Effect of Complex Decongestive Therapy on Quality of Life and Physical Parameters in Head and Neck Lymphedema.

OBJECTIVE: To assess the effect of complex decongestive therapy treatment (CDT) on quality of life, neck disability, cervical range of motion, and facial and neck lymphedema size using specific anatomical landmark points. METHODS: This prospective study was conducted in a tertiary cancer center in Turkey. Thirty patients included in the study were treated with CDT for 21 days. The patients were evaluated before and after CDT with MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNC) staging system, The Neck Disability Index, European Organization for Research and Treatment of Cancer Quality of Life 30 (EORTC-QLOC30), Facial Composite score and Neck Circumferences, cervical range of motion. RESULTS: Median follow-up was 7.2 months. After treatment of 30 patients significant cognitive function, emotional function, and social function (p < 0.001). After CDT treatment, the quality of life sub-parameters of EORTC QLQ-C30 showed significant improvement (p < 0.001). The facial composite score and neck circumferences indices showed significant improvement (p < 0.001). A decrease of 2% or more in the facial composite score and neck circumferences was observed in all patients participating in the study. CONCLUSION: There have been few studies on the effectiveness of CDT on the EORTC QLQ-C30, facial composite score, and neck circumferences in head and neck lymphedema. In patients with head and neck lymphedema following head and neck cancer, our study demonstrated the positive effects of complex decongestive therapy (CDT) on neck disability, range of motion, quality of life, and facial and neck lymphedema tissue size. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3152-3157, 2024.

Psychometric properties of Fullerton Advanced Balance Scale in patients with stroke.

BACKGROUND: Patients experience falls frequently after stroke. Preserved or acquired balance skills decrease fall risk and improve independence. Feasibility of Fullerton Advanced Balance Scale (FAB) has been shown in balance assessment in some neurological diseases except stroke. OBJECTIVES: The purpose of this study was to investigate the reliability and validity of Turkish version of FAB (FAB-T) in patients with stroke (PwS). METHODS: This cross-sectional study included 51 PwS (60.64 ± 7.66 years). Reliability analyses were conducted with Cronbach's alpha, intraclass correlation coefficient (ICC), and Spearman correlation analysis. Intra-rater and inter-rater reliability were assessed with three raters. FAB-T, Stroke Rehabilitation Assessment of Movement (STREAM), Brunnstrom Recovery Stages (BRS), Barthel Index (BI), and 36-Item Short Form Health Survey (SF-36) were used for convergent validity. Correlations of FAB-T with Berg Balance Scale (BBS) and Mini-Balance Evaluation Systems Test (Mini-BESTest) were measured for concurrent validity. Spearman correlation analysis was used for convergent and concurrent validity. For predictive validity patients' self-reports of falling were analyzed with ROC. RESULTS: Intra-rater (ICC = 0.998) and inter-rater reliability (ICCs = 0.984; 0.984; 0.990), and internal consistency (Cronbach's alpha = 0.930) were excellent. FAB-T had good correlations with STREAM (ρ = 0.677) and BI (ρ = 0.628), moderate correlations with BRS (ρ = 0.504 and ρ = 0.579) and physical function of SF-36 (ρ = 0.436). FAB-T excellently correlated with Mini-BESTest and BBS (ρ = 0.928 and ρ = 0.942). The cutoff score of FAB-T was determined to be 21.5 points, with sensitivity of 84% and specificity of 61% (AUC = 0.749). CONCLUSIONS: FAB-T is a reliable and valid balance assessment tool with an acceptable accuracy of fall prediction in PwS.

Mid-term effects of two different Kinesio tape treatments in female patients with subacromial impingement syndrome: Randomized controlled ultrasonographic study.

STUDY DESIGN: Randomized controlled study. PURPOSE OF THE STUDY: To evaluate the effect of Kinesio Tape (KT) applied differently in patients diagnosed with Subacromial Impingement Syndrome (SIS) on acromiohumeral distance (AHD) and supraspinatus tendon (SsT) thickness using ultrasound (US) and its effect on pain, upper limb functional status and hand grip muscle strength in the short and mid-term. METHODS: The 90 patients diagnosed with unilateral SIS by clinical examination were randomized into 3 groups. In addition to exercise therapy, the deltoid in group 1 and the supraspinatus muscle in group 2 were taped from insertion to origin. Group 3, which was the control group, was applied 9 sessions of sham taping for 3 weeks. Cases were evaluated for AHD and SsT thickness, pain was evaluated with the Visual Analog Scale (VAS), function with the Disabilities of the arm, shoulder and hand (DASH) and the Western Ontario Rotator Cuff Index (WORC), and hand grip strength (HGS) using a dynamometer before, and 3rd week and 3rd month after the KT application. RESULTS: There was a significant improvement in all parameters in the short and mid-term intra group comparisons in Group 1 and 2 after taping (P < .05). In intergroup comparisons, significant improvement was achieved in all parameters in Group 1 and Group 2 in the mid and short term compared to the control group (P < .05). In comparison of Group 1 and Group 2, HGS in the short term (p: 0.07) and the SsT thickness in the short and mid-term (p: 0.36, p: 0.85) did not exhibit any difference. The improvement in all other parameters in group 1 was statistically significant. CONCLUSION: The findings of our study provide definitive evidence for the effectiveness of KT treatment depending on the method of tape application employed.

Awareness and attitudes of oncology physicians recommending exercise to patients with cancer.

Objectives: The aim of our study was to evaluate oncology physicians' attitudes and awareness toward recommending exercise to their patients with cancer. Patients and methods: A total of 86 oncology physicians (52 males, 34 females; mean age: 46.7±10.9 years; range, 26 to 60 years) were included in the study between June 2019 and September 2019. A questionnaire was prepared to evaluate the physicians' perspectives about exercise and it consisted of five main sections including the physician's exercise habits, physicians' attitudes toward recommending exercise, the effects of exercise on cancer-related symptoms and cancer treatments, whether there was an exercise unit in the hospital, and whether the physician was referring the patients and on which subjects the physicians were willing to receive training. Results: A total of 87.2% of the physicians recommended exercise to their patients. There were three reasons for physicians who did not recommend exercise: "I don't have enough training to recommend exercise; I don't know which type of exercise to recommend; and I don't know what I should pay attention while recommending exercise." A total of 83.7% physicians considered that exercise reduced the symptoms associated with cancer. A total of 73.3%, 64%, and 80.2% physicians believed that exercise increased the effectiveness of chemotherapy, radiotherapy, and immunotherapy, respectively. About 94.2% of the physicians were willing to be trained on the effects of exercise in cancer. Conclusion: Oncology physicians believe that exercise has positive effects on cancer; however, they still need training on this subject.

Perception of pain in patients with adolescent cerebral palsy: self report or parent's report.

PURPOSE: To compare mothers' report on children's pain with patients' own reports and to explore the prevalence, intensity, localisation and the effect of pain on daily living activities of adolescents with CP. MATERIALS AND METHODS: A total of 75 adolescent with CP (34 females and 41 males) and their mothers were included in this cross-sectional study. Demographical and clinical characteristics were recorded. The adolescent and the mother independently completed the pain questionnaire in a face-to-face interview administrated by a physiatrist. RESULTS: The prevalance of pain in the previous week was 28% by self report and was 40% by mothers' report. No significant difference was determined between mother's report and self report (p = 0.121). There was no significant difference in the prevalence of pain, pain intensity, and the effect of pain on activities of daily living according to Gross Motor Functional Classification System levels and CP types in terms of mothers' report and self report. CONCLUSIONS: Pain is a common condition in adolescents with CP and it affects quality of life negatively. While the self-report of pain is ideal, parent's reports in various situations is important for the assessment of pain.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

Is it mastalgia or myofascial pain? A clinical confusion.

OBJECTIVES: This study aims to investigate the frequency of myofascial pain syndrome (MPS) and its characteristics in mastalgia patients. PATIENTS AND METHODS: The localization of pain, age, education, menopausal status, hormone replacement and employment status, and existence of comorbid diseases were reviewed on consecutive 131 female mastalgia patients (mean age 43.3±9.4 years; range, 18 to 75 years) in this prospective study conducted between June and December 2019. A total breast pain index (IBP) was obtained and mastalgia was classified according to these scores as mild, moderate, and severe. Patients were divided into four diagnostic groups of MPS, cyclic mastalgia, fibrocystic breast disease, and mastitis. RESULTS: The total IBP was significantly higher in MPS group (129.2±49.5) than in cyclic mastalgia group (98.3±11.9) (p<0.05). However, it was significantly higher in mastitis group (230.7±17.6) compared to MPS group (p<0.05). The fibrocystic disease group was similar to MPS group in terms of total IBP (p>0.05). Considering the localization of pain according to the quadrants where the pain was felt, 57.1% of the patients who felt pain in the upper quadrants were from MPS group (p=0.001) and 45.3% of the patients who felt pain in the lower quadrants were from cyclic mastalgia group (p=0.001). Myofascial pain was observed particularly in upper quadrants and almost all was unilateral; however, cyclic mastalgia was observed bilaterally in the majority, particularly in lower quadrants. CONCLUSION: Myofascial pain syndrome should be kept in mind as an extramammary disorder in the differential diagnosis of particularly unilateral upper quadrant mastalgia. It may be for the benefit of patients complaining of mastalgia with no primary breast disorder to be consulted with a physiatrist.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

The results of the intensive phase of complete decongestive therapy and the determination of predictive factors for response to treatment in patients with breast cancer related-lymphedema.

BACKGROUND: Lymphedema is a common complication of breast cancer or its treatment. The gold standard treatment for lymphedema is complete decongestive therapy. There are few studies about the predictive factors for the effectiveness of complete decongestive therapy. AIM: To evaluate the results of the intensive phase of complete decongestive therapy, and to determine the predictive factors for the response to treatment in patients with breast cancer-related lymphedema. METHODS AND RESULTS: Fifty-seven patients with breast cancer-related lymphedema (mean age: 56.2 ± 11.2 years) who underwent complete decongestive therapy between 2014 and 2016 were evaluated retrospectively. Extremity volume was calculated using circumferential measurements and the truncated cone formula technique. Response to treatment was evaluated using the percentage reduction of excess volume formula, which was obtained by calculating the extremity volume before and after treatment. The median percentage reduction of excess volume was 27.7% (IQR,13.6-50.3). The history of skin infection was related to lower percentage reduction of excess volume (P = 0.001). Although percentage reduction of excess volume was positively correlated with education level (r = 0.286, P = 0.031), percentage reduction of excess volume was negatively correlated with lymphedema duration (r = -0.361, P = 0.006), postoperative duration (r = -0.314, P = 0.018), percentage of excess volume (r = -0.398, P = 0.002), and number of complete decongestive therapy sessions (r = -0.436, P = 0.001). Univariate and multivariate analyses showed that the independent variables for percentage reduction of excess volume were percentage of excess volume (P = 0.009) and education level (P = 0.021). CONCLUSION: Complete decongestive therapy is an effective method in patients with breast cancer related-lymphedema. The most important predictive factors for the efficacy of treatment were found as percentage of excess volume and education level. Patients with breast cancer should be followed up regularly and receive complete decongestive therapy in the early stage of lymphedema.

LIMPRINT Study: The Turkish Experience.

Background: Lymphedema and chronic edema is a major health care problem in both developed and nondeveloped countries The Lymphoedema Impact and Prevelance - International (LIMPRINT) study is an international health service-based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF). Methods and Results: A total of 1051 patients from eight centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools that assess the demographic and clinical properties as well as disability and quality of life (QoL). Most of the Turkish patients were recruited from specialist lymphedema services and were found to be women, housewives, and having secondary lymphedema because of cancer treatment. The duration of lymphedema was commonly <5 years and most of them had International Society of Lymphology (ISL) grade 2 lymphedema. Cellulitis, infection, and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to lymphedema centers, nevertheless access seemed difficult because of distance and cost. Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment, as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis, and treatment in Turkey that utilize this informative data.

Complex Decongestive Therapy Enhances Upper Limb Functions in Patients with Breast Cancer-Related Lymphedema.

BACKGROUND: We aimed to evaluate the effects of complex decongestive therapy (CDT) on upper extremity functions, the severity of pain, and quality of life. We also searched the impact of the sociodemographic and clinical characteristics on the improvement in upper extremity functions. METHODS: A total of 37 women with breast cancer-related lymphedema (BCRL) [age, 53.6 ± 11.2 (28-72)] were included in this study. All patients underwent CDT-phase 1 program, including meticulous skin care, manual lymphatic drainage, remedial exercises, and compression bandages. Arm volume was calculated by a formula for truncated cone using circumferential measurements. A baseline questionnaire, including sociodemographic and clinical properties, was used for each patient. Short Form-36 (SF-36), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and Visual Analog Scale (VAS) for pain and heaviness were used as clinical assessment scales. RESULTS: The mean of the posttreatment volume of the affected limb was lower compared to pretreatment volume (2741.81 ± 696.85 and 2990.67 ± 745.49, respectively), and the mean percentage change in edema volume was 38.1% ± 26.5%. We observed a statistically significant reduction in pain and heaviness VAS scores and improvement of shoulder mobility among upper extremities with lymphedema (p < 0.001) after CDT. The mean of posttreatment DASH score was lower compared to pretreatment score (37.19 ± 16.01, 49.81 ± 18.84, respectively, p < 0.001). All subgroups of the SF-36 parameters were increased after the CDT application (p < 0.01). Besides being under 65 years old, having a body mass index above 30 and short duration of lymphedema were found to be related to greater improvement in upper extremity functions. CONCLUSIONS: CDT provides enhancement of upper extremity functions and quality of life in patients with BCRL. The reduction in lymphedema volume, pain, and heaviness and the improvement in shoulder mobility may be the contributed factors.

The importance of orthoses on activities of daily living in patients with unilateral lower limb amputations.

BACKGROUND: The role of the selected prothesis on activities of daily living (ADL). OBJECTIVE: To evaluate the impact of prothesis on ADL in patients with lower-limb amputations. METHODS: The data of 500 patients with unilateral lower limb amputation were recorded. The activity level was defined based on the Medicare Functional Classification Level. Old and new prescribed prosthesis were recorded. Nottingham Extended Activities of daily living activities Daily Living Scale was used to evaluate ADL. RESULTS: Amputation levels were transfemoral (TF) in 268 (53.6%), transtibial (TT) in 178 (35.6%), knee disarticulation (KD) in 54 (10.8%). In patients with TF and KD amputation active vacuum system, pin modular system, hydraulic system and mechanical modular prosthesis were replaced with the swing stance phase microprocessor-controlled prostheses. In patients with TT amputation pin modular system, hydraulic system and mechanical modular prosthesis were converted to active vacuum system prostheses. Prescribed new prosthesis has caused a statistically significant increase in all amputation levels in ADL of patients (p≤ 0.05). CONCLUSIONS: We observed that there was significant improvement in ADL when conventional prostheses replaced with advanced technology prostheses in unilateral lower extremity amputation patients.

The effects of central post-stroke pain on quality of life and depression in patients with stroke.

[Purpose] The aim of this study was to assess the effects of central poststroke pain on quality of life, functionality, and depression in stroke. [Subjects and Methods] Twenty-four patients with stroke having central poststroke pain (a mean age of 60.6±8.5 years; 14 males, 10 females; Group I) and 24 similar age-and gender-matched patients with stroke without central poststroke pain (Group II) were enrolled. Characteristics of pain were recorded in patients with stroke having central poststroke pain. The Visual Analogue Scale and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were used to evaluate pain. The Functional Independence Measure was used to assess functionality, the 36-Item Short-Form Health Survey was used to assess quality of life (QoL), and the Beck Depression Inventory was used to assess depression. [Results] There were no significant differences in Functional Independence Measure and Beck Depression Inventory. Some of the 36-Item Short-Form Health Survey domains (physical role limitations, pain, and physical scores) in Group II were significantly higher than those in Group I. Additionally, we found that a unit increase in Leeds Assessment of Neuropathic Symptoms and Signs score led to 0.679 decrease in physical score and 0.387 decrease in mental score. [Conclusion] The physical component of the 36-Item Short-Form Health Survey is negatively affected in patient with central poststroke pain, but the mood and mental components of the scale unaffected.

Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction.

In this study, we aimed to determine gastrointestinal problems associated with neurogenic bowel dysfunction in spinal cord injury patients and to assess the efficacy of bowel program on gastrointestinal problems and the severity of neurogenic bowel dysfunction. Fifty-five spinal cord injury patients were included in this study. A bowel program according to the characteristics of neurogenic bowel dysfunction was performed for each patient. Before and after bowel program, gastrointestinal problems (constipation, difficult intestinal evacuation, incontinence, abdominal pain, abdominal distension, loss of appetite, hemorrhoids, rectal bleeding and gastrointestinal induced autonomic dysreflexia) and bowel evacuation methods (digital stimulation, oral medication, suppositories, abdominal massage, Valsalva maneuver and manual evacuation) were determined. Neurogenic bowel dysfunction score was used to assess the severity of neurogenic bowel dysfunction. At least one gastrointestinal problem was identified in 44 (80%) of the 55 patients before bowel program. Constipation (56%, 31/55) and incontinence (42%, 23/55) were the most common gastrointestinal problems. Digital rectal stimulation was the most common method for bowel evacuation, both before (76%, 42/55) and after (73%, 40/55) bowel program. Oral medication, enema and manual evacuation application rates were significantly decreased and constipation, difficult intestinal evacuation, abdominal distention, and abdominal pain rates were significantly reduced after bowel program. In addition, mean neurogenic bowel dysfunction score was decreased after bowel program. An effective bowel program decreases the severity of neurogenic bowel dysfunction and reduces associated gastrointestinal problems in patients with spinal cord injury.

Fever during rehabilitation in patients with traumatic spinal cord injury: analysis of 392 cases from a national rehabilitation hospital in Turkey.

OBJECTIVE: To determine the incidence and etiology of fever and the risk factors related to fever in adults with spinal cord injury (SCI) at the rehabilitation stage. DESIGN/SUBJECTS: A retrospective examination of records of 392 consecutive adult patients with traumatic SCI who received inpatient rehabilitation program. SETTING: A national rehabilitation center in Turkey. OUTCOME MEASURES: Incidence and etiology of fever, period of hospitalization (days). RESULTS: A total of 187 patients (47.7%) had fever at least once during their rehabilitation program. The most common etiology was urinary tract infection. The rate of fever occurrence was significantly higher in patients with complete SCI (P = 0.001). In patients with fever, the use of an indwelling catheter was significantly higher compared with clean intermittent catheterization and spontaneous voiding (P = 0.001). The hospitalization period of patients with fever was significantly longer than that of patients without fever (P = 0.006). CONCLUSIONS: A high rate of fever was seen in patients with SCI during rehabilitation. Fever was caused by various infections, of which urinary tract infection was the most common. Patients with motor complete injuries and those with permanent catheters constituted higher risk groups. Fever prolonged the length of rehabilitation stay and hindered active participation in the rehabilitation program.

Musculo-skeletal pain, quality of life and depression in mothers of children with cerebral palsy.

OBJECTIVE: To evaluate musculoskeletal pain (MSP) in mothers of children with cerebral palsy (CP), and to determine the effects of zone of pain on health-related quality of life (QoL) and symptoms of depression. PATIENTS AND METHODS: The study included a total of 81 children with CP, together with their mothers (group 1), and a total of 60 healthy children, together with their mothers (group 2). Presence of MSP, and the zone of pain in mothers were evaluated [lower back pain (LBP), pain in other zones, without pain]. Mothers' QoL was assessed with Short Form-36 (SF-36) scale, and presence of symptoms of depression was assessed with Beck Depression Inventory (BDI). Multivariate analysis of variance test analysis was performed to see the main effects of the factors mother having a child with CP (group 1, group 2) and zone of pain (LBP, other, no pain) on the BDI scores and SF-36 QoL sub parameters of mothers. Logistic regression analysis was performed to determine the parameters predicting the presence of LBP in mothers in group 1. RESULTS: MSP and LBP were found to be significantly higher in group 1. Main effect of the mother having a child with CP on BDI score and physical role (PR) and mental health (MH) parameters was found to be significant. Mean BDI scores of mothers in group 1 was found to be significantly higher as compared to the other group, and mean PR parameter and MH values were found to be significantly lower. Main effect of the zone of pain (arising from the group of mothers with LBP) was found to be significant on physical functioning, bodily pain, general health perception, MH parameters and BDI. Logistic regression analysis showed that MH and bodily pain parameters significantly predicted the presence of LBP. CONCLUSION: Deterioration of MH in mothers with cerebral palsied child may be causing them to experience more LBP. Experience of increased LBP causes deterioration of health-related QoL.

Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement.

The aim of the study was to evaluate the extent of agreement between the findings of ultrasonography (US) and magnetic resonance imaging (MRI) in the assessment of anterior disc displacement (ADD), with or without reduction, and to assess the sensitivity, specificity and the accuracy of the US examination in establishing diagnosis. Fifty-two temporomandibular joints (TMJ) in 52 patients with chronic TMJ pain were examined by US and MRI with respect to ADD, with, and without reduction of the TMJ. The level of agreement between US and MRI findings was evaluated. The sensitivity, specificity, and the accuracy of US were found to be respectively 91%, 16% and 82% in the assessment of ADD; 70%, 38% and 57% in ADD with reduction; 50%, 89% and 76% in ADD without reduction. The findings of both methods were in agreement with each other. US method is fairly sensitive especially in detecting ADD, and it is very reliable in determining the absence of ADD without reduction. However, it was not found to be as quite effective in demonstrating ADD whether it was with or without reduction.

Depression in mothers of children with cerebral palsy and related factors in Turkey: a controlled study.

The primary objective of the study was to determine whether there was any difference, with respect to depression, between mothers of children with cerebral palsy (CP) and mothers of healthy children. The secondary objective was to evaluate whether some additional factors had an impact on the depression of the mothers. The study included 49 children with CP, 50 healthy children, and their mothers. The Beck Depression Inventory (BDI) was applied to all mothers to assess symptoms of depression. CP severity was assessed with the Gross Motor Functional Classification System. BDI scores of the mothers of children with CP were found to be significantly higher (P=0.002) than the mothers of healthy children. Mothers' depression did not vary depending on CP type. Gross Motor Functional Classification System level did not affect mothers' depression. Mothers' depression status was significantly affected by the presence of speech problems in children with CP (P=0.036) and a significant negative correlation was found between BDI scores and income (P=0.007). It is very important to pay attention to the psychological health of the mothers and to provide the families with psychological and social support to ensure the efficiency of rehabilitation program and to meet the objectives.

Effects of ideomotor apraxia on functional outcomes in patients with right hemiplegia.

The aim of this study was to investigate the effect of ideomotor apraxia on activities of daily living and to determine if the presence of apraxia interferes with rehabilitation. This study was conducted on 47 patients with right hemiplegia. All the patients were assessed at their admission and discharge, respectively, for apraxia by Ideomotor Apraxia Test, for daily living activities by Functional Independence Measure (FIM, Santa Clara Valley Medical Center, San Jose, California, USA), for cognitive functions by Mini Mental State Examination (MMSE), and for language components by Gulhane Aphasia Test (GAT). The effects of apraxia presence and time course on FIM, MMSE, and GAT scores were investigated. Presence of apraxia was found to have significant effect on all test scores (P<0.05). Time course had the main significant effect on FIM, MMSE, and GAT scores (P<0.05). Interaction effect of both presence of apraxia and time course on the test scores was not significant either. In other words, apraxic and nonapraxic patients seemed to gain benefits from the neurological rehabilitation. However, mean FIM scores of apraxic patients during discharge have failed to reach the mean FIM scores of nonapraxic patients during admission. Apraxia is considered as an important determinant in the dependence of patients with stroke in their activities of daily living. For this reason, during the initial assessment of patients with right hemiplegia, apraxia should be tested, and the presence of apraxia as well as its severity should be determined.

Evaluation of ideomotor apraxia in patients with stroke: a study of reliability and validity.

OBJECTIVE: This aim of this study was to determine the reliability and validity of an established ideomotor apraxia test when applied to a Turkish stroke patient population and to healthy controls. SUBJECTS: The study group comprised 50 patients with right hemiplegia and 36 with left hemiplegia, who had developed the condition as a result of a cerebrovascular accident, and 33 age-matched healthy subjects. METHODS: The subjects were evaluated for apraxia using an established ideomotor apraxia test. The cut-off value of the test and the reliability coefficient between observers were determined. RESULTS: Apraxia was found in 54% patients with right hemiplegia (most being severe) and in 25% of left hemiplegic patients (most being mild). The apraxia scores for patients with right hemiplegia were found to be significantly lower than for those with left hemiplegia and for healthy subjects. There was no statistically significant difference between patients with left hemiplegia and healthy subjects. CONCLUSION: It was shown that the ideomotor apraxia test could distinguish apraxic from non-apraxic subjects. The reliability coefficient among observers in the study was high and a reliability study of the ideomotor apraxia test was therefore performed.