Aynur Basaran

The Effect(s) of a Six-Week Home-Based Exercise Program on the Respiratory Muscle and Functional Status in Ankylosing Spondylitis

Background:Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. Involvement of costovertebral and costotransverse joints results in rigidity of the chest wall and inability to expand the chest fully on inspiration. Also significant reduction in exercise capacity in the AS patients was reported. Objectives:To determine the effects of a 6-week home-based exercise program on the respiratory muscle and energy cost in AS. Methods:Twenty-two AS patients were included. Chest expansion, tragus-wall distance, modified Schober test, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking distance, physiologic cost index and functional status Bath Ankylosing Spondylitis Functional Index of patients were measured at baseline and repeated at the end of an open 6-week home-based exercise program. Breathing exercises and upper extremity exercises were taught to all the patients. The patients were then asked to practice these exercises at home individually for 6 weeks. Results:Chest expansion, maximal inspiratory pressure, and maximal expiratory pressure values and Bath Ankylosing Spondylitis Functional Index scores of patients significantly increased after 6 weeks (P < 0.001). Six-minute walking distance and physiologic cost index values did not change at the end of the 6 weeks (P > 0.05). Conclusions:A home-based exercise program can have an effect on some measures respiratory muscle and functional status. Greater emphasis should be placed on maintaining cardiorespiratory fitness as well as spinal mobility to encourage patients with AS.

Is osteoporosis generalized or localized to central skeleton in ankylosing spondylitis

Background:Osteoporosis at the lumbar spine and at the femur is a well-established complication in ankylosing spondylitis (AS), but the exact mechanism and the distribution of osteoporosis are not known absolutely. Objective:To determine whether the osteoporosis is generalized or localized to central skeleton and to examine the relation between bone mineral density (BMD) and disease activity and radiologic progression in patients with AS. Methods:In this study, 26 patients with AS and 33 healthy controls matched for age and sex were recruited to the study. Hip and forearm BMD were measured by dual energy X-ray absorptiometry (DEXA). Laboratory and clinical disease activity parameters were documented, and anteroposterior sacroiliac radiographs were taken to determine the radiologic progression. Results:The urine deoxypyridinoline levels of the patients with AS were statistically significantly higher (P = 0.02) and the serum osteocalcin levels were significantly lower with respect to controls (P = 0.03). The femoral neck and femur BMD values and T scores were significantly lower in patients with AS compared with the controls (P = 0.019, 0.003, 0.01, and 0.01, respectively). The differences in BMD values and T scores of the distal 1/3 radius between 2 groups were not statistically significant. The relation between BMD and disease activity, and radiologic progression in patients with AS could not detected. Conclusion:Sparing of distal regions such as the as radius suggests that osteoporosis might be due to localized effects of inflammatory activity or immobility rather than a systemic effect. Both increased resorption and decreased formation might be involved in the pathogenesis of osteoporosis. Radius BMD may not be appropriate to evaluate bone loss in patients with AS.

Hand Splinting for Poststroke Spasticity: A Randomized Controlled Trial

Abstract Purpose: To determine the effect of volar and dorsal splinting on the spasticity of the wrist flexor muscles in patients who had stroke. Method: Thirty-nine subjects were prospectively randomized to use a dorsal or volar splint or no splint (control group). All the patients underwent home-based exercise program, and the experimental groups used either dorsal or volar hand splints according to their distribution. The primary outcome measure was spasticity assessed clinically by the Modified Ashworth Scale (MAS) and electrophysiologically by H latency and Hmax:Mmax ratio of flexor carpi radialis. Secondary outcome measure was passive range of motion (PROM) of wrist extension. Results: Spasticity parameters (MAS, H latency, Hmax:Mmax ratio) and wrist PROM were not significantly different among the groups. Conclusions: This study failed to demonstrate any statistically significant difference in spasticity or in wrist PROM of both the volar and dorsal splint groups. These splints could be recommended as part of an integrative approach without expecting a major clinical effect rather than as an alternative to other treatment.

Biering-Sorensen test scores in coal miners.

OBJECTIVES Biering-Sorensen test is an isometric back endurance test. Biering-Sorensen test scores have varied in different cultural and occupational groups. The aims of this study were to collect normative data on Biering-Sorensen holding times, to determine the discriminative ability of the Biering-Sorensen test in Turkish coal miners, and to examine the association between Biering-Sorensen test result and functional disability. METHODS One hundred and fifty male coal miners participated in this study. Trunk extensor muscle strength was measured using the Biering-Sorensen test. Oswestry disability index was used to measure the functional disability level of low back pain. RESULTS The mean Biering-Sorensen holding time for the total subject group was 107.3+/-22.5s. The mean time of Biering-Sorensen test of the subjects with and without low back pain were 99.9+/-19.8 and 128.6+/-15.2 s, respectively. The difference between the subjects with and without low back pain was statistically significant (p<0.001). There was a statistically significant negative correlation between Oswestry functional disability score and Biering-Sorensen holding time (r=-0.824, p<0.001). CONCLUSIONS Turkish coal miners have low mean back extensor endurance holding times. Biering-Sorensen test had a good discriminative ability in our study group. Trunk muscle strength has a significant effect on the disability level of low back pain. Thus trunk muscle endurance training exercise therapy may be effective for the reduction of disability in patients with low back pain.

Functional Outcomes of Multilevel Botulinum Toxin and Comprehensive Rehabilitation in Cerebral Palsy

The objective of this study was to measure the effect of lower extremity multilevel botulinum toxin A injections and comprehensive rehabilitation on spasticity and to determine the functional gains in ambulatory children with cerebral palsy. Sixteen ambulatory children with spastic cerebral palsy (9 hemiplegic, 7 diplegic), aged between 3 and 8 years, who were able to walk with or without assistance (Gross Motor Functional Classification System I-III) were recruited to the study. Botulinum toxin A injections were applied to a total of 23 extremities, followed by a comprehensive rehabilitation program. Walking distance and walking speed (evaluated by the Six-Minute Walk Test) were significantly improved after treatment. Similarly, scores on the Observational Gait Scale (assessed by video gait analysis) increased significantly. Improvements in muscle length, spasticity, and selectivity were recorded. Reduced muscle spasticity after botulinum toxin A injections in children with cerebral palsy, with a comprehensive rehabilitation program, enabled clinically relevant improvements in functional ability.

SoMAToSENSoRy EvokEd PoTENTIALS oF HANd MuSCLES IN STRokE ANd THEIR ModIFICATIoN by boTuLINuM ToxIN: A PRELIMINARy STudy

OBJECTIVE To determine the effect of botulinum toxin A on spasticity and somatosensory evoked potentials of hand muscles in patients who have undergone cerebrovascular accident. DESIGN Preliminary, prospective, before-after study design. PATIENTS Six subjects prospectively followed after application of botulinum toxin A in the rehabilitation department of a university hospital. METHODS All patients underwent botulinum toxin A injection to the upper extremity muscles in varying combinations and carried out a home-based exercise programme. Primary outcome measure was median somatosensory evoked potential of hand muscles (N20). Secondary outcome measures were: spasticity assessed clinically by Modified Ashworth Scales (MAS); functional ability analysis assessed by Physicians Rating Scale (PRS); and functional difficulties reported by patients or their care-givers by patient disability and care-giver burden rating scale (PD & CBRS). RESULTS MAS, PRS and PD & CBRS improved with botulinum toxin A treatment. In the affected limb, N20 potentials were impaired compared with those in the unaffected side. With botulinum toxin A treatment, although improvement in overall N20-P25 amplitudes was significant, as a result of limited sample size, post hoc pair-wise comparisons with Bonferroni correction failed to yield any significant pairs. CONCLUSION The improvement in the median somatosensory evoked potentials following botulinum toxin A treatment suggests that central somatosensory patterns in hemiplegia can be modified by peripheral inputs.

A new modification of KAFO for assistance in knee extension

In this paper, a dynamic knee – ankle – foot orthosis (KAFO) extension assisted with elastic support, has been described which contributes to stance phase stability and swing phase freedom. The temporal distance factors including velocity, cadence, stride length, and clinical gait assessment score (CGAS) with bare foot and orthosis have been documented. The orthosis enables walking without fully immobilizing the knee.