Wednesday, August 28, 2013

सितारे चाँद को चहिये ही क्यूं

चांदनी गर है ही उसके संग-संग चहार सू,
हर घड़ी इतने सितारे चाँद को चहिये ही क्यूं।
मेरे दिल में रहने वाला चाँद कुछ मायूस है,
सोचता हूँ कुछ सितारे नोच कर लेता चलूँ।।
*चहार सू = चारों तरफ

By- Dr. Krishna N. Sharma

Monday, August 26, 2013

अकेला चना

अकेला चना भाड़ फोड़े न फोड़े आँख ज़रूर फोड़ सकता है (जी शुक्रिया शुक्रिया ;) ). So beware of the 'akela chanaz'. :D

Tuesday, August 20, 2013

Quote

यूँ ज़िन्दगी भर तुमसे दो-दो हाथ करके क्या मिलेगा? चलो दो-दो कदम कर लेते हैं। एक दूसरे से हारे भी तो क्या हुआ… दूसरों से कुछ आगे तो बढ़ेंगे।

-Dr. Krishna N. Sharma

Tuesday, August 13, 2013

Song Study:: "Ye Tune Kya Kiya..." ;)

Song: "Ye Tune Kya Kiya..."
Contraindication: Post-Breakup Syndrome.
Side-effects: Prolonged and repetitive listening=> Grief=> Frustration=> Loneliness=> Depression=> Hyperactive Lacrimal glands=> Insomnia ;) :D

Saturday, August 3, 2013

Farewell!

Farewell!

Dear Friend (?),

So many issues in d life, so much work to do, so many dreams to fulfill, so many plans to execute, so many people to satisfy. How'll I handle all this alone? You know na... how bad am I in handling stuffs... yeah... actually only you know this (remember... u used to say that my RAM is slow... may be of 256 MB).

No one is here with me... no one to share my worries... my plans... my nervousness... my happiness... my joy... my love... my excitement... n many many more. No one makes Chowmein (though I dint like it and never told you) for me every evening just to make me feel better. No one hugs me when I m very nervous (oh I still remember your hair tickling my nose). No one fights with me when I do things wrong or break a cup.

I was sick... I sprained (yeah... the right ankle... again)... I made some bingo achievements and these were the events I missed u d most. I miss sharing u things... chattering all night even after spending all day together. I still flip your book (yes... exercise therapy wali book... I had stolen it when I was leaving... sorry) n I can smell u. I still touch your old pics n I can feel u. I still read the assignments we did together and I feel we r working together. I really want to burn all this but can't... I am afraid what will I do if I miss you again.

I can't cry... coz I m a guy. I allow my tears just to drop from the corners and feel the wet pillow (yes... I have started using pillow).

We always knew that someday we'll have to say bye-bye... but so earlier (I always thought you are boring but see... these 7 years passed sooooo fast)!!!. I know we can't live together forever as we are just friends and "we will probably kill each other if married" (I know... I borrowed this phrase from you).

Actually all this... memories... stress... loneliness... missing... create a mess that I mostly fail to handle and then call you up to trouble you. U understood na Babu! I m sry to call u 'Babu'. Actually I was really dying to call u so for the last time (Though I know it makes you n me weaker).

I'ld stop writing this note without any conclusion or P.S. as my nose is dropping (I this this bloody nose is another Vibhishan after eyes, but no one notices. Oh no... we used to notice it on phone... eh... that suduk suduk sound) and my eyes has become red now. So be happy, stay safe, God bless you.

A friend?
***

Monday, July 22, 2013

चुनाव

कहीं दुश्मनों में बनाव आया है, कहीं दोस्तों में तनाव आया है,
सबके पत्ते खुल के आ रहे हैं, लगता है 'चुनाव' आया है।

© 2013 Dr. Krishna N. Sharma

Saturday, July 20, 2013

कुछ ग़लतियाँ

एक ताज़ा ख्याल पेश-ए-ख़िदमत है (क्या करें आजकल तो टेंशन में भी शेर आते हैं). 
इन दूरियों के बढ़ने से बेहतर है हम ये मान लें,
कुछ ग़लतियाँ तुमसे हुईं, कुछ ग़लतियाँ हमसे हुईं।

- Dr. Krishna N. Sharma

Monday, July 15, 2013

Quote

'Arranged Marriages' are just like the MCQs. You have options, but you don't know which one is right. All you can do is just trust on your intuition and tick the option which seems to be nice. Baaki to fir Raaaaam bharose. ;) :D

Dr. Krishna N. Sharma

Thursday, June 20, 2013

अभी बरसात बाकी है

जो ढलके थे वो आँसू थे, अभी जज़्बात बाकी हैं।
ये तो बस चंद बूँदें थी, अभी बरसात बाकी है।।

                                   - डॉ० कृष्ण एन० शर्मा

Wednesday, June 12, 2013

ऐसी की तैसी

होती हैं बातें अपनी सबके दरमियाँ कैसी?!
कौन-कौन करता है बातें कहाँ-कहाँ कैसी?!
किस-किस की जुबान खैन्चें, किसको समझाएं?!
छोड़ दिया दिल पे ही लेना, ऐसी की तैसी।

छोटी-छोटी बातों पे भी जलजला आ जाता है,
चार लोग मिलते हैं और फैसला आ जाता है,
ऐसे किसी फैसले को भाव क्यों दें,
जिसमें ना मुकदमा, न कचहरी, न कोई पेशी!

- डॉ० कृष्ण एन० शर्मा

Monday, June 10, 2013

Sunday, June 9, 2013

'बड़े अजीब हैं ये' - Dr. Krishna N. Sharma

बड़े अजीब हैं ये मुझसे ख़ार खाते हैं,
खुद ही जलते हैं खुद ही ख़ाक में मिल जाते हैं।
मुझे लगता है ये परवाने हैं तरक्की के,
जहाँ भी देखते हैं खुद ही खींचे आते हैं।
                                                      -डॉ० कृष्ण एन० शर्मा

Saturday, April 20, 2013

Cognitive Rehabilitation in MS


Cognitive Rehabilitation in MS
Author: Dr. Krishna N. Sharma. MPT (Neuro), PhD (VC)
Email: dr.krisharma@gmail.com

Cognition refers to the ‘higher’ brain functions e.g. memory and reasoning. Sometimes the MS patients associate the cognitive dysfunction to severity of physical symptoms or to duration of the disease which is actually a misbelief.1,2 Cognitive problems are one of the most frequent symptoms of MS, which is evident in about 50% of the patients.3,4 Approximately 10% to 20% patients show significant cognitive dysfunction. Symptoms may be exaggerated by underlying depression.5 The most often affected cognitive functions are - memory, attention, speed of processing, abstract reasoning, verbal fluency, and executive functions.6,7,8 Widespread deterioration of intellectual function in MS is rare.9

Why do they occur?

The Cognitive problems in MS are actually the result of demyelination in the cerebral tracts that connect with primary sensory, motor, speech, and integration areas of the cerebrum. It may result in poor recognition of deficits as well as an inability to store and retrieve new information. The combination of these two issues becomes a major obstacle in the way to rehabilitation.10

Testing Cognitive Dysfunctions:

Neuropsychological testing can assist in determining the degree of cognitive impairment in patients with MS. Wallin et al (2006) et al. categorized the tests for cognitive dysfunctions associated with MS in three main schools of thought:11

  1.  Short screening with traditional measures in a neurologist’s office i.e. BRB-N (Brief Repeatable Battery of Neuropsychological Tests). It is composed of the Buschke Selective Reminding Test, the 7/24 Spatial Recall Test, the Paced Auditory Serial Addition Test (PASAT), and the Controlled Oral Word Association Test (COWAT).12
  2.  Testing by a neuropsychologist with a minimal (but comprehensive) neurocognitive battery i.e. MACFIMS (Minimal Assessment of Cognitive Function in Multiple Sclerosis). It is composed of PASAT, COWAT, SDMT etc.13
  3. Testing with automated, computerized measures in a neurologist’s office or as part of a clinical trial i.e. ANAM (Automated Neuropsychological Assessment Metrics). It is composed of Procedural Reaction Time, Code Substitution, Sternberg Memory Search etc.14


Such an evaluation could be helpful in the following ways:

  • It can identify impaired and intact functions.
  • It will help the MS patient and the family members understand the nature and extent of the illness.
  •  It may help the person develop realistic vocational and other life goals.
  • The results can suggest compensatory techniques.


Designing Interventions:

Designing intervention is the second step of the cognitive rehabilitation. It is intended to improve the patient's ability to function in all aspects - personal, family, social, and vocation life. Since the disease is unpredictable, progressive, and fluctuating in nature and there is a complex interaction of motor, sensory, cognitive, functional, and affective impairments, it requires periodic reassessment, monitoring, and rehabilitative interventions. The therapist recognizes the deficit and includes the functionally oriented therapeutic tasks accordingly.

There are two approaches - Restorative Strategies and Compensatory Strategies, which are believed to be helpful in the cognitive dysfunctions. Since the effectiveness of Restorative Strategies to cognitive rehabilitation is largely inconclusive15, Compensatory strategies (i.e. teaching to use intact skills with/without external aids) are widely used and are suggested by most authors.

Compensatory Strategies-
  • Cognitive Structuring- The therapist applies suitable learning theory and make the patient practice the cognitive task to turn it in a routine behaviors.
  • Substitution Strategies- The therapist teaches to use the intact cognitive abilities to circumvent the impaired abilities. For example- Using intact visual memory in place of impaired verbal memory function.
  •  Scheduling and Timelines- The patients are encouraged to use schedulers and alarms.
  • Using the recording devices- It helps the patients remember and store the important details.
  • Memory strategies- The patients are taught and encouraged to use mnemonics, lists, clustering, and visualization techniques etc. to remember things.
  • Assistive Technology- The patients are advised to use handheld computers, electronic calendars, and memory logs etc.
  • Creating structured environment- It helps the patients find their things on certain fixed places to avoid the hassle in forgetting and searching things.


Restorative Strategies-

Though so many verities of therapeutic tasks/ games/ activities are available for restoring or improving cognition, there is lack of evidence-based-practice of the restorative strategies for the cognitive deficits associated with MS. There are very less researches which confirm significant improvement by the cognitive games.16,17
There are many toy games for cognitive rehabilitation e.g.- Peg Board, Puzzle-cubes, Quoridor, Tenzi, Fiddlesticks etc. But in this age of computer and technology few application softwares e.g.- COGNIsoft-I, BrainTrain, MSTY Games etc; and online cognitive rehabilitation games available on multiplesclerosis.com18, BICBrainInjuryCentre.co.uk19, Peartrees.com20, Mind360.com21 etc. are proving to be effective and easily administrable.



An MS Patient using COGNIsoft-I for Cognitive Rehabilitation

Tips:
  • The activities should be conducted in quiet places to avoid distractions.
  • The sessions should be well-designed and engaging.
  • The activity should be demonstrated first.
  • The instructions should be simple and short.
  • The activities should be carried out with the concept of Errorless Learning22 in mind. Application of the principles of Spaced Retrieval Learning,23 Story Memory Technique,24 etc. would enhance the outcome.
  • Instructions may be given in the forms of Audio/ video tape, printed material also. It would help them remembering the activities even when they are at home.
  • The exercises should be done for the shorter periods of time to avoid cognitive fatigue.
  • New skills should not be taught before the previous skill has been strongly established.

 References:
1.    Peyser JM. Edwanb KR, Poser CM, et al: Cognitive function in patients with multiple sclerosis. Arch Neurol 37:577-579, 1980
2.  Beatty WW, Goodkin DE. (1990) Screening for cognitive impairment in multiple sclerosis: An evaluation of the Mini Mental State Examination. Arch Neurol, 47, 297–301.
3.  Aronson K, G. E.; Socio-demographic characteristics and health status of persons with multiple sclerosis and their care givers. MS Management 3(1), 5-15. 1996.
4.       Lublin F, Reingold S; Defining the course of multiple sclerosis. Neurology 46(4):907-911, 1996.
5.   Debra I. Frankel; Multiple Sclerosis. DA Umphred (Ed.), Neurological Rehabilitation, The CV Mosby Company, St. Louis, pp. 714. 1995
6.  Debra I. Frankel; Multiple Sclerosis. DA Umphred (Ed.), Neurological Rehabilitation, The CV Mosby Company, St. Louis, pp. 714. 1995
7.  Rao SM, Leo GL, Bernardin L, et al: Congnitive dysfunction in multiple sclerosis. I. Grequency, patterns, and prediction, Neurology 41(5):685-691, 1991
8.    Peyser JM. Edwanb KR, Poser CM, et al: Cognitive function in patients with multiple sclerosis. Arch Neurol 37:577-579, 1980
9.       Lublin F, Reingold S: Defining the course of multiple sclerosis. Neurology 46(4) :907-911, 1996.
10. Debra I. Frankel; Multiple Sclerosis. DA Umphred (Ed.), Neurological Rehabilitation, The CV Mosby Company, St. Louis, pp. 728. 1995
11.   Wallin et al. Cognitive dysfunction in multiple sclerosis. JRRD, Volume 43, Number 1, 63-71. 2006
12. Rao SM, Leo GJ, Bernardin L, Unverzagt F. Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology. 1991;41(5):685–91.
13.   Benedict RH, Fischer JS, Archibald CJ, Arnett PA, Beatty WW, Bobholz J, Chelune GJ, Fisk JD, Langdon DW, Caruso L, Foley F, LaRocca NG, Vowels L, Weinstein A, DeLuca J, Rao SM, Munschauer F. Minimal neuropsychological assessment of MS patients: a consensus approach. Clin Neuropsychol. 2002;16(3):381–97.
14. Wilken JA, Kane R, Sullivan CL, Wallin M, Usiskin JB, Quig ME, Simsarian J, Saunders C, Crayton H, Mandler R, Kerr D, Reeves D, Fuchs K, Manning C, Keller M. The utility of computerized neuropsychological assessment of cognitive dysfunction in patients with relapsing-remitting multiple sclerosis. Mult Scler. 2003;9(2):119–27.
15.    O’Brien AR, Chiaravalloti N, Goverover Y, Deluca J. Evidenced-based cognitive rehabilitation for persons with multiple sclerosis: a review of the literature. Arch Phys Med Rehabil 2008;89(4):761–9.
16. Chooi, Weng-Tink; Thompson, Lee A. (2012). "Working memory training does not improve intelligence in healthy young adults". Intelligence 40 (6): 531–42.
17.    Redick, T. S.; Shipstead, Z.; Harrison, T. L.; Hicks, K. L.; Fried, D. E.; Hambrick, D. Z.; Kane, M. J.; Engle, R. W. (2012). "No Evidence of Intelligence Improvement After Working Memory Training: A Randomized, Placebo-Controlled Study". General J Exp Psychol Gen. 2012 Jun 18.
18.    http://www.multiplesclerosis.com/us/index.php
19.    http://www.bicbraininjurycentre.co.uk
20.  http://www.pearltrees.com/#/N-play=0&N-s=1_4127047&N-u=1_487865&N-p=44503368&N-f=1_4127047&N-fa=4055621
21.    http://www.mind360.com/games
22.   Wilson BA, Baddeley A, Evans J, et al. Errorless learning in the rehabilitation of memory impaired people. Neurospsychol Rehabil 1994; 4(3): 307–26.
23.  Heesen C, Kasper J, Segal J, et al. Decisional role preferences, risk knowledge and information interests in patients with multiple sclerosis. Mult Scler 2004; 10: 1–8.
24.   Camp CJ, Foss JW, O’Hanlon AM, et al. Memory interventions for persons with dementia. Appl Cog Psychol 1996; 10: 193–210.

Sunday, February 17, 2013

31 Books Published on Same Day

Hi Friends,

I am verrrry exccccccccccccited and thrilled to inform you that 31 books of mine have been published on same day- Feb.16, 2013.

The list is given below. Click on the title to redirect to the amazon's purchase links:


  1. Acupressure for Alcohol Addiction Made Easy
  2. Acupressure for Allergies Made Easy
  3. Acupressure for Alzheimer's Disease Made Easy
  4. Acupressure for Backache Made Easy
  5. Acupressure for Cerebral Palsy Made Easy
  6. Acupressure for Cervical Slipped Disc Made Easy
  7. Acupressure for Cervical Spondylosis Made Easy
  8. Acupressure for Dementia Made Easy
  9. Acupressure for Diabetes Made Easy
  10. Acupressure for Drug Addiction Made Easy
  11. Acupressure for Epilepsy Made Easy
  12. Acupressure for Head Injury Made Easy
  13. Acupressure for Headache Made Easy
  14. Acupressure for Hemiplegia Made Easy
  15. Acupressure for Impotence Made Easy
  16. Acupressure for Infertility Made Easy
  17. Acupressure for Lumbar Slipped Disc Made Easy
  18. Acupressure for Lumbar Spondylosis Made Easy
  19. Acupressure for Migraine Made Easy
  20. Acupressure for Motor Neuron Disease Made Easy
  21. Acupressure for Muscular Dystrophy Made Easy
  22. Acupressure for Myasthenia Gravis Made Easy
  23. Acupressure for Neck Pain Made Easy
  24. Acupressure for Obesity and Weight Loss Made Easy
  25. Acupressure for Schizophrenia Made Easy
  26. Acupressure for Sciatica Made Easy
  27. Acupressure for Smoking Addiction Made Easy
  28. Acupressure for Stroke Made Easy
  29. Acupressure for Tics Made Easy
  30. Acupressure for Tinnitus Made Easy
  31. Acupressure for Trigeminal Neuralgia Made Easy