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   2014| January-March  | Volume 41 | Issue 1  
    Online since March 4, 2014

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The effect of repetitive bilateral arm training with rhythmic auditory cueing on motor performance and central motor changes in patients with chronic stroke
Enas M Shahine, Tarek S Shafshak
January-March 2014, 41(1):8-13
Objective The aim of this study was to compare the effects of bilateral arm training with auditory cueing (BATRAC) versus control intervention on motor performance of the upper extremity (UE) and to explore the central neurophysiological mechanism underlying this effect in moderately impaired chronic stroke patients. Design This was a randomized-controlled clinical trial. Materials and Methods Overall, 76 chronic stroke patients (mean age = 50.2 ± 6.2 years), 6-67 months after the onset of the first stroke were enrolled. They received either BATRAC (with both UE trained simultaneously in symmetric and asymmetric patterns) or control intervention (unilateral therapeutic exercises for the paretic UE). Each session lasted for 1 h, scheduled as three sessions/week (on an alternate day) for 8 successive weeks. Outcome measures included the Fugl-Meyer motor performance test for the UE (FMUE) and percutaneous transcranial magnetic stimulation to elicit motor-evoked potential (MEP) in paretic abductor pollicis brevis muscle. Results Group comparisons indicated a significantly better improvement in the MEP parameters (transcranial magnetic stimulation threshold, central motor conduction time, and MEP amplitude) in the BATRAC group. The FMUE scores increased in both groups, but there was no significant difference between groups in the FMUE scores. Conclusion These findings recommend the use of BATRAC in chronic stroke patients not only to improve motor performance but also to induce central neurophysiological effects.
  2,934 430 4
Suprascapular nerve block in the treatment of hemiplegic shoulder pain
Mohja A El-Badawy
January-March 2014, 41(1):20-27
Objective The aim of the study was to study the effectiveness of suprascapular nerve block (SSNB) in reducing pain and increasing range of motion (ROM) in hemiplegic shoulder pain and to compare them with therapeutic ultrasound (U/S). Design The study was designed as a randomized controlled trial. Setting The study was conducted in the Department of Physical Medicine, Rheumatology and Rehabilitation. Patients and methods Stroke patients with hemiplegic shoulder pain who met the inclusion criteria were included in the present study and allocated to the SSNB or U/S groups. Both groups were given the same standard program of ROM exercise, and visual analog scale score of pain, passive maximum ROM, and Croft Disability Questionnaire at second and fourth weeks were evaluated. Results Twenty stroke patients were equally allocated to the SSNB and U/S groups. There was a significant improvement in visual analog scale scores and Croft Disability Questionnaire at the second and fourth weeks in the SSNB group. For ROM outcome of the SSNB group, the increase in flexion at the second and fourth weeks was 18.96 ± 11.73 and 34.93 ± 17.58 and in abduction was 22.26 ± 15.48 and 41.12 ± 22.02, respectively. SSNB produced faster relief of pain and more effective restoration of ROM compared with U/S. Conclusion The present study suggested that SSNB is a safe and effective treatment for hemiplegic shoulder pain. It was more effective than therapeutic U/S in reducing pain score and improving ROM and upper limb function.
  2,993 293 -
Use of the SS Scale, FIQR, and FIQ VASs for assessment of symptom severity in Egyptian fibromyalgia patients
Gihan M Omar, Shereen R Kamel, Rasha A Abdel-Magied, Nashwa M Abd-Allah
January-March 2014, 41(1):28-33
Background Fibromyalgia (FM) is a complex syndrome associated with significant impairment in the quality of life and function. The ability to evaluate and measure the severity of FM is likely to provide several benefits. Objective This study aimed to assess symptom severity in Egyptian FM patients using the Symptom Severity Scale (SS Scale), Revised Fibromyalgia Impact Questionnaire (FIQR), and Fibromyalgia Impact Questionnaire Visual Analog Scales (FIQ VASs). Patients and methods Twenty-four female patients who fulfilled the ACR-2010 criteria of FM were included in the present study. The SS Scale, FIQR, and FIQ VASs were used to assess symptom severity of FM. Results The respective mean of the SS Scale, FIQR, and FIQ VASs were 7.3 ± 2.4, 52.9 ± 22.1, and 39.3 ± 14.2, and they were positively correlated with measure of pain distribution [widespread pain index (WPI)] in our patients. The SS Scale, WPI, FIQR, and FIQ VASs scores were positively correlated with many regional pain distribution sites (upper arm pain and jaw pain at most) and somatic pain symptoms (central nervous system symptoms, musculoskeletal symptoms, otological and hypersensitivity symptoms). The high scores of the SS Scale, FIQR, and FIQ VASs and their positive correlations with most of the regional pain sites and distribution and somatic symptoms indicate the severity of symptoms in the studied population. The FIQ VAS was the only significant independent determinant of FM severity (P < 0.001) in backward/stepwise multiple linear regression models. Conclusion The SS Scale of the ACR-2010 criteria, FIQR, and FIQ VASs were excellent methods for assessment of symptom severity in our Egyptian FM patients.
  1,961 174 -
Central neuroplasticity and functional outcome of swinging upper limbs following repetitive locomotor training of lower limbs in stroke patients
Enas M Shahine, Tarek S Shafshak
January-March 2014, 41(1):14-19
Aims The aim of the study was to investigate the effect of long-term repetitive locomotor training on a treadmill with partial body weight support (TTPBWS) on motor performance of the swinging and supported paretic upper limb and to explore the neurophysiological mechanism underlying this improvement. Materials and Methods Thirty ambulatory chronic hemiparetic stroke patients were assigned randomly to either one of two experimental conditions while being trained for 20 min on a treadmill with PBWS 6 days a week for 8 weeks. Patients under condition 1 received verbal cueing to perform bilateral upper limb swinging. In condition 2, patients were instructed to support both upper limbs by holding the treadmill handrails. Fugel-Meyer upper extremity motor performance test (FMUE) and motor evoked potentials (MEPs) of the paretic middle deltoid (D), biceps brachii (BB), and abductor pollicis brevis muscles were assessed before rehabilitation (A-begin), immediately at its end (A-end), and 3 months later (A-3m). Changes in the FMUE scores and MEP variables were used for comparisons among groups. Results Both rehabilitation conditions resulted in a greater than 10% increase in the mean FMUE score. Group I showed a significant improvement in MEP variables (lower resting threshold, shorter central motor conduction time, and higher amplitude) in the three tested muscles. Group II showed a significant improvement in all the MEP variables of abductor pollicis brevis muscle and an increase in the MEP amplitude of only the BB muscle. Changes in the MEP threshold and amplitude of D and BB muscles were significantly higher in the patients in group I than those in group II. Conclusion Active bilateral upper limb swinging during treadmill training is more effective in improving paretic upper limb motor performance than training with supported upper limbs on treadmill handrails. Central neural plasticity may be underlying this recovery. Task-dependent neuronal coupling between lower and upper limb muscles during walking could be beneficial in stroke rehabilitation.
  1,899 176 1
Atherosclerosis in Egyptian patients with ankylosing spondylitis
Dahlia A Hussein, Hanan M Farouk, Sameh A Mobasher, Noran O El-Azizi, Rasha N Thabet, Remon Z Elia
January-March 2014, 41(1):1-7
Background Ankylosing spondylitis (AS) is a systemic inflammatory disorder with extra-articular features including cardiovascular diseases. Objective The objective of this study was to assess the presence of atherosclerosis in Egyptian patients with AS and its relation to disease activity. Patients and methods Thirty patients with AS of at least 18 years of age and 30 age-matched and sex-matched controls were included. Assessment of medical history, clinical examinations, and assessment of AS disease activity using BASDAI, BASMI, and BASFI as well as dobutamine echocardiography were performed only for patients. Complete blood count, ESR, C-reactive protein, lipid profile, serum von Willebrand factor (vWF) Ag level by ELISA, ECG, and carotid duplex were performed for all participants. Results In patients, 11 had active disease and 19 were in remission. A hypertensive response (HTNR) appeared in eight patients; six of them had active disease. There was a significant increase in the level of vWF in actively diseased patients than inactive patients and controls. Carotid intima-media thickness (IMT) was significantly increased in AS patients than controls. Levels of low-density lipoprotein were significantly higher in AS patients than the controls and in AS patients receiving biologics than those not receiving biologics. In the inactive group, vWF and IMT were significantly increased in patients receiving biologics. vWF correlated positively with BASDI, BASMI, BASFI scores, ESR, and carotid IMT and negatively with high-density lipoprotein. Conclusion Patients with AS are more susceptible to atherosclerosis, which is related to disease activity, and receiving biologics may place them at a higher risk. vWF, as a useful marker of atherosclerosis in AS patients, was correlated positively with disease activity scores and IMT.
  1,623 129 -
Massive pulmonary embolism in rheumatoid patient treated with raloxifene: a case report
Hala M Haider
January-March 2014, 41(1):34-36
Introduction Rheumatoid arthritis (RA) is not generally considered a risk factor for venous thromboembolism. Case presentation A patient with RA and postmenopausal osteoporosis was reported with massive pulmonary embolism following treatment with raloxifene for 3 months. This patient met the American College of Rheumatology (ACR) criteria for RA diagnosis in 1988. She was controlled on regular disease modifying antirheumatic drug (DMARDs) for 4 years. Conclusion Pulmonary embolism in postmenopausal osteoporotic patient with RA could be due to raloxifene treatment rather than a complication of the disease itself.
  1,608 92 -
Type 2 diabetes raises serum sclerostin levels and disturbs the relation between sclerostin and bone mineral density: a call for caution with antisclerostin therapy in osteoporosis
Dina S Al-Zifzaf, Sarah A Hamza, Eman A Kaddah, Rania A Abo-Shady
January-March 2014, 41(1):37-43
Background Sclerostin is an osteocyte-secreted protein that negatively regulates osteoblasts. Wnt signaling may be crucial in the pathogenesis of impaired bone quality in type 2 diabetes mellitus (T2DM). The possibility that currently studied antisclerostin bone-forming agents could be useful to T2DM patients with osteoporosis needs further investigations. Aim The aim of this study was to investigate the relationship between serum sclerostin and bone mineral density in T2DM patients, in comparison with nondiabetic individuals. Patients and Methods This study was conducted on 21 T2DM patients and 22 nondiabetic individuals. All participants were 60 years or older. They underwent history taking, clinical examination, routine lab investigations, and glycated hemoglobin assessment. Serum sclerostin was measured by ELISA. Bone mineral density (BMD) was measured at the left femoral neck and lumbar spine. Results Serum sclerostin level was significantly higher in T2DM patients compared with nondiabetic individuals. Male participants showed significantly higher sclerostin levels among the nondiabetic individuals, whereas this difference was not significant among T2DM patients. The Bone mineral density (BMD) and t-values of T2DM patients and the nondiabetic group were not significantly different. We found a significant positive correlation between sclerostin level and lumbar spine BMD among nondiabetic individuals, whereas among T2DM patients, this correlation was not significant. Sclerostin levels did not show a significant difference between diabetic osteoporotic and diabetic nonosteoporotic patients. Conclusion Patients with T2DM have raised sclerostin levels that, unlike those in nondiabetic individuals, are not correlated with BMD. This pathological condition that is specific to diabetes necessitates further study, careful assessment of the role of antisclerostin therapy, and probable dose adjustment for osteoporosis in T2DM patients.
  1,495 160 1