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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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"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."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




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"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.
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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

Case report
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : YD07 - YD09 Full Version

Approach-oriented Physiotherapeutic Management of a Patient with Right Thalamic Bleed: A Case Report


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60780.18088
Neha Rajesh Badwaik, Pallavi Harjpal, Ragini Dadgal

1. Ex-Postgraduate (Student), Department of Physiotherapy, Ravi Nair Physiotherapy College, Wardha, Maharashtra, India. 2. Assistant Professor, Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Wardha, Maharashtra, India. 3. Professor, Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Wardha, Maharashtra, India.

Correspondence Address :
Neha Rajesh Badwaik,
Madha Colony Zade Layout, Wardha-442001, Maharashtra, India.
E-mail: nehabadwaik2000@gmail.com

Abstract

Rehabilitation is essential for stroke recovery. Professionals with experience in stroke rehabilitation from the different fields should make up a basic multidisciplinary stroke rehabilitation team. A stroke is the sudden loss of blood supply to the brain followed by a neurological deficit for more than 24 hours. A 42-year-old male patient presented with chief complaints of sudden weakness over one side of the body, slurred speech and blurred vision. The patient showed typical features of stroke-like tonal abnormalities, altered sensorium, diminished reflexes, reduced range of motion and strength. Magnetic Resonance Imaging (MRI) showed bleeding in the right lenticular capsular, basal ganglia and intraparenchymal part of the thalamus. The physiotherapy treatment started from the Intensive Care Unit (ICU) itself for better results with the collaboration with neurosurgeons and nurses, after the surgery. The Proprioceptive Neuromuscular Facilitation (PNF) approach and Rood’s approach were used to generate neuroplasticity as early as possible. The motor relearning program helped to regain the movements. Various outcome measures like the National Institute of Health Stroke Scale (NIHSS), Brunstorm grading, and Barthel index showed many crucial changes in tone, strength, balance, and coordination that improved the patient’s Quality of Life (QoL). Also, speech therapists and neuro-optometrist play an important role during rehabilitation.

Keywords

Brunstorm grading, Stroke, Tonal abnormalities

Case Report

A 42-year-old male patient, driver by profession, right-handed, presented with the complaints of weakness on the left-side of his body for the last two days. The patient experienced a sudden fall from the bed at night and was unable to move the left half of his body. He was unable to walk and severe headaches with vomiting were noted. The MRI showed a haemorrhage in the right lenticular capsular, basal ganglia and intraparenchymal thalamic area. Decompressive craniotomy and tracheostomy were done. He was unable to speak because of increased secretions. The patient’s bowel and bladder were affected, necessitating intermittent catheterisation. Manual muscle strength and deep tendon reflex findings were documented according to Modified Ashworth Scale (Table/Fig 1),(Table/Fig 2) (1). The postoperative thalamic bleed patient was referred for physiotherapy to normalise the muscle tone, increase strength and improve his functional independence.

Physiotherapeutic Intervention

The tailor-made physiotherapeutic protocol is discussed below in (Table/Fig 3),(Table/Fig 4).

The regimen primarily emphasises approaches like Rood’s method, PNF and strengthening combined with stretching. It was critical to maintain the joint integrity and mobility of the patient during the first week since he had no movement as a result of respiratory insufficiency. Therefore, the main objective was to prevent further complications from occurring during this phase.

In week 2, the patient became conscious and the respiratory issues were resolved, but the affected side’s muscles remained flaccid. So, the rood strategy was utilised. It causes the tone to increase. The patient was finally more stable in week 3, but it was a rise in tone that was causing the spasticity. To stop the synergistic movement, PNF was applied along with the rood’s inhibitory strategy. As the tone subsided, the concentration was on strengthening and stretching strategy.

Outcome Measures

National Institute of Health Stroke Scale (NIHSS): Pretreatment score was 37 (severe stroke) and the post-treatment score was 14 (moderate stroke) on day 24 (2). Brunstorm Stage of Recovery score for the upper limb on day 24 was 4 and for the lower limb was 6 (3). Montreal Cognitive Assessment Scale (MoCA) pretreatment score was 12 and postscore was 20 out of 30 total scores. The patient was followed-up to day 25 regularly, after that monthly for four months.

The dysarthria interventions provided by a speech therapist resulted in significant improvement in speech of the patient. Approximately, 20% of the visual field was affected, and proper glasses were prescribed by optometrist (4).

Discussion

The present case report focuses on early physiotherapy rehabilitation for better results. According to Krutulyte G et al., found that task-oriented strategies, like motor relearning programs, are preferred over facilitation/inhibition strategies (e.g., Bobath program) for stroke patients’ rehabilitation. Additionally, she emphasised on the patient’s body being guided by the physical therapist at key moments, activating natural postural reactions, and training natural movement patterns (5).

Research by Shimura K and Kasai T concluded that the PNF position increases the joint’s mobility by altering the order in which the muscle groups contract (6). According to Bordoloi K and Deka RS, a home exercise program that incorporates conventional physical therapy with Rood’s method is more effective than conventional physical therapy alone at enhancing patients’ capacity for independent self-care following intracranial haemorrhage (7).

Rehabilitation is essential for stroke recovery. Stroke patients commonly have reduced mobility, which limits their ability to participate in social events and Activities of Daily Living (ADL) and lowers their likelihood of returning to their prior level of work (8). The motor function may contribute to the low overall QoL, together with other factors (such as social or personal issues) (9). A high-intensity, early physical therapy program improves poststroke motor performance and functional capacity for performing ADLs, according to research (10).

Rood’s method was used in this case report, practical including both caregivers and patients since it is reasonably simple to use and places no cognitive demands on the patient. The study by Chaturvedi P and Kalani A suggested that rolling and light joint compressions are used to suppress aberrant hypertonia while exteroception and proprioception are promoted to produce muscle tone (11). According to Ankar P et al., methods of the Brunnstrom approach, Rood’s approach and NDT will aid the patient’s recovery of their motor skills. Therefore, if the entire treatment protocol is adhered to correctly and regularly, the patient will demonstrate a good recovery (12).

According to Sheikh S et al., haemorrhagic stroke patients who receive early therapy have a better chance of recovering quickly after their stroke. Basic bed mobility exercises enhance joint integrity and mobility. Active assisted range of motion exercises, bilateral training, and the Rood’s method are examples of joint integrity and tone facilitation techniques which were also used in this case report (13).

According to Rodrigues A et al., respiratory complications like atelectasis, sputum retention, facilitation of ventilatory weaning, and/or prevention of reintubation were historically the mainstay of physiotherapy treatment. Active mobilisation and rehabilitation may enhance muscle strength, functional independence and decrease delirium, according to mounting evidence, especially if started within the first few days of an ICU admission. Regular physical treatment and PNF were more efficient in enhancing static and dynamic balance in poststroke patients (14).

Interdisciplinary strategy is a major factor in the quality of care provided by stroke services. Professionals with experience in stroke rehabilitation from the following fields should make up a basic multidisciplinary stroke rehabilitation team including consultant physicians, nurses, physiotherapists, occupational therapists, speech therapists, clinical psychologists, rehabilitation aides and social workers (15),(16).

Conclusion

The thoroughly monitored rehabilitation after decompressive craniotomy with tracheostomy reduces the symptoms and enhances the QoL of the patient. Early intervention in neurosurgery, physiotherapy, speech therapy and optometrist can improve the development of neuroplasticity and enable a person to resume most of the activities of a normal day. An ICU based physical therapy rehabilitation protocol was initiated in order to reduce the risk of complications and improve tone. In order to improve early independent movements, Rood’s approach may be used to facilitate and inhibit tonal input at appropriate times. PNF is used to break synergistic patterns to be more effective in daily activities. Professionals with experience in stroke rehabilitation from the different fields should make up a basic multidisciplinary stroke rehabilitation team. The consultant neurosurgeon, nurses, speech therapist and optometrist play an important role in neurorehabilitation.

References

1.
Harb A, Kishner S. Modified Ashworth Scale. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm. nih.gov/books/NBK554572/.
2.
Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother. 2014;60(1):61. Available from: https://linkinghub.elsevier.com/ retrieve/pii/S1836955314000137. [crossref][PubMed]
3.
Huang CY, Lin GH, Huang YJ, Song CY, Lee YC, How MJ, et al. Improving the utility of the Brunnstrom recovery stages in patients with stroke. Medicine. 2016;95(31):e4508. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4979857/. [crossref][PubMed]
4.
Vision loss after stroke: Why it happens and how it’s treated [Internet]. Healthline. 2022. Available from: https://www.healthline.com/health/vision-loss-after-stroke.
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Krutulyte G, Kimtys A, Krisciu –nas A. The effectiveness of physical therapy methods (Bobath and motor relearning program) in rehabilitation of stroke patients. Med Kaunas Lith. 2003;39(9):889-95.
6.
Shimura K, Kasai T. Effects of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potentials in upper limb muscles. Hum Mov Sci. 2002;21(1):101-13. Available from: https://www. sciencedirect.com/science/article/pii/S0167945701000574. [crossref][PubMed]
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Bordoloi K, Deka RS. Modified Rood’s approach and ability of independent selfcare in haemorrhagic stroke patients of Assam, India. International Journal of Research in Medical Sciences. 2020;8(3):1070-1075. Available from: http:// imsear.searo.who.int/handle/123456789/212191. [crossref]
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Marwaa MN, Kristensen HK, Guidetti S, Ytterberg C. Physiotherapists’ and occupational therapists’ perspectives on information and communication technology in stroke rehabilitation. PLOS ONE. 2020;15(8):e0236831. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236831. [crossref][PubMed]
9.
Guiu-Tula FX, Cabanas-Valdés R, Sitjà-Rabert M, Urrútia G, Gómara-Toldrà N. The efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: A systematic review and meta-analysis protocol. BMJ Open. 2017;7(12):e016739. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728303/. [crossref][PubMed]
10.
Pak A, Eisen DP, McBryde ES, Adegboye OA. Hospitalisation for lower respiratory tract infection is associated with an increased incidence of acute myocardial infarction and stroke in tropical Northern Australia. Sci Rep. 2021;11(1):6826. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994310/. [crossref][PubMed]
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Chaturvedi P, Kalani A. Motor rehabilitation of aphasic stroke patient: The possibility of Rood’s approach. Neural Regen Res. 2023;18(3):551. Available from: https:// journals.lww.com/nrronline/Fulltext/2023/03000/Motor_rehabilitation_of_aphasic_ stroke_patient_.27.aspx. [crossref][PubMed]
12.
Ankar P, Samal S, Vikrant, Kovela RK, Dagal R, Thimoty R. Effect of physiotherapy on hand rehabilitation in acute ischemic stroke survivor: A case report. J Pharm Res Int. 2022;28-32. Available from: https://www.journaljpri.com/index.php/ JPRI/article/view/35343. [crossref]
13.
Sheikh S, Samal S, Kovela RK, Dagal R, Thimoty R, Harjpal P. Effect of early proprioceptive neuromuscular facilitation on a hemiplegic patient post-hemorrhagic stroke: A case report. J Pharm Res Int. 2021;2494-99. Available from: https://www.journaljpri.com/index.php/JPRI/article/view/34905. [crossref]
14.
Rodrigues A, Castro GM, Jácome C, Langer D, Parry SM, Burtin C. Current developments and future directions in respiratory physiotherapy. Eur Respir Rev [Internet]. 2020;29(158). Available from: https://err.ersjournals.com/content/ 29/158/200264. [crossref][PubMed]
15.
Clarke DJ, Forster A. Improving post-stroke recovery: The role of the multidisciplinary health care team. Journal of multidisciplinary healthcare. 2015;8:433-42. Available from: https://www.tandfonline.com/doi/abs/10.2147/JMDH.S68764. [crossref][PubMed]
16.
Dworzynski K, Ritchie G, Playford ED. Stroke rehabilitation: Long-term rehabilitation after stroke. Clinical Medicine. 2015;15(5):461. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953232/.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/60780.18088

Date of Submission: Oct 19, 2022
Date of Peer Review: Dec 08, 2022
Date of Acceptance: Apr 07, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• 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: Oct 29, 2022
• Manual Googling: Mar 14, 2023
• iThenticate Software: Apr 03, 2023 (3%)

ETYMOLOGY: Author Origin

EMENDATIONS: 7

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