Süreyya Ergin

Kinetic and kinematic characteristics of gait in patients with medial knee arthrosis

We compared the mechanics of gait in 13 patients with early medial arthrosis (OA) of the knee and 13 normal controls, by measuring gait events, kinematic and kinetic parameters. In the OA group, walking velocity, cadence and stride length were reduced and stride time and double support time accordingly increased on both sides, the overall stance phase was prolonged in the OA group, but the stance phase and swing phase peak flexion were reduced. The varus in the stance phase and the valgus in the swing phase were increased. The extensor moment in the loading response was increased and the flexor moment at late stance reduced in the OA group. Patients with OA had a greater valgus (abductor) and internal rotation moment during the stance phase. The times to second vertical force peak (VFP) were similar in the two groups. Values of VFP1 and VFP2 were lower in the OA group. Our findings indicate that computerized gait analysis can be used to reveal various mechanical abnormalities accompanying arthrosis of the knee joint at an early stage. Some of these abnormalities may have etiologic implications, but others may represent secondary changes developed in part as a compensatory mechanism in knee OA.

The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire

Abstract This study was undertaken to translate and adapt the Fibromyalgia Impact Questionnaire (FIQ) into the Turkish language and investigate its validity and reliability for Turkish female fibromyalgia (FM) patients. After translation into Turkish, we administered the FIQ and Health Assessment Questionnaire (HAQ) to 51 women with fibromyalgia. As well as socio-demographic characteristics, the severity of relevant clinical symptoms, e.g., pain intensity, fatigue, and sleep disturbance, were assessed by visual analog scales. A tender point score (TPS) was calculated from tender points conducted by thumb palpation. Test–retest reliability, internal consistency, and concurrent and construct validities of FIQ were evaluated. Test–retest reliability and internal consistency were good at 0.81 and 0.72, respectively. Correlation between FIQ and HAQ scores was 0.43, which was low but statistically significant. Significant moderate correlations were obtained between the FIQ items and severity of clinical symptoms (0.63–0.77), except TPS, 0.31. The FIQ is a reliable and valid instrument for measuring functional disability in Turkish female FM patients.

Effects of ankle-foot orthoses on hemiparetic gait

Objective: Ankle-foot orthoses (AFOs) are widely used to provide optimal ambulation in people with hemiplegia. In this study we evaluated the mechanical effects of metallic and plastic AFOs on severely hemiparetic stroke patients. Methods: Twelve hemiparetic patients were analysed on a Vicon 370 Motion Analysis System. Spatiotemporal, kinematic and kinetic parameters were measured. Results: The two types of orthoses generally had similar positive effects on hemiplegic gait parameters, increasing cadence, walking speed, single and double step length, ankle dorsiflexion angle at heel strike and swing. The metallic AFO was better at increasing the ankle dorsiflexion angle than the plastic AFO. Conclusion: Hemiplegic gait was improved by both orthoses. However, metallic AFOs provided better stabilization of the ankle, allowing improved heel strike and push-off.

A Placebo-Controlled, Multicenter, Randomized, Double-Blind, Flexible-Dose, Two-Way Crossover Study to Evaluate the Efficacy and Safety of Sildenafil in Men With Traumatic Spinal Cord Injury and Erectile Dysfunction

Abstract Background/objective: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects onquality of life (Qol) using the Life-Satisfaction Check List. Methods: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI(Sexual Health Inventory-Male score ≤21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). Results: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation,intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects onvital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient Qol. Sildenafil was well tolerated, with a profile comparable to that of placebo. Conclusions: Compared with placebo, treatment with oral sildenafil safelyand effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was theagent of choice in those who expressed a preference.

Immediate Effects of Silicone Insoles on Gait Pattern in Patients with Flexible Flatfoot

Background: Flatfoot in which a normal arch fails to develop is a common deformity in both children and adults. A frequently-used treatment is an over-the-counter insole to normalize foot mechanics and relieve pain. This study was designed to evaluate the effects of over-the-counter silicone insoles on the gait patterns of patients with flexible flatfoot. Methods: Thirty-four adults (24 women and nine men, average age 43.7 ± 9.7 years) with bilateral symptomatic flatfoot deformities were included in the study. Flatfoot was diagnosed by a lateral talometatarsal angle of more than 4 degrees and a talocalcaneal angle of more than 30 degrees. Three-dimensional gait analysis and video recordings were done at a single session. All patients walked at self-selected speeds over a 10-meter walkway with and without insoles. Time-distance parameters and kinematic and kinetic characteristics of gait in the sagittal plane were evaluated by a quantitative gait analysis system. Results: Mean lateral talometatarsal and talocalcaneal angles were 6.3 ± 2.5 degrees and 56.1 ± 8.6 degrees, respectively. There was no difference in gait parameters with or without the insoles. Conclusions: Over-the-counter insoles have no beneficial effect in normalizing forces acting on the foot and on the entire lower extremity in adults with flexible flatfoot.

Prevalence of carpal tunnel syndrome in patients with fibromyalgia

Abstract. This study was planned to investigate the prevalence of carpal tunnel syndrome (CTS) in patients with fibromyalgia (FM) and the normal population. Paresthesia in the hands, sensory and motor deficits, and atrophy of the thenar muscles of 50 patients with FM and 50 matched control subjects were evaluated. Tinels and Phalens signs and bilateral electrophysiological studies of the median nerves were performed. The differences between the groups in terms of paresthesia (13 FM patients, two control subjects, P<0.01) and sensory deficits (four FM patients, 0 control subjects, P<0.05) were statistically significant. In the FM and the control groups, a total of five (10%) and two (4%) cases of CTS were documented electrophysiologically, respectively. However, the difference between the groups in CTS prevalence was not statistically significant (P>0.05). In conclusion, paresthesias are a common symptom and associated condition of FM patients. Together with sensory deficits in the hands, they should remind the physician of the possibility of undiagnosed CTS.

Exercise and cognitive-behavioural treatment in fibromyalgia syndrome.

Fibromyalgia syndrome is a nonarticular rheumatic disorder characterised by diffuse musculoskeletal pain, stiffness, fatigue, disturbed sleep and tender points. The pathophysiology is not well understood and treatment remains a challenge. Although pharmacological therapy is still the primary treatment choice, a long-term effective intervention has not been demonstrated yet. Thus, besides pharmacotherapy, other multimodal interventions are often used. Exercise and cognitive-behavioural treatments which exist in the multimodal approach and encompass largely self-managed strategy, are reviewed in this article. Although, there is a great number of exercise studies, the large diversity of outcome measures and measurement instruments that have been used in studies, varying intensity and types of exercises, small sample sizes, high attrition rates, large variability in baseline function, symptom severity and psychosocial status limit to come to a conclusion about the efficacy of exercise in the treatment of fibromyalgia syndrome. There are also inconclusive results about the efficacy of cognitive-behavioural treatment because of limited number of studies with small sample sizes of patients with fibromyalgia syndrome. However, the results of the trials overall demonstrate the beneficial effects of both different types of exercise and cognitive-behavioural treatment, on the other hand, there is still a need for larger, more systematic and randomised controlled trials to evaluate the effectiveness.

Aphasia rehabilitation in patients with stroke.

Aphasia, the most common language disorder, is an important impairment which decreases the success of rehabilitation programmes for stroke patients. Previous studies indicate that 10 38% of stroke patients are expected to suffer from aphasia Ž . Wade et al., 1986 . Recovery of aphasia after stroke can occur within a matter of hours or days following onset. This recovery pattern has been attributed to neuroplasticity, which allows homologous regions in the right hemisphere to perform Ž the same processes Thulborn et al., 1999; Warbur. ton et al., 1999 . The natural history of aphasia and the effectiveness of therapeutic interventions have Ž been extensively searched in the literature De Pedro-Cuesta et al., 1992; Aftonomos et al., 1997; . Ž . Greener et al., 2000 . Musso et al. 1999 investigated the short-term changes in the cortical network involved in language comprehension using Ž . PET positron emission tomography during recovery from aphasia. They showed that the right hemisphere has an important role in recovery from aphasia and that the improvement induced by specific training is associated with functional brain Ž . reorganization. Aftonomos et al. 1997 have shown that even in chronic aphasia specific measures of language function can be broadly, positively and significantly influenced by computer-based language therapy. Aphasia rehabilitation 8 10 hours/week proved to be effective for at least sevŽ eral months after acute stroke De Pedro-Cuesta et . al., 1992 . There is a recent general consensus that the duration of spontaneous recovery can be extended up to 6 months post-onset and various forms of speech and language therapies, particularly when used during spontaneous recovery, appear to have an impact on the evolution of this Ž recovery pattern Nicholas et al., 1993; Aftonomos . et al., 1997 .