Investigating the status of using lower extremity orthoses recommended to patients with spinal cord injury.

STUDY DESIGN: Retrospective descriptive study. OBJECTIVES: The present study aimed to investigate the rate of using orthosis among spinal cord injury (SCI) patients for whom orthosis was recommended for standing and walking, the relationship between the clinical and demographic characteristics of SCI and the use of orthosis and the reasons for not using orthosis. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. METHODS: The study included 62 SCI patients for whom orthosis was recommended for standing and ambulation. The patients were classified into two groups as individuals using and not using the recommended orthosis every day in order to evaluate the effect of age, gender, residence, duration of disease/recommended duration of orthosis, recommended orthosis, lesion level-degree, lower extremity tonus-range of motion and ambulation level on the frequency of orthosis use. RESULTS: The orthosis most commonly recommended was hip-knee-ankle-foot orthosis with waist or pelvic belt (45.2%). Of the patients, 25.8% have never used the orthosis. The most common reason for not using the recommended orthosis was the failure to facilitate the daily life activities of the patient (30%), the difficulties in putting them on and taking them off (20%), the belief that it is unnecessary (15%) and the pressure (15%). In addition, the assessed clinical and demographic features were detected as not important risk factors for not using orthosis. CONCLUSION: At least one out of four patients with SCI do not use the recommended lower extremity orthosis. Selecting eligible patients, patient training and follow-up are important for increased frequency of orthosis usage.

Functional Outcomes of the Surgery and Rehabilitation in a Challenging Case of Heterotopic Ossification after Encephalitis.

Heterotopic ossification is the formation of the lamellar bone where normally osseous tissue does not exist. Since heterotopic ossification can cause severe functional loss, it is a challenging condition for both clinicians and patients. Neurogenic heterotopic ossification is a rare condition after encephalitis. Likewise, in this paper, we have presented a challenging case of heterotopic ossification after viral encephalitis and functional outcomes after the management of heterotopic ossification.

Hypospadias in spinal cord injury: association with indwelling catheter drainage and disturbance of behavior: a report of three cases.

STUDY DESIGN: Case series. OBJECTIVE: To present three cases of paraplegic patients with hypospadias and psychiatric comorbidities. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey. CASES: Three spinal cord injured male patients with hypospadias are presented. All three patients had a history of psychiatric disorders that is thought to be a precipitating factor. CONCLUSION: This is the first report in the literature of three cases of hypospadias associated with indwelling catheter drainage and behavioral disturbance.

Wheelchair appropriateness in patients with spinal cord injury: a Turkish experience.

STUDY DESIGN: Descriptive. OBJECTIVE: To determine the wheelchair appropriateness in patients with spinal cord injury (SCI). SETTING: National Rehabilitation Center in Ankara, Turkey. METHODS: Twenty-seven (25 male, 2 female) SCI patients were included. Demographic and clinical characteristics of the patients were noted. All wheelchairs were evaluated considering each part (seat length, seat depth, seat height, back height, armrest, headrest, wheels and seat belt) by a physiatrist who had attended the wheelchair-training course. The wheelchair was declared as inappropriate if at least three parts of wheelchair were not appropriate. RESULTS: The mean age of the patients was 32.9±9.3 years and mean duration of wheelchair use was 19.63±23.02 months. Among the patients, 21 (77.8%) were American Spinal Injury Association Impairment Scale (AIS) A, 4 (3.7%) AIS B, 1 (3.7%) AIS C and 1 (3.7%) AIS D. Five (18.5%) wheelchairs were motorized and 22 (81.5%) were manual. Overall, 15 (55.6%) wheelchairs were inappropriate. Seat height, cushion and back height were the most common inappropriate parts. CONCLUSION: In light of our first and preliminary results, we can argue that 55% of the patients with SCI use inappropriate wheelchairs. In order to achieve better mobility; personally designed wheelchairs should be prescribed by the clinicians.

Urinary dysfunction in multiple sclerosis.

We aimed to determine the prevalence of urinary symptoms and complications in multiple sclerosis (MS) and to investigate the correlation of these symptoms and complications with urodynamic findings and disease characteristics (primary progressive, relapsing-remitting and secondary progressive). Fifty-two patients with MS were enrolled in the study. Patients were divided into three clinical types: primary progressive, relapsing-remitting and secondary progressive. Urological symptoms and complications were recorded. Each patient underwent a urodynamic investigation. Patients were evaluated for overall disability using the Expanded Disability Status Scale (EDSS). We found that 22 patients had primary progressive, 18 patients had relapsing-remitting and 12 patients had secondary progressive MS. Urgency was the most frequent urinary symptom (65%). Urinary infection was the most frequent urinary complication (15%). Detrusor hyperreflexia was found to be the main bladder dysfunction (27%). Detrusor sphincter dyssynergia was found in 25% of patients, and detrusor hyporeflexia was detected in 6%. No relationship was found between urinary symptoms and urodynamic abnormalities (p>0.05) and between urinary complications and urodynamic findings (p>0.05). No significant correlation was found between disease characteristics and urinary symptoms, urinary complications or urodynamic findings (p>0.05). We suggest that the assessment of urological symptoms and urodynamic evaluation is critical for evaluating quality of life in MS.

Ear, nose and throat findings in cystic fibrosis patients.

An ear-nose-throat survey was carried out on 30 children with cystic fibrosis (CF) between two and 17 years of age. There were three (10%) confirmed cases of secretory otitis media. One child had previous surgery for polyps. Ten children had chronic pansinusitis mildly responsive to medical therapy. Hypertrophy of the nasal conchae was detected in eight cases. The data showed that the risk of ear-nose-and-throat disease was increased in CF patients, but audiologic problems are not very common in CF patients. CF should be kept in mind in children who have nasal polyps, hypertrophied turbinates or sinusitis unresponsive to medical therapy.

Delayed post-traumatic syringohydromyelia after an uncomplicated fracture of the spine: case report and literature review.

A patient who had had a traffic accident resulting with a compression fracture of the L1 vertebra but with no neurological deficits, developed urinary incontinence and weakness in his lower extremities 25 years after the spinal injury. An MRI scan of the spine revealed gliosis of the conus medullaris at the level of the compression fracture, with syringohydromyelia extending from T6 to conus medullaris. The patient underwent a rehabilitation program at the end of which he was able to ambulate independently.

Auditory nerve-brainstem responses in cystic fibrosis patients.

We conducted a study in 30 children with cystic fibrosis (CF) to determine if their hearing had been affected. Their ages ranged between 2 to 17 years and they were studied by means of complete audiologic evaluation and brainstem evoked response audiometry (BERA). Twenty of them had received some ototoxic drugs for variable periods. The results showed that there was no significant correlation between CF and BERA findings. The findings indicated that, except a few middle ear problems such as serous otitis media, CF did not affect hearing status of the CF children per se.

Kinematic gait analysis in hemiplegic patients.

Temporal-distance variables of gait were investigated in 8 female and 23 male hemiplegic patients in order to assess the distribution of these variables according to functional ambulation category and to evaluate their validity. Video-recording technique was used for obtaining the temporal-distance values. Velocity, step-time, stride length and stride length in relation to lower extremity length proved to be valuable measures in the gait analysis, while cadence, step-time and step-time differential values seemed to be less important.