Effects of modified-constraint induced movement therapy based telerehabilitation on upper extremity motor functions in stroke patients.

INTRODUCTION: The aim of this study is to investigate the effects of Modified-Constraint Induced Movement Therapy (m-CIMT) based telerehabilitation on upper extremity motor functions in stroke patients. METHODS: Eighteen stroke patients were included and randomly allocated into two groups. The Tele-CIMT (modified-constraint induced movement therapy-based telerehabilitation) (n = 10) group received m-CIMT based telerehabilitation for 90 min a day, 5 weekdays for 3 weeks at home. Additionally, both the Tele-CIMT group and the control group (CG) (n = 8) underwent the home exercise program aimed at improving range of motion, active movement, balance, and walking every weekday for 3 weeks at home. The outcome measures were the Stroke Rehabilitation Assessment of Movement Scale (STREAM), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FM-UE), Wolf Motor Function Test (WMFT), 9-Hole Peg Test (9-HPT), grip strengths, pinch strengths, Motor Activity Log-28 (MAL-28), and Functional Independence Measure (FIM). RESULTS: Significant group-by-time interactions on STREAM, FM-UE, WMFT, grip strength, pinch strengths, MAL-28, and FIM were found to be in favor of the Tele-CIMT group. Additionally, post hoc analyses revealed that the Tele-CIMT group significantly improved in terms of these parameters (p > .05). CONCLUSION: This is the first randomized controlled trial showing that Tele-CIMT improved upper extremity motor functions and activities of daily living in stroke patients. Tele-CIMT can help improve the upper extremities in stroke survivors who have difficulties reaching rehabilitation clinics.

Relationship between sensation and balance and gait in multiple sclerosis patients with mild disability.

BACKGROUND: Patients with Multiple Sclerosis (PwMS) often experience sensory, balance, and gait problems. Impairment in any sensation may increase imbalance and gait disorder in PwMS. This study aimed to (1) compare foot plantar sensations, knee position sense, balance, and gait in PwMS compared to Healthy Individuals (HI) and (2) examine the relationship between plantar sensations, knee position sense, balance, and gait in PwMS. METHODS: Thirty PwMS with mild disability and 10 HI participated in this study. Light touch threshold, two-point discrimination, vibration duration, and knee position sense were examined on the Dominant Side (DS) and Non-Dominant Side (NDS). Balance and spatio-temporal gait analysis were evaluated in all participants. RESULTS: PwMS had higher postural sway with eyes closed on the foam surface, longer swing phase of DS, longer single support phase of NDS, and shorter double support phase of DS compared to HI (p < 0.05). The results of regression analysis showed that the light touch thresholds of the 1st and 5th toes of the DS were associated with postural sway in different sensory conditions (p < 0.05). In contrast, the light touch thresholds of the 1st and 5th toes, two-point discrimination of the heel, vibration duration of the 1st metatarsal head and knee position sense of the NDS, and light touch threshold in the medial arch of both sides were associated with the gait parameters (p < 0.05). CONCLUSION: PwMS, even with mild disabilities needs neurorehabilitation to improve plantar sensation and knee position sense.

The immediate efficacy of the spinomed orthosis and biofeedback posture orthosis on balance and gait in older people with thoracic hyperkyphosis.

BACKGROUND: Increased kyphosis is a common condition among older people that may, directly or indirectly, be a risk factor for poor balance and gait. Spinomed and Biofeedback Posture Trainer (BPT) orthoses is an effective treatment approach for hyperkyphosis. This study aimed to compare the immediate effects of the Spinomed and BPT orthoses on balance and gait in the older population. METHODS: A total of 52 volunteer older people with hyperkyphosis (kyphosis angle>40°) participated in this study and were randomly allocated into two groups, to either the Spinomed orthosis (n = 26, mean age = 65.50 ± 5.50) or the BPT (n = 26, mean age = 65.38 ± 5.69) orthosis. All participants were asked to wear the orthoses for 1.5 h to get used to them. Balance parameters, which are Postural Stability Test (PST), Limits of Stability (LOS), and Clinical Test of Sensory Integration for Balance (m-CTSIB) were assessed using the Biodex Balance System, while walking parameters were assessed using the G-Walk with and without orthosis. RESULTS: The Spinomed had a positive effect on balance parameters (p < 0.05) except for the closed eyes firm surface and the opened eyes foam surface conditions of the m-CTSIB (p > 0.05). BPT had a significant impact on the PST score, LOS, and the closed eyes firm surface condition of the m-CTSIB (p < 0.001). Spinomed had a significant effect on cadence, speed, gait cycle duration, elaborated steps, and symmetry index of pelvic angles (p < 0.05), while the BPT had a significant effect only on step length and rotation symmetry index. No significant difference was detected between the two types of orthoses in the balance and gait parameters (p > 0.05). CONCLUSIONS: Spinomed and BPT were both effective in improving balance performance, with similar improvements demonstrated by both orthoses. Additionally, Spinomed may provide significant improvements in cadence, speed, gait cycle duration, elaborated steps, and all symmetry indexes of pelvic angles in the short term.

The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial.

BACKGROUND: Lee Silverman voice treatment (LSVT) BIG is an exercise program developed for patients with Parkinson's disease (PwPD), consisting of sets of exercises performed for 4 consecutive days a week for 4 weeks. However, the standard protocol suggests a treatment frequency difficult to follow for most patients who have difficulties reaching rehabilitation clinics. Our aim was to compare the standard LSVT BIG protocol with a modified LSVT (m-LSVT) BIG protocol (twice a week in the clinic for 4 weeks and twice a week at home for 4 weeks). METHODS: In this randomized controlled trial, 16 PwPD (aged 18-80 years, Hoehn and Yahr stages I-III) were recruited into two groups. The LSVT group received standard LSVT BIG training (four times per week for 4 weeks at the clinic). The other group was given m-LSVT BIG exercises, but unlike the LSVT group, the m-LSVT group exercised twice a week at the clinic and twice a week at home for 4 weeks. The Berg Balance Scale was used to assess functional balance. Biodex Balance System was used to assess laboratory balance measures. Timed Up and Go test and G-Walk sensor system were used to assess functional mobility and spatiotemporal gait analysis. RESULTS: Significant group-by-time interactions on the eyes open-firm surface score of the modified clinical test of sensory integration of balance (F = 10.138, p = .007) and gait cycle symmetry index (F = 10.470, p = .010) were found to be in favor of the LSVT group. Additionally, post hoc analyses revealed that both groups significantly improved postural stability, gait speed, motor symptoms, and functional mobility (p < .05). CONCLUSION: The results revealed the beneficial effects of the modified protocol on balance and gait in PwPD, as well as the superiority of the standard LSVT BIG protocol. The m-LSVT BIG protocol may be an effective intervention method, especially for PwPD who have difficulty adapting to the treatment frequency of the standard protocol.

Effects of Pilates-based telerehabilitation on physical performance and quality of life in patients with multiple sclerosis.

PURPOSE: It is known that clinical Pilates improves strength, core stability, balance, gait, fatigue, and quality of life (QOL) in patients with multiple sclerosis (PwMS). On the other hand, there is insufficient information about whether similar benefits can be achieved with Pilates-based telerehabilitation (Pilates-TR). We aimed to investigate the effects of Pilates-TR on physical performance and QOL in PwMS. METHODS: Thirty PwMS were recruited and randomly allocated into two groups. The Pilates-TR group received Pilates-TR via videoconferences three days per week during six weeks at home. The control group (CG) was a waitlist with no Pilates-TR treatment. Physical performance measures included extremity muscle strength, core endurance and power, balance, gait analysis, and functional exercise capacity. In addition, fatigue and QOL were evaluated. RESULTS: Extremity muscle strength, core endurance and power, balance, walking speed, cadence, distance, functional exercise capacity, and QOL were improved after Pilates-TR (p < 0.05). Fatigue level and the effects of fatigue on functions decreased in Pilates-TR, while fatigue level increased in CG (p < .05). The CG showed no changes in any other measurements (p > .05). CONCLUSION: Pilates-TR was effective in improving physical performance and QOL in PwMS. Pilates-TR can be recommended as an effective option, especially for patients with barriers to reaching the clinic.Trial registration: ClinicalTrials.gov (NCT04838886)IMPLICATIONS FOR REHABILITATIONPilates-based telerehabilitation (Pilates-TR) is an effective means of improving muscle strength, core stability, balance, walking, functional exercise capacity, and fatigue in patients with multiple sclerosis (PwMS).Pilates-TR seems like an appropriate option for improving both the mental and physical dimensions of quality of life in PwMS.Clinicians can safely use Pilates-TR to increase physical performance and quality of life in PwMS who have limitations to participate in clinical Pilates for various reasons.

Effects of multi-task training on motor and cognitive performances in multiple sclerosis patients without clinical disability: a single-blinded randomized controlled trial.

OBJECTIVE: This study aimed to investigate the effects of multi-task training on motor and cognitive performance in People with Multiple Sclerosis (PwMS) without clinical disability compared to single-task training and a control group. METHODS: A total of 42 patients were randomly assigned to three groups labeled as Multi-Task Training Group (MTTG, n:14), Single-Task Training Group (STTG, n:14), and Control Group (CG, n:14). The STTG performed only motor tasks based on the task-oriented training program twice a week for 6 weeks while the MTTG performed the same tasks concurrently with additional motor and cognitive tasks. The CG performed relaxation exercises at home. Postural stability by posturography, walking by Timed Up-and-Go, manual dexterity by Nine-Hole Peg Test, mental tracking by Counting Backward, and verbal fluency by Word List Generation were assessed before and after the intervention under single and dual-task conditions. RESULTS: In the MTTG, both single cognitive and single motor task performances increased, and, moreover, the cognitive Dual-Task Costs (DTCs) decreased although the motor DTCs were not changed significantly. There were significant group-by-time interactions in favor of MTTG only on the mental tracking DTC during walking compared to the STTG. Moreover, the changes in postural and walking DTCs were associated with changes in single-motor task performance. CONCLUSION: This study suggests that multi-task training is effective in reducing cognitive DTC rather than motor DTC under dual-task conditions in PwMS without clinical disability. TRIAL REGISTRATION NUMBER: NCT03512886.

Functional Performance, Leg Muscle Strength, and Core Muscle Endurance in Multiple Sclerosis Patients With Mild Disability: A Cross-Sectional Study.

This study aimed to investigate the relationship of sit-to-stand and walking performance with leg muscle strength and core muscle endurance in people with multiple sclerosis (PwMS) with mild disabilities. In this study, 49 PwMS (Expanded Disability Status Scale score = 1.59 ± 0.79) and 26 healthy controls were enrolled. The functional performances, including sit-to-stand and walking performances, were evaluated with the five-repetition sit-to-stand test, timed up and go test, and 6-min walking test. The PwMS finished significantly slower five-repetition sit-to-stand, timed up and go, and 6-min walking test than the healthy controls. In addition, the significant contributors were the weakest trunk lateral flexor endurance for five-repetition sit-to-stand; the Expanded Disability Status Scale score, and the weakest hip adductor muscle for timed up and go; the weakest hip extensor muscles strength for 6-min walking test. The functional performances in PwMS, even with mild disabilities, were lower compared with healthy controls. Decreases in both leg muscle strength and core muscle endurance are associated with lower functional performance in PwMS.

The reliability and validity of the Turkish version of the dual-task questionnaire in patients with multiple sclerosis.

BACKGROUND: Activities of daily living often require performing dual-task (DT). People with Multiple Sclerosis (PwMS) may have difficulties during dual-task and these difficulties negatively affect their quality of life. However, the number of validated questionnaires to assess DT difficulties in Multiple Sclerosis (MS) is very few. Therefore, the study aimed to translate and adapt the Dual-Task Questionnaire (DTQ) into Turkish, thereafter analyzing the psychometric properties in PwMS. METHODS: A total of 51 PwMS were recruited in the study. Cronbach's alpha coefficient was used to evaluate internal consistency. The test-retest reliability was determined using the intraclass correlation coefficient (ICC). Correlations of the DTQ with motor-dual task costs (DTCs) and cognitive-DTCs were used to assess construct validity. RESULTS: The mean age was 36.84±10.47 years. The internal consistency of the DTQ was acceptable (α= 0.780). The test-retest reliability of all items and the total score of the DTQ were excellent (ICC>0.90). The relationships of DTQ-Total between some parameters of motor-DTCs (ρ=-0.409-(-0.495) for walking-DTCs, ρ=-0.313 for manual dexterity-DTC during mental tracking, and ρ=-0.353 for balance-DTC during mental tracking) and cognitive-DTCs (ρ=0.328 for mental tacking-DTC during balance, ρ=0.290-0.342 for all verbal fluency-DTCs) were low to moderately significant. CONCLUSION: Turkish version of DTQ is a reliable and valid tool to measure DT difficulty in PwMS. Additionally, the questionnaire is a reliable and valid Patient Reported Outcomes Initiative for MS (PROMS) for Turkish-speaking PwMS.

The functional reach test in people with multiple sclerosis: a reliability and validity study.

BACKGROUND: Limits of stability (LOS) is a major component of balance dysfunction in people with multiple sclerosis (MS). The functional reach test (FRT) is a clinical LOS assessment; however, its psychometric properties have not been investigated in people with MS yet. Objectives: To investigate: (1) the intrarater, interrater, and test-retest reliability of the FRT in people with MS; (2) the minimum detectable change (MDC) in the FRT distances; (3) the concurrent and discriminant validity of the FRT; and (4) the cutoff distance that best discriminates people with MS from healthy people and fallers from non-fallers with MS. METHODS: Forty-three people with MS and 36 healthy people participated in this study. The FRT was administered along with the instrumented LOS test, Berg Balance Scale, Four Square Step Test, Timed Up and Go Test, and Expanded Disability Status Scale. The FRT was repeated by the same rater after 2 min from the first test session to determine the intrarater reliability and was simultaneously conducted by two independent raters to determine the interrater reliability. The FRT was also repeated after 7-10 days to determine the test-retest reliability. The reliability was quantified using intraclass correlation coefficients (ICC), Bland-Altman plots, and the MDC. The validity was assessed by correlating the FRT distances with the scores of other measures and by comparing the FRT distances between the MS group and healthy people, and between the fallers and non-fallers in the MS group. RESULTS: The FRT demonstrated good to excellent intrarater, interrater, and test-retest reliability with an ICC (3,1) of 0.80-0.88 (p < .001), an ICC (3,2) of 0.94-0.97 (p < .001), an ICC (2,3) of 0.84-0.86 (p < .001), respectively. Bland-Altman analyses showed no systematic bias between the assessments. The MDC was 8.28 centimeters. The FRT was correlated with the other outcome measures (correlation coefficients ranged from 0.31 to 0.79, p < .05 for all). Significant differences in the FRT distances were found between people with MS and healthy people; however, no significant difference was found between the fallers and non-fallers with MS (p < .001 and p = .09, respectively). The cutoff distance of 35.5 centimeters best discriminates healthy people from people with MS while of 28.5 centimeters did not discriminate between the fallers and non-fallers with MS. CONCLUSIONS: The FRT is a reliable, valid, and easy-to-administer tool for assessing LOS in people with MS.

Dual-Task Cost and Related Clinical Features in Patients With Multiple Sclerosis.

This study aimed to investigate the dual-task cost of both motor and cognitive performances in patients with multiple sclerosis (PwMS) and in healthy controls and to determine their relationships with clinical features in PwMS. The participants performed motor tasks (postural stability, walking, and manual dexterity) and cognitive tasks (mental tracking and verbal fluency) under single- and dual-task conditions. The results showed that postural stability under dual-task conditions did not change, whereas walking and manual dexterity deteriorated, regardless of the concurrent cognitive task, in PwMS (median Expanded Disability Status Scale score: 1) and the healthy controls. Verbal fluency decreased during postural stability, whereas it increased during walking, and it was maintained during manual dexterity in both groups. Mental tracking did not change during walking; it declined during manual dexterity in both groups. Mental tracking during postural stability deteriorated in PwMS, while it did not change in the healthy controls. In general, dual-task costs were associated with baseline performances of tasks rather than clinical features. Therefore, baseline performances of both tasks should be increased for improving dual-task performance in PwMS.

Reliability and validity of the timed 360° turn test in people with multiple sclerosis.

Objectives: To investigate (1) the intrarater, interrater, and test-retest reliability of the timed 360° turn test in people with Multiple Sclerosis (MS); (2) the minimum detectable change in the timed 360° turn test times; (3) the concurrent and discriminant validity of the timed 360° turn test times; and (4) the cut-off times that best discriminate people with MS from healthy people and fallers from non-fallers with MS.Method: Sixty-one people with MS (Expanded Disability Status Scale, EDSS, 0-6.5) and 34 healthy people were recruited in this cross-sectional study. The timed 360° turn test was administered along with the Timed Up and Go Test, Berg Balance Scale, Four Square Step Test, and EDSS by two independent raters.Results: The timed 360° turn test showed good intrarater, interrater, and test-retest reliability. Minimal detectable changes were 1.49 s and 1.53 s for the dominant and non-dominant sides, respectively. The timed 360° turn test was strongly correlated with other outcome measures. Significant differences in 360° turn times were found between people with MS and healthy people and between fallers and non-fallers with MS (p < .001 and p < .001, respectively). The cut-off times of 2.65 s on the dominant side and 2.42 s on the non-dominant best discriminated people with MS from healthy people, while 3.65 s on the dominant side and 3.75 s on the non-dominant best discriminated fallers from non-fallers with MS.Conclusions: The timed 360° turn test is a simple and reliable tool for assessing turning ability in MS.

Clinical features and physical performance in multiple sclerosis patients with and without cognitive impairment: a cross-sectional study.

The factors associated with cognitive functions in patients with multiple sclerosis (PwMS) are not yet clear. The aims of this study were (1) to compare clinical features and physical performance in healthy controls, and PwMS with and without cognitive impairment, and (2) to determine the relationship between cognitive domains and demographics characteristics, clinical features and physical performance in PwMS. A total of 112 PwMS and 25 healthy controls participated in this study. Cognitive functions were evaluated by Brief Repeatable Battery of Neuropsychological Tests (BRB-N). Based on cognitive performances by BRB-N, PwMS were divided into two groups as MS patients with impaired (MS-I, n: 57) and with normal (MS-N, n: 55) cognitive functions. For clinical features, fatigue, mood and sleep quality were evaluated by the Fatigue Impact Scale, Beck's Depression Inventory, Pittsburgh Sleep Quality Index, respectively. For physical performances, balance and walking capacity were evaluated by posturography and Six-Minute Walking Test, respectively. The results showed that the education years, postural stability and walking capacity in MS-N and healthy controls were higher than in MS-I (P < 0.05). In addition, visuospatial memory was correlated with both postural stability under all sensory conditions and walking capacity; verbal memory was correlated with education years, postural stability on eyes closed-foam surface and walking capacity; verbal fluency was correlated with only walking capacity; information processing speed was correlated with education years, postural stability under all sensory conditions and walking capacity (P < 0.001). This study suggests that the interventions that aim to improve physical performance might protect and even improve cognitive functions in PwMS.

Correlates of dual-task performance in people with multiple sclerosis: A systematic review.

BACKGROUND: Gait, balance, and cognitive disorders are common in people with Multiple Sclerosis (MS). In addition, people with MS have impaired ability to concurrently perform gait/balance and cognitive tasks due to cognitive-motor interference (CMI). Clinical features of MS may affect CMI; however, the relationship between CMI and clinical features of MS remains unclear. RESEARCH QUESTION: Are clinical features of MS associated with CMI? METHODS: A systematic review was conducted, and four databases (CINAHL, MEDLINE, ProQuest, and Web of Science Core Collections) were searched up to March 2019 using a combination of keywords related to MS and dual-tasking/CMI. Cross-sectional or longitudinal studies that reported the association between CMI and clinical features of MS were included in the review. The correlation coefficient for the relationship between CMI and clinical features of MS were extracted and the results were categorized according to the clinical feature measured. RESULTS: 13 studies were included in this review, of which nine investigated the association between CMI and disability and cognition, and four investigated the association between CMI and other clinical features of MS. While some studies reported that disability and cognition were negatively associated with CMI, the evidence was inconsistent regarding the magnitude and presence of these relationships. In addition, the relationship between CMI and other clinical features of MS (balance, falls risk, fatigue, anxiety, depression, pain, spasticity) remains unclear. SIGNIFICANCE: This review presents evidence from a small number of studies that suggests disability and cognition are negatively associated with CMI in people with MS, indicating that greater disability and cognitive dysfunction may be associated with lower dual-task performance. These findings highlight the potential importance of disability and cognition in the measurement and rehabilitation of people with dual-task impairments. However, further research is required to confirm these findings and determine the relationship between CMI and other clinical features of MS included in this review.

Combined exercise training improves cognitive functions in multiple sclerosis patients with cognitive impairment: A single-blinded randomized controlled trial.

BACKGROUND: Cognitive impairment is common in patients with multiple sclerosis (MS). The effects of different exercise trainings on cognitive functions in patients with MS are promising. However, the effects are not yet clear in MS patients with cognitive impairment. This study aimed to investigate the effect of combined exercise training on different cognitive functions in MS patients with cognitive impairment. METHODS: Relapsing-remitting and mild disabled MS patients with cognitive impairment were randomly assigned to two groups: Exercise Group (EG, n:17) and the Control Group (CG, n:17). The EG received a combined exercise training consisting of aerobic and Pilates training in three sessions per week for 8 weeks while the CG performed the relaxation exercises at home. Cognitive functions, walking capacity, fatigue, mood, and quality of life were assessed at baseline and after eight weeks using the Brief Repeatable Battery of Neuropsychological Tests (BRB-N), Six-Minute Walk Test (6-MWT), Fatigue Impact Scale (FIS), Beck's Depression Inventory (BDI) and MS Quality of Life-54 (MSQoL-54), respectively. RESULTS: This study showed significant group-by-time interactions on long-term verbal memory, walking capacity, cognitive fatigue, and physical quality of life in favor of the EG (p<0.003). Moreover, verbal memory, visuospatial memory, verbal fluency, information processing speed, walking capacity, fatigue, and quality of life improved in the EG (p<0.05) while only verbal memory increased in the CG (p<0.05). Furthermore, the change in visuospatial memory was associated with the change in mental quality of life (r:0.352, p: 0.041) while the change in verbal fluency (r: -0.362, p:0.035) and processing speed (r: -0.356, p:0.039) were associated with the change in mood. CONCLUSION: Combined exercise training has beneficial effects on different cognitive functions in mild disabled RRMS patients with cognitive impairment. In addition, there is a mutual relationship in improvements in cognitive functions, mood, and quality of life after exercise.

Reliability and validity of the timed 360° turn test in people with Parkinson's disease.

PURPOSE: The objectives of this study were to examine (1) the intrarater, interrater, and test-retest reliability of the timed 360° turn test in people with Parkinson's Disease (PwPD); (2) the minimum detectable change in the timed 360° turn test times; (3) the concurrent and discriminant validity of the timed 360° turn test; (4) the cut-off times which best discriminate PwPD from healthy people and fallers from non-fallers with Parkinson's Disease (PD). METHODS: Fifty-four PwPD and 32 healthy people were included. The timed 360° turn test was administered along with Timed Up and Go Test, Berg Balance Scale, Four Square Step Test, Unified Parkinson's Disease Rating Scale, and Hoehn and Yahr Scale. In addition, PwPD were categorized into fallers and non-fallers based on fall history. Reliability analyses were assessed using intraclass correlation coefficients in a subgroup of 38 PwPD. RESULTS: The timed 360° turn test had excellent intrarater, interrater, and test-retest reliability. It was strongly correlated with other outcome measures (p < 0.001). In both sides, significant differences in the timed 360° turn test times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The timed 360° turn test times of 3.76-3.89 s were found to best discriminate PwPD from healthy people, while 5.46-5.74 s were found to best discriminate fallers from non-fallers with PD. The minimum detectable change in the timed 360° turn test times were 1.98 s for dominant side and 1.48 s for non-dominant side in PwPD. CONCLUSIONS: The timed 360° turn test is a reliable, valid, and clinically available tool for assessing turning ability in PwPD.

Effect of task-oriented circuit training on motor and cognitive performance in patients with multiple sclerosis: A single-blinded randomized controlled trial.

BACKGROUND: Exercise training has positive effects on motor and cognitive performance which deteriorates over time in patients with Multiple Sclerosis (MS). The effects of task-oriented circuit training (TOCT) on motor and cognitive performance in patients with MS are not yet clear. OBJECTIVE: The aims of this study are to investigate the effects of TOCT on balance, walking, manual dexterity, cognitive performance, and to determine the extent to which patients are able to transfer changes in their performance to activities of daily living. METHODS: Twenty patients with MS (EDSS: 2-5.5), were randomly assigned to two groups; the task-oriented circuit training group (TOCTG, n:10) and the control group (CG, n:10). The TOCTG received TOCT twice a week for six weeks while the CG performed the relaxation exercises at home. All patients were assessed by using Modified Sensory Organization Test, Berg Balance Scale, Activities-specific Balance Confidence, Timed Up and Go, Functional Gait Assessment, 12-item Multiple Sclerosis Walking Scale, Nine-Hole Peg Test, Brief Repeatable Battery of Neuropsychological Tests, Multiple Sclerosis Neuropsychological Questionnaire. RESULTS: Balance and walking performance were improved after TOCT (p < 0.05), whereas manual dexterity and cognitive performance except for verbal memory did not change significantly (p > 0.05). The CG showed no changes in any measurements (p > 0.05). CONCLUSIONS: TOCT is quite effective to improve balance and walking in patients with MS. However, further studies are needed to determine the effect of TOCT on cognitive performance.

The sensitivity and specificity of the balance evaluation systems test-BESTest in determining risk of fall in stroke patients.

BACKGROUND: Balance disorders cause disability in stroke and increase risk of falls. The Balance Evaluation Systems Test (BESTest), examines balance, determines parameters causing balance disorders, provides information on risk factors for falls. OBJECTIVE: To investigate the sensitivity and specificity of the BESTest in determining the risk of falls in stroke patients. METHODS: Fifty patients with chronic stroke were included in the study. Balance was assessed using BESTest, Berg Balance Scale (BBS), Activity Specific Balance Confidence scale (ABC) and Biodex-BioSway Balance System. To examine the content validity of BESTest, the relationship between BESTest and other balance assessment methods was examined. The internal consistency reliability of BESTest was evaluated by Cronbach's α coefficient. Analysis of receiver operating characteristics (ROC) was performed to determine cut-off point, sensitivity and specificity. RESULTS: BESTest, BBS, ABC and Biodex-BioSway Balance System results of faller stroke patients were worse than that of non-faller (p <0.05). Internal consistency of BESTest was found to be Cronbach's α = 0.960. The BESTest value of area under curve (AUC) was 0.844, with a cut-off point of 69.44%, a sensitivity of 75% and a specificity of 84.6% (p < 0.01). CONCLUSION: BESTest is reliable and valid with high sensitivity and specificity in determining the risk of fall in stroke patients.

The effects of early neurodevelopmental Bobath approach and mobilization on quadriceps muscle thickness in stroke patients

Background/aim: Following stroke, damage to the central nervous system and adaptive changes in muscle tissue are factors responsible for the loss of muscle strength. Even though it is suggested that early physiotherapy and mobilization prevent structural adaptive changes in muscle tissue, studies regarding this issue are insufficient. The aim of this study is to investigate the effects of early physiotherapy and mobilization on quadriceps muscle thickness (QMT) in stroke patients. Materials and methods: Twelve stroke patients who were admitted to the neurology intensive care unit and 13 healthy controls were included in the study. QMT was examined at admission and discharge for each subject. Additionally, functional extremity movements, balance, and functional ambulation status were evaluated with the Stroke Rehabilitation Assessment of Movement Scale (STREAM). All of the patients were mobilized as early as possible by a physiotherapist and included in a treatment program consisting of the neurodevelopmental Bobath approach. Results: The patients' QMT values at admission and discharge were found to be similar to those of the healthy control group (P > 0.05). When the patients' QMT at the time of admission and discharge were compared, it was seen that the affected side and the nonaffected side were similar (P > 0.05). Additionally, when the admission and discharge results were compared, improvements in functional extremity movements, balance, and functional ambulation levels were observed (P < 0.05). Conclusion: It can be seen that QMT can be preserved and functional improvements can be provided through intense physiotherapy and mobilization initiated in the early period following stroke.

Effects of visual illusion and transcutaneous electrical nerve stimulation on neuropathic pain in patients with spinal cord injury: A randomised controlled cross-over trial.

BACKGROUND: Chronic pain is a common consequence of spinal cord injury (SCI). No therapeutic drugs or drug groups are proven to be superior for neuropathic pain and treatments only aim to convert pain from dull to tolerable levels and not to remove it. OBJECTIVE: This study was planned to compare the effect of visual illusion (VI) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pain quality and functional capacity in SCI patients with neuropathic pain. METHODS: Twenty-four patients were included and randomly categorized into two groups. In the first group (n= 12), visual illusion was applied for first two weeks, 1 week wash out period and then TENS was applied for 2 weeks. In second group (n= 12), TENS was applied firstly, 1 week wash out and then %visual illusion VI were applied. Pain severity, pain quality, and functional capacity were assessed with the visual analog scale (VAS), the neuropathic pain scale (NPS), and the brief pain inventory (BPI), respectively. A pre-post-treatment and cross over design was used. RESULTS: Wilcoxon signed-rank tests were used for within group analyses. Mann-Whitney U tests were used for analyses that compared different groups. It was observed that pain intensity decrease immediately after both applications (VI: p= 0.07, TENS: p= 0.08). After TENS application for 2 weeks, it was observed that significant decrease in most (p= 0.04) and less (p= 0.02) pain intensity; while there was no significant decrease in pain intensity after 2 weeks for VI (p> 0.05). When findings of NPS were analyzed, hot (p= 0.047), sharp (p= 0.02), unpleasant (p= 0.03) and deep items (p= 0.047) decreased after VI application. When the results of BPI were detected, they were observed that the negative effect of pain on moving ability (p= 0.04) after visual illusion application and the negative effect of pain on mood (p= 0.03), relationships with others (p= 0.04) and sleep (p= 0.04) after TENS application decreased significantly. CONCLUSION: TENS and VI therapies can be successfully used in clinical practice as an alternative treatment or as a supportive method separetely or together.