16 research outputs found
Osteoporosis and Heterotopic Ossification in Patients with Spinal Cord Injury
Osteoporosis is an important complication of spinal cord injuries. Trabecular bone is more affected. The pattern of bone loss in spinal cord injury (SCI) patients is different from that in osteoporosis which occurs as a result of other etiologies such as endocrine diseases, nutritional and drug-related disorders. Rehabilitation interventions include standing and walking exercises, electrical stimulation, low-intensity pulsed ultrasound, vibration and pulsed electromagnetic fields. Calcium, vitamin D, calcitonin and bisphosphonates are the pharmacological therapies. In SCI patients, the incidence of heterotopic ossification, radiologically or clinically detected, ranges from 10 to 53%. Etiology is not yet clear. After SCI, the hip is the most common site of heterotopic ossification, followed by the knee, elbow and shoulder. Humoral, neuro-immunological and local factors play a role in the pathophysiology. Three-phase bone scan with technetium (Tc)-99m-labeled methylene diphosphonate is used in the early diagnosis. Elimination of risk factors and prophylaxis are important detearminants of treatment. Bisphosphonates, indomethacin, radiation, surgical resection are the other treatment options. Turk J Phys Med Rehab 2010; 56 Suppl 2: 75-8
Neuralgic amyotrophy as the primary cause of shoulder pain in a patient with rotator cuff tear
A 66-year-old woman with no history of trauma presented with severe shoulder pain. Magnetic resonance imaging revealed rupture of the supraspinatus tendon, for which surgical treatment was considered. However, it was noted that shoulder pain was accompanied by weakness in the shoulder muscles, and the patient underwent electroneuromyographic examination, which revealed neuralgic amyotrophy. Following physical therapy and rehabilitation combined with appropriate medical therapy, her symptoms significantly improved. In cases with severe shoulder pain without a trauma history, characteristics of pain should be thoroughly analyzed and neuralgic amyotrophy considered in the differential diagnosis
Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system
Purpose: Cerebral palsy (CP) is the most common disability in childhood. The gross motor function classification system (GMFCS) has become an important tool to assess motor function in CP patient. In 2007, the expanded and revised (E&R) version of GMFCS which includes age band for youth 12-18 years of age was developed. The aim of this study was to evaluate reliability of Turkish version of expanded and revised GMCS. Methods: We assessed interobserver reliability between two physical medicine and rehabilitation specialists in 136 children with CP and test-retest reliability within a subgroup of 48 patients. Percent agreement, intraclass correlation coefficient (ICC) and mu statistics were used to evaluate reliability. Result: The ICC between two physicians was 0.97 and the total agreement was 89%. This result indicates excellent agreement. The overall weighted mu was 0.86. High test-retest reliability was found (ICC: 0.94 95% confidence interval) and the total agreement was 75% for test-retest reliability. Conclusion: The Turkish version of the E&R GMFCS is shown to be reliable and valid for assessment of Turkish CP children
Botulinum toxin a injection for spasticity in diplegic-type cerebral palsy
Botulinum toxin type A can be both safe and effective in relieving spasticity in pediatric patients with cerebral palsy. In our prospective study, we evaluated the functional effect of botulinum toxin A in spastic diplegic-type cerebral palsy. Patients were examined on enrollment and at 1, 3, and 6 months after injection. Passive dorsiflexion of the ankle joint was measured using a goniometer as an angle of possible maximal dorsillexion with the knee extended and flexed. Spasticity was graded using the Modified Ashworth Scale. Selective motor control at the ankle was assessed, and observational gait analysis was done. The functional status of the patients was determined by using the gross motor classification system. Botulinum toxin A was injected into the gastrocnemius muscle in all patients, and in four patients with concomitant jump knee gait, a hamstring muscle injection was added. Fourteen patients were included in the study. The mean age was 58.81 +/- 15.34 months. Following injection, spasticity was clinically decreased and statistically significant improvement was noticed in all clinical parameters after 1, 3, and 6 months of injection. The improvement in the clinical parameters decreased after 6 months but not to the baseline. One patient was Level II, four patients were Level III, and six patients were Level IV according to the Gross Motor Function Classification System at baseline. Improvement in the gross motor classification system is continued after 6 months in 12 children. The main goal of spasticity treatment in cerebral palsy is functional improvement. In our study, most of our patients had functional improvement according to the gross motor function classification system and did not change at 6 months
Do antispasmodics affect the body composition and basal metabolic rate in patients with cerebral palsy?
The aim is to describe differences in the basal metabolic rate, anthropometric and body composition measurements between cerebral palsy (CP) patients treated and not treated with antispasmodic agents. Children diagnosed with CP and a healthy control group were included in the study. Patients were divided into two groups: patients currently treated with antispasmodics (group 1) and patients without antispasmodic treatment (group 2). There were 34 children with CP, mean age 7.57±3.62 years. Although weight and height measurements were significantly reduced in patient groups compared to the healthy control group, there was no significant difference between group 1 and group 2. Body mass index, triceps and subscapular skinfold thickness, arm circumference, and waist/hip ratio were not statistically different between group 1 and group 2. Although there was significant reduction in lean mass, dry mass, body cell mass, basal metabolic rate and fat free mass index in patient groups as compared to control group, there was no significant difference between group 1 and group 2 according to fat percentage, fat mass, total body water, body fat mass index, lean mass, dry mass, body cell mass, basal metabolic rate, fat free mass index, and basal metabolic rate/body weight. In conclusion, additional studies are needed to detect the exact effect of antispasmodic drugs on body composition in CP
Impaired quality of life and functional status in patients with benign joint hypermobility syndrome
Objective: To evaluate the function and health-related quality of life [QoL], and to determine the relationship between pain, function and QoL in patients with benign joint hypermobility syndrome [BJHS]
Hypermobility syndrome increases the risk for low bone mass
Few studies on the benign joint hypermobility syndrome suggest a tendency toward osteopenia, but there are conflicting results. We assessed bone mineral density in pre-menopausal women with hypermobility. Twenty-five consecutive Caucasian women diagnosed with benign hypermobility syndrome by Beighton score and 23 age- and sex-matched controls were included in the study. Age, menarch age, number of pregnancies, duration of lactation, physical activity and calcium intake were questioned according to European Vertebral Osteoporosis Study Group (EVOS) form. All subjects were pre-menopausal and none of them were on treatment with any drugs effecting bone metabolism or had any other systemic disease. No statistically significant difference was found for body mass index, menarch age, number of pregnancies, duration of lactation, calcium intake, calcium score and physical activity score between the two groups. Total femoral and trochanteric bone mineral density and t and z scores were significantly lower in hypermobile patients compared to the control group. Ward's triangle and femoral neck z scores were also found to be significantly low in hypermobile patients (p < 0.05). Significant negative correlations were found between the Beighton scores and trochanteric BMD, t and z scores (r=-0.29, r=-0.30, and r=-0.32) in hypermobility patients. Low bone mass was more frequently found among subjects with hypermobility (p=0.03). Hypermobility was found to increase the risk for low bone mass by 1.8 times (95% confidence interval 1.01-3.38). Our study suggests that pre-menopausal women with joint hypermobility have lower bone mineral density when compared to the controls and hypermobility increases the risk for low bone mass
The Effect Of Arm Sling On Static Balance In Stroke Patients
Objective: Stroke is an important cause of disability in adults. Poststroke patients with hemiplegia have problems in standing and walking, and balance is deteriorated. Shoulder subluxation is a very common problem in patients with hemiplegia and use of arm slings is a traditional treatment in this condition. The aim of this study is to investigate the effect of arm sling on balance in patients with hemiplegia
Correlation between motor performance scales, body composition, and anthropometry in patients with duchenne muscular dystrophy
The aim of this study is to investigate the relationship between body composition, anthropometry, and motor scales in patients with Duchenne muscular dystrophy (DMD). Twenty six patients with DMD were evaluated by Expanded Hammersmith Functional Motor Scale (HFMSE), gross motor function classification system (GMFCS), multifrequency bioelectrical impedance analysis, and anthropometric measurements. Seventeen healthy children served as control group. There were 26 patients with a mean age of 9.5 +/- A 4.8 years. Ages and anthropometric measurements did not differ between groups. Of the 26 patients, nine were level I, seven were level II, two were level III, seven were level IV, and one was level V, according to the GMFCS. Despite the similar percentage of total body water, extracellular water/intracellular water ratio was significantly elevated in DMD patients (p = 0.001). Increased values of fat percentage and body fat mass index (BFMI) correlated positively with elevated GMFCS levels (r = 0.785 and 0.719 respectively). Increased fat-free mass index (FFMI) correlated negatively with elevated GMFCS levels (r = -0.401). Increased fat percentage and BFMI correlated negatively with HFMSE scores (r = -0.779 and -0.698, respectively). Increased values of FFMI correlated positively with HFMSE scores. There was also a negative correlation between increased skin fold measurements from triceps and scapula and HFMSE scores (r = -0.618 and -0.683, respectively). Increased skin fold values from the same regions correlated positively with elevated GMFCS levels (r = 0.643 and 0.712, respectively). Significant body composition changes occur in patients with DMD. Anthropometric and multifrequency bioelectrical impedance analyses measurements show good correlation between motor function scales. These results may also be helpful to evaluate the effects of new treatment strategies