Ferdi Yavuz

Influence of adapted sports on quality of life and life satisfaction in sport participants and non-sport participants with physical disabilities

BACKGROUND The lack of controlled trials in the relationship between participation in adapted sports, and quality of life (QoL) and life satisfaction in people with physical disabilities encouraged us to consider conducting this study. OBJECTIVE The aim of this study was to compare the QoL and life satisfaction scores between people with physical disabilities who participated in adapted sports and those who did not participate in any adapted sports. METHODS This cross-sectional controlled study included 60 individuals with physical disabilities (paraplegia and amputee). Participants were divided into two groups based on sports participation and non-sports participation. Group one included 30 disabled elite athletes who participated in adapted sports. The control group included 30 disabled individuals not involved in any adapted sports. We compared scores on the World Health Organization Quality-of-Life Scale (WHOQoL-BREF) and the Satisfaction With Life Scale (SWLS) between the two groups. Participation in the community and QoL was examined as a reflection of participants priority on sports participation. RESULTS We found that WHOQoL-BREF physical, psychological, and social domain scores were significantly higher in group one than in the control group (p < 0.05), whereas environment domain scores were similar (p = 0.13). Moreover, SWLS scores were significantly higher in group one than in the control group (p < 0.05). CONCLUSIONS These results showed that people with physical disabilities who participated in adapted sports had significantly higher QoL and life satisfaction scores compared to people with physical disabilities not involved in any adapted sports.

Early rehabilitation outcome in patients with middle cerebral artery stroke

Although important data on the prognosis and rehabilitation outcome in stroke patients have been reported, data on functional recovery according to stroke subtypes are limited. This retrospective study aimed to evaluate functional outcome in patients with middle cerebral artery (MCA) stroke-the most common subtype of ischemic stroke. The records of stroke patients that underwent the rehabilitation program at our brain injury rehabilitation service between January 2007 and December 2008 were reviewed, and those with MCA stroke were included in the study. Patient demographic and clinical data, and Barthel Index (BI) and Functional Independence Measure (FIM) scores at admission and discharge were collected. The study included 80 MCA stroke patients with a mean age of 63.54 years. FIM and BI scores improved significantly post rehabilitation (P<0.05). Age was negatively correlated with both BI and FIM scores at admission and discharge. Length of stay was not correlated with improvement in BI or FIM scores during hospitalization. The patients that had ≤1 month of inpatient rehabilitation had similar outcomes as those that had >1 month of inpatient rehabilitation (P>0.05). Length of time after stroke onset was not correlated with BI or FIM scores at admission. Regardless of initial functional status, prediction of discharge functional status was misleading. Physiatrists should keep in mind that functional improvement does not always increase with duration of inpatient therapy.

Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: A randomized clinical trial

OBJECTIVE The aim of this study was to compare the effectiveness of low-level laser therapy and ultrasound therapy in the treatment of subacromial impingement syndrome. MATERIALS AND METHODS Thirty one patients with subacromial impingement syndrome were randomly assigned to low-level laser therapy group (n=16) and ultrasound therapy group (n=15). Study participants received 10 treatment sessions of low-level laser therapy or ultrasound therapy over a period of two-consecutive weeks (five days per week). Outcome measures (visual analogue pain scale, Shoulder Pain and Disability Index -SPADI-, patients satisfactory level and sleep interference score) were assessed before treatment and at the 1st and 3rd months after treatment. All patients were analyzed by the intent-to-treat principle. RESULTS Mean reduction in VAS pain, SPADI disability and sleep interference scores from baseline to after 1 month, and 3 months of treatment was statistically significant in both groups (P< 0.05). However, there was no significant difference in the mean change in VAS pain, SPADI disability and sleep interference scores between the two groups (P > 0.05). The mean level of patient satisfaction in group 1 at the first and third months after treatment was 72.45 ± 23.45 mm and 71.50 ± 16.54 mm, respectively. The mean level of patient satisfaction in group 2 at the first and third months after treatment was 70.38 ± 21.52 mm and 72.09 ± 13.42 mm, respectively. There was no significant difference in the mean level of patient satisfaction between the two groups (p > 0.05). CONCLUSIONS The results suggest that efficacy of both treatments were comparable to each other in regarding reducing pain severity and functional disability in patients with subacromial impingement syndrome. Based on our findings, we conclude that low-level laser therapy may be considered as an effective alternative to ultrasound based therapy in patients with subacromial impingement syndrome especially ultrasound based therapy is contraindicated.

The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment

BACKGROUND AND AIM The aim of this retrospective study was to investigate the therapeutic effect of transforaminal epidural steroid injection in patients with chronic low back pain and radicular leg pain due to lumbar disc herniation. MATERIALS AND METHODS This study included 80 patients (32 female and 48 male; mean age: 45.8 years [range: 25-65 years]) that received fluoroscopically guided transforaminal epidural steroid injections for chronic radicular low back pain due to lumbar disc herniation. All of the patients had diagnostic MRI findings and did not respond to conservative treatment. All injections were performed by the same physician at the interventional pain unit of a tertiary hospital. The effectiveness of transforaminal epidural steroid injections was assessed via a standardized telephone questionnaire administered 2 years after the first injection. RESULTS Mean duration of radicular low back pain was 24.50 ± 18.25 months. Most of the epidural injections were administered at the L5 and S1 levels. The most effective post-injection period was the first 5.11 ± 3.07 months. Mean duration of injection effect was 12.46 ± 7.24 months. The response rate to the epidural steroid injections was 72%. CONCLUSIONS There was negative correlation between the duration of treatment effect and the duration of pre-treatment symptoms. Additionally, clinical improvement of radicular low back pain increased significantly as the duration of pre-treatment symptoms decreased. Based on the present findings, we think that transforaminal epidural steroid injections can be used as an alternative treatment for managing chronic radicular low back pain.

Pellegrini-stieda disease in a patient with cauda equina syndrome.

A 30-yr-old man with cauda equina syndrome resulting from a compression fracture of the L1 vertebra was enrolled in a rehabilitation program at the authors’ hospital, and on completion, he was able to walk with the aid of an ankle-foot orthosis and cane. One year later, at his clinical follow-up visit, the patient complained of pain and swelling in his left knee. Despite the absence of a history of knee trauma, patellar subluxation was observed by physical examination. The patient then underwent several orthopedic surgeries to improve this condition. After this surgical process, a kneeankle foot orthosis was prescribed to prevent any exacerbation of the knee lesion secondary to walking. Nonetheless, he again developed patellar subluxation 6 mos after his last surgery. There was no swelling of the knee or restriction of motion. Valgus stress test results were positive, and the medial knee was sensitive to palpation. Plain radiography showed a characteristic bony formation and calcification in the soft tissue next to the medial femoral condyle (Fig. 1). Pellegrini-Stieda disease was considered based on the characteristic x-ray findings and clinical course. Radiographically, Pellegrini-Stieda disease seems as an ossification arising from the epicondylar portion of the medial femoral condyle. Humoral, neural, and local factors including tissue hypoxia, hypercalcemia, changes in sympathetic nerve activity, prolonged immobilization, and mobilization with frequent periods of exercise after prolonged immobilization may result in neurogenic ectopic bone formation. Although Pellegrini-Stieda disease has rarely been reported in patients with spinal cord injury, this report highlights the need for its consideration in the diagnosis of such patients if knee symptoms are present.

Diabetic peripheral neuropathy: Correlation between nerve cross-sectional area on ultrasound and clinical features.

BACKGROUND AND OBJECTIVE To evaluate the correlations of the cross-sectional area (CSA) of peripheral nerves in diabetic peripheral neuropathy (DPN) patients based on ultrasound (US) with clinical and demographic characteristics. METHODS A DPN patient group (n= 53) and a matched healthy control group (n= 53) underwent US imaging of the sciatic, tibial and median nerves. The CSAs of these nerves were recorded, and their associations with pain intensity according to the visual analog scale (VAS) score and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale score, diabetes mellitus (DM) duration, body mass index (BMI), HbA1c level and blood glucose levels were evaluated. RESULTS The CSAs of the examined nerves in diabetic patients were larger than those in healthy individuals (p< 0.05). No correlations were detected between the CSAs of the examined nerves and the parameters of interest (p> 0.05), including the VAS and LANSS pain scale scores (p= 0.32 and p= 0.31, respectively). CONCLUSIONS US is a sensitive diagnostic technique for detecting DPN; however, it does not indicate disease severity.

Nerve block of articular branches of the obturator and femoral nerves for the treatment of hip joint pain.

OBJECTIVES The aim of this retrospective study was to investigate the effectiveness of the nerve block of articular branches of obturator and femoral nerves in patients with intractable pain due to hip osteoarthritis. MATERIAL AND METHOD Twenty patients (8 female and 12 male; with a mean age 53.5 years) were retrospectively identified who had received nerve block of articular branches of obturator and femoral nerves for chronic hip joint pain due to hip osteoarthritis. The outcome measures (visual analogue pain scale, the level of patient satisfaction with nerve block, reduction rate of NSAID using) were assessed before the treatment and at the 1st and 3rd months after injection. RESULTS Mean reduction in hip joint pain while walking and at night between the baseline and 1st month, and between the baseline and 3rd month were statistically significant (p< 0.05). At the 1st and 3rd months after treatment, the reduction rates of NSAID using were almost 67% and 71%; respectively. At the 1st and 3rd months after treatment, the level of patient satisfaction with nerve block were 73.00 ± 21.23 mm and 73.50 ± 18.14 mm; respectively. CONCLUSION We found that nerve blocks of articular branches of obturator and femoral nerves were effective in short- and mid-term for reducing chronic hip joint pain.

Reflex sympathetic dystrophy secondary to deep venous thrombosis mimicking post-thrombotic syndrome

The objective of this report is to represent a case of reflex sympathetic dystrophy (RSD) secondary to the upper extremity deep venous thrombosis (DVT). A 21-year-old man admitted with the complaints of pain and swelling in his right upper limb was presented. The patient had been diagnosed DVT in the right subclavian vein. The thrombosis had recovered completely with the standard treatment of DVT and doppler ultrasound had revealed normal findings at follow-up. After few months, he developed limb edema and pain considering post-thrombotic syndrome (PTS). The patient showed no response to the treatments for PTS. He was diagnosed with RSD according to the clinical findings. The bone scan confirmed the diagnosis. He responded well to the physical therapy and therapeutic exercises program. RSD and PTS are the two conditions having some common features and resembling clinical pictures. RSD also should be kept in mind in differential diagnosis of patients who developed limb pain and edema after DVT. There are some different points in the characteristics of the common symptoms obtained in both of the clinical conditions. Bone scan can help to confirm the diagnosis if RSD is suspected. Because the treatments of two conditions are different, making the differential diagnosis is crucial.

Hypertonic Dextrose Injection for The Treatment of a Baker's Cyst.

We present extremely rare and interesting case of a Bakers cyst treated with hypertonic dextrose injection. A 54-year-old female patient had a Bakers cyst which was diagnosed by an ultrasonography. After the failure of the two-weekly conservative treatment, we injected hypertonic dextrose (25%) into her right knee joint for the treatment of a Bakers cyst. Two weeks after the injection, the patient reported improvement in posterior knee pain, and an US showed a resolution of the posterior knee cyst. Certainly hypertonic dextrose injection for the treatment of a Bakers cyst appears to be a reasonable treatment option. Further studies are needed in order to elucidate the efficacy of hypertonic dextrose injection in the treatment of Bakers cysts.

An Accelerated Multi-Modality Rehabilitation Protocol Combined with Botulinum Toxin-A Injection in Adult Idiopathic Toe Walking: Case Report

Diagnosis of Adult Idiopathic Toe Walking (AITW) is very rare in clinical practice. High quality studies regarding AITW and its treatment options have not been conducted previously. A 28-year-old male patient complaining of lower leg pain was referred to outpatient rehabilitation clinic. Physical examination revealed a gait abnormality of insufficient heel strike at initial contact. The aetiology was investigated and the patients walking parameters were assessed using a computerized gait analysis system. The AITW was diagnosed. Botulinum toxin-A (Dysport(®)) was injected to the bilateral gastrocnemius muscles. A combined 10-days rehabilitation program was designed, including a daily one-hour physiotherapist supervised exercise program, ankle dorsiflexion exercises using an EMG-biofeedback unit assisted virtual rehabilitation system (Biometrics) and virtual gait training (Rehawalk) every other day. After treatment, the patient was able to heel strike at the initiation of the stance phase of the gait. Ankle dorsiflexion range of motions increased. The most prominent improvement was seen in maximum pressure and heel force. In addition center of pressure evaluations were also improved. To the best of our knowledge this is the first case, of AITW treated with combined botulinum toxin, exercise and virtual rehabilitation systems. This short report demonstrates the rapid effect of this 10-days combined therapy.