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Item Is there a relationship between upper limb function and swallowing function in children with cerebral palsy? A cross-sectional study(2022) Guzel, Sukran; Yigman, Zeynep Aykin; Umay, Ebru; 0000-0001-9852-0917; AAG-3148-2021Objective: Despite the association between gross motor and swallowing functions in patients with cerebral palsy (CP), there have been no studies examining the relationship between upper limb functions and swallowing in detail. The aim of this study was to evaluate the relationship between upper extremity skills and swallowing function in children with CP. Methods: The study included a total of 71 patients with CP who were attending the rehabilitation clinic. Upper limb functions were assessed using the Bimanual Fine Motor Function (BFMF) scale, and swallowing function with the Functional Oral Intake Scale (FOIS). The Nine-hole peg test (NPHT) was used to assess manual hand dexterity. Grip strength was measured with a Jamar hand dynamometer and pinchmeter. Correlation analysis was applied to outcome parameters. Results: The BFMF classification was level 1 in 6 patients (8.5%), level 2 in 22 patients (31.0%), level 3 in 27 patients (38.0%), level 4 in 12 patients (16.9%) and level 5 in 4 patients (5.6%). Nutrition was provided through oral intake in 59 (83.1%) patients and 12 (16.9%) were tube dependent. While a negative correlation was determined between swallowing function and BFMF and NHPT, a positive correlation was determined between swallowing function and grip strength values. Conclusions: The findings of this study demonstrated that there is a relationship between swallowing functions and upper limb functions. These findings may help in predicting functional improvement in terms of swallowing and/or if the patient needs further intervention such as upper limb rehabilitation in addition to oral motor training to improve oral intake, and thereby nutritional intake.Item An uncommon case of primary biliary cirrhosis and Hashimoto thyroiditis followed by the concurrent onset of multiple sclerosis and Sjogren syndrome(2022) Guzel, Sukran; Ozen, Selin; 0000-0001-9852-0917; 35949967; AAG-3148-2021A 51-year-old woman with a diagnosis of primary biliary cirrhosis and Hashimoto thyroiditis followed by concurrent onset of multiple sclerosis and Sjogren syndrome for seven years was admitted. The patient was treated with pulse steroid and cyclophosphamide combined with a physical therapy program. This is a case of four autoimmune diseases coexisting in a single patient, a finding which has not previously been described in the literature. This combination of autoimmune diseases should be kept in mind in patients with the relevant symptoms and signs of each to provide early diagnosis and appropriate treatment.Item Foot Deformity in Patients With Ankylosing Spondylitis: Is It Associated With Functionality and Disease Activity?(2022) Guzel, Sukran; Umay, Ebru; Ozturk, Erhan Arif; Gurcay, Eda; 0000-0001-9852-0917; 35227596; AAG-3148-2021Foot involvement affects mobility and functionality in patients with ankylosing spondylitis but it remains unknown if foot deformities in ankylosing spondylitis patients affect functionality, disease activity, and quality of life. The aim of this study was to evaluate in detail the presence of a relationship between radiologically detected foot deformities in ankylosing spondylitis patients and both clinical and electro-physiological findings. The cross-sectional study included 110 patients with ankylosing spondylitis who were diagnosed according to the Assessment in Spondyloarthritis International Society criteria and were followed in our hospital. Demographic and clinical data of all patients were recorded. Bilateral lateral foot x-rays and electrophysiology examinations were evaluated in all subjects. The arch in the dominant foot of the patients was classified in 3 groups as pes cavus, pes planus, or normal. The clinical outcomes, phys-ical examination and electrophysiological findings were compared between the groups, and correlations were examined of the foot deformities with these parameters. Foot deformities were determined at a high rate (74.5%). These deformities affected foot pain, disability and quality of life. Pes cavus deformity was found to be associated with hip pain and enthesopathy. In the electrophysiological studies, the pres-ence of pes planus was found to be associated with the findings of the tibial and sural nerve conduction studies, and the presence of pes cavus with the findings of the peroneal nerve conduction study. In con-clusion, foot deformities may have an effect on the quality of life and functionality in ankylosing spondy-litis patients. (c) 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.Item Functional electrical stimulation cycling in patients with chronic spinal cord injury: a pilot study(2021) Gurcay, Eda; Karaahmet, Ozgur Zeliha; Cankurtaran, Damla; Nazli, Fatma; Umay, Ebru; Guzel, Sukran; Gurcay, Ahmet Gurhan; 0000-0001-9852-0917; 33998960; AAG-3148-2021Objective To examine the therapeutic value of lower extremity functional electrical stimulation (FES) - evoked cycling on functional independence, health status, gait parameters, pulmonary functions, and biochemical values in patients with chronic complete/incomplete spinal cord injury (SCI). Materials and Methods Fifteen patients with SCI (duration of more than 6 months) who were able to stand up and walk with long leg braces or assistive devices and had stable neurological status and trunk balance undertook FES cycling for 6 weeks (three times per week). The main outcomes were: Functional Independence Measure (FIM), Nottingham Health Profile (NHP), 6-minute walk test (6MWT), and 20-meter walk test (20MWT). Secondary outcomes include measurements of pulmonary function tests and biochemical values. All parameters were evaluated at the beginning and end of the program. Results Improvements were seen in motor and total scores of FIM (p = 0.007), physical mobility subscale of NHP (p = 0.011), 6MWT (p = 0.001), and 20MWT (p = 0.011). In pulmonary functions, only forced vital capacity (FVC) levels demonstrated a significant increase compared with baseline (p = 0.011). Biochemical values reached no significant level. Conclusion The results of this study showed that the FES cycling exercise program improves motor and total FIM scores, gait parameters, and FVC values of pulmonary functions in patients with chronic SCI experience. The FES cycle might be a valuable and well-tolerated intervention in clinical rehabilitation.Item Computer Game Assisted Task Specific Exercises in the Treatment of Motor and Cognitive Function and Quality of Life in Stroke: A Randomized Control Study(2021) Ozen, Selin; Senlikci, Huma Boluk; Guzel, Sukran; Yemisci, Oya Umit; 0000-0001-6771-3265; 0000-0002-7290-8558; 0000-0001-9852-0917; 34293643; AAX-8965-2021; ABC-1305-2020; AAG-3148-2021Objectives: Computer game assisted task specific exercises (CGATSE) are rehabilitation gaming systems (RGS) used in stroke rehabilitation to facilitate patient performance of high intensity, task based, repetitive exercises aiming to enhance neuroplasticity. CGATSE maybe an appealing option in home based rehabilitation of stroke patients, especially during the COVID-19 pandemic. This study aimed to determine the effects of CGATSE on hemiplegic arm-hand function, cognitive function and quality of life in stroke. Materials and methods: Thirty stroke patients were randomized into two groups. All participants received twenty sessions of physical therapy. In addition, the therapy group undertook thirty minutes of CGATSE using the Rejoyce gaming system; while the control group undertook thirty minutes of occupational therapy (OT). Motor function was evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), Brunnstrom stages of stroke recovery (BSSR) arm and hand. The CGATSE group also completed the Rejoyce arm hand function test (RAHFT). Cognitive function was evaluated using the mini mental state examination, Montreal Cognitive Assessment (MoCA) and Stroke Specific Quality of Life (SS-QOL) scale. Results: The FMUE, BSSR arm and SSQOL improved in both groups (p < 0.05). BSSR of the hand improved only in the CGATSE group (p = 0.024). RAHFT scores improved in the CGATSE group (p = 0.008). MoCA scores significantly improved in the control group (p = 0.008). Conclusions: CGATSE may be beneficial in providing continuation of care after stroke, especially during the Covid-19 pandemic when home based rehabilitation options are becoming increasingly important. Benefits of CGATSE in improving cognitive function is less clear. RGS aimed at improving motor function may be compared to gaming systems designed to target cognitive development and more detailed higher cortical function deficit tests can be used as outcome measures.Item Swallowing difficulty in the older adults: presbyphagia or dysphagia with sarcopenia?(2021) Guzel, Sukran; 0000-0001-9852-0917; 34545853; AAG-3148-2021Oropharyngeal dysphagia is an important cause of mortality and morbidity in older adults. It has been reported in the literature that 11-68% of older adults experience swallowing difficulties. This study aimed to investigate the presence of dysphagia in older adults, whether this dysphagia is related to age (presbyphagia) or sarcopenia by comparing it with adults. Two hundred twenty-five patients were included in this cross-sectional study. The participants were divided into two groups by age as 'adults' and 'older adults'. Sarcopenia, dysphagia and malnutrition evaluations were performed. Older adult and adult groups were compared in terms of malnutrition, dysphagia and sarcopenia. The number of patients with dysphagia was significantly higher (P = 0.007) in the older adults. In older adults, all sarcopenic evaluation parameters were found significantly lower than adults (P < 0.05). The number of older adults with malnutrition was significantly lower in patients with normal swallowing (P < 0.05). The swallowing difficulty can be detected in older adults even if it does not cause any complaint. While most swallowing disorders may be due to age-related changes, about a third may be accompanied by sarcopenia.Item Effects of diaphragm thickness on rehabilitation outcomes in post-ICU patients with spinal cord and brain injury(2020) Guzel, Sukran; Umay, Ebru; Gundogdu, Ibrahim; Bahtiyarca, Zeynep Tuba; Cankurtaran, Damla; 0000-0001-9852-0917; 32601716; AAG-3148-2021Background Intensive care unit (ICU) complications affect outcomes but it remains unknown if the diaphragm thickness affects rehabilitation outcomes after ICU. We conducted a pilot study to evaluate the effect of diaphragm thickness on rehabilitation outcomes of post-ICU patients with spinal cord injury (SCI) and traumatic brain injury (TBI) and to evaluate factors that may be associated with diaphragm atrophy. Materials and methods Fifty-one patients (26 SCI, 25 TBI) who admitted to the rehabilitation clinic from the ICU included in this study. All demographic data were recorded. All participants underwent diaphragmatic ultrasonography evaluation before and after 12 weeks of neurologic rehabilitation program. The diaphragm thickness and outcome parameters were compared in all patient groups and in each patient subgroups. Evaluation parameters of patients before and after treatment were compared in patient subgroups. Results Diaphragm atrophy was found in 14 patients (64%) in TBI group and 12 patients (46%) in SCI group. The diaphragm thickness negatively correlated with the ICU length of stay and positively correlated with the before/after rehabilitation functional scores and the change in functional independence measure scores (p < 0.05). According to the regression analysis; the change in functional independence measure scores was found to be affected by the diaphragm thickness (p < 0.05). Conclusions The diaphragm thickness may be an effective factor on the rehabilitation process.Item Elastofibroma dorsi: A case report on an unobserved cause of back pain(2020) Guzel, Sukran; Ozen, Selin; Sozay, Seyhan; Kilic, Mehmet Dalokay; 0000-0002-8460-7699; 0000-0002-7290-8558; 0000-0001-9852-0917; 32962604; AAJ-2936-2021; ABC-1305-2020; AAG-3148-2021Elastofibroma dorsi (ED) is a rare, benign soft tissue tumor which often occurs in the subscapular region of elderly individuals and shows a female predominance. While many patients remain asymptomatic, ED can cause pain in the periscapular region. The clinical signs of ED are non-specific and variable which can result in misdiagnoses; it is often confused with rotator cuff and cervical spine pathologies. In this article, we present the case of a 78-year-old female patient with persistent back and shoulder pain. The patient was admitted to various clinics over a number of years for diagnostic investigations and treatment. However, the true etiology of back pain was never established and treatments were applied without any positive effect. Finally, when the patient presented to our clinic, a mass was detected in the right subcapular region. Thoracic computed tomography imaging was consistent with a diagnosis of ED. Due to the patient's persistent back pain, surgical excision of the tumor was performed. The pathology report confirmed the diagnosis. This case emphasizes the importance of a thorough examination in patients who may initially only have very subtle signs of the underlying pathology. This case also highlights the importance of re-visiting initial evaluations and differential diagnoses when faced with a difficult case of persistent back and shoulder pain so to avoid misdiagnoses and unnecessary treatments.Item Bilateral peroneal nerve palsy secondary to prolonged sitting in an adolescent patient(2020) Guzel, Sukran; Ozen, Selin; Cosar, Sacide Nur; 0000-0001-9852-0917; 0000-0002-7290-8558; 0000-0001-8306-463X; 33175582; AAG-3148-2021; ABC-1305-2020; AAF-1085-2021Peroneal nerve palsy most commonly occurs due to focal compression of the peroneal nerve at the level of the fibular head and causes foot drop and variable sensory loss. Mononeuropathies infrequently occur in childhood, bilateral peroneal palsy is very rare. In this article, we report the case of a 14-year-old boy with bilateral peroneal nerve entrapment which developed secondary to a prolonged sitting posture. We discuss the clinical assessment, diagnosis, and treatment of this rare case of bilateral peroneal palsy following prolonged immobility in light of the current literature.Item A CASE OF ISCHAEMIC STROKE FOLLOWING CERASTES CERASTES SNAKE BITE IN LIBYA(2020) Ozen, Selin; Guzel, Sukran; 0000-0001-9852-0917; 0000-0002-7290-8558; AAG-3148-2021; ABC-1305-2020Background: Cerastes cerastes is a venomous species of viper native to the deserts of northern Africa and parts of the Middle East. Reported cases of ischaemic stroke following a Cerastes cerastes bite are extremely few. Here we describe a case of ischaemic stroke occurring four days after envenomation by C.cerastes. Case presentation: A 26-year-old male was admitted to our rehabilitation unit with a history of ischaemic stroke and right sided hemiplegia. Four months previously he had been bitten by a C.cerastes viper in Libya. Four days after envenomation the patient developed sudden onset of aphasia and right sided weakness. Brain magnetic resonance imaging (MRI) revealed ischaemia in the territory of the left middle cerebral artery. On admission to our hospital, routine blood tests, coagulopathy and vasculitis screening was normal. Colour doppler ultrasound imaging of the carotid and vertebral arteries, MR angiography, transthoracic and transoesophageal echocardiography and Holter electrocardiogram were normal. A daily dose of aspirin 100 mg and physical therapy program was commenced. Conclusion: Only three cases of ischaemic stroke following C.cerastes bite have been reported in the literature. Hypotension, endothelial injury, hypercoagulability and vasculitis have been suggested as possible mechanisms for its occurrence. This probable case of stroke due to envenomation shows that stroke may occur as late as four days after the snake bit and highlights the importance of early administration of antivenom. Patient education on this subject maybe considered an important public health issue in areas of Africa and Asia in which viper bites occur.