Arzu Genç

The effect of supervised exercises on static and dynamic balance in Parkinson's disease patients.

BACKGROUND/AIM The aim of the this study was to examine the effects of supervised exercises on measures of static and dynamic balance Parkinsons disease (PD) patients. MATERIAL AND METHODS The study used a before-after study design. Seventeen PD patients with mild and moderate levels of disability were enrolled in the study. Patients followed an exercise program under a physiotherapists supervision one day a week for 12 weeks. The standard Balance Master protocol was used before and after exercise to assess static and dynamic balance. RESULTS A statistically significant difference was observed in the unilateral balance test, one of the static balance assessments performed while standing on the left or right leg with eyes closed (p < 0.05). With respect to dynamic balance, a statistically significant difference in the maximum excursion of limits of stability (LOS), one of the balance tests used in the supervised exercise programs for patient with Parkinsons disease, between measurements taken before and after exercises was also detected (p < 0.05). CONCLUSIONS The change of LOS revealed that dynamic balance improved due to the exercises. Thus, our supervised exercise program provided improvement in dynamic balance of PD patients.

Spinal Accessory Nerve Monitoring and Clinical Outcome Results of Nerve-Sparing Neck Dissections

Objective To investigate the role of intraoperative spinal accessory nerve monitoring in predicting postoperative shoulder function in spinal accessory nerve-sparing neck dissections. Study Design Prospective, double-blind clinical trial. Setting Academic, tertiary care center. Subjects and Methods This study was performed on 20 neck sites of 17 consecutive patients who had neck dissections sparing the spinal accessory nerve. Threshold increment ≥0.25 mA and amplitude decrement ≥72% were classified as significant intraoperative neuromonitoring changes while lesser differences were classified as insignificant intraoperative neuromonitoring changes. All patients had intraoperative neuromonitoring recordings when the spinal accessory nerve was first identified and at the end of surgery. Postoperative shoulder function was evaluated neurophysiologically with electromyography and clinically with Constant-Murley Score; daily activity restrictions were evaluated with Activity Restriction Scale. Results Clinical assessment of shoulder functions at postoperative first and second months showed statistically significant deteriorations when compared with preoperative values (P < .05). The shoulder function deterioration was statistically significantly less for patients with insignificant intraoperative neuromonitoring changes than patients with significant intraoperative neuromonitoring changes (P < .05). Daily activity restriction deteriorations were present in both groups at first postoperative month (P < .05). While they persisted in the group with significant intraoperative neuromonitoring changes during the second postoperative month (P < .05), there was continuing recovery in the insignificant intraoperative neuromonitoring change group and statistical significance disappeared (P > .05). Conclusion Our results support the predictive value of spinal accessory nerve intraoperative neuromonitoring for determining shoulder function deterioration and activity restriction scores.

The Nordic Musculoskeletal Questionnaire: cross-cultural adaptation into Turkish assessing its psychometric properties

Abstract Purpose: The purpose of this study was to linguistically and culturally adapt the Nordic Musculoskeletal Questionnaire (NMQ) for use in Turkey, and to examine the psychometric properties of this adapted version. Method: The cross-cultural adaptation was achieved by translating the items from the original version, with back-translation performed by independent mother-tongue translators, followed by committee review. Reliability (internal consistency and test–retest) was examined for 198 participants who completed the NMQ twice (with a 1 week interval). Construct validity was examined with data from 126 participants from the same population, who completed further four questionnaires related to the body regions described in the NMQ. Results: The internal consistency was excellent (Cronbach’s alpha = 0.896). The test–retest reliability was examined with the prevalence-adjusted bias-adjusted kappa (PABAK) and all items showed moderate to almost perfect reliability (PABAK = 0.57–0.90). Participants with a musculoskeletal problem in a related region had significantly more disability/pain, as assessed by the relevant questionnaires (p < 0.001), indicating that the NMQ had a good construct validity. Conclusions: This study provided considerable evidence that the Turkish version of the NMQ has appropriate psychometric properties, including good test–retest reliability, internal consistency and construct validity. It can be used for screening and epidemiological investigations of musculoskeletal symptoms. Implications for Rehabilitation The Nordic Musculoskeletal Questionnaire (NMQ) can be used for the screening of musculoskeletal problems. The NMQ allows comparison of musculoskeletal problems in different body regions in epidemiological studies with large numbers of participants. The Turkish version of the NMQ can be used for rehabilitation due to its appropriate psychometric properties, including good test–retest reliability, internal consistency and construct validity.

The prevalence differences of musculoskeletal problems and related physical workload among hospital staff

BACKGROUND The musculoskeletal problems (MSP) vary among different occupations since they had different characteristics and physical workloads. Therefore, it is important to know the difference between the occupational groups to design preventing physiotherapy interventions. OBJECTIVE To investigate the prevalence differences of MSPs and related physical workload among hospital staff. METHODS In this cross-sectional study, 416 hospital staff completed the Nordic Musculoskeletal Questionnaire for MSP and Physical Workload Questionnaire for assessing the physical workload. RESULTS One-year prevalence of low back, neck, upper back, and shoulders were 73.8%, 59.9%, 59.4%, and 52.2%, respectively. The most preventing MSPs from work found in the low back (39.2%), upper back (26.7%), and the neck (24.5%). MSP of low back impacted nurses the most with a 1-year prevalence of 81.3% and 57.1% of nurses were prevented from working. Nurses, service and cleaning staff had significantly more physical workload than secretaries and physicians. CONCLUSIONS MSP of low back had the highest prevalence among hospital staff and it was the leading cause which prevented from working. Nurses were the most in danger in terms of MSPs among hospital staff. Physical workload was significantly higher in nurses, service and cleaning staff than secretaries and physicians.

Effect of scapular muscle endurance on chronic shoulder pain in textile workers.

OBJECTIVE The aim of this study was to investigate the effect of scapular muscle endurance on chronic shoulder pain in textile workers. METHODS In total, 91 textile workers were divided into two groups based on the presence (n=43) or absence (n=48) of chronic shoulder pain, as assessed using the Nordic Musculoskeletal Questionnaire (NMQ). The endurance of the serratus anterior and trapezius muscles was assessed using the Scapular Muscle Endurance (SME) test. RESULTS In the group with chronic shoulder pain, mean scapular muscle endurance was significantly lower than that in the pain-free group (t-test, p< 0.05). There was a significant negative correlation between rest - activity pain intensity and SME (Pearson correlation analysis, p< 0.01). CONCLUSIONS Scapular muscle endurance has an effect on the development of shoulder pain in textile workers.

Use of tape measure in people with or without back pain in assessment of reposition error.

AIM Examining lumbar repositioning error (RE) using a tape measure in nonspecific low back pain (NLBP) and control groups and determining whether RE is different in subjects with nonspecific back pain than in controlled subjects. MATERIAL AND METHODS The study was totally applied to 36 subjects of whom 18 were healthy subjects and 18 were NLBP patients. The ability of the subjects to take the targeted positions was assessed. In subjects with NLBP the evaluation of the pain was assessed by using Visual Analog Scale (VAS), and disability measurement was made using Oswestry Disability Index (ODI). RESULTS RE was found in all the measurements except for lumbar flexion with eyes open(p=0.15) in control group (p < 0.05). There were RE for all the measurements in NLBP grpup (p < 0.05). When RE of two groups compared only lumbar flexion with eyes open measurement (p = 0.04) in NLBP group was higher then control group. CONCLUSION As a result of our study, it has been seen that RE measurement of the lumbar spine with tape measure, which is cheap and clinically practical, is a reliable method, and can be used in the assessment of NLBP patients and in the determination of the rehabilitation program.

What are the hemodynamic and respiratory effects of passive limb exercise for mechanically ventilated patients receiving low-dose vasopressor/inotropic support?

Passive limb exercises (PLEs) are used widely in the management of unconscious patients and an early start is recommended. The aim of this study was to determine the effects of PLEs on hemodynamic and respiratory parameters in mechanically ventilated critically ill patients receiving low-dose vasopressor/inotropic support. The charts of 120 mechanically ventilated patients who underwent PLEs were evaluated retrospectively between January 2000 and July 2002. Patients were grouped on the basis of administration of vasopressor/inotropic support. Thirty-eight patients did not get vasopressor/inotropic support (group 1) and 82 patients received low-dose vasopressor/inotropic support (dopamine <10 &mgr;g/kg/min, noradrenaline/adrenaline <0.1; group 2). Central venous pressure, heart rate, mean arterial pressure, and oxygen saturation were recorded before and immediately after PLEs. After PLEs in group 1 patients, central venous pressure and mean arterial pressure values increased significantly, and in group 2 patients, central venous pressure increased significantly (P < .05). No statistically significant difference was observed in the rate of change of hemodynamic or respiratory parameters between the 2 groups after the PLEs (P > .05). This retrospective study confirmed that PLEs result in similar hemodynamic and respiratory changes in critically ill patients who received low-dose vasopressor/inotropic support versus those who do not.

The Impact of Disability Level on Intention to Perform Home Exercises in Patients with Spinal Pain

Objectives: The aim of our study is to determine whether or not disability level affects the practice and perception of home exercises. Methods: Seventy-five patients diagnosed with cervical and lumbar disc herniation were included in this study. Some had undergone an operation, others had not. The patients were divided into three groups according to the lumbar and cervical Oswestry Disability Index [ODI] scores. Group 1 comprised those with minimal disability, Group 2 with moderate disability, and Group 3 had patients with severe disability. The patients were questioned on their performance of home exercises with a questionnaire developed from the Triandis model consisting of items about perceived consequences, affects, and social factors. Results: When the various sections of the home-based questionnaire were examined according to the groups, no difference was found in the General Intention scores among the three groups [p <.05]. However, the Perceived Consequences scores were found to be significantly lower in Group 2 compared to other groups. In Group 3, the Social Factors scores were in the worst condition when compared to other groups [p <.05]. The affect scores in Group 3 was significantly higher compared to Group 1 [p <.05]. Conclusions: Improving the perception of home exercises assigned to spinal pain patients according to disability status requires implementing more effective methods, such as written exercise sheets and video demonstrations, especially in the patients with lower disability status.

Effect of deep breathing exercises on oxygenation after major head and neck surgery

OBJECTIVES: To investigate respiratory and hemodynamic responses to deep breathing exercise (DBE) during the follow-up period in the intensive care unit after major head and neck surgery. STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: Thirty-five patients were instructed to perform DBE every hour for 3 consecutive hours during the first postoperative day. The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2), oxygen saturation (SpO2), respiratory rate (RR), heart rate (HR), and mean arterial pressure (MAP) was recorded. RESULTS: DBE increased the PaO2/FiO2 ratio from 416.7 ± 143.6 to 453.4 ± 141.4 mm Hg and increased SpO2 from 97.4 ± 1.9 to 99.2 ± 0.9. DBE decreased the RR from 24.1 ± 3.3 to 21.8 ± 2.9 breaths/min (P < 0.05). No statistically significant difference in HR or MAP was observed after DBE (P > 0.05). CONCLUSION: DBE improves oxygenation after major head and neck surgery, without causing additional harmful hemodynamic effects.

Evaluation of early period physical performance, physical activity, pain and disability levels of patients operated for cervical disc hernia

Abstract. Study design: A prospective study made into cervical disc hernias.Objectives: To assess the changes in the early postoperative period of the patients with cervical disc hernia in terms of the painand disability we measured according to ‘The Neck Pain and Disability Scale’, physical performance, fatigue, fear of activity(kinesiophobia), physical activity levels.Setting: Neurosurgical department.Summaryofbackgrounddata: Kinesiophobiaanditsassociatedavoidancebehaviorinthedevelopmentofchronicmusculoskeletalpain has been of great concern over the past decade, thus rendering appropriate and detailed assessments in the postoperativeperiod very important.Methods: Sixteenpatients operated onbecause ofcervical discherniawereincluded inourstudy. Thepain anddisability, physicalperformance, fatigue, kinesiophobia, and physical levels of the patients were evaluated pre-postoperatively, during discharge andat the end of the second month.Results: While pain, disability measured according to ‘The Neck Pain and Disability Scale’ fatigue were decreasing, allperformance measurements except the sit/stand, lying/sit and loaded reach were getting highest scores on the 2nd postoperativemonth. Although kinesiophobia, peaked at the 2nd postoperative month, physical activity level had also arrived the preoperativelevel at this time.Conclusion: Increased kinesiophobia, affected the physical performances and physical activity levels of the patients in daily livesin spite of decreased pain, disability and fatigue. Kinesiophobia had effects on postoperative recovery duration, daily life, andreturn to work. A detailed evaluation should be performed particularly for kinesiophobia in early postoperative period.Keywords: Cervical fusion, neck pain, performance, physical activity, performance early period