Balance performance measured by posturography in mild-moderate Alzheimer's Disease: An undervalued assessment.

PURPOSE: The aim of the study was to compare balance performance in mild-moderate stage Alzheimer's disease (AD) patients and healthy peers using clinical balance tests and computerized posturography. METHODS: We recruited 95 patients and divided them into two groups; 51 patients (62 % (n=32) female) in AD group and 44 patients in healthy controls group (50 % (n=22) female). Berg Balance Scale (BBS) and Timed Up & Go (TUG) test were performed. Computerized posturography was performed. RESULTS: The mean age was 77.2±5.5 years in the AD group and 73.8±4.4 years in the control group (p<0.001). Sensory organization test composite equilibrium score (60[30-81], p<0.001), step quick turn-sway velocity (69.2 [38.2-95.8], p<0.001) and step quick turn-time (3.8 [1.6-8.4], p<0.001) were significantly impaired in mild-moderate stage AD patients. Berg Balance Scale (50 [32-56], p<0.001) and TUG test (13.0 [7.0-25.7], p<0.001) results were worse in AD. CONCLUSIONS: Computerized posturography measures were impaired in mild-moderate AD patients. The results highlight importance of early screening for balance and fall risk in AD patients. The study provides multi-dimensional and holistic assessment of balance performance in early-stage AD patients. Alzheimer's disease patients at earlier stages are prone to fall risk and should be evaluated accordingly.

Effectiveness of supervised and functional level-based exercise program in elderly inpatients: Randomised controlled trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of supervised and unsupervised functional level-based exercises program for elderly inpatients on physical activity, mobility, health-related quality of life and depression status. DESIGN: A single-blinded randomised controlled trial. SETTING: Internal medicine service. SUBJECTS: Patients aged 65 years or older. INTERVENTIONS: A supervised functional level-based exercise program was applied to the intervention group by a physiotherapist, for 40 min 5 times a week during their hospitalisation. Patients in the control group were asked to perform an unsupervised functional level-based exercise program which was described by the physiotherapist during the first visit. MAIN MEASURES: Mobility, physical activity level and health-related quality of life were assessed at admission and discharge in both groups. Depression status was evaluated at admission and 3 months after discharge. RESULTS: Sociodemographic features between intervention group (n = 62) and control group (n = 62) were similar. The intervention group showed a higher increment in mobility, physical activity level and quality of life scores than the control group (d = 0.62, p < 0.05; d = 0.57, p < 0.05; d = 1.12, p < 0.05 respectively). Inpatients in the intervention group, depression scores were lower 3 months after discharge (d = 0.42, p < 0.05). The length of stay in the hospital was not different between the groups. CONCLUSIONS: A supervised functional level-based exercise program is more effective than an unsupervised functional level-based exercise program for mobility, physical activity, depression and quality of life in elderly inpatients. These positive contributions are seen within a short period like a 5 to 10 days stay in hospital. TRIAL REGISTRATION: ClinicalTrials.gov(NCT03516032).

The Turkish Version of Pain Assessment in Advanced Dementia (PAINAD) Scale.

INTRODUCTION: This study was conducted to test the reliability and validity of the Turkish version of the "Pain Assessment In Advanced Dementia (PAINAD) Scale". METHODS: One hundred and six older adults with advanced dementia (AD) were recruited in the study. Detailed medical history and demographic data of the participants were recorded. Initially, the Turkish version of PAINAD (PAINAD-TR), which was prepared by means of "back-translation", was applied. Along with this scale, Mini Mental State Examination, Clinical Dementia Rating scale, and Visual Analog Scale were also used. RESULTS: The Cronbach's α coefficient was 0.82 and 0.85 for the test and re-test, respectively. For the test-retest reliability of the PAINAD-TR scale, values of the intraclass correlation coefficient (ICC) and 95% confidence interval (CI) were 0.812 and 0.763-0.850 respectively. According to the results of a factor analysis carried out on the scale, a 2-domain structure was proved. CONCLUSION: The PAINAD-TR scale can be used for the assessment and management of pain in non-communicative older adults with AD.

Reliability and validity of the Turkish version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-T)

Background/aim: This study aimed to assess validity and reliability of the Turkish version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-T). Materials and methods: The individuals who met inclusion criteria of the study were in patients of a hospital and a long-term care facility. Mini Mental Status Exam (MMSE), Cornell Dementia Depression Scale (CDDS), Global Deterioration Scale (GDS), visual analogue scale (VAS), and PACSLAC-T were administered to all subjects. The scales were repeated with an interval of two weeks for test­retest reliability. Results: A total of 112 patients with dementia were included in the study. The intraclass correlation coefficient ICC for test­retest reliability of the PACSLAC-T was 0.713 with a 95% confidence interval of 0.486­0.843. The Cronbach's α coefficient for total PACSLAC-T was 0.842 for test and 0.888 for retest, which indicated substantial internal consistency. In convergent validity, there were significant correlations between PACSLAC-T total score VAS (r = 0.684, P < 0.001), while no correlation was found between PACSLAC-T total score and CDDS (r = 0.127, P = 0.094), and GDS (r = 0.096, P = 0.167). Also, significant correlations were found between PACSLAC-T total score and MMSE (r = ­0.468, P = 0.016). Conclusion: This study showed that PACSLAC-T could be a promising tool for the management of pain in older adults with limited communication skills.

Effect of low-intensity versus high-intensity resistance training on the functioning of the institutionalized frail elderly.

Frailty has emerged as an important risk factor for disability. Age-related declines in physical and physiological function lead to increased risk of loss of independence and poor quality of life. Recent evidence has shown the effectiveness of physical exercise programmes in preventing or reversing frailty. The aim of this study was to evaluate changes in the functioning of frail elderly individuals after undergoing resistance training for 3 days a week for 8 weeks. The effectiveness of exercise training was investigated in 48 frail elderly individuals who were randomly assigned to the following intervention groups: high-intensity (HI; n=16; age: 69-96 years) or low-intensity (LI; n=16; age: 77-93 years) strength training groups or a control group (n=16; age: 76-93 years) with no specific exercise programme. Participants were assessed for muscle strength, physical function, activities of daily living, depression and quality of life. The HI group had significantly better results (P<0.05) on the Short Physical Performance Test than the LI group; however, the LI group did show a significant improvement in those scores, whereas the scores of the control group worsened. Results for the other evaluations were similarly favourable in both exercise groups (P>0.05). The study showed that LI exercise was as effective as HI exercise for most parameters tested. Exercise training is useful for the prevention or treatment of frailty, as it improves functioning by contributing positively to muscle strength, gait, balance and quality of life.

The Turkish version of the Physical Activity Scale for the Elderly (PASE): its cultural adaptation, validation, and reliability.

BACKGROUND/AIM: This study aimed to describe the cultural adaptation of the Turkish Physical Activity Scale for the Elderly (PASE) and to examine the reliability and validity of the scale in older Turkish adults. MATERIALS AND METHODS: Eighty elderly people were recruited for the study. The assessments included the PASE, the International Physical Activity Questionnaire (IPAQ), the Short Physical Performance Battery and Short Form-36 Quality of Life Questionnaire (SF-36), and the Mini Mental State Test. Outcome measures were conducted twice within a week (test-retest) for reliability. RESULTS: Cronbach's α coefficient was 0.714 for the initial evaluation. The intraclass correlation coefficient for the test-retest reliability was 0.995 with a 95% confidence interval of 0.993-0.997. A high level of positive correlation (0.742, P < 0.001) was found between the total score of PASE and the total scores of IPAQ. There were strong positive correlations between the PASE and the total score of SPPB (0.622, P < 0.001), while an average level of positive correlation with SF-36 was found (0.432, P < 0.001). CONCLUSION: The results of the study suggest that the Turkish version of the PASE has powerful measurement qualities, which makes it a reliable and valid scale for the fields of research and practice.

Comparison of the Acute Effect of Radial Shock Wave Therapy and Ultrasound Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Study.

OBJECTIVE: This study compared the effectiveness of radial extracorporeal shock wave therapy (r-ESWT) with ultrasound (US) therapy in the treatment of plantar fasciitis (PF). STUDY DESIGN: Level II, randomized controlled study. DESIGN: A total of 54 female patients with unilateral PF were randomly assigned to two study groups and one control group. All groups performed home exercises. In addition, the first study group received three sessions of r-ESWT treatment and the second study group received seven sessions of US treatment. The Foot Function Index (FFI) and the American Orthopedic Foot and Ankle Association (AOFAS) hind foot score were determined. Static and dynamic equilibrium were evaluated with the single leg standing test and the functional reach test. Ankle proprioception sense was determined with the Biodex III isokinetic device. Patients were evaluated before and four weeks after the first treatment. RESULTS: According to the evaluation results, there was a decrease in FFI values in all groups and these decreases were more prominent in the US group than the other groups (P < 0.05). It was observed that the hind foot AOFAS scores increased in all groups, but this increase was less in the control group (P < 0.05). Static and dynamic balance increased in all groups (P < 0.05). Ankle proprioception sense increased only in the r-ESWT group (P <0.05). CONCLUSIONS: All groups and particularly the r-ESWT and US groups' symptoms were decreased after treatment. However; FFI parameters were reduced more in the US groups than the other two groups, the ankle proprioception sense increased in the r-ESWT group, and there was no change in the other groups.

Comparing routine neurorehabilitation program with trunk exercises based on Bobath concept in multiple sclerosis: pilot study.

This study compared trunk exercises based on the Bobath concept with routine neurorehabilitation approaches in multiple sclerosis (MS). Bobath and routine neurorehabilitation exercises groups were evaluated. MS cases were divided into two groups. Both groups joined a 3 d/wk rehabilitation program for 8 wk. The experimental group performed trunk exercises based on the Bobath concept, and the control group performed routine neurorehabilitation exercises. Additionally, both groups performed balance and coordination exercises. All patients were evaluated with the Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), and Multiple Sclerosis Functional Composite (MSFC) before and after the physiotherapy program. In group analysis, TIS, BBS, ICARS, and MSFC scores and strength of abdominal muscles were significantly different after treatment in both groups (p < 0.05). When the groups were compared, no significant differences were found in any parameters (p > 0.05). Although trunk exercises based on the Bobath concept are rarely applied in MS rehabilitation, the results of this study show that they are as effective as routine neurorehabilitation exercises. Therefore, trunk exercises based on the Bobath concept can be beneficial in MS rehabilitation programs.

Comparing routine neurorehabilitation programme with callisthenic exercises in multiple sclerosis.

We conducted a study that examined the effectiveness of callisthenic exercises in multiple sclerosis. 30 individuals were divided into two groups. The first group did 15~callisthenic exercises and the second group did routine neurorehabilitation programme. Both groups did the programmes for three days per week over six weeks. Visual Analogue Scale for Fatigue (VAS-F), muscle strength tests, Berg Balance Scale (BBS), Multiple Sclerosis Functional Composite (MSFC), Turkish versions of Short Form of 36 (SF-36), and Hospital Anxiety and Depression Scale (HAD) were used for evaluation. After physiotherapy programmes VAS-F, muscle strength, BBS scores decreased significantly in both groups. HAD anxiety score of the first group and HAD depression score of the second group changed significantly. There were no differences in MSFC and SF-36 scores in any groups. The difference between groups was not significant in any parameters, except for the muscle test for upper limbs of the second group. Callisthenic exercises are seen as a new therapy choice, which are different from routine exercises, in order to decrease fatigue, improve balance and muscle strength. Callisthenics are thought to be a beneficial tool for MS patients.

Improvement of muscle strength and fatigue with high voltage pulsed galvanic stimulation in multiple sclerosis patients--a non-randomized controlled trial.

OBJECTIVE: To examine the effects of High Voltage Pulsed Galvanic Stimulation (HVPGS), that was applied to the spasticity associated weakness in knee flexors and ankle dorsiflexors, on strength and fatigue, in Multiple Sclerosis (MS) patients, in a non-randomized controlled trial. METHODS: A total of 33 MS patients were included. Fatigue and strength were analyzed with 3rd and 30th second data by dynamometric measurements synchronously with surface electromyography (EMG) [power spectrum analysis (amplitude, mean frequency, median frequency and root means square]. In the experimental group HVPGS and in the control group repetitive contractions from Proprioceptive Neuromuscular Facilitation (PNF) technique were applied for 18 treatment sessions. RESULTS: In both groups and all muscle groups, dynamometric measurement and EMG results in the 30th second were significantly lower according to in the 3rd second before and after the treatments. Both strength and fatigue improved after the treatment both in the HVPGS and PNF group. CONCLUSION: It was concluded that, MS patients have both central and peripheral fatigue. FO2 localized and intensive effects in strength and fatigue, HVPGS was more impressive than the PNF. PNF was more effective to obtain general effects. Moreover, the application of HVPGS with other rehabilitation techniques may be more appropriate and effective.

Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases.

OBJECTIVE: The aim of this case series is to describe the effect of nerve mobilization techniques in the standard conservative management of cubital tunnel syndrome (CTS). METHODS: Seven patients with CTS participated in this study. Inclusion criteria were having grade 1 and grade 2 entrapment neuropathy according to the McGowan grading system and no other neuropathies. In the evaluation, gripping with grip dynamometer; palmar gripping with a pinchmeter; pain level and Tinel sign with visual analog scale; sensibility with Semmes-Weinstein monofilaments; and functional status of the patients with the Turkish version of the Disability of Arm, Shoulder, and Hand Index were performed before starting a rehabilitation program, at the end of the 8-week rehabilitation program, and at 12-month follow-up. The physiotherapy program consisted of cold application, pulsed ultrasound, nerve mobilization techniques, strengthening exercises, postural adaptations, patient education, and ergonomic modifications. RESULTS: Pain; Tinel sign; and Disability of Arm, Shoulder, and Hand Index scores were decreased, whereas grip and pinch strength increased in the observation period for these 7 patients. CONCLUSION: This case series demonstrated that conservative treatment of CTS may be beneficial for selected patients with mild to moderate symptoms. The treatment included neurodynamic mobilizations, including sliding techniques and tensioning techniques, which are thought to enhance ulnar nerve gliding and restore neural tissue mobility. Conservative treatment using neurodynamic mobilization with patient education and activity modification demonstrated some long-term positive results.

Interferential current versus biofeedback results in urinary stress incontinence.

BACKGROUND: Urinary stress incontinence is a common, disruptive and potentially disabling condition in which the subject complains of involuntary leakage on effort or exertion or on sneezing or coughing. AIM: This study was performed in order to compare the effects of interferential current and biofeedback applications on incontinence severity in patients with urinary stress incontinence. In addition, pelvic muscle strength and quality of life as important parameters in these subjects were investigated. METHODS: In this prospective, randomised, controlled study, forty women with moderate intensity of urinary stress incontinence as determined by one-hour pad test were included. Pelvic muscle strength was evaluated by a biofeedback device and quality of life was assessed by a 28-itemed questionnaire. All of the parameters were evaluated before and after the treatments. Twenty cases underwent interferential current therapy, while pelvic floor exercises via biofeedback were applied in the remaining cases. The treatments lasted 15 minutes per session, three times a week for a total of 15 sessions. RESULTS: All of the parameters improved after the treatments in each group (p <0.05) and both treatment modalities seemed to have similar effects on pad test (95% CI: -1.48 - 4.59), pelvic muscle strength (95% CI: -9.29 -1.78) and quality of life (95% CI: -11.91 - 5.31) outcomes. CONCLUSIONS: Physical therapy modalities used in this trial are applied easily and non invasive. Also, when the finding that no adverse effects were observed during the study period is taken into consideration, it can be concluded that both methods can be used effectively in patients with urinary stress incontinence.

The effect of transcutaneous electrical nerve stimulation on spasticity in multiple sclerosis patients: a pilot study.

The aim of this study was to examine the effects of transcutaneous electrical nerve stimulation on spasticity in patients with multiple sclerosis. The study was carried out in the Hacettepe University School of Physical Therapy and Rehabilitation. The subjects in the study were 10 clinically definite, primary and secondary progressive type multiple sclerosis outpatients with mild to moderate spasticity in the plantar flexor muscles of the ankle. Stimuli of frequency 100 Hz and pulse width 0.3 msec were used 20 minutes per day for 4 weeks. Patients were assessed by electromyography, Modified Ashworth Scale, and Ambulation Index. Electromyography was performed before and after the daily treatment of spastic muscles with transcutaneous electrical nerve stimulation in order to assess the effect on muscle relaxation. The Modified Ashworth Scale and Ambulation Index were used before and after 4 weeks' treatment. After 4 weeks of treatment, there were statistically significant reductions in spasticity of both extremities as assessed by myoelectric activity and the Modified Ashworth Scale (P < 0.05). Ambulation Index level was not improved significantly (P > 0.05).