Comparing the Efficacy of Manual Therapy and Exercise to Synchronized Telerehabilitation with Self-Manual Therapy and Exercise in Treating Subacromial Pain Syndrome: A Randomized Controlled Trial.

This study aimed to investigate the efficacy of manual therapy and exercise versus synchronized telerehabilitation with self-manual therapy and exercise in treating Subacromial Pain Syndrome (SAPS). Sixty individuals diagnosed with SPS, aged 18-50 years, were randomly assigned to home exercise (HE), manual therapy (MT), and telerehabilitation (TR) groups. Treatment protocols were administered over 8 weeks and included specific exercises and therapy interventions. Outcome measures included the Visual Pain Scale (VAS), shoulder range of motion (ROM) via goniometric measurements, Quick Disability Arm-Shoulder-Hand Problems Survey (Q-DASH), and patient satisfaction. Results revealed that both MT and TR groups exhibited reduced pain, increased ROM, lower Q-DASH scores, and higher patient satisfaction than the HE group. However, no significant differences were found between the MT and TR groups regarding pain levels, ROM, Q-DASH scores, or patient satisfaction. The study concludes that both telerehabilitation and manual therapy effectively alleviate pain and are well-received by patients with SPS. Additionally, manual therapy demonstrates superiority in enhancing functional levels compared to exercise-based interventions (Registration: NCT05200130).

A New Measuring Approach in Assessing Hamstring Flexibility: Reliability, Validity, and Applicability of Isolated Hamstring Flexibility Test.

OBJECTIVE: This study was planned to determine the reliability, validity, and applicability of the isolated hamstring flexibility test (IHFT). DESIGN: A cohort study (diagnosis); level of evidence, 2. SETTING: It was performed in the research and application laboratory. PARTICIPANTS: Seventy-five individuals aged 18 to 25 years, selected through simple probability random sampling, with a normal Beighton Horan and Joint Mobility Index scores, and who volunteered to participate, were included for evaluation. INTERVENTIONS: On then first and third days, participants underwent muscle strength, sit-and-reach test, active knee extension test, IHFT for validity and reliability. Stretching exercises were prescribed as a home program for 31 patients with limited knee extension, and measurements were repeated at the end of the eighth week. MAIN OUTCOME MEASURES: Sit-and-reach test, active knee extension test, IHFT. RESULTS: The test-retest reliability was high (intraclass correlation coefficient, 0.993). Our test demonstrated validity when compared in terms of flexibility gained. A significant difference was found between pre-post stretching exercise training in all 3 tests (P < 0.05). CONCLUSION: It was observed that the IHFT is reliable and applicable in determining hamstring flexibility. Given the absence of another test specifically measuring hamstring flexibility in isolation, its indirect validity was established through analysis with other tests using the gold standard for assessing gains in hamstring flexibility.

The effect of cervical mobilization on joint position sense, balance and gait in patients with multiple sclerosis: a randomized crossover study.

OBJECTIVE: To investigate the effect of cervical mobilization on joint position sense, balance and gait in multiple sclerosis (MS) patients. METHODS: Sixteen MS patients received traditional rehabilitation and traditional rehabilitation+cervical mobilization treatments in different orders, 2 days a week for 4 weeks. For the cervical mobilization, joint traction and shifts with myofascial release techniques were applied. Joint position sense was evaluated from the bilateral knee and ankle joints with a digital goniometer, balanced with the Berg Balance Test (BBT), the Functional Reach Test, and gait with the Dynamic Gait Index (DGI) and the Timed 25-Foot Walk Test. RESULTS: Improvements were determined in joint position sense, balance, gait with both treatment methods (p < 0.05). With the addition of cervical mobilization to traditional treatment, there was observed to be an increased effect carried over in knee joint position sense and BBT (p < 0.05). The BBT and DGI scores improved in the group applied with cervical mobilization following the washout period (p < 0.05). CONCLUSIONS: Cervical mobilization could be effective in improving joint position sense, balance and gait, and accelerated improvements in a short time. The application of cervical mobilization could be a supportive treatment method to improve position sense, balance and gait in patients with MS.

The effect of functional independence levels on sleep and constipation in children with cerebral palsy.

OBJECTIVE: The study aimed to examine the effect of functional independence levels on sleep behavior and constipation in children with cerebral palsy. METHODS: This cross-sectional observational single-center study was carried out in a special rehabilitation center in Istanbul. Inclusion criteria were those aged between 4 and 18 years with Gross Motor Function Classification System III-IV-V functional independence levels. Those who had surgery concerning intestinal health, had a chronic infectious bowel disease, had congenital intestinal anomalies, had received botox treatment in the last 6 months, had uncontrolled epileptic seizures, had complained of constipation in the last 6 months, and had cardiopulmonary disease were excluded from the study. The sociodemographic characteristics of the participants and the Gross Motor Function Classification System were recorded. Pediatric Functional Independence Scale (Functional Independence Measure for Children) was used to measure the functional independence level, Pediatric Sleep Questionnaire was used to measure the level of sleep problems, and Constipation Severity Scale was used to measure constipation severity. RESULTS: A total of 60 children who were diagnosed with cerebral palsy were included. According to Gross Motor Function Classification System, 46.7% of the cases were Level III, 35% were Level IV, and 18.3% were Level V. There was a negative moderate significant correlation between Functional Independence Measure for Children and Pediatric Sleep Questionnaire (r=-0.303; p=0.019) and between Functional Independence Measure for Children and Constipation Severity Scale (r=-0.342; p=0.007). CONCLUSION: We described that lower functional independence levels were related to worse sleep and constipation symptoms. The results suggest that effective strategies for developing functional independence levels may be beneficial for both sleep and constipation symptoms in the concept of cerebral palsy management.

Bruxism, parafunctional oral habits and oral motor problems in children with spastic cerebral palsy: A cross-sectional study.

BACKGROUND: Individuals with spastic cerebral palsy are more predisposed to parafunctional oral activities and oral motor problems because of spasticity. OBJECTIVES: The aim of the study was to evaluate the relationship between the gross motor function classification system score (GMFCS), age, bruxism, parafunctional oral habits and oral motor problems in children with cerebral palsy. METHODS: This cross-sectional study included 63 children with spastic cerebral palsy, aged 3-18 years, with developmental disabilities. The relationship between parentally reported bruxism, parafunctional oral activity rates, oral motor problems, and GMFCS was analysed. RESULTS: The prevalence of bruxism was 52.4%, and the rate decreased as age increased. There was a greater likelihood of bruxism in individuals with tongue thrust (OR [95% CI] = 8.15 [1.4-47.3]) and swallowing problems (OR [95% CI] = 5.78 [1.3-24.68]). CONCLUSION: In children with spastic cerebral palsy, bruxism and the rate of parafunctional oral habits were high, thus affecting oral motor activities. A relationship was found between oral motor problems and increased GMFCS levels, but no relationship was found between bruxism and GMFCS levels. Children with spastic cerebral palsy who display tongue thrust or swallowing problems have an increased likelihood of presenting with bruxism.

The effect of sleep hygiene and physiotherapy on bruxism, sleep, and oral habits in children with sleep bruxism during the COVID-19 pandemic.

BACKGROUND: Sleep bruxism has been associated with temporomandibular dysfunction, pain, fatigue, and poor sleep quality. OBJECTIVE: The aim of this study was to determine the gender and age distribution of sleep and oral habits of children with sleep bruxism and to examine the effect of a sleep hygiene and physiotherapy program. METHODS: In this cross-sectional study, 82 children aged 6-13 years with sleep bruxism were initially screened between March 2020 and June 2021, from which 37 of them voluntarily attended an 8-week sleep hygiene and physiotherapy program. Evaluations were made using a Visual Analogue Scale (VAS), the Children's Sleep Habits Questionnaire (CSHQ), and the Oral Habits Questionnaire (OHQ) at the beginning and at the end of the 8-week program. RESULTS: Statistically significant differences were determined between the 6-9 years and 10-13-year age groups in respect of the sleep habits subcategories of resistance to bedtime (p= 0.001), sleep anxiety (p= 0.043), parasomnia (p= 0.040), and sleep respiratory disorder (p= 0.041). Following the 8-week treatment program, a significant reduction was obtained in the VAS value (p< 0.05), CSHQ subcategories of resistance to bedtime (p= 0.001), sleep duration (p= 0.008), parasomnia (p= 0.000), and in the OHQ score (p= 0.000). CONCLUSION: There was no relationship between sleep bruxism and gender, but a relationship was found with age. The rate of bruxism was seen to decrease with an increase in age. It was determined that oral, sleep habits, and bruxism are closely related, and the rates at which bruxism is seen are affected by the oral habits. Sleep hygiene and physiotherapy have been effective in children with sleep bruxism.

The efficacy of orofacial myofunctional therapy in oral dysphagia accompanying temporomandibular dysfunction.

OBJECTIVE: Patients with temporomandibular dysfunction (TMD) may develop oral-stage dysphagia (OD) in the chronic phase. METHODS: This study investigated the effect of orofacial myofunctional therapy (OMT) in individuals with TMD-related OD. Fifty-one patients aged 18-65 years with TMD-related OD were separated into three groups using a simple randomization method: the control group (n = 12) underwent patient education and a home-exercise program; additionally, to an exercise program the manual therapy (MT) group (n = 19) received MT; and the OMT group (n = 20) received the OMT program. MT and OMT were applied in two sessions per week for 10 weeks. The patients were re-evaluated after treatment and at 3 months. RESULTS: The OMT group showed the most improvement in jaw functionality, swallowing-related quality of life, pain, and dysphagia (p < .05). DISCUSSION: OMT was superior to MT and exercises alone in reducing dysphagia and improving the swallowing-related quality of life.

The effect of functional independence levels on sleep and constipation in children with cerebral palsy

SUMMARY OBJECTIVE: The study aimed to examine the effect of functional independence levels on sleep behavior and constipation in children with cerebral palsy. METHODS: This cross-sectional observational single-center study was carried out in a special rehabilitation center in Istanbul. Inclusion criteria were those aged between 4 and 18 years with Gross Motor Function Classification System III-IV-V functional independence levels. Those who had surgery concerning intestinal health, had a chronic infectious bowel disease, had congenital intestinal anomalies, had received botox treatment in the last 6 months, had uncontrolled epileptic seizures, had complained of constipation in the last 6 months, and had cardiopulmonary disease were excluded from the study. The sociodemographic characteristics of the participants and the Gross Motor Function Classification System were recorded. Pediatric Functional Independence Scale (Functional Independence Measure for Children) was used to measure the functional independence level, Pediatric Sleep Questionnaire was used to measure the level of sleep problems, and Constipation Severity Scale was used to measure constipation severity. RESULTS: A total of 60 children who were diagnosed with cerebral palsy were included. According to Gross Motor Function Classification System, 46.7% of the cases were Level III, 35% were Level IV, and 18.3% were Level V. There was a negative moderate significant correlation between Functional Independence Measure for Children and Pediatric Sleep Questionnaire (r=-0.303; p=0.019) and between Functional Independence Measure for Children and Constipation Severity Scale (r=-0.342; p=0.007). CONCLUSION: We described that lower functional independence levels were related to worse sleep and constipation symptoms. The results suggest that effective strategies for developing functional independence levels may be beneficial for both sleep and constipation symptoms in the concept of cerebral palsy management.

Myotonometric comparison of sternocleidomastoideus and masseter muscles in multiple sclerosis patients with swallowing problem and healthy individuals.

BACKGROUND: Dysphagia occurring in the oral and pharyngeal phases of swallowing in MS patients may be caused by changes in muscles' viscoelasticity. The aim of this study was to compare the muscles' (sternocloideomastoideus and masseter) viscoelasticity properties by myotonometer between MS patients and healthy individuals. METHODS: This study design was a cross-sectional, non-interventional study. Ten healthy individuals were allocated to the control group, eleven MS patients without swallowing problems were allocated to the without swallowing group, ten MS patients with swallowing problems were allocated to the swallowing group. Disability was evaluated using the Expanded Disability Status Scale (EDSS), swallowing problem was assessed with Dysphagia in Multiple Sclerosis (DYMUS) scale, and to measure the viscoelastic parameters (tone, stiffness, elasticity) of sternocloideomastoideus (SCM) and masseter muscles bilaterally, MyotonPro® was used. The comparison between the groups was performed using the Kruskal-Wallis H test. RESULTS: It was observed that there was no difference in terms of viscoelastic properties of the masseter muscle in groups (p > 0.05). There was no difference between the groups in terms of the elasticity of the SCM muscle (p > 0.05). However, the tonus and stiffness of the SCM on the left side of the MS patients were higher than in other groups (p = 0.050, p = 0.005). CONCLUSION: The increment level of tone and stiffness of SCM muscle is related to swallowing problems in patients with MS. Due to swallowing problems in MS, the orofacial and neck region's muscles' viscoelastic properties may change in time and may be affected by phases of swallowing problems.

Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: A randomized controlled trial.

The purpose of this study was to compare the short-term effectiveness of home physical therapy (HPT) alone with that of manual therapy (MT) in conjunction with home physical therapy (MT-HPT) performed for four weeks in patients with temporomandibular disorders (TMD). Forty subjects (nine males and 31 females; age, 18-72 years) with TMD were randomly divided into two groups: HPT (n = 20; five males and 15 females; mean age, 34.8 ± 12.4 years) and MT-HPT (n = 20; four males and 16 females; mean age, 37.0 ± 14.6 years). Pain intensity was evaluated at rest and with stress using a visual analogue scale (VAS). Pain-free maximum mouth opening (MMO) was also evaluated. Mean change score (MCS) in VAS and the smallest detectable difference (SDD) in pain-free MMO were measured over time. The results were analysed by MANOVA to evaluate the effects of treatment over time. At baseline, the groups did not differ from each other with respect to VAS scores and pain-free MMO (p > 0.05). Within each group, VAS with stress decreased (p < 0.001) and pain-free MMO increased (p < 0.001) over time. Between groups, both time*treatment effect and treatment effect were significant for VAS with stress (p < 0.001); however, only time*treatment effect was significant for pain-free MMO (p = 0.009). In the MT-HPT group, MCS for VAS with stress was 91.3% and SDD for pain-free MMO was 10 mm. Our results suggest that a four-week period of MT-HPT has a clinically significant effect on both pain and pain-free maximum mouth opening in patients with TMD.