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June 2009KUWAIT MEDICAL JOURNAL 1334. Valensi P, Sachs RN, Harfouche B, et al. Predictive valueof cardiac autonomic neuropathy in diabetic patientswith or without silent myocardial ischemia. DiabetesCare 2001; 24:339-343.5. Gupta SB, Pandit RB. Silent myocardial ischaemia andcardiac autonomic neuropathy in diabetics. IndianHeart J 1992; 44:227-229.6. Jermendy G, Davidovitz Z, Khoor S. Connectionbetween painless abnormal ST- deflection andautonomic neuropathy in diabetes mellitus. Orv Hetil1993; 134:65-69.7. Langer A, Freeman MR, Josse RG, Steiner G, ArmstrongPW. Detection of silent myocardial ischemia in diabetesmellitus. Am J Cardiol 1991; 67:1073-1078.8. Melina D, Colivicchi G, Melina G, Pristipino C.Prevalence of silent ST segment depression duringlong term ambulatory electrocardiographic monitoringin asymptomatic diabetic patients with essentialhypertension. Minerva Med 1993; 84:301-305.9. Vaishnav S, Stevenson R, Merchant B, Lagi K,Ranjadayalan K, Timmis AD. Relation between heartrate variability early after acute myocardial infarctionand long-term mortality. Am J Cardiol 1994; 73:653-657.10. Dellborg M, Emanuelsson H, Swedberg K. Silentmyocardial ischemia during coronary angioplasty.Cardiology 1993; 82:325-334.11. Chierchia S, Muiesan L, Davies A, Balasubramian V,Gerosa S, Raftery EB. Role of the sympathetic nervoussystem in the pathogenesis of chronic stable angina.Implications for the mechanism of action of betablockers.Circulation 1990; 82:SII:71-81.12. White JC. Cardiac pain: anatomic pathways andphysiologic mechanisms. Circulation 1957; 16:644-655.13. McAreavey D, Neilson JM, Ewing DJ, Russell DC.Cardiac parasympathetic activity during the earlyhours of acute myocardial infarction. Br Heart J 1989;62:165-170.14. Stein PK, Bosner MS, Kleiger RE, Conger BM. Heartrate variability: a measure of cardiac autonomic tone.Am Heart J 1994; 127:1376-1381.15. Goseki Y, Matsubara T, Takahashi N, Takeuchi T,Ibukiyama C. Heart rate variability before the occurrenceof silent myocardial ischemia during ambulatorymonitoring. Am J Cardiol 1994; 73:845-849.16. Zharov E, Kazankov IuN, Grigor’ev MIu. Silentmyocardial ischemia in patients with diabetes mellituswithout the clinical manifestation of ischemic heartdisease. Kardiologiia 1993; 33:16 -18.17. Hikita H, Kurita A, Takase B, et al. Usefulness of plasmabeta endorphin level, pain threshold and autonomicfunction in assessing silent myocardial ischemia inpatients with and without diabetes mellitus. Am JCardiol 1993; 72:140-143.18. O ́Brien IA, O ́Hare JP, Lewin IG, Corrall RJ. Theprevalence of autonomic neuropathy in insulindependentdiabetes mellitus: a controlled study basedon heart rate variability. Q J Med 1986; 61: 957-967.19. Quek DK, Khor PG, Ong SB. Association of diabeticautonomic neuropathy with painless myocardialischaemia induced by exercise. Singapore Med J 1992;33:177-181.20. Lund DD, Subieta AR, Pardini BJ, Chang KS.Alterations in cardiac parasympathetic indices in STZinduceddiabetic rats. Diabetes 1992; 41:160-166.21. Malliani A, Lombardi F, Pagani M. Power spectrumanalysis of heart rate variability: a tool to exploreneural regulatory mechanisms. Br Heart J 1994; 71:1-2.22. Risk M, Bril V, Broadbridge C, Cohen A. Heart ratevariability measurement in diabetic neuropathy:review of methods. Diabetes Technol Ther 2001; 3:63-76.23. Biagini E, Schinkel AF, Bax JJ, et al. Long term outcomein patients with silent versus symptomatic ischaemiaduring dobutamine stress echocardiography. Heart2005; 91:737-742.24. Shakespeare CF, Katritsis D, Crowther A, Cooper IC,Coltart JD, Webb-Peploe MW. Differences in autonomicnerve function in patients with silent and symptomaticmyocardial ischaemia. Br Heart J 1994; 71:22-29.25. Valensi P, Paries J, Attali JR. French group forResearch and Study of Diabetic Neuropathy. Cardiacautonomic neuropathy in diabetic patients: influenceof diabetes duration, obesity and the microangiopathiccomplications - the French multicenter study.Metabolism 2003; 52:815-820.
134KUWAIT MEDICAL JOURNAL June 2009Preliminary ReportEffects of Visual Feedback Balance Training byUsing Computerized Dynamic Posturographyin Patients with Multiple SclerosisMaria Kondeva Ivanova, Mohieldin M Ahmed, Doahoo Mosalem M, Waleed Ahmed Al-BusairiPhysical Medicine and Rehabilitation Hospital, Ministry of Health, KuwaitKuwait Medical Journal 2009; 41 (2): 134-139ABSTRACTObjectives: To study the effects of the visual feedback balancetraining on the Berg Balance Scale (BBS) under static anddynamic conditions, the somatosensory, visual and vestibularsystems by dynamic posturography before and after trainingprogram in patients with multiple sclerosis (MS)Design: Retrospective case training studySetting: Physical Medicine and Rehabilitation Hospital,Ministry of Health, KuwaitSubjects and Methods: A total of 23 patients with MS wererecruited.Intervention: All patients were evaluated using both the BBSand the sensory organization test (SOT) using computerizeddynamic posturography (CDP) before and three months afterthe training program. The SOT consists of six conditions andcomposite equilibrium score (CES).Main Outcome Measures: CES (%) and SOT werecalculatedResults: Before training, all patients had a reduction of BBSSand parameters of the SOT. After training, a significantincrease of BBS (p < 0.05), all parameters of the SOT (p
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