The effects of the level of spinal cord injury on life satisfaction and disability.

BACKGROUND AND PURPOSE: Spinal Cord Injury (SCI) may often lead to significant disability in affected individuals and reduce life satisfaction. Herein we aimed to investigate the effects of the level of injury on disability and life satisfaction as well as the relation between life satisfaction and disability. METHODS: Patients with at least one-year history of SCI were included. Demographic-clinical data of patients were recorded. The Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) was used for quantifying the degree of patients' disability. Life satisfaction was assessed by the Satisfaction with Life Scale (SWLS). RESULTS: Of the 76 patients, 21 (27.6%) were tetraplegic and 55 (72.4%) were paraplegic. SWLS was found to be similar in tetraplegic vs. paraplegic patients (P=0.59), whereas CHART parameters such as physical independence, mobility, occupation, and total CHART value were significantly higher in paraplegic patients (P=0.04, P=0.04, P=0.001 and P=0.01, respectively). Social integration was found similarly high in both groups. There was a positive correlation between elapsed time after the injury and CHART physical independence, occupation and the level of economic sufficiency (P<0.01, P<0.01, P=0.01). Excluding the economic sufficiency (P=0.02), there was not any other association between the rest of CHART parameters and SWLS. CONCLUSION: According to our findings, although the level of injury seems to be influential on disability, it seems to have no significant effect on life satisfaction. Since the only thing that positively affects life satisfaction is economic sufficiency, more emphasis should be placed on regulations that increase the return to work in patients.

Enhancing balance and mobility in incomplete spinal cord injury with an overground gait trainer.

STUDY DESIGN: Prospective intervention study. OBJECTIVES: The study aimed to assess the effect of Andago on balance, overground walking speed, independence levels, fear of falling, and quality of life in patients with acute motor incomplete Spinal Cord Injury. SETTING: The study was conducted in Ankara/Türkiye. METHODS: Five participants, classified as AIS D, underwent an eight-week treatment regimen, including three days a week of Andago-assisted walking and balance exercises, supplemented by two days a week of 40-minute sessions of conventional in-bed exercises. RESULTS: Berg Balance Scale scores increased significantly by 129% (p = 0.043). Overground walking speed calculated from 10MWT improved by 33% (p = 0.042). WISCI II levels improved significantly compared to baseline scores (p = 0.041). In the mobility subscale of SCIM III, the total SCIM III scores increased significantly (p = 0.042, p = 0.043, respectively). However, there was no significant improvement in WHOQOL-BREF scores (p = 0.080). CONCLUSIONS: The use of Andago facilitated functional progress in patients with acute incomplete SCI, emphasizing the importance of challenging balance and walking activities in triggering motor learning.

Adiponectin in spinal cord injury: What is the role of nutrition in serum adiponectin concentration?

Objectives: The study aimed to analyze the relationship between serum adiponectin concentration, Mediterranean diet (MD) adherence, and Dietary Approaches to Stop Hypertension (DASH) diet adherence in patients with spinal cord injury (SCI). Patients and methods: Thirty-three SCI patients (21 males, 12 females; median age: 33 years; range, 18 to 65 years) and 33 age-, sex-, and body mass index-matched healthy controls (21 males, 12 females; median age: 33 years; range, 18 to 64 years) were included in this cross-sectional study between March 2021 and March 2022. Serum adiponectin concentrations of all participants were measured. Body weight, height, and neck, hip, waist, and mid-upper arm circumferences were measured. Twenty-four-hour dietary records were obtained by the researchers for evaluation of the nutritional status. The DASH diet score and MD score were measured for each participant. Results: Most of the cases of SCI were due to motor vehicle collisions (n=12, 36.4%) and complete paraplegic. Mid-upper arm circumference, waist circumference, hip circumference, and neck circumference of the patient group were significantly higher than the control group (p=0.020, p=0.002, p=0.042, and p<0.001, respectively). Mediterranean diet scores and DASH diet scores of the patient group were significantly higher than the control group (p<0.001 and p=0.031, respectively). Serum adiponectin concentration of patients was significantly higher than the control group (p=0.049). No correlation was detected between adiponectin concentration, MD score, and DASH diet score in both groups. Conclusion: Although correlation analysis in the current research did not show significant relation between nutrition and adiponectin concentrations, nutrition of patients with SCI, as demonstrated by higher adherence to MD and DASH, may have provided positive effects on adiponectin concentrations. Future studies focused on the effect of a healthy diet intervention on serum adiponectin concentration is warranted.

The effect of electromyography triggered electrical stimulation to abdominal muscles on sitting balance, respiratory functions, and abdominal muscle thickness in complete spinal cord injury: a randomized controlled trial.

Complete thoracic spinal cord injury (SCI) results in a loss of innervation to the abdominal muscles, which affects trunk stability and performance of activities of daily living from a sitting position. Respiratory function is also affected, leading to frequent pulmonary complications. Given the importance of trunk stability and respiratory function, we investigated the effects of electromyography triggered electrical stimulation (EMG-ES) applied to the abdominal muscles on sitting balance, respiratory functions and abdominal muscle thickness in individuals with complete thoracic SCI. This randomized controlled study included 34 participants with complete thoracic SCI who were randomly allocated to the experimental group ( n  = 17) and the control group ( n  = 17). During the 4-week intervention period, the experimental group received EMG-ES to their abdominal muscles, while the control group received isometric abdominal exercises three times per week. Both groups continued with their routine rehabilitation program (active or passive range of motion exercises, stretching, and balance coordination exercises). The primary outcome measures were the modified functional reach test (mFRT) and trunk control test (TCT). Secondary outcome measures included a pulmonary function test (PFT) and the bilateral abdominal muscle thicknesses using ultrasonography. At the end of the study, the experimental group showed significantly greater improvements in both primary outcomes. The mean difference in pre-post changes between the groups for the mFRT area was 242.8 cm² [95% confidence interval (CI): 181.3-329.8; effect size 0.92; P  < 0.001] and 5.0 points for TCT (95% CI: 3.9-6.0; effect size 0.98, P  < 0.001). The increase in the abdominal muscle thickness was also significantly greater in the experimental group ( P  < 0.001) without significant differences in the PFT ( P  > 0.05). We conclude that adding EMG-ES of abdominal muscles may further improve sitting balance and abdominal muscle thickness in individuals with complete thoracic SCI.

Early radial digital neuropathy of the thumb due to flexor pollicis longus tendinitis: value of ultrasound in an uncommon mild neuropathy.

INTRODUCTION: A 50-year-old man developed intermittent paresthesia of the outer portion of the right thumb. Paresthesia increased with thumb abduction and flexion. The remainder of the physical examination was normal. METHODS: Routine motor and sensory examinations of the median and ulnar nerves were within normal ranges. RESULTS: Ultrasonographic studies revealed that a tenosynovitis of the flexor pollicis longus of the right thumb was compressing the radial digital nerve of the thumb. CONCLUSIONS: Ultrasonographic evaluation was used in conjunction with nerve conduction studies to diagnose digital neuropathy. Ultrasound is a beneficial, complementary tool to electrodiagnostic studies, especially for uncommon focal neuropathies.

Ulnar nerve measurements in healthy individuals to obtain reference values.

The aim of this study was to obtain the ultrasonographical reference values of ulnar nerve cross-sectional areas at the common areas of nerve entrapment as well as any differences related to age, sex, weight, height, dominant arm. Cross-sectional areas of the ulnar nerves of 72 healthy volunteers were measured bilaterally at the level of the epicondyle, 2 cm proximal to and 2 cm distal to the epicondyle, just at the entrance of cubital tunnel, at arterial split, at Guyon's canal. Age, sex, body weight, height, body mass index, and dominant extremity were recorded. The mean ulnar nerve cross-sectional area was 5.8 ± 1.1 mm(2) at 2 cm proximal to medial epicondyle, 6.2 ± 1.1 mm(2) at the medial epicondyle, 5.6 ± 0.9 mm(2) at the entrance of the cubital tunnel, 5.6 ± 1.0 mm(2) at 2 cm distal to medial epicondyle (inside the flexor carpi ulnaris), 5.0 ± 0.6 mm(2) at arterial split, and 4.9 ± 0.6 mm(2) at Guyon's canal. There was statistically no difference between the dominant and nondominant sides (p > 0.05). Females had statistically smaller nerves than males (p < 0.05). There was a significant correlation with height at all levels; also, weight was significantly correlated with cross-sectional areas except at two levels: tip of medial epicondyle and 2 cm distal. This study provides normative data of ulnar nerve ultrasonography and as well as any differences related to age, sex, height, weight, and dominant arm.

Carpal tunnel syndrome and metabolic syndrome co-occurrence.

We aimed to evaluate the relation between the severity of carpal tunnel syndrome and metabolic syndrome. One hundred and fifty patients who had a clinical and electrophysiologically confirmed diagnosis of carpal tunnel syndrome (CTS), were included in this study. The patients were divided into two groups (with or without metabolic syndrome) according to the criteria of National Cholesterol Education Program. Eighty one (73.5 %) of the patients with CTS had metabolic syndrome. The patients with metabolic syndrome the severity of CTS was found 22.2 % had mild CTS, 56.8 % had moderate CTS, and 21 % had severe CTS. The patients without metabolic syndrome the severity of CTS was found 44.9 % had mild CTS, 40.6 % had moderate CTS, and 14.5 % had severe CTS. The severity of CTS between both groups was found to be statistically significant (p = 0.0009). While a correlation was found between the severity of CTS and high level of LDL with the presence of metabolic syndrome (correlation coefficient 0.209). In conclusion metabolic syndrome that appears to be a risk factor for CTS. At the same time, the presence of metabolic syndrome increases the severity of the disease.

Skin thickness on bony prominences measured by ultrasonography in patients with spinal cord injury.

OBJECTIVE: The detailed assessment of soft tissues over bony prominences and identification of methods of predicting pressure sores would improve the quality of care for patients with spinal cord injury (SCI). Comparing skin thicknesses on bony prominences in patients with SCI to those in healthy individuals will represent, to our knowledge, the first study aimed at determining whether differences in skin thicknesses between these groups can be detected by ultrasound. DESIGN: In both patients and controls, skin thicknesses on the sites at risk for pressure ulcers - sacrum, greater trochanter, and ischium - were evaluated using high-frequency ultrasound. The waist was also evaluated by the same method for control as it was considered to be a pressure-free region. PARTICIPANTS: Thirty-two patients with complete thoracic SCI and 34 able-bodied individuals. RESULTS: The skin was significantly thinner over the sacrum and ischial tuberosity in individuals with SCI compared with healthy individuals. No significant differences were observed in skin thicknesses over the greater trochanter or the waist between the two groups. CONCLUSIONS: Protecting skin integrity in patients with paraplegia is challenging due to many contributing factors, such as prolonged pressure, frictional/shearing forces, and poor nutrition. Thinning of the skin can increase the risk of soft tissue damage, leading to pressure ulcers. The significant differences in skin thickness at the sacrum and ischium provide the basis for establishing the early signs of pressure damage. Measuring skin thickness by ultrasound is a reliable non-invasive method that could be a promising tool for predicting pressure ulcers.

Accuracy of the methods used to estimate glomerular filtration rate compared to 24-hour urinary creatinine clearance in patients with chronic spinal cord injury.

OBJECTIVE: To compare the accuracy of glomerular filtration rate (GFR) estimation by 24-hour urinary creatinine clearance with GFR estimation by the Modification of Diet in Renal Disease (MDRD) equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, the Mayo Clinic Quadratic equation (MCQE), and the modified Cockcroft-Gault formula in patients with spinal cord injury (SCI). DESIGN: Cross-sectional study. PARTICIPANTS: Fifty-nine consecutive subjects, who were admitted to our hospital SCI rehabilitation and no additional acute medical disorders, were enrolled in this study. A 24-hour urine sample was collected for the determination of 24-hour urinary creatinine clearance, which was assumed as the standard technique for estimation of the GFR. The accuracy of several estimation formulas includes the 4-variable MDRD equation, the 6-variable MDRD equation, the Cockcroft and Gault equation, the CKD-EPI equation, and the MCQE. RESULTS: GFRs calculated by the Cockcroft-Gault equation and 4-variable MDRD were significantly different from the 24-hour urinary creatinine clearance, whereas there were no significant differences in GFRs calculated by CKD-EPI (P = 1.000), Mayo Clinic Quadratic formula (P = 0.794), and 6-variable MDRD equations (P = 0.435) and 24-hour urinary creatinine clearance. Both the 6-variable MDRD equation and CKD-EPI were accurate within ±20 of the reference methods in 52.54% of the subjects. CONCLUSIONS: Among the methods used for estimation of the GFR including the 4- and 6-variable MDRD, the CKD-EPI, the modified Cockcroft-Gault equation, and the MCQE, the 6-variable MDRD equation and the CKD-EPI demonstrated best performance to estimate the GFR. However, none of the formulas were sufficient to estimate the GFR in SCI patients accurately.

Position sense of the hemiparetic and non-hemiparetic ankle after stroke: is the non-hemiparetic ankle also affected?

BACKGROUND AND PURPOSE: Researchers have shown an increased interest in proprioception deficits of the paretic side in hemiplegic patients. However, far too little attention has been paid to the proprioception sense of the non-hemiparetic side. The objective of this research was to determine whether the position sense of the ankles, especially of the non-paretic side, is affected in stroke patients. METHODS: 20 inpatients with stroke and 10 healthy control subjects were evaluated using an isokinetic dynamometer. Proprioceptive error scores (in degrees) for passive reproduction of joint position tests (PRJPTs) were measured. RESULTS: Error values of PRJPT for 5° plantarflexion, 10° plantarflexion, and 15° dorsiflexion were significantly higher in patients on both the paretic and non-paretic side compared with the control group dominant side. CONCLUSION: The impaired results of PRJPT in both the paretic and non-paretic ankles of stroke patients are surprising when one expects that the non-paretic side would be preserved under the control of the healthy hemisphere.

Diabetic muscular infarct: an unusual cause of extremity pain and dysfunction.

Diabetic muscular infarct (DMI) is a rare condition, which begins with acute onset of extremity pain and swelling. Patients usually have long-standing disease and poorly controlled diabetes mellitus (DM). Thigh muscle group is the most commonly involved side, while lower leg involvement is rare. We represent herein a 22-year-old patient with type I DM who admitted to our outpatient clinic due to painful swelling of the left leg. In physical examination, anterior left leg was painful and firm on palpation; there was diffuse swelling extending to the knee and ankle with mild local fever and redness. T2-weighted MRI demonstrated hyperintensity in left leg muscles. A biopsy confirmed the diagnosis of DMI. She was treated with glucose regulation, analgesics, antiplatelet treatment and rest. At her 6 months, recurrence of DMI was observed. DMI should be considered in diabetic patients with extremity pain and swelling. Treatment plan should include the regulation of the blood glucose and evaluation of end-organ complications, analgesia, and bed rest.

How does metabolic syndrome affect the functional ambulation in stroke patients?

BACKGROUND/AIMS: Metabolic syndrome (MetS) is a risk factor for stroke. However, the role of MetS in stroke rehabilitation has not been assessed. The aim of this study was to evaluate the impact of MetS on rehabilitation from stroke. MATERIALS AND METHODS: A total of 337 consecutive patients with subacute stroke and 220 age-matched healthy controls were studied. The diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. Ambulation levels were evaluated using the Functional Ambulation Classification (FAC) measure. The correlation between MetS and FAC was investigated. The regression analysis included presence of hypertriglyceridemia, high fasting glucose, low high-density lipoprotein cholesterol, hypertension, abdominal obesity, MetS, and age ≯65 years. RESULTS: The prevalence of MetS in the control group and the ischemic and hemorrhagic stroke groups was 33.2% (n = 73), 59.8% (n = 156), and 68.4% (n = 52), respectively. MetS prevalence was significantly higher in stroke groups compared with the control group (P < .001). FAC and MetS were significantly and negatively correlated in the stroke groups (P < .001, rho = -0.387, for hemorrhagic stroke;P < .001, rho = -0.379, for ischemic stroke). Multivariable logistic regression analysis demonstrated that diastolic tension, MetS presence, and age were found to be independent risk factors for FAC in ischemic stroke groups. CONCLUSIONS: MetS is associated with worse functional ambulation for both ischemic and hemorrhagic stroke patients. Aggressive rehabilitation can be advocated in the presence of MetS in ischemic stroke patients.

Electromyography and ultrasonography in the diagnosis of a rare double-crush ulnar nerve injury.

Reported here is a 46-year-old man who was seen for pain, numbness, and weakness in his left upper limb and hand. Electromyographic studies demonstrated denervation of ulnar-innervated muscle groups except for the flexor carpi ulnaris. A localized nerve conduction block could not be depicted because of severe axonal loss. Ultrasonographic evaluation showed enlargement of the ulnar nerve at 2 sites: at the level of the epicondylar groove and the inside of the flexor carpi ulnaris muscle. Herein, we would like to emphasize the complementary role of an ultrasound in peripheral nerve pathologies, not only does it confirm the entrapment but it also displays the underlying cause(s).

Peripheral nerve involvement in a neurofibromatosis type 2 patient with plexiform neurofibroma of the cauda equina: a sonographic vignette.

We report a 20-year-old man with cauda equina syndrome and neurofibromatosis type 2. We discuss the role of sonographic and electromyographic evaluations in the management of our patient and suggest the use of sonographic imaging for visualization of peripheral nerve pathologic states, especially when involvement is widespread.

When is needle examination of thenar muscle necessary in the evaluation of mild and moderate carpal tunnel syndrome?

OBJECTIVES: This study aims to evaluate the predictors of standard nerve conduction study (NCS) parameters in determining the presence of axonal loss by means of spontaneous activity in patients with mild and moderate carpal tunnel syndrome (CTS). PATIENTS AND METHODS: Between May 2015 and April 2018, a total of 118 patients (11 males, 107 females; mean age: 52.3±10.6 years; range, 27 to 79 years) who underwent electrophysiological studies and were diagnosed with CTS were included. Demographic data of the patients including age, sex, and symptom duration were recorded. Electrodiagnostic studies were performed in all patients. All the needle electromyography (EMG) findings were recorded, but only the presence or absence of spontaneous EMG activities was used as the indicator of axonal injury. RESULTS: In 37 (31.4%) of the patients, spontaneous activity was detected at the thenar muscle needle EMG. No spontaneous activity was observed in any of 43 (36.4%) patients with normal distal motor latency (DML). There were significant differences in DMLs, compound muscle action potential (CMAP) amplitudes, sensory nerve action potentials amplitudes, and sensory nerve conduction velocities between the groups with and without spontaneous activity (p<0.05). The multiple logistic regression analysis revealed that DML was a significant independent risk variable in determining presence of spontaneous activity. The most optimal cut-off value for median DML was calculated as 4.9 ms. If the median DML was >4.9 ms, the relative risk of finding spontaneous activity on thenar muscle needle EMG was 13.5 (95% CI: 3.6-51.2). CONCLUSION: Distal motor latency is the main parameter for predicting the presence of spontaneous activity in mild and moderate CTS patients with normal CMAP. Performing needle EMG of the thenar muscle in CTS patients with a DML of >4.9 ms may be beneficial to detect axonal degeneration in early stages.

A rarely seen syndrome in rehabilitation of hemiplegia: antiphospholipid antibody-negative Sneddon's syndrome.

Sneddon's syndrome is a rarely seen disorder and it is characterized by livedo reticularis (LR) and neurologic findings. Some systematic findings may also be seen with neurologic and cutaneous findings. In this case, we aimed to present a 28-year-old female patient with diffuse LR, cardiac valve disease and migraine-type headache who had a right hemiplegic attack.

Efficacy of combined oral-intravesical oxybutynin hydrochloride treatment for patients with overactive detrusors and indwelling urethral catheters.

The purpose of this article is to investigate the efficacy of intravesical oxybutynin hydrochloride (OH) to treat patients with overactive detrusors who are unresponsive to oral anticholinergic therapy alone. Twenty-five patients who were treated with oral OH for overactive detrusor (but who did not respond to treatment and were using indwelling urethral catheters) were given intravesical OH without changing oral treatment. Pre- and posttreatment bladder capacities were compared in urodynamic studies. The study showed that positive clinical results can be achieved with combined oral and intravesical OH treatments in patients with overactive detrusors who had indwelling urethral catheters because of severely reduced bladder capacity. However, a significant number of patients discontinued this treatment because of infection and difficulty in performing the procedure. Clinicians and rehabilitation nurses should provide education and support to eliminate these problems. In addition, the development of single-use standard sterile OH preparations for intravesical applications may increase the efficacy of the method.

Dynamic thiol and disulphide homoeostasis in fibromyalgia.

INTRODUCTION: Thiol and disulphide levels are biomarkers that provide useful information about oxidative stress and antioxidant capacity, showing a different homoeostasis in inflammatory and proliferative diseases. We aimed to clarify the possible aetiology of this disease by using thiol and disulphide levels in patients with fibromyalgia, the basis of which has not yet been clearly elucidated. MATERIAL AND METHODS: A total of 156 individuals: 86 patients with fibromyalgia and 70 age-matched controls were included in this prospective non-randomised case-control study. Demographic characteristics including smoking status, body mass index (BMI), the duration of complaints, and pain levels were carefully recorded. Dynamic thiol-disulphide homoeostasis in blood samples was determined by an automatic-spectrophotometric method. The Mann-Whitney U and Student's t-test were used to determine the differences between the groups. RESULTS: Sex, BMI, and smoking status were similar between the groups (p = 0.62, p = 0.09, and p = 0.64, respectively). While native thiol levels were found to be high in patients with fibromyalgia (p = 0.018), disulphide levels and the rates of disulphide/native thiol and disulphide/total thiol were significantly low (p = 0.049, p = 0.007, and p = 0.007, respectively). Correlation analysis showed no significant relationship between thiol-disulphide levels and duration of complaints or pain level. CONCLUSIONS: Thiol-disulphide balance in fibromyalgia was found to be similar to benign proliferative diseases, suggesting that the underlying mechanism is more likely to be of proliferative pattern rather than inflammatory. Additionally, fibromyalgia is not directly associated with increase in oxidative stress. The molecular mechanisms need to be elucidated.

Association of anti-CCP positivity with serum ferritin and DAS-28.

Antibodies to cyclic citrullinated peptides (anti-CCP) are highly specific for the diagnosis of rheumatoid arthritis (RA) with a marginal increased prediction of the disease. In this study, we aimed to investigate the relation of the presence of anti-CCP with clinical manifestations and disease activity in a cohort of RA patients. A total of 61 RA patients were included in this study. Data of disease-related parameters such as duration of disease, medications, degree of pain (visual analog scale, VAS), disease activity score 28 (DAS-28) and health assessment questionnaire (HAQ) were recorded. Laboratory workup included erythrocyte sedimentation rate (ESR), plasma C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP, complete blood count and anemia parameters. Anti-CCP positivity was associated with higher scores of DAS-28, longer duration of morning stiffness, serum RF positivity and low levels of serum ferritin, while it was not associated with disease duration, VAS, HAQ, ESR, CRP and hemoglobin.