Songül Aksoy

Avaliação do equilíbrio em idosos que sofrem queda e aqueles que não sofrem quedas

Falls present a substantial health problem among the elderly population. Approximately one-third of community-dwelling people over 65 years of age will experience one or more each year. OBJECTIVE: The purpose of this study was to evaluate balance between fallers and non-fallers elderly. Study Design: Clinical study. METHODS: We studied 30 subjects older than 65 years of age. 15 subjects had a history of falls within a year (Group I) and 15 subjects had no history of falls (Group II). The scores of Computerized Dynamic Posturography (CDP); Sensory Organization Test (SOT), Limits of Stability (LOS), Rhytmic Weight Shift (RWS) and Berg Balance Scale (BBS) findings gathered from the individuals from Group I and Group II, were compared. RESULTS: The SOT 3, 6, composite, BBS scores and left-right on-axis velocity score of RWS test of the Group I were found to be significantly lower the Group II (p < 0.05). A positive correlation between the SOT 3, 5, composite and BBS scores of Group I and the SOT 4, 5, 6, composite and BBS scores of Group II is determined (p < 0.05). CONCLUSION: The CDP and BBS scores in fallers were found to be significiantly lower as compared to the non-fallers elderly.UNLABELLED Falls present a substantial health problem among the elderly population. Approximately one-third of community-dwelling people over 65 years of age will experience one or more each year. OBJECTIVE The purpose of this study was to evaluate balance between fallers and non-fallers elderly. STUDY DESIGN Clinical study. METHODS We studied 30 subjects older than 65 years of age. 15 subjects had a history of falls within a year (Group I) and 15 subjects had no history of falls (Group II). The scores of Computerized Dynamic Posturography (CDP); Sensory Organization Test (SOT), Limits of Stability (LOS), Rhytmic Weight Shift (RWS) and Berg Balance Scale (BBS) findings gathered from the individuals from Group I and Group II, were compared. RESULTS The SOT 3, 6, composite, BBS scores and left-right on-axis velocity score of RWS test of the Group I were found to be significantly lower the Group II (p < 0.05). A positive correlation between the SOT 3, 5, composite and BBS scores of Group I and the SOT 4, 5, 6, composite and BBS scores of Group II is determined (p < 0.05). CONCLUSION The CDP and BBS scores in fallers were found to be significantly lower as compared to the non-fallers elderly.

Comparative audiometric evaluation of temporomandibular disorder patients with otological symptoms

OBJECTIVES The purpose of this study was to assess the audiological status of temporomandibular disorder (TMD) patients with otological symptoms and to make comparisons with that of a control group of subjects without TMD and otological symptoms. METHODS 25 TMD patients with otological symptoms and 20 age and gender matched controls, 45 subjects in total, were included in the study. All subjects underwent a series of audiological tests that included pure-tone audiometry, impedance test and reflex tympanometry. The audiological parameters recorded in the two groups were compared statistically by means of unpaired t tests and corrected according to Bonferroni in the case of repeated tests. RESULTS The pure-tone thresholds at frequencies 125, 250, 500Hz, and 6kHz showed significant differences between the TMD patients and control subjects after the Bonferroni correction (p<0.007). Compliance peaks demonstrated significant differences when the TMD and control groups were compared (p<0.05). CONCLUSIONS The findings indicate that TMD patients with otological complaints have hearing impairment at low frequencies and also perhaps, at high frequencies.

Electrophysiologic vestibular evaluation in type 2 diabetic and prediabetic patients: Air conduction ocular and cervical vestibular evoked myogenic potentials

Abstract Objective: Chronically increased blood glucose levels may affect the vestibular system by damaging cells and neural structures in diabetes mellitus (DM). We aimed to search the effects of neurovascular degeneration on the vestibular system in type 2 DM and prediabetic patients by using air-conducted ocular (oVEMP) and cervical (cVEMP) vestibular evoked myogenic potentials. Design: Prospective study. Study sample: Thirty diabetic, 30 prediabetic patients, and 31 age- and sex-matched controls having no peripheral or central vestibular disease, were enrolled. All participants were evaluated by audiovestibular tests, oVEMP, and cVEMP. Results: In the diabetic group, mean values of both oVEMP and cVEMP p1, n1 latencies were significantly longer compared to the prediabetic group and the control group, whereas latencies were similar in prediabetic and the control groups. Bilateral neural dysfunction was recognized in both tests and lateralization was not seen in VEMP asymmetric ratios. In the diabetic group, prevalence of pathological p1 and n1 latencies in oVEMP were 30.4% and 37.5%, whereas they were 53.7%, 59.3% in cVEMP, respectively. p1 latencies of cVEMP and oVEMP were positively correlated with HbA1c and fasting plasma glucose level in the diabetic group. Conclusion: Subclinical vestibular neuropathy can be a newly defined diabetes-related complication.

Audiologic and impedancemetric findings within thalassaemic patients

The objective of this study is to investigate hearing losses in thalassaemic patients. This study was conducted on 34 thalassemic patients of which 27 of them had thalassaemia major and the remaining 7 had thalassaemia intermedia. Six (11.11%) of the 54 ears with thalassaemia major were found to have normal hearing. Thirty-two ears (59.26%) had conductive hearing loss, 8 ears (14.81%) had mixed type of hearing loss. Moreover, in this group, there was no ear which had pure sensorineural hearing loss. Of the majority of patients having thalassaemia major and thalassaemia intermedia, an air bone gap was found even though there was no negative pressure in the middle ear. In these patients a high degree of static compliance and normal shaped, stiff amplitude, normal pressure tympanograms were observed. Moreover, in most of these patients acoustic reflexes were not obtained. These findings are rather interesting since they show the pathological changes which may cause stiffness in the middle ear sound transmission system.

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.

The effects of concurrent cognitive tasks on postural sway in healthy subjects

INTRODUCTION Keeping balance of the upright stance is a highly practiced daily task for healthy adults and is effectively performed without overt attentional control in most. OBJECTIVE The purpose of this study was to examine the influence of concurrent cognitive tasks on postural sway in healthy participants. METHODS This was a prospective study. 20 healthy volunteer subjects were included. The cognitive and balance tasks were performed separately and then, concurrently. Postural control task consisted of 6 conditions (C) of the Sensory Organization Test. The cognitive task consisted of digit rehearsal task of varying presentation and varying levels of difficulty. RESULTS A statistically significant difference was noted between dual task and no task for C1, C2, C3 and C4 Sensory Organization Test scores (p<0.05). There was no statistically significant difference between dual task versus non-task for C5, C6 and combined Sensory Organization Test scores (p>0.05). CONCLUSION During dual task, increase has been determined in postural sway for C1, C2, C3 and C4 for all presentation modes and difficulty levels of the cognitive tasks.

Functional contributors to poor movement and balance control in patients with low back pain: A descriptive analysis.

BACKGROUND Automatic and voluntary body position control is essential for postural stability; however, little is known about individual factors that impair the sensorimotor system associated with low back pain (LBP). OBJECTIVE To evaluate automatic and voluntary motor control impairments causing postural instability in patients with LBP. METHODS Motor control impairments associated with poor movement and balance control were analyzed prospectively in 32 patients with LBP. Numeric Rating Scale (NRS) for pain assessment, Oswestry Disability Index (ODI) for disability measurement, and computerized dynamic posturography (CDP) for analysis of postural responses were used to measure outcomes of all patients. Computerized dynamic posturography tests including Sensory organization test (SOT), limits of stability test (movement velocity, directional control, endpoint, and maximum excursion), rhythmic weight shift (rhythmic movement speed and directional control), and adaptation test (toes-up and toes-down tests) were performed and the results compared with NeuroCom normative data. RESULTS The mean age of the patients was 40.50 ± 12.28 years. Lower equilibrium scores were observed in SOT (p < 0.05). There was a significant increase in reaction time and decrease in movement velocity, directional control, and endpoint excursion (p < 0.05). Speed of rhythmic movement along the anteroposterior direction decreased, while speed increased along the lateral direction (p < 0.05). Poor directional control was recorded in the anteroposterior direction (p < 0.05). Toes-down test showed an increased COG sway in patients compared with that in the controls (p < 0.05). CONCLUSIONS LBP causes poor voluntary control of body positioning, a reduction in movement control, delays in movement initiation, and a difficulty to adapt to sudden surface changes.

Turkish Standardized Reading Passage for the Evaluation of Hard Glottal Attack Occurrence Frequency

OBJECTIVE This study aimed to develop a Turkish reading passage that can be used in evaluating the frequency of hard glottal attack (HGA) and to assess its reliability. STUDY DESIGN This is a prospective case-control study. METHODS The Towne-Heuer reading passage is a valuable tool that can be used for the auditory-perceptual assessment of voice. The characteristics of the first four paragraphs of the reading passage were analyzed by a linguist. Then, a Turkish reading passage with similar characteristics was developed. The control group (n = 21) consisted of individuals with no voice disorder. The study group consisted of two subgroups that were diagnosed as having vocal fold nodules (n = 11) and muscle tension dysphonia (n = 10). A total of three listeners were evaluated for the frequency of HGAs. One of the listeners was a masters student, whereas the other two listeners were speech-language pathologists. Consistency between the listeners was evaluated by using the percent agreement and the kappa statistics. Intrarater reliability was assessed by the Wilcoxon sign test. The t test was used to evaluate potential differences between the groups. The results were considered as significant if the P value was <0.05. RESULTS The average attack number in the study group was found to be significantly higher than the controls (P < 0.05). No significant difference could be discerned between the muscle tension dysphonia and vocal nodule subgroups (P > 0.05). CONCLUSIONS Findings confirmed that HGAs are clearly related to the vocal hyperfunction; however, the mechanism of action needs more research. In addition, the relationship between syllable stress and HGA should be further researched to clarify the cause of the attack number differences between English and Turkish languages.

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.

The Comparison of Postural Stability in Adolescents with Mild and Moderate Idiopathic Scoliosis

Objective: Postural stability organizes body orientation in the upright stance and daily activities. Postural stability is affected by the trunk asymmetry and deformity in adolescent idiopathic scoliosis (AIS). The aim of this study was to compare mild and moderate curves in terms of postural stability in patients with AIS. Material and Methods: Thirty subjects, with right thoracic and left lumbar scoliosis, and in the age range of 13 15 years, were included in the study. Fifteen subjects had mild curves (10-20o of Cobb) while the other fifteen had moderate curves (21-45o of Cobb). Postural stability was tested with the Computerized Dynamic Posturography Somatosensorial Organization Test. Inter-group comparisons were performed with Mann-Whitney U test statistics. Results: Thoracic curve magnitude was 13.46 ± 1.98o and lumbar curve magnitude was 11.8 ± 6.18o for the mild group. For the moderate group, thoracic curve magnitude was 30.6 ± 10.0o and lumbar curve magnitude was 28.1 ± 7.6o. Higher scores were observed in the “eyes open, swayed vision” and “eyes open, swayed vision and swayed support” conditions for the moderate group (p < 0.05). No significant differences were observed for other test conditions between the groups. conclusion: This study demonstrated that patients with moderate curves had better equilibrium reactions and postural stability adaptations when compared to patients with mild curves in AIS.