Reliability and validity of the Turkish version of general sleep disturbance scale (GSDS-T) in stroke.

BACKGROUND: Stroke is a life-threatening condition with many complications. Sleep disturbances is one of them. Sleep disturbances effect quality of life, recovery and rehabilitation process. It is crucial to reveal sleep disturbances objectively in stroke patients. The aim of the study is to determine reliability and validity of the Turkish version of General Sleep Disturbance Scale (GSDS-T) in stroke patients. METHODS: After translation and culture validation of the scale was done, Pittsburgh Sleep Quality Index (PSQI) and the Turkish version of the GSDS was applied at admission and at 24 h to the 58 patients with stroke. RESULTS: Cronbach alpha coefficient of total score was found as 0.850 and test re-test reliability-related Cronbach alpha coefficient was 0.785. CONCLUSION: GSDS-T is a reliable and valid tool to assess sleep disturbance in stroke patients.

Scapula winging secondary to prone plank exercise: a case report.

Background: Scapular winging occurs when the muscles responsible for the stabilization of the scapula (serratus anterior, trapezius, rhomboid major and minor) are paralyzed due to any reason. The most frequently observed neurological aetiology is serratus anterior muscle dysfunction due to long thoracic nerve palsy. The cause of long thoracic nerve palsy may be traumatic or atraumatic. It has been previously reported that a wide variety of sports can cause long thoracic nerve palsy.Clinical presentation: In this article, we report a case of unilateral winging of the scapula due to injury to the long thoracic nerve which occurred secondary to performing prone plank exercises; the likes of which has not previously been described in the literature and which may have occurred due to the exercise being performed incorrectly. In this patient, nerve recovery became evident one month following conservative treatment and cessation of plank exercises.Conclusion: Long thoracic nerve injury may have occurred due to increased and incorrect scapula loading during plank exercises. In order to prevent compression neuropathies caused by load transfer imbalance, attention should be paid to correct positioning whilst performing core stabilization exercises such as the prone plank.

Comparison of the Effectiveness of Kinesiology Taping and Rigid Taping on Ankle Kinematics During Drop Landing in Individuals with Lateral Ankle Injury.

BACKGROUND: Lateral ankle sprain is an injury that often occurs during sports or daily life activities. Athletic tape and kinesiology tape applications are among the external support treatment options especially for athletes to support the ankle and protect it from recurrent sprains. We sought to compare the kinematic stabilization effects of different ankle taping applications on the ankle joint during drop landing in individuals with a history of unilateral lateral ankle injury. METHODS: In this randomized controlled study, 30 volunteers with unilateral ankle injury were evaluated. The participants were asked to land on one leg on the involved side and the contralateral side from a 30-cm-high platform. The same practice was repeated after applying kinesiology tape and rigid tape to the injured foot. Kinematic analysis of the foot and ankle was performed by recording three-dimensional spatial position information at a speed of 240 frames per second using infrared cameras. RESULTS: The highest inversion angles of the involved foot at initial contact and 150 msec after initial contact were higher than those of the uninvolved side (P = .03 and P = .04, respectively). There was no significant difference in ankle kinematic values in the involved foot among kinesiology taping, athletic taping, and no taping applications (P = .74). CONCLUSIONS: People with lateral ankle sprains show reduced inversion during landing. There were no significant differences among kinesiology taping, athletic taping, and no taping on the injured foot in terms of ankle kinematics. Care should be taken when using taping materials as protective measures for sports activities.

Effect of estrogen and progesterone on nerve conduction studies during ovarian cycle.

OBJECTIVES: This study aims to investigate the effects of estrogen and progesterone on nerve conduction studies (NCSs) in three different hormonal phases of the ovarian cycle. PATIENTS AND METHODS: Between April 2008 and July 2008, a total of 40 healthy volunteer women (mean age: 24.1±5.1 years; range 21 to 43 years) with regular menstrual cycles were included in this prospective study. The participants were regularly menstruating for at least one year, without any hormonal disease and without taking any medication that could lead to hormonal dysregulation. Motor and sensory conduction velocities, amplitudes, and distal latencies were analyzed at the dominant extremities within the early follicular phase (EFP), late follicular phase (LFP), and the midluteal phase (MLP). RESULTS: Except for the median nerve motor conduction velocity (MCV), there were no statistically significant differences between the peripheral NCS results in the three ovarian cycle phases (p=0.033). After adjusting for multiple comparisons, a significant difference was found between the EFP and LFP (p=0.004). CONCLUSION: Our study results showed that only median nerve MCV was affected in the menstrual cycle. However, this would be an incidental finding, or an increased sensibility of the median nerve motor fibers to ovarian steroids by an unknown mechanism. Further studies are warranted.

Exercise, Manipulative Therapy, and Physical Modalities in the Treatment of Notalgia Paresthetica: A Case Report.

Objective: The purpose of this case report is to describe the care of a patient with notalgia paresthetica (NP). Clinical Features: A 61-year-old man presented with a 7-year history of upper back pain, concentrated in the right periscapular region. Physical examination revealed a hyperpigmented area in the right dorsal paravertebral and infrascapular region with local paraesthesia. After investigations, a diagnosis of NP was made. Intervention and Outcome: An exercise program including back and shoulder stretching and shoulder strengthening exercises, and transcutaneous electrical nerve stimulation resulting in a reduction of symptoms. Conclusion: In the case described here, the patient's symptoms regressed when treated conservatively with exercise and physical therapy modalities.

Elastofibroma dorsi: A case report on an unobserved cause of back pain.

Elastofibroma dorsi (ED) is a rare, benign soft tissue tumor which often occurs in the subscapular region of elderly individuals and shows a female predominance. While many patients remain asymptomatic, ED can cause pain in the periscapular region. The clinical signs of ED are non-specific and variable which can result in misdiagnoses; it is often confused with rotator cuff and cervical spine pathologies. In this article, we present the case of a 78-year-old female patient with persistent back and shoulder pain. The patient was admitted to various clinics over a number of years for diagnostic investigations and treatment. However, the true etiology of back pain was never established and treatments were applied without any positive effect. Finally, when the patient presented to our clinic, a mass was detected in the right subscapular region. Thoracic computed tomography imaging was consistent with a diagnosis of ED. Due to the patient's persistent back pain, surgical excision of the tumor was performed. The pathology report confirmed the diagnosis. This case emphasizes the importance of a thorough examination in patients who may initially only have very subtle signs of the underlying pathology. This case also highlights the importance of re-visiting initial evaluations and differential diagnoses when faced with a difficult case of persistent back and shoulder pain so to avoid misdiagnoses and unnecessary treatments.

Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study.

BACKGROUND AND PURPOSE: Transcranial direct current stimulation (tDCS) is a treatment used in the rehabilitation of stroke patients aiming to improve functionality of the plegic upper extremity. Currently, tDCS is not routinely used in post stroke rehabilitation. The aim of this study was to establish the effects of bihemspheric tDCS combined with physical therapy (PT) and occupational therapy (OT) on upper extremity motor function. METHODS: Thirty-two stroke inpatients were randomised into 2 groups. All patients received 15 sessions of conventional upper extremity PT and OT over 3 weeks. The tDCS group (n = 16) also received 30 minutes of bihemispheric tDCS and the sham group (n = 16) 30 minutes of sham bihemispheric tDCS simultaneously to OT. Patients were evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), functional independence measure (FIM), and Brunnstrom stages of stroke recovery (BSSR) by a physiatrist blind to the treatment group RESULTS: The improvement in FIM was higher in the tDCS group compared to the sham group (P = .001). There was a significant within group improvement in FMUE, FIM and BSSR in those receiving tDCS (P = .001). There was a significant improvement in FIM in the chronic (> 6months) stroke sufferers who received tDCS when compared to those who received sham tDCS and when compared to subacute stroke (3-6 months) sufferers who received tDCS/sham. CONCLUSIONS: Upper extremity motor function in hemiplegic stroke patients improves when bihemispheric tDCS is used alongside conventional PT and OT. The improvement in functionality is greater in chronic stroke patients.

The effects of two different water exercise trainings on pain, functional status and balance in patients with knee osteoarthritis.

METHODS: Eighty-nine female patients who had been diagnosed with knee osteoarthritis were divided into three groups as two experimental and a control group. All groups have received the standard therapy (hotpack, ultrasound, TENS). Both experimental groups underwent water exercise program. While Group 1 performed lower extremity exercise training, Group 2 performed upper extremity exercises as well as trunk exercises in addition to the lower extremity exercises used in the Group 1. The third group was control group who did not receive water exercise treatment. The pain severity was measured with the Visual Analog Scale (VAS). Functional status was assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Balance was evaluated by using the single leg stance test. RESULTS: The change in VAS scores from pre-to post-treatment was highest in Group 1 (p < 0.001). On the other hand, the change in WOMAC pain, stiffness and physical function values from pre-to post-treatment was highest in Group 2 (p < 0.001). DISCUSSION: Water exercise training was found to be beneficial in the treatment of knee osteoarthritis in both groups. Moreover, adding upper extremity and trunk exercises to the lower extremity exercises was found to be more effective for improving the function.

Diurnal variation in clinical and electrophysiologic parameters associated with carpal tunnel syndrome.

OBJECTIVE: Patients with carpal tunnel syndrome (CTS) often report aggravated symptoms in the early morning. In this study, we aimed to identify diurnal variations in clinical and electrophysiologic parameters of patients with CTS. DESIGN: A cross-sectional clinical and electrophysiologic study was designed. First, electrophysiologic examinations were performed at 2 p.m. to confirm the diagnosis of patients who had been clinically labeled with CTS. Patients who were electrophysiologically and clinically diagnosed with CTS were included in the study, and electrophysiologic examinations were repeated at 7 p.m. and 7 a.m. A total of 64 hands with CTS (27 bilateral, 10 unilateral) and 40 control hands were studied. Grip and pinch strength of all the patients included in the study were measured using a hand dynamometer. Finally, a CTS clinical symptom severity scale and functional status scale were used to measure the symptoms and functional impairment, respectively. RESULTS: The median motor nerve distal latency and median F-minimum latency were found to be prolonged in the CTS group in the morning, and the grip strength was also markedly reduced at this time. Similar results were obtained for the median palm mixed nerve conduction velocity and amplitude. CONCLUSIONS: This study demonstrated that the clinical and electrophysiologic parameters of CTS patients were clearly different in the morning hours, with the symptoms of CTS manifesting at that time.

Effects of osteoarthritis and fatigue on proprioception of the knee joint.

OBJECTIVE: To evaluate the impact of knee osteoarthritis (OA) and periarticular muscular fatigue on knee joint kinesthesia. DESIGN: Cross-sectional study. SETTING: A physical medicine and rehabilitation outpatient clinic. PARTICIPANTS: Fifty patients with bilateral OA of the knee, and a control group of 30 age-matched healthy volunteers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Kellgren-Lawrence grading system was used to determine the radiographic severity of knee OA. The Lequesne index of severity for knee osteoarthritis was used for assessment of pain, kinesthesia was measured by determining angle reposition error at the knee joint using isokinetic dynamometry, and muscle strength was measured by isokinetic dynamometry. RESULTS: Reposition errors did not differ between the patient and the control groups, nor did they differ between pre- and postexercise. CONCLUSIONS: Mild-to-moderate OA of the knees does not affect reposition error. Fatigue produced by mild-to-moderate exercise also has no effect on reposition error.

The effect of abdominal massage on bowel function in patients with spinal cord injury.

OBJECTIVES: To investigate the effect of abdominal massage on clinical aspects of bowel dysfunction and colonic transit time in patients with spinal cord injury. Twenty-four patients were placed on a standard bowel program (phase I), after which abdominal massage was added to the regimen (phase II). Parameters of gastrointestinal system function and colonic transit times were evaluated. DESIGN: Uncontrolled clinical study. RESULTS: Eleven (45.8%) of the 24 patients had abdominal distention, and 10 (41.7%) had fecal incontinence in phase I; corresponding results for phase II were three (12.5%) and four (16.7%) (P = 0.008 and 0.031, respectively). There were no significant differences between the proportions of patients with difficult intestinal evacuation or abdominal pain or in mean time required for bowel evacuation in phase I vs. phase II. The mean frequencies of defecation in phases I and II were 3.79 +/- 2.15 (2.75-4.55) and 4.61 +/- 2.17 (3.67-5.54) bowel movements per week, respectively (P = 0.006). Mean total colonic transit time decreased from 90.60 +/- 32.67 (75.87-110.47) hrs in phase I to 72 +/- 34.10 (58.49-94.40) hrs in phase II (P = 0.035). CONCLUSIONS: Abdominal massage has positive effects on some clinical aspects of neurogenic bowel dysfunction in patients with spinal cord injury.

Relationships between muscle strength and bone mineral density of three body regions in sedentary postmenopausal women.

This cross-sectional study was designed to investigate correlations between muscle strength and regional bone mineral density (BMD) in sedentary postmenopausal women. Sixty-two women who ranged in age from 41 to 76 years were investigated. Hip and trunk muscle strength was measured by isokinetic dynamometry. Grip strength of the nondominant hand was measured using a hand-held dynamometer. Bone mineral density of the lumbar spine, femur, and distal radius was measured by dual-energy X-ray absorptiometry. Only the correlation between hip abductor strength and femoral BMD was significant (P = 0.009, r = 0.327). There was no correlation between trunk muscle strength and lumbar vertebral BMD or between grip strength and distal radius BMD. Subjects with osteoporosis (T score < -2.5) or osteopenia T (-2.5 to -1) and normal subjects (T > -1) exhibited similar isokinetic hip and trunk muscle strength. Women with osteoporotic distal radii had significantly lower grip strength than subjects who were osteopenic or normal at this site, but the osteoporotic group was also significantly older. In conclusion, our results indicate that the isokinetic strength of hip abductors weakly correlates with femoral BMD in postmenopausal women with and without osteoporosis. Trunk muscle strength did not correlate with lumbar vertebral BMD in either of these groups. The weaker handgrip we observed in the women with osteoporotic radii may be attributed to older age.

Prolonged P300 latency in thyroid failure: a paradox. P300 latency recovers later in mild hypothyroidism than in severe hypothyroidism.

This study was performed to analyze quantitatively the cognitive functions of patients with mild and severe hypothyroidism by measuring P300 event-related evoked potentials before and after euthyroidism was established. Patients diagnosed as having Hashimato's thyroiditis with thyroid stimulating hormone (TSH) levels between 5 and 10 mU/L (mild thyroid failure; n = 24) and those with severe hypothyroidism (n = 13) were enrolled randomly to the study protocol. P300-event related potentials were recorded during thyroid insufficiency, and in the first and sixth month of euthyroidism. P300 latencies were prolonged in both the mild and severe hypothyroid patients compared to controls (p = 0.042, p < 0.001, respectively). The overt hypothyroid patients showed significant decrease in their P300 latencies after the first month of euthyroidism (p = 0.001). These P300 latency values did not differ in the subsequent 6-month period. The mild hypothyroid group, however, displayed no improvement of P300 latency in the first month but normalized at the sixth month of euthyroidism. In conclusion, both the overt and the mild hypothyroid patients revealed prolonged P300 latencies. Unexpectedly, P300 latencies in the patients with mild thyroid failure required more time to recover compared to the overt hypothyroid patients. This finding indicates different clinical outcomes of various thyroid insufficiency states on the brain.

A comparison study of quality of life in women with fibromyalgia and myofascial pain syndrome.

PURPOSE: To compare the quality of life scores of fibromyalgia patients with myofascial pain syndrome patients. METHOD: Thirty-three fibromyalgia patients, 33 myofascial pain syndrome patients, and 33 age-matched controls completed Beck Depression Inventory and Short Form-36 questionnaires. RESULTS: Compared with myofascial pain syndrome patients, fibromyalgia patients reported significantly more often fatigue, numbness, tingling, gastrointestinal discomfort, and poor sleep. The mean scores on VAS and on Beck Depression Inventory were significantly higher in fibromyalgia patients than myofascial pain syndrome patients. Patients with fibromyalgia had significantly poorer health than the patients with myofascial pain syndrome in pain, general health, vitality, and role emotional subscales. CONCLUSIONS: The quality of life profile of fibromyalgia patients is quite different from those in the myosfascial pain syndrome group. Myofascial pain syndrome impacted mostly on physical health whereas fibromyalgia impacted on both physical and mental health.

Hemorrhagic transformation in stroke patients.

OBJECTIVE: To identify the predictors of hemorrhagic transformation in stroke patients and to evaluate the impact of hemorrhagic transformation on rehabilitation outcome. DESIGN: The records of 203 hemiplegic patients hospitalized for rehabilitation after the acute phase of stroke were retrospectively analyzed. In 121 cases, the first computed tomographic scan and a repeat scan were compared to determine whether hemorrhagic transformation occurred. Correlations between the occurrence of hemorrhagic transformation and use of anticoagulants, antiaggregants, and antiedema drugs were evaluated. Admission and discharge FIM trade mark and Adapted Patient Evaluation Conference System scores were noted, and functional gain was calculated from these. These data were also analyzed for associations with hemorrhagic transformation. RESULTS: Hemorrhagic transformation was detected in 39 of the 121 cases. There was no significant difference in functional outcome between patients who did and did not show hemorrhagic transformation. Although not statistically significant, the use of antiedema drugs was found to increase the risk of hemorrhagic transformation, whereas the use of anticoagulants and antiaggregants had no influence. CONCLUSIONS: Hemorrhagic transformation of an ischemic lesion does not affect rehabilitation outcome in stroke survivors. The study results favor the use of anticoagulants and antiaggregants in the acute phase unless these drugs are contraindicated by the patient's condition. Still, prospective trials are needed to make definite conclusions.

Diffuse idiopathic skeletal hyperostosis in a patient with idiopathic retroperitoneal fibrosis: a case report.

Idiopathic retroperitoneal fibrosis (IRF) is a rare rheumatologic disease with obscure pathogenesis. Its manifestations depend upon the structures involved. Diffuse idiopathic skeletal hyperostosis (DISH) is usually seen in male patients over 45 years of age and characterized by new bone formation at the entheses. The dorsal spine is most commonly involved, but radiographic findings in both the spine and extraspinal structures suggest a generalized disorder of ossification rather than a localized spinal disease. The association of IRF and DISH has not been reported before. There is proliferation of connective tissue in both of these diseases, and they may share a common etiopathogenetic basis. We describe a patient having features of both IRF and DISH.