Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics.

OBJECTIVE: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. METHODS: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. RESULTS: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. CONCLUSIONS: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Is it possible to objectively determine morning stiffness in rheumatoid arthritis?

Objectives: This study aimed to objectively and quantitatively exhibit morning stiffness by using electrophysiological methods. Patients and methods: The prospective, controlled study was conducted with 52 participants between February 2013 and February 2014. Of the participants, 26 were recruited among RA patients (3 males, 23 females; mean age: 55.9±11.2 years; range, 24 to 74 years) followed at the rheumatology clinic, and 26 were healthy subjects (4 males, 22 females; mean age: 54.9±8.3 years; range, 41 to 70 years) for the control group. Duration and severity of morning stiffness were recorded for all participants. Activity of disease and functional status were evaluated by the Disease Activity Score 28 and Health Assessment Questionnaire (HAQ), respectively. Electrophysiological reaction times, severity of pain (Visual Analog Scale), HAQ, and grip strength were measured for each participant twice in 24 h in the morning (08:00-09:00 am) and afternoon (03:00-05:00 pm). Results: In the RA group, motor reaction and response times and severity of pain values were significantly lower in the afternoon compared to the morning (p=0.030, p=0.031, and p=0.002, respectively), and hand grip strengths were significantly higher in the afternoon (p=0.007). In the control group, no change was observed between morning and afternoon measurements in the strength and reaction time variables. Conclusion: Our hypothesis that stiffness would slow down the movements in the morning in RA was supported by the prolonged motor and response times in the morning compared to the afternoon. However, in the control group (no morning stiffness), there was no difference in reaction time variables between the morning and afternoon, objectively demonstrating the concept of morning stiffness in this study.

Impairment of upper trapezius branch of the spinal accessory nerve during bypass grafting: a stretch injury?

Internal jugular vein catheterization has been implicated in spinal accessory nerve (SAN) injuries after coronary artery bypass grafting (CABG). Stretch injury due to prolonged positioning during CABG has also been proposed as another mechanism of injury. Herein we describe a male patient with left shoulder pain and abduction difficulty following CABG, who displayed electromyographic abnormalities confined to the left upper trapezius muscle. Internal jugular vein catheterization had not been performed during surgery. Although unusual, the possibility of upper trapezius muscular branch paralysis should be considered in patients with shoulder pain or weakness after CABG.

Intraoperative neurophysiological monitoring during surgery for tethered cord syndrome.

AIM: The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented. MATERIAL AND METHODS: An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries. RESULTS: MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation. CONCLUSION: Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits.

Evaluation of pain and flexor reflex responses and their association with clinical parameters in patients with fibromyalgia.

OBJECTIVES: In the present study, we aimed to evaluate electrophysiological outcomes of flexor reflexes (FR) emerging in response to painful stimuli in fibromyalgia (FM) patients. PATIENTS AND METHODS: This study included a total of 21 female FM patients (mean age 36.8±8.0 years; range, 20 to 50 years) and 28 healthy female controls (mean age 37.3±8.8 years; range, 22 to 53 years). Clinical features of the patients, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores were recorded. Electrophysiological stimulation threshold, visual analog scale (VAS) scores of generated pain after each stimulation, current intensity, flexor responses obtained from muscles, and electrophysiological measurement of these responses were noted. RESULTS: The threshold for perception of electrical current was higher and resistance level to maximum electrical current was lower in FM patients (p<0.05). The VAS scores of FM patients under maximum electrical current were higher than the control group (p<0.05), while the lowest current value in which FR response obtained in FM patients was lower (p<0.05). The latency was lower, amplitude was higher, and response area was wider in FM patients (p<0.05). No significant relationship between the FIQ, BDI, BAI scores and stimulant perception threshold levels was found in FM patients (p>0.05). CONCLUSION: Based on these findings, FR responses may be useful as an electrophysiological parameter in FM diagnosis.

The effect of a single session submaximal aerobic exercise on premotor fraction of reaction time: an electromyographic study.

BACKGROUND: Numerous studies investigating the effect of exercise on reaction time have yielded contradictory results. Most of the studies use computer based methods to measure reaction time instead of electromyography, yielding total reaction time rather than premotor time. In this study, we aimed to investigate the effect of a single session aerobic exercise on premotor fraction of reaction time in sedentary healthy individuals. METHODS: Twenty-two sedentary healthy subjects (11 subjects for the study group and 11 for the control group) enrolled in this study. Subjects in the exercise group performed a single session submaximal cycling exercise. Electromyographic reaction times were measured before and after the exercise session. In the control group, reaction time measurements were taken twice with an interval of 20 min. FINDINGS: In the exercise group, premotor fraction of reaction time values decreased considerably (P=0.01) after the exercise session. INTERPRETATION: A single bout of cycling exercise significantly improved premotor fraction of reaction time in healthy young sedentary subjects. Physical activity improves not only physical fitness but also cognitive functions. Electromyographic reaction time evaluations may be used in the sports medicine field where both aerobic fitness and short reaction time are indispensable demands.

Muscular and condylar response to rapid maxillary expansion. Part 1: electromyographic study of anterior temporal and superficial masseter muscles.

INTRODUCTION: In this prospective clinical study, we investigated the effects of rapid maxillary expansion (RME) on the electromyographic (EMG) activities of the anterior temporal and superficial masseter muscles. METHODS: The sample included 18 subjects (11 girls, 7 boys; mean age, 12.54 years) with unilateral or bilateral posterior crossbites involving 3 or more posterior teeth. There was no control group in this study because of the short observation period. The EMG activity was recorded simultaneously from both muscles during swallowing a sip of water and unilateral gum chewing. RESULTS: The mean EMG (mEMG) activities of the right and left anterior temporal muscles showed no statistically significant difference during swallowing and unilateral chewing. The mEMG activities of the right and left masseter muscles showed a statistically significant difference at unilateral chewing (P <0.01). There were a decrease of the mEMG activities for both muscles after RME and an increase during the observation period for unilateral chewing (P <0.05). Swallow-related mEMG activities of both muscles showed increases after RME and during the observation period (P <0.05). CONCLUSIONS: RME affected the EMG activities of the anterior temporal and superficial masseter muscles during swallowing and unilateral chewing. These findings suggest that the alterations in the EMG activities of these muscles should be considered in both the treatment and the the stability of maxillary transverse deficiencies.

Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery.

OBJECTIVE: The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age. METHODS: 43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient. RESULTS: Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups. CONCLUSION: Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery. LEVEL OF EVIDENCE: Level III, Diagnostic Study.

What is the optimal repetition number in electromyographic reaction time studies?

BACKGROUND: To find out how many trials of electromyographic reaction time measurements are needed for reliable interpretation. METHODS: The electromyographic reaction time values were obtained by surface electromyography from the flexor digitorum superficialis muscle of the 20 healthy volunteers. After five practice trials, the measurements were repeated 20 times. The differences between the 20 reaction time measurements were analyzed to find out the optimal repetition number of reaction time trials. FINDINGS: The electromyographic reaction time values decreased upon repetition. The first consecutive five records were significantly longer than the second, third and fourth consecutive five records. However no difference was found among second, third and fourth consecutive five records. INTERPRETATION: The results of our study indicate that before 15 test trials, 10 practice trials are needed for learning in simple electromyographic reaction time studies that use similar testing conditions with our study. However this conclusion needs verification with a study using a larger group of subjects.

Reaction time and movement time in patients with carpal tunnel syndrome: an electromyographic study.

OBJECTIVE: To measure the motor performance of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles using the parameters electromyographic muscle reaction time and movement time in patients with carpal tunnel syndrome during key turning function. METHOD: A total of 37 female patients with right hand pain were divided into two groups: 21 with an electrophysiologically confirmed diagnosis of carpal tunnel syndrome (Group I), and 16 with normal electrophysiological findings (Group II). The reaction time and movement time values obtained by surface electromyography of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles were compared between groups. RESULTS: Of the 21 patients in Group I, 15 had mild, four moderate, and two severe median nerve lesions. No significant difference between groups was found in the electromyographic reaction time and movement time values of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during key turning (P>0.05). There was also no significant difference in electromyographic reaction time and movement time between six patients with severe or moderate carpal tunnel syndrome and 15 patients with mild carpal tunnel syndrome in Group I (P>0.05). Sixteen patients in Group II did not have carpal tunnel syndrome. CONCLUSION: The results indicate that patients with and without carpal tunnel syndrome have similar values of reaction time and movement time of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during the pinch grasp function of the hand. RELEVANCE: Muscle reaction time and movement time, and hence the motor performance in electrophysiologically confirmed carpal tunnel syndrome patients appear to have similar parameters in patients with hand pain whose diagnosis were not confirmed with electrophysiologically.

Femoral nerve injury following a lumbar plexus blockade.

BACKGROUND: Lumbar plexus blockade (LPB) combined with sciatic nerve block (SNB) is frequently used for lower extremity surgery. Perioperative nerve injury is a rarely encountered complication of peripheral nerve blocks (PNB). CASE REPORT: Here we report a 44-year-old male patient who developed a partial femoral nerve injury (FNI) following a LPB which was performed before the surgery of a patellar fracture. The clinical and electroneuromyographic findings of the patient were recovered almost completely within the following six months. CONCLUSION: The presented case demonstrated a FNI despite the absence of any pain or paresthesia sensation, with the disappearance of motor response under 0.3 mA of neurostimulation in the experienced hands.

Effects of perineural tramadol on nerve conduction of sural nerve.

OBJECTIVES: The aim of this study was to investigate whether tramadol had a dose-dependent blocking effect on nerve conduction when administered perineurally to the sural nerve of healthy volunteers. METHODS: Twenty-four informed healthy subjects were randomized into four equal groups [Saline (placebo), 0.5% tramadol, 1% tramadol and 1.5% tramadol]. The study was designed to be double-blinded. Sensory nerve action potentials were recorded electroneurographically. Two milliliters of study solution was administered to the sural nerve perineurally at the level of the ankle with the guidance of a nerve stimulator. A sensory block was assumed to have developed when the amplitude of the averaged sensory nerve action potentials diminished below 80% of the baseline value in the subsequent recordings. RESULTS: According to the electroneurographical recordings, none of the volunteers in the saline group had block. However, the block rates with 0.5%, 1% and 1.5% tramadol were 1/6, 4/6 and 6/6, respectively (p<0.05). The maximum decrement in the sensory action potential amplitudes with respect to baseline amplitudes (given as median values) were as follows: 7.8% with saline; 12.5% with 0.5% tramadol; 38.5% with 1% tramadol; and 77.5% with 1.5% tramadol (p<0.05). While the median duration of sensory block with 0.5% tramadol was 5 minutes, it was 15 minutes with 1% tramadol and 35 minutes with 1.5% tramadol. CONCLUSION: Perineurally administered tramadol blocks sensory nerve conduction of the sural nerve in a dose-dependent manner.

Carpal lock and the volar-supporting orthosis in mild and moderate carpal tunnel syndrome.

OBJECTIVE: The carpal lock, which is a hand/wrist orthosis that supports the dorsal aspect of the hand, was used in patients with mild-moderate carpal tunnel syndrome, and its clinical and electrophysiological effectiveness was compared with that of a volar-supporting orthosis. DESIGN: Nerve conduction study and clinical evaluation of 24 patients (41 hands) with mild or moderate carpal tunnel syndrome were performed before and 3 mos after the use of the carpal lock or the volar-supporting orthosis. RESULTS: Significant improvement was observed in electrophysiological parameters and clinical outcomes after use of both orthoses. There was no statistically significant difference between the two groups. Patients in the carpal lock group used the orthosis 89.6% of the prescribed time, whereas those in the volar-supporting orthosis group used the orthosis 79.2% of the prescribed time (P < 0.05). CONCLUSIONS: The carpal lock may be used as an alternative to the volar-supporting orthosis.

Effects of perineural tramadol on sensory and motor conduction of ulnar nerve.

STUDY OBJECTIVE: We aimed to study the effects of perineural tramadol on both sensory and motor conduction of ulnar nerve by electroneurography (ENG). DESIGN: Prospective. SETTING: Physical Medicine and Rehabilitation Electrophysiology Laboratory. PATIENTS: Eight healthy volunteers. INTERVENTION: Either 3-mL of saline or 50 mg of tramadol in 3-mL saline was initially administered perineurally to ulnar nerve of nondominant extremity. After two weeks, volunteers who received tramadol were given saline, whereas the ones who received saline were given tramadol. MEASUREMENTS: Baseline sensory and motor responses of ulnar nerve were recorded by ENG prior to injection of study solutions. Perineural injections were realized by means of a teflon-coated needle and a nerve stimulator. Following injections, sensory and motor responses were monitored every five minutes in the first hour and then every 10 minutes until the sensory and motor amplitudes reached at least 80 percent of the baseline value. MAIN RESULTS: Perineural tramadol administration showed a significant decrease from baseline measurement in the sensory response amplitude with respect to saline administration (65.9 percent vs 12. 7 percent, p < 0.05). Decrease in the motor response amplitudes from baseline versus saline was insignificant (32.9 percent vs 15.2 percent). Sensory block was observed in all of the subjects after tramadol injection when compared with saline administration and lasted 25 minutes (p < 0.05). The duration of motor block lasted 12.5 minutes, and motor block developed in four out of eight subjects when compared with saline administration (p < 0.05). Time to reach maximum sensory and motor block were 15 and 10 minutes, respectively, after tramadol injection. CONCLUSIONS: Tramadol has a brief local anesthetic-like action when administered to ulnar nerve perineurally.

Acute effects of a single session of aerobic exercise with or without weight-lifting on bone turnover in healthy young women.

This study aimed to investigate the acute effects of exercise on bone turnover and to determine whether brisk walking with or without weight-lifting makes a difference on bone metabolism. Nine healthy women performed two exercise bouts: brisk walking on a treadmill for 30 min (E), and similar exercise carrying 5 kg of weight in a backpack (WE). Serum parathyroid hormone (PTH), osteocalcin (OC), calcitonin (CT), procollagen type 1 carboxy terminal propeptide (PICP), procollagen type 1 amino terminal propeptide (PINP), type 1 collagen carboxy terminal telopeptide (ICTP), total alkaline phosphatase (ALP), and urine deoxypyridinoline (D-Pyr) levels were studied. Resting values served as control. Significant variances were observed only in serum ALP and PTH values. Variances in ALP values within subjects after exercise were statistically significant (analysis of variance in repeated measurements [AVRM], P=0.000). E caused a significant decrease, while WE caused a significant increase in ALP values at the 24th h (Bonferroni pairwise comparisons tests [BPC t-test]: P=0.028, P=0.000, respectively). Variances in PTH values within subjects after exercise were statistically significant (AVRM, P=0.029), while diurnal variation was not significant (P=0.981). E caused significant alterations in PTH levels (an increase at the 30th min, turned towards baseline at the 45th min) (BPC t-test, P=0.007). WE also caused alterations in PTH levels, though insignificant (BPC t-test, P=1.00). Brisk walking for 30 min has stimulating effects on bone turnover by various mechanisms without any additive effect of weight bearing.