Fatma Mutluay

Effects of home exercises on motor performance in patients with Parkinson's disease

Objective: To investigate the effect of home exercises on the motor performance of patients with Parkinsons disease. Design: A prospective blinded study with allocation of patients into their groups by alternate weeks. Setting: A University Hospital neurology and physiotherapy department. Subjects: Recruited from a movement disorders outpatient clinic of Cerrahpasa School of Medicine diagnosed with Parkinsons disease, classified as Hoehn and Yahr Grades I, II and III. Interventions: Patients who fulfilled the inclusion criteria were recruited to the study. Each patient was evaluated at the end of first and second month after the baseline evaluation. Patients were divided into two groups. Those in the first and third week were put in the exercise group and second and fourth week in the control group. Patients in the exercise group (n=15) were given a schedule of exercises to undertake at home; the others (n=15) did not receive this instruction. Measures: Ten- and 20-m walking test, first pace length, pace number in 10 m, walking around a chair, Nine Hole Peg Board (NHPB) test. Results: Following the home exercise programme, patients in the exercise group showed improvement in walking 10 and 20 m, time elapsed to complete walking around a chair and length of the first pace length, and in the motor performance of both hands (p < 0.001). Conclusions: A home-based rehabilitation programme for patients with Parkinsons disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme.

Effects of multiple sclerosis on respiratory functions

Objectives: To measure respiratory functions of ambulatory patients with multiple sclerosis and compare the results with expected values from healthy general population data. Further, to study the correlation of respiratory function impairment with the multiple sclerosis-induced disability level. Subjects: Thirty-eight patients with definite diagnosis of multiple sclerosis from the multiple sclerosis outpatient clinic. Methods: The Expanded Disability Status Scale (EDSS) scores (mean 4.34±1.39) were evaluated to measure disability level. Respiratory functions tested in the laboratory included spirometric (FVC, FEV1, FEV1/FVC), maximal inspiratory (MIP) and expiratory (MEP) mouth pressure measurements. Patients were clinically assessed using a pulmonary dysfunction index (PDI) and dyspnoea index; various breathing features were also recorded. Results: With respect to expected values from healthy general population, important decreases were found in mouth pressures with MIP (77%±23%, p ≃ 0) and MEP (60%±13%, p ≃ 0) while spirometric measures were significantly but less affected (FVC 94%±12%, p < 0.01, FEV1 91%±16%, p < 0.001). FEV1/FVC ratios were normal. Notable increases in PDI (5.58±0.68, p ≃ 0) and dyspnoea index (0.32±0.47, p ≃ 0) were observed. Significant relationships (p < 0.01) between respiratory function impairment and the multiple sclerosis disability level could be detected for FVC, MEP and PDI. Conclusions: Multiple sclerosis clearly impairs respiratory functions; maximal mouth pressures are more severely reduced. This impairment increases with multiple sclerosis-induced disability level but is found to be independent from duration of disease.

Breathing-enhanced upper extremity exercises for patients with multiple sclerosis

Objective: To explore the effectiveness of breathing-enhanced upper extremity exercises on the respiratory function of patients with multiple sclerosis. Design: Randomized controlled study of six-week duration. Subjects: Forty patients with multiple sclerosis (age 39.2 ± 7 years; Kurtzke Expanded Disability Status Scale scores: 4.51 ± 1.55) randomly divided into two groups. Methods: The training group followed a six-week home training programme designed to strengthen accessory respiratory muscles. Controls performed no exercises. All subjects submitted to baseline and post-training tests of spirometry, respiratory muscle strength and 6-minute walking. They were also assessed with pulmonary dysfunction and exertion fatigue indices. Results: Spirometry revealed clear improvement in forced expiratory volume in 1 second (FEV 1) (+13%, P = 0.003) resulting in higher FEV1/FVC (forced vital capacity) (+8.5%, P = 0.03). Maximal inspiratory pressure (P Imax) increased by +7.1% but not significantly. Maximal expiratory pressure (P Emax) and FVC were significantly higher (by +7.1%, P = 0.0066 and +4.8%, P = 0.036 respectively) with respect to baseline measures. Pulmonary dysfunction was reduced (—9%, P = 0.002) while 6-minute walking distance was longer (+16%, P = 0.029) at equal exertion fatigue level. Conclusions: The programme improved most pulmonary performance measures and had clinical significance. Its sustained application may prevent respiratory complications frequently observed in the later stages of multiple sclerosis.

Disabled children's functionality and maternal quality of life and psychological status.

Physiotherapy is being provided for different disabled groups in pediatric rehabilitation centers. The quality of life (QOL) and psychological status of the mothers of these children is affecting their compliance in the rehabilitation period. The aim of this study was therefore to assess the relationship between disability level of individuals receiving rehabilitation and maternal QOL, psychological status and influencing factors.

Health related quality of life in patients with epilepsy in Turkey

[Purpose] This study measured the quality of life in epilepsy and determined associated demographic and clinical factors by means of the Short Form-36 health survey. [Subjects and Methods] 124 consecutive epilepsy patients were enrolled and their demographic variables and clinical characteristics recorded. The Short Form-36 questionnaire was completed independently by each participant. Short Form-36 dimensional and composite scores were computed and scaled with data from an extensive survey of the healthy population. [Results] Short Form-36 scores for physical dimensions were similar to healthy values, but those for mental dimensions except for energy/vitality were remarkably and significantly lower than normal. All Short Form-36 average scores for women were lower than those for men and significantly so for mental health composite scores. Patients responding well to treatment were aware of their improving health as measured by the Change in Health score and had better dimensional scores than those with a poor response. [Conclusion] Patients with epilepsy do not perceive impaired physical health status. However, their mental health appears vulnerable, especially in women. Therefore, the major burden in epilepsy is in the mental health category. A positive treatment response is also an important determinant of the related quality of life measure.

The impact of epilepsy on preschool children and their families

This study investigated the possible presence of sensory-motor developmental impairments in preschool children with epilepsy and explored epilepsy impact on their activities and quality of life and on the stress load of their family. Study participants were children aged 2-6years diagnosed with epilepsy without any other comorbidities (epi-only children). The instruments used for assessment included the Neurological, Sensory, Motor, Developmental Assessment (NSMDA) scale for sensory-motor development, the Impact of Childhood Neurologic Disability Scale (ICNDS), and the Impact of Pediatric Epilepsy Scale (IPES) for disease impact on disability and Quality of Life (QoL), as well as the Pediatric Outcomes Data Collection Instrument (PODCI) for functional health status, and the Parental Stress Scale (PSS) for the family stress load. Required data were obtained from direct testing or observation of childrens activities and mother-supplied answers to questions. Eighty-two children were investigated. The NSMDA scores were in the normal development range 6-8. Significant moderate impact of the disease on disability and QoL was estimated with the ICNDS and IPES instruments. The PODCI scores were similar to healthy population levels except for the happiness dimension which was better for children with epilepsy. PSS were significantly above normal. The functional health and QoL of the children as well as their family stress were found to be positively correlated with increasing age. It is found that epilepsy does not degrade neuromotor development and functional health status of preschool epi-only children, though it has a significant impact on their neurological disability and QoL and the stress level of their families; this impact seems to decrease with age.

The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial

Objective: To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. Design: Prospective randomized controlled trial. Setting: Pulmonary Rehabilitation center. Subjects: A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. Methods: All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. Results: The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups (P = 0.075). There was no change in spirometric variables in both groups. Conclusion: A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.

Examining the postural awareness and flexibility changes in physical therapy students who took clinical Pilates class

Objective: This study aimed to evaluate postural awareness and changes in posture and flexibility of students who took Clinical Pilates class as an elective course at the undergraduate level. Methods: The study conducted from 2013-2016 included 98 students who took Clinical Pilates class at the Department of Physical Therapy and Rehabilitation, School of Health Sciences, Istanbul Medipol University, Turkey. The flexibility levels of the study participants were measured before and after the Clinical Pilates education using finger-to-floor test and modified Schober’s test. Observational posture analysis and postural awareness were recorded using the scale prepared by the researchers. Results: The post-education evaluations showed that postural distortions were fixed, and a significant increase in the postural awareness of the students was observed compared with the pre-education period. The results of both modified Schober’s test and finger-to-floor test, which were used to measure the flexibility levels, showed a statistically significant increase in post-education scores compared with those of the pre-education period. Conclusion: This study showed that the Clinical Pilates course increased postural awareness and flexibility of physical therapy students and fixed postural distortions. Thus, the inclusion of Clinical Pilates class in the undergraduate education is considered to be important.

Genç Erişkinlerde Fiziksel Aktivite Düzeyi İle Vücut Kompozisyonu İlişkisi: Pilot Çalışma

Amac: Genc eriskinlerde fiziksel aktivite duzeyi ile vucut kompozisyonu ve cinsiyet arasindaki iliskiyi arastirmakti. Materyal ve Metod: Son 6 ay icinde kardiyopulmoner, ortopedik, romatizmal ya da metabolik hastalik hikayesi olmayan 62 ogrenci calismada yer aldi. Ogrencilerin demografik ve fiziksel ozellikleri kaydedildi. Fiziksel aktivite duzeyi FIT Skoru ile belirlendi, vucut kompozisyonunu degerlendirmesinde Beden Kutle Indeksi ile skinfold kaliper olcumlerinden elde edilen degerler kullanilarak hesaplanan vucut yag orani ve ideal vucut agirligi kullanildi. Bulgular: Katilimcilarin fiziksel aktivite ortalamasi 27,08±18,74 olarak bulundu. Fiziksel aktivite seviyesi cok iyi olan ogrenciye rastlanmadi. Kizlarin fiziksel aktiviteleri (26,53±19,73) ve erkeklerin fiziksel aktivite (27±18,55) ortalamalari arasinda fark bulunmadi (p=0,936). Erkeklerin beden kutle indeksi (24,92±3,15 kg/m2) kizlardan (21,23±3,18 kg/m2) yuksekti (p=0,004). Kizlarin vucut yag orani (%22,74±6,93) erkeklerin vucut yag oranindan (%16,60±5,46) yuksekti (p=0,003). Her iki cinsiyet arasinda fazla kilo yuzdesi bakimindan fark yoktu (kizlar:0,05±0,12 erkekler:0,06±0,11, p=0,804). Korelasyon analizinde kizlarda fiziksel aktivite ve beden kutle indeksi arasinda anlamli iliski saptanmadi (p=0,055) ancak erkeklerde fiziksel aktivite ile beden kutle indeksi (rs=0,662, p=0,007), vucut yag orani (rs=0,602, p=0,018), ideal vucut agirligi (rs=0,544, p=0,036) ve fazla kilo yuzdesi arasinda pozitif yonde anlamli iliski saptandi (rs=0,560, p=0,030).Sonuc: Katilimcilarin fiziksel aktivite duzeylerinin dusuk seviyede olup beden kutle indekslerinin ve yag oranlarinin normal sinirlar icerisinde olmasi calismanin genc populasyonda yapilmis olmasi ile aciklanabilir. Genclerin vucut kompozisyonlarinin saglikli olmasi sevindiricidir ancak ileride inaktiviteye bagli olarak ortaya cikabilecek sorunlari onlemek acisindan fiziksel aktiviteye daha fazla tesvik edilmesi gerektigi dusunulmektedir.

Engelli Bireylerde Sigara Kullanımının Değerlendirilmesi

Amac: Engelli bireylerde sigara kullanimi ve sigaraya bakis acisini degerlendirmek. Yontem: Istanbul Bagcilar Belediyesi Engelliler Sarayi’nin hizmetlerinden yararlanan bedensel engelli bireylerin demografik karakteristikleri ve sigara kullanma durumlari kaydedildi. Sigara bagimliligini tanimlama ve skorlandirmada Fagerstrom Testi kullanildi. Bulgular: 15-42 yas arasi 47 gonullu engelli birey (kadin/erkek =14/33) degerlendirildi. Katilimcilardan 8 kisi aktif sigara icicisi, 4 kisi sigarayi birakmis ve 35 kisi sigara kullanmiyordu. Aktif olarak sigara icenler ve sigarayi birakmis olanlarda ilkokul yillarinda sigaraya baslama orani %50 iken, son 5 yil icinde sigaraya kullanmaya baslama orani %33,3 olarak saptandi. Arkadas faktoru sigara icmede rol oynayan major neden (%78,7) olarak ifade edildi. Fagerstrom nikotin bagimlilik testi sonuclarina gore; cok dusuk derecede sigara bagimliligi %4,3, dusuk derecede sigara bagimliligi %10,6, orta derecede sigara bagimliligi %4,3, yuksek derecede sigara bagimliligi %4,3, cok yuksek derecede sigara bagimliligi %2,1 olarak belirlendi. Nikotin bagimliligi ile sigara kullanim suresi (rs=0,825 p<0,001) ve erkek cinsiyet ile gunluk icilen sigara sayisi (rs=0,325, p=0,018) arasinda pozitif yonde iliski saptandi. Sonuc: Calismamizda yer alan engelli bireylerde sigara bagimlilik orani Turkiye ortalamasinin altinda bulunsa da katilimcilarin sigaraya baslama yasinin dusuk olmasi dikkat cekicidir. Engelli bireyler icin planlanacak sosyal destek projelerinde sigara birakma destegine de yer verilmelidir. Anahtar Kelimeler: Engelli, sigara, nikotin bagimliligi