Ridvan Alaca

Medical complications, physical function and communication skills in patients with traumatic brain injury: a single centre 5-year experience.

Objective: The aim of this retrospective study was to review the medical complications of patients with traumatic brain injury (TBI) who were followed in 2000–2006. Methods and procedures: The demographic data, functional and cognitive status of 116 persons with TBI were noted. The presence of communication problems, swallowing disturbances, urinary and faecal incontinence, pressure ulcer, deep venous thrombosis (DVT), post-traumatic seizure (PTS) and heterotopic ossification (HO) were recorded at first admission and follow-up. Main outcome and results: This study detected aphasia in 19.0%, dysarthria in 30.2%, dysphagia in 17.2%, pressure ulcers in 6.9% and DVT in 2.6% the our patients with TBI. Urinary and faecal incontinence on admission were 32.7% and 26.7%, respectively. Patients with incontinence had poorer cognitive function than those with normal continence. HO rate was 18.1% and the ambulation levels of patients with HO were worse than those without HO. PTS was seen in 13.8% of the patients on admission and this ratio increased to 21.6% during the follow-up. In these patients, the aetiological risk factors for PTS were gunshot and fall injuries. Conclusions: Considering the wide spectrum of complications, this study advocates that these persons with TBI should be followed promptly by a multidisciplinary team.

Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial

Objective: To determine which injection technique was effective for patients with hemiplegic shoulder pain. Design: Randomized prospective double-blind study. Setting: Brain Injury Rehabilitation Unit. Intervention: Patients with hemiplegic shoulder pain were recruited over a 12-month period and all were hospitalized in our clinic. Intra-articular steroid injection or suprascapular nerve block was performed on all patients. Main measures: Range of motion values at the moment that pain started (range of motion A) and passive maximum range of motion values (range of motion B) were recorded. Pain intensity levels (visual analogue scale) at these two range of motion values (pain A and pain B) were also taken. Evaluations were made before the injection, and 1 hour, one week and one month after the injection. Results: Twenty-six patients were enrolled in the study, the mean age was 61.53u2009±u200910.30 years. The mean time since injury was 8.69u2009±u200915.71 months. The aetiology was ischaemic in 16 (61%) patients. Intra-articular steroid injection was performed in 11 (42 %) patients, and suprascapular nerve block in 15 (57%) patients. Range of motion A and range of motion B were changed statistically in repeated measures. There were important differences in repeated measures of pain intensity levels at these two range of motion values (Pu2009<u20090.05). However, no significant differences were determined in all measurements between intra-articular steroid injection and suprascapular nerve block groups (Pu2009>u20090.05). Conclusions: Our results showed that neither injection technique was superior to the other. Both injection procedures are safe and have a similar effect in stroke patients with hemiplegic shoulder pain.

Does standing protect bone density in patients with chronic spinal cord injury

Abstract Background/Objective: To compare the t-scores of proximal femur and lumbar spine of patients with spinal cord injury (SCI) with different levels of weight bearing. Methods: Cross-sectional study comparing 3 groups of patients with SCI: patients with daily standing times of more than 1 hour, patients with daily standing times of less than 1 hour, and nonstanding patients. Seventy-one patients with chronic SCI were recruited. They were assigned to 1 of 3 groups according to their reported daily standing time. The bone density of lumbar and proximal femoral regions was measured with dual-energy x-ray absorptiometry. Results: The 3 groups were similar in terms of demographics and clinical variables. No significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups. However, the patients in the group that stood more than 1 hour daily had a slight tendency to have higher t-scores than those in the control group. Conclusions: There was no significant difference among the 3 groups. However, standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization.

Early rehabilitation outcome in patients with middle cerebral artery stroke

Although important data on the prognosis and rehabilitation outcome in stroke patients have been reported, data on functional recovery according to stroke subtypes are limited. This retrospective study aimed to evaluate functional outcome in patients with middle cerebral artery (MCA) stroke-the most common subtype of ischemic stroke. The records of stroke patients that underwent the rehabilitation program at our brain injury rehabilitation service between January 2007 and December 2008 were reviewed, and those with MCA stroke were included in the study. Patient demographic and clinical data, and Barthel Index (BI) and Functional Independence Measure (FIM) scores at admission and discharge were collected. The study included 80 MCA stroke patients with a mean age of 63.54 years. FIM and BI scores improved significantly post rehabilitation (P<0.05). Age was negatively correlated with both BI and FIM scores at admission and discharge. Length of stay was not correlated with improvement in BI or FIM scores during hospitalization. The patients that had ≤1 month of inpatient rehabilitation had similar outcomes as those that had >1 month of inpatient rehabilitation (P>0.05). Length of time after stroke onset was not correlated with BI or FIM scores at admission. Regardless of initial functional status, prediction of discharge functional status was misleading. Physiatrists should keep in mind that functional improvement does not always increase with duration of inpatient therapy.

The efficacy of serial casting after botulinum toxin type A injection in improving equinovarus deformity in patients with chronic stroke

Introduction: Spasticity is an important early complication of stroke, which may lead to shortening of gastrocnemius and soleus muscles and contracture in the Achilles tendon and soft tissues of the ankle. Botulinum toxin A (BTX-A) is a promising drug for the management of focal spasticity. Serial casting is another alternative method for reducing contractures due to spasticity. The present study aimed to determine if serial casting after BTX-A injection could help to limit the development of calf contracture in chronic hemiplegic patients. Method: The records of patients with stroke that were treated in the brain injury rehabilitation clinic between January 2007 and December 2008 were screened. In all, 10 patients that underwent a serial casting programme for 24 days following BTX-A injection were included in the study. Goniometric scores for ankle ROM, Physician Rating Scale (PRS) and Functional Independence Measurement (FIM) scores were recorded. Results: Mean age of the patients was 33.2 years. Mean time interval after stroke onset was 35.0 months. Improvements in ROM were quite significant after serial casting. Moreover, FIM and PRS scores improved significantly. Conclusion: Serial casting may be an appropriate intervention following BTX-A injection to prevent equinovarus deformity and improve the quality of walking in chronic stroke patients. The role of casting and splinting are important topics that require further research.

Assessment of Spasticity With Sonoelastography Following Stroke: A Feasibility Study

To investigate the feasibility of sonoelastography to show muscle stiffness in poststroke spasticity, as well as the relationship between sonoelastography findings and muscle architecture features and clinical spasticity scores in the spastic gastrocnemius.

Severe heterotopic ossification in the non-affected limbs of a hemiplegic patient with traumatic brain injury

Background/objective: Heterotopic ossification characterized by new bone formation in the periarticular regions of large joints in patients with neurologic injury most commonly occurs on the neurologically involved side. This study presents a very rare localization of heterotopic ossification that developed in the non-paretic limbs of a hemiplegic patient with traumatic brain injury (TBI). Case report: A 25-year-old left hemiplegic male with TBI due to a gunshot wound was admitted to the rehabilitation centre after a 2.5-month period of coma in the intensive care unit. He had limited range of motion accompanied by pain in the bilateral hip, bilateral elbow and right knee joints. Neurological examination revealed upper motor neuron lesions only on the left side in neurological exam. Plain radiographs of the involved joints revealed bilateral heterotopic ossification, which was more severe on the non-paretic side. Discussion: Clinicians should keep in mind that heterotopic ossification can occur in non-hemiplegic extremities as well as hemiplegic extremities in patients with TBI in whom the extent of neurologic damage cannot be definitely established.