effect of rehabilitation program on bone turnover in patients with stroke

The hemiplegia accelerates hone loss and is associated with an increased bone turnover. To study any difference of bone mineral density [BMD] between the affected and the unaffected sides of chronic stroke patients and the effect of rehabilitation program on bone mass and on the markers of bone resorption: urinary excretion of pyridinohine and deoxypyridinoline. Cohort correlational study. Prince Abdullah Bin Abdul Aziz hospital, Bisha, Saudi Kingdom Patients: 33 males, with mean age 59.6 +/- 4.1 yr [range, 54-67 yr] at the time of ad mission. On the paretic and nonparetic sides and biochemical markers of bone turnover were measured at the time of admission and after completing a 3 months rehabilitation program. BMI] was measured by dual energy X-ray absorptiometry [l]EXA] at the lumbar spine, femoral neck, and distal radius. Urinary f-pyr and f-Dpyr were measured in fasting urine samples by spectrofluorometry after high performance liquid chromatography [HPLC] and corrected for creatinine excretion. The baseline values of UMD were lower than normal in all selected regions and a significant difference of BMD was found between the paretic and nonparetic limbs. A significant increase in the BMD was observed only in the femoral neck after 3 months of rehabilitation program [<0.05]. The baseline values of bone resorption markers f-Pyr and f-Dpyr, were higher than normal and a significant improvement in the levels of these markers was observed after the rehabilitation program [p<0.001 and<0.05 respectively]. Patients with hemiplegia have increased bone resorption. Additionally, the results suggest that the early weight-bearing and electrically stimulated muscle contraction can have a beneficial effect on the preservation of hone mass and reduces the progression of osteoporosis found in those patients. BMD in our patients showed no significant difference before and after rehabilitation program while bone markers increased significantly reflecting a decrease in the bone resorption rate. The bone markers are therefore more useful than DEXA for therapeutic monitoring of patients with osteoporosis

Non-invasive treatment of idiopathic carpal tunnel syndrome

Non-invasive treatment for carpal tunnel syndrome [CTS] is frequently offered to those with mild to moderate symptoms. The effectiveness and duration of benefits from noninvasive treatment remain unknown. To evaluate the therapeutic effect and duration of benefits from non-invasive treatment [other than medical treatment] for treating mild and moderate idiopathic carpal tunnel syndrome. Prospective randomized, before and after treatment trial with assessment at baseline, 4 weeks' treatment, and at a follow up assessment 6 months later [7 months after baseline]. Outpatient Clinic of Rheumatology and Rehabilitation department in Prince Abdulla Bin Abdulaziz Hospital [PABAH], Saudi Kingdom. 45 Patients with mild to moderate idiopathic carpal tunnel syndrome in 57 hands as verified by electroneurography. Three groups, each with 15 cases of carpal tunnel syndrome were randomly established. In group I only a custom made neutral volar splint was given to the patients. The patients were instructed to wear the splints all night and during the day as much as possible for 4 weeks. In group II a custom made neutral volar splints were given to the patients and sessions of ultrasound treatment [1 MHz, 1.0 W/cm2, pulsed mode, 5 minutes per session, 5 sessions a week] were applied to the area over the carpal tunnel of the affected wrist for 4 weeks. In group III a custom made neutral volar splints were given to the patients and they were instructed to perform series of nerve and tendon gliding exercises for 4 weeks. Score of symptom severity scale ratings assessed by visual analogue scale; a functional status scale, electroneurographic measures. Statistically significant improvement was observed in all groups except for distal motor latency [DML] in group I at 4 weeks of therapy and for 2-point discrimination in group I and III and sensory antidromic nerve conduction velocity [SNCV] in group I at 4 weeks of therapy and 6 months' follow up. The improvement in group II was greater than in group I and the difference was statistically significant for grip strength and symptom severity score [p<0.05] at 4 weeks and for all measurements except functional severity score at 6 months. The improvement in group III was greater than group I and the difference was not statistically significant except for symptom severity score at 6 months [p<0.05]. The improvement in group II was greater than group III and the difference was not statistically significant except for grip strength at 4 weeks and 6 months [p<0.05 and <0.01 respectively]. Results suggest there are satisfying longer term effects due to ultrasound treatment and tendon and nerve gliding exercises in patient with mild to moderate idiopathic carpal tunnel syndrome compared with standard conservative treatment of splinting. Findings of ultrasound and exercise treatment need to be compared with invasive treatment options. Combination of these treatment methods needs further investigations

Concurrence of heterotopic ossification and deep venous thrombosis in patients with osteoarthritis

A patient with local heterotopic ossification [HQ] associated with knee osteoarthritis is presented. Concurrent limitation of knee range of motion and deep venous thrombosis as a result of HO are discussed. The effect of surgical therapy of the HO in our patient was good

Treatment of reflex sympathetic dystrophy in hemiplegic patients by iontophoresis

To evaluate the efficacy and safety of tap water iontophoresis in the treatment of reflex sympathetic dystrophy [RSD] in stroke patients and to compare it with other types of physical therapy. Prospective randomized controlled study, with six months follow up. Forty five Saudi patients with hemiplegia following cerebrovascular disease [either cerebral hemorrhage or infarction] who had been suffering from reflex sympathetic dystrophy [RSD] of one upper extremity for less than one year. RSD was diagnosed if four typical symptoms were present in the upper extremity. Three groups, each with 15 cases were established. All three groups received medical treatment. Patients were assigned to 24 weeks' treatment with physical therapy [PT] in group I, tap water iontophoresis in group II and medical treatment only in group III [control group]. The reduction in symptoms was assessed objectively and subjectively by improvement in impairment level sum score [ISS] over 6 months by [student's t test]. A difference of 5 ISS points between the groups was defined as being clinically relevant. Furthermore, severity of disability and handicap was measured and tested exploratively [Wilcoxon; alpha=0.05]. Forty five patients were included. The mean age of the patients was 63.6 [ +/- 5.8] years, the mean time since the stroke was 8.7 [ +/- 1.7] months and the mean duration of symptoms was 3.1 +/- 1.4 months. Iontophoresis and to a lesser extent PT resulted in a significant and also more rapid improvement in the ISS as compared with the controls [5 and 4 ISS points repectively]. On a disability and a handicap levels, no difference was found between the groups. The side effects reported with tap water iontophoresis were all mild and transient. Tap water iontophoresis and physical therapy contribute to the recovery from the RSD of the upper extremity. Iontophoresis is a, safe and useful treatment modality for RSD