Meral Bayramoglu

Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients.

Karatas M, Çetin N, Bayramoglu M, Dilek A: Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil 2004;83:81–87. ObjectiveTo evaluate trunk muscle strength in unihemispheric stroke patients and to assess how it relates to body balance and functional disability in this patient group. DesignThis prospective case-comparison study investigated isometric and isokinetic reciprocal trunk flexion and extension strength at angular velocities in 38 unihemispheric stroke patients and 40 healthy volunteers. The Berg balance scale was used to assess balance and stability, and the FIM™ instrument was used to evaluate functional disability in the patient group. Patients were evaluated as soon as they were able to stand long enough for testing. ResultsPeak torque values for trunk flexion and extension were lower in the stroke patients than in the controls. The differences were significant for trunk flexion and for trunk extension. In both groups, peak torque values for trunk flexors were greater than peak torque values for trunk extensors. There was a significant positive correlation between trunk muscle strength and Berg balance scale score at discharge. Trunk muscle strength was not correlated with FIM total score or FIM motor score, but the locomotion-transfers FIM subscore at discharge was positively correlated with trunk muscle torque values, except for isometric extension. ConclusionThe findings indicate trunk flexion and extension muscle weakness in unihemispheric stroke patients, which can interfere with balance, stability, and functional disability.

Isokinetic measurement of trunk muscle strength in women with chronic low-back pain.

Bayramoğlu M, Akman MN, Kılınç Ş, Çetin N, Yavuz N, Özker R: Isokinetic measurement of trunk muscle strength in women with chronic low-back pain. Am J Phys Med Rehabil 2001;80:650–655. Objectives: To investigate the relationships among chronic low-back pain and obesity, total spinal range of motion, and trunk muscle strength. The short-term impact of trunk muscle strengthening exercises on this condition was also examined. Design: A controlled, prospective study of trunk muscle strengths of patients with chronic low-back pain and the short-term impact of exercise on strength. The study group consisted of 25 female patients who had been experiencing low-back pain for at least 3 mo, and the control group included 20 age-matched women without known low-back trouble. The Davenport Index was used to calculate the body mass indexes of all subjects. The Oswestry Disability Questionnaire was used to assess pain in the study group. Full flexion and extension ranges of motion were measured, then isokinetic measurements of trunk muscles were performed at 60-, 120-, and 180-degrees/sec velocities. Isometric measurements were also recorded for both flexors and extensors at a 60-degree angle. Results: Increased body mass index and decreased trunk muscle strength were found to be directly associated with chronic low-back pain (P < 0.05). After a 15-day standard trunk strengthening exercise program in the patient group, trunk muscle strength was found to be increased (P < 0.05). Conclusions: Obesity and decrease in trunk muscle strength are important factors in chronic low-back pain, and a trunk muscle strengthening program will be helpful in reducing the pain.

The Effect of Abdominal Massage on Bowel Function in Patients with Spinal Cord Injury

Ayaş Ş, Leblebici B, Sözay S, Bayramoğlu M, Niron EA: The effect of abdominal massage on bowel function in patients with spinal cord injury. Am J Phys Med Rehabil 2006;85:951–955. Objectives:To investigate the effect of abdominal massage on clinical aspects of bowel dysfunction and colonic transit time in patients with spinal cord injury. Twenty-four patients were placed on a standard bowel program (phase I), after which abdominal massage was added to the regimen (phase II). Parameters of gastrointestinal system function and colonic transit times were evaluated. Design:Uncontrolled clinical study. Results:Eleven (45.8%) of the 24 patients had abdominal distention, and 10 (41.7%) had fecal incontinence in phase I; corresponding results for phase II were three (12.5%) and four (16.7%) (P = 0.008 and 0.031, respectively). There were no significant differences between the proportions of patients with difficult intestinal evacuation or abdominal pain or in mean time required for bowel evacuation in phase I vs. phase II. The mean frequencies of defecation in phases I and II were 3.79 ± 2.15 (2.75–4.55) and 4.61 ± 2.17 (3.67–5.54) bowel movements per week, respectively (P = 0.006). Mean total colonic transit time decreased from 90.60 ± 32.67 (75.87–110.47) hrs in phase I to 72 ± 34.10 (58.49–94.40) hrs in phase II (P = 0.035). Conclusions:Abdominal massage has positive effects on some clinical aspects of neurogenic bowel dysfunction in patients with spinal cord injury.

Hemorrhagic transformation in stroke patients.

Bayramoğlu M, Karataş M, Leblebici B, Çetin N, Sözay S, Turhan N: Hemorrhagic transformation in stroke patients. Am J Phys Med Rehabil 2003;82:48–52. Objective To identify the predictors of hemorrhagic transformation in stroke patients and to evaluate the impact of hemorrhagic transformation on rehabilitation outcome. Design The records of 203 hemiplegic patients hospitalized for rehabilitation after the acute phase of stroke were retrospectively analyzed. In 121 cases, the first computed tomographic scan and a repeat scan were compared to determine whether hemorrhagic transformation occurred. Correlations between the occurrence of hemorrhagic transformation and use of anticoagulants, antiaggregants, and antiedema drugs were evaluated. Admission and discharge FIM™ and Adapted Patient Evaluation Conference System scores were noted, and functional gain was calculated from these. These data were also analyzed for associations with hemorrhagic transformation. Results Hemorrhagic transformation was detected in 39 of the 121 cases. There was no significant difference in functional outcome between patients who did and did not show hemorrhagic transformation. Although not statistically significant, the use of antiedema drugs was found to increase the risk of hemorrhagic transformation, whereas the use of anticoagulants and antiaggregants had no influence. Conclusions Hemorrhagic transformation of an ischemic lesion does not affect rehabilitation outcome in stroke survivors. The study results favor the use of anticoagulants and antiaggregants in the acute phase unless these drugs are contraindicated by the patient’s condition. Still, prospective trials are needed to make definite conclusions.

Effects of Lower-Extremity and Trunk Muscle Fatigue on Balance

Objective: To examine the impact of lower-extremity and trunk muscle fatigue on static and dynamic balance tests. Methods: An isokinetic dynamometer at constant angular velocities of 60°/s, 90°/s, 120°/s, and 180°/s was used to test the isokinetic strength of knee and trunk muscles in 30 healthy sedentary volunteers (14 men and 16 women). Lower- extremity fatigue was produced with the StairMaster, and trunk muscle fatigue was produced with an isokinetic dyna- mometer. Static and dynamic balance measurements were assessed with a balance assessment system before and after muscle fatigue in each subject. Results: There was a significant difference between the prefatigue - postfatigue trunk and lower extremity muscles and the static balance scores. But the dynamic right, left and front balance test scores were not significantly different before and after fatigue of the trunk and lower-extremity muscles. Conclusion: Balance is affected by a generalized fatigue of trunk muscles and lower-extremity muscles. However, it ap- pears that static balance control is affected by the fatigue of trunk and lower-extremity muscles while dynamic balance is affected partly by trunk and lower-extremity muscular fatigue.

Diffuse idiopathic skeletal hyperostosis in a patient with idiopathic retroperitoneal fibrosis: a case report

Abstract. Idiopathic retroperitoneal fibrosis (IRF) is a rare rheumatologic disease with obscure pathogenesis. Its manifestations depend upon the structures involved. Diffuse idiopathic skeletal hyperostosis (DISH) is usually seen in male patients over 45 years of age and characterized by new bone formation at the entheses. The dorsal spine is most commonly involved, but radiographic findings in both the spine and extraspinal structures suggest a generalized disorder of ossification rather than a localized spinal disease. The association of IRF and DISH has not been reported before. There is proliferation of connective tissue in both of these diseases, and they may share a common etiopathogenetic basis. We describe a patient having features of both IRF and DISH.