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Objective: This study was performed to evaluate the shoulder ultrasound (US) findings of the hemiplegic patients without shoulder pain and to evaluate the relationship between the sonographic findings and the motor stage, activities of daily living (ADL), and functional status. Material and Methods: This cross-sectional study included a total of 22 hemiplegic patients and 18 healthy controls. The demographic data of all participants, and, Brunnstrom recovery scale (BRS), functional ambulation scale (FAC) scores, Barthel index, and muscle tone, were analyzed. Shoulder cartilage, deep joint space of the acromioclavicular joint (ACJ), and ultrasound shoulder pathology rating scale (USPRS) scores of healthy controls and hemiplegic patients were evaluated by the US. Results: The demographic data of the patient and healthy control groups were comparable. The total USPRS score and the scores of each component were significantly higher in the hemiplegic shoulder compared to healthy controls (p

Objectives: This study aims to assess the correlations between disease specific quality of life (QoL), general health status and clinical variables in patients with ankylosing spondylitis (AS), and also to determine a cutoff value for the disease specific QoL questionnaire. Patients and methods: A total of 124 patients (80 males, 44 females; mean age 40.6±11.1 years; range, 20 to 65 years) who fulfilled the modified New York criteria for AS were included in this cross-sectional study. All patients received a comprehensive rheumatologic assessment including disease specific instruments for disease activity, functional status, spinal mobility and QoL. Furthermore, short form-36 (SF-36) was used to determine general health status. Pain levels of the patients were assessed with visual analog scale (VAS). Pearson’s analysis was used to assess correlation among variables, with moderate, strong, or very strong correlations if the value was between 0.40-0.69, 0.70-0.89, and 0.90-0.99, respectively. To determine a cutoff value for the ankylosing spondylitis quality of life (ASQoL) score, the area under the receiver operating characteristic curve (AUC) was computed according to clinical parameters which have the strongest correlations with ASQoL. Results: The mean ASQoL score was 8.8±4.9. There was a significantly positive correlation between ASQoL and disease activity, functional status, spinal mobility and pain VAS whereas there was a significantly negative correlation between ASQoL and the SF-36 subscale scores except for mental health and emotional role (p

Objectives: this study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: the median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p, NA

Aim To identify physical, cognitive, and metabolic factors affecting gait speed in patients with type-2 diabetes mellitus (T2DM) without neuropathy. Methods This cross-sectional study enrolled 71 diabetic patients without neuropathy (mean age 55.87 +/- 7.74 years, 85.9% women). Neuropathy status was assessed with Douleur Neuropathique 4. We used a cut-off point for gait speed of 1 m/s to classify the participants into two groups: slow walkers (SW) and average and brisk walkers (ABW). The groups were compared in terms of age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), fasting glucose, systolic blood pressure, maximal aerobic capacity (VO2 max), percentage of muscle mass, percentage of lower extremity muscle mass, Mini-Mental State Examination (MMSE) score, and years of education. Results Compared with the ABW group, the SW group had significantly lower VO(2)max (14.49 +/- 2.95 vs 16.25 +/- 2.94 mL/kg/min) and MMSE score (25.01 +/- 3.21 vs 27.35 +/- 1.97), fewer years of education, and these patients were more frequently women (P < 0.05). In the multivariate regression models, the combination of VO2 max, sex, and MMSE score explained only 23.5% of gait speed (P < 0.001). MMSE score and VO2 max independently determined gait speed after adjustment for age, BMI, HbA1c, fasting glucose, systolic blood pressure, percent of muscle mass, percent of lower extremity muscle mass, and years of education. Conclusion In diabetic patients without neuropathy, physical impairment and disability could be prevented by an improvement in aerobic capacity and cognitive function.

The aim of this case report was to represent a case with multiple insufficiency fractures detected in an elderly female patient who was referred to our clinic for the differential diagnosis of bilateral sacroiliitis. A 71-year-old female patient was admitted to our outpatient clinic with the complaint of low back pain and also pain in her both hips and groin. On assessment of her musculoskeletal system, she had limited range of motion for low back and also had bilateral painful hip rotations. Bilateral Faber, Mennel and sacroiliac compression tests were positive. In her laboratory examination, 25-hydroxy-Dvit level was 3 ng/ml and parathormone level was 70 pg/ ml. In consistent with physical examination pelvic radiograph revealed bilateral subchondral sclerosis in the sacroiliac joint, narrowing in the coxafemoral joint space, irregularity in symphisis pubis. Sacroiliac magnetic resonance imaging showed diffuse hypointense signal on T1-weighted images and hyperintense signal change on STIR images in the periarticular surfaces of bilateral sacroiliac joints and also fracture lines were detected on T1-weighted images. Subsequently, multiple insufficiency fracture lines were detected on the anterior face of the sacrum, bilateral iliac bones and the pubic ramus on the sacroiliac computed tomography. The patient was diagnosed with multiple insufficiency fractures due to vitamin D deficiency. Vitamin D was replaced and conservative treatment was planned. In conclusion, insufficiency fractures should be considered in differential diagnosis in elderly patients who present with low back pain and who have joint changes that may mimic sacroiliitis in imaging.

Introduction: The aim of this study was to determine whether there is an association between fall risk measured posturographically and clinical balance tests among people who are over 65 years of age, and to identify the discriminative ability of the posturographic fall risk index., Materials and Methods: Two hundred and twenty participants who were over 65 years of age were included in the study. The balance and fall risk of participants were assessed with the Berg balance scale (BBS) and a posturography device; functional mobility with the Timed Up and Go (TUG) test; lower extremity neuromuscular function with the Chair Stand test (CST) and quality of life with the Short Form-36 (SF-36). Participants were grouped into two, as fallers and non-fallers, on the basis of the past year’s fall history., Results: A total of 78 participant (35.5%) had a history of falling, while 142 (64.5%) of the subjects did not. Age, TUG and posturographic fall risk index of fallers were significantly higher than for nonfallers, whilst some subgroups of the SF-36, BBS and mean CST scores were lower (p, Conclusion: It was shown that fallers had poorer balance, functional mobility, lower extremity neuromuscular function and quality of life than nonfallers. The study also demonstrated that posturographically obtained fall risk was significantly correlated with clinical balance tests and had good discriminative ability to identify fallers. © 2014, Geriatrics Society. All rights reserved.

Objective: To examine the effects of a six-month aerobic exercise program on pulmonary function and cardiorespiratory capacity in obese women. Materials and Methods: A total of 50 subjects - 25 obese women who neither did regular exercise nor applied a special diet program, and 25 healthy controls - were included in the study. Body mass index (BMI), maximum oxygen consumption (VO2max) and pulmonary function tests (PFT) values were measured as evaluation parameters in both groups. Obese women were enrolled to a supervised hospital-based bicycle aerobic exercise program for six months at an individualized target heart rate range (50-85% of heart reserve), with an increasing frequency and duration. Evaluation parameters were reevaluated after the exercise program and were compared with the pre-exercise values. Results: VO2max, forced vital capacity (FVC), forced expiratory volume at first second (FEV1), FEV1/FVC, and maximum mid-expiratory flow rate (FEF25-75) were significantly lower in obese women (p

Objective: The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis. Design: This study was designed as a prospective, randomized-controlled, and single-blinded clinical trial. Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were randomly assigned into two groups and were treated with mature mud packs (n 15) or hot packs (n=12). Patients were evaluated for pain [based on the visual analog scale (VAS)], function (WOMAC, 6 min walking distance), quality of life [Short Form-36 (SF-36)], and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and insulin-like growth factor-1 (IGF-1) at baseline, post-treatment, and 3 and 6~months after treatment. Results: The mud pack group shows a significant improvement in VAS, pain, stifness, and physical function domains of WOMAC. The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack. For a 6 min walking distance, mud pack shows significant improvement, and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment. Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment. Significant improvements are found for the social function, vitality/energy, physical role disability, and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment. A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline, and the difference is significant between groups 3 months after the treatment. Conclusion: Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis. © 2012 - IOS Press and the authors. All rights reserved.

Introduction: We aimed to investigate the effects of home-based vestibular exercise and biofeedback training on balance, fall risk, functional mobility, emotional state and quality of life among osteoporotic women. Materials and Method: Sixty osteoporotic women aged over 65 were randomized to four groups of 15 people: home-based vestibular exercise, biofeedback training, vestibular exercise+biofeedback training and control group. Training programs were performed in all groups. Biofeedback training was performed in 20 minute sessions,10 sessions a month. Vestibular exercises were prescribed once daily with 10 repetitions for one month. Fall risk obtained by Tetrax, Berg balance test, Timed Up-and- Go test, Geriatric Depression Scale (GDS) and Short Form-36 (SF-36) questionnaire were evaluated at the beginning and the end of the study. Results: Compared to the control group, statistically significant improvements in fall risk, balance, GDS scores and physical function, role emotional and general health subgroups of SF-36 test were observed in all of the intervention groups (p

Coexsisting ankylosing spondylitis (AS) and gouty arthritis have rarely been reported in the literature previously. We present a 43-year-old male patient with AS who had been diagnosed as having gout based on some clinical and laboratory findings. In this paper, the clinical features of both rheumatic diseases are discussed in light of the recent literature. The gouty arthritis should be considered in the differential diagnosis of acute peripheral arthritis in patients with AS. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing.

Objective: It was aimed to investigate the relationship of lesion level and severity with bladder behavior based on urodynamic findings in patients with spinal cord injury (SCI). Materials and Methods: Forty nine patients who were on inpatient rehabilitation programme in our clinic with the diagnosis of SCI after the spinal shock period were included in the study. Neurological level (cervical, thoracal, lumbosacral) and severity of the lesion (complete, incomplete) were set according to the American Spinal Injury Association (ASIA) classification. It was assessed if the level and severity of the SCI related to neurogenic bladder type, maximum cystometric capacity (MCC) and compliance which were designated with urodynamic study and methods of bladder management. Results: There was no difference in terms of age, sex, disease duration, neurogenic bladder type, MCC, compliance, method of bladder management on admission according to the level and severity of the lesion among patients with SCI (p>0.05).Level and severity of SCI were significantly associated with the method of bladder drainage at discharge (r: 0.33, p

Amaç: Paraplejik erkeklerde cinsel fonksiyon bozukluklarının ve hastalar için öneminin belirlenmesi, hastaların yaşam beklentilerinin değerlendirilmesi. Yöntemler: Çalışmaya spinal şok döneminden çıkmış, yaralanmanın ilk yılı içinde olan 33 paraplejik erkek hasta alındı. Anket yoluyla hastaların yaralanma öncesi ve sonrası cinsel fonksiyonları hakkında ayrıntılı bilgi edinildi. Erektil fonksiyon; International Index of Erectile Function (IIEF) ile değerlendirildi. Nörolojik seviye American Spinal Injury Association'a (ASIA) göre belirlendi. Bu seviyeler, ürogenital sistemin innervasyonu dikkate alınarak T1-T10, T11-L2 ve L3 ve altı olmak üzere 3 grupta sınıflandırdı. Ereksiyon, ejakülasyon ve orgazm ile nörolojik düzey arasındaki ilişkiler araştırıldı. Bulgular: Ortalama IIEF skoru erektil disfonksiyonu yansıtacak şekilde 19,84±7,4 idi. Erektil fonksiyon skoruna (EFAS) göre tüm hastalarda erektil disfonksiyon saptandı. Lezyon seviyesi T1-T10 olan hastalarda refleks ereksiyonların (RE) %100 oranında, L3 ve altı lezyonlu hastalarda ise psikojenik ereksiyonların (PE) %55,6 oranında korunduğu saptandı. Komplet hastaların % 95'inde RE'nin, inkomplet hastaların %58,3‘ünde PE'nin korunduğu belirlendi. Sadece 1 hastada (L3 ASIA-D) ejakülasyon fonksiyonu ve orgazmın korunduğu belirlendi. Yaralanma sonrası cinsel ilişki isteği, sıklığı ve cinsel yaşamdam memnuniyet yaralanma öncesine göre anlamlı düzeyde azalmıştı (p

Objective: To assess the effectiveness of therapeutic exercises alone and in combination with a single physical agent - ultrasound - in patients with lumbar spinal stenosis. Design: Randomized, prospective, controlled trial. Setting: Department of Physical Medicine and Rehabilitation, University Hospital. Subjects: Forty-five patients presenting with symptoms of neurological claudication and magnetic resonance image-proven lumbar spinal stenosis were assigned to one of three groups: ultrasound plus exercise group (group 1, n =15), sham ultrasound plus exercise group (group 2, n= 15) and no exercise - no treatment group (control group, n = 15). Interventions: Stretching and strengthening exercises for lumbar, abdominal, leg muscles as well as low-intensity cycling exercises were given as therapeutic exercises. Ultrasound was applied with 1 mHz, 1.5 W/cm2 intensity, in continuous mode on the back muscle for 10 minutes in group 1 while ultrasound on/off mode was applied in group 2. Main outcome measures: Before and after a three-week period, all subjects were evaluated by pain, disability, functional capacity and consumption of analgesic. Results: Thirty-two of the participants were women and 13 were men, with an average age of 53.2 ± 12.68 years (range 25-82 years). After a three-week treatment period, leg pain decreased in group 1 (-1.47 ± 3.02) and group 2 (-2.47 ± 3.75) compared with the control group (P0.05). The amount of analgesic consumption is significantly less in the group with ultrasound application compared to that in the control group (P

Bu çalışmada, omurilik yaralanmalı hastaların temiz aralıklı kateterizasyona uyumunu ve temiz aralıklı kateterizasyona uyum ile ilişkili olabilecek demografi k ve klinik faktörleri belirlemek amaçlandı. Kliniğimizde yatarak rehabilitasyon programı uygulanmış ve taburculukta temiz aralıklı kateterizasyon önerilmiş 37 omurilik yaralanmalı hasta çalışmaya alındı. Hastalara telefon ile ulaşılarak temiz aralıklı kateterizasyona devam konusunda bilgi alındı. Hastalar, izlem sonunda “Temiz aralıklı kateterizasyona devam eden” ve “Daimi kateter’e geçen” şeklinde gruplara ayrılarak, temiz aralıklı kateterizasyona uyum ile demografi k ve klinik faktörler arasındaki ilişki araştırıldı. Taburculuk sonrası ortalama izlem süresi 18.75±8.80 (8-34) ay idi. Hastaların %27’sinin temiz aralıklı kateterizasyon uygulamasını bırakıp daimi kateter kullanımına geçtiği ve temiz aralıklı kateterizasyona uyum oranının %73 olduğu belirlendi. Temiz aralıklı kateterizasyona uyum ile spastisite (r:0.506), maksimum sistometrik kapasite (r:0.377), kateterizasyon sayısı (r:0.444), kateterizasyonu uygulayan kişi (r:0.488) ve kateter tipi (r:0.699) arasında anlamlı korelasyon saptandı (p0.05). Omurilik yaralanmalı hastalarda temiz aralıklı kateterizasyona uyumun spastisite, maksimum sistometrik kapasite, günlük temiz aralıklı kateterizasyon sayısı, uygulamayı kimin yaptığı ve kateter tipi ile ilişkili olduğu belirlenmiş olup, spastisitenin düşük, maksimum sistometrik kapasitenin yüksek, günlük temiz aralıklı kateterizasyon sayısının az olması, hastanın uygulamayı kendisinin yapması ve hidrofi lik kateter kullanılmasının temiz aralıklı kateterizasyona uyumu artırdığı sonucuna varılmıştır., Our pupose was to examine the compliance with clean intermittent catheterisation and determine clinical and demographical factors that can be related with the compliance in patients with spinal cord injury. Thirty-seven patients with spinal cord injury who were hospitalized for rehabilitation and recommended clean intermittent catheterisation at discharge were enrolled in the study. Information about the compliance with clean intermittent catheterisation was gathered by telephone calls. At the end of follow-up period patients were categorized as “continuing on clean intermittent catheterisation” and “reverted to indwelling catheter” and the relationship between compliance with clean intermittent catheterisation and clinical and demographical factors were investigated. Mean follow up time after discharge was 18.75±8.80 (8-34) months. It was determined that 27% patients reverted clean intermittent catheterisation to indwelling catheters and the clean intermittent catheterisation compliance rate was 73%. Compliance with clean intermittent catheterisation was signifi cantly related to spasticity (r:0.506), maximum cystometric capacity (r:0.377), number of intermittent catheterisation applications (r:0.444), person who applies (r:0.488) and the type of the catheter (r:0.699) (p0.05). It was concluded that compliance with clean intermittent catheterisation in spinal cord injury patients is related to spasticity, maximum cystometric capacity, how many times a day catheterisation is performed, who applies the catheter and the type of the catheter. Low degree of spasticity, high maximum cystometric capacity, few number of catheterisation in a day, patient’s own application of the catheter and usage of hydrophilic catheters were shown to increase the compliance.

The objective is to report a patient with concomitant ankylosing spondylitis (AS) and Behçet's disease (BD) successfully treated with adalimumab. A 44-year-old male diagnosed as AS applied to our outpatient clinic with complaints of morning stiffness, pain and limitation of motion at spine, concurrence of oral and genital ulcerated lesions. He was on sulfasalazine together with different NSAIDs for the past 1 year. According to the criteria of International Study Group, he was diagnosed as BD. The patient was considered as refractory to current treatment and adalimumab treatment was started. During follow-up, not only AS was in remission, but also no new oral and genital ulcerations appeared. There were no complications related to the use of anti-TNFα therapy. In our case it was observed that anti-TNFα therapy, specifically adalimumab, was effective for symptoms of both AS and BD. © 2009 Springer-Verlag.

Amaç: Bu çalışmada menopoz sonrası osteoporotik ve osteopenik hastaların kalsiyum + vitamin D (CaD) tedavisine uyumu araştırıldı. Hastalar ve yöntemler: Bir yıl önce osteoporoz veya osteopeni nedeniyle tedavileri yapılan ve tedavi yönetimi için kliniğimize kabul edilen iki yüz otuz yedi kadın hastanın demografik özellikleri ve osteoporoz için risk faktörleri değerlendirildi. Hastalar osteoporoz grubu (Opo grubu, n=171; ort. yaş 65.0±8.4 yıl; dağılım 42-80 yıl) ve osteopeni grubu (Ope grubu, n=66; ort. yaş 58.9±9.5 yıl; dağılım 45-79 yıl) olarak iki gruba ayrıldı. Haftada kaç gün düzenli ilaç kullandıkları sorularak medikal tedaviye uyumları değerlendirildi. Bulgular: Tüm hastalar menopoz sonrası dönemdeydi. Opo grubunun eğitim düzeyi Ope grubuna göre anlamlı derecede düşük idi (p=0.016). Opo grubunda hastaların %90’ı CaD preparatını düzenli ve uygun kullanırken, Ope grubunda uyum %29 idi ve gruplar arası anlamlı farklılık göstermekte idi. (p=0.001). Bir yılda CaD kullanılan ortalama gün sayısı Opo grubunda, Ope grubuna göre anlamlı olarak yüksekti (sırasıyla 339 gün/yıl ve 137 gün/yıl; p=0.001). Sonuç: Ope grubu, Opo grubuna göre daha genç ve eğitim düzeyi yüksek hastalardan oluşmasına rağmen, yıllık bazda kullandıkları CaD preparatı miktarının Opo grubuna göre anlamlı düşük olması Ope grubunda tedaviye uyumun bozuk olduğunu göstermektedir. Bu çalışmanın sonuçları, CaD ilaç tedavisi planlanırken, eğitim düzeyleri daha iyi olsa da, osteopeni tespit edilen hastaların tedaviye uyumunu artırmak için, hastalıkları hakkında osteoporotik hasta grubu kadar yeterli şekilde aydınlatılmaları ve osteopeninin de tedavi ve düzenli doktor kontrolü gerektiren bir durum olduğu konusunda bilgilendirilmeleri gerektiğini göstermiştir.

Amaç: Omurilik yaralanmalı (OY) hastalarda hastaneye kabulde ve rehabilitasyon sürecinde saptanan semptomatik idrar yolu enfeksiyonu (İYE) ile demografik, klinik, laboratuvar bulgular arasında ilişkili olabilecek faktörlerin belirlenmesi amaçlanmıştır. Yöntemler: OY tanısı ile kliniğimizde yatarak rehabilitasyon programı uygulanmış 46 hasta retrospektif olarak incelenmiştir. Hastalar hastaneye kabulde İYE olan ve olmayan ve rehabilitasyon sürecinde İYE gelişen ve gelişmeyen şeklinde gruplara ayrılarak, İYE'nin demografik, klinik ve laboratuvar bulgular ile ilişkisi araştırılmıştır. Bulgular: Hastaneye kabulünde İYE saptanan hastalarda piyüri ve CRP artışının, İYE saptanmayan gruba göre daha fazla olduğu belirlenmiştir (p

Objective: We aimed at exploring the correlation among demographic features, clinical findings, radiological and functional status of patients with plantar heel pain. Material and Methods: Patients with plantar heel pain who had lateral feet X-rays in last 6 months were evaluated retrospectively. Patients were questioned for duration of symptoms and whether there is pain with first step in the morning. The presence of epin calcanei was evaluated on the lateral X-rays of feet. Clinical evaluation is made by heel press test, pain intensity by 10cm visual analog scale(VAS), and functional evaluation by the Rearfoot Score of the American Orthopaedic Foot and Ankle Society (RFS). Results: Seventy-one patients, 112 feet were evaluated. The mean body mass index, duration of symptoms, VAS, RFS was respectively 30.26 ± 4.29 kg/m2, 20.00 ± 20.20 months, 8.6 ± 1.47, 52.17 ± 5.59. The pain with first step in the morning was present in 106(%94.6) feet, pain with palpation of heel was positive in 92(%82.1) feet. Epin calcanei was detected in lateral X-rays of 85(%75.9) feet. A significant correlation between pain with palpation of heel and epin calcanei findings on X-ray was detected (r= 0.282, p= 0.003). There was significant correlation between RFS and age(r= -0.302, p= 0.011), duration of symptoms (r=-0.310, p= 0.001), X-ray findings (r=-0.275, p= 0.003). A significant correlation was also detected between age and X-ray findings (r= 0.277, p= 0.019). Conclusion: Epin calcanei was frequently detected in lateral X-rays of feet in patients with plantar heel pain who have pain with pressing of heel and this frequency increases with increasing age. Epin calcanei findings in the X-ray, increased age and long duration of symptoms negatively effects the RFS. It is observed that pressing test with palpation of heel and RFS are effective evaluation methods for diagnosing epin calcanei because of their correlation with radiologic findings. Copyright © 2010 by Türk Tibbi Rehabilitasyon Kurumu Derne?i.

Objective: Retrospective investigation of the relationship among physical examination findings which are used for designating meniscal lesion, Magnetic resonance Imaging (MRI) findings and functional status of patients and was aimed. Material and Methods: Seventy-nine patients who had knee MRI upon preliminary diagnosis of meniscal lesion in last 6 months were questioned with Visual Analog Scale(VAS) for severity of pain during walking and for duration of symptoms. Pain with knee range of motion, McMurray test, Apley test, medial or lateral joint space sensitivity with palpation were determined in the examination. MRIs of patients were assessed for meniscal lesions. The functional status of patients were evaluated by Lysholm Knee Score(LKS). Results: While mean VAS was 7.05±1.86, the pain with knee motion was detected in 68(%86.1) patients. McMurray, Apley tests, sensitivity of medial or lateral joint space was positive respectively in 66(83.5%), 47(59.5%), 52(65.8%),10(12.7%) patients. Mean LKS was 61.32±14.93. The correlations between MRI findings of medial meniscal lesion, symptom duration, sensitivity of medial joint space and LKS were detected p= 0.044, r= 0.227, p= 0.005, r= 0.315, p= 0.001, r= 0.361,p= 0.001, r= -0.401 respectively. While the correlation was detected between MRI findings of lateral meniscal lesion and McMurray test, no correlation was detected with LKS (respectively p= 0.028, r= 0.247, p= 0.098, r= 0.187). Conclusion: The McMurray test for diagnosis of medial and lateral meniscal lesion and medial joint space sensitivity correlation with medial meniscal MRI findings were important tests in the diagnosis of meniscal lesion. The Lysholm score could be suggested to evaluate for patients who were suspected medial meniscal lesion, because of its correlation with medial meniscal MRI finding. Copyright © 2009 by Türk Tibbi Rehabilitasyon Kurumu Derne?i.

Amaç: İnmeli hastalarda, fonksiyonel kazançları etkileyen faktörleri araştırmak Gereç ve yöntem: İnme tanısıyla kliniğimizde yatmış 114 hastanın kayıtları tarandı, bir haftadan kısa süreli veya önceden başka bir merkezde yatarak rehabilitasyon uygulanan ve medikal kayıtlarında eksiklik olan hastalar dışlandı. Kalan 82 hastanın demografik ve klinik özellikleri incelendi. Fonksiyonel durumları ve yatış sürecindeki fonksiyonel kazançları, Fonksiyonel Bağımsızlık Ölçümü (FBÖ) ve Fonksiyonel Ambulasyon Sınıflandırması (FAS) ile değerlendirildi. Hastalar etyolojilerine göre; iskemik, hemorajik, yaşa göre

Introduction Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow.

Heterotopik ossifikasyon, omurilik ve travmatik beyin yaralanmaları, femoral, asetabular kırık ve artroplasti operasyonları ve geniş yanıklar sonrası oldukça sık görülen, periartiküler dokularda yeni kemik oluşumu ile karakterize bir komplikasyondur. Buna karşılık, hemiplejik hastalarda oldukça ender olarak (%0.5-1.2) gözlenmektedir. Serebrovasküler olay sonucu hemipleji ve kalça eklemlerinde heterotopik ossifikasyon gelişen 2 olgu ve konuyla ilgili genel literatür incelemesi sunulmaktadır. Hemiplejik hastalarda, özellikle eklem ile ilgili ağrı, hassasiyet, ısı artışı, şişlik ve eklem hareket açıklığında azalma gibi bulgular saptandığında ayırıcı tanıda heterotopik ossifikasyon düşünülmelidir.

Introduction: To determine the relationship between vitamin-D (vitD) levels and balance, fall risk, functional mobility, lower extremity neuromuscular function and quality-of-life and to examine short-term effects of vitD replacement in the elderly. Materials and Method: 100 people 65 years and older, who were able to communicate and stand independently were included in the study. They were grouped according to serum 25- hydroxy-vitD levels as low (

Tez (Tezsiz Yüksek Lisans)- Süleyman Demirel Üniversitesi, Sosyal Bilimler Enstitüsü, İşletme Anabilim Dalı, 2012., Kaynakça var.

Amaç: İdiyopatik aşırı aktif mesaneli (AAM) kadınlarda, mesane eğitimine (ME) eklenen perkutanöz (PTSS) ve transkutanöz tibial sinir stimulasyonu (TTSS) etkinliklerinin karşılaştırılması. Metod: Araştırmamızın gücü %80 olacak şekilde (Beta=20 ve alfa=0,05) belirlenen örneklem büyüklüğü hesaplamasına göre, çalışmada her bir grup için en az 18 hastanın alınması planlandı. Çalışmaya alınan AAM'lı 60 kadın, rastgele sayılar tablosu kullanılarak 3 gruba randomize edildi. Birinci gruba (n:19) ME, ikinci gruba (n:19) ME'ye ek olarak PTSS (ME+PTSS) ve üçüncü gruba (n:20) ME'ye ek olarak TTSS (ME+TTSS); haftada 2 gün, günde 30 dakika, 6 hafta süresince toplam 12 seans uygulandı. Hastalar, tedavi öncesi ve tedavi sonunda inkontinans şiddeti (24 saatlik ped testi), PTK gücü (perineometre), 3 günlük işeme günlüğü (işeme sıklığı, inkontinans sayısı, nokturi ve ped sayısı), semptom şiddeti (OAB-V8), sosyal aktivite düzeyi (SAI), yaşam kalitesi (IIQ-7), cinsel fonksiyonlar (IFSF), tedavi başarısı (kür/iyileşme oranı), tedaviden memnuniyet ve uygulamadan rahatsızlık düzeyi (Likert skala) ile değerlendirildi.Bulgular: Her üç grupta da tedavi sonunda tedavi öncesine göre; inkontinans şiddeti, işeme sıklığı, inkontinans sayısı, nokturi, ped sayısı, semptom şiddeti, sosyal aktivite düzeyi ve yaşam kalitesi değerlendirmelerinde istatistiksel olarak anlamlı iyileşme olduğu gözlendi.Tedavi sonunda; inkontinans şiddeti, işeme sıklığı, inkontinans sayısı, nokturi, ped sayısı, semptom şiddeti, sosyal aktivite düzeyi ve yaşam kalitesi açısından, ME+PTSS ve ME+TTSS gruplarında ME grubuna göre istatistiksel olarak anlamlı düzeyde daha fazla iyileşme sağlandığı, tedavi başarısı ve tedavi memnuniyetinin daha yüksek olduğu görüldü. PTK gücü ve cinsel fonksiyon açısından 3 grup arasında fark saptanmadı. ME+TTSS grubunda, ME+PTSS grubuna göre; uygulamadan rahatsızlık düzeyinin daha düşük ve tedavi memnuniyetinin daha yüksek olduğu gözlendi. Diğer değerlendirme parametreleri açısından PTSS ve TTSS grupları arasında fark saptanmadı. Sonuç: İdiyopatik AAM'lı kadınlarda ME'ye eklenen hem PTSS hem de TTSS, tek başına ME'den daha etkilidir. Benzer klinik etkinliğe sahip olan bu iki tibial sinir stimulasyon yöntemi arasındaki fark; TTSS'nin rahatsızlık düzeyinin daha az ve hasta memnuniyetinin daha yüksek olmasıdır.Anahtar Kelimeler: Aşırı aktif mesane, mesane eğitimi, perkutanöz tibial sinir stimulasyonu, transkutanöz tibial sinir stimulasyonu Objective: To compare the efficacy of percutaneous (PTNS) and transcutaneous tibial nerve stimulation (TTNS) added to bladder training (BT) in women with idiopathic overactive bladder (OAB)Method: The power of our research to be 80% (Beta=20 and alpha=0.05) based on the determined sample size calculations, the study was planned to include at least 18 patients for each group. Sixty women with OAB were randomized into three groups (n: 20) using the random numbers table. The first group (n: 19) was given BT, the second group (n: 19) was given PTNS in addition to BT, and the third group (n: 20) was given TTNS in addition to BT. PTNS and TTNS; two days a week, 30 minutes a day, a total of 12 sessions for 6 weeks were performed using the techniques described in the literature. Patients were evaluated with incontinence severity (pad test), PFM strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence and number of pads), symptom severity (OAB-V8), social activity level (SAI), quality of life (IIQ-7), sexual function (IFSF), treatment success (cure/improvement rate), satisfaction with treatment and discomfort level (Likert scale) before and at the end of treatment (6th week).Results: At the end of the treatment in all groups compared to the pretreatment; incontinence severity, frequency of voiding, number of incontinence, nocturia, number of pads, symptom severity, social activity level and quality of life were significantly improved.At the end of treatment; severity of incontinence, frequency of voiding, number of incontinence, nocturia, number of pads, symptom severity, social activity level and quality of life were significantly improved in the BT+PTNS and BT+TTNS groups compared to the BT group. Treatment success and treatment satisfaction were higher in the BT+PTNS and BT+TTNS groups than the BT group. No difference was found between the 3 groups in terms of PFM strength and sexual function. In the BT+TTNS group, compared to the BT+PTNS group; it was observed that the level of discomfort was lower and treatment satisfaction was higher. There was no difference between the BT+PTNS and BT+TTNS groups in terms of other evaluation parameters. Conclusion: Both PTNS and TTNS added to BT are more effective than BT alone in women with idiopathic OAB. The difference between these two tibial nerve stimulation methods with similar clinical efficacy; TTNS is less discomfort level and higher patient satisfaction.Keywords: idiopathic overactive bladder, bladder training, percutaneous tibial nerve stimulation, transcutaneous tibial nerve stimulation 101

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH) D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain. Amaç: Bu çalışma ile özgül olmaya kas iskelet sistemi ağrısı olan hastalarda; vitamin D düzeyi ile ağrı şiddeti, lokalizasyonu ve süresi arasındaki ilişkinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Türkiye genelinde 19 merkezde özgül olmayan kas ağrısı nedeniyle fiziksel tıp ve rehabilitasyon polikliniklerine başvuran hastalar retrospektif olarak tarandı. Taranan hastalar arasında ağrı düzeyi visüel analog skala (VAS) ile belirlenmiş olan ve ağrılı bölge, ağrı süresi ve vitamin D düzeyi kayıtlarına ulaşılabilen 3104 hasta çalışmaya alındı. 25(OH)D düzeyi 20 ng/mL’den düşük ise D vitamini eksikliği (grup 1), 21 ile 29 ng/mL arasında ise D vitamini yetersizliği olan grup (grup 2) ve 30 ng/mL’den yüksek ise normal grup (grup 3) olarak kabul edildi. Gruplar ağrı süresi, lokalizasyonu ve şiddeti açısından karşılaştırıldı. Ayrıca D vitamini düzeyleri ile ağrı lokalizasyonu, şiddeti ve süresinin korelasyonları incelendi. Bulgular: Üç bin yüz dört kayıtlı hastanın 2202’sinde (%70,9) D vitamini eksikliği saptanırken, 516’sında (%16,6) D vitamini yetersizliği ve 386’sında (%12,4) normal sınırlarda D vitamini olduğu tespit edildi. Gruplar; yaş, vücut kitle indeksi, gelir düzeyi, şikayet süresi, eğitim düzeyi, aile tipi ve çalışma durumu yönünden benzer olarak saptandı (p>0,05). VAS, ağrı lokalizasyonu ve süresi skorları yönünden gruplar arasında istatistiksel olarak anlamlı fark bulunmadı (p>0,05). Sonuç: Çalışmamız özgün olmayan kas iskelet ağrısı olan hastalarda D vitamini eksikliğinin ağrının şiddeti ve süresi ile ilişkili olmadığını göstermektedir., NA

Amaç: Sıkışma tipi idrar kaçırma (STİK) yakınması olan kadınlarda mesane eğitimine eklenen intravajinal biofeedback (BF) yardımlı pelvik taban kas egzersizleri (PTKE) ve intravajinal elektrik stimülasyonunun (ES) ayrı ayrı ve kombine kullanımını içeren konservatif yöntemlerin etkinliklerinin karşılaştırılması. Materyal Metod: Ürodinamik olarak STİK ve sıkışma baskın miks tip idrar kaçırma (MTİK) tanısı konmuş 70 hasta, randomize olarak 4 gruba ayrıldı. Birinci gruba (n:18) mesane eğitimi (ME), ikinci gruba (n:17) ME'ye ek olarak intravajinal basınç BF yardımlı PTKE (ME+BF), üçüncü gruba (n:18) ME'ye ek olarak intravajinal ES (ME+ES) ve dördüncü gruba (n:17) ME'ye ek olarak intravajinal basınç BF yardımlı PTKE + intravajinal ES (ME+BF+ES) uygulandı. Mesane eğitimi dört aşamalı olarak gerçekleştirildi. İlk olarak hasta alt üriner sistem hakkında bilgilendirildi. İkinci aşamada işemeyi erteleme ve acil idrar hissini önlemeye yönelik program uygulandı. Üçüncü aşamada iki işeme arasındaki süre her başarılı haftadan sonra 30 dakika artırılarak 2-4 saat olacak şekilde program uygulandı. Son olarak da hasta motive edilerek programa uyması için desteklendi. ME+BF grubunda ME'ye ek olarak biofeedback yardımlı PTKE 8 hafta süresince, haftada 3 gün, günde 20 dakika toplam 24 seans olacak şekilde hastanede gözetimli olarak uygulandı. Her seans kasma süresi 10 saniye, dinlenme süresi 20 saniye olan 40 siklustan oluşmaktaydı. ME+ES grubunda ME'ye ek olarak intravajinal ES 8 hafta süresince, haftada 3 gün, günde 20 dakika toplam 24 seans olacak şekilde hastanede gözetimli olarak uygulandı. ME+BF+ES grubunda ME'ye ek olarak her iki uygulama günde 20'şer dakika, haftada 3 gün, 8 hafta süresince toplam 24 seans olacak şekilde hastanede gözetimli olarak uygulandı. Tedavi öncesi ve tedavi sonunda (8.hafta) inkontinans ciddiyeti, inkontinans şiddeti (24 saatlik ped testi), PTK gücü (perineometre), sosyal aktivite düzeyi (Görsel Analog Skala (GAS)), yaşam kalitesi (Incontinence Impact Questionnaire (IIQ7)), cinsel fonksiyonlar (Index of Female Sexual Function (IFSF)), tedaviden memnuniyet düzeyi (Likert skalası), tedavi başarısı (kür/iyileşme) ve uygulamadan rahatsızlık düzeyi (GAS) değerlendirildi. Bulgular: ME grubunda PTK gücü, ME ve ME+BF gruplarında cinsel fonksiyonlar hariç tüm gruplarda başlangıç değerlerine göre tedavi sonunda inkontinans şiddeti, PTK gücü, işeme sıklığı, noktüri, inkontinans sayısı, ped sayısı, sosyal aktivite düzeyi, yaşam kalitesi ve cinsel fonksiyonlarda istatistiksel olarak anlamlı iyileşme olduğu gözlendi. Tedavi sonunda ME+ES ve ME+BF+ES gruplarında diğer iki gruba (ME ve ME+BF) göre inkontinans şiddeti, işeme sıklığı ve inkontinans sayısı açısından anlamlı düzeyde daha fazla iyileşme sağlandığı tespit edildi. Buna karşın, ME+ES ve ME+BF+ES, ME ve ME+BF grupları arasında inkontinans şiddeti, işeme sıklığı ve inkontinans sayısında iyileşme açısından anlamlı farklılık gözlenmedi.Tedavi sonunda, noktüri ve yaşam kalitesi açısından ME+ES ve ME+BF gruplarında ME grubuna göre, ME+BF+ES grubunda ise diğer üç gruba göre anlamlı düzeyde daha fazla iyileşme olduğu belirlendi. Bununla birlikte, ME+ES ve ME+BF grupları arasında noktüri ve yaşam kalitesinde iyileşme açısından istatistiksel olarak anlamlı farklılık saptanmadı. PTK gücü, ped sayısı, sosyal aktivite düzeyi, cinsel fonksiyonlar ve uygulamadan rahatsızlık düzeyi açısından dört grup arasında tedavi sonunda fark olmadığı gözlendi. Tedavi sonunda değerlendirilen tedavi başarısının (kür/iyileşme oranları) ME+ES ve ME+BF+ES gruplarında ME ve ME+BF gruplarına göre daha yüksek olduğu, benzer şekilde tedavi memnuniyetinin de ME+ES ve ME+BF+ES gruplarında ME ve ME+BF gruplarına göre daha fazla olduğu, her iki parametre açısından da ME+ES ve ME+BF+ES grupları arasında fark olmadığı ve en az hasta memnuniyetinin ME grubunda görüldüğü belirlendi. Sonuç: STİK'li kadınların tedavisinde ME'ye eklenen BF yardımlı PTKE ve/veya ES etkin ve tolere edilebilir tedavi seçenekleridir. İçerisinde ES bulunan kombinasyonlar, inkontinans şiddeti, işeme sıklığı, inkontinans sıklığı, tedavi başarısı ve tedavi memnuniyeti açısından daha etkilidir. Noktüri ve yaşam kalitesi açısından kombinasyon tedavileri etkinliği artırmaktadır, bununla birlikte en etkili kombinasyon ME+BF+ES'dir. Sonuç olarak STİK'li hastalarda, konservatif tedavi kombinasyonunun seçiminde hastanın ön planda olan şikayetleri ve hasta tercihi göz önünde bulundurulabilir. Aim: To compare the effectiveness of conservative methods including individual and combined use of intravaginal biofeedback (BF) assisted pelvic floor muscle training (PFMT) and intravaginal electrical stimulation (ES) added to bladder training (BT) in women with urge urinary incontinence (UUI).Material and Method: 70 patients urodynamically diagnosed as UUI and mixed urinary incontinence with predominant urge symptoms divided into 4 groups. The first group (n = 18), bladder training (BT), the second group (n = 17) intravaginal pressure BF assisted PFMT in addition to the BT (BT + BF), the third group (n = 18) intravaginal ES in addition to the BT (BT + ES) and the fourth group (n = 17) intravaginal pressure BF assisted PFMT and intravaginal ES in addition to BT (BT + BF + ES) were performed. Bladder training was performed in four stages. Firstly, patients were informed about the lower urinary tract. In the second stage, a program aimed to prevent postponement of micturition and the sensation of urgency was applied. In the third stage, a program was applied until the time between the two micturition reaches to 2-4 hours, by increasing 30 minutes after each successful week. Finally, the patient was supported to fit the program by motivating. In BT+BF group, BF assisted PFMT in addition to BT was applied in hospital supervised for 8 weeks, 3 times a week, 20 minutes a day for a total of 24 sessions. Each session had 40 cycles, which consisted of 10 seconds contraction period, 20 seconds rest period. In BT+ES group, intravaginal ES in addition to BT was applied in hospital supervised for 8 weeks, 3 times a week, 20 minutes a day for a total of 24 sessions. In BT + BF + ES group, both application in addition to BT was applied in hospital supervised for 8 weeks, 3 times a week, 20 minutes a day for a total of 24 sessions. Before treatment and after 8 weeks of treatment, incontinence severity (24-hour pad test), PFM strenght (perineometre), the social activity level (Visual Analog Skala (VAS)), quality of life (Incontinence Impact Questionnaire (IIQ7)), sexual function (Index of Female Sexual Function (IFSF)), treatment satisfaction (Likert scale), treatment success (cure / improvement) and the level of discomfort of application (VAS) was detected.Results: It was observed statistically significant improvement in all groups except PFM strenght in BT group and sexual functions in BT and BT+BF group in terms of incontinence severity, PFM strenght, urinary frequency, nocturia, incontinence episodes, pad count, social activity level, quality of life and sexual functions at the end of treatment compared to baseline values. It was found to provide significantly greater improvement in incontinence severity, urinary frequency and incontinence episodes in the groups of BT+ES and BT+BF+ES compared to the other two groups (BT and BT+BF). However, there were no significant differences in the incontinence severity, urinary frequency and incontinence episodes between BT+ES and BT+BF+ES groups. Also there were no significant differences in same parameters between BT and BT+BF groups. At the end of treatment, it was determined to be significantly greater improvements in nocturia and quality of life in BT+ES group and BT + BF group compared to BT group, and BT + BF + ES group compared to the other three groups. However, there were no statistically significant differences in nocturia and quality of life in the groups of BT+ES and BT+BF. At the end of treatment, it was showed no difference in PFM strength, pad count, social activity level, sexual functions and application of the level of discomfort between four groups. The success of treatment (cure/improvement rates) was found significantly higher than the BT+ES group and BT+BF+ES group compared to BT and BT+BF groups at the end of treatment. Similarly, treatment satisfaction were also found higher in BT+ES and BT+BF+ES groups compared to BT and BT+BF groups. There were no differences between BF+ES and BT+BF+ES groups for both parameters. The least patient satisfaction were seen in the BT group. Conclusion: Conservative methods including individual and combined use of intravaginal BF assisted PFMT and intravaginal ES added to BT can be used as effective and tolerable treatment options in women with UUI. Combinations with ES is more effective in terms of incontinence severity, urinary frequency, incontinence episodes, treatment success and treatment satisfaction. Combination therapy increases the effectiveness in terms of nocturia and quality of life. However, the most effective combination is BT+BF+ES. As a result, in the treatment of women with UUI, patient's cardinal symptoms and choices may be considered in the selection of the combination of conservative treatment. 115

Ürodinamik olarak SÜİ tanısı konmuş 51 hasta, randomize bir şekilde her grupta 17'şer hasta olacak şekilde 3 gruba ayrıldı. İlk grup yalnızca PTK ev egzersiz programı, ikinci grup PTK ev egzersiz programına ek olarak hastanede gözetimli olarak intravajinal basınç biofeedback yardımlı PTK egzersiz programı, üçüncü grup ise PTK ev egzersiz programına ek hastanede gözetimli perianal EMG biofeedback yardımlı PTK egzersiz programı uyguladı. Ev egzersiz programında PTK egzersizleri günde 30, 60, 90 kontraksiyon olacak şekilde zamanla artan yoğunlukta, hastanede gözetimli biofeedback grupları ise ev egzersiz programına ek olarak günde 20 dakika, haftada 3 gün, 8 hafta, toplam 24 seans biofeedback tedavisi olacak şekilde tedavi aldı. Tedavinin başlangıcında, 4. hafta ve 8. hafta değerlendirmelerinde inkontinans şiddeti (1 saatlik ped testi), PTK gücü (perineometre), sosyal aktivite düzeyi, Incontinence Impact Questionnare (IIQ7), Index of Female Sexual Function (IFSF), tedaviden memnuniyet düzeyi, kür ve iyileşme oranı ve uygulamadan rahatsızlık düzeyi değerlendirildi.Sonuç olarak her üç grupta da başlangıç değerlerine göre tedavinin 4. ve 8. hafta değerlendirmelerinde inkontinans şiddeti, PTK gücü, sosyal aktivite düzeyi, yaşam kalitesi ve cinsel fonksiyon değerlendirmelerinde istatistiksel anlamlı iyileşme olduğu gözlemlendi. Ayrıca her iki biofeedback grubunda, inkontinans şiddeti, PTK gücü ve sosyal aktivite düzeyi açısından sadece PTK ev egzersizi alan kontrol grubuna göre tedavinin 8. haftasında istatistiksel olarak anlamlı düzeyde daha fazla iyileşme kaydedildiği tespit edildi (p

Amaç: Spastisitesi olan hemiplejik hastalarda üst ekstremite proksimal kaslarına Botulinum toksin enjeksiyonun üst ekstremite fonksiyonları üzerine etkilerini araştırmak.Gereç ve Yöntem: Çalışmaya, pektoralis major ve biseps braki kasında spastisitesi olan, 21-80 yaş arası 23 inmeli hasta alındı. Hastaların bir grubuna randomize olarak Botulinum toksin-A (BT-A) (n=12) diğerine plasebo enjeksiyon uygulandı (n=11). Enjeksiyon yapılan kaslara ilk 10 gün hastanede fizyoterapist eşliğinde, ardından ev programı şeklinde günde bir kez, 20 dakika süre ile germe egzersizi uygulandı. Modifiye Ashworth Skalası (MAS), eklem hareket açıklığı (EHA), VAS, Fugl Meyer Motor Fonksiyon Skalası (FM) kol bölümü, Fonksiyonel Bağımsızlık Ölçeği (FBÖ) kendine bakım kısmı, yaşam kalitesi Short Form-36 (SF-36) tedaviden önce, tedaviden sonra 2., 4. ve 12. haftalarda değerlendirildi.Bulgular: Botulinum toksin-A uygulanan grupta, omuz adduktör ve dirsek fleksör MAS skoru tedavi sonrası 2. ve 4. haftalarda tedavi öncesine göre anlamlı azalma, aktif omuz abduksiyon EHA'da anlamlı artış saptanırken tedavi sonrası 12. haftada farklılık bulunmadı. Pasif omuz abduksiyon EHA'da tedavi sonrası 2., 4. ve 12. haftalarda tedavi öncesine göre anlamlı artış, aktif dirsek ekstansiyon kısıtlılığında ve pasif omuz VAS'da anlamlı azalma saptandı. FM kol skorunda tedavi sonrası 4. ve 12. haftalarda tedavi öncesine göre anlamlı artış saptandı.Plasebo uygulanan grupta, aktif ve pasif omuz abduksiyon EHA'da tedavi sonrası 2. ve 4. haftalarda tedavi öncesine göre anlamlı artış, aktif dirsek ekstansiyon kısıtlılığında ve pasif omuz VAS'da anlamlı azalma saptanırken, tedavi sonrası 12. haftada farklılık bulunmadı. Dirsek fleksör MAS skoru tedavi sonrası 2. haftada tedavi öncesine göre anlamlı azalma saptanırken tedavi sonrası 4. ve 12. haftalarda farklılık bulunmadı.Gruplar arası karşılaştırmada omuz adduktör MAS skoru ve aktif dirsek ekstansiyon kısıtlılığında tedavi sonrası 2. ve 4. haftalarda BT-A grubu lehine anlamlı azalma, aktif omuz abduksiyon EHA da anlamlı artma saptanırken tedavi sonrası 12. haftada gruplar arasında farklılık bulunmadı. FM kol skorunda, BT-A grubunda tedavi sonrası 2., 4. ve 12. haftalarda plasebo grubuna göre anlamlı artış bulundu.Sonuç: BT-A enjeksiyonu ile 4 hafta süreyle spastisite ve EHA'larda elde edilen kazançların 12 hafta süre boyunca kol motor fonksiyonlara da yansıdığı ancak elde edilen bu kazançların fonksiyonel bağımsızlığı ve yaşam kalitesini tam olarak etkilemediği sonucuna varılmıştır. Purpose: To determine the effects of the injection of botulinum-toxin A into upper limb proximal muscles on upper limb functions in hemiplegic patients with spasticity.Material and Methods: Twenty three stroke patients who are between 21 and 80 years old with spasticity on pectoralis major and biceps brachii were included in the study. Botulinum toxin-A (BT-A) (n=12) was injected into a group of patients and placebo (n=11) was injected into the other group randomly. Stretch exercises were applied to the injected muscles for twenthy minutes once a day firstly at the hospital with physiotherapist and then with a home work. Modified Ashworth Scale (MAS), range of motion (ROM), visual analog scale (VAS), upper extremity component of the Fugl-Meyer motor assesment (FMA), the self-care component of the Functional Independence Measure (FIM), quality of life the Short Form-36 (SF-36) were evaluated before the treatment and at the 2nd, 4th and the 12th weeks after the treatment.Results: In the BT-A group, while finding a significant decrease in the shoulder adductor and elbow flexor MAS scores and a significant increase in active shoulder abduction ROM at the 2nd and 4th weeks after the treatment compared to pretreatment, no significant differences were found at the 12th week after the treatment. A significant increase was observed in passive shoulder abduction ROM and significant decrease was observed in active elbow extension limitation and passive shoulder VAS at the 2nd, 4th and the 12th weeks after the treatment compared to pretreatment. A significant increase was detected in FM arm score at the 4th and the 12th weeks after the treatment compared to the pretreatment.In the placebo group, while finding a significant incease in the active and passive shoulder abduction ROM and a significant decrease in the elbow extension limitation and passive shoulder VAS at the 2nd and 4th weeks after the treatment compared to pretreatment, no significant differences were found at the 12th week after the treatment. A significant decrease was detected in elbow flexor MAS score at the 2nd weeks after the treatment compared to the pretreatment but no differences were found after the 4th and the 12th weeks after the treatment.While comparing the two groups, a significant decrease was detected in shoulder adductor MAS score an active elbow extension limitation for BT-A group and a significant increase was detected in active shoulder abduction ROM at the 2nd and 4th weeks after the treatment, but there was no significant difference between the groups at the 12th week after the teratment. A significant increase was found in FM arm score in BT-A group compared with the placebo group at the 2nd, 4th and the 12th weeks after the treatment.Conclusion: It was concluded that, the improvements obtained at the spasticity and the ROM with BT-A injection in four weeks time reflected at arm motor functions during twelve weeks however these improvoments did not affect the functional independence and the quality of life impressively. 99