Fusun Koseoglu

Respiratory muscle training improves cardiopulmonary function and exercise tolerance in subjects with subacute stroke: a randomized controlled trial

Objective: To determine whether two types of exercise — breathing retraining (BRT) and inspiratory muscle training (IMT) — improve on cardiopulmonary functions and exercise tolerance in patients with stroke. Design: A randomized controlled trial. Setting: Education and research hospital. Subjects: Forty-five inpatients with stroke (24 men, 21 women) were recruited for the study. The subjects were randomized into three groups: 15 assigned to receive inspiratory muscle training (IMT); 15 assigned to received breathing retraining, diaphragmatic breathing and pursed-lips breathing (BRT); 15 assigned to a control group. Interventions: All study groups participated in a conventional stroke rehabilitation programme. For the same period, the IMT and BRT groups trained daily, six times a week, with each session consisting of one half-hour of training for six weeks. Main measures: Each subject underwent pulmonary function and cardiopulmonary exercise tests. Subjects were also assessed for exertional dyspnoea, stages of motor recovery, ambulation status, activity of daily living and quality of life. Results: After the training programme, the IMT group had significantly improved forced expiratory volume at 1 second (FEV1), forced vital capacity (FVC), vital capacity (VC), forced expiratory flow rate 25—75% (FEF 25—75%) and maximum voluntary ventilation (MVV) values compared with the BRT and control groups, although there were no significant differences between the BRT and control groups (P<0.01). Peak expiratory flow rate (PEF) value was increased significantly in the BTR group compared with the IMT and control groups. The IMT group also had significantly higher peak oxygen consumption (Vo2peak) than the BRT and control groups, although there were no significant differences between the BRT and control groups (P<0.001). There was a statistically significant increase in maximum inspiratory pressure (PImax) and maximum inspiratory and expiratory pressure (PEmax) in the BRT group and, PImax in the IMT group compared with baseline and the control group. In the IMT group, this was associated with improvements in exercise capacity, sensation of dyspnoea and quality of life. Conclusions: Significant short-term effects of the respiratory muscle training programme on respiratory muscle function, exercise capacity and quality of life were recorded in this study.

Low-frequency pulsed electromagnetic field therapy in fibromyalgia: a randomized, double-blind, sham-controlled clinical study.

ObjectiveTo evaluate the clinical effectiveness of low-frequency pulsed electromagnetic field (PEMF) therapy for women with fibromyalgia (FM). MethodsFifty-six women with FM, aged 18 to 60 years, were randomly assigned to either PEMF or sham therapy. Both the PEMF group (n=28) and the sham group (n=28) participated in therapy, 30 minutes per session, twice a day for 3 weeks. Treatment outcomes were assessed by the fibromyalgia Impact questionnaire (FIQ), visual analog scale (VAS), patient global assessment of response to therapy, Beck Depression Inventory (BDI), and Short-Form 36 health survey (SF-36), after treatment (at 4 wk) and follow-up (at 12 wk). ResultsThe PEMF group showed significant improvements in FIQ, VAS pain, BDI score, and SF-36 scale in all domains at the end of therapy. These improvements in FIQ, VAS pain, and SF-36 pain score during follow-up. The sham group also showed improvement were maintained on all outcome measures except total FIQ scores after treatment. At 12 weeks follow-up, only improvements in the BDI and SF-36 scores were present in the sham group. ConclusionLow-frequency PEMF therapy might improve function, pain, fatigue, and global status in FM patients.

Functional and cognitive progress in aphasic patients with traumatic brain injury during post-acute phase.

Objectives: To investigate the relationship between language functions and cognitive and functional outcome and to evaluate the effects of a conventional language rehabilitation programme on aphasic adult patients in the post-acute stage of traumatic brain injury (TBI). Design: Non-concurrent prospective study. Patients were assessed pre-treatment and post-treatment with standardized assessment tools. Subjects: Sixty-one aphasic patients with TBI who were admitted to a rehabilitation centre in the post-acute phase for a late inpatient rehabilitation programme. Methods: The motor sub-scales of the Functional Independence Measures and Disability Rating Scale were used to assess functional status and disability. Cognitive status was evaluated with the Mini-Mental Status Examination and the Functional Independence Measure cognitive sub-scale. The language function was evaluated with the Gülhane Aphasia Test. Results: All functional, cognitive and language scores increased significantly during the rehabilitation programme. Language functions at admission were correlated with the Functional Independence Measure motor change scores and the Mini-Mental Status Examination change scores. Regression analyses revealed that auditory comprehension at admission was the most important independent determinant of functional and cognitive gain during rehabilitation. Conclusion: Post-acute language functions after late admission to a rehabilitation centre appear to be related to measures of cognitive and functional progress in patients with TBI. Functional and cognitive outcome is mainly affected by auditory comprehension. Results also showed the effectiveness of post-acute conventional rehabilitation in improving language functions.

Adult case of acrodysostosis with severe neurologic involvement

OBJECTIVE Acrodysostosis is a rare syndrome characterized by peripheral dysostosis, nasal hypoplasia and frequently mental retardation. Only one adult case of acrodysostosis has been reported to have neurologic symptoms. We report one further adult case of acrodysostosis with severe neurologic findings including myelopathy and spastic paraparesis due to diffuse spinal stenosis and recurrent deep vein thrombosis possibly caused by neurologic deficits. RESULTS We report a 43-year-old woman who had back and neck pain with weakness in the extremities of several years. 1~year before admission to our hospital, she had been treated with a missed diagnosis of sero (-) spondyloarthropathy but had not benefited. She became unable to walk, thereafter she underwent decompression surgery with a diagnosis of degenerative spinal stenosis. She presented at our outpatient department complaining of lowback pain and difficulty walking. She had marked facial and peripheral appearance of acrodysostosis. Spinal MRI revealed extensive spinal stenosis. A diagnosis was made through the genetic investigation, clinical and radiological findings. Spastic paraparesis were detected. There was widespread neuropathic pain. 15 days after admission, she developed swelling and redness of the left lower extremity and the venous doppler ultrasonography showed left acute and right past DVT. We treated DVT with anticoagulant therapy. Gabapentin and Baclofen were initiated for neuropathic pain and spasticity. A conventional rehabilitation program was performed. She left walking with a walker without pain and spasticity. CONCLUSIONS We would like to remind physicians to be aware of peripheral malformations as signs of skeletal dysplasias and to consider acrodysostosis in the differential diagnosis. Although it is a rare condition, if diagnosed early, possible complications can be treated and outcomes may be improved.

Fever during post-acute rehabilitation in patients with brain injury.

OBJECTIVE To investigate the incidence of fever during the post-acute rehabilitation phase in patients with brain injury. DESIGN Prospective study. SUBJECTS Seventy-four patients with brain injury. METHODS Patients were evaluated for the presence of fever during the rehabilitation phase. Demographics, time since injury, acute hospital and rehabilitation stay, brain injury and clinical characteristics were recorded for all subjects. RESULTS Of the study group, 36 patients (36/74; 48.6%) had at least 1 event qualified as fever. The most common cause of fever was urinary tract infection. There were only 2 patients considered as having central fever. Fever was significantly more frequent in patients with a greater number of neurological impairments, more severe neurological impairments and a lower level of independence. The rehabilitation stay was prolonged in patients with fever. The average length of rehabilitation stay was 62.5 days and 49.8 days in patients with or without fever, respectively. CONCLUSION Infection is the most common cause of fever after brain injury and the incidence of central fever is low.

Spinal cord injury associated with thoracic osteoporotic fracture.

Demir SÖ, Akın C, Aras M, Köseoğlu F: Spinal cord injury associated with thoracic osteoporotic fracture. Am J Phys Med Rehabil 2007;86:242–246. This report details a case of sudden neurologic deficit attributable to acute thoracic fractures associated with senile osteoporosis. A 73-yr-old female patient with a history of occasional back pain during the past 4 mos had sudden thoracic vertebral fracture with spinal cord injury. The patient, who had a benign past medical history, had not been evaluated for osteoporosis. Thoracic spine radiographs showed a compression fracture at T8. Thoracic magnetic resonance imaging exposed a compression fracture at T7–T8. She was treated operatively. She was found to have spinal cord injury with American Spinal Injury Association classification C (T7), and she had poor sitting balance. She was discharged in a wheelchair and was administered clean intermittent catheterization every 6 hrs. Six months after discharge, she ambulated with a walker and had spontaneous micturition. Vertebral fractures are a common presentation of senile osteoporosis. The risk of neurologic impairment attributable to vertebral fracture is a rare but potentially severe complication. Besides medical therapy and suitable rehabilitation programs, surgical treatment is an integral part of the management of patients with osteoporotic vertebral fractures.