Serap Alsancak

Knee muscle strength in multiple sclerosis: relationship with gait characteristics

[Purpose] To investigate the relationship between isokinetic knee muscle strength and kinematic, kinetic and spatiotemporal gait parameters of patients with multiple sclerosis (MS). [Subjects and Methods] Twenty-nine MS patients (mean age 31.5±6.5) were investigated in this study. The isokinetic knee muscle strength and gait parameters of MS patients with moderate and severe disability, as determined by the expanded disability status scale (EDSS): EDSS=1–4.5 (n=22, moderate disability) and EDSS>4.5 (n=7, severe disability) were measured. [Results] Isokinetic knee muscle strength, kinematic, kinetic and spatiotemporal gait parameters differed between moderate (EDSS=1–4.5, n=22) and severe disability (EDSS>4.5, n=7). The correlation between each of gait speed, stride length, total range of knee joint movement and the four strength parameters (minimum and maximum quadriceps and hamstring muscle strengths) were significant for the MS group as a whole. Within subgroups, the correlation between minimum hamstring strength and total range of knee movement was significant only in group EDSS>4.5; minimum hamstring correlated with peak knee extensor moment in group EDSS=1–4.5, but at a reduced level of significance. [Conclusion] The present study revealed significant correlations between gait characteristics and isokinetic strength parameters of the quadriceps and hamstring muscles. Our study suggests that rehabilitation protocols for MS patients should include a critical strength training programme particularly for the hamstring and quadriceps muscles.

First ray reconstruction with distraction osteogenesis

Disarticulation of the thumb at the metacarpophalangeal joint level is not beneficial either aesthetically or functionally without additional surgery because it requires a bulky and an unacceptable prosthesis to be made for this amputation level. In this study, the authors have presented our experience of 12 metacarpal distractions in thumb amputated patients. Twelve male patients who had thumb amputation due to gunshot wounds were included in the study. Before the operation, aesthetic hand prostheses were made for 5 of the12 patients. Callus distraction was performed with the use of a mini Ilizarov type external fixator in 7 cases and uniplanar dynamic mini external fixator in 5 cases too. External fixators were removed after the completion of the radiographic consolidation. Five patients whose prosthesis had been made before the operation wore their prosthesis for an average 6.8 months (5 – 14) due to poor appearance and poor construction. Union of the lengthened segment was observed in all cases. Average lengthening was 28.9 mm (range from 25 – 37). Average healing time was 2.1 months (range from 1.8 – 2.5). Average healing index was 0.73 month/cm (range from 0.65 – 0.88). Pin tract infection was seen in 7 cases (58.3%). Volar angulation developed after removing the external fixator in 1 case. Webplasty was performed in all cases. Patients were evaluated by means of Disability of the Arm, Shoulder and Hand (DASH) score and pick-up test. It was concluded that the metacarpus lengthening by callus distraction technique may be a functionally and cosmetically effective reconstruction method for traumatic thumb amputations. It is believed that the possibility for a functionally and aesthetically acceptable fabrication of a thumb prosthesis, by providing a suction suspension with distraction and/or webplasty procedures.

Splint satisfaction in the treatment of traumatic radial nerve injuries

Between the years 1986–2001, 135 patients who have had traumatic radial nerve injury, were supplied with dynamic wristhand orthoses (WHOs). The aim of this study is to examine the applied splints, considering aspects such as apperance, practicality of use, function, comfort and endurance. The authors assessments show that the biggest problem was due to the unaesthetic appearance of the finger extensor spring of the splints. For this reason, modification of these finger extensor outriggers has been attempted. Also, aspects of the splints such as the problems faced and regeneration of the nerve, have been considered and modifications made in order to eliminate any disfunction. This study reflects the reactions and satisfaction of 83 patients concerning the splints they have used. Conventional wire springs have been used in the splints of 71 patients, and 12 had modifications done on their outriggers. In terms of appearance, there were significant differences between modified outriggers and conventional outrigger (p<0.05). Also, when the modified outriggers were compared in terms of appearance and durability, there was a statistically significant opinion in favour of them (p<0.01).

Effect of two different kinesio taping techniques on knee kinematics and kinetics in young females

[Purpose] The application of kinesio taping may improve strength and performance, inhibit and facilitate motor activity, and increase range of motion. The aim of this study was to compare the effects of kinesio taping facilitation and inhibition applications on spatiotemporal knee kinematics and kinetics during walking activity in healthy subjects. [Subjects and Methods] A three-dimensional quantitative gait evaluation was performed without tape and with, facilitation and inhibition kinesio taping application on the knee. Sixteen healthy female college students (age, 19.7 ± 0.4 years; height, 1.64 ± 3.4 cm; body mass, 51.5 ± 4.8 kg) participated in the study. [Results] Spatiotemporal parameters (cadence, walking speed, stride length) were significantly different among the trials. Knee joint sagittal plane range of motion was not different with either kinesio taping application. Knee external flexion moment during the early stance phase decreased significantly with facilitation kinesio taping and increased with the inhibition kinesio taping. Knee external extension moment during the mid-stance phase increased with facilitation kinesio taping. Knee power parameters, eccentric activity in the rectus femoris during the pre-swing phase was significantly increased with inhibition kinesio taping application, while eccentric activity of the hamstrings during the terminal swing of gait was decreased. [Conclusion] These findings showed that facilitation kinesio taping application affected the terminal stance phase and that inhibition kinesio taping influenced the terminal swing phase compared with the no tape condition.

Orthotic variations in the management of infantile tibia vara and the results of treatment

Background: Infantile tibia vara is an acquired form of tibial deformity associated with tibial varus and internal torsion. Several methods have been described for orthotics treatment. The purpose of this study was to determine the effectiveness of orthotics treatment in infantile tibia vara. Study design: Controlled trial. Objective: The aim of this study was to compare the effect of different types of orthoses and correction methods on decreasing the curve in children with severe genu varum. Methods: Three different types of knee–ankle–foot orthoses were applied to 35 lower extremities of 22 pediatric participants who were 19–38 months of age. The same orthotic design principles were used to correct the femur, while different designs were applied to correct the tibia. The orthoses used on 20 participants were evaluated for differences among them and their effects on the treatment process. In addition, methods used in the treatment, problems encountered, production of different types of orthoses, convenience of application of the orthoses, and degree of patients satisfaction are discussed in this article. Results: The mean duration of treatment of the participants until completion of treatment was 25.3 ± 9.7 weeks with a minimum of 9 weeks and a maximum of 41 weeks. No statistically significant correlation was found between the duration of orthotic use in patients with a successful outcome and percentile height and percentile weight. When the duration of treatment using the different types of orthoses was analyzed, significant differences were found between Type 1 and Type 2, and Type 1 and Type 3 orthoses (p < 0.05), while no difference was observed between Type 2 and Type 3 orthoses (p > 0.05). Conclusion: We found that bracing is an effective form of treatment for infantile tibia vara up to 38 months of age. We conclude that full-time use of knee–ankle–foot orthoses exerting corrective forces from five points along the full length of the limb was effective. Clinical relevance: The localization of the distal tibial correction, the quality of the midtibial correction band, and the importance of the application of corrective forces from five points with rigid methods were found.

Efficacy of splinting variations in two different treatment protocols in trigger thumb

ABSTRACT Introduction: The aim of this study was to evaluate the comparative final outcome of two different conservative treatment protocols for trigger thumb using three different types of splints with varying restrictions of interphalangeal (IP), metacarpophalangeal (MCP), and carpometacarpal (CMC) joint motions of the thumb and with additional exercise programs. Materials and Methods: Twenty-nine patients with 43 trigger thumbs were included in this study. Participants were divided into two treatment protocol groups and used three different types of thumb splints (1 daytime consistent to both groups and 2 different nighttime) with an additional exercise program and connective tissue manipulation (CTM). Patients were seen for follow-up after 10 weeks of the treatment; the preoutcome and postoutcome measures were assessed by stages of stenosing tenosynovitis (SST) and Visual Analog Scale (VAS). The data were analyzed to determine the efficacy of splint protocol intervention in relation to each other. Results: After using the thumb splints, there were statistically significant improvements in both SST and VAS scores in both groups (P < 0.05). This study demonstrates the benefit of splint usage and an additional exercise program with CTM in the conservative treatment of trigger thumb. Conclusions: Keeping in mind that splint 3 was used with both groups, splint 1 of the night splints that limited IP, MCP, and CMC joint flexion and extension was found to be more effective for conservative treatment in trigger thumb.

Effect of elastic bandaging and prosthesis on the decrease in stump volume.

OBJECTIVES The aim of this study was to compare the effect of elastic bandaging, pneumatic prosthesis, and temporary prosthesis on postoperative stump management. METHODS This study included 14 patients, between 15 and 70 years old, whose causes of amputation were tumor, diabetes, Burgers disease, osteomyelitis, and traffic accident. Fifteen stumps in 14 patients, one of whom was bilateral, were evaluated. The elastic bandaging was applied for five stumps, the pneumatic prosthesis for five stumps, and temporary prosthesis for five stumps. RESULTS A decrease in stump volume was observed for at least 2 or 3 weeks after the use of all three methods in patients who came to the Prosthetics and Orthotics Laboratory at Ankara University. The volume decrease induced by temporary prosthesis fitting was more significant than that achieved using elastic bandaging or pneumatic prosthetics (p<0.01). The greatest volume changes were identified distally for the elastic bandage group, proximally for the pneumatic group, and medially for the temporarily applied prosthesis group. The temporary prosthesis group took less time to permanent prosthesis (39 days) and required less prosthesis training (p<0.01). Three amputees in the elastic bandaging group had postoperative contractures. CONCLUSION Use of a temporary prosthesis results in ideal shaping of the stump in the shortest period of time. This approach also shortens the period of transition to permanent prosthesis, improves the quality of life of the amputee, and re-integrates the patient to normal life over a shorter period of time.

Elbow Orthosis to Re-establish Elbow Extension Motion

This study describes a uniaxial elbow orthosis designed at Ankara University Department of Prosthetics and Orthotics as a custom-molded orthosis to improve elbow extension. Five children with post-traumatic elbow flexion contracture were treated using the static progressive elbow orthosis for a mean of 2.2 ± 0.8 months. None of the patients received any physical therapy or surgical treatment for flexion contracture. At the 18-month follow-up evaluation, the median correction was measured at 35° in active extension limitation and 15° in passive extension limitation. The findings show that the elbow orthosis is a safe and effective treatment to consider for children who present with elbow flexion contracture.

Orthosis Effects on the Gait of a Child with Infantile Tibia Vara

Infantile tibia vara (ITV) is an acquired form of tibial deformity associated with tibial varus and internal torsion. As there is currently insufficient data available on the effects of orthotics on gait parameters, this study aimed to document the influence of orthosis on walking. A male infant with bilateral tibia vara used orthoses for five months. Gait evaluations were performed pre- and posttreatment for both legs. The kinematic parameters were collected by using a motion analysis system. The orthotic design principle was used to correct the femur and tibia. Posttreatment gait parameters were improved compared to pretreatment parameters. After 5 months, there was remarkable change in the stance-phase degrees of frontal plane hip joint abduction and knee joint varus. We found that orthoses were an effective treatment for the infantile tibia vara gait characteristics in this patient. Full-time use of single, upright knee-ankle-foot orthosis with a drop lock knee joint and application of corrective forces at five points along the full length of the limb were effective.

Postoperatif dönemde güdüğün proteze hazırlanması

Postoperatif donemde gudugun kalici proteze hazir oluncaya kadar gecen sure ve bu donemde yapilanlar ileride kalici protezin fonksiyonel kullanimi bakimindan onemlidir. Bu nedenle amputasyon sonrasi yara iyi-lesmesinin tamamlanmasi, agrinin giderilmesi, odemin cozulmesi ve gudugun sekillen-dirilmesi, gudukte kontraktur olusumuna izin vermeyen pozisyonlarin verilmesi, kaslarin guclendirilmesi, eklem hareket serbestliginin saglanmasi ve genel olarak amputenin kuvvet, endurans ve performansini artirici uygula-malara yer verilmesi gerekir.