Inhibitory kinesiotaping has no effect on post-stroke spasticity: Prospective, randomised, controlled study.

OBJECTIVE: Motor neuron pool activity is high in spasticity. The effect of inhibitory kinesiotaping (KT) on spasticity is unclear. The aim of this study is to investigate the effect of inhibitory KT on spasticity after stroke. METHODS: Fifty stroke patients with ankle plantarflexor spasticity were randomised to intervention (27) and control (23) groups. Inhibitory KT was applied to the triceps surae muscle in the intervention group and sham KT to the Achilles tendon in the control group. Inhibitory and sham KT were applied for 72 h with a combined conventional rehabilitation programme. Spasticity was assessed at baseline and 72 h after KT using three instruments: Modified Ashworth Scale (MAS), Homosynaptic Post-Activation Depression (HPAD) reflecting the level of motor neuron pool activity, and joint torque as a measure of resistance to passive ankle dorsiflexion. RESULTS: The baseline MAS score, HPAD levels and dorsiflexion torque of the two groups were not significantly different. The change in MAS score was -3.7 ± 17.5 (p = 0.180) in the intervention group and 3.6 ± 33.3 (p = 0.655) in the control group. The change in dorsiflexion torque was -0.3 ± 16.1 kg m (p = 0.539) in the intervention group and 8.0 ± 24.1 kg m (p = 0.167) in the control group. The change in mean HPAD was 8.7 ± 34.7 (p = 0.911) in the intervention group and 10.1 ± 41.6 (p = 0.609) in the control group. CONCLUSIONS: The present study showed that inhibitory KT has no antispastic effect in stroke patients.

Postsynaptic potentials of soleus motor neurons produced by transspinal stimulation: a human single-motor unit study.

Transspinal (or transcutaneous spinal cord) stimulation is a noninvasive, cost-effective, easily applied method with great potential as a therapeutic modality for recovering somatic and nonsomatic functions in upper motor neuron disorders. However, how transspinal stimulation affects motor neuron depolarization is poorly understood, limiting the development of effective transspinal stimulation protocols for rehabilitation. In this study, we characterized the responses of soleus α motor neurons to single-pulse transspinal stimulation using single-motor unit (SMU) discharges as a proxy given the 1:1 discharge activation between the motor neuron and the motor unit. Peristimulus time histogram, peristimulus frequencygram, and surface electromyography (sEMG) were used to characterize the postsynaptic potentials of soleus motor neurons. Transspinal stimulation produced short-latency excitatory postsynaptic potentials (EPSPs) followed by two distinct phases of inhibitory postsynaptic potentials (IPSPs) in most soleus motor neurons and only IPSPs in others. Transspinal stimulation generated double discharges at short interspike intervals in a few motor units. The short-latency EPSPs were likely mediated by muscle spindle group Ia and II afferents, and the IPSPs via excitation of group Ib afferents and recurrent collaterals of motor neurons leading to activation of diverse spinal inhibitory interneuronal circuits. Further studies are warranted to understand better how transspinal stimulation affects depolarization of α motor neurons over multiple spinal segments. This knowledge will be seminal for developing effective transspinal stimulation protocols in upper motor neuron lesions.NEW & NOTEWORTHY Transspinal stimulation produces distinct actions on soleus motor neurons: an early short-latency excitation followed by two inhibitions or only inhibition and doublets. These results show how transspinal stimulation affects depolarization of soleus α motor neurons in healthy humans.

Whole body vibration activates the tonic vibration reflex during voluntary contraction.

[Purpose] The beneficial neuromuscular effects of whole-body vibration are explained by the tonic vibration or bone myoregulation reflex. Depending on factors that remain undefined, whole-body vibration may activate the tonic vibration or bone myoregulation reflex. We aimed to examine whether voluntary contraction facilitates activation of the tonic vibration reflex during whole-body vibration. [Participants and Methods] Eleven volunteers were included in this study. Local and whole-body vibrations were applied in a quiet standing (without voluntary contraction) and a semi-squatting (isometric soleus contraction) position. Local vibration was applied to the Achilles tendon. Surface electromyography was obtained from the soleus muscle. The cumulative average method was used to determine soleus reflex latency. [Results] In the quiet standing position, the bone myoregulation reflex latency was 39.9 ± 4.1 milliseconds and the tonic vibration reflex latency was 35.4 ± 3.6 milliseconds. Whole-body vibration application in the semi-squatting position activated the tonic vibration reflex in four participants and the bone myoregulation reflex in seven participants. Local vibration activated the tonic vibration reflex in both positions for all participants. [Conclusion] Simultaneous whole-body vibration application and voluntary contraction may activate the tonic vibration reflex. Determining the spinal mechanisms underlying the whole-body vibration exercises will enable their effective and efficient use in rehabilitation and sports.

Estimating and minimizing movement artifacts in surface electromyogram.

While recording surface electromyography [sEMG], it is possible to record the electrical activities coming from the muscles and transients in the half-cell potential at the electrode-electrolyte interface due to micromovements of the electrode-skin interface. Separating the two sources of electrical activity usually fails due to the overlapping frequency characteristics of the signals. This paper aims to develop a method that detects movement artifacts and suggests a minimization technique. Towards that aim, we first estimated the frequency characteristics of movement artifacts under various static and dynamic experimental conditions. We found that the extent of the movement artifact depended on the nature of the movement and varied from person to person. Our study's highest movement artifact frequency for the stand position was 10 Hz, tiptoe 22, walk 32, run 23, jump from box 41, and jump up and down 40 Hz. Secondly, using a 40 Hz highpass filter, we cut out most of the frequencies belonging to the movement artifacts. Finally, we checked whether the latencies and amplitudes of reflex and direct muscle responses were still observed in the highpass-filtered sEMG. We showed that the 40 Hz highpass filter did not significantly alter reflex and direct muscle variables. Therefore, we recommend that researchers who use sEMG under similar conditions employ the recommended level of highpass filtering to reduce movement artifacts from their records. However, suppose different movement conditions are used. In that case, it is best to estimate the frequency characteristics of the movement artifact before applying any highpass filtering to minimize movement artifacts and their harmonics from sEMG.

High-frequency whole-body vibration activates tonic vibration reflex.

Objectives: The aim of this research was to examine whether high-frequency whole-body vibration activates the tonic vibration reflex (TVR). Patients and methods: The experimental study was conducted with seven volunteers (mean age: 30.8±3.3 years; range, 26 to 35 years) between December 2021 and January 2022. To elicit soleus TVR, high-frequency (100-150 Hz) vibration was applied to the Achilles tendon. High-frequency (100-150 Hz) whole-body vibration and low-frequency (30-40 Hz) whole-body vibration were applied in quiet standing. Whole-body vibration-induced reflexes were recorded from the soleus muscle using surface electromyography. The cumulative average method was used to determine the reflex latencies. Results: Soleus TVR latency was 35.6±5.9 msec, the latency of the reflex activated by high-frequency whole-body vibration was 34.8±6.2 msec, and the latency of the reflex activated by low-frequency whole-body vibration was 42.8±3.4 msec (F(2, 12)=40.07, p=0.0001, ƞ2 =0.87). The low-frequency whole-body vibration-induced reflex latency was significantly longer than high-frequency whole-body vibration-induced reflex latency and TVR latency (p=0.002 and p=0.001, respectively). High-frequency whole-body vibration-induced reflex latency and TVR latency were found to be similar (p=0.526). Conclusion: This study showed that high-frequency whole-body vibration activates TVR.

A reliability study on the cumulative averaging method for estimating effective stimulus time in vibration studies.

Finding the reflex circuitry responsible for high-frequency vibration-induced muscle contraction takes work. The main challenge is to determine the effective stimulus time (EST) point at which continuous (sinusoidal) stimulation (i.e., vibration) triggers the reflex response. A novel "cumulated averaging method" has been previously proposed for estimating the EST point. In the current study, we aimed to test the reliability of the cumulated average method. We used five different whole-body vibration (WBV) frequencies in two experiments. The consistency between the EST points estimated from the first and second experiments was analysed with the intraclass correlation (ICC) and technical error of measurement (TEM). The ICC coefficient with 95% CI for the EST point estimation was 0.988 (0.950-0.997). The relative TEM was 1.3%. We concluded that the cumulated average method is highly reliable in estimating the effective stimulus time point for high-frequency continuous sinusoidal signals.

Vitamin D levels in children with cerebral palsy.

PURPOSE: The aim of this study was to assess serum vitamin D levels and related factors in children with cerebral palsy (CP). METHODS: One hundred and nineteen children with CP between the ages of 1 year to 10 years 9 months who were admitted to the children's inpatient rehabilitation unit of a tertiary rehabilitation hospital between January 1, 2017, and December 31, 2018, were included in this study. Demographic and clinical characteristics were obtained from the patient files. CP types and serum 25 hydroxyvitamin D (25OHD) levels were recorded. Gross Motor Function Classification System (GMFCS) was used to assess the functional level. RESULTS: Mean age was 5.1±2.9 years. Forty-two (35.3%) were girls, 105 (88.3%) were spastic, and 14 (11.7%) were ataxic and mixed type CP. Mean GMFCS level was 4 (IQR:2). Thirty-one (26.1%) were getting extra liquid feed while the rest were eating a normal diet. Mean serum 25OHD level was 27.4±15.7 (3-79) ng/mL. Vitamin D levels were normal in 68 children (57.1%), whereas 36 (30.3%) had vitamin D insufficiency and 15 (12.6%) showed vitamin D deficiency. Those whose serum vitamin D levels were within a normal range had a median age of 3.8 (IQR:4.2) years. On the other hand, mean age was 6.4 (4.3) years for those with low vitamin D level (p < 0.0001). Vitamin D level was 19.8 (21.4) ng/mL in those (n = 88) who had regular diets, whereas it was 31.0 [16] ng/mL in those (n = 31) who were getting extra liquid feed (p = 0.015). There was no statistically significant correlation between vitamin D level and gender, GMFCS, CP type, season or antiepileptic drug treatment. A binary logistic regression model showed that older age and having only regular meals were significant risk factors for low vitamin D. CONCLUSION: In this study, 42.9% of the children with CP had low vitamin D. Older children with CP or those who had regular diets were higher risk groups in terms of low vitamin D.

The reflex mechanism underlying the neuromuscular effects of whole-body vibration: Is it the tonic vibration reflex?

OBJECTIVES: Whole-body vibration (WBV) is applied to the sole of the foot, whereas local mechanical vibration (LMV) is applied directly to the muscle or tendon. The time required for the mechanical stimulus to reach the muscle belly is longer for WBV. Therefore, the WBV-induced muscular reflex (WBV-IMR) latency may be longer than the tonic vibration reflex (TVR) latency. The aim of this study was to determine whether the difference between WBV-IMR and TVR latencies is due to the distance between the vibration application point and the target muscle. METHODS: Eight volunteers participated in this study. The soleus reflex response was recorded during WBV, LMVs, and tendon tap. LMVs were applied to the Achilles tendon and sole of the foot. The latencies were calculated using the cumulative averaging technique. RESULTS: The latency (33.4±2.8 ms) of the soleus reflex induced by the local foot vibration was similar to the soleus TVR latency (30.9±3.2 ms) and T-reflex (32.0±2.4 ms) but significantly shorter than the latency of the soleus WBV-IMR (42.3±3.4 ms) (F(3,21)=27.46, p=0.0001, partial η2=0.797). CONCLUSIONS: The present study points out that the neuronal circuitries of TVR and WBV-IMR are different.

The efficacy of robot-assisted training for patients with upper limb amputations who use myoelectric prostheses: a randomized controlled pilot study.

The aim of this pilot study was to investigate whether a movement therapy robot can improve skills in using a myoelectric prosthesis by patients with upper limb amputations. This prospective randomized, controlled study included a total of eleven patients with upper limb amputations who use myoelectric prostheses. The patients were randomized into a robot-assisted exercise group (n = 6) and a control group (n = 5). The robot group received robot-assisted training. No training program was provided to the control group. The outcome measure was kinematic data (A-goal hand-path ratio, A-goal deviation, A-goal instability and A-move) evaluated by the Armeo®Spring movement therapy robot. Significant improvements were noted in the A-goal hand-path ratio; A-goal deviation and A-goal instability in the robot group after treatment while compared with control group. No significant changes in A-move scores. We concluded that robot-assisted training may improve myoelectric prosthesis use skills in patients with upper limb amputation.

The effect of whole-body vibration on spasticity in post-stroke hemiplegia: A prospective, randomized-controlled study.

Objectives: This study aims to investigate whether whole-body vibration (WBV) has an anti-spastic effect on the ankle plantar flexors. Patients and methods: This single-blind, prospective, randomized-controlled clinical study included a total of 48 patients with chronic stroke (33 males, 15 females; mean age: 60.7±10.9 years; range, 25 to 80 years) between May 2019 and February 2020. They were randomized into two groups: WBV group (n=24) and sham WBV group (n=24). A training program of 12 sessions (three days a week for four weeks) was applied regularly in both groups. The spasticity degree of the plantar flexors was evaluated by using both a subjective assessment method (modified Ashworth scale [MAS]) and several objective assessment methods (Hmax/Mmax, homosynaptic post-activation depression [HPAD], and torque) before and after the training program. Results: There were no significant changes in the torque values, Hmax/Mmax, and HPAD level after the training program in both groups (p>0.05). However, the MAS score in the WBV group significantly decreased (-9.0%), but no change in the control group was observed (0.7%) (p=0.027, effect size = 0.32). Conclusion: The objective assessment methods for spasticity show that WBV has no anti-spastic effect.

A new method to determine stretch reflex latency.

INTRODUCTION/AIMS: Motion artifact signals (MASs) created by the relative movement of intramuscular wire electrodes are an indicator of the mechanical stimulus arrival time to the muscle belly. This study proposes a method that uses wire electrodes as an intramuscular mechanosensor to determine the stretch reflex (SR) latency without lag time. METHODS: Gastrocnemius SR was induced by tendon tap, heel tap, and forefoot tap. The MASs recorded by intramuscular wire electrodes were extracted from background electromyographic activity using the spike-triggered averaging technique. Simultaneous recordings were obtained from multiple sites to validate the MAS technique. RESULTS: Using intramuscular wire electrodes, the MASs were successfully determined and extracted for all stimulus sites. In the records from the rectus femoris, MASs were also successfully extracted; thus, the reflex latency could be calculated. DISCUSSION: Wire electrodes can be used as an intramuscular mechanosensor to determine the mechanical stimulus arrival time to the muscle belly.

Sarcopenia in patients following stroke: an overlooked problem.

Our aim was to investigate the prevalence of sarcopenia in stroke patients, the relationship between sarcopenia detected with different low muscle mass (LMM) adjustment methods, and between stroke-related parameters. Eighty-one patients with chronic stroke who underwent inpatient rehabilitation were included. Spasticity was evaluated by modified Ashworth scale, Brunnstrom staging approach was used for motor function evaluation, physical independence was evaluated using Barthel Index, quality-of-life was evaluated by EQ-5D-3L, and the Cumulative Illness Rating Scale was used to measure multimorbidity. Muscle strength was evaluated by handgrip strength, muscle quantity through a bioelectric impedance analysis, and physical performance by gait speed and short physical performance battery. LMM was calculated through two different methods: Skeletal muscle mass (SMM)/height2, and SMM/BMI. For the definition of sarcopenia, we followed the EWGSOP2 recommendation. Associated sarcopenia factors were predicted by multivariate binary logistic regression analysis. The prevalence of probable sarcopenia was 32.1%. The prevalence of confirmed/sarcopenia when LMM was adjusted for BMI was higher than when adjusted for height2 (16 and 1.2%, respectively). Age was significantly higher in those with probable sarcopenia (P = 0.006). Stroke duration was shorter in those with probable or confirmed sarcopenia (P = 0.004, P < 0.001, respectively). EQ-5D-3L scores were significantly lower in those with confirmed sarcopenia (P = 0.050). The strongest associated factor with confirmed sarcopenia was stroke duration (OR: 0.77; 95% CI, 0.618-0.965). This study suggests that prevalence of sarcopenia after a stroke is significantly high. LMM adjusted for BMI comes in front as the adjustment method for LMM after a stroke.

The Effect of Postamputation Pain and Phantom Sensations on Prosthesis Use, Body Image, and Quality of Life in Patients with Lower-extremity Amputation.

OBJECTIVE: The aim of this study was to investigate phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP) after lower-extremity amputation and their effect on patients' effective prosthesis use, body image, and quality of life in prosthetic users. METHODS: Fifty-seven patients with lower-extremity amputation who used prosthesis for at least three months were included in our study. PLP, PLS, and RLP were evaluated via the prosthesis evaluation questionnaire (PEQ). Prosthetic use, locomotor skills, body image, quality of life were measured by administering Houghton scale, locomotor capabilities index (LCI), amputee body image scale (ABIS), and short-form health survey (SF-36), respectively. RESULTS: On the PEQ, 43.9% of the patients reported PLP, while 63.2% reported PLS, and 40.4% reported RLP. Correlation analyses revealed that as the frequency and duration of PLP increased, the patients' basic and advanced locomotor skills and quality of life decreased. When the intensity of PLP and the degree of distress caused by it increased, the patients' quality of life decreased, and when the frequency of PLS increased, the patients' emotional state worsened. When the intensity of PLS and the degree of bother caused by it increased, the patients' body image, emotional state, and social status worsened. There was no correlation between the rate, frequency, severity, or duration of RLP and scores on Houghton scale, LCI, ABIS, or SF-36. CONCLUSIONS: The presence of PLP and PLS decreases the use of prostheses and impairs body image and quality of life in prosthetic users.

Sleep quality in individuals with short-duration chronic spinal cord injury.

The aim of the study is to estimate the association between spinal cord injuries related medical factors and subjective sleep disturbance in individuals with short-duration chronic spinal cord injury. Seventy-nine individuals with traumatic spinal cord injuries were included in our study and evaluated using the Beck Depression Index for severity of depressive symptoms, Short-Form Health Survey for quality of life, Douleur Neuropathique 4 score for neuropathic pain severity, and the Pittsburgh Sleep Quality Index for subjective sleep disturbances in a tertiary rehabilitation center. Associated subjective sleep disturbance factors were predicted using multivariate binary logistic regression analysis. Subjective sleep disturbance frequency was 74.7 %, and significantly higher in individuals with paraplegia (P = 0.025, odds ratio, 9.74, 95% confidence interval, 1.21-78.14). Intermittent nighttime catheterization frequency and neuropathic pain severity levels were significantly higher in individuals with subjective sleep disturbance, and quality of life and depressive symptoms were significantly worse in individuals with subjective sleep disturbance. Poor-sleep quality was associated significantly with shorter spinal cord injury duration. The strongest associated factors for sleep disturbance were paraplegic involvement, severity of depressive symptoms (Beck Depression Index score), and quality of life (Short-Form Health Survey general health perceptions score) (odds ratio: 95% confidence interval, 29.75; 1.66-534.36, 1.47; 1.11-1.95, and 0.91; 0.85-0.97, respectively). Our study suggests that paraplegic involvement, low quality of life, and depressive mood are related to sleep disturbance in individuals with traumatic spinal cord injury.

A stimulus rate that is not influenced by homosynaptic post-activation depression in chronic stroke.

PURPOSE: To determine a stimulus rate that is not influenced by homosynaptic post-activation depression for H-reflex studies in patients with chronic spasticity. MATERIALS AND METHODS: A cohort of 15 chronic stroke patients with soleus spasticity who received inpatient treatment at our rehabilitation centre participated in this study. The effect of stimulus frequency related depression on H-reflex size was tested using four different stimulus rates (0.1, 0.2, 0.3 and 1 Hz). The affected sides stibial nerve was stimulated by a bipolar electrode. The H-reflex was recorded from the affected sideed sidee sidehe affected smine stimulus frequency related depression of H-reflex size, amplitude of the first H-reflex response (H1) was used as control and amplitude of the second H-reflex response (H2) as test. RESULTS: H2 amplitude for frequency of 1 Hz, 0.3 Hz, 0.2 Hz and 0.1 Hz were 74.3, 84.1, 85.5 and 92.7% of H1, respectively. Depression of H2 amplitude was statistically significant for 1 Hz, 0.3 Hz and 0.2 Hz (p < 0.001, p = 0.002, p = 0.024, respectively). CONCLUSIONS: Higher frequency stimulation of Ia afferents than 0.1 Hz induced a stimulus frequency-related depression of H-reflex size in patients with chronic spasticity. The optimal stimulus rate for H-reflex was found to be 0.1 Hz.

Cross-training effect of chronic whole-body vibration exercise: a randomized controlled study.

Purpose: To determine whether unilateral leg whole-body vibration (WBV) strength training induces strength gain in the untrained contralateral leg muscle. The secondary aim was to determine the potential role of spinal neurological mechanisms regarding the effect of WBV exercise on contralateral strength training.Materials and Methods: Forty-two young adult healthy volunteers were randomized into two groups: WBV exercise and Sham control. An isometric semi-squat exercise during WBV was applied regularly through 20 sessions. WBV training was applied to the right leg in the WBV group and the left leg was isolated from vibration. Sham WBV was applied to the right leg of participants in the Control group. Pre- and post-training isokinetic torque and reflex latency of both quadricepses were evaluated.Results: The increase in the strength of right (vibrated) knee extensors was 9.4 ± 10.7% in the WBV group (p = .001) and was 1.2 ± 6.6% in the Control group (p = .724). The left (non-vibrated) extensorsvibrated) knee extensors w4 ± 8.4% in the WBV group (p = .038), whereas it decreased by 1.4 ± 7.0% in the Control (p = .294). The strength gains were significant between the two groups. WBV induced the reflex response of the quadriceps muscle in the vibrated ipsilateral leg and also in the non-vibrated contralateral leg, though with a definite delay. The WBV-induced muscle reflex (WBV-IMR) latency was 22.5 ± 7.7 ms for the vibrated leg and 39.3 ± 14.6 ms for the non-vibrated leg.Conclusions: Chronic WBV training has an effect of the cross-transfer of strength to contralateral homologous muscles. The WBV-induced muscular reflex may have a role in the mechanism of cross-transfer strength.

Exploring the receptor origin of vibration-induced reflexes.

STUDY DESIGN: An experimental design. OBJECTIVES: The aim of this study was to determine the latencies of vibration-induced reflexes in individuals with and without spinal cord injury (SCI), and to compare these latencies to identify differences in reflex circuitries. SETTING: A tertiary rehabilitation center in Istanbul. METHODS: Seventeen individuals with chronic SCI (SCI group) and 23 participants without SCI (Control group) were included in this study. Latency of tonic vibration reflex (TVR) and whole-body vibration-induced muscular reflex (WBV-IMR) of the left soleus muscle was tested for estimating the reflex origins. The local tendon vibration was applied at six different vibration frequencies (50, 85, 140, 185, 235, and 265 Hz), each lasting for 15 s with 3-s rest intervals. The WBV was applied at six different vibration frequencies (35, 37, 39, 41, 43, and 45 Hz), each lasting for 15 s with 3-s rest intervals. RESULTS: Mean (SD) TVR latency was 39.7 (5.3) ms in the SCI group and 35.9 (2.7) ms in the Control group with a mean (95% CI) difference of -3.8 (-6.7 to -0.9) ms. Mean (SD) WBV-IMR latency was 45.8 (7.4) ms in the SCI group and 43.3 (3.0) ms in the Control group with a mean (95% CI) difference of -2.5 (-6.5 to 1.4) ms. There were significant differences between TVR latency and WBV-IMR latency in both the groups (mean (95% CI) difference; -6.2 (-9.3 to -3.0) ms, p = 0.0001 for the SCI group and -7.4 (-9.3 to -5.6) ms, p = 0.011 for Control group). CONCLUSIONS: The results suggest that the receptor of origin of TVR and WBV-IMR may be different.

Self-Reported Medication Adherence in Patients With Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs.

OBJECTIVES: This study aims to investigate medication adherence in Turkish patients with ankylosing spondylitis (AS) and analyze the related factors for non-adherence. PATIENTS AND METHODS: Ninety-nine patients with AS (60 males, 39 females; mean age 41.3±8.4 years; range, 18 to 66 years) were included in the study. Sociodemographic and clinical data were collected. Disease activity (Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and erythrocyte sedimentation rate), functional status (Bath Ankylosing Spondylitis Functional Index), spinal pain and fatigue (visual analog scale), quality of life (Ankylosing Spondylitis Quality of Life), and depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated. Adherence to anti-rheumatic drugs was elicited using the Compliance Questionnaire on Rheumatology (CQR). Medication beliefs were assessed using the Beliefs about Medicines Questionnaire (BMQ), and illness perception using the Brief Illness Perception Questionnaire (B-IPQ). RESULTS: Non-adherence was reported in 64 patients (64.6%). No significant relationship between demographic, clinical, or psychological factors and adherence was found, except for disease duration (p=0.031). High B-IPQ treatment follow-up, illness coherence, and BMQ-Specific necessity scores were associated with good adherence (p=0.007, p=0.039, and p=0.002, respectively). BMQ-General overuse and harm scores showed an inverse correlation with the CQR score (p=0.005 r=-0.278; p=0.029 r=-0.219, respectively). Longer disease duration [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99] and higher B-IPQ item-1 score regarding the effect of the illness on the individual's life (OR: 0.58, 95% CI: 0.42- 0.81) were important predictors of low adherence. CONCLUSION: Nearly three out of five AS patients were identified as at risk for non-adherence with the CQR. Medication adherence is influenced by the patient's beliefs about medicines and illness perceptions, and these may be key targets for future interventions to improve medication adherence.

Effect of aging on H-reflex response to fatigue.

Injury as a result of tripping is relatively common among older people. The risk of falling increases with fatigue and of importance is the ability to dorsiflex the foot through timely activation of the tibialis anterior (TA) muscle to ensure the foot clears the ground, or an obstacle, during the swing phase of walking. We, therefore, questioned whether the muscle spindle input to the motoneurons alters with ongoing fatigue in older people. We electrically stimulated the common peroneal nerve to assess the TA primary afferent efficacy using H-reflex before, immediately following and after a fatiguing maximal isometric contraction. M-response was kept unchanged throughout the experiment to ensure a similar stimulus intensity was delivered across time points. H-reflex increased significantly while the TA muscle was in a state of fatigue for the younger participants but tended to decrease with increasing age. The main contributor to the tonicity of TA muscle, i.e., excitatory synapses of spindle primary endings of motoneurons that innervate TA muscle, tend to lose their efficacy during fatigue in the older individuals but increased efficiency in the majority of the younger people. Since TA muscle is the main dorsiflexor of the foot and it needs to be active during the swing phase of stepping to prevent tripping, older individuals become more susceptible to falling when their muscles are fatigued. This finding may help improve devices/treatments to overcome the problem of tripping among older individuals.