2-[(E)-(2-Morpholinoeth­yl)iminiometh­yl]-4-nitro-1-oxocyclo­hexa­dienide

The mol­ecule of the title compound, C13H17N3O4, exists as a zwitterion, with the H atom of the phenol group being transferred to the imine N atom. The C=O, CAr—CAr and C—N bond lengths are in agreement with the oxocyclo­hexa­dienide–iminium zwitterionic form. A strong intra­molecular N+—H⋯O hydrogen bond generates an S(6) ring motif. The morpholine ring adopts a chair conformation. In the crystal, mol­ecules are linked into centrosymmetric dimers by inter­molecular N—H⋯O hydrogen bonds. In addition, C—H⋯O hydrogen bonds and very weak C—H⋯π inter­actions are observed

İlk ve Ortaokula Devam Eden Hemiplejik Serebral Palsi’li Çouklarda Modifiye Zorunlu Kısıtlayıcı Hareket Terapisi ve Bimanuel Eğitimin Üst Ekstremite Fonksiyonlarına, Aktiviteye ve Katılıma Etkilerinin Karşılaştırılması: Randomize Kontrollü Çalışma

This study aimed to compare the effects of Modified Constraint-Induced Movement Therapy (mCIMT) and Bimanual Training (BIT) based on the International Classification of Functioning, Disability, and Health’s conceptual framework in children with hemiplegic Cerebral Plasy (CP) attending primary and secondary schools. Thirty-two children (mean age 10.43 years [SD 2.9 years]; 15 females, 17 males) whose functional profiles associated with Manual Ability Classification System (MACS), Gross Motor Function Classification System (GMFCS) and Communication Function Classification System (CFCS) changed between level I-III, were randomly distributed to one of the mCIMT or BIT groups with equivalent dosing frequency and intensity (10 weeks/3 days per week/2.5 hours per day). Upper extremity body structure/functions (Modified Ashworth Scale and handheld dynamometer), activity (Quality of Upper Extremity Skills Test, Children’s Hand-use Experience Questionnaire, ABILHAND-Kids, Children’s Hand‐Skills Ability Questionnaire, and Pediatric Motor Activity Log), and participation outcomes (Child and Adolescent Scale of Participation) were assessed before and after treatment, and at 16 weeks post-intervention. Overall, mCIMT produced more significant improvements in all outcomes than BIT at the immediate post-intervention period, which were maintained better in the mCIMT group throughout the 16-week follow-up period (effect size: dmCIMT>dBIT). However, effect size for the quantity of bimanual use was found to be larger in BIT group than mCIMT group (dBIT=1.41 and dmCIMT =1.23), while the immediate effect of mCIMT for quality of bimanual use parameters was observed better than BIT (ranges of dmCIMT=0.91-0.96 and ranges of dBIT=0.63-0.77). If the goal of the upper limb rehabilitation is to achieve better outcomes in unimanual capacity and developmental non-use in children with hemiplegic CP, mCIMT might be the best choice. In contrast, BIT might be more practical for the problems with spontaneous use of the more affected side.Bu çalışma modifiye Zorunlu Kısıtlayıcı Hareket Terapisi (mZKHT) ve Bimanuel Eğitimin (BIT) etkilerini hemiplejik Serebral Palsi (SP)’li ilk ve ortaokul çocuklarında İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırması (ICF-CY) kavramsal çerçevesine dayalı olarak karşılaştırmayı amaçlamıştır. El Becerileri Sınıflandırma Sistemi (EBSS), Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS) ve İletişim Fonksiyonları Sınıflandırması Sistemine (İFSS) göre fonksiyonel profilleri I-III arasında değişen 32 hemiplejik Serebral Palsi (SP)’li çocuk (ortalama yaş 10,43 yıl [SD 2,9 yıl]; 15 kız, 17 erkek) benzer doz/ frekanslı ve yoğunlukta (10 hafta/haftalık 3 seans/günlük 2,5 saat) m ZKHT ve BIT gruplarından birine eşit sayıda rasgele dağıtıldı. Üst ekstremite yapı/işlevsellik (Modifiye Ashworth Skalası [MAS] ve el dinamometresi), aktivite (Üst Ekstremite Kalitesi Becerileri Testi [QUEST], Çocukların El Kullanım Deneyimi Anketi [ÇEDA], ABILHAND-Kids ve Çocuk El Beceri Anketi [ÇEBA] ve Pediatrik Motor Aktivite Günlüğü [PMAG]) ve katılım sonuçları (Çocuk ve Adölesan Katılım Anketi [CASP]) çalışmadan önce ve hemen sonra ve 16 haftalık takip döneminin sonunda değerlendirildi. Genel olarak, mZKHT hem tedaviden hemen sonraki dönemde hem de 16 haftalık takip döneminde tüm sonuçlarda BIT’e nazaran daha iyi gelişmelere yol açtı (EB: dmCIMT>dBIT). Bununla birlikte, iki taraflı kullanım miktarı parametresi için etki büyüklüğü Bimanuel Eğitim grubunda görece daha büyük bulunurken (dBIT=1,41 ve dmCIMT =1,23), iki taraflı kullanım kalitesi paramaterlerinde mZKHT’nin daha etkili olduğu gözlemlendi (dmCIMT=0,91-0,96 ve dBIT=0,63-0,77). Gelişimsel ihmal ve tek taraflı kapasite problemleri daha ön planda olan hemiplejik SP’li çocuklarda mZKHT tercih edilmelidir. Buna karşılık, etkilenen elin kendiliğinden kullanımı ile ilgili problemlerde ise Bimanuel Eğitim tercih edilmelidir

The Effect of the Function of Forearm Supination on Participation Activities and Communication Skills of Children with Hemiparetic Cerebral Palsy

Objective: The aim of this study is to investigate the effect of forearm supination function of children with hemiparetic CP on their participation activities and communication skills. Materials and Methods: This study was carried out with 58 children aged 7-14 who were diagnosed with hemiparetic CP and regularly followed up in special education and rehabilitation centers. In addition to the demographic information of the children, outcome measurements of Gschwind Tonkin Classification System, Child and Adolescent Scale of Participation (CASP), and Communication Function Classification System (CFCS) were also recorded. Results: It was found that participation activities and communication skills levels of children with hemiparetic CP were statistically different according to forearm supination function (p<0.05). Conclusions: It was investigated that participation activities and communication skills levels of children with hemiparetic CP were decreased with the decrease in the function of forearm supination according to the Gschwind Tonkin Classification System. While planning rehabilitation programs to increase participation activities and communication skills levels of children with hemiparetic CP, it can be suggested to consider increasing children’s function of supination level and treatment practices that increase this function

Fonksiyonel masajın serebral palsili çocuklarda spastisite ve motor fonksiyon üzerine etkileri: rastgele kontrollü çalışma

Purpose: The purpose of this study was to investigate the effects of functional massage on the severity of lower limb spasticity and gross motor function of children with cerebral palsy (CP). Methods: In this study, 20 children who were classified as level I-IV according to Gross Motor Classification System (GMFCS), who had communication skills (according to Communication Function Classification System, level I-III), who had never undergone surgery and who were between the ages of 5-12 years, were recruited from two rehabilitation centers. Children were randomized to control or experimental groups to receive either only Traditional Physiotherapy (TP) or TP combined with Functional Massage (FM). Interventions were delivered at equal dosage (total eight weeks, 2 days per week, 45 minutes/day) in the same environment. The severity of spasticity was measured with Modified Ashworth Scale (MAS), and functional level and gross motor function were quantified according to GMFCS and Gross Motor Function Measure (GMFM), respectively. Results: When the pre-therapy and post-therapy data covering GMFM and hip adductors, hip flexors, hamstrings and calf muscles spasticity score of the both groups were compared, no statistically significant difference was determined in the hip flexor spasticity score of the control group (p>0.05), while considerable differences were defined in the hip flexors spasticity score of the experimental group (p0.05). Conclusion: In conclusion, it was identified that FM combined with TP is effective in treating spasticity and in improving some parameters related to motor function in children with CP.Amaç: Bu çalışmanın amacı; fonksiyonel masajın serebral palsili (SP) çocukların alt ekstremite spastisite şiddetine ve kaba motor fonksiyonlarına etkilerini araştırmaktı. Yöntem: Çalışmaya iki farklı rehabilitasyon merkezinden, iletişim becerisi olan (İletişim Becerileri Sınıflandırma Sistemine göre iletişim becerileri I-III arasında), fonksiyonel seviyeleri Kaba Motor Fonksiyon Sınıflandırma Sistemi’ne (KMFS) göre I-IV arasında değişen, hiç ameliyat geçirmemiş ve yaşları 5-12 yaş arasında değişen 20 SP‘li çocuk dahil edildi. Çalışmaya dahil edilen çocuklar kontrol veya araştırma gruplarına sırasıyla sadece Konvansiyonel Fizyoterapi (KF) veya KF’ye ek olarak Fonksiyonel Masaj (FM) almak üzere rastgele dağıtıldı. Uygulamalar gruplara aynı ortamda ve eşit dozlarda verildi (toplam sekiz hafta, haftada 2 gün, günde 45 dk). Spastisite şiddeti Modifiye Ashworth Skalası (MAS), fonksiyonel seviye ve kaba motor fonksiyonlar sırasıyla KMFS ve Kaba Motor Fonksiyon Ölçütü (KMFÖ) ile değerlendirildi. Bulgular: Her iki gruba ait terapi öncesi ve terapi sonrası KMFÖ, kalça fleksörleri, adduktörleri, hamstringler ve baldır kaslarının spastisite skorlarını kapsayan veriler karşılaştırıldığında, kontrol grubuna ait kalça fleksörleri spastisite skorunda herhangi bir fark bulunmazken (p>0.05); araştırma grubuna ait kalça fleksörleri spastisite skorunda iyileşme saptandı (p<0.05). MAS’daki diğer üç kas grubuna ait spastisite skorunda ve KMFÖ skorundaki değişimler her iki grup için benzerdi. Sonuç: Sonuç olarak, SP’li çocuklarda FM’nin KF ile kombinasyonu spastisitenin tedavisinde ve motor fonksiyonlarla ilgili bazı parametreleri iyileştirmede etkili olduğu sonucuna varılmıştı

Comparing the effects of modified constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy mainstreamed in regular school: A randomized controlled study

Purpose: The aim of this study was to compare the effects of modified constraint-induced movement therapy (mCIMT) and bimanual training (BIT) based on the International Classification of Functioning, Disability, and Health, Children and Youth (ICF-CY) conceptual framework. Research method: A total of 32 children (mean age 10.43 years [SD 2.9 years]; 15 girls, 17 boys) whose functional motor and communication levels, according to the Manual Ability Classification System, Gross Motor Function Classification System, and Communication Function Classification System, changed between level I and III were randomly distributed to one of the mCIMT or BIT groups with equivalent dosing frequencies and intensities (10 weeks, 3 days/week, 2.5 h/day). Upper extremity body function outcomes (handheld dynamometer), activity outcomes (Quality of Upper Extremity Skills Test, The Children's Hand-use Experience Questionnaire, ABILHAND-Kids, Pediatric Upper Extremity Motor Activity Log), and participation outcomes (Child and Adolescent Scale of Participation) were assessed before and after treatment, and at 16 weeks post-intervention. The clinical trial number of the study is NCT04577391. Results: mCIMT resulted in more significant improvements in all outcomes than BIT at the immediate postintervention period (T2), which were maintained in the mCIMT group throughout the 16-week postintervention period (p d(BIT)). Conclusion: The potential advantage of mCIMT versus BIT is the larger short-term effect sizes (ESs) and the more sustainable improvements. (C) 2021 Published by Elsevier Masson SAS on behalf of French Society of Pediatrics

[The effects of hand deformity on upper-limb function and health-related quality of life in children with spastic hemiplegic cerebral palsy] [Les effets des déformations de la main sur les fonctions du membre supérieur et la qualité de vie liée à la santé chez les enfants atteints de paralysie cérébrale hémiplégique spastique]

The aim of this study was to investigate the effect of hand deformity on upper-limb function and health-related quality of life (HRQOL) in children with hemiplegic cerebral palsy (CP). The study included 44 children with hemiplegic CP between the ages of 6 and 14 years (mean age, 10.04 years; SD, 3.1; 23 males, 21 females). The Manual Ability Classification System (MACS) and Gross Motor Function Classification System (GMFCS) were used, with the Zancolli classification to characterize hand deformities on the more affected side. Upper-limb function was assessed in terms of unilateral capacity (Quality of Upper Extremity Skills Test: QUEST) and bimanual performance (Children's Hand-use Experience Questionnaire: CHEQ), while HRQOL was evaluated on the KIDSCREEN-27 questionnaire. Comparison of bimanual performance and unilateral capacity in children with Zancolli level 1 and 2a hemiplegic CP found statistically significant differences (p 0.05). Upper-limb function and the HRQOL physical health domain were poorer with greater hand deformity in children with hemiplegic CP. © 2021 SFC

The Efficacy of Two Models of Intensive Upper Limb Training on Health-Related Quality of Life in Children with Hemiplegic Cerebral Palsy Mainstreamed in Regular Schools: A Double-Blinded, Randomized Controlled Trial

Background: Children with hemiplegic cerebral palsy (CP) are at risk of reduced upper limb function and poorer quality of life than their typically developing peers. Although upper limb impairments have potential negative impact on the health-related quality of life (HRQOL) in children with hemiplegic CP, the efficacy of upper limb rehabilitation approaches aiming to improve upper limb impairments on HRQOL has not been adequately investigated. Objective: This study compares the efficacy of two modes of activity-based upper limb rehabilitation (modified constraint-induced movement therapy [mCIMT] and bimanual training [BIM]) on HRQOL outcomes in children with hemiplegic CP mainstreamed in regular schools. Methods: Thirty children with hemiplegic CP aged between 7 and 11 years (mean age 8.53 ± 1.54 years) who had functional ability levels of I–III according to the Manual Ability Classification System (MACS), Gross Motor Classification System (GMFCS), and Communication Function Classification System (CFCS) were randomly assigned to receive mCIMT or BIM training. Result: Both mCIMT and BIM yielded statistically significant improvements in all HRQOL domains immediately after the 10-week interventions (P < .001), which were retained at 16 weeks. Conclusion: While there were some differences in the intervention effects, both of these upper limb rehabilitation approaches based on intensive unimanual or bimanual activity may be beneficial for improving perceived life satisfaction related to physical activity, general mood, family, friends, and school among children with hemiplegic CP mainstreamed in regular schools. © 2021 Taylor & Francis Group, LLC

Validity and Reliability of the Turkish Version of the KIDSCREEN-27 for Individuals With Cerebral Palsy

Our aims in this study were to examine the construct/concurrent validity and internal/test-re-test reliabilities of both the self-report and parent-report questionnaires of a Turkish version of the KIDSCREEN-27 for adolescents with cerebral palsy (CP). We used a convenience sample of 135 children and adolescents with CP aged 8-18 years (65 males, 70 females; M age = 12.39, SD = 3.57) and their parents/caregivers (123 mothers, seven fathers, and five grandmothers). We explored structural construct validity via confirmatory factor analysis (CFA). Concurrent validity was examined via Spearman's correlations between the KIDSCREEN-27 questionnaires and the self-report and primary caregiver report forms of the Cerebral Palsy Quality of Life for Children (CP QOL-Child) and adolescents (CP QOL-Teen). We explored test-retest and internal consistency reliabilities utilizing intraclass correlation coefficients (ICC) and Cronbach's alpha (alpha), respectively. CFA goodness-of fit indices verified that the predefined model of the KIDSCREEN-27 was a good fit for data from the CP population (X-2/df0.90, AGFI >0.90, RMSEA0.70). Both versions of the KIDSCREEN-27 have satisfactory psychometric properties for use in evaluating health-related quality of life (HRQOL) outcomes in children and adolescents with CP

Clinical Usage of Cardiovascular Magnetic Resonance Imaging: Single-Center Experience in the New Era of Cardiovascular Imaging

Introduction: Utilization of cardiac magnetic resonance imaging (CMRI) has been increasing year by year for the most cardiovascular diseases. In this paper, we documented a real-life experience of our center as a high-volume CMRI performing center. Methods: We have retrospectively analyzed the 100 patients who have undergone CMRI at our center during the last 1 year. All the preliminary diagnoses, specialty or subspecialty of referring physicians, patient characteristics and CMRI findings were analyzed. Results: In 87 of 100 scans, a gadolinium-based contrast agent was used and in none of these procedures neither complications nor adverse events related to the contrast agent has occurred. Among these 100 consecutive CMRIs were referred to by a clinical cardiologist, invasive cardiologists, heart failure specialist, cardiovascular imaging specialists, electrophysiologists, and other specialists. On referral from a clinical cardiologist, the CMRI findings were high consistency. In these patients, the biggest number of preliminary diagnoses belongs to hypertrophic cardiomyopathy. The most common MRI finding was reduced left ventricular ejection fraction. In 25 patients we observed extracardiac findings. Conclusion: CMRI is increasingly occurring in cardiovascular imaging and diagnosis of various cardiovascular diseases. CMRI not only produces high-resolution morphological images but also provides quantitative information on the severity of reGürgitant or stenotic lesions in valvular diseases or cardiac shunts with the velocity and flow measurements