Assessment of lower limb peripheral nerves with ultrasound in patients with traumatic amputation.

OBJECTIVES: This study aims to assess the sciatic nerve (SN), common peroneal nerve (CPN), and tibial nerve (TN) by ultrasound in patients with traumatic lower limb amputation (LLA) and to examine the possible relationship between ultrasonographic and clinical findings. PATIENTS AND METHODS: This cross-sectional study included a total of 33 male patients (mean age: 36.6±8.7 years; range, 21 to 48 years) who had LLA due to traumatic injury between May 2019 and April 2020. Amputation and prosthesis use and functional K level of activity were recorded. Ultrasound examinations were performed to measure the cross-sectional areas (CSAs) of the SN, CPN, and TN bilaterally at the same levels. The values from the normal sides were accepted as controls. RESULTS: The CSA values were greater on the amputated sides than the non-amputated sides for SN (p=0.001), TN (p=0.001), and CPN (p=0.015), regardless of the activity level. The amputated side SN (p=0.001), TN (p=0.001), and CPN (p=0.016) were thicker in patients with level of K4 activity than the non-amputated side. For the patients with K3 activity level, larger TN CSA values were determined on the amputated side, compared to those at the K4 level (p=0.035). The SN was found to be greater in patients using microprocessor-controlled knee prosthesis (p=0.032) and TN was larger in hypobaric sealing membrane users on the amputated sides (p=0.041). CONCLUSION: The SN, CPN, and TN were found to be larger in all patients on the amputated sides and in patients with K4 activity level. Based on these findings, the K3 activity level and the use of hypobaric sealing membrane seems to affect the CSA values of TN. Additionally, the use of microprocessor knee prosthesis affects the CSA values of SN. We believe that these results may be essential for the analysis or prediction of lower extremity nerve involvement according to the K activity level and the use of prosthesis in patients with traumatic LLA.

Independent predictors of mortality in subacute and chronic stroke patients: A single center study in Turkey.

BACKGROUND: Although the long-term survival and related predictors have been identified in stroke patients, there is little evidence about the mortality rates and its associated factors in stroke patients treated in rehabilitation units. OBJECTIVE: To evaluate 5-year mortality rates of patients with stroke and its relationship with the clinical characteristics after inpatient subacute-chronic rehabilitation. METHODS: The files of 1016 stroke patients (482 male, 534 female) who received inpatient rehabilitation program were examined retrospectively. Patients' characteristics and functional ambulation category were recorded at the end of the rehabilitation program. The survival probability was estimated using the Kaplan-Meier method and the univariate effects of predictors were determined using the log-rank test. The possible factors determined with univariate analyses were checked in the Cox regression analysis. RESULTS: A total of 273 patients (32%) died within 5 years after stroke. Age (p< 0.001, RR: 1.06, 95% CI: 1.05-1.08), presence of coronary artery disease (p= 0.003, RR: 1.53, 95% CI: 1.16-2.03) and poor walking ability (p< 0.001, RR: 2.06, 95% CI: 1.49-2.86) were independent prognostic factors for increased mortality. CONCLUSIONS: About one-third of the rehabilitation patients died within 5 years after stroke. As independent ambulation was a strong predictor for long-term survival, it should be provided via rehabilitation techniques. Future studies are proposed to determine the effects of rehabilitation methods on mortality rates.

Training postural control and sitting in children with cerebral palsy: Kinesio taping vs. neuromuscular electrical stimulation.

OBJECTIVE: To elucidate the effects of Kinesio Taping (KT) in addition to neurodevelopmental therapy (NDT) on posture and sitting, and to compare the effects of KT and neuromuscular electrical stimulation (NMES). MATERIALS-METHODS: Seventy-five children were randomized into control, KT, and NMES groups. NDT was applied to all children 4 times a week for 4 weeks. In addition, KT and NMES were applied to KT and NMES groups, respectively. Sitting subset of Gross Motor Function Measure (GMFM) and kyphosis levels of the groups were analyzed by two way mixed ANOVA. RESULTS: GMFM and kyphosis values improved significantly in all groups (all p < 0.01), yet change levels were more prominent in the KT and NMES groups than the control group. Moreover, NMES group showed better improvement. CONCLUSION: KT or NMES application for four weeks in addition to NDT is effective on improving kyphosis and sitting. Besides, NMES is more effective than KT.

Isokinetic muscle performance of the hip and ankle muscles in women with fibromyalgia.

OBJECTIVE: To compare isokinetic muscle performances of a proximal (hip) and a distal (ankle) muscle of fibromyalgia syndrome (FMS) patients with those of age- and body mass index (BMI)-matched healthy subjects. METHODS: Thirty female patients with FMS (mean age: 41.5 ± 6.7 years [range, 27-54]) and 30 age- (mean age: 40.6 ± 6.0 years [range, 27-54]) and BMI-matched female healthy controls were consecutively enrolled. Demographic and clinical characteristics of the subjects were recorded. Isokinetic measurements of hip and ankle flexion and extension at angular velocities of 60°/s and 180°/s, peak torques, flexor-extensor torque ratios, muscle fatigue resistance values and average power were obtained. RESULTS: Mean disease duration of FMS patients was 2.4 ± 1.9 years. Mean weight, height and BMI values were 70.4 ± 12.5 kg, 159.5 ± 6.0 cm and 27.7 ± 4.7 kg/m² (FMS patients) and 69.3 ± 10.1 kg, 161.7 ± 6.2 cm and 26.6 ± 4.3 kg/m² (control subjects), respectively (all P > 0.05). All isokinetic values were statistically decreased in the FMS group when compared with the control group, except for the peak torques at angular velocity of 180°/s on flexion of the hip and extension of the ankle and the total work and average power on extension of the ankle. We did not find any correlation between isokinetic values and disease related parameters of FMS patients. CONCLUSIONS: In the light of our results, we may conclude that muscle strength and muscle fatigue seem to decrease in FMS patients' both proximal and distal lower extremity muscles.

Short-Term effects of neuromuscular electrical stimulation on muscle architecture of the tibialis anterior and gastrocnemius in children with cerebral palsy: preliminary results of a prospective controlled study.

OBJECTIVE: The aim of this study was to explore the short-term effects of neuromuscular electrical stimulation application on tibialis anterior (stimulated muscle) and gastrocnemius (antagonist) muscles' size and architecture in children with cerebral palsy by using ultrasound. DESIGN: This prospective, controlled study included 28 children diagnosed with spastic diplegic cerebral palsy. Participants were treated either with neuromuscular electrical stimulation application and conventional physiotherapy (group A) or with conventional physiotherapy alone (group B). Outcome was evaluated by clinical (gross motor function, selective motor control, range of motion, spasticity) and ultrasonographic (cross-sectional area, pennation angle, fascicle length of tibialis anterior and gastrocnemius muscles) measurements before and after treatment in both groups. RESULTS: Cross-sectional area values of tibialis anterior (238.7 ± 61.5 vs. 282.0 ± 67.1 mm) and gastrocnemius (207.9 ± 48.0 vs. 229.5 ± 52.4 mm) (P < 0.001 and P = 0.008, respectively) muscles were increased after treatment in group A. Cross-sectional area values of tibialis anterior muscle were decreased (257.3 ± 64.7 vs. 239.7 ± 60.0 mm) after treatment in group B (P < 0.001), and the rest of the measurements were found not to have changed significantly in either group. CONCLUSIONS: These results have shown that cross-sectional area of both the agonist and antagonist muscles increased after 20 sessions of neuromuscular electrical stimulation treatment. Future studies with larger samples and longer follow-up are definitely awaited for better evaluation of neuromuscular electrical stimulation application on muscle architecture and its possible correlates in clinical/functional outcome.

Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain.

BACKGROUND: The aim of this study was to evaluate the ultrasonography (US) and MRI findings in hemiplegic patients with shoulder pain and investigate the correlation between them. It is not possible for these patients to fully perform active range of motion (ROM) and stress tests, so imaging methods take center stage in diagnosis and treatment planning. MATERIALS AND METHODS: A total of 68 hemiplegic patients with shoulder pain attending the inpatient rehabilitation program were included in the study. MRI and US results from the patient files were recorded. The frequency of each pathology identified by US and MRI was determined. The distribution of MRI and US findings was investigated to see whether there was a statistical difference between the correlation of MRI and US results. RESULTS: The mean (SD) age of the patients was 63.7 (8.3) years and the mean (SD) duration of hemiplegia was 49 (8.9) days. According to the MRI results, glenohumeral and acromioclavicular joint degeneration was found in 77.9% and 79.7% of the patients, respectively; subacromial-subdeltoid bursitis in 80.9%; fluid increase in the joint space in 41.2%; supraspinatus tendinitis in 36.8%; and supraspinatus partial rupture in 33.8%. Shoulder US findings were supraspinatus tendinitis in 54.4%, acromioclavicular joint degeneration in 26.5%, bicipital tendinitis in 20.6%, and subacromial-subdeltoid bursitis in 19.1%. There was a statistically significant difference between MRI and US findings. The results were not compatible with each other (P ≯ .05), and these findings were not consistent with each other since the kappa coefficient was under 0.40 for all these results. CONCLUSION: Although US is recommended as the first method in determining shoulder pathologies in hemiplegic patients, we suggest that MRI should be used as the first choice in hemiplegic patients with shoulder pain. MRI and US findings were not consistent, and US is dependent on the experience of the operator. MRI should be the first choice in cases where the diagnosis will affect the treatment choice due to the lack of correlation between US and MRI findings.

The effect of electromyographic biofeedback treatment in improving upper extremity functioning of patients with hemiplegic stroke.

This study evaluated the effect of electromyographic biofeedback (EMG-BF) treatment on wrist flexor muscle spasticity, upper extremity motor function, and ability to perform activities of daily living in patients with hemiplegia following stroke. A total of 40 patients were enrolled and were randomly assigned to two groups: a group treated with EMG-BF (study group) and a untreated (control) group. Both groups participated in a hemiplegia rehabilitation program consisting of neurodevelopmental and conventional methods and verbal encouragement to "relax" spastic wrist flexor muscles. In addition, the study group received 3 weeks of EMG-BF treatment, 5 times a week, for 20 minutes per session at hemiplegic side wrist flexors. Clinical findings were assessed before and after rehabilitation using the Ashworth scale (AS), Brunnstrom's stage (BS) of recovery for hemiplegic arm and hand, the upper extremity function test (UEFT), the wrist and hand portion of the Fugl-Meyer scale (FMS), goniometric measurements of wrist extension, surface EMG potentials, and the Barthel Index (BI). There was no statistically significant difference between the two groups in terms of age, sex, systemic disease, and the etiology, side, and duration of hemiplegia. There also was no statistically significant difference in the pretreatment values between two groups. We found statistically significant improvements posttreatment in the AS, BS, UEFT, goniometric measurements of wrist extension, and surface EMG potentials in the study group. We also noted statistically significant differences in the wrist and hand portion of the FMS and the BI in both groups, but with significantly greater improvements in the study group. Our findings indicate a positive effect of EMG-BF treatment in conjunction with neurodevelopmental and conventional methods in hemiplegia rehabilitation.

Effects of functional electrical stimulation on trunk control in children with diplegic cerebral palsy.

PURPOSE: This study aimed to investigate the efficiency of FES application on the abdomen-posterior back muscles in children with CP that were enrolled into physical therapy and rehabilitation (PTR) program. METHOD: The study included 55 spastic diplegic children that were hospitalized for rehabilitation. Those with deformities that could disrupt the balance in sitting and cause problems in evaluations were excluded. The patients were randomly divided into two equal groups according to their time of presentation. Thirty-two children completed the study. The control group received PTR program only for 4 weeks. The children in the FES group received PTR in addition to electrical stimulation. Electrical stimulation was applied 5 days a week for 4 weeks to abdomen-posterior back muscles in 30-minute-long sessions. To evaluate the balance in sitting, sitting score of gross motor function measurement (GMFM) and to evaluate the trunk asymmetry in sitting, radiographic measurements were used. Thus, kyphosis, Cobb and sacral angles were measured. RESULTS: The comparisons of the measurements of the two groups before and after the treatment showed that the GMFM sitting score and the sacral angle were statistically significantly increased, and the kyphotic and Cobb angles were statistically significantly decreased. After the treatment, both groups demonstrated an increase in the GMFM score, but the increase in the FES group was statistically significantly higher than that in the control group. With respect to radiological measurements, the changes observed in both the kyphotic and Cobb angles after the treatment were statistically significantly higher in the FES group than in the control group. The rates of the changes in the sacral angle did not differ among the groups. CONCLUSION: We believe to provide balance in sitting for children with CP, FES applied on abdomen-back muscles along with conventional therapy to maintain trunk control is more effective than conventional therapy alone.