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Proforma for registration of subjects for dissertation


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PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION




1.


Name of the Candidate

and Address




S JAVED ALI

P.G. SCHOLAR, DEPARTMENT OF MOALAJAT,

NATIONAL INSTITUTE OF UNANI MEDICINE,

KOTTIGEPALYA, MAGADI MAIN ROAD, BANGALORE-91.





2.

Name of the Institution




NATIONAL INSTITUTE OF UNANI MEDICINE, BANGALORE.




3.


Course of study and subject



M.D. MOALAJAT.




4.

Date of Admission to course


14 November, 2011 (Batch 2011-2012)


5.

Title of the Study


EFFICACY OF MUNZIJ AND MUSHILE BALGHAM AND INKEBAB WITH ADVIA HARRAH IN REHABILITATION OF HEMIPLEGIC GAIT IN PATIENTS OF STROKE



6.

6.1

6.2

6.3


7

7.1

Brief resume of the intended work:

Need for the study:
Stroke is one of the leading causes of mortality and morbidity worldwide. Approximately 20 million people each year suffer from stroke and of these 5 million do not survive. (Dalal et al 2007) Developing countries account for 85% of global deaths from stroke (Gupta et al 2008).Stroke is also a leading cause of functional impairments, with 20% of survivors requiring institutional care after 3 months and 15% - 30% being permanently disabled. (AHA 2009) According to the American Stroke Association (ASA), approximately 700,000 individuals are diagnosed with a stroke each year, of these individuals, who survive, up to 90% of them reports one or more disabilities. [1]Initial walking function is impaired in two-thirds of the stroke population and this impairment is the greatest contributor to functional disability after stroke (2). After a stroke, the ability to control balance in the sitting and standing positions is a fundamental skill of motor behaviour for achieving autonomy in everyday activities .The postural performance of patients soon after a stroke has been found to be closely correlated with long-term functional improvement. (3)

Stroke rehabilitation refers to a comprehensive program designed to regain as much function as possible and compensate for permanent losses. In high-income countries, the evidence suggests that 10% of stroke survivors are without any significant disability and able to function independently. Another 10% are so severely affected that they must remain institutionalized for severe disability; the remaining 80% can return home with appropriate therapy, training, support, and care (4). The ability to walk has been stated to one of the most important goals of rehabilitation for stroke patients (5). In conventional system of medicine locomotor training using overhead harness and treadmill is used which requires a great capital. (6) Keeping in view this, a study is planned to evaluate the efficacy of Unani treatment in gait rehabilitation.



Review of literature:

According to modern pathology, Hemiplegia is the commonest manifestation of stroke (7). The Hemiplegic gait is a spastic gait affecting one leg; the ipsilateral arm may be held in a decorticate posture with hand near chest. It occurs after a contralateral hemispheric stroke and other corticospinal lesion.(8)

According to Unani physicians Hemiplegia is the paralysis of one half of the body longitudinally with loss of sensory and motor functions of affected side. Paralysis involving face, limb and trunk is called Falij maa Laqwa (complete stroke).(9, 10,11) The extent of paralysis differs according to the underlying cause, site of the brain affected, and type of the khilt (humour) involved. Hemiplegia occurs due to the occlusion in the pathway of Rooh Haiwani, which obstruct the pathway of Rooh Hissi (nervous impulse). (9, 10,11, 1) It is believed that this condition develops due to accumulation of Ghaleez Balgham or Dam in Batoone Dimagh. (12) This Ghaleez Balgham is evacuated by tanqia which involves the use of Munzij Balgham to suitably modify the consistency of Balgham in order to prepare it for easy elimination, followed by using Mushil Balgham to evacuate the morbid Balgham through stool.

Abul hasan ahmad bin tabri had also advocated to eliminate this morbid balgham through diaphoresis (10) and Hakim Mohd Azam Khan mentioned drugs to be used in inkebab after course of Munzij and Mushil.(12)


.

Objective of the study:

To evaluate the efficacy of Munzij- Mushile Balgham and inkebab with Advia Harrah in gait rehabilitation of patients of Stroke



MATERIAL AND METHODS:

Source of Data: Moalajat OPD/IPD of NIUM Hospital Bangalore.




7.2

Method of Collection of data:

Inclusion criteria:

  • Post stroke gait disability

  • Patients aged between 18–64 years

  • Stroke having history at least of 3 months

  • Either gender


Exclusion criteria:


  • Patients below 18 years and above 64 years of age

  • Patients with less than 3 months history of stroke

  • Patients with terminal medical conditions such as Cancer

  • Unstable cardiac diseases

  • Uncontrolled hypertension

  • Renal insufficiency

  • Pregnant and lactating women

  • Other significant lower limb impairment e.g. fractures within six months, severe arthritis, and amputation

  • Evidence of fixed contracture

  • Other diagnoses which may contribute to gait disorder e.g. bony deformities, cerebral palsy

Assessment:

Functional Ambulation Category (FAC) (13)



Study design: Observational, open, clinical trial

Sample size: 30 patients

Duration of study: 28 days

Follow up: Zero, 14th and 28th day

Test Formulation(12)

The ingredients of Munzije Balgham:


  • Aslussoos (Glycyrrhiza glabra)............................. 4 grams/day

  • Badyan ( Foeniculum vulgare)………………....4 grams/day

  • Bekhe Badyan ( Foeniculum vulgare)………………....4 grams/day

  • Ustukhuddoos (Lavandula stoechas)………….……....4 grams/day

  • Anisoon (Pimpinella anisum)…....……….....…..4 grams/day

  • Tukhme Karafs (Apium graveolens)……………………4 grams/day

  • Ood saleeb (Paeonia emodi).....….…………….…..4 grams/day

  • Bekhe Izkhar (Andropogon jwarancusa).....................4 grams/day

  • Berge Gaozaban (Borago officinalis)................................ 4 grams/day

  • Gulqand Asali (Rosa damascena petals+ honey)..........40 grams/day








The ingredients of Mushile-Balgham:

  • Ustukhuddoos (Lavandula stoechas)…………………..5 grams/day

  • Berge Sana (Cassia angustifolia)………………….10 grams/day

  • Turbud (Operculia turpethom)………………...3 grams/day

  • Maghze faloos (Cassia fistula)…………...…………..70 grams/day

  • Roghane zard (Ghee)………………….……………..5 grams/day


The ingredients Inkebab:(12)

  • Baboona (Matricaria chamomilla)………………..….12 grams/day

  • Hulba (Trigonella foenum - graceum)................ ....12 grams/day

  • Aqar qarha (Anacyclus pyrethrum) ……………………12 grams/day

  • Tukhm Shibbat ( Peucedanum graveolus) …………………..12 grams/day

Procedure of study:

Hemiplegic patients having gait disability and fitting into the inclusion criteria will be selected from the OPD/IPD after obtaining a written voluntary consent for the clinical trial. Before starting the treatment, the degree of gait disability will be assed using Functional Ambulation Category (FAC).

The ingredients of Munzije Balgham will be administered in decoction from orally, once in the morning for 12 days. On the thirteenth day, The ingredients of Munzije Balgham will be mixed with that of Mushile Balgham and given in decoction form only for one day. On 14th day of treatment, the Inkebab will be started, once a day for ten minutes for a period of 12 days (six day in a week) in two weeks. After completion of the trial, the comparison will be made between pre and post treatment values of gait abnormality to assess the improvement.




7.3

Does the study require any investigations or interventions to be conducted on patients?



YES


Hb%, TLC, DLC, ESR,

Urine routine & microscopic

BLOOD SUGAR-F/PP,

KFT- Blood urea & serum creatinine

LFT-SGOT, SGPT, S. bilirubin

ECG




7.4

Has ethical clearance been obtained from your Institution in case of 7.3?



APPROVED








References:
1. Duncan P.W. “Stroke Disability.” Physical therapy (1994), vol.74(5) pp.30-39

2. Teixeria-Salmella et al. “Effects of muscle strengthening and physical condition training on temporal, kinematic and kinetic variables during gait chronic survivors.”J Rehab Med (2001); Vol3 pp. 53-60.

3. Benaim C at el. “Validation of a standardized assessment of postural control in stroke patients: the postural assessment scale for stroke patients (PASS).” Stroke (1999) vol.30 pp.1862-1868. Published by American Heart Association 7272 Green Ville Avenue Dallas.

4. Taylor C Fiona. “Stroke in India”; South Asia Network for Chronic Disease

5. L Nilsson et al. “Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on treadmill with body support and walking training on the ground”. Clinical rehabilitation 2001; 15; pp.515-527

6. O’Sullivan S B, Thomas J T “Physical Rehabilitation” 5th ed.(2007) Published by Jaypee Brothers Medical Publishers ,New Delhi, pp. 756

7. K. Park. “Park Text Book of Preventive and Social Medicine” 20th edition, (2009) Published by Banarsidas Bhanvat, Jabalpur, pp.327.

8. Swash M., Glynn M “Hutchison’s Clinical Methods” 26th ed. (2007) Published by Elsevier Publication pp.228.

9. Abul Hasan Ali Ibn Ahmad Ibn Ali Ibn Hubal. “Kitabul Mukhtarat Fit Tibb” Urdu Translation by CCRUM Published by CCRUM, Vol. 3, pp.53.

10. Abul Hasan Ahmed Ibn Mohammad Al Tabri. “Moalajat Buqratiya.” Urdu Translation by CCRUM Published by CCRUM, Vol:1 pp.420-421

11. Shaikhurrais Abu Ali Ibn Sina. “Alqanoon Fit Tibb” Urdu Translation by Hakim Ghulam Hasnain Kantauri. Vol: 1 Part: 3 pp. 582.

12. Azam Khan. “AlAkseer” (2003) Urdu translation by Hakeem Kabeer-ud-din Vol: 1, Ejaz Publication House, New Delhi, pp.47, 306-312.

13. Mehrholz j, Wagner k et al. (2007). “Predictive validity and responsiveness of the Functional Ambulation Category in hemiparetic patients after stroke.”Arch Phys Med Rehabil 88(17908575):1314-1319.




9.

Signature of Candidate


10.

Remarks of the Guide


11.

Name & Designation of Guide


11.1

Signature of Head of

Department





12

Remarks of the Director


12.1



Signature of the Director




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