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The aim of the study was to determine which vasoactive agent was more efficacious for erectile dysfunction (ED), intracavernosal papaverine or oral sildenafil, in paraplegic men within the first year after injury by using a penile color Doppler ultrasound as a quantitative imaging method and to determine the association between responses to these two vasoactive agents and factors such as neurological lesion level and lesion severity. A total of 31 male in-patients with spinal cord injury, aged over 18 years, and with neurological lesions below the T6 level within the first year after injury with ED were included. Visual and auditory sexual stimulus (VASS) on day 1 (group 1), VASS with 25 mg intracavernosal papaverine (group 2) and after a wash-out period of papaverine on day 2, and VASS with 50 mg oral sildenafil on day 5 (group 3) were administered to each patient. Measurements of the peak systolic velocity and end diastolic velocity, which were used as vascular parameters during each procedure type, were taken using penile color Doppler ultrasound. Considering the severity of the lesion and the levels of the neurological lesion, there was a statistically significant difference between the PSV values of the group 1 and the other two groups (P0.05) in terms of both the severity and the levels of the lesion. Efficacies of intracavernosal papaverine hydrochloride or oral sildenafil citrate for ED were similar at all neurological lesion levels and lesion severity in paraplegic men within the first year after spinal cord injury. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Ozet Amac: Lateral epikondilit tanisi almis hastalarda ultrason tedavisinin etkinligini arastirmak ve plasebo ultrason tedavisi ile karsilastirmakti. Yontem ve Gerecler: Calismaya, lateral epikondilit tanisi konan 25-62 yas (ort. yas 46.7±8.1) arasinda 60 hasta (40 kadin ve 20 erkek) dahil edildi. Hastalar randomize olarak 2 gruba ayrildi: ultrason (US) grubu ve plasebo grubu. Ultrason grubundaki hastalara (n=30) surekli ultrason; plasebo grubuna (n=30) ise calismayan basligin kullanildigi ultrason 5 dakika sureyle 3 hafta boyunca toplam 15 seans uygulandi. Tum hastalara tedavi suresince (3 hafta) gece splinti verildi. Hastalar tedavi baslangici, sonu (3. hafta) ve 15 gun sonra (5. hafta ) degerlendirildi. Istirahat ve hareket agrisi vizuel agri skalasi (VAS) ile, el sikma gucu el dinamometresi ile, gunluk yasam aktivite degerlendirmesi Disabilities of the Arm, Shoulder, and Hand (DASH-T) anketi Turkce versiyonu ile, yasam kalitesi Short-Form (SF)-36 olcegi ile degerlendirildi Ayrica hasta memnuniyeti de sorgulandi. Bulgular: Istirahat agrisi (VAS); US grubunda hem tedavi sonunda (3. hafta) hem de 15 gun sonraki takipte (5. hafta) tedavi oncesine gore anlamli duzelmisti, ancak plasebo grubundaki duzelme sadece 3. haftada gozlendi (p 0.05). DASH-T skorlari acisindan iki grup arasinda tedavi sonunda ve 15 gun sonraki takipte fark yoktu. Tedavi oncesine gore 3. ve 5. haftalardaki DASH-T’taki degisim, US grubunda plasebo grubuna kiyasla anlamli yuksekti (p

Objective: To determine whether two types of exercise — breathing retraining (BRT) and inspiratory muscle training (IMT) — improve on cardiopulmonary functions and exercise tolerance in patients with stroke.Design: A randomized controlled trial.Setting: Education and research hospital.Subjects: Forty-five inpatients with stroke (24 men, 21 women) were recruited for the study. The subjects were randomized into three groups: 15 assigned to receive inspiratory muscle training (IMT); 15 assigned to received breathing retraining, diaphragmatic breathing and pursed-lips breathing (BRT); 15 assigned to a control group.Interventions: All study groups participated in a conventional stroke rehabilitation programme. For the same period, the IMT and BRT groups trained daily, six times a week, with each session consisting of one half-hour of training for six weeks.Main measures: Each subject underwent pulmonary function and cardiopulmonary exercise tests. Subjects were also assessed for exertional dyspnoea, stages of motor recovery, ambulation status, activity of daily living and quality of life.Results: After the training programme, the IMT group had significantly improved forced expiratory volume at 1 second (FEV1), forced vital capacity (FVC), vital capacity (VC), forced expiratory flow rate 25—75% (FEF 25—75%) and maximum voluntary ventilation (MVV) values compared with the BRT and control groups, although there were no significant differences between the BRT and control groups (P2peak) than the BRT and control groups, although there were no significant differences between the BRT and control groups (Pmax) and maximum inspiratory and expiratory pressure (PEmax) in the BRT group and, PImaxin the IMT group compared with baseline and the control group. In the IMT group, this was associated with improvements in exercise capacity, sensation of dyspnoea and quality of life.Conclusions: Significant short-term effects of the respiratory muscle training programme on respiratory muscle function, exercise capacity and quality of life were recorded in this study.

To evaluate the clinical effectiveness of low-frequency pulsed electromagnetic field (PEMF) therapy for women with fibromyalgia (FM).Fifty-six women with FM, aged 18 to 60 years, were randomly assigned to either PEMF or sham therapy. Both the PEMF group (n=28) and the sham group (n=28) participated in therapy, 30 minutes per session, twice a day for 3 weeks. Treatment outcomes were assessed by the fibromyalgia Impact questionnaire (FIQ), visual analog scale (VAS), patient global assessment of response to therapy, Beck Depression Inventory (BDI), and Short-Form 36 health survey (SF-36), after treatment (at 4 wk) and follow-up (at 12 wk).The PEMF group showed significant improvements in FIQ, VAS pain, BDI score, and SF-36 scale in all domains at the end of therapy. These improvements in FIQ, VAS pain, and SF-36 pain score during follow-up. The sham group also showed improvement were maintained on all outcome measures except total FIQ scores after treatment. At 12 weeks follow-up, only improvements in the BDI and SF-36 scores were present in the sham group.Low-frequency PEMF therapy might improve function, pain, fatigue, and global status in FM patients.

Objective Acrodysostosis is a rare syndrome characterized by peripheral dysostosis, nasal hypoplasia and frequently mental retardation. Only one adult case of acrodysostosis has been reported to have neurologic symptoms. We report one further adult case of acrodysostosis with severe neurologic findings including myelopathy and spastic paraparesis due to diffuse spinal stenosis and recurrent deep vein thrombosis possibly caused by neurologic deficits. Results We report a 43-year-old woman who had back and neck pain with weakness in the extremities of several years. 1~year before admission to our hospital, she had been treated with a missed diagnosis of sero (-) spondyloarthropathy but had not benefited. She became unable to walk, thereafter she underwent decompression surgery with a diagnosis of degenerative spinal stenosis. She presented at our outpatient department complaining of lowback pain and difficulty walking. She had marked facial and peripheral appearance of acrodysostosis. Spinal MRI revealed extensive spinal stenosis. A diagnosis was made through the genetic investigation, clinical and radiological findings. Spastic paraparesis were detected. There was widespread neuropathic pain. 15 days after admission, she developed swelling and redness of the left lower extremity and the venous doppler ultrasonography showed left acute and right past DVT. We treated DVT with anticoagulant therapy. Gabapentin and Baclofen were initiated for neuropathic pain and spasticity. A conventional rehabilitation program was performed. She left walking with a walker without pain and spasticity. Conclusions We would like to remind physicians to be aware of peripheral malformations as signs of skeletal dysplasias and to consider acrodysostosis in the differential diagnosis. Although it is a rare condition, if diagnosed early, possible complications can be treated and outcomes may be improved.

Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F, Atay MB, Stam HJ. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Objective To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. Design Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting Rehabilitation education and research hospital. Participants A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke. Interventions Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. Main Outcome Measures The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument). Results The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P P Conclusions In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.

Sezer N, Yavuzer G, Sivrioglu K, Basaran P, Koseoglu BF. Clinimetric properties of the Duruoz Hand Index in patients with stroke. Objective To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke. Design Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program. Setting Three different inpatient rehabilitation centers. Participants A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days. Interventions Not applicable. Main Outcome Measures Brunnstrom stages, Modified Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach α coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman ρ correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test. Results The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval, .93−.99) and α of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (ρ=−.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis ( P P Conclusions The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.

Sutbeyaz S, Yavuzer G, Sezer N, Koseoglu F. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Objective To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. Design Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting Rehabilitation education and research hospital. Participants A total of 40 inpatients with stroke (mean age, 63.5y), all within 12 months poststroke and without volitional ankle dorsiflexion. Interventions Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. Main Outcome Measures The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories [FAC]), and motor functioning (motor items of the FIM instrument). Results The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2–2.1; vs mean, 0.8; 95% CI, 0.5–1.2; P =.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2–24.7; vs mean, 12.5; 95% CI, 9.6–14.8; P =.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4–1.2; vs mean, 0.3; 95% CI, 0.1–0.7; P =.102) nor FAC (mean, 1.7; 95% CI, 1.2–2.1; vs mean, 1.5; 95% CI, 1.1–1.9; P =.610) showed a significant difference between the groups. Conclusions Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.

To compare the functional, cognitive and disability status of aphasic and non-aphasic traumatic brain injury patients.A prospective comparative study in which 103 patients with traumatic brain injury participated.Fifty-one aphasic and 52 non-aphasic patients with traumatic brain injury.Functional Independence Measure and Disability Rating Scale were used to determine functional status and disability. Cognitive status was evaluated by the Mini-Mental Status Examination. Aphasic patients were evaluated using the Gülhane Aphasia Test for language disorders.The most frequent type of aphasia was Broca aphasia at 26.49% followed by anomic at 19.6% and trans-cortical motor at 15.6%. Functional Independence Measure, Disability Rating Scale and Mini-Mental Status Examination scores at admission and at discharge showed significant differences in aphasic patients (p0.001). There were no significant differences in the Functional Independence Measure, Disability Rating Scale and Mini-Mental Status Examination gains between the aphasic and non-aphasic patients (p0.01).Although aphasia could be accepted as a negative prognostic indicator in patients with traumatic brain injury, we could not detect any difference in functional and cognitive gains between the aphasic and non-aphasic patients.

Study objectives To assess exercise tolerance and determine the distinct role of cardiac, respiratory, or peripheral factors on it after delayed surgical repair in patients with tetralogy of Fallot Design The aerobic exercise capacity of 15 adult patients (mean [± SD] age, 21 ± 6; age range, 9 to 30 years) undergoing successful total correction at a mean age of 12 ± 5 years (patients) was compared to healthy, matched control subjects by using right ventricle echocardiography, resting spirometry, and cardiopulmonary exercise tests at a mean postoperative time of 7.5 ± 4.6 years Setting Tertiary care referral centers Patients Fifteen adult patients (mean age, 21 ± 6 years; age range, 9 to 30 years) undergoing successful total correction at a mean age of 12 ± 5 (patients) and 15 healthy, matched volunteers (control subjects) Results There was evidence for a slight right ventricular diastolic dysfunction in the patients. Mean FVC (88 ± 9% vs 109 ± 12% predicted, respectively) and FEV1(89 ± 9% vs 109 ± 12% predicted, respectively), although being within the normal range, were also decreased in comparison to those of control subjects (p < 0.0001). Maximal oxygen consumption ( V . o2max) decreased in both groups (55 ± 16% vs 61 ± 23% predicted, respectively; p=0.5); however, there were more individuals with severely decreased values among the patients (p = 0.05). V . o2at the anaerobic threshold was also decreased in patients (33 ± 15% vs 51 ± 8% predicted, respectively; p=0.004). The maximum tolerable exercise time was 17.3 ± 4.5 min in patients vs 21.2 ± 6.4 min in control subjects (p = 0.06) Conclusions The exercise capacity after delayed repair was good in general compared to matched control subjects; however, exercise capacity may be slightly limited by ventilatory dysfunction, low anaerobic threshold, and lack of physical fitness despite New York Heart Association class improvement after undergoing the operation

WOS: 000343521300003, Objective: Cardiopulmonary (CPR) programs were developed to improve and stabilize the physical, psychological, social, mental, professional, and economic conditions of patients with cardiovascular and pulmonary diseases. Although it is known that CPR reduces mortality and morbidity, it is not widely implemented as it is in Turkey. In this study, we aimed to determine the level of CPR awareness among physicians and allied health professionals. Material and Methods: This was a multi-center, cross-sectional survey study. The study included physicians, nurses, physiotherapists, and other allied health professionals who were informed about the survey and provided written consent to participate. Results: A total of 727 volunteers from 12 different centers were included in the study. Of the participants, 59.5% were physicians, 31.4% were nurses, 5.9% were physiotherapists, and 3.2% were other allied health professionals; 79.3% participants answered the question on if they have had any idea about CPR. Participants indicated that patients should be referred to cardiac pulmonary rehabilitation after a coronary artery bypass (83.8%), chronic obstructive pulmonary disease (83.2%), and cardiac valve surgery (38.9%). Only 40.1% of the survey participants provided information about CPR to patients, while 20.5% did not provide any information about CPR. Conclusion: This survey study determined that in centers where CPR could be implemented, health professionals have knowledge about CPR. If the study were conducted nationwide, the level of awareness might be even lower. Although it is an idea of CPR, the level of knowledge for this issue is not adequate. As the number of the CPR centers will increase, the knowledge of doctors and allied health professionals will advance.

The purpose of this article is to investigate the efficacy of intravesical oxybutynin hydrochloride (OH) to treat patients with overactive detrusors who are unresponsive to oral anticholinergic therapy alone. Twenty-five patients who were treated with oral OH for overactive detrusor (but who did not respond to treatment and were using indwelling urethral catheters) were given intravesical OH without changing oral treatment. Pre- and posttreatment bladder capacities were compared in urodynamic studies. The study showed that positive clinical results can be achieved with combined oral and intravesical OH treatments in patients with overactive detrusors who had indwelling urethral catheters because of severely reduced bladder capacity. However, a significant number of patients discontinued this treatment because of infection and difficulty in performing the procedure. Clinicians and rehabilitation nurses should provide education and support to eliminate these problems. In addition, the development of single-use standard sterile OH preparations for intravesical applications may increase the efficacy of the method.

WOS: 000243787100008 PubMed: 17378230 Objectives: To investigate the relationship between language functions and cognitive and functional outcome and to evaluate the effects of a conventional language rehabilitation programme on aphasic adult patients in the post-acute stage of traumatic brain injury (TBI). Design: Non-concurrent prospective study. Patients were assessed pre-treatment and post-treatment with standardized assessment tools. Subjects: Sixty-one aphasic patients with TBI who were admitted to a rehabilitation centre in the post-acute phase for a late inpatient rehabilitation programme. Methods: The motor sub-scales of the Functional Independence Measures and Disability Rating Scale were used to assess functional status and disability. Cognitive status was evaluated with the Mini-Mental Status Examination and the Functional Independence Measure cognitive sub-scale. The language function was evaluated with the Gulhane Aphasia Test. Results: All functional, cognitive and language scores increased significantly during the rehabilitation programme. Language functions at admission were correlated with the Functional Independence Measure motor change scores and the Mini-Mental Status Examination change scores. Regression analyses revealed that auditory comprehension at admission was the most important independent determinant of functional and cognitive gain during rehabilitation. Conclusion: Post-acute language functions after late admission to a rehabilitation centre appear to be related to measures of cognitive and functional progress in patients with TBI. Functional and cognitive outcome is mainly affected by auditory comprehension. Results also showed the effectiveness of post-acute conventional rehabilitation in improving language functions.

This report details a case of sudden neurologic deficit attributable to acute thoracic fractures associated with senile osteoporosis. A 73-yr-old female patient with a history of occasional back pain during the past 4 mos had sudden thoracic vertebral fracture with spinal cord injury. The patient, who had a benign past medical history, had not been evaluated for osteoporosis. Thoracic spine radiographs showed a compression fracture at T8. Thoracic magnetic resonance imaging exposed a compression fracture at T7-T8. She was treated operatively. She was found to have spinal cord injury with American Spinal Injury Association classification C (T7), and she had poor sitting balance. She was discharged in a wheelchair and was administered clean intermittent catheterization every 6 hrs. Six months after discharge, she ambulated with a walker and had spontaneous micturition. Vertebral fractures are a common presentation of senile osteoporosis. The risk of neurologic impairment attributable to vertebral fracture is a rare but potentially severe complication. Besides medical therapy and suitable rehabilitation programs, surgical treatment is an integral part of the management of patients with osteoporotic vertebral fractures.

There is a high incidence of reflex sympathetic dystrophy of the upper limbs in patients with hemiplegia, and its painful and functional consequences present a problem to specialists in physical medicine and rehabilitation. This study was designed to assess the role of several factors in the occurrence of reflex sympathetic dystrophy in patients with hemiplegia. Ninety-five consecutive stroke patients (63 male and 32 female, mean age 59+/-12 years) admitted to our hospital were evaluated. Of the study group, 29 patients (30.5%) were found to develop reflex sympathetic dystrophy. There were no significant differences between the hemiplegic patient groups with or without reflex sympathetic dystrophy regarding age, gender, etiology, side of involvement, disease duration and the presence of comorbidities. The recovery stages of hemiplegia, as shown by Brunnstrom functional classification, were significantly different between the two groups; patients in lower recovery stages tended to develop reflex sympathetic dystrophy more frequently (P

Objective: To investigate the incidence of fever during the post-acute rehabilitation phase in patients with brain injury. Design: Prospective study. Subjects: Seventy-four patients with brain injury. Methods: Patients were evaluated for the presence of fever during the rehabilitation phase. Demographics, time since injury, acute hospital and rehabilitation stay, brain injury and clinical characteristics were recorded for all subjects. Results: Of the study group, 36 patients (36/74; 48.6%) had at least 1 event qualified as fever. The most common cause of fever was urinary tract infection. There were only 2 patients considered as having central fever. Fever was significantly more frequent in patients with a greater number of neurological impairments, more severe neurological impairments and a lower level of independence. The rehabilitation stay was prolonged in patients with fever. The average length of rehabilitation stay was 62.5 days and 49.8 days in patients with or without fever, respectively. Conclusion: Infection is the most common cause of fever after brain injury and the incidence of central fever is low.