Papers by Gita M Ramdharry
Background: Self-management support (SMS) forms a central pillar in the management of many long-t... more Background: Self-management support (SMS) forms a central pillar in the management of many long-term conditions. It is firmly aligned with national health policy but there is a paucity of evidence exploring how it is enacted in the context of neuromuscular diseases (NMDs). Bridges is a SMS programme originally developed in stroke. A new version of the programme (Neuromuscular Bridges) has recently been developed in collaboration with people with lived experience of NMD using co-design methods and requires evaluation. The implementation of SMS is inherently complex with potential barriers at the level of the patient, provider, and wider organisation. The success of implementing programmes can be highly dependent on context, indicating a rationale for considering implementation determinants at an early stage. This study aims to explore the feasibility of delivering and evaluating Neuromuscular Bridges, whilst simultaneously testing the feasibility of an implementation strategy bundle ...
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This pilot study aims to compare physical activity levels, recorded using the SenseWear activity ... more This pilot study aims to compare physical activity levels, recorded using the SenseWear activity monitor (SAM), in people with Charcot-Marie-Tooth (pwCMT) and healthy matched controls. Correlations between SAM activity levels, self reported activity levels and impairments were investigated. Twelve pwCMT and 12 healthy matched controls wore a SAM for the waking hours of 7 days. Primary comparisons of body mass index (BMI), calorie expenditure, energy expenditure (METs), time spent performing sedentary (<3 METs) and moderately vigorous (≥3 METs) activities were measured using the SAM in both groups, expressed as an individual’s mean day. Secondary measures included reported activity levels (Phone-FITT questionnaire) and fatigue severity (FSS questionnaire) plus disease severity using the CMT Examination Score (CMTES). Results: There were no significant group differences between calorie expenditure, energy expenditure, or time spent performing sedentary or moderate activities. Disea...
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Best Practice & Research Clinical Rheumatology
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International Journal of Therapy and Rehabilitation, 2017
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Disability and Rehabilitation, 2016
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Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology, 2014
To examine the effects of dysfunction of specific musculature of the shank a reliable and valid p... more To examine the effects of dysfunction of specific musculature of the shank a reliable and valid protocol can be used to induce a localised fatigue effect. A localised dynamometry based protocol was developed to illicit a fatigue effect in either plantar flexors or dorsiflexors. An isokinetic protocol allowing for movement through the full range of motion, set at an angular velocity of 45°s(-1), was used to allow fatigue to be developed. Fatigue was established when three consecutive torque measures dropped below 50% of the average three peak contractions. Bouts of activity were based on a ratio of 40 contractions interspaced with a 30s rest. Results suggest that the protocol elicited a fatigue effect in the prime movers of either plantar flexion or dorsiflexion, supported through the analysis of power spectral density and amplitude shift of surface electromyography measures. The protocol demonstrated sound reliability with Interclass Correlation scores for all measures ranging from ...
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Physiotherapy Research International, 2012
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Muscle & Nerve
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International Journal of Therapy and Rehabilitation
Background/aims This randomised controlled feasibility trial evaluated the recruitment, engagemen... more Background/aims This randomised controlled feasibility trial evaluated the recruitment, engagement and effect of the Graded Repetitive Arm Strengthening Programme in a community rehabilitation setting in London, UK. Methods A parallel design was used to ascertain the effect of the Graded Repetitive Arm Strengthening Programme plus standard care compared to standard care only over four weeks. Eleven participants were randomised using permuted blocks randomisation following discharge, with six participants allocated to the Graded Repetitive Arm Strengthening Programme (study) group and five to the standard care (control) group. The primary outcome was the Wolf Motor Function Test. Secondary outcomes were the Motor Activity Log and grip strength. Results A total of five participants in each group were analysed as one person withdrew from the study group. Participants in the study group gave more time to supplementing their exercise time independently (160% more vs 42% more). Most Wolf ...
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Muscle & Nerve
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Neurology
ObjectiveThe aim of this phase 2 trial was to ascertain the feasibility and effect of community-b... more ObjectiveThe aim of this phase 2 trial was to ascertain the feasibility and effect of community-based aerobic exercise training for people with 2 of the more common neuromuscular diseases: Charcot-Marie-Tooth disease type 1A (CMT) and inclusion body myositis (IBM).MethodsA randomized single-blinded crossover trial design was used to compare a 12-week aerobic training program using recombinant exercise bicycles compared to a control period. The training occurred 3 times per week in community gyms local to the participants. Support was available from trained gym staff and a research physiotherapist. The 2 disease groups were analyzed separately. The primary outcome measure was peak oxygen uptake (VO2 peak) during a maximal exercise test, with secondary measures of muscle strength, function, and patient-reported measures.ResultsData from 23 people with CMT and 17 people with IBM were included in the analysis. Both disease groups had high levels of participation and demonstrated improve...
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Journal of Neurology, Neurosurgery & Psychiatry
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Physiotherapy research international : the journal for researchers and clinicians in physical therapy, Jan 28, 2017
People with Charcot-Marie-Tooth (CMT) disease may be at risk of falls due to distal muscle weakne... more People with Charcot-Marie-Tooth (CMT) disease may be at risk of falls due to distal muscle weakness and sensory impairment. We aimed to understand the frequency of falls in a cohort, where they occurred, injury and to what people attributed the possible cause. A cross-sectional survey design was used. It was sent by post to ascertain the frequency of falls and near falls, plus the circumstances of the last three falls events they could recall. The survey was administered to 252 people with CMT who were patients at a specialist neuromuscular centre. People were approached who had a clinical diagnosis by a neuromuscular specialist neurologist. Not applicable. The Falls Event Questionnaire. Responses were received from 107 people with CMT. Falls and near falls were reported by 86% of survey respondents. The majority of falls occurred at home, and muscular weakness appeared to be blamed the most, with participants describing tripping due to foot drop or joints giving way. A similar patt...
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BMJ open, Jan 5, 2017
To assess the effectiveness of orthotic devices for the management of instability of the knee in ... more To assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder. A systematic review of primary studies. Community. Adults with a neuromuscular disorder or central nervous system disorder and impaired walking ability due to instability of the knee. Orthoses with the clinical aim of controlling knee instability, for example, knee-ankle-foot orthoses, ankle-foot orthoses and knee orthoses or mixed design with no restrictions in design or material. Condition-specific or generic patient-reported outcome measures assessing function, disability, independence, activities of daily living, quality of life or psychosocial outcomes; pain; walking ability; functional assessments; biomechanical analysis; adverse effects; usage; patient satisfaction and the acceptability of a device; and resource utilisation data. Twenty-one studies including 478 patients were included. Orthotic devices were e...
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Muscle & nerve, Jan 20, 2017
Foot deformities are frequent complications in Charcot-Marie-Tooth disease (CMT) patients, often ... more Foot deformities are frequent complications in Charcot-Marie-Tooth disease (CMT) patients, often requiring orthopedic surgery. However, there are no prospective, randomized studies on surgical management, and there is variation in the approaches among centers both within and between countries. In this study we assessed the frequency of foot deformities and surgery among patients recruited into the Inherited Neuropathies Consortium (INC). We also designed a survey addressed to orthopedic surgeons at INC centers to determine whether surgical approaches to orthopedic complications in CMT are variable. Foot deformities were reported in 71% of CMT patients; 30% of the patients had surgery. Survey questions were answered by 16 surgeons working in different specialized centers. Most of the respondents were foot and ankle surgeons. There was marked variation in surgical management. Our findings confirm that the approaches to orthopedic management of CMT are varied. We identify areas that re...
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Musculoskeletal Science and Practice, 2017
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Musculoskelet Sci Pract 2017; 27(Suppl 1): 32-37
Exposure to the microgravity environment induces physiological changes in the cardiovascular, mus... more Exposure to the microgravity environment induces physiological changes in the cardiovascular, musculoskeletal and sensorimotor systems in healthy astronauts. As space agencies prepare for extended duration missions, it is difficult to predict the extent of the effects that prolonged exposure to microgravity will have on astronauts. Prolonged bed rest is a model used by space agencies to simulate the effects of spaceflight on the human body, and bed rest studies have provided some insights into the effects of immobilisation and inactivity. Whilst microgravity exposure is confined to a relatively small population, on return to Earth, the physiological changes seen in astronauts parallel many changes routinely seen by physiotherapists on Earth in people with low back pain (LBP), muscle wasting diseases, exposure to prolonged bed rest, elite athletes and critically ill patients in intensive care. The medical operations team at the European Space Agency are currently involved in preparin...
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Health Technology Assessment, 2016
BackgroundPatients who have knee instability that is associated with neuromuscular disease (NMD) ... more BackgroundPatients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee–ankle–foot orthoses (KAFOs).ObjectivesTo assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.MethodsQualitative study of views of orthoses users – a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review – 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of s of Reviews of Effects, Health Technology ...
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Physiotherapy Research International, Jul 1, 2006
Cervical dystonia is a complex chronic neurological disorder which is more commonly managed with ... more Cervical dystonia is a complex chronic neurological disorder which is more commonly managed with pharmacological interventions. This Case Report outlines the rehabilitation of a patient who was able to reduce the effective dose of botulinum toxin when physiotherapy management was added to a long- term pharmacological regime. A good outcome is demonstrated from a combined physiotherapy and botulinum toxin intervention.
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Papers by Gita M Ramdharry