Hakan Genc

The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease

Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability, dynamic balance and fear of falling in patients with idiopathic Parkinsons disease. Design : Randomized controlled trial. Setting : Ankara Education and Research Hospital, 2nd PM&R Clinic, Cardiopulmonary Rehabilitation Unit. Subjects : Fifty-four patients with idiopathic Parkinsons disease in stage 2 or 3 of the Hoehn Yahr staging entered, and 31 patients (21 training, 10 control) had outcome data. Interventions : Postural instability of patients with Parkinsons disease was assessed using the motor component of the Unified Parkinsons Disease Rating Scale (UPDRS), Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. Twenty-one patients with Parkinsons disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training. Before and after the training programme, balance, gait, fear of falling and walking distance and speed on treadmill were assessed in both Parkinsons disease groups. Main measures : Walking distance and speed on treadmill, UPDRS, Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session (P < 0.001). Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h (P < 0.001). Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme (P < 0.01). There was no significant improvement in any of the outcome measurements in the control group (P > 0.05). Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility, reduce postural instability and fear of falling in patients with Parkinsons disease.

Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study.

Çakıt BD, Nacir B, Genç H, Saraçoğlu M, Karagöz A, Erdem HR, Ergün U: Cycling progressive resistance training for people with multiple sclerosis: A randomized controlled study. Objective:To evaluate the effects of cycling progressive resistance training combined with balance exercises on walking speed, balance, fatigue, fear of falling, depression, and quality of life in patients with multiple sclerosis. Design:In this prospective randomized controlled trial, 45 patients were randomized into two exercise training (n = 30) groups and one control (n = 15) group. The patients in training group 1 (n = 15) underwent progressive resistance training on a bicycle ergometer and balance exercise, whereas group 2 (n = 15) patients received a home-based lower-limb strengthening and balance exercise. Outcome measures, including the duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, Falls Efficacy scale, 10-m walk test, Fatigue Severity Scale, Beck Depression Inventory, and Short Form 36 scores, were assessed initially and at 8 wks. Results:After dropouts, the whole study group consisted of 20 women and 13 men (mean age, 37.9 ± 10.43 yrs). In training group 1, duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, falls efficacy scale, 10-m walk test, Fatigue Severity scale, and Beck Depression Inventory scores, and in group 2, the mean duration of exercise, tolerated maximum workload, and Falls Efficacy scale scores were significantly improved after the training program (P < 0.05). There were no significant improvements in any of the outcome measurements in the control group (P > 0.05). In between-group comparisons, improvements in outcome measures of group 1 patients were significantly higher than those in other groups, except for 10-m walking test. Group 1 patients showed statistically significant improvement in physical functioning and role-physical functioning scales of the Short Form 36 (P < 0.01 and P < 0.05, respectively), and group 2 patients showed statistically significant improvement in only physical functioning scale of Short Form 36 (P < 0.05) after 8 wks. Conclusions:Specific exercise programs, including cycling progressive resistance training, may improve balance, fatigue, and depression and reduce fear of falling in patients with multiple sclerosis without worsening multiple sclerosis signs and symptoms.

Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects

The objective of this study was to determine tendon involvements and enthesal abnormalities in patients with rheumatoid arthritis (RA) using high-resolution ultrasonographic images and to compare the findings with those seen in patients with ankylosing spondylitis (AS) and healthy controls. A total of 24 patients with RA, 18 with AS, and 20 healthy controls matched by age and body mass index (BMI) were included in the study. All of the patients and controls underwent clinical and ultrasonographic examinations of both lower limbs at five enthesal sites (superior and inferior pole of the patella, tibial tuberosity, Achilles tendon, and plantar aponeurosis) and both upper limbs at two tendon sites (tendons of m. biceps brachii and supraspinatus at the shoulder). High-resolution ultrasonographic examinations were performed to detect bursitis, structure thickness, bony erosion, and enthesophyte. An ultrasonographic score of lower limb enthesitis was calculated using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) in all patients. Tendon involvements and enthesal abnormalities were found significantly more often in the RA group than in controls (p<0.05 to <0.001), but were not found to be different from the AS group (p>0.05). On clinical examination 67 of 336 (19.9%) tendon and enthesal sites were abnormal and on ultrasonographic examination 130 of 336 (38.2%) sites were abnormal in RA patients. The most frequently affected enthesal sites in the lower limbs were suprapatellar, infrapatellar, and Achilles tendon in both the RA and AS groups. The tibial tuberosity was less affected in both groups, and involvement of the plantar aponeurosis was not different from the controls. A statistically significant correlation was found between the Ritchie articular index and GUESS (r=0.578, p=0.008). Tendon involvements and enthesal abnormalities in RA patients were found more often than had been estimated. Further studies are required to validate our results.

Muscle imbalance in hallux valgus: An electromyographic study

Arinci İncel N, Genç H, Erdem HR, Yorgancioglu ZR: Muscle imbalance in hallux valgus: An electromyographic study. Am J Phys Med Rehabil 2003;82:345–349. Objective Hallux valgus is a very common foot deformity in modern societies. Muscle imbalance in abductor and adductor muscles was cited as a major factor in the production of hallux valgus. Our aim in this study was to evaluate the role of certain muscles in this deformity. Design Twenty hallux valgus patients and 20 healthy volunteers participated in the study. After thorough physical, neurologic, and radiographic investigations, we performed an electromyographic study to observe the relationship of hallux valgus deformity with the muscles coordinating first metatarsophalangeal joint movements. Voluntary extension, flexion, abduction, and adduction at the hallux with maximum resistance were performed. Firing rates and amplitudes of motor unit potentials of four muscles: musculus abductor hallucis, musculus adductor hallucis, musculus extensor hallucis longus, and musculus flexor hallucis brevis were recorded. Statistical analysis, including Spearman’s correlation analysis and Mann-Whitney U tests were performed with SPSS 8.0 for Windows. Results We observed that in the hallux valgus group, abduction activity of musculus abductor hallucis was markedly decreased when compared with adduction of musculus adductor hallucis. Motor unit potential amplitude of abductor activity recorded from musculus abductor hallucis was slightly more than half of the activity in flexion. Conclusion Muscle imbalance in abductor and adductor muscles is apparent in hallux valgus deformity, and this imbalance may be the reason or the result of joint deformity.

Comorbidity of fibromyalgia and cervical myofascial pain syndrome

The aims of this study are to determine the frequency of fibromyalgia syndrome (FMS) in patients with chronic cervical myofascial pain (CMP) and to investigate the FMS characteristics in CMP patients. Ninty-three patients with CMP and 30 age-matched healthy women were included in this study. Main outcome measures included visual analog scale (VAS), Beck Depression Inventory (BDI), and pain pressure thresholds. CMP patients were evaluated for the existence of FMS. The severity of FMS was assessed with total myalgic score (TMS) and control point score (CPS). Most common clinical characteristics of FMS were noted. Of the 93 CMP subjects, 22 (23.6%) patients fulfilled the classification criteria for FMS. Number of tender points were higher (p = 0.0), while TMS (p = 0.0) and CPS (p = 0.0) values were lower in comorbid CMP and FMS patients than regional CMP group. There were statistically significant differences between regional CMP patients and comorbid CMP and FMS patients regarding presence of fatigue (p = 0.0) and irritable bowel syndrome (p = 0.022). There was no statistically significant difference between patient groups regarding VAS values (p > 0.05). BDI values of the regional CMP patients were significantly lower than comorbid CMP and FMS patients (p = 0.011). In conclusion, we found that nearly a quarter of CMP patients were comorbid with FMS, and psychological and comorbid symptoms were more prominent in comorbid patients. We thought that, these two syndromes might be overlapping conditions and as a peripheral pain generator or inducer of central sensitisation, MPS might lead to FMS or precipitate and worsen the FMS symptoms.

Complex regional pain syndrome type-I after rubella vaccine

Complex regional pain syndrome type I (CRPS‐I) is a complex disorder characterised by pain, autonomic dysfunction, and decreased range of motion. The syndrome was believed as a well‐recognized disorder in adults but, less commonly recognized in children. CRPS‐I after vaccination has been rarely reported. We reported an 11‐year‐old young girl with CRPS‐I due to rubella vaccine.

Disability and related factors in patients with chronic cervical myofascial pain

The aim of this study is to detect whether cervical myofascial pain leads to disability and to determine factors associated with disability in patients with chronic cervical myofascial pain. One hundred-three female patients with chronic cervical myofascial pain and 30 age-matched healthy females participated. Main outcome measurements are visual analog scale, Neck Pain and Disability scale, Beck Depression Inventory and pain pressure threshold measurements from the most usual trigger-point locations of trapezius, levator scapula, multifidus, and splenius capitis muscles. The Neck Pain and Disability scale and Beck Depression Inventory scores of the patient group were higher than controls. In the patient group, the total Neck Pain and Disability scale scores were significantly correlated with the pain pressure threshold values of the trapezius and levator scapula muscles and Beck Depression Inventory scores. Regression analyses showed that increased disease duration (R2 = 0.37), decreased pain pressure threshold values of trapezius muscle (R2 = 0.04), unilateral disease (R2 = 0.02) and increased Beck Depression Inventory scores (R2 = 0.02) were associated with higher disability. Cervical myofascial pain is a reason for disability in chronic neck pain population. Disease duration was found as the strongest predictor of disability.

Evaluation of Upper Extremity Nerve Conduction Velocities and the Relationship Between Fibromyalgia and Carpal Tunnel Syndrome

BACKGROUND AND AIMS We undertook this study to evaluate upper extremity nerve conduction velocities (NCVs) in fibromyalgia syndrome (FS) and the relationship of the electrophysiological findings between carpal tunnel syndrome (CTS) and FS. METHODS Sixty three right-handed female patients diagnosed with FS and 52 right-handed age- and gender-matched healthy controls were enrolled in the study. Conduction studies of the median and ulnar nerves and median nerve F-wave latencies were assessed in both upper extremities using standard methods. CTS was diagnosed electrophysiologically if the median nerve sensory NCV was decreased and/or motor distal latency (DL) was prolonged. RESULTS CTS was detected electrophysiologically in 26 (20.63%) of 126 extremities of 63 patients and in three (2.82%) of 104 extremities of 52 individuals of the control group. Statistically significant differences were detected between groups with respect to rate of carpal tunnel syndrome (p <0.05). There were no differences between results of NCVs of patients in FS group and healthy controls except the prolongation of the right median nerve motor DL (p = 0.019), decrease of the sensory NCV (p = 0.003) in the right median nerve, in the left median nerve (p = 0.011) and in the left ulnar nerve (p = 0.015). CONCLUSIONS We determined an increased rate of CTS and decreased NCVs in the upper extremities in patients with FS. We should consider that complaints of paresthesia and pain in hands, increasing especially at nights, observed in FS may mask that CTS can be an associated illness.

The Efficacy of Gabapentin in Patients with Failed Back Surgery: A Prospective Case Series

Objective: Failed back surgery syndrome [FBSS] causes persistent low back problems in approximately 15 percent of patients who undergo spinal surgery for lumbar disc herniation. As reported by recent clinical data, gabapentin, an antiepileptic agent, is increasingly being used for chronic pain, with a favorable side effect profile. The aim of this study was to investigate the efficacy of gabapentin in patients with FBSS associated chronic back pain Methods: Nine patients with chronic back pain diagnosed with FBSS according to clinical, lumbar spinal magnetic resonance imaging and electrodiagnostic findings were studied. Each patient received titrated dosage of gabapentin from 900 to 2400 mg/day. Pretreatment levels of pain and the degree of disability were measured using a visual analog scale and the Oswestry disability index. All nine patients were re-evaluated at six weeks and six months Results: Eight of nine patients reported significant decrease in pain and disability scores at six weeks and six months after treatment. One patient who underwent spinal surgery five times did not report benefit from gabapentin. Gabapentin was well tolerated and there were no significant side effects Conclusion: Our results indicate that gabapentin monotherapy may be an effective adjunct for the treatment of FBSS associated chronic low back pain.

Coexisting seronegative rheumatoid arthritis and ankylosing spondylitis

The coexistence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) in the same patient is a phenomenon that has been only rarely reported [1]. The coexistence of seronegative rheumatoid factor (RF) is unusual. We here report a female patient who satisfied the diagnostic criteria for both AS and seronegative RA. A 62-year-old woman with a 10-year diagnosis of seronegative RA was admitted to hospital because of increased disease activity. She had bilateral pain and limited range of motion in her finger, wrist, elbow, shoulder, hip and knee joints, and swelling in her right knee with morning stiffness that lasted for more than an hour. There was no family history of any arthritic disorders or any form of spondylarthropathy. She denied any history of psoriasis, urethritis, iritis or symptoms suggestive of inflammatory bowel disease (IBD). Examination revealed symmetrical synovial thickening of the wrists, metacarphophalangeal and proximal interphalangeal joints. Spinal movement was restricted in all planes. Ritchie articular score was 40 and Stoke index showed severe inflammatory activity. Psoriasis, subclinical gout inflammation, IBD and crystal-induced arthropathy such as CPPD were excluded by laboratory and clinical examinations. Keratoconjunctivitis sicca and pulmonary involvement consistent with RA were found as extra-articular findings by consultant specialists. Laboratory results were as follows: erythrocyte sedimentation rate 77 mm/h, C-reactive protein 95.7 mg/dl and RF negative. Histocompatibility locus antigen (HLA) testing demonstrated the presence of HLA B27, but HLA DR4 was not present. Radiographs revealed bilateral erosive arthritis of the hands and wrists, bilateral symmetrical narrowing of the sacroiliac joint space, and bony sclerosis and syndesmophyte formation in the lumbosacral spine (Fig. 1). CT scans of the sacroiliac joint revealed bilateral grade III sacroiliitis. Pulmonary high-resolution CT showed linear fibrotic changes in the left upper lobe and a reticulonodular pattern in the lung bases. Pulmonary function tests showed a restrictive pattern. We suspected coexisting seronegative RA and AS because of the patient s marked limitation of lumbar