Zafer Günendi

The effect of 4-week aerobic exercise program on postural balance in postmenopausal women with osteoporosis

The aim of this study is to evaluate the effect of submaximal aerobic exercise program on postural balance in postmenopausal women with osteoporosis. Twenty-five postmenopausal women without osteoporosis and 28 postmenopausal women with osteoporosis enrolled in this study. Balance ability of all subjects was measured by timed up and go test (TUG), four square step test (FSS), Berg balance scale (BBS) and Kinesthetic ability trainer 3000. After completion of initial measurements of balance, postmenopausal women with osteoporosis attended the submaximal aerobic exercise program on treadmill. At the end of the exercise program, balance tests were repeated. Balance tests of postmenopausal women without osteoporosis were repeated approximately 4-weeks after the initial measurement. There was statistically significant improvement in all balance scores in the postmenopausal women with osteoporosis after exercise training whereas there were no statistically significant differences in the scores of postmenopausal women without osteoporosis who did not exercise. This study showed that a 4-week submaximal aerobic exercise program provided significant improvements in static and dynamic balances in postmenopausal osteoporotic women.

Validity and reliability of the clock drawing test as a screening tool for cognitive impairment in patients with fibromyalgia

OBJECTIVE The objective of the study was to assess the validity and reliability of the clock drawing test (CDT) in comparison with the Mini-Mental State Examination (MMSE) as a screening tool for cognitive impairment in patients with fibromyalgia (FM). METHODS Fifty female patients with FM and 51 healthy female controls were enrolled in the study. Cognitive functioning of the subjects was evaluated by the CDT and the MMSE. Each CDT was scored according to 3 different clock scoring methods (Shulman, Sunderland, and Watson). Two experienced clinicians scored the CDTs to evaluate the interrater reliability. Validity, sensitivity, specificity, and predictive accuracy of each clock scoring method were analyzed. RESULTS The Shulman score had the highest correlation with the MMSE score (r =0.65, P < .01). The Shulman and Sunderland methods had significantly the largest areas under the receiver operating characteristic curve (0.82 and 0.81, respectively; P = .000). They also had the highest sensitivity (68.8% and 65.5%, respectively) and specificity (84.2%, and 84.1%, respectively). The interrater correlation coefficients were high for all 3 clock scoring methods. CONCLUSION The CDT has been proven to be a valid and reliable tool for screening cognitive impairment in FM patients. The Shulman or Sunderland scoring methods are more appropriate than the Watson scoring method. Further studies are needed for using the CDT to detect cognitive impairment in patients with FM.

Is there a relationship between Eagle Syndrome and cervicofacial painful soft tissue rheumatisms

Objectives/Hypothesis: To investigate the incidence of locomotor system pathologies such as myofacial pain syndrome (MPS), fibromyalgia syndrome (FMS), and temporomandibular dysfunction in patients with Eagle Syndrome.

Do anticholinergics affect reaction time? A possible impact on the course of rehabilitation.

OBJECTIVE To assess if oxybutynin and tolterodine have an effect on simple reaction time in healthy volunteers. METHODS Simple reaction time was evaluated before and 90 minutes after the oral administration of oxybutynin and tolterodine in a cross-over design. Twenty seven healthy volunteers, aged 26 to 48 years, were included in the study. The electromyographic activity of the flexor digitorum superficialis muscle that was used for the response was recorded, and premotor time was measured. RESULTS The mean age of the study group was 33.1 ± 7.4 years. Mean premotor times before oxybutynin and before tolterodine administration were statistically non-significant. Mean premotor times after the administration of oxybutynin and tolterodine were significantly longer than the initial premotor times (p = 0.003). CONCLUSIONS The results of the study showed that oxybutynin and tolterodine prolonged the simple reaction time. The prolonged simple reaction time may suggest a perceptive impairment. The potential for perceptive impairment as a side effect of oxybutynin and tolterodine might suggest a negative impact on the rehabilitation interventions and the activities of daily living because of central nervous system effects.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

Diffuse cavernous haemangioma complicated with regional osteoporosis

Capillary and cavernous haemangiomas are the most common benign soft tissue tumours of infancy. Cavernous haemangiomas have larger vascular channels and frequently exist in deep dermal tissues. Many haemangiomas require no special treatment. Development of complications such as cardiac failure, malignant change, ulceration and infection are indications for intervention. In this report we present an 11-year-old girl with a pathological fracture after a minimal trauma that might be a result of secondary regional osteoporosis due to diffuse cavernous haemangioma.

The effect of a 4-week aerobic exercise program on muscle performance in patients with fibromyalgia

The objective of our nonrandomised controlled study was to evaluate the effect of a 4-week aerobic exercise program on muscle performance in patients with fibromyalgia. Thirty-two women were consecutively divided into two groups, either study or control group. Study group attended at aerobic exercise program on treadmill lasting 30 minutes, five times a week for four weeks. Electrotherapy and thermotherapy also were applied to back region of patients in study group for two weeks. Control group were treated only the same electrotherapy and thermotherapy interventions lasted 30 minutes, five times a week for two weeks. All patients were assessed before and after treatment protocols with respect to pain, fatigue, fibromyalgia-related symptoms, tender point count/score, psychological status and muscle strengths of knee extensors and flexors. There were statistically significant improvements in the intensity of pain, fatigue, percentage of morning stiffness, paresthesia, irritable bowel syndrome, tender point count/score, psychological status and muscle strengths after aerobic exercise program. However, there were significant improvements only in the intensity of pain, percentage of paresthesia, tender point count/score in the control group. Submaximal aerobic walking program increased muscle performance in addition to positive effects on pain, fatigue, fibromyalgia-related symptoms and psychological status in patients with fibromyalgia.

A case of recurrent complex regional pain syndrome accompanying Raynaud's disease: a prospective coincidence?

Complex regional pain syndrome (CPRS) and Raynauds disease are disorders characterized by vasomotor disturbances associating with abnormal autonomic nervous system. We present a case of CRPS involving a history of recurrence and no initiating event. Raynauds disease accompanying CRPS was diagnosed clinically in the patient. We propose that a sympathetic dysfunction underlies the pathophysiologies of both disorders and may be responsible for the coexistence of these two distinct entities. Recurrence and unknown etiology of CRPS might account for temporary alterations in sympathetic function.

The association between patellar alignments features and tibiofemoral joint osteoarthritis

Knee osteoarthritis (OA) is the most common chronic joint disease causing pain and functional disability especially among older adults [1]. Mechanical risk factors such as increased body mass index, previous knee injury, and intensive physical activity are important for onset and progression of knee OA [1]. Biomechanical alterations of femorotibial joint such as varus–valgus alignment have also been shown to be associated with development of knee OA [2, 3]. Alterations in the congruence of the patellofemoral joint, the other compartment of the knee joint, may also lead to abnormal stress on the articular surface of this compartment and predispose subjects to developing patellofemoral OA. The combined tibiofemoral joint osteoarthritis and patellofemoral joint osteoarthritis is more common than isolated osteoarthritis of each compartment [4]. It means that malalignment in one compartment of the knee joint (tibiofemoral or patellofemoral) may probably affects the distribution of mechanical stress on both compartments of the knee and may lead to the degenerative changes in both compartments. In this study, we aimed to investigate the relationship between the alignment of patellofemoral joint and femorotibial joint osteoarthritis. Materials methods

Revisiting Length of Stay in Stroke Rehabilitation in Turkey

OBJECTIVE To investigate the parameters influencing length of stay (LOS) in stroke rehabilitation in Turkey. DESIGN Retrospective study. SETTING Rehabilitation ward in a university hospital, a referral center in the capital of Turkey. PARTICIPANTS Consecutive inpatient stroke survivors (N=142) after ischemic or hemorrhagic cerebrovascular events rehabilitated in a university rehabilitation center between January 2005 and October 2009. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The primary study outcome measurement is LOS on the rehabilitation ward. RESULTS LOS was best predicted by Brunnstroms motor recovery stages (BMRS) lower extremity on admission, BMRS hand on admission, and the presence of infections (LOS in days = 70.6 - 5 × BMRS lower extremity - 3.2 × BMRS hand + 10.3 × presence of infections [infection; present=2, absent=1]; R(2)=.37). CONCLUSIONS Motor impairments and infections were the parameters that most affected LOS in stroke rehabilitation. Prevention strategies for infections should be pursued more aggressively. The prevention of infections, which is an essential component of a patients general well-being, also shortened LOS in stroke rehabilitation. High medical costs urge LOS to shorten in the developing countries hereafter. A national rehabilitation policy should be implemented to reach the same functional outcome with shorter LOS in stroke patients.