Investigation of health literacy level and its effect on quality of life in patients with spinal cord injury.

OBJECTIVES: To determine the health literacy (HL) level in patients with traumatic spinal cord injury (SCI) and evaluate the relationship between HL and the quality of life (QoL). STUDY DESIGN: Cross-sectional study. SETTING: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Turkey. PARTICIPANTS: A total of 77 patients with traumatic SCI aged 15-65 years where the trauma had occurred at least a month ago before data collection and who were attending the rehabilitation program at the hospital as inpatients we included in the study. OUTCOME MEASURES: The European Health Literacy Questionnaire Turkish Adaptation (HLS-TR) was used for the evaluation of the HL level, and the Short Form-36 was used for the evaluation of the QoL. RESULTS: The HL level was inadequate in 32.5%, problematic-limited in 40.3%, sufficient in 19.5%, and excellent in 7.8% of the patients. The vitality and mental health subdimensions of the QoL were found to be statistically significantly better in participants with excellent, sufficient or problematic-limited HL compared to those with an inadequate level. CONCLUSIONS: According to our results, the HL level of the majority of patients with SCI who are hospitalized in our hospital is low, and there is a relationship between HL and QoL. In conclusion, steps need to be taken to increase the HL levels of patients to improve their QoL, taking into account the important effect of HL on the QoL.

Investigation of Sexual Function in Men with Spinal Cord Injury in a Rehabilitation Hospital in Turkey.

Background: Sexual function is one of the most important functions for males with spinal cord (SC) injuries, and there are wide ranges and conflicting results about sexual dysfunction and the frequency of education of these patients. Objectives: The aim of our retrospective study is to evaluate sexual function and to determine the level of sexual education provided by medical professionals in males with SC injury. Patients and Methods: Eighty-one inpatient males with SC injury were included in the study. "International Index of Erectile Function" and "International Spinal Cord Injury Male Sexual Function Basic Data Set" were used to evaluate sexual function. Results: The median age of the patients was 31 years old (range 20-63), and the median disease duration was 190 days (range 30-5475). Of 81 patients, 55.6% had C1-T10, 33.3% had T11-L2, and 11.1% had L3 and lower injury. Of the patients, 90.1% were never informed about the impact of SC injury on sexual function. The rates of normal psychogenic and reflex erection were 16 and 18.5%, respectively. Erectile dysfunction was severe in 66.7% and moderate in 16% of patients. Only 4.9% of patients had normal ejaculation and 7.4% had normal orgasmic function. Sexual desire was very high or high in 49.4% and moderate in 32.1%. Overall, sexual satisfaction was high or moderate in only 6.2% of patients. Conclusion: Sexual education rates of male SC injured persons are very low. Although most of the patients have normal sexual desire, erection, ejaculation, orgasmic function, and sexual satisfaction are severely damaged.

Demographic and clinical characteristics of inpatient stroke patients in Turkey.

Objectives: This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion: This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Recurrent priapism in spinal cord injury: A case report.

Context: Recurrent priapism is characterized by repetitive episodes of erections which are unrelated to sexual interest or stimulation. It is extremely rare in patients with spinal cord injury (SCI). There are a number of conservative agents used in the treatment.Findings: We describe the case of a 20-year-old male with cervical-5 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A tetraplegia as a result of a diving accident 2 years ago. He declared that the recurrent penile erections occurred up to 15-20 times day and night every day and lasted up to 20 min each time unrelated to sexual interest or stimulation. He was prescribed baclofen 10 mg, twice daily. The frequency and duration of erections decreased to 3-5 times/day lasting for about 5 min each and the patient reported a high treatment satisfaction.Conclusion: The presentation of this case is to remind clinicians this rare but distressing condition of recurrent priapism seen in men with complete spinal cord lesions and to summarize the use of medications, most commonly baclofen, to alleviate the condition.

Effect of virtual reality therapy on functional development in children with cerebral palsy: A single-blind, prospective, randomized-controlled study.

OBJECTIVES: The aim of this study was to investigate the effect of virtual reality (VR) therapy on motor and functional development in children with cerebral palsy (CP). PATIENTS AND METHODS: In this single-blind, prospective, randomized-controlled study, a total of 41 patients (28 males, 13 females; mean age 8.49 years; range, 5 to 15 years) receiving inpatient treatment for CP were included between April 2009 and September 2009. The patients were randomly divided into two groups as the study group (n=21) and control group (n=20). Neurophysiological and conventional treatment methods, and occupational therapy were applied to all patients. In addition, a total of 12 VR therapy sessions for one hour were administered three days a week for four weeks to the study group. Before and after treatment, the Bimanual Fine Motor Function (BFMF) test was performed to measure hand functioning, Gross Motor Function Classification System (GMFCS) for functional levels, and Functional Mobility Scale (FMS) for mobility. RESULTS: There was a significant increase in the BFMF, GMFCS, and FMS scores after treatment, compared to baseline values in the study group (p<0.05). There was a statistically significant results in favor of the study group for all parameters after treatment compared to pre-treatment values (p<0.05). CONCLUSION: Our study results indicate that VR therapy is a useful treatment method which can be used in rehabilitation of CP with improved motor function. The addition of this method to conventional rehabilitation techniques may have a significant impact on treatment success.

The regularity of orthosis use and the reasons for disuse in stroke patients.

This is a Retrospective descriptive study. Orthoses and walking aids are used frequently in stroke rehabilitation to facilitate ambulation. The aim was to describe the regularity of orthosis use and the reasons for disuse in stroke after discharge from inpatient rehabilitation. The study included 64 (43 men, 21 women) subacute stroke patients who had been discharged from our clinic in the last 6 months. Demographic and clinical findings, proposed orthoses and walking aids, frequency of usage for the proposed orthoses, reasons for disuse, and the ambulation levels were recorded. A total of 54 (84.4%) patients had an ankle-foot orthosis and 10 (15.6%) patients had a knee-ankle-foot orthosis. The orthosis frequency of use was every day in 38 (59.4%) patients and one to seven times a week in seven (10.9%) patients, whereas 19 (29.7%) did not use them. The reasons for orthosis disuse were finding them unnecessary in seven (27%) patients, usage difficulties in six (23%) patients, pressure sensation in five (19.2%) patients, the belief that they did not make life easier in five (19.2%) patients, lack of a suitable environment in one (3.8%) patient, orthosis wear in one (3.8%) patient, and systemic disease in one (3.8%) patient. Age, sex, residence, the disease duration, and recommended orthosis duration (how long the prescribed orthosis was used), recommended orthosis, range of motion limitation in the lower extremities, presence of spasticity, type of orthosis, and the ambulation level were not statistically significantly associated with the frequency of orthosis use (P>0.05). The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage (P<0.008). Orthosis use had been discontinued by 29% of the patients. The most common reasons reported for discontinuing orthosis use were that the patients found it unnecessary, usage difficulty, pressure sensation, not making life easier, lack of a suitable environment, and orthosis wear. The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage.

Demographic and clinical features and rehabilitation outcomes of patients with Friedreich ataxia: A retrospective study.

OBJECTIVES: This study aims to investigate the demographic and clinical features, and rehabilitation outcomes of Friedreich Ataxia patients in the inpatient setting. PATIENTS AND METHODS: Between January 2000 and December 2012, a total of 37 Friedreich Ataxia patients (26 males, 11 females; mean age 29.2±9.6 years; range, 16 to 53 years) were included in the study. Demographic and clinical features of the patients and rehabilitation outcomes were reviewed retrospectively. Duration of rehabilitation, age at onset of disease, first onset of extremity, were determined. The Functional Ambulation Category (FAC) and Hoffer Ambulation Scale levels were used to assess the ambulation levels of patients. The Barthel Index scores were used to assess daily living activities of the patients before and after the treatment. RESULTS: The mean rehabilitation duration was 4.7±1.4 weeks. There was cardiac involvement in nine (24.3%) patients and obstructive/ restrictive pulmonary disease in five patients (13.5%). A total of 33 patients (89.2%) had severe ataxia, four (10.8%) had mild ataxia, 33 (89%) had dysarthria, 18 (48.6%) had scoliosis, 16 (43.2%) had kyphose, 15 (40.5%) had pes cavus, five (13%) had optic atrophy, and two (6%) had nystagmus of all patients. At the end of the rehabilitation program, all patients were discharged with functionally improved levels based on the FAC, Hoffer Ambulation Scale (p<0.05), and Barthel Index (p<0.001), indicating a statistically significant difference. CONCLUSION: An appropriate and comprehensive rehabilitation program improves the ambulation level and independence level of daily activities in patients with Friedreich ataxia, which highlights the importance of rehabilitation in these patients.

Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center.

OBJECTIVE: To define the demographic and clinical characteristics of persons with spinal cord injury, rehabilitated in a primary referral rehabilitation center in Turkey. DESIGN: Retrospective study. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey. METHODS: Medical records of all patients with spinal cord injury (acute-subacute-chronic) at a single academic referral center over the course of one year were reviewed. Variables of each patient were recorded, including: age, sex, etiology, length of rehabilitation stay, neurological level of injury, level of neurological impairment and severity of injury. RESULTS: Among 262 persons with spinal cord injury, 69.8% were male (male:female ratio is 2.31 : 1). Mean age was 38.3 ± 17.6 years. Falls were the most common cause of injury. The majority of falls were falls from a height (93.3%). More than 20% of falls from a height were related to occupational injury. The most common neurological level of injury was L1. Of all persons 46.2% had thoracic, 27.5% had lumbar and 26.3% had cervical lesions. The mean length of rehabilitation stay was 52.1 ± 25.5 days. Persons with motor complete injury and with a shorter (<12 months) time since injury had longer length of rehabilitation stay. CONCLUSION: The mean age of SCI population is increasing. Falls constitute the majority of etiologic factors and are more common in persons >60 years old. More than 20% of falls from a height are related to occupational injury. Male-female ratio is decreasing. Thoraco-lumbar injures are more common than cervical injuries.

The effects of the number of physical therapy sessions on pain, disability,and quality of life in patients with chronic low back pain

Background/aim: The aim of this study was to investigate and compare the effect of different physical therapy (PT) session numbers on pain, impairment. and quality of life in patients with chronic low back pain (LBP).Materials and methods: In this prospective, randomized-controlled, single-blind trial, a total of 60 patients with chronic LBP were divided into 2 groups with simple randomization within the scope of the study. A PT program of a total of 10 sessions was applied for patients in Group 10 (n = 30) and a total of 15 sessions for patients in Group 15 (n = 30). The main outcome measures were fingertip-to-floor distance (FFD), a visual analog scale (VAS), the modified Oswestry Disability Index (mODI), and the Nottingham Health Profile (NHP).Results: We found statistically significant differences in both groups between the before-treatment (BT) and after-treatment (AT) results in terms of all evaluation parameters. We detected significant differences between the 2 groups in terms of AT VAS, mODI, NHP Pain, and NHP Total; however, no significant differences were found in terms of FFD and the other NHP subdimension levels.Conclusion: We determined that 15 treatment sessions were more effective than 10 sessions on pain and disability in patients with chronic LBP.

A Randomized Controlled Study: Effectiveness of Functional Electrical Stimulation on Wrist and Finger Flexor Spasticity in Hemiplegia.

AIM: The objective of this study was to investigate the effectiveness of functional electrical stimulation (FES) applied to the wrist and finger extensors for wrist flexor spasticity in hemiplegic patients. METHODS: Thirty stroke patients treated as inpatients were included in the study. Patients were randomly divided into study and control groups. FES was applied to the study group. Wrist range of movement, the Modified Ashworth Scale (MAS), Rivermead Motor Assessment (RMA), Brunnstrom (BS) hand neurophysiological staging, Barthel Index (BI), and Upper Extremity Function Test (UEFT) are outcome measures. RESULTS: There was no significant difference regarding range of motion (ROM) and BI values on admission between the groups. A significant difference was found in favor of the study group for these values at discharge. In the assessment within groups, there was no significant difference between admission and discharge RMA, BS hand, and UEFT scores in the control group, but there was a significant difference between the admission and discharge values for these parameters in the study group. Both groups showed improvement in MAS values on internal assessment. CONCLUSION: It was determined that FES application is an effective method to reduce spasticity and to improve ROM, motor, and functional outcomes in hemiplegic wrist flexor spasticity.

Comparision of two different dry-needling techniques in the treatment of myofascial pain syndrome.

OBJECTIVES: To compare the efficacy of two different dry needling (DN) techniques (deep dry needling & peppering) in myofascial pain syndrome (MPS). METHODS: Seventy-two patients, who were diagnosed as MPS at our outpatient clinic were randomly assigned into two groups as deep dry needling (DDN) and peppering. All patients were evaluated four times as: before the treatment and 1-5-12 weeks after the completion of treatment protocol. In each evaluation, Visual analogue scale (VAS), Nottingham extended activities of daily living scale (NEADLS), Beck depression inventory (BDI) scores were recorded. Additionally, all patients were evaluated for the pain felt during the procedure and side effect profile. RESULTS: Twenty-six patients from DDN group and twenty-eight patients from peppering group accomplished the follow-up period. Both DDN and peppering seem to be effective for relieving pain and depressive symptoms and improving functionality compared to baseline when evaluated on the 1st, 5th and 12th weeks. On the other hand the intergroup analyses showed no significant differences between DDN and peppering groups. The only significant difference between the groups is the lesser pain felt during the procedure in the DDN group. CONCLUSION: Both DDN and peppering are effective in MPS and the effects last up to 12 weeks. Also the adverse event profiles of the two techniques are similar. On the other hand, DDN is a painless procedure.

Wheelchair appropriateness in children with cerebral palsy: A single center experience.

BACKGROUND: Although wheelchair appropriateness has been studied in general wheelchair users and spinal cord injury patients, it has not been studied in children with cerebral palsy yet. OBJECTIVE: To describe the wheelchair appropriateness in children with cerebral palsy. MATERIALS AND METHODS: Thirty children with cerebral palsy were included. Demographical and clinical features of the children were noted. All wheelchair parts were evaluated by the same rehabilitation physician who has attended a wheelchair-training course. Overall, the wheelchair was accepted as inappropriate if at least three parts were inappropriate. RESULTS: There were 30 children (15 M, 15 F) with a mean age of 10.8 ± 3.5 years. Seat depth (n= 21, 70%), cushion (n= 17, 56.7%), seat height (n= 16, 53.3%), and footrest (n= 16, 53.3%) were the most common inappropriate parts. Overall, 24 (80%) of the children use inappropriate wheelchair. Two (6.7%) children obtained wheelchairs by prescription, 28 (93.3%) obtained without prescription. Twenty-nine wheelchairs were manual and one wheelchair was motorized. Among 30 children, five (16.7%) experienced at least one wheelchair-related fall. CONCLUSION: In the light of our results, 80% of the children with cerebral palsy seem to use inappropriate wheelchair. Individually designed wheelchairs should be maintained for these children.

A functional tool demonstrating the physical function decline independentof age in patients with predialysis chronic kidney disease.

BACKGROUND/AIM: Physical function decline in chronic kidney disease (CKD) patients has been a popular area of investigation in the last decade. It has been shown that lower levels of physical function in CKD results in poor outcomes. Nevertheless, nephrology practice does not include routine assessment of physical function. The aim of the present study is to elucidate which physical function assessment tool is better in CKD. MATERIALS AND METHODS: A total of 148 predialysis CKD patients and 40 healthy controls were included in this cross-sectional single-blind study. CKD patients were further divided into two groups as stage 3 and stage 4/5. A hand dynamometer, the Short Physical Performance Battery (SPPB), and the Timed Up and Go Test (TUGT) were applied to all study participants. RESULTS: All physical function tests were significantly different between study and control groups. In multivariate analysis the SPPB (P < 0.001) emerged as an independent variable in CKD group. CONCLUSION: The SPPB is a promising, easily applicable, inexpensive, and sensitive tool that can indicate functional decline independent of age in predialysis CKD patients and can be used in clinical practice to monitor these patients.

Sleep disordered breathing in children with cerebral palsy.

OBJECTIVES: The purpose of this study was to investigate the frequency of Sleep Disordered Breathing (SDB) in children with Cerebral Palsy (CP), and determine whether a relationship between SDB and age, gender, weight status, type of CP, motor function level, and spasticity can be established. METHODS: The study included 94 children with CP and 94 healthy children with normal development, between the ages two and 18. SDB was assessed using the Sleep-Related Breathing Disorder (SRBD) scale of the Pediatric Sleep Questionnaire (PSQ). RESULTS: No statistically significant difference was found with respect to age and gender between the study and the control groups. It was found that 9.6% of the patients with CP had snoring, 12.8% had sleepiness, 37.2% had attention deficiency-hyperactivity, and 18.1% had SRBD. SRBD was statistically significantly higher in patients with CP compared with the control group. No significant relationship was detected between SRBD and age, gender, weight status, type of CP, motor function level, spasticity, and epilepsy. CONCLUSIONS: Our result confirm that SDB is more common in children with CP than typically developing children. Thus, SDB problems should be identified in routine clinical practice in patients with CP, by using the SRBD scale of the PSQ.

Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity.

Osteoarthritis (OA) is a low grade systemic inflammatory disease in which many inflammatory mediators are known to be elevated in the peripheric blood. Blood platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) are accepted as novel markers in many of the systemic inflammatory disorders, but have not been investigated in synovitis-free radiographic OA yet.The aim of this study was to evaluate the levels of blood PLR and MPV in radiographic hip OA. A total of 880 patients were evaluated retrospectively and after certain exclusion criteria, 237 of them who have primary hip OA were included. Age, sex, height, weight, body mass index, neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR), PLR, and MPV levels were recorded, Kellgren-Lawrence (KL) grading of the hip joints were performed. Patients were then divided into 2 groups as KL grades 1 to 2 (mild-moderate) and KL grades 3 to 4 (severe) hip OA.Mean age, mean neutrophil, lymphocyte and platelet counts, mean MPV, mean PLR, and mean ESR were statistically significantly different between mild/moderate hip OA group and severe hip OA group. In univariate analysis, older age and higher MPV, PLR, and ESR were severely associated with severe hip OA. In multiple logistic regression analysis, MPV, PLR, and ESR emerged as independent predictors of severe hip OA.The results of the present study, for the first time in the literature, suggest blood PLR and MPV as novel inflammatory markers predicting the radiographic severity of hip OA in the daily practice.

Does vitamin D affect muscle strength and architecture? An isokinetic and ultrasonographic study.

BACKGROUND AND OBJECTIVES: The objective of this study was to explore the association between 25- hydroxyvitamin D (25(OH)D) and muscle strength/architecture. METHODS AND STUDY DESIGN: Thirty patients (27 women, 3 men) were allocated into Group I (n=15, mean age; 44.4±9.4 years) and Group II (n=15, mean age; 39.0±9.9 years) according to the median of 25(OH)D (<13.7 ng/mL vs >13.7 ng/mL, respectively). Peak torque/body weight of the knee flexor/extensor muscles at 60°/sec and 180°/sec and those of ankle flexor/ extensor muscles at 30°/sec and 90°/sec were evaluated by using a Biodex System 3 Pro Multijoint System isokinetic dynamometer. A 7-12 MHz linear array probe was used to evaluate thickness (MT), pennation angle (PA) and fascicle length (FL) of medial gastrocnemius and vastus lateralis muscles. RESULTS: Mean of 25(OH)D was 9.4±2.5 ng/mL and 20.7±8.3 ng/mL in Groups I and II, respectively. Although all isokinetic strength parameters were lower in Group I, significant differences were found in knee flexion at 180°/sec (p=0.007), knee extension at 30°/sec (p=0.038) and 180°/sec (p=0.001), and ankle extension at 30°/sec (p=0.002) and 90°/sec (p=0.007). On the other hand, no significant difference was found between the groups regarding MT, PA and FL values (all p>0.05). CONCLUSION: In light of our results, we can argue that 25(OH)D is associated with muscle strength but not with muscle architecture. Further studies concerning the long-term follow-up effects of 25(OH)D treatment on muscle strength are awaited.

The analysis of serum lipid levels in patients with spinal cord injury.

STUDY DESIGN: Retrospective study. OBJECTIVES: The purposes of this investigation were to evaluate the serum lipid profile among a broad sample of patients with spinal cord injury (SCI), examining the impact of disease duration, lesion level, lesion grade and functional activity level on serum lipid levels of patients with SCI. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. METHODS: Serum lipid profiles of 269 participants with SCI were analyzed and correlated to disease duration, lesion level, lesion grade and ambulation status. RESULTS: Total cholesterol (TC) was higher than normal in 21.2%, low density lipoprotein cholesterol in 24.4%, and triglycerides levels in 31% of the patients. The high density lipoprotein cholesterol (HDL-c) level was found to be lower than 40 mg/dl in 79.5% of the patients, TC/HDL-c ratio was 4.5 and above in 65.7% of the patients in our study. TC/HDL-c ratio was significantly higher in patients with SCI with a disease duration of 0-12 months than the group with a longer disease duration (P = 0.009). TC/HDL-c ratio was significantly higher in patients who could not be community ambulated than the patients who were community ambulated (P = 0.005). HDL-c levels in patients with motor complete SCI were significantly lower than patients with motor incomplete SCI (P = 0.028). CONCLUSION: Dyslipidemia is observed in a large number of patients with SCI. The risk of dyslipidemia was seen to have increased in motor complete SCI patients, in patients who can not be community ambulated and whose disease duration is between 0 to 12 months.

Predictive Factors for Inpatient Falls among Children with Cerebral Palsy.

OBJECTIVE: Inpatient falls are of significant concern. The aim of this prospective study was to determine the predictors of inpatient falls among children with cerebral palsy in a rehabilitation hospital. DESIGN AND METHODS: A total of 93 patients with cerebral palsy were assessed based on history, physical findings, the Selective Motor Control Test, the Gross Motor Functional Classification System, the Berg Balance Scale and the Manual Ability Classification System. Previous history of falls/frequent falls, and any falls which occurred during hospitalization, were recorded. RESULTS: Of all 93 patients, 25 (27%) fell and 68 (73%) did not fall. The mean age of the fallers (6.3±2.0 years) was lower than that of the non-fallers (8.1±3.9 years). Behavioral problems according to the mother's statement (OR 26.454), not being able to maintain a long sitting position (OR 10.807), ability to balance on knees without support (OR 9.810), a history of frequent falls (OR 4.893) and a negative Thomas test (OR 4.192 fold) were found to increase the risk of inpatient falls. CONCLUSIONS: In these children with cerebral palsy, behavioral problems according to the mother's statement, a history of frequent falls, not being able to maintain a long sitting position, a negative Thomas test, and able to balance on knees without support were associated with the risk of inpatient falls. Children with cerebral palsy may experience inpatient falls. Further studies are required in order to develop prevention programs. PRACTICE IMPLICATIONS: For patients diagnosed with cerebral palsy, these results may help identify possible inpatient fallers on hospital admission.

Speech and language therapy for aphasia following subacute stroke.

The aim of this study was to investigate the time window, duration and intensity of optimal speech and language therapy applied to aphasic patients with subacute stroke in our hospital. The study consisted of 33 patients being hospitalized for stroke rehabilitation in our hospital with first stroke but without previous history of speech and language therapy. Sixteen sessions of impairment-based speech and language therapy were applied to the patients, 30-60 minutes per day, 2 days a week, for 8 successive weeks. Aphasia assessment in stroke patients was performed with Gülhane Aphasia Test-2 before and after treatment. Compared with before treatment, fluency of speech, listening comprehension, reading comprehension, oral motor evaluation, automatic speech, repetition and naming were improved after treatment. This suggests that 16 seesions of speech and language therapy, 30-60 minutes per day, 2 days a week, for 8 successive weeks, are effective in the treatment of aphasic patients with subacute stroke.