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In-hospital predictors of falls in community-dwelling individuals after stroke in the first 6 months after a baseline evaluation: a prospective cohort study.

OBJECTIVE To determine predictors of falls in stroke patients in the first 6 months after a baseline evaluation before their discharge from inpatient rehabilitation. DESIGN Prospective cohort study. SETTING Rehabilitation hospital, then home. PARTICIPANTS Consecutive stroke patients (N=66) were followed at home after discharge from the rehabilitation hospital. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fall occurrence within 6 months after a baseline evaluation. All patients were assessed for baseline data during their inpatient rehabilitation (1.5±1.2 wk before discharge). Data regarding cerebrovascular accident (CVA) date, number of attacks, and brain imaging results were obtained; motor function and balance impairment were examined by the Fugl-Meyer Assessment Scale. The FIM and Functional Ambulation Category were also used. Presence of urinary incontinence, drug use, fall history, postural hypotension, neglect, cognitive status, poor vision, and hearing were evaluated. Six months after the baseline evaluation, any fall occurrence was ascertained via telephone calls to the caregivers of each patient. Multivariate logistic regression analysis was used to identify risk factors. RESULTS The mean age ± SD was 64±10 years. The median time elapsed since CVA at the time of admission was 4 months. Twenty-four (36%) patients fell within the 6-month period. The fall rate was significantly higher in patients with left (47%) versus right (21%) hemispheric stroke. Left hemispheric lesion (vs right) showed a 4 times greater risk of fall within 6 months (odds ratio=4.093; 95% confidence interval, 1.082-15.482). There were no other significant differences between fallers and nonfallers with respect to the other evaluated factors. CONCLUSIONS Our results suggest that the fall risk within 6 months after a baseline evaluation is greater in patients with left hemispheric lesions versus those with right hemispheric lesions.

Comparison of effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy

Abstract Objective: The aim of the study was to compare the effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy (CP). Methods: We included 48 children with CP using lower extremity orthosis. Energy expenditures determined based on heart rate, yielded an energy expenditure index (EEI) with and without orthosis during walking. Results were compared statistically between orthosis groups (solid polyethylene ankle foot orthosis (PAFO), articulated PAFO, ground reaction foot orthosis (GRAFO), plastic and metallic knee-ankle-foot-orthosis (KAFO), and metallic AFO). Results: It was found that an advancement in energy expenditure was seen with plastic orthoses which is more prominent by solid PAFO (p = 0.008). Conclusion: It was concluded that especially solid PAFO can be more beneficial in terms of energy consumption in CP patients. In rehabilitation phase, the EEI measurement was seen to be a useful and practical method for choosing the proper orthosis type.

Whole thoracal spinal cord involvement in case of neuro-Behçet's disease.

Behçet’s disease is a chronic inflammatory, multisystem vasculitis. Neurological involvement is one of the most serious manifestations of Behçet’s disease. Although brain stem and diencephelon are the most affected areas in neuro-Behçet’s disease, spinal cord involvement are rarely seen. We report a case of paraplegia caused by completely thoracic cord involvement of Behçet’s disease in a 20-year-old woman.

Paraplegia associated with spinal hydatid cyst: a case report.

Study Design. Case report. Objectives. To report a case with paraplegia caused by spinal hydatid cyst. Summary of Background Data. Hydatid cyst is a disease caused by larval Echinococcus granulosus tapeworm. Spinal hydatid cyst rarely leads to severe neurologic problems. Methods. A 34-year-old male patient was referred to our outpatient clinic due to back and low back pain, progressive weakness and numbness in both lower extremities, and a prediagnosis of lumbar disc hernia. He had spastic paraplegia, and thorax magnetic resonance imaging revealed a lobulated cystic lesion with extradural intraspinal localization. Results. After surgery and following 2 months of rehabilitation program, the patient showed a dramatic clinical improvement. Conclusion. By this case, it is emphasized that spinal hydatid cyst should come to mind in the differential diagnosis of spinal cord compression, and the importance of prevention, early diagnosis, and treatment is highlighted because of high mortality and morbidity.

The effect of upper-extremity aerobic exercise on complex regional pain syndrome type I: a randomized controlled study on subacute stroke

Abstract Background and purpose: Complex regional pain syndrome type I (CPRS I), is a complex of symptoms characterized by diffuse pain usually with associated swelling, vasomotor instability, and severe functional impairment of the affected extremity in stroke patients. Pain is a prominent feature and is often refractory to variety of treatment. Methods: To investigate the clinical, functional, and psychosocial effects of upper extremity aerobic exercise (UEAE) and compare the effect of aerobic exercise with that of conventional physiotherapy in patients with CPRS type I following stroke as a randomized controlled assesor blinded 4 week-study. A total of 52 inpatients with stroke [mean age: 65.95 ± 8.7 (min. = 53, max. = 80) years, and the mean age of the control group was 67.50 ± 11.2 years], all within 6 months post-stroke and diagnosed with CPRS I. The UEAE program consisted of an arm crank ergometer (10 W/min), in addition to a conventional physiotherapy (whirlpool, TENS, retrograd massage). Primary outcome measures were CPRS clinical determinants (pain, hyperalgesia, allodynia, and autonomic abnormalities) secondary outcome measures were functional independence measure (FIM), Nottingham Health Profile (NHP), and Beck Depression Scale scores that were performed at 0 month (baseline) and 4 weeks (post-treatment). Results: In UEAE group, patients reported significant pain relief (89.9%) and significant decline in CRPS signs and symptoms. The mean change in pain at shoulder, pain at the hand as well as and NHP and BDS scores between groups were statistically significant (P < 0.05). Conclusions: UEAE made an excellent improvement in the symptoms and signs of CRPS I. Combined treatment of conventional physiotherapy and aerobic exercises may be an excellent synthesis for this syndrome in these patients.

Pain in Patients with Traumatic Spinal Cord Injury

Objectives The aim of this study was to investigate the prevalence and characteristics of pain in patients with spinal cord injuries. Methods Patients with traumatic spinal cord injury [73 males, 17 females] who had taken part in a rehabilitation program in our inpatient clinic were included. The American Spinal Injury Association Impairment Scale, McGill Pain Questionairre, Numerical Rating Scale, and the Functional Independence Measure were used to evaluate the spinal cord level of the injury, the severity of injury, the resultant pain intensity and the functional state of the study subjects. Results The prevalence of pain was 86.7 percent in patients with spinal cord injury. The nature of the pain was neuropathic in 40 [44.4 percent] of these patients, musculoskeletal in 17 [18.9 percent] patients, and mixed origin in 21 [23.3 percent] patients. There was no apparent relationship between presence, or type of pain and level or severity of the injury [P > 0.05]. A positive relationship was observed between the extent of the injury and the severity of the pain [P = 0.012]. No relationship was found between the pain and the functional state of the patient [P > 0.05]. Conclusion Neuropathic pain is a common clinical manifestation in patients with traumatic spinal cord injury but some also exhibited a musculoskeletal component. The severity of the pain is related to the extent of the spinal cord injury but not to the functional state.

Complex regional pain syndrome (CPRS type I) after a burn injury of the hand

Complex regional pain syndrome (CRPS) type I is a clinical condition characterized by persistent pain in one part or the entire extremity after a minor trauma, fracture, or after an operation which does not involve nerve damage and/or sympathetic hyperactivity. Despite large-scale studies on the complications that arise after burns, literature reveals few reports on neurological problems and CRPS developing after burns. It is a rare complication of a burn injury to an extremity. Its early signs and symptoms are similar to those of burn wound itself. This study describes an unusual cause of complex regional pain syndrome in burn patients. The report highlights physical examination findings, the new diagnostic criteria of complex regional pain syndrome, and difficulties in diagnosis.

Critical illness polyneuropathy: a case report.

Critical illness polyneuropathy (CIP) is defined as a common complication of critically ilness patients who were admitted to the intensive care unit due to sepsis, multiple trauma and/or multi-organ failure. We aimed to present a patient who was diagnosed as CIP. He was admitted to our outpatient clinic due to weakness and pain in his lower extremities. He had been followed in an intensive care unit due to suicid five months ago. There were symmetrically and predominantly muscle weakness, sensory impairment, absence of deep tendon reflexes in his lower extremities. Electrophysiological evaluation demonstrated motor and sensory axonal distal polyneuropathy predominantly in lower extremities. At follow up, he had high fever, and elevated acute phase responses. Therefore source of infection was investigated and was suspected to a diagnosis of infective endocarditis. He was discharged to be hospitalized in cardiology clinic. With this case, we think that physiatrists should take into consideration a diagnosis of critical illness polyneuropathy in patients with symmetric motor weakness. In CIP, muscle weakness, sensory loss, neuropathic pain, and autonomic problems lengthened the rehabilitation period. Due to a diagnosis of infective endocarditis in our case, we point out that source of infection should be carefully investigated if there is acute phase responses in CIP patients even if during rehabilitation period.

Predictive Factors for Inpatient Falls among Children with Cerebral Palsy

Objective: Inpatient falls are of significant concern. The aim of this prospective study was to determine the predictors of inpatient falls among children with cerebral palsy in a rehabilitation hospital. Design and Methods: A total of 93 patients with cerebral palsy were assessed based on history, physical findings, the Selective Motor Control Test, the Gross Motor Functional Classification System, the Berg Balance Scale and the Manual Ability Classification System. Previous history of falls/frequent falls, and any falls which occurred during hospitalization, were recorded. Results: Of all 93 patients, 25 (27%) fell and 68 (73%) did not fall. The mean age of the fallers (6.3 ± 2.0 years) was lower than that of the non‐fallers (8.1 ± 3.9 years). Behavioral problems according to the mothers statement (OR 26.454), not being able to maintain a long sitting position (OR 10.807), ability to balance on knees without support (OR 9.810), a history of frequent falls (OR 4.893) and a negative Thomas test (OR 4.192 fold) were found to increase the risk of inpatient falls. Conclusions: In these children with cerebral palsy, behavioral problems according to the mothers statement, a history of frequent falls, not being able to maintain a long sitting position, a negative Thomas test, and able to balance on knees without support were associated with the risk of inpatient falls. Children with cerebral palsy may experience inpatient falls. Further studies are required in order to develop prevention programs. Practice Implications: For patients diagnosed with cerebral palsy, these results may help identify possible inpatient fallers on hospital admission. HighlightsChildren with cerebral palsy are prone to fall.Behavioral problems and history of frequent falls increase the risk of inpatient falls among children with cerebral palsy.In children with cerebral palsy the Gross Motor Function Classification score is not related to fall risk.