The regularity of orthosis use and the reasons for disuse in stroke patients.

This is a Retrospective descriptive study. Orthoses and walking aids are used frequently in stroke rehabilitation to facilitate ambulation. The aim was to describe the regularity of orthosis use and the reasons for disuse in stroke after discharge from inpatient rehabilitation. The study included 64 (43 men, 21 women) subacute stroke patients who had been discharged from our clinic in the last 6 months. Demographic and clinical findings, proposed orthoses and walking aids, frequency of usage for the proposed orthoses, reasons for disuse, and the ambulation levels were recorded. A total of 54 (84.4%) patients had an ankle-foot orthosis and 10 (15.6%) patients had a knee-ankle-foot orthosis. The orthosis frequency of use was every day in 38 (59.4%) patients and one to seven times a week in seven (10.9%) patients, whereas 19 (29.7%) did not use them. The reasons for orthosis disuse were finding them unnecessary in seven (27%) patients, usage difficulties in six (23%) patients, pressure sensation in five (19.2%) patients, the belief that they did not make life easier in five (19.2%) patients, lack of a suitable environment in one (3.8%) patient, orthosis wear in one (3.8%) patient, and systemic disease in one (3.8%) patient. Age, sex, residence, the disease duration, and recommended orthosis duration (how long the prescribed orthosis was used), recommended orthosis, range of motion limitation in the lower extremities, presence of spasticity, type of orthosis, and the ambulation level were not statistically significantly associated with the frequency of orthosis use (P>0.05). The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage (P<0.008). Orthosis use had been discontinued by 29% of the patients. The most common reasons reported for discontinuing orthosis use were that the patients found it unnecessary, usage difficulty, pressure sensation, not making life easier, lack of a suitable environment, and orthosis wear. The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage.

The effect of the stroke etiology on functional improvement in our geriatric hemiplegic patients.

OBJECTIVE: We aimed to determine the effect of the cerebrovascular accident etiology in the geriatric patients with hemiplegia included in our physical medicine and rehabilitation program on functional improvement. METHODS: A total of 46 geriatric patients with hemiplegia attending the inpatient physical medicine and rehabilitation program were included in the study. The patients were divided into two groups-thromboembolic vessel disease (TEVD) and intracerebral hemorrhage (ICH)-depending on the cerebrovascular accident etiology. The daily living activities of the patients in both groups were evaluated using the Barthel Index (BI) and the ambulation levels were evaluated using the Functional Ambulation Classification (FAC) at admittance and at discharge from hospital. RESULTS: There was a statistically significant difference between admission and discharge BI values in both groups. There was no significant difference between the admission and discharge BI scores of the TEVD and ICH groups. For both groups, on admission there were 19 (82.5%) patients at the FAC 0, 1, and 2 levels, and 4 (17.3%) patients at the FAC 3 and 4 levels. On discharge there were 11 (47.8%) patients in the TEVD group at the FAC 0 and 2 levels, and 12 (52.1%) patients at the FAC 3, 4, and 5 levels; whereas in the ICH group there were 8 (34.7%) patients at the FAC 0, 1, and 2 levels, and 15 (65.2%) patients at the FAC 3, 4, and 5 levels. CONCLUSIONS: We found that the disease etiology did not influence the rehabilitation results for our geriatric patients with hemiplegia attending a physical medicine and rehabilitation program following TEVD or ICH.

Is age or the body mass index (BMI) more determinant of the bone mineral density (BMD) in geriatric women and men?

The objective was to determine the effect of the body mass index (BMI) and age on the bone mineral density (BMD) in geriatric women and men. 900 geriatric patients were included in the study. BMD was measured in the right femoral neck and the antero-posterior lumbar region. All geriatric patients were classified in 1 of 4 categories on the basis of their BMI, as underweight, ideal weight, overweight, and obese. They were separated into three groups, 65-74, 75-84 and 85 and older, according to age groups. While a significant relationship was only determined between the femoral BMD measurements and the BMI in men; significant relationship was shown between both the lumbar and the femoral BMD measurements and the BMI in women. Significant relationship was also determined between the femoral BMD measurements and the BMI and age among women. While the BMDs of those aged 65-74 years group were found to be high compared to those aged 75-84 years and those aged 85 years and older groups, no difference was found between the two groups. This study confirms the effect of a high BMI on femoral neck and L2-L4 BMD among older men and women, but the effect of age was not shown above 75 years of age.