Investigation of health literacy level and its effect on quality of life in patients with spinal cord injury.

OBJECTIVES: To determine the health literacy (HL) level in patients with traumatic spinal cord injury (SCI) and evaluate the relationship between HL and the quality of life (QoL). STUDY DESIGN: Cross-sectional study. SETTING: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Turkey. PARTICIPANTS: A total of 77 patients with traumatic SCI aged 15-65 years where the trauma had occurred at least a month ago before data collection and who were attending the rehabilitation program at the hospital as inpatients we included in the study. OUTCOME MEASURES: The European Health Literacy Questionnaire Turkish Adaptation (HLS-TR) was used for the evaluation of the HL level, and the Short Form-36 was used for the evaluation of the QoL. RESULTS: The HL level was inadequate in 32.5%, problematic-limited in 40.3%, sufficient in 19.5%, and excellent in 7.8% of the patients. The vitality and mental health subdimensions of the QoL were found to be statistically significantly better in participants with excellent, sufficient or problematic-limited HL compared to those with an inadequate level. CONCLUSIONS: According to our results, the HL level of the majority of patients with SCI who are hospitalized in our hospital is low, and there is a relationship between HL and QoL. In conclusion, steps need to be taken to increase the HL levels of patients to improve their QoL, taking into account the important effect of HL on the QoL.

Effect of virtual reality therapy on functional development in children with cerebral palsy: A single-blind, prospective, randomized-controlled study.

OBJECTIVES: The aim of this study was to investigate the effect of virtual reality (VR) therapy on motor and functional development in children with cerebral palsy (CP). PATIENTS AND METHODS: In this single-blind, prospective, randomized-controlled study, a total of 41 patients (28 males, 13 females; mean age 8.49 years; range, 5 to 15 years) receiving inpatient treatment for CP were included between April 2009 and September 2009. The patients were randomly divided into two groups as the study group (n=21) and control group (n=20). Neurophysiological and conventional treatment methods, and occupational therapy were applied to all patients. In addition, a total of 12 VR therapy sessions for one hour were administered three days a week for four weeks to the study group. Before and after treatment, the Bimanual Fine Motor Function (BFMF) test was performed to measure hand functioning, Gross Motor Function Classification System (GMFCS) for functional levels, and Functional Mobility Scale (FMS) for mobility. RESULTS: There was a significant increase in the BFMF, GMFCS, and FMS scores after treatment, compared to baseline values in the study group (p<0.05). There was a statistically significant results in favor of the study group for all parameters after treatment compared to pre-treatment values (p<0.05). CONCLUSION: Our study results indicate that VR therapy is a useful treatment method which can be used in rehabilitation of CP with improved motor function. The addition of this method to conventional rehabilitation techniques may have a significant impact on treatment success.

Demographic and clinical features and rehabilitation outcomes of patients with Friedreich ataxia: A retrospective study.

OBJECTIVES: This study aims to investigate the demographic and clinical features, and rehabilitation outcomes of Friedreich Ataxia patients in the inpatient setting. PATIENTS AND METHODS: Between January 2000 and December 2012, a total of 37 Friedreich Ataxia patients (26 males, 11 females; mean age 29.2±9.6 years; range, 16 to 53 years) were included in the study. Demographic and clinical features of the patients and rehabilitation outcomes were reviewed retrospectively. Duration of rehabilitation, age at onset of disease, first onset of extremity, were determined. The Functional Ambulation Category (FAC) and Hoffer Ambulation Scale levels were used to assess the ambulation levels of patients. The Barthel Index scores were used to assess daily living activities of the patients before and after the treatment. RESULTS: The mean rehabilitation duration was 4.7±1.4 weeks. There was cardiac involvement in nine (24.3%) patients and obstructive/ restrictive pulmonary disease in five patients (13.5%). A total of 33 patients (89.2%) had severe ataxia, four (10.8%) had mild ataxia, 33 (89%) had dysarthria, 18 (48.6%) had scoliosis, 16 (43.2%) had kyphose, 15 (40.5%) had pes cavus, five (13%) had optic atrophy, and two (6%) had nystagmus of all patients. At the end of the rehabilitation program, all patients were discharged with functionally improved levels based on the FAC, Hoffer Ambulation Scale (p<0.05), and Barthel Index (p<0.001), indicating a statistically significant difference. CONCLUSION: An appropriate and comprehensive rehabilitation program improves the ambulation level and independence level of daily activities in patients with Friedreich ataxia, which highlights the importance of rehabilitation in these patients.

A Randomized Controlled Study: Effectiveness of Functional Electrical Stimulation on Wrist and Finger Flexor Spasticity in Hemiplegia.

AIM: The objective of this study was to investigate the effectiveness of functional electrical stimulation (FES) applied to the wrist and finger extensors for wrist flexor spasticity in hemiplegic patients. METHODS: Thirty stroke patients treated as inpatients were included in the study. Patients were randomly divided into study and control groups. FES was applied to the study group. Wrist range of movement, the Modified Ashworth Scale (MAS), Rivermead Motor Assessment (RMA), Brunnstrom (BS) hand neurophysiological staging, Barthel Index (BI), and Upper Extremity Function Test (UEFT) are outcome measures. RESULTS: There was no significant difference regarding range of motion (ROM) and BI values on admission between the groups. A significant difference was found in favor of the study group for these values at discharge. In the assessment within groups, there was no significant difference between admission and discharge RMA, BS hand, and UEFT scores in the control group, but there was a significant difference between the admission and discharge values for these parameters in the study group. Both groups showed improvement in MAS values on internal assessment. CONCLUSION: It was determined that FES application is an effective method to reduce spasticity and to improve ROM, motor, and functional outcomes in hemiplegic wrist flexor spasticity.

The analysis of serum lipid levels in patients with spinal cord injury.

STUDY DESIGN: Retrospective study. OBJECTIVES: The purposes of this investigation were to evaluate the serum lipid profile among a broad sample of patients with spinal cord injury (SCI), examining the impact of disease duration, lesion level, lesion grade and functional activity level on serum lipid levels of patients with SCI. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. METHODS: Serum lipid profiles of 269 participants with SCI were analyzed and correlated to disease duration, lesion level, lesion grade and ambulation status. RESULTS: Total cholesterol (TC) was higher than normal in 21.2%, low density lipoprotein cholesterol in 24.4%, and triglycerides levels in 31% of the patients. The high density lipoprotein cholesterol (HDL-c) level was found to be lower than 40 mg/dl in 79.5% of the patients, TC/HDL-c ratio was 4.5 and above in 65.7% of the patients in our study. TC/HDL-c ratio was significantly higher in patients with SCI with a disease duration of 0-12 months than the group with a longer disease duration (P = 0.009). TC/HDL-c ratio was significantly higher in patients who could not be community ambulated than the patients who were community ambulated (P = 0.005). HDL-c levels in patients with motor complete SCI were significantly lower than patients with motor incomplete SCI (P = 0.028). CONCLUSION: Dyslipidemia is observed in a large number of patients with SCI. The risk of dyslipidemia was seen to have increased in motor complete SCI patients, in patients who can not be community ambulated and whose disease duration is between 0 to 12 months.

Coexistence of Deep Vein Thrombosis, Heterotopic Ossification, and Complex Regional Pain Syndrome due to Hemorrhagic Stroke.

CASE: A patient who developed hemiplegia related to a hemorrhagic stroke and who had not been started on venous thromboembolism prophylaxis or a physical medicine and rehabilitation program was admitted to our clinic on the 4th month after the event. Our patient had pain, swelling, redness, increased temperature at the right lower extremity, range of motion limitation at the hip and knee, deep vein thrombosis (DVT) and complex regional pain syndrome (CRPS) at the same side lower extremity, and heterotopic ossification (HO) at the hip. CONCLUSIONS: Our case is presented to emphasize the HO that is not frequently seen after stroke, the importance of DVT prophylaxis in hemorrhagic stroke, and the association between DVT, HO, and CRPS.

Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study.

OBJECTIVE: To investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. DESIGN: Randomized controlled trial. SETTING: Training and research hospital. PARTICIPANTS: Adult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30). INTERVENTIONS: Both groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5 d/wk, for 2 to 4 h/d. The mirror therapy group received an additional mirror therapy program for 30 min/d. MAIN OUTCOME MEASURES: We evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity. RESULTS: After 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores. CONCLUSIONS: In patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy.

Effects of neuromuscular electrical stimulation on the wrist and finger flexor spasticity and hand functions in cerebral palsy.

PURPOSE: To evaluate the effects of neuromuscular electrical stimulation on wrist range of motion, wrist and finger flexor spasticity, and hand functions in patients with unilateral cerebral palsy. METHOD: Twenty-four children with unilateral spastic cerebral palsy (14 boys and 10 girls) between the ages of 5 and 14 years were randomized into neuromuscular electrical stimulation and control groups. Conventional exercises were applied, and static volar wrist-hand orthosis was administered to all patients 5 days a week for 6 weeks. Additionally, 30-minute neuromuscular electrical stimulation sessions were applied to the wrist extensor muscles in the neuromuscular electrical stimulation group. Patients were evaluated by Zancolli Classification System, Manual Ability Classification System, and Abilhand-Kids Test. RESULTS: Compared with baseline, a significant increase was evident in active wrist extension angle at the fourth and sixth weeks in both groups (all P < 0.001), more prominent in the neuromuscular electrical stimulation group at the fourth and sixth weeks (P = 0.015 and P = 0.006, respectively). A decrease was observed in the spasticity values in the neuromuscular electrical stimulation group at the fourth and sixth weeks (P = 0.002 and P = 0.001, respectively) and in the control group only at the sixth week (P = 0.008). Abilhand-Kids values improved only in the neuromuscular electrical stimulation group (P < 0.001). CONCLUSION: Neuromuscular electrical stimulation application in addition to conventional treatments is effective in improving active wrist range of motion, spasticity, and hand functions in cerebral palsy.

The effect of electromyographic biofeedback treatment in improving upper extremity functioning of patients with hemiplegic stroke.

This study evaluated the effect of electromyographic biofeedback (EMG-BF) treatment on wrist flexor muscle spasticity, upper extremity motor function, and ability to perform activities of daily living in patients with hemiplegia following stroke. A total of 40 patients were enrolled and were randomly assigned to two groups: a group treated with EMG-BF (study group) and a untreated (control) group. Both groups participated in a hemiplegia rehabilitation program consisting of neurodevelopmental and conventional methods and verbal encouragement to "relax" spastic wrist flexor muscles. In addition, the study group received 3 weeks of EMG-BF treatment, 5 times a week, for 20 minutes per session at hemiplegic side wrist flexors. Clinical findings were assessed before and after rehabilitation using the Ashworth scale (AS), Brunnstrom's stage (BS) of recovery for hemiplegic arm and hand, the upper extremity function test (UEFT), the wrist and hand portion of the Fugl-Meyer scale (FMS), goniometric measurements of wrist extension, surface EMG potentials, and the Barthel Index (BI). There was no statistically significant difference between the two groups in terms of age, sex, systemic disease, and the etiology, side, and duration of hemiplegia. There also was no statistically significant difference in the pretreatment values between two groups. We found statistically significant improvements posttreatment in the AS, BS, UEFT, goniometric measurements of wrist extension, and surface EMG potentials in the study group. We also noted statistically significant differences in the wrist and hand portion of the FMS and the BI in both groups, but with significantly greater improvements in the study group. Our findings indicate a positive effect of EMG-BF treatment in conjunction with neurodevelopmental and conventional methods in hemiplegia rehabilitation.

The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial.

PURPOSE: To investigate the effect of functional electrical stimulation (FES) for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients. METHOD: A total of 50 hemiplegic patients with shoulder subluxation and shoulder pain were included in the study. The patients were randomly divided into the study and control groups. All patients were put on a rehabilitation program using conventional methods while the study group patients were additionally applied FES to supraspinatus and posterior deltoid muscles. The shoulder pain of all patients during resting, passive range of motion (PROM) and active range of motion (AROM) was measured with the visual analog scale (VAS) while the shoulder subluxation levels were evaluated with the classification developed by Van Langenberghe and by using the millimetric measurements on anteroposterior shoulder X-ray before and after the physical treatment and rehabilitation program and compared. RESULTS: Comparison of the resting AROM vs. PROM VAS value changes showed no significant difference between the groups. There was a significant difference between the two groups for the amount of change in shoulder subluxation in favor of the study group. CONCLUSIONS: The results of our study have shown that applying FES treatment to the supraspinatus and posterior deltoid muscles in addition to conventional treatment when treating the subluxation in hemiplegic patients is more beneficial than conventional treatment by itself.