Nuri Çetin

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.

Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial.

Cetin N, Aytar A, Atalay A, Akman MN: Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil 2008;87:443–451. Objective:To investigate the therapeutic effects of physical agents administered before isokinetic exercise in women with knee osteoarthritis. Design:One hundred patients with bilateral knee osteoarthritis were randomized into five groups of 20 patients each: group 1 received short-wave diathermy + hot packs and isokinetic exercise; group 2 received transcutaneous electrical nerve stimulation + hot packs and isokinetic exercise; group 3 received ultrasound + hot packs and isokinetic exercise; group 4 received hot packs and isokinetic exercise; and group 5 served as controls and received only isokinetic exercise. Results:Pain and disability index scores were significantly reduced in each group. Patients in the study groups had significantly greater reductions in their visual analog scale scores and scores on the Lequesne index than did patients in the control group (group 5). They also showed greater increases than did controls in muscular strength at all angular velocities. In most parameters, improvements were greatest in groups 1 and 2 compared with groups 3 and 4. Conclusions:Using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance, reduced pain, and improved function. Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome.

Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study.

Study design:Retrospective review of medical notes.Objective:To evaluate spinal cord injury (SCI) patients’ compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs).Setting:Inpatient rehabilitation unit of tertiary research hospital.Methods:Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs.Results:The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC.Conclusion:Many factors, including urological complications, patient’s preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

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.

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.

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.

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears.

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success.

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.

Neuropathic Pain in Patients with Spinal Cord Injury

Background: The aims of this study were to determine the prevalence of neuropathic pain in patients with spinal cord injury (SCI) during rehabilitation and follow-up, and to examine the relationship between neuropathic pain and the demographic and clinical characteristics of the patients. Methods: The medical records of 93 patients who were admitted to our inpatient rehabilitation hospital with a diagnosis of SCI were evaluated. Patients with neuropathic pain were contacted by telephone after discharge and questioned whether the pain continued and whether they were on any medication. Results: The mean age was 38.73 ± 15 years. Thirty-two percent of the group consisted of women. Based on neurological levels, 28 (30.4%) patients were tetraplegic, 49 (53.3%) were paraplegic and 15 (16.3%) had conuscauda equina injury. Sixty-four patients (68.8%) had complete lesions and 28 patients had incomplete lesions (The American Spinal Injury Association Impairment Scale (AIS) grade B-D). Neuropathic pain was present in 49 (52.7%) and absent in 44 (47.3%) patients during their hospital stay. While a statistically significant difference was found between the groups in terms of gender, there was no such difference for mean age, SCI etiology, neurological level and AIS grade (p=0.021, p=0.151, p=0.368, p=0.686, p=0.340). During follow-up, the pain continued in 36 (78.3%) patients and had resolved in 10 (21.7%) patients. The daily living activities were affected in 23 (55%) patients. When we questioned the treatment in the neuropathic pain group, 28 (77.8%) of the patients did not take any medication for neuropathic pain while 8 (22.2%) were on related medication. Conclusion: Taking into account that neuropathic pain is an important factor that affects daily living activities, SCI patients should be evaluated in detail to determine the characteristic of any pain, and the medical treatment prescribed to the patient should be closely monitored.