A Case Report of Probable Secondary Sarcopenia After Intensive Care Hospitalization.

Malnutrition, inflammation, comorbid diseases, and inactivity are known causes of sarcopenia. It results in clinical consequences like fractures, falls, low quality of life, cognitive dysfunction, and mortality. Especially in the treatment of patients with prolonged immobilization syndrome, management should not only focus on functional limitations but patients should also be evaluated and followed up for sarcopenia. In this case report, we present the management of probable secondary sarcopenia in the intensive care unit as a result of urosepsis and discuss it in the light of the literature.

Conservative Treatment in Adult Degenerative Scoliosis: a Prospective Cohort Study.

Background: Adult degenerative scoliosis (ADS) is a coronal deviation of the spine greater than 10° resulting from the progressive degeneration of the vertebral elements in middle age, which is a three-dimensional deformity. In this study, the effect of conservative treatment methods on pain, disability, and quality of life of patients with ADS was evaluated. Methods:Thirty females with ADS were included in the present study. Demographic characteristics, Cobb angles, Visual Analog Scale (VAS), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22) and Roland Morris Disability Questionnaires (RMDQ) were noted. Fifteen sessions of physical therapy (hotpack, TENS and ultrasound) and exercises were administered to all patients. All assessment scales were used for evaluation at baseline as well as one month and three months after treatment. Results:Visual Analog Scale scores statistically differed between the first, second and third measurements (p<0,001). There was a significantly improvement in RMDQ between periods of time (p<0,001). While the second assessment was significantly lower than the first measure (p=0,001), there was no difference between the third and second measures (p=0,496). Similarly, quality of life assessments (SRS-22, SF-36) significantly differed between the first and second assessments and continued at the third assessment. Conclusion:Given the difficulties of surgical treatment and patients' comorbidities, conservative treatment methods are becoming important for ADS. Non-surgical treatments for ADS should be taken into consideration to improve pain, disability and quality of life outcomes.

The effects of low-intensity resistance training with blood flow restriction versus traditional resistance exercise on lower extremity muscle strength and motor functionin ischemic stroke survivors: a randomized controlled trial.

BACKGROUND: Blood flow restriction (BFR) training can temporarily reduce cortical GABA concentrations and increase the size of motor volleys to deafferented muscles, which can promote motor recovery in stroke survivors. OBJECTIVE: To determine the effect of low-intensity resistance training with BFR (LIRT-BFR) on lower extremity muscle strength, balance, functional mobility, walking capacity, gait speed, anxiety, and depression in stroke survivors and to compare the results with high-intensity resistance training (HIRT). METHOD: It was a two-arm, single-blinded, randomized controlled trial in which 32 ischemic stroke participants were randomly allocated to LIRT-BFR or HIRT group. The LIRT-BFR group received low load resistance training (40% of 1-Repetition Maximum (1-RM)) with BFR, whereas HIRT group received high load resistance training (80% of 1-RM). The 6-Minute Walk Test (6-MWT), five-time sit-to-stand test (5TSTST), Timed Up and Go (TUG) test, and Barthel index were the primary outcome measures. The secondary outcome measures included gait speed (m/s), stride length (cm), cadence (steps/min), and Hospital Anxiety and Depression. RESULTS: All the primary and secondary outcome measures were significantly improved in both groups (p < 0.05). The LIRT-BFR group showed a slightly greater, but non-significant, improvement as compared to the HIRT group in terms of mean change observed in 6-MWT (81 m vs 62 m), 5TSTST (-5.27 vs -4.81), gait speed (0.19 vs 0.12), stride length (18 vs 13), and cadence (8 vs 6). No adverse event was reported. CONCLUSION: LIRT-BFR produced a significant improvement in muscle strength, balance, walking capacity, and anxiety and depression in ischemic stroke patients, and the improvement are comparable to HIRT. CLINICAL TRIAL REGISTRATION: NCT05281679.

The relationship between quadriceps femoris thickness measured by US and femoral cartilage thickness in knee osteoarthritis, its effect on radiographic stage and clinical parameters: comparison with healthy young population.

Objective: In this study, we aimed to investigate the relationship between quadriceps muscle thickness and femoral cartilage thickness measured by ultrasonography (US) in knee osteoarthritis (OA), to correlate this relationship with radiographic stage and clinical parameters, and to compare these values with those in healthy young adults. Methods: A total of 71 patients with knee osteoarthritis and 31 healthy young adults were included in the study. Patients with knee osteoarthritis (Group 1) and healthy young adults (Group 2) were divided into two groups. Muscle thickness measurements of the quadriceps femoris muscle (M. vastus intermedius + M. rectus femoris) were performed by US. Results: Bilateral quadriceps muscle thickness and bilateral femoral cartilage thickness values were significantly lower in Group 1 than in Group 2. The 10-metre walk test score and Time Up and Go (TUG) test score were significantly higher in Group 1 than in Group 2. A strong positive correlation was found between bilateral quadriceps (RF+VI) muscle thickness and bilateral femoral cartilage thickness (medial, intercondylar, lateral) in Group 1. Conclusions: This study showed a strong positive correlation between quadriceps thickness and femoral cartilage thickness. According to these results, we conclude that US may have a place in the diagnosis of knee osteoarthritis.

Management of spasticity in individuals with spinal cord injury in the era of COVID-19 pandemic societal restrictions.

STUDY DESIGN: Cross-sectional telephone interviews. OBJECTIVE: The coronavirus disease (COVID-19) pandemic placed unprecedented pressure on healthcare systems worldwide. Here, we aimed to investigate the disruptions in management of spasticity and activities of daily living (ADL) in individuals with spinal cord injury (SCI) during the COVID-19 pandemic. SETTING: Two university hospitals in Istanbul, Turkey. METHODS: Twenty-four individuals with SCI exhibiting moderate and severe spasticity were enroled. All participants underwent ultrasound-guided botulinum toxin type A (BoNT-A) injections at two centres. A self-rated spasticity survey prepared by the authors was conducted. We questioned whether there was an increase in spasticity and the need for new BoNT-A injections during the societal restrictions of the COVID-19 pandemic. Spasticity severity in the previous week was rated using a numeric rating scale (NRS). ADL disrupted by spasticity were assessed by asking open-ended questions. RESULTS: In total, 75% participants reported a moderate increase in spasticity, 12.5% reported a severe increase, and 12.5% reported no difference. The mean spasticity NRS score was 6 (standard deviation = 2). Further, 87.5% (21) participants reported the need for BoNT-A treatment because of symptom re-emergence. When spasticity-induced deterioration in ADL was assessed, individuals mostly reported difficulties in walking, sitting on a wheelchair, and sleep disturbance due to spasticity. CONCLUSIONS: Most (87.5%) individuals with SCI reported a moderate or severe increase in spasticity during COVID-19 restrictions. Individuals with disabilities are an especially sensitive group and require specialised care during extraordinary circumstances, such as pandemics, hurricanes, or earthquakes. SPONSORSHIP: None.

The relationship between severity of overactive bladder symptoms and cognitive dysfunction, anxiety and depression in female patients with multiple sclerosis: Running head: OAB-V8, BICAMS and HAD scale in MS.

BACKGROUND: Overactive bladder (OAB), cognitive dysfunction, depression and anxiety are common problems encountered in MS. This study was planned to investigate the relationship between the severity of OAB symptoms and cognitive function, anxiety and depression in MS. METHODS: 100 patients with MS diagnosis with OAB symptoms were recruited. OAB symptoms was assessed with the OAB-V8 questionnaire. Symbol Digit Modalites Test (SDMT), California Verbal Learning Test II (CVLT-II) and Brief Vasospatial Memory Test-Revised (BVMT-R) in BICAMS Battery were used to evaluate cognitive function. Depression and anxiety were assessed with the Hospital Anxiety Depression (HAD) Scale. RESULTS: The mean age of the patients was 40.9±12.3, the duration of the disease was 9.03±6.89 years, and the mean OAB-V8 score was 17.6±8.9. SDMT test (r=-0.299, p<0.01) showed a moderately significant, CVLT-II (r= -0.219, p<0.05) and BVMT-R (r=-0.218, p<0.05) tests showed a weakly significant negative correlation with OAB-V8 score. There was a moderate positive correlation between the OAB-V8 score and HAD-D (r=0.279, p=0.005) and HAD-A (r=0.318, p=0.001) scores. SDMT and BVMT-R scores were significantly lower in anticholinergic (Ach) drug users (especially oxybutynin users) compared to those who did not use Ach drugs. CONCLUSIONS: It has been observed that the severity of OAB symptoms is related to worsening of information processing speed and an increase in depression and anxiety. It has been determined that there is a significant effect on information processing speed, visual learning and memory in patients using Ach drugs, especially in those using oxybutynin, compared to those who do not use Ach drugs.

Suicidal ideation, post-traumatic stress disorder, and depression in traumatic spinal cord injury: What resilience tells us.

OBJECTIVE: Identification of unmet psychiatric needs, protective and risk factors for suicide are crucial for people with traumatic spinal cord injury (SCI). In this study, we aimed to explore depression, post-traumatic stress disorder (PTSD) status (non-PTSD, partial-PTSD, full-PTSD), resilience, suicidal ideation (SI) and to examine predictors and clinical correlates of current SI in traumatic SCI. METHOD: Sixty-three individuals with traumatic SCI who were at least 3 months post-injury were included in the study. The participants were evaluated in terms of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), depression, SI, and resilience using the PCL-5, the Patient Health Questionnaire-9, the Brief Resilience Scale, and sociodemographic measures. RESULTS: 33% of our sample (n = 21) had SI over the past two weeks. 71.4% of the patients with SI (n = 15) had depression. A total of 52.4% of the patients with SI (n = 11) were diagnosed with full PTSD. Resilience was found to be significantly lower in individuals with depression and individuals with SI. While depression predicted SI in traumatic SCI, resilience stands as a protective factor against SI. CONCLUSION: SI is quite common in individuals with traumatic SCI and is accompanied by substantial psychiatric comorbidities such as depression and PTSD. Along with depression and PTSD, resilience - which has protective and predictive values and is inversely associated with SI - constitutes a significant psychotherapeutic intervention and screening area.

Demographic and clinical characteristics of inpatient stroke patients in Turkey.

Objectives: This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion: This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Effect of Pulmonary Rehabilitation Approaches on Dyspnea, Exercise Capacity, Fatigue, Lung Functions, and Quality of Life in Patients With COVID-19: A Systematic Review and Meta-analysis.

OBJECTIVE: To qualitatively synthesize and quantitatively evaluate the effect of pulmonary rehabilitation (PR) on dyspnea, lung functions, fatigue, exercise capacity, and quality of life (QoL) in patients with COVID-19. DATA SOURCES: PubMed, Web of Science, and Cochrane databases were searched from January 2020 to April 2022. DATA SELECTION: Randomized controlled trials (RCTs) assessing the effect of PR on dyspnea, lung functions, fatigue, exercise capacity, and QoL in patients with COVID-19. DATA EXTRACTION: The mean difference (MD) and a 95% CI were estimated for all the outcome measures using random effect models. The following data were extracted by 2 independent reviewers: (1) first author; (2) publication year; (3) nationality; (4) number of patients included (5) comorbidities; (6) ventilatory support; (7) length of inpatient stay; (8) type of PR; (9) outcome measures; and (10) main findings. The risk of bias was evaluated using the cochrane risk of bias tool. DATA SYNTHESIS: A total of 8 RCTs involving 449 participants were included in the review. PR was found to be significantly effective in improving dyspnea (5 studies, SMD -2.11 [95% CI, -2.96 to -1.27; P<.001]) and exercise capacity (MD 65.85 m [95% CI, 42.86 to 88.83; P<.001]) in patients with both acute and chronic COVID-19 with mild to severe symptoms, whereas fatigue (MD -2.42 [95% CI, -2.72 to -2.11, P<.05]) and lung functions (MD 0.26 L [95% CI, 0.04 to 0.48, P<.05]) were significantly improved in acute COVID-19 patients with mild symptoms. The effect of PR on QoL was inconsistent across studies. PR was found to be safe and feasible for patients with COVID-19. CONCLUSION: Evidence from studies indicates that PR program is superior to no intervention in improving dyspnea, exercise capacity, lung functions, and fatigue in patients with COVID-19. PR appears to be safe and beneficial for both acute and chronic COVID-19 patients.

S1 Guidelines on Bone Impairment in Spinal Cord Injury.

During the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are affected. Bone mineral density of lower limbs is decreased up to 28%-50% below that of age-matched peers at 12-18 mo post injury. Coexisting secondary etiologies of osteoporosis may be present, and during ageing additional loss of bone occurs. All these compose a complex canvas of bone impairment after spinal cord injury and make the therapeutical approach challenging. The risk of fragility fractures is increased after the 2nd decade post SCI affecting the functionality and quality of life of individuals with SCI. Diagnostic flaws, lack of a ranking system to categorize the degree of bone impairment similar to the one of World Health Organization, and evidence-based clinical guidelines for management in SCI requires interdisciplinary cooperation and appropriate planning of future research and interventions. Spinal Cord Section of Hellenic Society of Physical Rehabilitation Medicine convened an expert panel working group on bone and spinal cord injury at the Pan-Hellenic Congress 2018 of PRM in Athens Greece, to establish an evidence-based position statement for bone loss in individuals with SCI of traumatic or non-traumatic etiology. This was reviewed by an International Task Force and used to create S1 Guidelines. This first version S1 guideline will work towards to provide help with prophylactic basic osteoporosis therapy diagnostic and therapeutic decisions in acute and chronic phase and rehabilitation countermeasures against osteoporosis related with spinal cord injury.

The frequency of neuropathic pain in Turkish patients with low back pain: a cross-sectional study.

The aim of this study was to evaluate the frequency of neuropathic pain (NP) in patients with low back pain (LBP) and the relationship of NP with demographic characteristics and pain duration. Four hundred and forty patients were evaluated with respect to NP. Demographic data were collected and Douleur Neuropathique 4 Questions (DN4) questionnaire was used to identify NP. Any difference in demographic characteristics or duration of pain was investigated between the patients with and without NP. Sociodemographic factors which are independently associated with NP were analyzed. According to DN4, 43.9% of the patients had NP. Mean age of the patients was 44.8 years (± 13.7). 343 (77.9%) of the patients had chronic LBP (more than 3 months). The patients with NP were older (p < 0.001), had higher BMI (p = 0.005) and longer LBP duration (p < 0.001) and had lower educational level (p 0.018). NP was significantly more common in unemployed patients and less common in high-activity employees (p 0.001). Logistic regression analyses identified that high-active workers' risk of having NP was 1.76 times lesser than other groups (office workers, housewives and retired patients). Nearly half of the patients with LBP were accompanied by NP. It was remarkably more common in sedentary patients and patients with low socioeconomic status. High physical activity at work was found to decrease the risk of having NP. Clinicians should emphasize on exercise training as a therapeutic intervention while LBP is being treated.

Prevalence, etiology, and biopsychosocial risk factors of cervicogenic dizziness in patients with neck pain: A multi-center, cross-sectional study.

OBJECTIVES: This study aims to investigate the prevalence, etiology, and risk factors of cervicogenic dizziness in patients with neck pain. PATIENTS AND METHODS: Between June 2016 and April 2018, a total of 2,361 patients (526 males, 1,835 females; mean age: 45.0±13.3 years; range, 18 to 75 years) who presented with the complaint of neck pain lasting for at least one month were included in this prospective, cross-sectional study. Data including concomitant dizziness, severity, and quality of life (QoL) impact of vertigo (via Numeric Dizziness Scale [NDS]), QoL (via Dizziness Handicap Inventory [DHI]), mobility (via Timed Up-and-Go [TUG] test), balance performance [via Berg Balance Scale [BBS]), and emotional status (via Hospital Anxiety- Depression Scale [HADS]) were recorded. RESULTS: Dizziness was evident in 40.1% of the patients. Myofascial pain syndrome (MPS) was the most common etiology for neck pain (58.5%) and accompanied with cervicogenic dizziness in 59.7% of the patients. Female versus male sex (odds ratio [OR]: 1.641, 95% CI: 1.241 to 2.171, p=0.001), housewifery versus other occupations (OR: 1.285, 95% CI: 1.006 to 1.642, p=0.045), and lower versus higher education (OR: 1.649-2.564, p<0.001) significantly predicted the increased risk of dizziness in neck pain patients. Patient with dizziness due to MPS had lower dizziness severity scores (p=0.034) and milder impact of dizziness on QoL (p=0.005), lower DHI scores (p=0.004), shorter time to complete the TUG test (p=0.001) and higher BBS scores (p=0.001). CONCLUSION: Our findings suggest a significant impact of biopsychosocial factors on the likelihood and severity of dizziness and association of dizziness due to MPS with better clinical status.

Caregiver burden in stroke inpatients: a randomized study comparing robot-assisted gait training and conventional therapy.

The effects of caregiver burden during the inpatient rehabilitation period have not yet been investigated. The purpose of this study was to evaluate the burden on stroke survivors' caregivers during the inpatient rehabilitation period, and to compare the associations of robot-assisted gait training and conventional therapy with caregiver burden. Our randomized, crossover, prospective study included 63 stroke survivors and their caregivers, who were randomly assigned to one of two groups. The patients in group I received robot-assisted gait training for 2 weeks, followed by conventional therapy for a further 2 weeks. The patients in group II received conventional therapy for 2 weeks followed by robot-assisted gait training for a further 2 weeks. The caregiver burden inventory, beck depression index, and beck hopelessness scale were administered to the caregivers at day 0, on the "switch day" (day 15), and day 30. Before inpatient rehabilitation, 18 (35%) of the caregivers had somewhat elevated scores on the caregiver burden inventory; however, at the end of rehabilitation, 42 (66.6%) of the caregivers were in a high-burden state. The caregiver burden inventory scores differed significantly between baseline and the end of rehabilitation in both groups. Caregiver depression scores also increased significantly in both groups (p < 0.0001), while hopelessness scores increased only in group II (p = 0.027). Caregiver burden increased during the inpatient stroke rehabilitation period. During inpatient rehabilitation, both robot-assisted gait training and conventional therapy increased caregiver burden.ClinicalTrials.gov Number NCT03535467, First Posted: 24 May 2018.

The effects of COVID-19 on Physical Medicine and Rehabilitation in Turkey in the first month of pandemic.

OBJECTIVES: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. PATIENTS AND METHODS: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. RESULTS: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2±128.5 per week before the pandemic, it significantly decreased to 23.4±33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7±39.3 per week to 2.5±10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. CONCLUSION: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians.

Rehabilitation of Patients With Osteoporotic Fractures.

Osteoporosis is a silent, asymptomatic disease until a fragility fracture is sustained. Fractures greatly affect the physical functioning and health-related quality of life and are associated with increased mortality and morbidity rates. Furthermore, once a fragility fracture occurs, the patient is more susceptible to sustain further fractures. Repeated falls are the main causes of fractures in patients with osteoporosis. The management of osteoporosis postfracture is a combination of medical treatment, nutritional interventions, and rehabilitation in order to improve activities of daily living to prevent falls and increase safety while reducing the loss of bone mass. In this article the principles of fracture prevention and physical rehabilitation of patients with osteoporosis postvertebral and hip fragility fractures will be discussed, as well as the rehabilitation management to prevent further falls and fractures.

Does robot-assisted gait training improve mobility, activities of daily living and quality of life in stroke? A single-blinded, randomized controlled trial.

The purpose of this study was to investigate the effects of robot-assisted gait training (RAGT) on mobility, activities of daily living (ADLs), and quality of life (QoL) in stroke rehabilitation. Fifty-one stroke patients randomly assigned to Group 1, Group 2, and Group 3 received conventional training (CT) plus RAGT, CT, and RAGT, respectively. The training duration was for 6 weeks. The primary outcome measures were the Barthel Index (BI), Stroke Specific Quality of Life Scale (SS-QOL), 6-Minute Walk Test (6-MWT), and Stair Climbing Test (SCT). The secondary outcomes were Fugl Meyer Assessment-Lower Extremity (FMA-LE), Comfortable 10-m Walk Test (CWT), Fast 10-m Walk Test (FWT), and Rate of Perceived Exertion (RPE). The mean change in all the primary [BI (p = 0.001), 6-MWT (p = 0.001), SS-QOL (p < 0.0001), and SCT (p = 0.004)] and except the FWT (p = 0.354) all the other secondary outcomes [FMA-LE (p = 0.049), CWT (p = 0.025) and RPE (p = 0.023)] improved significantly between the three groups. In the subgroup analysis, BI, 6-MWT, SS-QOL, and SCT improved significantly in Group 1 compared to Group 2 and Group 3 (p < 0.016). However, FMA-LE, CWT, and the RPE significantly improved in Group 1 compared to Group 2 and, also, only CWT improved significantly in Group 1 compared to Group 3 (p = 0.011). In a subgroup analysis of the primary and secondary outcome measures, there were no significant differences in Group 2 compared to Group 3 (p > 0.05). While combined training leads to more improvement in mobility, ADLs, and QoL, CT showed a similar improvement compared to the RAGT in stroke patients.

The effects of different injection techniques of botulinum toxin a in post-stroke patients with plantar flexor spasticity.

The purpose of this study was to compare the effects of different injection technique guidance with electrical stimulation (ES) vs ultrasonography (USG) of botulinum toxin A injection (BoNT A) in post-stroke patients with plantar flexor spasticity. Forty chronic post-stroke patients with plantar flexor spasticity and who were able to walk were included in the study. They were randomized into two groups: in 20 patients the BoNT A injection was applied with the guidance of ES and in 20 patients with the guidance of USG by the same physician. Gastrocnemius, soleus, and tibialis posterior were injected. Spasticity was evaluated by ashworth scale; the functional status was evaluated by ankle goniometry for range of motion, Brunnstrom stages, Barthel Index, and 10-m walk test before the treatment, 2nd week, and 3rd month after the treatment. Statistical significance was defined as p < 0.05. Two groups were similar in respect to demographical and clinical features. In both groups, walking speed and range of motion increased significantly after the treatment. When the two groups were compared at 3rd month after the treatment; range of motion of the ankle joint plantar flexion and dorsiflexion when knee in extension showed a significant difference between the two groups. Ashworth scale, Brunnstrom stages, Barthel index, walking speed tests, and other ankle goniometry for range of motion showed no statistically significant difference between two groups. We can conclude that USG and ES guidence are both effective injection techniques when applying BoNT A to ankle plantar flexor muscles.

Assessment of quality of life in relation to spasticity severity and socio-demographic and clinical factors among patients with spinal cord injury.

Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical factors on quality of life (QOL) and to identify factors predicting poor QOL among patients with spinal cord injury (SCI)Design: Descriptive cross-sectional study.Setting: Tertiary care clinic in Istanbul, Turkey.Participants: A total of 110 patients with SCI (mean (SD) age: 43.8 (14.7) years, 58.2% were males) were enrolled.Assessments: The American Spinal Injury Association (ASIA) Impairment Scale (AIS), Modified Ashworth Scale (MAS) and Turkish version of the World Health Organization Quality of life questionnaire (WHOQOL-BREF) were utilized to determine the SCI category, severity of spasticity and QOL scores, respectively.Outcome measures: The WHOQOL-BREF scores were evaluated with respect to the severity of spasticity, aetiology and duration of SCI, AIS category and method of bladder management.Results: The mean (SD) physical health (41.9 (15.3) vs. 46.5 (10.9), P = 0.029), social relationships (45.6 (20.2) vs. 53.8 (17.3), P = 0.025) and total WHOQOL-BREF scores were significantly lower in patients with more severe spasticity. Multivariate linear regression analysis revealed that severity of spasticity was a significant predictor of decreased WHOQOL-BREF total scores, physical domain scores and social relations domain scores by 11.381 (P = 0.007), 11.518 (P = 0.005) and 17. 965 (P = 0.004), respectively.Conclusion: In conclusion, addressing QOL in relation to severity of spasticity for the first time among Turkish SCI patients, our findings revealed a negative impact of the spasticity severity on the WHOQOL-BREF scores, particularly for physical health and social relationship domains.

Unexpected foreign body in the bladder of a spinal cord injured patient: A case report.

Context: Bladder dysfunction is common in patients with spinal cord injuries. Clean intermittent catheterization is a preferred method of neurogenic bladder management among spinal cord injured patients. Some complications may occur due to the use of clean intermittent catheterization.Findings: In this report, we presented a case with an unexpected foreign body detected in the bladder of a patient who used to perform clean intermittent catheterization for her neurogenic bladder management, to our knowledge, which has not been reported in the literature so far.Conclusion/Clinical Relevance: In this case report, we want to emphasis the importance of different kind of foreign bodies remaining in the bladder during clean intermittent catheterization.

Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study.

BACKGROUND: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. OBJECTIVE: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. MATERIAL AND METHODS: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). RESULTS: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (-) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). CONCLUSION: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.