Objectives: This study aims to investigate the efficacy of radial extracorporeal shock wave therapy (rESWT) on pain and functional capacity in the treatment of patients with calcaneal spur and to compare the efficiency of different energy densities of rESWT.Patients and methods: Ninety patients with heel pain for at least three weeks who were radiologically diagnosed with calcaneal spur, admitted to our policlinic between June 2014 and February 2015, were included in the study. Patients were randomly and equally assigned to placebo (control group), low and medium dose groups. They were evaluated through the visual analog scale (VAS) for pain score (resting, stretching, pression), maximum standing/walking time, Roles Maudsley (RM) score, Foot Function Index (FFI) and the American Orthopedic Foot and Ankle Society (AOFAS) score at pretreatment, at three and 12 weeks.Results: Calcaneal spur was more common in women, in patients with high body mass index (BMI) and patients who work in a standing position. While the improvement in VAS pression, FFI and AOFAS pain scores of low and medium dose groups were higher than that of the placebo group in the third week, there was no significant difference between these two groups. The improvement in these scores was higher in medium dose group than the low dose group, and it was higher in the low dose group than the placebo group in the 126 week. The patients in medium dose group gained better scores in AOFAS total, FFI disability, activity limitation and total scores than the other two groups and they only gained better scores in maximum walking time and AOFAS function than the control group in the 12th week. Except for AFI total, these scores showed no significant difference between the low dose group and the placebo group in the 12th week. Intragroup RM and AOFAS and maximum standing/walking time showed significant improvement from the baseline.Conclusion: In conclusion, the improvement in pain was found to be better in therapy groups compared to the control group in the early period and also medium dose group had better gain in both pain and functional capacity compared to others in the medium phase. However, there are no clear guidelines for choosing density in rESWT therapy yet. Therefore we should optimize the density high enough so that the patients can tolerate it and low enough to prevent side effects.
Objectives: This study aims to evaluate the efficacy of botulinum toxin A (BtA) injection applied to the gastrocnemius muscle in children with hemiplegic cerebral palsy (CP).Patients and methods: Between January 2014 and December 2014 nine patients (8 boys, 1 girl; mean age 6 years; range 5 to 10 years) who were diagnosed with hemiplegic CP in our clinic were included in this study. All patients underwent physical examination and computerized three-dimensional gait analysis before and at three and six months after the administration of the BtA.Results: Increased the stride length and walking speed prior to treatment decreased after BtA injection at three months. At six months, increased walking speed and stride length were observed, although they did not return to their baseline values. Significant improvements at the knee flexion at the initial contact (K1), ankle plantar flexion at the initial contact (A1), maximum ankle dorsiflexion during the stance phase (A2), and maximum ankle dorsiflexion moment (Am1) after BtA injection, which were maintained up to six months.Conclusion: Our study results show that the position of the ankle and knee during the heel strike is significantly improved after BtA injection and this improvement can be maintained up to six months.
While elderly onset arthritis frequently demonstrates degenerative features, the inflammatory arthritis should not be ignored. Paraneoplastic arthritis should be kept in mind during the etiological examination of inflammatory arthritis. Paraneoplastic arthritis, or carcinomatous polyarthritis, is a rare condition, and it may precede the clinical manifestation before being diagnosed, without the cancer becoming symptomatic. There is a lack of defined diagnostic algorithm to diagnose paraneoplastic arthritis in the elderly onset arthritis. This may cause significant difficulties in differential diagnosis and delays in the early treatment of cancer. In this article, we present the case of a patient with paraneoplastic arthritis, who was diagnosed with rheumatoid arthritis after two years of follow-up, and we discuss the clinical features of paraneoplastic arthritis at an advanced age.
Objectives: This study aims to examine the factors that may affect the exercise tolerance test (ETT), which was performed on ischemic stroke patients. Patients and methods: This study, which was conducted between December 2012 and August 2014, included 42 patients (27 males; 15 females; mean age 54.4 +/- 14.3 years) who were admitted to and hospitalized at the rehabilitation clinic between the first two weeks and six months since the date of the stroke, who had sitting balance or were suitable to undergo ambulation. Age, gender, dominant hand, hemiplegic side, disease duration, comorbidities, drugs, premorbid exercise habits and tobacco use of the patients were recorded. Cycling ergospirometry was performed to determine the exercise capacity of the patients. After the test, maximum oxygen uptake (VO2) reached, metabolic equivalent, time spend in the test (EET time), load at the time test was finalized, Borg Scale that indicates the patient's degree of strain, maximal heart rate reached, forced expiratory volume at first second (FEV1), forced vital capacity (FVC) and FEV1/FVC values were recorded. Results: We determined that of the patients, 43% had hypertension, 35% had coronary artery disease, 33% had diabetes, 29% had beta-blocker usage, 30% had cigarette smoking, 40% had right hemiparesis and 6% had regular exercise habits. We found that the use of beta-blockers was the only ETT effective factor among all parameters. Atrial fibrillation was developed in one patient as a side effect. Conclusion: When creating an exercise plan, the consideration of the patients' beta blocker use is important for the calculation of target heart rate.
The respiratory secretions of patients with cystic fibrosis (CF) cause frequent pulmonary infections by thickening. These recurrent infections lead to lung damage and other pulmonary diseases. Pulmonary rehabilitation is descriptive in the management of CF and has an important role to clear the airways, to relieve shortness of breath and to increase chest expansion. Pulmonary rehabilitation of patients with CF includes individual-dependent techniques such as postural drainage, percussion and vibration; controlled breathing exercises such as autogenic drainage and active cycle of breathing technique; use of airway clearance devices such as the positive expiratory pressure device and devices that provide airway oscillation such as high frequency chest wall oscillation device. Exercises for poor posture and shortened accessory muscles of respiration should be integrated to all of these techniques. This article aims to define rehabilitation techniques for CF and to help the physicians to choose the suitable technique for the rehabilitation program.
Objectives: This study aims to compare the superiority of different suprascapular nerve block (SSNB) application methods on hemiplegic shoulder pain (HSP), in a blinded and stimulator guided manner.Patients and methods: Twenty-six stroke patients (19 males, 7 females; mean age 61.0 +/- 9.4 years; range 53 to 76 years) meeting the enrollment criteria, were included in this study between September 2014 and November 2014. Patients were randomly divided into two equal groups. Patients in group A received blinded SSNB and patients in group B received stimulator guided SSNB. Range of motion (ROM) (by goniometer) and pain levels (by visual analog scale-VAS) were assessed. Evaluations were made before, one hour after and one week after SSNBs.Results: In each group, VAS pain scores significantly decreased over time (p<0.0001) and a significant increase in terms of flexion and abduction ROM angles (group A: p=0.002 and p=0.010; group B: p=0.004 and p=0.012, respectively) was observed. In addition, internal rotation ROM angles were found to have increased in group B (p=0.036). There were no significant differences in ROM and VAS one hour and one-week change scores between the two groups (p>0.05).Conclusion: Both blinded or stimulator guided suprascapular nerve block techniques were safe and effective for pain relief in hemiplegic shoulder pain management. None of the injection techniques was superior to the other.
Objectives: This study aims to investigate the efficacy of acupuncture in preventing migraine attacks.Patients and methods: Between December 2013 and June 2014, a total of 54 patients with a diagnosis of migraine in our neurology clinic were randomized into two groups. Venlafaxine was administered for three months to one group (drug therapy group: 4 males, 21 females; mean age 32.0 +/- 9.1 years; range, 18 to 65 years), while the other group was treated with acupuncture (acupuncture group: 5 males, 24 females; mean age 30.3 +/- 7.4 years; range, 18 to 65 years). The control group consisted of a total of 29 healthy individuals (7 males, 22 females; mean age 30.3 +/- 7.4 years; range 18 to 65 years). Blood serotonin levels were assessed before and after treatment along with visual analog scale (VAS) and Migraine Disability Assessment (MIDAS) in both groups.Results: There was no statistically significant difference in the mean analgesic use before and after the treatment and VAS and MIDAS scores between the acupuncture and drug therapy groups (p>0.05). The number and duration of attacks was found to be significantly lower in both groups, compared to the pre-treatment values (p<0.0001). The serotonin levels in the acupuncture and drug therapy groups were significantly higher compared to the pre-treatment values (p<0.001). Serotonin levels were found to be significantly lower in healthy individuals compared to the study groups (p<0.0001).Conclusion: Based on our study findings, acupuncture may be an effective option in the migraine prophylaxis.
Objectives: This study aims to analyze the demographic and clinical properties of patients with spinal cord injury (SCI) and to investigate the functional outcomes after rehabilitation.Patients and methods: In this retrospective and descriptive study, we investigated a total of 118 SCI patients (74 males, 44 females; mean age 41 16 years; range 13 to 74 years) with full records who were admitted to our rehabilitation program between January 2005 and December 2010. Demographic characteristics of the patients, etiological factors, time since injury, length of hospital stay, level of injury, as assessed by the American Spinal Injury Association (ASIA) Impairment Scale and functional status, as assessed by the Functional Independence Measure (FIM (TM)) on admission and discharge were analyzed. Complications related to SCI were also noted. Characteristic features of the patients', frequency of complications, and functional and neurological recovery were evaluated.Results: Of the patients, 70% were tetraplegic. The median time since injury was four months (IQR: 1 to 15 months), while the median length of stay was 76 days (IQR: 46 to 104 days). Four of 47 patients (8%) with Grade A (complete) according to the ASIA Impairment Scale on admission progressed to Grade B on discharge. Functional independence measure motor scores showed significant improvements at discharge (p<0.0001). The most common complications were urinary tract infections (70%), pressure ulcers (31%), and pain (28%).Conclusion: Inpatient rehabilitation in a tertiary referral hospital appears to provide substantial functional and motor gains in patients with SCI. Based on our study results, considerable improvement in the activities of daily living, as assessed by FIM motor scores, can be achieved with rehabilitation.
Objectives: This study aims to investigate the reliability of the Cumulative Illness Rating Scale (CIRS) and the frequency of comorbidity in stroke.Patients and methods: Fifty-two consecutive patients who had stroke once (25 males, 27 females; mean age 65.6 +/- 9.9 years; range 37 to 83 years), admitted to the stroke unit of the rehabilitation hospital between 01.09.2011 and 31.12.2011, were included in this study. After the first evaluation, three physicians scored the CIRS from the medical records. The same three physicians repeated this process after a one-week interval. Intraclass correlation coefficients were calculated for the measurement of intra-rater and inter-rater reliability studies.Results: Mean CIRS score was 16 +/- 4.4. Mean number of the affected organ systems was 6.8 +/- 1.8 (range, 4-12). The intraclass correlation coefficients were between 0.97-0.99. The most common chronic conditions associated to stroke were vascular problems, endocrine and metabolic disorders and psychiatric problems.Conclusion: As a result, both the intra-rater and inter-rater reliability results of the CIRS were very good in stroke. The patients with stroke had six system problems as a mean in this study.
Objectives: This study aims to investigate the rate of balance disorders and risk of falling in the geriatric population who do not complain of a balance disorder. Patients and methods: Sixty-eight elderly participants (24 males, 44 females; mean age 72.1±5.5 years), who were admitted to outpatient clinic between May 2012 and September 2012, were included in the study. Demographic data were recorded. Participants were divided into two age groups as young old (65-74 years) and old (75-85 years). Static balance was evaluated with Sharpened Romberg and the one-legged stance test. The dynamic balance and walking of the individuals were evaluated with Timed Up and Go (TUG) test, Berg Balance Scale (BBS), Tinetti (balance and gait) test (TT), and 20-meter walk test. Results: None of the participants had sought medical help due to loss of balance or falling. According to BBS, 41% of the participants had a moderate risk of falling; 66% had moderate and high risk of falling according to TT; and 63% of them had a high risk of falling according to TUG. Thirty-four percent of elderly had experienced at least one fall over the last year. Loss of balance was more significant in women and number of falls was more (p<0.05). The total evaluation results in TUG and TT for the individuals in the young old group were better than the individuals in the older age group in terms of balance. Conclusion: Loss of balance is a common finding in geriatric individuals and is associated with the risk of falling. Physicians, who frequently encounter with the geriatric population, should take this condition into account even for the patients who do not complain of a balance disorder. Thus, rehabilitation may be an option to prevent the fall and related complications, through the evaluation of balance.
Alkaptonuria is a rare inborn error of metabolism caused by mutations in the gene responsible for the production of homogentisate 1,2-dioxygenase, an enzyme that plays an important role in the normal degradation of the aromatic amino acids tyrosine and phenylalanine. Defective production of this enzyme results in the accumulation of homogentisic acid, a tyrosine degradation product, in the bloodstream. Accumulation of homogentisic acid and its metabolites in tissues cause ochronosis. The word ochronosis refers to the dark bluish black discoloration of connective tissues including the sclera, cornea, auricular cartilage, heart valves, articular cartilage, tendons, and ligaments. In this article, we present a 38-year-old male patient with alkaptonuria associated degenerative L4-5 disc hernia, in which the patient was diagnosed after lumbar discectomy.
Objectives: This study aims to investigate the incidence and severity of spasticity in patients with traumatic spinal cord injury (TSCI) from the perspective of both patients and physicians. Patients and methods: Between January 2006 and December 2010, a total of 119 TSCI patients (91 males, 28 females; mean age 34.9±13.1 years; range 18 to 79 years) were included in the study. The patients were asked for localization of the spasticity, its beneficial and harmful effects and whether it caused pain. The patients with pain were evaluated using the visual analog scale (VAS). The physicians used the Modified Ashworth Scale (MAS) for all patients. The spasticity was also evaluated using the Penn Spasm Frequency Scale, Spasm Severity Scale, Hygiene Scale, Deep Tendon Reflexes Scale, Clonus Score, and the Plantar Stimulation Response Scale. The patients were functionally evaluated with the Barthel Index (BI) and the Functional Independence Measurement (FIM). Results: Spasticity was reported by 42 patients (35.3%). Based on the MAS evaluation of the physicians, 54 patients (45.4%) had spasticity. The FIM, BI, and VAS scores of patients with spasticity were statistically significantly worse than those without spasticity. There was a statistically significant correlation between the spasticity evaluation performed by the physicians and patients (r=0.772; p=0.001). We also found a significant correlation between the MASS and VAS scores (r=0.200; p=0.029) and between the patient-reported spasticity and VAS scores (r=0.345; p=0.001). Conclusion: Our study results suggest that different measurement tools should be used during clinical examination to accurately evaluate the incidence and severity of spasticity in TSCI patients.
Objectives: This study aims to investigate the efficacy of injection of subcutaneous lidocaine in the management of pain that arises after total knee arthroplasty (TKA).Patients and methods: Data of 56 patients who had postoperative pain related with TKA between December 2013 and April 2014 were retrospectively evaluated. All patients were given an exercise program and oral non-steroidal anti-inflammatory drugs. According to the treatment applied, the patients were divided into two groups: 33 patients given lidocaine injection to the painful knee sites by the same physiatrist constituted group 1, and the remaining 23 patients, who had been treated only with exercise program and oral non-steroidal antiinflammatory drugs, constituted group 2. Demographic data, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores were recorded. These data were taken into consideration for the first and third month evaluations.Results: Both of the groups had higher initial scores for VAS and WOMAC (WOMAC total score group 1: 29.9, group 2: 34.2; VAS total score group 1: 8.3, group 2: 8.0). There were significant decreases in WOMAC and VAS scores (p<0.001) in both groups when the values before and after the treatment were compared. The decrease in the scores of group 1 was significantly higher than that of group 2.Conclusion: Subcutaneous lidocaine injections had short-term positive effects in patients who had postoperative pain after TKA. Future studies with larger sample may make the long-term effects of this intervention explicit.
