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.

A challenging case of diffuse diabetic musculoskeletal system involvement: diagnostic confusion with rheumatoid arthritis.

A diabetic patient who was misdiagnosed as rheumatoid arthritis because of complicated musculoskeletal manifestations of diabetes is reported here. A 57 year old woman had been on sulphasalazine treatment with a diagnosis of rheumatoid arthritis for 3 years but failed to respond. Her past medical history disclosed that she had been using metformin due to diabetes mellitus for 8 years. On physical examination there was no evidence of arthritis. Her clinical picture was compatible with diffuse idiopathic skeletal hyperostosis (DISH), shoulder periarthritis, carpal tunnel syndrome, limited joint mobility of diabetes and furthermore myalgia due to metformin induced by hypovitaminosis D. Finally rheumatoid arthritis was excluded and a diagnosis of diabetes mellitus originated diffuse musculoskeletal system involvement was made. Diabetic musculoskeletal complications are common and sometimes cause clinical dilemmas. This case is also important for highlighting the contribution of low vitamin D status to the clinical status.

The effect of electromyographic biofeedback treatment in improving upper extremity functioning of patients with hemiplegic stroke.

This study evaluated the effect of electromyographic biofeedback (EMG-BF) treatment on wrist flexor muscle spasticity, upper extremity motor function, and ability to perform activities of daily living in patients with hemiplegia following stroke. A total of 40 patients were enrolled and were randomly assigned to two groups: a group treated with EMG-BF (study group) and a untreated (control) group. Both groups participated in a hemiplegia rehabilitation program consisting of neurodevelopmental and conventional methods and verbal encouragement to "relax" spastic wrist flexor muscles. In addition, the study group received 3 weeks of EMG-BF treatment, 5 times a week, for 20 minutes per session at hemiplegic side wrist flexors. Clinical findings were assessed before and after rehabilitation using the Ashworth scale (AS), Brunnstrom's stage (BS) of recovery for hemiplegic arm and hand, the upper extremity function test (UEFT), the wrist and hand portion of the Fugl-Meyer scale (FMS), goniometric measurements of wrist extension, surface EMG potentials, and the Barthel Index (BI). There was no statistically significant difference between the two groups in terms of age, sex, systemic disease, and the etiology, side, and duration of hemiplegia. There also was no statistically significant difference in the pretreatment values between two groups. We found statistically significant improvements posttreatment in the AS, BS, UEFT, goniometric measurements of wrist extension, and surface EMG potentials in the study group. We also noted statistically significant differences in the wrist and hand portion of the FMS and the BI in both groups, but with significantly greater improvements in the study group. Our findings indicate a positive effect of EMG-BF treatment in conjunction with neurodevelopmental and conventional methods in hemiplegia rehabilitation.

The effect of the stroke etiology on functional improvement in our geriatric hemiplegic patients.

OBJECTIVE: We aimed to determine the effect of the cerebrovascular accident etiology in the geriatric patients with hemiplegia included in our physical medicine and rehabilitation program on functional improvement. METHODS: A total of 46 geriatric patients with hemiplegia attending the inpatient physical medicine and rehabilitation program were included in the study. The patients were divided into two groups-thromboembolic vessel disease (TEVD) and intracerebral hemorrhage (ICH)-depending on the cerebrovascular accident etiology. The daily living activities of the patients in both groups were evaluated using the Barthel Index (BI) and the ambulation levels were evaluated using the Functional Ambulation Classification (FAC) at admittance and at discharge from hospital. RESULTS: There was a statistically significant difference between admission and discharge BI values in both groups. There was no significant difference between the admission and discharge BI scores of the TEVD and ICH groups. For both groups, on admission there were 19 (82.5%) patients at the FAC 0, 1, and 2 levels, and 4 (17.3%) patients at the FAC 3 and 4 levels. On discharge there were 11 (47.8%) patients in the TEVD group at the FAC 0 and 2 levels, and 12 (52.1%) patients at the FAC 3, 4, and 5 levels; whereas in the ICH group there were 8 (34.7%) patients at the FAC 0, 1, and 2 levels, and 15 (65.2%) patients at the FAC 3, 4, and 5 levels. CONCLUSIONS: We found that the disease etiology did not influence the rehabilitation results for our geriatric patients with hemiplegia attending a physical medicine and rehabilitation program following TEVD or ICH.

Evaluation of upper extremity rehabilitation in hemiplegic patients with and without complex regional pain syndrome type 1.

We investigated the effects of the complex regional pain syndrome (CRPS) type 1 on upper extremity rehabilitation in hemiplegic patients. Eighty patients were enrolled and were randomly assigned to either study (40 hemiplegic patients with CRPS) or control (40 hemiplegic patients without CRPS) groups. All patients participated in a hemiplegia rehabilitation program consisting of neurodevelopmental techniques, stretching and strengthening exercises, and conventional methods. Additionally, participants in the study group received analgesic and calcitonin therapy, elevation, range of movement therapy for the affected joints, and contrast baths. Clinical findings were assessed before and after rehabilitation using the upper-limb function (ULF), hand movements (HM), and advanced hand activities (AHA) subscales of the Motor Assessment Scale (MAS) and the Ashworth scale for upper extremities. A statistically significant difference in MAS ULF was apparent at admission and upon discharge in both groups. In the control group, a significant difference was found between MAS HM and MAS AHA on admission and at discharge, no difference was found in the study group for these parameters. No difference was found for either group with regard to the Ashworth scale. No between-group differences were found regarding MAS ULF, MAS HM, and MAS AHA at admission and at discharge. Our data showed no influence of CRPS on MAS ULF, MAS HM, and MAS AHA and the Ashworth scale for upper extremities.