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Öğe Acute effects of a single session of aerobic exercise with or without weight-lifting on bone turnover in healthy young women(2006) Tosun, Aliye; Bölükbaşı, Nesrin; Çingi, Elif; Beyazova, Mehmet; Ünlü, MustafaThis study aimed to investigate the acute effects of exercise on bone turnover and to determine whether brisk walking with or without weight-lifting makes a difference on bone metabolism. Nine healthy women performed two exercise bouts: brisk walking on a treadmill for 30min (E), and similar exercise carrying 5kg of weight in a backpack (WE). Serum parathyroid hormone (PTH), osteocalcin (OC), calcitonin (CT), procollagen type 1 carboxy terminal propeptide (PICP), procollagen type 1 amino terminal propeptide (PINP), type 1 collagen carboxy terminal telopeptide (ICTP), total alkaline phosphatase (ALP), and urine deoxypyridinoline (D-Pyr) levels were studied. Resting values served as control. Significant variances were observed only in serum ALP and PTH values. Variances in ALP values within subjects after exercise were statistically significant (analysis of variance in repeated measurements [AVRM], P = 0.000). E caused a significant decrease, while WE caused a significant increase in ALP values at the 24th h (Bonferroni pairwise comparisons tests [BPC t-test]: P = 0.028, P = 0.000, respectively). Variances in PTH values within subjects after exercise were statistically significant (AVRM, P = 0.029), while diurnal variation was not significant (P = 0.981). E caused significant alterations in PTH levels (an increase at the 30th min, turned towards baseline at the 45th min) (BPC t-test, P = 0.007). WE also caused alterations in PTH levels, though insignificant (BPC t-test, P = 1.00). Brisk walking for 30 min has stimulating effects on bone turnover by various mechanisms without any additive effect of weight bearing. © Japan College of Rheumatology 2006.Öğe Clinical and laboratory features of patients with musculoskeletal brucellosis(Turkiye Klinikleri, 2005) Aydin, Gülümser; Keleş, İlayda Ceren; Atalar, Ebru; Ayaşlioğlu, Ergin; Tosun, Aliye; Orkun, S.Objective: To evaluate the demographic, clinical and laboratory features of patients with musculoskeletal brucellosis in urban and rural areas of Kirikkale, Turkey. Material and Methods: Twenty-eight patients with the diagnosis of musculoskeletal brucellosis were included in the study. All patients were questioned for demographic characteristics, duration and characteristics of complaints and possible source of infection. The findings of detailed systemic and musculoskeletal examinations were noted. Routine blood chemistries, complete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody, blood culture and standard tube agglutination tests were carried out. Radiographs of the sacroiliac joints and lumbosacral spine of all patients and, if required, radiographs of peripheral joints were evaluated. Magnetic resonance imaging was performed on those in whom deep joint involvement was suspected clinically and radiographically. Results: Patient mean age was 39.4±14.4 yr, mean duration of disease was 10.1 ± 12.7 yr, and 64.3% of the patients were male. The most frequent symptom was arthralgia (85.7%), and the most prevalent sign was splenomegaly (32.1%). Blood cultures were positive in 39.3% of the patients. Peripheral arthritis had the highest incidence with a rate of 71% in joint manifestations, and the most frequent involvement sites were hip and knee with a ratio of 35%. Sacroiliitis was detected in 32% and was unilateral in 89% of the patients. Spondylitis was found in 14% of the patients, most frequently in lumbar segments (75%). Each musculoskeletal involvement site in terms of all parameters were compared with the others and only the sacroiliac test in the sacroiliitis group and age, vertebral tenderness with percussion and the presence of painful spinal movements in spondylitis group were significantly different from the others (p<0.05). Conclusion: Peripheral joints are the most common articular involvement sites in patients with musculoskeletal brucellosis in our region. Specific sacroiliac joints tests may serve as guides to sacroiliitis. Spinal involvement should be kept in mind in elderly patients with brucellosis, particularly when spinal movements are painful or tenderness is elicited with percussion over the spine. Brucellosis should be included in the differential diagnosis of patients with spinal or peripheral joint pain and in those presenting with complaints due to soft tissue rheumatism. Copyright © 2005 by Türkiye Klinikleri.Öğe Conservative treatment of femoral neuropathy following retroperitoneal hemorrhage: a case report and review of literature(Lippincott Williams & Wilkins, 2014) Tosun, Aliye; Inal, Elem; Keles, Isik; Tulmac, Murat; Tosun, Ozgur; Aydin, Gulumser; Orkun, SevimAnticoagulant drugs are used to reduce the incidence thromboembolic events in patients at risk. However, minor and major bleeding complications may occur during anticoagulation therapy. Femoral neuropathy secondary to retroperitoneal hematoma is a well known complication of anticoagulant drugs. However, treatment of these patients is still controversial, both conservative and surgical treatments have been advocated. Herein, we report a male patient receiving warfarin for 7 years who developed femoral neuropathy due to retroperitoneal hematoma and was successfully treated with conservative methods. We suggest that conservative treatment and appropriate rehabilitation program should be given to the patients who do not demonstrate any signs of a continued bleeding and any progressive neurological deficits. Blood Coagul Fibrinolysis 25:769-772 2014 (C) Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Öğe Correlations between autonomic dysfunction and circadian changes and arrhythmia prevalence in women with fibromyalgia syndrome(Turkish Soc Cardiology, 2009) Dogru, Mehmet Tolga; Aydin, Gueluemser; Tosun, Aliye; Keles, Isik; Gueneri, Mahmut; Arslan, Ayse; Orkun, SevimObjective: It is known that increased sympathetic activity and decreased parasympathetic activity are present in patients with fibromyalgia syndrome (FMS). This study aims to investigate the correlations of autonomic dysfunction and differences in autonomic circadian activity with arrhythmia prevalence in women with FMS. Methods: Fifty female patients with FMS and 30 healthy female controls were included in this cross-sectional, case-controlled study. A 12-lead electrocardiogram and 24-hour Holter monitoring were performed in all patients to evaluate arrhythmias and autonomic function tests. Heart rate variability (HRV) parameters were utilized to detect autonomic dysfunction in patients with FMS. HRV measurements were performed in total 24-hour, day time (06:00-22:59), night time (23:00-05:59) periods and during autonomic tests (stand - supine, inspiration-expiration and Valsalva tests) using 24-hour Holter monitoring recordings. Student t-test, Mann-Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The correlation of data was tested by using Spearman correlation analysis. Results: The mean ages of the patient and control groups were 38 +/- 7.4 and 36 +/- 8.1 years, respectively. In HRV measurements, high frequency (HF) power, was significantly decreased in the patient group as compared with control group (167.4 msec(2) (107.0-312.0) vs.314.5 msec(2) (124.0-905.0), p=0.017). The low frequency/HF ratio (LF/HF) values for total 24 hours (2.22 +/- 0.18 vs. 1.22 +/- 0.12, p<0.001) and in the night time period (2.78 +/- 1.97 vs.1.15 +/- 0.77, p<0.001) were found to be significantly higher in the patient group than in control one. The ratio of LF/HFDay/LF/HFNight was markedly higher in the control group (2.67 (1.22-5.65) vs. 1.45 (0.83-2.05), p=0.004). The prevalence (p=0.028) and total number (127.1 +/- 21.4 vs. 187.3 +/- 62.3, p=0.019) of supraventricular extrasystoles in 24-hour period was higher in the patient group. Conclusion: The sympathetic activity was significantly increased and parasympathetic activity significantly decreased in FMS patients. Additionally, significant autonomic circadian activity changes were also detected in these patients. These autonomic changes might be linked to increased arrhythmia prevalence. (Anadolu Kardiyol Derg 2009, 9: 110-7)Öğe Does Autonomic Dysfunction Exist in Postmenopausal Osteoporosis?(Lippincott Williams & Wilkins, 2011) Tosun, Aliye; Dogru, Mehmet Tolga; Aydin, Gulumser; Keles, Isik; Arslan, Ayse; Guneri, Mahmut; Ebinc, HaksunTosun A, Dogru MT, AydNn G, Keles I, Arslan A, Guneri M, Orkun S, Ebinc H: Does autonomic dysfunction exist in postmenopausal osteoporosis? Am J Phys Med Rehabil 2011;90:1012-1019. Objective: The aim of this study was to investigate the presence of autonomic dysfunction in patients with osteoporosis. Design: This is a prospective controlled trial. Sixteen postmenopausal female patients with osteoporosis and 10 age-matched postmenopausal nonosteoporotic controls were included in the study. Participants were divided into the postmenopausal osteoporosis group and the nonosteoporotic control group according to bone mineral densities. Heart rate variability parameters and sympathetic skin responses were studied to evaluate autonomic functions. Results: The latencies of sympathetic skin responses obtained from both hands were significantly increased in the patient group when compared with the control group. The sympathetic skin response amplitude of the right hands and both feet of the patient group were found to be decreased significantly when compared with that of the control group. A 24-hr high-frequency value was significantly decreased in the patient group than in control group. A 24-hr low-/high-frequency value was significantly higher in the patient group than in the control group. Conclusions: Autonomic dysfunction characterized with increased sympathetic and decreased parasympathetic activity may be present in osteoporosis, and cardiac functions in patients with osteoporosis may also be affected by accompanying autonomic dysfunction.Öğe Effects of ovariectomy and ascorbic acid supplement on oxidative stress parameters and bone mineral density in rats(Taylor & Francis Ltd, 2011) Arslan, Ayse; Orkun, Sevim; Aydin, Gulumser; Keles, Isik; Tosun, Aliye; Arslan, Mustafa; Caglayan, OsmanObjectives: The aim of this study is to investigate the effects of ovariectomy on bone mineral density (BMD) and oxidative state in rats, and the alterations in these effects that vitamin C supplementation may produce. Materials and methods: Twenty female Wistar albino rats were randomly divided into three groups: control (C, n = 6); ovariectomy (O, n = 7); and ovariectomy + vitamin C supplement (OV, n = 7). Oxidative stress (OS) was assessed 100 days postovariectomy by measuring the activity of several enzymes, including catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase, as well as the concentrations of malondialdehyde (MDA), nitric oxide (NO), and total sulfhydryl groups in plasma and bone homogenates. Results: A significant decrease in BMD was observed in O group compared with C group (p = 0.015), and a significant increase was observed in OV compared with O group (p = 0.003). When groups were compared with respect to parameters of OS, MDA and NO levels in bone tissue were significantly higher in O than in C (p = 0.032, p = 0.022) and were significantly lower in OV than in O (p = 0.025, p = 0.018). SOD activity was significantly higher in O than in C (p = 0.032). In plasma, MDA activity was significantly higher in O than in C (p = 0.022) and NO level was significantly higher in O than in C and OV (p = 0.017, p = 0.018). Conclusions: Our results suggest that ovariectomy may produce osteoporosis and OS in females, and vitamin C supplementation may provide alterations regarding improvement in OS and BMD values. We assume that studies including more subjects are needed to make a decisive conclusion about OS-BMD relation.Öğe Electrophysiologic evaluation of genitofemoral nerve in children with inguinal hernia repair(W B Saunders Co-Elsevier Inc, 2008) Soyer, Tutku; Tosun, Aliye; Keles, Isik; Inal, Elem; Cesur, Oezkan; Cakmak, MuratAim: Genitofemoral nerve (GFN) injury may occur because of chronic pressure of hernia sac or surgical intervention. A prospective study was performed to evaluate GFN electrophysiologically in children with inguinal hernia repair. Methods: Children with inguinal hernia were evaluated for GFN electrophysiologically before and after (3-6 months postoperatively) inguinal hernia repair. Bilateral GFN motor response latencies and durations were investigated electrophysiologically by surface electrodes. Wilcoxon signed ranked test was used for statistical analysis, and P values lower than .05 was considered to be significant. Results: Eleven patients with a mean age of 4.45 +/- 2.16 were enrolled in the study. Mean latency of patients was 2.37 +/- 0.89 milliseconds preoperatively and 3.14 +/- 1.02 milliseconds postoperatively. Latency of GFN was found prolonged after hernia repair (P = .008). Duration of GFN motor response was 9.94 +/- 1.49 milliseconds and 11.18 +/- 2.44 milliseconds, respectively, in preoperative and postoperative recordings. There was no significant difference detected in mean durations (P > .05). Conclusion: Latency of GFN may prolong after inguinal hernia repair. Prolongation of GFN latency may be the result of surgical injury during hernia repair and consequently also related with chronic groin pain. (C) 2008 Elsevier Inc. All rights reserved.Öğe Evaluation of genitofemoral nerve motor conduction in inguinoscrotal pathologies(W B Saunders Co-Elsevier Inc, 2008) Soyer, Tutku; Tosun, Aliye; Aydin, Gueluemser; Kaya, Murat; Arslan, Ayse; Orkun, Sevim; Cakmak, MuratAim: Inguinoscrotal pathologies are commonly seen in childhood. The genitofemoral nerve (GFN) is responsible for sensitive innervations of scrotal region and the motor innervations of cremasteric muscle. GFN also innervates the afferent and efferent pathways of cremasteric reflex. A prospective study was performed to evaluate the possible relation between inguinoscrotal pathologies and GFN motor functions. Methods: Patients with inguinal hernia, hydrocele, undescended or retractile testicles, aged between 2-12 years were enrolled in the study. Bilateral latency and duration of GFN motor conductions (GFNMC) were obtained electrophysiologically by Surface electrodes. GFNMC recordings of non-pathological sides were assessed as control group. Latency and duration of each group were compared with control group (Mann-Whitney U test). P values lower than .05 were considered significant. Results: Seventy-three electrophysiologic evaluations were investigated in inguinal hernia (n:18), hydrocele (n:9). undescended testicle (n: 14), retractile testicle (n: 12) and control (n:20) groups. There was no age difference between groups and controls. Latency was significantly prolonged in inguinal hernia group when compared with control group (P = .028). Although the latencies were shortened in Undescended testicle group, no significant difference detected (P > .05). Conclusion: Prolonged latencies in inguinal hernia may be a result of nerve trap caused by hernia sac. GFN motor functions showed no causative role in other inguinoscrotal pathologies. It can be also suggested that clinical features of other inguinoscrotal pathologies were not affected by GFN motor functions. Electrophysiological studies in Younger age groups with large number of patients are needed to support our suggestions. (C) 2008 Elsevier Inc. All rights reserved.Öğe Evaluation of panoramic radiography measures for identifying reduced bone mineral density in elderly(Gunes Kitabevi Ltd Sti, 2010) Nalcaci, Rana; Baran, Ilgi; Orkun, Sevim; Tosun, Aliye; Misirlioglu, MeldaIntroduction: The purpose of this study was to assess the validity of panoramic based indices (Mandibular cortical index, cortical width, panoramic mandibular index, and mandibular ratio) and to determine whether they correlate with bone mineral density in elderly. Materials and Method: The participants of this study were 120 patients; 53 males (45-83 years old, mean: 61.6 +/- 10.02) and 67 females (42-81 years old, mean: 60.58 +/- 9.15). Mandibular indices and number of teeth were measured and evaluated from panoramic radiographs. Bone mineral density (BMD) at the lumbar spine was measured by dual energy X-ray absorptiometry. BMD values were categorized as normal (T-score greater than -1.0), and as indicative of osteopenia (T-score -1.0 to -2.5) or osteoporosis (T-score less than -2.5) according to the World Health Organization classification. Results: There were statistically significant correlations between bone mineral density and sex, cortical width, mandibular ratio and mandibular cortical index (p<0.05). However, there were no significant correlations between panoramic mandibular index and bone mineral density. Also, there were significant correlations between mandibular cortical index and panoramic mandibular index (p<0.01), cortical width (p<0.05), mandibular ratio (p<0.05) and the number of mandibular (p<0.01) and maxillary teeth (p<0.05). However, there was no statistical significant difference between the mandibular cortical index and age (p>0.05). Conclusion: Mandibular cortical index can be used for identifying subjects with low bone mass, allowing the dentists to have sufficient clinical and radiographic information to play a useful role in screening for individuals with osteoporosis.Öğe Familial Mediterranean fever and ankylosing spondylitis in a patient with juvenile idiopathic arthritis: a case report and review of the literature(Springer Heidelberg, 2006) Keleş, Işık; Aydin, Gülümser; Tosun, Aliye; İnal, Elem; Keles, Hatice; Orkun, SevimThe association of familial Mediterranean fever (FMF) with juvenile idiopathic arthritis (JIA) or ankylosing spondylitis (AS), most commonly with negative HLA-B27 antigen, was described in several previous reports, although the pathogenic mechanism of this association still remains unknown. Herein we report an uncommon association of FMF with HLA-B27 positive AS as an occasional coincidence in a patient who had been diagnosed as having JIA 23 years previously.Öğe Kas-iskelet sistemi tutulumu olan brusellozisli hastalarda klinik ve laboratuvar özellikler(2005) Aydın, Gülümser; Keleş, Işık; Atalar, Ebru; Açıkgöz, Ergin Ayaşlıoğlu; Tosun, Aliye; Orkun, SevimAmaç: Kırıkkale ve kırsalında kas-iskelet sistemi tutulumu olan brusellozisli hastalarda demografik, klinik ve laboratuvar özellikleri incelemek. Gereç ve Yöntemler: Çalışmaya kas-iskelet sistemi tutulumu olan brusellozis tanısı konulmuş 28 hasta dahil edildi. Hastaların demografik özellikleri, yakınmasının süresi, şekli, olası enfeksiyon kaynağı sorgulandı. Ayrıntılı sistemik ve kas-iskelet sistemi muayene bulguları not edildi. Rutin biyokimya, tam kan sayımı, eritrosit sedimentasyon hızı, C-reaktif protein, romatoid faktör, antinükleer antikor, kan kültürü ve standart tüp aglütinasyon testleri yapıldı. Hastaların tümünde sakroiliak, lumbosakral ve gerekli görülen durumlarda periferik eklem radyografileri değerlendirildi. Klinik ve radyografik olarak derin eklemlerin tutulumundan şüphede kalındığı durumlarda magnetik rezonans görüntüleme yönteminden faydalanıldı. Bulgular: Hastaların yaş ortalaması 39.4 ± 14.4 yıl, hastalık süreleri 10.1 ± 12.7 aydı ve %64.3’ü erkekti. En sık izlenen semptom artralji (%85.7), bulgu ise splenomegaliydi (%32.1). Kan kültürü %39.3 hastada pozitifti. Eklem tutulumu olarak periferik artrit %71 oranı ile ilk sıradaydı ve en sık tutulan periferik eklemler %35 ile kalça ve dizdi. Sakroiliit %32 hastada tespit edildi ve %89’u unilateraldi. Spondilit %14 hastada ve en sık lomber segmentte (%75) izlendi. Her bir kas-iskelet sistemi tutulumunun tipi tüm parametreler açısından diğerleri ile kıyaslandığında sakroiliit grubunda sadece sakroiliak testleri pozitifliği, spondiliti olan grupta yaş, perküsyonla vertebra hassasiyeti ve spinal hareketlerle ağrının varlığı, diğerlerinden anlamlı düzeyde farklıydı (p< 0.05). Sonuç: Bölgemizde brusellozis saptanan ve aynı zamanda kas-iskelet sistemi tutulumu olan olgularda en sık tutulum periferik eklemlerde izlenmektedir. Sakroiliak ekleme yönelik özel testler sakroiliit için yol gösterici olabilir. Özellikle spinal hareketleri ağrılı ve perküsyonla hassasiyet saptanan brusellozisli yaşlı hastalarda omurga tutulumu olabileceği akılda tutulmalıdır. Spinal ya da periferik eklem ağrısı olan ve yumuşak doku romatizmasına bağlı şikayeti bulunan hastalarda brusellozis ayırıcı tanıda yer almalıdır.Öğe Lipoma Arborescens in Childhood: A Report of Two Sisters(Turkish League Against Rheumatism, 2012) Aydin, Gulumser; Keles, Isik; Tosun, Ozgur; Tosun, Aliye; Yilmaz, Latife Ozlem; Karagulle, Tuba Kendi; Orkun, SevimLipoma arborescens (LA) is a rare benign lesion of synovial joints and bursae. The knee is the most common site of the involvement. Magnetic resonance imaging findings are typical in the diagnosis. The number of case reports of LA in children is significantly lower compared to the adults. In this article, two nine-year-old and 15-year-old sisters who were examined for the complaints of bilateral pain and swelling in knees were presented. Magnetic resonance imaging demonstrated typical features of LA in the right knees of both children. Pediatric patients with mono/oligoarticular effusion and synovial hypertrophy without systemic involvement, LA should be considered in differential diagnosis. Magnetic resonance imaging is a sensitive modality in the diagnosis of LA.Öğe Obstructive Sleep Apnea in Ischemic Stroke patients(Hospital Clinicas, Univ Sao Paulo, 2008) Tosun, Aliye; Köktürk, Oğuz; Karataş, Gülçin Kaymak; Ciftci, Tansu Ulukavak; Sepici, VesileOBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index >= 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO(2) was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO(2), and minimum SaO(2), and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.Öğe Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report(Springer Heidelberg, 2007) Sepici, Vesile; Tosun, Aliye; Köktürk, OğuzFibromyalgia syndrome (FMS) is characterized by chronic widespread musculoskeletal pain, stiffness and tenderness at multiple points. Sleep disturbances are common in FMS and patients usually complain about nonrestorative sleep. Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive pharyngeal collapse during sleep. Recurrent arousals from sleep occurs to restore pharyngeal patency in OSAS and this results in increased sympathetic activity and fragmentation of sleep. Sleep disturbances may lead to musculoskeletal pain and some studies suggest a relation between OSAS and FMS. Since OSAS is strongly associated with increased risk of myocardial infarction, cerebrovascular accidents and congestive heart failure, its diagnosis and treatment are of particular importance. Herein we present a female patient with diagnosis of FMS for 10 years who had complaints of morning fatigue, restless sleep, sleepiness during day and snoring besides musculoskeletal symptoms. Severe OSAS was diagnosed after polysomnographic analysis and FMS symptoms were totally improved with nasal continuous positive airway pressure treatment.Öğe Predictive value of grip strength for bone mineral density in males: site specific or systemic?(Springer Heidelberg, 2006) Aydın, Gülümser; Atalar, Ebru; Keleş, Işık; Tosun, Aliye; Zog, Gülfer; Keleş, Hatice; Orkun, SevimThis study aimed to investigate the predictive role of grip strength on bone mineral density (BMD) of different sites in males. Two hundred thirty-four male patients were included in the study. BMD of lumbar spine, femoral neck, proximal radius-ulna (PRU) and distal radius-ulna (DRU) sites were measured by dual-energy X-ray absorptiometry and grip strength by using a hand dynamometer. Grip strength and BMD values of PRU and DRU at forearms were significantly higher on the dominant sides (P = 0.001, P = 0.001, P = 0.001, respectively). Stepwise linear regression analysis revealed that only the grip strength of the same side was the best predictor of the BMD of the dominant and non-dominant PRU with a ratio of 8.5 and 10.2%, respectively, whereas grip strength of the same side, age and weight were the best predictors of the BMD of the dominant and non-dominant DRU with a ratio of 25 and 24.6%, respectively. There was no predictive value of grip strength for BMD of lumbar spine and femoral neck. In conclusion, grip strength appears to be predictive of site specific rather than systemic BMD.Öğe Upper extremity problems in paraplegic patients: Review(Ortadogu Ad Pres & Publ Co, 2007) Tosun, Aliye; Karataş, Gülçin KaymakThe incidence of upper extremity problems has increased along with the prolonged mean lifespan in spinal cord injured people. Depending on a wheelchair for ambulation and for performing daily life activities, bones, joints and soft tissues of the upper extremities in such cases continuously bear weight and consequently several upper extremity problems develop. Therefore, people on wheelchairs should be trained for the necessity of protecting the upper extremities for the continuity of their independence. In addition to the protection of joints, training about upper extremity conditioning techniques including strengthening and flexibility programs should also be provided.
