Persian Translation of the Sport Concussion Assessment Tool 6 (SCAT6); a Cross-Cultural Adaptation and Validation Study.

Introduction: Sport Concussion Assessment Tool (SCAT) aids the physicians in early management of concussion among suspected athletes and its 6th version was published in 2023 in English. This study aimed to describe the translation and validation process of SCAT6 from English to Persian. Methods: The Persian translation of SCAT6 and its evaluation has been done in seven stages: initial translation, appraisal of the initial translation, back translation, appraisal of the back-translation, validation (face and content validities), final reconciliation and testing by simulation. Results: Initial translation, was done by two bilingual translators followed by an initial appraisal, which was made by both translators and one general physician. Back translation was done by two naïve translators who were unfamiliar with SCAT6, followed by its appraisal by initial translators. Face and content validity of the translation were surveyed by medical professionals and athletes and the results of the validation process were provided to the reconciliation committee and this committee made the modifications needed. Finally, the use of Persian SCAT6 was simulated and the mean time needed to complete the Persian SCAT6 was roughly a little more than 10 minutes. Conclusions: The present study provides the readers with the translation and cross-cultural adaptation process of SCAT6 from English to Persian. This translated version will be distributed among the Iranian sports community for assessing concussions among athletes.

Ulnar neuropathy.

Ulnar neuropathy at the elbow is the second most common compressive neuropathy. Less common, although similarly disabling, are ulnar neuropathies above the elbow, at the forearm, and the wrist, which can present with different combinations of intrinsic hand muscle weakness and sensory loss. Electrodiagnostic studies are moderately sensitive in diagnosing ulnar neuropathy, although their ability to localize the site of nerve injury is often limited. Nerve imaging with ultrasound can provide greater localization of ulnar injury and identification of specific anatomical pathology causing nerve entrapment. Specifically, imaging can now reliably distinguish ulnar nerve entrapment under the humero-ulnar arcade (cubital tunnel) from nerve injury at the retro-epicondylar groove. Both these pathologies have historically been diagnosed as either "ulnar neuropathy at the elbow," which is non-specific, or "cubital tunnel syndrome," which is often erroneous. Natural history studies are few and limited, although many cases of mild-moderate ulnar neuropathy at the elbow appear to remit spontaneously. Conservative management, perineural steroid injections, and surgical release have all been studied in treating ulnar neuropathy at the elbow. Despite this, questions remain about the most appropriate management for many patients, which is reflected in the absence of management guidelines.

Carpal tunnel syndrome.

Median neuropathy at the wrist, commonly referred to as carpal tunnel syndrome (CTS), is the most common entrapment neuropathy. It is caused by chronic compression of the median nerve at the wrist within the space-limited carpal tunnel. Risk factors that contribute to the etiology of compression include female gender, obesity, work-related factors, and underlying medical conditions, such as hypothyroidism, pregnancy, and amyloidosis. The diagnosis is made on clinical grounds, although these can be confounded by anatomical variations. Electrodiagnostic studies, which are specific and sensitive in diagnosing CTS, support the diagnosis; however, a subgroup may present with normal results. The advent of imaging techniques, including ultrasound and MRI, further assists the diagnostic process. The management of CTS is divided into the nonsurgical approaches that include hand therapy, splinting and corticosteroid injection, and surgical decompression of the carpal tunnel. Although several surgical techniques have been developed, no one method is more effective than the other. Each of these management approaches are effective at providing symptom relief and are utilized at different severities of the condition. There is, however, a lack of consensus on standardized diagnostic criteria, as well as when and to whom to refer patients for surgery.

Discovery of a Novel Yadav-Kunal Reflex in Context of Upper Motor Neuron Lesions: A Report of Three Cases.

Introduction: Numerous reflexive responses have been documented as alterations to the Babinski sign within upper motor neuron lesions. However, scant attention has been given to reflexes beyond these, which exhibit independence from the extensor plantar response. These reflexes predominantly form polysynaptic arcs, with nociceptive stimuli acting as afferents. Case Report: The reflex was serendipitously discovered in an 18-year-old female patient who presented with spastic paraplegia with bowel and bladder involvement, as a consequence of an aneurysmal bone cyst of the D3 (dorsal) vertebrae, and the same was named after the authors as "Yadav-Kunal reflex" which can be defined as: "In individuals with spastic paraparesis, forcibly plantarflexing the toes will result in sudden jerky flexion of the knee and hip on the same side." This novel reflex was further investigated and validated in two additional patients with spastic paraplegia: one, a 45-year-old female with D9-D10 Pott's spine and bowel and bladder involvement, and the other, a 65-year-old male with D10-D11 compressive myelopathy and bowel and bladder involvement. This reflex was meticulously tracked until the abatement of spasticity following surgical intervention. Notably, its manifestation was evident in individuals experiencing spastic paraparesis, dissipating concomitantly with the resolution of spasticity - a direct clinical correlation. Conversely, the reflex was conspicuously absent in cases of flaccid paraplegia. Conclusion: Spasticity, characterized by an increase in muscle tone on swift stretching movements, is a manifestation of a stretch reflex disorder. This condition is primarily induced by lesions affecting upper motor neurons. The activation of muscle spindles in toe dorsiflexors (primarily governed by the L5 nerve) occurs during forceful elongation caused by plantarflexion.

Reliability and Construct Validity of a Mobile Application for the Finger Tapping Test Evaluation in People with Multiple Sclerosis.

The finger tapping test (FTT) is a tool to evaluate the motor performance of the hand and fingers and eye-hand coordination with applicability in people with multiple sclerosis (pwMS). The aim of this study was to evaluate the intra- and inter-rater reliability of the TappingPro® mobile app and the construct validity between this app and validated clinical scales for motor performance in healthy subjects and pwMS. 42 healthy subjects (mean age 25.05) and 13 pwMS (mean age 51.69, EDSS between 3 and 7.5E) participated. FTT was performed with the TappingPro® mobile app. All participants were examined twice, with a one-week interval between the two appointments. For the analysis of construct validity, the Jamar® hydraulic hand dynamometer, Box and Blocks Test (BBT), and Nine Hole Peg Test (NHPT) were used. The intra-rater reliability showed a good correlation (Intraclass Correlation Coefficient, ICC > 0.787) for both upper limbs and both times of FTT for healthy subjects, and an excellent correlation (ICC > 0.956) for upper limbs and both times of FTT for pwMS. The ICC for the inter-rater reliability was good (ICC = 0.869) for the non-dominant upper limb in the FTT 10 s of the healthy subjects, and excellent (ICC > 0.904) for all the other measurements of the healthy subjects and pwMS. However, the Bland-Altman plots showed disagreement between observers and measurements that should be considered in the interpretation of clinical evaluations. The correlation analysis for healthy subjects showed poor associations between all variables, except for the association between hand grip strength and the FTT 60 s in the non-dominant upper limb, which had a moderate coefficient. For pwMS, there were moderate to excellent associations between BBT and the NHPT and FTT for both upper limbs. The correlations between hand grip strength and FFT were poor. This mobile app could be a useful and low-cost assessment tool in pwMS, allowing a simple evaluation and follow-up that has excellent correlation with clinical scales validated in this pathology.

History and Evolution of the Tuning Fork.

This paper is a summary of the evolution of the tuning fork, a crucial part of the cranial nerves and auditory examination. The tuning fork is a two-pronged fork that resonates at a specific pitch when struck against a surface and has been proven to be incredibly useful in diagnosing and detecting hearing disorders. The tuning fork, an unassuming device in modern medicine, traces its origins back to an era when scientific understanding and medical diagnostics were in their nascent stages. Since its inception, this unpretentious instrument has played a pivotal role in the hands of healthcare practitioners, aiding in the diagnosis and assessment of various medical conditions. This paper embarks on a captivating journey through time to explore the origin, evolution, and significant milestones in the development of the tuning fork. From the first suggestion of differentiating hearing disorders to present-day tuning forks, this paper maps the different stages that the tuning fork has gone through and how its use has changed over time. Along the way, we will discover how the tuning fork has harmonized with music, medicine, and various scientific pursuits, enriching our understanding of sound and resonance while leaving an indelible mark on the course of human history. Delving into the historical context of its creation, this review uncovers the ingenious minds that birthed this innovative device and the pivotal moments that brought it to the forefront of human endeavors.

Differential effects of growth restriction and immaturity on predicted psychomotor development at 4 years of age in preterm infants.

BACKGROUND: Fetal growth restriction and immaturity are associated with poor neurocognitive development and child psychopathology affecting educational success at school and beyond. However, the differential effects of either obstetrical risk factor on predicted psychomotor development have not yet been deciphered. OBJECTIVE: This study aimed to separately study the impact of growth restriction and that of immaturity on predicted psychomotor development at the preschool age of 4.3 (standard deviation, 0.8) years using birthweight percentiles in a prospective cohort of preterm infants born at ≤37+6/7 weeks of gestation. Differences between small for gestational age newborns with intrauterine growth restriction and those without were described. We examined predicted total psychomotor development score, predicted developmental disability index, calculated morphometric vitality index, and predicted intelligence quotient, Porteus Maze test score, and neurologic examination optimality score in 854 preterm infants from a large prospective screening cohort (cranial ultrasound screening, n=5,301). STUDY DESIGN: This was a prospective cranial ultrasound screening study with a single-center cohort observational design (data collection done from 1984-1988, analysis done in 2022). The study included 5,301 live-born infants, of whom 854 (16.1%) were preterm infants (≤37+6/7 weeks' gestation), and was conducted on the day of discharge of the mother at 5 to 8 days postpartum from a level 3 perinatal center. Predicted psychomotor development, as assessed by the predicted total psychomotor development score, predicted developmental disability index, calculated morphometric vitality index, predicted intelligence quotient, Porteus Maze test score, and neurologic examination optimality score were calculated. We related psychomotor development indices and measures to gestational age in 3 groups of birthweight percentiles (ie, 10%, 50%, and 90% for small, appropriate, and large for gestational age newborns, respectively) using linear regression analysis, analysis of variance, multivariate analysis of variance, and t test procedures. RESULTS: The key result of our study is the observation that in preterm infants born at ≤37+6/7 weeks of gestation, growth restriction as compared with immaturity is the prime risk factor for impairment of overall predicted psychomotor development, intelligence quotient, Porteus Maze test results, and neurologic examination optimality score at the preschool age of 4.3 (standard deviation, 0.8) years (P<.001). This is particularly true for intrauterine growth restriction. These detrimental effects of growth restriction become more prominent with decreasing gestational age (P<.001). As expected, growth restriction in preterm infants born at ≤37+6/7 weeks of gestation was associated with a number of obstetrical risk factors, including hypertension in pregnancy (P<.001), multiple pregnancy (P<.001), pathologic cardiotocography (P=.001), and low pH (P=.007), increased pCO2 (P=.009), and poor pO2 (P<.001) in umbilical arterial blood. Of note, there were no differences in cerebral hemorrhage or white matter damage among small, appropriate, and large for gestational age birthweight percentile groups, suggesting an independent mechanism of brain injury caused by preterm growth restriction resulting in poor psychomotor development. CONCLUSION: Compared with immaturity, growth restriction in preterm infants has more intense detrimental effects on psychomotor development, necessitating improved risk stratification. This finding has implications for clinical management, parental consultation, and early intervention strategies to improve school performance, educational success, and mental health in children. The mechanisms of brain injury specific to growth restriction in preterm infants require further elucidation.

Síndrome de Balint y trombosis de senos venosos cerebrales: reporte de caso / Balint syndrome and cerebral venous sinus thrombosis: Case report

Introducción: El síndrome de Balint es un trastorno neurológico infrecuente, de etiología diversa, cuya presentación incluye la triada clásica de: simultagnosia, ataxia óptica y apraxia oculomotora, síntomas secundarios asociados a lesiones parieto-occipitales, con pronóstico variable según la etiología que se encuentre. A continuación, se reporta un caso secundario a una trombosis de senos venosos. Presentación del caso: Mujer de 66 años que ingresa a urgencias por cefalea aguda asociada a síntomas neurológicos progresivos con compromiso visual. Presentó tensión arterial elevada, simultagnosia, ataxia óptica y apraxia oculomotora. Los estudios imagenológicos reportaron hemorragia subaracnoidea por trombosis de seno sigmoideo izquierdo, por lo que se inició anticoagulación, antihipertensivo, con adecuada evolución del cuadro clínico. Discusión: A pesar de que el síndrome de Balint es un trastorno poco común, de etiología diversa, con escasos reportes a escala global, el caso comentado concordó con las características descritas en la literatura. El abordaje de la paciente en su atención inicial permitió la sospecha diagnóstica oportuna y la indicación de ayudas diagnósticas imagenológicas pertinentes. Tales ayudas soportaron un manejo temprano y la adecuada evolución y resolución del cuadro, en el contexto de la asociación del síndrome a una trombosis de senos venosos cerebrales (una etiología infrecuente). Conclusión: Mediante una historia clínica completa y minuciosa, junto a un adecuado examen neurológico, es posible hacer un acercamiento diagnóstico temprano que permita generar la sospecha del síndrome de Balint y la solicitud temprana de imágenes diagnósticas que orienten en el estudio de su etiología y manejo oportuno, con mejores desenlaces en el paciente.

Introduction: Balint Syndrome is a rare neurological disorder with multiple etiologies. The physical signs include a classic triad (simultagnosia, optic ataxia, and oculomotor apraxia). These symptoms are associated with parieto-occipital lesions, and the prognosis depends on the etiology. This article reports a case secondary to venous sinus thrombosis. Presentation of the case: A 66-year-old woman presented to the emergency room with acute headache associated with progressive neurological symptoms and visual impairment. She had high blood pressure, simultanagnosia, optic ataxia, and oculomotor apraxia. Imaging studies revealed subarachnoid hemorrhage due to thrombosis of the left sigmoid sinus, for which anticoagulation and antihypertensive therapy were started. The patient had a favorable clinical outcome. Discussion: Although Balint syndrome is a rare disorder of diverse etiology with few clinical cases reported globally, the case discussed here was consistent with the characteristics described in the literature. The patient's initial assessment allowed for timely diagnostic suspicion and appropriate imaging studies, which supported early management and the appropriate evolution and resolution of the condition, given the association of the syndrome with an uncommon cause as cerebral venous sinus thrombosis. Conclusion: A complete and thorough medical history, along with a proper neurological exam, can lead to an early diagnostic approach that raises suspicion of Balint's syndrome and prompts timely imaging studies to guide the investigation of its etiology and management, ultimately leading to better outcomes for the patient.

Brain MRI and EEG overemployment in patients with vasovagal syncope: results from a tertiary syncope unit.

BACKGROUND: The diagnosis of vasovagal syncope (VVS) is mainly based on history-taking and physical examination. However, brain Magnetic Resonance Imaging (MRI) and Electroencephalogram (EEG) are commonly used in the diagnostic course of VVS, despite not being indicated in the guidelines. This study aims to find the possible associated factors with the administration of brain MRI and EEG in patients with VVS. METHODS: Patients with a diagnosis of VVS from 2017 to 2022 were included. Several demographic and syncope features were recorded. The association of these was assessed with undergoing MRI, EEG, and either MRI or EEG. Univariate and multivariable logistic regression models were also used to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A total of 1882 patients with VVS were analyzed, among which 810 underwent MRI (43.04%), 985 underwent EEG (52.34%), and 1166 underwent MRI or EEG (61.96%). Head trauma (OR 1.38, 95% CI 1.06 to 1.80), previous neurologist visit (OR 6.28, 95% CI 4.24 to 9.64), and gaze disturbance during syncope (OR 1.75, 95% CI 1.13 to 2.78) were all positively associated to the performance of brain MRI/EEG. Similar results were found for urinary incontinence (OR 2.415, 95% CI 1.494 to 4.055), amnesia (OR 1.421, 95% CI 1.053 to 1.930), headache after syncope (OR 1.321, 95% CI 1.046 to 1.672), and tonic-clonic movements in head-up tilt table test (OR 1.501, 95% CI 1.087 to 2.093). However, male sex (OR 0.655, 95% CI 0.535 to 0.800) and chest pain before syncope (OR 0.628, 95% CI 0.459 to 0.860) had significant negative associations with performing brain MRI/EEG. CONCLUSION: Based on our findings, performing MRI or EEG was common among VVS patients while it is not indicated in the majority of cases. This should be taken into consideration to prevent inappropriate MRI/EEG when there is a typical history compatible with VVS.

Evaluation of a Virtual Reality Simulation to Improve Problem-Based Learning for Neurologic Examination in Nursing Students.

Background: In the era of the fourth industrial revolution, there is a requirement of innovative strategies to enhance nursing students' learning transfer. Virtual Reality Simulation Problem-Based Learning (VRS-PBL) has been validated to be an advantageous strategy that can improve knowledge, clinical performance, and self-efficacy. We aimed to identify the effectiveness of VRS-PBL for improving nursing students' neurologic examination. Methods: Data were collected in 2021. Seventy-six participants were recruited via the convenience sampling. Students in the control group underwent conventional lecture and demonstration of neurological assessment prior to practicum, whereas students in the experimental group underwent VRS-PBL once a week for 2 weeks (60 minutes per session). Results: Compared with the control group, the academic self-efficacy (t = -2.80, P = .007) and neurological examination performance (t = -11.62, P < .001) of the nursing students increased significantly in the experimental group. On the other hand, there was no significant difference between the two groups of the transfer motivation (t = -1.76, P = .082). Conclusion: The nursing students integrated the knowledge and skills learned through VRS-PBL, and improved the effectiveness and efficiency of their learning. VRS-PBL that reflects various clinical situations can be used as a foundation for establishing effective teaching strategies to improve nursing competency from novice to expert nurses.

Assessing Stroke-Related Sarcopenia in Chronic Stroke: Identification of Clinical Assessment Tools-A Pilot Study.

Stroke-related sarcopenia has recently been defined as the muscle atrophy consequent to stroke and assessing it following the guidelines with simple clinical tools is crucial in chronic stroke survivors. The aim of this study was to determine the characteristics of patient-friendly instruments sarcopenia in a chronic stroke sample (SG) compared to non-stroke counterparts (CG). Each participant underwent a single assessment which consisted of: SARC-F questionnaire, assessment of muscle strength (hand grip and five-times sit-to-stand test, 5STS), the calf circumference (CC) of both legs, the short physical performance battery (SPPB), and the 10 m walk test. A total of 68 participants were included (SG, n = 34 and CG, n = 34). All variables showed statistical differences (p < 0.05) between the SG and the CG, except handgrip although it showed lower values for SG. The values of the 5STS (16.26 s) and the SPPB (7 points) were below to the cutoff values for the SG. The five-times sit-to-stand test, SPPB, and gait speed can lead clinicians to detect stroke-related sarcopenia. Maximum handgrip shows a trend of low values for men and women in the SG, however, CC did not detect sarcopenia in our sample.

Reliability of telemedicine evaluation for EDSS functional systems in multiple sclerosis.

Introduction: There was an increase in telemedicine during the COVID-19 pandemic to follow patients with multiple sclerosis (MS). However, there is scarce data if online evaluations can cover important information assessed during in-clinic appointments, especially the Expanded Disability Status Score (EDSS). This study aims to develop a remote evaluation tool for EDSS functional systems and compare the performance with face-to-face evaluations. Methods: This was a single-center study that included all MS patients followed up at outpatient clinics of Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul, between April and August 2022. Initially, patients were routinely in-clinic evaluated by one trained neurologist for EDSS. After, patients were evaluated remotely without any information about the in-clinic EDSS results. We used a standardized interview with an interactive video platform to evaluate EDSS functional systems by telemedicine. Results: Forty-nine participants completed the two steps. Intra-class coefficient was 0.97 (95% CI: 0.95-0.98), concordance for EDSS below 4.0 was 0.87 (95% CI: 0.77-0.93) and ≥4.0 was 0.97 (95% CI: 0.89-0.99). There was perfect agreement in the final EDSS in 71.4% of the online and in-clinic evaluations. In the multivariate analysis, the visual (beta = 0.453; p = 0.003) and pyramidal (beta = 0.403; p = 0.009) systems contributed significantly to the difference in the final EDSS. Conclusion: The telemedicine tool created in this study can detect changes in functional systems with reliable results compared to in-clinic EDSS assessment. Telemedicine evaluations may reduce the number of in-clinic visits and the disease burden for patients with MS.

Acute assessment of spinal cord injury in New South Wales: A retrospective study of current practice in two spinal cord injury referral centers.

INTRODUCTION: Interventions provided in the early phases after spinal cord injury (SCI) may improve neurological recovery and provide for best possible functional outcomes. Knowing this relies on early and clear documentation of the level and grade of the spinal cord injury. Guidelines advocate for early documentation of neurological status within 72 h of injury to allow early prognostication and to help guide initial management. It is unclear whether this is current practice in New South Wales (NSW). METHODS: Patients with acute SCI who were admitted to two SCI referral centers during 2018-2019 in NSW were included. Data relating to documentation of neurological status, timing of imaging, surgery and transfer to spinal cord injury center were collected and summarized using descriptive statistics. RESULTS: Only 18 percent of patients had an acceptable neurological examination according to the International Standards for Classification of Spinal Cord Injury (ISNCSCI) within 72 h of injury (either not done, or unable to determine the neurological level of injury). At the first neurological examination, the neurological level of injury and grade was unable to be determined in 26.8% of patients and 29.9% of patients respectively. At discharge from acute care and transfer to rehabilitation, the neurological level was undetermined in 28.9% of patients and grade undetermined in 26.8%. ISNCSCI examination was most commonly performed by spinal rehabilitation doctors after patients were discharged from the intensive care unit (ICU). CONCLUSIONS: Documentation of neurological level and grade of SCI within 72 h of injury is not being performed in the large majority of this cohort, which may impede evaluation of neurological improvement in response to acute treatment, and hinder prognostication.

Diffuse Axonal Injury Pattern Predicts Timing of In-Hospital Neurologic Recovery: A Retrospective Case Series.

BACKGROUND: Diffuse axonal injury (DAI) is a devastating traumatic neurologic injury with variable prognosis. Although outcomes such as mortality have been described, the time course of neurologic progression is poorly understood. We investigated the association between DAI neuroanatomic injury pattern and neurologic recovery timing. METHODS: A retrospective review of our institution's trauma registry identified patients diagnosed with DAI from 2017-2021. The neuroradiologist's review of a head computed tomography scan was used to score DAI severity. In-hospital neurologic examinations were reviewed, and the Glasgow Coma Scale (GCS) was calculated for all patients throughout the hospital stay. Categorical variables were analyzed using the Fisher exact test, and continuous variables were analyzed using the Kruskal-Wallis test. RESULTS: Nineteen DAI patients (grade 1 = 8; grade 2 = 1; grade 3 = 10) were included (mean age 31 years, 79% male). Mean Rotterdam computed tomography score, Injury Severity Scale, and admission GCS were comparable across DAI grades. Mean time in days to follow commands was shorter for those with grade 1 DAI (9.3) compared with grade 2 (17 days) or grade 3 (19 days) DAI (P = 0.02). Throughout hospitalization, patients with grade 1 DAI had higher motor (P = 0.006), eye (P = 0.001), and total GCS (P = 0.011) scores compared with those with grade 2 or 3 DAI. At the time of discharge, total GCS and the frequency of command following was similar across DAI grades. CONCLUSIONS: Patients with grade 1 DAI demonstrated the fastest short-term neurologic recovery, although final discharge neurologic examination was comparable across DAI grades. DAI classification can provide useful short-term prognostic information regarding in-hospital neurologic improvement.

Interrater Reliability of the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and Functional Independence Measure Motor Domain in Individuals With Hereditary Cerebellar Ataxia.

OBJECTIVE: To determine the interrater reliability of the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), and motor domain of the FIM (m-FIM) administered by physiotherapists in individuals with a hereditary cerebellar ataxia (HCA). DESIGN: Participants were assessed by 1 of 4 physiotherapists. Assessments were video-recorded and the remaining 3 physiotherapists scored the scales for each participant. Raters were blinded to each other's scores. SETTING: Assessments were administered at 3 clinical locations in separate states in Australia. PARTICIPANTS: Twenty-one individuals (mean age=47.63 years; SD=18.42; 13 male and 8 female) living in the community with an HCA were recruited (N=21). MAIN OUTCOME MEASURES: Total and single-item scores of the SARA, BBS, and m-FIM were examined. The m-FIM was conducted by interview. RESULTS: Intraclass coefficients (2,1) for the total scores of the m-FIM (0.92; 95% confidence interval [CI], 0.85-0.96), SARA (0.92; 95% CI, 0.86-0.96), and BBS (0.99; 95% CI, 0.98-0.99) indicated excellent interrater reliability. However, there was inconsistent agreement with the individual items, with SARA item 5 (right side) and item 7 (both sides) demonstrating poor interrater reliability and items 1 and 2 demonstrating excellent reliability. CONCLUSIONS: The m-FIM (by interview), SARA, and BBS have excellent interrater reliability for use when assessing individuals with an HCA. Physiotherapists could be considered for administration of the SARA in clinical trials. However, further work is required to improve the agreement of the single-item scores and to examine the other psychometric properties of these scales.

Feasibility for evaluating motor aspects of Parkinson's disease through video consultations in a resource-limited setting in Southern Brazil / Viabilidade para avaliar os aspectos motores da doença de Parkinson através de consultas por vídeo em um ambiente de recursos limitados no sul do Brasil

Abstract Background Performing motor evaluations using videoconferencing for patients with Parkinson's disease (PD) is safe and feasible. However, the feasibility of these evaluations is not adequately studied in resource-limited settings. Objective To evaluate the feasibility of performing motor evaluations for patients with PD in a resource-limited setting. Methods The examiners rated motor aspects of parkinsonism of 34 patients with PD from the Brazilian public healthcare system through telemedicine with the patient's own means by using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) rating scale. Quality measures of the video meeting were also obtained. The feasibility of rating the motor aspects was the primary outcome whereas the rating of individual motor aspects, video meeting quality and predictors of a complete evaluation served as secondary outcomes. Results The least assessable parameters were freezing of gait (52.9%), gait (70.6%), leg agility, and rest tremor (both 76.5%). Complete MDS-UPDRS part III was possible in 41.2% of patients and 62 out of 374 motor aspects evaluated (16.6%) were missed. Available physical space for a video evaluation was the worst quality measure. Incomplete evaluations were directly associated with disability (p = 0.048, r = 0.34) and inversely with available physical space (p = 0.003, r = 0.55). Conclusion A significant portion of the MDS-UPDRS part III is unable to be performed during telemedicine-based evaluations in a real-life scenario of a resource-limited setting.

Resumo Antecedentes Realizar avaliações motoras usando videoconferência para pacientes com doença de Parkinson (DP) é seguro e viável. Entretanto, a viabilidade dessas avaliações não é adequadamente estudada em cenários com recursos limitados. Objetivo Identificar a viabilidade de realizar avaliações motoras para pacientes com DP em um ambiente com recursos limitados. Métodos Os examinadores avaliaram os aspectos motores da DP de 34 pacientes do sistema público de saúde brasileiro através da telemedicina com os próprios meios do paciente usando a escala Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Medidas de qualidade da videochamada também foram obtidas. A viabilidade da classificação dos aspectos motores foi o resultado primário, enquanto a classificação dos aspectos motores individuais, a qualidade das videoconferências e os preditores de uma avaliação completa serviram como resultados secundários. Resultados Os parâmetros menos avaliáveis foram congelamento da marcha (52,9%), marcha (70,6%), agilidade dos membros inferiores e tremor de repouso (ambos 76,5%). A parte III completa da MDS-UPDRS foi possível em 41,2% dos pacientes, mas não foi possível avaliar 62 do total de 374 aspectos motores (16,6%). O espaço físico disponível para uma avaliação em vídeo foi a pior medida de qualidade. As avaliações incompletas foram diretamente associadas ao nível de dependência (p = 0,048, r = 0,34) e inversamente ao espaço físico disponível (p = 0,003, r = 0,55). Conclusão Uma porção significativa da parte III da MDS-UPDRS é perdida durante as avaliações baseadas em telemedicina em um cenário da vida real com recursos limitados.

Reliability and validity of the Turkish version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy.

PURPOSE: This study aims to translate the Selective Control Assessment of the Lower Extremity (SCALE) into Turkish language, assess its reliability and validity in children with spastic cerebral palsy. MATERIALS AND METHODS: Fifty-two children with CP (mean age 9 years 8 months, range 4-18 years) included in this cross-sectional study. Intra- and interrater reliability was assessed by intraclass correlation coefficient (ICC). The SCALE was correlated with the Gross Motor Function Classification System (GMFCS), the Physician's Rating Scale (PRS), and Gross Motor Function Measurement (GMFM) to assess validity. RESULTS: Intra- and interrater reliability of the SCALE were excellent (ICC > 0.75). SCALE and GMFCS (r = -0.786, p < 0.001), SCALE and PRS (r = 0.761, p < 0.001), SCALE and GMFM (r = 0.863, p < 0.001) were highly correlated. SCALE scores differed significantly between GMFCS levels and between types of spastic CP. CONCLUSIONS: The Turkish version of the SCALE appears to be a valid and reliable tool to assess selective voluntary motor control of the lower limbs in children with spastic CP.IMPLICATIONS FOR REHABILITATIONThe Turkish version of the Selective Control Assessment of the Lower Extremity is a valid and reliable assessment for children with spastic CP.The SCALE scores differed significantly between Gross Motor Function Classification System levels I versus II and levels II versus III as well as between types of spastic CP.The current study suggests that the SCALE is a quick and easy outcome measure to assess selective motor control in patients with spastic CP.

Quantifying Neurological Examination in 21st Century: Yilmaz- Ilbay Plantar Flexion Test, A Novel and Reliable Test for Evaluation of Plantar Flexion in L5-S1 Disc Herniation.

Background: Current methods used to measure the muscle strength required to achieve plantar flexion may yield highly variable results depending on the perception of the physician conducting the examination because these tests involve subjective and qualitative evaluation. Objective: To describe and evaluate the efficacy of a novel examination technique that can quantitatively measure plantar flexion in L5-S1 disc herniation. Materials and Methods: A total of 32 patients (average age: 49.4 years, range: 23-78) with L5-S1 disc herniations were included. The patient to be tested stood next to a table on which they could lean with their hands. The leg closer to the table was fully flexed at the knee, and the other foot was brought to maximum plantar flexion on the toes. At this point, a stopwatch was started to measure the time that passed until the muscles fatigued and the heel fell. The differences between the right and left plantar flexion times were noted. In addition, three different physicians graded muscle strength by using the classical "The Medical Research Council of the United Kingdom" method. Results: The time until fatigue in right and left plantar flexion was measured using the proposed method, and each test underwent a video recording. The Yilmaz-Ilbay plantar flexion test yielded the correct classification for all cases. Conclusion: We suggest that the proposed method "Yilmaz-Ilbay plantar flexion test" can serve as a useful, practical, and effective test to detect quantitative evaluation of plantar flexion in L5-S1 herniation.