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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effectiveness of Art Therapy and Physical Activity in Improving Quality of Sleep in Children with Hemiplegic Cerebral Palsy: A Quasi-experimental Pilot Study
Correspondence Address :
Dr. Pallavi R Palaskar,
Associate Professor, Department of Physiotherapy, MGM School of Physiotherapy (A Constituent Unit of MGM Institute of Health Sciences), Navi Mumbai, Aurangabad-431003, Maharashtra, India.
E-mail: pallavi.palaskar@mgmsop.edu.in
Introduction: Hemiplegic Cerebral Palsy (CP) is characterised by abnormalities in movement and posture, along with sensory and tone abnormalities. It also represents significant impairments in cognition and sleep quality. Art activity involves playfulness, creativity, improvisation, and brings benefits to cognition and the alleviation of mental suffering. Physical activity shows considerable improvement in sleep quality as it concentrates on cardiorespiratory fitness and increases total energy expenditure.
Aim: To evaluate the effect of art therapy and physical activity on sleep quality in children with hemiplegic CP.
Materials and Methods: This quasi-experimental pilot study was performed among six ambulant children with hemiplegic CP in December 2022 at MGM School of Physiotherapy, Aurangabad, Maharashtra, India. Both male and female children aged between 4 to 12 years were included in the study. Pretest scores were recorded using the Paediatric Sleep Questionnaire (PSQ). The participants then underwent a physiotherapy protocol lasting one hour, which included art therapy along with upper limb physical activities for four weeks. Art therapy included colouring pictures, drawing geometrical shapes, line-drawing connections, thumbprints, and vegetable prints. The protocol was given for one month, which included three sessions of art therapy and physical activity each week. Parents and children were encouraged to follow the protocol before sleep. At the end of one month, postscoring of all outcome measures was calculated, and statistical analysis was done using the paired t-test.
Results: From the results, the median pretest and post-test PSQ scores were 0.68 and 0.49, respectively. Interquartile Range (IQR) value for the outcome measure was 0.0675 and 0.0775, which was significant.
Conclusion: Art therapy, along with physical activity, improved sleep quality in children with hemiplegic CP.
Art intervention, Physiotherapy, Posture, Sleep quality, Tone abnormality
The CP is a permanent movement and posture disorder that causes limitations in activities due to abnormalities in the foetal or newborn brain. With an incidence of 2.1 per 1000 live births, it is a significant contributor to impairments and disabilities, children with hemiplegic CP make up 39% of the overall CP population (1). In children with CP, movement deficiencies frequently include poor coordination, muscular weakness, tremors, sensory deficits, poor vision, and difficulties with attention (1). Spastic-type CP accounts for 85-91% of all CP cases, making it the most prevalent kind. Hemiplegia (38% of all spastic CP cases), diplegia (37%), and quadriplegia (24% of cases) are further subclassified into spastic CP. The causes of hemiplegic CP include stroke, vascular abnormalities, unilateral intraventricular haemorrhage, and periventricular leukomalacia (2). Despite this, children with hemiplegic CP may have trouble adapting to and carrying out daily tasks. Movement and muscle tone are often affected on one side of the body in hemiplegic CP (3).
Around 23-46% of kids with CP experience sleep problems, and sleep disruption is thought to be highly frequent in this population. This prevalence is significantly higher than the 20-30% range observed in children with normal development (4). Recent studies have found that poor sleep relates to increased pain sensitivity and disruption of the Hypothalamus-Pituitary-Adrenal Axis (HPA) (4),(5),(6). In up to 50% of children with CP, studies have shown aberrant patterns on the Electroencephalogram (EEG) during sleep, including the lack of rapid eye movement and irregularities in the formation of sleep spindles (5). Sleep difficulties may be correlated with a number of CP-related co-morbidities, including spasticity, dystonia, pain, seizures, behavioural problems, and visual impairments (6).
Numerous researches have been conducted on how children with CP use their motor skills. Nevertheless, the parents claim that learning challenges are more difficult, and that cognition is more important for communication, academic performance, involvement, and social functioning. Children with CP are more prone than typically developing kids to experiencing sleep issues, which can include trouble falling asleep, frequent night awakenings, pain or discomfort in bed, and early waking. Emphasising physical activity in children with CP has shown greater results in improving sleep quality (7),(8). Physical training combined with action observation has emerged as a new rehabilitation strategy. This type of training was developed to effectively induce neuroplasticity by doubling the effects of task-oriented training. It is strongly connected to observational learning and imitation (9).
Playfulness, creativity, symbolism, and improvisation are all key components of art therapy, which has advantages including promoting spiritual development and alleviating mental pain. Consequently, implementing artistic activities may enhance quality of life. For disabled children with suffering, resentment, and unmet needs, the goal of art therapy is to maximise their potential in the sensory, psychological, and social development domains. In physical activity, repeated joint movements increase motivation and enhance upper extremity strength, as well as fine and gross motor function. Additionally, art therapy helps persons with impairments in improving cognitive skills (10). As no other studies have been conducted on improving sleep quality in children with hemiplegic CP so far, this study aimed to study the effect of art intervention and physical activity on sleep impairments in these children.
The quasi-experimental pilot study was performed in MGM School of Physiotherapy in Aurangabad, Maharashtra, India for four weeks, Study started in 1st week of December 2022 and ended on last week of December 2022. The study was commenced after taking ethical committee (IEC no. MGM/SOP/2023/192).
Inclusion criteria: Both male and female ambulant children, aged between 4 to 12 years, with hemiplegic CP, normal speech, and right-hand dominance were included in the study.
Exclusion criteria: Severely mentally retarded children, children with other types like quadriplegic, ataxic, mixed, and dystonic, were excluded from the study. Also, children with cardiorespiratory disorders, visual impairments, recent fractures, and other musculoskeletal disorders were also excluded from the study.
Sample size: Fourteen participants were initially selected for the study, of which five participants discontinued the protocol at the end of 3rd and 4th weeks. Three participants failed to carry out the protocol due to lack of cooperation from their parents. Therefore, the study was carried out among six ambulant children with hemiplegic CP.
Data collection: Informed consent was taken from the parents prior to study. Before starting the intervention, pretest scores were recorded PSQ (5) as the outcome measure.
University of Michigan PSQ: It contains total of 22 questions divided into three domains, about snoring, difficulty breathing during sleep, daytime sleepiness, inattentive or hyperactive behaviour, and other features of paediatric Obstructive Sleep Apnoea (OSA). Participants respond to items with ‘yes,’ ‘no,’ or ‘don’t know.’ More than eight positive responses may indicate a problem with sleep-related breathing disorders (5).
A total of six children received art activity along with upper limb physical activity. Colouring pictures, drawing geometrical shapes, line joining drawings, thumbprints, and vegetable prints. The upper limb physical activities included various exercises, like clapping hands, moving the upper body, and rotating the neck and head in various directions. Each session of physical activity and art therapy lasted for one hour. The protocol spanned one month and included three sessions of art therapy and physical activity each week. The difficulty level of the art therapy was gradually increased gradually (Table/Fig 1). Parents and children were encouraged to follow art activity and physical activity protocol before sleep.
Statistical Analysis
Statistical analysis was done using MS Excel for Windows and Statistical Package for Social Sciences (SPSS) version 23.0. A paired t-test was used to compare pretest and post-test results.
There were three males and three females participants who followed the protocol. Age distribution is shown in (Table/Fig 2).
In the present study, the median for pre and post-test PSQ scores was 0.68 and 0.49, respectively. Therefore, based on the median, IQR was calculated for the outcome measures, which was 0.0675 and 0.0775, respectively, which was significance (Table/Fig 3).
The process of art therapy promotes changes in sentiments and thoughts, which then lead to improvements in self-confidence. Participants have a means of expressing emotions and translating their ideal perspectives into tangible experiences through activities like doodle art. Doodle art therapy aims to aid counselees in developing self-awareness and resolving emotional issues. This therapy includes cognitive components, such as mental concentration and stimulation, concept organisation, and creative stimulation. Present study also observed that art therapy had a positive impact on behavioural symptoms, ultimately showed positive changes in mood. Drawing on the spot can give client as secure approach to communicate concerns, fears, desires, and challenges. People can express and explore unconscious emotions through the symbolic and verbal use of doodle art, individuals can express and explore unconscious emotions (11),(12).
The correlation between sleep spindles and cognitive performance was identified in a two-year longitudinal study that evaluated early adolescent performance on executive function and response inhibition tests while assessing sleep EEG coherence and waking performance on these tasks. Sleep spindles are produced by long-range thalamocortical loops; therefore, this activity may include significant data about the health and function of the cortical circuits that support cognitive function (11).
Being creative involves the capacity to develop unique and valuable concepts or actions. Creativity in the arts and sciences has greatly contributed to the advancement of human civilisation. The regional grey matter volume of the left Middle Frontal Gyrus (MFG) and left Inferior Occipital Gyrus (IOG) were significantly associated with creativity. Because it draws upon various cognitive skills, including sustained attention, the ability to filter out irrelevant ideas, working memory, and cognitive flexibility, artistic creativity may be considered a fundamental cognitive process (12),(13).
The majority of art therapies have emphasised neuropsychiatric outcomes like anxiety and depression, art therapy can also be utilised to improve cognitive performance. In instance, art therapy trains on a number of cognitive processes through its art creation and evaluation components. It is not rare for there to be a strong correlation between changes in the cortical thickness of the MFG and increase in immediate memory. Functional MRI studies have linked the use of different encoding and retrieval strategies during learning and memory which has been linked to greater activation in the MFG (13).
Furthermore, another study revealed a substantial correlation between the grey matter volume of the MFG and the employment of elaborate encoding techniques during a memory test (14). The ability of art to express cultural norms, history, ideas, emotions, aesthetics, and other elements of human civilisations through its many forms (visual art, music, literature, dance, theatre, etc.) makes it a vital component of human society. The most likely conditions for creativity in the arts and other fields are sound knowledge and semantic conceptual systems, which are expressed through several pathways in the cortex. Thus, from the referenced articles, present study proves that the correlation of art therapy has a positive impact on children’s behaviour (15).
Children with CP are at a significant risk of experiencing pain, which requires special consideration when addressing sleep problems. In children with CP, conditions including skin breakdown and pressure ulcers, spasticity, altered muscle tone, involuntary movements, and aberrant postures might make it more difficult for them to adjust their body positions at night and make them more sensitive to pain. These elements work as risk factors for sleep issues when combined. Improvement in behavioural functions has indirectly shown improvement in sleep functions (13),(14),(15).
Limitation(s)
Since this study was conducted solely among six hemiplegic CP participants, a larger sample size could be considered to implement this protocol.
From the analysed data and results, this study concludes that art therapy, along with physical activity, improved sleep quality in children with hemiplegic CP. The clinical implications of this study suggest that art therapy can be integrated into physiotherapy interventions and incorporated into daily activities to improve sleep quality in children with hemiplegic CP.
DOI: 10.7860/JCDR/2024/63759.19541
Date of Submission: Feb 28, 2023
Date of Peer Review: Apr 03, 2023
Date of Acceptance: Apr 23, 2024
Date of Publishing: Jun 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 02, 2023
• Manual Googling: Apr 17, 2024
• iThenticate Software: Apr 22, 2024 (7%)
ETYMOLOGY: Author Origin
EMENDATIONS: 10
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
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