Hand splinting for poststroke spasticity: a randomized controlled trial.

PURPOSE: To determine the effect of volar and dorsal splinting on the spasticity of the wrist flexor muscles in patients who had stroke. METHOD: Thirty-nine subjects were prospectively randomized to use a dorsal or volar splint or no splint (control group). All the patients underwent home-based exercise program, and the experimental groups used either dorsal or volar hand splints according to their distribution. The primary outcome measure was spasticity assessed clinically by the Modified Ashworth Scale (MAS) and electrophysiologically by H latency and Hmax:Mmax ratio of flexor carpi radialis. Secondary outcome measure was passive range of motion (PROM) of wrist extension. RESULTS: Spasticity parameters (MAS, H latency, Hmax:Mmax ratio) and wrist PROM were not significantly different among the groups. CONCLUSIONS: This study failed to demonstrate any statistically significant difference in spasticity or in wrist PROM of both the volar and dorsal splint groups. These splints could be recommended as part of an integrative approach without expecting a major clinical effect rather than as an alternative to other treatment.

Somatosensory evoked potentials of hand muscles in stroke and their modification by botulinum toxin: a preliminary study.

OBJECTIVE: To determine the effect of botulinum toxin A on spasticity and somatosensory evoked potentials of hand muscles in patients who have undergone cerebrovascular accident. DESIGN: Preliminary, prospective, before-after study design. PATIENTS: Six subjects prospectively followed after application of botulinum toxin A in the rehabilitation department of a university hospital. METHODS: All patients underwent botulinum toxin A injection to the upper extremity muscles in varying combinations and carried out a home-based exercise programme. Primary outcome measure was median somatosensory evoked potential of hand muscles (N20). Secondary outcome measures were: spasticity assessed clinically by Modified Ashworth Scales (MAS); functional ability analysis assessed by Physician's Rating Scale (PRS); and functional difficulties reported by patients or their care-givers by patient disability and care-giver burden rating scale (PD & CBRS). RESULTS: MAS, PRS and PD & CBRS improved with botulinum toxin A treatment. In the affected limb, N20 potentials were impaired compared with those in the unaffected side. With botulinum toxin A treatment, although improvement in overall N20-P25 amplitudes was significant, as a result of limited sample size, post hoc pair-wise comparisons with Bonferroni correction failed to yield any significant pairs. CONCLUSION: The improvement in the median somatosensory evoked potentials following botulinum toxin A treatment suggests that central somatosensory patterns in hemiplegia can be modified by peripheral inputs.

Burnout, depression and anxiety levels in mothers of infants with brachial plexus injury and the effects of recovery on mothers' mental health.

OBJECTIVE: To evaluate depression, anxiety and burnout in mothers of infants with brachial plexus injury and assess the effects of the severity of injury on the mothers' mental health, as the literature provides no information on this topic. STUDY DESIGN: The study was based on eighteen mothers without psychiatric antecedents who had infants with perinatal brachial plexus paralysis (PBPP). The severity of the brachial plexus injury was classified according to the Narakas classification system. The recovery rate following conservative treatment was classified according to the Modified Mallet Classification System. The Maslach burnout inventory, Beck depression inventory, and Beck anxiety inventory were administered to the mothers. RESULTS: The mothers whose infants were in the third Narakas group were mildly depressed and the depression scores of the mothers in Narakas groups II and III were regularly increased. Mothers in the first and second groups reported a minimal level of anxiety scores. There was no statistically significant difference between the depression, anxiety, emotional exhaustion, depersonalization, and personal accomplishment scores of the mothers in relation to the severity of the injury in the child (p=0.218, p=0.078, p=0.149, p=0.138, and p=0.246). In addition, the depression and anxiety levels of the mothers whose infants recovered fully or partially showed a statistically significant decrease when compared to the mothers of infants with no recovery (p=0.003, p=0.015). There was, however, no statistically significant difference between the emotional exhaustion, depersonalization, and personal accomplishment scores of the mothers of infants with full recovery, partial recovery and no recovery (p=0.591, p=0591, p=0.062). CONCLUSION: Infants' disability may cause psychological distress in their mothers. When brachial plexus injury is predicted in infants, more mothers may become depressed.

Awareness of osteoporotic patients.

Osteoporosis has recently been recognized as a major public health problem by some governments and health care providers. Despite significant progress in knowledge about osteoporosis, public awareness is required for effective management if precautions are to be taken. The aim of this study was to evaluate the educational status of osteoporotic individuals, and their awareness about the disease and sources of information. We also aimed to compare the variables between the geographical regions of the country, since significant differences exist in socioeconomic status and lifestyle within the same cultural context. This multicenter study was carried out in eight cities located in six different geographical regions between September 2001 and January 2002. To our knowledge, this is the first multicenter study in Turkey evaluating the relationship between awareness of osteoporotic patients and other variables such as educational level and economic factors. Ten centers took part in this study and consecutive patients with either femoral or lumbar T-scores below -2.5 SD were enrolled into the study group. Bone mineral density was measured using dual energy X-ray absorptiometry (DXA). Patients were interviewed using a questionnaire on past medical history, education, awareness about their disease and risk factors for osteoporosis. A total of 540 women (93.8%) and 36 men (6.3%) were included in the study. Fifty-four percent of patients declared that they were aware of osteoporosis. With regard to sources of information, 56.8% of patients reported physicians as the main source of information. Awareness of the patients was negatively correlated with age (P=0.025, r=-0,94) but positively correlated with education (P=0.0001, r=0.327), level of physical activity (P=0.001, r=143), calcium intake (P=0.005, r=119) and modern clothing style (P=0.0001, r=309). Educational status of the patients was negatively correlated with BMI (P=0.0001, r=-283) and positively correlated with physical activity (P=0.0001, r=268), modern clothing style (P=0.0001, r=600) and smoking (P=0.0001, r=273). Regional comparison of female patients demonstrated that significant differences exist in terms of educational status, clothing style, smoking, level of physical activity, calcium intake, and knowledge about osteoporosis. As a result, education has profound effects on awareness about osteoporosis and many aspects of human behavior, such as calcium intake, physical activity, clothing style and smoking. Significant disparities may be observed between the geographical regions of the same country.