Effects of visual feedback balance training by using computerised dynamic posturography in patients with multiple sclerosis

To study the effects of the visual feedback balance training on the Berg Balance Scale [BBS] under static and dynamic conditions, the somatosensory, visual and vestibular systems by dynamic posturography before and after training program in patients with multiple sclerosis [MS]. Retrospective case training study. Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait. A total of 23 patients with MS were recruited. All patients were evaluated using both the BBS and the sensory organization test [SOT] using computerized dynamic posturography [CDP] before and three months after the training program. The SOT consists of six conditions and composite equilibrium score [CES]. CES [%] and SOT were calculated. Before training, all patients had a reduction of BBSS and parameters of the SOT. After training, a significantincrease of BBS [p < 0.05], all parameters of the SOT [p < 0.05] and CES [p < 0.001] were observed. Improvement in all parameters of the SOT after training program could be explained by change in the somatosensory system of the posture control system. Also, there is impairment of the somatosensory system, rather than a specific lesion of vestibular and/or visual systems

Our Experience with posturography in hemiparetic patients after stroke in Kuwait

To study the Berg Balance Scale [BBS] as balance functional impairment of hemiparetic stroke patients after onset of stroke; to quantitatively assess control of balance by computerized dynamic posturography [CDP]; to correlate composite equilibrium score [ES] with sex, side of lesion and stroke type; and to correlate ES with static and dynamic posturography in hemiparetic stroke patients. A retrospective case control study. Outpatient clinic in Physical Medicine and Rehabilitation Hospital, Kuwait. A total of 21 hemiplegic ambulatory stroke patients and 19 age-matched healthy individuals as control group. BBS and CDP. ES and sensory organization test [SOT] 1-6. BBS scores of stroke patients were below the lower limit of the normal control group [p < 0.001]. Significant reduction was observed for composite ES of stroke patients compared to control group. Although no significant difference of static balance function was observed between patients and controls, significant reduction of dynamic balance function [SOT 4, SOT 5, SOT 6] was observed in stroke patients, compared to control group [p < 0.05]. In linear regression correlation [r-] of stroke patients, no significant correlation was observed of ES with static balance function [SOT 1, SOT 2, SOT 3] in hemiparetic stroke patients [p > 0.05]. However, there was a direct significant correlation of ES with dynamic balance function including SOT 4, SOT 5 and SOT 6 [r = -0.71; p < 01], [r = 0.761, p < 0.01] and [r = -0.761, p < 0.05] respectively in hemiparetic stroke patients. Impaired dynamic equilibrium in stroke patients is likely to reflect reduction of muscle strength of the paretic side along with the possible impairment of sensory organization

Intracavernous injection of prostaglandin E1 for the treatment of erectile dysfunction in spinal cord injured patients: experience with 30 patients

To evaluate the efficacy of intracavernous injections of alprostadyl [Caverject] in the treatment of erectile dysfunction in patients with spinal cord injury [SCI] and to determine the mean necessary dose to obtain functional erection. Material and Thirty patients aged between 20 to 44 years, duration of lesion from one to 13 years and level of SCI from C5 incomplete to L3 complete, were included in the study. The treatment started with a minimal dose of 1.125 micrograms and the dosage was titrated to achieve rigid erection. Following the establishment of the effective dose, the patients were trained in the technique of self-injection. They returned periodically for follow up. Twenty seven patients achieved functional erection [Schramek grade 4 or 5] with a dose equal or less than 20 micrograms [mcg] of Caverject. The average effective dose was 11.75 +/- 4.6 mcg. Average duration of erection was 48.3 minutes. No side effects from the t reatment were observed except discomfort in two patients and mild penile pain in one patient. 76% of the patients were satisfied and very satisfied with the treatment. Intracavernous injections of Caverject are e ffective and safe therapy for erectile dysfunction provided that individual dose is established by titration, the patients are trained in the technique of self-injection

Our experience with interamuscular injections of botulinum toxin A for the treatment of upper limb flexors spasticity after stroke

Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect of Botulinum toxin A[Botox A] for relief of spasticity. To evaluate the therapeutic effects of intramuscular injections of Botox A [Btx A] on spasticity of the upper limb. D e s i g n: An open-label non-controlled trial for a duration of 16 weeks was design to determine the e fficacy and safety of intramuscular Btx A injections in the treatment of 56 patients with spastic hemiparesis after stroke. The patients were assessed at baseline, 2, 4, 12 and 16 weeks after treatment by several outcome measures - modified Ashworth scale, motricity index arm score, limb position at rest, semi-quantitative o rdinal scale for severity of pain, patient's global response to Btx A t reatment, Barthel index of activities of daily living, difficulties encountered during thre e upper limb motor tasks. Significant reduction of muscle tone, spasticity related pain and improvement in the three selected functional tasks [cleaning the palm of the affected hand, cutting the fingernails of the affected hand, putting the affected arm into the sleeve] were observed one week after Btx A injections and were sustained throughout the 16 weeks follow-up period. Botox A is effective and safe adjunctive treatment to on-going rehabilitation for patients with post - stroke localized moderate-to-severe spasticity refractory to physical and medical treatments

Neck pain, neck mobility and alignment of cervical spine in 30 patients with cervical strain

Neck pain due to acute and repetitive neck injuries is a common complaint in the general population. Functional assessment of cervical spine by measurement of cervical range of movements [CROM] is informative and beneficial for planning proper treatment of patients with cervical strain. Muscle spasm is the widely used explanation for straightening and reversal of cervical lordosis commonly seen after trauma, but more specific interpretation is not supported in the literature. To evaluate the intensity of neck pain, the mobility of cervical spine and the cervical curve in patients with chronic cervical strain. Semiquantitative ordinal scale was used for evaluation of the severity of neck pain. Assessment of cervical movements was performed using cervical gonimeter with three separate inclinometers, measuring the movements in frontal, sagittal and horizontal planes. Two line Cobb method was used to determine the angle of cervical curve on lateral cervical radiographs. Significant reduction of total active CROM was found in patients with cervical strain with predominantly restricted neck extension followed by neck flexion, lateral flexion and to a lesser extent rotation. No significant difference was found in the prevalence of lordotic, straight and kyphotic curves in the group of patients with cervical strain compared to those in the control group. In our study, the existence of CROM limitation in cervical strain patients did not show a different than normal distribution of lordotic, straight and kyphotic cervical spine on radiographic images established by Cobb method

Methods for measurement of tibial torsion

No conventional technique for routine assessment of tibial torsion, the twisting of tibia around the longitudinal axis, has yet gained acceptance. Clinical measurements give approximate values only. Methods employing tropometers and other mechanical devices have mainly been used for measurement in skeletal specimens and in patients, though on a limited scale. Certain roentgenographic methods are considered complicated, whereas others require trigonometric calculations on the roentgenograms. With the development of the whole body computed tomography [CT] where distinct cross-sectional images can be obtained, reference points are easy to be determined, which make it possible to accurately measure this torsional deformity. Considering the demands for availability, simplicity, and precision, fluoroscopic techniques have been developed

Rotational malalignment in osteoarthritic knees

To study the rotational alignment of lower limbs in patients with osteoarthritis of the knees, measuring two of its components, knee rotation and tibial torsion, by computer tomography. Material and Method: 46 subjects [36 patients with osteoarthritis of the knees and 10 age- and sex-matched asymptomatic volunteers] were included in the study. Cases were required to be "knee pain positive", ascertained using a previously standardized questionnaire and to have at least grade 3 radiographic changes using Kellgren and Lawrence criteria. All 92 limbs were scanned at the level of distal femoral condyle, proximal tibial condyles and ankle joint. Rotation of the knee joint was measured as an angle between the tangent to the dorsal aspect of femoral condyles [pro x i m a l reference line] and the dorsal tangent to the tibial condyles. Tibial torsion was measured as an inclination between the dorsal tangent to the tibial condyles and the tangent to the distal tibia at the level of the medial malleolus. The mean values of the two variables were reduced in patients with osteoarthritis of the knee. The decrease of tibial torsion [28.3° +/- 5.1°] in the osteoarthritic patients compared to the control group [35.4° +/- 6.2°] showed significance. Rotational malalignment may have some implications in the genesis of osteoarthritis of the rotationally intolerant knee joint

Serum levels of insulin-like growth factor-1 in patients with osteoarthritis of the knee

Insulin related growth factor-1 [IGF-1] is an important growth promoting peptide which has anabolic effects on cartilage metabolism. The fact that serum levels tend to decrease in elderly subjects while osteoarthritis [OA] increases in prevalence suggests that suboptimal levels of IGF-1 may play a part in the development of OA. This study therefore considers the hypothesis that IGF-1 levels are low in subjects with OA of the knee. Serum levels of 48 patients with symptomatic knee OA and radiographic changes of different grade were compared with normal controls. No significant difference was found in serum levels between cases and controls [mean [SD] 20,67 [7.73] for cases and 23.91 [12.0] mmol for controls]. No significant correlations were shown between IGF-1 levels, age and total radiographic score. The study provides no evidence that serum levels of IGF-1 are low in OA