Barriers and facilitators to physical activity participation among community-dwelling physically inactive individuals after stroke: a qualitative exploratory study.

Physical activity has been shown to reduce the risk for first-ever stroke as well as recurrent stroke with positive effects on almost all known modifiable risk factors. However, the perceived barriers and facilitators for engaging in physical activity have been insufficiently studied and may differ between cultures. Therefore, the aim of this study was to explore the perceptions of community-dwelling physically inactive individuals with stroke about barriers and facilitators to their participation in physical activity. This qualitative study included two focus groups of ten individuals with stroke classified as physically inactive based on accelerometer recordings. A semi-structured set of questions was posed in each focus group session and the transcripts were analysed using thematic analysis. The results revealed three main themes and subthemes: individual factors (physical impairments, psychological factors, spirituality), interaction with the family (attitudes of family members/close community) and social and environmental factors (hobbies, lack of or presence of facilities, the use of orthosis). We conclude that physical activity participation is affected by a multitude of factors as well as cultural differences. Thus, interventions aimed at increasing participation in physical activity after stroke should not only be planned according to individual clinical characteristics but also take into account a range of personal-to-social factors, including cultural differences.

Hawthorne Effect in Gait Analysis of Children with In-Toeing Caused by Increased Femoral Anteversion.

Background: In-toeing is one of the main reasons children are applying to the orthopedics clinic. In the clinical settings, during in-toeing gait assessment parents often define that their child does not walk same at the clinic as at home, linked possibly to Hawthorne effect. Research Question: How does the in-toeing angle differ when children are aware, versus when they are not aware of their gait inspection? Methods: This single center, clinical, cross-sectional, observational study looked into the variation in gait pattern of twelve children with in-toeing, with and without their awareness. Two videos for each child was recorded with a smart phone, once at the clinic while aware and once by the family without awareness, and uploaded into Kinovea software for gait analysis. The angle of foot in-toeing was measured and analyzed using SPSS comparison of means and correlations. Results: The gait pattern evaluated with the angle of in-toeing showed a significant difference between the two videos of the same child. The angle difference returned a p value of 0.000 using paired sample t test and a Cohen's d value of 1.4, representing the large significance between clinic and family recorded videos. The initial foot in-toeing angle showed a moderate positive Pearson's correlation of 0.031 when compared with the angle difference in both settings. Significance: These results highlight the importance of including family recorded videos in gait pattern analysis without the patient's awareness. The study not only shows the significant difference found which can be explained by Hawthorne Effect but also suggests a clearer path of understanding the child's condition with the family.

Collaboration between two CF centers; one in USA and one in Turkey before and during CoV2 pandemic.

To address the discrepancy in the quality of care and outcomes between cystic fibrosis centers (CFCs) in high-income countries and limited resources countries (LRCs), a collaboration between our team at the University of Michigan CFC (UMCFC) and a CF center in Turkey (Marmara University CFC [MUCFC], Istanbul) was established. The collaboration included evaluation of all aspects of care and initiation of quality improvement (QI) measures. Teaching and implementing QI tools has led to start of improvement in MUCFC care. Close monitoring and sharing resources like UMCFC algorithms, protocols, and QI processes were done.

Does ultrasound imaging of the spastic muscle have an additive effect on clinical examination tools in patients with cerebral palsy?: A pilot study.

Objective: The Modified Ashworth Scale, the Modified Tardieu Scale, and measuring the passive range of motion is commonly preferred examination tools for spasticity in cerebral palsy (CP). Ultrasonography has become increasingly used to provide relevant insight into spastic muscle morphology and structure recently. It was aimed to reveal associations between the clinical and ultrasonographic parameters of gastrocnemius medialis (GM) and lateralis muscles in this population. Methods: Thirty-four children with spastic CP aged between 4 and 12 years who did not have botulinum neurotoxin A intervention within 6 months or had no previous history of any orthopedic or neurological surgery were included. The spasticity of GM and lateralis was evaluated firstly by the Modified Ashworth Scale, Modified Tardieu Scale, and ankle passive range of motion. Then, the cross-sectional area (CSA), muscle thickness (MT), qualitative and quantitative echo intensity (EI) values of both muscles were measured from their ultrasonographic images. Results: The CSA of GM, and qualitative EI of both muscles were found to be mild-to-moderately correlated to all clinical examination tools (p<0.01), whereas the CSA of gastrocnemius lateralis was mildly related to Modified Ashworth Scale (p=0.009). The MT and quantitative EI of both muscles were not associated with any of the clinical tools (p>0.05). Conclusion: Ultrasonographic measurements of GM and lateralis partially reflect ankle spasticity in children with CP. Ultrasonography can be used as an alternative tool in this patient population where the clinical evaluation can not perform ideally.

Botulinum toxin application to the internal and external oblique muscles for abdominal spasms in spinal cord injury.

INTRODUCTION: Abdominal spasms are involuntary contractions that can be caused by denervation due to spinal cord injury. We present a case that benefited from botulinum toxin injections. CASE PRESENTATION: A 42-year-old male patient was followed up due to spinal cord injury that developed secondary to burst fracture in the 6th thoracic vertebra as a result of falling off the train in 1996, was classified as International Standards for Neurological Classification of SCI (ISNCSCI) T8 American Spinal Injury Association Impairment Scale (AIS) grade-B. His complaint of contraction and spasms in his abdominal muscles has been present for 2 years but has escalated significantly in the last 3 months. His complaint of contraction and spasms in his abdominal muscles has been present for 2 years but has escalated significantly in the last 3 months. He used oral baclofen 20 mg three times a day for the complaint of contraction, but his complaints did not completely disappear. The use of a baclofen pump was recommended to the patient in his previous visits, but the patient did not accept it. Due to the lack of alternatives and considering the local nature of the complaints, we planned botulinum toxin injection for the patient's bilateral internal oblique and external oblique abdominal muscles with ultrasonography guidance. He benefited significantly from botulinum toxin injection, and his complaints decreased. CONCLUSION: In selected patients with spinal cord injury, ultrasound guided botulinum toxin injections to external and internal oblique muscles can be a safe alternative.