Bilge Yilmaz

Platelet-Rich Plasma Injections in the Treatment of Chronic Rotator Cuff Tendinopathy A Randomized Controlled Trial With 1-Year Follow-up

Background: Rotator cuff tendinopathy (RCT) is a significant source of disability and loss of work. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of RCT. Purpose: To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic were included in this placebo-controlled, double-blind randomized clinical trial. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week standard exercise program. Outcome measures (Western Ontario Rotator Cuff Index [WORC], Shoulder Pain and Disability Index [SPADI], 100-mm visual analog scale [VAS] of shoulder pain with the Neer test, and shoulder range of motion) were assessed at baseline and at 3, 6, 12, and 24 weeks and 1 year after injection. Results: Comparison of the patients revealed no significant difference between the groups in WORC, SPADI, and VAS scores at 1-year follow-up (P = .174, P = .314, and P = .904, respectively). Similar results were found at other assessment points. Within each group, the WORC, SPADI, and VAS scores showed significant improvements compared with baseline at all time points (P < .001). In the range of motion measures, there were no significant group × time interactions. Conclusion: At 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.

Medical complications, physical function and communication skills in patients with traumatic brain injury: a single centre 5-year experience.

Objective: The aim of this retrospective study was to review the medical complications of patients with traumatic brain injury (TBI) who were followed in 2000–2006. Methods and procedures: The demographic data, functional and cognitive status of 116 persons with TBI were noted. The presence of communication problems, swallowing disturbances, urinary and faecal incontinence, pressure ulcer, deep venous thrombosis (DVT), post-traumatic seizure (PTS) and heterotopic ossification (HO) were recorded at first admission and follow-up. Main outcome and results: This study detected aphasia in 19.0%, dysarthria in 30.2%, dysphagia in 17.2%, pressure ulcers in 6.9% and DVT in 2.6% the our patients with TBI. Urinary and faecal incontinence on admission were 32.7% and 26.7%, respectively. Patients with incontinence had poorer cognitive function than those with normal continence. HO rate was 18.1% and the ambulation levels of patients with HO were worse than those without HO. PTS was seen in 13.8% of the patients on admission and this ratio increased to 21.6% during the follow-up. In these patients, the aetiological risk factors for PTS were gunshot and fall injuries. Conclusions: Considering the wide spectrum of complications, this study advocates that these persons with TBI should be followed promptly by a multidisciplinary team.

Energy expenditure of walking with prostheses: Comparison of three amputation levels

Amputee patients spend more energy during walking than able-bodied persons. It is generally accepted that more proximal amputation is associated with more energy need. However, the picture is not clear, especially for partial foot amputees. The purpose of this study was to compare the energy consumption of walking in traumatic unilateral amputees with three different amputation levels (trans-femoral, trans-tibial and partial foot amputations). Sixty-four male unilateral traumatic amputees participated in this study. Energy expenditure during walking was measured for four different speed and slope combinations: 1.5u2009km/h and 0° slope, 3u2009km/h and 0° slope, 1.5u2009km/h and 5° slope, 3u2009km/h and 5° slope. Mean O2 consumption (ml/kg/min) of the last 2u2009min of each 5-min session was calculated. In all four combinations, energy expenditure of trans-tibial amputees was the lowest, and energy expenditure of trans-femoral amputees was the highest. Statistical significance, however, could not be obtained for the differences among the groups. In conclusion, walking of partial foot amputees does not seem to be more energy efficient than that of higher level amputees.

The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury.

Abstract Objective To investigate the analgesic effect of repetitive transcranial magnetic stimulation (rTMS) on intractable neuropathic pain in patients with spinal cord injury (SCI). Design A single center, prospective, randomized, double-blinded, controlled study. Setting SCI rehabilitation unit of university rehabilitation center. Participants Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012. Interventions Ten daily treatment sessions of real or sham rTMS (30 trains of 10-Hz stimuli for a duration of 5 seconds; a total of 1500 pulses at intensity equal to 110% of the resting motor threshold) was applied over vertex using a figure-of-8-shaped coil. Outcome measures Pain was assessed with visual analog scale (VAS) at baseline and 10 days, 6 weeks and 6 months after the treatment. Patients’ satisfactions obtained using a 5-point Likert scale at 6 months. Results Both real and sham rTMS provided a significant reduction in the VAS scores (real rTMS group, P = 0.004; sham rTMS group, P = 0.020). Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS group. Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point (P > 0.05). Conclusion Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo. However, middle-term (over 6 weeks) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size.

Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial

Objective: To determine which injection technique was effective for patients with hemiplegic shoulder pain. Design: Randomized prospective double-blind study. Setting: Brain Injury Rehabilitation Unit. Intervention: Patients with hemiplegic shoulder pain were recruited over a 12-month period and all were hospitalized in our clinic. Intra-articular steroid injection or suprascapular nerve block was performed on all patients. Main measures: Range of motion values at the moment that pain started (range of motion A) and passive maximum range of motion values (range of motion B) were recorded. Pain intensity levels (visual analogue scale) at these two range of motion values (pain A and pain B) were also taken. Evaluations were made before the injection, and 1 hour, one week and one month after the injection. Results: Twenty-six patients were enrolled in the study, the mean age was 61.53u2009±u200910.30 years. The mean time since injury was 8.69u2009±u200915.71 months. The aetiology was ischaemic in 16 (61%) patients. Intra-articular steroid injection was performed in 11 (42 %) patients, and suprascapular nerve block in 15 (57%) patients. Range of motion A and range of motion B were changed statistically in repeated measures. There were important differences in repeated measures of pain intensity levels at these two range of motion values (Pu2009<u20090.05). However, no significant differences were determined in all measurements between intra-articular steroid injection and suprascapular nerve block groups (Pu2009>u20090.05). Conclusions: Our results showed that neither injection technique was superior to the other. Both injection procedures are safe and have a similar effect in stroke patients with hemiplegic shoulder pain.

Does standing protect bone density in patients with chronic spinal cord injury

Abstract Background/Objective: To compare the t-scores of proximal femur and lumbar spine of patients with spinal cord injury (SCI) with different levels of weight bearing. Methods: Cross-sectional study comparing 3 groups of patients with SCI: patients with daily standing times of more than 1 hour, patients with daily standing times of less than 1 hour, and nonstanding patients. Seventy-one patients with chronic SCI were recruited. They were assigned to 1 of 3 groups according to their reported daily standing time. The bone density of lumbar and proximal femoral regions was measured with dual-energy x-ray absorptiometry. Results: The 3 groups were similar in terms of demographics and clinical variables. No significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups. However, the patients in the group that stood more than 1 hour daily had a slight tendency to have higher t-scores than those in the control group. Conclusions: There was no significant difference among the 3 groups. However, standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization.

Intestinal Microbiota in Patients with Spinal Cord Injury

Human intestinal flora comprises thousands of bacterial species. Growth and composition of intestinal microbiota is dependent on various parameters, including immune mechanisms, dietary factors and intestinal motility. Patients with spinal cord injury (SCI) frequently display neurogenic bowel dysfunction due to the absence of central nervous system control over the gastrointestinal system. Considering the bowel dysfunction and altered colonic transit time in patients with SCI, we hypothesized the presence of a significant change in the composition of their gut microbiome. The objective of this study was to characterize the gut microbiota in adult SCI patients with different types of bowel dysfunction. We tested our hypothesis on 30 SCI patients (15 upper motor neuron [UMN] bowel syndrome, 15 lower motor neuron [LMN] bowel syndrome) and 10 healthy controls using the 16S rRNA sequencing. Gut microbial patterns were sampled from feces. Independent of study groups, gut microbiota of the participants were dominated by Blautia, Bifidobacterium, Faecalibacterium and Ruminococcus. When we compared all study groups, Roseburia, Pseudobutyrivibrio, Dialister, Marvinbryantia and Megamonas appeared as the genera that were statistically different between groups. In comparison to the healthy group, total bacterial counts of Pseudobutyrivibrio, Dialister and Megamonas genera were significantly lower in UMN bowel dysfunction group. The total bacterial count of Marvinbryantia genus was significantly lower in UMN bowel dysfunction group when compared to the LMN group. Total bacterial counts of Roseburia, Pseudobutyrivibrio and Megamonas genera were significantly lower in LMN bowel dysfunction group when compared to healthy groups. Our results demonstrate for the first time that butyrate-producing members are specifically reduced in SCI patients when compared to healthy subjects. The results of this study would be of interest since to our knowledge, microbiome-associated studies targeting SCI patients are non-existent and the results might help explain possible implications of gut microbiome in SCI.

Recruitment of Spinal Cord Injury Patients to Clinical Trials: Challenges and Solutions

Clinical trials are the cornerstone of scientific evidence. Participant identification and recruitment is one of the most important challenges to any clinical trial. This article will review the whole recruitment process, with its method and strategy, and the problems faced during consecutive steps of recruitment. It then will give recommendations for those problems according to the scientific evidence and the authors experience with clinical trials of patients with spinal cord injury (SCI).

Effects of Sociodemographic Characteristics, Illness Process, and Social Support on the Levels of Perceived Quality of Life in Veterans

Quality of life is a broad, complex, multidimensional concept incorporating psychological, sociopsychological, economic, philosophical, social, cultural, and spiritual dimensions. As accompanying or even constituting the concept of quality life, social support (empathic, informational, instrumental, and reassurance support) has not been studied. This study sought to determine the effects of sociodemographic characteristics, illness process, and type of social support on the quality of life levels of veterans hospitalized in a rehabilitation center. Seventy-nine veterans were involved in the study. None of the sociodemographic characteristics of the veterans correlated with the quality of life of the veterans except housing conditions. The perceived quality of life scores of the veterans who needed psychological help were lower than those of their counterparts (p < 0.01). The quality of life scores of the veterans were not different from those of the average Turkish population, but veterans who had not received any type of social support had lower quality of life scores (3.74 vs. 4.70). Veterans who had empathic, informational, and reassurance social support had higher quality of life scores than did those who did not have these types of social support. Having tangible social support did not change the quality of life scores. Our findings indicate that social support has a greater impact on the perceived quality of life than sociodemographic and medical factors among the veterans.

The efficacy of serial casting after botulinum toxin type A injection in improving equinovarus deformity in patients with chronic stroke

Introduction: Spasticity is an important early complication of stroke, which may lead to shortening of gastrocnemius and soleus muscles and contracture in the Achilles tendon and soft tissues of the ankle. Botulinum toxin A (BTX-A) is a promising drug for the management of focal spasticity. Serial casting is another alternative method for reducing contractures due to spasticity. The present study aimed to determine if serial casting after BTX-A injection could help to limit the development of calf contracture in chronic hemiplegic patients. Method: The records of patients with stroke that were treated in the brain injury rehabilitation clinic between January 2007 and December 2008 were screened. In all, 10 patients that underwent a serial casting programme for 24 days following BTX-A injection were included in the study. Goniometric scores for ankle ROM, Physician Rating Scale (PRS) and Functional Independence Measurement (FIM) scores were recorded. Results: Mean age of the patients was 33.2 years. Mean time interval after stroke onset was 35.0 months. Improvements in ROM were quite significant after serial casting. Moreover, FIM and PRS scores improved significantly. Conclusion: Serial casting may be an appropriate intervention following BTX-A injection to prevent equinovarus deformity and improve the quality of walking in chronic stroke patients. The role of casting and splinting are important topics that require further research.