Metin Karatas

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.

Initial effects of kinesio® taping in patients with patellofemoral pain syndrome: A randomized, double-blind study

The purpose of this randomized, double-blind study was to determine the acute effects of kinesio ® taping on pain. strength, joint position sense and balance in patients with patellofemoral pain syndrome (PFPS). Twenty-two subjects with PFPS participated in the study. Subjects were separated into two groups; kinesio ® taping (KT) and placebo kinesiotaping (PKT). All subjects were assessed before and 45-min after the applications. Muscle strength, joint position sense, static and dynamic balance and pain intensity were used as the main outcome measures. Among all outcome parameters significant differences were found between strength of quadriceps muscle at 60 and 180°/s, and static and dynamic balance scores before and 45-min after application of KT. There was also a significant difference between strength of quadriceps muscle at 60°/s and static balance scores before and 45 minutes after application of the PKT. Therefore KT application does not seem to be an effective treatment method for both decreasing pain and improving joint position sense for patients with PFPS.

Postpartum sacral stress fracture: an unusual case of low-back and buttock pain.

Low-back and buttock pain is a common complaint during pregnancy and the postpartum period and is usually attributable to mechanical lesions of the pelvis. Sacral stress fractures are unusual but important causes that should be considered in differential diagnosis. To date, only eight postpartum sacral stress fractures have been reported in the literature. A 32-yr-old woman presented with low-back and right buttock pain that started 15 days after uneventful cesarean section delivery. Imaging studies revealed a right sacral stress fracture. Lumbar spine and femoral neck bone mineral density were normal and, except for pregnancy and lactation, no risk factors for osteoporosis were identified. There was no history of trauma, excessive weight gain, strenuous physical activity, or contribution of mechanical factors. The question remains whether this is an insufficiency fracture or a fatigue fracture. Clinicians should consider sacral fracture during pregnancy and the postpartum period as a diagnostic possibility in patients with low-back and/or buttock pain.

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.

Complex decongestive therapy and taping for patients with postmastectomy lymphedema: a randomized controlled study.

PURPOSE The purpose of our study was to investigate the effects of Kinesio Taping(®) Application with Complex Decongestive Therapy (CDT) in patients with lymphedema. MATERIALS AND METHODS 45 patients were randomly divided into 3 groups (CDT including Bandage, CDT including Bandage + Kinesio Tape(®), CDT including Kinesio Tape(®) without bandage). Assessments included the severity of the symptoms such as pain, discomfort, heaviness, tension, stiffness and weakness. Bilateral circumference measurements were done for evaluation of the edema. RESULTS Symptoms were decreased in all three groups (p < 0.05). CDT was found effective only during treatment in arm volume (p < 0.05). Kinesio Taping(®) applied with CDT had effect of decreasing edema after 10 days of treatment period (p < 0.05) and for control period (p < 0.05). Only the application of Kinesio Taping(®) group also had significant decrease at edema (p < 0.05). CONCLUSION Kinesio Taping(®) Application along with CDT may have a better effect on decreasing lymphedema which can stimulate the reduction of edema for long term effects.

Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study

Study design:Retrospective, 12-year case series.Objective:To compare neurological and functional outcomes, and complications of patients with traumatic vs non-traumatic spinal cord injury (SCI) after in-patient rehabilitation.Setting:In-patient rehabilitation unit of a tertiary research hospital.Materials and Methods:The sample consisted of 165 newly injured patients with traumatic and non-traumatic spinal cord lesions whose medical records were retrospectively reviewed. Demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) subgroup scores, length of stay and medical complications in both groups were compared.Results:In all, 38 patients (23%) were non-traumatic and 127 patients (77%) were traumatic in etiology. Compared with patients with traumatic SCI (mean age 37.81±13.65 years), patients with non-traumatic SCI (mean age 53.97±14.48 years) were significantly older (P<0.05). Incomplete SCI was significantly higher in the non-traumatic group when compared with the traumatic group (P<0.001). In the non-traumatic group, admission motor FIM scores were significantly higher (28.29±16.04) than scores from the traumatic group (36.60±21.65; P=0.029); however, there was no significant difference in discharge motor FIM scores between the two groups (P=0.140). ASIA impairment scale scores were significantly higher in non-traumatic group both at admission and discharge (P=0.000 and P=0.000, respectively). The length of hospital stay was significantly shorter in the non-traumatic group (P=0.002).Conclusion:According to the results of this study, although patients with non-traumatic SCI had shorter length of stay and higher ASIA scores, there was no significant difference in functional outcomes between traumatic and non-traumatic SCI patients.

Ulnar nerve conduction abnormalities in carpal tunnel syndrome

Introduction: The aim of this study was to verify the involvement of ulnar nerve fibers in cases of carpal tunnel syndrome (CTS) and investigate the correlation between ulnar nerve conduction parameters and extra‐median spread of symptoms. Methods: Electrophysiological studies were conducted in 93 CTS and 76 control hands. Patients were analyzed with regard to symptoms in the fifth finger. Results: In the CTS cases, ulnar distal motor latency (DML) and distal sensory latency (DSL) were significantly longer, and amplitudes were lower than in controls. Increased median nerve DML correlated with increased ulnar nerve DSL and decreased sensory amplitudes and conduction velocities (SCVs). In cases with symptoms in the fifth finger, ulnar nerve SCVs and amplitudes were lower than in patients without symptoms. Conclusions: Pathological processes leading to median neuropathy in CTS may affect ulnar nerve motor and sensory fibers in the Guyon canal. This may explain the extra‐median spread of sensory symptoms in CTS patients. Muscle Nerve 44: 352–357, 2011

Evaluation of restless legs syndrome in fibromyalgia syndrome: An analysis of quality of sleep and life

BACKGROUND AND OBJECTIVE The aim of this study is to find prevalence and severity of restless legs syndrome (RLS) in patients with fibromyalgia syndrome (FMS) and detect effect of FMS and RLS coexistance on quality of sleep and life. METHODS In this study, presence and severity of RLS were detected in patients with FMS and Pitsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Fibromyalgia Impact Questionnaire (FIQ) scores of all patients were measured. RESULTS One hundred and fifteen female patients with median age 49 (39.0-57.0)[median (25-75{\%} interquartile range)] were included in the study. In 42.6% of patients RLS coexisting with FMS was found. RLS was classified as moderate in 42.9% of patients and as severe in 49.0% of patients. In patients with FMS ans RLS sleep quality, daytime sleepiness and quality of life were more severely impaired (PSQI scores were 9.0 ± 4.4 vs 7.8 ± 4.3, p=0.003; ESS scores were 5.0(3.0-7.5) vs 3.0(1.0-4.3), p=0.036 and FIQ scores were 68.1 ± 9.8 vs 59.4 ± 16.9, p=0.027) compared to patients with only FMS. Prevalence of RLS was found higher in FMS than normal population and quality of sleep and quality of life were worse in patients with RLS. CONCLUSIONS Presence of RLS should be investigated in every patient with FMS and treatment plans should also cover RLS in case of coexistance with FMS. Prospective cohort studies are needed for better explanation of FMS and RLS coexistance.

Association of vitamin D deficiency with muscle strength and quality of life in postmenopausal women

Abstract Aim The aim of this study was to analyze the effect of vitamin D deficiency on muscle strength and quality of life in postmenopausal women. Methods Self-sufficient, community-dwelling, postmenopausal women over 55 years old attending the Physical Medicine and Rehabilitation outpatient clinic were included in the study. 25-Hydroxyvitamin D levels below 20 ng/ml were accepted as indicative of vitamin D deficiency. A computerized isokinetic dynamometer (Cybex 770 Norm, Lumex Inc., Ronkonkoma, NY, USA) was used for testing knee extensor muscle strength. Results Forty-nine postmenopausal women with median age 64.3 years (interquartile range 59.0–69.5 years) were included in the study. Vitamin D deficiency was detected in 49% of the participants. There was no relation between vitamin D deficiency and knee muscle strength in both right and left legs. Vitamin D deficiency was found not to be associated with any of the domains of SF-36. Conclusions Vitamin D deficiency is not related to decreased muscle strength and lowered quality of life in postmenopausal women. Other factors rather than vitamin D deficiency should be investigated for illuminating the causalities of these two common clinical conditions.

Is there a relationship between core stability, balance and strength in amputee soccer players? A pilot study

Background: The body is a kinetic chain and all the systems and muscle groups play important roles in this chain. Core stability, strength and balance are important components of performance within many sports, and in particular soccer. However, the relationship between these components is not fully understood. Objectives: To investigate the relationship between core stability, balance and strength in amputee soccer players. Study Design: Clinical pilot trial. Methods: Eleven amputee soccer players (mean age = 24.63 ± 6.48 years) participated in our study. A Kinesthetic Ability Trainer device was used to assess balance. Trunk strength was evaluated by isokinetic dynamometer. Gillet test was used to evaluate the sacroiliac joint movement. Modified plank test was used to determined dynamic core stability. Disability was evaluated using the Oswestry Disability Index. Results: The results showed that there was a correlation between flexor isokinetic trunk muscle strength at the velocity of 60°/sec and modified plank test (r = 0.630, p = 0.038). There was a negative correlation between flexor isokinetic trunk muscle strength at the velocity of 180°/sec and Oswestry Disability Index score (r = −0.649, p = 0.031). Conclusions: Amputee soccer is a sport which is generally performed with one limb balance with crutches. It is therefore perceived that a relationship between balance and sacroiliac mobility, and should be considered for evaluation process and performance analysis in amputee soccer. However, in future studies, we recommend that such evaluations on amputee soccer players should be carried out with increased numbers. Clinical relevance Many aspects should be considered in the evaluation of amputee soccer players. Core stability, balance and strength should not be ignored when designing a training program for an amputee soccer team.