Birkan Sonel Tur

Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey.

The Functional Independence Measure for Children (WeeFIM) instrument has recently been adapted and validated for non‐disabled children in Turkey. The aim of this study was to validate the instrument in children with cerebral palsy (CP). One hundred and thirty‐four children with CP were assessed using the WeeFIM. Reliability was tested by internal consistency, intraclass and interrater correlation coefficients (ICCs), internal construct validity by Rasch analysis, and external construct validity by correlation with the Denver II Development Test (Denver II). Mean age of the participants (70 females, 64 males) was 4y 6mo (SD 3y 8mo, range 6mo–16y). CP type was: diplegia in 37.3%, hemiplegia in 20.2%, quadriplegia in 8.2%, ‘baby at risk’ (i.e. infants who show neuromotor delay but cannot be classified in a CP type) in 29.9%, and other in 4.5%. Reliability of the WeeFIM was excellent with high Cronbach’s alpha and ICC values ranging between 0.91 and 0.98 for the motor and cognitive scales. After collapsing response categories, both motor and cognitive scales met Rasch model expectations. Unidimensionality of the motor scale was confirmed after adjustment for local dependency of items. There was no substantive differential item functioning and strict unidimensionality for both scales was shown by analysis of the residuals. External construct validity was supported by expected high correlations with developmental ages determined by the social, fine motor function, language, and gross motor function domains of the Denver II. We conclude that the WeeFIM is a reliable and valid instrument for evaluating the functional status of Turkish children with CP.

Psychometric properties of the Rivermead Motor Assessment: its utility in stroke.

OBJECTIVE To investigate the psychometric properties of the Rivermead Motor Assessment by Rasch analysis and conventional statistics to improve its clinical utility. METHODS A total of 107 patients after stroke were evaluated using the Rivermead Motor Assessment and Functional Independence Measure (FIM). Scaling properties were assessed using Mokken scaling, internal construct validity using Rasch analysis, reliability using Cronbachs alpha and intra-class correlation coefficients, external construct validity through convergent validity with FIM, and responsiveness using the effect size and standardized response mean. RESULTS Cronbachs alpha and intra-class correlation coefficients for 3 sections of the Rivermead Motor Assessment were between 0.88 and 0.95. Mokken scaling showed appropriate Guttman patterns, but the hierarchical ordering of the items differed from that of the original. After removing 4 items of gross function, 1 of leg-trunk, and 4 of arm, all sections met Rasch model expectations. External construct validity was confirmed. Mean values of effect size and standardized response were 0.38-0.51 and 0.60-0.89, respectively. CONCLUSION The Rivermead Motor Assessment has been shown to be reliable and responsive. Guttman scaling is apparent, but not as originally defined. After removing some items, the scale satisfies the most stringent Rasch measurement criteria and can produce interval scaling for the assessment of motor function in stroke.

Does aerobic exercise affect the hypothalamic-pituitary-adrenal hormonal response in patients with fibromyalgia syndrome?

[Purpose] The hypothalamic-pituitary-adrenal (HPA) axis in the etiopathogenesis of fibromyalgia is not clear. This study aimed to analyze the effects of a 6-week aerobic exercise program on the HPA axis in patients with fibromyalgia and to investigate the effects of this program on the disease symptoms, patients’ fitness, disability, and quality of life. [Subjects and Methods] Fifty fibromyalgia patients were randomized to Group 1 (stretching and flexibility exercises at home for 6 weeks) and Group 2 (aerobic exercise three times a week and the same at-home exercises as Group 1 for 6 weeks). Serum levels of cortisol, adrenocorticotropic hormone, insulin-like growth factor-1, and growth hormone were analyzed at baseline and at the end of, and 1 hr after an exercise stress test. [Results] Group 2 showed better improvement in morning stiffness duration and pain. Growth hormone levels significantly increased after intervention and cortisol levels significantly decreased at time-time interaction in both groups. No significant differences in adrenocorticotropic hormone and insulin-like growth factor-1 were found. [Conclusion] The results of this study seem to support the hypothesis that there is a dysregulation of the HPA axis in patients with FM, and that a six-week exercise program can influence symptoms and affect the HPA axis hormones.

Cerebral infarct due to meningovascular neurobrucellosis: a case report.

Brucellosis is a common and multisystemic zoonotic infectious disease. Central nervous system involvement is rarely seen in brucellosis, with an incidence of 0.5-25%. The aim of this report is to underline the importance of brucellosis, which is an endemic infection in our country, during the diagnostic evaluation of stroke.

Nerve conduction in children suffering Insulin Dependent Diabetes Mellitus

Objective: To determine the incidence of peripheral neuropathy in children suffering Insulin Dependent Diabetes Mellitus (IDDM) as well as to determine the relationship between other criteria of the disease and neuropathy.Methods : 40 children (17 males, mean age 11.9 years) suffering IDDM and receiving insulin therapy involving two injections a day and 30 healthy children (17 males, mean age 11.7 years) were included in the study. They were inquired about their demographical characteristics as well as the presence of neurological symptoms. Their detailed neurological examinations were conducted. Their glycemic control values (Hb A1C) were recorded, and their nerve conduction studies were performed from right upper and lower extremities.Results : All nerve conduction values of children with IDDM were found to be significantly lower (p <0.0001) as compared to the control group. 60% of diabetic children (n=24) were found to suffer peripheral neuropathy. Statistically significant relationships were found between the glycemic control values and the peroneal, sural, tibial, ulnar and median nerve conduction velocities, and also between the duration of disease and the peroneal, sural, tibial and median nerve conduction velocities.Conclusion : The peripheral neuropathy is rather a frequently observed complication in diabetic children. The duration of disease and impaired glycemic control play an important role in the development of neuropathy. The introduction of new methods designed to ensure better glycemic control will reduce the incidence of the complication.

A thermal dysregulation problem after breast cancer surgery; what could be?

Rationale: Chronic fatigue syndrome (CFS) is a complicated disorder characterized by severe fatigue that is not relieved with rest and associated with physical symptoms such as sleep problems, headache, muscle pain, or joint pain. Patient concerns: Forty-one year old patient complained from feeling cold after breast cancer surgery. Diagnoses: The diagnoses of fibromyalgia, depression, neurological, psychiatric, and vascular disorders were excluded by appropriate clinical and laboratory investigations. She was diagnosed as CFS. Interventions: The patient was treated successfully via aerobic exercise therapy that scheduled for 30 min at least 3 days per week. Outcomes: At 6-month follow-up, her complaints were almost resolved and the patient regained her physical health and mental attitude. Lessons: A thermal dysregulation should be taken into consideration as one of the symptoms of CFS.

Metastatic vertebral tumor misdiagnosed in magnetic resonance imaging as benign degenerative bone marrow changes: a case report

Many disorders including congenital, degenerative, inflammatory, and neoplastic lesions are associated with low back pain. It is essential to differentiate between malignant disease and the more common causes of back pain. We report a man with low back and right groin pain as a result of metastatic breast carcinoma which was misdiagnosed in magnetic resonance imaging as benign degenerative changes.