Sevgi Ikbali Afsar

Is 25(OH)D Associated with Cognitive Impairment and Functional Improvement in Stroke? A Retrospective Clinical Study

BACKGROUND In recent years, vitamin D deficiency has been suggested as a risk factor for ischemic stroke and stroke severity in both animal models and clinical studies. In this retrospective study, we investigated the relationship between 25-hydroxyvitamin D [25(OH)D] levels and functional outcomes in stroke patients during neurological rehabilitation program. We also investigated whether there is an association between 25(OH)D levels and cognitive impairment. METHODS The study included the medical records of 120 stroke patients who participated in a neurological rehabilitation program. The motor and cognitive components of the Functional Independence Measurements of all patients at admission and discharge were recorded. The Functional Ambulatory Scale was used to assess motor functional status, and the Turkish-validated version of the minimental state examination test was used to assess cognitive status. RESULTS A significant correlation was found between 25(OH)D level and cognitive impairment among patients who had ischemic strokes. High levels of 25(OH)D were associated with greater functional gain during the rehabilitation program in both ischemic stroke patients and hemorrhagic stroke patients. CONCLUSIONS High 25(OH)D levels might be associated with greater functional improvement and with less cognitive impairment in stroke patients.

Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial

[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60–120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients.

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.

Comparison of the efficacy of physical therapy and corticosteroid injection in the treatment of pes anserine tendino-bursitis

[Purpose] The aims of this study were twofold. The first was to compare the functional capacity and pain of patients with knee osteoarthritis (KOA), with or without pes anserine tendino-bursitis (PATB). The second is to compare the efficacy of two treatment methods (physical therapy and corticosteroid injection) for patients with PATB. [Subjects and Methods] Sixty patient with KOA and PATB (Group 1) and 57 patients with KOA but without PATB (Group 2) were enrolled in the study. The patients’ visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores and three-meter timed-up and go scores were measured. The PATB group was randomly divided into two groups (Group A and B). Physical therapy (PT) modalities were applied to the first group (Group A), and the second group (Group B) received corticosteroid injections to the pes anserine area. Eight weeks later, patients’ parameters were measured again. [Results] Initial WOMAC scores and timed up-and-go times were significantly higher in Group 1 than in Group 2. Both treatments resulted in significant improvements in all measured parameters, but no significant difference was detected between Group A and B. [Conclusion] Patients with PATB tend to have more severe pain, more altered functionality, and greater disability than those with KOA but without PATB. Both corticosteroid injection and PT are effective methods of treatment for PATB. Injection therapy can be considered an effective, inexpensive and fast therapeutic method.

Virtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial

OBJECTIVE Virtual reality game system is one of novel approaches, which can improve hemiplegic extremity functions of stroke patients. We aimed to evaluate the effect of the Microsoft Xbox 360 Kinect video game system on upper limb motor functions for subacute stroke patients. METHODS The study included 42 stroke patients of which 35 (19 Virtual reality group, 16 control group) completed the study. All patients received 60 minutes of conventional therapy for upper extremity, 5 times per-week for 4 weeks. Virtual reality group additionally received Xbox Kinect game system 30 minutes per-day. Patients were evaluated prior to the rehabilitation and at the end of 4 weeks. Box&Block Test, Functional independence measure self-care score, Brunnstorm stage and Fugl-Meyer upper extremity motor function scale were used as outcome measures. RESULTS The Brunnstrom stages and the scores on the Fugl-Meyer upper extremity, Box&Block Test and Functional independence measure improved significantly from baseline to post-treatment in both the experimental and the control groups. The Brunnstrom stage-upper extremity and Box&Block Test gain for the experimental group were significantly higher compared to the control group, while the Brunnstrom stage-hand, the Functional independence measure gain and Fugl-Meyer gain were similar between the groups. CONCLUSIONS We found evidence that kinect-based game system in addition to conventional therapy may have supplemental benefit for stroke patients. However, for virtual reality game systems to enter the routine practice of stroke rehabilitation, randomized controlled clinical trials with longer follow-up periods and larger sample sizes are needed especially to determine an optimal duration and intensity of the treatment.

An unresolved relationship: the relationship between lesion severity and neurogenic bladder in patients with spinal cord injury.

Objectives: We aimed to investigate the relationship between the severity of the spinal lesion and urodynamic findings, bladder drainage method at discharge, and incidence of renal calculi in patients with spinal cord injury (SCI). Studydesign: Retrospective. Setting: In-patient rehabilitation unit of a tertiary research hospital. Methods: A total of 131 patients who were admitted to our clinic with a diagnosis of SCI and placed into a rehabilitation program were included in the study. The severity of the lesion was determined according to the American Spinal Injury Association Impairment Scale (AIS). We evaluated the relationship between the severity of the lesion and the detrusor hyperactivity and compliance as determined by urodynamic investigation, the bladder drainage method used at discharge, and the renal calculi rate as determined by ultrasonography. Results: While no difference was found between the patients with complete and incomplete injuries in terms of age, sex, disease duration, detrusor hyperactivity and compliance, the bladder drainage method was found to show a significant change according to the severity of the lesion. None of the patients were found to have hydronephrosis and the rate of renal calculi showed no statistically significant difference according to the severity of the lesion. Conclusions: We concluded that urodynamic examination is required in each patient with SCI as the severity of the lesion is not sufficient to determine the bladder type, and patients with complete and incomplete injuries should be monitored with the same sensitivity in terms of complications.