Kadriye Armutlu

Six-minute walk distance as a measure of functional exercise capacity in multiple sclerosis.

Purpose. We hypothesised that six-minute walk (6MWT) distance of patients with ambulatory multiple sclerosis (MS) would differ from age-matched healthy control subjects. We also investigated the contribution of demographic, physical and physiological factors to impaired functional capacity in MS. Method. Thirty MS patients and 30 healthy subjects participated in this study. Respiratory muscle strength was measured. Pulmonary function test and 6MWT were performed. The Barthel Index (BI) was used to assess activities of daily living, and the Modified Ashworth Scale was used to determine spasticity. Symptomatic fatigue was measured using the Fatigue Severity Scale (FSS). Results. Pulmonary function and respiratory muscle strength of ambulatory MS patients were significantly lower, and baseline heart rate and fatigue perception were significantly higher than were healthy controls (p < 0.05). MS patients reached a significantly higher exercise heart rate, and walked significantly shorter distance than did healthy subjects (p < 0.05). The BI score, baseline heart rate and FSS score together accounted for 81 percent variance in 6MWT distance of MS patients (p < 0.05). Conclusion. The shorter distance covered during a 6MWT is determined by the limitations in activities of daily living, resting heart rate and subjective symptomatic fatigue in ambulatory patients with MS. Respiratory muscle weakness, lung function and level of neurological impairment do not contribute to impaired functional exercise capacity in these patients.

Physiotherapy Approaches in the Treatment of Ataxic Multiple Sclerosis: A Pilot Study

Objective: This study was planned to investigate the efficacy of neuromuscular rehabilitation and Johnstone Pressure Splints in the patients who had ataxic multiple sclerosis. Methods: Twenty-six outpatients with multiple sclerosis were the subjects of the study. The control group (n = 13) was given neuromuscular rehabilitation, whereas the study group (n = 13) was treated with Johnstone Pressure Splints in ad dition. Results: In pre- and posttreatment data, significant differences were found in sensation, anterior balance, gait parameters, and Expanded Disability Status Scale (p < 0.05). An important difference was observed in walking-on-two-lines data within the groups (p < 0.05). There also was a statistically significant difference in pendular movements and dysdiadakokinesia (p < 0.05). When the posttreatment values were compared, there was no significant difference between sensation, anterior balance, gait parameters, equilibrium and nonequilibrium coordination tests, Expanded Disability Status Scale, cortical onset latency, and central conduction time of somatosensory evoked potentials and motor evoked potentials (p > 0.05). Comparison of values re vealed an important difference in cortical onset-P37 peak amplitude of somatosen sory evoked potentials (right limbs) in favor of the study group (p < 0.05). Conclu sions : According to our study, it was determined that physiotherapy approaches were effective to decrease the ataxia. We conclude that the combination of suitable phys iotherapy techniques is effective multiple sclerosis rehabilitation. Key Words: Multi ple sclerosis—Ataxia—Physical therapy.

Psychometric study of Turkish version of Fatigue Impact Scale in multiple sclerosis patients

BACKGROUND The aims of this study were to test the validity, test-retest reliability, and internal consistency of Turkish version of FIS; the variables affecting FIS score. MATERIALS AND METHODS 71 MS patients and 68 healthy subjects were included to the study. RESULTS Total FIS score and subscale scores were different statistically between MS patients and healthy volunteers in both first and second FIS applications (p<0.001). These results showed that FIS is validated in divergent direction. BDI score was higher in MS patients than healthy volunteers (p<0.001). There was no statistically significant difference between two study groups for cognitive subscale scores, after the effect of depression was eliminated (p>0.05). To assess the test-retest reliability, the scores of two FIS applications did not differ statistically (cognitive t=1.948 p>0.05, physical t=1.420 p=0.160, social t=1.470 p=0.146, total t=1.990 p=0.05). Intraclass correlation coefficients were 0.89 (99% confidence interval: 0.79-0.94) for cognitive, 0.95 (0.91-0.97) for physical, 0.91 (0.83-0.95) for social, and 0.93 (0.86-0.96) for total FIS scores (p<0.001). EDSS correlated with physical subscores in both applications of FIS. CONCLUSION Turkish version of FIS, which is valid and reliable, seems an appropriate tool for the assessment of the effects of fatigue in Turkish MS population.

The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients

Objective: To examine the efficiency of electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. Design: A prospective randomized controlled trial. Setting: Intensive care unit and inpatient clinics of neurology in a university hospital. Subjects: Forty-eight patients with acute stroke, divided equally into control and study groups. Intervention: Subjects in both groups were treated in accordance with the Bobath concept during the early hospitalization period. In addition to Bobath techniques, electrical stimulation was also applied to the supraspinatus muscle, mid and posterior portions of the deltoid muscle of patients in the study group. Main measures: Two radiological methods were used to measure the horizontal, vertical and total asymmetry and vertical distance values of the shoulder joint. Motor functions of the arm were evaluated with the Motor Assessment Scale. Results: The hospitalization period was 12.62 ± 2.24 days for the control group and 11.66 ± 1.88 days for the study group. Shoulder subluxation occurred in 9 (37.5%) subjects in the control group, whereas it was not observed in the study group. All shoulder joint displacement values were higher in the control group than in the study group (horizontal asymmetry P = 0.0001, vertical asymmetry P = 0.0001, total asymmetry P = 0.0001, vertical range P = 0.002). Conclusion: Application of electrical stimulation combined with the Bobath approach proved to be efficient in preventing inferior and anterior shoulder subluxation in the acute stages of stroke.

A correlation between sex hormone levels and pressure pain threshold and tolerance in healthy women

Abstract The aim of this study was to investigate the relationship between sex hormone levels and pressure pain threshold (PPT) and pressure pain tolerance (PPTO) in healthy women. Forty-one volunteers with mean age 33.00 ± 6.28 years participated in the study. Before PPT and PPTO, plasma levels of estrogen, progesterone, prolactin, luteinizing hormone (LH), testosterone and follicular stimulating hormone (FSH) were determined. The PPT and PPTO were measured at masseteric muscle by pressure algometer. There was a significant positive correlation between estrogen, progesterone, prolactine and PPT and PPTO (p < 0.01), but there was no correlation between FSH and PPT, PPTO. It was concluded that sex hormone levels influence pain perception in healthy women. It must be taken into consideration that in pain treatment of women, due to fluctuation of hormone levels, perception of pain may change.

Analysis of age and gender related differences in pressure pain threshold and pressure pain tolerance levels

AbstractThe purpose of this study was to investigate age and gender differences in pressure pain threshold (PPTh) and pressure pain tolerance (PPTo). PPTh and PPTowere assessed be means of a pressure algometer in 40 young subjects (20 men, 20 women; mean age 26.22 ± 4.69 years) and 60 old subjects (30 men, 30 women; mean age 73.43±7.16 years) in four different points of the body. When the data from all four sites were added and averaged the older subjects showed a significantly higher value of PPTh and a lower value of PPTo. PPTh was lower in older females than in older males. There was the same tendency in the younger group although it did not reach statistical significance. PPTo was significantly higher in males, both in the older and younger groups.

The Validity and Test-Retest Reliability of the Leeds Multiple Sclerosis Quality of Life Scale in Turkish Patients.

The aim of the study was to translate and test the reliability and validity of the Leeds Multiple Sclerosis Quality of Life Scale (LMSQoL) in Turkish patients with multiple sclerosis (MS). Demographic data of MS patients who had a registration in and followed up by a university hospital were recorded. The LMSQoL and Turkish Quality of Life questionnaire were applied to the patients. The internal consistency of the scales was assessed by Cronbachs alpha coefficient. The validity of LMSQoL was examined by using correlation between the total scores of LMSQoL and Turkish Quality of Life questionnaire. Test-retest reliability was examined by using the correlation for the first and second applications of LMSQoL. Sixty-nine MS patients, (40.6% male, 59.4% female) were enrolled in the study. Cronbachs alpha coefficient was found as 0.67 for the three positive items of LMSQoL. For the five negative items, Cronbachs alpha was found as 0.78. The correlation coefficient between the total scores of the scales was 0.80 (P<0.001). The Turkish version of the LMSQoL is a reliable and valid instrument and can be effectively used for measuring the impact of MS on the QoL.

Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study.

Abstract Purpose: To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS). Method: A total of 42 MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3–5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions. Results: The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p < 0.05). According to multiple comparison analyses of the ICARS total score and the composite balance score, the LS, and the TT group were different from the BT group (p < 0.005), while the LS and the TT groups improved similarly (p > 0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly. Conclusion: Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation. Implications for rehabilitation Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease. Different exercise modalities are commonly employed to control ataxic symptoms in MS patients. Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis patients.

Validity and reliability of the International Cooperative Ataxia Rating Scale (ICARS) and the Scale for the Assessment and Rating of Ataxia (SARA) in multiple sclerosis patients with ataxia

BACKGROUND Ataxia is an extremely common problem in multiple sclerosis (MS) patients. Thus, appropriate scales are required for detailed assessment of this issue. The aim of our study was to investigate the reliability and validity of the Turkish version of the International Cooperative Ataxia Rating Scale (ICARS) and Scale for the Assessment and Rating of Ataxia (SARA), which are widely used in ataxia evaluation in the context of other cerebellar diseases. METHOD This cross-sectional study included 80 MS patients with Kurtzke cerebellar functional system score (C-FSS) greater than zero and slight pyramidal involvement. The Expanded Disability Status Scale (EDSS), C-FSS, and Berg Balance Scale (BBS) were administered. SARA and ICARS were assessed on first admission by two physical therapists. Seven days later, second assessments were repeated in same way for reliability. RESULTS Intra-rater and inter-rater reliability were found to be high for both ICARS and SARA (p< 0.001) The Cronbachs α coefficients were 0.922 and 0.921 for SARA (reviewer 1 and reviewer 2 respectively) and 0.952 and 0.952 for ICARS (reviewer 1 and reviewer 2, respectively). There were no floor or ceiling effects determined for either scale except for item 17 of ICARS (p= 0.055). The EDSS total score had significant correlations with both SARA and ICARS (rho: 0.557 and 0.707, respectively). C-FSS had moderate correlation with SARA and high correlation with ICARS (rho: 0.469 and 0.653, respectively). BBS had no significant correlation with SARA and ICARS. (rho: -0.048 and -0.008 respectively). According to the area under the curve (AUC) value, ICARS is the best scale to discriminate mild and moderate ataxia. (AUC: 0.875). Factor analyses of ICARS showed that the rating results were determined by five different factors that did not coincide with the ICARS sub-scales. CONCLUSION Our study demonstrated that ICARS and SARA are both reliable in MS patients with ataxia. Although ICARS has some structural problems, it seems to be more valid given its high correlations with EDSS and C-FSS. SARA also can be preferred as a brief assessment.

Sensorimotor integration training in Parkinson’s disease

OBJECTIVE To determine the effects of sensorimotor integration training on postural control in Parkinson`s disease. METHODS This prospective, randomized controlled trial was conducted at Hacettepe University (Ankara, Turkey). The study was carried out from August 2012 until March 2015 and included 24 Parkinson`s patients with stage 2-3 according to the Modified Hoehn&Yahr Rating Scale. The patients were divided into 2 groups (control and study). The control group received conventional physiotherapy; the study group received sensorimotor integration training combined with conventional physiotherapy, 2 times per week for 6 weeks. We assessed the patients with clinical balance tests and computerized dynamic posturography. Assessments were performed at baseline, 7- and 12-weeks follow-up. RESULTS Computerized dynamic posturography posturography values (5th and 6th positions, composite balance, and vestibular system scores) were higher in the study group than in the control group. The improvements were maintained at the 12-week follow up except 6th positions scores (p<0.05). CONCLUSION Sensorimotor integration training combined with conventional physiotherapy approach ameliorated postural control by improving vestibular system in patients with Parkinson`s disease by improving sensory processes.