Effects of scapular exercises on trunk control in patients with acute stroke: a double-blind randomized controlled study.

PURPOSE/AIM: The ability to perform routine tasks during reaching and activities of daily living (ADLs) is impaired as a result of deterioration in the postural adjustments after stroke. Trunk stability is needed to maintain balance, correct scapular position and posture while moving the upper extremity. The objective was to examine the effect of scapular exercises on the scapular stability, trunk control and ADLs. MATERIALS AND METHODS: Patients (50-85 years) with acute hemiparetic stroke were participated in this double blind randomized controlled study. The patients in both group were treated with the exercise program according to the Bobath concept and isometric scapular exercises were applied to the study group in addition to these exercises. The participants in both groups were taken into the physiotherapy program for 5 days and each program were taken 30 min. Patient assessment included Lateral scapular slide test (LSST), Trunk Impairment Scale (TIS), Trunk Control Test (TCT), Modified Barthel Index (MBI) and Reaching Performance Test (RPT). RESULTS: Significant increases were observed distance in protraction, between protraction - retraction at 90° of shoulder abduction and flexion and retraction in 90° of shoulder abduction within both groups. Only the study group produced improvement in protraction of 90° of shoulder flexion (p < 0.05). While both groups achieved a significant improvement in TIS, MBI, RPT scores, TCT scores increased significantly only in study group (p < 0.05). CONCLUSIONS: The adding isometric scapular exercises to the rehabilitation program significantly increased the effectivity of neurorehabilitation on increasing trunk control, independence during ADLs, reaching performance and reducing trunk impairment.

Effects of whole body vibration on functional capacity and respiratory functions in individuals with stroke: A randomized controlled study.

BACKGROUND: Management of respiratory-related functional problems using sensory rehabilitation strategies has been poorly researched in patients with stroke. OBJECTIVE: This study aimed to investigate whether whole body vibration (WBV) training has an effect on functional capacity and respiratory functions in patients with stroke. METHODS: In the randomized-controlled study, 28 participants were randomized into two groups: one receiving Neurodevelopmental Treatment (NDT; n = 13) and one receiving both NDT and WBV (NDT + WBV; n = 15). The primary outcome measures were 6-Minute Walking Test (6MWT) and Pulmonary Function Test which evaluate functional and respiratory capacity. Secondary outcome included the chest circumference measurement to evaluate the thoracic expansion ability. RESULTS: Both groups showed positive significant changes in walking distance and maximum oxygen consumption volume (VO2max), inspiratory capacity, vital capacity and chest circumference measurement scores (p < 0.05). While the NDT +WBV group showed a significantly greater increase in walking distance and VO2max levels than the NDT group (p < 0.05), there were no significant group differences in respiratory function flow and volume parameters, and chest circumference measurement. CONCLUSION: The addition of WBV training to the treatment program has some incremental benefits on increasing functional capacity and thoracic expansion, and rehabilitating respiratory dysfunction.

The Effects of Trunk Impairment on Fatigue and Balance in Children with Cerebral Palsy.

Cerebral palsy (CP) involves trunk impairment, leading to decreased postural control that is an important contributor to problems maintaining daily activities without undue fatigue. Our aim in this research was to determine the effects of trunk impairment on fatigue and balance in children with hemiplegic CP. We included 65 ambulatory children with CP in this cross-sectional study, and we grouped them into those with greater trunk impairment (Group 1, n = 33) and lesser trunk impairment (Group 2, n = 32) according to their scores on the Trunk Imparment Scale (TIS). We assessed their fatique level using the Pediatric Quality of Life Inventory™ Version 4.0 Multidimensional Fatigue Scale (PedsQL-MFS), and their balance ability using the Pediatric Balance Scale (PBS). We found that the PedsQL-MFS parameters, except the general and cognitive fatigue scores, were significantly better for participants in Group 2 than in Group 1; however Group 2 showed significantly higher scores for balance ability than did Group 1 (p < .001). All of the TIS parameters were significantly correlated with sleep/rest fatigue, and PBS scores and trunk coordination were also significantly correlated with general fatigue (p = .013) and cognitive fatigue (p = .003) which are subparameters of the PedsQL-MFS and PBS (p < .001). However static balance was highly and negatively correlated with cognitive fatigue (p < .037).Increased trunk impairment contributed to the exacerbation of fatigue and balance problems in children with hemiplegic CP. Inadequate trunk control was associated with poor sleep and poor resting quality rather than perceived general and cognitive fatigue.

The effects of hemiplegic shoulder pain on upper extremity motor function and proprioception.

BACKGROUND: Hemiplegic shoulder pain (HSP) after stroke has negative effects on functional use of hemiplegic arm. OBJECTIVE: This study aimed to investigate the effects of HSP on upper extremity motor function and proprioception. METHODS: Hundred and twenty-two patients with hemiplegia were included in this study. The patients' shoulder pain was evaluated by Visual Analog Scale. According to pain scores, patients were divided into two groups as group with HSP (Group 1, n = 76) and group without HSP (Group 2, n = 46). Upper extremity motor function level and proprioception were assessed by using Fugl Meyer Motor Function Scale and the Laser-pointer Assisted Angle Reproduction Test for the 45°, 60° and 90° of shoulder flexion. RESULTS: Upper extremity motor function and shoulder's proprioceptive sense at each angles of group 1 were found significantly worse than group 2's (p≤0.005). Correlation analysis revealed a significant positive correlation between HSP severity, and upper extremity motor dysfunction and proprioceptive impairment (p < 0.005). CONCLUSIONS: Presence of HSP is one of the main determinators of upper extremity motor function level and proprioceptive ability at different angles. Management of HSP can make a significant contribution to sensorimotor integration by leading to recovery in the motor function and proprioceptive acuity.

The Turkish version of the Modified Falls Efficacy Scale: reliability and validity from the viewpoint of balance

Background/aim: The factors associated with fall-related self-efficacy should be addressed, especially in the elderly. The Modified Falls Efficacy Scale (MFES) is a simple instrument with good scaling properties and reliability. The aim of the present study was to determine the reliability and the validity of the Turkish version of the MFES from the viewpoint of balance. Materials and methods: In this study, 164 participants aged >65 years were included. The use of walking aids and assistive devices, history and frequency of falls in the previous year, living environment, and exercise habits were noted. Balance and risk of falling were assessed with the Berg Balance Scale (BBS). A forward-backward translation procedure was used for the Turkish version of the MFES. Results: None of the 14 items in the MFES were modified. The Turkish version of the MFES has excellent internal consistency (Cronbach's alpha, 0.978) and reliability (interclass correlation coefficient, 0.928­0.982), and its construct validity was supported by its ability to distinguish between the groups with respect to fall-risk factors and balance. According to the BBS scores, the high-fall-risk group had lower MFES scores than the moderate- and low-fall-risk groups (χ2 = 34.153, P = 0.001). Conclusion: The Turkish version of the MFES is a sensitive instrument for evaluation of fall-related confidence while carrying out indoor/outdoor activities. It also predicts falls, reduced physical activity, balance and mobility problems, and restricted social participation and daily living activities.

Effect of proprioceptive training on balance in patients with chronic neck pain.

OBJECTIVES: The aim of this randomized controlled study was to investigate the effect of proprioceptive training on balance in patients with chronic neck pain (CNP). METHODS: Forty patients participating in the study were randomly divided into study and control groups. Both of the groups underwent conventional physical therapy; additionally, the study group was rehabilitated with gaze direction recognition exercise (GDRE) for proprioceptive training. Exercises were performed during 3 weeks with five sessions per week. Pain intensity [visual analog scale (VAS)], neck disability [Neck Disability Index (NDI)], and balance [four step square test (FSST), single leg balance test (SLBT) with eyes opened and closed] assessments were conducted in the patients before and after the treatment and 3 weeks after the last session. RESULTS: No differences were observed between the groups in terms of pre-treatment measurements. There was a statistically significant decrease in VAS scores in both groups compared with pre-treatment conditions (p<0.05). In addition, whereas a statistically significant improvement in the study group's NDI, FSST, and SLBT with eyes opened and closed scores was observed after the treatment, pre- and post-treatment results were similar in the control group (p>0.05). CONCLUSION: Proprioceptive training should be included in physiotherapy programs to improve balance; it decreases the disability level in patients with CNP.

The relationship between physical fitness and falling risk and fear of falling in community-dwelling elderly people with different physical activity levels.

BACKGROUND/AIM: The aim of this research was to determine the effects of physical activity level (PAL) and physical fitness on falling parameters in community-dwelling elderly people. MATERIALS AND METHODS: Seventy-six elderly people were grouped as low PAL group (group 1, n: 38) and high PAL (group 2, n: 38) according to their PAL scores. PAL was measured by the Physical Activity Scale for the Elderly and muscle strength, muscle endurance, aerobic endurance, and flexibility tests were applied; body mass index (BMI) was calculated for physical fitness measurement. Fall assessment included falling risk (Berg Balance Scale), dynamic balance (Time Up and Go Test), and fear of falling (FOF) (Falls Efficacy Scale) evaluation. RESULTS: While physical fitness parameters except flexibility in group 2 were significantly better than they were in group 1 (P < 0.05), no significant difference was found between the groups with regard to fall assessments (P ˃ 0.05). In both groups, while physical fitness parameters except BMI showed a positive and low or medium significant correlation with falling risk and FOF, the same fitness parameters showed a negative and low or medium significant correlation with dynamic balance. CONCLUSION: The results show that PAL may have an indirect effect on fall parameters by increasing physical fitness.