Arzu Razak Ozdincler

Wii-based Balance Therapy to Improve Balance Function of Children with Cerebral Palsy: A Pilot Study.

[Purpose] Cerebral palsy is a sensorimotor disorder that affects the control of posture and movement. The Nintendo® Wii Fit offers an inexpensive, enjoyable, suitable alternative to more complex systems for children with cerebral palsy. The aim of this study was to investigate the efficacacy of Wii-based balance therapy for children with ambulatory cerebral palsy. [Subjects] This pilot study design included fourteen ambulatory patients with cerebral palsy (11 males, 3 females; mean age 12.07 ± 3.36u2005years). [Methods] Balance functions before and after treatment were evaluated using one leg standing, the functional reach test, the timed up and go test, and the 6-minute walking test. The physiotherapist prescribed the Wii Fit activities,and supervised and supported the patients during the therapy sessions. Exercises were performed in a standardized program 2 times a week for 12 weeks. [Results] Balance ability of every patient improved. Statistically significant improvements were found in all outcome measures after 12 weeks. [Conclusion] The results suggest that the Nintendo® Wii Fit provides a safe, enjoyable, suitable and effective method that can be added to conventional treatments to improve the static balance of patients with cerebral palsy; however, further work is required.

The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis: A randomised controlled clinical trial

Objective: To compare the efficacy of three-dimensional (3D) Schroth exercises in patients with adolescent idiopathic scoliosis. Design: A randomised-controlled study. Setting: An outpatient exercise-unit and in a home setting. Subjects: Fifty-one patients with adolescent idiopathic scoliosis. Interventions: Forty-five patients with adolescent idiopathic scoliosis meeting the inclusion criteria were divided into three groups. Schroth’s 3D exercises were applied to the first group in the clinic and were given as a home program for the second group; the third group was the control. Main Measures: Scoliosis angle (Cobb method), angle of rotation (scoliometer), waist asymmetry (waist – elbow distance), maximum hump height of the patients and quality of life (QoL) (SRS-23) were assessed pre-treatment and, at the 6th, 12th and 24th weeks. Results: The Cobb (-2.53°; P=0.003) and rotation angles (-4.23°; P=0.000) significantly decreased, which indicated an improvement in the clinic exercise group compared to the other groups. The gibbosity (-68.66mm; P=0.000) and waist asymmetry improved only in the clinic exercise group, whereas the results of the other groups worsened. QoL did not change significantly in either group. Conclusion: According to the results of this study the Schroth exercise program applied in the clinic under physiotherapist supervision was superior to the home exercise and control groups; additionally, we observed that scoliosis progressed in the control group, which received no treatment.

The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome

Purpose. To investigate the effectiveness of low-level laser therapy (LLLT) in addition to exercise programme on shoulder function in subacromial impingement syndrome (SAIS). Method. Sixty-seven patients with SAIS were randomly assigned to either a group that received laser (n = 34) or a group that received placebo Laser (n = 26). Pain, functional assessment, disability and muscle strength of shoulder were assessed before and after a 3-week rehabilitation programme. Besides Laser or placebo Laser, superficial cold and progressive exercise programme were administered to both groups, 5 days a week, for 3 weeks. A progressive exercise programme that was done daily twice under supervision in clinic and at home was given to the patients. Results. After the treatment, all outcome measurements had shown significant improvement except muscle strength in both the groups. When the parameters of the improvement were compared, there were no significant differences between the two groups after treatment. Conclusion. We concluded that there is no fundamental difference between LLLT and placebo LLLT when they are supplementing an exercise programme for rehabilitation of patients with shoulder impingement syndrome.

Bobath Concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients: a randomized controlled trial:

Objective: To compare the effects of the Bobath Concept and constraint-induced movement therapy on arm functional recovery among stroke patients with a high level of function on the affected side. Design: A single-blinded, randomized controlled trial. Setting: Outpatient physiotherapy department of a stroke unit. Subjects: A total of 24 patients were randomized to constraint-induced movement therapy or Bobath Concept group. Intervention: The Bobath Concept group was treated for 1 hour whereas the constraint-induced movement therapy group received training for 3 hours per day during 10 consecutive weekdays. Main measures: Main measures were the Motor Activity Log-28, the Wolf Motor Function Test, the Motor Evaluation Scale for Arm in Stroke Patients and the Functional Independence Measure. Results: The two groups were found to be homogeneous based on demographic variables and baseline measurements. Significant improvements were seen after treatment only in the ‘Amount of use’ and ‘Quality of movement’ subscales of the Motor Activity Log-28 in the constraint-induced movement therapy group over the the Bobath Concept group (P = 0.003; P = 0.01 respectively). There were no significant differences in Wolf Motor Function Test ‘Functional ability’ (P = 0.137) and ‘Performance time’ (P = 0.922), Motor Evaluation Scale for Arm in Stroke Patients (P = 0.947) and Functional Independence Measure scores (P = 0.259) between the two intervention groups. Conclusions: Constraint-induced movement therapy and the Bobath Concept have similar efficiencies in improving functional ability, speed and quality of movement in the paretic arm among stroke patients with a high level of function. Constraint-induced movement therapy seems to be slightly more efficient than the Bobath Concept in improving the amount and quality of affected arm use.

Reliability and responsiveness of algometry for measuring pressure pain threshold in patients with knee osteoarthritis.

[Purpose] This study aimed to establish the intrarater reliability and responsiveness of a clinically available algometer in patients with knee osteoarthritis as well as to determine the minimum-detectable-change and standard error of measurement of testing to facilitate clinical interpretation of temporal changes. [Subjects] Seventy-three patients with knee osteoarthritis were included. [Methods] Pressure pain threshold measured by algometry was evaluated 3 times at 2-min intervals over 2 clinically relevant sites—mediolateral to the medial femoral tubercle (distal) and lateral to the medial malleolus (local)—on the same day. Intrarater reliability was estimated by intraclass correlation coefficients. The minimum-detectable-change and standard error of measurement were calculated. As a measure of responsiveness, the effect size was calculated for the results at baseline and after treatment. [Results] The intrarater reliability was almost perfect (intraclass correlation coefficient = 0.93–0.97). The standard error of measurement and minimum-detectable-change were 0.70–0.66 and 1.62–1.53, respectively. The pressure pain threshold over the distal site was inadequately responsive in knee osteoarthritis, but the local site was responsive. The effect size was 0.70. [Conclusion] Algometry is reliable and responsive to assess measures of pressure pain threshold for evaluating pain patients with knee osteoarthritis.

Effects of Nintendo Wii-Fit(®) video games on balance in children with mild cerebral palsy.

This study compared the effects of Nintendo Wii‐Fit® balance‐based video games and conventional balance training in children with mild cerebral palsy (CP).

The Turkish version of the Achilles tendon Total Rupture Score: cross-cultural adaptation, reliability and validity

PurposeThe Achilles tendon Total Rupture Score (ATRS) is a questionnaire designed to evaluate pain, symptoms, function and physical activity after Achilles tendon rupture. The purpose of this study was to translate and culturally adapt the ATRS into Turkish and to determine its reliability and validity.MethodsThe ATRS was translated into Turkish in accordance with the stages recommended by Beaton. Seventy-four patients (73 male; average age: 42.3xa0±xa07.6; range 27–63xa0years) suffering from previous Achilles tendon ruptures were included for the study. The ATRS-Turkish was administered twice at 7–14xa0days intervals with 52 of the 74 patients (51 male, average age: 41.8xa0±xa07.8) to assess the test–retest reliability. Cronbach’s α was used for internal consistency, and the inter-rater correlation coefficient (ICC) was used to calculate the test–retest reliability. The Turkish Short-Form-12 (SF-12) and the Foot and Ankle Outcome Score (FAOS) were employed for validity estimation.ResultsThe internal consistency (Cronbach’s αxa0=xa00.95) and the test–retest reliability (ICCxa0=xa00.98) were excellent. The mean interval between the two tests was 7.1xa0±xa03.1xa0days. The mean and standard deviation of the first and second assessment of the ATRS were 78.1xa0±xa023.1 and 79.1xa0±xa022.5, respectively. The correlation coefficient between the ATRS-Turkish and the FAOS subscales (pain, symptoms, activities of daily living, sports and recreational activities, and quality of life) were determined (rxa0=xa00.82, rxa0=xa00.66, rxa0=xa00.79, rxa0=xa00.83 and rxa0=xa00.60, respectively, pxa0<xa00.0001). The ATRS-Turkish displayed good correlation with the SF-12 physical component score (rxa0=xa00.63, pxa0<xa00.001) and no correlation with the SF-12 mental component score (rxa0=xa00.22, pxa0=xa00.06).ConclusionThe ATRS-Turkish was found to be reliable and valid for outcome evaluation after Achilles tendon ruptures.Level of evidenceII.

Intensive supervision of rehabilitation programme improves balance and functionality in the short term after bilateral total knee arthroplasty

AbstractPurposenTo evaluate the short-term results of the rehabilitation programme with two different supervision on balance and functionality after simultaneously bilateral total knee arthroplasty (SBTKA) in patients with osteoarthritis and to compare the results with those of healthy individuals.MethodsThis study was a single-blind randomized controlled study. Two exercise groups who underwent primary bilateral total knee arthroplasty (Group 1, nxa0=xa020 and Group 2, nxa0=xa020) and a control group of healthy individuals (Group 3, nxa0=xa020) included in the study. Group 1 applied exercise programme with intensive supervision of the physiotherapist for a period of 1xa0month (2xa0days/1xa0week). Group 2 performed exercise programme under the control of same physiotherapist twice monthly (1xa0day/2xa0weeks), and the patients were checked every week by telephone interview. Pre-operative and post-operative blind evaluations were made at first and second month. Static balance with single leg stance test, dynamic balance with timed get up & go (TGUG), functionality with walking cadence, stair climbing test (SCT) and Western Ontario McMaster Universities (WOMAC) index were assessed.nResultsGroup 1 improved statistically significantly better in terms of SLST (pxa0=xa00.0 (right), pxa0=xa00.0 (left)) and WOMAC function (pxa0=xa00.0) at first month, and SLST (pxa0=xa00.0), TGUG (pxa0=xa00.0), SCT (pxa0=xa00.0), WOMAC pain (pxa0=xa00.0), stiffness (pxa0=xa00.0) and function (pxa0=xa00.0) at second month. In Group 1, TGUG, walking cadence, SCT, WOMAC pain, stiffness and function results reached the levels of healthy individuals at second month, and SLST was better for two legs as compared to healthy individuals. In Group 2, cadence results were similar to healthy individuals at second month.ConclusionsThe osteoarthritis patients who had the applied rehabilitation programme after SBTKA with intensive supervision of the physiotherapist for 1xa0month have obtained more improvements in balance and functional parameters, and it was demonstrated that their performances approached the healthy control group values. As a clinical relevance of our study, intensive supervision of rehabilitation programme should be provided to the patients after SBTKA surgery to accomplish early balance and functional improvements.

Plantar flexor muscle weakness may cause stiff-knee gait

AIMnThe iterative simulation studies proclaim that plantar flexor (PF) muscle weakness is one of the contributors of stiff knee gait (SKG), although, whether isolated PF weakness generates SKG has not been validated in able-bodied people or individuals with neuromuscular disorders. The aim of the study was to investigate the effects of isolated PF muscle weakness on knee flexion velocity and SKG in healthy individuals.nnnMETHODnTwenty able-bodied young adults (23±3 years) participated in this study. Passive stretch (PS) protocol was applied until the PF muscle strength dropped 33.1% according to the hand-held dynamometric measurement. Seven additional age-matched able-bodies were compared with participants to discriminate the influence of slow-walking. All participants underwent 3D gait analysis before and after the PS. Peak knee flexion angle, range of knee flexion between toe-off and peak knee flexion, total range of knee-flexion, and time of peak knee flexion in swing were selected to describe SKG pattern.nnnRESULTSnAfter PS, the reduction of plantar flexor muscle strength (33.14%) caused knee flexion velocity drop at toe-off (p=0.008) and developed SKG pattern by decreasing peak knee flexion (p=0.0001), range of knee flexion in early swing (p=0.006), and total knee flexion range (p=0.002). These parameters were significantly correlated with decreased PF velocity at toe-off (p=0.015, p=0.0001, p=0.005, respectively). The time of peak knee flexion was not significantly different between before and after stretch conditions (p=0.130).nnnCONCLUSIONSnThese findings verified that plantar flexor weakness cause SKG pattern by completing three of SKG parameters. Any treatment protocol that weakens the plantar flexor muscle might impact the SKG pattern.

Translation, cross-cultural adaptation, reliability and validity of the Turkish version of the Western Ontario Meniscal Evaluation Tool (WOMET)

AbstractPurposenThe Western Ontario Meniscal Evaluation Tool (WOMET) is a questionnaire designed to evaluate quality of life related to the health (HRQOL) of patients with meniscus pathology. The purpose of this study was to translate and culturally adapt the WOMET into Turkish, and thereby to determine the reliability and validity of the translated version.MethodsThe WOMET was translated into Turkish in accordance with the stages recommended by Guillemin. Ninety-six patients [35 male, 61 female; mean age: 43.6xa0±xa011.7 (23–71)xa0years] with meniscal pathology were included in the study. The WOMET was completed twice at 3–7-day intervals. The inter-rater correlation coefficient was used for reliability, and Cronbach’s α was used for internal consistency. Patients were asked to answer the Lysholm knee scale and the short form-36 (SF-36) for the validity of the estimation. The distribution of ceiling and floor effects was determined.ResultsMean and standard deviation of the first and second evaluations of the total WOMET were 1,048.9xa0±xa0271.6 and 1,000.4xa0±xa0255.2 (pxa0=xa00.03), respectively. The test–retest reliability of the total score, physical function, sports/work/lifestyle and emotion domains were 0.88, 0.78, 0.80 and 0.85, respectively. Cronbach’s α was 0.89. WOMET was most strongly related to the physical function scale and the physical component score (ρ 0.54, ρ 0.60, respectively; pxa0<xa00.001). The weakest correlations between the WOMET and the SF-36 were for the mental component score and the emotional role functioning (ρ 0.11, ρ 0.03, respectively). We observed no ceiling and floor effects of the overall WOMET score, but 36.5xa0% of the patients showed floor effect in the question of “numbness”, and 40.6xa0% of the patients showed ceiling effect in the question of “consciousness”.ConclusionThe Turkish version of the WOMET is valid and reliable. It can therefore be used for HRQOL of patients with meniscal pathology.Level of evidenceII.