Use of an Individualized Relaxation Technique Using Raga Darbari for Rehabilitation of Pediatric Spinal Cord Injury: A Case Report - Open Journal ...
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3910 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3
Use of an Individualized Relaxation Technique Using Raga
Darbari for Rehabilitation of Pediatric Spinal Cord Injury: A
Case Report
Pallavi Rameshwar Palaskar1, Namrata Sant2
1
Assistant Professor, 2Clinical Therapist, MGM School of Physiotherapy, Aurangabad
Abstract
Introduction:- A 14 years old male child with spinal cord injury faced great difficulties during transition
and walking with HKFO and walker due to autonomic dysreflexia.
Methods: - A child with thoracic D3-D9 spinal cord injury was included in the study .After discharge
from hospital; he came to physiotherapy OPD regularly. He had achieved sitting with support by 9-10
weeks, floor to bed transitions by 11-12 weeks, sit to stand with HKAFO with walker and parallel bar by 12
weeks, walking with walker with HKFO (indoor) BY 13 weeks. During the transitions he was suffering from
raised blood pressures and palpitation and flushes. Fluctuation in vitals indicated episodes of autonomic
dysreflexia. But day by day he was having less tolerance to therapy and he had started losing confidence
in performing transitions and wheel chair rehabilitation, an individualized relaxation therapy Raga Darbari
of Indian classical music in instrumental form of FLUTE to induce relaxation in him. Post physiotherapy
and post transitions, child was given relaxation for 20-25 minutes and vitals were recorded pre and post
relaxation therapy on day 1 and after last session of 4 weeks of relaxation therapy.
Results: - Post 4 weeks of relaxation therapy the child has more stable vital parameters after the transitions,
gait training. Frequency of episodes of autonomic dysreflexia was also reduced.
Conclusion:- An individualized relaxation therapy using Raga Darbari of Indian Classical music in the
instrumental form has given satisfactory results for autonomic dysreflexia
Keywords: Pediatric spinal cord injury, individualized relaxation, Raga Darbari
Introduction hour to reach him to the hospital .After admission to the
hospital roentography, MRI and CT scan investigations
A14 year old male child studying higher secondary
were done where it was diagnosed to have spinal cord
schooling that came to farm after school and had fallen
injuries with D3-D9 pedicel and lamina fractures. He
from the top of the tree on outstretched hands. After fall
also suffered fracture lower end of radius on right side.
child was unconscious for short duration and regained
Next day he was operated for D3-D6 spinal fixation
consciousness immediately, later he felt pain in the chest
and K wire fixation for lower end of radius. The child
and was unable to move lower trunk and both the lower
was having paraplegia with loss of bowel and bladder
extremities. As the child was in rural area, it took an
control. He was unable to do self catheterization
Corresponding author Methods
Dr Rinkle Malani
A child with thoracic D3-D9 spinal cord injury was
Department -Professor and principal, MGM School of
included in the study .After discharge from hospital, he
physiotherapy, Aurangabad.
came to physiotherapy OPD regularly, he had achieved
drrinklemalani@gmail.com
good transitions from bed to wheelchair in 14 weeks,
Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 3911
floor to bed in 16 weeks and sit to stand with HKAFO treatment at time if he feels uncomfortable. Consent was
in 18 weeks .During transitions he was suffering raised taken from parents. On Day 1 of relaxation therapy, pre
blood pressures and palpitation and flushes. As after treatment heart rate, respiratory rate and blood pressures
spinal cord injury, he has put on 5 kgs of weight that were recorded. Episodes of autonomic dysreflexia were
was also a hurdle in transitions for him. A well guided also recorded on Day 1 of relaxation therapy. Then a
diet plan under the supervision of a dietician was started soothing instrumental FLUTE music in the form of Raga
for him. Fluctuation in vitals indicated episodes of Darbari was started for 20 minutes. He was asked to relax
autonomic dysreflexia. Pre and post vital were assessed and imagine himself comfortable and smiling. After 20
during all treatment sessions to avoid any life threatening minutes he was made aware about his surroundings.
episodes of autonomic dysreflexia(1) .But day by day he Then he was asked to rub both the palms, make them
was having less tolerance to therapy and he had started warmer and keep hands on eyes and later open the eyes.
losing confidence in performing transitions and wheel Post treatment parameters were recorded. Treatment
chair rehabilitation. He was on medications to reduce was given for 4 weeks once in a day. In the last session
anxiety but still there were episodes of autonomic pretreatment post treatment parameters were recorded.
dysreflexia. So we have structured an individualized Episodes of autonomic dysreflexia were recorded at end
relaxation technique for him. As the child was playing of 4 weeks of relaxation therapy.
Tabala prior and fond of music so it was easy to connect
him to music to induce relaxation, so we have introduced Results
Raga Darbari of Indian classical music in instrumental Pre relaxation therapy, heart rate ,respiratory rate
form of FLUTE to induce relaxation in him. Post ,blood pressures and episodes of autonomic dysreflexia
physiotherapy and post transitions, child was given were recorded and compared with these parameters
relaxation for 20-25 minutes and vitals were recorded recorded immediately after one session of relaxation
pre and post relaxation(2,3). .At the end of 4 weeks of relaxation therapy ,theses
parameters were recorded before and after the session of
Relaxation therapy protocol
relaxation therapy and compared . Pre session parameters
After the physiotherapy session, the child was made on Day 1and at the end of 4 weeks were compared and
to sit for 10-15 minutes later he was made to lie down post session parameters were also compared. It has been
on bed. Then he was explained about the treatment and observed that vitals were getting stabilized at the end of
its benefits and was told that he was free to stop the 4 weeks of relaxation therapy.
Table ;-1 -Day 1 of relaxation therapy pre and post treatment vitals
Parametres Before RT pre t/t Before RT post T/t
Heart rate 90 80
Respiratory rate 24 22
Blood pressures 170/90 160/80
Episodes of autonomic dysreflexia 33912 Indian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3
Here, converging evidence for the modulatory
role of chronic psychological stress in the recovery
process following spinal cord injury (SCI) is presented
(5). Here comes the role of the relaxation techniques
but again these treatments must be planned according
to need and interest of the child .As mentioned in this
case study we knew that the child has interest in music
so we have planned accordingly and that’s why we got
more cooperation from the child. Initially the child was
reluctant to each new activity or exercises introduced to
.
him but as we took his interest as a treatment then he
started cooperating.
Relaxation treatment has been proved to have the
effects opposite to that of stress. That means if stress
is disturbing the physiological stability then relaxation
technique may be helpful to provide the physiological
stability .The completely relaxed individual is
having reduced sympathetic activity and increased
parasympathetic activity(4).
In the later stages of rehabilitation other stressful
Discussion situations will occur. In fact, throughout his life a spinal
The individuals with spinal cord injury are under cord injured person must cope with many stressful
high levels of stress(7) .This becomes more challenging situations in an able-bodied designed world, as well
in case of adolescent age where child has started as with social attitudes of rejection and coldness.
understanding everything. They feel more distressed Appropriate coping strategies must be learned (4).
when they find they cannot perform the activities which
Relaxation techniques applied flexibly and adapted
other children of their age can do. So handling this stress
to the physical and emotional situation of the patient
with episodes of autonomic dysreflexia becomes more
throughout the rehabilitation process, can prove useful
challenging. Many researches are supporting that the
for a great variety of patients. Relaxation therapy
social environment triggers changes to the psychological
may prove to be beneficial as an adjunct therapy for
stress response and glucocorticoid receptor functions (5).
rehabilitation of a person with spinal cord injury. (4)
Autonomic dysreflexia (AD) is a serious
The post treatment vitals of patients were compared
cardiovascular disorder in patients with spinal cord injury
in this case study,it has been found that heart rate
(SCI). The cause of AD is loss of supraspinal control
,respiratory rate ,blood pressures are getting stabilized
over sympathetic preganglionic neurons (SPNs) caudal
after the treatment with relaxation therapy for 4 weeks.
to the injury, which renders the SPNs hyper-responsive
A single session response indicated that the heart rate,
to stimulation. Central maladaptive plasticity, including
respiratory rate and blood pressures were dropped down
C-fiber sprouting and propriospinal fiber proliferation
to accepted range after relaxation therapy. As researcher
exaggerates noxious afferent transmission to the SPNs,
have found that Music therapy in the form of Indian
causing them to release massive sympathetic discharges
classical music as Raaga Darbari may be useful to induce
that result in severe hypertensive episodes. In parallel,
relaxation(2).So the results we got can be justified based
upregulated peripheral vascular sensitivity following SCI
on the results supported in above mentioned research.
exacerbates the hypertensive response by augmenting
gastric and pelvic vasoconstriction.(6) So relaxation technique with Music therapy in theIndian Journal of Forensic Medicine & Toxicology, July-September 2021, Vol. 15, No. 3 3913
form of Indian classical music as Raaga Darbari in the level and person factors. Rehabilitation Psychology.
form of instrumental music of flute may prove to be 2002 Nov;47(4):415.
beneficial to these individuals. 4. Curcoll ML. Psychological approach to the
rehabilitation of the spinal cord injured: the
Ethical Clearance- Taken from institutional
contribution of relaxation techniques. Spinal Cord.
committee
1992 Jun;30(6):425-7.
Source of Funding- Self 5. Maldonado Bouchard S, Hook MA. Psychological
stress as a modulator of functional recovery
Conflict of Interest - Nil
following spinal cord injury. Frontiers in neurology.
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training in spinal cord injury: Importance of injuryYou can also read
