The effects of ankle mulligan mobilisation in children with cerebral palsy: A randomized single blind control study.

OBJECTIVE: To assess the impact of range of motion changes before and after Mulligan mobilisation with ankle movement interventions on the daily lives of children with diplegic cerebral palsy. METHODS: The single blind randomised controlled study was conducted from July 30, 2022, to January 10, 2023, at 3 rehabilitation centres in Hebron, Palestine, after approval from the ethics review committee of Eastern Mediterranean University, Northern Cyprus, and comprised children with cerebral palsy, who were randomised into intervention group IG and control group CG. All the subjects received regular physiotherapy sessions, overseen by their parents, while those in group IG received mobilisation with ankle movement treatment 3 times per week for 4 weeks. Post-intervention assessment of ankle range of motion, balance, functional performance and quality of life was done using a goniometer, the timed up and go test, 88-item gross motor function measure, 6-minute walk test and the cerebral palsy quality of life questionnaire. Data was analysed using SPSS 24. RESULTS: Of the 64 patients, 40(63%) were girls, and 24(37%) were boys. The overall age range was aged 4-12 years. There were 32(50%) patients in each of the two groups. Mobilisation with movement had a significant effect on active and passive range of motion for the left and right ankles (p<0.05) as well as on balance, gross motor function and quality of life (p>0.05). However, mobilisation with movement had no significant effect on the the distance covered during the 6-minute walk test (p>0.05). CONCLUSIONS: Mobilisation with movement had a significant impact on active and passive ankle range of motion, balance and quality of life in diplegic children with cerebral palsy, but it had no impact on gait function. Clinical trial registration number: The study was registered at the United States National Institutes of Health (ClinicalTrials.gov) with registration number NCT05500924.

Melatonin serum level, sleep functions, and depression level after bilateral anodal transcranial direct current stimulation in patients with Parkinson's disease: a feasibility study.

OBJECTIVE: Parkinson's disease (PD) is associated with non-motor complications such as sleep disturbance and depression. Transcranial direct current stimulation (tDCS) showed therapeutic effects on the motor dysfunctions. However, the potential effects of tDCS therapy on melatonin hormone, sleep dysfunctions, and depression in patients with PD still unclear. This feasibility study aimed to identify any potential changes in melatonin serum level, sleep functions and depression after the bilateral anodal tDCS in patients with PD. MATERIAL AND METHODS: Tensessions of bilateral anodal tDCS stimulation applied over left and right prefrontal and motor areas were given to twenty-five patients with PD. Melatonin serum level, Pittsburgh sleep quality index, and geriatric depression scale examined before and after tDCS stimulation. RESULTS: After bilateral anodal tDCS, there was a significant reduction in melatonin serum level, improvement in depression, improvements in overall sleep quality, and sleep latency. Correlations test showed significant associations between melatonin serum level reduction and changes in subjective sleep quality, and sleep duration, as well as between improvements in depression and overall sleep quality, sleep latency, and sleep disturbance. CONCLUSION: Bilateral anodal tDCS therapy was a feasible and safe tool that showed potential therapeutic effects on melatonin serum level, sleep quality, and depression level in patients with PD. Although the further large scale and randomized-control trial studies are crucially needed, there is still a need for such a feasibility study to be established before such trials can be implemented as is recommended in the new medical research council guidelines.

Effects of Exercise Interventions on Habitual Physical Activity and Sedentary Behavior in Adolescents With Cerebral Palsy.

PURPOSE: Exercise interventions have been shown to increase motor capacities in adolescents with cerebral palsy; however, how they affect habitual physical activity (HPA) and sedentary behavior is unclear. The main objective was to correlate changes in HPA with changes in mobility capacity following exercise interventions. METHODS: A total of 54 participants (aged 12-20 y) with bilateral spastic cerebral palsy at Gross Motor Function Classification System (GMFCS) levels II and III received 4 months of group progressive resistance training or treadmill training. Mobility measurements and HPA (averaged over 96 h) were made before and after interventions. RESULTS: Averaged baseline mobility and HPA measures and improvements in each after both interventions were positively correlated in all participants. Percentage of sedentary/awake time decreased 2%, with significant increases in HPA measures of step count (16%), walk time (14%), and upright time (9%). Mobility measures and HPA changes were quite similar between Gross Motor Function Classification System levels, but improvement in HPA after group progressive resistance training was greater than after treadmill training (12% vs 4%) and correlated with mobility improvement. CONCLUSIONS: Mobility capacity improved after these interventions and was clearly associated with improved HPA. The group progressive resistance training intervention seems preferable to improve HPA, perhaps related to greater social interaction and motivation provided by group training.

Comparison of Habitual Physical Activity and Sedentary Behavior in Adolescents and Young Adults With and Without Cerebral Palsy.

PURPOSE: The comparison of habitual physical activity and sedentary time in teenagers and young adults with cerebral palsy (CP) with typically developed (TD) peers can serve to quantify activity shortcomings. METHODS: Patterns of sedentary, upright, standing, and walking components of habitual physical activity were compared in age-matched (16.8 y) groups of 54 youths with bilateral spastic CP (38 who walk with limitations and 16 who require mobility devices) and 41 TD youths in the Middle East. Activity and sedentary behavior were measured over 96 hours by activPAL3 physical activity monitors. RESULTS: Participants with CP spent more time sedentary (8%) and sitting (37%) and less time standing (20%) and walking (40%) than TD (all Ps < .01). These trends were enhanced in the participants with CP requiring mobility devices. Shorter sedentary events (those <60-min duration) were similar for TD and CP groups, but CP had significantly more long sedentary events (>2 h) and significantly fewer upright events (taking <30, 30-60, and >60 min) and less total upright time than TD. CONCLUSION: Ambulant participants with CP, as well as TD youth must be encouraged to take more breaks from being sedentary and include more frequent and longer upright events.

Recovering of Dizziness of a Patient with Sinusitis after Root Canal Therapy for Upper Second Molar.

This case report illustrates the recovery of dizziness of a young healthy patient after root canal therapy of upper second molar. The patient developed dizziness and unbalanced walking four months ago. After cardiac, ENT, neurological, physiotherapy and medical investigations, his entire checkup showed no abnormalities. The patient visited a dental clinic for a routine checkup; after dental clinical and radiographical examination, a chronic abscess infection in an upper second molar region close to the sinus was diagnosed. Root canal therapy was performed that resulted in a disappearance of the dizziness and full recovery was achieved. Conclusion. Infected upper teeth with periapical lesion are associated with dizziness as a complication of odontogenic-related sinusitis. Dental and medical cooperation contributes to a better management diagnosis of the dizziness.

Effects of a group circuit progressive resistance training program compared with a treadmill training program for adolescents with cerebral palsy.

OBJECTIVE: To determine whether goal-directed group circuit progressive resistance exercise training (GT) can improve motor function in adolescents with cerebral palsy (CP) and to compare outcomes with a treadmill training (TT) intervention. METHODS: In a multi-centered matched pairs study, 95 adolescents with spastic CP (GMFCS II-III) were allocated to GT or TT interventions for 30 bi-weekly one hour training. Outcome measures of GMFM-66, GMFM-D%, GMFM-E%, TUG, 10 meter walk test (10 MWT), and 6 minute walk test (6 MWT) were made at baseline (T1), after interventions (T2) and 6 months post training (T3). RESULTS: Both training programs induced significant improvement in all outcome measures (T2-T1) that were mostly retained at T3. At the end of the intervention, the GT group showed an advantage in all measured changes compared to the TT group and in percentage changes. Differences were significant (p < 0.02) for GMFM-66, GMFM-D%, GMFM-E% and TUG. The advantage trend for the GT group was less apparent at follow up (T3-T1). CONCLUSION: Both programs were effective in improving motor function in adolescents with cerebral palsy. The GT program had generally greater benefits based on the functional measures.