I have also been interviewed by VOICES on All India Radio, Bangalore (on Rehabilitative Surgery for Locomotor Disabilities: July, 2002), E-TV, Bangalore (on Backpacks and Postural Problems in Indian School Children: telecast during national news on January 9, 2003 and Bangalore news on January 10, 2003; and on Cerebral Palsy on November 22, 2003), and India Vision, Kochi (on Cerebral Palsy on October 22, 2004).
To read Dr.Deepak Sharan's RSI/MSD educational columns in the World's topmost English Newspaper CLICK HERE
Horse sense
Equine therapy can help disabled children improve their coordination and concentration. Varuna Verma visits a centre in Bangalore that heals with the help of horses
It’s a Saturday and Pushpa P. Bopaiah has been on her feet all day. Her classes start at six in the morning and the therapist has 32 children with disabilities enrolled for riding lessons. “I’m running a one-woman show,” she says.
Bopaiah has been at it for the last eight years. And she still remembers the stares she got the first time she walked into a school for disabled children dressed in breaches, boots and a helmet. “People asked me whether I was off to the races,” she recalls.
She had to repeatedly clarify that she was a qualified therapist and not a race junkie. She had gone to assemble the first batch of students who had enrolled for her equine therapy classes — a 40-year-old horse-riding therapy prescribed for people with disabilities.
Bopaiah has treated 372 patients — mostly children — with equine therapy at her centre — Healing Horse — located at Bangalore’s sprawling, green Palace Grounds. Bopaiah has seven retired race horses — all specially trained to stay calm and trot in slow, smooth strides — in her stable.
“Children are more receptive to equine therapy because they are interacting with a live animal and are in the midst of nature,” says Bopaiah, herself a keen rider. Children with disabilities ranging from multiple sclerosis, Down Syndrome, cerebral palsy, attention deficit disorder and autism have sought therapy at Bopaiah’s centre.
Equine therapy is actually merely a medical name for horseback riding. While for most people horse riding is a sport, for disabled children mounting and riding the animal is a lesson in co-ordination, concentration and confidence building. Saying hello to the horse every morning and talking to him helps strengthen speech skills. “Horse riding modifies the behaviour and emotions of disabled children. It also helps their muscles to tone up and improves blood circulation and appetite,” says Bopaiah, who has trained in equine therapy at the Special Equestrian Riding Therapy Centre, California.
Her one-woman centre, however, is set to change. Healing Horse — which claims to be the only equine therapy centre in India —is going national. It is collaborating with the Army Wives Welfare Association (AWWA) in Ambala, Haryana, to set up a centre. In the pipeline are similar centres in Calcutta, Delhi and Hyderabad and a training school for equine therapists in Bangalore. “I also want to prepare my students to participate in the Para-Olympic Games,” she says.
Bopaiah is dreaming of gold medals. But for bank employee Shekhar M, seeing his 11-year-old son Keshav mounting a big, brown horse without fumbling gives the ultimate thrill. Keshav suffers from attention deficit hyperactive disorder. Six months ago, he was overweight and clumsy in his actions. “Now, there’s an improvement in his motor skills and body movement co-ordination,” says Shekhar, as he watches his son trot around the riding ground. The outdoor activity has also helped Keshav shed some kilos.
Some surgeons believe equine therapy has medical benefits. Bangalore’s RECOUP Neuromusculoskeletal Rehabilitation Centre uses the therapy as part of its post-operative rehabilitation programme. “I have been using equine therapy for children with cerebral palsy and other neuro-motor disorders who undergo surgery,” says Deepak Sharan, medical director, RECOUP. Over a hundred of his patients have undergone equine therapy so far.
Severely spastic and autistic children are unable to keep their head upright or sit straight. Sharan says that post-surgery, equine therapy helps to normalise muscle tone and develop head and trunk postural control and body balance.
As seven-year-old Shubhajeet Roy rides his favourite mare, Saraswati, his autism is the last thing you notice about him. When he started riding lessons a year ago, he couldn’t sit straight on the horse. “He would cry constantly, not concentrate and not talk,” recalls Bopaiah. That’s history now. Shubhajeet freely chats with Bopaiah as she takes him around the ground, lets him pluck leaves and bond with Saraswati. “His concentration and hand co-ordination have improved dramatically,” says Bopaiah.
Patients cannot turn up for equine therapy directly. It must be prescribed by a physician who is familiar with the risks and benefits of the treatment. “A child should be physically and mentally capable of riding,” says Bopaiah, who charges Rs 200 for every 40-minute riding session.
Bopaiah draws a customised lesson plan for every child and chooses a horse according to individual needs. “A spastic child, for example, needs a calm horse with a smooth, short stride,” explains the therapist.
Each riding session begins with free hand exercises and deep breathing to help the muscles relax. “While riding, I get the children to play games and ask them to recognise colours, pluck leaves and play with coloured rings. This breaks the monotony of just riding around the ring,” says Bopaiah. As an incentive to the children, Bopaiah has conducted three horse shows, where her students showed off their riding prowess and were awarded medals and certificates. “It helped boost the children’s self-confidence,” she says.
Thirteen-year-old cerebral palsy patient Varsha Rao is among Bopaiah’s first and most regular students. As the girl couldn’t talk, the therapist learnt sign language to communicate with her. After eight years of training, Varsha has learnt to sit upright, gain confidence and develop a love for animals.
But Varsha’s mother, Rekha Rao, likes equine therapy for other reasons. “As Varsha goes from monotonous physiotherapy sessions to speech classes and special schools all day, horse riding comes as a welcome break for her,” says Rao. This is one therapy session that Rao doesn’t have to force her daughter to attend.
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Equine therapy | Healing rides
Author: Archana Rai
Equine therapy is said to benefit those who suffer from disabilities such as multiple sclerosis, Down’s syndrome, spinal cord injury, autism and cerebral palsy. We visit Healing Horses, a therapy centre in Bangalore, the only one of its kind in India
Move the horse faster,” urges Manish Rana, juggling the reins of his mount as he watches his younger sibling Anish trot around the park in Bangalore. Manish, 13, is undergoing an equine therapy session under the watchful eyes of his trainer Pushpa Bopaiah, India’s only certified instructor in therapeutic riding. Once astride the big brown horse, Manish, who was born with cerebral palsy, assumes a straight-backed posture, his head steady and eyes smiling. In the 18 months since he began this therapeutic course, the youngster, who earlier walked with a stoop and a shuffling gait, has made steady progress moving about now with greater assurance. “There has been a tremendous reduction in Manish’s spasticity,” says his father Major Jagdish Rana, who ensures that his younger son, Anish, a junior national silver-medallist in equestrian sport, accompanies Manish for these sessions.
Fifteen-year-old Varsha Rao, too, is excited by her 10-minute routine. Also born with cerebral palsy, she mounts the horse with help and rides around the park—her hands on the reins and posture upright. “The course has a lot of ups and downs and she has to be steady. All this has improved her posture and focus,” says her mother Rekha Rao.
Both Manish and Varsha have enrolled at Bangalore’s Healing Horses, a centre for equine therapy set up by Bopaiah, a therapist who trained at Sert, the Special Equestrian Riding Therapy Centre in California.
Bopaiah trains children from age 3 onwards, but only after certifying that the child is fit for the therapy. “Because riding a horse involves moving the body gently and rhythmically in a manner similar to human gait, children with disabilities gain a lot in improved flexibility, muscle strength and balance,” says Bopaiah, who has trained more than 350 children from across the country.
She begins her therapy by encouraging the child to touch and mount a horse. A regular warm–up routine includes stretching exercises such as reaching out to touch the horse’s head or bending backwards, with the child trained to sit upright and independent of a trainer. During each 40-minute module that Bopaiah offers at a choice of two riding institutes in the city, the children loop rings on a long pole while astride a horse, to improve coordination, or play games with coloured balls in a group, among other things.
“I have been using equine therapy for the past seven years, mainly for children with cerebral palsy and other neuro-motor disorders who undergo a surgical procedure,” says Deepak Sharan, a Bangalore-based orthopaedic consultant who specializes in rehabilitation and ergonomics. Children who have undergone a specialist procedure called the “single event multi-level lever arm restoration and anti-spasticity surgery”, devised by Dr Sharan, are offered equine therapy as a post–operative rehabilitation option at Healing Horses. “The excitement of working with a horse creates the enthusiasm and motivation needed for the child to be an active participant in therapy. This improves the outcome of the surgery,” says Dr Sharan, who has treated more than 100 children with this combination of surgery and therapy.
Typically, equine therapy benefits patients with a wide range of disabilities, such as multiple sclerosis, Down’s syndrome, spinal cord injury, attention deficiency, autism and cerebral palsy. However, it should be prescribed by a physician familiar with its risks and benefits. For instance, special care is needed in the cases of children whose conditions lead to tightness in the hips and knees, or those who have suffered hip dislocations.
To ensure that the therapy is well-directed, Bopaiah insists on a recent medical evaluation of the children. For instance, in the cases of children with Down’s syndrome, she insists on an evaluation as recent as 30 days before the start of the session. “Some children with Down syndrome wear a shunt and cannot ride. It is the same for people with scoliosis or arthritis,” says Bopaiah. Healing Horses also does not take children who have had a history of epileptic seizures.
“Equine therapy offers more sensory–motor stimulation and a bond between rider and horse that cannot be simulated artificially in a clinic or with an inanimate horse,” says Dr Sharan.
At present, it is children who are largely benefiting from this therapeutic sport at Healing Horses. The therapy, though, could benefit adults as well, particularly those who suffer from multiple sclerosis, have a spinal cord injury or cerebral palsy. “This is not just sport. There is a human and social need that it fulfils, something that children with special needs benefit the most from,” says Bopaiah.
CURE IN A NUTSHELL
• Therapeutic riding benefits people with muscular dystrophy, cerebral palsy, visual impairment, Down’s syndrome, mental retardation, autism, multiple sclerosis, emotional disabilities, brain injuries, spinal cord injuries, amputations, learning disabilities, attention deficit disorder, deafness, cardiovascular accident/stroke.
• A therapeutic riding course must be preceded by a medical evaluation, in some cases as recent as 30 days before the start of a riding session.
• Therapy is customized for specific disorders. This includes choosing the right horse; for instance, those with rigid muscle tone must ride a horse with a fast gait, while those with lower muscle tone are encouraged to ride a horse with a short stride.
Equine therapist
“Organized equine therapy is a 40-year-old concept that began in the West,” says Pushpa Bopaiah, a keen rider who trained as a teacher for children with special needs. A chance introduction to equine therapy during an online surfing session piqued her interest and led her to the website of Narha (North American Riding for the Handicapped Association).
With her credentials she was awarded a scholarship to train at Sert, the Special Equestrian Riding Therapy centre in California that is certified by Narha. At Sert, the training was rigorous with even a skilled rider such as Bopaiah expected to start from scratch.
First off are the lessons in horsemanship that involve caring for and choosing the right mount for each disability.
Once adept at handling horses, students graduate to working with children with special needs. “For instance, if I worked with a child with cerebral palsy in the morning, the noon session would be with an autistic child and the evening session with a Down’s syndrome child,” says Bopaiah.
Riding was first used as a therapy during Word War I, when injured soldiers were prescribed riding sessions. It gained prominence when Liz Hartel, a Danish Olympic medallist, stricken with polio and confined to a wheelchair, overcame her handicap to win a silver medal for Grand Prix Dressage at the Helsinki Olympics in 1952. She went on to repeat her feat in 1956 and motivated medical professionals and equine specialists to set up therapeutic riding centres across Europe.
Since then, such schools have proliferated with Narha setting up more-than-800-member centres across the US and Canada. Narha also has been certifying instructors outside the US for many years, and in 2006 the first Narha accredited centre outside North America was set up in Barcelona, Spain.
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Watch out for signs of your kid’s struggle
Author:Deepak Sharan
Mail Today, Date: April 14, 2008
The health hazards of ill- designed and over- sized school backpacks is an important public health problem in India that is often glossed over by schools, parents and medical professionals. The immediate result of carrying unbalanced weight for too long is muscle soreness and strained ligaments. Backpacks lead to restricted movement of the spine and alter the fluid content of discs. This makes backpack wearers prime targets for herniated discs and arthritic spines. There are simple signs of an overloaded schoolbag, which parents can watch out for. These include — struggle in getting the backpack on or off; pain while wearing the backpack; tingling, burning or numbness in the back, shoulders or arms; red marks or swelling around shoulders; and bending forward or leaning on one side while wearing backpack. In addition to the problems created by heavier backpacks, children could also getting exposed to problems due to wrong posturing while working on computers. The backpack problem can be handled through simple measures by schools, parents and schoolbag manufacturers. When children go to buy a new backpack, they should take the books and articles that they usually carry to school. The backpacks should be tried on with the typical weight that they usually carry, so that they will know for sure how it feels and if all the articles fit in. Schools can provide storage space under the benches in classrooms and encourage the folder system. Children should learn to pack sensibly and leave non- essential items behind. They should organise articles in the backpack so that the heaviest items are closest to the back. Lighter articles, like lunch or clothing can be placed on top of books or in compartments further away from the back. Since there is lack of data on this subject, we have designed a national study to estimate the extent of health problems arising out of heavy backpacks. Initially, the study will commence at Bangalore and Kochi ( in collaboration with Indian Academy of Pediatrics), and may be later extended to other cities. Parents, medical professionals and schools interested in finding solutions to the backpack issue are invited to join this study. The author has won presidential recognition for his work in cerebral palsy
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Ray of hope
Author: Manu Vipin
www.newindpress.com,Wednesday April 9 2008
WHEN I met five-year- old Sneha she was sitting on her father’s lap at the out patient wing of Welcare hospital, Vyttila, for her routine check-up after SeMLARASS. “She is showing positive results,” says her father Praveen V P. A bright and cheerful infant, Sneha was detected with cerebral palsy when she was seven months old. It became obvious to her parents that she had more than a slight problem. She had not reached any of the normal developmental milestones for a child of her age - her muscles frequently went into spasm, she could not sit up.“It came as a massive shock. But now she can sit straight without assistance and has started learning swimming which is a part of the therapy,” says her mother Smitha.
Three-year-old Romal was diagnosed with spastic hemiplegia on the right side of the body. “We started looking for treatment for this particular problem of limping of the right leg. He also had a tendency to turn his right hand inwards. He underwent SeMLARASS and started the rehabilitation process,” says Renny Jose, Romal’s father. After the surgery he was taken to ReCOUP rehabilitation centre in Bangalore for a month-long post surgical rehabilitation. While there he underwent hippo therapy (horse riding) for 14 days. “This made his rehabilitation faster and made him very confident to try out new activities which were not at all possible for him before,” says Renny. Now the deformities have reduced to a great extent and Romal is able to climb steps without assistance. He is also doing everything a normal left-handed child does.
Like Sneha and Romal, more than a 100 children affected with cerebral palsy (CP) are showing positive results today after this surgery.There is an estimated 25 lakh Indians with CP today. The usual medical advice is that CP is incurable. Or they maybe referred to a physiotherapist for further treatment. Not many are aware of SEMLARASS or Single Event Multilevel Lever Arm Restoration and Anti Spasticity Surgery.
“We have been performing SeMLARASS since 2000 and have found improved functional results in almost all patients,” says Dr Deepak Sharan, the developer of SeMLARASS. Dr Deepak is now flooded with patients from all over the world- because the surgery is not performed in any other part of the world. “The surgical method draws its origin from two prevalent concepts in the surgical treatment of CP developed by Dr Takashi Matcuo from Tokyo and Dr James Gage from Minnesota, USA,” he says.
Dr Deepak is currently the consultant in paediatric orthopaedic and rehabilitation and medical director of ReCOUP neuromusculoskeletal Rehabilitation Centre, Bangalore.
After graduation and postgraduation in orthopaedics from JIPMeR, Pondicherry, Dr Deepak trained for over five years at various paediatric centres in the world. Besides being an expert on the management of CP, he has post-graduate qualifi- cations in orthopaedic engineering and orthopaedic rehabilitation technology.
This is the 13th time that he is coming to Welcare hospital for consultation and surgery and has already had more than 150 patients. 51 surgeries were done on children in the state, of which 50 were affected by CP; one had neuroblastoma. The success rate of this particular type of surgery is high compared to other methods. “Out of 51 children, 60 percent have achieved 100 percent success. That doesn’t mean that they have become “normal”. It means they have achieved the outcome that the doctor expected before the surgery,” says Aswin, head, community based rehabilitation projects, Adarsh.
The co-ordination and arrangements for the operation and post-operative care like surgical physiotherapy are done by Adarsh Charitable Trust.
According to Dr Deepak, postsurgical physiotherapy for over six months is more important than surgery itself. “Our focus is on functional rehabilitation,” he says. Dr Deepak who is also a member of the expert committee on CP constituted by the Ministry of Social Justice and empowerment.
“The success rate depends on various factors like age of the child, severity of the disability, functional status, communication and above all post operative physiotherapy, which is a major factor,” says Aswin. For more details on SeMLARASS, contact 9447391730
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Deformity correction of cerebral palsy at SK Hospital
Thursday June 8 2006
THIRUVANANTHAPURAM: SK Hospital, Thiruvananthapuram, is the only hospital in south Kerala, which offers facilities for consultation and deformity correction of cerebral palsy in children.
Regular camps at an interval of three to four months are being conducted d at the hospital under the guidance of Deepak Sharan, a well-known pediatric surgeon based in Bangalore, along with Ranjith Narayanan and Sudhir S.Pai for consultation and deformity correction. Many people have been benefited from these camps.
Cerebral palsy is an umbrella term covering a group of non-progressive, but often changing motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development of the children up to 5 years. More details are available on the information desk of the hospital (Ph.0471-2356256 and 2350971).
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Good posture projects confidence
Author: Dr. Deepak Sharan
Bangalore Times, The Times of India, May 24, 2001
"Stand up straight!" "Pull your shoulders back!" "Stop slouching" As children, some of us were reprimanded to maintain good posture. Yet we were seldom taught effective ways to accomplish this. Most of us remain blissfully unaware of the harmful consequences of postural neglect.
As we start to grow older and worry, our posture deteriorates. We have a series of reflexes throughout the body that support us against the force of gravity and naturally co-ordinates our movements. Inappropriate muscular tension creates an interference with these reflexes and many of us end up moving in ways that are awkward and inefficient.
The consequences of poor posture can be seen all around us: stiff necks, shoulders hunched forward or pulled tightly back, restricted breathing, and tightness in the thighs, legs and ankles. The result is headaches, neckaches, backaches, and sciatica.
So what is 'good' posture? Posture is essentially the position of the body in space. The correct posture is one in which the body segments are balanced in the position of optimal alignment and maximum support, with full pain-free movement with a minimum of energy expenditure. The key to this low-tension position is balance: your upper torso and head are balanced over the mid-torso and lower back so that they rest on top of one another and don't require muscle tension to hold things in place.
Nature has aligned us so our center of gravity falls through our body and moves through specific bony landmarks: Earlobe over the middle of the shoulders, over the hip joint, and over a point about an inch in front of the ankle joint. In the correct position, your spine has the natural curvature, your chest is 'open', meaning that they are centered on the plane of the torso. With correct muscle flexibilities and strength balances, proper posture can be maintained without conscious effort. However, when you are fatigued or stressed, you tend to revert to your relaxed posture and alignment. You will then fatigue even more quickly and perform less efficiently.
But how is poor or faulty posture developed? Children stand or sit in a hunched over position for a variety of reasons: habitually; psychological factors, especially low self-esteem (adolescent girls may slouch to hide developing breasts), laziness, to irritate their parents, or to express their growing independence; muscle spasm; respiratory conditions; excess weight; and high-heeled shoes/boots, tight clothing and wide belts.
Poor posture often worsens during the adolescent growth spurt, when a child may assume a more pronounced round back. Other common postural problems are when the spine curves inward, slouching and side-to-side curving. The aggravating cause of a significant number of modern injuries related to posture is computer use, which will be discussed in a subsequent column.
Many think straightening up is important only for appearances. Although good posture does project confidence, strength and poise, it is important because it contributes to our health and capabilities. An awareness campaign to promote the importance of good posture in students is the need of the hour, and is an important activity of "Open Door". Good postural habits must be instilled at an early age. Get your school or college to organize lecture-demonstrations in Postural Correction. Treatment of postural problems includes individualized assessment, exercises and practice. A special method called Alexander Technique is popular in the west, though largely unheard of in India. Muscle relaxation techniques, biofeedback, manipulation, massage and stretching exercises are also used to relieve pain and muscle tension. Regular non-jarring exercises, such as swimming, and maintaining high levels of activity are recommended. Appropriate supportive furniture (e.g., firm beds and chairs) may be required. Posture can be improved, and the sooner the better. Pulling back into alignment may feel awkward and uncomfortable at first, but we adjust to it quickly.
You can let your posture get worse and suffer the consequences, or you can improve it NOW. The choice is yours.
Rage Spills Over Into Sporting Arenas
Author: Asha Chowdary
Bangalore Times, The Times of India, July 27, 2001
Fury, as in a fire in the chest and a burn in the gut, is no longer restricted to high pressure work areas or bad roads. In a malady now on the rise in the city, anger is erupting on the sports field, not always during a national level match but even during friendly club events. Sports rage, as the disorder is often termed, has led to grave injuries caused by a moment of fury or fleeting carelessness.
Today, anything can precipitate a physical attack- losing a match or even anger spilling over from an earlier grudge. Whatever the cause, the victims who suffer, do so in silence, often too scared to even tell their doctors what caused the mishap.
"We are always trying to find excuses for this," says Malini N (name changed) who was deliberately injured during a badminton match and is now suffering from a serious eye wound. "In my case, I was playing badminton with this club member who was annoyed by women being included in the club. In a moment of anger, he smashed the shuttlecock with unnecessary force and it hit my eye. I was rushed to the hospital with a haemorrhage in my eye and though that was treated in some weeks, a cataract has developed and I now suffer from blurred vision. I now require an operation that can cost over Rs. 40,000."
According to Malini, these events happen all the time, but most people do not bring them to light. "I had a friend who had her contact lens smashed, another person had his eyelids crushed in a club match. I don't see why we should be the target of someone else's personal angst."
"People will do anything to win," says national level hockey player, Ashish Ballal. "In some matches, a lot of people get hurt because some of them begin hitting each other on the field. You see, in an important match, you train a lot and you want to taste success. Sometimes in hockey, a person can be hooking you and your blood pressure shoots up and you react in anger. I've seen it happen. One of my teammates had to have several stitches and I have had some bruises myself. The frustration levels and the desire to win is definitely on the increase."
Dr. Hemanth Kalyan, consultant in orthopaedic surgery and sports medicine at Lakeside Medical Centre says, "This usually happens in the informal level of sports. In the interschool hockey match, I once saw a student who scored a goal being hit with a hockey stick and the bones of his wrist were damaged. Only education, protective gear and healthy sporting attitudes can help in any sport."
Dr. M Venu, senior registrar, orthopaedics, at HOSMAT says, " There has been an increase in injuries due to foul play. People have come to me with knee injuries and severe bleeding, especially after a football match. The amount of competition is on the increase which could be reason behind this." Dr. Deepak Sharan, head of pediatric orthopaedics department, Bangalore Children's Hospital adds, "Pent up emotions and hidden psychological problems can surface during a game. In many countries, there are sports counsellors who can help out."
In foreign countries, sports rage extends to parents and coaches who often resort to violence on the sports field. Press accounts describe a youngster actually beaten to death and others who were viciously beaten. Many countries are even enacting laws increasing penalties for sports violence and to curb sports rage.
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Obesity: Kids at Health Risk
Author: Kanak Hirani
Bangalore Times, The Times of India, August 23, 2002
A five-minute run tires him out. He can put away two packets of chocolate at a go. He feels drowsy in school and has low self-esteem. His cholesterol is high and he complains of frequent backaches.
If this sounds like a description of your child, it's possible that he counts among the 20 per cent of students who suffer from obesity.
A recent study by doctors from the Bangalore Children's hospital (BCH), showed 20 per cent of pre-school children surveyed to be suffering from obesity. Of that, five per cent were at risk of cardiac diseases.
Dr. Nandini Mundkur, CEO, BCH says this survey is just an indication of increasing obesity among young children. Right from the time they're in the womb, babies are at risk. However, signs of obesity can be detected from the age of three.
"Factors like breast-feeding, nutrition, exercise and eating habits play an important role," says Dr. Mundkur. She adds that exercise isn't on the agenda of either parents or schools. "How many schools insist that their students exercise every morning? How many children eat healthy meals? Schools conduct health camps but don't focus on these issues. It's essential that every child should have an annual health check up. They should be taught that they are responsible for their body."
Obesity can hinder a child's development in various ways: They are at the risk of heart diseases, orthopaedic and joint problems. "Obese children also get isolated and are called names. Their weight makes it impossible for them to participate in sports and they get tired fast," adds Dr. Mundkur.
Children and adolescents with obesity keep Dr. Deepak Sharan active professionally. "I've just seen an obese 12-year-old with slipped capital femoral epiphysis (the head of the femur slips away from the rest of the femur)," says the head, department of pediatric orthopaedics and rehabilitation, BCH.
He explains that the tensile strength of bone and cartilage in children doesn't adapt well to excess loading due to being overweight, causing a variety of orthopaedic and joint problems.
Dr. Kavita Bhat, pediatric endocrinologist, Manipal Hospital and BCH says, "Up to 60 per cent of the children who are checked for obesity have elevated cholesterol as young as four to five years. Sometimes, obese children snore a lot at night, causing respiratory problems and hindering their performance in school."
You can check if your child is obese by finding out his Body Mass Index, by calculating his weight in kg divided by height (squared) in metres. A BMI of over 29 indicates obesity and a BMI between 20 to 25 is ideal. The Bangalore Children's Hospital also has an obesity clinic with a panel of doctors at their Rajarajeshwarinagar center on Monday mornings, and at their Malleswaram center on Wednesday mornings from 10 am to 1 pm. For details call 8600252 or 3347794, or email bchrc@vsnl.com.
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Backpacks Make for Bad Backs
Author: Seth Swift
October 23, 2002
Easterneronline.com (USA), October 23, 2002
Recent studies have shown that backpacks, especially in adolescents, may be the cause of an increase in cases of bad backs. Some results of students shouldering a load that at times exceeds a quarter of their bodyweight are chronic back, neck, and shoulder pain. In a way, it's almost like a perpetual pregnancy that students wear on their back for five to eight hours a day, five days a week, in excess of nine months a year for upwards of 18 years. As students, we practically live out of our backpacks.
While backpacks may be an improvement over the hand held book satchels of the past as far as organization and such are concerned, it may be that the cons outweigh the pros.
This is not just an American phenomenon either. In India, Dr. Deepak Sharan, who is the head of the Department of Pediatric Orthopedics & Rehabilitation at Bangalore Children's Hospital, has documented cases of people with back pain that he believes are related to the use of backpacks. "The immediate result of carrying too much unbalanced weight for too long is muscle soreness and strained ligaments. Backpacks lead to restricted movement of the spine and alter the fluid content of discs." This makes backpack wearers prime targets for herniated discs and arthritic spines later in life.
The imbalance in one's center of gravity created by lugging the books around on one's back is one of the easiest things that can be corrected, according to some. One way to counteract this imbalance is to carry the load higher on the back, because, according to Dr. Randolph Trowbridge, who specializes in the science and medicine of biomechanics, "The shape of our backs makes it easier to carry a load there."
With some people, however, this piece of advice does not mesh with their own personal experience. Tim Wooddy, a graduate student in the History and High Tech Communications programs, said, "The weight in a backpack is going down, so the bottom vertebrae are taking (the brunt of) the load. That's why the military uses backpacks (that rest) low on the backs. It's pretty effective."
Another way to help counteract the center of gravity created by too many books in a backpack is by rearranging the books. Researchers recommend that students pack the heavier items nearest to the back, and when they do pack the items do it so the weight is evenly distributed. That way the weight doesn't shift to one side and place even more stress on just one side of the spine.
One thing for students to beware of is that the weight of the backpack should not exceed 10-15 percent of one's bodyweight. The number and weight of books is not something most students have much control over, since books regularly weigh 5-7 pounds, but some doctors recommend carrying a book or two in your arms if the weight exceeds the maximum safe weight.
One petite sophomore student, who prefers to remain anonymous, remarked, "I never knew that (too much weight) could be so bad for your back. I always wondered why my back always hurt."
Students should also beware of the saddlebag single strap backpacks. The major problem with these is that it puts all the weight and stress on one side only and doesn't distribute it. Another thing to be wary of is only wearing one strap of a backpack. This can cause even more undue stress on one's back and, besides, is a remnant of the ultra crappy 1980s.
The backpacks that have numerous compartments for storage can be a good investment for students. According to researchers, this allows for a more even distribution of the weight. Students should avoid overpacking their backpack. Instead of bringing the kitchen sink, first find out whether it is really needed in class that day. Wide shoulder straps and backpacks made of lighter material are also recommended.
A useful tip that Dr. Sharan gives to backpack wearers is that, "If the backpack forces the wearer to move forward to carry (it), it's overloaded." He also stresses that postural problems "Do not go away with time if nothing is done about them. Remember," he said, "as the twig is bent, so grows the tree."
Wooddy remarks of backpacks and their users, "Backpacks are designed for light loads, but still people pack 20-30 pounds in there. This is unhealthy because most people aren't fit enough (to carry that load)." The president of Jansport was not available for comment for this issue.
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'Rs. 40 cr. a month for schemes for the disabled'
Bangalore, The Hindu, January 22, 2003
Doctors and government officials met here on Tuesday to try correct the handicaps in the State's disabled care system. The programme, organized by the Commissionerate for Persons with Disabilities, had doctors from Bangalore Children's Hospital (BCH) addressing orthopaedic surgeons from government hospitals state-wide.
The Assistant Commissioner from the Commissionerate, B.C. Pradeep Kumar, regretted that very few parents or doctors knew that the State Government gave a maximum of Rs. 15,000 for corrective surgeries.The money was given regardless of the level of disability or the age of the disabled person, but was subject to income levels-for children of parents below poverty level who earned less than Rs. 24,000 a year.
"The State Government spends Rs. 40 crore a month on pensions and other schemes for disabled people," he said. The money could be better used on post-operative care, etc.
The BCH doctors - Nandini Mundkur and Deepak Sharan - asked government doctors not to give "permanent" disability certificates for children below five. "Such a certificate will hamper the child for life," Dr. Mundkur pointed out. Besides, without proper counselling, parents would prefer to let children remain disabled, as corrective surgery would cut off government aid. If the parents are in the below poverty line category, a disabled child gets Rs. 125 a month for life.
Dr. Sharan spoke of identifying patients for surgery. "For cerebral palsy, most doctors warn against surgery. But lower limb surgery can be successful for children between four and six years while those between six and eight years can have upper limb surgery," he said. Doctors had to operate only in cases where benefits outweighed the risks, he stressed.
The government doctors said they worked in severely understaffed hospitals (one nurse for three wards) with ill-equipped operating theatres. "Though the government has said that those with 45 per cent disability need only one ID, disabled people come asking for certificates for job applications, travel concessions, pension, etc.," the doctors said. Mr. Kumar said the commissionerate would organize another workshop to discuss assessment of disability. Those who wanted to know more about the corrective surgery scheme can contact the District Disability Welfare Officer or the commissionerate (phone: 548 2639/41) or Mr. Kumar (phone: 548 2659).
Doctors inept to treat disabled
Author: Paawana Poonacha
Bangalore, Sunday Times, February 2, 2003
An estimated eight million disabled persons in Karnataka need to undergo surgeries to correct/reduce deformities resulting from polio, cerebral palsy, limb deformities and post burns contractures. But sadly, government orthopaedic surgeons with postgraduate qualifications are not "technically skilled or adequately exposed" to conduct these corrective surgeries, a recent study by the State Commissionerate of Disabilities found out.
This is certainly bad news for those with locomotor disabilities. Though the Karnataka government has allocated Rs. 15,000 per person per year for surgical correction of locomotor disability, there are no good surgeons or hospitals available to see the project through. As of today, surgeries are conducted in just a couple of hospitals and most rural patients do not have access to them.
"The government incurs an expense of Rs. 36 crore, just to provide maintenance allowance to the disabled. Of this, Rs. 12 crore could be saved if the disabled undergo corrective surgeries," Chief Resource Person, State Corrective Surgery Scheme for Locomotor Disabilities, Dr. Deepak Sharan, said.
Another discouraging trend is that some of the disabled, who underwent surgeries for free at camps, have been crippled due to complications caused by the lack of technical expertise. "Therefore, most disabled believe that it is better to suffer disability than face complications of a failed surgery," Dr. Sharan says.
Ironically, locomotor disability is handled by the Department for the Welfare of Disabled under Women and Child Welfare, with absolutely no involvement of the health department.
At a recent orientation program for government orthopaedic surgeons, willing doctors were given a comprehensive training programme at all regional levels by the health department, before being asked to carry out corrective surgeries independently.
The Commissionerate of Persons with Disabilities, which conducted the programme, has a long list of recommendations, including a multi-disciplinary team approach, on-the-spot assessment and documentation, and expert postoperative care.
"Rajasthan has earmarked Rs. 7 crore for such surgeries and set a target of 25,000 cases for 2002-03. The state Health department too should launch a drive in setting targets and earmarking budgets to this exercise," Assistant Commissioner (Disabilities) B.C. Pradeep Kumar said.
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‘Handicapped’ on medical certificate
Author: Paawana Poonacha
Bangalore, The Times of India, March 11, 2003
Shocking but true. An estimated 25 lakh disabled persons in the state do not possess medical certificates conforming to GOI guidelines to avail of benefits of various schemes. Reason: Doctors are unaware of the procedure to issue such certificates as no one possesses the copy of guidelines.
In a letter to Chief Minister S.M. Krishna last week, the Union Ministry for Social Justice and Empowerment directed the government to take immediate steps to set up a medical board to issue certificates as per guidelines.
“Unfortunately, the health department has not yet circulated copies of the guidelines to government hospitals to issue medical certificates as required under the Disabilities Act,” laments Assistant Commissioner for Disabilities, B.C. Pradeep Kumar.
While there is alarming rise in number of cases before courts where the disabled weren’t provided GOI-approved medical certificates, large-scale discrepancies have been noticed in issuing certificates.
As a result, a very negligible section of the disabled have so far availed of concessions for reservation in employment, education, allotment of houses and sites, issuance of bus passes, travel tickets, etc. All those who suffer from any kind of disability beyond 40 per cent are entitled to receive certificates.
At a recently held orientation programme on corrective surgery, orthopaedic surgeons felt the reasons for lack of interest to receive guidelines to issue certificates was the procedure was exhaustive and time consuming.
“The guidelines to issue certificates run into 100 pages. The one-day camps being organized by the Department of the Welfare of the Disabled expects surgeons to issue certificates to about 2,000 disabled in a spa of a few hours,” doctors complained, adding that calculations to find out whether patients suffer from 40 per cent disability was complicated.
Software. Two Bangalore-based Orthopaedics- Dr. Prabhakar Murthy, medical superintendent of Bangalore Children’s Hospital, and Dr. Deepak Sharan, HOD, Pediatric Orthopaedics and Rehabilitation- have been asked to evolve a software package to simplify the procedure for issue of certificates.
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Quack, quack: beware of ‘docs’
Author: Paawana Poonacha
Bangalore, The Times of India, March 27, 2003
"I'll get to the root of your problem and swear painless, speedy treatment," a quack operating near Shantinagar assured anxious parents of nine-month-old Arfa K. who recently suffered a dislocated elbow. Several sessions of massage, applications of splints and herbal pastes followed, but the trauma only increased.
A week later, the infant’s upper limb swelled up like a balloon and she went into a coma. Doctors attending on Arfa drained out half a litre of pus from the elbow. She had also developed septic arthritis of the hips requiring another surgery.
In another case reported recently, doctors found a girl of the same age suffering from septicemia and septic arthritis of the hip because of "branding" (using hot iron rods) treatment administered by quacks.
Following conducting a series of assessment camps, Karnataka's Corrective Surgery Programme for Locomotor Disability, has reported a sudden rise in the popularity of quacks in the city.
Incidents where "fixing the bones" by quacks and delay in proper treatment by a couple of weeks, has led to a lifetime of disability. In extreme cases limbs have even had to be amputated.
"Orthopaedic Surgeons encounter numerous limb deformities resulting from failed folk healing and bone-setting," the report reads. Quacks are found to be operating in the by lanes of Shivajinagar, Kalasipalya, Yashwantpur, Cubbon Park and surrounding areas.
"Injudicious massage for injuries around the elbow leads to stiffness because of extra bone formation or to joint instability due to ligament damage following forcible manipulation. This is in addition to the risks of infection, gangrene (due to damage of blood supply), deformities or fractures that fail to join," warns Dr. Deepak Sharan, chief Resource Person, State Corrective Surgery Programme.
"Many educated and well-to-do people rationalise such treatment by stating that disciplines such as Osteopathy and Chiropractic, based on manipulation of spine and joints, are very popular in the west. Unfortunately, native practitioners undergo no systematic training and ply obscure techniques secretly handed down the ages. They have no knowledge of anatomy and they can damage nerves and blood vessels by blind manipulation," Dr. Sharan feels.
Although both children described above, made complete recoveries from a life-threatening condition, parents admitted that they sought the help of quacks due to poverty. Radhika Mandal, a charitable organisation has sponsored over 20 successful operations, including these two cases, in the last one year.
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Save your child's back
Author: Kanak Hirani Nautiyal
Bangalore Times, The Times of India, May 26, 2003
Forget about how it looks and don't choose the pink schoolbag with the Mickey Mouse. When you buy a bag for your child this year, make sure that when he packs it with his books, it's easy on his back.
Ideally, a child shouldn't carry a bag more than 10 per cent of his or her body weight. And there's a good reason. The top of the shoulder where the straps of a backpack rest is rich in nerves and blood vessels that serve much of the rest of the body- head, arms and hands, neck and back.
Excessive weight of a backpack can lead to several health problems for a child.
Seema Shah's son Manek who weighs 22 kg carries at least five kg to school. "I feel my poor boy has developed a hunch because he carries such a heavy bag. He has to carry all his textbooks and notebooks to school every day," she says.
Sseema says that she'd rather buy a sensible school bag that's easy on her son's shoulders, he won't let her. "Kids also want their bags to be fun." She suggests that schools can make things simple and have a cupboard where the students can store their textbooks. According to Dr Deepak Sharan, department of pediatric orthopaedics and rehabilitation, Bangalore Children's Hospital (BCH), next month BCH is conducting a workshop for children, teachers and parents titled Kids, Computers and Backpacks. "We have a visiting US faculty for this workshop. I believe that we need a forum to address this issue where everyone can take a concrete decision."
In schools like the Gear Foundation, things are different. According to their head, M Srinivas, children do not carry bags weighing more than a kg. "They leave most of their books in school. They only carry a small file with some papers and a comment card for the parents. Most children in other schools carry 200 page notebooks when they need just one or two pages," he says.
Ravi Ladha, local distributor for Genius bags, says since the past two years his company has manufactured bags that are easy on a child's shoulder and back. "The Orthofit bag remains on the shoulder and doesn't shiftthe stress on the vertebral column. It also fits against the curve of the back as it has been ergonomically designed." Ladha says another bag, Orthogrip, has good padding, shape and grip so that the bag straps don't dig into the skin. "Since the bag weight is a serious issue we also have school bags with trolleys," he adds.
If your child is buckling under his school bag, this is how he or she may feel: an aching in the shoulders, neck and back; tingling in the arms, wrist and hands, especially at night; noticeable imbalances in posture, including tilting of the head and neck to one side and an uneven gait; frequent headaches and poor voice quality.
Weight and watch
o Use a knapsack with well-padded straps and use both straps when carrying the knapsack
o Buy a knapsack with several compartments to better distribute the weight
o Pack heavier items near the top of the pack. That way, the legs are carrying most of the weight. Heavy items packed at the bottom of the pack put more stress on the back
o Both straps should be worn across the shoulders and upper back to equalize the weight
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'Heavy backpacks affecting children'
By Staff Reporter
Bangalore, The Hindu, July 5, 2003
Backpacks, bad postures, and computers can do enough harm to children if proper care is not taken while carrying bags to school and while working on the computer, according to experts from Bangalore Children's Hospital.
Speakers at a workshop on "Kids, backpacks and computers," organized by The Hindu under the Newspaper in Education (NIE) programme and Bangalore Children's Hospital here on Friday expressed concern over the fact hat most schoolchildren suffered from backaches, neck pains, and other musculoskeletal problems due to heavy backpacks and bad sitting postures. Around 300 children from 16 schools in Bangalore, 35 teachers, and 45 parents participated in the programme, which also discussed computer-related injuries (CRI) in children. Nandini Mundkur, Paediatrician, Bangalore Children's Hospital, stressed the need for schoolchildren to be seated in the correct posture in the classroom. She said chairs in the classroom should be of the appropriate size according to the age of the child. Students should rest their backs on the seat and the feet should touch the ground while seated.
"Schoolchildren are posed with the problem of carrying bulky backpacks to schools, and Indian students are not alone in facing this problem," Shruthi R. Iyer, Researcher from Houston, said.
According to a study conducted by her, around 49 percent of the Indian students complain of pain in the upper back, lower back, neck, and shoulders. She said there was a need to implement "pain prevention screening" in schools so that children were not subjected to the torture of carrying heavy backpacks.
Deepak Sharan, Orthopaedic Surgeon, said a lot of IT professionals suffered from CRI or repetitive strain injury (RSI), which was caused due to bad postures while sitting in front of the monitor. Children were at a high risk of developing CRI or RSI, which might cripple them at a later stage, he cautioned.
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Rehabilitate cerebral palsy patients
Author: Paawana Poonacha
Bangalore, The Times of India, November 22, 2003
What does it take to bite, chew and swallow food or what synchronises our speech as we breathe? Ask thew country's estimated 40-80 lakh children suffering from cerebral palsy (CP), a disorder causing lack of control over one's movements.
The disorder causes inter-connected disabilities due to a 'minor problem' in the brain, which could occur before, during or after birth.
Even as there are signs of phasing out polio, CP is emerging as the most common disability in the country, health experts warn.
As there is no complete cure for CP, multiple corrective surgeries and neuro rehabilitation can help patients lead a better life, a concept doctors in India are largely unaware of, they say. A report compiled for the Bangalore Children's Hospital for the state health department states that 75 per cent out of 1000 cases of locomotory disabilities evaluated in 2002-03 were found to be that of CP.
In a residential school for the disabled in Tumkur, 90 per cent of the children were found to be suffering from it. None were ambulant with or without locomotory assistive devices and many were bed-bound or wheelchair-bound.
"Most children had the potential to walk but despite promise of government funding, parents of these patients refuse to seek adequate treatment," says Dr Deepak Sharan, HoD, pediatric orthopaedics and rehabilitation, Bangalore Children's Hospital, who conducted the study.
According to him, a common advice given by most doctors is that nothing can be done medically for these children.
"Many CP patients are bluntly referred to physiotherapists who are not equipped to handle CP patients with disabilities like speech, vision, swallowing, epilepsy, mental retardation, behavioral and learning disabilities," he says.
Shortage of medical professionals trained in rehabilitation trends seems to be the reason why treatment of CP patients is lagging behind in India. "There are corrective surgeries based on current international recommendations which have shown encouraging results," says Dr Sharan.
Neuro rehabilitation of CP patients is equally dismal, if not worse, says, Dr A.S. Hegde, HoD, neurosurgery at Satya Sai Hospital. "NIMHANS offers neuro rehabilitation, while Vittal Medical College in Vellore, Armed Forces Medical College at Pune, Dr Ahluwalia's Institute of Rehabilitation at Delhi and St. John's Hospital at Bangalore offer succour to CP patients on both neuro and ortho fronts," Dr Hegde details.
Ajay Vijayaraghavan (photo) before and after surgery. On Saturday, Ajay and 30 other CP patients who have been operated upon by Dr Deepak Sharan, will have a get-together at Bangalore Children's Hospital to set up a support group.
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Heavy school bags cause musculoskeletal disorders: Study
Kochi, Daily Excelsior, August 13th, 2004
KOCHI, Aug 12: Three out of four computer professionals in India develop musculoskeletal disorders after working continously on computers and history of most of these cases are traced to their school days, a study by the Indian Academy of Paediatrics Shows. According to the survey conducted among 3,500 professionals at Bangalore alone, 75 per cent of them reported disorders and the academy was now on a massive drive to collect data from across the country. For most of them, the disorder began from their school days when they had to carry heavy backpacks, according to Dr Deepak Sharan who has been on an intense campaign for the last two years to reduce the load of school bags.
Dr Deepak, who is the head of the Department of Paediatric Orthopaedics at Bangalore Children’s Hospital and Research Centre, was in the city to conduct study among the students, parents and others. "If the current trend persists, it will be a rarity to find a pain-free adult when the present generation of school children grows up to enter the work force," he warned. According to a study in 2001, which is the only one available on Indian students, 50 per cent of them were tested positive for chronic pain due to carrying heavy backpacks. "Half of them go through a severe episode of pain at least once before they enter adulthood," he poined. Adolescents with back, neck and shoulder pain were at increased risk of experiencing chronic musculoskeletal pain, he said citing different studies abroad. "All this will have a serious impact on the productivity and thereby the economy of the nation," Dr Deepak said.
The academy had launched a national-level drive to collect data on the ill-effects of heavy backpacks and is into a campaign across the country to get the weight of bags reduced, national executive member Dr Sachidananda Kamath said. As per their findings, carrying of backpacks would change the centre of gravity in the body and would affect stability. It causes the body to lean forward and baseline oxygen consumption increases. Tiredness or muscle fatigue, swelling, pain in the head or neck, back or shoulders, muscle spasms or stiffness, numbness, curved or rounded back and altered gait could be some of the results of carrying heavy baggage. The academy had also come out with some suggestions to the schools, parents and the manufacturers of bags in this regard. The cochin chapter had recently made some schools accept their suggestions, including bags with less weight. (UNI)
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Workshop on cerebral palsy
By Staff Reporter
Kochi, The Hindu, October 19, 2004
The high cost of new technologies in medicine prevents ordinary people access to modern medical treatment, said the District Collector, A.P.M. Mohammed Hanish. Inaugurating a free surgical workshop for managing cerebral palsy in children, Mr. Hanish said it was difficult for the Government to evolve welfare schemes in the health sector because of the lack of funds. But the Government would ensure an environment for such enterprises to flourish.
The Bangalore-based expert in orthopaedics and rehabilitation, Deepak Sharan, will lead the four-day surgical camp at the Welcare Hospital. Organised by the Adarsh Institute for Cerebral Palsy and Childhood Development Disorders, the camp will select about six children below 15 years for surgery. According to the organisers, the surgery would help children with cerebral palsy to a great extent in going about their daily activities without external help.
At the inaugural function, paediatrician Abraham K. Paul, vice-chairman (Tech.) of Adarsh, introduced the team which would conduct the surgery and take follow-up action. The technical director of Adarsh, S. Ramakrishnan, welcomed the gathering. Senior orthopaedic surgeon, Sudheer Thomas, and the director of Adarsh, P.N. Narayanan, spoke on the occasion. Paediatrician Sachidananda Kamath proposed a vote of thanks.
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New surgical procedure to treat cerebral palsy
By Shyama Rajagopal
Kochi, The Hindu, October 31, 2004
There is no programme yet to manage cerebral palsy in spite of the fact it accounts for the maximum number of cases of disability in the country, said Deepak Sharan, Bangalore-based consultant in Orthopaedics and Rehabilitation. Talking to The Hindu here, Dr. Sharan said there were no parameters to measure disability in a person. Disability certificates were issued quite arbitrarily, he said. Many a time, it was noticed that disability of a person measured at one centre differed with the result from another centre, he said.
Setting parameters
Dr. Sharan, who is consultant to the Union Ministry of Social Justice and Empowerment and also the Disability Commissioner of Karnataka, said the Government had appointed a team of specialists, including developmental paediatricians, paediatric neurosurgeon, paediatric orthopaedic surgeon, physio therapist, occupational therapist and other specialists, to set parameters to define disability. The Childhood Disability Group of the Indian Academy of Paediatricians would provide the basic structure to define disability and provide a measuring yardstick. The Government also has plans to modify the definition of cerebral palsy, said Dr. Sharan, who is part of a five-member expert committee on cerebral palsy and autism under the Union Ministry. There are about 5-8 million people in the country afflicted with cerebral palsy, he said. The Spastic Society of India and other NGOs provided more of vocational training to cerebral palsy-afflicted children. Medical treatment of cerebral palsy was non-existent, he said.
He said the perception of an attack of cerebral palsy had been linked to difficult labours. But, now the theory has been extended to say that a child with disabilities could also lead to difficult labours, he added. The incidence of cerebral palsy has been measured at 2-2.5 out of 1,000 births. At a disability screening camp held in Bangalore in 2002-03, it was found that out of 1,000 disabled cases, 75 per cent of locomotor disabilities were due to cerebral palsy.
Advanced surgery
Conventional methods of correcting cerebral palsy through surgery were not generally successful, said Dr. Sharan, who has a Fellowship in Paediatric Orthopaedics from the U.K. and is also a member of the American Academy for Cerebral Palsy and Developmental Medicine. According to him, a poorly done operation is worse than no operation at all. After a five-year training in the U.K. in the most advanced technique in managing cerebral palsy called Orthopaedic Selective Spasticity Control Surgery (OSSCS) using an advanced computer aided three-dimensional analysis of muscle function, Dr. Sharan has performed about 45 surgeries in the last three years in Bangalore, all of which have boosted his confidence to make available such surgery to more people. OSSCS is not a technique but a principle devised by the Japanese orthopaedic surgeon, Takashi Matsuo, explains Dr. Sharan. About 30 muscles are involved in taking one step. In the case of a cerebral palsy-afflicted person, a few muscles fail to function. All the dysfunctional muscles in a limb need to be identified and should be corrected in a single operation, he said. It also reduces the trauma of going through a number of surgeries, he said.
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