Comparison of high-intensity laser therapy and combination of transcutaneous nerve stimulation and ultrasound treatment in patients with chronic lumbar radiculopathy: A randomized single-blind study.

OBJECTIVE: To compare the effects of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) with ultrasound (US) therapy on pain and functionality in patients with chronic lumbar radiculopathy. METHODS: This prospective randomized comparative study was conducted in Department of physical medicine and rehabilitation, Turgut Ozal Medicine Center, Malatya, Turkey from April 2016 to September 2016. A total of 54 patients with chronic lumbar radiculopathy were enrolled in this study. The patients were randomly divided into two groups: Group 1 (n:27) received 10 sessions of a combination of hot pack, TENS, US and exercise, and Group 2 (n:27) received hot pack, HILT and exercise. The outcomes measured were low back with unilateral leg pain level measured by visual analog scale (VAS) and functionality measured with the Oswestry Disability Index (ODI) at the end of the therapy and four weeks later. p-value less than 0.05 considered statistically significant. RESULTS: In two groups, VAS (low back with unilateral leg pain) and ODI scores showed significant changes. At the end of the 2 weeks intervention, participants in Group-1 showed a significantly greater decrease in pain than participants in Group-2. Statistically significant differences in pain variation and functionality (VAS and ODI) were observed four weeks after treatment sessions for participants in the TENS+US therapy group compared with participants in the HILT group. CONCLUSION: HILT and TENS+US combined with exercise were effective treatment modalities in decreasing the VAS and ODI scores. TENS+US combined with exercises were more effective than HILT combined with exercise.

Neuropathic pain in patients with post-COVID-19.

OBJECTIVE: In this study, we aimed to determine the continuing pain during the post-COVID-19 period the frequency of neuropathic pain in these patients, and the factors affecting the frequency. METHODS: A total of 209 participants were included in the study who had COVID-19 disease (PCR-positive) aged 18-75 years. The demographic characteristics and COVID-19 severity data were recorded by questioning the patients. The musculoskeletal pain was also assessed using Visual Analog Scale (VAS) and the extended Nordic musculoskeletal system questionnaire (NMQ-E). In addition, the neuropathic components of pain were evaluated using the Leeds Assessment of neuropathic symptoms and Signs (LANSS) pain scale and the Pain-DETECT questionnaire (PDQ). RESULTS: The mean time elapsed since COVID-19 was 5.76±2.95 months (min, 1; max, 12). Six patients (2.9%) had neuropathic pain according to the LANSS score, and 12 patients (5.7%) according to the PDQ score. The NMQ-E indicated that the most pain was detected in the back (20.1%), low back (15.3%), and knee (11.5%) regions during the post-COVID-19 period. According to both neuropathic pain scales; low back pain (p=0.001/0.001) and knee pain (p=0.001/0.01) were more common in patients with PDQ/LANSS neuropathic pain. Logistic regression analysis showed that there were significant associations between neuropathic pain and acute COVID-19 VAS score. CONCLUSION: This study demonstrated that musculoskeletal pain was prominent mostly in the back, low back, and knee during the post-COVID-19 period. The incidence of neuropathic pain was 2.9%-5.7% depending on the evaluation parameters. Neuropathic pain is a finding that should be considered during the post-COVID-19 period.

Effects of early physical therapy on motor development in children with Down syndrome.

Objective: The objective of the study was to compare the motor development of children with Down syndrome (DS) who received physical therapy (PT) and did not receive PT, and to show the effect of PT programs started before the age of one on movement development. Methods: The study included aged between 6 and 42 months, 58 children with DS. Children with DS were divided into two groups as receiving PT and non-receiving PT. Children with DS who received PT were further divided into two groups according to the age of starting PT as before and after 1 year of age. Gross motor and fine motor development of the cases were evaluated with Bayley Scales of Infant and Toddler Development III. Results: Gross motor scaled scores (GM-SS: 3.88±3.46-1.67±1.23), fine motor scaled scores (FM-SS: 4.29±3.24-1.79±0.93), and composite scores (64.4±19.5-50.38±5.38) of PT group were statistically higher than the non-PT group (p<0.05). In addition, GM-SS (5.22±4.23-2.38±1.20), FM-SS; (5.61±3.85-2.81±1.37), and composite scores (72.33±23.85-55.56±5.7) of the cases who started PT before the age of one were statistically higher than those who started after the age of one (p<0.05). Conclusion: Our results revealed that PT especially when started early childhood under had a positive effect on the development of gross and fine motor in children with DS and provided a scientific basis for referring children with DS to PT programs before the age of one. Clinicians should recommend PT for children with DS in the early period.

The relationship between motor performance and femoral cartilage thickness in children with Down syndrome.

Down syndrome (DS) is a genetic disorder associated with mental and motor developmental delays in childhood. The aim of this study was to investigate the relationship of the femoral cartilage thickness with motor performance in children with Down syndrome (DS). A total of 39 children with DS in the age range of 12-42 months were included in the study (female/male: 21/18; mean age: 23.4 ± 8.2 months). Femoral cartilage thickness was measured with ultrasound in the medial and lateral condyles and intercondylar areas of both knees. Gross motor subtest scaled scores of the Bayley Scales of Infant and Toddler Development III were used for the motor performance assessment. There was a positive correlation between the gross motor scaled scores and the femoral cartilage thickness in both knee joints (p < .05; r = 0.415 for the right medial condyle; r = 0.323 for the right lateral condyle; r = 0.339 for the right intercondylar area; r = 0.369 for the left medial condyle; r = 0.364 for the left lateral condyle, and r = 0.590 for the left intercondylar area). The study demonstrated that the femoral cartilage thickness was positively correlated with gross motor functioning in children with DS.

Impacts of combined osteopenia/osteoporosis and sarcopenia on balance and quality of life in older adults.

OBJECTIVE: Combined osteopenia/osteoporosis and sarcopenia is a major public health problem for old adults. In this study, we aimed to evaluate the impacts of combined osteopenia/osteoporosis with sarcopenia on balance and quality of life in patients older than 65 years. METHODS: In this sudy, 77 patients with sarcopenia, who were older than 65 years, were included. The diagnosis of sarcopenia was made according to the diagnostic criteria developed by The European Working Group on Sarcopenia in Older People (EWGSOP). Bone densitometry was performed to screen for osteoporosis or osteopenia. The balance was assessed with the anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and the general stability index (OSI), which were calculated using a Biodex Stability System device (BSS). The quality of life was assessed using SF-36. RESULTS: Patients with sarcopenia were included in this study. Of them, 40 had osteoporosis and 37 had osteopenia. The measures of balance and the OSI, APSI, and MLSI values were low in both groups of patients, but they were statistically significantly lower in the sarcopenia with osteoporosis group compared to the sarcopenia with osteopenia group (p=0.01; p=0.002; p=0.04, respectively). The quality of life was lower in all sub-categories of SF-36, excluding the mental health when sarcopenia was accompanied by osteoporosis compared to the joint occurrence of sarcopenia with osteopenia (p<0.05). CONCLUSION: Our study suggests that the joint occurrence of osteoporosis with sarcopenia is associated with a risk of balance loss, a decrease in quality of life, and a potentially increased fracture risk in older adults.

Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests.

INTRODUCTION: To evaluate the ultrasound findings of the median nerve in patients with clinical assigned carpal tunnel syndrome but normal nerve conduction studies. METHODS: This prospective, cross-sectional study involved 41 patients (51 hands) with clinically assigned CTS and normal nerve conduction studies and 20 healthy controls (30 hands). Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity, and mobility of the median nerve were evaluated. All patients were assessed with Boston Carpal Tunnel Questionnaire (BCTQ). RESULTS: CSA of the median nerve in the wrist was significantly higher in the patient group when compared to the control group. Echogenicity and mobility were significantly decreased in the patient group. Ultrasound abnormalities were positively correlated with clinical features. A significant correlation was observed among sensory loss, provocative tests, body mass index, BCTQ, and high CSA. CONCLUSION: US can help the clinicians with the diagnosis of carpal tunnel syndrome in patients with clinical symptoms but negative nerve conduction study results.

Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients.

OBJECTIVE: To determine the validity and reliability of the Turkish version of the Trunk impairment scale (TIS), used in the evaluation of somatic, motor, and coordination disturbances in stroke patients, and provide a culturally adapted version for use in the Turkish population. METHODS: A total of 80 patients who were either hospitalized at our facility and rehabilitated for stroke or admitted at our outpatient clinics were included in this study. Reliability was evaluated by the internal consistency (Cronbach α) and test reproducibility [intra-class correlation coefficient (ICCC)] methods, and validity was evaluated by the correlation between subgroups and the total scores of the TIS and Berg Balance Scale (BBS), Brunnstrom phases, Barthel index (BI), Rivermead mobility index (RMI), and Short Form-36 (SF-36) scores. RESULTS: The mean age of the patients was 63.00±12.1 years. Out of a total of 80 subjects, 34 were female and 46 were male. The reliability of the scale was evaluated by the internal consistency, inter- and intra-observer reliability, and test reproducibility. The findings showed that the Turkish form of the scale was reliable at a good level. The test values were as follows; Cronbach α: >0.70, ICCC: 0.969-1, subgroups and total score comparison: 0. The correlation between TIS and BBS was considerably high in the validity analysis (p<0.001). Further, significant associations among the BI, RMI, KF-36, Brunnstrom, and TIS scores were found (p<0.001), which indicate the structural validity of this scale. CONCLUSION: TIS is a scale used in measuring the motor derangement that develops after a stroke. It has sufficient reliability, internal consistency, and validity for use in clinical practice and stroke investigations. Our study has shown that TIS used for the evaluation of body balance is valid and reliable for the Turkish population.

Comparison of blood platelet distribution width and neutrophil-lymphocyte ratio in patients with different grades of knee osteoarthritis.

OBJECTIVE: The aim of this study was to compare platelet distribution width (PDW) and neutrophil to lymphocyte ratio (NLR) values in mild-to-moderate and severe knee osteoarthritis (OA). METHODS: This was a retrospective study of patients with knee OA according to the Kellgren-Lawrence (KL) grading system. Of 465 patients, 231 were excluded (62 due to not meeting the inclusion criteria and 169 due to the lack of simultaneous haemogram and radiographic evaluations). Demographic characteristics and PDW and NLR values were recorded. The patients were then divided into two groups: KL grade 1-3 (mild-to-moderate OA) and KL grade 4 (severe OA). RESULTS: In severe knee OA patients, blood PDW (13.44 ± 2.58, p= 0.01) and NLR values (2.16 ± 0.84, p= 0.04) were elevated as compared with those in mild-to-moderate knee OA patients. Blood PDW and NLR values of ⩾ 12.5 and ⩾ 2.1, respectively, were taken as cut-offs based on a receiver operating characteristics (ROC) curve analysis. In the ROC curve analysis, blood NLR ⩾ 2.1 had 60% sensitivity and 64.8% specificity, and PDW ⩾ 12.5 had 61% sensitivity and 58% specificity in predicting severe knee OA. In a univariate analysis, age (p< 0.001), PDW ⩾ 12.5 (p= 0.029) and blood NLR ⩾ 2.1 (p= 0.030) emerged as significant predictors of the severe knee OA. CONCLUSION: The results suggested that the blood PDW and NLR are novel inflammatory markers that can predict the radiographic severity of knee OA in clinical practice.

Functional outcomes following ultrasound-guided botulinum toxin type A injections to reduce spastic equinovarus in adult post-stroke patients.

OBJECTIVE: The aim of this study is to identify the effect on spasticity and walking of US-guided botulinum toxin type A (BoNT-A) injections administered to improve equinovarus walking pattern commonly observed in patients after stroke. MATERIAL AND METHOD: Twenty-three patients with post-stroke spastic equinovarus deformity were recruited. The US-guided BoNT-A injections were administered into the spastic muscles (including gastrocnemius; GK, soleus; S and tibialis posterior; TP) using a specific approach, and all of the patients were enrolled in rehabilitation programmes after the injections. Modified Ashworth Scale (MAS), Brunnstrom stage of lower limb, Functional Ambulation Score (FAS), Preferred Gait Speed (PGS) and the six-minute walk test (6MWT) were assessed at the baseline, 4 and 12 weeks after the BoNT-A injection. RESULTS: Significant decreases in the MAS scores of the lower limb muscle (GK, S and TP) tone were measured 4 and 12 weeks after the BoNT-A injection when compared to the baseline scores (p < 0.05). In parallel with a reduction in spasticity there was an increase in 6MWT and PGS in the 4th and 12th weeks. Increases in motor improvement and functional ambulation score were ensured in the 12th week (p < 0.05). CONCLUSION: Spastic equinovarus deformity observed in patients after stroke creates significant limitations in the patient's functional walking speed and distance. As a result, when BoNT-A injections accompanied by ultrasound to improve equinovarus deformity considering the innervation zones of the muscles with a specific approach are administered directly into the muscle at the correct point, we can say it provides hopeful results from a functional point of view.

Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients: an observational study.

BACKGROUND: Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach are not yet available in the literature. AIM: The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. DESIGN: Observational study. SETTING: Inpatient post-stroke patients. POPULATION: Twenty-five post-stroke patients with post-stroke upper limb spasticity were recruited. METHODS: The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programs after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. RESULTS: Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (P<0.025). When compared with the baseline Fugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (P<0.025). However, only the Fugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (P<0.025). CONCLUSIONS: Ultrasound-guided botulinum toxin type A injection via the Euro-musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programs decrease spasticity and improve the upper extremity motor functions in stroke patients. CLINICAL REHABILITATION IMPACT: This new approach for ultrasound-guided botulinum toxin type A injection is very practical and effective method for upper extremity spasticity.

Effects of ultrasound-guided botulinum toxin type-A injections with a specific approach in spastic cerebral palsy.

The aim of this study was to detect effects of ultrasound-guided botulinum toxin type-A (US-guided BoNT-A) injections prepared according to lower extremity innervation zones on spasticity and motor function in 3-16 years children with diplegic and hemiplegic spastic cerebral palsy. This study included 25 patients between 3 and 16 years of age who admitted to our clinic in 2017, were being followed in our clinic with a diagnosis of cerebral palsy, had BoNT-A injections due to lower extremity spasticity. The US-guided BoNT-A injections were administered into the spastic muscles using a specific approach according to innervation zones of muscle. Modified Ashworth Scale (MAS) and Gross Motor Functional Classification System (GMFCS) were assessed at the baseline, and 4 and 12 weeks after the BoNT-A injections. Minimum and maximum ages of the patients were 45 and 192 months, and gender distribution was 8 females and 17 males. Significant decreases in the MAS scores of the knee and ankle tones were measured 4 and 12 weeks after the BoNT-A injection when compared to the baseline scores (p < 0.025). Hip muscle tonus only decreased 12 weeks after the injection (p < 0.025). In parallel with a reduction in spasticity GMFCS improved from 3 to 2 in the 4th and 12th weeks. US-guided BoNT-A injections with Euro-musculus approach is a practical and effective method to perform injections into proper points of proper muscles in children with spastic cerebral palsy.

Comparison of splinting and Kinesio taping in the treatment of carpal tunnel syndrome: a prospective randomized study.

The aim of this study was to investigate and compare the effectiveness of splinting and Kinesio taping (KT) as forms of treatment for patients with mild to moderate idiopathic carpal tunnel syndrome (CTS) by evaluating the symptoms and measuring the range of function and electrophysiological findings. This single-blind, randomized, prospective study included 44 patients (58 hands) suffering mild to moderate idiopathic CTS according to nerve conduction studies (NCS). The patients were randomized into two groups and evaluated before treatment and 6 weeks after treatment by means of physical examination findings, NCS, and the Boston Carpal Tunnel Questionnaire (BCTQ) functional status and symptom severity scale scores. When the differences in both groups before and after treatment were compared, a significant improvement was observed in the KT group compared to the splint group in terms of electrophysiological changes, provocative test responses, BCTQ symptom severity, and functional status scores. KT may help prevent the disease from progressing further in mild and moderate idiopathic CTS when applied in time using the appropriate technique and be a good alternative to neutral splinting in terms of patient compliance.

Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia.

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain and systemic symptoms. The aetiology and pathogenesis of fibromyalgia are not yet fully understood. Blood neutrophil/lymphocyte ratio (NLR) is a marker of systemic inflammatory response. Platelet distribution width (PDW) and mean platelet volume (MPV) are the determinants of platelet activation and studied as markers in inflammatory diseases. The aim of the present study was to evaluate levels of NLR,PDW and MPV in patients with fibromyalgia. A total of 197 FMS patients and 53 healthy controls are included in the study. Demographic characteristics, erythrocyte sedimentation rate, C-reactive protein, neutrophil, lymphocyte and platelet counts, platelet distribution width and mean platelet volume levels were recorded. In the patient group, the blood NLR and MPV were significantly higher and the PDW was significantly lower compared to the control group. In the roc curve analysis, blood PDW ≥had 90.4% sensitivity and 90% specificity in predicting fibromyalgia. The results of this study suggest NLR and PDW as promising inflammatory markers indicating fibromyalgia and may be beneficial in facilitating the diagnosis of FMS patients.