Expectations of patients with hemiparesis from physiotherapy programme: concordance among patients, patients’ caregiver and physiotherapists

Purpose: The aim of this study was to examine the agreement between physiotherapists (PTS), patients and caregivers about the physiotherapy of patients with hemiparesis. Materials and methods: Fifty-two patients with hemiparesis (M¼24, F¼28), caregivers (N¼52) and PTs (N¼52) who applied for the physiotherapy programme were interviewed. Demographic and clinical characteristics of the patients were recorded. A questionnaire composed of six questions was used to describe the expectations of the PTs, caregivers and patients about the physiotherapy programme. Results: The Kappa calculator revealed a statistically moderate level of agreement between PTs and caregivers (K¼0.532, p¼.0001), patients and caregivers (K¼0.496, p¼.0001) and PTs and patients (K¼0.401, p¼.0001) regarding the expectations of physiotherapy programme. Conclusion: Expectations of the patients and caregivers must be considered for rehabilitation; hence, participation in the therapy and efficacy of the physiotherapy programme will increase. Consequently, we believe that the expectations of the patients and caregivers should be considered by the PTs when preparing a treatment programme for patients with hemiparesis

Spinal cord stimulation in failed back surgery

Objective: Spinal cord stimulation is used for treating failed back surgery syndrome, chronic arachnoiditis, peripheral neuropathies, postamputation phantom pain, complex regional pain syndrome and pain secondary to spinal cord injury. In this study we present 7 cases with intractable neuropathic radicular pain which developed following spine surgery. Material and Methods: Spinal cord stimulation was applied to 7 (3male/4 female) patients who had failed back surgery syndrome and pain resistant to medical and invasive methods, with the council decision, which included neurosurgery, neurology, and psychiatry. One week stimulation trial was applied to all cases. Results:The mean age of the patients was 54.85±7.64 years. The mean of pain intensity in Visual Analog Scale was 8.71±0.74 at preoperative status and post operative pain intensity was 2.27±0.67 at 6 months. Pain intensity significantly decreases after spinal cord stimulation (p=0.000). One of the three cases who had unsuccessful trial period received morphine pump implantation, and percutaneous lumbar sympathectomy was applied to another one. One case who received permanent implantation was replaced to another location due to skin erosion. There was no morbidity. Conclusion: Spinal cord stimulation is an effective tool in reducing pain, in patients who have unsuccessful lower back surgery with the correct indications

Effect of Chronic Non-specific Neck Pain on Aerobic Capacity in Females

Objective: To examine the effect of chronic non-specific neck pain (NSNP) on maximal aerobic capacity (VO2max) in females. Methods: This study evaluated a total of 104 participants including 52 females aged 20-40 years who were diagnosed with chronic NSNP for at least 1 year (patient group) and 52 healthy females (control group). Mean age of the patient group was 31.04±5.65 years and of the control group was 31.33±5.10 years. Pain severity was evaluated with visual analog scale (VAS), neck disability degree with Neck Disability Index (NDI), and VO2max with Bruce Protocol Treadmill Test. Results: Mean VAS score was 5.86±1.11 cm and mean disease duration was 4.72±4.20 years in the patient group. There was no significant difference in terms of VO2max level between the two groups (p>0.05). However, in the patient group, there was a moderate negative significant correlation between NDI value and VO2max level (r=-0.344, p=0.012). In addition, there was a moderate positive significant relationship between pain duration (hours/day) and NDI value in the patient group (r=0.308, p=0.026). Conclusion: As a result of the study, it was seen that there was no difference between the patient and healthy groups in terms of aerobic capacity. However, in the patient group, aerobic capacity decreased as the degree of neck disability increased. In the treatment of patients with neck pain, considering the respiratory dysfunction and the factors that cause it may contribute to the treatment processes

Parkinson hastalarında subtalamik çekirdek derin beyin stimülasyonunun fiziksel, emosyonel, kognitif fonksiyon ve günlük yaşam aktiviteleri üzerine etkisi

Aim: To describe effectiveness of deep brain stimulation of subthalamic nucleus (DBS STN) on physical, emotional, cognitive functions and daily activities in Parkinson's patients. Material and Methods: Ten patients (51.20 ±10.20 yr.) were assessed three times. The Time Up and Go Test, 12 m Walking Test and Chair Stand Test were used to assess mobility and balance. Purdeu Pegboard and hand writing tests were used to evaluate hand function. The Hospital Anxiety and Depression Scale (HAD) was used to detect depressive symptoms and anxiety score. The Unified Parkinson\'s Disease Rating Scale (UPDRS) and Hoehn &Yahr Scale were also used. The Schwab and England Test was used to evaluate the daily activities (ADL). Results: The results showed that all the patients' mobility and balance ability improved after surgery (p<0.05). Depressive symptoms/anxiety scores were found to be lower than before surgery (p<0.05). There were differences in terms of ADL and UPDRS scores after surgery (p<0.05). At six month after surgery; depressive symptoms decreased by 78%. ADL and UPDRS motor and total scores improved by 190%, 72%, and 78% respectively. Conclusion: STN DBS is an effective treatment to improve physical functioning, emotional status and daily activities in Parkinson's patients. However, it did not show any positive effect on cognitive function

Lumbar spinal schwannoma with retroperitoneal invasion: a case report

Schwannom periferik sinir kılıfının schwann hücrelerinden köken alan nadir bir tümördür. Genellikle baş, boyun ve üst extremitelerde yerleşirler. Nadiren de posterior mediasten ve retroperitonda yerleşebilirler. 47 yaşinda bayan bir hasta rektal dolgunluk hissi ve bel ağrisi yakinmalari ile başvurdu. Yapilan radyolojik incelemeler sonucu pelvik retroperitoneal yerleşimli solid bir kitle tanisi ile yatirildi. Kadin Hastaliklari ve Doğum Kliniği ile Nöroşirürji Kliniğinin birlikte yaptiği cerrahi uygulama ile total olarak çikartilan kitlenin histopatolojik incelemesi Schwannom olarak rapor edildi. Kismi çikartilan destrükte olmuş L5 korpusu nedeniyle lumbosakral bölge enstrümante edilip stabillendi ve kemik greft ile füzyon yapildi. Postoperatif dönemde sorunu olmayan hasta takip edilmek üzere taburcu edildi.SUMMARY Schwannomas or neurilemmomas are encapsulated tumours arising from the neural sheath of peripheral nerves. They are usually located in the head and neck or in the upper extremities, but may appear in the posterior mediastinum and more rarely in the retroperitoneum. A 47 year-old-female complaining of pelvic and lumbar pain has been admitted with the diagnosis of retroperitoneal pelvic solitary mass after radiologic evaluation. The mass has been resected totally through an anterior abdominopelvic incision and histopathology evaluation reported to be the schwannoma. Lumbosacral instrumentation and fusion with bone graft have been performed following the resection of the mass and destructed L5 vertebrae corpus. Postoperative period went uneventful

The effects of deep brain stimulation of subthalamic nucleus on physical, emotional, cognitive functions and daily living activities in patients with parkinson's disease: short term results

Bu çalışma parkinson hastalarında Subtalamik Çekirdek Derin Beyin Stimülasyon'un (STN DBS) fiziksel, emosyonel, kognitif fonksiyon ve günlük yaşam aktiviteleri üzerine olan erken dönem etkilerini değerlendirmek amacıyla gerçekleştirilmiştir. Çalışmada parkinson dışında herhangi bir nörolojik hastalığı olmayan STN DBS cerrahisi uygulanan 10 hasta cerrahi öncesi, cerrahi sonrası 5. gün, 1. ay ve 3. ayda değerlendirilmiştir. Mobilite ve denge yeteneğini değerlendirmek için Süreli Kalk Yürü Testi, 12 m Yürüme Testi, Otur-Kalk Testi uygulanmıştır. El fonksiyonlarının değerlendirilmesi için Purdue Pegboard Testi ve el ile yazı yazma testi uygulanmıştır. Emosyonel statüyü değerlendirmek için Hastane Anksiyete ve Depresyon Ölçeği (HAD) kullanılmıştır. Parkinson hastalığının klinik şiddetini belirlemek için Birleşik Parkinson Hastalığı Değerlendirme Ölçeği (BPHDÖ) kullanılmıştır. Parkinson hastalığının evresini belirlemede ise Hoehn&Yahr Parkinson Hastalığı Düzeyi Ölçeği, günlük yaşam aktivitelerinin (GYA) değerlendirilmesi için Schwab ve England Günlük Yaşam Aktiviteleri Değerlendirme Ölçeği kullanılmıştır. Olguların yaş ortalaması 51,20 ±10,20 yıldır (5 kadın, 5 erkek). Çalışmanın sonucunda bütün hastaların mobilite ve denge yeteneğini test sonuçlarında cerrahi sonrasında anlamlı gelişmeler elde edilmiştir (p<0.05). Depresyon ve anksiyete skorları cerrahi öncesine göre daha düşük bulunmuştur (p<0.05). Cerrahi sonrasında GYA ve BPHDÖ skorları arasında istatistiksel olarak anlamlı farklılık bulunmuştur (p<0.05). Tedavinin etkinliği açısından incelendiğinde cerrahi sonrası 3. ayda depresif semptomlarda %69 azalma bulunmuştur. GYA %200, BPHDÖ motor bulgularda %69, BPHDÖ toplam skorda %66 oranında gelişme elde edilmiştir. Bu çalışmanın sonuçları STN DBS cerrahisinin parkinson hastalarında fiziksel fonksiyon, emosyonel statü ve GYA üzerine iyileştirici yönde etkileri olduğunu, fakat kognitif fonksiyonlar üzerine etkisi olmadığını göstermiştir.The aim of this study was to descibe the effects of deep brain stimulation of subtalamic nucleus (DBS STN) on physical, emotional, cognitive functions and daily living activities in patients with Parkinson's disease in early term. Ten patients without any other neurological disorders who underwent DBS STN were assessed at before and fift day, at first month, and at third month after surgery. Time up and go test, a 12 m walking test, chair stand test were used to asses mobility and balance. Purdeu Pegboard and hand writing tests were also used to evaluate hand function of the patients. Hospital Anxiety and Depression Scale (HAD) was applied to detect depressive symptoms and to describe anxiety score. Unified Parkinson's Disease Rating Scale (UPDRS) was applied to define severity of Parkinson?s disease. To desribe the stage of Parkinson?s disease, the Hoehn&Yahr Scale was also used. The Schwab and England Test was used to evaluate the daily living activities. The mean age of the patients (5 female and 5 male) was 51, 20 ±10, 20 years. The results of this study showed that all the patients? mobility and balance ability improved after surgery significantly (p<0.05). Depressive symptoms and anxiety scores were also found to be lower than before surgery (p<0.05). There were also differences in terms of ADL and UPDRS scores after surgery (p<0.05). At third month after surgery; depressive symtoms decreased by 69%. ADL and UPDRS motor and total scores improved by 200%, 69%, 66% respectively. The results indicate that the STN DBS is an effective treatment to improve physical functioning, emotional status and daily living activities in patients with Parkinson?s disease. But, it did not show any positive effect on cognitive function in these patients

Clinical experience from Turkey in rehabilitation of parkinson’s disease after deep brain stimulation: What are we doing?

Motor symptoms in Parkinson's disease from the early stages of the disease affect balance and mobility. Functional disorders caused by clinical symptoms lead to deterioration in activities of daily living and quality of life, depending on the severity of disease. The physiotherapy program to be applied according to the needs of the patient in different phases of Parkinson's disease will also vary. Beginning the physiotherapy program in early stages of disease may help to avoid problems that lead to dependence, inactivity, social isolation and reduced quality of life. Rehabilitation starting in the early postoperative period prolongs the effectiveness of deep brain stimulation. Physiotherapy improves both activities of daily living and the quality of life as well as motor symptoms after surgery