Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Reviews
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : KE01 - KE05 Full Version

Role of Teleconsultation and Telerehabilitation in Cerebral Palsy Patients during COVID-19 Era in India- A Review


Published: October 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55086.16930
Minhaj Akhter, Satyasheel Singh Asthana, Rambeer, Nitesh Manohar Gonnade

1. Senior Resident, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. 2. Senior Resident, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. 3. Senior Resident, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. 4. Associate Professor, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Correspondence Address :
Dr. Nitesh Manohar Gonnade,
Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur-342005, Rajasthan, India.
E-mail: niteshgonnadepmr@gmail.com

Abstract

Recently Coronavirus Disease-2019 (COVID-19) pandemic has caused major problems throughout the world. Apart from all morbidity and deaths due to this virus many patients with other chronic illness have also suffered due to lack of follow-up. Many general and specialised hospitals were turned into COVID centres and partial or complete lockdown was enforced by Governments. Due to this, patient with Cerebral Palsy (CP) were not able to follow their scheduled physical appointments. Many CP patients who were taking calibrated medication for different complication and following individualised rehabilitation programs were in turmoil without guidance of specialist doctors. This has led to exponential rise in use of telemedicine appointments. Telemedicine has both advantages and disadvantages which are discussed in this review. This review also focuses on rehabilitation of cerebral palsy patients using telemedicine in this dire situation where it is difficult for most patients to visit hospitals for physical appointments.

Keywords

Coronavirus disease-2019, Multidisciplinary approach, Spastic hemiplegia, Spastic quadriplegia, Spasticity, Telemedicine, Video call

Telemedicine is an effective way to provide healthcare facilities wherever physician and patient physical interactions is not necessary or not possible. Telemedicine services include telephonic consultation, video call, social media platform, health related videos, digital X-ray and remote surgery (1),(2),(3). World Health Organisation (WHO) has defined telemedicine as, “the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities” (4).

Multiple approaches, which are commonly used in telemedicine are (A) Virtual Visits: Live online meeting, (B) Chat-based Interactions: It transmit healthcare saved data (C) Remote Patient Monitoring: It is helpful in monitoring and management of chronic disease (D) Technology-enabled Modalities: In this method physician-to-physician approach and data transmission and interpretation is done (5).

Importance of telemedicine has significantly increased after coronavirus pandemic as this maintains social distancing and provides appropriate and cost-effective treatment to the patient. There is a possible risk of coronavirus like pandemic in future. Keeping this in mind, telemedicine technology can be developed further (6). With the help of National Aeronautics and Space Administration (NASA) and Indian Space Research Organisation (ISRO) telemedicine gained momentum in India and lots of milestone has been achieved. Various national programmes such as the ICMR-AROGYASREE, the National e-Health Authority (NeHA) and the Village Resource Centre (VRC) are ongoing in India to empower telemedicine (7).

During COVID pandemic, Government of India started the e-sanjeevani Outpatient Department (OPD) which is a National consultation service through telemedicine. Despite all these initiative, there is low satisfaction among healthcare workers and patients. This may be due to non familiarity of healthcare workers for telemedicine, unavailability of appropriate guidelines and lack of appropriate internet services in India (7),(8). Telemedicine is essential in today’s scenario as this can decrease burden on healthcare facilities in India (9).

With world’s second highest population, India has a high population density and low income per capita, which pose major hurdle for fight against COVID in India (10). Telemedicine may be the most practical solution accessible in India for the safety of patients and doctors. This is the right time to integrate digital technology in healthcare system on a larger scale (11). Telemedicine can reduce long-distance travel and cost. With appropriate guidelines and training, telemedicine can be used even in post pandemic era as a routine patient consultation for infectious and non infectious chronic diseases (1),(9).

“The term ‘Cerebral palsy’ is defined as a group of permanent disorders of the development of movement and posture, that cause activity limitation, and are attributed to non progressive insults to the developing foetal or infant brain. The motor impairment of cerebral palsy is often accompanied by sensory disturbances, perception, intellectual disability, communication, behaviour, by epilepsy and by secondary musculoskeletal problems” (12). This review focuses on telemedicine technology; elaborate the approach towards the Cerebral Palsy (CP) patients, role of physician, patient examination by telemedicine, allied health personnel and patient’s active involvement with proper implementation and future aspect of dealing CP patients and family members through telemedicine. Both health personnel and the CP patients can achieve satisfactory consultation at their convenience.

TELEMEDICINE-AVAILAIBILITY AND ADVANTAGES

Despite availability of telemedicine services in India on a large scale, there are multiple challenges which still persist. Few of most are, doctor and patient unfamiliarity with telemedicine, poor financial background, lack of basic facilities (e.g., internet), poor education, unawareness with technologies and barriers to good quality of health services (13).
Patients of CP and their parents face more difficulties in both telemedicine and physical appointment. Telemedicine can help CP children with long duration problems and decrease economic burden of hospital visit (3),(9). Study conducted by Harper DC in 2010 concluded that telemedicine evaluation was as good as face to face evaluation (14). Grigsby J et al., suggested that unanticipated consequences like increased risk of certain complications are likely while using telemedicine. This may be due to underuse or excessive use of telemedicine (15). Jnr. BA, suggested that this mode is safe and easily available but due to lack of infrastructure, funds and experience may limit its use (16).

At present many hospitals are targeting for reduction of spread of COVID as much as possible. Since onset of pandemic, teleconsultation facilities have significantly increased in healthcare system (17). Turer RW et al., mentioned telemedicine as an electronic personal protective equipment because of zero chances of spread of infection (17). In this pandemic, CP child may face increased stress levels which can alter their quality of life (18),(19). At early stages of pandemic most of the countries including India closed basic OPD services which affected follow-up of new and old CP patients. So, for these types of patient’s teleconsultation and telerehabilitation is a boon, as we know many children with CP are capable of using mobile phones, tablet and computer (9).

CHANGES IN HEALTHCARE SYSTEM DURING COVID-19

Cerebral palsy is a disorder that needs long lasting and consistent treatment to prevent further complications and for improving patient’s participation, integration in society and quality of life (20). Physical therapy, orthotic prescription, medicines, Botulinum neurotoxin A injection, baclofen pump, rhizotomy, and musculoskeletal correction operations are currently accessible for CP patients. All these options require regular follow-up for effectiveness and management of complications (21). After outbreak of COVID, healthcare system has changed, and all scheduled appointments were postponed and were more focused on implementation of tele-healthcare system (22). If a patient needs any intervention, patient’s physical check-up become necessary (22),(23). With telemedicine, patient can be evaluated to some extent (9). For spasticity, any improvement in joint Range of Motion (ROM), (Activity of Daily Living (ADL) need constant monitoring, this may need physical appointment. However, some complaints of patient does not need regular physical consultation and these can be monitored through telemedicine including dietary habit, medications, sleeping pattern, community participation and quality of life (3),(9),(24).

Patient’s priorities such as elective surgeries can be monitored with the help of telemedicine and can be scheduled according to their need and the patients can be called for physical examination similar to neurosurgery patients where they were categorised in A, A+ and A++, in which A++ require urgent treatment, A+ appointment can be given in 7-10 days and category A appointment can be given in month (25). Health Insurance Portability and Accountability Act (HIPAA) compliant platform can be used. This is for Indian companies who are providing telemedicine platform and secures medical data (22). Medical Council of India (MCI) with the help of National Institute for Transforming India (NITI) Aayog issued telemedicine guidelines which should be followed before planning any procedure. The Tele-guidelined and Structured Continuous Care (TGSCC) can be used among patients and doctors. In this pandemic time, these guidelines can be used for patient care and further follow-up. However, these guidelines can also be used in postCOVID period to avoid transmission of infection other than COVID (26).

CHANGES IN CEREBRAL PALSY

Cerebral palsy is a disease of heterogenous group of permanent and non progressive disorder of movement and posture due to insult of foetal brain or infant. The life expectancy of cerebral palsy patients is almost normal with a smaller number of mortalities. In these approximately 10% children die in childhood who have associated epilepsy, severe motor changes, poor communication and poor intellectual ability. Care of cerebral palsy require long term follow-up, continuous monitoring of rehabilitation, education, psychological support and social participation. If a patient who is not on regular rehabilitation programme, then he may suffer muscle or tendon tightness, altered range of motion, subluxations or dislocations of joints, poor ADL outcome and behavioural changes (20),(21). Hip dislocation and scoliotic changes are common in CP child which is strongly associated with Gross Motor Function Classification System (GMFCS). Hip surveillance programme is based on hip displacement in child and preventing this by early monitoring can reduce incidence of pain, decreased function and quality of life. There are lots of limitations for hip displacement monitoring but still solutions are available. Regular clinical examination, radiographs are major tools for finding hip joint abnormality. GMFCS level and migration percentage should be considered while planning management. If migration percentage is more than 33% surgery plays an important role. Gradual changes occur in CP child and finding these abnormalities could be challenging because these are gradual and no time limit is fixed about when they will develop. Routine check-up is most effective method (9),(27),(28),(29),(30). Due to COVID, regular follow-up of CP child has significantly suffered; which can lead to increase in chances of complications such as contracture, dislocations, deconditioning etc. This could require change of treatment option.

TELEMEDICINE IN CEREBRAL PALSY

Telemedicine can be efficacious for regular follow-up and management of cerebral palsy child. Training of doctors, nursing officer, physical therapist, occupational therapist and speech therapist should be done for telemedicine for regular follow-up and prevention of further complications (9),(31).

Cerebral palsy surveillance programme depends on CP type, grade of Gross Motor Function Classification System (GMFCS) and clinical examination. GMFCS score III-V are at more risk of dislocations. Physical examination of the patient can determine the severity of CP and the likelihood of dislocation, following which a rehabilitation programme can be planned based on the patient's needs (32). By telemedicine, gait and radiological finding (If radiographs are available) can also be assessed but need further expert guidance. Tele-hip monitoring can detect hip abduction, with appropriate camera position. All these measures can reduce severe complications and decrease disability burden of cerebral palsy on society and improve quality of life (9),(33). Patient selection for telemedicine and physical consultation should be done according to their clinical status and need (Table/Fig 1).

Integrative Approach

Availability of doctors and paramedical staff are already limited in India. Patients with CP require highly trained personnel and cutting-edge technologies (20),(21). Integrative approach from many specialities like Physiatry, Paediatrics, Neurology and Orthopaedics is highly recommended. It is helpful for physiatrist in designing a comprehensive rehabilitation protocol in CP. This leads to proper management of patients in well organised manner and increase trust in patient’s relatives (3),(27). Although this type of approach is quite difficult when social distancing is required as CP patient require more physical visits as compared to others. Due to the closing of a special school for CP patients and a reduction in transportation facilities, challenges for CP patients and their caregivers have worsened during this epidemic. Integrative management through telemedicine is less time consuming and decrease caretaker burden. Telemedicine gives a proper platform to the patients and healthcare providers with secured conditions (14),(26),(34),(35),(36). There is no need for Personal Protective Equipments (PPE), gloves, sanitisers, extra masks, or social distancing with a telemedicine method. Doctor can examine and talk to the patients directly and make them comfortable along with safety (18). Following the pandemic, healthcare workers should become more acquainted with telemedicine and use it on a regular basis. This integrative approach should be harmonising and centred on the needs of the patient. (22),(37),(38). There are varieties of platforms available that allow numerous people to connect via video chat at the same time. This can improve communication because doctors will be available on one platform at the same time and will be able to provide appropriate management (39).

Inclusive Approach

Participatory medicine is becoming new concept in medical field which is given in P4 concept where Ps stands for predictive, preventive, personalised and participatory (40). In today's technological world, it's important to encourage patients and family members to learn about technology and to engage with social media platforms like WhatsApp, Facebook, Instagram, Telegram, and Twitter. Here they can get self-education and get advance information about the disease (41),(42). But these apps also have potential of being misused and must be used cautiously (43). People are becoming more aware and responsible and they are welcoming this participatory medicine. People have been more worried about their health and became creative in sharing ideas on social media to raise awareness throughout this pandemic. Before pandemic most of the people even many healthcare workers did not know about telemedicine but now many are getting to know about it (22). In chronic issues such as CP, participatory medicine is more effective. Patient and caretaker’s participation in management may improve outcomes of intervention (44),(45). In time, telemedicine will grow and will be the main tool of healthcare system to provide better treatment option for patient (9).

Discussion

This review is focused on availability and accessibility of telemedicine for cerebral palsy patients. CP patients and families are markedly affected in COVID era due to less community participation, financial insecurity and emotional instability. Consultation through telemedicine can provide continuous patient management. Medications, exercises, orthosis and dietary changes can be advised through telemedicine. Telemedicine can also provide regular follow-up with increase in contribution from patient and their caretakers (9),(42),(44). Most of the patients favour video calling type of teleconsultation rather than telephonic and chatting (23),(46). After this global attack of COVID-19; telemedicine is now practised globally (17),(37),(38). After worldwide lockdown, normal OPD services were limited only to urgent medical conditions, India also suffered in this pandemic but somehow telemedicine facilities are being used to overcome the disease burden in society (8),(23).

Due to lack of regular follow-up, CP patients may develop complications such as spasticity, infection and psychological disturbance (19),(21),(27). The flow of healthcare can be maintained by sharing prerecorded videos of patient’s daily routine activities such as eating, dressing, walking, playing, studying and while interacting to the people. During this pandemic, there are lots of benefits of telemedicine for patients but still many problems are faced by patient and doctors such as lack of physical examination, privacy, payment transaction, difficulties in patient’s compensation (9). More drawbacks are patient recognition, privacy issues and authorisation from patient. But these problems can be controlled by regular change in approach and can be modified according to needs (22). Patient facilities have improved in world in last few months after increased utility of telemedicine in this pandemic (37). All healthcare workers should regularly follow new changes and acquire them. After many years of telemedicine still there are lots of misconceptions both for patients and doctors. Many doctors, nursing officers and therapists are not friendly with technology-based treatment especially for CP, but after proper training this can get better results (23),(36),(37),(47). In India and other developing countries, there is lack of high-end devices, even most of the people don’t have mobile phone so communication with these people is so much difficult. Government should install telemedicine booth facilities situated in a community so that they can go there and attend the session of consultations. Telemedicine cannot replace face to face interaction with doctors but it can be useful in these pandemic-like situations.

As many advantages of telemedicine have been discussed but still most of health professionals oppose this way of management (Table/Fig 2) (35),(36),(48). Telemedicine is accessible and can be used for prevention of complications like contracture for CP patients (9). Ben-Pazi H et al., suggested that execution of “Guide-lined and Structured Continuous Care” (TGSCC) for CP patients will be effective. According to this, telemedicine programme should be patient oriented and should bring motivation for patient and caretakers participation in managements (9). Patient and caregiver’s perspectives on disease progression and treatment efficacy might also be beneficial. Telemedicine services for cerebral palsy patients would help to maintain or improve quality of life of CP patients.

Conclusion

More research is needed in the future to determine the significance of telemedicine for CP patients and to raise awareness among patients and healthcare staff. Integrative approaches involving participation from other experts should be researched and implemented generally after their usefulness has been established. In the future, attention should be paid to improving technology, internet access, and data accessibility for all patients.

All Cerebral Palsy patients, whether new or old, should have access to telemedicine. Management of both new and old Cerebral Palsy patients require robust telemedicine guidelines. To ensure the best use of Telemedicine, healthcare providers should be trained and provided with necessary equipment. Telemedicine services must also be deployed in places with minimal health-care resources.

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DOI and Others

DOI: 10.7860/JCDR/2022/55086.16930

Date of Submission: Feb 04, 2022
Date of Peer Review: Mar 19, 2022
Date of Acceptance: Aug 06, 2022
Date of Publishing: Oct 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

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