Immobilisation secondary to spinal cord injury (SCI) is associated with marked and rapid atrophy of trabecular bone. The purpose of this study was to evaluate bone mineral density (BMD) in both the upper and lower extremities following SCI sustained for various lengths of time and to correlate the BMD to the level of the lesion, time from injury, spasticity and serum calcium, phosphorus and alkaline phosphatase (ALP) levels. A study was undertaken in 41 SCI patients with a mean age of 35.8+12.7 years. A signi®cant di erence in BMD between upper and lower extremities of the paraplegics were found. BMD of upper and lower extremities were similar in tetraplegies. The BMD values were signi®cantly di erent when the upper extremity scores of paraplegics and tetraplegics were compared but BMD scores of the lower extremities were similar in the two groups. The decrease in BMD was less in the spastic patients when compared to the¯accid group. There was a positive correlation between time from injury and the degree of BMD de®cit in the paralysed areas. In the whole group of patients a signi®cant positive correlation was found between the duration of SCI and serum ALP levels.

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Side effects are often seen when using oral drug treatment for spasticity. Adding hydrotherapy to the rehabilitation program can be helpful in decreasing the amount of medication required. Future studies must evaluate benefits of hydrotherapy for rehabilitation.

Objective: To compare the standard risk factors for coronary heart disease (CHD), de®ned in National Cholesterol Education Program II (NCEP II) of Turkish spinal cord injury (SCI) patients with healthy controls, discuss the results according to the ®ndings in Turkish population, and SCI patients in the literature. Design: We assessed 52 age and sex matched healthy control subjects, and 69 SCI patients (16 females, 53 males with the mean age of 33.9+11.37 years) with time since injury of 12.8+13.45 months. The study consisted of 45 paraplegics, and 24 tetraplegics with 54% incomplete, and 46% complete injury. Results: Risk factors for CHD according to NCEP II were; age and sex in 16%, positive family history in 0%, cigarette smoking in 54%, hypertension (HT) in 0%, high total cholesterol (TC) in 32%, high low-density lipoprotein cholesterol (LDL) in 41%, low highdensity lipoprotein cholesterol (HDL) in 52%, and diabetes mellitus (DM) in 7% of our SCI patients, respectively. Compared to controls DM, high TC, LDL, and low HDL were statistically more frequent in SCI patients. We found a negative correlation between serum HDL and time since injury. TC (186+32 vs 205+36; P=0.025), TC/HDL (5.34+1.17 vs 6.26+1.5; P=0.005), and LDL/HDL (3.57+0.9 vs 4.16+1.3; P=0.027) were signi®cantly increased in patients with time since injury of more than 1 year, while HDL levels (35.8+6.36 vs 33.86+6.47; P=0.213) decreased without reaching statistical signi®cance. The lipid pro®les did not show any correlation with the neurological level, and completeness of lesions. Conclusions: SCI confers additional CHD risk over that present inherently in the parent population due to enforced sedentary lifestyle and this increases with time since injury.The preliminary study consisting of 26 patients was accepted for poster presentation in

Effects of balneotherapy on Primary Fibromyalgia Syndrome (FMS) have been studied well, except for its effect on the respiratory symptoms of FMS. In this study we allocated 56 patients with FMS into three groups who matched according to age, gender and duration of illness. All three groups received the same three physical therapy modalities (PTM): transcutaneous electrical nerve stimulation (TENS), ultrasound (US) and infrared (IR). The first group received PTM plus balneotherapy (PTM+BT), the second group received PTM alone (PTM), whilst the third group received PTM plus hydrotherapy (PTM+HT). All groups were treated for three weeks and in the same season. All patients were assessed at four time points: (a) at baseline, (b) on the 7th day of therapy, (c) at the end of therapy (after 3 weeks) and (d) at 6 months after the end of therapy. The effectiveness of treatments in all groups were evaluated in three main categories (pain, depressive and respiratory symptoms). Tender point count, total algometric measurements and pain with visual analog scale for pain; Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) for depression; dyspnea scale, and spirometric measurements for respiratory symptoms; plus quality of life with visual analog scale as a general measurement of effectiveness were taken at all four assessment time points.Both at the end of therapy and at the 6 months follow up significant improvements in dyspnea scale, and spirometric measurements, as well as in other measured parameters were observed in group PTM+BT. All groups achieved significant improvements in BDI and HDRS but scores of PTM and PTM+HT groups had overturned at 6 months follow up. Except second group which receieved PTM alone, pain evaluation assessments were improved at 6 month follow up in PTM+HT and PTM+BT groups. But PTM+BT group had more significant improvements at the end of therapy. PTM group had no significant change for dyspnea scale and spirometric measurements. PTM combined BT and HT groups achieved significant improvements at the end of therapies for dyspnea scale and spirometric measurements, but only PTM +BT group had significant improvements for dyspnea scale and spirometric measurements at six month follow up. The group of PTM+BT was significantly better than other groups. Our results suggest that supplementation of PTM with balneotherapy is effective on the respiratory and other symptoms of FMS and these effects were better than other protocols at 6 month follow up.