The effect of the COVID-19 pandemic on the caregiving burden of individuals caring for patients with chronic neurological diseases.

BACKGROUND: Caring for neurological patients poses a serious burden on caregivers, even in normal times. It is likely that this burden has become even more painful post-COVID-19 pandemic. OBJECTIVE: This study evaluates the effect of the COVID-19 pandemic on the care burden of those who care for patients with chronic neurological diseases. METHODS: The study included 50 patients and 50 caregivers. All the tests were conducted twice, it was answered firstly, according to the pre-COVID-19 pandemic, and secondly, during the COVID-19 pandemic period. The depression levels of the patients and caregivers were assessed with the Beck Depression Scale, their sleep quality with the Pittsburgh Sleep Quality Index, their quality of life was assessed with the RAND 36-Item Health Survey, and caregivers' burden of care was evaluated with the Zarit Caregiver Burden Scale. RESULTS: It was observed at the end of the study that the depression levels of patients (p = 0.00), and caregivers (p = 0.00) increased post-COVID-19 pandemic, the sleep quality of caregivers (p = 0.00), and patients (p = 0.02) decreased post-COVID-19 pandemic. On the other hand, it was determined that caregivers' burden of care increased (p = 0.00). Sub-parameters of the RAND 36-Item Health Survey, physical functioning (p = 0.02), role limitations due to physical health (p = 0.00), and role limitations due to emotional problems (p = 0.03) decreased for caregivers. CONCLUSION: In summary, we concluded that the well-being and psychological status of both patients and their caregivers were adversely affected by the COVID-19 pandemic.

Time perspective of patients with multiple sclerosis.

OBJECTIVE: The time perspective of individuals with chronic disease is a little-studied parameter. Our aim is to examine multiple sclerosis (MS) patients' time perspective and factors that may affect time perspective and to research the correlation of past, present, and future perspectives. METHODS: Demographic characteristics, the Zimbardo Time Perspective Inventory (ZTPI) score, and the expanded disability status scale score were recorded. Overall, 50 with MS were included in the study. RESULTS: We found that there was a significant difference between present-fatalistic (x=3.18), and present-hedonistic (x=3.49), (p=0.017); also between present-fatalistic (x=3.18), and future (x=3.57), (p=0.011). There was no significant difference in ZTPI scores between gender, place of residence, marital status, number of attacks, or education level. CONCLUSION: MS patients focus mostly on the hedonistic dimension of the life than the fatalistic one in present time. We concluded that patients with MS focused mostly on the future. We found that our patients' present-fatalistic scores were lower, and the future was higher time perspective dimension.

Burnout and anxiety level of healthcare professionals during the COVID-19 pandemic in Turkey.

BACKGROUND: COVID-19 has affected many countries in the world and has been known as one of the fast-spreading viruses in recent history. OBJECTIVE: Our aim is to reveal the level of anxiety and burnout, attitudes, thoughts, and behaviors of healthcare professionals about COVID-19 in Turkey. METHODS: The individuals included in the study answered seven questions containing demographic information, 27 questions determining their views and perspectives on COVID-19. Anxiety level was measured by Beck Anxiety Scale (BAI), and State Anxiety Inventory (SAI); burnout was measured by Maslach Burnout Inventory (MBI). RESULTS: We included 66 health staff (50 female, 16 male) whose mean age was 31.71±5.18 years (22-46 ranged). Twenty-two (33.3%) of the participants worked on the COVID-19 frontline while 44 (66.6%) of them worked on usual wards.We found that participants' anxiety was at a moderate level in BAI (mean: 14.00±12.66). The mean of the SAI was 49.93±13.06. MBI subscales were low. We found that there was a significant difference in BAI between COVID-19 frontline healthcare professionals and those who worked on the usual wards (p = 0.01). CONCLUSIONS: It is important to consider the level of anxiety and burnout in all healthcare professionals and to help them to protect their mental health.

Can diplopia complaint be reduced by telerehabilitation in multiple sclerosis patient during the pandemic?: A case report.

Hospital visits and regular rehabilitation of chronic patients due to COVID-19 pose a risk. Therefore, patients with chronic illnesses who need regular rehabilitation have been victims of the pandemic process. Because of their fear of being infected, they were deprived of the chance of their symptoms being rehabilitated. Therefore, it is extremely important to rehabilitate individuals with chronic illnesses in need of rehabilitation through telerehabilitation. In this study, we aimed to show the effect of Cawthorne-Cooksey exercises to be applied through telerehabilitation on eye movements, vision, and quality of life in a patient suffering from diplopia due to multiple sclerosis (MS). It has been found that Cawthorne-Cooksey exercises improve the quality of life and reduce the complaints of diplopia in MS patients with diplopia. In addition, the patient verbally stated that his balance increased after Cawthorne-Cooksey exercises. As a result, Cawthorne-Cooksey exercises are a rehabilitation method that gives positive results in the treatment of diplopia and it is recommended to apply this method via telerehabilitation.

There is an impairment in time perception of patients with multiple sclerosis.

OBJECTIVE: The objective of this study is to examine time perception impairment in multiple sclerosis (MS) patients. METHOD: The study was performed with 60 MS patients and 60 age-matched healthy people. Estimation and Production Tests were carried out with a standard personal laptop computer and participants were aware to count the seconds by the 'start' command and to stop by the 'stop' command. The outcome measure was the ratio between the estimated duration and the target (7 s, 32 s, or 58 s) one for the Estimation Test and the Produced duration and the target (7 s, 32 s, or 58 s) one for the Production Test; and each time duration was repeated three times both for Production and Estimation Tests. RESULTS: We found a significant difference in the Estimation Test (7 s, 32 s, 58 s), and the Production Test (7 s, 32 s, 58 s) between the MS group and healthy control group (p < .05). It was observed that patients with MS had a higher deviation from the target time compared to the control group. It was found that this difference was statistically significant (p < .05). There was a high and negative correlation between the Estimation and Production Tests in MS patients. CONCLUSION: In conclusion, our data suggests that time estimation and production are disturbed in MS patients, and cognitive rehabilitation is required for most of them.

Somatosensory impairments in patients with multiple sclerosis: association with dynamic postural control and upper extremity motor function.

Purpose: We planned this study to bring attention to the somatosensory impairments in patients with multiple sclerosis (PwMS) and to investigate relationship of somatosensory impairments with dynamic postural stability and upper extremity motor function.Methods: Seven males and 23 females, 30 patients with mean EDSS 2.9 (SD = 1.4), aged between 18 and 65 years (mean = 41.43 ± 14.90 years) were included in this clinical study. Light touch sensorial assessment was made with Semmes Weinstein monofilament test and proprioception by distal proprioception test. Hand strength was measured by the Jamar dynamometer, fine motor skill was examined with nine-hole peg test, functional reach test in sitting and standing position was applied. Nottingham Extended Activities of Daily Living Scale (NEADLS) was used to measure everyday activities.Results: We found a negative and moderate correlation between FRT in standing and light touch of the middle of the heel (right: -0.515), metatarsal bone (right r: 0.453, left r: -0.426), and medial of the foot (right r: -0.462). There was a negative and moderate correlation between NEADLS and light touch of the metatarsal bone (right r: -0.564, left r: -0.472), medial of the foot (right r: -0.531, left r: -0.479), and lateral of the foot (right r: -0.526). We found a positive and moderate correlation between proprioception of the ankle (right r: 0.421 left r: 0.588) and NEADLS.Conclusions: We found impairment in light touch and proprioception and, associations between sensorial functions and dynamic postural stability in PwMS. Also impaired sensorial functions cause dependent patients in daily living activities. In the assessment of balance and falling risk, independency in daily living activities; foot light touch and proprioception sense should be taken into account, hence it may provide guidance in planning rehabilitation programmes.Abbreviations: MS: multiple sclerosis; PwMS: patients with multiple sclerosis; VAS: visual analogue scale; FRT: functional reach test; 9-HPT: Nine-hole peg test; EDSS: The Expanded Disability Status Scale; NEADLS: Nottingham Extended Activities of Daily Living Scale.

Analysis of the effects of subthalamic nucleus deep brain stimulation on somatosensation in Parkinson's disease patients.

OBJECTIVE: Despite the subthalamic nucleus (STN) deep brain stimulation (DBS) is a treatment commonly used to ameliorate the motor symptoms of Parkinson's disease (PD), its effects on somatosensation is unclear. The purpose of this study was to investigate the potential effects of DBS on temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification in PD patients. METHODS: The study included 14 patients (with a mean age of 59.78 ± 11.03 years; range, 44-70 years) with idiopathic PD who underwent DBS surgery for movement disorders caused by PD at the same Neurosurgery Department. All patients were tested while DBS was turned on (DBS-ON) and off (DBS-OFF). To clearly observe the effect of removing stimulation off, DBS devices were turned off by experimental clinical personnel for a minimum duration of 30 min prior to examination. Temperature, proprioceptive, tactile, exteroceptive, pain and cortical sensations, and odor identification were examined. RESULTS: We found that two-point discrimination was significantly lower during DBS-ON than DBS-OFF (p = 0.031). Tactile sensation and kinesthesia deviation degree were lower during DBS-ON than DBS-OFF, but were non-significant (p > 0.05). The number of correct answers on an assessment of graphesthesia was higher during DBS-ON, but was non-significant as well (p > 0.05). Odor identification was better during DBS-OFF. CONCLUSIONS: DBS may have an effective role to improve somatosensation and DBS-related benefits may not be explained by improvements in motor function alone, but rather by enhanced somatosensory processing. Further studies with larger study groups are needed.

The Turkish version of the Modified Falls Efficacy Scale: reliability and validity from the viewpoint of balance

Background/aim: The factors associated with fall-related self-efficacy should be addressed, especially in the elderly. The Modified Falls Efficacy Scale (MFES) is a simple instrument with good scaling properties and reliability. The aim of the present study was to determine the reliability and the validity of the Turkish version of the MFES from the viewpoint of balance. Materials and methods: In this study, 164 participants aged >65 years were included. The use of walking aids and assistive devices, history and frequency of falls in the previous year, living environment, and exercise habits were noted. Balance and risk of falling were assessed with the Berg Balance Scale (BBS). A forward-backward translation procedure was used for the Turkish version of the MFES. Results: None of the 14 items in the MFES were modified. The Turkish version of the MFES has excellent internal consistency (Cronbach's alpha, 0.978) and reliability (interclass correlation coefficient, 0.928­0.982), and its construct validity was supported by its ability to distinguish between the groups with respect to fall-risk factors and balance. According to the BBS scores, the high-fall-risk group had lower MFES scores than the moderate- and low-fall-risk groups (χ2 = 34.153, P = 0.001). Conclusion: The Turkish version of the MFES is a sensitive instrument for evaluation of fall-related confidence while carrying out indoor/outdoor activities. It also predicts falls, reduced physical activity, balance and mobility problems, and restricted social participation and daily living activities.

Neuropathic pain's biopsychosocial effects.

The aim of our study is to understand neuropathic pain's social, psychological, and biological effects on the patients. All of the patients who were diagnosed with neuropathic pain (NP) by a neurologist were invited to participate in the study. The diagnoses were made based on the patients' history and symptoms and the results of their neurological examinations. Demographic characteristics (age and pain duration), diagnoses, and medical histories of the patients were recorded. Average daily pain intensity was measured using a 100-mm visual analogue scale (VAS). Quality of life was measured with RAND 36-Item Health Survey 1.0. Pittsburgh Sleep Quality Index (PSQI) was used to examine the quality of sleep, and Beck Depression Scale was used to examine depression status of the patients. A total of 26 patients (14 male, 12 female) between 33 and 79 years of age participated in the study. There were no dropouts from the study. Eleven (42.3%) patients' mood was normal and the others (57.7%) had different levels of depression. Two patients' (7.7%) quality of sleep was normal, but 24 (92.3%) of the patients' quality of sleep was poor. The patients' pain intensity was at an important and high value (VAS: 6.88). The most important result of this clinical study was that the biopsychosocial approach would be appropriate to understand and treat NP. The biopsychosocial approach to pain addresses psychological, sociocultural factors, and biomedical/physiological aspects. We wanted to draw attention to NP's psychological, emotional and sociocultural characteristics to show that the NP treatment can be applied within this framework.

Effect of sensory training of the posterior thigh on trunk control and upper extremity functions in stroke patients.

Some studies show that sensorial rehabilitation is effective on functionality. The aim of this study is to investigate the effect of sensory training of the posterior thigh on the functionality of upper extremity and trunk control in stroke patients. Thirteen subjects (53.23 ± 6.82 years) were included in the intervention group and 13 subjects (58.69 ± 5.94 years) in the control group. The control and intervention groups were treated for ten sessions. The control group was treated only with neurodevelopmental treatment, and the intervention group was treated with sensorial training on the posterior thigh in addition to the neurodevelopmental treatment. Subjects were evaluated three times, pre- and post-treatment and 10 days after finishing the treatment. Trunk control was assessed by the Trunk Impairment Scale, reaching function by the Functional Reach Test, balance by the Berg Balance Test, upper extremity symptom and disability severity by the Disabilities of the Arm, Shoulder, Hand and Minnesota, independence level in daily living activities by the Barthel Index, and sensory function of the posterior thigh by sensorial tests. In the post-treatment assessment, it was found that the intervention group was better than the control group in the parameter of functional reach while sitting (p < 0.005). In the third assessment, reaching while sitting and independence level were better in the intervention group than the control group (p < 0.005). There was no difference in sensorial assessment between the groups. Sensory training of the posterior thigh should be included in the rehabilitation programme of stroke patients.