Does electromyographic biofeedback improve exercise effects in hemiplegic patients? A pilot randomized controlled trial

Objective: The aim of this pilot randomized study was to assess the efficacy potential of an electromyo-graphic biofeedback-assisted exercise programme on clinical and functional outcomes of hemiplegic patients in comparison with sham electromyogra-phic biofeedback. Patients and methods: Thirty-four patients with hemiplegia were randomized into 2 groups. Both groups participated in an inpatient rehabilitation programme including exercise interventions and ambulation training 5 days a week for 2 weeks. Lower extremity exercises were performed via electromyogra-phic biofeedback in Group 1 (n = 17), while a sham technique was used for patients in Group 2 (n = 17). Range of motion, spasticity, muscle strength, func-tional level and walking speed were assessed before and after treatment. Follow-up was performed at 1 and 3 months after treatment. Results: Significant improvements were found for range of motion, muscle strength, Barthel Index and 10-m walking time in both groups. Conclusion: This study suggests that exercise with or without electromyographic biofeedback is effective for improving clinical and functional parameters in hemiplegic patients. Larger studies are needed to determine whether electromyographic biofeedback-assisted exercises provide additional benefits

Botulinum Toxin in Poststroke Spasticity

Poststroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Although most hemiparetic patients are able to reach different ambulatory levels with rehabilitation efforts, upper and lower limb spasticity can impede activities of daily living, personal hygiene, ambulation and, in some cases, functional improvement. The goals of spasticity management include increasing mobility and range of motion, attaining better hygiene, improving splint wear and other functional activities. Conservative measures, such as positioning, stretching and exercise are essential in spasticity management, but alone often are inadequate to effectively control it. Oral antispastic medications often provide limited effects with short duration and frequent unwanted systemic side effects, such as weakness, sedation and dry mouth. Therefore, neuromuscular blockade by local injections have become the first choice for the treatment of focal spasticity, particularly in stroke patients. Botulinum toxin (BTX), being one of the most potent biological toxins, acts by blocking neuromuscular transmission via inhibiting acetylcholine release. Currently, focal spasticity is being treated successfully with BTX via injecting in the spastic muscles. Two antigenically distinct serotypes of BTX are available on the market as type A and B. Clinical studies of BTX used for spastic hemiplegic patients are reviewed in this article in two major categories, upper and lower limb applications. This review addresses efficacy in terms of outcome measures, such as muscle tone reduction and functional outcome, as well as safety issues. Application modifications of dose, dilutions, site of injections and combination therapies with BTX injections are also discussed

2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis

WOS: 000438624900001PubMed ID: 29777340In a Turkish League Against Rheumatism (TLAR) project, evidence-based recommendations for the management of knee osteoarthritis (OA) was developed for the first time in our country in 2012 (TLAR-2012). In accordance with developing medical knowledge and scientific evidence, recommendations were updated. The committee was composed of 22 physical medicine and rehabilitation specialists (4 have rheumatology subspeciality also) and an orthopaedic surgeon. Systematic literature search were applied on Pubmed, Embase, Cochrane and Turkish Medical Index for the dates between January the 1st 2012 and January the 29th of 2015. The articles were assessed for quality and classified according to hierarchy for the level of evidence, and the selected ones sent to committee members electronically. They were asked to develop new recommendations. In the meeting in 2015, the format of the recommendations was decided to be patient-based and considering the grade and the severity of the disease. By the discussion of the each item under the light of new evidences, the final recommendations were developed. Each item was voted electronically on a 10-cm visual analogue scale (VAS) and the strength of recommendation (SoR) was calculated. In the light of evidences, totally 11 titles of recommendations were developed; the first 7 were applicable to each patient in every stages of the disease, remaining were for defined specific clinical situations. The mean SoR value of the recommendations was between 7.44 and 9.93. TLAR-2012 recommendations were updated in a new format. We think that, present recommendations will be beneficial for the physicians who manage, as well as the patients who suffer from the disease

Neuropathic Pain in Patients with Knee Osteoarthritis and Related Factors: A Multicenter Longitudinal Study-Preliminary Report

WOS: 00041182410504