Assessment of the impact of proprioceptive exercises on balance and proprioception in patients with advanced knee osteoarthritis.

Impaired proprioceptive perception and the balance function are known to associate with knee osteoarthritis. The previous publications have reported the beneficial effects of proprioceptive exercises on mild or moderate knee osteoarthritis. Scientific data in the literature regarding their effects in advanced stages of knee osteoarthritis are lacking. The objective of this study is to investigate the impact of the proprioceptive exercises on balance, proprioceptive perception and clinical findings in advanced-stage knee osteoarthritis. Fifty-four patients diagnosed as having knee osteoarthritis according to the American Collage of Rheumatology criteria with grade of 3 or higher according to the Kellgren-Lawrence scale were enrolled in the study. Patients were allocated randomly into two groups. The study group included 30 patients, and the control group included 24 patients. The proprioceptive perception was assessed by the ability to reproduce the knee position. The balance function was assessed by stabilometric evaluation in static and dynamic patterns. The clinical evaluation was made by using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients were reevaluated after the three-week proprioceptive rehabilitation program. The improvement in the scores of static balance was significant statistically. No significant improvement in the dynamic balance scores was obtained. Although the measurements of proprioceptive perception showed a tendency toward improvement, the difference was not significant statistically. The WOMAC scores showed better improvements in the study group. As conclusion, in further stages of knee osteoarthritis, proprioceptive exercises have beneficial effects on static balance and to some extent on proprioceptive accuracy. In the treatment for advanced knee osteoarthritis, adding exercises specifically targeting the proprioceptive and balance dysfunction might be useful.

Epidemiologic data of the patients with spinal cord injury: seven years' experience of a single center.

BACKGROUND: We aimed to present the demographic and epidemiologic data on spinal cord injury (SCI) patients who were rehabilitated at our hospital, to identify high-risk groups and etiological factors, and to evaluate the factors that affect the duration of hospitalization (DOH). METHODS: Data on 905 SCI patients treated on an inpatient basis between December 2000 and June 2007 at our hospital were retrospectively evaluated. Patient age, sex, etiology of injury, DOH, neurologic level, and functional grouping were analyzed. Additionally, the effects of age and sex on DOH were evaluated. RESULTS: In total, 661 (73%) of the patients were male and 244 (27%) were female. The mean age of the patients was 33.4±15.0 years; 51.27% of the patients were 20-33 years of age. The mean DOH was 73.6±49.8 days. In all, 304 (33.5%) of the patients were tetraplegic and 601 (66.5%) were paraplegic. Motor vehicle collisions were the most common cause of injury (n=318, 35.1%), followed by falls from an elevated height (n=170, 18.8%). DOH was significantly higher among the tetraplegia American Spinal Injury Association (ASIA) A-B patients than among the other patients (p<0.01). CONCLUSION. It is clear that most of the SCIs we observed were preventable. Comprehensive identification of the epidemiologic, demographic and pathologic features of SCIs contributes to identifying high-risk groups, thereby making it possible to pay personal and communal attention to precautions for SCIs.

Effect of autonomic dysfunction on p-wave dispersion in patients with chronic spinal cord injury.

OBJECTIVE: To provide information about the effect of autonomic dysfunction on P-wave dispersion, as a predictor of atrial fibrillation, in patients with spinal cord injury. DESIGN: Thirty patients with chronic traumatic spinal cord injury and 27 healthy controls were included in this study. The initial assessment of the patients included routine physical examination and evaluation of 12-lead electrocardiography. In the patient group, blood pressure and electrocardiography recordings were obtained during urodynamic assessment. The measurements of the P-wave duration were performed manually by two blinded investigators. P-wave dispersion was calculated as the difference between maximum P-wave duration and minimum P-wave duration. P-wave dispersion values of resting electrocardiography recordings in control and study groups were compared. In the patient group, subgroup analyses were also performed according to the injury level and severity and existence of autonomic dysfunction in examinations. RESULTS: P-wave dispersion values were greater in patients with spinal cord injury than in healthy controls. There was statistically significant difference between P-wave dispersion values of the patients with and without autonomic dysfunction. P-wave dispersion values at initial sensation of vesical filling were greater than those of the resting state in the patients without autonomic dysfunction. CONCLUSIONS: Our findings indicate that P-wave dispersion increases significantly in chronic spinal cord injured patients with autonomic dysfunction. This finding suggests a tendency for atrial fibrillation occurrence in patients with spinal cord injury, which may cause further cerebrovascular complications in this special subset of patients by creating a thromboembolic milieu.

Osteoporosis: A factor on residual limb pain in traumatic trans-tibial amputations.

Residual limb pain is defined as a painful sensation or feeling from the remaining part of the leg. Aggressive bone edge, bone spur formation, neuroma, abscess or bursitis are common causes of residual limb pain. On the other hand, regional osteoporosis on femur and tibia is an inevitable consequence in patients with lower limb amputations. The etiology of bone loss is uncertain but it is likely to be a local phenomenon in lower limb amputees. Altered gait pattern, decreased weight load, disuse atrophy and lack of muscular action at the limb seem to be important causal factors in the development of both local and generalized osteoporosis. The aims of this study are: (i) To determine if there is significant bone mineral density (BMD) difference at proximal tibias and femurs between intact and amputated limbs, (ii) to investigate the factors affecting bone loss in these areas and (iii) to investigate the possible relationship between residual limb pain and local bone loss. The 36 men who participated in this study had amputations due to land-mine injuries. Dual energy X-ray absorptiometry was used to determine BMD of the proximal femur and proximal tibia. The non-amputated limb was used as a control for the amputated side. BMD values on the amputated side were significantly lower than non-amputated side. In addition, BMD values on the amputated limbs with residual limb pain were significantly less than in those without residual limb pain. Insufficient mechanical loading leads to bone loss in patients with trans-tibial amputations. Furthermore, bone loss at tibia may be a cause of residual limb pain. However, this needs to be confirmed with more specific studies in the future.

Basal metabolic rate and autonomic nervous system dysfunction in men with spinal cord injury.

OBJECTIVES: The purpose of this study was to determine the relationship between autonomic nervous system dysfunction and basal metabolic rate (BMR), and the effect of spasticity on basal metabolic rate. RESEARCH METHOD AND PROCEDURES: Twenty men (11 paraplegic and 9 tetraplegic) with American Spinal Injury Association (ASIA)-A and -B grade chronic spinal cord injury (SCI) participated in this study. Total body fat mass and lean tissue mass were measured in all participants using DXA by standard methods. Patients were allocated into 2 groups to determine the effect of autonomic nervous system dysfunction on BMR: Group I (T6 and upper-level injuries with history of autonomic dysreflexia) and Group II (T7 and lower-level injuries without history of autonomic dysreflexia). Measurements of BMR were determined by indirect calorimetry under standardized conditions. RESULTS: There were 13 patients in Group I and 7 patients in Group II and the difference between these two in terms of time since injury, BMI, age, weight, lean tissue mass, BMR, and BMR/kg were not significant. CONCLUSION: We concluded that autonomic nervous system dysfunction does not affect BMR, and it might be ignored in considering energy needs in spinal cord injury.

The relationship between basal metabolic rate and femur bone mineral density in men with traumatic spinal cord injury.

OBJECTIVES: To investigate the relationship between basal metabolic rate (BMR) and hip bone mineral density (BMD) in people with spinal cord injury (SCI) and to determine whether neurologic factors contribute to this relationship. DESIGN: Cross-sectional study. SETTING: Inpatient SCI unit in a rehabilitation hospital. PARTICIPANTS: Thirty men with chronic (time since injury, >1 y) traumatic SCI with an American Spinal Injury Association Impairment Scale grade A or B. Subjects' mean age was 32 years (range, 20-45 y). INTERVENTIONS: All participants were evaluated with neurologic examination to define the level and severity of injury. BMR was determined by indirect calorimetry, and BMD was determined by dual-energy x-ray absorptiometry (DXA). Patients were allocated to osteoporotic, osteopenic, and normal bone density groups according to World Health Organization criteria. DXA was used also to estimate lean- and fat-tissue mass (in kilograms) by standard methods. DXA measurements were performed on the same day as BMR analysis. MAIN OUTCOME MEASURES: DXA and indirect calorimetry. RESULTS: BMR correlated significantly with BMD of the total femur, femur neck, trochanter, and shaft. However, there was no correlation between BMR and femur Ward's triangle. These correlations were stronger in patients with tetraplegia. There was a moderate correlation between BMR and lean tissue mass (r = .66, P < .001), although femur BMD values did not correlate with lean tissue mass in our study group (P > .05). CONCLUSIONS: BMR is closely associated with BMD in men with SCI.

The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy.

PURPOSE: To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines. METHOD: Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0 degrees with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period. RESULTS: AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking. CONCLUSION: The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.

Evaluation of late functional results of patients treated with free muscle flaps for heel defects caused by land-mine explosions.

BACKGROUND: High-energy land-mine explosions cause extensive soft-tissue and bone defects in the heel area, which mostly require free flap coverage. In this article, the authors present the long-term functional outcomes of 72 patients who had free muscle flap reconstructions for composite heel defects caused by land-mine explosions. METHODS: The composite heel defects of 72 male patients caused by land-mine explosions were reconstructed by means of free muscle flaps. The mean follow-up was 6.5 years (range, 1 to 12 years). Each patient completed a questionnaire rating his level of satisfaction. Dynamic foot pressure distribution testing, three-dimensional motion analysis, and dynamic electromyography were performed for all patients. The data were compared with the control group of 20 volunteers. Statistical analysis was performed by Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests. RESULTS: Dynamic pressure distribution tests revealed significantly higher pressure and load in the injured feet of the patients (p < 0.05). Three-dimensional motion analysis showed restricted range of motion at the ankle joints of the injured extremity (p < 0.05). Seventeen patients were able to stand as long as the control group; the mean standing time for the others was 2.85 hours per day (range, 36 minutes to 5.32 hours). Many of the patients (71 percent) declared their satisfaction of having their own feet instead of prostheses. CONCLUSIONS: This is the longest series documenting the long-term functional results of patients injured by land mines who were treated with free muscle flaps. Reconstructive options should be preferred to amputation procedures in extensive tissue loss caused by land-mine explosion where possible.

Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis.

OBJECTIVES: To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis. PATIENTS AND METHODS: Fifty patients with knee osteoarthritis were randomly recruited. They underwent a comprehensive spa therapy program for 21 days. Forty-six patients completed the study. The results were evaluated with Medical Outcomes Study 36-Item Short Form-36 (SF-36) and Arthritis Impact Measurement Scale 2 (AIMS2). RESULTS: Statistically significant improvement was observed in all subscales of SF-36. All subscales of AIMS2 improved too, but only half of them were significant. Correlation between matching subscales of each test was also significant, except physical activity. CONCLUSION: Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term.

Bone density loss after spinal cord injury: elite paraplegic basketball players vs. paraplegic sedentary persons.

OBJECTIVE: To compare the bone mineral density of elite paraplegic basketball players with the values obtained from their paraplegic sedentary counterparts. DESIGN: A total of 17 male paraplegic basketball players and 17 male paraplegic sedentary persons were included in the study. Bone mineral densities of the distal third of radius of the dominant arm, L2-L4 spine, and trochanters, Ward's triangles, and the femoral necks of both hips were measured. RESULTS: The densities of trochanters, Ward's triangles, and the femoral necks were found to be decreased in both groups, with no significant difference between them. The densities of lumbar and radial regions were found to be increased in both groups. Radial density was significantly higher in paraplegic basketball players than in paraplegic sedentary patients, whereas the groups were not significantly different for lumbar density. CONCLUSIONS: Wheelchair basketball in spinal cord-injured patients was associated with greater bone density in distal radius compared with sedentary paraplegics. However, it was not associated with greater density below the injury level.

Quantitative three-phase bone scintigraphy in the evaluation of intravenous regional blockade treatment in patients with stage-I reflex sympathetic dystrophy of upper extremity.

OBJECTIVE: To investigate the role of quantitative three phase bone scintigraphy (QTPBS) in the evaluation of efficacy of intravenous regional blockade treatment in patients having reflex sympathetic dystrophy (RSD) of the upper extremity. MATERIAL AND METHODS: Twenty-six patients with stage-I RSD were focused on in this study. Patients were treated with physical therapy and intravenous (I.V.) regional blockade therapy consisting of dexamethasone and lidocaine. All patients were clinically evaluated before and 1 month after the completion of the therapy protocol. QTPBS was applied to patients before therapy and 1 month after the therapy. As a control group, 11 healthy subjects also underwent QTPBS. Perfusion, hyperemic and fixation indices were calculated from three-phase bone scintigraphy. RESULTS: All patients showed statistically significant clinical improvement after the therapy (p < 0.01). Pre-treatment, perfusion (1.67 +/- 0.63), hyperemic (1.44 +/- 0.48) and fixation (1.69 +/- 0.48) indices of patients were higher than those of healthy subjects (PI: 0.95 +/- 0.05, HI: 0.94 +/- 0.06, FI: 1.01 +/- 0.2) (p < 0.01) and all indices significantly decreased after the treatment (PI: 1.33 +/- 0.46, HI: 1.18 +/- 0.23, FI: 1.42 +/- 0.26) (p < 0.01). CONCLUSION: I.V. regional blockade therapy combined with corticosteroids is a simple, safe and effective method for the treatment of patients with stage-I RSD in the upper extremity. QTPBS is a valuable and objective method to evaluate the response to therapy and may be useful for staging of patients and predicting the response to therapy.

Efficacy of isokinetic exercise on functional capacity and pain in patellofemoral pain syndrome.

OBJECTIVE: To assess the effect of an isokinetic exercise program on symptoms and functions of patients with patellofemoral pain syndrome. DESIGN: A total of 22 consecutive patients with the complaint of anterior knee pain who met the inclusion criteria were recruited to assess the efficacy of isokinetic exercise on functional capacity, isokinetic parameters, and pain scores in patients with patellofemoral pain syndrome. A total of 37 knees were examined. Six-meter hopping, three-step hopping, and single-limb hopping course tests were performed for each patient with the measurements of the Lysholm scale and visual analog scale. Tested parameters were peak torque, total work, average power, and endurance ratios. RESULTS: Statistical analyses revealed that at the end of the 6-wk treatment period, functional and isokinetic parameters improved significantly, as did pain scores. There was not statistically significant correlation between different groups of parameters. CONCLUSION: The isokinetic exercise treatment program used in this study prevented the extensor power loss due to patellofemoral pain syndrome, but the improvement in the functional capacity was not correlated with the gained power.