Asuman Doğan

The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial

Purpose. To investigate the effect of functional electrical stimulation (FES) for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients. Method. A total of 50 hemiplegic patients with shoulder subluxation and shoulder pain were included in the study. The patients were randomly divided into the study and control groups. All patients were put on a rehabilitation program using conventional methods while the study group patients were additionally applied FES to supraspinatus and posterior deltoid muscles. The shoulder pain of all patients during resting, passive range of motion (PROM) and active range of motion (AROM) was measured with the visual analog scale (VAS) while the shoulder subluxation levels were evaluated with the classification developed by Van Langenberghe and by using the millimetric measurements on anteroposterior shoulder X-ray before and after the physical treatment and rehabilitation program and compared. Results. Comparison of the resting AROM vs. PROM VAS value changes showed no significant difference between the groups. There was a significant difference between the two groups for the amount of change in shoulder subluxation in favor of the study group. Conclusions. The results of our study have shown that applying FES treatment to the supraspinatus and posterior deltoid muscles in addition to conventional treatment when treating the subluxation in hemiplegic patients is more beneficial than conventional treatment by itself.

Effects of functional electrical stimulation on trunk control in children with diplegic cerebral palsy.

Purpose: This study aimed to investigate the efficiency of FES application on the abdomen-posterior back muscles in children with CP that were enrolled into physical therapy and rehabilitation (PTR) program. Method: The study included 55 spastic diplegic children that were hospitalized for rehabilitation. Those with deformities that could disrupt the balance in sitting and cause problems in evaluations were excluded. The patients were randomly divided into two equal groups according to their time of presentation. Thirty-two children completed the study. The control group received PTR program only for 4 weeks. The children in the FES group received PTR in addition to electrical stimulation. Electrical stimulation was applied 5 days a week for 4 weeks to abdomen-posterior back muscles in 30-minute-long sessions. To evaluate the balance in sitting, sitting score of gross motor function measurement (GMFM) and to evaluate the trunk asymmetry in sitting, radiographic measurements were used. Thus, kyphosis, Cobb and sacral angles were measured. Results: The comparisons of the measurements of the two groups before and after the treatment showed that the GMFM sitting score and the sacral angle were statistically significantly increased, and the kyphotic and Cobb angles were statistically significantly decreased. After the treatment, both groups demonstrated an increase in the GMFM score, but the increase in the FES group was statistically significantly higher than that in the control group. With respect to radiological measurements, the changes observed in both the kyphotic and Cobb angles after the treatment were statistically significantly higher in the FES group than in the control group. The rates of the changes in the sacral angle did not differ among the groups. Conclusion: We believe to provide balance in sitting for children with CP, FES applied on abdomen-back muscles along with conventional therapy to maintain trunk control is more effective than conventional therapy alone. Implications for Rehabilitation FES is used to increase the muscle strength and improve functions. When used in children with CP, FES application on the abdomen-posterior muscles reduces cobb and kyphosis angles and increases sitting balance. It is well-tolerated by children with CP and offers positive contributions to rehabilitation program.

Is age or the body mass index (BMI) more determinant of the bone mineral density (BMD) in geriatric women and men

The objective was to determine the effect of the body mass index (BMI) and age on the bone mineral density (BMD) in geriatric women and men. 900 geriatric patients were included in the study. BMD was measured in the right femoral neck and the antero-posterior lumbar region. All geriatric patients were classified in 1 of 4 categories on the basis of their BMI, as underweight, ideal weight, overweight, and obese. They were separated into three groups, 65-74, 75-84 and 85 and older, according to age groups. While a significant relationship was only determined between the femoral BMD measurements and the BMI in men; significant relationship was shown between both the lumbar and the femoral BMD measurements and the BMI in women. Significant relationship was also determined between the femoral BMD measurements and the BMI and age among women. While the BMDs of those aged 65-74 years group were found to be high compared to those aged 75-84 years and those aged 85 years and older groups, no difference was found between the two groups. This study confirms the effect of a high BMI on femoral neck and L2-L4 BMD among older men and women, but the effect of age was not shown above 75 years of age.

A Multicenter Pilot Study of Burden Among Caregivers of Geriatric Rehabilitation Patients with Neuromusculoskeletal Diseases

Purpose: In this study, we aimed to describe the sociodemographic characteristics of caregivers of patients in a geriatric unit and to clarify the relationship between caregiver burden and specific clinical variables in the patients and the characteristics of the caregivers. Design: Cross-sectional multicenter study. Methods: One hundred twenty-three patients and 123 caregiver dyads, with mean ages of 72.5 ± 7.7 years and 51 ± 14.7 years, respectively, were included. The functional, psychological, and cognitive statuses of the patients were determined, and the sociodemographic characteristics of the caregivers as well as the type and duration of caregiving were recorded. Caregivers completed the Caregiver Burden Inventory (CBI) to measure the perceived burden of care. Most patients were female and generally lived with their family. Findings: Most of the caregivers were family members (90%), female (73.2%), primary school graduates (52.8%), and first-degree relatives (73.1%). The average CBI score was 33, and the highest CBI subscores were for time, developmental, and physical burdens. Caregiver burden correlated with the patient’s ambulatory, psychological, and cognitive status and with the caregiver’s age, gender, income level, and duration of caregiving. Conclusions: We have highlighted the relationship between caregiver and patient characteristics in a cohort of elderly Turkish patients with neurological and musculoskeletal disorders. In particular, we have highlighted the heavy caregiver burden in a developing country. Clinical Relevance: Our results may guide the nurses to understand the requirements of caregivers and to help them find suitable resources that would meet their needs to cope with their burden.

The Effect of the Stroke Etiology on Functional Improvement in our Geriatric Hemiplegic Patients

OBJECTIVE We aimed to determine the effect of the cerebrovascular accident etiology in the geriatric patients with hemiplegia included in our physical medicine and rehabilitation program on functional improvement. METHODS A total of 46 geriatric patients with hemiplegia attending the inpatient physical medicine and rehabilitation program were included in the study. The patients were divided into two groups-thromboembolic vessel disease (TEVD) and intracerebral hemorrhage (ICH)-depending on the cerebrovascular accident etiology. The daily living activities of the patients in both groups were evaluated using the Barthel Index (BI) and the ambulation levels were evaluated using the Functional Ambulation Classification (FAC) at admittance and at discharge from hospital. RESULTS There was a statistically significant difference between admission and discharge BI values in both groups. There was no significant difference between the admission and discharge BI scores of the TEVD and ICH groups. For both groups, on admission there were 19 (82.5%) patients at the FAC 0, 1, and 2 levels, and 4 (17.3%) patients at the FAC 3 and 4 levels. On discharge there were 11 (47.8%) patients in the TEVD group at the FAC 0 and 2 levels, and 12 (52.1%) patients at the FAC 3, 4, and 5 levels; whereas in the ICH group there were 8 (34.7%) patients at the FAC 0, 1, and 2 levels, and 15 (65.2%) patients at the FAC 3, 4, and 5 levels. CONCLUSIONS We found that the disease etiology did not influence the rehabilitation results for our geriatric patients with hemiplegia attending a physical medicine and rehabilitation program following TEVD or ICH.

Can kinesio tape be used as an ankle training method in the rehabilitation of the stroke patients

OBJECTIVE To investigate the effects of the kinesio tape application to the tibialis anterior on rehabilitation outcomes of the stroke patients. DESIGN AND SETTING Twenty patients with stroke were allocated into two groups: the first group of ten patients was assigned to receive kinesio tape in addition to the conventional rehabilitation program while a second group of 10 patients was assigned to receive a conventional rehabilitation program only. MAIN OUTCOME MEASURES The clinical variables and health-related quality of life (HRQoL) were evaluated at baseline and at the end of the forth week. RESULTS The present study showed that kinesio tape application to the tibialis anterior has significant effects on motor recovery of the lower extremity, spasticity, ambulation capacity, HRQoL and gait compared to the control group and baseline. CONCLUSIONS The results of this study suggest that kinesio tape can be used as an ankle training method.

Developmental age and motor function levels in children with cerebral palsy

We determined the developmental level of 107 children (mean age, 66.41 ± 32.92 mo) with cerebral palsy in an inpatient rehabilitation program and assessed both the difference between calendar age and developmental age and the effect of developmental level on motor function improvement. The Denver II test was used to reveal the difference between calendar age and developmental age, and we determined whether there was a statistically significant difference between the admission and discharge motor function measurements of the subjects. The effect of the Denver II developmental levels of language, fine-motor, personal-social, and gross-motor skillson motor function was investigated. Wefound a statisticallysignificant difference between thedevelopmental levelsandcalendar agesof thestudy subjects. Denver II testresultsrevealed astatisticallysignificant difference between the personal-social, gross-motor, and fine-motor levels of the subjects. We found no difference only between personal- social and language levels. Gross-motor development was the most delayed value by calendar age. Regardless of developmental level, there was a statistically significant difference between motor activity levels at admission and discharge as revealed by the Gross-motor Functional Classification System and the Gross-motor Function Measure. The developmental ages of the subjects were much lower than their calendar ages. We concluded that the Denver II language and fine-motor developmental level did not have an effect on functional gains but that the subjects with good personal-social and gross-motor function developmental levels exhibited relatively better motor function gains at the time of discharge.