Erbil Dursun

Effects of biofeedback treatment on gait in children with cerebral palsy

Purpose: We evaluated the effectiveness of biofeedback treatment on gait function in children with cerebral palsy. Method: Thirty-six children with spastic cerebral palsy and dynamic equinus deformity were included in the study. The biofeedback group consisted of 21 children who each received EMG biofeedback training plus conventional exercise programme. The control group consisted of 15 children who each received conventional exercise programme only. Active range of motion of the ankle joints, muscle tone of plantar flexors, and gait function of the children were evaluated and compared. Results: The biofeedback group displayed statistically significant improvements regarding tonus of plantar flexor muscles and active ROM of ankle joints (p < 0.000 for all parameters). Gait function showed statistically significant progress in both of the groups, but the biofeedback group was superior to controls. Conclusions: Children with cerebral palsy and dynamic equinus deformities may benefit from biofeedback treatment for ambulation.

Ankle-foot orthoses: effect on gait in children with cerebral palsy.

Purpose: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. Method: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. Results: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p<0.001), no significant difference in cadence (p=0,501), and stride width (p=0.796), and a significant decrease in CGAS (p<0.001), compared to barefoot condition. Conclusions: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.

Angular Biofeedback Device for Sitting Balance of Stroke Patients

BACKGROUND AND PURPOSE Impaired sitting balance is an important and time-consuming complication for stroke patients. We examined the effect of the use of an angular biofeedback device in addition to physical therapy in training stroke patients with impaired sitting balance compared with outcome in patients receiving conventional physical therapy only. METHODS The biofeedback group consisted of 24 patients who received angular biofeedback training in addition to conventional physical therapy. The number of biofeedback signals and the lengths of time a patient could sit balanced throughout a period of 5 minutes before the training program, after 10 days of treatment, and at discharge were recorded and compared with those of the control group of 13 patients who received conventional physical therapy only. RESULTS It was found that 75% of the biofeedback group gained sitting balance after 10 days of treatment in comparison with 15.4% of the control group (P < .001). At discharge, 91.6% of the biofeedback group and 84.6% of the control group gained sitting balance (P = .510), and 45.8% of the biofeedback group and 46.2% of the control group managed independent ambulation (P = .985). The mean rehabilitation periods among the ambulatory patients of the biofeedback and control groups were 9.45 +/- 0.71 and 13.83 +/- 1.70 weeks, respectively (P = .049). The mean training time in which the biofeedback group gained sitting balance was significantly shorter than that of the control group (P < .001). CONCLUSIONS Angular biofeedback intervention, by providing earlier postural trunk control, is a useful adjunct to conventional physical therapy in the rehabilitation of stroke patients with impaired sitting balance.

Abnormal QT dispersion in Behçet's disease.

Behçets disease, which was originally described by Hulusi Behçet in 1937, is a generalized chronic inflammatory disease characterized by recurrent oral and genital ulcerations, ocular and dermal manifestations. Cardiac manifestations include pericarditis, myocarditis, conduction system disturbances, coronary arteritis, mitral valve insufficiency, dilated cardiomyopathy, ventricular arrhythmias and sudden cardiac death. There is little knowledge about the mechanism of ventricular arrhythmias in Behçets disease. In this study, we examined the value of dispersion of ventricular repolarization as a diagnostic tool to assess the risk for ventricular arrhythmias and sudden cardiac death in Behçets disease. We examined 38 patients (age: 34 +/- 4.6 years, 20F, 18M) with Behçets disease and 30 age-matched healthy subjects were selected to serve as the control group. Repolarization dispersion parameters were calculated as the difference between maximal and minimal values of QT, QTc, JT and JTC from 12-lead ECG recordings at 25 or 50 mm/s. We found QTd, QTc-d, JTd and JTc-d intervals of 60.65 +/- 16.1, 78.45 +/- 11.4, 71.51 +/- 18.3 and 92.33 +/- 15.4 ms in Behçets disease patients, these values in control subjects were 40.1 +/- 9.7, 56.36 +/- 7.5, 41.66 +/- 4.3 and 53.92 +/- 9.2 ms respectively (p < 0.001). Striking increases in QT and JT dispersion indicating regional inhomogeneity of ventricular repolarization were noted in patients with Behçets disease. This new finding suggests a possible explanation for the presence of ventricular arrhythmias in patients with Behçets disease.

Randomized Controlled Trial on Effectiveness of Intermittent Serial Casting on Spastic Equinus Foot in Children with Cerebral Palsy After Botulinum Toxin-a Treatment

Objective Physical therapy (PT) and botulinum toxin-A (BTX-A) injections are widely used in the treatment of spastic equinus foot due to cerebral palsy. The aim of this study was to show effects of intermittent serial casting (SC) in addition to standard treatment on spasticity, passive range of motion (PROM), and gait. Design Fifty-one ambulatory patients, treated by BTX-A to plantar flexor muscles, were randomly assigned to casting or control groups in a 2:1 ratio. Both groups received PT for 3 weeks. Casting group additionally received intermittent SC during 3 consecutive weekends. Assessments included Modified Ashworth Scale (MAS), Tardieu Scale, Observational Gait Scale (OGS), and Physician Global Assessment at baseline and posttreatment weeks 4 and 12. Results Significant improvements in PROM, MAS, Tardieu Scale, and OGS were recorded in both groups (P < 0.001 for all). Average changes in MAS, PROM, angle of catch, spasticity angle, and OGS of the casting group were significantly higher than those of the controls at week 4 (P = 0.006, P = 0.002, P < 0.001, P = 0.005, P = 0.011), and 12 (P = 0.013, P < 0.001, P < 0.001, P = 0.011, P < 0.001). Follow-up Physician Global Assessment also favored casting group (P < 0.001 for both). Conclusions Combining intermittent SC with BTX-A injections and PT might provide additional benefits for spastic equinus foot. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) identify treatment options for spastic equinus goot in children with cerebral palsy; (2) explain different approaches of serial casting with an additional model of intermittent casting; and (3) describe the potential benefits of combined treatment modalities, including intermittent serial casting, for spastic equinus foot in children with cerebral palsy. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Risk of falls in patients with ankylosing spondylitis.

BackgroundRisk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. MethodsEighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured. ResultsForty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients’ BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R =0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000). ConclusionsAssessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.

Effectiveness of a new joint position biofeedback training system development and its application on hemiplegic patients

Biofeedback is a technique of increasing importance in the field of rehabilitation. Several studies have been published in which biofeedback was utilized in gait training of stroke patients. A variety of electronic and non-electronic biofeedback approaches have been used. Joint position biofeedback was preferred in this study as it requires concentration only on the joint position. The purpose of this study was to show the effectiveness of Joint Position Biofeedback training in controlling genu recurvatum in adult stroke.<<ETX>>

Reliability and validity of the Turkish version of the fibromyalgia rapid screening tool (FiRST)

[Purpose] An easy-to-use, psychometrically validated screening tool for fibromyalgia is needed. This study aims to evaluate the reliability and validity of the Turkish version of the Fibromyalgia Rapid Screening Tool by correlating it with 2013 American College of Rheumatology alternative diagnostic criteria and the Hospital Anxiety and Depression Scale. [Subjects and Methods] Subjects were 269 Physical Medicine and Rehabilitation clinic outpatients. Patients completed a questionnaire including the Fibromyalgia Rapid Screening Tool (twice), 2013 American College of Rheumatology alternative diagnostic criteria, and the Hospital Anxiety and Depression Scale. Scale reliability was examined by test-retest. The 2013 American College of Rheumatology alternative diagnostic criteria was used for comparison to determine criterion validity. The sensitivity, specificity, and positive and negative likelihood ratios were calculated according to 2013 American College of Rheumatology alternative diagnostic criteria. Logistic regression analysis was conducted to find the confounding effect of the Hospital Anxiety and Depression Scale on Fibromyalgia Rapid Screening Tool to distinguish patients with fibromyalgia syndrome. [Results] The Fibromyalgia Rapid Screening Tool was similar to the 2013 American College of Rheumatology alternative diagnostic criteria in defining patients with fibromyalgia syndrome. Fibromyalgia Rapid Screening Tool score was correlated with 2013 American College of Rheumatology alternative diagnostic criteria subscores. Each point increase in Fibromyalgia Rapid Screening Tool global score meant 10 times greater odds of experiencing fibromyalgia syndrome. [Conclusion] The Turkish version of the Fibromyalgia Rapid Screening Tool is reliable for identifying patients with fibromyalgia.

AB0927 Reliability and validity of turkish version of fibromyalgia participation questionnaire

Background Fibromyalgia (FMS) is a chronic health problem characterized by a wide range of physical and psychological symptoms. There are few high-quality instruments to evaluate the participation and social functioning of fibromyalgia patients. Farin et al. designed the Fibromyalgia Participation Questionnaire (FPQ) as an instrument for measuring the participation and social functioning of FMS patients. The original version of FPQ has been demonstrated to have acceptable internal consistency, reliability and criterion validity. Objectives To test reliability and validity of Turkish version of Fibromyalgia Participation Questionnaire (FPQ-T) Methods One hundred and eighty-four female fibromyalgia syndrome patients were included in the study. All patients filled FPQ-Turkish (FPQ-T) questionnaire which was obtained by translation from German according to the guideline for the cross-cultural adaptation process. The patients filled the revised Fibromyalgia Impact Questionnaire (FIQ) and reevaluated FPQ-T two hours later. Internal consistency reliability of FPQ-T was assessed by calculating “if item deleted” using Cronbach alpha and “item-total correction” coefficient for each item of the questionnaire. Consistency of sub-scales and correlation of test-retest values were assessed. Test-retest values were compared using Wilcoxon test. Criterion validity was measured using FIQ scales by Spearmans rho correlation coefficient. Results For internal reliability, Cronbach alpha coefficient was calculated as 0.957 for non-working and 0.958 for working patients. Cronbach alpha values of 0.939, 0.871, and 0.914 were obtained for daily, social, and work life, respectively. Correlation coefficients were 0.888 for daily life, 0.859 for social life, and overall 0.901 in non-working group versus 0.896 in working group. Comparison of scores obtained from test-retest measurements showed no significant difference except for Item-3. Correlation of symptom severity score (SSS) and FPQ-T were r=0.385 (p<0.001) and r=0.390 (p<0.001) for the non-working and working sub-groups, respectively. Construct validity evaluation showed significant correlation between SSS and FPQ-T. Conclusions The results of our study showed that FPQ-T is reliable and valid for assessing participation and social functioning in fibromyalgia patients in our society. References Williams DA, Clauw DJ (2009) Understanding fibromyalgia: Lessons from the broader pain research community. J Pain 10:777–791. Farin E, Ullrich A, Hauer J (2013) Participation and social functioning in patients with fibromyalgia: development and testing of a new questionnaire. Health Qual Life Outcomes 11:135. Disclosure of Interest None declared

Evaluation of dance therapy effects on gait pattern in patients with previous cerebrovascular events: Randomized study results from a single center

Aims: As stroke is a complex medical condition involving physical, psychological and cognitive impairments, and also causes restrictions in daily activities and social participation, its rehabilitation is very important, but challenging. Therefore, we aimed to investigate the effects of therapeutic dance programs on walking ability and balance in post-stroke patients, when combined with botulinum toxin A (BTX-A) injections and conventional rehabilitation program. Methods: A total of 51 post-stroke hemiplegic patients treated with BTX-A, who attended the conventional neurological rehabilitation program of the Physical Therapy and Rehabilitation Clinic of Kocaeli University Medical School between November 2014 Erbil Dursun1, Soner Yalcin2, Tugba Gokbel3, Cagla Karacan4, Beril Melina Dursun5, Melike Akarsu6, Nigar Dursun1 Affiliations: 1MD, Professor of Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey; 2MD and Certified tango trainer; 3Resident of the Department of Physical Therapy and Rehabilitation, Izmit Rehabilitation and Training Center, Kocaeli University Medical School, Kocaeli, Turkey; 4Recreational Therapist, Department of Physical Therapy and Rehabilitation, Izmit Rehabilitation and Training Center, Kocaeli University Medical School, Kocaeli, Turkey; 5Student of Istanbul University National Music Conservatory; 6Orthotist at the Department of Physical Therapy and Rehabilitation, Izmit Rehabilitation and Training Center, Kocaeli University Medical School, Kocaeli, Turkey. Corresponding Author: Nigar Dursun, MD, Kocaeli Üniversitesi Tıp Fakültesi Kampüsü, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Umuttepe Kampüsü, Kocaeli-Turkey; Email: nigard@hotmail.com Received: 25 April 2016 Accepted: 19 August 2016 Published: 20 October 2016 and December 2015, were included in this prospective, randomized, single center study. Patients were randomized as 1:1 into adapted tango classes (n = 27) and control group (n= 24). Clinical and functional outcomes were evaluated by the Modified Ashworth Scale (MAS), BBS, and Timed Up and Go (TUG) tests. Results: Patients in the tango and control groups were well-matched in age, gender, and stroke side during randomization. There were statistically significant improvements in the tango group in MAS (p = 0.002), in TUG (p<0.001), and Berg Balance Scale (BBS) (p< 0.001) when compared with the control group, respectively (p<0.001, p=0.042, p<0.001). Balance improvement was more prominent in the tango group than in the control group (p= 0.003). Conclusion: Partner adapted tango dance therapy accompanying BTX-A injections may improve postural balance in ambulatory post-stroke patients, who are treated with the conventional rehabilitation program.