Araştırma Çıktıları

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Author: search.filters.author.Civelek, Gul Mete

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    Medical complications experienced by first-time ischemic stroke patients during inpatient, tertiary level stroke rehabilitation
    (SOC PHYSICAL THERAPY SCIENCE, 2016-01-01) Civelek, Gul Mete; Atalay, Ayce; Turhan, Nur
    {[}Purpose] The aim of this study was to assess the medical complications in first-time ischemic stroke patients, to identify the factors related to occurrence of complications. {[}Subjects and Methods] First-time ischemic stroke patients (n=81) admitted to a tertiary level inpatient rehabilitation center during a 5 year period were included in the study. The attending physiatrist noted the presence of specific medical complications and complications that required transfer to the acute care facility from patient records. The Oxfordshire Community Stroke Project classification was used to define the clinical subtypes of the ischemic stroke patients. The Charlson comorbidity index was used to evaluate co-morbid conditions. Functional disability was assessed using the Functional Independence Measure at admission and discharge. {[}Results] We found that 88.9\% of the patients had at least one complication. The five most common complications were urinary tract infection (48.1\%), shoulder pain (37.0\%), insomnia (37.0\%), depression (32.1\%), and musculoskeletal pain other than shoulder pain (32.1\%) and 11.1\% of patients were transferred to acute care facility during rehabilitation period. Functional Independence Measure scores both at admission and discharge were significantly lower in patients with at least one complication than in patients with no complications. {[}Conclusion] Medical complications are common among patients undergoing stroke rehabilitation. Close interdisciplinary collaboration between physiatrists and other medical specialities is necessary for optimal management.
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    Treatment of Spasticity in Cerebral Palsy
    (GALENOS YAYINCILIK, 2016-01-01) Civelek, Gul Mete; Atalay, Ayce
    The cerebral palsy diagnosis is a clinical one and it includes motor development delay, abnormal muscle tone and hyperreflexia. Muscle weakness, spasticity, loss of coordination, the continuation of the primitive reflexes and non-developed normal motor control are often seen in children with cerebral palsy. Spasticity is the velocity dependent increase in the resistance against passive muscle stretching. Spasticity treatment program should be established after detailed evaluation of degree and effects. Treatments to achieve optimal muscle tone include physical therapy and rehabilitation program, oral and injectable medications and surgical treatments. In the treatment of spasticity, a personalized physical therapy and rehabilitation program including stretching exercises should be in the treatment plans, absolutely. There is no consensus regarding the optimal application of pharmacotherapy for the treatment of spasticity in cerebral palsy. Oral medications such as baclofen, benzodiazepine, tizanidine and dantrolene can be used for the treatment of generalized spasticity. Oral drugs have significant side effects such as sedation and cognitive deficits. Chemodenervation with perineural phenol or ethanol injection or intramuscular injection of botulinum neurotoxin A can be used as treatment of localized spasticity. It is shown that botulinum neurotoxin type A is safe and effective in reducing spasticity in children. Most commonly used surgical technique for the treatment of spasticity in cerebral palsy is selective dorsal rhizotomy and it can be applied to selected cases. Treatment options that are used in the treatment of spasticity in cerebral palsy are discussed in this review.