foot and ankle being most vulnerable part for injury happen to be an important cause of locomotor disability which requires special attention. Hence it is proposed to start an Ankle and Foot Clinic twice in a week with existing Rehabilitation and Orthopaedic Specialists.
4. Amputee Clinic :A large no of amputee patients are reported to this Institute for fitment of  their artificial limbs. Therefore it is proposed to start a special amputee clinic to give focus to this type of patients.
5. Scoliosis Cinic :A large no of  Spinal deformed patients are reported to this Institute for therapy & bracing . Therefore it is proposed a special Scoliosis  clinic  to be conducted to give focus to this type of patients.
6. Proposed New Courses :ediatric Orthopaedics: 1 yr. (Two seats), MS/DNBOrtho. (Fellowship):
   Lots of pediatric patients’ i.e. CTEV, Congenital Pseudoarthrosis Tibia, Cong. absence of limbs, C.P., Spinal Bifida are coming to the Institute. A general Orthopedic Surgeon has little exposure to manage these patients effectively. In view of above, a group of specialist should be trained and developed who can deal with such patients to rehabilitate them. Therefore it is proposed to start a course in the Institute for which eminent Pediatric Orthopedic Surgeons of India level will be invited as guest faculty

Proposed New Courses :

1. Pediatric Orthopaedics: 1 yr. (Two seats), MS/DNBOrtho. (Fellowship):Lots of pediatric patients’ i.e. CTEV, Congenital Pseudoarthrosis Tibia, Cong. absence of limbs, C.P., Spinal Bifida are coming to the Institute. A general Orthopedic Surgeon has little exposure to manage these patients effectively. In view of above, a group of specialist should be trained and developed who can deal with such patients to rehabilitate them. Therefore it is proposed to start a course in the Institute for which eminent Pediatric Orthopedic Surgeons of India level will be invited as guest faculty
2. Rehabilitation Surgery: 1 year Fellowship (Two seats) PMR, Post MS/MD/DNB PMR:There are lots of cases of neurological deficiency conditions like Hansen’s disease, PPRP, C.P., CPT, Spina Bifida, Spinal Cord Injury, Neurological Condition and Paraplegic with bedsores who are increasingly requiring surgical interventions for their rehabilitation. This is a very challenging area where special training is required, in other wards it will be difficult to deal with such patients unless they are trained especially in Rehabilitation.
3. Postgraduate Diploma in Geriatric Rehabilitation:2 yrs (2 seats) After MBBS:It will be in collaboration with SCB Medical College, Cuttack, under Utkal University. With the increasing life span, Geriatric patients are increasing in the society day-by-day. They require special treatment like pediatric patients. But all the doctors are not well trained to handle their needs effectively. Therefore it is suggested to start the course in collaboration with SCB Medical College, Cuttack, under Utkal.
4. Rehabilitation Technician/Nursing: 1 yr (04 seats): After +2   Sciences:Rehabilitation is a special area where a large number of paramedical are required to cater the patients. They are important component of rehabilitation team. They should have basic exposure on rehabilitation on early detection of disability, positioning in Bed for paralytic patients and bed sore dressing, knowledge on aids and appliances and knowledge of therapy maneuvers at home situations.

Dadhichi award (IAPMR) – Dr Sanjay Das
Prof K P Srivastav gold medal (IOACON) – Dr Sakti Prasad Das
Hanumanta Rao award ( IAPMR 2014 ) – Dr Pabitra Kumar Sahoo