Measuring tactile sensitivity and mixed-reality-assisted exercise for carpal tunnel syndrome by ultrasound mid-air haptics

IntroductionCarpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy, which causes numbness and pain in the thumb, the index and middle fingers and the radial side of the ring finger. Regular hand exercises may improve the symptoms and prevent carpal tunnel surgery. This study applied a novel ultrasonic stimulation method to test tactile sensitivity in CTS and also a mixed-reality-assisted (MR-assisted) exercise program which measured hand movements and provided haptic feedback for rehabilitation.MethodsTwenty patients with mild unilateral CTS took part in the experiments. A mid-air haptics device (Ultrahaptics STRATOS Explore) was used to apply amplitude-modulated ultrasound waves (carrier frequency: 40 kHz) onto the skin to create tactile stimulation mechanically. Participants performed a two-alternative forced-choice task for measuring tactile thresholds at 250-Hz modulation frequency. They were tested at the index fingers and the thenar eminences of both hands. Additionally, 15 CTS patients used an MR-assisted program to do hand exercises with haptic feedback. Exercise performance was assessed by calculating errors between target and actual hand configurations. System Usability Scale (SUS) was adopted to verify the practical usability of the program.ResultsThresholds at the thenar eminences of the affected and healthy hands were not significantly different. While the thresholds at the healthy index fingers could be measured, those of the affected fingers were all higher than the stimulation level produced by the maximum output from the ultrasound device. In the exercise program, a significant positive correlation (ρ = 0.89, p < 0.001) was found between the performance scores and the SUS scores, which were above the criterion value established in the literature.DiscussionThe results show that thenar tactile sensitivity is not affected in mild CTS as expected from the palmar cutaneous branch of the median nerve (PCBm), but index finger threshold is likely to be higher. Overall, this study suggests that mid-air haptics, with certain improvements, may be used as a preliminary test in the clinical setting. Moreover, the device is promising to develop gamified rehabilitation programs and for the treatment follow-up of CTS

The effects of Covid-19 on physical medicine and rehabilitation in Turkey in the first month of pandemic

Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians

Laron sendromlu 5 olgu: Klinik ve moleküler değerlendirme

Laron Syndrome is defined as primary growth hormone resistance or insensitivity. Our aim is to discuss the clinical,laboratory findings and growth hormone receptor gene mutation analysis of the Laron Syndrome cases.5 patients'(two girls, 3 boys) pretreatment height standard deviation score (SDS), annual growth rates, growth hormone, and IGF-1, IGFBP3 levels , age at initial treatment age, and also the height SDS, and annual growth rates, at first, second, and third years of the treatment, the doses of the targeted drugs which can be used were evaluated to find the effectiveness of the treatment.Growth hormone receptor gene mutations were evaluated. The mean age was 3.0;plusmn;2.7 years, height SDS was -5.06;plusmn;0.7 and target height SDS was -0.72;plusmn;0.95. Pretreatment annual growth rate was 3.5;plusmn;1.7 cm (1.8-6.0). Baseline growth hormone levels were over 40 pg/ml in all patients. Mean baseline IGF, mean IGF response to IGF generation test values were 9.7;plusmn;9.9 ng/ml, and 10.7;plusmn;9.8 ng/ml, respectively. Due to the difficulties to get the recombinant IGF treatmen, we could start the therapy at the mean age of 4.06;plusmn;2.6 years. Usually the doses of the drugs used per year were under the targeted doses for the patients. The average annual growth rates were 3.73 cm/year, 4,24 cm/year, 3,55 cm/year, at 1st, second and third years, respectivelly. Growth hormone receptor gene analysis revealed homozygote missense c.1630 A;gt;C(p.I544L) mutation in one patient and; c.1419 C;gt;T(p.S473S) polymorphism in two siblings and c.1681 C;gt;A(p.P561T) homozygous mutation in one patient, c.629 T;gt;G(p.V210G) ve c.1567 A;gt;C(p.I526L) compound heterozygous mutation in one patient. As a result, it has been demonstrated that cases with Laron syndrome patients do not give adequate clinical response to recombinant IGF treatment.Laron sendromu, primer büyüme hormon direnci veya duyarsızlığı olarak tanımlanan bir hastalıktır. Bu çalışmada kliniğimizde izlenen Laron sendromu tanılı olguların klinik, laboratuvar ve "Büyüme Hormon Reseptor" gen mutasyonlarının değerlendirilmesi amaçlandı. Beş (2 kız, 3 erkek) olgunun, tedavi öncesi boy SDS, yıllık büyüme hızları, büyüme hormonu, IGF-1, IGF-BP3 düzeyleri, tedavi başlama yaşı, tedavini etkinliğini belirlemek amacıyla tedavinin birinci, ikinci ve üçüncü yıllarında boy SDS ve yıllık büyüme hızı ölçümleri, hedeflenen ve kullanılabilen ilaç dozları (mg/kg/yıl) değerlendirildi. "Büyüme Hormon Reseptor" gen mutasyonları çalışıldı. Tanıda ortalama yaş 3,0±2,7 yıl, boy SDS -5,06±0,7, hedef boy SDS -0,72±0,95, tedavi öncesi yıllık büyüme hızı 3,5±1,7 cm idi. Laboratuvar incelemelerinde bazal büyüme hormonu tüm hastalarda 40 pg/ml üzerinde, bazal IGF-1 düzeyleri 9,7±9,9 ng/ml, IGF jenerasyon testine ortalama IGF yanıtı 10,7±9,8 ng/ml saptandı. İlaç temininde oluşan aksaklıklar nedeni ile rekombinant IGF-1 tedavisine başlama yaşı 4,06±2,6 idi. Yıllık uygulanan ilaç miktarlarının genel olarak hedeflenen düzeyin altında kaldığı saptandı. Olguların ortalama yıllık büyüme hızı tedavinin 1. yılında; 3,73 cm/yıl, 2. yılında 4,24 cm/yıl, 3. yılında 3,55 cm/yıl olarak bulundu. Olguların birinde "Büyüme Hormon Reseptor" geninde homozigot missense c.1630 A>C (p.I544L) mutasyon ve iki kardeşte c.1419 C>T (p.S473S) polimorfizmi, 1 olguda c.1681 C>A (p.P561T) homozigot mutasyonu, 1 olguda c.629 T>G (p.V210G) ve c.1567 A>C (p.I526L) bileşik heterozigot mutasyonu saptandı. Sonuç olarak, Laron sendrom'lu bu olgularda rekombinant IGF-1 tedavisine yeterli klinik yanıt olmadığı gösterildi

Five cases with Laron syndrome: Clinical and molecular evaluation

WOS: 000392950600010Laron Syndrome is defined as primary growth hormone resistance or insensitivity. Our aim is to discuss the clinical, laboratory findings and growth hormone receptor gene mutation analysis of the Laron Syndrome cases. 5 patients'(two girls, 3 boys) pretreatment height standard deviation score (SDS), annual growth rates, growth hormone, and IGF-1, IGFBP3 levels, age at initial treatment age, and also the height SDS, and annual growth rates, at first, second, and third years of the treatment, the doses of the targeted drugs which can be used were evaluated to find the effectiveness of the treatment. Growth hormone receptor gene mutations were evaluated. The mean age was 3.0+/-2.7 years, height SDS was -5.06+/-0.7 and target height SDS was -0.72+/-0.95. Pretreatment annual growth rate was 3.5+/-1.7 cm (1.8-6.0). Baseline growth hormone levels were over 40 pg/ml in all patients. Mean baseline IGF, mean IGF response to IGF generation test values were 9.7+/-9.9 ng/ml, and 10.7+/-9.8 ng/ml, respectively. Due to the difficulties to get the recombinant IGF treatmen, we could start the therapy at the mean age of 4.06+/-2.6 years. Usually the doses of the drugs used per year were under the targeted doses for the patients. The average annual growth rates were 3.73 cm/year, 4,24 cm/year, 3,55 cm/year, at 1st, second and third years, respectivelly. Growth hormone receptor gene analysis revealed homozygote missense c. 1630 A>C(p. I544L) mutation in one patient and; c. 1419 C>T(p. S473S) polymorphism in two siblings and c. 1681 C>A(p. P561T) homozygous mutation in one patient, c. 629 T>G(p. V210G) ve c. 1567 A>C(p. I526L) compound heterozygous mutation in one patient. As a result, it has been demonstrated that cases with Laron syndrome patients do not give adequate clinical response to recombinant IGF treatment

Seating system for scoliosis in nonambulatory children with cerebral palsy: a randomized controlled trial

OBJECTIVE: This study aimed to investigate the effect of an adaptive seating system on pelvic obliquity and spinal coronal/sagittal balance in children with nonambulatory cerebral palsy and scoliosis. METHODS: This was a single-blind, prospective, randomized interventional study. Nonambulatory children aged 6???15 years with cerebral palsy and scoliosis were included. The seating system was used for 4 h/day, and exercises were performed 3 days/week for 12 weeks. The Cobb angle, spinopelvic parameters, pelvic obliquity, Reimer???s migration index, and Sitting Assessment Scale were measured before and after treatments. RESULTS: A total of 29 participants were randomized into two groups, namely, the seating system+exercise group (SSE-group; n=15) and the exercise group (E-group; n=14). There was no significant change in Cobb angle and Reimer???s migration index for both hips in SSE-group, but there was a significant increase in E-group (p=0.002, 0.049, and 0.003, respectively). The sagittal vertical axis, pelvic incidence, and pelvic obliquity decreased in SSE-group. However, there was no difference in the other sagittal parameters and Sitting Assessment Scale-total scores among groups. CONCLUSION: The adaptive seating system was found to be superior in reducing the progression of Cobb angle and hip subluxation/dislocation, decreasing pelvic obliquity, and improving the sagittal balance of the spine/pelvis compared with exercise therapy

Comparison of platelet-rich plasma and extracorporeal shock wave therapy in patients with chronic lateral epicondylitis: A prospective, randomized-controlled study

Objectives: In this study, we aimed to investigate the effectiveness or comparative therapeutic superiority of exercise, extracorporeal shock wave Patients and methods: Between January 2016 and February 2017, a total of 74 patients (14 males, 60 females; mean age; 49.7 +/- 7.6 years, range, 26 to 60 years) with chronic LE were included in this prospective, randomized-controlled study. All patients received stretching and eccentric strengthening exercises for three months. The patients were divided into three groups. The first group (Exercises group, n=24) was given home exercises. The second group (ESWT+Exercises group, n=25) received one session of ESWT added once a week for three weeks. The third group (PRP+Exercises group, n=25) received one session of PRP in addition to the exercise program. All patients were evaluated for pain Elbow Evaluation (PRTEE), handgrip strength by a dynamometer, and extensor tendon thickness by ultrasonography (USG) at baseline and at Results: A significant improvement was found in the VAS, DASH, PRTEE, handgrip strength values at six months compared to between in all groups (p 0.001). Extensor tendon thickness as assessed by USG indicated no significant difference (p 0.05). Regarding the VAS activity levels, there was a significant difference in the PRP+Exercises group compared to the Exercises group at six months of follow-up (p<0.001). The decrease in the DASH scores during six-month follow-up was significantly higher in the PRP+Exercises group compared to the Exercises group (p=0.004). For the PRTEE scores at six months, the PRP+Exercises group showed a statistically significant improvement than both Exercises (p<0.001) and Conclusion: In the treatment of chronic LE, PRP combined with exercise seems to be superior to exercise or ESWT in terms of pain an