The effect of offline anosognosia for hemispatial neglect on neglect rehabilitation in patients with subacute and chronic right hemispheric brain injury. A retrospective cohort study.

CLINICAL TRIALS REGISTRATION NUMBER: NCT05145855.

What are the factors affecting dual-task gait performance in people after stroke?

BACKGROUND: People after stroke have difficulties when they undertaking two tasks simultaneously. PURPOSES: To investigate the relationships between dual-task performance and factors such as motor function, balance, cognitive state, and fatigue, to identify factors that have an impact on dual-task performance after a stroke. METHODS: Thirty-seven people with stroke and 38 healthy participants were assessed with 10-m walking test in different performances which were single-task-based, motor dual-task-based and cognitive dual-task-based. Results were evaluated according to the Rivermead Motor Assessment, the Static balance index, the Mini-Mental State Examination, and the Fatigue Severity Scale. RESULTS: Participants with stroke were slower compared to the control group with the following mean speed values for single-task (M = 0.73 m/s, t = -7.612, p < .001), motor dual-task (M = 0.70 m/s, t = -8.232, p < .001), cognitive dual-task (M = 0.59 m/s, t = -7.944, p < .001). For people after stroke, motor dual-task performance was significantly affected by the total motor function scores (r = 0.648, p < .001), static balance (r = -0.499, p < .05), and fatigue rates (r = -0.349, p < .05). Furthermore, cognitive dual-task performance was affected by the total motor function score (r = 0.537, p < .05) static balance (r = -0.541, p < .05) and fatigue rates (r = -0.350), p < .05). Multivariate factor analysis indicated that impairment in the gross function influenced motor dual-task performance (B = 0.086, p = .031) and cognitive dual-task performance (B = 0.083, p = .010). Cognitive dual-task performance was affected by leg-trunk function (B = 0.063, p = .015) and age (B = -0.006, p = .009). CONCLUSION: The present study indicated that dual-task performance was related to motor function, balance, and fatigue, whereas gross motor function was the unique determinant of dual-task performance.

Validity and reliability of the fatigue impact scale in stroke.

BACKGROUND: Fatigue is one of the significant problems of post-stroke patients as it causes a decreased quality of life. Although the fatigue impact scale (FIS) is used in stroke, it lacks validation studies. OBJECTIVE: This study evaluates the psychometric properties of the FIS in patients with stroke. SUBJECTS AND METHODS: A total of 41 subjects with stroke and 41 control subjects admitted to Physical Medicine and Rehabilitation Department were included. Convergent validity was assessed using the SF-36 vitality (SF-36 v) scale and the fatigue severity scale (FSS). Divergent validity was assessed using the Hospital Anxiety and Depression Scale (HADS). RESULTS: All subscores of the FIS were significantly higher in the stroke group than in the control group (p < .05). FIS showed excellent internal consistency in stroke patients (Cronbach's alpha = 0.946). There was a negative correlation among FIS and SF-36 v (r = -0.506, p = .001), and a positive correlation between the HADS anxiety score (r = 0.356, p = .026) and the HADS depression score (r = 0.293, p = .071). FIS total scores were weakly correlated with the FSS (r = 0.323, p = 0.039). The test-retest reliability of FIS was good in terms of its cognitive, physical, and psychosocial subscales and total scores, with ICC values of 0.78, 0.73, 0.80, and 0.83, respectively. CONCLUSION: FIS is a valid and reliable multidimensional scale that sensitively discriminated fatigue in the stroke patients from that in the control subjects.

A novel approach to the diagnostic assessment of carpal tunnel syndrome based on the frequency domain of the compound muscle action potential.

Conventional electrophysiological (EP) tests may yield ambiguous or false-negative results in some patients with signs and symptoms of carpal tunnel syndrome (CTS). Therefore, researchers tend to investigate new parameters to improve the sensitivity and specificity of EP tests. We aimed to investigate the mean and maximum power of the compound muscle action potential (CMAP) as a novel diagnostic parameter, by evaluating diagnosis and classification performance using the supervised Kohonen self-organizing map (SOM) network models. The CMAPs were analyzed using the fast Fourier transform (FFT). The mean and maximum power parameters were calculated from the power spectrum. A counter-propagation artificial neural network (CPANN), supervised Kohonen network (SKN) and XY-fused network (XYF) were compared to evaluate the classification and diagnostic performance of the parameters using the confusion matrix. The mean and maximum power of the CMAP were significantly lower in patients with CTS than in the normal group (p < 0.05), and the XYF network had the best total performance of classification with 91.4%. This study suggests that the mean and maximum power of the CMAP can be considered as less time-consuming parameters for the diagnosis of CTS without using additional EP tests which can be uncomfortable for the patient due to poor tolerance to electrical stimulation.

Bilateral pan-plexus lesion after substance use: A case report.

Peripheral nervous system complications such as acute demyelinating polyradiculopathy and mononeuropathy may rarely develop after substance use. A 27-year-old man used illegal drugs the day before his admission to the emergency service. Initially, he was suspected for rhabdomyolysis, due to elevated blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, myoglobin, and creatine kinase levels. On Day 4, generalized edema and flask paralysis were noted in both upper limbs. The patient was diagnosed with bilateral brachial pan-plexopathy based on electrophysiological study results. He underwent a rehabilitation program. After eight months, repeated electrophysiological study revealed a significant improvement in all bilateral upper limb muscles, except for the right abductor pollicis brevis and abductor digiti minimi muscles. The underlying cause of bilateral brachial pan-plexopathy was rhabdomyolysis secondary to substance use. In conclusion, substance use in patients with non-traumatic plexopathy should always be questioned.

Validity and reliability of fatigue severity scale in stroke.

BACKGROUND: Fatigue is a frequent complaint after stroke and may be associated with dependence in activities of daily living, decreased quality of life, increased institutionalization and mortality. Although fatigue severity scale (FSS) is the most frequently used scale in stroke, validation studies are scarce. OBJECTIVES: This study aimed to examine the psychometric properties of FSS in subjects with stroke. METHODS: A total of 46 subjects with stroke who were admitted for rehabilitation and 52 control subjects who were admitted for local musculoskeletal problems were included. A comprehensive assessment including functional independence measure, Folstein Mini-Mental State Examination, Hospital Anxiety and Depression Scale (HADS), visual analog scale for fatigue (VAS), FSS, and vitality subscale of 36-item Medical Outcomes Study Short-Form Health Survey (SF-36v) was conducted. FSS, VAS and SF-36v were repeated 7 days later. RESULTS: FSS demonstrated excellent internal consistency in subjects with stroke (Cronbach's alpha: 0.928). There was a moderate correlation between FSS and SF-36v (r = -0.498, p < 0.001). FSS was weakly correlated with HADS anxiety (r = 0.310, p = 0.041) and HADS depression (r = 0.334, p = 0.027). Test-retest reliability of SF-36v (ICC: 0. 746, CI: 0.518-0.866), VAS (ICC: 0.829, CI: 0.671-0.911) and FSS (ICC: 0.742, CI: 0.512-0.863, p < 0.001) was good. ICC values for individual items of FSS were good except for item 6. CONCLUSIONS: FSS is a valid and reliable scale to measure fatigue in stroke. FSS is not sensitive to differentiate fatigue in stroke from the control subjects with orthopedic problems with similar age and gender.

Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study.

OBJECTIVE: To investigate the efficacy of Nintendo Wii Fit®-based balance rehabilitation as an adjunc-tive therapy to conventional rehabilitation in stroke patients. METHODS: During the study period, 70 stroke patients were evaluated. Of these, 23 who met the study criteria were randomly assigned to either the experimental group (n = 12) or the control group (n = 11) by block randomization. Primary outcome measures were Berg Balance Scale, Functional Reach Test, Postural Assessment Scale for Stroke Patients, Timed Up and Go Test and Static Balance Index. Secondary outcome measures were postural sway, as assessed with Emed-X, Functional Independence Measure Transfer and Ambulation Scores. An evaluator who was blinded to the groups made assessments immediately before (baseline), immediately after (post-treatment), and 4 weeks after completion of the study (follow-up). RESULTS: Group-time interaction was significant in the Berg Balance Scale, Functional Reach Test, anteroposterior and mediolateral centre of pressure displacement with eyes open, anteroposterior centre of pressure displacement with eyes closed, centre of pressure displacement during weight shifting to affected side, to unaffected side and total centre of pressure displacement during weight shifting. Demonstrating significant group-time interaction in those parameters suggests that, while both groups exhibited significant improvement, the experimental group showed greater improvement than the control group. CONCLUSION: Virtual reality exercises with the Nintendo Wii system could represent a useful adjunctive therapy to traditional treatment to improve static and dynamic balance in stroke patients.

Do postural changes affect balance in patients with ankylosing spondylitis?

OBJECTIVE: To investigate the effect on balance control of postural changes related to ankylosing spondylitis. DESIGN: Thirty-four subjects with ankylosing spondylitis and 34 healthy individuals were enrolled. Examination of postural alignment was conducted using lumbar Schober, hand to ground distance, tragus to wall distance and occiput to wall distance measurements, and Bath Ankylosing Spondylitis Metrology Index. Balance was evaluated by Berg Balance Scale, Functional Reach Test, Lateral Reach Test, and Static Balance Index. Postural sway during quiet standing was assessed by centre of pressure displacement in 2 conditions: eyes open and eyes closed. RESULTS: Functional reach test and right-side lateral reach tests were significantly lower in subjects with ankylosing spondylitis. Eyes closed anteroposterior centre of pressure sway was significantly higher in the subject group. CONCLUSION: Ankylosing spondylitis can lead to balance deterioration due to postural changes.

Is there any association between cognitive status and functional capacity during exacerbation of chronic obstructive pulmonary disease?

The aim of this study is to screen the cognitive function during exacerbation of chronic obstructive pulmonary disease (COPD) and investigate whether there is any association between cognitive function and functional impairment, disease severity, or other clinical parameters. Age and sex-matched 133 subjects with COPD exacerbation, 34 stable COPD subjects, and 34 non-COPD subjects were enrolled in this study. For the purpose of this study, mini-mental state examination (MMSE) and Hospital Anxiety and Depression scale were performed. Six-minute walk distance (6MWD) was recorded, and BODE index was calculated. COPD subjects with exacerbation had the lowest MMSE scores (p = 0.022). Frequency of subjects with MMSE score lower than 24 is 22.6, 8.8, and 8.8% in the COPD subjects with exacerbation, stable COPD, and non-COPD control subjects, respectively. The COPD subjects with exacerbation who had MMSE scores lower than 24 were older and less educated. Subjects with COPD exacerbation had shorter 6MWD than that of stable COPD and non-COPD subjects. After controlling for the impact of age and educational level on MMSE, there was no association between 6MWD and MMSE scores in subjects with COPD exacerbation. Cognitive impairment is an important comorbidity during COPD exacerbation. Functional capacity is also lower in exacerbation. However, no association was found between cognitive impairment and functional capacity during exacerbation.

Prospective evaluation of free radicals and antioxidant activity following 6-month risedronate treatment in patients with postmenopausal osteoporosis.

In addition to the well-described implications of estrogen deficiency in postmenopausal osteoporosis (PMO), free radicals are also effective on bone metabolism. The antioxidant vitamins C and E play an important role in the production of collagen, mesenchymal cell differentiation into osteoblasts, and bone mineralization. Therefore, the incidence of osteoporosis and the risk of fractures were decreased with vitamin C and E. It was proposed that free oxygen radicals are responsible for biological aging, atherosclerosis, carcinogenesis, and osteoclastic activity via their negative effects on the cell and DNA. In this study, we aimed to investigate and compare the levels of free radicals and serum antioxidant activity in patients with PMO and healthy subjects before and after six-month treatment with risedronate, which is an inhibitor of bone resorption. Twenty-three postmenopausal patients aged between 52-83 (mean [± standard deviation] 67.6 ± 8.17) with T scores below -2.5 in femur neck or L1-L4, and 23 postmenopausal healthy subjects were enrolled into the study. Patients who had received any medications within the last 6 months that could alter bone metabolism were excluded. Serum malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels were analyzed in both groups. The patients with PMO were commenced on 5 mg of risedronate, 1,200 mg of calcium, and 800 IU of vitamin D daily. The patients were reevaluated at the end of the sixth month. MDA and SOD levels were similar in patients with PMO when compared to the healthy group before the treatment, while the GPx levels were lower in patients with PMO (P = 0.014). GPx (P = 0.028) and MDA (P = 0.04) levels were increased in patients with PMO after the treatment. In contrast, SOD levels were decreased when compared to the initial levels (P = 0.006). There may be an insufficiency in different steps of the enzymatic antioxidant systems in patients with PMO without treatment. We observed an increment in lipid peroxidation levels and GPx levels with risedronate. We think that the decrement in SOD levels may be related with the utilized antioxidants due to the increased free radicals and the compensatory increment in the other steps of the antioxidant system.

The effect of arm sling on balance in patients with hemiplegia.

The aim of this study was to investigate the effect of an arm sling on balance in patients with, hemiplegia following a stroke. Twenty-six patients with hemiplegia (11 men, 15 women) who had, shoulder subluxation were enrolled in the study. Balance was evaluated by the Berg Balance Scale, the, Functional Reach test, and a static balance index which was measured by the Kinesthetic Ability, Trainer 3000. Balance tests were performed twice, with arm sling and without arm sling use. Results of, this study show that the Berg Balance Scores and static balance index ameliorated with arm sling use (p=0.005 and p=0.004, respectively). Likewise, the Functional Reach test was better when performed with an arm sling (p=0.039). In conclusion, arm slings have a beneficial effect on balance in patients, with hemiplegia. An arm sling may be applied for its possible beneficial effect on balance especially in, the early phases of stroke rehabilitation while the upper extremity is still flaccid and arm swing is, reduced.

Do anticholinergics affect reaction time? A possible impact on the course of rehabilitation.

OBJECTIVE: To assess if oxybutynin and tolterodine have an effect on simple reaction time in healthy volunteers. METHODS: Simple reaction time was evaluated before and 90 minutes after the oral administration of oxybutynin and tolterodine in a cross-over design. Twenty seven healthy volunteers, aged 26 to 48 years, were included in the study. The electromyographic activity of the flexor digitorum superficialis muscle that was used for the response was recorded, and premotor time was measured. RESULTS: The mean age of the study group was 33.1 ± 7.4 years. Mean premotor times before oxybutynin and before tolterodine administration were statistically non-significant. Mean premotor times after the administration of oxybutynin and tolterodine were significantly longer than the initial premotor times (p = 0.003). CONCLUSIONS: The results of the study showed that oxybutynin and tolterodine prolonged the simple reaction time. The prolonged simple reaction time may suggest a perceptive impairment. The potential for perceptive impairment as a side effect of oxybutynin and tolterodine might suggest a negative impact on the rehabilitation interventions and the activities of daily living because of central nervous system effects.

Diffuse cavernous haemangioma complicated with regional osteoporosis.

Capillary and cavernous haemangiomas are the most common benign soft tissue tumours of infancy. Cavernous haemangiomas have larger vascular channels and frequently exist in deep dermal tissues. Many haemangiomas require no special treatment. Development of complications such as cardiac failure, malignant change, ulceration and infection are indications for intervention. In this report we present an 11-year-old girl with a pathological fracture after a minimal trauma that might be a result of secondary regional osteoporosis due to diffuse cavernous haemangioma.

Center-of-pressure displacement during postural changes in relation to pressure ulcers in spinal cord-injured patients.

OBJECTIVE: To evaluate the center-of-pressure displacement in spinal cord-injured patients, to investigate dynamic sitting stability and its relationship with pressure ulcers. DESIGN: Sixteen spinal cord-injured patients and 18 healthy volunteers were included in the study. For the assessment of dynamic sitting stability, center-of-pressure displacement during maximum unsupported forward, backward, and right- and left-sided trunk leaning were measured with a seat sensor system, which was placed between the subject's buttocks and chair. RESULTS: Center-of-pressure displacements in all directions in spinal-injured patients were smaller than healthy volunteers (P < 0.05). Center-of-pressure displacements for high- and low-thoracic spinal cord-injured patients were not significantly different. History of previous pressure ulcer was not different between high- and low-thoracic spinal cord-injured patients (chi = 0.90, P = 0.62). Mean center-of-pressure displacement during forward and backward leaning were smaller in patients with pressure ulcer history (P = 0.04 and 0.03, respectively). CONCLUSIONS: The results of this study suggest that impaired dynamic sitting stability is associated with pressure ulcer development.

Acute gouty arthritis during pyrazinamide treatment: a case report.

Abstract Gout is a disease caused by an inflammatory response to an aggregation of monosodium urate crystals that develop secondary to hyperuricemia. Throughout its natural history it has four stages: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic tophaceous gout. In this article, we report the case of a patient who had asymptomatic hyperuricemia secondary to pyrazinamide, which was prescribed for pulmonary tuberculosis, and had developed an acute gouty arthritis immediately after the "Feast of Sacrifice" due to a dietary excess of purine.

A handicap in treatment and follow-up of ankylosing spondylitis: sports hematuria.

A 19-year-old male patient with a 7-year history of ankylosing spondylitis (AS) was admitted to our clinic. After completion of the laboratory and radiologic investigations, we prescribed an exercise program besides his medical therapy. After these exercises, he complained of painless dark urine sometimes with passage of clot that disappeared the following day. To investigate this hematuria related with exercise, further laboratory and radiologic studies were carried out. After exclusion of the other causes of hematuria, we concluded that the diagnosis was sports hematuria.

Suprascapular nerve entrapment in newsreel cameramen.

OBJECTIVES: To determine presence of suprascapular nerve entrapment in a group of newsreel cameramen. DESIGN: Thirty-six men working as newsreel cameramen participated in the study. In addition to musculoskeletal and neurologic examinations, bilateral suprascapular nerve conduction studies and needle electromyography were performed. A group of 19 healthy, male volunteers were included in the study as normal controls for suprascapular nerve conduction studies. RESULTS: In newsreel cameramen, mean suprascapular nerve latency was 3.20 +/- 0.56 msec and 2.84 +/- 0.36 msec for right and left shoulders, respectively (P = 0.001). The mean latency difference between right and left suprascapular nerves was -0.05 +/- 0.19 msec in the control group and 0.36 +/- 0.58 msec in the cameramen group (P < 0.001). Six subjects' right suprascapular nerve motor latencies were 2 SD above the normal mean values. There was no relationship between suprascapular nerve latencies and the age, professional life, and number of hours worked daily by the subjects. CONCLUSIONS: Carrying a heavy, mobile camera on the shoulder might cause suprascapular nerve entrapment in newsreel cameramen. This could be considered an occupational disorder of the suprascapular nerve, like meat-packer's neuropathy.

Autonomic nervous system involvement in Behçet's disease.

In this study, R-R interval variation (RRIV) and sympathetic skin response (SSR) were used to evaluate autonomic nervous system (ANS) involvement in 25 patients with Behçet's disease. Normative values of RRIV and SSR were determined in a group of 25 healthy volunteers. R-R interval variation at rest (R%) and during deep breathing (D%), the difference between D% and R% (D-R), and the ratio of D% to R% (D/R) were determined. R-R interval variations did not show a significant difference between patients and the control group. There was a negative correlation with age for R%, D%, and D-R in the control group, but none was found in the patient group. The SSR latencies were two standard deviations above the normal mean values in three patients who described symptoms of autonomic dysfunction. In conclusion, symptoms of autonomic disturbance must be evaluated carefully for a possible involvement of ANS that might occur in Behçet's disease.

Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques.

OBJECTIVE: To evaluate the clinical effectiveness of 2 suprascapular nerve block techniques in adhesive capsulitis. DESIGN: A single-blinded, randomized, comparative clinical trial. SETTING: Physical medicine and rehabilitation department of a university hospital in Turkey. PARTICIPANTS: Forty-one patients with adhesive capsulitis. INTERVENTIONS: Suprascapular nerve block with patients randomly divided into 2 groups: group A, needle tip guided by superficial bony landmarks, or group B, near-nerve electromyographically guided technique. MAIN OUTCOME MEASURES: Visual analog scale (VAS) score for pain severity and range of motion (ROM) were assessed before the injection and at 10 and 60 minutes after it. RESULTS: Active and passive ROM changes and VAS score changes from baseline were statistically significant for each group (P<.05). Passive ROM changes within time after the injection were statistically significant between the 2 groups in all planes except glenohumeral abduction. Achieved VAS score changes in the groups within time were significantly different from each other (P=.001). The VAS score difference after the suprascapular nerve block was more prominent in the near-nerve electromyography group. CONCLUSION: The near-nerve electromyography technique for suprascapular nerve block was more successful in providing and maintaining pain relief for up to 60 minutes.

Reliability of isokinetic trunk muscle strength measurement.

OBJECTIVE: To determine the intrarater and interrater reliability of reciprocal concentric trunk flexion and extension peak torque values at different angular velocities using the Cybex NORM isokinetic dynamometer. DESIGN: Trunk flexor and extensor muscles of 15 healthy subjects were assessed at 60 degrees/sec and 90 degrees/sec angular velocities. Each subject was tested by two physicians three times, with at least 48 hr between test sessions. Intraclass correlation coefficients were used to determine the intrarater and interrater reliability of the reciprocal concentric trunk flexion and extension peak torques at 60 degrees/sec and 90 degrees/sec angular velocities. RESULTS: For intrarater reliability intraclass correlation coefficients for trunk flexion, peak torque values ranged from 0.89 to 0.95; for the extensors, values ranged from 0.80 to 0.92. The intraclass correlation coefficient values for interrater reliability were also found to be highly reliable, and peak torque values demonstrated intraclass correlation coefficients values that ranged from 0.95 to 0.98. CONCLUSIONS: Reciprocal concentric trunk flexion and extension peak torque measurements at 60 degrees/sec and 90 degrees/sec angular velocities had a high intrarater and interrater reliability with the Cybex NORM isokinetic dynamometer in healthy subjects.