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Objective: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. Methods: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. Results: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. Conclusions: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Objective: The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age. Methods: 43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient. Results: Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups. Conclusion: Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery. Level of evidence: Level III, Diagnostic Study. Keywords: Intraoperative monitoring, Motor evoked potentials, Somatosensory evoked potentials, Children, Spine surgery

©2012 Turkish League Against Rheumatism. All rights reserved. Amac: Bu calismada saglikli bireylerde tek doz indometazinin bilgi islem hizini etkileyebilecegi hipotezi arastirildi. Hastalar ve yontemler: Kesitsel, randomize, plasebo kontrollu, cift kor, capraz gecisli bu calismada, 30 saglikli eriskin bireye (8 erkek, 22 kadin; ort. yas 32.4±5.3 yil; dagilim 24-42 yil) tek doz 25 mg’lik indometazin (Endol, oral kapsul, DEVA Ilac, Kartepe, Turkiye) ve plasebo uygulandi. Ilac uygulamalari oncesi ve sonrasi premotor reaksiyon zamani ve tepki zamani calismaya kor bir arastirmaci tarafindan Ankara Gazi Universitesi Tip Fakultesi Fiziksel Tip ve Rehabilitasyon Anabilim Dali Elektrofizyoloji Laboratuvari’nda elektromiyografik olarak olculdu. Bulgular: Tek doz indometasin oncesi ve sonrasi premotor reaksiyon zamanlari sirasiyla 169.1±36.3 ve 160.2±29.5 msn (p=0.113) olarak olculdu. Tek doz plasebo oncesi ve sonrasi premotor reaksiyon zamanlari sirasiyla 158.7±35.5 ve 161.5±36.3 msn (p=0.516) olarak olculdu. Indometazin ve plasebo gruplari arasinda premotor reaksiyon zaman olcumleri acisindan istatistiksel anlamli fark saptanmadi. Sonuc: Tek doz indometazin saglikli eriskinlerde premotor reaksiyon zamani ve tepki zamani olcumlerini degistirmedi. Indometazinin saglikli eriskinlerde bilgi islem hizini etkilemedigi dusunulebilir.

OZET Amac: Iskeletsel acik ve derin kapanis gruplarinda, bilateral masseter ve anterior temporal kas aktivitelerinin yutkunma, cigneme ve maksimum sikma fonksiyonlarinda elektromiyografi (EMG) yontemi kullanilarak degerlendirilmesidir. Bireyler ve Yontem: Iskeletsel acik kapanis (8 erkek, 8 kiz, yas ortalamasi 12,6±2,5 yil) ve iskeletsel derin kapanisa (10 erkek, 5 kiz, yas ortalamasi 11,6±2,1 yil) sahip 31 bireyden yutkunma, cigneme ve maksimum sikma fonksiyonlarinda yuzeyel disk elektrodlar kullanarak masseter ve anterior temporal kas yuzeyel EMG kayitlari alinmistir. Tespit edilen aktivitenin tepe degerleri arasindaki amplitud olculmus ve mikrovolt (Iv) olarak hesaplanmistir. Her bir fonksiyon icin tekrarlanan olcumlerin ortalamalari alinmistir. Elde edilen verilerin istatistik degerlendirmesi Faktoriyel duzende tekrarlanan olcumlu varyans analizi teknigi ve Duncan testi kullanilarak yapilmistir. Bulgular: Masseter ve anterior temporal kas aktiviteleri tum fonksiyonlarda farkli bulunmustur (p

Background Numerous studies investigating the effect of exercise on reaction time have yielded contradictory results. Most of the studies use computer based methods to measure reaction time instead of electromyography, yielding total reaction time rather than premotor time. In this study, we aimed to investigate the effect of a single session aerobic exercise on premotor fraction of reaction time in sedentary healthy individuals. Methods Twenty-two sedentary healthy subjects (11 subjects for the study group and 11 for the control group) enrolled in this study. Subjects in the exercise group performed a single session submaximal cycling exercise. Electromyographic reaction times were measured before and after the exercise session. In the control group, reaction time measurements were taken twice with an interval of 20 min. Findings In the exercise group, premotor fraction of reaction time values decreased considerably ( P = 0.01) after the exercise session. Interpretation A single bout of cycling exercise significantly improved premotor fraction of reaction time in healthy young sedentary subjects. Physical activity improves not only physical fitness but also cognitive functions. Electromyographic reaction time evaluations may be used in the sports medicine field where both aerobic fitness and short reaction time are indispensable demands.

Objectives: This study aimed to develop and assess the reliability of a visual feedback system intended to improve the patient’s perception and the performance of posterior pelvic tilt [PPT] exercises. The feedback setup designed and constructed by the authors included a bed covered with a mat with three embedded force sensors corresponding to the lumbosacral region of the subject lying supine; a data acquisition card to collect and convert data; and two monitors, one above the subject and one on the physician’s table. Software was developed to monitor the force exerted vertically upon the force sensors during PPT to be followed both by the physician and the subject.Methods: Fifteen healthy volunteers were enrolled for a relability trial. The subjects were asked to perform five consecutive PPT with maximum effort. Each subject was evualated three times by two physicians. Intraclass correlation coefficients (ICC) were computed to determine the intrarater and interrater reliability of the maximum fo...

Background: Lumbar plexus blockade (LPB) combined with sciatic nerve block (SNB) is frequently used for lower extremity surgery. Perioperative nerve injury is a rarely encountered complication of peripheral nerve blocks (PNB). Case Report: Here we report a 44-year-old male patient who developed a partial femoral nerve injury (FNI) following a LPB which was performed before the surgery of a patellar fracture. The clinical and electroneuromyographic findings of the patient were recovered almost completely within the following six months. Conclusion: The presented case demonstrated a FNI despite the absence of any pain or paresthesia sensation, with the disappearance of motor response under 0.3 mA of neurostimulation in the experienced hands.

Amaç: Bu çalışmada amaç, Fiziksel Tıp ve Rehabilitasyon (FTR) polik liniklerine başvuran geriatrik hastaların demografik ve klinik özelliklerini belirlemek, bu klinik ve demografik özelliklerin, yaş, cinsiyet ve öğrenim düzeylerine göre farklılıklarını ortaya çıkarmaktı. Gereç ve Yöntem: Çok merkezli çalışma kapsamına 20 FTR polikliniğine başvuran 65 yaş üzeri toplam 820 hasta alındı. Demografik verilerin yanın da; yakınmaları, hastalıkları, ağrı düzeyleri, kullandıkları ilaçlar, alışkanlıkları ve tıbbi durumları kaydedildi. Yaş, cinsiyet ve öğrenim düzeyinin yakın malar, hastalıklar ve alışkanlıklar üzerindeki etkisi araştırıldı. Bulgular: Hastaların yaş ortalaması 71,7±5,5 yıl idi. %16,7’si tek başına yaşıyordu, %61,7’si ev hanımı idi. %86'sının bir veya daha fazla komorbid hastalığı mevcuttu; en sık hipertansiyon (HT) daha sonra mide ve kalp hastalıkları görülmekte idi. En sık yakınma nedenleri sıklığı sırasıyla eklem ağrısı, halsizlik-yorgunluk, yaygın vücut ağrısıydı. Günde yutulan ilaç sayısı ortalama 4,02±0,9 (ortanca 4), VAS'a göre ağrı ortalaması 5,1±1,3 (ortan ca 5) olarak belirlendi. %16,5’nin düşme öyküsü mevcuttu. %30,1’i yürüyüş yapıyor ve sadece %15,4’ü ev içinde egzersiz yapıyordu. Omurga deformitesi, omurga ağrısı, idrar kaçırma, görme sorunu, yutma güçlüğü, duymada azalma, denge ve diş sorunu 75 yaşın üzerindekilerde istatistiksel açıdan anlamlı olarak daha fazla görülmekteydi. Sonuç: FTR polikliniklerinde hastaların çoğunluğunu yaşlı popülasyon oluş turmaktadır. İleri yaş grubunda komorbid hastalıkların varlığı, kullanılan ilaç sayısının fazla olması, osteoporoz ve düşme sıklığının artması, FTR heki minin hem medikal tedavi planlama aşamasında ve hem de rehabilitasyon programı hazırlarken dikkatli davranmasını gerektirmektedir. İleri yaş grubunun günlük yaşamlarında bağımsız ve daha aktif olabilmesi için sadece kas-iskelet yakınmaları değil, bütün organ sistemleri değerlendiril erek kapsamlı ve çok yönlü bir geriatrik rehabilitasyon programı düzenlen melidir. Türk Fiz Tıp Rehab Derg 2011;57:143-9., Aim: The aim of this study was to define the demographic and clinical characteristics of geriatric patients who referred to physical medicine and rehabilitation (PMR) outpatient clinics and to detect the differences between these characteristics in regard to age, sex and education level. Materials and Methods: 820 patients over 65 years old who attended 20 outpatient clinics were included in the study. In addition to demographic data, the complaints, comorbid diseases, pain levels, drugs being used, exercise and medical status of the patients were recorded. The effects of age, sex and education level on complaints, comorbid diseases and exercise habits were investigated. Results: The mean age of the patients was 71.7±5.5 years. 16.7% were living alone, 61.7% were housewives. 86% of the patients had one or more comorbid diseases - hypertension, gastric problems and heart disease were mostly encountered. The most common complaints were joint pain, fatigue and widespread body pain. The average number of pills taken per day was 4.02±0.9 (median 4), and the VAS pain score was 5.1±1.3 (median 5.0). History of falling was present in 16.5% of patients. 30.1% were routinely walking and 15.4% were performing exercise at home. In patients over 75 years, vertebral pain and deformity, urinary incontinence, eye problem, difficulty in swallowing, decrease in hearing, as well as balance and teeth problems were significantly more frequent than in younger subjects. Conclusion: Aged population constitutes most of the PMR outpatient clinic patients. Considering comorbid diseases, high number of daily taken drugs and falls, PMR specialist should be cautious in prescribing drugs and planning rehabilitation programme. For independence in activities of daily living in this age group, besides the musculoskeletal system, all other systems should be evaluated and a comprehensive geriatric rehabilitation programme should be constructed. Turk J Phys Med Rehab 2011;57:143-9.

Objective: Nonsteroidal anti-inflammatory drugs (NSAID) are among the most widely prescribed agents in osteoarthritis patients, and may lead to important side-effects which increase the risk of hospitalization and death. Transdermal administration of NSAIDs can provide relief of pain locally with relatively less side effects. This study was aimed to evaluate the efficacy of a single administration of 40 mg transdermal flurbiprofen on pain and on strength of quadriceps and hamstring muscles in patients with knee osteoarthritis. Material and Methods: This study is a double blind, placebo-controlled cross-over preliminary study. Transdermal flurbiprofen and placebo patches were administered to the 24 patients with knee osteoarthritis. Knee pain was evaluated using a visual analog scale (VAS) and the strength of quadriceps and hamstring muscles using an isokinetic dynamometer. Results: Mean VAS scores reduced from 5.3 +/- 1.7 to 4.7 +/- 1.6 (p= 0.88) after placebo administration, and from 5.4 +/- 1.9 to 3.9 +/- 1.7 (p= 0.04) following flurbiprofen administration. Peak torque and total work values of flexor and extensor muscles of knee did not differ statistically after flurbiprofen or placebo administrations. Conclusion: Pain significantly reduced after single dose of transdermal flurbiprofen patch. However, no significant difference in isokinetic assessment parameters was observed in the present study. To assess the effects of transdermal flurbiprofen and its efficacy on knee pain and function, further controlled studies in larger groups of patients with different doses of flurbiprofen are recommended.

AIM The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented. MATERIAL AND METHODS An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries. RESULTS MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation. CONCLUSION Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits.

Internal jugular vein catheterization has been implicated in spinal accessory nerve (SAN) injuries after coronary artery bypass grafting (CABG). Stretch injury due to prolonged positioning during CABG has also been proposed as another mechanism of injury. Herein we describe a male patient with left shoulder pain and abduction difficulty following CABG, who displayed electromyographic abnormalities confined to the left upper trapezius muscle. Internal jugular vein catheterization had not been performed during surgery. Although unusual, the possibility of upper trapezius muscular branch paralysis should be considered in patients with shoulder pain or weakness after CABG. Muscle Nerve 41: 144-147, 2010

Background: Meperidine has been shown to exhibit a sensory block in peripheral nerves. However, its motor blockade ability is controversial. The aim of this study was to investigate, electroneurographically, the ability of meperidine to inhibit conduction in both sensory and motor fibres in the ulnar nerve. Materials and methods: The study was conducted in a double-blind, placebo-controlled fashion. Eighteen healthy volunteers were randomized into three groups (Saline, meperidine 1% and meperidine 2%). Three millilitre of the study solution was administered to the ulnar nerve perineurally at the level of the wrist by the guidance of a nerve stimulator. Sensory nerve action potential (SNAP) and compound motor action potential (CMAP) amplitudes were recorded. At least a 20% decrease in the initial response amplitude was accepted as a block. Results: The number of individuals with sensory and motor block with saline, meperidine 1% and meperidine 2% were 0/6, 6/6, 6/6 and 0/6, 5/6, 6/6, respectively (P

Study objective: We aimed to study the effects of perineural tramadol on both sensory and motor conduction of ulnar nerve by electroneurography (ENG).Design: Prospective.Setting: Physical Medicine and Rehabilitation Electrophysiology Laboratory.Patients: Eight healthy volunteers.Intervention: Either 3-mL of saline or 50 mg of tramadol in 3-mL saline was initially administered perineurally to ulnar nerve of nondominant extremity. After two weeks, volunteers who received tramadol were given saline, whereas the ones who received saline were given tramadol.Measurements: Baseline sensory and motor responses of ulnar nerve were recorded by ENG prior to injection of study solutions. Perineural injections were realized by means of a teflon-coated needle and a nerve stimulator. Following injections, sensory and motor responses were monitored every five minutes in the first hour and then every 10 minutes until the sensory and motor amplitudes reached at least 80 percent of the baseline value.Main Results: Perineural tramadol administration showed a significant decrease from baseline measurement in the sensory response amplitude with respect to saline administration (65.9 percent vs 12.7 percent, p < 0.05). Decrease in the motor response amplitudes from baseline versus saline was insignificant (32.9 percent vs 15.2 percent). Sensory block was observed in all of the subjects after tramadol injection when compared with saline administration and lasted 25 minutes (p < 0.05). The duration of motor block lasted 12.5 minutes, and motor block developed in four out of eight subjects when compared with saline administration (p < 0.05). Time to reach maximum sensory and motor block were 15 and 10 minutes, respectively, after tramadol injection.Conclusions: Tramadol has a brief local anesthetic-like action when administered to ulnar nerve perineurally.

Introduction: In this prospective clinical study, we investigated the effects of rapid maxillary expansion ( RME) on the electromyographic ( EMG) activities of the anterior temporal and superficial masseter muscles. Methods: The sample included 18 subjects ( 11 girls, 7 boys; mean age, 12.54 years) with unilateral or bilateral posterior crossbites involving 3 or more posterior teeth. There was no control group in this study because of the short observation period. The EMG activity was recorded simultaneously from both muscles during swallowing a sip of water and unilateral gum chewing. Results: The mean EMG ( mEMG) activities of the right and left anterior temporal muscles showed no statistically significant difference during swallowing and unilateral chewing. The mEMG activities of the right and left masseter muscles showed a statistically significant difference at unilateral chewing ( P < 0.01). There were a decrease of the mEMG activities for both muscles after RME and an increase during the observation period for unilateral chewing ( P < 0.05). Swallow-related mEMG activities of both muscles showed increases after RME and during the observation period ( P < 0.05). Conclusions: RME affected the EMG activities of the anterior temporal and superficial masseter muscles during swallowing and unilateral chewing. These findings suggest that the alterations in the EMG activities of these muscles should be considered in both the treatment and the the stability of maxillary transverse deficiencies.

PubMed: 17039311 This study aimed to investigate the acute effects of exercise on bone turnover and to determine whether brisk walking with or without weight-lifting makes a difference on bone metabolism. Nine healthy women performed two exercise bouts: brisk walking on a treadmill for 30min (E), and similar exercise carrying 5kg of weight in a backpack (WE). Serum parathyroid hormone (PTH), osteocalcin (OC), calcitonin (CT), procollagen type 1 carboxy terminal propeptide (PICP), procollagen type 1 amino terminal propeptide (PINP), type 1 collagen carboxy terminal telopeptide (ICTP), total alkaline phosphatase (ALP), and urine deoxypyridinoline (D-Pyr) levels were studied. Resting values served as control. Significant variances were observed only in serum ALP and PTH values. Variances in ALP values within subjects after exercise were statistically significant (analysis of variance in repeated measurements [AVRM], P = 0.000). E caused a significant decrease, while WE caused a significant increase in ALP values at the 24th h (Bonferroni pairwise comparisons tests [BPC t-test]: P = 0.028, P = 0.000, respectively). Variances in PTH values within subjects after exercise were statistically significant (AVRM, P = 0.029), while diurnal variation was not significant (P = 0.981). E caused significant alterations in PTH levels (an increase at the 30th min, turned towards baseline at the 45th min) (BPC t-test, P = 0.007). WE also caused alterations in PTH levels, though insignificant (BPC t-test, P = 1.00). Brisk walking for 30 min has stimulating effects on bone turnover by various mechanisms without any additive effect of weight bearing. © Japan College of Rheumatology 2006.

Purpose: To determine the effect of foot arch structure on ankle muscle strength. Methods: Forty-seven young female volunteers (94 feet) were classified in to low'(LA), high (HA) and normal (NA) arch groups according to their arch ratio (AR) and Chippaux-Smirak index (CSI) values. The distribution of the participants among LA, HA and NA groups did not differ when AR or CSI was preferred for classification. Isokinetic muscle strength of ankle invertor/evertors and plantar/dorsal flexors was measured by using an isokinetic dynamometer. One-way ANOVA, Pearson correlation test and ROC curve analysis were used in statistical analyses. Results: A strong correlation was found between AR and CSI values. Significant differences were found in mean strength measurements of ankle muscles in favor of NA group at 120°/s for dorsiflexion and plantar flexion, 120 and 150°/s for eversion and at 120°/s for the ratio between ankle inversion and eversion. Sensitivity and specificity rates of muscular strength as an indicator of arch anomalies were low. Conclusion: Normal arched individuals have higher muscular strength values only at faster testing speeds.

Objective. To measure the motor performance of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles using the parameters electromyographic muscle reaction time and movement time in patients with carpal tunnel syndrome during key turning function. Method. A total of 37 female patients with right hand pain were divided into two groups: 21 with an electrophysiologically confirmed diagnosis of carpal tunnel syndrome (Group I), and 16 with normal electrophysiological findings (Group II). The reaction time and movement time values obtained by surface electromyography of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles were compared between groups. Results. Of the 21 patients in Group I, 15 had mild, four moderate, and two severe median nerve lesions. No significant difference between groups was found in the electromyographic reaction time and movement time values of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during key turning (P>0.05). There was also no significant difference in electromyographic reaction time and movement time between six patients with severe or moderate carpal tunnel syndrome and 15 patients with mild carpal tunnel syndrome in Group I (P>0.05). Sixteen patients in Group II did not have carpal tunnel syndrome. Conclusion. The results indicate that patients with and without carpal tunnel syndrome have similar values of reaction time and movement time of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during the pinch grasp function of the hand. Relevance Muscle reaction time and movement time, and hence the motor performance in electrophysiologically confirmed carpal tunnel syndrome patients appear to have similar parameters in patients with hand pain whose diagnosis were not confirmed with electrophysiologically.

Autonomic nervous system involvement with peripheral neuropathy is a well known complication of rheumatoid arthritis (RA). In the assessment of autonomic function of patients with rheumatoid arthritis, we performed sympathetic skin response (SSR) and R-R interval variation (RRIV) tests in 30 patients and in 30 normal controls. Of 30 patients, 5 had complaints of clinical dysautonomic symptoms. SSRs were abnormal in 6 of 30 patients, whereas 8 showed abnormal RRIVs during deep breathing. Nine of 30 patients also showed electrophysiologic evidence of peripheral neuropathy. All 5 of the patients with clinical dysautonomic symptoms showed abnormal SSR and RRIV test results. No patients with normal results on both tests had clinical dysautonomia. This study showed that there are frequent abnormalities in SSR and RRIV tests in patients with rheumatoid arthritis whether there is a clinical symptom of autonomic dysfunction or not.

In this study the effects of agonist acting drugs (morphine sulphate, fentanyl citrate and meperidine hydrochloride) on nerve conduction were studied in 43 healthy young volunteers divided into four groups randomly. According to analgesic equivalent doses, the first group received 2 mg morphine sulphate, the second group 0.02 mg fentanyl citrate, the third group 20 mg meperidine hydrochloride, and as control the fourth group received 2 ml of saline. The latencies, amplitudes of the responses and nerve conduction velocities were obtained immediately before and every 5 min after injections up to 30 min. No significant change was observed within or among the morphine sulphate, fentanyl citrate and saline groups whereas in the meperidine hydrochloride group the amplitudes diminished significantly and this finding was still apparent at 30 min. Four of the cases displayed complete blocks. Nerve conduction velocity did not change in the other 6 cases. The significant decrement of the amplitude of the compound nerve action potential in the meperidine hydrochloride group is probably due to local anesthetic-like action of this drug. Morphine sulphate, fentanyl citrate or saline did not show this effect.