The prosthesis evaluation questionnaire: reliability and cross-validation of the Turkish version.

[Purpose] Currently, there are a limited number of amputee-specific instruments for measuring prosthesis-related quality of life with good psychometric properties in Turkey. This study translated the Prosthetic Evaluation Questionnaire to Turkish and analyzed as well as discussed its construct validity and internal consistency. [Subjects and Methods] The Prosthetic Evaluation Questionnaire was adapted for use in Turkish by forward/backward translation. The final Turkish version of this questionnaire was administered to 90 unilateral amputee patients. Second evaluation was possible in 83 participants within a median 28 day time period. [Results] Point estimates for the intraclass correlation coefficient ranged from 0.69 to 0.89 for all 9 Prosthetic Evaluation Questionnaire scales, indicating good correlation. Overall Cronbach's alpha coefficients ranged from 0.64 to 0.92, except for the perceived response subscale of 0.39. The ambulation subscale was correlated with the physical functioning subscales of Short Form-36 (SF-36) (r=0.48). The social burden subscale score of the Prosthetic Evaluation Questionnaire was correlated with social functioning subscales of SF-36 (r= 0.63). [Conclusion] The Turkish version of the Prosthetic Evaluation Questionnaire is a valid and reliable tool for implementation in the Turkish unilateral amputee population.

Evaluation of joint findings with gait analysis in children with hemophilia.

BACKGROUNDS AND OBJECTIVES: Hemophilic arthropathy due to recurrent joint bleeding leads to physical, psychological and socioeconomic problems in children with hemophilia and reduces their quality of life. The purpose of this study was to evaluate joint damage through various parameters and to determine functional deterioration in the musculoskeletal system during walking using kinetic and kinematic gait analysis. MATERIAL AND METHOD: Physical examination and kinetic and kinematic gait analysis findings of 19 hemophilic patients aged 7-20 years were compared with those of age, sex and leg length matched controls. RESULTS: Stride time was longer in the hemophilia group (p=0.001) compared to the age matched healthy control group, while hip, knee and ankle joint rotation angles were more limited (p=0.001, p=0.035 and p=0.001, respectively). In the hemophilia group, the extensor moment of the knee joint in the stance phase was less than that in the control group (p=0.001). Stride time was longer in the severe hemophilia group compared to the mild-moderate hemophilia and control groups (p=0.011 and p=0.001, respectively). Rotation angle of the ankle was wider in the control group compared to the other two groups (p=0.001 for both). Rotation angle of the ankle joint was narrower in the severe hemophilia group compared to the others (p=0.001 for each). Extensor moment of the knee joint was greater in the control group compared to the other two groups (p=0.003 and p=0.001, respectively). Walking velocity was higher in the control group compared to the severe hemophilia group. CONCLUSION: Kinetic and kinematic gait analysis has the sensitivity to detect minimal changes in biomechanical parameters. Gait analysis can be used as a reliable method to detect early joint damage.

Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study.

We evaluated the gait characteristics of patients who had short or long-segment fusion after thoracolumbar burst fractures. The study included 12 patients (5 male, 7 female) who had vertebral fusion after traumatic thoracolumbar region (T12-L2) burst fractures. Patients were divided into two groups based on fixation type (short or long segment). Twelve healthy age and sex-matched subjects (seven male, five female) served as controls. Quantitative gait data, including all time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle), and kinetic data (moments of hip in sagittal and coronal plane) were collected. Three patients had a T12, six patients an L1, and three patients had an L2 lesion. Patients in the two groups were similar in terms of age, sex, and time since operation. No significant differences were found in the time-distance, kinematic, and kinetic gait characteristics between the two groups. This preliminary study reveals that the gait characteristics of patients with short and long-segment fusion after thoracolumbar burst fractures were similar to those of healthy subjects and did not differ from each other. However, the present results should be interpreted with caution due to the small sample size. Future studies with larger groups are needed to provide additional data to validate these findings.

Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial.

OBJECTIVE: To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. METHODS: A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline-posttreatment and at 6 months-were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). RESULTS: Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P < .05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P < .05). CONCLUSION: This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.

Gait analysis in adults with severe hip dysplasia before and after total hip arthroplasty.

Anatomical reconstruction of high riding hips by total hip arthroplasty (THA) and subtrochanteric shortening osteotomy aims to normalise gait pattern and improve functional hip scores. We present the medium-term clinical results of a group of patients with high riding dislocated hips in whom a cementless THA and subtrochanteric shortening osteotomy had been performed. We compared them with their preoperative status, with patients who had undergone a cementless THA for primary osteoarthritis, and also with a group of healthy gender and age-matched controls. Prospective computerized, three-dimensional gait analyses were performed in 8 female patients with uni-/ or bilateral severe developmental dysplasia of the hip (Group I). Gait analysis was performed preoperatively and at a mean of 12.5 months postoperatively. A group of 8 individuals who received cementless hip replacement for primary osteoarthritis (Group II), and a control group of 8 able-bodied individuals (Group III) were recruited for comparison. Patients in Group I improved and approached the values of Group II. However both were behind Group III. Limb length discrepancy was reduced from a mean of 4.3 cm (range, 1 - 8 cm) to a mean of 0.8 cm (range, 0 - 2 cm) at the latest follow-up. Pain was reliably relieved and activities of daily living were improved in patients with high riding developmental dysplasia of the hip, but they were still behind the normal population average. Nevertheless, the results can be as satisfactory as those in patients who undergo a THA for primary osteoarthritis.

Gait symmetry in patients with unilateral partial hip arthroplasty.

OBJECTIVES: In this study gait deviations symmetry and asymmetry in patients with unilateral partial hip arthroplasty was determined. PATIENTS AND METHODS: Gait characteristics and time since operation (11.9+/-6.1; range 7 to 29 months) of 16 patients (9 females, 7 males; mean age 61.5+/-16.5 years; range 27 to 86 years) with unilateral partial hip arthroplasty were evaluated. Ten healthy volunteers (3 females, 7 males; mean age 54.1+/-11.9 years; range 35 to 65 years) were included in the study as control group. Quantitative gait data was collected with the Vicon 370 System (Oxford Metrics, Oxford, UK). Spatio-temporal (walking velocity, cadence, step time, step length, double support time) and kinematic (joint rotation angles of pelvis and hip in sagittal plane) data were processed by using Vicon Clinical Manager software package. Spatio-temporal and kinematic gait symmetry indices of both groups were calculated. RESULTS: Spatio-temporal and kinematic gait characteristics, but not the symmetry indices, of patients with unilateral partial hip arthroplasty were different from the control group (p>0.05). CONCLUSION: Findings of this study reveal that patients with unilateral partial hip arthroplasty had various gait deviations compared to healthy subjects, but that symmetry was preserved.

Quantitative gait characteristics of children who had successful unilateral clubfoot operation.

OBJECTIVES: In this study, we aimed to evaluate the functional results of patients operated for unilateral clubfoot who had good clinical outcome with gait analysis. We also investigated the deviation from the normal, and determined the compensation mechanisms by comparing this data with the unaffected feet and with the feet of healthy children. METHODS: Sixteen children [10 boys, 6 girls; mean age, 6.8 years (range 4-9 years)] with surgically treated unilateral clubfoot and 24 age-matched healthy children were included in the study. Foot length, calf circumference, ankle range of motion, and radiographic measurements were recorded. All time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle in sagittal, coronal and transverse planes), and kinetic (ground reaction forces, moments, and powers of hip, knee, and ankle) data were evaluated. RESULTS: Calf circumference and ankle range of motion of involved extremity were significantly less than the unaffected side (p<0.05). Quantitative gait data revealed that children with clubfoot had slower walking velocity (0.75±0.25 m/sec vs. 1.02±0.18 m/sec, p=0.01), shorter stride length (0.72±0.23 m vs. 0.91±0.05 m, p=0.01) than healthy children group. Affected foot of unilateral clubfoot patients had more toe-in than healthy children (-14.24±21.78° vs. 18.54±7.90°, p=0.001). Unaffected side showed increased pelvic excursions and medio-lateral ground reaction forces as well as decreased ankle and hip motion in sagittal plane. CONCLUSION: Even asymptomatic well-treated children with unilateral clubfoot may have gait deviations both in the affected and unaffected sides. These alterations may also be the result of the subclinical involvement of the so called healthy foot by disease (clubfoot) as well as the compensatory mechanisms.

The value of calcaneal bone mass measurement using a dual X-ray laser Calscan device in risk screening for osteoporosis.

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score < or = -2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r= -0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r= -0.229, p=0.001), breast feeding time (r= -0.064, p=0.001), and age at menarche (r= -0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.33, p=0.001) at the femoral neck were statistically significant. CONCLUSION: Bone mineral density measurements in the calcaneus using a dual energy X-ray laser are valuable for screening Turkish women over 40 years of age for the risk of osteoporosis.

[Three-dimensional quantitative gait analysis]. / Uçboyutlu niceliksel yürüme analizi.

Gait analysis is one of the essential steps of clinical examination in musculoskeletal medicine. Gait can be measured by various qualitative and quantitative techniques. In this article, the advantages and limitations of three-dimensional quantitative gait analysis will be discussed.

Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey.

The Functional Independence Measure for Children (WeeFIM) instrument has recently been adapted and validated for non-disabled children in Turkey. The aim of this study was to validate the instrument in children with cerebral palsy (CP). One hundred and thirty-four children with CP were assessed using the WeeFIM. Reliability was tested by internal consistency, intraclass and interrater correlation coefficients (ICCs), internal construct validity by Rasch analysis, and external construct validity by correlation with the Denver II Development Test (Denver II). Mean age of the participants (70 females, 64 males) was 4y 6mo (SD 3y 8mo, range 6mo-16y). CP type was: diplegia in 37.3%, hemiplegia in 20.2%, quadriplegia in 8.2%, 'baby at risk' (i.e. infants who show neuromotor delay but cannot be classified in a CP type) in 29.9%, and other in 4.5%. Reliability of the WeeFIM was excellent with high Cronbach's alpha and ICC values ranging between 0.91 and 0.98 for the motor and cognitive scales. After collapsing response categories, both motor and cognitive scales met Rasch model expectations. Unidimensionality of the motor scale was confirmed after adjustment for local dependency of items. There was no substantive differential item functioning and strict unidimensionality for both scales was shown by analysis of the residuals. External construct validity was supported by expected high correlations with developmental ages determined by the social, fine motor function, language, and gross motor function domains of the Denver II. We conclude that the WeeFIM is a reliable and valid instrument for evaluating the functional status of Turkish children with CP.

The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA). MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13 percent of the subjects had osteoporosis, while another 56 percent had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r=-0.229, p=0.001), breast feeding time (r=-0.064, p=0.001), and age at menarche (r=-0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- ...

No detectable major changes in gait analysis after soft tissue release in DDH.

UNLABELLED: The iliopsoas and adductor tendons are often soft tissue barriers obstructing relocation of the femoral head into the acetabulum and are frequently released to obtain reduction. We assessed whether posteromedial soft tissue release including sectioning of the adductor longus and iliopsoas tendons would lead to alterations in joint angles and moments of the hip joint or other major changes in the gait pattern. We conducted 3-D quantitative gait analysis of 10 patients (mean age, 8.1 years) who had unilateral and surgically treated DDH before the age of 18 months. The mean single support time was shorter in the unaffected side of the patients than in the healthy control group. Mean pelvic excursions in both frontal and sagittal planes and maximum knee extension at stance of the affected and unaffected sides were higher in the patients than in the control group. Peak hip flexion moment during swing phase was somewhat reduced, and the hip moment crossover point from extension to flexion was slightly delayed in both the affected and unaffected sides. We could not identify an explanation for the slight deviations due to limited data. However, sectioning of the adductor longus and iliopsoas tendons in DDH patients under 18 months old did not appear to lead to major objective clinical gait alterations. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Mirror therapy improves hand function in subacute stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke. INTERVENTIONS: Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument). RESULTS: The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS. CONCLUSIONS: In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.

Repeatability and variation of quantitative gait data in subgroups of patients with stroke.

We aimed to determine the repeatability and variation of quantitative gait data in patients with stroke and to compare the subgroups in terms of gait variability. Time-distance and kinematic characteristics of gait were evaluated in 90 inpatients (30 women) with hemiparesis (mean+/-S.D. age 57.7+/-12.5 years and time since stroke 5.99+/-6.46 months). Subgroups were based on "gender", "side of paresis", "lesion type", "motor recovery level", "sensory status", "time since stroke" and "walking velocity". Repeatability was adequate to excellent in all stroke subgroups (ICC range 0.48-0.98). Walking velocity was the most repeatable gait parameter after stroke. Variation in step length was significantly higher in women than in men (CV 16% versus 9%, p<0.05). Slow walkers (walking velocity <0.34 m/s) had a higher variation than fast walkers in step length (CV 12.5% versus 7.5%, p<0.01), single support time (CV 11.9% versus 6.3%, p<0.05), peak hip extensions in stance (CV 11.5% versus 3.7%, p<0.01) and knee flexion in swing (CV 11.8% versus 6.5%, p<0.05). In our stroke patients, their age, time since injury, lesion characteristics, impaired proprioception or level of motor recovery had no effect on gait variability. For better interpretation of quantitative gait data, clinicians should consider that variation in step length, single support time, peak hip extension in stance and knee flexion in swing differs according to walking velocity after stroke.

Repeatability of lower limb three-dimensional kinematics in patients with stroke.

The within- and between-session repeatability of time-distance and sagittal plane kinematic gait parameters were evaluated in 20 hemiparetic patients with sub-acute stroke. A test-retest design was used in which the patients were tested during two sessions within a 2h period. Each session comprised three consecutive trials. The intraclass correlation coefficients (ICCs) for time-distance parameters ranged from 0.82 to 0.99. The within- and between-session repeatability of pelvis, hip, knee and ankle kinematic waveforms were high: the mean coefficient of multiple correlations (CMCs) ranged from 0.85 to 0.95. The within-session coefficient of variation (CV%) for time-distance parameters ranged from 3.9 to 14.1, whereas, between-session CV% ranged from 6.1 to 17.2, showing similar but higher variability. The within- and between-session CV% for sagittal plane kinematics of the paretic lower limb ranged from 3.6 to 32.4. The results indicate that time-distance parameters and sagittal plane gait kinematics of the paretic lower limb, measured by the Vicon 370 gait analysis system, are repeatable and can be used to assess treatment effects after stroke.

Immediate effects of silicone insoles on gait pattern in patients with flexible flatfoot.

BACKGROUND: Flatfoot in which a normal arch fails to develop is a common deformity in both children and adults. A frequently-used treatment is an over-the-counter insole to normalize foot mechanics and relieve pain. This study was designed to evaluate the effects of over-the-counter silicone insoles on the gait patterns of patients with flexible flatfoot. METHODS: Thirty-four adults (24 women and nine men, average age 43.7 +/- 9.7 years) with bilateral symptomatic flatfoot deformities were included in the study. Flatfoot was diagnosed by a lateral talometatarsal angle of more than 4 degrees and a talocalcaneal angle of more than 30 degrees. Three-dimensional gait analysis and video recordings were done at a single session. All patients walked at self-selected speeds over a 10-meter walkway with and without insoles. Time-distance parameters and kinematic and kinetic characteristics of gait in the sagittal plane were evaluated by a quantitative gait analysis system. RESULTS: Mean lateral talometatarsal and talocalcaneal angles were 6.3 +/- 2.5 degrees and 56.1 +/- 8.6 degrees, respectively. There was no difference in gait parameters with or without the insoles. CONCLUSIONS: Over-the-counter insoles have no beneficial effect in normalizing forces acting on the foot and on the entire lower extremity in adults with flexible flatfoot.

Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study.

OBJECTIVE: To evaluate the effects of sensory-amplitude electric stimulation (SES) of the paretic leg on motor recovery and gait kinematics of patients with stroke. DESIGN: Randomized, controlled, double-blind study. SETTING: Rehabilitation ward and gait laboratory of a university hospital. PARTICIPANTS: A total of 30 consecutive inpatients with stroke (mean age, 63.2 y), all within 6 months poststroke and without volitional ankle dorsiflexion were studied. INTERVENTION: Both the SES group (n=15) and the placebo group (n=15) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks. The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks. MAIN OUTCOME MEASURES: Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait. RESULTS: Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the SES group and 56% of the placebo group gained voluntary ankle dorsiflexion. The between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the between-group difference was not significant. CONCLUSIONS: In our patients with stroke, SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics.

Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.5 y), all within 12 months poststroke and without volitional ankle dorsiflexion. INTERVENTIONS: Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories [FAC]), and motor functioning (motor items of the FIM instrument). RESULTS: The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 0.8; 95% CI, 0.5-1.2; P=.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2-24.7; vs mean, 12.5; 95% CI, 9.6-14.8; P=.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4-1.2; vs mean, 0.3; 95% CI, 0.1-0.7; P=.102) nor FAC (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 1.5; 95% CI, 1.1-1.9; P=.610) showed a significant difference between the groups. CONCLUSIONS: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.

Validation of the Middlesex Elderly Assessment of Mental State (MEAMS) as a cognitive screening test in patients with acquired brain injury in Turkey.

PURPOSE: Assessment of cognitive impairment with a valid cognitive screening tool is essential in neurorehabilitation. The aim of this study was to test the reliability and validity of the Turkish-adapted version of the Middlesex Elderly Assessment of Mental State (MEAMS) among acquired brain injury patients in Turkey. METHODS: Some 155 patients with acquired brain injury admitted for rehabilitation were assessed by the adapted version of MEAMS at admission and discharge. Reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and person separation index; internal construct validity by Rasch analysis; external construct validity by associations with physical and cognitive disability (FIM); and responsiveness by Effect Size. RESULTS: Reliability was found to be good with Cronbach's alpha of 0.82 at both admission and discharge; and likewise an ICC of 0.80. Person separation index was 0.813. Internal construct validity was good by fit of the data to the Rasch model (mean item fit -0.178; SD 1.019). Items were substantially free of differential item functioning. External construct validity was confirmed by expected associations with physical and cognitive disability. Effect size was 0.42 compared with 0.22 for cognitive FIM. CONCLUSION: The reliability and validity of the Turkish version of MEAMS as a cognitive impairment screening tool in acquired brain injury has been demonstrated.

Clinimetric properties of the Duruoz hand index in patients with stroke.

OBJECTIVE: To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke. DESIGN: Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program. SETTING: Three different inpatient rehabilitation centers. PARTICIPANTS: A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Brunnstrom stages, Modified Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach alpha coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman rho correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test. RESULTS: The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval, .93-.99) and alpha of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (rho=-.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis (P<.01). The DHI score improved significantly after a 4-week inpatient rehabilitation program (P<.05). CONCLUSIONS: The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.