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Öğe The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis(Springer-Verlag, 2001) Özdemir, F; Birtane, M; Kokino, SPain is a major symptom in cervical osteoarthritis (COA). Low-power laser (LPL) therapy has been claimed to reduce pain in musculoskeletal pathologies, but there have been concerns about this point. The aim of this study was to evaluate the analgesic efficacy of LPL therapy and related functional changes in COA. Sixty patients between 20 and 65 years of age with clinically and radiologically diagnosed COA were included in the study. They were randomised into two equal groups according to the therapies applied, either with LPL or placebo laser. Patients in each group were investigated blindly in terms of pain and pain-related physical findings, such as increased paravertebral muscle spasm, loss of lordosis and range of neck motion restriction before and after therapy. Functional improvements were also evaluated. Pain, paravertebral muscle spasm, lordosis angle, the range of neck motion and function were observed to improve significantly in the LPL group, but no improvement was found in the placebo group. LPL seems to be successful in relieving pain and improving function in osteoarthritic diseases.Öğe Cognitive evaluation and functional outcome after stroke(Lippincott Williams & Wilkins, 2001) Özdemir, F; Birtane, M; Tabatabaei, R; Ekuklu, G; Kokino, SObjective: To investigate the initial overall cognitive ability and its components as a predictor of functional improvement and ambulation during rehabilitation. Initial cognitive status is widely known to be a predictive factor in functional recovery in patients with stroke although some reports have found no such relationship. Design: Baseline cognitive status was scored by Minimental State Examination and its subsections with such headings as orientation, registration, attention and calculation, recall, and language in 43 patients with postacute stroke, aged between 51 and 68 yr. Function was evaluated in terms of motor FIM(TM) and functional ambulation as categorized in Adapted Patient Evaluation and Conference System functional scale at the time of admission and discharge. Results: Only total baseline Minimental State Examination score showed a significant correlation with discharge motor FIM improvement (r = 0.31, P = 0.04) and baseline orientation score correlated significantly with functional ambulation score improvement (r = 0.31, P = 0.03). In stepwise linear regression model, the same Variables had an effect on similar outcome parameters. Conclusions: Cognitiveion evaluation should be taken as a whole to predict functional outcome in patients with postacute stroke, except for the baseline orientation score that seemed more predictive for ambulation.Öğe Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings(W B Saunders Co-Elsevier Inc, 2001) Özdemir, F; Birtane, M; Tabatabaei, R; Kokino, S; Ekuklu, GObjective: To compare outcomes in stroke survivors who received rehabilitation services in an acute inpatient rehabilitation setting (multidisciplinary rehabilitation team) with outcomes in survivors in a home-based setting (family caregivers, limited team supervision). Design: Randomized clinical trial, with mean follow-up after 60 days. Setting: Inpatient rehabilitation setting and home-based settings. Patients: Sixty patients (age range, 43-80yr) who had a stroke between 1996 and 1999 and had been referred after medical stabilization, randomly divided into 2 groups: group 1, inpatient rehabilitation; group 2, home-based rehabilitation. Interventions: Group 1: therapeutical and neuromuscular exercises with occupational therapy with professional supervision; group 2: conventional exercises with family caregiver and limited professional supervision. Main Outcome Measures: Spasticity was evaluated with the Ashworth Scale, motor status with Brunnstrom's stages, functional status with the FIMTM instrument, and cognitive status with the Mini-Mental State Examination before and after rehabilitation. Results: Patients rehabilitated in acute inpatient settings had better motor, functional, and cognitive outcomes (p < .05). Spasticity changes did not differ between the groups. Conclusion: Intense inpatient rehabilitation services for stroke survivors provide significantly more favorable functional and cognitive outcomes with relatively low complications than did nonintense rehabilitation efforts in home settings.Öğe Comparison of the effects of tenoxicam and mid-laser irradiation on chronic adjuvant arthritis in rats(Clinical & Exper Rheumatology, 1997) Ulugol, A; Unalan, H; Dokmeci, I; Kokino, SObjective. This controlled experimental study was designed to compare the effects of a well-known NSAID, tenoxicam, with mid-laser irradiation on the inflammatory component of adjuvant-induced arthritis (AIA). Four groups of animals, each consisting of 10 Wistar mts, were included iri the study. The primary concern was not to investigate the antiinflammatory effects of tenoxicam, but to compare the previously proven effects of this drug with a physical therapy agent which might be considered to have fewer side effects and/or contraindications. Method. The first group received only 0.1 mi of complete Freund's adjuvant (CFA) and served as the control for the other groups. The 2nd, 3rd and 4th groups, after having CFA injected into the plantar surfaces of their right paws, were treated with tenoxicam alone, mid-laser alone, or with a combination of the two, respectively. Results and conclusion. All 3 groups showed significantly reduced paw edema compared with the control group. Although the reduction in paw edema in the animals treated with tenoxicam or with tenoxicam+ mid-laser was more significant, mid-laser is proposed as an alternative therapy for symptomatic relief in certain conditions well known to limit the use of NSAIDs.Öğe Efficacy of low level laser therapy in myofascial pain syndrome(Wiley, 2003) Hakgüder, A; Birtane, M; Gürcan, S; Kokino, S; Turan, FNBackground and objectives: The efficacy of low level laser therapy (LLLT) in myofascial pain syndrome (MPS) seems controversial. Our aim was to clarify the effect of LLLT in MPS by using algometry and thermography. Study Design/Materials and Methods: Sixty-two patients with MPS having an active trigger point in the neck or upper back region were randomly divided into two equal groups according to therapy applied (group 1: LLLT + stretching exercises, group 2: stretching exercises alone). The outcome measures were pain measured with visual analogue scale (VAS), algometry on the trigger point, algometric difference, thermographic difference, and thermal asymmetry. Comparison was made within and between the groups pre- and post-therapeutically and 3 weeks after therapy. Results: Mean pain values decreased more significantly in group 1 from baseline to 3 weeks followup, (7.54-3.06) while these values were 7.03-5.19 in group 2 (P < 0.05). Group comparisons revealed significant favorable differences in group 1 patients in terms of all other parameters at the first and the second evaluation post therapeutically (P < 0.05). Conclusions: LLLT seemed to be beneficial for pain in MPS by using algometry and thermography. (C) 2003 Wiley-Liss, Inc.Öğe How do marginal osteophytes, joint space narrowing and range of motion affect each other in patients with knee osteoarthritis(Springer Heidelberg, 2006) Ozdemir, F; Tukenmez, O; Kokino, S; Turan, FNTo assess the number, location, direction and size of osteophytes and the change of the joint space width (JSW) in radiographs of the tibiofemoral (TF) joint in middle-aged people with longstanding knee pain with radiographic osteoarthritis (OA), and to correlate between the range of motion (ROM). In the format of a retrospective study, the OA of both knee in 84 people, 8 men and 76 women (aged 42-77 years), with chronic knee pain at inclusion were examined. The JSW of the TF joint and the number, location, direction and size of osteophyte were evaluated using a PA view in weightbearing. The location and direction of osteophytes showed some variation at each site, particularly at the lateral tibial plateau and medial femoral trochlea. Significant correlations were found between ROM of the right and left knee and the size, location and direction of the most osteophytes. In both knees, the JSW medially was lower when compared with the lateral compartment. The mean JSW in the lateral tibiofemoral compartment of the right knee was associated with active and passive flexion degree of the patients. The mean JSW in the medial and lateral tibiofemoral compartment of the left knee correlated with BMI, and changes in the Kellgren and Lawrence grade of the patients. There was found statistically significant correlation between mechanical medial proximal tibial angle and the osteophyte size of the right and left knee. We think that definitions which incorporate both osteophytes and joint space narrowing offer the association with worsening of active and passive ROM.Öğe Lumbosacral transitional vertebral articulation(Lippincott Williams & Wilkins, 2004) Pekindil, G; Sarikaya, A; Pekindil, Y; Gültekin, A; Kokino, SIt has been suggested that low back pain (LBP) may arise from lumbosacral transitional vertebral articulation (LSTVA) itself. It is known that bone scintigraphy is a valuable tool for the recognition of pain arising from bone and articular diseases. Therefore we aimed to show planar and SPELT bone scintigraphic findings of LSTVA and compare them with the LBP and X-ray findings. Twenty-eight patients (aged 20-63 years) in whom LSTVA had been identified radiographically were evaluated with planar bone scintigraphy, utilizing Tc-99m methylene diphosphonate; and single photon emission computed tomography (SPELT) bone scintigraphy. Eighteen patients had LBP whereas 10 had not. There were 25 type IIA, one type IIB and two type IIIA LSTV articulation. On planar images, normal or non-focal minimally increased uptake superimposed on the upper sacroiliac joint was seen in patients without degenerative changes regardless of LBP whereas SPELT showed non-focal mild increased uptake on the area medial to the upper sacroiliac joint. Planar scans showed normal to non-focal mild, and mild-to-moderately increased uptake whereas SPELT demonstrated focal mild-to-moderately and markedly increased uptake in patients with degenerative changes without LBP and with LBP, respectively. The X-ray results showed an association of LBP degenerative changes, and the SPELT results showed a focal, markedly increased, uptake. We conclude that this focal, markedly increased, uptake may show the metabolically active degenerative changes of LSTV articulation and may help to reveal the pain arising from LSTVA. Therefore we propose that bone scintigraphy may be considered for the evaluation of patients with LBP thought to arise from LSTV articulation. ((C) 2004 Lippincott Williams Wilkins).Öğe Pedobarography and its relation to radiologic erosion scores in rheumatoid arthritis(Springer Heidelberg, 2005) Tuna, H; Birtane, M; Tastekin, N; Kokino, SThe aim of this study was to assess probable plantar pressure alterations in rheumatoid arthritis (RA) patients by comparison with normal subjects and to investigate the probable relation between pressure distribution under the foot and radiologic foot erosion score. Two hundred feet of 50 chronic RA patients and 50 healthy controls were evaluated. Static and dynamic pedobarographic evaluations were used to define the plantar pressure distribution. Also, the modified Larsen scoring system was used to detect the staging of erosions on feet radiograms of the RA patients. Static pedobarography revealed higher pressure and contact areas in the forefoot. All dynamic pedobarographic parameters except for plantar contact area were significantly different between the RA patients and control subjects. Patients with high erosion scores had higher static forefoot and dynamic phalanx peak pressure values. Pedobarographic investigation can be useful to evaluate pressure distribution disorders in RA feet and may provide suitable guidelines for the design of various plantar supports.Öğe Pressure-induced pain on the tibia: an indicator of low bone mineral density?(Springer Tokyo, 2004) Birtane, M; Tuna, H; Ekuklu, G; Demirbag, D; Tuna, F; Kokino, SPrevious literature investigating bone pain in osteoporosis has prominently focused on painful conditions following osteoporotic fractures. Is osteoporosis really a silent disease without bone pain and tenderness unless a fracture occurs? Our aim in this study was to answer the question by assessing the questionable tenderness on tibia bones of fracture-free patients with low bone density and to compare the findings with a normal population. One-hundred-thirty-three consecutive postmenopausal female patients with the mean age of 56 years admitted to our clinic for bone mass measurement were included in the study. Bone mineral density (BMD) values of lumbar spine (L2-L4) and right proximal femur (neck, trochanter, Ward's triangle) were measured by dual-energy X-ray absorptiometry (DXA). Patients with T scores lower than -1 formed the osteopenic-osteoporotic group of patients (low BMD group) whereas those with T scores higher than -1 constituted the normal BMD group according to the osteoporosis definition regarding T score for DXA. Mechanical pressure was applied by a hand algometer on the middle points of three equally divided sections on the anterior part of tibia, and the pressure levels starting the pain sensation (POPL) were recorded. Although the patients in the normal BMD group reported consistently high POPL at all regions of tibia for all BMD measurement sites, this difference reached to a statistical significance level only for the femur neck region. Only mean POPL for the whole tibia had independent association with only femur neck BMD by multiple linear regression analysis. These results are encouraging for assessing the significance of pressure-induced tibial pain as an indicator of low BMD in the future.Öğe 'Quality of life of primary caregivers of children with cerebral palsy(Cambridge Univ Press, 2004) Tuna, H; Ünalan, H; Tuna, F; Kokino, S[Abstract Not Available]Öğe The relationship between bone mineral content and functional disability in hemiparetic patients(Springer London Ltd, 2005) Demirbag, D; Ozdemir, F; Kokino, S; Berkarda, S[Abstract Not Available]Öğe The relationship between bone mineral density and immobilization duration in hemiplegic limbs(Springer, 2005) Demirbag, D; Ozdemir, F; Kokino, S; Berkarda, SObjective: Prolonged immobilization in stroke is known to result in hypercalciuria, hypercalcemia, accelerated bone resorption, and osteoporosis. Furthermore, bone mineral loss accelerated with increasing duration of hemiplegia. Although stroke is a common disease that causes sudden immobilization, relatively few investigations of bone metabolism in stroke have been reported. The aim of this study was to investigate the changes in bone mineral density of the forearms and legs related to duration of hemiplegia-induced immobilization after stroke. Methods: Forty-one hemiplegic patients with stroke were evaluated. The patients' age, gender and duration of hemiplegia-induced immobilization were recorded. The measurements of bone mineral density (BMD) in all patients were evaluated with DEXA using the Norland apparatus. The BMD values (g/cm(2)) C were determined by measurements made in the lumbar vertebrae, both forearm and legs (femoral neck and trochanter). Results: We found that bone mineral density was decreased in the affected extremities relative to the intact contralateral side on measurements by dual energy x-ray absorptiometry in bones such as forearm, femoral neck and trochanter. There was a significant difference between bone mineral density of paretic and nonparetic forearms and legs. Bone mineral density of the upper limbs was lower than that of the lower limbs. There was a negative correlation between duration of hemiplegia and BMD values. Conclusions: Bone mineral loss may be related to the duration of hemiplegia-induced immobilization. Bone mineral loss is accelerated when the duration of hemiplegia is prolonged.Öğe Tc99m sestamibi muscle scintigraphy to assess the response to electrical stimulation and isometric exercise of quadriceps femoris muscle(Springer-Verlag, 2001) Pekindil, Y; Birtane, M; Sankaya, A; Salan, A; Kokino, S[Abstract Not Available]
