Multiple Skleroz’lu Hastalarda Üst Ekstremite Ataksisinin Bilgisayar Analizi İle Değerlendirilmesi

Objective: Neurological and neurophysiologic disorders such as Multiple Sclerosis (MS) and disorders with disabilities need to be evaluated thoroughly and thoroughly. In MS we developed a new test (Multiple Sclerosis Ataxia Test) (MSAT) to evaluate the upper extremity coordination problem. This test provides a computer-based evaluation platform to fully assess the severity of the upper extremity coordination problem. Method: (MSAT) was tested on 23 patients (MS) with 18 MS in EDSS groups with different (Expanded Disability Status Scale) MS disease. The amount of deviation of the following patient by the spiral line pen on the tablet is given as a percentage. Since the same practices were applied in healthy group, dominant and non dominant hand were compared in MS and healthy group. Results The Ataxia Ratio Scale (UAQ) was compared with the upper extremity kinetic functions section. Findings: No statistically significant correlation was found between EDSS and patients' dominant hand (right h and). (p>0.05). There was no significant correlation between ICAR variance and dominant and non-dominant hand (p>0.05). There was a statistically significant difference between the two groups in the analysis of right hand comparison of patients and healthy subjects (p<0.05). Conclusion: MSAT evaluates upper extremity ataxia more objectively and can give information about the functional status of the patient before and after treatment. This method may have the same transformative effect on clinical evaluation and research in MS, as does standardized computerized tests in the field of education, which have a clear potential to accelerate progress in clinical evaluation and research

Effects of Gluteus Maximus Muscle Strength on Ataxia, Gait, and Equilibrium in Multiple Sclerosis

Introduction: Multiple sclerosis (MS) is an autoimmune disease that causes scar tissue in the nervous system and seriously affects the quality of life of people. Muscle weakness, spasticity and coordination problems are seen primarily in the lower extremities. Strengthening exercises improve muscle strength in people with multiple sclerosis, but there is no consensus on their effect on walking capacity. Methods: To determine the relationship between gluteus maximus muscle strength, ataxia, balance and walking capacity in Multiple Sclerosis. An experimental study design was applied. Gluteus maximus muscle strength was measured using a dynamometer. Walking capacity was determined by the 6-minute walk test (6MWT) and dynamic gait index (DGI). Balance was evaluated with the one-leg standing test (SLS). The severity of ataxia was measured with the International Ataxia Rating Scale (ICARS). Fatigue was evaluated with VAS and quality of life of all patients with SF36 short form. Results: EDSS mean of the study = 3.39 ± 1.4; 2 men and 16 women with mean age = 37.17 ± 9.16 years were included. 6MWT, DGI, ALS, ICARS, VAS were different before and after treatment (p\u3c0.05). There was no significant difference other than physical function and general health among the sub-parameters of SF36 (p\u3e0.05). Correlation of muscle strength with ataxia, gait and balance was not significant (p\u3e0.05) Conclusion: In individuals with MS, the fact that the treatment program consists of modalities that include balance and sensory exercises as well as muscle strengthening exercises increases the success of rehabilitation

Investigation of the effects of depression on the functional capacity, swallowing function and quality of life in geriatric individuals in the nursing home: Huzurevinde kalan geriyatrik bireylerde depresyonun, fonksiyonel kapasite, yutma fonksiyonu ve yaşam kalitesi üzerine etkilerinin araştırılması

Research Problem: To investigate the relationship between depression, functional capacity, swallowing and quality of life in patients over 65 years of age in a nursing home. Method: A sample of this cross-sectional and descriptive study. After demographic data of 60 individuals over the age of 65 were recorded, Standardized Mini Mental Test (SMMT), Geriatric Depression Scale (GDS), 6 minutes walking test, and Bedhead Water Drinking Evaluation Test with Eat 10 test were applied. Findings: 71% of the patients were female and 28% were male.&nbsp; The mean age of males is 71.83 and the average age of females is 69 years. There was no significant difference in the relationship between depression and functional capacity (p&gt; 0.05). There was a significant difference between depression and social functioning of SF36 and social health perception (p &lt;0.05). Conclusion: &nbsp;Even though anatomical differences are observed in elderly individuals, they can function as functional swallowing. ​Extended English summary is in the end of&nbsp;Full Text&nbsp;PDF (TURKISH)&nbsp;file. &nbsp; &nbsp; Özet Amaç: Huzurevinde kalan 65 yaş üstü hastaların depresyon ile fonksiyonel kapasite,yutma ve yaşam kalitesi arasındaki ilişkiyi araştırmak. Metod: Karşılaştırmalı tanımlayıcı bir çalışma olup; 65 yaş üstü bireylerin demoğrafik verileri kaydedildi ve hastalara Standartize mini mental test, Geriyatrik depresyon skala, 6dk yürüme testi, yatak başı su yutma testi yapıldı. Bulgular: Hastaların %71’i kadın, %28’i erkek idi. Erkek hasta yaş ortalaması 71.83 kadınların ise 69 idi.Depresyon ile fonksiyonel kapasite arasında anlamlı bir fark bulunamadı.Ancak depresyon ile SF-36nın sosyal fonksiyonu,sağlık algısı arasında anlamlı fark bulundu. (p &lt;0.05). Sonuç: Yaşlı bireylerde gençlere göre anatomik olarak farklılıklar görülse bile fonksiyonel olarak yutma işlevini yerine getirebilmektedirler

Multiple Skleroz'lu Bireylerde Gövde ve Alt Ekstremite Ataksisinin Yürürme ve Denge Parametreleri Üzerine Etkisinin Karşılaştırılması

. The aim of this study was to investigate the effects of lower extremity and trunk ataxia on walking, plantar pressure and balance in ataxic Multiple Sclerosis (MS) patients and determine their differences with truncal ataxia. 60 MS patients who could walk independently between 3 and 5 in the EDSS (Expanded Disability Status Scale) score were included in the study. In patients, it was decided by EDSS which of the trunk and extremity ataxia was predominant. According to EDSS, 36 subjects with predominant trunk ataxia and 24 patients with extremity ataxia (limb ataxia) were included. 32 healthy subjects were included in the control group. Functional Reach Test (FUT), International Cooperative Rating Scale (ICARS), Dynamic Gait Index (DGI), Pedobarography (PBG) and Stabilometer were used to evaluate balance and gait. Pedobarography (PBG) and stabilometer were applied to the subjects in the control group. Spatiotemporal parameters of MS patients with ekstremty ataxia and trunk ataxia and healthy individuals showed statistically significant differences (p 0,05). Statistically significant differences were observed in the static and dynamic plantar pressure distribution of MS patients with ekstremty ataxia and trunk ataxia (p <0,05). When the static plantar pressure distribution was examined, the pressure in the lateral of back foot of the extremity ataxia group was significantly higher than the trunk ataxia and the control group (p <0,05). Dynamic plantar pressure was found to be lower in the forefoot and middle foot lateral to healthy individuals. Dynamic plantar pressure was found to be lower in the middle and lateral hind of foot compared to healthy individuals (p <0,05). Stabilometric evaluation of the trunk ataxia individuals eyes open and eyes closed swing length, was found to be higher than the extremity ataxia. Lower extremity ataxia was found to be more effective than the body ataxia. Trunk ataxia was shown to affect the balance more than the lower extremity ataxia.The importance of determining the type of ataxia that predominates in the person with MS, taking into account the treatment approaches to increase the plantar pressure and balance activities was emphasized.ONAY SAYFASI iii YAYIMLAMA VE FİKRİ MÜLKİYET HAKLARI BEYANI iv ETİK BEYAN v TEŞEKKÜR vi ÖZET vii ABSTRACT viii İÇİNDEKİLER ix SİMGELER VE KISALTMALAR xi ŞEKİLLER xii TABLOLAR xiii 1.GİRİŞ 1 2.GENEL BİLGİLER 3 2.1. Normal Yürüyüş 3 2.1.1 Yürüyüş Döngüsü 3 2.1.2. Yürüyüşün Zaman ve Mesafe Parametreleri 4 2.1.3. Yürüyüş Analizinin Önemi 6 2.2. Serebellum 7 2.3. Ataksi 9 2.3.1 Ataksiyi Tanımlayan Diğer Terimler 12 2.4. Postural Salınım ve Denge 13 2.5. Multipl Skleroz 13 2.5.1. Epidemiyoloji 14 2.5.2. Etyoloji ve Patogenez 14 2.5.3. MS’de Bulgu ve Belirtiler 15 2.5.4. MS alt tipleri 16 2.5.5. MS’de Ataksi 17 2.5.6. MS’de Denge 18 2.5.7. MS’de Yürüyüş 19 2.5.8. MS’ de Değerlendirme 20 3. BİREYLER VE YÖNTEM 25 3.1.Bireyler 25 3.2. Yöntem 27 3.2.1. Fiziksel özellikler ve hikayenin alınması 27 3.2.2. Yürüyüşün Değerlendirilmesi 30 3.2.3. Dengenin Değerlendirilmesi 32 3.2.4. İstatistiksel analiz 34 4. BULGULAR 36 4.1. Demografik ve Fiziksel Bulgular 36 4.2. Yürüyüşe Ait Bulgular 37 4.2.1. Yürüyüşün Spatio-temporal Parametrelerinin Değerlendirilmesi 37 4.2.2. Dinamik ve Statik Plantar Basıncının Değerlendirme Sonuçları 41 4.3. Dengenin Değerlendirilmesi 46 4.3.1. Uluslararası Ataksi Oranlama Ölçeği Değerlendirme Sonuçları 46 4.3.2. Fonksiyonel Uzanma ve DYİ Değerlendirme Sonuçları 46 4.3.3. Stabilometre Testi Sonuçları 47 5. TARTIŞMA 49 6. SONUÇ 59 7. KAYNAKLAR 61 8. EKLER Ek 1. Etik Kurul Onayı Ek 2. Araştırma Amaçlı Çalışma İçin Aydınlatılmış Onam Formu (Hasta Grubu) Ek 3. Araştırma Amaçlı Çalışma İçin Aydınlatılmış Onam Formu (Kontrol Grubu) Ek 4. Genişletilmiş Özürlülük Durum Ölçeği (EDSS) Ek 5. Dinamik Yürüme İndeksi Ek 6. Uluslararası Ataksi Değerlendirme Skalası Ek 7. Orjinallik Ekran Çıktısı Ek 8. Dijital Makbuz 9. ÖZGEÇMİŞBu çalışmanın amacı, ataksik Multipl Skleroz’lu (MS) bireylerde alt ekstremite ve gövde ataksisinin yürüyüş, plantar taban basıncı ve denge üzerine olan etkilerini araştırmak ve gövde ataksisi ile olan farklılıklarını belirlemektir. Çalışmaya dahil edilme kriterlerine uygun Expanded Disability Status Scale (EDSS) puanı 3 ile 5 arasında bağımsız yürüyebilen 60 MS’li birey alındı. Hastalarda, gövde ve ekstremite ataksisinden, hangisinin baskın olduğuna EDSS ile karar verildi. EDSS’ye göre, gövde ataksisi baskın olan 36 ve ekstremite ataksisi baskın olan 24 MS’li birey alındı. Kontrol grubuna ise 32 sağlıklı birey dahil edildi. Dengeyi ve yürüyüşü değerlendirmek için Fonksiyonel Uzanma Testi (FUT), Uluslararası Ataksi Oranlama Ölçeği (UAOÖ), Dinamik Yürüyüş İndeksi (DYİ), Pedobarografi (PBG) ve Stabilometre kullanıldı. Kontrol grubundaki bireylere sadece Pedobarografi (PBG) ve stabilometre uygulandı. Ekstremite ataksisi ve gövde ataksisi olan MS hastalarının ve sağlıklı bireylerin spatiotemporal parametrelerinde istatiksel olarak anlamlı farklılıklar görüldü (p0,05). Ekstremite ataksisi ve gövde ataksisi olan MS hastalarının ve sağlıklı bireylerin statik ve dinamik plantar basınç dağılımları yönünden istatiksel olarak anlamlı farklılıklar görüldü (p<0,05). Statik plantar basınç dağılımı incelendiği zaman ekstremite ataksili grubun arka ayak lateralindeki basınç, gövde ataksili gruba ve kontrol grubuna göre anlamlı düzeyde yüksek bulundu (p<0,05). Gövde ve ekstremite ataksili grubun dinamik plantar basıncı, sağlıklı bireylere göre ön ayak orta ve lateralinde düşük, orta ve arka ayağın orta ve lateral bölgesinde sağlıklı gruba göre yüksek bulundu (p<0,05). Stabilometrik değerlendirmede ise gövde ataksili bireylerin gözler açık ve gözler kapalı salınım uzunluğu, ekstremite ataksili bireylere göre fazla bulundu. Alt ekstremite ataksisinin yürüyüşü ve taban basıncını, gövde ataksisine göre daha fazla etkilediği bulundu. Gövde ataksisinin ise alt ekstremite ataksisine göre dengeyi daha fazla etkilediği gösterildi. Ms’li bireyde baskın olan ataksi türünü belirlemenin, yürüyüş, plantar taban basıncı ve denge aktivitelerinin arttırılmasına yönelik tedavi yaklaşımlarında göz önünde bulundurulmasının önemi vurgulandı

Examination Of The Effects Of Coordination And Balance Problems On Gait In Ataxic Multiple Sclerosis Patients

Objectives: To investigate the effects of coordination and balance problems on gait and plantar pressure distribution in multiple sclerosis patients. Methods: This was an observational, cross-sectional study. It was conducted at Necmettin Erbakan University between March and December 2017. Twenty-four individuals with coordination problems, 36 individuals with balance problems and 32 healthy individuals were included in the study. The EDSS, Functional Reach Test, Dynamic Gait Index, baropodometry and stabilometry evaluations were performed. Results: There were significant differences between the groups (velocity p=0.000, cadence p=0.000, step width p=0.018, step length p=0.000, foot angle p=0.000). Multiple comparisons demonstrated that the velocities and cadences of the coordination group were lower, while their step widths were found to be higher, compared to the balance group (p=0.012, p=0.004, p=0.017, respectively). In static plantar pressure distribution, lateral Forefoot pressure, lateral hindfoot pressure and medial hindfoot pressure were significantly different between the groups (p=0.002, p=0.000, respectively) Multiple comparisons showed that the pressure on the lateral part of the hindfoot in the coordination group was found to be significantly higher compared to the balance group (p=0.002). According to the dynamic plantar pressure distribution, lateral forefoot, medial forefoot, lateral hindfoot and medial hindfoot pressures were significantly different between the groups (p<0.05). Conclusion: Coordination and balance problems affect gait and plantar pressure distribution. The identification of these changes will help physiotherapists determine specific therapeutic targets.WoSScopu

Evaluation of Upper Extremity Ataxia in Multiple Sclerosis Disease with Computer Analysis

Amaç: Multipl Skleroz (MS) gibi nörolojik ve nörofizyolojik bozukluk ve özrü olan hastalıkları tam ve kusursuz değerlendirmek zordur. MS'te üst ekstremite koordinasyon problemini değerlendirmek amacıyla yeni bir test (Multipl Skleroz Ataksi Testi)(MSAT) geliştirdik. Bu test bize üst ekstremite koordinasyon probleminin şiddetini tam değerlendirmek için bilgisayar tabanlı bir değerlendirme platformu sağlamaktadır. Bulgular: EDSS ile hastaların dominant el (sağ el)arasında istatiksel olarak anlamlı bir korelasyon tespit edilmedi. (p0.05).ICAR değişkeni ile dominant ve non-dominant el arasında anlamlı bir korelasyon tespit edilmedi (p0.05).Hasta ve sağlıklı kişilerin sağ el karşılaştırması için yapılan analizde bu iki grup arasında ortalamalar açısından istatistiksel olarak anlamlı bir farklılık vardır (p0.05). Sonuç: MSAT, üst ekstremite ataksisini daha objektif değerlendirebilir. Tedavi öncesi ve sonrası hastanın fonksiyonel durumu hakkında bilgi verebilir. Bu yöntem, klinik değerlendirme ve araştırmada kaydedilen ilerlemeyi hızlandıracak açık bir potansiyele sahip, eğitim alanında standartlaştırılmış bilgisayara uyarlanmış testlerin yaptığı gibi, MS'deki klinik değerlendirme ve araştırma üzerinde aynı dönüştürücü etkiye sahip olabilir.Objective: Neurological and neurophysiologic disorders such as Multiple Sclerosis (MS) and disorders with disabilities need to be evaluated thoroughly and thoroughly. In MS we developed a new test (Multiple Sclerosis Ataxia Test) (MSAT) to evaluate the upper extremity coordination problem. This test provides a computer-based evaluation platform to fully assess the severity of the upper extremity coordination problem. Method: (MSAT) was tested on 23 patients (MS) with 18 MS in EDSS groups with different (Expanded Disability Status Scale) MS disease. The amount of deviation of the following patient by the spiral line pen on the tablet is given as a percentage. Since the same practices were applied in healthy group, dominant and non dominant hand were compared in MS and healthy group. Results The Ataxia Ratio Scale (UAQ) was compared with the upper extremity kinetic functions section. fonksiyonel klinisyen değerlendirme &ouml;lçeğidir. EDSS, hastalığın ilerlemesini araştırmalarda etkinliğini kullanılmaktadır