Sumru Özel

Validity and reliability of the Turkish translation of the Pediatric Evaluation of Disability Inventory (PEDI)

Purpose. To investigate the validity and reliability of the Turkish translation of the original Pediatric Evaluation of Disability Inventory (PEDI). Method. On May 2003, we received permission from Boston University to translate and use the PEDI for Research purposes. PEDI Functional Skills scale and Caregiver Assistance scale was administered by physiatrists to 573 healthy Turkish children (295 males and 278 females; the age range: 7 months to 7½ years) in two different healthcare centres in Ankara. The Turkish translation of the PEDI was again administered to 102 children after five days in order to assess test-retest reliability. Intraclass correlation coefficients (ICC) and Cronbachs alphas (α) were calculated. The test-retest reliability was assessed by Spearmans correlation coefficient. Internal construct validity was assessed by using Rasch unidimensional measurement model. Results. High Cronbachs α coefficients (≥0.98), high ICC values (≥0.96) and high Spearman correlation coefficients (≥0.86) were found. The internal construct validity was confirmed by good fit to the Rasch measurement model. The fit statistics conducted in the study was acceptable, except for some items. Conclusions. The Turkish translation of the PEDI is valid and reliable for the Turkish child population. We believe that PEDI is a detailed and useful instrument for the evaluation of efficiency of pediatric rehabilitation programme.

Acute ulnar neuropathy at the wrist: a case report and review of the literature

Acute ulnar neuropathy at the wrist is an extremely uncommon condition, at times requiring a high index of suspicion for the diagnosis. Clinical presentations of ulnar nerve lesions at the wrist and hand show variations due to the complex anatomic course of the nerve in distal sites. We report a case of acute ulnar neuropathy at the wrist caused by a ganglion in Guyon’s canal, being initially misinterpreted as flexor tenosynovitis. The accurate diagnosis of selective distal motor neuropathy of ulnar nerve was made electrophysiologically. Magnetic resonance imaging revealed a well defined soft tissue mass consistent with a ganglion, compressing the ulnar nerve in Guyon’s canal. Entrapment neuropathies are one of the common conditions handled by physiatrists. Ulnar nerve lesions at the wrist should be kept in mind in the differential diagnosis of patients with wrist or hand pain. Magnetic resonance imaging is a useful method in the anatomical evaluation of acute focal neuropathies.

Demonstration of specific antibodies against infliximab induced during treatment of a patient with ankylosing spondylitis.

Therapeutic proteins, such as infliximab, have revolutionized the treatment of many diseases during the last decade and more than 80 therapeutic proteins are currently approved for clinical use. However, all exogenous proteins have the potential to cause antibody formation. In order to ensure patient safety and the efficacy of therapeutic proteins, careful monitoring of the immunogenicity of therapeutic proteins is therefore necessary not only during preclinical trials, but also during the treatment of patients. Here, we report a clear-cut demonstration of the induction of anti-infliximab antibodies during the treatment of a patient with ankylosing spondylitis (AS). Assessment of anti-infliximab antibodies in sera obtained at various time periods were performed using a highly specific double antigen assay system developed in our laboratory. Immunoreactivity was found to be solely specific for infliximab. Because all sera obtained from the patient were found to be negative for the presence of human anti-mouse antibody (HAMA) and anti-human antibodies. The loss of effect of infliximab, as judged by observing the relapse of signs and symptoms of disease in the patient, seemed to be related with the appearance of antibodies. This study clearly demonstrates that monitoring for the induction of specific antibodies during clinical trials is an important issue for therapeutic proteins.

ADL assessment of nondisabled Turkish children with the WeeFIM instrument.

Aybay C, Erkin G, Elhan AH, Sirzai H, Ozel S: ADL assessment of nondisabled Turkish children with the WeeFIM instrument. Am J Phys Med Rehabil 2007;86:176–182. Objective: To evaluate the WeeFIM instrument’s reliability and internal construct validity for the Turkish child population. Design: License was taken from UDSmr to use the WeeFIM instrument. For the reliability and validity studies of the Turkish translation of the WeeFIM instrument, 573 Turkish nondisabled children were included in the study. The reliability of the instrument was assessed by Cronbach’s alpha coefficient, intraclass correlation coefficient (ICC), and test–retest reliability. Internal construct validity was assessed by both using Rasch unidimensional measurement model and testing for differential item functioning for age and gender. Results: Cronbach α value was 0.99 for motor WeeFIM rating and 0.99 for cognitive WeeFIM rating. ICC was 0.81 for motor WeeFIM rating and 0.92 for cognitive WeeFIM rating. The internal construct validity of the Turkish translation of the WeeFIM instrument was confirmed by excellent fit to the Rasch measurement model. Two subscales were found from the principal component analysis of standardized residual correlation for items. Among the items, bowel management, bladder management, eating, and comprehension showed considerable levels of misfit. Conclusions: The Turkish translation of the WeeFIM instrument is valid, reliable, and practical for the Turkish child population. Further studies are required to determine the cross-cultural validity of the instrument.

Bladder storage and emptying disorder frequencies in hemorrhagic and ischemic stroke patients with bladder dysfunction.

Background: Bladder dysfunction is common in stroke patients and it has a considerable impact on their lives. The objective of this study was to investigate the frequencies of urine storage and emptying disorders in hemorrhagic and ischemic stroke patients with persistent bladder dysfunction. Methods: A total of 48 stroke patients who underwent urodynamic tests because of persistent bladder dysfunction were evaluated retrospectively. Urine storage and emptying disorder frequencies were determined and compared in hemorrhagic and ischemic stroke subgroups. Results:Storage disorder frequencies were 73.3 and 63.6% in hemorrhagic and ischemic stroke groups, respectively (p > 0.05), while emptying disorder frequencies were 13.3 and 51.5% (p < 0.02). Conclusions: Evaluation of the stroke type may be helpful in the determination of the type of urinary dysfunction and in choosing the appropriate bladder management strategy, but further studies with larger sample sizes are needed.

Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement

The aim of the study was to evaluate the extent of agreement between the findings of ultrasonography (US) and magnetic resonance imaging (MRI) in the assessment of anterior disc displacement (ADD), with or without reduction, and to assess the sensitivity, specificity and the accuracy of the US examination in establishing diagnosis. Fifty-two temporomandibular joints (TMJ) in 52 patients with chronic TMJ pain were examined by US and MRI with respect to ADD, with, and without reduction of the TMJ. The level of agreement between US and MRI findings was evaluated. The sensitivity, specificity, and the accuracy of US were found to be respectively 91%, 16% and 82% in the assessment of ADD; 70%, 38% and 57% in ADD with reduction; 50%, 89% and 76% in ADD without reduction. The findings of both methods were in agreement with each other. US method is fairly sensitive especially in detecting ADD, and it is very reliable in determining the absence of ADD without reduction. However, it was not found to be as quite effective in demonstrating ADD whether it was with or without reduction.

Risk factors and clinical profiles in Turkish children with cerebral palsy: analysis of 625 cases.

The aim of the study was to investigate risk factors, clinical profiles and gross motor function levels of Turkish children with cerebral palsy (CP). A total of 625 consecutive children with CP, who were rehabilitated in the pediatrics rehabilitation clinic between 2000 and 2004 years, were included. Factors causing CP were investigated by interviewing the families and by scanning medical files. Risk factors were recorded as consanguineous marriage, maternal disorder, preterm birth, birth asphyxia, low birth weight, multiple pregnancy, neonatal convulsion, kernicterus, postnatal central nervous system infection and brain injury. Swedish classification was followed in CP typing. Of 625 children with CP, 370 (59.2%) were males and 255 (40.8%) were females, with ages ranging between 2 and 13 years (the mean age was 5.11±2.19 years). It was determined that 47.8% of the cases were spastic diplegic CP, 27.7% were spastic tetraplegic CP, 12.8% spastic hemiplegic CP and 11.7% were other types (ataxic, dyskinetic and mixed CP types). The most frequently encountered risk factors were low birth weight (45.1%), preterm birth (40.5%), birth asphyxia (34.6%) and consanguineous marriage (23.8%). Low birth weight, preterm birth, birth asphyxia and consanguineous marriage were top-ranked risk factors that were determined in Turkish children with CP. Compared with other countries, consanguineous marriage is still an important problem in Turkey.

Fever During Rehabilitation in Patients With Traumatic Spinal Cord Injury: Analysis of 392 Cases From a National Rehabilitation Hospital in Turkey

Abstract Objective: To determine the incidence and etiology of fever and the risk factors related to fever in adults with spinal cord injury (SCI) at the rehabilitation stage. Design/Subjects: A retrospective examination of records of 392 consecutive adult patients with traumatic SCI who received inpatient rehabilitation program. Setting: A national rehabilitation center in Turkey. Outcome Measures: Incidence and etiology of fever, period of hospitalization (days). Results: A total of 187 patients (47.7%) had fever at least once during their rehabilitation program. The most common etiology was urinary tract infection. The rate of fever occurrence was significantly higher in patients with complete SCI (P = 0.001). In patients with fever, the use of an indwelling catheter was significantly higher compared with clean intermittent catheterization and spontaneous voiding (P = 0.001). The hospitalization period of patients with fever was significantly longer than that of patients without fever (/> = 0.006). Conclusions: A high rate of fever was seen in patients with SCI during rehabilitation. Fever was caused by various infections, of which urinary tract infection was the most common. Patients with motor complete injuries and those with permanent catheters constituted higher risk groups. Fever prolonged the length of rehabilitation stay and hindered active participation in the rehabilitation program.

Evaluation of bone mineral density in patients with spinal cord injury.

Abstract Background/Objective: This study was performed to evaluate the bone mineral density (BMD) values in patients with spinal cord injury (SCI) and determine the effects of the level, severity, and duration of the neurological lesion and spasticity on BMD values. Methods: A total of 75 patients with traumatic SCI and a healthy control group of 39 people were included in the study. The BMD values of the lumbar spine and 4 different regions of the hip (femoral neck, Wards triangle, trochanter, and femoral shaft) of all cases were measured using dual energy x-ray absorptiometry. The biochemical markers were also analyzed. Results: The BMD values in all measured regions were found to be decreased in patients compared with that of controls. The level and seventy of the lesion and the spasticity did not significantly affect BMD values in the regions analyzed. The BMD values of the hip decreased as the duration of SCI increased. The levels of plasma phosphorus and alkaline phosphatase, calcium in 24-hour urine samples, and the calcium/creatinine ratio in spot urines were found to be significantly higher in the patient group. Conclusion: All patients with SCI had lower BMD values than controls. The level and severity of SCI and spasticity did not significantly affect BMD values. The BMD values of the hip decreased as the duration of SCI increased.

EVALUATION OF IDEOMOTOR APRAXIA IN PATIENTS WITH STROKE: A STUDY OF RELIABILITY AND VALIDITY

OBJECTIVE This aim of this study was to determine the reliability and validity of an established ideomotor apraxia test when applied to a Turkish stroke patient population and to healthy controls. SUBJECTS The study group comprised 50 patients with right hemiplegia and 36 with left hemiplegia, who had developed the condition as a result of a cerebrovascular accident, and 33 age-matched healthy subjects. METHODS The subjects were evaluated for apraxia using an established ideomotor apraxia test. The cut-off value of the test and the reliability coefficient between observers were determined. RESULTS Apraxia was found in 54% patients with right hemiplegia (most being severe) and in 25% of left hemiplegic patients (most being mild). The apraxia scores for patients with right hemiplegia were found to be significantly lower than for those with left hemiplegia and for healthy subjects. There was no statistically significant difference between patients with left hemiplegia and healthy subjects. CONCLUSION It was shown that the ideomotor apraxia test could distinguish apraxic from non-apraxic subjects. The reliability coefficient among observers in the study was high and a reliability study of the ideomotor apraxia test was therefore performed.