Comparison of the functional and cardiovascular effects of home-based versus supervised hospital circuit training exercises in male wheelchair users with chronic paraplegia.

OBJECTIVES: The aim of this study was to compare the efficacy of home-based upper extremity circuit training exercises (CTEs) with supervised hospital program in male patients with traumatic complete paraplegia. PATIENTS AND METHODS: Twenty men with paraplegia (mean age: 38±10.1 years; range, 30 to 43 years) between January 2007 and November 2007 were randomized into two groups. The first group had supervised hospital CTE program, whereas the second group had home-based CTE. The effects of the upper extremity CTE by using elastic bands 60 min per day, five days a week, for a total of eight weeks (70% maximal oxygen consumption [VO2max]) were examined. The Cybex was used for the isokinetic testing of the upper extremities. The VO2max and maximum heart rate (HR) were assessed using an arm ergometer. The Craig Handicap Report Technique Short Form (CHART-SF) was used for the evaluation of functional independence and mobility. Serum lipid profiles were measured. RESULTS: The mean injury duration was 7.9±2 years. The peak torque values of the upper extremities, VO2max, maximum HR, CHART-SF physical independence and mobility scores, and serum lipid profile were all improved in both groups (p<0.05). There were no significant differences in terms of the increase in the muscle strength and serum lipid levels between the groups (p>0.05). The improvement in the VO2max, physical independence, and mobility scores were greater in the supervised exercise group. CONCLUSION: Upper extremity strength, cardiovascular endurance, and lipid profile were improved after supervised and home-based CTE in the men with paraplegia. Home-based exercise programs may be good alternatives to the hospital rehabilitation for this patient population.

Turkish adaptation of Spinal Cord Independence Measure--version III.

Various rating scales have been used to assess ability in individuals with spinal cord injury. There is no specific functional assessment scale for Turkish patients with spinal cord injury. The Spinal Cord Independence Measure (SCIM) is a specific test, which has become popular in the last decade. A study was conducted to validate and evaluate the Turkish adaptation of the SCIM III (T-SCIM III). The SCIM III was translated into Turkish. Reliability, (internal consistency, interrater reliability, and test-retest reliability), validity (with Functional Independence Measurement), and sensitivity (changes in 8-week exercise program) were studied. Internal consistency for total score was sufficient (Cronbach α=0.79). The interrater reliability was moderate to high (Cohen κ between 0.72 and 1). Convergent validity was high (r=0.89, P<0.01). The T-SCIM III was found to be more sensitive than the Functional Independence Measurement to changes in function. Hence, we recommend the use of T-SCIM III in clinical practice as a reliable, valid, and easy-to-use tool.

[The relationship between level of injury and bladder behavior in patients with post-traumatic spinal cord injury]. / Posttravmatik spinal kord lezyonlu hastalarda travma seviyesi ile mesane davranisi arasindaki iliski.

BACKGROUND: After the spinal shock period, suprasacral injuries classically result in detrusor hyperreflexia/overactive bladder and detrusor sphincter dyssynergia. Sacral cord injuries produce detrusor areflexia consistent with lower motor neuron injury and often increased bladder compliance. However, previous investigators have noted an inexact correlation between spinal cord injury level and urodynamic findings. The aim of this study was to evaluate the relationship between level of injury and urodynamic findings. METHODS: Fifty-one patients with post-traumatic spinal cord injury were classified by the radiographically determined level of injury, clinical neurologic level and completeness of injury. Urodynamic studies were performed in all patients. RESULTS: Twenty-six of 36 patients with suprasacral injuries had hyperreflexia/overactive bladder (72.2%). Twenty-nine (80.5%) had detrusor sphincter dyssynergia, 9 (25%) had normal compliance and 1 (2.8%) had areflexia. Six of the 14 patients with sacral injuries had areflexia (42.8%), 2 (14.3%) had hyperreflexia/overactive bladder, 2 (14.3%) had detrusor sphincter dyssynergia, and 6 (42.8%) had normal compliance. CONCLUSION: The correlation between somatic neurologic findings or spinal imaging studies and urodynamic findings in patients with spinal cord injury is not exact. These data suggest that the neurologic examination alone is not an adequate parameter to predict urological dysfunction and that urodynamic evaluation provides a more precise diagnosis for each patient.

Evaluation of sympathetic response in cases with failed back surgery syndrome.

OBJECTIVES: The aim of this study was to investigate whether sympathetic skin response (SSR) was affected in cases with failed back surgery syndrome (FBSS). METHODS: Twenty-nine cases admitted to our department and diagnosed as FBSS were recruited for the study. All the cases had back, leg or back and leg pain in the months or in one year following spinal surgery. The control group consisted of 13 healthy hospital personnel. Electrophysiologic nerve conduction studies and SSR recordings were applied on the symptomatic side (29 legs) in study cases and both sides (26 legs) in the control group. SSRs of the study group were compared with those of the sex-, body mass index- and age-matched control group of 13 people. Patients having peripheral nerve entrapment syndromes, peripheral vascular disease, neurologic or psychiatric disease, alcoholism, or drug abuse were excluded from the study. Pain intensity was recorded by visual analog scale (VAS) and depression was recorded by Beck Depression Inventory (BDI). RESULTS: Latency duration in SSR in the study group was significantly higher (p=0.006) when compared with the healthy controls. There was no SSR in 4 patients and there was a positive correlation between BDI and SSR (r=0.46). CONCLUSION: It was concluded that the sympathetic nervous system is affected in FBSS patients with changes in SSR, and that the dysfunction of the sympathetic nervous system may contribute to the intensity and chronicity of pain states in this group of patients.

The efficiency of electromagnetic field treatment in Complex Regional Pain Syndrome Type I.

INTRODUCTION: Complex Regional Pain Syndrome Type I is a pathological condition that occurs without evident nerve injury and follows a course characterized by severe pain. PURPOSE: The aim of this study is to assess whether or not electromagnetic field treatment administered with calcitonin and exercise has positive effects on clinical improvement, scintigraphic assessment and bone markers compared to calcitonin and exercise administration. METHOD: In this randomized double-blind, placebo-controlled study, 40 patients with Complex Regional Pain Syndrome Type I, that developed after a Colles fracture were included in the assessments and were administered calcitonin and exercise treatment for 6 weeks. In addition to this treatment, half the patients received electromagnetic field treatment, and the other half received placebo treatment. The patients were evaluated at the beginning and end of treatment with clinical parameters, scintigraphic assessment and biochemical markers. RESULTS: Although we found some significant improvements in our evaluation criteria, we could not find a significant statistical difference between groups. CONCLUSIONS: The absence of a significant difference between the two groups in the assessment parameters has been interpreted as evidence that electromagnetic field treatment does not provide additional benefit to calcitonin and exercise treatment.

Involvement of sympathetic reflex activity in patients with acute and chronic stroke: A comparison with functional motor capacity.

OBJECTIVE: To investigate sympathetic nervous system functions in patients with acute and chronic phase of stroke by measuring sympathetic skin reflex (SSR) and the relationship between sympathetic dysfunction and motor function capacity. DESIGN: Cross-sectional, case-control study. SETTING: A physical medicine and rehabilitation department in a research hospital of a university referral center in Turkey. PARTICIPANTS: Fifty-six patients with stroke-13 in the acute phase and 43 in the chronic phase-and 42 age- and sex-matched healthy volunteers were included. INTERVENTION: SSR was recorded with electric stimulation of the bilateral median nerves. MAIN OUTCOME MEASURES: SSR was recorded to assess sympathetic reflex activity in patients in the acute and chronic phase of stroke and in controls. Motor functions was classified using the Brunnstrom stages. RESULTS: The mean SSR latency in the acute phase was significantly prolonged and the amplitudes were decreased compared with controls. In the chronic phase, the mean amplitudes were significantly attenuated compared with controls, whereas the mean latency did not change. The mean latency of SSR in patients in Brunnstrom groups 1 and 2 was longer, and the mean amplitude was smaller than in controls (P<.05). The mean amplitude was significantly reduced in patients classified as Brunnstrom groups 3 and 4 compared with controls (P<.05), but the mean latency was not affected. CONCLUSIONS: Depression of sympathetic reflex activity was more prominent in the acute phase of stroke and was associated with moderate or highly limited motor function capacity. Improvement of motor dysfunction may parallel recovery of sympathetic reflex activity.

MR imaging and electrophysiological evaluation in carpal tunnel syndrome.

The objective of this study was to compare the MRI findings of wrists in patients diagnosed with CTS with those of the healthy controls, and to evaluate the correlation between the MRI differences and the electrophysiological findings in the patient group. This study involved 55 wrists, 30 of which were clinically and electrophysiologically diagnosed with CTS and 25 healthy controls. These 55 wrists were evaluated electrophysiologically, and in terms of median nerve diameter, ratio of median nerve diameter at psiform bone level to distal radio-ulnar joint level, the flexor retinaculum bulging ratio and the median nerve intensity by MRI. When the patient group, which were clinically and electrophysiologically diagnosed with CTS, and the healthy control group were compared, a significant difference (p < 0.001) was observed between the two in terms of median nerve diameters (at psiform bone level: 8.47 +/- 1.41mm and 2.91 +/- 1.01 mm, distal radio-ulnar joint level: 4.04 +/- 1.06 mm and 2.42 +/- 0.95 mm), ratio of median nerve diameter at psiform bone level to distal radio-ulnar joint level (2.17 +/- 0.54 and 1.25 +/- 0.12), their flexor retinaculum bulging ratios (26.21 +/- 5.98% and 7.27 +/- 4.53%) and their median nerve intensities. In the patient group, no significant correlation between MRI and the electrophysiological findings was found (p > 0.05). According to the data obtained from the study, we believe that the MRI examination of structural changes that occur in the carpal tunnel, neighboring structures and the median nerve would be useful in the diagnosis of CTS, especially in cases with suspected clinical and electrophysiological diagnosis.