Effect of community-based group exercises combined with action observation on physical and cognitive performance in older adults during the Covid-19 pandemic: A randomized controlled trial.

OBJECTIVE: This study investigates the impact of community-based exercises with action observation therapy (AOT) on the physical and cognitive performance of older adults experiencing social isolation during the COVID-19 pandemic. METHODS: One hundred participants aged 65-80 years were randomly divided into two groups: the AOT group, which engaged in balance, strengthening, and mobility exercises guided by 15-minute action observation videos before a 45-minute exercise session, and the control group, which performed the same exercises without action observation. Both groups underwent three sessions per week for eight weeks (24 sessions in total). The assessment tools used in this study included the following: For evaluating mobility and fall risk in older adults, the Timed Up-and-Go (TUG) Test was employed. To assess functional strength of lower extremities, balance, and fall risk, the Five Times Sit-to-Stand (5XSST) Test was administered. Balance and gait were measured using the Tinetti Balance and Gait Assessment (TBGA), utilizing the Tinetti Scale. Individuals' confidence in performing daily activities without falling or losing balance was assessed using the Activities-Specific Balance Confidence Scale (ABC). Furthermore, cognitive functions across multiple domains, including attention-concentration, executive function, memory, language, visual construction skills, abstract thinking, calculation, and orientation, were evaluated using the Montreal Cognitive Assessment (MoCA) Tests. RESULTS: Results revealed significant improvements in both groups. Group I, which received Action Observation Therapy (AOT) in addition to exercise, demonstrated superior outcomes in the 5XSit-to-Stand test (Δ = -1.92, p < 0.0001, Cohen's d = 0.77), Tinetti Balance and Gait Scale (Balance: Δ = 2.77, p < 0.0001, Cohen's d = 0.91), and Timed Up and Go test (Δ = -1.98, p < 0.0005, Cohen's d = 0.83). On the other hand, Group II, which received exercise only, exhibited substantial gains in the Tinetti Balance and Gait Scale (Walking: Δ = 0.52, p < 0.01, Cohen's d = 0.27) and Activity-Specific Balance Confidence Scale (Δ = 5.77, p < 0.0001, Cohen's d = 0.26). CONCLUSION: These findings underscore the effectiveness of AOT-enhanced community-based exercises in enhancing both physical and cognitive performance among older adults facing social isolation during the pandemic, with Group I (AOT + exercise) showing particularly promising results. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov Identifier: NCT04759690, ClinicalTrials Protocol ID: p3957ghb.

The effects of mechanical hippotherapy riding on postural control, balance, and quality of life (QoL) in patients with stroke.

PURPOSED: This study aimed to investigate the effects of exercises by mechanical hippotherapy devices on postural control, balance, mobility, and Quality of Life in patients with stroke. MATERIAL AND METHODS: This was a randomized controlled clinical trial with a total of 30 which were randomly divided into two groups. The participants in the mechanical hippotherapy group (MHG) (n = 15) were given exercises with a mechanical hippotherapy device for 15 min in addition to intensive conventional treatments (45 min), while the control group (CG) (n = 15) received additional 15 min of postural control and balance exercises for five days per week for four consecutive weeks. The primary outcome was The Berg Balance Scale (BBS). Secondary outcomes were the Fugl-Meyer (FM) Rating Scale, Biodex Balance Measurement (BBM), Trunk Impairment Scale (TIS), the Timed Up and Go Test (TUG) and quality of Life Short Form (SF-36). RESULTS: In the MHG, FM-Lower extremity score (-6.4, p = 0.024), FM-Upper extremity score (-12.87, p = 0.013), TIS (-5.87, p = 0.04) and TUG (5.73, p = 0.027) improved statistically significant compared to CG. CONCLUSION: Exercises using mechanical hippotherapy devices could improve postural control, functional mobility and balance in patients with stroke. It may also improve the quality of life. CLINICAL TRIAL REGISTRATION NUMBER: NCT03528993IMPLICATIONS FOR REHABILITATIONNCT03528993It was concluded from our results that mechanical hippotherapy could be included in the treatment programs of stroke patients.

Effect of Treadmill Backward Walking Training on Motor Capacity in Cerebral Palsy: A Randomized Controlled Study.

OBJECTIVE: To evaluate treadmill backward walking training (BWT) effects on walking speed, balance, mobility, and walking endurance in children with cerebral palsy (CP). METHODS: The study evaluated 41 children with CP (age, 6-18; Gross Motor Function Classification System levels I and II). They were randomly allocated into control and BWT groups. BWT was applied (two sessions/week, 15 min/session for 8-week) to BWT group after the neurodevelopmental-based physiotherapy program routinely followed by all participants while the control group did not receive BWT. 10-Meter Walk Test (10MWT), Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Two-Minute Walk Test (2MWT) were selected as outcome measures for assessing walking speed, balance, mobility and endurance respectively. RESULTS: In BWG, 2MWT distance (3.5%), PBS (3.5%) increased significantly, and TUG decreased by 5.1% (all p<0.001) after training, 10MWT was shorter by 6.1% for BWG, corresponding to 7.4% faster walking speed (p<0.01). Control group assessment variations were stationary and not statistically significant. CONCLUSION: Backward treadmill walking training induces small but statistically significant motor capacity improvements in children with CP.

Effect of transcutaneous posterior tibial nerve stimulation and repetitive transcranial magnetic stimulation on neurogenic overactive bladder symptoms in female patients with multiple sclerosis: The study protocol of a randomized controlled study.

Introduction: Neurogenic bladder is frequently seen in patients with multiple sclerosis (MS). Electrical stimulation methods (neuromodulation) can be used for patients that have persistent symptoms despite pharmacological treatment. This study aims to compare the effects of two different neuromodulation techniques used in the treatment of neurogenic bladder. Methods and analysis: This is a single-center randomized controlled trial for MS patients with neurogenic bladder. Patients determined to be eligible according to the study criteria will be randomized into two treatment groups: the transcutaneous posterior tibial nerve stimulation (PTNS) and repetitive transcranial magnetic stimulation (rTMS) groups. Each group will include eight patients. The patients will be treated for a total of 10 sessions for two consecutive weeks. The pressure-flow study will be used to compare the initial and final urodynamic results as the primary outcome. All the participants will fill in a 3-day bladder diary before and after the treatments in each group. Patients will also be asked to complete specific questionnaires for incontinence and quality of life (QOL): Overactive Bladder Questionnaire-V8 score (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale score (I-QOL), International Incontinence Questionnaire (ICIQ-SF) score, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score) as the secondary outcomes. Ethics and dissemination: An ethical approval number was obtained from the Non-Invasive Clinical Research Ethics Committee of Istanbul Medipol University (ethical approval number: 768). Support was received within the scope of the Istanbul Medipol University Scientific Research Project with project number 2020-2017. The result of this study will be published in a peer-reviewed journal. Trial registration: NCT05312138.

Effects of neuromuscular electrical stimulation combined with resistance exercises on muscle strength in adult hematological cancer patients: A randomized controlled study.

OBJECTIVE: We compared the effects of resistance exercise (REx) and resistance exercise combined with neuromuscular electrical stimulation (NMES+REx) on muscle strength, functional lower extremity strength, and mobility in hematological cancer patients during chemotherapy. METHODS: Forty-three adult patients were recruited and randomized into the REx group versus personalized and progressive NMES+REx. The lower extremity muscle strength (digital hand dynamometer) test and functional and mobility tests [30-s sit-to-stand test, Timed Up and Go test (TUG)] were performed pre-and postintervention. RESULTS: The Eastern Cooperative Oncology Group-Performance Score (ECOG-PS) of 90% of all patients was ≥2. Increases in steroid dose after transplantation were associated with decreases in hip flexion and knee extension muscle strength values (respectively; rs:-0.468, p:0.008; rs:-0.527, p: 0.002). There was a significant improvement in strength measurement, functional and mobility tests, and ECOG-PS in both groups (p<0.05). The NMES+REx group had significantly higher hip flexion and knee extension values than the REx group (respectively; p=0.001; p=0.048). CONCLUSION: REx training given to hematological cancer patients receiving intensive chemotherapy after hematopoietic stem cell transplantation improved muscle weakness. The combination of NMES training with resistance exercises resulted in significant results comparable to REx training alone in adult hematological patients with moderate-low ECOG-PS.

Radial shock-wave therapy for frozen shoulder patients with type 2 diabetes mellitus: a pilot trial comparing two different energy levels.

BACKGROUND: Extracorporeal shock-wave therapy (ESWT) is highly recommended for the management of orthopedic shoulder pathologies. Yet, the clinical relevance of the dose difference effect of radial ESWT approaches in the management of frozen shoulder patients with type 2 diabetes mellitus remains uncertain. AIM: The aim was to examine the short-term effects of medium-and high-energy levels of radial ESWT (rESWT) in the treatment of frozen shoulder patients with type 2 diabetes mellitus. DESIGN: Prospective clinical pilot study. SETTING: This study was conducted in an outpatient clinic. POPULATION: Thirty-nine patients who had frozen shoulder untreated for at least 3 months, diagnosed with type 2 diabetes mellitus for ≥3 years were included. METHODS: The patients were randomly allocated to receive either high-energy rESWT (hrESWT), or medium-energy rESWT (mrESWT) or placebo at 8 Hz twice a week for six weeks. The primary outcome measure was pain, evaluated by the Visual Analog Scale (VAS) Score. Secondary outcome measures were function evaluated by the Shoulder Pain and Disability Index (SPADI) Score, and shoulder active range of motion (AROM). The mechanical properties of the deltoid and trapezius muscles were assessed using the MyotonPRO (Myoton AS, Tallinn, Estonia). RESULTS: The mrESWT resulted in statistically significant reductions in night pain at 6 weeks (ηp2=0.27, P=0.003). Significantly improved function (SPADI scores: -35.42±21.29 vs.-29.59±22.60; ηp2=0.39, P˂0.001) was found in both hrESWT and mrESWT group by 6 weeks. Significantly higher mean shoulder AROM values were recorded for external rotation (ηp2=0.53, P<0.001), and internal rotation (ηp2=0.21, P=0.020), in the hrESWT group at the 6th week. A significantly improved resting tone (ηp2=0.58) and stiffness of deltoid muscle (ηp2=0.62) were found in the mrESWT group (P<0.001). The trapezius muscle resting tone reduced with hrESWT (ηp2=0.17, P=0.033). CONCLUSIONS: Regardless of the energy levels, rESWT appears to be an effective therapeutic intervention for frozen shoulder patients with type 2 diabetes mellitus in the short-term results. CLINICAL REHABILITATION IMPACT: Our results suggest that this rESWT can be a useful strategy for the rehabilitation of frozen shoulder patients with type 2 diabetes mellitus. This is the first study on dose difference effectiveness in terms of the clinical significance of rESWT which is key to transfer research evidence into practice.

Walking training augments the effects of expiratory muscle training in Parkinson's disease.

OBJECTIVES: To investigate the effects of walking training combined with respiratory muscle training (RMT) on pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with Parkinson's disease. MATERIALS & METHODS: Thirty patients with Parkinson's disease were included in the study. Patients were randomly divided into two groups: the walking and RMT group (W + RMT, n = 15) and the RMT (n = 15) group. Spirometry, respiratory muscle strength, and a 6-min walking test were measured before and after the eighth week of the study. RMT was performed using inspiratory and expiratory threshold loading methods. Walking training intensity was adjusted according to the 6-min walking test. Patients performed 15 min of inspiratory muscle training and 15 min of expiratory muscle training in both groups, and 15 min of walking training in the W + RMT group in addition to RMT, twice per day, 5 days/week, for a total of 8 weeks at home. Training intensity was adjusted once per week for the groups at the hospital. RESULTS: Respiratory muscle strength and 6-min walking distance were significantly increased (p = .001), and UPDRS-III scores were significantly improved (W + RMT: p = .008 and RMT: p = .01) in the two groups. The increase in maximal expiratory pressure was significantly higher in the W + RMT group than in the RMT group (p = .007). CONCLUSION: Walking training increases the effect of expiratory muscle training in patients with Parkinson's disease.

Effects of peripheral and different inspiratory muscle training methods in coronary artery disease patients with metabolic syndrome: A randomized-controlled trial.

Background OBJECTIVE: To investigate the effects of peripheral muscle training (PMT) and different inspiratory muscle training (IMT) methods on respiratory functions, exercise capacity, and biochemistry parameters in coronary artery disease patients with metabolic syndrome. METHODS: This prospective, single-blind, randomized-controlled study included 60 patients of stable coronary artery disease with metabolic syndrome (New York Heart Association [NYHA] Class I-II, left ventricular ejection fraction >40%). Patients were randomly divided into three groups: neuromuscular electrical stimulation (NMES) plus PMT group (NMES + PMT group, n = 20), IMT plus PMT group (IMT + PMT group, n = 20) and PMT group (PMT group, n = 20). Treatment continued for six weeks for all groups. The NMES was applied to rectus abdominis, IMT was applied with 30% of maximal inspiratory pressures, and PMT was applied at home. Spirometry, maximal inspiratory and expiratory pressure, dyspnea scores, exercise stress test, and biochemistry parameters were measured before and after training. RESULTS: There were significant improvements in spirometric tests, respiratory muscle strength, dyspnea scores, exercise capacity, fasting blood glucose, and antistreptolysin O after treatment in all groups (p < 0.05). Significant improvements in C-reactive protein and erythrocyte sedimentation rate were observed in NMES + PMT and IMT + PMT groups (p < 0.05). Among the groups, there was a significant difference in maximal inspiratory pressure (p = 0.02) and erythrocyte sedimentation rate (p = 0.037) in favor of NMES + PMT group (p < 0.05). CONCLUSION: Our study results showed significant improvements in respiratory functions, exercise capacity, and biochemistry markers in all groups. Different IMT methods can be used in cardiopulmonary rehabilitation to improve exercise intolerance in coronary artery disease patients with metabolic syndrome. CLINICAL TRIAL REGISTRATION NUMBER: NCT03523026.

Impact of aerobic training with and without whole-body vibration training on metabolic features and quality of life in non-alcoholic fatty liver disease patients.

The present study examined the effectiveness of adding exercises with whole-body vibration (WBV) to aerobic training in terms of metabolic features and quality of life. Patients with non-alcoholic fatty liver disease (NAFLD), confirmed on imaging, underwent an 8-week individualized exercise program randomized between aerobic training with and without WBV. Training was performed at 60-80% heart rate workload for 165 min/week. The WBV amplitude was 2-4mm and the training frequency was 30Hz, for 15min. Assessments were carried out on surrogate scores of steatosis and fibrosis including transient elastography (FibroScan), metabolic features (biochemical analysis) and quality of life (SF-36). Insulin resistance was markedly reduced (-2.36; 95% CI: -4.96 to -0.24; P: 0.049) in aerobic training with WBV. The decrease in serum aspartate transaminase was significantly greater in aerobic training without WBV (-14.81; 95% CI: -23.36 to -6.25; P: 0.029). There were no significant differences between groups for the other metabolic features (P<0.05). All quality of life well-being domains improved in both groups (P<0.05). Given this reduction in insulin resistance, WBV can usefully be added to aerobic training. However, WBV did not provide further benefits in improving metabolic properties or quality of life.

The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial.

OBJECTIVE: To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. DESIGN: Prospective randomized controlled trial. SETTING: Pulmonary Rehabilitation center. SUBJECTS: A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. METHODS: All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. RESULTS: The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups ( P = 0.075). There was no change in spirometric variables in both groups. CONCLUSION: A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.

Examining the postural awareness and flexibility changes in physical therapy students who took clinical Pilates class.

OBJECTIVE: This study aimed to evaluate postural awareness and changes in posture and flexibility of students who took Clinical Pilates class as an elective course at the undergraduate level. METHODS: The study conducted from 2013-2016 included 98 students who took Clinical Pilates class at the Department of Physical Therapy and Rehabilitation, School of Health Sciences, Istanbul Medipol University, Turkey. The flexibility levels of the study participants were measured before and after the Clinical Pilates education using finger-to-floor test and modified Schober's test. Observational posture analysis and postural awareness were recorded using the scale prepared by the researchers. RESULTS: The post-education evaluations showed that postural distortions were fixed, and a significant increase in the postural awareness of the students was observed compared with the pre-education period. The results of both modified Schober's test and finger-to-floor test, which were used to measure the flexibility levels, showed a statistically significant increase in post-education scores compared with those of the pre-education period. CONCLUSION: This study showed that the Clinical Pilates course increased postural awareness and flexibility of physical therapy students and fixed postural distortions. Thus, the inclusion of Clinical Pilates class in the undergraduate education is considered to be important.

The impact of epilepsy on preschool children and their families.

This study investigated the possible presence of sensory-motor developmental impairments in preschool children with epilepsy and explored epilepsy impact on their activities and quality of life and on the stress load of their family. Study participants were children aged 2-6years diagnosed with epilepsy without any other comorbidities (epi-only children). The instruments used for assessment included the Neurological, Sensory, Motor, Developmental Assessment (NSMDA) scale for sensory-motor development, the Impact of Childhood Neurologic Disability Scale (ICNDS), and the Impact of Pediatric Epilepsy Scale (IPES) for disease impact on disability and Quality of Life (QoL), as well as the Pediatric Outcomes Data Collection Instrument (PODCI) for functional health status, and the Parental Stress Scale (PSS) for the family stress load. Required data were obtained from direct testing or observation of children's activities and mother-supplied answers to questions. Eighty-two children were investigated. The NSMDA scores were in the normal development range 6-8. Significant moderate impact of the disease on disability and QoL was estimated with the ICNDS and IPES instruments. The PODCI scores were similar to healthy population levels except for the happiness dimension which was better for children with epilepsy. PSS were significantly above normal. The functional health and QoL of the children as well as their family stress were found to be positively correlated with increasing age. It is found that epilepsy does not degrade neuromotor development and functional health status of preschool epi-only children, though it has a significant impact on their neurological disability and QoL and the stress level of their families; this impact seems to decrease with age.

Disabled children's functionality and maternal quality of life and psychological status.

BACKGROUND: Physiotherapy is being provided for different disabled groups in pediatric rehabilitation centers. The quality of life (QOL) and psychological status of the mothers of these children is affecting their compliance in the rehabilitation period. The aim of this study was therefore to assess the relationship between disability level of individuals receiving rehabilitation and maternal QOL, psychological status and influencing factors. METHODS: One hundred and twenty-six disabled children and their mothers were included in this cross-sectional study. Demographic information was noted. Child motor level was assessed using the Gross Motor Function Classification System and the level of independency in activities of daily living (ADL) was assessed with the Katz ADL scale. Maternal QOL was assessed with the 36-item Short Form (SF-36), and psychological status with the Beck Depression Inventory (BDI). SPSS 18.0 was used to analyze data. RESULTS: Mean maternal age was 36.46 ± 7.2 years. Of the children, 67.5% had physical problems, 16.7% had mental problems, 7.9% had autism, 4.8% had hyperactivity, and 3.2% had hearing and speaking problems. Mild depression was detected in mothers (mean BDI score, 11.27 ± 8.1). There was no correlation between child disability level and maternal QOL and depression (P > 0.05). Maternal BDI score was negatively correlated with all SF-36 subscale scores (P < 0.001 for all parameters). CONCLUSION: The SF-36 subscale scores of mothers of disabled children were decreased compared with Turkish community norms. Psychological support of mothers of children in the rehabilitation period may positively affect this period.

Health related quality of life in patients with epilepsy in Turkey.

[Purpose] This study measured the quality of life in epilepsy and determined associated demographic and clinical factors by means of the Short Form-36 health survey. [Subjects and Methods] 124 consecutive epilepsy patients were enrolled and their demographic variables and clinical characteristics recorded. The Short Form-36 questionnaire was completed independently by each participant. Short Form-36 dimensional and composite scores were computed and scaled with data from an extensive survey of the healthy population. [Results] Short Form-36 scores for physical dimensions were similar to healthy values, but those for mental dimensions except for energy/vitality were remarkably and significantly lower than normal. All Short Form-36 average scores for women were lower than those for men and significantly so for mental health composite scores. Patients responding well to treatment were aware of their improving health as measured by the Change in Health score and had better dimensional scores than those with a poor response. [Conclusion] Patients with epilepsy do not perceive impaired physical health status. However, their mental health appears vulnerable, especially in women. Therefore, the major burden in epilepsy is in the mental health category. A positive treatment response is also an important determinant of the related quality of life measure.