Turkish Journal of Physical Medicine and Rehabilitation最新文献

Objectives: The aim of this study was to determine the workload and problems of physiatrists in disability assessment in Türkiye. Materials and methods: A 39-question electronic survey was administered between May 2023 and October 2023 to 217 physiatrists from all geographical regions of Türkiye. The survey was comprehensive in scope, encompassing a range of inquiries pertaining to demographic characteristics, time allocation for assessment, additional payment status, comprehensive training received, knowledge and skill levels, consistency of the national guideline used for disability assessment, attitudes toward decision-making, communication with other specialists, and medico-legal issues.

Results: A total of 217 physiatrists (86 males, 131 females; mean age: 41.5±8.0 years; range, 28 to 68 years), 155 (71.4%) specialists and 62 (28.6%) academics, with a mean residency experience of 11.99±8.31 years, participated in the study. The survey results showed that disability assessment was a heavy burden and a difficult task that may involve disadvantages for physiatrists, and a significant majority reported not having received comprehensive training in disability assessment during or after residency. Additionally, only 65% felt that their knowledge and skills in disability assessment were adequate. In addition, only 13.8% of physiatrists felt that the national guideline accurately reflected an individual's level of disability, with the results highlighting inadequacies and inconsistencies in the guideline. Another striking finding was that there was disagreement among clinicians regarding the rate of impairment and the determination of full dependency.

Conclusion: Physiatrists, who play an important role in disability assessment, face several challenges in this process in Türkiye. The results of this study are expected to guide the implementation of effective and accurate disability assessment methods and provide sustainable solutions.

Objectives: The aim of this study was to investigate the impact of a newly developed motion capture camera-supported telerehabilitation gamification software on upper extremity functions and quality of life (QoL) in patients with stroke and cerebral palsy (CP).

Patients and methods: Between November 14^th 2022 and November 14^th 2023, a total of 122 patients were included in the study, 90 with stroke (52 males, 38 females; mean age: 59.8±14.7 years; range, 23 to 80 years) and 32 with CP (17 males, 15 females; mean age: 11.7±2.8 years; range, 8 to 18 years). All patients received a telerehabilitation program, supported by motion capture technology, incorporated gamification elements to engage patients were conducted for 30 sessions. The patients were assessed by hemiplegic upper extremity functionality tests and QoL scales.

Results: Both groups showed statistically significant improvements in the upper extremity functions and QoL, as measured by Fugl-Meyer Assessment of Upper Extremity (FMA-UE) Scale (p<0.001), Action Research Arm Test (ARAT) (p<0.001), Nine-Hole Peg Test (9HPT) (CP: p<0.05, Stroke: [p<0.001]), Motor Activity Log-28 (MAL-28) (p<0.001), Stroke-Specific Quality of Life Scale (SS-QOL) (p<0.001) and Pediatric Quality of Life Inventory (PedsQL) (p<0.001).

Conclusion: Our study findings highlight the potential of motion capture camera-supported telerehabilitation gamification software in enhancing upper extremity functional outcomes and significant improvement in QoL for patients with stroke and CP.

Herein, we reported a case of spinal myoclonus following an ultrasound-guided suprascapular nerve block. A 58-year-old male patient who had a diagnosis of calcific tendinitis inside the right supraspinatus tendon received a right suprascapular nerve block (3 mL of 2% prilocaine mixed with 2 mL of 1% lidocaine) under the guidance of ultrasound. Sudden, painless, and involuntary movements began in the upper extremity 10 min after the intervention. Three months after the injection, the involuntary movements were entirely stopped. Involuntary, painless, and brief muscle jerks may be suggestive of myoclonus after interventions with local anesthetics.

Transverse myelitis is a rare disease characterized by inflammation of the spinal cord. These findings may present with findings related to primary motor neuron damage or with nonspecific findings, such as loss of muscle strength and sensation in the extremities. Herein, we presented a 21-year-old female patient with transverse myelitis with complaints of muscle weakness and urinary incontinence who was diagnosed with lumbar disc herniation after lumbar imaging and whose complaints did not improve after surgery.

The most common etiologic cause of winged scapula (WS) is paralysis of the serratus anterior muscle (SAM), typically due to an injury of the long thoracic nerve (LTN), often associated with overhead activities, including heavy weightlifting. Herein, we reported a 30-year-old male patient with WS secondary to an LTN lesion caused by carrying weight under the armpit, rather than overhead, which differs from previous reports regarding the anatomical site and cause of the LTN lesion. The ultrasonographic technique used to evaluate distal lesions of the LTN was described in detail, with the SAM thickness significantly reduced and the cross-sectional area of the LTN increased on the symptomatic side. Electroneuromyography revealed an acute/subacute, mild partial axonal lesion of the LTN, with ultrasonographic evaluation pinpointing the exact anatomical location of the lesion. Ultrasonography should be the first imaging modality used to support electrophysiological studies and evaluate the affected nerves and muscles to reveal precise anatomical localization.

Objectives: This study aims to evaluate the influence of complex decongestive therapy (CDT) on patients with breast cancer-related lymphedema (BCRL) in terms of reducing volume, improving functional capabilities, and enhancing the quality of life and analyze the effect of obesity on their recovery process.

Patients and methods: This retrospective study was conducted between January 2018 and March 2020. The investigation comprised individuals with unilateral BCRL who received CDT during the previous year. The participants were split into two classifications: those with a normal or overweight status (Group 1) and those classified as obese or morbidly obese (Group 2). Each participant engaged in CDT sessions five times weekly for three weeks. The groups were compared regarding their functional status and quality of life scores as measured by the Quick Disabilities of the Arm, Shoulder, and Hand and Lymphedema Quality of Life (LYMQOL)-Arm questionnaires.

Results: This study included 81 female patients (mean age: 53.6±10.4 years; range, 28 to 87 years) with BCRL. Half of the participants were identified as obese and the mean body mass index (BMI) was 30.32±4.63 kg/m² . The median lymphedema duration was 12 months. After treatment, there was a notable reduction in both the mean initial limb volume and excess volumes (3183±681 cm³ vs. 2912±599 cm³ and 30.1% vs. 19.3%, respectively; p<0.001). Both groups showed substantial and similar enhancements in volumes, functional scores, and all subscores of the LYMQOL-Arm questionnaire following CDT. When the patients with a BMI below and above 30 were compared, the improvement in function and appearance scores of LYMQOL-Arm was substantially distinct between the two categories. We also indicated a substantial negative relationship between the enhancement of LYMQOL-Arm function and appearance subscores and BMI (p=0.005, r=-0.486 and p=0.042, r=-0.361).

Conclusion: The influence of CDT on decreasing volume and improving functionality was comparable between obese and nonobese patients with BCRL; however, obesity may negatively impact CDT outcomes concerning quality of life issues.

Objectives: This study aimed to evaluate the effectiveness of radial extracorporeal shock wave therapy (ESWT) in treating spasticity in post-stroke patients using shear wave elastography (SWE).

Patients and methods: This randomized controlled trial was conducted with 42 patients (29 males, 13 females; mean age: 64.0±8.5 years; range, 47 to 80 years) between June 2022 and August 2023. Stroke patients with biceps muscle spasticity were randomly assigned to either an active ESWT treatment group or a control group. Both groups underwent conventional rehabilitation programs. The ESWT group received four treatment sessions once a week for four weeks. Primary assessment criteria included SWE measurement values. Secondary criteria included the Modified Ashworth Scale, Modified Tardieu Scale, Fulg-Meyer Upper Extremity Assessment, and Functional Independence Measures. Evaluations were performed before treatment, immediately after treatment, one month after treatment, and three months after treatment.

Results: In the ESWT group, significant decreases in Modified Ashworth Scale and Modified Tardieu Scale scores observed one month after treatment were not maintained at three months. Improvements in Fulg-Meyer Upper Extremity Assessment and Functional Independence Measures scores were noted immediately after treatment and at one and three months after treatment, whereas these improvements were only observed at three months in the control group. Significant decreases in SWE measurements at 90° flexion and 180° extension observed one month after treatment in the ESWT group were not sustained at three months.

Conclusion: Our study highlights the short-term efficacy of ESWT as an adjunct to conventional rehabilitation in reducing spasticity in post-stroke patients with biceps muscle involvement. The correlation of SWE with physical examination methods emphasizes its potential role in the assessment and follow-up of spasticity treatment.

Objectives: The aim of this study was to investigate the effects of kinesiotaping (KT) using facilitation and inhibition techniques on electrical muscle activity in the vastus medialis (VM) muscle in healthy individuals and to examine the relationship between the initial electrical activity level of the muscle and the changes in electrical activity that may occur after taping.

Patients and methods: Between May 2024 and August 2024, a total of 75 healthy female volunteers (median age: 32 years; range, 21 to 56 years) were included in the study. The maximum and mean amplitude values of electrical activity in the VM muscle were recorded during a six-second maximum voluntary isometric contraction. Surface electrodes were attached to the motor point of the VM muscle on the dominant leg. Measurements were taken three times: before the KT application and 30 min after KT applications using facilitation and inhibition techniques.

Results: Compared to before the KT application measurements, the maximum and mean amplitude values of electrical muscle activity significantly increased after the facilitation technique (p<0.001) and significantly decreased after the inhibition technique (p<0.001). Additionally, the maximum amplitude value recorded before KT was negatively correlated with the increase in maximum amplitude observed after facilitation, and positively correlated with the decrease in amplitude after inhibition.

Conclusion: Kinesiotaping applications using muscle techniques can modulate electrical muscle activity, either increasing or decreasing it. When before the KT application muscle activity is high, the facilitation effect is less pronounced, while the inhibition effect becomes more prominent.

Objectives: This study aims to evaluate fear of falling, balance, and kinesiophobia among survivors of the earthquake that occurred in Türkiye on February 6^th, 2023 and to identify potential predictors of fear of falling and impaired balance.

Patients and methods: In this single-center, cross-sectional study, a total of 260 Kahramanmaraş earthquake survivors (105 males, 155 females; median age: 44.0 years; range, 18 to 91 years) between May 08, 2024 and July 08, 2024 were included. The sociodemographic data including age, sex, body mass index (BMI), marital status (single, married, widow), education status (years), monthly income (Turkish Lira [TL]), smoking status (never smoked, smoking before the earthquake or started smoking after the earthquake), alcohol intake (never, regular use of alcohol before the earthquake, or started alcohol consumption after the earthquake) of the participants were recorded. Comorbidities were evaluated using the modified Charlson Comorbidity Index (CCI), anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), post-traumatic stress disorder (PTSD) using the National Stressful Events Survey for PTSD-Short Scale (NSESSS-PTSD), sleep disorders using the Jenkins Sleep Evaluation Scale (JSS), fear of falling using the Falls Efficacy Scale (FES), functional balance using the Berg Balance Scale (BBS), and kinesiophobia using the Tampa Scale for Kinesiophobia (TSK).

Results: Of the survivors (n=260), 4.6% and 33.8% experienced loss of first-degree relatives and house damage, respectively. The FES and TSK scores were higher, while the BBS score was lower in older adults (n=56) compared to younger counterparts (n=204) (p<0.001). Multivariate linear regression analysis revealed that increased age affected the BBS (β=-0.124; 95% CI: -0.263 - -0.185; p<0.001) and FES scores (β=0.404; 95% CI: 0.255 - 0.451; p<0.001). The PTSD-SS score had a significant effect on the FES score (β=0.915; 95% CI: 0.734 - 1.110; p<0.001).

Conclusion: The Kahramanmaraş earthquake caused detrimental effects. Older people were more affected in terms of balance, fear of falling, and kinesiophobia. Increased age and post-traumatic stress are significantly associated with fear of falling following the earthquake. As a potential risk factor for fear of falling, post-traumatic stress should be managed properly in survivors of such disasters, particularly in those at older age.