Comparison of telerehabilitation versus home-based video exercise in patients with Duchenne muscular dystrophy: a single-blind randomized study.

INTRODUCTION: Patients with Duchenne muscular dystrophy (DMD) have lost their access to on-site rehabilitation due to the COVID-19 pandemic. Telerehabilitation can be a viable approach for these patients to protect their muscle strength and functional status. The aim of this study is to compare telerehabilitation with home-based video exercises. PATIENTS AND METHODS: Male, ambulatory DMD patients were randomized into telerehabilitation and video-exercise groups. Nineteen patients were included in the final analyses. Telerehabilitation consisted of live online exercises, while video exercise implemented a pre-recorded video as a home-based program. Both programs spanned 8 weeks, three times a week. Patients' muscle strength with a hand-held dynamometer, Quick Motor Function Test, North-Star Ambulatory Assessment (NSAA), 6-Minute Walk Test (6MWT) and Caregiver Burden were recorded before and after treatment. RESULTS: The 6MWT of the telerehabilitation group was391.26 ± 95.08 m before and387.75 ± 210.93 after treatment (p = 0.94) and 327.46 ± 103.88 m before treatment and313.77 ± 114.55 after treatment in video group (p = 0.63). The mean NSAA score of the telerehabilitation group were26.70 ± 8.04 before treatment and 25.20 ± 11.33 after treatment (p = 0.24). In the video group scores were 21.66 ± 6.65 before to 22.00 ± 8.61 after treatment (p = 0.87). There were no significant changes between groups at the end of the treatments. The telerehabilitation group's neck extension, bilateral shoulder abduction, and left shoulder flexion, bilateral knee flexion and extension, bilateral ankle dorsiflexion, and left ankle plantar flexion strength improved significantly and were better than the video group (p < 0.05 for all measurements). CONCLUSION: A telerehabilitation approach is superior in improving muscle strength than a video-based home exercise, but none of the programs improved functional outcomes in ambulatory patients with DMD.

Efficacy comparison of oral rosuvastatin versus oral progesterone and bevacizumab on regression of surgically endometriotic implants in rats.

This study hypothesizes that oral rosuvastatin, oral dienogest and intraperitoneal bevacizumab might improve endometriosis in randomly selected female Wistar albino rats with surgically endometriotic implants. Thirty female Wistar albino rats with surgically endometriotic implants were randomized into three treatment groups: oral rosuvastatin (20 mg kg/day; oral rosuvastatin group 1; n = 10), oral progesterone (dienogest group 2; n = 10) and intraperitoneal bevacizumab (2.5 mg/kg of single intraperitoneal injection of bevacizumab; bevacizumab group 3; n = 10), for 10 days. Post-treatment variables were compared. The oral rosuvastatin group showed higher reduction for the glandular epithelium and uterine vessels of histopathological scores values than the oral progesterone group (both, p < 0.017, respectively). The median glandular epithelium and uterine vessels and histopathological scores values did not show a statistically significant difference between group 1 and group 3 (p > 0.017). Endometrial thickness values and uterine volume values were more significantly reduced in the oral rosuvastatin group than the oral progesterone group (both, p < 0.017, respectively). Moreover, endometrial thickness and uterine volume values were not different in groups wecompared with group 3 (p > 0.017). In conclusion, oral rosuvastatin and intraperitoneal injection of bevacizumab may cause more significant regression of surgically endometriotic implants in rats than oral progesterone medications.

Reliability and cross-cultural adaptation of the Turkish version of the Spinal Cord Injury Spasticity Evaluation Tool.

The Spinal Cord Injury Spasticity Evaluation Tool is a 7-day recall self-reported questionnaire that assesses the problematic and useful effects of spasticity on daily life in patients with spinal cord injury (SCI). We aimed to determine the reliability and cross-cultural validation of the Turkish translation of the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SETT). After translation and back translation of the Spinal Cord Injury Spasticity Evaluation Tool, 66 patients between the ages of 18 and 88 years with SCI, American Spinal Injury Association impairment scale grades from A to D with spasticity, and at least 6 months after injury were assessed. Participants rated the SCI-SETT at the same time period of the day, 1 week apart, and test-retest agreement was investigated. Also, the Penn Spasm Frequency Scale, self-assessment of spasticity severity, self-assessment of spasticity impact, Functional Independence Measure motor subscale, and 36-Item Short Form Health Survey were assessed for the evaluation of the convergent validity. There were 45 participants with tetraplegia and 21 patients with paraplegia. The test-retest reliability for the SCI-SETT was good. The intraclass correlation coefficient was 0.80 at 95% confidence interval. There were no significant correlations between the SCI-SETT scores and Functional Independence Measure motor subscale and Penn Spasm Frequency Scale scores. There was a significant correlation between the SCI-SETT scores and vitality scores of the 36-Item Short Form Health Survey. The SCI-SETT showed statistically significant correlations with other measures including self-assessed spasticity severity and self-assessed spasticity impact (P<0.05). The SCI-SETT is a reliable self-rating tool for assessing spasticity in patients with SCI in the Turkish population.

Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes.

OBJECTIVE: To assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS). DESIGN: Observational reliability study of the SCATS. SETTING: Inpatient rehabilitation unit at an education and research hospital. PARTICIPANTS: Subjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interrater and test-retest reliability of the SCATS. RESULTS: The SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05). CONCLUSIONS: The SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.

Spinal cord stimulators: typical positioning and postsurgical complications.

OBJECTIVE: Implantation of a spinal cord stimulator (SCS) is one option for pain control in individuals with chronic lumbosacral radicular or axial lumbar pain. The expected positioning of SCSs based on the location of pain, the types of electrodes (percutaneous vs surgical paddle), and the types of electrode arrays and the potential complications have not been described to date in the radiology literature. MATERIALS AND METHODS: A 5-year retrospective review of the radiology information system at our institution revealed 24 patients with images of 36 SCSs. Those images were reviewed to identify the location and type of electrodes as well as the location of the lead within the spinal canal. Not all implantable pulse generators were within the radiologic field of view. Complications identified by reviewing medical records were correlated with imaging findings. RESULTS: Fourteen different types of electrodes were identified. Most were placed in the thoracic spine only, but six thoracolumbar and two cervical spine electrodes were also present. We measured the position of the electrodes within the spinal canal on 26 CT studies of the 24 patients. On 22 of 26 CT studies, the electrodes were placed in the epidural space in the posterior one third of the spinal canal. Complications included misplaced, retained, and broken leads; puncture of the thecal sac; infection; and hematoma. CONCLUSION: Radiologists should be familiar with the different types of electrodes and typical spinal locations of electrodes, leads, and implantable pulse generators. Improper placement of electrodes may lead to ineffective pain relief or to other complications.