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Amaç: Bu çalışmada unilateral (tek taraflı) tutulumu olan serebral palsi (SP)’li çocuklarda el bileği dorsi fleksör kas grubuna fasilitasyon tekniğiyle (kas güçlendirmeye yönelik) uygulanan kinezyolojik bantlamanın (KB) egzersizden bağımsız olarak el fonksiyonları üzerindeki erken etkilerinin araştırılması amaçlanmıştır.Yöntem: Çalışmaya unilateral SP tanısı almış toplam 20 hasta dahil edildi. Tüm hastaların plejik taraf el bileği dorsi fleksör ve parmak ekstansörlerine yönelik kinezyolojik bantlama yapıldı. Hastalar yaş, cinsiyet, dominant el açısından değerlendirildi. Hastaların el fonksiyonları Jebsen Taylor El Fonksiyon Testi (JTEFT) ile değerlendirildi. Hastaların el fonksiyonu; kinezyolojik bantlamadan önce, kinezyolojik bant uyguladıktan hemen sonra ve kinezyolojik bant çıkarıldıktan sonra üç ayrı zamanda olacak şekilde değerlendirildi.Bulgular: Hastaların kinezyolojik bantlama öncesi ve kinezyolojik bantlamadan sonra yapılan değerlendirmesinde sayfa çevirme, küçük objeleri taşıma, yemek yeme, tavla pulu üst üste dizme, hafif-büyük nesneleri ve ağır-büyük nesneleri taşıma aktivitelerinde istatistiksel olarak anlamlı fark saptandı (tüm parametreler için p0,05).Sonuç: Unilateral SP’li çocukların el bileği dorsi fleksör ve parmak ekstansör kas grubuna KB uygulamasının el fonksiyonlarını geliştirmeye katkısı olduğu düşünülmektedir. KB'nin uzun vadede etkisini görmek için daha uzun süreli takip çalışmalarına ihtiyaç vardır., Objective: To research the effect of kinesiologic taping (KT), applied to the wrist dorsiflexor muscle group using a facilitating (muscle strengthening) technique, on the hand function of children with unilateral cerebral palsy (CP) at its early stages and independent of exercise.Methods: The study tests 20 patients who have been diagnosed with unilateral CP. KT, was applied to the plegic aspect of the dorsiflexor muscle group on the wrists and fingers of all subjects. Patients were evaluated in terms of age, gender, dominant hand. Hand function was evaluated by the Jebsen Hand Function Test (JHFT). The hand function of the patients was evaluated at three time points: before the KT; immediately after the application with KT in situ; and immediately after the KT was removed.Results: The assessment of the patients' ability to perform activities such as turning pages, carrying small objects, eating simultaneously, stacking backgammon pieces on top of each other, moving light-large objects and heavy-large objects, before the KT and after the KT was applied showed a significant stastistical difference (p0.05 for all parameters).Conclusion: It is thought that the application of KT to the wrist dorsiflexor and finger extensor muscle groups of children with unilateral CP contributes to the improvement of hand functions. There is a need for long term follow-up studies to see the long-term effect the KT.

[Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group. [Conclusion] Early and two-stage reconstruction of patients with flexor tendon injuries can be performed with similarly favorable responses and effective rehabilitation programs.

OBJECTIVE Spinal cord injury (SCI) can lead to significant cardiac arrhythmia. However, P-wave, QT dispersion, and risk factors in these patients have not been widely investigated. In this study, we assessed whether there is a relationship between electrocardiogram (ECG) parameters and risk factors in SCI patients. METHODS The study population consisted of 85 SCI patients and 38 control subjects. P-wave durations were measured using 12 leads of the surface ECG. P-wave dispersion was defined as the difference between the P-wave maximum and P-wave minimum duration. QT dispersion was defined as the difference between the largest and smallest QT interval for any of the 12 leads (QTmax-QT-min). QT intervals were also corrected (QTc) in accordance with the heart rate using Bazett's formula (QT Interval/√[RR interval]). We also evaluated the independent risk factors for P-wave dispersion and QT dispersion in SCI patients. RESULTS The P-wave minimum, P-wave maximum, QT minimum, and dispersion were significantly different between the control and SCI groups. There was no significant difference in P-wave dispersion, QT maximum, or QTc. Multivariate regression analysis showed that disease duration, glucose and high-density lipoprotein cholesterol (HDL-C) levels, and systolic tension were independent risk factors for P-wave dispersion. CONCLUSION Our results demonstrate that QT dispersion is related to SCI and that P-wave dispersion was linked to the duration of SCI, HDL-C and glucose levels, and arterial tension in SCI patients.

This was a cross-sectional study in the setting of a rehabilitation hospital.The aim of the study was to determine the serum levels of heart-type fatty acid-binding protein (H-FABP) in patients with spinal cord injury (SCI). A further goal was to examine whether there is a relationship between H-FABP levels and Functional Ambulation Classification (FAC) scale, Functional Independence Measure (FIM) score, American Spinal Injury Association (ASIA) status, and metabolic syndrome (MetS).The study included 56 SCI patients and 37 age- and sex-matched healthy control subjects who had not been diagnosed with coronary artery disease in the past.Serum H-FABP levels were significantly higher in patients with SCI than in control subjects: paraplegia group, 18.5 ± 11.4; tetraplegia group, 16.3 ± 9.1; control group, 6.7 ± 5.1 ng/ml (p 0.001). There was no difference between the other cardiac enzymes (troponin I, AST, ALT, CK, CK-MB, and LDH) among the groups. The relationship between the serum H-FABP levels and FAC status was examined. There was a negative correlation between FAC status and H-FABP levels (p 0.001, r = - 0.581). Patients with complete SCI were divided into two groups according to the level of the lesion: (lesion levels in C6-T6, n = 25; lesion levels in T7-L2, n = 11). In patients with complete motor injury, H-FABP levels were higher in subjects with injuries above T6 than in those with injuries below T6 (24.21 ± 10.1 and 14.1 ± 10.4, respectively; p = 0.011). Serum levels of H-FABP were higher in SCI patients with MetS (n = 10) than in those without MetS (n = 46; 25.8 ± 11.6 ng/ml vs. 16.42 ± 10.3 ng/ml, respectively; p = 0.014). Patients were then divided into two groups according to SCI duration: 12 months (n = 27) and 12 months (n = 29). H-FABP levels showed statistically significant differences between the two groups (14.8 ± 11.7 ng/dl and 20.9 ± 9.9 ng/dl, respectively; p = 0.036).H-FABP is related to MetS and FAC status in asymptomatic SCI patients.

Background: Flexible flatfoot deformity is likely to be caused by ligamentous laxity of the medial longitudinal arch, and this deformity could change the mechanics of other joints, ligaments and tendons as well as foot alignment. Aim: We hypothesized that position sense and muscle strength could be impaired in patients with flatfoot compared to normal controls, therefore we investigated position sense and ankle eversion inversion strengths of individuals with flexible flatfoot. Design: Cross sectional study. Setting: A rehabilitation center. Population: Twenty-six individuals with flexible flatfoot and 27 healthy control subjects were evaluated. Methods: Absolute error (in degrees) for passive reproduction of joint position tests and peak isokinetic strength of ankle muscles for eversion and inversion were tested using the Biodex isokinetic dynamometer. Results: For individuals with flatfoot, passive reproduction of joint position error scores in eversion were significantly higher for the dominant side compared with the control group. No significant differences in eversion and inversion muscle strength between flexible flatfoot and control groups were found. Conclusion: We suggest that flexible flatfoot deformity may cause deficits in proprioception accuracy. Clinical Rehabilitation Impact: In our opinion, clinicians must be aware and should take into account this possible deficit in the management of these patients.

Metabolic syndrome (MetS) is a risk factor for stroke. However, the role of MetS in stroke rehabilitation has not been assessed. The aim of this study was to evaluate the impact of MetS on rehabilitation from stroke.A total of 337 consecutive patients with subacute stroke and 220 age-matched healthy controls were studied. The diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. Ambulation levels were evaluated using the Functional Ambulation Classification (FAC) measure. The correlation between MetS and FAC was investigated. The regression analysis included presence of hypertriglyceridemia, high fasting glucose, low high-density lipoprotein cholesterol, hypertension, abdominal obesity, MetS, and age ≯65 years.The prevalence of MetS in the control group and the ischemic and hemorrhagic stroke groups was 33.2% (n = 73), 59.8% (n = 156), and 68.4% (n = 52), respectively. MetS prevalence was significantly higher in stroke groups compared with the control group (P.001). FAC and MetS were significantly and negatively correlated in the stroke groups (P.001, rho = -0.387, for hemorrhagic stroke;P.001, rho = -0.379, for ischemic stroke). Multivariable logistic regression analysis demonstrated that diastolic tension, MetS presence, and age were found to be independent risk factors for FAC in ischemic stroke groups.MetS is associated with worse functional ambulation for both ischemic and hemorrhagic stroke patients. Aggressive rehabilitation can be advocated in the presence of MetS in ischemic stroke patients.

Study design:A cross-sectional survey.Objectives:To investigate the changes in the occupation of patients after spinal cord injury (SCI) and the factors that cause this change.Subjects:The study involved 192 Turkish patients (41 female, 151 male) who had suffered SCI. The mean age of patients was 36.1+/-12.0 years. The mean follow-up time was 43.4+/-38.0 months. Before injury, 138 patients were employed in gainful occupations, 26 patients were housewives, 10 were retired, 7 were students and 11 patients were unemployed. Only 15 patients (7.8%) returned to their original occupations after injury. Thirteen patients (6.8%) are currently working in another job; 1 patient (0.5%) is a student; 10 (5.2%) are retired as was earlier; 40 (20.8%) are retired on grounds of disability; 26 (13.5%) are housewives; and 87 patients (45.3%) are currently unemployed.Methods:Prospective data collection through a face-to-face interview on an established SCI Turkish sample.Results:In our study, the rate of returning to work was found to be 14.6%. In the evaluation of factors affecting return to work after injury, educational level (P=0.00), pre-injury employment (P=0.01) and bladder-emptying method (P=0.03) were statistically significantly correlated with return to work.Conclusion:In this study, education, pre-injury employment and bladder-emptying method were found to be important factors in returning to work after SCI. Language: en

Antibodies to cyclic citrullinated peptides (anti-CCP) are highly specific for the diagnosis of rheumatoid arthritis (RA) with a marginal increased prediction of the disease. In this study, we aimed to investigate the relation of the presence of anti-CCP with clinical manifestations and disease activity in a cohort of RA patients. A total of 61 RA patients were included in this study. Data of disease-related parameters such as duration of disease, medications, degree of pain (visual analog scale, VAS), disease activity score 28 (DAS-28) and health assessment questionnaire (HAQ) were recorded. Laboratory workup included erythrocyte sedimentation rate (ESR), plasma C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP, complete blood count and anemia parameters. Anti-CCP positivity was associated with higher scores of DAS-28, longer duration of morning stiffness, serum RF positivity and low levels of serum ferritin, while it was not associated with disease duration, VAS, HAQ, ESR, CRP and hemoglobin.

A total of 73 patients with obstetric brachial plexus palsy and extremity shortness were evaluated clinically, electrophysiologically, and with cervical magnetic resonance imaging. Patients were separated into groups according to age and the level of lesion. The differences of the length of the humerus, ulna, radius, and the second and fifth metacarpal bones were significant between the involved and uninvolved extremities. The difference in shortness increased in relation to the age of the groups and stabilized to approximately 10% in the groups aged 4 to 8 years and 8+ years. A significant relationship was observed between bone length differences and lesion levels. Differences in bone lengths were statistically significant in patients with avulsion in the group aged 8+ years. Extremity shortness appears to be related to avulsion and the level of lesion. The effect of avulsion on extremity shortness gradually increases with age. Finally, root avulsion can be an important factor in extremity shortness of obstetric brachial plexus palsy patients.

The aim of this study is to identify fungi isolated from mouth flora of a group of hospitalized patients and to determine slime production and to assess the relationships between oral prosthesis and tooth brushing among fungi isolated patients. One-hundred hospitalized patients (at least two weeks) were interviewed by using a questionnaire to determine oral hygiene and an oral examination were done before their mouth samples were collected. “Slime” productions of isolated fungi from these samples were determined with modified tube adherence test. The mean of age of the study group was (± SD) 49 ± 16.2 and 57% of them were males and 43% of them were females. Fungi were isolated among 61 of 100 mouth samples and of 61 samples, 59 had Candida [54 (91.5%) C. albicans, 3 (5%) C. tropicalis, 1 (1.7%) C. kefyr, 1 (1.7%) C. guilliermondii] and two had Rhodotorula rubra and Geotricum candidum. Of the identified 61 fungi, 27 (44.3%) had “slime” production. Of the “slime” production of Candida species, 21 (35.6%) were strong positive, 4 (6.7%) were poor positive and R. rubra and G. candidum were strong positive. Of the patients with oral prosthesis, 71% had fungi and of the patients without prosthesis, 54% had fungi (p> 0.05). Of the patients brushing tooth at least once a day, 57% had fungi and of the patients without using toothbrush, 64% had fungi (p> 0.05). As a conclusion, “slime” production of fungi isolated from mouth flora of hospitalized patients were so high that they have the risk for Candida infection, in case of they have other conditions for fungi pathogenesis. There were no difference between brushing tooth and isolation of fungi and also oral prosthesis and fungi.

Reported here is a 46-year-old man who was seen for pain, numbness, and weakness in his left upper limb and hand. Electromyographic studies demonstrated denervation of ulnar-innervated muscle groups except for the flexor carpi ulnaris. A localized nerve conduction block could not be depicted because of severe axonal loss. Ultrasonographic evaluation showed enlargement of the ulnar nerve at 2 sites: at the level of the epicondylar groove and the inside of the flexor carpi ulnaris muscle. Herein, we would like to emphasize the complementary role of an ultrasound in peripheral nerve pathologies, not only does it confirm the entrapment but it also displays the underlying cause(s).

Resume Nous rapportons l’observation d’une femme âgee de 21 ans qui presentait une contracture isolee du muscle droit femoral. Au vu de la litterature, nous discutons le role etiologique possible d’une naissance apres un accouchement par le siege, ainsi que le role de l’echographie dans le diagnostic et le suivi rapproche.

Sneddon's syndrome is a rarely seen disorder and it is characterized by livedo reticularis (LR) and neurologic findings. Some systematic findings may also be seen with neurologic and cutaneous findings. In this case, we aimed to present a 28-year-old female patient with diffuse LR, cardiac valve disease and migraine-type headache who had a right hemiplegic attack.

We aimed to evaluate the relation between the severity of carpal tunnel syndrome and metabolic syndrome. One hundred and fifty patients who had a clinical and electrophysiologically confirmed diagnosis of carpal tunnel syndrome (CTS), were included in this study. The patients were divided into two groups (with or without metabolic syndrome) according to the criteria of National Cholesterol Education Program. Eighty one (73.5 %) of the patients with CTS had metabolic syndrome. The patients with metabolic syndrome the severity of CTS was found 22.2 % had mild CTS, 56.8 % had moderate CTS, and 21 % had severe CTS. The patients without metabolic syndrome the severity of CTS was found 44.9 % had mild CTS, 40.6 % had moderate CTS, and 14.5 % had severe CTS. The severity of CTS between both groups was found to be statistically significant (p = 0.0009). While a correlation was found between the severity of CTS and high level of LDL with the presence of metabolic syndrome (correlation coefficient 0.209). In conclusion metabolic syndrome that appears to be a risk factor for CTS. At the same time, the presence of metabolic syndrome increases the severity of the disease.

Retrospective case survey. To examine incidence and clinical characteristics of hepatitis B infection in individuals with spinal cord injury (SCI). Inpatient clinic within a physical medicine and rehabilitation hospital specialized in rehabilitation. A total of 161 patients with SCI. Patients’ records were investigated and the status of hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), anti-hepatitis B surface antigen positivity, alanine aminotransferase levels, duration of hospitalization and cost were recorded. Incidence of acute hepatitis B. Six patients were diagnosed with acute hepatitis B on the first hospitalization for rehabilitation. A total of 11 patients (4.2%) were HBsAg positive with a previously established diagnosis of hepatitis B virus infection, 1 patient (0.4%) was anti-HCV positive. After a follow-up of 6 months, three of the acute hepatitis B patients progressed into chronic hepatitis B stage. In acute hepatitis B patients’ initiation of the rehabilitation was delayed, duration of hospitalization was increased. After SCI, patients are at high risk of acute hepatitis B infection. A high rate of chronicity may be associated with impaired immune response, secondary to neurological deficit. Screening and vaccination protocols may prevent the spread of the hepatitis B infection, healthcare losses and financial loss.

Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients’ complaints about heel spurs.

Cervical osteophytes may cause dysphagia by compressing the esophagus and may cause dysphonia by compressing the larynx and inferior laryngeal nerve. The occurrence of dysphagia and dysphonia due to cervical osteophytes has rarely been reported in literature. In this article, a case, in which the multiple cervical osteophytes were found to be the cause of dysphagia and dysphonia, was evaluated by imaging methods and electrophysiological evaluation of swallowing and the case was discussed in the light of relevant literatures.

Background and Aims: To investigate whether there were changes in the sympathetic skin responses (SSR) in the limbs with complex regional pain syndrome (CRPS) type I in hemiplegic patients. Setting: A physical medicine and rehabilitation center in Turkey . Materials and Methods: Sympathetic skin responses were evaluated in 69 stroke patients (41 with CRPS and 28 without CRPS) and 20 healthy volunteers. SSR were recorded on the paretic and healthy hands after stimulation of the ipsilateral median nerve. Patients' ages ranged from 33 to 77 years, with a mean of 60.0 ± 12.9 years. Results: The SSR were obtained in all patients with CRPS, whereas SSR was absent in 9 of 28 patients with hemiplegia who did not have CRPS after stimulation of the plegic side and the difference was statistically significant ( P =0.023). SSR amplitudes were increased at the hemiplegic limbs in patients affected by CRPS compared to individuals unaffected; this group difference was statistically significant ( P =0.014). The mean amplitude of the SSR in the advanced stage of CRPS was greater than lower stage and the difference was statistically significant ( P =0.035). Conclusion: Our results suggest that SSR can be obtained in stroke patients with CRPS even in the early stages of CRPS. SSR acquirability and amplitude increase as the stage of the disease advances. As an electrophysiologic technique, SSR may be used in the evaluation of the sympathetic function in hemiplegic patients and also in the diagnosis of CRPS and in monitoring of its treatment.

Autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord lesion above the splanchnic outflow (T6). It is characterized by a sudden onset and severe increase in blood pressure and is potentially life threatening. The most common causes are bladder and rectum distention. In this case study, we report an autonomic dysreflexia case that developed after intramuscular injection in a 29-yr-old tetraplegic patient with C5 American Spinal Injury Association grade A lesion. After careful scrutiny of English literature, this clinical manifestation seems to be an unusual event.

Reported here is a 21-year-old female with isolated contracture of the rectus femoris muscle. Its possible relation to breech positioning, and the role of sonography for its diagnosis and close follow-up are discussed in the light of the relevant literature.

WOS: 000250351700007, PubMed ID: 18247234