Elastic Stable Intramedullary Nailing in Length Stable Versus Unstable Pediatric Femoral Shaft Fractures: A Comparison of Clinical, Radiographic, and Pedobarographic Outcomes.

BACKGROUND: Pediatric diaphyseal femoral fracture (PDFF) is one of the most common injuries requiring hospitalization. Elastic stable intramedullary nailing (ESIN) is commonly used for PDFFs in ages 5 to 11. The optimal treatment method for length unstable PDFF is a subject of ongoing debate. This study aimed to compare clinical, radiographic, and pedobarographic outcomes of ESIN between length stable and unstable PDFF. METHODS: We retrospectively reviewed patients undergoing ESIN treatment for isolated PDFF between 2016 and 2021. Exclusion criteria were (1) history of ipsilateral or contralateral lower extremity fractures, (2) highly comminuted or segmental fractures, (3) body weight >50 kg, and (4) comorbidities affecting bone quality, range of motion, or neurologic status. The patients were divided into 2 groups according to length stability. Clinical, radiographic, and pedobarographic data were then assessed to compare groups. RESULTS: Twenty-five patients were included (17 length stable and 8 length unstable PDFF) with a mean age of 73.6±17.8 months. There was no significant difference between groups in age, side of injury, body weight, follow-up duration, and nail-canal diameter ratio. Mean deformity in the fracture site in the early postoperative x-rays was not significantly different between groups (P=0.661). After a mean follow-up of 27.8±14.2 months (range, 12-67), there was no significant difference in mechanical axis deviation, distal femur joint orientation angle, or limb-length discrepancy in both groups. The pedobarographic assessment revealed that the length unstable group had a significantly higher external foot progression angle in the injured extremity (9.8°±6.9° vs. 1.3°±5.6°, P=0.031). However, the length stable group had no significant difference in the foot progression angle (4.9°±5° vs. 3°±4.3°, P=0.326). There was no significant difference in either group for other pedobarographic parameters. CONCLUSION: ESIN is a safe and effective option for length-unstable PDFF, yet attention should be paid to the rotational alignment. Although significant external rotation deformity occurs in length-unstable PDFF, it has no implications for the other pedobarographic parameters. LEVEL OF EVIDENCE: Level IV.

Evaluation of Informative Content on Cerebral Palsy in the Era of Artificial Intelligence: The Value of ChatGPT.

AIMS: In addition to the popular search engines on the Internet, ChatGPT may provide accurate and reliable health information. The aim of this study was to examine whether ChatGPT's responses to frequently asked questions concerning cerebral palsy (CP) by families were reliable and useful. METHODS: Google trends were used to find the most frequently searched keywords for CP. Five independent physiatrists assessed ChatGPT responses to 10 questions. Seven-point Likert-type scales were used to rate information reliability and usefulness based on whether the answer can be validated and is understandable. RESULTS: The median ratings for reliability of information for each question varied from 2 (very unsafe) to 5 (relatively very reliable). The median rating was 4 (reliable) for four questions. The median ratings for usefulness of information varied from 2 (very little useful) to 5 (moderately useful). The median rating was 4 (partly useful) for seven questions. CONCLUSION: Although ChatGPT appears promising as an additional tool for informing family members of individuals with CP about medical information, it should be emphasized that both consumers and health care providers should be aware of the limitations of artificial intelligence-generated information.

Comparison of Ultrasound-Guided Prolotherapy Versus Extracorporeal Shock Wave Therapy in the Treatment of Chronic Plantar Fasciitis: A Randomized Clinical Trial.

This study aimed to compare the effectiveness of extracorporeal shockwave therapy (ESWT) versus dextrose prolotherapy on pain and foot functions in patients with chronic plantar fasciitis with a prospective randomized-controlled trial. A total of 29 patients in whom conservative care failed were enrolled for the study after the clinical and ultrasonographic assessment. The patients were randomly assigned to receive ESWT (ESWT group, n = 15) or dextrose prolotherapy (dextrose prolotherapy group, n = 14). ESWT group received 1800 to 2000 focused shock waves (session of 0.20-0.30 mJ/mm2 with a frequency of 4-6 Hz) followed by soft tissue 3000 to 3500 radial pulses (session of 1.8-3.0 bar with a frequency of 15-21 Hz). Dextrose prolotherapy group underwent an injection of 5 ml 15% dextrose solution with 2% lidocaine. ESWT and dextrose prolotherapy were repeated 3 times by 2 weeks apart. A 100-mm Visual Analog Scale (VAS) for overall and morning pain, Foot Function Index (FFI) and the Roles and Maudsley Scale score (RMS) were assessed at baseline, 6 weeks, and 12 weeks after the last intervention. Overall VAS, Morning VAS, RMS and FFI scores improved significantly in both treatment groups at 6 weeks and 12 weeks compared to baseline (p < .001). Comparison of changes in overall VAS, Morning VAS, RMS and FFI scores did not show a significant difference between the groups at each time point (p > .05) In our study dextrose prolotherapy and ESWT had similar effectiveness in patients with chronic plantar fasciitis who have not respond to conservative care. The results showed ESWT and dextrose prolotherapy were not superior to each other.

Investigation of the relationship between kinesiophobia and sensory processing in fibromyalgia patients.

Purpose/aim: The aims of this study are to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia (FM) patients and obtain new information about kinesiophobia in light of these results.Materials and methods: This study has been conducted with 82 literate subjects aged 18-65 years and diagnosed with FM based on ACR 2010 diagnostic criteria. Fibromyalgia Impact Questionnaire was used for measuring functional status in FM patients, The Tampa Scale of Kinesiophobia was used for determine the levels of kinesiophobia and Adolescent/Adult Sensory Profile was used for determine the characteristics of sensory process patterns of the individuals.Results: Among the participants, sensory sensitivity scores of 65.85% and sensation avoiding scores of 40.24% were higher than that in the general population. Sensation seeking scores of 48.78% the subjects were lower compared to the general population. A significant and weak positive correlation was found between the kinesiophobia scores and responses of sensory sensitivity and sensation avoiding (r = 0.23, p = 0.04; z = 0.29, p = 0.01)Conclusion: This is the first study conducted to investigate the relationship between kinesiophobia and sensory processing in fibromyalgia patients. However, different studies investigating this subject are warranted in order to be able to generalize the findings and increase the value of evidence.

Response to Speech and Language Therapy According to Artery Involvement and Lesion Location in Post-stroke Aphasia.

PURPOSE: Aphasia is one of the most common complications after stroke and occurs in 21-38% of the patients during acute period. The present study aimed to investigate the response to speech and language therapy according to artery involvement and lesion location in patients with post-stroke aphasia. METHOD: The medical records of 107 patients with post-stroke aphasia (mean age, 58.8 ± 14.8 years) who were admitted to a single rehabilitation center for usual care after stroke were reviewed. Location of the ischemic lesion and involved artery was determined assessing the brain MRI of the patients. All the patients received 24 sessions speech and language therapy (3 days a week) as a part of 8-week rehabilitation program. Evaluation of the aphasia was performed with Gülhane Aphasia Test-2 (GAT-2) at baseline and at the end of the rehabilitation program. RESULTS: Baseline GAT-2 scores was significantly worse in patients with middle cerebral artery (MCA) involvement compared to patients with other artery involvements (p = 0.007). While the GAT-2 scores of patients with MCA involvement were improved significantly after speech and language therapy (p < 0.001), the changes in those with anterior cerebral artery (ACA) and posterior cerebral artery (PCA) involvements were not significant (p > 0.05). CONCLUSIONS: The present findings suggested that speech functions might be more affected in ischemic lesion of MCA and response to SLT might be better in patients with MCA involvement.

Comparison of the effectiveness of anti-gravity treadmill exercises and underwater walking exercises on cardiorespiratory fitness, functional capacity and balance in stroke patients.

INTRODUCTION: Aerobic exercise training after stroke has positive effects on quality of life, motor recovery, and aerobic endurance. The aim of this study was to investigate the effectiveness of anti-gravity treadmill gait training and underwater walking therapy on cardiorespiratory fitness, gait and balance in stroke survivors. METHODS: The study included 39 patients with a history of stroke who were admitted to our center between July 2017 and January 2018. The patients were randomly assigned to anti-gravity treadmill training, underwater walking therapy, or a control group. The aerobic capacity of the participants was evaluated with the 6-min walk test and cycle ergometer testing before and after the treatment. Balance was examined using the Berg Balance Scale (BBS). RESULTS: There was a statistically significant increase from pre- to post-treatment with regard to maximum heart rate and length of walking distance during 6-min walk test parameters in patients who underwent anti-gravity treadmill training (p < 0.05). The cycle ergometer training results showed significant improvements compared to baseline after treatment in patients who underwent anti-gravity training in terms of maximum heart rate attained during exercise stress testing, time to complete the test, rates of metabolic equivalents of task scores and peak oxygen consumption (p < 0.05). Improvements were also observed in ventricular repolarization indices including corrected QT intervals (QTc), Tp-e interval and Tp-e/QT, Tp-e/QTc ratio in the anti-gravity group (p < 0.05). BBS results showed no statistically significant difference in all groups (p > 0.05). CONCLUSION: The data of this study showed that anti-gravity treadmill training has favorable effects on cardiorespiratory fitness in stroke survivors.

Sonographic measurement of the neck extensor muscle thickness in patients with fibromyalgia.

OBJECTIVE: The aim of this cross-sectional study was to compare cervical extensor muscle thickness measurements in patients with fibromyalgia (FM) with chronic neck pain and an asymptomatic control group, and to examine the relationship between cervical extensor muscle thickness and pain, quality of life, and disability. METHODS: The study included 41 patients with FM and 41 asymptomatic control subjects. The thickness of the cervical extensor muscles (multifidus, semispinalis capitis, semispinalis cervicis, splenius capitis and trapezius muscles) was evaluated with ultrasonography. The severity of FM was evaluated with the Fibromyalgia Impact Questionnaire (FIQ), neck disability with the Neck Disability Index (NDI) and pain severity with a Numeric Rating Scale (NRS). RESULTS: The mean sonographic thickness values of all the neck extensor muscles were significantly decreased in the FM group compared with the control group (p < 0.001). There were negative correlations between the FIQ and multifidus, splenius capitis and trapezius thickness values. NDI was significantly negatively correlated with multifidus and trapezius thickness. There was no significant correlation between neck extensor muscle thickness and age, duration of FM, and NRS scores. CONCLUSION: This study demonstrated a decrease in cervical extensor muscle thickness in patients with FM with chronic neck pain. Cervical extensor muscle morphologies should be considered by the clinician when planning treatment in patients with FM with neck pain.

Temporomandibular Joint Dysfunction and Impaired Stomatognathic Alignment: A Problem Beyond Swallowing in Patients With Stroke.

The aim of this study is to evaluate the efficacy of supervised structured exercise programme in post stroke patients with temporomandibular joint dysfunction (TMJD). 30 post stroke patients diagnosed as TMJD according to "diagnostic criteria for temporomandibular disorders" (DC/TMD) were included for the study. A structured exercise programme including active and active-assisted range of motion (ROM) exercises for neck and temporomandibular joint (TMJ), chins tuck exercises, breathing and relaxing exercises and posture exercises were performed. Cervical ROMs including flexion, extansion, lateral flexion and rotation, Mann assessment of swallowing ability (MASA) and mini mental state exam (MMSE) scores, maximal mouth opening (MMO) and craniomandibular index (CMI) of the patients compared at baseline, 1st and 6th month after supervised rehabilitation procedure. All parameters were significantly improved both in 1st and 6th month evaluation. At 6th month evaluation, the cervical ROMs of the patients improved from severe to mild restriction (p = 0.001), the mean MASA score of the patients improved from moderate to mild swallowing disorder (p = 0.001), mean MMSE score of 30 patients was accepted as normal (p = 0.001), mean MMO of the patients was 56.00 ± 4.84 mm and mean CMI was 0.16 ± 0.05 indicating that the patients had a "mild" limitation in mouth opening and "mild" dysfunction in TMJ (p = 0.001 respectively). Our structured supervised exercise programme improves swallowing quality by establishing proper stomatognathic alignment and TMJ function.

Effectiveness of Suprascapular Nerve Pulsed Radiofrequency Treatment for Hemiplegic Shoulder Pain: A Randomized-Controlled Trial.

BACKGROUND: Hemiplegic shoulder pain is one of the most common complications after stroke. Although there are many treatment strategies for this complication, sometimes very resistant cases are also seen. OBJECTIVES: To evaluate the effect of suprascapular nerve pulsed radiofrequency (PRF) treatment for hemiplegic shoulder pain (HSP). STUDY DESIGN: A prospective randomized-controlled trial. SETTING: University hospital. METHODS: This study included 30 patients with HSP following stroke. The patients were randomly assigned to receive PRF to the suprascapular nerve (PRF group, n = 15) or suprascapular nerve block (NB) with lidocaine (NB group, n = 15). The patients were randomized into 2 groups (n = 15 both). In addition, the patients received physical therapy to the shoulder, including hot pack, transcutaneous electrical nerve stimulation, and stretching and strengthening exercise (5 days per week for 3 weeks in a total of 15 sessions). Visual Analog Scale (VAS) for pain, the Goal Attainment Scale (GAS) during upper-body dressing, and shoulder range of motion (ROM) were assessed at baseline, 1 month, and 3 months after the procedure. RESULTS: Between the groups, comparison revealed that decrease in the VAS score was statistically significantly higher at the first (3.5 1.9 vs. 1.2 1.0) and third month (4.2 1.7 vs. 1.2 0.9) in the PRF group compared with the NB group (P < 0.01). The PRF group had significantly higher increases in shoulder ROM compared with the NB group (P < 0.05).The positive changes in GAS score at month 3 in the PRF group was significantly higher than that in the NB group (P < 0.05). LIMITATION: There is a need for further studies with a longer follow-up period. CONCLUSIONS: In light of these findings, the combination of PRF applied to the suprascapular nerve and physical therapy was superior to the combination of suprascapular NB and physical therapy. KEY WORDS: Hemiplegic shoulder, stroke, pain, radiofrequency, suprascapular nerve.

Ultrasonographic Measurement of Talar Cartilage Thickness in Patients With Cerebral Palsy.

OBJECTIVE: Foot deformities are one of the most common musculoskeletal problems in children with cerebral palsy (CP). These deformities affect the walking ability and function of the patients. Talar cartilage is the hyaline joint cartilage of the tibiotalar joint that plantarflexes and dorsiflexes of the ankle. The aim of this study was to determine whether talar cartilage thickness was affected in children with ambulant diplegic CP. DESIGN: Forty patients with diplegic CP (19 boys, 21 girls) and 40 age-, sex-, and weight-matched healthy control subjects (20 boys, 20 girls) were included in the study. The demographic and clinical characteristics of the patients, including age, sex, and body mass index, were recorded. Patients were classified using the Gross Motor Function Classification System. A 12-MHz linear probe was used for ultrasonographic cartilage measurements at the tibiotalar joint according to European Musculoskeletal Ultrasound Study Group (EURO-MUSCULUS) and the Ultrasound Study Group in Physical and Rehabilitation Medicine (USPRM) scanning protocols. RESULTS: Mean talar cartilage thickness was significantly decreased in the CP group compared with the healthy control group (P < 0.001). There was a significant negative correlation between Gross Motor Function Classification System levels and talar cartilage thickness measurements (P < 0.001, Tb = -0.695). CONCLUSION: This study demonstrates that patients with CP have a thinner talar cartilage compared with healthy control subjects.

Migraine in patients with fibromyalgia and outcomes of greater occipital nerve blockage.

OBJECTIVES: The aim of this study is to evaluate the efficacy of greater occipital nerve (GON) blockage in patients with migraine and fibromyalgia (FM) comorbidity. PATIENTS AND METHOD: 20 patients who were diagnosed as FM according to 2010 American College of Rheumatology (ACR) diagnostic criteria and migraine according to International Classification of Headache Disorers II criteria and did not recieve any medication or GON block for both disorders were included for the study. GON blocks were repeated every week in the first month and repeated montly for the following 2 months. The frequency and duration of the migraine attacks, pain severity with visual analogue scale (VAS), quality of life (QoL) with revised fibromyalgia impact questionnaire (FIQR) and migraine disability assesment questionnaire (MIDAS) before,1 st month and 3rd months after treatment were recorded and compared. RESULTS: 95% of 20 patients were female (n = 19) and 5% was male (n = 1). The affected site was left in 60% of the patients (n = 12) and 40% was right (n = 8). There was significant improvement in terms of all evaluation parameters both at 1 st month and 3rd months after treatment compared to the baseline. Likely, all parameters were significantly improved at 3rd month compared to the 1 st month. CONCLUSIONS: GON blockage reduces pain severity, headache frequency and duration and increases QoL in patients with migraine and FM comorbidity.

Comparison of the effectiveness of partial body weight-supported treadmill exercises, robotic-assisted treadmill exercises, and anti-gravity treadmill exercises in spastic cerebral palsy.

OBJECTIVES: This study aims to compare the effectiveness of the partial body weight-supported treadmill exercise (PBWSTE), robotic-assisted treadmill exercise (RATE), and anti-gravity treadmill exercise (ATE) in children with spastic cerebral palsy (CP). PATIENTS AND METHODS: Between December 01, 2015 and May 01, 2016, a total of 29 children (18 males, 11 females; mean age 9.3±2.3 years; range, 6 to 14 years) with spastic CP were included in the study. The patients were randomly divided into three groups as the PBWSTE group (n=10), RATE group (n=10), and ATE group (n=9). Each group underwent a total of 20 treadmill exercise sessions for 45 min for five days a week for a total of four weeks. The patients were assessed using three-dimensional gait analysis, open-circle indirect calorimeter, six-minute walking test, and Gross Motor Functional Measurement (GMFM) scale before and after treatment and at two months of follow-up. RESULTS: No significant change compared to baseline was found in the walking speed on gait analysis among the groups after the treatment. There was no statistically significant difference among the groups in terms of the GFMF-D, GMFM-E and six-minute walking test (p>0.05). There was a significant improvement in the oxygen consumption in the ATE group (p>0.05) and RATE group (p>0.05), but not in the PBWSTE group (p<0.05). CONCLUSION: Our study findings indicate that all three treadmill exercises have a positive impact on walking, and RATE and ATE can be used more actively in patients with spastic CP.

The effectiveness of cervical transforaminal epidural steroid injection for the treatment of neck pain due to cervical disc herniation: long-term results.

AIM: To investigate the long-term effect of fluoroscopy guided cervical transforaminal epidural steroid injection on neck pain radiating to the arm due to cervical disc herniation. MATERIALS & METHODS: 64 patients (26 women [40.6%], 38 men [59.4%]; mean age, 44.9 ± 12.1 years) who had received fluoroscopy guided cervical transforaminal epidural steroid injection for neck pain due to cervical disc herniation at least 1 year before were included in the study. The effectiveness of transforaminal epidural steroid injection was assessed using data obtained by medical records and a standardized telephone questionnaire. Multiple linear regression analysis was applied to evaluate the factors affecting the pain reduction after injection and the duration of treatment effect. RESULTS: The mean duration of neck pain symptom was 23.3 ± 23.9 months. Most of the patients received a single injection (50 patients, 78.1%). The mean time since injection at the time of interview was 21.4 ± 9.4 months. There was a significant reduction in mean pain visual analog scale (VAS [10 cm]) score, from 8.6 ± 1.4 at baseline to 3.2 ± 2.5 at check visit two weeks after injection (p < 0.001). 52 patients (81.2%) reported pain relief of more than 50%. The mean duration of treatment effect was 13.3 ± 9.44 months. Greater pain on the VAS was found to predict strongly the higher pain reduction and longer treatment effect (p = 0.042 and 0.011, respectively). CONCLUSION: The results suggested that cervical transforaminal epidural steroid injections might be an effective treatment for neck back pain radiating to the arm due to cervical disc herniation.

Are rehabilitation outcomes after severe anoxic brain injury different from severe traumatic brain injury? A matched case-control study.

Many reports have investigated rehabilitation outcomes after a traumatic brain injury (TBI); however, comparably less is known about whether they differ from outcomes of an anoxic brain injury (ABI). Thus, we aimed to compare the rehabilitation outcomes of patients with ABI with control patients who have TBI. Forty participants with ABI and 40 participants with TBI were included in this retrospective study. Participants with ABI were matched with participants with TBI who had similar clinical characteristics such as age, initial Functional Independence Measurement (FIM) score, and duration of coma. FIM and Functional Ambulation Classification (FAC) scores on rehabilitation admission and on rehabilitation discharge were recorded. The FIM score in the ABI group was 41.7±28.5 on rehabilitation admission and increased to 57.1±31.4 on rehabilitation discharge. The FIM score in the TBI group was 40.8±24.0 on rehabilitation admission and increased to 65.9±35.3 on rehabilitation discharge. There was no statistically significant difference in the FIM scores on rehabilitation discharge between groups. Initial FAC was similar in both groups and there was no statistically significant difference in the FAC scores on rehabilitation discharge. The multiple linear regression analysis showed that intensive care unit length of stay had an inverse relationship with the FAC change. We did not find significant differences in the rehabilitation outcomes of participants with ABI compared with participants with TBI. Considering the lack of information in the literature on ABI rehabilitation, this study may be important to guide rehabilitation teams.

Botulinum toxin injection for bruxism associated with brain injury: case report.

Bruxism is involuntary grinding of the teeth and can occur as a complication of brain injury. If untreated, bruxism can lead to severe occlusal trauma. Herein, we present a patient with traumatic brain injury and nocturnal bruxism that was treated with botulinum toxin injection. A 21 yr old male patient with traumatic brain injury from a car accident was admitted to our inpatient rehabilitation unit. He had a history of coma for 2 wk in the intensive care unit. The initial cranial computed tomography scan indicated a superior thalamic hemorrhage. On admission to our department 3 mo postinjury, his mental status was good and he was able to walk without assistance, but he had mild ataxia. He complained about severe teeth grinding at night, which began 2 mo postinjury. Botulinum toxin-A was injected into the masseter muscles (20 U in each muscle) and temporalis muscles (15 U in each muscle) bilaterally. A decrease in bruxism was reported within 3 d. Clinical improvement persisted at assessment 4 mo posttreatment. Botulinum toxin injection can be used as an effective treatment for bruxism associated with brain injury.