Diaphragm ultrasonography and pulmonary function tests in patients with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To investigate the role of ultrasonographic measurement of the diaphragm thickness on pulmonary function tests in patients with spinal cord injury (SCI). SETTING: Rehabilitation center in Ankara, Turkey. METHODS: A total of 42 patients (34 M, 8 F) with SCI and 20 able-bodied volunteers (8 M, 12 F) were enrolled. Patients with SCI were divided into three groups according to their neurological (injury) levels. All participants underwent ultrasonographic measurements for diaphragm thickness on both sides and spirometric tests for pulmonary functions. The thickness ratio of the diaphragm was also calculated. RESULTS: There were seven patients (5 M, 2 F) in C2-C4 injury group, 14 patients (12 M, 2 F) in C5-T5 group, 21 patients (14 M, 7 F) in T6-L2 group, and 20 able-bodied volunteers (8 M, 12 F). The diaphragms of C2-C4 group were thicker than those of the controls at end-inspirium on the right side (2.7 ± 0.7 mm vs. 2.0 ± 0.5 mm; p = 0.035). The thickness ratios of C2-C4 group were lower than those of controls on the right (0.8 ± 0.4 vs. 1.5 ± 0.5; p = 0.005) and left (0.8 ± 0.5 vs. 1.6 ± 0.7; p = 0.003) sides. For all the pulmonary function tests (except for FEV1/FVC); patients with SCI had worse results than controls; and among the SCI groups, the higher the injury level, the worse the results. CONCLUSION: Although patients with high-level SCI had worse pulmonary function tests and decreased the contractile capacity of the diaphragm, they had thicker diaphragm muscles than controls. This may have been due to the compensatory effect of the diaphragm (performing its maximum contraction capacity and increasing frequency of inspiration).

Sonographic guide for botulinum toxin injections of the upper limb: EUROMUSCULUS/USPRM spasticity approach.

The pertinent literature lacks overt technical data for optimal upper limb muscle botulinum toxin injections using ultrasound (US) imaging. Therefore, this guide is prepared for the commonly injected muscles of the upper limb and the shoulder girdle mainly in spasticity. It includes clinical information, anatomical description and explanation regarding the US imaging of several muscles. The figures have been organized to orient the readers on the innervation, injection sites, probe positioning and the US images simultaneously.

Sonographic guide for botulinum toxin injections of the lower limb: EUROMUSCULUS/USPRM spasticity approach.

The pertinent literature lacks overt technical data for optimal lower limb muscle botulinum toxin injections using ultrasound (US) imaging. Therefore, this guide is prepared for the commonly injected muscles of the lower limb and the pelvic girdle mainly in spasticity. It includes clinical information, anatomical description and explanation regarding the US imaging of several muscles. The figures have been organized to orient the readers on the innervation zones, injection sites, probe positionings and the US images simultaneously.

Do male and female patients with chronic neck pain really have different health-related physical fitness, depression, anxiety and quality of life parameters?

AIM: The purpose of this study was to investigate whole body physical fitness parameters such as maximal aerobic capacity (VO2 max), muscle strength, trunk flexibility, daily physical activity, pulmonary function, body composition, anxiety and depression, as well as other disease-related changes in patients with chronic neck pain (CNP), and to compare them with healthy controls. METHOD: Eighty patients (40 male, 40 female) with CNP and 80 (40 male, 40 female) controls were included in this study. VO2 max, handgrip and back-leg strengths, trunk flexibility, daily physical activity, pulmonary function test (PFT), body composition and pressure pain threshold (PPT) measurements were carried out. Neck disability index (NDI), Beck anxiety inventory (BAI), Beck depression inventory (BDI), Pittsburg sleep quality index (PSQI), and Short-Form health survey (SF-36) questionnaires were applied to all participants. RESULTS: Handgrip and back-leg strengths and suboccipital and paraspinal-C7 PPTs and health-related quality of life (HRQoL) were lower, and PSQI, BAI and BDI were higher, in female patients with CNP, compared to healthy controls; whereas, VO2 max and HRQoL were lower, and body fat percantage and PSQI were higher, in male patients with CNP, compared to healthy controls. Trunk flexibility and PFT values were not significantly different between the patients and the controls in both genders. CONCLUSION: We suggest that, on the basis of gender, consideration of not only the neck region but also whole body physical fitness, anxiety and depression parameters in patients with CNP might be helpful to the development of more benefical strategies for illness management.

Evaluation of health-related physical fitness parameters and association analysis with depression, anxiety, and quality of life in patients with fibromyalgia.

AIM: The purpose of this study was to investigate the physical fitness parameters (maximal aerobic capacity, muscle strength and flexibility), daily physical activity, resting metabolic rate (RMR), pulmonary function tests (PFTs), body composition, depression, anxiety and health-related quality of life (HRQoL) changes as well as the associations among these parameters in patients with fibromyalgia and to compare them with healthy controls. METHODS: Thirty-nine women with fibromyalgia and 40 controls were included in this study. Physical measurements, HRQoL questionnaire, Beck Depression Inventory (BDI) score and Beck Anxiety Inventory (BAI) score were applied to all participants. RESULTS: Maximal aerobic capacity, trunk flexibility, daily step numbers, total energy expenditure, RMR and PFT values were not significantly different between the patients and the controls. Fibromyalgia patients had higher daily moderate activity times, active energy expenditure values, and BDI and BAI scores, while their lower handgrip strength and back-leg strength values and Short-form health survey (SF)-36 scores were comparable to controls. Handgrip strength and back-leg strength values showed moderately positive correlations with SF-36 scores (total, physical health, mental health) and moderately negative correlations with BDI and BAI scores in patients with fibromyalgia. CONCLUSION: Our results suggested that muscle strength, HRQoL, depression and anxiety symptomatology were impaired in fibromyalgia patients compared to healthy controls. Low muscle strength is related to reduced HRQoL and increased depression and anxiety symptomatology in patients with fibromyalgia. Also we suggest that performing daily exercises, including aerobic and strength training, as part of one's lifestyle may have beneficial effects in fibromyalgia patients.