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.

The relationship of tremor severity with proximal and distal muscle strength and upper extremity functional skills in older adults with essential tremor.

BACKGROUND: Although it is known that muscle strength training is effective in Essential Tremor (ET), it is not known which muscle groups are more affected. AIM: The study was conducted to examine the relationship between tremor severity and proximal and distal muscle strength and upper extremity functional skills in older adults with ET. METHODS: A total of 40 older adults who were diagnosed with ET (mean age of 74.07 ± 4.83 years) and 40 older adults without tremor (mean age of 70.10 ± 4.05 years) were included in the study. Tremor severity was evaluated with the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS), the proximal muscular strength with digital muscle dynamometer, handgrip strength with hand dynamometer, and pinch grip strength with pinchmeter. The Arm and Shoulder Problems Questionnaire (DASH) was used to determine the functional status of the upper extremities. Fine Manual Dexterity was measured with the Nine-Hole Peg Test (NHPT). RESULTS: All proximal and distal muscle strengths were significantly lower, DASH and NHPT were significantly higher in the group with ET (p < 0.05). A significant negative correlation was detected between tremor severity and all proximal and distal muscular strength and a significant positive correlation between tremor severity and DASH in group with ET (p < 0.05). However, no significant correlations were found between tremor severity and NHPT in the group with ET. CONCLUSIONS: It was found that older adults who had tremors had low proximal and distal muscular strength, upper extremity functionality was affected and hand skills was impaired. Furthermore tremor severity is affected by both proximal and distal muscle strength.

The effect of Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Currents (IFC) on pain, functional capacity, and quality of life in patients with multiple sclerosis: A randomized controlled, single-blinded study.

OBJECTIVE: The aim is to compare the effects of different electrical stimulations on pain, functional capacity and quality of life in patients with Multiple Sclerosis (pwMS). METHOD: 40 pwMS were included in the study, randomized by simple random method and divided into 2 groups. Low-frequency Transkutaneal Electric Stimulation (TENS) was applied to 1st group and Interferential current was applied to 2nd group for 30 min 5 days/a week for 4 weeks. For pain severity Visual Analogue Scale (VAS), for neuropathic pain the LANSS questionnaire was used. Functional capacity was evaluated with the 2-minute walk test (2MWT) and quality of life was evaluated with the 'Multiple Sclerosis International Quality of Life Scale (MusiQol)'. RESULTS: The most severe and mean VAS and LANSS results significiantly decreased, 2MWT results significiantly increased in two groups (p<0.05). A significiant increase was found in all sub-headings of the MusiQol, except for the relationship with the health system in TENS group (p<0.05). An increase was found in the total score, activities of daily living, well-being, relationship with friends, relationship with family, sexual life, rejection sub-headings of the MusiQol in IFC group (p<0.05). There was no significant difference between the groups in terms of VAS, LANSS, 2MWT and MusiQol (p>0.05). CONCLUSION: In this study, it was found that interference current and TENS applications decrease pain and increase functional capacity. However, it was determined that TENS application was a more effective method in increasing the quality of life. CLINICALTRIALS: NCT05110586.

The relationship between the backward walking and proprioception, trunk control, and muscle strength in children with cerebral palsy.

OBJECTIVE: This study was planned to determine the factors affecting backward walking in children with cerebral palsy (CP). METHODS: The study included 30 children with CP, with a mean age of 10.43 ± 2.76 years. Backward walking abilities were evaluated with the 3-Meter Back Walk Test (3MBWT). A digital goniometer was used to evaluate proprioception, the Trunk Control Measurement Scale (TCMS) was used for trunk control, a digital muscle dynamometer was used for muscle strength, and the Gillette Functional Assessment Questionnaire (FAQ) was used for gait evaluation. RESULTS: When the spasticity of children at levels I and II according to the Gross Motor Function Classification System (GMFCS) was compared, a significant difference was found in favor of level I in hamstring, gastro-soleus, and gastrocnemius spasticity (p < 0.05). When the results of the 3MBWT, TCMS, and FAQ were compared, a significant difference was found in favor of level I (p < 0.05). No significant relationship was revealed between the 3MBWT and lower extremity proprioception and TCMS (p > 0.05). A significant negative correlation was observed between the 3MBWT and FAQ (p < 0.05). No significant correlation was found between the 3MBWT and lower extremity muscle strengths (p > 0.05). A significant positive correlation was found only between hip extension proprioception and iliopsoas muscle strength (p = 0.023). There was no significant correlation between the FAQ and lower extremity muscle strength (p > 0.05). CONCLUSION: It was revealed that the backward walking ability increased as the forward walking function improved in children with CP, but it was not affected by proprioception, trunk control, and muscle strength. CLINICAL TRIALS: NCT05088629 (10/11/2021).

Investigation of the effectiveness of family collaborative physiotherapy programs applied to high-risk infants.

BACKGROUND: The inclusion of families in intervention programs for infants may be more effective in ensuring adherence and positive outcomes. Approaches that include natural and enriched environments that provide communication and family interaction are important in the rehabilitation of high-risk infants. OBJECTIVE: To compare the effectiveness of Family Collaborative Approach (FCA) and Neurodevelopmental Therapy (NDT)-based family training. METHODS: High-risk infants (n = 63) with a mean age of 32.60 ± 4.53 months received early intervention for 12 weeks. Prechtl's General movements (GMs) assessment, Hammersmith Neonatal Neurological Examination (HNNE), Hammersmith Infant Neurological Examination (HINE), BAYLEY-III Scales of Infant and Toddler Development, and Third Addition (BSID-III) were performed. RESULTS: Significant differences between groups were found in HINE scores at the 3rd, 6th, and 12th months (p ≤ .028), and in BSID-III scores at the 6th month (cognitive, language, and motor) (p < .001) and the 12th month (language) (p = .031). There was significant difference between NDT and control group in 3rd month HINE scores and Reflex&Reactions scores (p ≤ .021). FCA group and NDT group was significantly different from control group in 6th month HINE (p = .032) and 12th month HINE scores (p = .007). FCA group significantly different from NDT group (p ≤ .002) and control group (p < .001) in 6th month BSID-III cognitive, language, and motor scores. There was significant difference between FCA and control group in 12 month BSID-III language scores (p = .024). CONCLUSIONS: Early physiotherapy interventions were effective in high-risk infants and FCA program was superior to NDT.

The reliability and validity of the Figure of 8 walk test in mildly disabled persons with multiple sclerosis.

BACKGROUND: Figure of 8 Walk Test (F8WT) assesses the multidirectional and adaptive requirements of both straight and curved path walking. The study aimed to examine the reliability, validity, and minimal detectable change (MDC) of the F8WT in patients with Multiple Sclerosis (pwMS). METHODS: 45 mildly disabled pwMS (10 male, 35 female) were included in the study. Reliability of F8WT test was evaluated with Intraclass Correlation Coefficient (ICC). MDC estimates were calculated using baseline data. The correlation between the F8WT and Berg Balance Scale (BBS), The Timed Up and Go test (TUG), The Timed 25-Foot Walk Test (T25FW), The Four Square Step Test (FSST) was used for the validity. RESULTS: The intra-rater (ICC 0.980-0.983) and inter-rater (ICC 0.976-0.985) reliability of the F8WT was determined to be excellent. MDC values for intra-rater were 1.04-1.08 s, and MDC values for inter-rater were 1.16-0.99 s. The correlation with F8WT and BBS (p = 0.000, r = -0.702), TUG (p = 0.000, r = 0.854), T25FW (p = 0.000, r = 0.784), FSST (p = 0.000, r = 0.748) was found to be statistically significant. CONCLUSION: The F8WT has good reliability and validity in mildly disabled pwMS. According to the MDC results, small differences in pwMS can be adequately detected with F8WT. Therefore, it may be a clinically suitable test for detecting balance and walking.

The effects of different procedures on pain levels in preterm and term infants in neonatal intensive care unit: a cross-sectional survey of pain assessment in newborns.

BACKGROUND: Newborns show a series of behavioral and physiological reactions to painful stimuli. AIMS: The current study aimed to determine the effect of different procedures on the pain levels of newborns in the Neonatal Intensive Care Unit (NICU). METHODS: One hundred ninety-six newborns with gestational age (GA) of 23-40 weeks, birth weight (BW) between 2235 ± 911 g were included. Painful procedure (PP) (vascular access (VA), heel prick (HP), umbilical catheter (UC), orogastric catheter (OC), and intubation (I)) were recorded. Pain during the PP was evaluated with Neonatal Infant Pain Scale (NIPS). Pulse and O2 saturation were recorded before (BP), during (DP) and after (AP) procedure. RESULTS: NIPS total scores were found to be significantly higher with term infants (p < 0.05). When NIPS total scores were compared according to the type of PP, significant difference was observed between groups (p = 0.000). Positive correlation was found between birth week (p = 0.000, r = 0.364), BW of infants and NIPS total score (p = 0.000, r = 0.371), pulse values of DP and NIPS total score (p = 0.000, r = 0.386). Negative correlation was found between O2 saturation values DP and the NIPS total scores (p = 0.000, r = -0.405). CONCLUSIONS: It is concluded that as GA and BW increase, so do the pain responses of the infant, which showed that the pain thresholds of term-preterm infants are different, and decrease as GA and BW increase.

Validity and reliability of the 3-meter backward walk test in patients with multiple sclerosis.

BACKGROUND: The 3-meter backward walk test (3MBWT) evaluates neuromuscular control, proprioception, protective reflexes, fall risk, and balance. This study aimed to examine the reliability, validity, and minimal detectable change (MDC) of the 3MBWT in patients with Multiple Sclerosis (pwMS). METHODS: 40 pwMS (8 male, 32 female) were included in the study. The Intraclass Correlation Coefficient (ICC) was used for the reliability of the 3MBWT. MDC estimates were calculated using baseline data. The validity of the 3MBWT was evaluated by the correlation between The Timed Up and Go test (TUG), The 12-item Multiple Sclerosis Walking Scale (MSWS-12), The 2 Min Walk Test (2MWT), The Timed 25-Foot Walk Test (T25FW), and The Four Square Step Test (FSST) RESULTS: The intra-rater (ICC 0.944-0.945) and inter-rater (ICC 0.932-0.935) reliability of the 3MBWT was determined to be excellent. MDC values for intra-rater were 1.13-1.30 sec, and MDC values for inter-rater were 1.10-1.24 sec. The correlation with 3MBWT, TUG, MSWS-12, and 2MWT was found to be statistically significant. CONCLUSION: The 3MBWT was found to be valid and reliable in pwMS. It is a short and easily applied test in outpatient and inpatient clinics without any need for equipment. According to the MDC results, small differences in pwMS can be adequately detected with 3MBWT. Therefore, it may be a clinically suitable test for detecting subtle changes in synergistic motor functions related to prorioception in relapsing or remitting periods. It, also may add some more information on to EDSS data for following the disease progression as well as treatment responses.

Turkish Validity and Reliability of the Hammersmith Infant Neurological Examination (HINE) with High-Risk Infant Group: A Preliminary Study.

OBJECTIVE: The purpose of this study was to establish the reliability of the Turkish translation of the Hammersmith Infant Neurological Examination in infants at 8-12 months corrected age and compare Hammersmith Infant Neurological Examination scores to other predictive assessments. MATERIALS AND METHODS: Perinatal risk factors, term-age magnetic resonance imaging, general movements at 3-month corrected age, and 12-month corrected age The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) scores were obtained in 35 high-risk infants. The Hammersmith Infant Neurological Examination was evaluated using intra-rater and interrater reliability. Hammersmith Infant Neurological Examination scores were compared to the findings from the three other assessments. RESULTS: Intra-rater and inter-rater reliability was high (intraclass correlation coefficient = 1.00; intraclass correlation coefficient = 0.969, P < .001, 95% CI = 0.939-0.984, respectively). Global Hammersmith Infant Neurological Examination scores were significantly lower in infants with magnetic resonance imaging evidence of brain injury than without (P < .05) and in infants without general movements Fidgety movements (P < .05), than with. There was a significant positive correlation between global Hammersmith Infant Neurological Examination scores and Bayley Scales-III cognitive (P < .001), language (P < .001), and motor composite scores (P < .001). CONCLUSION: This study strongly supports the use of the Turkish translation of the Hammersmith Infant Neurological Examination. Users found it readily understandable and easy to use, and the scores were consistent with 3 different methods of predicting neurodevelopmental outcomes. These findings will aid the early diagnosis, management, and support for children with neurodevelopmental problems.

Effects of modified pilates on trunk, postural control, gait and balance in children with cerebral palsy: a single-blinded randomized controlled study.

OBJECTIVE: This study aimed to determine the effects of modified pilates exercises (MPE) and neurodevelopmental therapy (NDT) on trunk, postural control, gait, and balance in children with cerebral palsy (CP). METHODS: 18 children with CP between gross motor function classification system (GMFCS) I and III were randomized into two groups as study (Group A, MPE) and control (Group B, NDT). Physiotherapy (PT) took place 2 days a week for 8 weeks. Trunk control measurement scale (TCMS), seated postural control measurement (SPCM), pediatric reach test (PRT), pediatric berg balance measurement (PBBM), 6 minute walking test (6MWT), observational gait scale (OGS), core stability performance measurements, and muscle strength tests were performed. RESULTS: Mean age of group A (n = 9) was 9 ± 1.58 years, and group B (n = 9) was 10 ± 2.73 years. Significant differences were found in the SPCM posture (p = 0.000), TCMS (p = 0.004), OGS right (p = 0.019) and left (p = 0.001) scores, abdominal fatigue test (AFT) (p = 0.014), modified side bridge (MSBT) test (right p = 0.04, left p = 0.031), pressure biofeedback unit test (PBU) (p = 0.024), and sit-ups test (SUT) (p = 0.011) in favor of group A. According to the initial measurements of the percentage changes of the tests, significantly difference was found in PBBMR (p = 0.001), PBBML (p = 0.000), SPCM posture (0.001), TCMS (0.000), MBSTET (0.000), MSBT left (p = 0.034), AFT (p = 0.002), PBU (p = 0.015), SUT (p = 0.000), MPUT (p = 0.018), and OGS right (p = 0.029) in favor of group A. CONCLUSION: The results revealed that MPEs in children with CP positively affects trunk, postural control, gait, and balance compared to NDT. It is concluded that MPE can be used as an alternative treatment approach in children with CP. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION/STUDY START DATE/URL OF THE RECORD: NCT04035954/ 24/07/2019/ August 1, 2019/ https://clinicaltrials.gov/ct2/show/NCT04035954 .

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.