Ferda Özdemir

The Clinical Efficacy of Low-Power Laser Therapy on Pain and Function in Cervical Osteoarthritis

Abstract: Pain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.

Cognitive evaluation and functional outcome after stroke.

Özdemir F, Birtane M, Tabatabaei R, Ekuklu G, Kokino S: Cognitive evaluation and functional outcome after stroke. Am J Phys Med Rehabil 2001;80:410–415. ObjectiveTo investigate the initial overall cognitive ability and its components as a predictor of functional improvement and ambulation during rehabilitation. Initial cognitive status is widely known to be a predictive factor in functional recovery in patients with stroke although some reports have found no such relationship. DesignBaseline cognitive status was scored by Minimental State Examination and its subsections with such headings as “orientation,” “registration,” “attention and calculation,” “recall,” and “language” in 43 patients with postacute stroke, aged between 51 and 68 yr. Function was evaluated in terms of motor FIMTM and functional ambulation as categorized in “Adapted Patient Evaluation and Conference System” functional scale at the time of admission and discharge. ResultsOnly total baseline Minimental State Examination score showed a significant correlation with discharge motor FIM improvement (r = 0.31, P = 0.04) and baseline orientation score correlated significantly with functional ambulation score improvement (r = 0.31, P = 0.03). In stepwise linear regression model, the same variables had an effect on similar outcome parameters. ConclusionsCognitiveion evaluation should be taken as a whole to predict functional outcome in patients with postacute stroke, except for the baseline orientation score that seemed more predictive for ambulation.

The relationship between bone mineral density and immobilization duration in hemiplegic limbs

ObjectiveProlonged immobilization in stroke is known to result in hypercalciuria, hypercalcemia, accelerated bone resorption, and osteoporosis. Furthermore, bone mineral loss accelerated with increasing duration of hemiplegia. Although stroke is a common disease that causes sudden immobilization, relatively few investigations of bone metabolism in stroke have been reported. The aim of this study was to investigate the changes in bone mineral density of the forearms and legs related to duration of hemiplegia-induced immobilization after stroke.MethodsForty-one hemiplegic patients with stroke were evaluated. The patients’ age, gender and duration of hemiplegia-induced immobilization were recorded. The measurements of bone mineral density (BMD) in all patients were evaluated with DEXA using the Norland apparatus. The BMD values (g/cm2) were determined by measurements made in the lumbar vertebrae, both forearm and legs (femoral neck and trochanter).ResultsWe found that bone mineral density was decreased in the affected extremities relative to the intact contralateral side on measurements by dual energy x-ray absorptiometry in bones such as forearm, femoral neck and trochanter. There was a significant difference between bone mineral density of paretic and nonparetic forearms and legs. Bone mineral density of the upper limbs was lower than that of the lower limbs. There was a negative correlation between duration of hemiplegia and BMD values.ConclusionsBone mineral loss may be related to the duration of hemiplegia-induced immobilization. Bone mineral loss is accelerated when the duration of hemiplegia is prolonged.

The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: a single-blind, randomised, controlled trial.

Objective. In this study, the effectiveness of neuromuscular electrical stimulation (NMES) was evaluated in lower extremity rehabilitation in patients with chronic stroke. Method. The study enrolled 40 patients with chronic stroke. Twenty patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received NMES treatment for hemiplegic foot dorsiflexor muscles for 4 weeks, 5 days a week. The sessions were performed as one session per day and added to a total of 20 sessions. Clinical parameters were evaluated before and after the treatment. Results. Pre-treatment and post-treatment evaluations showed a significant increase in ankle dorsiflexion and a significant decrease in the level of spasticity in the treatment group (p < 0.05); however, there were no significant differences in the control group between the pre-treatment and post-treatment measures. Although Brunnstrom Stage, Rivermead leg and trunk score and Functional Independence Measurement motor subscore showed a significant improvement in pre- and post-treatment comparisons for both groups, the treatment groups scores were significantly higher than the control group (p < 0.05). Functional Ambulation Categories showed a significant improvement in both groups following the treatment; however, there was no significant difference between the two groups (p > 0.05). Conclusions. Use of NMES in hemiplegic foot dorsiflexion can contribute to the clinical improvement of patients when used in combination with rehabilitation programs.

Effects of coffee consumption and smoking habit on bone mineral density.

This study aims to investigate how a person’s smoking and coffee consumption habits in the premenopausal stage can affect the postmenopausal BMD values. Two hundred females in the postmenopause stage were evaluated. The average daily coffee consumption and smoking habits in the premenopause stage and the demographic characteristics, age and duration of menopause of all the cases were identified and noted. The bone mineral density (BMD) evaluations of these cases were made with Dual Energy X-ray Absorbsiometer (DEXA) technique. The relationship of the questioned risk factors with BMD and differences among the groups were investigated. No correlation was found between the amount of coffee consumption and BMD. The BMD values of the smokers’ group were lower than non-smokers’ group. As a result, advancing age, duration of menopause and smoking habits have been identified to be risk factors in relation to OP.

Painful and painless shoulder Magnetic Resonance Imaging comparisons in hemodialysis patients and correlation with clinical findings

BACKGROUND Shoulder pain is frequently observed in haemodialysis patients. OBJECTIVE To compare haemodialysis patients with or without shoulder pain in terms of shoulder motion ranges, β2 microglobulin levels and magnetic resonance imaging findings. METHODS Forty-three patients undergoing dialysis were enrolled, of which 23 patients had explicit shoulder pain at night, which appeared during dialysis. Range of joint motion and impingement tests were evaluated. β 2 microglobulin value was recorded. MRI was used to evaluate rotator cuff tendons for thickness, homogeneity, integrity and presence of effusion. RESULTS Ranges of motion were significantly lower in the painful shoulder group. Supraspinatus tendon thickness and the number of areas with effusion were higher in the painful group. There was a positive correlation between the β 2 microglobulin level and supraspinatus (r:0.352 p< 0.05) and subscapular (r:0.454 p< 0.05) tendon thicknesses. While effusion areas and pain (r:0.351 p< 0.05) showed positive correlation, there was a negative correlation between pain and shoulder motion ranges. CONCLUSIONS Shoulder pain in dialysis patients can be related with tendon thickness and effusion. While the β 2 microglobulin level affects tendon thickness, it has no relation to pain and movement constraint.

Frequency, distribution and severity of prevalent osteoporotic vertebral fractures in postmenopausal women.

AIM Assessment of previous vertebral fractures provides useful information to predict future fracture risk. This study aimed to determine the frequency, distribution and severity of prevalent osteoporotic vertebral fractures in postmenopausal women. MATERIAL AND METHODS Data on patient characteristics, bone densitometry values, and spine radiographs (T2-L5) were reviewed in 232 postmenopausal women admitted to our osteoporosis clinic. RESULTS Prevalent vertebral fractures were detected in 28 (12.1%) women (95%CI: 7.8 16.3). Fifteen women (6.5%) had mild fractures and 13 (5.6%) had moderate or severe fractures according to Genants semi-quantitative technique. The T-score was associated with the presence of prevalent vertebral fractures (OR= 0.61; 95%CI: 0.38-0.96, P= 0.034). The most frequently fractured vertebrae were T11 and T12, followed by T7 and T9. Sixty percent of fractures were wedge-type while 40% were biconcave. The frequency of wedge-type fractures at the T11-T12 levels (93.8%) was higher compared to that at all other levels (44.1%) (P= 0.001). CONCLUSION We determined the frequency, distribution, and severity of prevalent fractures and identified certain distribution patterns of fracture locations and types. To verify our results and detect possible predictive factors for fracture risk, population-based larger trials are needed.

Pain, Body Mass Index, and Bone Mineral Density in Patients with Postmenopausal and Senile Osteoporosis

Objective: Osteoporosis [OP] itself does not cause pain and usually has no signs or symptoms. However, pain occurs when there is a fracture or a posture change due to OP. The purpose of this retrospective study was to explore the pain condition in patients with postmenopausal and senile OP. Methods: We studied symptoms of pain in 909 postmenopausal women between the ages of 33 and 89 years. The patients were retrospectively assessed in our outpatient service. Menopause age, duration of menopause, bone mineral density [BMD] values [gr/cm2], their reports of pain, duration of the pain experienced, and body mass index [BMI] were recorded. Results: We found 695 patients [76.45 percent] reported experiencing pain and 214 patients [23.54 percent] reported no pain. The duration of pain was 8.7 ± 5.27 [minimum: 1, maximum: 26] years. We detected 82 cervical [11.79 percent], 77 dorsal [11.07 percent], 175 lumbar [25.17 percent], 183 knee [26.33 percent], and 177 general [25.46 percent] cases of pain. There was no significant difference in BMD between patients with and without pain [P > 0.05]. The mean BMI of patients with pain were significantly higher than the mean BMIs of patients without pain. Among the patients who reported experiencing pain, the highest BMI values were in the knee pain group. Mean BMIs of the knee pain and dorsal pain groups were significantly higher than the mean BMIs of the painless group. Conclusion: OP commonly affects the spine and may cause debilitating pain. Pain can be either a warning sign of weakened bones and potential injury for women or a symptom of a spinal fracture. However, we did not find a significant association between a change in BMD and pain in postmenopausal and senile women. We detected a relationship between pain and BMI in the patients with knee, dorsal, and general pain.

Evaluation of the efficacy of therapeutic ultrasound on bone mineral density in postmenopausal period

Therapeutic ultrasound is a frequently used modality in the practice of physical therapy. However, its effects on osteoporosis (OP) are not clear. We investigate the effect of therapeutic ultrasound on bone mineral density (BMD). We examined retrospectively 1,610 postmenopausal patients’ data and we created two groups. The treatment group consisted of 36 patients who have been applied only the ultrasound treatment and the control group consisted of 38 patients who have never received any kind of physical treatment. Both of two groups have never received OP treatment. The mean values of BMD showed no significant difference between the treatment and control groups. Patients’ BMD values, within the treatment group, were compared according to the treatment application region. There was no significant difference among groups. We determined that the ultrasound application has no effect on BMD. However, we consider that therapeutic ultrasound will help to decrease the skeletal system related complaints of the patients, improve their exercise capacity, and decrease the risk of osteoporosis.

Dirençli Diyabetik Nöropatik Ağrıda Puls Elektromanyetik Alan Tedavisinin Etkinliği

Objectives: Diabetic polyneuropathy is the most common and disabled complication of diabetes mellitus. Pharmacological treatment of diabetic neuropathy is limited because of the side efects of the drugs, used in the treatment of diabetic neuropthy. Alternative treatments are also used in diabetic neuropathy. Systemic side effects of non-pharmacological treatment modalities are rare. We evaluated the value of pulsed electromagnetic field treatment in patients with pain due to diabetic polyneuropathy. Patients and Methods: Symptomatic 95 patients were included in the study, and from these patients, 25 patients were randomized in pulsed electromagnetic field treatment group and 25 patients were randomized in placebo group. Pulsed electromagnetic field device was applied over both feet of the patients for one hour a day (during 10 days). Visual analog scale and neuropathic pain scale of all patients were performed before and after treatment and 6th week. Electroneuromyography was also performed before treatment and 6th week. Results: Improvement of pain determined by visual analog scale was 53% after treatment and 67% six weeks later. The improvement of visual analog scale scores were statistically significant in study group when compared with control subjects. Conclusion: The pulsed electromagnetic field may be an alternative treatment modality in diabetic patients with neuropathic pain. Amac: Diyabetik periferik noropati, diyabetin en sik gorulen ve ozurluluge neden olan komplikasyonudur. Noropatik agri siklikla coklu farmakolojik tedaviye direnclidir ve bu ajanlarin yan etkileri kullanimlarini sinirlar. Noropatik agri tedavisinde farkli alternatif tedaviler arastirilmaktadir. Nonfarmakolojik tedavilerin sistemik yan etkileri dusuktur. Bu rasgele secilmis, plasebo kontrollu calismada, direncli diyabetik noropatik agrida puls elektromanyetik alan tedavisinin etkinligi arastirildi. Hastalar ve Yontemler: Calisma, rasgele ayrilan, 25 puls elektromanyetik alan tedavisi (PEMF) ve 25 plasebo grubunda olmak uzere 50 hastayla tamamlandi. Tedavi grubundaki hastalarin her iki ayagina on ardisik gun ve gunde 1 saat PEMF uygulandi. Olgularin tedaviden once, sonra ve 6. haftadaki kontrollerinde vizuel analog skala ve noropatik agri skala degerlendirmeleri yapildi. Elektronoromiyografi tetkikleri, tedaviden once ve 6. hafta kontrollerinde degerlendirildi. Bulgular: Calismanin sonucunda, vizuel analog skala ile yapilan agri degerlendirmesinde tedavi sonunda %53, kontrol degerlendirmesinde %67 iyilesme saptandi. Noropatik agri skalasi farkli verilerinde saptanan duzelme, tedavi grubunda plasebo grubuna gore istatistiksel olarak anlamliydi. Sinir ileti hizi calismalarinda iki grup verileri arasinda anlamli istatistiksel fark saptanmadi. Sonuc: Puls elektromanyetik alan tedavisi, agri skorlari ve polinoropati semptomlari uzerindeki olumlu etkileri ile diyabetik noropatik agri tedavisinde alternatif bir secenek olarak dusunulebilir.