Nur Kesiktas

Comparison of the therapeutic efficacy of TENS versus intra-articular hyaluronic acid injection in patients with knee osteoarthritis: A prospective randomized study

Knee osteoarthritis (OA) is perceived as a major public health problem, and today, various treatment modalities are used to manage this condition. The purpose of this study was to assess and compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and intra-articular hylan G-F 20 (Synvisc®; Genzyme Corporation, Ridgefield, NJ) in patients with symptomatic knee OA. A total of 60 patients with primary knee OA were randomized into 2 treatment groups. TENS was applied for 3 weeks in the first group, and in the second group, hylan G-F 20 was injected intra-articularly once a week for 3 weeks. Patients were then followed for 6 months. Disease severity was measured with the Lequesne Index. Efficacy in terms of pain, functional status, and quality of life was assessed through analysis of changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 Health Survey (SF-36) scores. Adverse events were monitored throughout the study. WOMAC pain scores were improved at the first control visit in the TENS group and in the viscosupplementation group; this improvement was statistically significant. WOMAC stiffness scores showed a statistically significant decrease in the TENS group at the first control visit. Stiffness did not decrease during the first month in the second group; however, these patients exhibited improvement during the sixth month after injection. Physical function scores and SF-36 total scores did not change in either group after treatment. Pain relief was observed at the first month and continued throughout the 6-month follow-up period in both groups. Stiffness decreased by the sixth month in both groups. Improvement in WOMAC physical function scores was greater in the intra-articular hylan group than in the TENS group at the end of follow-up; however, quality of life was not improved in either group. These therapies used in combination may alleviate symptoms in patients with OA.

Gait speed and related factors in Parkinson’s disease

[Purpose] The aim of this study was to investigate the relationship between gait speed and various factors in ambulatory patients with idiopathic Parkinson’s disease. [Subjects] Fifty ambulatory patients with idiopathic Parkinson’s disease who were admitted to an outpatient clinic were included in this cross-sectional study. [Methods] The Hoehn and Yahr Scale was used for measurement of the disease severity. Gait speed was measured by the 10-Meter Walk Test. Mobility status was assessed by Timed Up and Go Test. The Hospital Anxiety and Depression Scale was used for evaluation of emotional state. Cognitive status was examined with the Mini-Mental State Examination. The Downton Index was used for fall risk assessment. Balance was evaluated with the Berg Balance Scale. Comorbidity was measured with the Cumulative Illness Rating Scale. The 36-Item Short Form Health Survey was completed for measurement of quality of life. [Results] The mean age was 66.7 (47–83) years. Twenty-eight (56%) patients were men. Gait speed was correlated positively with height, male gender, Mini-Mental Examination score, Berg Balance Scale score and physical summary scores of the 36-Item Short Form Health Survey. On the other hand, there was a negative correlation between gait speed and age, disease severity, TUG time, Downton Index, fear of falling, previous falls and the anxiety and depression scores of the Hospital Anxiety and Depression Scale. There was no correlation between gait speed and comorbidity. [Conclusion] The factors related with the slower gait speed are, elder age, clinically advanced disease, poor mobility, fear of falling, falling history, higher falling risk, and mood disorder.

The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia

Effects of balneotherapy on Primary Fibromyalgia Syndrome (FMS) have been studied well, except for its effect on the respiratory symptoms of FMS. In this study we allocated 56 patients with FMS into three groups who matched according to age, gender and duration of illness. All three groups received the same three physical therapy modalities (PTM): transcutaneous electrical nerve stimulation (TENS), ultrasound (US) and infrared (IR). The first group received PTM plus balneotherapy (PTM+BT), the second group received PTM alone (PTM), whilst the third group received PTM plus hydrotherapy (PTM+HT). All groups were treated for three weeks and in the same season. All patients were assessed at four time points: (a) at baseline, (b) on the 7th day of therapy, (c) at the end of therapy (after 3 weeks) and (d) at 6 months after the end of therapy. The effectiveness of treatments in all groups were evaluated in three main categories (pain, depressive and respiratory symptoms). Tender point count, total algometric measurements and pain with visual analog scale for pain; Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) for depression; dyspnea scale, and spirometric measurements for respiratory symptoms; plus quality of life with visual analog scale as a general measurement of effectiveness were taken at all four assessment time points.Both at the end of therapy and at the 6 months follow up significant improvements in dyspnea scale, and spirometric measurements, as well as in other measured parameters were observed in group PTM+BT. All groups achieved significant improvements in BDI and HDRS but scores of PTM and PTM+HT groups had overturned at 6 months follow up. Except second group which receieved PTM alone, pain evaluation assessments were improved at 6 month follow up in PTM+HT and PTM+BT groups. But PTM+BT group had more significant improvements at the end of therapy. PTM group had no significant change for dyspnea scale and spirometric measurements. PTM combined BT and HT groups achieved significant improvements at the end of therapies for dyspnea scale and spirometric measurements, but only PTM +BT group had significant improvements for dyspnea scale and spirometric measurements at six month follow up. The group of PTM+BT was significantly better than other groups. Our results suggest that supplementation of PTM with balneotherapy is effective on the respiratory and other symptoms of FMS and these effects were better than other protocols at 6 month follow up.

Turkish Adaptation of Spinal Cord Independence Measure--Version III.

Various rating scales have been used to assess ability in individuals with spinal cord injury. There is no specific functional assessment scale for Turkish patients with spinal cord injury. The Spinal Cord Independence Measure (SCIM) is a specific test, which has become popular in the last decade. A study was conducted to validate and evaluate the Turkish adaptation of the SCIM III (T-SCIM III). The SCIM III was translated into Turkish. Reliability, (internal consistency, interrater reliability, and test–retest reliability), validity (with Functional Independence Measurement), and sensitivity (changes in 8-week exercise program) were studied. Internal consistency for total score was sufficient (Cronbach &agr;=0.79). The interrater reliability was moderate to high (Cohen &kgr; between 0.72 and 1). Convergent validity was high (r=0.89, P<0.01). The T-SCIM III was found to be more sensitive than the Functional Independence Measurement to changes in function. Hence, we recommend the use of T-SCIM III in clinical practice as a reliable, valid, and easy-to-use tool.

Effects of robotic treadmill training on functional mobility, walking capacity, motor symptoms and quality of life in ambulatory patients with Parkinson's disease: A preliminary prospective longitudinal study

BACKGROUND Decreased mobility and walking capacity occur frequently in Parkinsons disease (PD). Robotic treadmill training is a novel method to improve the walking capacity in rehabilitation. OBJECTIVES The primary aim of this study was to investigate the effects of robotic treadmill training on functional mobility and walking capacity in PD. Secondly, we aimed to assess the effects of the robotic treadmill training the motor symptoms and quality of life in patients with PD. METHODS Seventy patients with idiopathic Parkinsons disease who admitted to the outpatient clinic of the rehabilitation hospital were screened and 12 ambulatory volenteers who met the study criteria were included in this study. Patients were evaluated by Hoehn Yahr (HY) scale clinically. Two sessions robotic treadmill training per week during 5 weeks was planned for every patient. Patients were evaluated by the Timed Up and Go (TUG) test, 10 meter walking test (10 MWT), Unified Parkinsons Disease Rating Scale (UPDRS) motor section and Parkinsons Disease Questionnaire-39 (PDQ-39) at the baseline, at the 5 and 12 weeks. Cognitive and emotional states of the patients were assessed by Mini Mental State Examination (MMSE) test and Hospital Anxiety and Depression Scale (HADS) at the baseline. All patients were under medical treatment for the PD in this study and drug treatment was not changed during the study. RESULTS Ten patients completed the study. The mean age was 65.6 ± 6.6 years. Five patients (50%) were women. Disease severity was between the HY stage 1-3. Two patients did not continue the robotic treadmill training after 7 sessions. They also did not want to come for control visits. TUG test, 10 MWT and UPDRS motor subscale scores showed statistically significant improvement after robotic treadmill training (p = 0.02, p = 0.001, p = 0.016). PDQ-39 scores improved significantly after robotic treadmill training (p = 0.03), however, the scores turned back to the baseline level at the 12. week control. CONCLUSION As a result of this preliminary study, robotic treadmill training was useful to improve the functional mobility, walking capacity and motor symptoms in mild to moderate PD. Robotic treadmill training provided a transient improvement in the quality of life during the treatment.

Reliability of the Turkish version of the hospital anxiety and depression scale in the people with traumatic spinal cord injury.

BACKGROUND Emotional problems are common in spinal cord injury (SCI). Self report questionnaires are easy and useful for screening the emotional status in clinical practice. OBJECTIVES The aim of this study was to assess the reliability of the Turkish version of the Hospital Anxiety and Depression Scale (HADS) as well as to investigate the frequency of anxiety and depression in a group with SCI admitted to the outpatient clinic of a rehabilitation hospital. METHODS One hundred seventy-five persons with traumatic SCI were included in this study. The American Spinal Injury Association Impairment Scale, Functional Independence Measure (FIM) and HADS were used for assessments. RESULTS The mean age of the participants was 35 ± 13 years, and the mean time elapsed since injury was 13 ± 29 months. The mean motor FIM score was 41 ± 21. The Cronbachs alpha coefficient was 0.90 and 0.77 for the anxiety and depression subscales of the HADS, respectively. Forty percent of the participants had anxiety and 28% had depression. Anxiety was positively correlated with time since injury (r = 0.2). Depression was negatively correlated with the education level (r = 0.25), and positively correlated with age (r = 0.17). There was a positive correlation with completeness and anxiety and depression (r = 0.49, r = 0.55). CONCLUSION The Turkish version of the HADS is a reliable psychological screening test for anxiety and depression in people with SCI. Rehabilitation team should gather maximum information about the emotional status of the person with SCI, and plan the appropriate treatment for anxiety and depression.

Is There a Relationship between Vitamin B12 and Stress Urinary Incontinence

Objective: Pelvic floor, which includes collagen, elastin, and smooth muscle, is very important in preventing urinary incontinence (UI). Studies suggest that vitamin B12 is involved in collagen synthesis. In the present study we aimed to determine the association of vitamin B12 deficiency with stress UI in a sample of Turkish women.

İNMELİ HASTALARDA OTONOMİK FONKSİYONLAR: VASKÜLER TUTULUMUN YERİ İLE KARŞILAŞTIRMA

Amac: Calismamizin amaci; inmeli hastalarin sempatik ve parasempatik sistem fonksiyonlarini arastirmak ve vaskuler tutulumun yeri ile iliskisini incelemekti. Gerec ve yontem: Her iki ust ekstremitenin sempatik deri yaniti (SSR) ve RR interval varyasyonlari (RRIV) inmeli 56 hasta ve 42 saglikli gonullude istirahat ve derin nefes sirasinda kayit edildi. Bulgular: Inmeli hastalarin her iki (etkilenen ve etkilenmeyen) tarafinin ortalama SSR latanslari kontrollerinki ile karsilastirildiginda anlamli olarak uzamisti (p < 0,05). Inmeli hastalarin her iki ekstremitesinden elde edilen ortalama amplitudler (0,8±0,6 mV etkilenen, 0,9±0,8 mV etkilenmeyen) kontrollerden anlamli olarak daha kucuktu (1,4 ±0,9 mV) (p < 0,001, p < 0,01). Hastalarda istirahatte RRIV’ler kontrollerle karsilastirildiginda 30,97± 27,99 karsi 16,5±5,1 ve derin nefes alma ile 34,2±25,2 karsi 19,9±8,6 idi (p < 0,05). Infarkt lokalizasyonuna gore lezyonlar hemisferik (n=46) ve beyin sapi olarak siniflandi (n=10). Hemisferik lezyonlu hastalarin kontroller ile karsilastirildiginda anlamli olarak artmis latanslari vardi (p < 0,05) ve amplitudleri dusuktu (p < 0,001), istirahat (p < 0,001) ve hiperventilasyon sirasinda (p < 0,001) RRIV artmisti. Istirahat ve derin nefes ile RRIV’nin her ikisi sag taraf kortikal lezyonlarinda sol taraf kortikal lezyonlarindan daha yuksekti (p < 0,05, p < 0,01). Beyin sapi lezyonlarinin etkilenen ellerinden artmis SSR latanslari ve etkilenmeyen ellerinden azalmis amplitudleri kontrollere gore kayit edilmistir (p < 0,05). Sonuc: Sonuc olarak beyin damar tutulumlarinda esas olarak sag taraf kortikal lezyonlari sempatik ve parasempatik fonksiyonlari etkilendi. Beyin sapi vaskuler lezyonlari sadece sempatik refleks aktivitenin tutulumu ile karakterize idi.

Multiple anomalies with scoliosis – a case study

Discussion Long-standing overt ventriculomegaly in adults is a clinical entity characterized by chronic hydrocephalus. The onset of this condition occurs in infancy with a slow evolution and onset of clinical symptoms during adulthood. Limited case reports exists which describe this condition of severe hydrocephalus with the relatively spared neurological functioning and cognitive aspects. This case report demonstrates in vivo the level of adaptation to which human brain can reach under chronic mechanic stress conditions. Scoliosis may present with other anomalies. from 5th International Conference on Conservative Management of Spinal Deformities Athens, Greece. 3–5 April 2008