Obezite ve fiziksel tıp yöntemleri

Patolojik bir hastalık olan obezitenin gelişmiş ülkelerde sıklığı giderek artmaktadır. Obezite genelde enerji sağlayan gıdaların fazla alınışı ve kısmen az harcanmasıyla oluşan bir dengesizliğin sonucudur. Sedanter yaşam tarzı da obezite ve obeziteye bağlı kronik hastalıklarla ilişkilidir. Çocukluk çağı obezitesinin prognozu yetişkin obezitesidir. Bu nedenle, obezite tedavisine en kısa sürede başlanmalıdır. Her durumda obezite kompleks bir sorundur ve etkin tedavisi farklı yaklaşımları içerir. Tedavi süreci, diyabet ve hipertansiyonda olduğu gibi devamlıdır. Kilo kaybının sağlanmasında ve uygun kilonun sürdürülmesinde kişiye özgü diyet ve düzenli egzersizler en etkin yöntemlerdir. Diğer tedavi stratejileri arasında psikolojik destek, ısı uygulamaları, sauna tedavileri, elektrikli akım tedavileri (TENS), lazer, akupunktur ve farmakoterapi faydalı destek tedaviler olarak kabul edilmektedir

The effect of neuromuscular electrical stimulation on shoulder subluxation in stroke patients

Amaç: Bu çalışmada, kas-sinir elektrik uyarımının (KSEU) inmeli olgularda omuz subluksasyonu üzerine olan etkinliği araştırıldı. Hastalar ve Yöntemler: Akut ve kronik evreli inmesi olan 20 hasta (9 kadın, 11 erkek; ort. Yaş 58.32±11.07; dağılım 42-78) çalışmaya alındı. Olgularda ortalama hastalık süresi 5.47±3.17 ay (dağılım 2-12 ay) idi. Sublukse omuzlara KSEU dört hafta süreyle 25 dakika/gün uygulandı. Olgular tedavi öncesi ve sonrasında omuz eklem hareket açıklıkları, omuz grafilerinde subluksasyon ölçümleri, Brunnstrom evreleme, Ashworth skalası, fonksiyonel bağımsızlık ölçütü kullanılarak ve ağrı şiddeti ve hasta memnuniyeti açısından değerlendirildi. Bulgular: Tedavi öncesine göre, tedavi sonrasında aktif ve pasif olarak ölçülen fleksiyon, abdüksiyon, dış ve iç rotasyon derecelerinde istatistiksel olarak anlamlı artış elde edildi. Subluksasyon ölçümlerindeki sayısal azalmanın anlamlı olmadığı görüldü. Fonksiyonel bağımsızlık ölçütü, bunun alt birimi olan kişisel bakım, Brunnstrom değerlendirmesi ve ağrı sorgulamasında anlamlı iyileşme izlendi. Sonuç: Kas-sinir elektrik uyarımı, olumlu etkileri göz önüne alındığında, inmeli omuzlarda rehabilitasyon sürecinin bir parçası olabilir.Objectives: In this study we investigated the effect of neuromuscular electrical stimulation (NMES) on shoulder subluxation in stroke patients. Patients and Methods: We included 20 acute and chronic stroke patients (9 females, 11 males; mean age 58.32±11.07 years; range 42 to 78 years) into the study. The mean duration of disease was 5.47±3.17 months (range 2 to 12 months). Neuromuscular electrical stimulation was applied to the shoulders with subluxation for 25 minutes daily for four weeks. Evaluations were made before and after treatment with regard to range of motion of the shoulder, subluxation measured on radiographs, Brunnstrom levels, Ashworth scale, Functional Independence Measure, pain, and patient satisfaction. Results: After the treatment, statistically significant improvements were achieved in active and passive flexion, abduction, external and internal rotation; however, the numeric decrease in subluxation was not statistically significant. Functional Independence Measure scores, personal care levels, Brunnstrom scale scores, and the severity of pain improved significantly. Conclusion: Considering it favorable effects, NMES may be a part of rehabilitation process for shoulder subluxation in stroke patients

The relationship between functional disability and bone mineral content in hemiparetic patients

Amaç: Hemiparezi, inme sonrasında en sık görülen nörolojik sorundur. Hemiparezik hastalarda gelişen motor zayıflığa bağlı immobilizasyon, kemik doku üzerinde olumsuz etki gösterir. Bu çalışmada, hemiparezik hastalarda fonksiyonel disabilitenin kemik kütlesi ile ilişkisi araştırıldı.Hastalar ve Yöntemler: Bu çalışmaya, inme geçirdikten sonra ilk kez rehabilitasyon için yatırılmış sol hemiparezik 41 hasta (13 kadın, 28 erkek; ort. yaş 59.5±14.2; dağlım 16-78) alındı. Nöromotor gelişim düzeyleri Brunnstrom skorlaması (BR) ile, kas tonus değerlendirmesi ise modifiye Ashworth indeksine göre belirlendi. Günlük yaşam aktiviteleri ve fonksiyonel disabilite değerlendirmesi Barthel indeksi (B‹) ile yapıldı. Sağlam ve parezik ekstremite ile önkol ve femurdan dual enerji X-ray absorbsiyometri yöntemiyle kemik mineral yoğunluğu (KMY) ölçümü yapıldı. Bulgular: Parezik ekstremite tarafında KMY değerleri hem önkol hem de femurda daha düşük bulundu(p0.05). Hastanın nöromotor gelişimi ve bağmsızlık düzeyi ile kemik kütlesi doğrudan ilişkili bulundu. Sonuç: Etkin bir tedavi ve fonksiyonel gelişimin sağlanması ile hemipareziye bağlı kemik kütlesi kaybının önüne geçilebilir. Böylece, hastanın düşük kemik yoğunluğuna eşlik edebilecek komplikasyonlardan korunması na da yardımcı olunur.Objectives: Hemiparesis is the most frequent neurological problem after stroke. The immobilization resulting from motor weakness in hemiparetic patients has adverse effects on bone tissue. In this study, the relationship between functional disability and bone mass was investigated. Patients and Methods: Forty-one left hemiparetic patients (13 women, 28 men; mean age 59.5±14.2 years; range 16 to 78 years) who were hospitalized for the first time after stroke for rehabilitation were recruited. Motor recovery was evaluated according to the Brunnstrom stages (BR), and spasticity was assessed according to the modified Ashworth index. Activities of daily living and functional disability were evaluated by the Barthel Index (BI). Bone mineral content (BMC) was measured by dual X- ray absorptiometry in the forearm and femur on both nonparetic and paretic sides. Results: On the paretic side, BMC values of both the forearm and femur were significantly lower (p<0.05). Bone mineral content showed a positive correlation with BR scores and BI (p<0.05). We did not find any significant association between BMC values and the Ashworth index (p>0.05). The neuromotor improvement and independency level of the patient were found to be in relationship with the bone mass. Conclusion: Loss of BMC due to hemiparesis may be prevented with an effective treatment resulting in functional improvement. This may be helpful in protecting the patient from secondary complications of low bone density

Correlation of spinal mobility, pain and disability in chronic neck pain patients Kronik boyun aǧrili olgularda spinal mobilite, aǧri ve özürlülük İlişkisinin deǧerlendirilmesi

Objective: This study evaluated relation between spinal mobility, pain and disability in chronic neck pain patients. Materials and methods: One hundred patients (19 men, 81 women), ages ranged between 20-60 (45.48±8.83) years with chronic neck pain for a period of at least six months were included in the study. A cervical range-of-motion (CROM) device, developed by Minnesota University, was used to assess spinal mobility, including flexion, extension, right-left lateral flexion and, right-left lateral rotation. Pain intensity was assessed by using Visual Analogue Scale. The Neck Disability Index (NDI) related cervical spine disorder that was employed to the patients. Results: Statistically significant correlation was observed among pain intensity and flexion (r=-0.27, p<0.05) and NDI score (r=0.69, p<0.001). There was significant correlation between NDI and flexion (r=-0.51, p<0.001), and left lateral rotation. Conclusion: We believe that the evaluation of chronic neck pain with many-side measurement methods might be useful clinical indicators of diagnosis, treatment and monitoring of treatment outcome

Evaluation Of Hormone Profile And Dexa Values in Premenopausal, Perimenopausal and Postmenopausal Women

This study was carried out in 130 women, between 44-55 ages, admitted to outpatient clinic of Physical Medicine and Rehabilitation Department of Trakya University Medical Faculty in order to make. comparison of hormone profile and DEXA values of premenopausal, perimenopausal, and postmenopausal women . Three groups were allocated according to climacteric symptoms and menopause condition. Premenopausal group consisted of women who had regular menstruation and did not have any climacteric symptoms , perimenopausal group consisted of women who had menstruation disorder and climacteric symptoms within one year and postmenopausal group consisted of women who had last menstruation within more than one year and less than 5 years. Women who had prior osteoporosis diognosis and treatment, hormone replacement therapy, surgical menopause and menopause duration more than 5 years were excluded from the study. Age, body weight ,height, hormone profile including estradiol (E2), progesterone (P), follicule stimulating hormone (FSH), luteinizing hormone (LH), parathyroid hormone (PTH), thyroid hormones (T3, T4), thyroid stimulating hormone (TSH) and DEXA values representing bone mineral density (BMD) of both groups were evaluated. In peri and postmenopausal groups, E2, P, FSH and LH values were significantly lower, while there was no significant difference for PTH and thyroid hormone levels comparing to premenopausal group. For DEXA values, T scores of L2-L4, L2, L3, L4, femur neck, trochanter, Wards and Z scores of femur neck, Wards area were significantly lower in peri and postmenopausal groups. It was demonstrated paralel to literature that BMD decreased in peri and early postmenopausal women associated with hormone profile changes, mainly lower E2

The evaluation of clinical rehabilitated and home rehabilita hemiplegic patients according to Hodkinson Mental Test and Rivermead Mobility Index

Amaç: Bu çalışma; serebrovasküler olaylara bağlı olarak hemipleji gelişen hastalarda, uygulanan rehabilitasyon tedavisi ile erişilen fonksiyonel bağımsızlık ve kognitif durumu, standart değerlendirme skalaları ile ölçebilmek ve bilinçli tedavi çalışmalarının başarısını tartışabilmek amacı ile yapıldı. Hastalar ve Yöntem: Araştırına Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı Kliniğinde rehabilite edilen 44 hemiplejik hasta ile evlerinde medikal ve egzersiz tedavi programına alınan 44 hemiplejik hasta olmak üzere toplam 88 olguda yapıldı. 8 hafta süren tedavi periyodu öncesi (T.Ö.) ve sonrasında (T.S.) Hodkinson Mental Test ve Rivermead Mobilite İndeks test sonuçları karşılaştırıldı. Bulgular: 1I. gruptaki hastaların Hodkinson Mental Testi (z = 3.823; p = 0.000) ve Rivermead Mobilite indeks (z=5.645; p=0.000) sonuçlarına göre tedavi öncesi ve tedavi sonrası istatistiksel değerlerinin anlamlı olarak gelişim gösterdiği belirlenmiştir. II. gruptaki hastaların Hodkinson Mental Testi (z=3.173; p = 0.001) ve Rivermead Mobilite indeks z=4.782; p=0.000) sonuçlarına göre tedavi öncesi ve tedavi sonrası istatistiksel değerlerinin anlamlı olarak gelişim gösterdiği belirlenmiştir (Şekil II,III, Tablo V). I. Ve II. grup karşılaştırıldığında I. Grupta II. gruba göre istatistiksel olarak daha anlamlı olduğu gözlendi (p<0.005). Sonuç: Bu değerlendirme skalalarının sonuçlarına göre hem I. hem II. grupta fonksiyonel bağımsızlık ve kognitif durumlarında gelişim olduğu, gelişimin I. grupta II. gruba göre istatistiksel olarak daha anlamlı olduğu gözlendi (p<0.005).Purpose: The aim of this study is to measure the achieved functional independency and cognitive condition with rehabilitation programs by using standart assessment scales in hemiplegic patients due to cerebrovasculer accidents and to evaluate the efficiency of rehabilitation therapy. Methods: 88 hemiplegic patients admitted to Physical Medicine and Rehabilitation Department were randomly separated into two groups. In the first group, 44 patients were hospitalised for clinical rehabilitation programs. And the other 44 patients, instructed for home rehabilitation program, formed the second group. Before and after 8 weeks period of treatment program, the results of Hodkinson Mental Test and Rivermead Mobility Index were compared. Results: Hodkinson Mental test and Rivermead Mobility Index values in.Group I patients were found out to improve after the therapy when compared with before therapy values. The same improvement for Hodkinson Mental Test, Rivermead Mobility Index were also observed in Group II patients. The amount of improvement was significantly higher in Group I. when compared with that of Group II. Conclusion: Improvements in functional and cognitive status were both observed in Group I and II patients M-according to the evaluation of the scales This improvement wax significantly more prominent in Group I than Group II (p&lt;0.05)

Strok tipi komplikasyonların rehabilitasyon sonuçlarıyla ilişkisi

Amaç: Çeşitli etyolojik nedenli hemiparezisi olan olgular tedavi öncesi ve sonrası incelenerek fonksiyonel geri dönüşüm oranları, motor gelişimleri, oluşan komplikasyonlar ve bunlar üzerinde etkisi olabilecek faktörler araştırıldı. Hastalar ve Yöntemler: Rehabilitasyona alınan 82 hasta (52 erkek; ort. yaş 57.06±15.43; dağılım 8-82 ve 30 kadın; ort. yaş 56.17±14.41; dağılım 18-78) retrospektif olarak değerlendirildi. Olguların yaş, cinsiyet, tutulan taraf, etyolojik neden, mental durum, lisan özelliği, rehabilitasyona başlayana kadar geçen süre, giriş ve taburcu öncesi Brunnstrom değerleri, Ashworth indeksleri, fonksiyonel ambulasyon evreleri (FAE), Barthel indeksleri (Bİ), takip süresince ortaya çıkan komplikasyonlar ve hastanede toplam yatış süreleri kaydedildi. Bulgular: Tüm hastaların hastaneden çıkış öncesi Brunnstrom değerleri, Bİ ve FAE'leri hastaneye yatışlarına göre anlamlı düzeyde farklıydı. Rehabilitasyona başlayana kadar geçen süre ile tedavi sonrası değişim oranı arasında negatif korelasyon vardı. Hastanede yatış süresi ile skorlardaki değişim oranının pozitif korelasyon gösterdiği görüldü. Takip sırasında gelişen enfeksiyonların Bİ ve FAE'deki değişimi olumsuz etkilediği saptandı. Sonuç: Çalışmamızın bulguları hemiparezik olguların fonksiyonel durumlarının rehabilitasyonla olumlu yönde etkilendiğini, bu değişimin etyolojik nedenlerle ilişkisiz olduğunu ve komplikasyonların tedavi sonuçlarını etkilemediğini göstermektedir.Objectives: We examined cases of hemiparesis with various aetiological reasons, before and after treatment in order to analyse the factors which may affect functional recovery rates, motor development and complications. Patients and Methods: Eighty-two patients (52 males; mean age 57.06&plusmn;15.43; range 8-82 and 30 females; mean age 56.17&plusmn;14.41; range 18-78) were retrospectively evaluated. Patient characteristics including age, gender, side of hemiparesis, type of stroke, mental condition, speech ability, the onset to rehabilitation admission interval, Brunnstrom values, the Ashworth index, the Functional Ambulation Categories (FAC), Barthel index (BI) on admission and before discharge from the hospital, complications and length of inpatient stay were recorded. Results: There were significant differences between admission and discharge Brunnstrom values, BI and FAC's in all the patients. There was a negative correlation between the onset to rehabilitation admission interval and the rate of change after treatment. A positive correlation was observed between the length of inpatient stay and the rate of change in the scores. It was determined that infections negatively affected the changes in BI and FAC's after treatment. Conclusions: Our results suggest that the functional outcome of hemiparetic patients was positively affected by rehabilitation, and that the aetiological reasons and complications did not affect the results of the treatment

Multiple myeloma and spinal involvement: Case report Multipl miyelom ve spinal tutulum: Olgu sunumu

Multiple myeloma is a malignant tumor, usually presenting with multiple or diffuse bone involvement, characterized by plasma cells showing varying degrees of immaturity, including atypical forms. The most frequent clinical symptom is bone pain, generally referred to the spine, often remaining unlocalized. Three cases with delayed multiple myeloma diagnosis, admitted with back pain and initially diagnosed as benign spine disease, are presented in this study and literature is rewieved

The Effects of Medical Treatments on Bone Mineral Density and Laboratory Data in Osteoporosis Patients

This study was carried out in order to compare the effects and relations between the scores of bone mineral density (BMD) values and laboratory data parameters such as serum Ca, Mg, P, ALP, creatinine, urinary Ca, creatinine, creatinine clearance before and after different treatments in patients with senil and postmenopausal OP. 251 female patients referred to OP outpatient clinic, were included in this study. The baseline demographic characteristics were inquired. BMD measurments were performed with DEXA and laboratory data related to bone metabolism such as serum Ca, P, Mg, ALP, creatinine; urinary Ca, creatinine, creatinine clearance, were obtained before and after treatment periods. The patients were divided into 7 groups according to their different medical treatments (Ca, Ca+Vit D, Ca+active Vit D, Calcitonin+Ca), Alendronate 10-70 mg+Ca, Risedronate+Ca regarding similar treatment durations. The comparisons between laboratory data and BMD values were investigated. According to the results statistical correlations were found; 1. Between P and femoral neck BMD (r=0.525, p=0.030), urinary Ca and ward’s triangle BMD (r=0.525, p=0.044) in the first group; 2. Between ALP and L2 BMD (r=0.652, p=0.04), Ca and L3 BMD (r=0.672, p=0.033) in the second group; 3. Between ALP and L2 BMD (r=-0.360, p=0.000), (r=-0.360, p=0.000), ALP and L3 (r=-0.229, p=0.029), urinary Ca and femoral neck BMD (r=0.238, p=0.029) in fourth group; 4. Between Mg and throcanteric BMD (r=0.599, p=0.024) in the sixth group; 5. Between P and femoral neck BMD (r=0.377, p=0.014), urinary Ca and L3 BMD (r=0.319, p=0.040) in seventh group. Up to day, there is no consensus about the choice of medical treatment for OP. It is reported that researches made on the effectiveness of the OP treatments often were condratiction to each other. We conclude that different kinds of medical treatments used in OP were effective on increasing BMD values, however there was not any evident effect on laboratory data parameters

Static and dynamic plantar pressure measurements in adolescents Ergenlik dönemindeki çocuklarda statik ve dinamik ayak basinç degerleri.

OBJECTIVES: This study was designed to determine normal values of pedobarography during standing and walking in adolescents in our country and to investigate correlations between demographic data and pedobarographic values. METHODS: Fifty volunteers (25 girls, 25 boys; mean age 14 years; range 13 to 15 years) who were found to have healthy feet according to the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating system for the ankle and foot were enrolled into the study. Plantar pressures were measured during standing and walking tasks with the use of the Mini-Emed pedobarographic device. RESULTS: Static measurements showed significantly higher pedobarographic values for right medial forefoot and toes in girls, and for left midfoot in boys (p<0.05). Overall, no significant differences existed between static pressure values for the right and left feet. The mean right medial foot pressure was higher than that of the contralateral foot in girls. There were no significant differences between the right and left feet in boys. Dynamic measurements showed a significantly larger contact area of the right foot in boys, and a significantly higher maximum plantar pressure of the left medial forefoot in girls (p<0.05). The strength of the correlation of body weight and body mass index was high with maximum plantar pressures (r=0.87 and r=0.83), and moderate with contact area of the foot (r=0.63 and r=0.59) in static measurements. Body weight (r=0.64) and body mass index (r=0.54) were moderately correlated with contact area of the foot in dynamic measurements. CONCLUSION: Appreciation of normal plantar pressure values in adolescents is important in monitoring the development stages of foot, in the assessment of foot disorders, and in making proper footwear modifications in compliance with age