Haydar Mohur

The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy.

Purpose. To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines. Method. Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0° with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period. Results. AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking. Conclusion. The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.

Bone density loss after spinal cord injury: Elite paraplegic basketball players vs. paraplegic sedentary persons

Goktepe AS, Yilmaz B, Alaca R, Yazicioglu K, Mohur H, Gunduz S: Bone density loss after spinal cord injury: Elite paraplegic basketball players vs. paraplegic sedentary persons. Am J Phys Med Rehabil 2004;83:279–283. Objective To compare the bone mineral density of elite paraplegic basketball players with the values obtained from their paraplegic sedentary counterparts. Design A total of 17 male paraplegic basketball players and 17 male paraplegic sedentary persons were included in the study. Bone mineral densities of the distal third of radius of the dominant arm, L2–L4 spine, and trochanters, Ward’s triangles, and the femoral necks of both hips were measured. Results The densities of trochanters, Ward’s triangles, and the femoral necks were found to be decreased in both groups, with no significant difference between them. The densities of lumbar and radial regions were found to be increased in both groups. Radial density was significantly higher in paraplegic basketball players than in paraplegic sedentary patients, whereas the groups were not significantly different for lumbar density. Conclusions Wheelchair basketball in spinal cord–injured patients was associated with greater bone density in distal radius compared with sedentary paraplegics. However, it was not associated with greater density below the injury level.

Basal Metabolic Rate and Autonomic Nervous System Dysfunction in Men With Spinal Cord Injury

Objectives: The purpose of this study was to determine the relationship between autonomic nervous system dysfunction and basal metabolic rate (BMR), and the effect of spasticity on basal metabolic rate.

Epidemiologic data of the patients with spinal cord injury: seven years' experience of a single center.

BACKGROUND We aimed to present the demographic and epidemiologic data on spinal cord injury (SCI) patients who were rehabilitated at our hospital, to identify high-risk groups and etiological factors, and to evaluate the factors that affect the duration of hospitalization (DOH). METHODS Data on 905 SCI patients treated on an inpatient basis between December 2000 and June 2007 at our hospital were retrospectively evaluated. Patient age, sex, etiology of injury, DOH, neurologic level, and functional grouping were analyzed. Additionally, the effects of age and sex on DOH were evaluated. RESULTS In total, 661 (73%) of the patients were male and 244 (27%) were female. The mean age of the patients was 33.4±15.0 years; 51.27% of the patients were 20-33 years of age. The mean DOH was 73.6±49.8 days. In all, 304 (33.5%) of the patients were tetraplegic and 601 (66.5%) were paraplegic. Motor vehicle collisions were the most common cause of injury (n=318, 35.1%), followed by falls from an elevated height (n=170, 18.8%). DOH was significantly higher among the tetraplegia American Spinal Injury Association (ASIA) A-B patients than among the other patients (p<0.01). CONCLUSION. It is clear that most of the SCIs we observed were preventable. Comprehensive identification of the epidemiologic, demographic and pathologic features of SCIs contributes to identifying high-risk groups, thereby making it possible to pay personal and communal attention to precautions for SCIs.

Effect of autonomic dysfunction on p-wave dispersion in patients with chronic spinal cord injury.

Yasar E, Yilmaz B, Yasar AS, Goktepe AS, Alaca R, Mohur H: Effect of autonomic dysfunction on P-wave dispersion in patients with chronic spinal cord injury. Objective:To provide information about the effect of autonomic dysfunction on P-wave dispersion, as a predictor of atrial fibrillation, in patients with spinal cord injury. Design:Thirty patients with chronic traumatic spinal cord injury and 27 healthy controls were included in this study. The initial assessment of the patients included routine physical examination and evaluation of 12-lead electrocardiography. In the patient group, blood pressure and electrocardiography recordings were obtained during urodynamic assessment. The measurements of the P-wave duration were performed manually by two blinded investigators. P-wave dispersion was calculated as the difference between maximum P-wave duration and minimum P-wave duration. P-wave dispersion values of resting electrocardiography recordings in control and study groups were compared. In the patient group, subgroup analyses were also performed according to the injury level and severity and existence of autonomic dysfunction in examinations. Results:P-wave dispersion values were greater in patients with spinal cord injury than in healthy controls. There was statistically significant difference between P-wave dispersion values of the patients with and without autonomic dysfunction. P-wave dispersion values at initial sensation of vesical filling were greater than those of the resting state in the patients without autonomic dysfunction. Conclusions:Our findings indicate that P-wave dispersion increases significantly in chronic spinal cord injured patients with autonomic dysfunction. This finding suggests a tendency for atrial fibrillation occurrence in patients with spinal cord injury, which may cause further cerebrovascular complications in this special subset of patients by creating a thromboembolic milieu.

Delayed subdural block as an unusual complication following stellate ganglion blockade

AbstractThe inadvertent injection of local anesthetic into subdural space is an unusual condition, following an attempt to block the stellate ganglion. In this report, we present a complication of subdural analgesia with late onset in a 21-year-old young man who underwent stellate ganglion blockade. The clinical picture of injection into the subdural space and other potential cavities is described and previous cases reported in the literature are reviewed.