Do the core stability and position sense of trunk affect balance in patients with multiple sclerosis?

Objective: The trunk is known to be the most important key point where sensory inputs are received and motor responses occur, necessary for the maintenance of balance and postural control. The aims of the present study were to investigate the relationship between balance with core stability and position sense of trunk in patients with Multiple Sclerosis (PwMS) and to compare core stability, position sense of trunk and balance in PwMS and healthy controls. Methods: The study was completed with 45 PwMS and 29 healthy controls with matching age and gender. Balance was assessed with Postural Stability Test (PST) and Modified Sensory Organization Test (MSOT) by using Biodex Balance System (R). Core stability was evaluated with core endurance tests according to McGill procedure. Position sense of trunk was evaluated with the lumbosacral (LS) reposition tests by using Dualer IQTM digital inclinometer. Results: PST, MSOT and LS repositioning tests scores were higher (p<0.001) and the trunk flexor, extensor, right and left lateral endurance tests scores were lower (p<0.001) in PwMS compared to healthy controls. PST and MSOT were found to be correlated with core endurance tests scores (rs=-0.406/-0.602, p<0.05) and LS reposition test scores (rs=0.357/0.510, p<0.05) in PwMS. Conclusion: This study suggested that core stability and position sense of trunk were affected and caused imbalance in PwMS. Therefore, clinicians should consider assessments and interventions directed at decreased core stability and trunk position sense in PwMS

Görsel Illüzyon Uygulamasının Ağrı Şiddeti, Niteliği ve Fonksiyonel Kapasite Üzerine Etkileri

This study was planned to compare the effect of visual illusion and TENS on pain intensity, pain quality and functional capacity in spinal cord injury patients with neuropathic pain. In the study, twenty four patients were included and randomly categorized into two groups. In the first group, visual illusion was applied for first two weeks and 1 week wash out period and then TENS was applied for 2 weeks. In second group, TENS was applied for first 2 weeks and 1 week wash out period and then visual illusion were applied for last 2 weeks. The signs and symptoms of the neuropathic pain was assessed with DN4 scale; present, mean, the most and less pain was evaluated with visual analog scale (VAS), quality of the pain was evaluated with the neuropathic pain scale (NPS), the effect of pain on functional capacity was assessed with Brief Pain Inventory (BPI). All assessments were performed four times before and after both treatments. It was observed that pain intensity decrease immediately after both applications (p0,05). When findings of NPS were analyzed, pain intensity, heat, sharpness, unpleasant, deepness decreased after visual illusion application (p0,05). When the results of BPI were detected, they were observed that the negative effect of pain on moving ability after visual illusion application and the negative effect of pain on mood, relationships with others and sleep after TENS application decreased significantly (p0,05). NAÖ sonuçları incelendiğinde, görsel illüzyon sonrasında ağrının şiddeti, keskinliği, yanıcılığı, sevimsizliği ve derinliğinde anlamlı derecede azalma olurken (p0,05). KAE sonuçları incelendiğinde, görsel illüzyon sonrasında ağrının hareket etme yeteneği üstünde oluşturduğu olumsuz etkinin; TENS sonrasında ise ağrının ruh haline, insan ilişkilerine ve uykuya olan olumsuz etkilerinin anlamlı derecede azaldığı görüldü (p<0,05). Sonuç olarak, her iki uygulamanın da medikal tedavi ile istenilen sonuçlara ulaşılamadığı durumlarda, alternatif bir seçenek olarak ya da medikal tedaviyi destekleyen bir yaklaşım olarak klinikte kullanılabileceği düşünülmektedir

Effect of combined aerobic and pilates training on biochemical factors, physical performance, fatigue and quality of life in patients with multiple sclerosis

Çalışmamız, Multipl Skleroz (MS) hastalarında aerobik eğitimle kombine Pilates eğitiminin serum Sitokin Sinyal Baskılayıcı-1 (SOCS-1), SOCS-3 ve Beyin Kaynaklı Nörotrofik Faktör (BDNF) üzerine etkisi başta olmak üzere, fiziksel performans, yorgunluk ve yaşam kalitesi üzerine etkilerini incelemek amacıyla planlandı. Çalışmamıza EDSS skoru 5'in altında olan 36 MS hastası ve sadece biyokimyasal analizlere dahil edilmek üzere 18 sağlıklı birey dahil edildi. Hastalar randomize olarak, MS-egzersiz [n:18, EDSS ortanca (IQR):1(0.87-2.12)] ve MS-kontrol grubu [n:18, EDSS ortanca (IQR):1(1-2)] olarak 2 gruba ayrıldı. MS-egzersiz grubundaki bireylere haftada 3 gün 8 hafta boyunca orta şiddetli aerobik ve Pilates eğitiminden oluşan kombine eğitim verildi. MS-kontrol grubuna ise haftada 3 gün 8 hafta boyunca gevşeme egzersizlerinden oluşan bir ev programı verildi. Biyokimyasal analizlerde ticari sandviç "Enzyme-Linked İmmunosorbent Assay" (ELISA) kiti kullanıldı. Kas kuvveti; el dinamometresi ile, "core" endurans; lateral köprü testi, "Modifiye Biering-Sorensen" testi, gövde fleksiyon testi, "prone bridge" testi ile, "core" güç; "sit ups" ve "push-ups" testleri ile, denge; Biodex-BioSway Portatif Denge Sistemi ile, günlük yaşamda denge gerektiren aktivitelerdeki güven düzeyi; Aktiviteye Spesifik Denge Güvenlik Ölçeği (ABC) ile, foksiyonel mobilite; Süreli Kalk Yürü testi (TUG) ile, fonksiyonel egzersiz kapasitesi; 6 dakikalık yürüme testi (6-DYT) ile, yorgunluk; Yorgunluk Şiddet Ölçeği (FSS) ve Yorgunluk Etki Ölçeği (FIS) ile, yaşam kalitesi; Multipl Skleroz Yaşam Kalitesi Anketi (MSQOL-54) ile değerlendirildi. Kombine eğitim sonucunda, MS-egzersiz grubunun serum SOCS-1 ve SOCS-3 düzeylerinde anlamlı değişim görülmezken (p>0.05); serum BDNF düzeyi, kas kuvveti, "core" stabilite, denge, mobilite, fonksiyonel egzersiz kapasitesi, yorgunluk ve yaşam kalitesinde anlamlı gelişme olduğu görüldü (p0.05). Sonuç olarak, MS hastalarında haftada 3 gün 8 haftalık aerobik eğitimle kombine Pilates eğitiminin serum SOCS-1 ve SOCS-3 düzeylerine belirgin etkisinin olmadığı, fakat serum BDNF düzeyinde anlamlı artış sağladığı sonucuna varıldı. Çalışmamızın diğer bir sonucu olarak, kombine egzersiz eğitimin MS hastalarının fiziksel performans, yorgunluk ve yaşam kalitesini geliştirmede etkili olduğudur Buradan yola çıkarak, çalışmamızda kullandığımız kombine eğitimin frekans ve şiddetinin, çalışmamızla benzer sonuçlara ulaşmak isteyen fizyoterapistlere yol gösterici olacağını düşünmekteyiz.This study was planned to investigate the effects of combined exercise training consisting of aerobic and Pilates training in patients with Multiple Sclerosis (MS) primarily on Suppressor of Cytokine Signalling-1 (SOCS-1), SOCS-3, Brain-Derived Neurotrophic Factor (BDNF), and secondary on physical performance, fatigue, and quality of life. The study included 36 MS patients with EDSS score below 5 and 18 healthy subjects. The healthy individuals were evaluated only once for biochemical analysis. The patients were randomly divided into 2 groups as MS-exercise [n:18, EDSS median (IQR):1 (0.87-2.12)] and MS-control groups [n:18, EDSS median (IQR):1 (1-2)]. While MS-exercise group was given combined training consisting of moderate-intesity aerobic and Pilates training 3 days per week for 8 weeks, MS-control group was given a home exercise program consisting of relaxation exercises. For biochemical analysis, commercial sandwich "Enzyme-Linked Immunosorbent Assay" (ELISA) kit was used. Muscle strength; with a hand dynamometer, ''core'' endurance; with trunk flexion test, modified ''Biering-Sorensen'' test, ''prone bridge'' test and right and left lateral bridge test, ''core'' power; with ''sit-ups'' test and modified ''push-ups'' test, Balance; with Biodex-BioSway Portable Balance System, confidence in activities requiring balance in daily life; with Activity Specific Balance Confidence Scale (ABC), functional mobility; with Timed "Up and Go" test (TUG), fatigue; with Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS), the quality of life; with Multiple Sclerosis Quality of Life Questionnaire(MSQOL-54) were assesed. After the combined training, there was no significant change in the serum SOCS-1 and SOCS-3 levels (p>0.05), but serum BDNF level, muscle strength, "core" stability, balance, mobility, functional exercise capacity, fatigue and quality of life were significantly improved in MS-exercise group (p0.05), while serum SOCS-1 level and fatigue severity increased significantly (p<0.05). In conclusion, it was concluded that the combined training 3 days per week for 8 weeks in patients with MS had no significant effect on serum SOCS-1 and SOCS-3 levels, but significantly increased serum BDNF levels. As another result of our work, the combined training in patients with MS is effective for improving physical performance, fatigue, and quality of life. We think that the frequency and intensity of the combined training was used in our study will guide physiotherapists to achieve similar results with our study