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Context: Recurrent priapism is characterized by repetitive episodes of erections which are unrelated to sexual interest or stimulation. It is extremely rare in patients with spinal cord injury (SCI). There are a number of conservative agents used in the treatment.Findings: We describe the case of a 20-year-old male with cervical-5 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A tetraplegia as a result of a diving accident 2 years ago. He declared that the recurrent penile erections occurred up to 15-20 times day and night every day and lasted up to 20 min each time unrelated to sexual interest or stimulation. He was prescribed baclofen 10 mg, twice daily. The frequency and duration of erections decreased to 3-5 times/day lasting for about 5 min each and the patient reported a high treatment satisfaction.Conclusion: The presentation of this case is to remind clinicians this rare but distressing condition of recurrent priapism seen in men with complete spinal cord lesions and to summarize the use of medications, most commonly baclofen, to alleviate the condition.

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OBJECTIVE: To evaluate the effects of robotic rehabilitation on upper extremity functions, cognitive development, and activities of daily living in patients with subacute stroke. METHODS: This study was set as prospective and controlled. Subjects with subacute stroke were allocated into two groups as the robotic and control groups. All subjects received a conventional rehabilitation program five times a week for 3 weeks. In addition, robotic group received robotic rehabilitation five times a week for 3 weeks (30 minutes per session). RESULTS: There were 20 patients in the robotic group (mean age of 63.27 ± 3.88 years) and 15 patients in the control group (mean age of 59.25 ± 8.10 years). Compared with baseline, the Functional independence measure (both motor and cognitive subscale), Fugl-Meyer Assessment Scale, and Motricity Index values did increase in both groups. Change levels of Fugl-Meyer Assessment FMA shoulder/elbow/forearm, and Motricity Index shoulder scores were significantly higher in the robotic group than the control group (p< 0.05). Compared with the baseline, physical component summary scores improved only in the robotic group, yet motor component summary scores improved only in the control group. Although Brunnstrom levels increased in both groups compared with baseline, change levels were similar. CONCLUSION: In the light of our results, robotic rehabilitation in addition to the conventional rehabilitation program seems to be effective on improving motor recovery and the quality of life in subacute stroke patients.

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BACKGROUND: Although wheelchair appropriateness has been studied in general wheelchair users and spinal cord injury patients, it has not been studied in children with cerebral palsy yet. OBJECTIVE: To describe the wheelchair appropriateness in children with cerebral palsy. MATERIALS AND METHODS: Thirty children with cerebral palsy were included. Demographical and clinical features of the children were noted. All wheelchair parts were evaluated by the same rehabilitation physician who has attended a wheelchair-training course. Overall, the wheelchair was accepted as inappropriate if at least three parts were inappropriate. RESULTS: There were 30 children (15 M, 15 F) with a mean age of 10.8 ± 3.5 years. Seat depth (n= 21, 70%), cushion (n= 17, 56.7%), seat height (n= 16, 53.3%), and footrest (n= 16, 53.3%) were the most common inappropriate parts. Overall, 24 (80%) of the children use inappropriate wheelchair. Two (6.7%) children obtained wheelchairs by prescription, 28 (93.3%) obtained without prescription. Twenty-nine wheelchairs were manual and one wheelchair was motorized. Among 30 children, five (16.7%) experienced at least one wheelchair-related fall. CONCLUSION: In the light of our results, 80% of the children with cerebral palsy seem to use inappropriate wheelchair. Individually designed wheelchairs should be maintained for these children.

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BACKGROUND AND OBJECTIVES: The objective of this study was to explore the association between 25- hydroxyvitamin D (25(OH)D) and muscle strength/architecture. METHODS AND STUDY DESIGN: Thirty patients (27 women, 3 men) were allocated into Group I (n=15, mean age; 44.4±9.4 years) and Group II (n=15, mean age; 39.0±9.9 years) according to the median of 25(OH)D (<13.7 ng/mL vs >13.7 ng/mL, respectively). Peak torque/body weight of the knee flexor/extensor muscles at 60°/sec and 180°/sec and those of ankle flexor/ extensor muscles at 30°/sec and 90°/sec were evaluated by using a Biodex System 3 Pro Multijoint System isokinetic dynamometer. A 7-12 MHz linear array probe was used to evaluate thickness (MT), pennation angle (PA) and fascicle length (FL) of medial gastrocnemius and vastus lateralis muscles. RESULTS: Mean of 25(OH)D was 9.4±2.5 ng/mL and 20.7±8.3 ng/mL in Groups I and II, respectively. Although all isokinetic strength parameters were lower in Group I, significant differences were found in knee flexion at 180°/sec (p=0.007), knee extension at 30°/sec (p=0.038) and 180°/sec (p=0.001), and ankle extension at 30°/sec (p=0.002) and 90°/sec (p=0.007). On the other hand, no significant difference was found between the groups regarding MT, PA and FL values (all p>0.05). CONCLUSION: In light of our results, we can argue that 25(OH)D is associated with muscle strength but not with muscle architecture. Further studies concerning the long-term follow-up effects of 25(OH)D treatment on muscle strength are awaited.

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OBJECTIVE: To evaluate botulinum toxin serotype A (BoNT-A) effects on sleep problems in children with cerebral palsy (CP) and on mothers` sleep quality and depression at multiple time points. METHODS: This is a single center, cross sectional, and observational study was conducted to assess children with CP who were admitted. We recruited children with CP who were admitted to Ministry of Health Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey between September 2012 and April 2014 for the BoNT-A injection for lower limb spasticity. Sleep quality of children with CP were determined at baseline and at the first, third and sixth month after the BoNT-A injection. Sleep quality Pittsburgh Sleep Quality Index (PSQI) and depression (by Beck Depression Inventory-II Turkish version) in mothers were also assessed. RESULTS: Twenty-four children with CP (7.05+/-2.69 years) underwent final assessment. Their bedtime resistance (11.71+/-3.26 versus (vs) 10+/-2.75, p<0.01), sleep anxiety (8.00+/-2.57 vs. 7.13+/-2.27, p=0.046) and daytime sleepiness (11.67+/-2.14 vs. 10.25+/-1.96, p<0.01) were significantly improved in the first month after the BoNT-A injection. In accordance with this, PSQI and BDI scores of the mothers decreased in the first month after the BoNT-A injection. Thereafter, BDI scores continued to decrease, whereas PSQI slightly increased in the third month. CONCLUSION: The BoNT-A injection for spasticity in children with CP may have the potential to improve sleep quality in children with CP and their primary caregiver, the mother, as well as to reduce depression in the mother.

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OBJECTIVE: The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. DESIGN: Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). RESULTS: A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P < 0.001). While the kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P < 0.05). CONCLUSIONS: Addition of kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate kinesiotaping and corticosteroid injections into the treatment plan for patients with shoulder impingement syndrome. LEVEL: Advanced ACCREDITATION: : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for amaximumof 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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OBJECTIVE: To compare the distal femoral cartilage thickness of the non-amputee sides in patients who had unilateral transfemoral amputation with those of healthy subjects by using ultrasound. METHODS: Thirty transfemoral amputees (27 male, 3 female) and 30 age-, sex-, and body mass index-matched healthy controls were included. Functional usage of the prosthesis was evaluated by using Houghton score. The cartilage thickness was measured from the following midpoints; medial femoral condyle (MFC), intercondylar area, and lateral femoral condyle. RESULTS: Thirty patients with unilateral transfemoral amputation (mean age; 38.6 ± 9.5 years) and 30 healthy controls (mean age; 38.4 ± 9.4 years) were included. Although femoral cartilage thicknesses were found to be lower for all measurements in the amputees, the difference reached significance only in the MFC (p= 0.031). In the patient group, cartilage thickness values did not correlate with age, duration of amputation, daily walking time, stump length or Houghton score. CONCLUSION: The distal femoral cartilage thickness seems to be decreased medially on the non-amputee sides of the transfemoral amputees when compared with the healthy subjects. Further studies concerning the follow-up designs, functional parameters and osteoarthritis scales are awaited.

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OBJECTIVE: To evaluate the effects of the bilateral isokinetic strengthening training applied to knee and ankle muscles on balance, functional parameters, gait, and the quality of in stroke patients. METHODS: Fifty patients (33 M, 17 F) with subacute-chronic stroke and 30 healthy subjects were included. Stroke patients were allocated into isokinetic and control groups. Conventional rehabilitation program was applied to all cases; additionally maximal concentric isokinetic strengthening training was applied to the knee-ankle muscles bilaterally to the isokinetic group 5 days a week for 3 weeks. Biodex System 3 Pro Multijoint System isokinetic dynamometer was used for isokinetic evaluation. The groups were assessed by Functional Independence Measure, Stroke Specific Quality of Life Scale, Timed 10-Meter Walk Test, Six-Minute Walk Test, Stair-Climbing Test, Timed up&go Test, Berg Balance Scale, and Rivermead Mobility Index. RESULTS: Compared with baseline, the isokinetic PT values of the knee and ankle on both sides significantly increased in all cases. PT change values were significantly higher in the isokinetic group than the control group (P<0.025). Furthermore, the quality of life, gait, balance and mobility index values improved significantly in both groups, besides the increase levels were found significantly higher in the isokinetic group (P<0.025, P<0.05). CONCLUSION: Bilateral isokinetic strengthening training in addition to conventional rehabilitation program after stroke seems to be effective on strengthening muscles on both sides, improving functional parameters, gait, balance and life quality.

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BACKGROUND AND PURPOSE: Researchers have shown an increased interest in proprioception deficits of the paretic side in hemiplegic patients. However, far too little attention has been paid to the proprioception sense of the non-hemiparetic side. The objective of this research was to determine whether the position sense of the ankles, especially of the non-paretic side, is affected in stroke patients. METHODS: 20 inpatients with stroke and 10 healthy control subjects were evaluated using an isokinetic dynamometer. Proprioceptive error scores (in degrees) for passive reproduction of joint position tests (PRJPTs) were measured. RESULTS: Error values of PRJPT for 5° plantarflexion, 10° plantarflexion, and 15° dorsiflexion were significantly higher in patients on both the paretic and non-paretic side compared with the control group dominant side. CONCLUSION: The impaired results of PRJPT in both the paretic and non-paretic ankles of stroke patients are surprising when one expects that the non-paretic side would be preserved under the control of the healthy hemisphere.

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OBJECTIVE: To compare the functional, cognitive and disability status of aphasic and non-aphasic traumatic brain injury patients. DESIGN: A prospective comparative study in which 103 patients with traumatic brain injury participated. SUBJECTS: Fifty-one aphasic and 52 non-aphasic patients with traumatic brain injury. METHODS: Functional Independence Measure and Disability Rating Scale were used to determine functional status and disability. Cognitive status was evaluated by the Mini-Mental Status Examination. Aphasic patients were evaluated using the Gülhane Aphasia Test for language disorders. RESULTS: The most frequent type of aphasia was Broca aphasia at 26.49% followed by anomic at 19.6% and trans-cortical motor at 15.6%. Functional Independence Measure, Disability Rating Scale and Mini-Mental Status Examination scores at admission and at discharge showed significant differences in aphasic patients (p<0.001). There were no significant differences in the Functional Independence Measure, Disability Rating Scale and Mini-Mental Status Examination gains between the aphasic and non-aphasic patients (p>0.01). CONCLUSION: Although aphasia could be accepted as a negative prognostic indicator in patients with traumatic brain injury, we could not detect any difference in functional and cognitive gains between the aphasic and non-aphasic patients.

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OBJECTIVE: To compare the sensitivity of median sensory nerve conduction tests performed by stimulating digital branches in patients with carpal tunnel syndrome. DESIGN: A prospective study in 506 hands of patients with carpal tunnel syndrome diagnosed electrophysiologically. RESULTS: The sensitivity of median sensory nerve conduction tests across the first three digit-to-wrist segments and palm-to-wrist segment was determined. The most common abnormal electrophysiologic finding was the slowing of sensory nerve conduction velocity over the palm-to-wrist segment, which was detected in 98.5% of the hands. Slowing of sensory nerve conduction velocity over the digit 1-, 2-, and 3-to-wrist segments of the median nerve was found in 95.4%, 88%, and 82% of the hands, respectively. CONCLUSION: The sensory nerve conduction velocity test of the digit 1-to-wrist segment has the most sensitivity among the three digital branches of the median sensory nerve, and it may be used more widely in the electrodiagnosis of carpal tunnel syndrome.

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