Nil Sayiner Caglar

Effects of age, gender, and cognitive, functional and motor status on functional outcomes of stroke rehabilitation.

Our objective was to evaluate the relation between age, gender, initial functional, cognitive and motor condition, spasticity, diabetes mellitus, and functional outcome after rehabilitation of stroke patients. Eighty-eight patients who had suffered stroke were administered in this study. Participants were stroke patients undergoing rehabilitation in Istanbul Physical Treatment and Rehabilitation Training and Research Hospital. Functional condition (Functional Independence Measurement (FIM)), spasticity (Ashworth Scale), cognitive condition (Mini Mental State Evaluation (MMSE)), post-treatment FIM were measured. A significant positive association between MMSE at admission and the functional discharge measures was observed. A significant positive association Brunnstrom (upper lower extremity assessment) scores and the functional discharge measures was observed. A significant positive association between spasticity at admission and the functional discharge measures was observed. In conclusions, the admission functional, motor, cognition condition, age, spasticity were a significant predictors of total and motor FIM score at discharge, but not gender and diabetes mellitus.

Rehabilitation Outcomes of Children with Cerebral Palsy

[Purpose] To evaluate the results of Bobath-based rehabilitation performed at a pediatric cerebral palsy (CP) inpatient clinic. [Subjects and Methods] The study subjects were 28 children with CP who were inpatients at a pediatric service. Inclusion criteria were: being an inpatient of our hospital aged 2–12 with a diagnosis of CP; having one permanent primary caregiver; and the caregiver having no medical or psychotic problems. All of the patients received Bobath treatment for 1 hour per day, 5 days a week. The locomotor system, neurologic and orthopedic examination, Gross Motor Function Measure (GMFM) of the patients, and Short Form-36 (SF-36) of permanent caregivers were evaluated at the time of admission to hospital, discharge from hospital, and at 1 and 3 months after discharge. [Results] Post-admission scores of GMFM at discharge, and 1 and 3 months later showed significant increase. Social function and emotional role subscores of SF-36 had increased significantly at discharge. [Conclusion] Bobath treatment is promising and randomized controlled further studies are needed for rehabilitation technics.

Chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and the relationship between sleep disorder and pain level, quality of life, and disability.

[Purpose] The aim of this study was to ascertain the prevalence of chronic widespread musculoskeletal pain in patients with obstructive sleep apnea syndrome and to assess the relationship between sleep disorder and pain, quality of life, and disability. [Subjects and Methods] Seventy-four patients were included in the study and classified as having mild, moderate, or severe obstructive sleep apnea. Chronic widespread pain, quality of life, and disability were evaluated. [Results] Forty-one patients (55.4%) had chronic widespread pain. Female patients had a higher incidence of chronic pain, and female patients with chronic pain had higher body mass indexes, pain levels, and disability scores than did male patients. Physical component scores of female patients with chronic pain were lower than those of male patients. No correlation was observed between the degree of sleep disorder and severity of pain, pain duration, disability, or quality of life in obstructive sleep apnea patients with pain. [Conclusion] This study showed a 55.4% prevalence of chronic widespread pain in patients with obstructive sleep apnea and a greater risk of chronic pain in female than in male patients. Female patients with obstructive sleep apnea and chronic pain have higher pain and disability levels and a lower quality of life.

Pain syndromes in hemiplegic patients and their effects on rehabilitation results

[Purpose] The aim of this study was to determine the frequency, type, and location of pain in hemiplegic patients and the effects on rehabilitation results in our inpatient rehabilitation unit. [Subjects and Methods] Patients rehabilitated between January 2010 and July 2012 were investigated retrospectively. Properties of pain were recorded. Pre- and post-rehabilitation motor evaluation and achievement in daily activities were considered, and differences in scores between groups classified as with and without pain were examined. [Results] The number of patients included in the study was 156. The mean age was 64.28 ± 12.45 years, the mean disease duration was 11.10 months, and the gender distribution was 75 males (48%) and 81 females (52%). Fortysix (29.5%) patients had pain complaints. The nociceptive pain ratio was 86.7%, and the neuropathic pain ratio was 13.3%. Pain was mostly localized at the shoulder joint, with the proportion being 86.9%. In the pain group, statistically significant improvement was found in pain scores after the treatment. There was no significant difference between groups in the pre- and post-rehabilitation Brunnstrom motor evaluation and functional independence measurement scores. [Conclusion] Nociceptive pain is more common than neuropathic pain in patients with hemiplegia, and the shoulder joint is the most frequent location of nociceptive pain.

Comparison of static wrist splint with static wrist and metacarpophalangeal splint in carpal tunnel syndrome

BACKGROUND The position of metacarpophalangeal (MCP) joints may be an important factor affecting the efficacy of splinting in patients with carpal tunnel syndrome (CTS). OBJECTIVE The aim of the present study was to compare the efficacy of a neutral volar static wrist splint with a neutral volar static wrist and MCP splint in patients with CTS. METHODS Fifty-four hands were included into the study. A neutral volar static wrist splint was given to the symptomatic hands of the patients in group 1 while a neutral volar static wrist and MCP splint was given to the symptomatic hands of the patients in group 2. Evaluation parameters were Visual Analog Scale for pain severity (VASp), grip strength, pinch strength, electrophysiologic tests and CTS Questionnaire (CTSQ) at baseline and four weeks later. RESULTS At baseline there was no difference between groups. The intergroup comparison of the improvement showed significant differences in VASp at rest, grip strength, pinch strength and CTSQ functional capacity scores between groups in favor of wrist MCP splint. Although there were significant improvements with regard to sensory amplitude and motor latency in both groups after therapy, the differences between groups were not at the level of significance. CONCLUSIONS The position of MCP joints seems to be an important factor for the treatment of CTS and should be considered while prescribing a splint to the patients with CTS.

Differential diagnosis of a rare case of upper limb pain: Paget-Schroetter syndrome in a doner kebab chef

[Purpose] Paget-Schroetter syndrome (PSS) is an uncommon deep vein thrombosis of the axillary and subclavian veins which may occur spontaneously, but is usually caused by excessive upper limb activity. PSS is clinically similar to other upper limb musculoskeletal disorders and soft tissue infections, and this may lead to delay in correct diagnosis in its early stages. The aim of our case report is to discuss this rare condition with reference to the available literature. [Subjects and Methods] Here we report the case of a doner kebab chef who complained of swelling and pain in his right arm around the biceps muscle. The initial diagnosis was biceps tendon rupture, for which the patient underwent magnetic resonance imaging (MRI) of the right arm and shoulder. Since the MRI revealed no pathological findings, right upper limb venous Doppler ultrasound analysis was performed. Subacute thrombosis materials were detected in the subclavian, axillary, and brachial veins. [Results] With rapid anticoagulant therapy, the patient’s symptoms quickly improved. [Conclusion] Early diagnosis and treatment of PSS is critical for preventing potentially fatal complications such as pulmonary embolism. Prophylaxis is important for preventing recurrent thrombosis and for avoiding the development of post-thrombotic syndrome. PSS should be considered a possible cause of painful swelling of the upper limbs, especially in young, active patients who use their arms excessively.

Where are we in terms of poststroke functional outcomes and risk factors

BACKGROUND Stroke is acute vascular deterioration of cerebral functions and 2nd leading cause of death. As population gets older, as well as the increasing prevalence of stroke and disability from chronic disease, the demand for rehabilitation care will continue to rise. There is need for evidence based rehabilitation approaches and rehabilitation outcomes should be proved by objective questionnairres to qualify the process. OBJECTIVE To present the functional outcomes of stroke rehabilitation process among functional impairment measure evaluation. Determine the contributing factors on functional gain. MATERIAL-METHODS Retrospectively assessment of data of 142 posttroke patients performed. In addition to demographical and clinical properties, functional outcomes with functional impairment measurement (FIM) and motor evaluation by Brunnstrom Motricitiy Index were recorded. Risk factors for stroke were questionned also. RESULTS The mean of ages was 64.30 ± 11.9 years, male/female ratios were 47.2%/ 52.8%. The functional gain was 20.4% in M-FIM, 14.7% in C-FIM. Better outcomes gained by the patients who stayed longer than 15 days (ANOVA, p: 0.000) and who had hemorrhagic etiology (MannWhitney U, p: 0.048), meanwhile there was no significant difference in gender and plegic side groups on both Motor-FIM and Cognitive-FIM gains (p > 0.05, MannWhitney U). Regression models exhibited highest impact on the M-FIM gain were the admission M-FIM scores and DM (adjusted Rsquare: 0.173, p: 0.000). Admission C-FIM scores had positive correlation with discharge C-FIM scores (r: 0.917, p: 0.000). Although older age was the negative determinant of C-FIM gain (r: -0.202, p: 0.016). We obtained the risk factor distribution 71.8% for HT, 29.6% for CAD, 25.6% for smoking, 16.2% for TIA and 33.1% for DM. All had negative impact on functional outcomes but DM had significantly (regression analysis p < 0.05). CONCLUSION Improvement by rehabilitation programme determined by FIM scores. Data provided about the poststroke patients and present risk factors. Still there exists similar ratios of risk factors as studies before eventhough prevention recommendations.

Spondyloepiphyseal dysplasia related osteoporosis in a young male patient

Spondyloepiphyseal Dysplasia (SED) is a rare bone growth disorder. Clinical manifestations may include dwarfism, short trunk and neck, flat face, shortened limbs, coxa vara, genu varum/valgum, kyphoscoliosis, increased lomber lordosis, platyspondylia, barrel-shaped chest (pectus carinatum). Type II collagen is the dominant protein of cartilage in which is thought to play a major role in the etiology of the disorder. Many congenital diseases, including osteogenesis imperfecta, hypophosphatemic rickets and lysosomal storage diseases, have been associated with abnormal bone metabolism and osteoporosis. Coexistence of SED and osteoporosis rarely reported in the scientific literature. In this case report, we discussed SED related osteoporosis in a young male patient in the context of current literature.

Ultrasonographic Evaluation of Lower Extremity Entheseal Sites in Diabetic Patients Using Glasgow Ultrasound Enthesitis Scoring System Score

Objective: The prevalence of musculoskeletal complications in diabetes mellitus (DM) increases with the duration of disease and with poor glycemic control. Our aim was to evaluate lower extremity musculoskeletal complications in patients with DM using the Glasgow Ultrasound Enthesitis Scoring System, and to reveal the relationship between clinical and sono-graphic findings. Materials and methods: A total of 67 patients (25 men, 42 women) with DM were included in the study. All the diabetic patients were selected if they did not have any symptom of muscu-loskeletal system in the lower extremities. They were divided into four groups. Ultrasonographic assessment was performed according to the Glasgow Ultrasound Enthesitis Scoring System with an Esaote MyLab 5 device equipped with a 5–13 MHz linear transducer. Correlation between diabetes duration and lower extremity enthesopathy scores were evaluated. Results: There was a significant correlation between duration of DM and total Glasgow Ultrasound Enthesitis Scoring System scores (p < 0.001). In addition, duration of DM was significantly correlated with enthesophyte scores and erosion scores (both p < 0.001). There was a significant difference among Groups 1 –4 for the mean enthesophyte score and mean erosion score (both, p < 0.001). Conclusion: Musculoskeletal ultrasonography is an effective, inexpensive, and useful tool without radiation for evaluating diabetic patients for the early diagnosis of musculoskeletal complications.

The effectiveness of extracorporeal shockwave treatment in subacromial impingement syndrome and its relation with acromion morphology

Objective The aim of this study was to evaluate the effectiveness of the extracorporeal shock wave therapy in the subacromial impingement syndrome and its relationship with the acromion morphology. Methods Thirty patients (24 women, 6 men) with subacromial impingement were evaluated. The average age of patients was 53.6 ± 9.8 years (range 39–80). Patients were divided into 3 groups according to the acromion morphology. ESWT 1500 at 0.12 am mL/mm2 violence was applied once a week for 3 weeks. Shoulder pain and disability index (SPADI) was used to assess function and pain scores of the patients. The evaluations were made prior to and 12 weeks after the ESWT. Results Thirteen shoulders had type 1 acromion, 11 shoulders type 2 acromion and 6 shoulders type 3 acromion. After ESWT, the SPADI pain score decreased from 16.1 ± 5.1 (7–25) to 10.4 ± 4.9 (1–20); SPADI functional score decreased from 37.3 ± 19.8 (5–70) to 26.7 ± 17.5 (1–60); SPADI total score decreased from 53.4 ± 24.5 (14–95) to 37.1 ± 21.6 (2–74) (p < 0.05; paired t test). In each group better functional outcomes were achieved after ESWT (p < 0.05; paired t test). There were no differences between the groups according to functional outcome both before and after the ESWT treatment (p > 0.05, one way ANOVA test). Conclusion ESWT was found to be effective in the treatment of impingement syndrome both for pain and functional outcome in the early period regardless of acromion morphology. Level of evidence Level IV, Therapeutic study.