Ece Unlu

The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study

Objective: To evaluate the effect of home versus in-hospital exercise (under supervision) programmes on hip strength, gait speed and cadence in patients with total hip arthroplasty at least one year after operation. Setting: Physical therapy and rehabilitation department. Subjects: Twenty-six patients who had had a total hip arthroplasty operation 12—24 months prior to the study were enrolled. Interventions: The patients were randomized into three groups: group 1 patients were assigned a home exercise programme, group 2 patients exercised under physiotherapist supervision in hospital, and group 3 served as the control group, with no specific intervention. The study duration was six weeks. Main measures: Maximum isometric abduction torque of operated hip muscle, gait speed and cadence were measured before and after the study. Results: Maximum isometric abduction torques of the hip abductor muscles improved in groups 1 and 2, but not in group 3 (30 ± 12 to 38 ± 11 ft.lb in group 1, 18 ± 10 to 30 ± 9.8 ft.lb in group 2). Gait speed improved from 67.8 ± 23 to 74.35 ± 24 m/min in group 1, from 48.53 ± 4 to 56.7 ± 5 m/min in group 2 and from 58.01 ± 12 to 59.8 ± 14 m/min in group 3. Cadence also improved, from 97.7 ± 18 to 111 ± 17 steps/min in group 1, from 90.75 ± 6 to 104.75 ± 7 steps/min in group 2, and from 87 ± 16 to 88.22 ± 16 steps/min in group 3. When the three groups were compared, group 2 showed the best improvement (P = 0.006) only in maximum isometric abduction torque. Conclusion: Our findings suggest that both home and supervised exercise programmes are effective one year after total hip arthroplasty. Home exercise programmes with close follow-up could be recommended.

Multilevel botulinum toxin type a as a treatment for spasticity in children with cerebral palsy: a retrospective study

INTRODUCTION: Cerebral palsy is the most common cause of physical disability in children. Spasticity is a disabling clinical symptom that is prevalent among patients suffering from cerebral palsy. The treatment of spasticity with botulinum toxin type A (BTX-A) is a well-established option in the interdisciplinary management of spasticity, providing focal reductions in muscle tone in cerebral palsy patients. OBJECTIVE: The aim of this retrospective study was to describe the effect of multilevel BTX-A injections in the lower extremities, focusing mainly on gross motor function and functional status in cerebral palsy patients. METHODS: Data from 71 cerebral palsy patients (64% male, 36% female, mean age 6.7 ±3.2 years) were analyzed retrospectively. We used the Ashworth and Tardieu scales to evaluate the degree of spasticity. Motor function was measured by the Gross Motor Function Measure (GMFM–88), and functional status was classified by the Gross Motor Function Classification System (GMFCS I-V). Multilevel BTX-A injections were applied after sedation and with electrostimulation guidance. The evaluations were repeated every three months, and the patients were followed for six months. RESULTS: We found that the Ashworth and Tardieu scores decreased significantly at the three-month evaluation (p<0.05) but not at the six-month evaluation (p>0.05). Although the improvement in spasticity was not maintained at the six-month evaluation, GMFM-88 scores increased significantly at the three- and six-month assessments. GMFSC levels showed no change in the three- and six-month assessments. CONCLUSION: We believe that a single multilevel BTX-A injection reduces spasticity and improves motor function in children with cerebral palsy.

Outcomes of Botulinum Toxin Type A Injection Followed by Rehabilitation in Cases of Cerebral Palsy With Upper Extremity Involvement

We evaluated the efficiency of botulinum toxin type A injection followed by a rehabilitation program including individual therapy, group therapy, and occupational therapy in cases of cerebral palsy with upper extremity involvement. A total of 29 injections were performed on 25 patients, and the patients were placed on rehabilitation program. At 3-month and 6-month assessments, there was a significant improvement in lateral grip strength, 9 Hole Peg test, Upper Limb Physician’s Rating Scale and pediatric functional independence measure total scores. There were significant decreases in active range of motion in elbow extension, supination, and wrist extension, and Modified Ashworth Scale in elbow flexion, elbow pronation, and wrist flexion at 6-week, 3-month, and 6-month assessments. Combination of group therapy with traditional therapy methods after injection is effective in cases of cerebral palsy with upper extremity involvement.

Ultrasonographic Evaluation of the Radial Nerves in Patients with Unilateral Refractory Lateral Epicondylitis

Objective To evaluate the possible radial nerve entrapment of patients with unilateral refractory lateral epicondylitis (LE) by using ultrasound (US) and electroneuromyography. Design Cross-sectional study. Setting Three physical medicine and rehabilitation departments. Subjects Consecutive 44 patients (15 M, 29 F) with unilateral refractory LE. Methods All patients underwent detailed clinical, electrophysiological and ultrasonographic evaluations. Ultrasound imaging was used to evaluate thickness and presence of abnormal findings of the common extensor tendon (CET) and cross-sectional area (CSA) of the radial nerve (at spiral groove and before bifurcation) bilaterally. Unaffected sides of the patients were taken as controls. Results When compared with the unaffected sides, CET thickness and radial nerve CSAs (at both levels) were higher, and abnormal US findings regarding LE (47.7% vs. 6.8%) were more common on the affected sides than nonaffected sides (all P  < 0.001). Grip strength values were lower on the affected sides ( P  < 0.001). Electrophysiological studies were all normal, and similar between the two sides (all P  > 0.05). When subgroup analyses were performed after taking into account the hand dominance, affected and dominant sides were found to be the same in 31 and different in 13 patients. In subgroups, CETs and radial nerve CSAs at both levels were higher on the affected sides (all P  < 0.01). Conclusions Radial nerves and the CETs seem to be swollen on the affected sides, independent from the hand dominance of the patients with refractory LE. These results morphologically support the previous literature that attributes some of the chronic complaints of these patients actually to radial nerve entrapment.

Myopathy related to vitamin D deficiency in patient with celiac disease.

of Charcot-Marie-Tooth disease. Lancet Neurol 2009;7:654–667. 4. Matthews E, Fialho D, Tan SV, Venance SL, Cannon SC, Sternberg D, et al. The non-dystrophic myotonia: molecular pathogenesis, diagnosis and treatment. Brain 2010;133:9–22. 5. Lehmann-Horn F, Jurkat-Rott K and R€ udel R. Diagnostics and therapy of muscle channelopathies—guidelines of the Ulm Muscle Centre. Acta Myol 2008;XXVII:98—113. 6. Brugnoni R, Kapetis D, Imbrici P, Pessia M, Canioni E, Colleoni L, et al. A large cohort of myotonia congenita probands: novel mutations and a high-frequency mutation region in exons 4 and 5 of the CLCN1 gene. J Hum Genet 2013;58:581–587. 7. Leiden Open Variation Database. Chloride channel 1, skeletal muscle (CLCN1). http://chromium.liacs.nl/LOVD2/; 2012. 8. Aarskog NK, Vedeler CA. Real-time quantitative polymerase chain reaction. A new method that detects both the perypheral myelin protein 22 duplication in Charcot–Marie–Tooth type 1A disease and the peripheral myelin protein 22 deletion in hereditary neuropathy with liability to pressure palsies. Hum Genet 2000;107:494–498. 9. Kim HS, Chung KW, Kang SH, Choi SK, Cho SY, Koo H, et al. Myotonic dystrophy type I combined with X-linked dominant Charcot– Marie–Tooth neuropathy. Neurogenetics 2010;11:425–433. 10. Kurt S, Karner H, Kaplan Y, Akat I, Battaloglu E, Druslu D, et al. Combination of myotonic dystrophy and hereditary motor and sensory neuropathy. J Neurol Sci 2010;288:197–199. 11. Bergman C, Senderek J, Hermanns B, Jauch A, Janssen B, Schroder JM, et al. Becker muscular dystrophy combined with Xlinked Charcot–Marie–Tooth neuropathy. Muscle Nerve 2000;23: 818–823. 12. Schreiber O, Schneiderat P, Kress W, Rautenstrauss B, Senderek J, Schoser B, et al. Facioscapulohumeral muscular dystrophy and Charcot–Marie–Tooth neuropathy 1A—evidence for “double-trouble” overlapping syndromes. BMC Med Genet 2013;14:92. 13. Hodapp JA, Carter GT, Lipe HP, Michelson SJ, Kraft GH, Bird TD. Double trouble in hereditary neuropathy: concomitant mutations in the PMP-22 gene and another gene produce novel phenotypes. Arch Neurol 2006;63:112–117.

Importância do período de silêncio cutâneo na fibromialgia e sua relação com as características da doença, distúrbios psicológicos e qualidade de vida dos pacientes

INTRODUCTION: Cutaneous silent period (CSP) is an inhibitory spinal protective reflex and its afferents consist of A-delta nerve fibers. We aimed to evaluate patients with fibromyalgia (FM) and healthy controls to determine any differences between the groups in terms of CSP duration and latency, and if present, to determine whether there is any relationship with disease characteristics, psychological disorders and quality of life. MATERIALS AND METHODS: Thirty-two patients with FM and 32 healthy volunteers were included in the study. The patient and control groups were compared in terms of CSP latency and duration in both upper and lower extremities. Disease characteristics, psychological disorders and quality of life of patients were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36). Patients with CSP measurements equal to or lower than those of the control group were compared with those with higher values than controls in terms of disease characteristics, psychological status and quality of life. RESULTS: Significantly prolonged CSP latencies in both upper and lower extremities were determined in patients compared to controls. We found that prolongation of CSP latency in the lower extremity is associated with disease severity and functional disability. CONCLUSIONS: CSP latencies in both upper and lower extremities in patients with FM are longer than in healthy volunteers. Moreover, prolongation of CSP latency in the lower extremity is associated with disease severity and physical functional disability.

Botulinum toxin injection of the subscapularis muscle

Patients with hemiplegia frequently suffer from pain and have a limited range of motion (ROM) of the shoulder. The common pattern of shoulder movement in a patient with spastic hemiplegia is primarily adduction and internal rotation. Spasticity of the subscapularis muscle limits the abduction, external rotation and flexion of the shoulder. Injection of botulinum toxin or application of phenol can reduce the spasticity of the subscapularis muscle and various techniques to inject this muscle have been reported. We injected five patients with hemiplegia with botulinum toxin using our previously reported inferior approach, which is easy, safe and effective. We observed a reduction in pain and spasticity and improvement in the ROM of the shoulder for all patients.

A new technique for subscapularis muscle needle insertion.

Unlu E, Sen T, Esmer AF, Tuccar E, Elhan A, Çakcı A: A new technique for subscapularis muscle needle insertion. Am J Phys Med Rehabil 2008;87:710–713. Objective:To investigate a new technique for needle insertion into the subscapularis muscle for botulinum toxin injection, nerve block with phenol, and electromyography. Design:A new technique, which we have termed the inferior approach, was delineated by cadaver study. In the first step of the study, the thickest part of the subscapularis muscle and the route for the accurate course of the needle were determined by an anatomist on eight cadavers (16 sides). In the second step, using this technique, a physician attempted to inject India ink into the thickest part of the muscle on a separate 12 cadavers (24 sides). The anatomist then examined the accumulated ink by careful dissection of the involved muscle. Results:The thickest part was determined to be at the lateral half of the muscle. With the exception of two muscles, all the cadavers were successfully injected using the defined route. If the route and injection sites are correct, there is no risk of injecting any muscle in that anatomic region other than the subscapularis. Furthermore, there were no neurovascular structures identified at risk in the area using the inferior approach. Conclusion:This new technique, termed the inferior approach, is both easy and anatomically safe: it did not involve any risk of damage to any major artery, vein, or nerve.

The Role of Electrophysiologic Evaluation in Dysphagia Diagnosis in Acute Stroke Patients

Background and Purpose: It was aimed at investigating the efficiency of electrophysiological evaluation procedure by compared to healthy controls in acute period stroke patients in this study. As a secondary aim, it was evaluated that whether the patient groups defined as “dysphagic” and “with normal swallowing” were different from each other or not, in respect to the stroke severity and disability. Methods: Forty-two stroke patients and 15 healthy hospital personnel were included in this study. Demographic and disease characteristics of patients were recorded. The stroke severity and disability rate were evaluated. Electrophysiological evaluation was performed in all participants. Electro neuromyography recordings were received from submental electrodes and laringeal sensor. Swallowing interval times and dysphagia limit were recorded. Patient and control groups were compared in terms of electrophysiologic evaluation method. The patient group separated in itself as “normal swallowing” and “patients with dysphagia” according to the interval times and dysphagia limit and were compared in terms of stroke severity and disability rate. Results: The all interval times in the patient group were found significantly longer than the control group. The stroke severity and the disability of the patients defined as “with dysphagia” were found significantly higher than the “normal swallowing” patients, in term of the pharyngeal phase time. Conclusions: The electrophysiologic evaluation the swallowing phase times is a sensitive and objective method in acute period stroke patients that can drink liquid in normal quantities, especially.

Importance of cutaneous silent period in fibromyalgia and its relationship with disease characteristics, psychological disorders and quality of life of patients

INTRODUCTION Cutaneous silent period (CSP) is an inhibitory spinal protective reflex and its afferents consist of A-delta nerve fibers. We aimed to evaluate patients with fibromyalgia (FM) and healthy controls to determine any differences between the groups in terms of CSP duration and latency, and if present, to determine whether there is any relationship with disease characteristics, psychological disorders and quality of life. MATERIALS AND METHODS Thirty-two patients with FM and 32 healthy volunteers were included in the study. The patient and control groups were compared in terms of CSP latency and duration in both upper and lower extremities. Disease characteristics, psychological disorders and quality of life of patients were assessed using the Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36). Patients with CSP measurements equal to or lower than those of the control group were compared with those with higher values than controls in terms of disease characteristics, psychological status and quality of life. RESULTS Significantly prolonged CSP latencies in both upper and lower extremities were determined in patients compared to controls. We found that prolongation of CSP latency in the lower extremity is associated with disease severity and functional disability. CONCLUSIONS CSP latencies in both upper and lower extremities in patients with FM are longer than in healthy volunteers. Moreover, prolongation of CSP latency in the lower extremity is associated with disease severity and physical functional disability.