Usefulness of the Berg Balance Scale for prediction of fall risk in multiple sclerosis.

INTRODUCTION: The Berg Balance Scale, possibly the most widely used balance-related measure, has gained popularity in clinical trials. It provides information about patients' balance-related abilities and can be used to assess improvement or worsening after rehabilitation. The aim of this study is to determine the cut-off value of the Berg Balance Scale for the fall risk in patients with multiple sclerosis (MS). METHODS: This study was designed as a prospective descriptive trial, and 186 patients with MS were included. Fall history was recorded by interview; balance was assessed using the Berg Balance Scale (BBS). RESULTS: The mean ages of 96 patients with a fall history within the previous month and 90 patients without a fall history were 35.98 ± 8.58 and 35.71 ± 9.33 years, respectively. The mean value of the BBS score of the faller group was 49.44 ± 5.43 while 52.36 ± 3.53 in non-faller group. The cut-off value of the BBS for fall risk in patients with MS was determined as 50.50 points. CONCLUSIONS: For patient safety and the success of rehabilitation, it is crucial to evaluate the risk of falling in patients with MS, one of the neurological patient groups where complaints about falling are most prevalent. The results showed that BBS is a sensitive and specific measure for identifying in patients with MS at risk of falling.

The Effects of Exergame on Postural Control in Individuals with Ataxia: a Rater-Blinded, Randomized Controlled, Cross-over Study.

Exergame trainings might have therapeutic value in ataxic patients. The aim of this study was to investigate the effect of exergame training with an exercise program on postural control by comparing it with traditional balance and coordination exercise program. Nineteen patients were randomly allocated to two groups. In the first group, exergame training and an exercise program (EEP) were applied together for the first 8 weeks; after 10 weeks washout, a conventional exercise program (CEP) was applied for the second 8 weeks. In the second group, the CEP was applied first followed by the EEP. Outcome measures were Limits of Stability test (LoS), International Classification Ataxia Ratio Scale (ICARS), Berg Balance Scale (BBS), and Timed-Up and Go test with a cognitive task (TUG-C), Reactive postural control and sensory orientation subscales of the Mini-BESTest. Seventeen patients (mean age ± SD, 32.53 ± 11.07 years) completed the study. ICARS, BBS scores improved only after EEP (p < 0.05). While there was no change in the RT and MVL parameters of the LoS test after EEP, the MXE, EPE, and DCL parameters improved significantly (p < 0.05). The MXE and MVL parameters of LoS improved after CEP (p < 0.05). There were no significant improvements in the Mini-BESTest's reactive postural control and sensory orientation subscale scores after both EEP and CEP (p > 0.05). The results of the present study demonstrated that exergame training can be used as a complementary training option in physiotherapy to improve postural control in patients with ataxia. ClinicalTrial.gov Identifier: NCT03607058.

Association of posturography with clinical measures in balance rehabilitation of ataxic patients.

The assessment of balance includes posturography measures and clinical balance tests in individuals with ataxia. Although both advantages and disadvantages of these assessments have been stated, no relationship between them in individuals with ataxia has been shown in the literature. The aim of this cross-sectional study was to investigate the relationships between commonly used clinical balance tests and posturography measures in ataxic individuals. The study included a total of 42 patients (mean age: 33.90 ± 8.75 years) with different diagnoses causing ataxia. The sensory organization test (SOT), limits of stability (LOS), unilateral stance and rhythmic weight shift (RWS) tests in computerized dynamic posturography and the clinical balance tests of Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS) and timed up and go (TUG) test were used to assess balance. The Spearman correlation test was used to evaluate the relationships between the clinical balance tests and posturography variables. Moderate and strong correlations were found between the ICARS, BBS and TUG scores and Unilateral Stance sway velocity, directional control parameter of RWS and LOS (P < 0.01-0.05). The ICARS and BBS scores were correlated with the SOT-Composite Equilibrium Score (P < 0.01-0.05). The results of this study suggest the use of both posturography and clinical balance tests in the rehabilitation of ataxic individuals with mild-moderate balance impairment, because posturography variables determine the underlying cause of imbalance and clinical tests evaluate balance in functional activities.

Effects of low vs. high frequency local vibration on mild-moderate muscle spasticity: Ultrasonographical and functional evaluation in patients with multiple sclerosis.

BACKGROUND: Local vibration (LV) is a physiotherapy application that aims to reduce spasticity. The study aimed to compare the effects of 50 Hz vs. 100 Hz LV on mild-moderate spasticity, functional performance and muscle architecture. METHODS: Thirty-three patients were randomly divided into three groups: 50 Hz LV group, 100 Hz LV group and the control group. Physical therapy was applied for one hour a day, three days a week, for a total of eight weeks. LV was applied to the right and left medial gastrocnemius muscles for five minutes. Clinical (spasticity, ankle joint position sense, balance, gait) and ultrasonographic (gastrocnemius fascicle length and pennation angle) measurements were performed before and after treatment. RESULTS: The study was completed with 27 patients. The decrease in spasticity and the increase in fascicle length were found to be statistically significant in the 50 Hz group (both p<0.05). Ankle joint position sense, single-leg stance time, limits of stability/postural sway range in the medio-lateral direction significantly improved in the vibration treatment groups (all p<0.05). The antero-posterior limits of stability and postural sway showed significant improvement in all groups (all p<0.05). While the 50 Hz group showed significant improvement for all walking parameters; velocity, step length and base of support values improved in the 100 Hz group (all p<0.05). The exercise group showed significant improvement only for single support and stance phase percentages of the gait cycle (both p<0.05). According to between group comparisons, significant difference was found only in medio-lateral limits of stabillity (p<0.05). Medio-lateral limits of stabillity scores were better for the 50 Hz group than the 100 Hz and exercise group. CONCLUSION: Our findings show that LV does not have any substantial effect except for medio-lateral limits of stability. CLINICAL TRIAL NUMBER: NCT04192786.

The Effect of Whole Body Vibration on Postural Control of Ataxic Patients: a Randomized Controlled Cross-Over Study.

Whole body vibration (WBV) applications have been used in recent years to increase muscle strength, power, and postural control in healthy and various disease populations. This study aims to investigate the effects of WBV on postural control in patients with ataxia. Twenty-four patients were randomly allocated to two groups. In the first group, whole body vibration and exercise therapy (WBV + E) were applied together for the first 8 weeks; after 1 week washout, only exercise program (OE) was applied for the second 8 weeks. In the second group, the OE program was applied first followed by the WBV + E program. Outcome measures were Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability Test (LOS), International Classification Ataxia Ratio Scale (ICARS), Berg Balance Scale (BBS), and Timed Up and Go Test with cognitive task (TUG-C). Twenty patients (mean age ± SD, 34.00 ± 9.16 years) completed the study. The scores of SOT, ICARS, and BBS improved significantly after both OE and WBV + E program (p < 0.05). Improvements in the WBV + E program were higher (p < 0.05). The scores of ADT, TUG-C, and three parameters of LOS improved significantly after WBV + E (p < 0.05), while there was no significant change after OE (p > 0.05). This study demonstrated that exercise programs supported by WBV can play an important role in the improvement of all components of postural control in patients with ataxia. ClinicalTrial.gov Identifier: NCT02977377.

Electromyographic activity and kinematics of sit-to-stand in individuals with muscle disease.

OBJECTIVE: The aim of this study was to compare activation levels of rectus femoris, biceps femoris, tibialis anterior, and soleus muscles and biomechanical properties of individuals with muscle disease and healthy individuals during sit-to-stand. METHODS: Fifteen patients (11 muscular dystrophy, 4 myopathy) and 15 healthy individuals were included in the study. A Noraxon superficial electromyography device and high-speed cameras were used to evaluate muscle activations and biomechanical properties. RESULTS: There was a difference between the activation levels of bilateral rectus femoris, tibialis anterior, soleus, and right biceps femoris of patients and healthy subjects (p < 0.05). When groups were compared in terms of biomechanical properties, there was no difference in the range of motion during sit-to-stand (p > 0.05), but there was a difference in phase 1: flexion momentum phase, phase 3: extension phase, phase 4: stabilization phase, and total time of sit-to-stand (p < 0.05). CONCLUSION: We observed that individuals with muscle disease are able to stand up in a similar sit-to-stand pattern to healthy individuals with longer duration and higher muscle activation levels. Prolonged high muscle activation during functional activities may cause fatigue and muscle destruction in patients. For this reason, planning of exercise programs for appropriate muscles and phases will enable the patients to perform the activity of sit-to-stand more easily. Thus, patients will become more functional and independent in their daily lives with less effort.

Correction to: Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy.

The published version of this article unfortunately contained a mistake in Fig. 2. Only one graphic of different movement of scapula was published instead of three. The Figure is corrected here.

Effect of taping on scapular kinematics of patients with facioscapulohumeral muscular dystrophy.

The aim of this study is to investigate the effects of scapular taping on scapular kinematics by three-dimensional electromagnetic system during shoulder elevation in facioscapulohumeral muscular dystrophy patients. A total of 11 patients with facioscapulohumeral muscular dystrophy were included in the study. Scapular anterior-posterior tilt, upward-downward rotation, and internal-external rotations were evaluated using the three-dimensional electromagnetic system during the elevation of the upper limbs in the scapular plane before and after kinesio taping. For maximum humerothoracic elevation, there were no differences between the patients before and after taping on both dominant (p = 0.72) and non-dominant sides (p = 0.64). For scapular internal rotation, upward rotation, and posterior tilt, there were no differences between patients before and after taping during humerothoracic elevation on both dominant and non-dominant sides (p > 0.05). These results showed us that the excessive and abnormal movements of the scapula observed during the humeral elevation in facioscapulohumeral muscular dystrophy patients cannot be supported with flexible methods like kinesio taping. Therefore, we recommend to evaluate the scapula position by applying flexible and rigid taping to the patients who can reach over 90o in humerothoracic elevation in future studies.

The International Classification of Functioning, Disability and Health-based factors related to physical activity level in adults with muscle diseases.

The aim of this study was to investigate the physical activity (PA) level of adults with muscle diseases and the association of factors affecting PA behaviour. Forty-five adults with muscle diseases and 44 healthy participants were included. The PA was assessed by a SenseWear Armband and the International Physical Activity Questionnaire. The muscle strength, pain, fatigue severity, activity limitations, functional mobility level and quality of life were also assessed. Compared with the healthy group, adults with muscle diseases had significantly lower step counts and duration of moderate and vigorous PA (P < 0.05). The BMI of the patients was related to total energy expenditure (P < 0.05). The total number of steps, energy expenditure and duration of moderate PA of the patients were related to the 6-min walk test (P < 0.05). There was a correlation between total, moderate and vigorous PA and mental health in adults with muscle diseases (P < 0.05). The most important factors in reflecting PA in adults with muscle diseases are considered as BMI from personal factors, functional mobility from activity limitations and quality of life in the dimension of participation.

Functional range of motion in the upper extremity and trunk joints: Nine functional everyday tasks with inertial sensors.

BACKGROUND: Functional range of motion is defined as the required range of motions for individuals to maintain maximal independence, along with optimal conditions for activities of daily living. Intervention plans for rehabilitation are directed towards the acquisition of anatomical range of motion. However, this isn't always possible based on person's etiology, prognosis, or severity of disease. RESEARCH QUESTION: The aim of this study is to determine functional range of motion during different unilateral, bilateral symmetrical and bimanual asymmetrical tasks of activities of daily living. METHODS: Participants completed nine basic activities of daily living (hand to head, hanging jacket, eating, wallet placement to back pocket, washing hands and face, removing belt, water pouring, brushing teeth) linked according to International Classification of Functioning, Disability and Health, while joint kinematics of the trunk and upper extremity were recorded with inertial measurement units. Peak values of mean joint angles were determined for each activities of daily living. MVN BIOMECH Awinda MTW2-3A7G6 sensors (Xsens Technologies B.V. Enschede, Netherlands) were used for 3D kinematic analysis of activities. RESULTS: Forty-six healthy subjects (right-dominant) were included in this study. Range of motion requirements of all activities were defined 37.85° extension, 91.18° flexion, 1.25° adduction, 39.45° abduction, 63.6° internal rotation, 21.8° external rotation in the dominant shoulder, 124.17° flexion in the dominant elbow, 40.29° extension, 23.66° flexion, 18.31° supination, 12.56° pronation, 18.27 ulnar deviation and, 18.36° radial deviation in the dominant wrist. Maximum trunk range of motions were found to be 29.75° flexion in C7-T1, 10.74° flexion in T12-L1, and 24.16° flexion in L5-S1. SIGNIFICANCE: It is thought that the results of this research will contribute to the determination of normative data needed for surgical interventions, technological rehabilitation devices and task-spesific rehabilitation programs which based patient's motor skill level.

Functional exercise capacity evaluated by timed walk tests in myasthenia gravis.

INTRODUCTION: We sought to evaluate the test-retest reliability and construct validity of the 6- and 2-minute walk tests (6mWT and 2mWT, respectively) in patients with myasthenia gravis (MG). METHODS: Thirty-one patients with generalized MG were enrolled in this study. The 6mWT, 2mWT, MG-specific quality of life questionnaire Turkish version (MG-QoL15T), quantitative myasthenia gravis test (QMG), and pulmonary function tests were administered. RESULTS: The intraclass correlation coefficients of 2mWT and 6mWT were 0.894 and 0.932, respectively. The 6mWT and 2mWT had moderate correlations with forced vital capacity, maximal inspiratory pressure, QMG score, and MG-QoL15T score (ρ for 6mWT: 0.579, 0.539, -0.572, and -0.474; ρ for 2mWT: 0.460, 0.446, -0.532, -0.457). Both tests had similar performances for predicting disease severity (area under the curve = 0.761 for 6mWT and 0.759 for 2mWT). DISCUSSION: The 6mWT and 2mWT have excellent test-retest reliability as well as moderate construct validity for the evaluation of functional exercise capacity patients with MG. Muscle Nerve 59:208-212, 2019.

The relationship between trunk position sense and postural control in ataxic individuals.

BACKGROUND: The proprioceptive system plays a role in the maintenance of postural control more than the visual and vestibular systems in ataxic patients with postural control disorders, but the relationship between trunk proprioception and postural control has not been sufficiently investigated yet. This relationship can provide a different perspective to the ataxia rehabilitation. RESEARCH QUESTION: This study aimed to examine the relationship between trunk position sense and postural control in ataxic individuals by comparing them to healthy individuals. METHODS: Twenty ataxic and 20 healthy individuals were included. The Sensory Organization Test, Limits of Stability Test, and Unilateral Stance Test in the Computerized Dynamic Posturography and Berg Balance Scale were used to evaluate postural control. The Baseline Digital Inclinometer (Norwalk, CA, USA) measured trunk position sense. RESULTS: It was found that repositioning error degree of the trunk position sense was higher in ataxic individuals than in healthy individuals, including scores of clinical and objective tests in postural control evaluation: they were lower in ataxic individuals (p < 0.05). As a result, trunk position sense was associated with almost all evaluated parameters, including sensory integration, postural sway, limits of stability, and functional balance (p < 0.05). SIGNIFICANCE: The impairment of postural control, which is the most important cause of activity and participation limitations in ataxic patients, is not only affected by motor disorders, but by sensory disturbances. Our study demonstrated that impairment of the trunk position sense in ataxic individuals was higher than that of healthy individuals, and affected the different components of postural control.

The use of Goal Attainment Scaling (GAS) in the rehabilitation of ataxic patients.

The aim of this study was to formulate an exercise program according to GAS, an approach that reflects the patients' point of view and expectations and investigate the effects of this program in ataxia rehabilitation. This study was designed as an assessor-blinded, single-group trial, and 24 patients with cerebellar ataxia were included. Treatment goals, postural control, disease severity, and daily living activities were assessed pre- and post-treatment using the Goal Attainment Scaling (GAS), the Sensory Organization Test (SOT), the International Cooperative Ataxia Rating Scale (ICARS), and the Barthel Index (BI), respectively. An exercise program was applied by taking patients' individual expectations and treatment goals into account. The participants enrolled in the physiotherapy program for 8 weeks, 3 days a week for 1 hour per day. The mean age of the patients was 34.00 ± 9.15 years. While the GAS, kinetic functions ICARS subscores, ICARS total scores, SOT-composite, and BI scores improved significantly after treatment (p < 0.05), other ICARS subscores did not change after treatment (p > 0.05). The results showed that putting the patient at the center of the evaluation and treatment process while formulating a treatment plan had a positive effect on treatment outcome. If the functions that patients consider important are known and the treatment process concentrates on these functions, a patient's participation in his/her individual treatment is supported by increasing his/her motivation and contribution to more successful rehabilitation practices.