Effect of Modified Constraint-Induced Movement Therapy on Upper Extremity Function for Stroke Patients with Right/Left Arm Paresis: A Single-Blind Randomized Controlled Trial

Purpose: Stroke is one of the most common causes of disability because of functional, cognitive, and psychological issues. Motor deficits in the afflicted upper extremity affect about 50% of stroke survivors. This study aimed to evaluate the effects of modified constraint-induced movement therapy (mCIMT) on hemiparetic right/left upper limb functions and quality of life (QOL). Materials and Methods: In this prospective, randomized, controlled and single-blind study, 40 patients were assigned to the right-mCIMT (n=10), left-mCIMT (n=10), and control (n=20). mCIMT was applied 4h/day, 2 weeks, 10 sessions. A conventional rehabilitation program was applied to all patients. Patients were evaluated using the Fugl-Meyer Motor Assessment (FMA), Motor Activity Log (MAL), Stroke Impact Scale (SIS), Box-Block Test (BBT), the number of repetitions in shaping exercises, and the duration of task exercise. Results: There was a statistically significant improvement in the FMA of the left-mCIMT group (p=0.040). Both mCIMT groups showed statistically significant improvements in the MAL-amount of use (AoU) and MAL-quality of use (QoU), the number of repetitions in the shaping exercises, and the BBT (p<0.05). The activity of daily living, hand function, and stroke recovery domains of the SIS were increased significantly in both groups (p<0.01). There was a statistically significant increase in the strength domain of the SIS in the left-CIMT group (p=0.037). Conclusions: mCIMT was effective in improving motor functions, dexterity, and QOL in patients with right/left arm paresis. These positive effects continued for 3 months. Although left mCIMT had a positive effect on arm motor impairment, further research is needed

Parkinson's Disease and Rehabilitation

Parkinson's disease is a chronic progressive neurodegenerative movement disorder, characterized by bradykinesia, rigidity, rest tremor and postural instability. In addition to these cardinal motor symptoms, secondary motor symptoms (e.g. flexion posture, hypomimia, dysarthria, loss of arm swing) and non-motor symptoms (e.g. cognitive impairments, autonomic disturbances, dementia, sleep disorders, pain, hyposmia) appear in Parkinson's disease. The neuropathologic features of Parkinson's disease are dopaminergic neuronal loss in the substantia nigra and the presence of cytoplasmic eosinophilic Lewy bodies. Genetic susceptibility and environmental factors share the responsibility in the pathogenesis of the disease. Although medical therapy may provide an effective control of motor symptoms, rehabilitation is an important treatment approach for improvement of quality of life and functional capacity of the patients. Individual rehabilitation program should be initiated in the early stages of the disease and treatment continuity should be targeted. Turk J Phys Med Rehab 2011;57:38-44

Comparison of the effects of mirror therapy and electromyography-triggered neuromuscular stimulation on hand functions in stroke patients: a pilot study

To determine the effectiveness of mirror therapy and electromyography (EMG)-triggered neuromuscular stimulation on improvement of functions of the upper extremity in patients with subacute stroke in comparison with conventional therapy as well as to evaluate the advantage of each treatment over another, we conducted a prospective, randomized, and controlled trial involving 24 patients with ischemic stroke. The mean age and mean time since stroke of the patients were 58.79 +/- 11.49 years and 5.25 +/- 2.25 months. Patients were assigned randomly to a mirror therapy group (MT group, n= 9), which consisted of therapy with a mirror box 5 days/week, 30 min/day, for 3 weeks, an electrostimulation group (ES group, n= 7), which consisted of therapy with EMG-triggered stimulation (EMG-stim) of similar duration and frequency of treatment as the MT group, and a control group (n= 8). All the groups received conventional physiotherapy for the same period as the MT group. Patients in the MT group practiced their therapy at home after supervised sessions. The Fugl-Meyer scores of the upper extremity, grip force, wrist extension, and Box and Block Test were evaluated at baseline, after treatment, and at 3 months after the treatment. All of these measures were evaluated by a blinded researcher. We found that there was no significant improvement in wrist extension range and grip force in control group. The MT and EMG-stim were effective in increasing the Fugl-Meyer motor scale for upper extremity (MT group: P< 0.01), increasing wrist extension range, grip force, and hand dexterity determined by the Box and Block Test (MT group and ES group P< 0.05). Furthermore, hand skills were increased significantly in the MT group compared with the ES group at the follow-up assessment (P< 0.05). This pilot study suggested that MT was more efficient in improving motor performance than physiotherapy alone. Also, MT may be more useful in improving the hand skills compared with EMG-stim. We assume that this difference might be related to the feasibility of maintenance of MT at home. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study.

Purpose: Dual-energy X-ray absorptiometry (DXA) is considered the gold standard in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case-control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX (R) (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. Materials and methods: This case-control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX (R) 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. Results: While all DXA BMD, and QUS variables and FRAX (R) fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX (R) major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. Conclusions: It can be concluded that QUS variables, particularly BUA, and FRAX (R) major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures

Turkish Translation and Adaptation of Foot Function Index in Patients with Plantar Fasciitis

Objective: The aim of this study was to translate the Foot Function Index into Turkish and perform its cross-cultural adaptation

World Report on Disability: analysis of the disability issues and contributions of physical medicine and rehabilitation medical specialty in Turkey

World Report on Disability was prepared to facilitate the implementation of the United Nations Convention on the Rights of Persons with Disabilities which puts forward the requirement of full and effective participation of people with disabilities in the society as a human rights issue. The Report indicates concrete steps at international and national levels to achieve this goal. The aim of this paper is to analyse the situation in Turkey with regard to disability in relation to underlined concepts and recommendations in the World Report on Disability and to emphasise the already available and potential contributions of Physical Medicine and Rehabilitation medical specialty in the implementation of this Report at the national level

The utility of dual-energy X-ray absorptiometry, calcaneal quantitative ultrasound, and fracture risk indices (FRAX® and Osteoporosis Risk Assessment Instrument) for the identification of women with distal forearm or hip fractures: A pilot study

Purpose: Dual-energy X-ray absorptiometry (DXA) is considered the gold standard in predicting osteoporotic fractures. Calcaneal quantitative ultrasound (QUS) variables are also known to predict fractures. Fracture risk assessment tools may also guide us for the detection of individuals at high risk for fractures. The aim of this case-control study was to evaluate the utility of DXA bone mineral density (BMD), calcaneal QUS parameters, FRAX (R) (Fracture Risk Assessment Tool), and Osteoporosis Risk Assessment Instrument (ORAI) for the discrimination of women with distal forearm or hip fractures. Materials and methods: This case-control study included 20 women with a distal forearm fracture and 18 women with a hip fracture as cases and 76 age-matched women served as controls. BMD at the spine, proximal femur, and radius was measured using DXA and acoustic parameters of bone were obtained using a calcaneal QUS device. FRAX (R) 10-year probability of fracture and ORAI scores were also calculated in all participants. Receiver operating characteristic (ROC) analysis was used to assess fracture discriminatory power of all the tools. Results: While all DXA BMD, and QUS variables and FRAX (R) fracture probabilities demonstrated significant areas under the ROC curves for the discrimination of hip-fractured women and those without, only 33% radius BMD, broadband ultrasound attenuation (BUA), and FRAX (R) major osteoporotic fracture probability calculated without BMD showed significant discriminatory power for distal forearm fractures. Conclusions: It can be concluded that QUS variables, particularly BUA, and FRAX (R) major osteoporotic fracture probability without BMD are good candidates for the identification of both hip and distal forearm fractures

Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?

WOS: 000476771900010Key summary pointsAimOur aim was to investigate which swallowing difficulty of food consistency in older people who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD) risk.FindingsWe have found that the eating/drinking difficulty of thick liquids was the highest predictive value with respect to OD risk and the eating difficulty of mixed content food had the highest diagnostic ratio.MessageThe present study reports that even in older person who do not go to the hospital with the complaints of swallowing difficulty, the difficulty of swallowing thick liquids and especially the mixed content food should be questioned. AbstractPurposeThe present study aimed to investigate which swallowing difficulty of food consistency in participants over 65years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD).MethodsThe cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged >= 65years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the yes or no questions including swallowing difficulty of various types of food consistency with the face-to-face interview.ResultsParticipants were divided into two groups as normal swallowing (EAT-10= 3 group) (n=244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p=0.327 and p=0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p<0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211).ConclusionWhile eating difficulty of hard solid food is the most common symptom in healthy participants over 65years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio

The GUSS test as a good indicator to evaluate dysphagia in healthy older people: a multicenter reliability and validity study

Purpose Dysphagia is known to be a disorder of the swallowing function, and is a growing health problem in aging populations. Swallowing screening tests have mostly been studied in comorbidities such as stroke associated with old age. There is no simple, quick and easy screening test to best determine the risk of oropharyngeal dysphagia in geriatric guidelines. We aimed to evaluate whether the Gugging Swallowing Screen (GUSS) test is an effective method for evaluating swallowing difficulty in healthy older people. Methods This cross-sectional and multicenter study was conducted at 13 hospitals between September 2017 and February 2019. The study included 1163 participants aged >= 65 years and who had no secondary dysphagia. Reliability was evaluated for data quality, scaling assumptions, acceptability, reliability, and validity as well as cutoff points, specificity and sensitivity. Results The age distribution of 773 (66.5%) patients was between 65 and 74 years and 347 (29.8%) of them were male and 767 (66%) patients were female. The average total GUSS score was 18.57 +/- 1.41. The Cronbach's alpha was 0.968. There was a moderate statistically significant negative correlation between the total GUSS and 10-item Eating Assessment Tool scores as well as between the total GUSS score and quality of life. The cutoff point of the total GUSS score was 18.50, sensitivity was 95.5% and specificity was 94.4%. Conclusions The GUSS test is a valid and reliable test to identify possible oropharyngeal dysphagia risk in healthy older people who had no secondary dysphagia. It is suitable as a screen test for clinical practice

Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics