An evaluation of bladder emptying methods and the effect of demographic and clinical factors on spontaneous voiding frequency in stroke patients.

In this study, the bladder emptying methods at different stages of the post-stroke period along with the effects of demographic and clinical parameters on spontaneous voiding frequency were investigated. The frequencies of bladder emptying methods at admission to the rehabilitation clinic, after neurourological and urodynamic assessment and at home after discharge were spontaneous voiding (SV) 51/99 (51.5 %), 62/99 (62.6 %), 73/99 (73.7 %), emptying without a urinary catheter + an external collector system (EWUC + ECS) 24/99 (24.2 %), 18/99 (18.2 %), 17/99 (17.2 %), intermittent catheterization (IC) 1/99 (1.0 %), 15/99 (15.2 %), 6/99 (6.1 %), indwelling urethral catheter (IUC) 23/99 (23.2 %), 4/99 (4.0 %) and 3/99 (3.0 %), respectively. Lower spontaneous voiding frequencies were observed in single-divorced and geriatric individuals (p < 0.05). The number of patients who modified the method at home was 2/62 for SV, 5/18 for EWUC + ECS, 9/15 for IC, and 2/4 for IUC. The majority of stroke patients were able to void spontaneously and the spontaneous voiding frequency increased at follow-up. The spontaneous voiding frequency was low in geriatric and single-divorced subgroups. The method in which the most changes occurred was IC.

Fever during rehabilitation in patients with traumatic spinal cord injury: analysis of 392 cases from a national rehabilitation hospital in Turkey.

OBJECTIVE: To determine the incidence and etiology of fever and the risk factors related to fever in adults with spinal cord injury (SCI) at the rehabilitation stage. DESIGN/SUBJECTS: A retrospective examination of records of 392 consecutive adult patients with traumatic SCI who received inpatient rehabilitation program. SETTING: A national rehabilitation center in Turkey. OUTCOME MEASURES: Incidence and etiology of fever, period of hospitalization (days). RESULTS: A total of 187 patients (47.7%) had fever at least once during their rehabilitation program. The most common etiology was urinary tract infection. The rate of fever occurrence was significantly higher in patients with complete SCI (P = 0.001). In patients with fever, the use of an indwelling catheter was significantly higher compared with clean intermittent catheterization and spontaneous voiding (P = 0.001). The hospitalization period of patients with fever was significantly longer than that of patients without fever (P = 0.006). CONCLUSIONS: A high rate of fever was seen in patients with SCI during rehabilitation. Fever was caused by various infections, of which urinary tract infection was the most common. Patients with motor complete injuries and those with permanent catheters constituted higher risk groups. Fever prolonged the length of rehabilitation stay and hindered active participation in the rehabilitation program.

Effects of ideomotor apraxia on functional outcomes in patients with right hemiplegia.

The aim of this study was to investigate the effect of ideomotor apraxia on activities of daily living and to determine if the presence of apraxia interferes with rehabilitation. This study was conducted on 47 patients with right hemiplegia. All the patients were assessed at their admission and discharge, respectively, for apraxia by Ideomotor Apraxia Test, for daily living activities by Functional Independence Measure (FIM, Santa Clara Valley Medical Center, San Jose, California, USA), for cognitive functions by Mini Mental State Examination (MMSE), and for language components by Gulhane Aphasia Test (GAT). The effects of apraxia presence and time course on FIM, MMSE, and GAT scores were investigated. Presence of apraxia was found to have significant effect on all test scores (P<0.05). Time course had the main significant effect on FIM, MMSE, and GAT scores (P<0.05). Interaction effect of both presence of apraxia and time course on the test scores was not significant either. In other words, apraxic and nonapraxic patients seemed to gain benefits from the neurological rehabilitation. However, mean FIM scores of apraxic patients during discharge have failed to reach the mean FIM scores of nonapraxic patients during admission. Apraxia is considered as an important determinant in the dependence of patients with stroke in their activities of daily living. For this reason, during the initial assessment of patients with right hemiplegia, apraxia should be tested, and the presence of apraxia as well as its severity should be determined.

Evaluation of ideomotor apraxia in patients with stroke: a study of reliability and validity.

OBJECTIVE: This aim of this study was to determine the reliability and validity of an established ideomotor apraxia test when applied to a Turkish stroke patient population and to healthy controls. SUBJECTS: The study group comprised 50 patients with right hemiplegia and 36 with left hemiplegia, who had developed the condition as a result of a cerebrovascular accident, and 33 age-matched healthy subjects. METHODS: The subjects were evaluated for apraxia using an established ideomotor apraxia test. The cut-off value of the test and the reliability coefficient between observers were determined. RESULTS: Apraxia was found in 54% patients with right hemiplegia (most being severe) and in 25% of left hemiplegic patients (most being mild). The apraxia scores for patients with right hemiplegia were found to be significantly lower than for those with left hemiplegia and for healthy subjects. There was no statistically significant difference between patients with left hemiplegia and healthy subjects. CONCLUSION: It was shown that the ideomotor apraxia test could distinguish apraxic from non-apraxic subjects. The reliability coefficient among observers in the study was high and a reliability study of the ideomotor apraxia test was therefore performed.

Evaluation of bone mineral density in patients with spinal cord injury.

BACKGROUND/OBJECTIVE: This study was performed to evaluate the bone mineral density (BMD) values in patients with spinal cord injury (SCI) and determine the effects of the level, severity, and duration of the neurological lesion and spasticity on BMD values. METHODS: A total of 75 patients with traumatic SCI and a healthy control group of 39 people were included in the study. The BMD values of the lumbar spine and 4 different regions of the hip (femoral neck, Ward's triangle, trochanter, and femoral shaft) of all cases were measured using dual energy x-ray absorptiometry. The biochemical markers were also analyzed. RESULTS: The BMD values in all measured regions were found to be decreased in patients compared with that of controls. The level and severity of the lesion and the spasticity did not significantly affect BMD values in the regions analyzed. The BMD values of the hip decreased as the duration of SCI increased. The levels of plasma phosphorus and alkaline phosphatase, calcium in 24-hour urine samples, and the calcium/creatinine ratio in spot urines were found to be significantly higher in the patient group. CONCLUSION: All patients with SCI had lower BMD values than controls. The level and severity of SCI and spasticity did not significantly affect BMD values. The BMD values of the hip decreased as the duration of SCI increased.

Effect of oxidized fibrinogen on hemostatic system: in vitro study.

Standard coagulation assays were performed with control and oxidized fibrinogen (Fg), using prothrombin time (PT; 12.5 ± 0.4 vs 25 ± 0.8 seconds, P < .001) and activated partial thromboplastin time (aPTT; 33 ± 2.5 vs 63 ± 4.7 seconds, P < .001). Fibrin clot (MA), clot formation initiation (r), and rate of clot lysis (LY30) were measured, a reflection exposure of Fg to Fe(3+)/ ascorbate oxidative system by thrombelastograph (TEG) analysis (0, 6, 12, 24, and 48 hours, 6.2 ± 1.3 vs 5.5 ± 1.2, 4.3 ± 1.0 [P < .01], 3.9 ± 1.6, 3.2 ± 0.8, [P < .001]). Maximum amplitude level was found to be lower than control (69.1 ± 7.2 vs 67.9 ± 12.4, 64.0 ± 11.4, 60.2 ± 21.2, 42.2 ± 15.2, P < .001). The lysis rate was changed according to oxidation time between Fg exposed to Fe(3+)/ascorbate and control exposed to Fe( 3+)/ascorbate for the same treatment time (1.9 ± 0.71 vs 7 ± 0.5, 1.6 ± 0.1, 1.2 ± 0.5, 0.9 ± 1.3, P < .001). We revealed dysregulation of hemostatic system with contribution of oxidized Fg, which was in direct proportion to the intensity of Fg oxidation.

Oxidative modification of fibrinogen affects its binding activity to glycoprotein (GP) IIb/IIIa.

AIM: Proteins are sensitive biomarkers of human disease condition associated with oxidative stress. Alteration of protein structures by oxidants may result in partial or complete loss of protein functions. We have investigated the effect of structural modifications induced by metal ion catalyzed oxidation of fibrinogen on its binding capacity to glycoprotein IIb/IIIa (GpIIb/IIIa) and human platelets. METHODS: We identified and quantified of binding capacity of native and oxidized fibrinogen to its receptor in vitro by flow cytometer. Dityrosine formation on oxidized fibrinogen were detected spectrophotometrically. Elevated degradation products of fibrinogen after oxidation were revealed in the HPLC analysis. The native and oxidized fibrinogen were analyzed on mass spectrum upon digestion with trypsin. RESULTS: Oxidatively modified fibrinogen showed less binding activity than native fibrinogen to GpIIb/IIIa coated micro beads and human platelets whereas slightly higher binding capacity to ADP induced stimulated platelets. Formation of di-tyrosines in the amino acid side chains of fibrinogen were observed upon oxidation. Decreased binding capacity of oxidized fibrinogen correlated with intensities of dityrosine formation. Oxidized fibrinogen had more ion-mass intensities at higher than native fibrinogen. CLINICAL IMPLICATIONS: Important point is decreased of binding capacity of the oxidized fibrinogen to own receptor. The decreased rate of binding, leading to effect in the diseases of clot formation may account for the association between oxidation of fibrinogen and the incidence of effect in human diseases.

Musculo-skeletal pain, quality of life and depression in mothers of children with cerebral palsy.

OBJECTIVE: To evaluate musculoskeletal pain (MSP) in mothers of children with cerebral palsy (CP), and to determine the effects of zone of pain on health-related quality of life (QoL) and symptoms of depression. PATIENTS AND METHODS: The study included a total of 81 children with CP, together with their mothers (group 1), and a total of 60 healthy children, together with their mothers (group 2). Presence of MSP, and the zone of pain in mothers were evaluated [lower back pain (LBP), pain in other zones, without pain]. Mothers' QoL was assessed with Short Form-36 (SF-36) scale, and presence of symptoms of depression was assessed with Beck Depression Inventory (BDI). Multivariate analysis of variance test analysis was performed to see the main effects of the factors mother having a child with CP (group 1, group 2) and zone of pain (LBP, other, no pain) on the BDI scores and SF-36 QoL sub parameters of mothers. Logistic regression analysis was performed to determine the parameters predicting the presence of LBP in mothers in group 1. RESULTS: MSP and LBP were found to be significantly higher in group 1. Main effect of the mother having a child with CP on BDI score and physical role (PR) and mental health (MH) parameters was found to be significant. Mean BDI scores of mothers in group 1 was found to be significantly higher as compared to the other group, and mean PR parameter and MH values were found to be significantly lower. Main effect of the zone of pain (arising from the group of mothers with LBP) was found to be significant on physical functioning, bodily pain, general health perception, MH parameters and BDI. Logistic regression analysis showed that MH and bodily pain parameters significantly predicted the presence of LBP. CONCLUSION: Deterioration of MH in mothers with cerebral palsied child may be causing them to experience more LBP. Experience of increased LBP causes deterioration of health-related QoL.

Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement.

The aim of the study was to evaluate the extent of agreement between the findings of ultrasonography (US) and magnetic resonance imaging (MRI) in the assessment of anterior disc displacement (ADD), with or without reduction, and to assess the sensitivity, specificity and the accuracy of the US examination in establishing diagnosis. Fifty-two temporomandibular joints (TMJ) in 52 patients with chronic TMJ pain were examined by US and MRI with respect to ADD, with, and without reduction of the TMJ. The level of agreement between US and MRI findings was evaluated. The sensitivity, specificity, and the accuracy of US were found to be respectively 91%, 16% and 82% in the assessment of ADD; 70%, 38% and 57% in ADD with reduction; 50%, 89% and 76% in ADD without reduction. The findings of both methods were in agreement with each other. US method is fairly sensitive especially in detecting ADD, and it is very reliable in determining the absence of ADD without reduction. However, it was not found to be as quite effective in demonstrating ADD whether it was with or without reduction.

Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes.

The objective of this study was to assess the possible causes of hemiplegic shoulder pain (HSP) in Turkish patients with stroke, to identify the correlation between HSP and clinical factors, and to review the effects of HSP on functional outcomes. A total of 187 consecutive patients with stroke were evaluated for the presence of HSP and for the possible causes. Each patient was evaluated by clinical, radiographic, and ultrasonographic examination. Daily living activities were assessed using the Functional Independence Measure at admission and at discharge. Patients were divided into two groups, one comprising patients with shoulder pain and the other comprising patients without shoulder pain. They were then compared with respect to clinical characteristics, radiologic findings, and Functional Independence Measure scores. Shoulder pain was present in 114 (61%) patients. Of the 114 patients with pain, 71 patients showed various grades of glenohumeral joint subluxation, 70 patients had complex regional pain syndrome-type I, 70 patients had impingement syndrome, 68 patients had spasticity, 49 patients had adhesive capsulitis, and 10 patients had thalamic pain. No correlation was found between shoulder pain and clinical factors (sex, hemiplegic side, hand dominance, etiologic cause, comorbidities). The relationship between shoulder pain and adhesive capsulitis was significant (P=0.01) and also complex regional pain syndrome-type I was statistically significant (P=0.001). The group without HSP showed significantly more improvement than the group with HSP in functional outcomes (P=0.01) and the hospitalization period was significantly shorter (P=0.03). Shoulder pain is a frequent problem in patients with stroke. It is, however, often difficult to isolate a specific cause and it causes a prolonged hospitalization period and can have a negative effect on functional outcomes.

Depression in mothers of children with cerebral palsy and related factors in Turkey: a controlled study.

The primary objective of the study was to determine whether there was any difference, with respect to depression, between mothers of children with cerebral palsy (CP) and mothers of healthy children. The secondary objective was to evaluate whether some additional factors had an impact on the depression of the mothers. The study included 49 children with CP, 50 healthy children, and their mothers. The Beck Depression Inventory (BDI) was applied to all mothers to assess symptoms of depression. CP severity was assessed with the Gross Motor Functional Classification System. BDI scores of the mothers of children with CP were found to be significantly higher (P=0.002) than the mothers of healthy children. Mothers' depression did not vary depending on CP type. Gross Motor Functional Classification System level did not affect mothers' depression. Mothers' depression status was significantly affected by the presence of speech problems in children with CP (P=0.036) and a significant negative correlation was found between BDI scores and income (P=0.007). It is very important to pay attention to the psychological health of the mothers and to provide the families with psychological and social support to ensure the efficiency of rehabilitation program and to meet the objectives.

Skin disorders in patients with hemiplegia and papaplegia.

OBJECTIVE: The aim of this study was to determine the incidence of skin disorders in patients with hemiplegia and paraplegia. Several skin disorders have been reported previously in these patients. METHODS: Seventy inpatients with hemiplegia, 30 with paraplegia, and 90 individuals as a control group were included in the study. RESULTS: The most common skin disorder in the patient group was tinea pedis, which was observed in 18 of the 100 patients. The other common dermatological disorders in the patient group were onychomycosis of the toenails (n = 14), xerosis of the extremities (n = 13) and reduction in hair on the lower extremities (n = 12). The incidence of tinea pedis (p = 0.004), onychomycosis of the toenails (p = 0.010), xerosis of the extremities (p = 0.017) and reduction in hair on the lower extremities (p = 0.027) in the patient group were significantly more common than in the control group. There was no significant correlation between tinea pedis, onychomycosis of the toenails, xerosis of the extremities and reduction in hair on the lower extremities and the duration of hemiplegia and paraplegia. CONCLUSION: Dermatological disorders are observed more commonly in hemiplegic and paraplegic patients than in controls, therefore routine dermatological examination should be performed in these patients.

Noninvasive evaluation of lower urinary tract function in children with cerebral palsy.

OBJECTIVE: The aim of this study was noninvasive evaluation of voiding function in children with cerebral palsy. DESIGN: Sixty children with cerebral palsy were enrolled in the study. Urinary system symptoms were recorded. Uroflowmetric tests were carried out, and postvoid residual volume was measured immediately after voiding by using a portable ultrasonic device developed for children. The expected age-related bladder capacity was calculated and compared with the observed bladder capacity. Uroflowmetric curves were evaluated and classified as normal (bell-shaped) and abnormal. RESULTS: Thirty-three of the children (55%) were symptomatic. In 17 (28.3%) of the children, postvoid residual urine was observed. There was a statistically significant difference between the expected bladder capacity (271.6 +/- 38.3 ml) and the observed bladder capacity (154.5 +/- 111.8 ml) (P < 0.001). Observed bladder capacity was lower than the expected bladder capacity in 56 (93.3%) of the children. In the evaluation of the uroflowmetric charts, 22 (36.7%) children had abnormal curves. CONCLUSIONS: Bladder capacity is decreased in most children with cerebral palsy, and postvoid residue is present in an important proportion. Uroflowmetry and portable ultrasonic device combination is a noninvasive, well-tolerated, and efficient method in the first line evaluation of lower urinary tract function in children with cerebral palsy.