Sibel Aksu Yildirim

Wii Fit balance training or progressive balance training in patients with chronic stroke: a randomised controlled trial

[Purpose] The aim of this study was to compare the effects of Wii Fit balance training (WBT) and progressive balance training (PBT) approaches on balance functions, balance confidence, and activities of daily living in chronic stroke patients. [Subjects] A total of 30 patients were randomized into the WBT (n=15) and PBT (n=15) groups. [Methods] All of the subjects received exercise training based on a neurodevelopemental approach in addition to either Wii Fit or progressive balance training for total of 1 hour a day, 3 days per week for 4 weeks. Primary measurements were static balance function measured with a Wii Balance Board and dynamic balance function assessed with the Berg Balance Scale, Timed Up and Go test, Dynamic Gait Index, and Functional Reach Test. Secondary measures were balance confidence assessed with the Activities-specific Balance Confidence scale and activities of daily living evaluated with the Frenchay Activity Index. [Results] There was not remarkable difference between the two treatments in dynamic balance functions, balance confidence, and activities of daily living. [Conclusion] Although both of the approaches were found to be effective in improving the balance functions, balance confidence, and activities of daily living, neither of them were more preferable than the other for the treatment of balance in patients with chronic stroke.

Rehabilitation robotics ontology on the cloud

We introduce the first formal rehabilitation robotics ontology, called RehabRobo-Onto, to represent information about rehabilitation robots and their properties; and a software system RehabRobo-Query to facilitate access to this ontology. RehabRobo-Query is made available on the cloud, utilizing Amazon Web services, so that 1) rehabilitation robot designers around the world can add/modify information about their robots in RehabRobo-Onto, and 2) rehabilitation robot designers and physical medicine experts around the world can access the knowledge in RehabRobo-Onto by means of questions about robots, in natural language, with the guide of the intelligent user-interface of RehabRobo-Query. The ontology system consisting of RehabRobo-Onto and RehabRobo-Query is of great value to robot designers as well as physical therapists and medical doctors. On the one hand, robot designers can access various properties of the existing robots and to the related publications to further improve the state-of-the-art. On the other hand, physical therapists and medical doctors can utilize the ontology to compare rehabilitation robots and to identify the ones that serve best to cover their needs, or to evaluate the effects of various devices for targeted joint exercises on patients with specific disorders.

The effects of Bobath-based trunk exercises on trunk control, functional capacity, balance, and gait: a pilot randomized controlled trial

Objective: The aim of this study was to investigate the effects of Bobath-based individually designed trunk exercises on trunk control, upper and lower extremity function, and walking and balance in stroke patients. The main aim of treatment was to eliminate individual trunk impairments during various patient functions. Methods: The study was planned as an assessor-blinded, randomized controlled trial. A total of 22 patients volunteered to participate in the study. Trunk function, functional capacity, and gait were assessed with the Trunk Impairment Scale (TIS), stroke rehabilitation assessment of movement (STREAM), and a 10-m walking test, respectively. The Berg Balance Test (BBT), functional reach (FR), and timed up-and-go (TUG) tests were used to evaluate balance. After the initial assessment, the patients were divided randomly into two groups, the study group (12 patients) and the control group (10 patients). The mean age of the patients in the study group was 55.91 years (duration of stroke 58.66 months) and that of the control group was 54.00 years (duration of stroke 67.20 months). Individual training programs were determined for the patients in the study group, taking into consideration their evaluation results; and strengthening, stretching, range of motion, and mat exercises were determined for the control group according to their functional level. The participants in both groups were taken into the physiotherapy program for 12 weeks, 3 days a week for 1 hour a day. Results: In group analyses, both groups showed improvement in STREAM, TIS, and TUG tests. Only the study group produced significant gains in the BBT, FR, and 10 m walking tests (P < 0.05). According to the pre- and post-treatment results, no significant difference was observed in any of the evaluated parameters between the two groups (P>0.05). Conclusion: Individually developed exercise programs in the Bobath concept improve trunk performance, balance, and walking ability in stroke patients more than do conventional exercises.

Effects of visual illusion and transcutaneous electrical nerve stimulation on neuropathic pain in patients with spinal cord injury: A randomised controlled cross-over trial.

BACKGROUND Chronic pain is a common consequence of spinal cord injury (SCI). No therapeutic drugs or drug groups are proven to be superior for neuropathic pain and treatments only aim to convert pain from dull to tolerable levels and not to remove it. OBJECTIVE This study was planned to compare the effect of visual illusion (VI) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pain quality and functional capacity in SCI patients with neuropathic pain. METHODS Twenty-four patients were included and randomly categorized into two groups. In the first group (n= 12), visual illusion was applied for first two weeks, 1 week wash out period and then TENS was applied for 2 weeks. In second group (n= 12), TENS was applied firstly, 1 week wash out and then %visual illusion VI were applied. Pain severity, pain quality, and functional capacity were assessed with the visual analog scale (VAS), the neuropathic pain scale (NPS), and the brief pain inventory (BPI), respectively. A pre-post-treatment and cross over design was used. RESULTS Wilcoxon signed-rank tests were used for within group analyses. Mann-Whitney U tests were used for analyses that compared different groups. It was observed that pain intensity decrease immediately after both applications (VI: p= 0.07, TENS: p= 0.08). After TENS application for 2 weeks, it was observed that significant decrease in most (p= 0.04) and less (p= 0.02) pain intensity; while there was no significant decrease in pain intensity after 2 weeks for VI (p> 0.05). When findings of NPS were analyzed, hot (p= 0.047), sharp (p= 0.02), unpleasant (p= 0.03) and deep items (p= 0.047) decreased after VI application. When the results of BPI were detected, they were observed that the negative effect of pain on moving ability (p= 0.04) after visual illusion application and the negative effect of pain on mood (p= 0.03), relationships with others (p= 0.04) and sleep (p= 0.04) after TENS application decreased significantly. CONCLUSION TENS and VI therapies can be successfully used in clinical practice as an alternative treatment or as a supportive method separetely or together.

Reliability and validity of Trunk Control Test in patients with neuromuscular diseases

Abstract Objective: The aim of our study was to determine the reliability and validity of the Trunk Control Test (TCT) in people with adult neuromuscular diseases (NMD). Subjects: Sixty six people with NMD participated in the study. Methods: Patients were evaluated using the TCT, manual muscle test (trunk, upper and lower extremities), Motor Function Measurement (MFM), Functional Independency Measurement (FIM) and the Rivermead Mobility Index (RMI). Results: Test–retest reliability (intraclass correlation coefficients) was excellent for the TCT. The intraclass correlation coefficient score was 0.979 (95% confidence interval 0.968–0.986). Cronbach alpha value was 0.749, and item-to-total correlation coefficient for “rolling from supine to the dominant side,” “rolling from supine to the other side” and “sitting up from lying down” was (r = 0.61), (r = 0.57) and (r = 0.92), respectively, for construct validity. The TCT was found to be correlated with MFM (r = 0.57), MFM trunk (r = 0.62), trunk muscle strength (r = 0.61), shoulder flexion muscle strength (r = 0.39), hip flexion muscle strength (r = 0.39), FIM (r = 0.35), FIM motor (r = 0.66) and RMI (r = 0.39) for convergent validity. Conclusion: Our results confirm that the TCT is an easy, reliable and valid instrument for the measurement of trunk performance in ambulatory NMD patients.

Three different points of view in stroke rehabilitation: patient, caregiver, and physiotherapist

Abstract Background: The similarities or differences of the threesome (physiotherapists, patients, and caregivers) thought about the process of stroke rehabilitation can play a key role in the success of rehabilitation. Objective: The aim of this qualitative study was to investigate the perspectives of the threesome, with regard to the two themes of the study: (1) What are the problems faced by the patients after stroke?; and (2) What does recovery after stroke mean to you? Methods: The qualitative questions and possible answers were prepared by four physiotherapists. The answers were matched to International Classification of Functioning (ICF) components. Seventy patients who were having treatment as in-patient rehabilitation centers, their caregivers, and physiotherapists were invited to the study. After the questions were asked and the possible response choices were presented, subjects were asked to prioritize these response choices. Results: One hundred and fifty-nine subjects, including 53 patients, 53 caregivers, and 53 physiotherapists, were included to the study. When the theme 1 were examined, we found that the patients’ first priority was functional abilities (ICF: body function and structure) such as using the hands and feet while the caregivers and physiotherapists prioritized self-care problems (ICF: activity and participation). The most common response to the theme 2 was “being in same health condition before the disease” (ICF: activity and participation) among the patients and caregivers and “being able to move arm and leg on the affected side” (body function and structure) among the physiotherapists. Conclusion: As a conclusion, problems faced by the patients, caregivers, and physiotherapists were perceived under the same ICF domain and that caregivers’ and physiotherapists’ priorities were the same.

Reliability and validity of the Turkish version of ABILHAND-Kids’ questionnaire in a group of patients with neuromuscular disorders

ABSTRACT This study was performed to examine the reliability and validity of the Turkish version of ABILHAND-Kids questionnaire which assesses manual functions of children with neuromuscular diseases (NMDs). A cross sectional survey study design and Rasch analysis were used to assess the reliability and validity of the Turkish version of scale. Ninety-three children with different neuromuscular disorders and their parents were included in the study. The scale was applied to the parents with face-to-face interview twice; on their first visit and after an interval of 15 days. The test–retest reliability was assessed with intraclass correlation coefficient (ICC), and internal consistency of the multi-item subscales by calculating Cronbach alpha values. Brooke Upper Extremity Functional Classification (BUEFC) and Wee-Functional Independency Measurement (Wee-FIM) were correlated to determine the construct validity. The ICC value for the test/retest reliability was 0.94. The internal consistency was 0.81. Floor (1.1%) and ceiling (11.8%) effects were not significant. There were moderate correlations between the Turkish version of ABILHAND-Kids and Wee-FIM (0.67) and BUEFC (−0.37). Rasch analysis indicated good item fit, unidimensionality, and model fit. The Turkish version of ABILHAND-Kids questionnaire was found to be a reliable and valid scale for the assessment of the manual ability of children with NMDs.

The effects of electrical stimulation and exercise therapy in patients with limb girdle muscular dystrophy: A controlled clinical trial

Objective: To evaluate and compare the effects of exercise therapy and electrical stimulation on muscle strength and functional activities in patients with limb-girdle muscular dystrophy (LGMD). Methods: This controlled clinical trial included 24 subjects who were diagnosed with LGMD by the Neurology Department of the Hacettepe University Hospital, Ankara, Turkey and were referred to the Physical Therapy Department between May 2013 and December 2014. Subjects were enrolled into an electrical stimulation (11 patients) group, or an exercise therapy (13 patients) group. Results: The mean age of patients was 31.62 years in the electrical stimulation group, and 30.14 years in the exercise therapy group. The most important results in this controlled clinical study were that the muscle strength in both groups was significantly decreased and post-treatment evaluation results indicated that muscle strength of the Deltoideus was higher in the electrical stimulation group, and the difference between the groups was maintained in the follow-up period (p<0.05). However, the muscle strength of quadriceps was similar in both groups, according to the post-treatment and follow-up evaluation results (p>0.05). Additionally, the electrical stimulation group presented more obvious overall improvements than the exercise therapy group according to muscle strength, endurance, and timed performance tests. Conclusions: Since no definitive treatments currently exist for patients with LGMD, these results provide important information on the role of exercise therapy and electrical stimulation for clinicians working in rehabilitation.

Evaluation of the Properties of Falling in Patients with Peripheral Neuropathy

AIM: The purpose of this study is to identify characteristics of falling in patients with peripheral neuropathy METHODS: 31 (mean age 47.00 ± 19.47 years ) cases with neuropathy were included in the study. Superficial and deep sensation in lower exremities ,foot dorsi flexion, knee extension and flexion of hip muscle strength (0-5) were evaluated. Patients were asked to report the falling activity, the number of falls, cause of falling, the shape of falling, fear of falling and type of injury caused by falls in the last 6 months. RESULTS: Duration of disease 09.37 ± 09.64 years. The cases of muscle strength 51.9%/57.8% at the left/right foot dorsiflexion, 7.6%/8% knee extension, 7.7%/8%, hip flexion value of the 3 under was found. The cases of 32%/ 28% \s of the left/right loss sensation of pressure under the sole. 50% cases of the style of socks hypoesthesia was found. 71% of the cases reported falling, 38% fell more than 3, 63% have a fear of falling, 46.7% was occurred by foot insertion, 57.7 % cases for a fall during a walking activity. CONCLUSIONS: Understanding the properties of falling in patients with peripheral neuropathy will guide physiotherapists in the practice of neurological rehabilitation for practice and therapatic purposes