Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study

OBJECTIVE

The objective of this study was to determine the efficacy of the exercises administered to stroke patients with the balance trainer (BALANCE-trainer, art.nr. 07001-001(TM)) on balance, level of independence and ambulation parameters.

MATERIAL AND METHOD

Fifty patients with hemiplegia were randomized into either study group or control group. Patients in the control group received 30 sessions of conventional rehabilitation program and patients in the study group were trained with balance trainer in addition to conventional rehabilitation program. Balance level and postural control were evaluated with Berg Balance Scale (BBS) and Timed-Up and Go Test (TUG). Their functional statuses were evaluated using Functional Independence Measure (FIM). Evaluations were repeated following the six-week rehabilitation program.

RESULTS

Of the 50 participants, 19 were women (38%) and 31 were men (62%). The mean age was 57.1 ± 9.2 years. The time that elapsed after stroke was 87.3 ± 26.3 days. Statistically significant improvements were noted in BBS, TUG and FIM in intra-group evaluations for both groups. Statistically significant improvements were documented in BBS and TUG levels for inter-group evaluation (respectively p =0.038, p =0.025), while the difference in FIM levels was not statistically significant (p >0.05).

CONCLUSION

Positive impact of balance trainer on balance and postural control was demonstrated in stroke patients in the current study. Hippokratia 2015; 19 (2):125-130.

The correlation of neurophysiological findings with clinical and functional status in patients following traumatic nerve injury

In this study, we aimed to determine whether there is a correlation between the electrodiagnostic findings and the functional status, muscle strength and sensibility in patients with traumatic nerve injury to the wrists. We assessed 50 patients at a mean of 11.6 months (SD 5.85) (range 6-25) after nerve injury. Sensibility was assessed by monofilament testing. Motor function was evaluated by assessing the manual muscle grade of the abductor pollicis brevis and abductor digiti minimi muscles. Function was evaluated by the Sollerman Hand Function Test. The amplitudes of the compound muscle action potential and the sensory nerve action potential were determined by electroneuromyography. While the compound muscle action potential and sensory nerve action potential amplitudes had significant correlation with muscle grade and Semmes Weinstein Monofilament tests, there was no correlation with the functional scores.

Reliability and validity of the Turkish version of the ECOS 16 questionnaire in postmenopausal osteoporosis

AIM

The purpose of this study was to develop a Turkish version of ECOS 16 Questionnaire and assess its reliability and validity.

METHODS

Sixty four women with postmenopausal osteoporosis were included in the study. It was mandatory for all patients to be Turkish literate and without symptoms of dementia. Patients who were diagnosed as secondary osteoporosis by clinical and laboratory examinations were excluded from the study. After translation process, the Turkish version of the scale was applied to each participant twice with an interval of 2 weeks. For reliability study, internal consistency (Chronbach alpha) of ECOS 16 total score and test-retest intraclass correlation coefficient (ICC) were calculated. Validation study was assessed by correlating the scale with QUALEFFO 41.

RESULTS

The mean age at menopause and age of patients were 45.61+/-6.04 years and 59.91+/-8.69 years respectively. Chronbach alpha of the Turkish version of the ECOS 16 was 0.90. The test-retest reliability (ICC) of the Turkish version of the ECOS 16 was determined as 0.83 for the total score, and ranged between 0.72-0.88 for individual items. In terms of validity; the Turkish version of ECOS 16 correlated significantly with QUALEFFO 41 (r=0.844 P<0.0001).

CONCLUSIONS

. The Turkish version of the ECOS 16 is a reliable and valid questionnaire to be used in the evaluation of Turkish women with postmenopausal osteoporosis.

Synthesis and serotonin receptor activity of the arylpiperazine alkyl/propoxy derivatives of new azatricycloundecanes

A set of 36 arylpiperazine derivatives with two novel complex terminal imide fragments, 8,11-dimethyl-3,5-dioxo-4-azatricyclo[5.2.2.0(2,6)]undec-8-en-1-yl acetate and 1,11-dimethyl-4-azatricyclo[5.2.2.0(2,6)]undecane-3,5,8-trione, were synthesized and tested for their affinity for 5-HT(1A) and 5-HT(2A) receptors. The Fujita-Ban analysis showed that the influence of structural modifications on the affinity for both receptor subtypes is additive and that the activity of similar compounds could be predicted with high accuracy. Compounds 46, 48 and 18 out of 14 screened in a functional model of anxiety and depression demonstrated antidepressant activity in the forced swimming tests in mice, and were devoid of neurotoxic effects (chimney test in mice).

Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic, progressive, systemic inflammatory rheumatic diseases that lead to serious disability. The objective of this study was to investigate the demographic and clinical characteristics of the patients with RA and AS who were treated in tertiary hospitals in Turkey and to analyze their current medical management. A total of 562 RA and 216 AS patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6 years. The female to male ratio was 3.7:1. Of the RA patients, 72.2% had positive rheumatoid factor (RF), 62.9% had high C-reactive protein, and 75.2% had radiological erosion. The ratio of patients with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with Health Assessment Questionnaire (HAQ) > or =1.5 was 20.9%. There was a statistically significant increase in RF positivity and HAQ scores in the group with higher DAS 28 score. Frequency of extraarticular manifestations was 22.4%. The ratio of the patients receiving disease modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the patients were using anti-tumor necrosis factor (TNF) blocking agents. In AS, the mean age of the patients was 38.1 +/- 10.6, and the female to male ratio was 1:2.5. The time elapsed between the first symptom and diagnosis was 4.3 years. The ratio of peripheral joint involvement was 29.4%. Major histocompatibility complex, class I, B 27 was investigated in 31.1% of patients and the rate of positivity was 91%. In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was > or =4. The erythrocyte sedimentation rate, Bath AS Functional Index, and peripheral involvement were significantly higher in the group with BASDAI > or =4. Frequency of extraarticular involvement was 21.2% in AS patients. In the treatment schedule, 77.5% of AS patients were receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents. Despite widespread use of DMARD, we observed high disease activity in more than half of the RA and AS patients. These results may be due to relatively insufficient usage of anti-TNF agents in our patients and therefore these results mostly reflect the traditional treatments. In conclusion, analysis of disease characteristics will inform us about the disease severity and activity in RA and AS patients and could help in selecting candidate patients for biological treatments.

Compressive neuropathy of long thoracic nerve and accessory nerve secondary to heavy load bearing. A case report

Carrying heavy loads that compress the shoulders is a possible etiological factor for both accessory and long thoracic nerve entrapment. In our patient, shouldering heavy loads damaged both nerves. A 27-year-old right-hand-dominant man was referred because of difficulty in raising his arms after a brief period of painful episodes due to heavy load bearing on both shoulders. Atrophic muscles around the shoulders, depressed and winged scapula were noted. An EMG confirmed entrapment of long thoracic and accessory nerves. An exercise program was instituted; 16 months after initial referral, though winged scapula was still noted, manual muscular strength had returned without functional limitation.

Bilateral shoulder fracture dislocations and radiculopathies secondary to electrical injury (a case report)

INTRODUCTION

In this report a case of bilateral shoulder fracture dislocations and C5 radiculopathy developed after an electrical injury is presented.

CASE

A 29 year-old male patient referred to our hospital with complaints of inability to raise his hands overhead starting 3 months ago after an electrical injury. The first physical examination revealed loss of strength (3/5) in deltoid muscles bilaterally, bilateral shoulder fracture dislocations and C5 radiculopathies. An open reduction and internal fixation (using K wire, cortical screw) procedure was applied for the right side in the Department of Orthopedics. Postoperatively active (A) and passive (P) ranges of motion (ROMs) were restricted extremely in the right and left shoulder respectively. Since applications of 15 sessions of electrical stimulation for deltoid muscle and physical treatment for both shoulders failed to achieve satisfactory ROMs, K wire extraction was instituted with resultant increase in the right shoulder A/P ROMs after 10 sessions of physical therapy postoperatively. At the last examination which was 18 months after the injury, ROMs of the right shoulder were increased, but not normal.

CONCLUSION

It must be remembered that in electrical injury, fractures and dislocations might occur in affected sites without any evidence of trauma with associated neurologic complications, and that these cases must be promptly detected and managed without any delay.

Comparison of functional disability scales and their relevance to radiological progression in patients with rheumatoid arthritis in remission

OBJECTIVE

To look for any correlations between radiological scores and hand functions evaluated with two different methods in patients with rheumatoid arthritis in remission.

METHODS

Forty-two patients diagnosed with rheumatoid arthritis (RA) in remission according to ACR criteria were assessed for their hand functions with Duruöz's Hand Index (DHI), and with Sollerman Function Test (SHFT) as well as with Health Assessment Questionnaire (HAQ). Hand X-rays were evaluated according to Modified Sharp Index; joint space narrowing score (JSNS), erosion score (ES), and total score (TS) were calculated. The X-rays were assessed by the same rheumatologist three times.

RESULTS

Mean HAQ score, mean DHI score and mean SHFT scores were 0.88+/-0.68, 17.74+/-17.81, 72.24+/-9.23 respectively. Radiologic scores were as follows: JSN 35.04+/-28.14, ES 25.19+/-36.23, TS 60.26+/-66.21. Intraobserver reliability was high (r=0,98). There was a positive correlation between HAQ and DHI (p<0.001), a negative correlation between SHFT. There was also a negative correlation between DHI and SHFT. The correlations between JSNS, ES and TS with respect to HAQ and SHFT were strong (p<0.0001) along with DHI (p<0.05).

CONCLUSION

HAQ was found correlated with DHI and SHFT. Modified Sharp scores were found correlated with the general disability and hand functions. SHFT, with respect to DHI, takes a longer period of time, depends on equipment and needs an observer. On the contrary, DHI offers a more practical and economical way of assessment.

Protracted febrile myalgia of familial Mediterranean fever

Protracted febrile myalgia (PFM) includes severe myalgia of the upper and lower extermities accompanied by fever lasting up to 6 weeks, an elevated erythrocyte sedimentation rate and leucucytosis. We report a 13-year-old girl with PFM, and discuss the magnetic resonance imaging findings of the involved calf muscles. To our knowledge these are the only images of the pathology in the literature.

Reiter syndrome following intracavitary BCG administration

BCG vaccine was given intravesically to a patient with bladder tumour. After the fifth dose she developed bilateral conjunctivitis, painful swelling in her wrist, dysuria and arthritis in her left knee and right metacarpophalangial joints. The diagnosis was Reiter syndrome and is the second case in the literature.