Turkish translation and transcultural validity and reliability of an assessment tool for spasticity: Leg Activity Measure (Leg A).

BACKGROUND: The Leg Activity Measure is the only self-report measure that has been published to date that takes into account both the influence on quality of life and passive and active function in the literature. AIMS: The purpose is to examine the translation, cross-cultural adaptation validity and reliability of the Turkish version of the Leg Activity Measure (Tr-LegA). METHODS: Neurological patients (n = 52) with lower limb spasticity (aged 47.09 ± 14.74 years) were enrolled. The study consisted of two stages. At the first stage, the scale was translated into Turkish and culturally adapted. Validity and reliability analyses were conducted at the second stage. Construct validity was evaluated by exploratory factor analysis (EFA). The Rivermead Mobility Index (RMI), Nottingham Health Profile (NHP), and Functional Independence Measure (FIM) were used for convergent validity. The reproducibility (test-retest reliability) was assessed by the intraclass correlation coefficient (ICC). Furthermore, the standard error of measurement (SEM) was calculated. RESULTS: EFA suggested one factor for the Passive Function and two factors for the Active Function and Impact on Quality of Life Scales (QoL). Tr-LegA Passive and Active Function Scales were correlated with the total RMI, NHP, and FIM (p < 0.05). Tr-LegA Impact on Quality of Life Scale was correlated with the RMI and NHP (p < 0.05). Tr-LegA Passive Function Scale (ICC = 0.997), Tr-LegA Active Function Scale (ICC = 0.996), and Tr-LegA Impact on Quality of Life Scale (ICC = 0.976) had good reliability. Only Passive Function Scale had a significant floor effect (25%). CONCLUSIONS: Tr-LegA is a valid and reliable multidimensional scale for passive and active function and quality of life in patients with lower limb spasticity. THE CLINICAL TRIAL NUMBER: NCT05182411.

The effect of proprioceptive neuromuscular facilitation on functional skills, muscle strength, and trunk control in children with cerebral palsy: A randomized controlled trial.

BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) is generally used for the lower limbs in children with Cerebral Palsy (CP). This study aimed to determine the effect of PNF and Neurodevelopmental Therapy (NDT) on functional abilities, muscle strength, and trunk control in children with CP. METHODS: Thirty spastic CP children classified as either level I-II in the Gross Motor Function Classification System (GMFCS) or level I-II in the Manual Ability Classification System (MACS) were included. The PNF (n = 15) and the NDT group (n = 15) had physiotherapy for six weeks. The ABILHAND-Kids scale, the Purdue Pegboard Test (PBPT), the Nine-Hole Peg Test (9-HPT), and the Jebson-Taylor Hand Function Test (JTHFT) were employed. Pinch meters, Jamar handheld dynamometers, and digital muscular strength assessments were used. RESULTS: The PNF group increased shoulder flexion (p < 0.05), adduction (p < 0.05), elevation (p < 0.05), scapular abduction (p < 0.05), elbow extension (right) (p < 0.05), grip (p < 0.05), and pinch strengths (left p < 0.05, right p < 0.05). The PNF group had significantly lower 9-HPT (p < 0.05), JTHFT (card turning), JTHFT (simulated feeding), JTHFT (lifting light cans), and JTHFT (lifting weight cans) durations (p < 0.05), and significantly higher PBPT (right-left) PBPT (bimanual), PBPT (assembly). (p < 0.05), ABILHAND (p < 0.05), and TCMS total scores (p < 0.001). While JTHFT (simulated feeding-left), JTHFT (stacking checkers-left), JTHFT (lifting light cans-left), and JTHFT (lifting weight cans-right/left) (p < 0.05) durations decreased in the NDT group, PBPT (right) (p < 0.05) had an increase in duration. CONCLUSION: PNF improves trunk control, upper extremity functional skills, selective proximal muscle strength, and distal upper extremity muscle and grip strength.

Validity and reliability of the 3-meter backward walk test in children with cerebral palsy.

OBJECTIVE: To examine the validity and reliability of 3-Meter Backwalk Test (3MBWT) in children with Cerebral Palsy (CP). METHODS: Study included 55 children with CP with the mean age of 12.34 ± 3.78 years, at Expanded and Revised Gross Motor Functional Classification System (GMFCS-E&R) I and II levels. Intraclass Correlation Coefficient (ICC) was used for the intra-rater and inter-rater reliability of 3MBWT according to the GMFCS-E&R levels. MDC estimates were calculated using baseline data. Convergent validity of 3MBWT was evaluated with its correlation between the Timed Up and Down Stairs Test (TUDS), Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), Pediatric Reach Test (PRT), Four Square Step Test (FSST). RESULTS: Intra-rater and inter-rater reliability of 3MBWT was determined excellent at GMFCS-E&R I (Intra-rater ICC = 0.981-0.987, inter-rater ICC = 0.982-0.993), and GMFCS-E&R II (ICC = 0.927-0.933, ICC = 0.954-0.968). Intra-rater MDC values for GMFCS-E&R I were 1.17-1.22 s (s); 1.40-1.42 s for GMFCS-E&R II. Inter-rater MDC values for GMFCS-E&R I were 1.00-1.28 s, and MDC values for GMFCS-E&R II were 1.08-1.22 s. There was strong correlation between 3MBWT and PBS, TUG, and FSST in GMFCS-E&R I, moderate correlation between 3MBWT and TUDS, strong correlation between BBS, moderate correlation between TUG, and strong correlation between FSST in GMFCS-E&R II (p < 0.05). CONCLUSION: The 3MBWT was found to be valid and reliable in children with CP. According to the MDC results, small differences in CP children can be adequately detected with 3MBWT. The 3MBWT also may add some more information on to GMFCS (E&R) data for following the disease progression as well as rehabilitation responses. TRIAL REGISTRATION NUMBER: NCT04653363.

Muscle architecture and its relationship with lower extremity muscle strength in multiple sclerosis.

This study was planned to determine the muscle architecture (pennation angle, muscle fiber length, and muscle thickness) and its relationship to lower extremity muscle strength in patients with Multiple Sclerosis (pwMS). The muscle architecture (pennation angle, muscle fiber length, and muscle thickness) and lower extremity muscle strength were assessed in 33 pwMS [13 Relapsing-Remitting MS (RRMS), 5 Primary Progressive MS (PPMS), 5 Secondary Progressive MS (SPMS), and 11 matched healthy controls (HC)]. Muscle architecture features were assessed with ultrasonography and muscle strength were assessed with a digital hand-held dynamometer. The rectus femoris muscle thickness and pennation angle, gastrocnemius muscle thickness, and the tibialis anterior pennation angle were significantly lower in pwMS compared to HC (p < 0.05). The strength of hip flexors, hip extensors, knee extensors, foot plantar, and foot dorsi flexors were lower in pwMS. In PPMS group, muscle strength of hip flexors was lower than RRMS and SPMS groups, and muscle strength of foot dorsi flexors was lower than RRMS (p < 0.05). In pwMS, positive correlations were found, between knee flexor strength and biceps femoris pennation angle. Also knee extensor strength and rectus femoris fiber length and muscle thickness were correlated positively (p < 0.05). According to our results the muscle architecture is affected in MS. The determination of architectural changes of lower extremity muscles may guide the arrangement of optimal strength exercises in functional rehabilitation programs.ClinicalTrials: NCT03766698.

Correlation of proximal and distal muscle strength with upper limb functional ability in patients with essential tremor.

Despite being considered as a benign, genetic and monosymptomatic disorder, ET is a poorly understood entity with etiological and pathological heterogeneity. The aim of the present study was to examine the relation between proximal and distal muscle strength and upper limb functionality and tremor severity in patients with essential tremor (ET). The study enrolled 25 tremor patients followed at the neurology clinic of a university hospital and 19 healthy controls. Demographic data, risk factors, disease duration and dominant hand of the participants were recorded. Back and leg strength was assessed using a back and leg dynamometer and hand dynamometer and pinchmeter were used to determine hand strength. Functional ability of the participants was evaluated using the Minnesota Manual Dexterity Test (MMDT), Perdue Pegboard (PPBT) and Nine Hole Peg Test (NHPT). Tremor severity was assessed using the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) and the Lower Extremity Clinical Tremor Assessment Scale (LECTAS). A significant difference was found in the average back and leg muscle strength between ET patients and healthy controls (p < 0.05). The mean values for right/left hand muscle strength were not significantly different between the two groups (p > 0.05). Among the upper limb functional ability tests, significant differences were found between the two groups in the mean time to complete NHPT, Minnesota placing subtest and PPBT test (p < 0.05). While gender and risk factors were not significantly different between the two groups (p > 0.05), there was a significant difference with respect to the educational level (p < 0.01). No significant difference was found between back and leg muscle strength and FTMTRS and LECTAS (p > 0.05). A negative correlation and a significant association were found between average strength measurements obtained with the left hand dynamometer and FTMTRS in the ET group (p = 0.030, r = - 0.434). A positive correlation and a significant association were found between left hand strength and mean turning time in the MMDT in the control group (p = 0.041, r = 0.473). ET patients experience loss of proximal muscle strength and functional disability. Further studies are planned to investigate the effects of physical therapy modalities targeting increased proximal muscle strength on tremor severity and functional ability in ET patients.