Thoracolumbar fascia and chronic low back pain in idiopathic lumbar scoliosis: an ultrasonographic study.

PURPOSE: The role of thoracolumbar fascia (TLF) in the development of chronic low back pain (CLBP) has growing evidence in the literature. Although CLBP is reported in individuals with idiopathic scoliosis (IS), its relationship with the TLF has yet not been established. This study aims to evaluate the TLF and its relationship with CLBP in IS. METHODS: A total of 60 individuals were included in the study. They were divided into three groups as follows: painful scoliosis (n = 20, age: 17.1 ± 3.7 years, Cobb angle: 15-43°), non-painful scoliosis (n = 20, age: 16.4 ± 3.4 years, Cobb angle: 15-45°), and healthy group (n = 20, age: 16.4 ± 4.7 years). Pain was evaluated using the short form of the McGill Pain Questionnaire. TLF thickness was evaluated on the lumbar region using ultrasonography. Trunk range of motion was assessed using a universal goniometer, and flexibility was assessed with sit-and-reach test. RESULTS: The thickness of the right TLF was greatest in the painful group, followed by non-painful (p = 0.007) and healthy (p < 0.001) groups. The thickness of the left TLF in the non-painful and painful groups was greater compared to the healthy group (p < 0.001). In the painful group, right TLF thickness was negatively correlated with trunk flexion/extension (r = -0.540, p = 0.014/r = -0.514, p = 0.020) and left rotation (r = -0.499, p = 0.025) but positively correlated with pain (r = 0.562, p = 0.01). CONCLUSIONS: Thickening of the TLF was observed in IS, whereby, in the presence of CLBP, it was further intensified. We suggest considering fascial thickening as a potential contributing factor to both pain and limited motion in relevant patients.

Comparison of the efficacy of Schroth and Lyon exercise treatment techniques in adolescent idiopathic scoliosis: A randomized controlled, assessor and statistician blinded study.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most common vertebral disorder in adolescence. OBJECTIVES: The purpose of this study was to compare the effectiveness of Schroth and Lyon exercise methods on Cobb angle (CA), angle of trunk rotation (ATR), quality of life (QoL), and perceived trunk appearance in patients with AIS. METHODS: The 31 participants diagnosed (diagnosis age = 12.2 ± 0.9) with AIS by a physician following the Lenke criteria and subsequently referred to the outpatient clinic were enrolled in the study. All participants were randomly assigned between the Schroth group (SG) and Lyon group (LG) for 6 months of supervised and home treatment. The participants' CA, ATR, Scoliosis Research Society-22 (SRS-22), and Walter-Reed Visual Assessment Scale (WRVAS) were assessed as a baseline, and again following the treatment by the same researcher who remained blinded to the study. RESULTS: In 2-way mixed-design repeated-measures ANOVA analysis, when the change in time was analyzed between the groups (Group × Time [interaction]), a statistical difference was found more significant in SG for the CA-thoracic (F = 103.1, p < .01, 95% CI = 4.1; 2.0 to 6.2), CA-lumbar (F = 19.1, p < .01, 95% CI = 1.7; 1.0 to 2.4), ATR (F = 64.1, p < .01, 95% CI = 1.7; 1.2 to 2.3), and WRVAS (F = 169.5, p < .01, 95% CI = 6.5; 3.2 to 9.9) parameters. The LG was only more significantly improved in the SRS-22 total score (F = 15.7, p < .01, 95% CI = -0.9; -0.2 to -1.6). CONCLUSION: In the study, The Schroth exercises gave more favorable results than Lyon exercises in terms of CA-T, CA-L, ATR and WRVAS in the conservative treatment of AIS, while Lyon exercises gave more favorable results in terms of QoL. Additionally, according to the results of this study, it was found that the QoL of participants in SG decreased after treatment compared to baseline.

Effect of pain on activity and participation in individuals with unilateral lower-extremity amputation based on the International Classification of Functioning, Disability, and Health.

BACKGROUND: Amputation is a major life-changing event and is regarded as one of the loading causes of permanent disability. However, amputation often causes changes in painful and nonpainful sensory experiences. Pain after amputation has been shown to increase functional limitations caused by limb loss and lower quality of life. OBJECTIVE: This study aimed to examine the effect of pain on activity and participation in individuals with unilateral below-knee amputations according to the International Classification of Functioning, Disability, and Health. STUDY DESIGN: Cross-sectional study. METHODS: In the study, 64 individuals were divided into 2 groups: those who experienced pain and those who did not. Group 1 included 33 below-knee amputees who experienced pain (27 males, mean age 43.9 ± 12.6 years) and Group 2 included 31 below-knee amputees who did not experience pain (25 males, mean age 47.4 ± 12.1 years). The McGill Pain Questionnaire and visual analog scale were used to assess pain, the Prosthetic Limb Users Survey of Mobility was used to assess activity, and the Reintegration to Normal Living Index was used to assess participation. RESULTS: Demographic characteristics of the 2 groups were statistically insignificant (P > 0.05). The nonpainful group had significantly higher activity and participation scores than the painful group (P < 0.001). CONCLUSIONS: It was found that phantom pain and stump pain in below-knee amputees limited activity and participation. It was also shown that phantom pain has a more negative effect on the activity level of individuals than stump pain.

The effect of different taping techniques on transtibial amputation walking parameters: A case report.

Buerger disease is a nonatherosclerotic, segmental inflammatory disease of the occlusive tract, often involving medium-sized muscular and small-diameter arteries and veins of the extremities. If medical treatment is not successful, amputation is inevitable. The aim of this study was to investigate the effect of different kinesiological taping techniques on walking parameters of transtibial amputee with knee extension limitation. Two different kinesiological taping methods (Kinesio Tape and Dynamic Tape) were applied to the transtibial patient with knee extension limitation. Walking performance of patients was assessed with The Biodex Gait Trainer 2. Gait parameters without tape were as follows: average walking speed 0.38 m/s, average step cycle 0.48 cyl/s, average left step length 50 cm, average right step length 43 cm, coefficient of variation 9% at the left, and coefficient of variation 9% at the right. After applying Kinesio Tape and Dynamic Tape, these values were measured as follows: average walking speed 0.50.56 m/s, average step cycle 0.51.56 cyl/s, average left step length 61-60 cm, average right step length 53-54 cm, coefficient of variation 6%-5% at the left, and coefficient of variation 6%-4% at the right side. Dynamic Tape and Kinesio Tape both had positive effects on active joint motion and walking parameters. Regarding walking speed and step length, Dynamic Tape was found to be more effective than Kinesio Tape. Taping methods applied to amputees have positive effects on range of motion, which in return causes improvements on walking parameters.

Effects of Virtual Reality on Transtibial Amputation Rehabilitation Outcomes: A Randomized Study.

Purpose: Virtual reality is widely used in patients with chronic musculoskeletal problems. However, the short-term effects on individuals with transtibial (TT) amputation during this process remain unclear. This study aimed at investigating the effects of virtual reality on rehabilitation outcomes in TT amputees. Methods: The study included 20 TT amputees who were using TT prostheses. The participants were divided into two groups randomly as follows: physiotherapy (PT) and virtual reality (VR). Participants were treated 3 days a week, for 4 weeks, and evaluations were made before and after treatment; a 6-minute walk test was used for performance, a single-leg balance test for balance, Trinity Amputation Prosthesis Experience Scale for prosthesis satisfaction, a 10-meter walking test for gait speed, and a wearable smart t-shirt to determine cadence. Results: It was found that there was a statistically significant difference in performance, balance, prosthesis satisfaction, cadence, and gait speed before and after PT (P < 0.05). There were differences in terms of performance, prosthesis satisfaction, balance, cadence, and gait speed before and after VR (P < 0.05). There was no statistically significant difference between PT and VR (P > 0.05). Conclusion: The 4 weeks of VR training improved performance, prosthesis satisfaction, balance, cadence, and gait speed in TT amputation rehabilitation similar to physiotherapy methods. The addition of VR training to amputation rehabilitation will bring improvements since it is a fun and safe intervention. Clinical Trial Registration: The trial is registered at Clinical Trials.gov, Trial No: NCT03872193.

Dual Task Performance in Adolescents With Idiopathic Scoliosis.

Daily life activities commonly include many combinations of dual tasks. Although dual task ability has been studied in healthy young adults, dual task performance in adolescents with idiopathic scoliosis (IS) has not been explored. Our objective in this study was to investigate dual task performance in adolescents with IS. We paired 33 adolescents diagnosed with IS and 33 healthy control participants (age range: 11-17 years) and administered to both groups the Stroop Color and Word test as a measure of cognitive ability, and both the Expanded Timed Up and Go (ETUG) test and the Tandem Gait test as measures of motor tasks. During the motor tasks, we had participants spell five-letter words in reverse and count down by seven from a randomly presented number between 50 and 100 to assess their dual task (cognitive-motor) performance. All cognitive, motor, and dual cognitive-motor test scores differed significantly between the IS and healthy control groups. The time taken to complete all these tasks was longer for participants with IS compared with controls (p < .05). These results revealed diminished performances on dual cognitive-motor tasks among adolescents with IS when compared to peers without IS. Dual task performance is a new research paradigm in the scoliosis rehabilitation field, and it should be further investigated in future studies.

Investigation of the correlation between knee joint position sense and physical functional performance in individuals with transtibial amputation.

INTRODUCTION: In individuals with transtibial amputation, the distal part of the lower extremity is lost. Therefore, the knee joint is of greater importance to be able to provide physical performance. The aim of this study was to evaluate the correlation between knee joint position sense and physical functional performance in individuals with transtibial amputation. METHODS: The study included 21 subjects with transtibial amputation. A digital inclinometer was used to evaluate the joint position sense of the amputated side knee joint. The timed up and go test, the 4-square step test, and 10-m walk test were used to evaluate physical functional performance. Linear regression analysis was used to investigate the associations between independent variables and functional performance tests. RESULTS: The mean age of the participants was 52.52 ± 15.68 years. The mean of the error in knee joint position sense was 5.33 degree (standard deviation = 3.08 degree). The error in knee joint position sense of the amputated limb predicted 45% of the variance in the 4-square step test and 22% of the variance in the 10-m walk test ( P < 0.05). CONCLUSIONS: The knee joint position sense on the amputated side was found to be associated with physical functional performance in individuals with transtibial amputation. Residual limb knee joint position sense should be considered when prescribing prostheses and planning rehabilitation programs.

Factors influencing of quality of life in adolescent idiopathic scoliosis.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the lateral and horizontal deformity of the vertebral column which occurs idiopathically during adolescence. The aim of this study is to identify independent predictors of quality of life in AIS patients. METHODS: In total, 31 adolescent patients diagnosed with AIS aged between 10 and 18 years old were included in the study. The scoliosis severity was determined for each patient according to the Cobb method, and their scoliosis perception using the Walter Reed Visual Assessment Scale, a pain assessment was conducted based on the Visual Analog Scale, quality of life using the Scoliosis Research Society-22 questionnaire, and depression level according to the Children's Depression Scale. Multiple Linear Regression analysis was then performed in order to determine the independent determinants of health-related quality of life. FINDINGS: According to the Linear Regression analysis results, children's depression scale, walter reed visual assessment scale, cobb, and anterior trunk rotation explained 52.7% of the variance as independent determinants of SRS-22. INTERPRETATION: The study examined the determinants affecting the quality of life in AIS patients. The results of the study showed that scoliosis severity, perception of cosmetic deformity, degree of rotation, and depression level to be predictors of quality of life in AIS patients. "This trail registered with NCT05242601."

The effects of cognitive versus motor concurrent task on gait in individuals with transtibial amputation, transfemoral amputation and in a healthy control group.

BACKGROUND: Lower limb amputation causes difficulties in mobility together with motor and sensory loss. Challenging situations such as concurrent tasks cause gait parameters to deteriorate. Understanding the effect of concurrent tasks on gait is important for the rehabilitation of amputees. RESEARCH QUESTION: Are the effects of concurrent cognitive and motor tasks on gait parameters at fixed speed different in individuals with transtibial amputation, or transfemoral amputation compared to healthy individuals? METHODS: The gait parameters were evaluated of 20 individuals with transtibial amputation, 13 individuals with transfemoral amputation and 20 healthy individuals while walking on a motorized treadmill under single task (ST), cognitive dual task (CDT) and motor dual task (MDT) conditions. The self-selected comfortable velocity, which was determined in the single-task gait, was used in all three walking tests. RESULTS: ST, CDT and MDT gait parameters of individuals with transtibial amputation, transfemoral amputation and healthy individuals were significantly different (p < 0.01). Covariance of step length variability increased in amputees when walking under MDT (p < 0.05). The dual task cost (DTC) for all the gait parameters was similar in all three groups (p > 0.05). The motor DTC of covariance of step length was greater than cognitive DTC (p < 0.05). SIGNIFICANCE: Individuals with lower limb amputation have the capacity to walk with cognitive and motor tasks without changing velocity on the treadmill, but concurrent motor tasks cause an increase in gait variability. The results of this study suggest that there is an increase in gait variability especially with motor tasks, which may cause a higher risk of falling. Trial number: NCT04392466 (clinicaltrials.gov).

Investigation of the Effects of Dual-Task Balance Training on Gait and Balance in Transfemoral Amputees: A Randomized Controlled Trial.

OBJECTIVES: To investigate the effects of dual-task balance training on static and dynamic balance, functional mobility, cognitive level, and sleep quality in individuals with transfemoral amputation. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Transfemoral amputees (N=20). INTERVENTIONS: Participants were randomly assigned to the single-task gait and balance training group (n=10) or the dual-task gait and balance training group (n=10). Training was given in sessions of 60 min/d, 3 d/wk for 4 weeks. The single-task training group performed traditional gait and balance exercises, and the dual-task training group practiced cognitive and motor tasks while performing gait and balance exercises. MAIN OUTCOME MEASURES: The 1-leg stance test and the Four Square Step Test were used for balance assessment. The timed Up and Go test and 10-m walk test were used for gait assessment. Three test conditions to evaluate the training effects were single walking, walking while performing a cognitive task (serial subtraction), and walking while performing a motor task (tray carrying). The Montreal Cognitive Assessment scale was used for cognitive assessment and the Pittsburgh Sleep Quality Index for sleep quality assessment. RESULTS: Balance and mobility improved in both groups. Dual-task balance performance, functional mobility, and gait speed improved more in the dual-task training group after training (P<.05). Cognitive status and sleep quality improved significantly in the dual-task group (P<.05). CONCLUSIONS: Dual-task training was more effective than single-task training in the improvement of dual-task performance and cognitive status. The inclusion of dual-task exercises in the rehabilitation program of transfemoral amputees will provide a different perspective because of increased task automation.

Comparison of gait variability and symmetry in trained individuals with transtibial and transfemoral limb loss.

PURPOSE: Gait variability is a determinant of qualified locomotion and is useful for monitoring the effects of therapeutic interventions. The aim of this study was to compare gait variability and symmetry in trained individuals with transtibial (TT) amputation and transfemoral (TF) amputation. METHODS: The design of this study was planned as observational. Eleven individuals with TF amputation, 14 individuals with TT amputation, and 14 healthy individuals (HI) were evaluated with a motorized treadmill. The mean step length, the step length variability, an ambulation index, and the time on each foot (stance phase symmetry) of participants were recorded. RESULTS: There were differences between the three groups in the residual/non-preferred limb (RNp) step length ( p = 0.031), the intact/preferred (IP) limb step length variability ( p = 0.001), the RNp step length variability ( p < 0.001), the time on each foot ( p < 0.001), and the ambulation index score ( p < 0.001). There was a similarity between the groups (TF, TT, HI) in IP limb step lengths ( p = 0.127) and duration of prosthesis usage since amputation in individuals with lower limb loss ( p = 0.224). CONCLUSIONS: This study provided basic data about gait variability and symmetry in individuals with traumatic lower limb loss. The results of the study showed that the variability of gait increased with the level of loss, and individuals with TT amputation showed partially equivalent performance with the healthy group. Similarities in gait characteristics may have resulted from effective prosthetic usage or effective gait rehabilitation.

A comparison of the effects of mirror therapy and phantom exercises on phantom limb pain

Background/aim: Although mirror therapy (MT) and phantom exercises (PE) have been shown to reduce pain, the efficacy of these methods in terms of pain, quality of life (QoL), and psychological status (PS) has not been investigated and compared to date. The aim of this study was to determine whether there is any difference between MT and PE in the treatment of phantom limb pain (PLP). Materials and methods: Forty unilateral transtibial amputees (aged 18­45 years) participated in this study. The subjects were randomly divided into 'MT group' and 'PE group'. QoL was assessed using Short-Form 36 (SF-36), psychological status using the Beck depression inventory (BDI), and pain intensity using a visual analog scale (VAS), before and at the end of the program, and on the 3rd and 6th months thereafter. Results: All assessments for all parameters improved significantly in both groups (P < 0.05). Comparison of the two groups revealed a significant difference in changes for VAS and BDI in all measurements, and in pre- and posttreatment scores for all SF-36 parameters (except for Role-Emotional) in favor of the MT group (P < 0.05). Conclusion: While pain intensity decreased and QoL and PS improved in both the MT and PE groups, these improvements were greater in the MT group.

The effectiveness of a back school program in lowerlimb amputees: a randomized controlled study.

BACKGROUND/AIM: A few studies have been carried out in lower limb amputees (LLAs) and they examined the incidence of and reasons for low back pain. The aim of this study was to assess the effectiveness of a back school program in LLAs with mechanical low back pain (MLBP). MATERIALS AND METHODS: Forty male unilateral transfemoral amputees with MLBP were randomly allocated into two groups. A back school program was applied to Group 1 over 2 weeks. A booklet for home use was given to each participant in Group 2. Pain was assessed using a visual analogue scale. Spinal flexibility measurements were obtained. For the assessment of back pain-related disability, the Oswestry Disability Index was used. Patients were assessed at baseline, at month 1, and at month 3. RESULTS: At the month 1 assessment, a reduction in pain intensity and disability, and increase in spinal flexibility measurements were detected in Group 1 only (P < 0.05). At the month 3 assessment, there were improvements in all measured parameters in both groups(P < 0.05). Group 1 had better results in all parameters compared with Group 2. CONCLUSION: The back school program, combined with an exercise program, decreased pain and disability and improved the spinal flexibility significantly in LLAs with MLBP.

Evaluation of functionality in acquired and congenital upper extremity child amputees.

OBJECTIVE: The aim of this study was to evaluate the functional level of children with congenital and acquired upper limb loss after a rehabilitation program. METHODS: This study included a total of 40 children, aged 8 to 17 years with upper limb loss. Children were divided into two groups; congenital amputees (n=20) and acquired amputees (n=20). The children underwent prosthetic fitting, prosthetic training and rehabilitation. The Child Amputee Prosthetics Project - Functional Status Inventory (CAPP-FSI) and Prosthetic Upper Extremity Functional Index (PUFI) were used at the initial visit to the prosthetic unit without prosthesis, 3 weeks after the prosthetic training and 6 months after discharge with and without prosthesis. The results with and without the prosthesis were compared between the acquired and congenital amputee groups. RESULTS: There were significant differences in all tests performed at the baseline, at the 3rd week, and at the 6th month without prosthesis and at the 3rd week and at the 6th month with prosthesis (p<0.05). The congenital group received higher scores in the CAPP-FSI and PUFI at the baseline, at the 3rd week and at the 6th month (p<0.05). Patients in the congenital group used their prostheses for 8 hours a day and the acquired group for 4 to 8 hours. CONCLUSION: Daily prosthesis usage time and the child's experience with the prosthesis during daily activities are the determining factors for the functional level in upper limb child amputees. Functionality may improve based on these factors.

The effect of physical fitness training on reaction time in youth with intellectual disabilities.

The purpose of this study was to assess whether reaction time in persons with intellectual disabilities can be improved with an exercise program. 50 children and adolescents (M age = 14.7 yr., SD = 1.4, range = 11-18) with mild intellectual disability without Downs syndrome were randomly divided into control (20 boys, 5 girls) and experimental (19 boys, 6 girls) groups. The experimental group participated in a structured physical fitness program for 12 weeks. Reaction time was assessed at baseline and after 12 weeks. Significant improvements in reaction time were observed in the exercise group but not for the control group. Results indicated that reaction time can be improved with an exercise program in youth with intellectual disability.

Effectiveness of phantom exercises for phantom limb pain: a pilot study.

OBJECTIVE: To investigate the effects of phantom limb exercises on phantom limb pain. METHODS: A total of 20 traumatic amputees participated in the study. Ten received phantom exercises and prosthetic training, and 10 were treated with routine prosthetic training and a general exercise programme. Intensity of pain was evaluated using a 10-cm visual analogue scale before therapy and after 4 weeks of therapy. RESULTS: Baseline scores on the visual analogue scale were similar between the groups. Pain intensity decreased in all subjects after 4 weeks of treatment in both groups. According to the visual analogue scale scores at the end of 4 weeks, the phantom exercises group differed significantly from the general exercise group (p < 0.05). CONCLUSION: Phantom exercises appear to be effective in reducing phantom pain, but further research is required to confirm this.The results of this study indicate that phantom exercises can be used safely to alleviate phantom limb pain in lower and upper limb amputees.