Effects of dynamic lumbar stabilization exercises following lumbar microdiscectomy on pain, mobility and return to work. Randomized controlled trial

BACKGROUND

Various lumbar exercise programs are prescribed for rehabilitation purposes following microdiscectomy applied for the treatment of lumbar disk herniation. The literature contains several studies on this subject. However, there are no studies investigating the effects of supervised dynamic lumbar stabilization exercises on fear and fear/regression attitudes of patients and on their return to work.

AIM

This study investigates the effects of supervised dynamic lumbar stabilization exercises during postoperative rehabilitation on spinal mobility, pain, functional status, return to work, quality of life, and fear/regression attitude of patients who underwent lumbar microdiscectomy for the first time.

SETTING

The study was conducted at physical therapy and rehabilitation clinics.

STUDY DESIGN

A randomized clinical trial comparing exercise programs after lumbar microdiscectomy.

PATIENTS SAMPLE

Forty-four lumbar microdiscectomy patients were randomized into two groups.

OUTCOME MEASURES

Each group was assessed in terms of low back pain, leg pain, spinal mobility, Oswestry Disability Index (ODI), and Nottingham Health Profile (NHP), at the postoperative first, second, and sixth months. Fear/regression beliefs and level of pain were evaluated through the Fear Avoidance Belief Questionnaire (FABQ).

METHODS

Forty-four patients were randomly divided into two equal groups of 22 subjects, respectively, as a study group with Dynamic Lumbar Stabilization (DLS) exercises and home exercises, and a control group with only home exercises for a period of four weeks.

RESULTS

Leg pain decreased more in the study group compared with the control group (P=0.004). Spinal mobility scores demonstrated greater increases in the study group (P<0.001). Statistically greater reductions were observed in the study group regarding ODI and FABQ scores (P<0.017).

CONCLUSION

DLS exercises may be recommended to patients following spinal surgery due to their benefits in reducing pain, increasing spinal mobility, and ensuring faster return to work periods.

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity

BACKGROUND

In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity.

METHODS

The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention.

RESULTS

The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%.

CONCLUSION

ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene with an efficacy lasting for about 3 months.

Evaluation of the effect of local corticosteroid injection and anti-inflammatory medication in carpal tunnel syndrome

BACKGROUND AND AIMS

To evaluate the effect of local corticosteroid injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of carpal tunnel syndrome (CTS), 32 patients were included in this study.

METHODS

A prospective, randomised clinical trial, assessing functional findings by Functional Status Scale (FSS), (JTT) Jebsen Taylor Test and electrophysiologic examinations, analysed on initial visit and at the third month after treatment. Group A was treated with betamethasone injection and group B with NSAIDs, both with concomitant use of wrist splints.

RESULTS

The mean age of the patients was 40.8 +/- 11.2 (range 21-64) years. There was a significant improvement in FSS in groups A and B at the third month. In JTT, 'writing', 'picking up small common objects' and 'picking up large heavy objects' activities were improved in group A; 'writing' and 'stacking checkers' activities were improved in group B. Statistically significant improvement was observed in peak sensory conduction velocity and distal motor latency in groups A and B. Mixed nerve conduction velocity and compound sensory action potential were improved in group A.

CONCLUSIONS

The results showed that neither of the groups demonstrated superior results. We conclude that local steroid injection and NSAIDs with concomitant use of wrist splints may offer patients with CTS variable and effective treatment options for the management of functional scores and nerve conduction parameters.

Ultrasound-guided botulinum toxin type A injection to the iliopsoas muscle in the management of children with cerebral palsy

OBJECTIVE

To determine the effect of botulinum toxin type A (BTX-A) on spasticity and functional development in children with cerebral palsy (CP) in conjunction with a physiotherapy program.

METHOD

In this prospective study, 18 CP patients were evaluated. Multilevel BTX-A injection was applied to children at a dose of 15 U/kg. Children were assessed before and at the 5th and 12th week post-injection using Thomas test, Duncan-Ely test, passive range of motion (pROM) measurement, Distance Between Knee (DBK), Selective Motor Control (SMC) scale, modified Ashworth Scale (MAS) and modified Physician Rating Scale (mPRS). To assess functional improvement, Gross Motor Function Measure (GMFM) and Functional Independence Measure for Children (WeeFIM) were used before and at the 12th week post-injection.

RESULTS

At 5th week post-injection, a statistically significant decrease was determined in spasticity (p < 0.01). Improvement was observed in mPRS and pROM, but not in SMC. At the 12th week post-injection, GMFM (p< 0.001) and WeeFIM improved significantly (p< 0.001). The improvement in pROM and mPRS (p< 0.01) lasted until the 12th week post-injection, but the improvement in MAS (p > 0.05) and in the Tardieu test of hip adductors (p > 0.05) did not last after the 5th week.

CONCLUSION

BTX-A injection enhances functional and motor abilities in the development process.

Sacroiliitis and polyneuropathy during isotretinoin treatment

Isotretinoin, a medication for acne, has been reported to cause a variety of side effects on the musculoskeletal system. We present a case of sacroiliitis (a relatively uncommon feature) and sensorimotor demyelinating polyneuropathy, which has been reported previously in only a few cases during isotretinoin therapy. Clinical symptoms were improved after the withdrawal of isotretinoin and the follow-up electrophysiological study performed 2 years after the initial diagnosis of polyneuropathy showed mild improvement. Dermatologists are advised to be alert to symptoms of polyneuropathy and sacroiliitis during treatment with isotretinoin.

Dynamic postural stability in blind athletes using the biodex stability system

Three systems affect the upright standing posture in humans - visual, vestibular, and somatosensory. It is well known that the visually impaired individuals have bad postural balance. On the other hand, it is a well documented fact that some sports can improve postural balance. Therefore, it is aimed in this study to evaluate the dynamic postural stability in goal-ball athletes. Twenty blind goal-ball players, 20 sighted and 20 sedentary blind controls were evaluated using the Biodex Stability System. Three adaptation trials and three test evaluations (a 20-second balance test at a platform stability of 8) were applied to the blind people, and to the sighted with eyes open and closed. Dynamic postural stability was measured on the basis of three indices: overall, anteroposterior, and mediolateral. Means of each test score were calculated. The tests results were compared for the blind athletes, sighted (with eyes open and closed) subjects, and sedentary blind people. There were significant differences between the results of the blind people and the sighted subjects with regards to all of the three indices. Although the stability of goal-ball players was better than sedentary blinds', only ML index values were statistically different (4.47 +/- 1.24 in the goal-ball players; 6.46 +/- 3.42 in the sedentary blind, p = 0.04). Dynamic postural stability was demonstrated to be affected by vision; and it was found that blind people playing goal-ball 1 - 2 days per week have higher ML stability than the sedentary sighted people.

Dynamic postural balance in ankylosing spondylitis patients

OBJECTIVES

In this study, our objectives were to investigate whether patients with ankylosing spondylitis (AS) have a poorer dynamic balance than normal subjects, and to study the relationship between balance and posture.

METHODS

Seventy patients (57 men, 13 women) with AS and 35 (31 men, 4 women) controls matched for age, weight, height and body mass index were tested using the Biodex Stability System. Anteroposterior (AP), mediolateral (ML) and overall (OA) indices were obtained with bilateral stance at platform stabilities of 8 and 4. Subjects were tested with 'eyes open' at all times. Correlation analyses were performed between stability indices (OA, AP, ML) and disease duration, cervical rotation (CR), tragus to wall distance (TWD), lumbar side flexion (LSF), lumbar flexion (LF), intermalleolar distance (IMD) and Bath Ankylosing Spondylitis Metrology Index (BASMI) total score.

RESULTS

No significant difference was found between the AS patients and healthy subjects with respect to all three stability indices at levels 4 and 8. A positive correlation was found only between ML stability index and TWD at level 8 (r, 0.249; P = 0.038). No other positive correlation was detected between stability indices and CR, TWD, LSF, LF, IMD, total BASMI score and disease duration.

CONCLUSIONS

AS has no negative effect on postural stability. The only clinically significant association was found between dynamic postural balance and TWD.

The assessment of functional status in Turkish children with cerebral palsy (a preliminary study)

INTRODUCTION

Cerebral palsy (CP) is one of the most common causes of disability in childhood leading to functional limitations. Assessment of the functional limitations is important to determine the severity of the disability in CP and to evaluate the benefit of the rehabilitation programme. However, the results of the measurements show variations according to different sociocultural characteristics. The Functional Independence Measure of Children (WeeFIM) had not been studied in Turkish children previously. The aims of this study were to evaluate the functional disability of Turkish children with CP by using WeeFIM and to compare the results with those of healthy counterparts.

METHODS

A total of 86 children aged 24 months to 120 months were included in the study. Forty-five children with CP and 41 healthy children representing the controls were evaluated with WeeFIM. Both children with CP and healthy controls were categorized into four groups according to their chronological age. The variations in the WeeFIM subsets scores (self-care, sphincter control, transfers and locomotion, communication and social cognition) and total WeeFIM scores in children with CP and healthy controls were analysed.

RESULTS

The children with CP had lower WeeFIM scores than healthy controls. The sphincter control subset scores of children with CP increased as they grew up. There was no statistically significant difference in all WeeFIM subset scores and the total WeeFIM scores among the four age groups of children with CP.

CONCLUSION

The WeeFIM appears to be a useful instrument for measuring the disability of Turkish children with CP. However, studies with wider series are needed to generalize our results.

Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients

OBJECTIVE

To examine the relation between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients.

DESIGN

Case-control study.

SETTING

Inpatient rehabilitation hospital.

PATIENTS

Thirty-five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non-RSD group) were included in the study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded.

MAIN OUTCOME MEASURES

Both the RSD and non-RSD groups were assessed for presence and grade of subluxation from radiographs using a 5-point categorization. The degree of shoulder pain of the non-RSD group was assessed by a visual analogue scale of 10 points.

RESULTS

Glenohumeral subluxation was found in 74.3% of the RSD and 40% of the non-RSD group (p = .004). In the non-RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (p = .019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non-RSD group (p = .152).

CONCLUSION

Findings from this study suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients.

Calcitonin treatment in reflex sympathetic dystrophy: a preliminary study

Reflex sympathetic dystrophy is one of the important complications effecting the rehabilitation programmes of hemiplegic patients in a negative manner by causing pain and function loss. In this study, the aim was to investigate the effects of salmon calcitonin treatment in reflex sympathetic dystrophy that develops in hemiplegia. Forty-one patients with hemiplegia resulting from cerebrovascular events and stage 1-2 reflex sympathetic dystrophy were included in the study. Salmon calcitonin, 1 x 100 IU/day intramuscularly for 4 weeks, was administered to 25 of these patients (calcitonin group) to the other 16 patients physiological saline, 1 ml/day intramuscularly for 4 weeks, was administered (control group). At the end of the fourth week of treatment the pain score of the calcitonin group was significantly lower than that of the control group. Shoulder abduction and external rotation, wrist flexion and metacarpophalangeal extension of the calcitonin group were found to be significantly better than those of the control group. In the calcitonin group the significant decrease in pain and tenderness resulted in improvement of range of motion and motor functions.

Angular biofeedback device for sitting balance of stroke patients

BACKGROUND AND PURPOSE

Impaired sitting balance is an important and time-consuming complication for stroke patients. We examined the effect of the use of an angular biofeedback device in addition to physical therapy in training stroke patients with impaired sitting balance compared with outcome in patients receiving conventional physical therapy only.

METHODS

The biofeedback group consisted of 24 patients who received angular biofeedback training in addition to conventional physical therapy. The number of biofeedback signals and the lengths of time a patient could sit balanced throughout a period of 5 minutes before the training program, after 10 days of treatment, and at discharge were recorded and compared with those of the control group of 13 patients who received conventional physical therapy only.

RESULTS

It was found that 75% of the biofeedback group gained sitting balance after 10 days of treatment in comparison with 15.4% of the control group (P < .001). At discharge, 91.6% of the biofeedback group and 84.6% of the control group gained sitting balance (P = .510), and 45.8% of the biofeedback group and 46.2% of the control group managed independent ambulation (P = .985). The mean rehabilitation periods among the ambulatory patients of the biofeedback and control groups were 9.45 +/- 0.71 and 13.83 +/- 1.70 weeks, respectively (P = .049). The mean training time in which the biofeedback group gained sitting balance was significantly shorter than that of the control group (P < .001).

CONCLUSIONS

Angular biofeedback intervention, by providing earlier postural trunk control, is a useful adjunct to conventional physical therapy in the rehabilitation of stroke patients with impaired sitting balance.