Database covering the prayer movements which were not available previously.

Lower body implants are designed according to the boundary conditions of gait data and tested against. However, due to diversity in cultural backgrounds, religious rituals might cause different ranges of motion and different loading patterns. Especially in the Eastern part of the world, diverse Activities of Daily Living (ADL) consist of salat, yoga rituals, and different style sitting postures. A database covering these diverse activities of the Eastern world is non-existent. This study focuses on data collection protocol and the creation of an online database of previously excluded ADL activities, targeting 200 healthy subjects via Qualisys and IMU motion capture systems, and force plates, from West and Middle East Asian populations with a special focus on the lower body joints. The current version of the database covers 50 volunteers for 13 different activities. The tasks are defined and listed in a table to create a database to search based on age, gender, BMI, type of activity, and motion capture system. The collected data is to be used for designing implants to allow these sorts of activities to be performed.

Anti-spastic effect of contralesional dorsal premotor cortex stimulation in stroke patients with moderate-to-severe spastic paresis: a randomized, controlled pilot trial.

OBJECTIVE: This study aimed at investigating the effect of a single-session repetitive transcranial magnetic stimulation (rTMS) of the contralesional dorsal premotor cortex on poststroke upper-limb spasticity. MATERIAL AND METHODS: The study consisted of the following three independent parallel arms: inhibitory rTMS (n = 12), excitatory rTMS (n = 12), and sham stimulation (n = 13). The primary and secondary outcome measures were the Modified Ashworth Scale (MAS) and F/M amplitude ratio, respectively. A clinically meaningful difference was defined as a reduction in at least one MAS score. RESULTS: There was a statistically significant change in MAS score within only the excitatory rTMS group over time [median (interquartile range) of - 1.0 (- 1.0 to - 0.5), p = 0.004]. However, groups were comparable in terms of median changes in MAS scores (p > 0.05). The proportions of patients achieving at least one MAS score reduction (9/12 in the excitatory rTMS group, 5/12 in the inhibitory rTMS group, and 5/13 in the control group) were also comparable (p = 0.135). For the F/M amplitude ratio, main time effect, main intervention effect, and time-intervention interaction effect were not statistically significant (p > 0.05). CONCLUSIONS: Modulation of the contralesional dorsal premotor cortex with a single-session of excitatory or inhibitory rTMS does not appear to have an immediate anti-spastic effect beyond sham/placebo. The implication of this small study remains unclear and further studies into excitatory rTMS for the treatment of moderate-to-severe spastic paresis in poststroke patients should be undertaken. CLINICAL TRIAL REGISTRATION NO: NCT04063995 (clinicaltrials.gov).

Painful ischemic monomelic neuropathy: An unusual complication in a lung cancer patient.

Ischemic monomelic neuropathy (IMN) is a rare type of acute axonal neuropathy which results from ischemia of multiple nerves in affected limb. The electroneuromyography is useful in detecting characteristic features of this neuropathy. It usually occurs after vascular interventions. Here, we present the first case who has IMN secondary to lung cancer and/or chemo-therapy and aim to draw attention to this infrequently recognized entity.

Inter-rater reliability of the Australian Spasticity Assessment Scale in poststroke spasticity.

To investigate the inter-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adult stroke patients with spasticity, two experienced clinicians rated the elbow flexor, wrist flexor, and ankle plantar flexor spasticity by using the ASAS in 85 persons with stroke. Unweighted and weighted (linear and quadratic) kappa statistics were used to calculate the inter-rater reliability for each muscle group. Unweighted kappa coefficients for elbow flexors (n = 83), wrist flexors (n = 80), and ankle plantar flexors (n = 77) were 0.67, 0.60, and 0.55, respectively. Linear and quadratic weighted kappa coefficients, respectively, were 0.77 and 0.87 for elbow flexors, 0.72 and 0.82 for wrist flexors, and 0.72 and 0.85 for ankle plantar flexors. The raters never disagreed by more than a single score in the rating of elbow flexors. On the contrary, the raters disagreed by more than a single score in three patients in the rating of ankle plantar flexors and in one patient in the rating of wrist flexors. The results suggested that inter-rater reliability of the ASAS differed according to the spastic muscle group assessed and the statistical method used. The strength of the agreement on the ASAS, an ordinal scale, ranged from good to very good when the weighted kappa values were considered.

Effect of muscle selection for botulinum neurotoxin treatment on spasticity in patients with post-stroke elbow flexor muscle over-activity: an observational prospective study.

PURPOSE/AIM: To investigate the effect of muscle selection for botulinum neurotoxin A (BoNT-A) treatment on spasticity in patients with post-stroke elbow flexor muscle over-activity. MATERIALS AND METHODS: Chronic stroke patients with a deforming spastic paresis in the upper limb (elbow flexion with forearm pronation) who were injected BoNT-A into at least one of elbow flexor muscles (brachialis, brachioradialis, and biceps brachii) were included in this prospective observational study. The main outcome measure was spasticity angle by Tardieu Scale recorded at pre-treatment and week 4 after treatment. RESULTS: Three muscle selection groups with sufficient sample size for statistical analysis were able to be created; brachialis (n = 14), biceps brachii (n = 21), and brachialis plus brachioradialis (n = 11). Although there was a significant improvement in spasticity angle within all groups over time (p < 0.05), the change in spasticity angle was not different between the groups (p > 0.05 for each pairwise comparison). However, the magnitude of the change in spasticity angle was larger in the groups in which brachialis was preferred. CONCLUSIONS: In stroke patients with a spontaneous spastic posture of elbow flexion and forearm pronation, targeting brachialis for BoNT-A injection seems more effective in reducing the severity of spasticity. CLINICAL TRIAL REGISTRATION NO: NCT04036981.

Effect of static knee joint flexion on vastus medialis obliquus fiber angle in patellofemoral pain syndrome: An ultrasonographic study.

INTRODUCTION: In patients with patellofemoral pain syndrome, the vastus medialis obliquus muscle fiber angle measured by ultrasound at knee extension was found to be different from that in healthy individuals. An important feature of patellofemoral pain syndrome is the increase in pain severity during activities that require knee flexion. OBJECTIVE: To investigate whether there was an ultrasonographic change in the vastus medialis obliquus fiber angle by flexing the knee joint in patients with patellofemoral pain syndrome compared to healthy pain-free individuals. DESIGN: A cross-sectional clinical study. SETTING: An outpatient clinic of a tertiary care hospital. PARTICIPANTS: Forty-seven patients with patellofemoral pain syndrome (median age of 40 years) and 43 healthy volunteers (median age of 39 years) were included in the study. INTERVENTIONS: No intervention. MAIN OUTCOME MEASURES: Vastus medialis obliquus fiber angle measured by ultrasonography at three different positions of knee joint including extension, 30° of flexion, and 45° of flexion. RESULTS: There was no significant change in the vastus medialis obliquus fiber angle with knee flexion in both groups (p > .05 for each group). However, the median vastus medialis obliquus fiber angle values in the group with patellofemoral pain syndrome were significantly lower at all knee joint angles than those in the comparison group (p < .05 at all knee joint angles). CONCLUSIONS: Although the vastus medialis obliquus fiber angle does not change with static knee flexion, the lower angle of the vastus medialis obliquus fiber in those with patellofemoral pain syndrome implicitly suggests that vastus medialis obliquus dysfunction may exist.

Prevalence of pistol-grip deformity in patients with axial spondyloarthritis.

OBJECTIVE: To our knowledge, the prevalence of pistol-grip deformity (PGD) has not previously been studied in patients with axial spondyloarthritis (axSpA). This study aimed to evaluate PGD prevalence in patients with axSpA and to assess its relationship with the clinical and demographic factors. METHODS: A total of 158 patients with axSpA in whom diagnosis was established according to the Assessment of SpondyloArthritis International Society criteria in rheumatology department and 193 age- and sex-matched controls admitted to the emergency room and had anteroposterior (AP) pelvic X-rays were included in the study. PGD was identified by determining the non-spherical shape of the femoral head on AP hip or pelvic X-rays. RESULTS: Prevalence of PGD was significantly higher in patients with axSpA than in controls (20.3% vs. 8.8%, respectively, p=0.002). PGD was also found to be more frequent in patients with radiographic axSpA than in those with non-radiographic axSpA (26/106 [24.5%] vs. 6/52 [11.5%]); however, this difference did not reach statistical significance (p=0.056). The presence of PGD was significantly associated with the presence of hip arthritis (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-8.7; p=0.023), ever smoking (OR, 4.5; 95% CI, 1.4-13.6; p=0.008), and male sex (OR, 38.7; 95% CI, 5.1-292.7; p<0.001) in univariate analyses. In multivariate model, ever smoking (OR, 2.9; 95% CI, 1.10-10.05; p=0.03) and male sex (OR, 27.0; 95% CI, 3.5-208.4; p=0.002) were associated with PGD. CONCLUSION: PGD was significantly more common in patients with axSpA. Presence of PGD correlated significantly with hip arthritis, smoking, and sex. We assume that new bone formation could be the possible reason for increased PGD prevalence. Femoroacetabular impingement should be considered as a secondary cause of hip pain in patients with axSpA.

Wearable Motion Capture System Evaluation for Biomechanical Studies for Hip Joints.

Human motion capture (MOCAP) systems are vital while determining the loads occurring at the joints. Most of the clinical MOCAP systems are very costly, requiring investment and infrastructure. Therefore, alternative technologies are in demand. In this study, a novel markerless wearable MOCAP system was assessed for its compatibility with a biomechanical modeling software. To collect evidence, experiments were designed in two stages for quantifying the range of motion (ROM) of the hip joint, in vitro and in vivo. Three constrained single-plane motions-abduction/adduction, flexion/extension, and internal/external rotation movements of the active leg-were analyzed. The data were collected from 14 healthy volunteers, using the wearable system and a medical grade optoelectronic MOCAP system simultaneously and compared against. For the in vitro study, the root-mean-square error (RMSE) for the abduction/adduction motion of the hip joint was calculated as 0.11 deg/0.30 deg and 0.11 deg/0.09 deg, respectively, for the wearable and the opto-electronic system. The in vivo Bland-Altman plots showed that the two system data are comparable. The simulation software is found compatible to run the simulations in offline mode. The wearable system could be utilized in the field of biomechanics software for running the kinetic simulations. The results demonstrated that the wearable system could be an alternative in the field of biomechanics based on the evidence collected.

Effects of High-Frequency Neuronavigated Repetitive Transcranial Magnetic Stimulation in Fibromyalgia Syndrome: A Double-Blinded, Randomized Controlled Study.

OBJECTIVE: The primary aim of the study was to investigate the effect of 10-Hz repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex on pain in fibromyalgia. Secondary aims were to determine its effects on stiffness, fatigue, quality of life, depression/anxiety, and cognitive functions. DESIGN: Twenty participants were randomized into two groups. Group A received 10-Hz repetitive transcranial magnetic stimulation to left dorsolateral prefrontal cortex and group B received sham stimulation. Visual analog scale for pain, visual analog scale-stiffness, Fibromyalgia Impact Questionnaire, and Fatigue Severity Scale were assessed at the baseline, 2nd, and 6th weeks, whereas Hospital Anxiety Depression Scale and Addenbrooke's cognitive examination were assessed at the baseline and 6th week. RESULTS: There was no significant difference in visual analog scale-pain and Fatigue Severity Scale within and between groups over time (P > 0.05). In group A, significant improvement was found in visual analog scale-stiffness and fibromyalgia impact questionnaire at the 2nd week in comparison to the baseline (P < 0.05). However, no significant difference was detected in comparison with group B. There was no significant change in Hospital Anxiety Depression Scale scores between and within groups. All cognitive measures were similar in terms of differences from baseline between the groups (P > 0.05). CONCLUSIONS: High-frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex did not show any significant beneficial effect on pain, stiffness, fatigue, quality of life, mood, and cognitive state over sham stimulation.

YouTube as a Source of Information for Transcranial Magnetic Stimulation in Stroke: A Quality, Reliability and Accuracy Analysis.

BACKGROUND AND OBJECTIVES: Studies using YouTube data for various diseases are rapidly increasing. This study aimed to investigate the educational quality, reliability and accuracy of the YouTube videos concerning repetitive transcranial magnetic stimulation (rTMS) applications in patients with stroke. METHODS: This is a descriptive study. A video based search on YouTube was performed on April 18th, 2020 by using keyword 'stroke repetitive transcranial magnetic stimulation'. The videos were queried using the default settings on YouTube and the results were listed according to relevance. Video parameters and sources were recorded. Quality, reliability and accuracy of the videos were determined with Global Quality Score (GQS), Journal of American Medical Association (JAMA) Benchmark Criteria and Modified DISCERN Questionnaire, respectively. RESULTS: A total of 21 videos were included in the study. The median number of views for videos was 884 (range: 89-28589) and the median duration was 135 seconds. None of the videos had a negative interaction index. The median value was found to be 3 for all three measurements (GQS, JAMA, and DISCERN). Most of the videos were of intermediate quality (47.6%) and had partial sufficient data (61.9%). In the high-quality group, the number of views, dislikes, the duration of the videos, JAMA and DISCERN scores were higher than the low-quality group (p < 0.05). At the same time, viewing rates of the high-quality group were better than the low and the intermediate-quality group (p < 0.05). There was a significant positive correlation between GQS and number of the views, video duration, number of likes, number of dislikes, viewing rate and modified DISCERN questionnaire scores (p < 0.05). CONCLUSION: Our results showed that most of the rated videos were of intermediate quality and had partially sufficient data. It has also been found that high-quality videos have higher viewing rates, more dislikes, longer video durations as well as better reliability and accuracy scores. YouTube videos of higher quality and accuracy are needed to increase awareness of rTMS by stroke patients.

Validity and reliability of the Turkish version of caregiver self-assessment questionnaire.

Objective: This study aims to translate the Caregiver Self-Assessment Questionnaire (CSAQ) into Turkish language and to test its reliability and validity in Turkish informal family caregivers.Materials and methods: This is a cross-sectional and methodological study. Eighty family caregivers (54.53 ± 12.07 years; range 25 to 77 years; 65 females, 15 males) were included in the study. Demographic properties of the participants (age, sex, education, occupation, marital status), relationship with care recipient, caregiving time, main diseases of the patients were recorded. After that CSAQ, Caregiver Well-Being Scale (CWBS) and Hospital Anxiety Depression Scale (HADS) were used for data collection. A test-retest interval of seven-days was used to assess the reliability. Internal consistency between the items was assessed by Cronbach's alpha coefficient. For reliability; test-retest reliability, intraclass correlation coefficient, and paired sample t tests were used. Intercorrelation of variables was performed with Spearman's rho tests. A ROC curve and sensitivity and specificity analysis were performed to determine the ability of the CSAQ to predict depression or anxiety.Results: Totally 80 participants completed test/retest procedures. Content Validity Index values of the Items were sufficient and all items were included in the questionnaire. During exploratory factor analysis, 1 factor with eigenvalues greater than 1 were extracted, explaining 62.36% of the total variance. The corrected item total correlation coefficients for Item 2 and Item 5 were found to be <0.3. Therefore, these two items were omitted. Cronbach's α value was found as 0.90 (excellent level). Test-retest reliability (Intraclass correlation coefficient values range: 0.93-0.97) of the CSAQ was found to be excellent. Statistically negative moderate correlations were detected between CSAQ total score and CWBA basic needs and activities of living sub scores (rho = -0.605, rho = -0.523, p < 0.001), while positive strong correlations were detected between HADS depression and anxiety scores (rho = 0.610, rho = 0.651, p < 0.001). CSAQ score of 9 or greater resulted in a sensitivity of 0.56 and a specificity of 0.87 for depression and sensitivity of 0.84 and a specificity of 0.83 for anxiety. According to the scoring instructions of CSAQ with the positivity of any one of four criteria, we found sensitivity of 0.87 for depression and 0.96 for anxiety.Conclusion: The Turkish version of the CSAQ is a valid and reliable questionnaire for evaluating stress-levels of informal family caregivers.Implications for rehabilitationMeasures of caregivers' psychological status are of clinical value.The Caregiver Self-Assessment Questionnaire functions as a screening measure for symptoms of depression and anxiety.The Turkish version of the Caregiver Self-Assessment Questionnaire is a valid and reliable questionnaire for evaluating stress-levels of informal family caregivers.

Activities and participation after stroke: validity and reliability of the Turkish version of IMPACT-S questionnaire.

Objective: This study aims to translate the screener part of the The International Classification of Functioning, Disability and Health (ICF) Measure of Participation and ACTivities Questionnaire (IMPACT-S) into Turkish and to test its reliability and validity in Turkish patients with stroke.Materials and methods: Participants were recruited from the inpatient rehabilitation clinic of a university hospital. Eighty-six stroke patients (mean ages: 60.43 ± 12.62 years; range 20-82 years; 51 males and 35 females) were included in the study. Demographic properties of the patients (age, sex, education, occupation, and body mass index), the start of in-patient rehabilitation treatment, affected extremity, types of stroke, and comorbidities were recorded. After that IMPACT-S questionnaire and World Health Organization Disability Assessment Schedule-II (WHODAS-II) were used for data collection. A test-retest interval of 7 d was used to assess the reliability. Internal consistency between the items was assessed by Cronbach's alpha coefficient. For reliability; test-retest reliability, intraclass correlation coefficient (ICC), paired sample t-test were used. Intercorrelation of variables was performed with Spearman's rho tests.Results: Totally 86 patients completed test/retest procedures. Cronbach's alpha coefficient of the questionnaire was found to be 0.96. Both internal consistency (Cronbach's alpha score range: 0.65-0.98) and test-retest reliability (ICC values range: 0.86-0.97) of the IMPACT-S were found to be good. The correlations between all IMPACT-S subscales were moderate to strong (correlation range: 0.45-0.80). The correlation between the Activities and Participation scores (0.86) and IMPACT-S total score (0.96) were very strong. Statistically significant negative correlations were detected between all sub-scores of IMPACT-S and WHODAS-II, except for life activities/communication and life activities/knowledge. These findings show excellent concurrent validity. However, a lower-than-expected correlation between Major life areas (IMPACT-S) and Life activities (WHODAS-II) was observed.Conclusion: The Turkish version of the IMPACT-S is a valid and reliable questionnaire for evaluating activities and participation in patients with stroke.Implications for rehabilitationPatients with stroke experience difficulties across multiple participation domains, such as major life areas and community life.The screener part of the IMpact on Participation and ACTivities (IMPACT-S) questionnaire is the only measure that accurately reflects The International Classification of Functioning, Disability and Health (ICF) sections and appears a promising outcome measure in rehabilitation research.The Turkish version of the IMPACT-S was found to be valid and reliable for evaluating "Activities and Participation" in stroke patients.

Ultrasonographic and electrophysiologic evaluation of median and ulnar nerves in chronic stroke patients with upper extremity spasticity.

Objective: To evaluate the upper extremity nerves of stroke patients morphologically and electrophysiologically and to determine whether there is a relationship between clinical evaluations, ultrasonographic measurements, and electrodiagnostic findings. Methods: This cross-sectional study included 30 chronic stroke patients. After recording demographical data, clinical, ultrasonographic, and electrophysiological evaluations were performed. Clinical evaluations included Brunnstrom Recovery Stages (BRS), Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motricity index (MI), Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS). For ultrasonographic measurements, median and ulnar nerves were scanned. Median and ulnar nerve conduction studies were performed bilaterally. Results: Mean ages of the patients were 62.2 ± 13.0 years (range 24-84 years; 22 males, 8 females). There was no significant difference in median/ulnar nerve ultrasonographic measurements between paretic and non-paretic sides (p > .05), whereas median nerve motor conduction velocity was significantly slower and median nerve F-wave latency was prolonged on the paretic side (p < .05). The median and ulnar nerve compound motor action potential (CMAP) amplitudes of paretic sides were positively correlated with lower extremity BRS and FAS scores. Median CMAP amplitudes were also positively correlated with FIM scores and ulnar CMAP amplitudes were positively correlated with motricity scores. Moreover, on the paretic side, there were positive correlations of median SNAP amplitudes with FIM and FAS scores (p < .05). Conclusions: Our results showed electrophysiological changes in peripheral nerves on the paretic upper extremities, however, no morphological change was determined. Further studies with larger number of patients and longer follow-up periods are needed to clarify the effect of stroke and spasticity on the peripheral nervous system.

Is high-frequency repetitive transcranial magnetic stimulation of the left primary motor cortex superior to the stimulation of the left dorsolateral prefrontal cortex in fibromyalgia syndrome?

OBJECTIVE: To investigate effectiveness of two different high-frequency repetitive transcranial magnetic stimulation (rTMS) protocols on pain, fatigue, quality of life (QoL) and depression in female patients with fibromyalgia. METHODS: Thirty patients were randomized into three groups. Fifteen sessions of 10 Hz (90% resting motor threshold-RMT, 1200 pulses) rTMS were applied to left primary motor cortex and left dorsolateral prefrontal cortex (DLPFC) in Group M1 (n:10) and Group DLPFC (n:10), respectively. Group sham (n = 10) received 15 sessions of sham rTMS over 3 weeks. Visual Analogue Scale, Fibromyalgia Impact Questionnaire, Fatigue Severity Scale, Short-form 36, and Beck Depression Inventory were assessed at baseline and at the end of the treatments by a blinded-experienced assessor. RESULTS: Significant improvements in pain, QoL, and depression scores were observed in three groups. However, improvements in depression, physical functioning, physical role functioning, and general health perceptions were greater in active rTMS groups than in sham group. Emotional role functioning was only improved in Group M1. The decrease in VAS scores was significantly greater in Group M1 when compared to sham group. Change in physical role functioning was significantly greater in Group DLPFC than in Group M1. CONCLUSIONS: Significant improvements in physical role functioning, physical functioning, depression, and general health perceptions were achieved in active rTMS groups. Further clinical studies on larger samples involving both sexes with longer follow-up durations are needed.

Assessment of post-stroke elbow flexor spasticity in different forearm positions.

Purpose/Aim: There have been conflicting results regarding which muscle contribute most to the elbow spastic flexion deformity. This study aimed to investigate whether flexor spasticity of the elbow changed according to the position of the forearm, and to determine the muscle or muscles that contributed most to the elbow spastic flexion deformity by clinical examination. METHODS: This study is a single group, observational and cross-sectional study. Sixty patients were assessed for elbow flexor spasticity in different forearm positions (pronation, neutral and supination) with Modified Tardieu Scale. The primary outcome measure was a domain of the Modified Tardieu Scale, the dynamic component of spasticity (spasticity angle). RESULTS: In general, there was a significant difference between forearm positions regarding spasticity angle (p < .001). In pairwise comparisons, median spasticity angles in pronation (70 degrees) and neutral position (60 degrees) were significantly higher than those in supination (57.5 degrees) (adjusted p < .001 and adjusted p = .003, respectively). However, median spasticity angle in pronation did not differ significantly from those in neutral position in favour of pronation (adjusted p = .274). CONCLUSIONS: The severity of spasticity changes according to the elbow position which suggests that the magnitude of contribution of each elbow flexor muscle to spastic elbow deformity is different. Reduction of spasticity from pronation to supination leads us to consider brachialis as the most spastic muscle. Since biceps was suggested to be the least spastic muscle in this study, and also to avoid spastic pronation deformity of the forearm, it should be rethought before performing chemodenervation into biceps muscle.

Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke.

BACKGROUND: Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function. OBJECTIVE: To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke. METHODS: In this randomized controlled trial, group A received 20 sessions of physical therapy (PT) + 20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients' motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement. RESULTS: Statistically significant improvements in game scores (p < 0.05) were observed in group A. In within-group analysis, there were statistically significant improvements in all clinical outcome measures except for the BRS-hand, MAS-distal, and MAS-hand in group A; MAS-(proximal, distal, hand) and BRS-(UE, hand) in group B compared with baseline values. Differences from baseline of FMA, MI, and AROM (except adduction of shoulder and extension of elbow) were greater in group A (p < 0.05). CONCLUSIONS: To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.

Paradoxical Side Effect Related With Anti-Tumor Necrosis Factor Alpha Treatment.

INTRODUCTION: Anti-tumor necrosis factor (anti-TNF) treatments are effective in controlling disease activity in many immune-mediated diseases such as psoriasis and ankylosing spondylitis (AS). Although side effects such as infection and skin reactions are predictable in anti-TNF treatment; susceptibility to psoriasis is considered as a paradoxical side effect. CASE REPORT: We report a case of forty-year-old male patient with 7 years of AS was taking anti-TNF therapy. He admitted our clinic with widespread guttate sized round, crusty rashes at feet, legs and elbows. In pathological examination of lesions; focal parakeratosis, mild acanthosis, capillary proliferation in the papillary dermis and focal extravasated erythrocytes were observed. He was diagnosed as anti-TNF induced guttate psoriasis. Although there is no definite treatment option, topical treatments, interrupting drug treatment or adding a disease-modifying agent for psoriasis are recommended. In this case report, we aimed to share our clinical approach to the paradoxical psoriasis manifestation which developed after two different anti-TNF treatments in a patient with AS.

The evaluation of cervical spinal angle in patients with acute and chronic neck pain.

BACKGROUND/AIM: Clinicians associate the changes in cervical lordosis with neck pain, but there is no clear consensus on this. We aimed to investigate the relationships of cervical angles, neck pain, disability, and the psychological status of the patients with acute and chronic neck pain. MATERIALS AND METHODS: A total of 110 patients with neck pain were included in this study. Demographic and clinical characteristics of the patients were recorded. The lordosis angle was determined by the posterior tangent method. A visual analog scale (VAS), the Neck Disability Index (NDI), and the Hospital Anxiety and Depression (HAD) scale were administered to all patients. RESULTS: The mean cervical lordosis angle was 23.10 ± 8.07 degrees. A statistically negative correlation was detected between cervical angle and duration of disease (P < 0.05). The cervical angle of the acute neck pain group was higher than that of the chronic pain group (P < 0.05). There was no difference between the acute and chronic neck pain groups with respect to VAS, NDI, and HAD scores (P > 0.05). CONCLUSION: We found that the cervical angle was significantly lower in chronic neck pain patients when compared to acute patients, and patients with higher pain scores had more severe disability and that disability increased with the duration of disease.

Comparison of biochemical parameters of blood and urine in spinal cord injury patients and association with urinary stone formation.

OBJECTIVE: The aim of this study was to compare the biochemical parameters of the urine and blood in spinal cord injury (SCI) patients and healthy subjects. METHODS: Thirty male patients with SCI were enrolled. Biochemical features of the urine and blood of the SCI patients were compared to healthy subjects. Extracted stones were analyzed by X-ray diffraction. RESULTS: A total of 30 patients with SCI (mean age of 28.77 ± 7.3 years) and 10 healthy subjects (mean age of 27.6 + 6.2 years) were included. Among the patients with SCI; 12 of them (40%) had urinary stones and 18 of them (60%) did not. Urinary stone was localized in the kidneys and bladder in 25% and 75% of the subjects, respectively. The mean duration of cord injury at diagnosis of urinary stone was 9.2 ± 6 months. Urine cultures obtained on admission were negative for the control group, while the microorganism isolation rate was 73.3% in the SCI group. The urinary excretion of citrate and Mg were lower in the patient group compared with control group (p= 0.008, p= 0.001, respectively). As for the diffraction analysis of eight stones; five (62.5%) of the stones were calcium oxalate, two (25%) of them were calcium phosphate, and one (12.5%) was magnesium ammonium phosphate. CONCLUSION: Both infection and metabolic changes play an important role in stones formation in SCI patients. The urinary excretion of citrate and Mg was decreased and urinary PH was increased in SCI patients.

Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial.

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) was suggested as a preconditioning method that would increase brain plasticity and that it would be optimal to combine rTMS with intensive rehabilitation. OBJECTIVE: To assess the efficacy of inhibitory rTMS on upper extremity motor recovery and functional outcomes in chronic ischemic stroke patients. METHODS: In this randomized controlled trial, experimental group received low-frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT), and control group received PT. RESULTS: No statistically significant difference was found in baseline demographical and clinical characteristics of the subjects including stroke severity or severity of paralysis prior to intervention. There were statistically significant improvements in all clinical outcome measures except for the Brunnstrom Recovery Stages. Fugl-Meyer Assessment, Box and Block test, motor and total scores of Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS) scores were significantly increased in both groups, however, these changes were significantly greater in the rTMS group except for FAS score. FIM cognitive scores and standardized mini-mental test scores were significantly increased and distal and hand Modified Ashworth Scale scores were significantly decreased only in the rTMS group (p < .05). CONCLUSIONS: LF-rTMS can safely facilitate upper extremity motor recovery in patients with chronic ischemic stroke. TMS seems to be a promising treatment for motor, functional, and cognitive deficits in chronic stroke. Further studies with a larger number of patients with longer follow-up periods are needed to establish its effectiveness in stroke rehabilitation.