Impact of central sensitization on clinical parameters in patients with rheumatoid arthritis.

OBJECTIVE: This study aimed to investigate the effects of central sensitization (CS) on pain sensitivity, disease activity, neuropathic symptoms and quality of life (QoL) in patients with rheumatoid arthritis (RA). METHODS: Sixty patients diagnosed with RA according to the American College of Rheumatology and the European League Against Rheumatism (ACR/EULAR) 2010 classification criteria were included in the study. Patient assessment tools included visual analog scale (VAS) for pain, algometer for pain pressure threshold (PPT), disease activity score in 28 joints (DAS-28) for disease activity (DA), central sensitization inventory (CSI) for CS and rheumatoid arthritis QoL questionnaire for QoL. RESULTS: Central sensitization was identified in 29 (48.3%) patients. Although erythrocyte sedimentation rate (ESR), C-reactive protein and swollen joint count were comparable between patients with or without CS, higher VAS, tender joint count and DAS-28 scores were observed in patients with CS (all p<0.05). Pain pressure thresholds (PPT) at the wrist (PPTW) and the trapezius muscle (PPTT) were lower in patients with CS (p=0.004, p=0.001, respectively). It was found that neuropathic pain components increased and quality of life decreased as CSI scores increased (all p=0.000). CONCLUSION: The presence of CS leads to pain sensitivity as well as overestimation of disease activity in RA patients. The presence of CS should not be overlooked in RA patients to avoid overtreatment for inflammation and to determine the treatment need for nociplastic pain.

Effects of trunk stabilization exercises on balance, functionality and abdominal muscle thickness in hemiplegic patients.

Objectives: This study aims to investigate the effects of trunk stabilization exercises (TSEs) in addition to conventional exercises in patients with stroke on balance, functionality and abdominal muscle thickness as measured by ultrasonography (USG) and to compare the patients' non-paretic side abdominal muscle thickness with healthy population. Patients and methods: Between April 2019 and June 2019, a total of 26 hemiparesis/hemiplegic patients with stroke (15 males, 11 females; mean age: 62.3±7.8 years; range, 52 to 71 years) confirmed by neurological examination or computed tomography (CT) / magnetic resonance imaging (MRI) and 20 age-matched healthy volunteers (12 males, 8 females; mean age: 62.3±7.2 years; range, 53 to 70 years) were included in the study. The patients were randomized into two groups. In the first group (n=13), TSE were performed in addition to conventional neurorehabilitation program, five times/week for a total of four weeks. The second group (n=13) was given conventional neurorehabilitation program, five times/week for a total of four weeks. Also, healthy volunteers as the third group were compared with the patient population. The evaluations were made at the beginning and end of the treatment. The Berg Balance Scale (BBS), Barthel Index (BI), Postural Assessment Scale for Stroke Patients (PASS), and Functional Reach Test (FRT) were used. Abdominal muscle thickness at rest and contraction were evaluated using USG. Results: Ten patients in Group 1 and 10 patients in Group 2 completed study. A significant improvement was observed in all abdominal muscles in both groups (p<0.05), indicating no significant difference between the groups (p>0.05). There was a statistically significant improvement for BBS and FRT in both groups. The PASS and BI scores showed a significant improvement only in TSE group. Conclusion: Both the TSE and conventional neurorehabilitation program provided significant improvements in abdominal muscle thickness, balance and trunk control. For postural control and functionality, additional TSE seems to be more effective.

Can Early Fatigue in Leg Muscles After Exercise Cause Postural Instability in Women With Fibromyalgia?

OBJECTIVES: This study aimed to investigate the effects of exercise-induced lower limb muscle fatigue on postural stability in female patients with fibromyalgia (FMS). METHOD: This study included 19 female patients diagnosed with FMS according to the 2010 American College of Rheumatology criteria and 19 age-matched healthy controls. Muscle fatigue was induced by chair sit-to-stand (STS) repetitions in all participants. Postural stability was evaluated before and immediately after muscle fatigue test (MFT) in standard bipedal and tandem stances with eyes open (EO) and eyes closed (EC), and in single leg stance with EO using a foot pressure platform. RESULTS: The mean number of STS repetitions on MFT was lower in FMS patients (p<0.001). Before MFT, plantar center of pressure (CoP) excursions was greater in FMS patients versus controls in all postures tested except in EO bipedal stance (all p<0.01). Postural sway increased post-MFT in both FMS and control groups in all stances (all p<0.001). Post-MFT increase in postural sway was greater in the FMS group versus controls (all p<0.05). CONCLUSION: Lower limb muscle fatigue occurs earlier in FMS patients than in healthy individuals and exacerbates postural stability problems. This indicates the importance of planning tailored exercise programs for these patients.

The relationship of multifidus and gastrocnemius muscle thickness with postural stability in patients with ankylosing spondylitis.

Objectives: This study aimed to investigate potential changes in the thickness of the multifidus and gastrocnemius muscles and to demonstrate the association of muscle thickness with postural stability in ankylosing spondylitis (AS) patients. Patients and methods: The cross-sectional observational study enrolled 32 AS patients (23 males, 9 females; mean age: 39.4±7.2 years; range, 18 to 65 years) diagnosed according to the modified New York criteria and 32 healthy controls (22 males, 10 females; mean age: 36.6±7.5 years; range, 18 to 65 years) between April 2017 and October 2018. Plantar center of pressure (CoP) excursions were recorded using a pressure platform to evaluate postural stability. The thickness of the lumbar multifidus and gastrocnemius muscles was measured using ultrasound. Results: Patients with AS showed reduced muscle thickness at the multifidus (p<0.05) muscle and medial gastrocnemius (p=0.002) and lateral gastrocnemius (p=0.002) muscles compared to controls. Increased CoP excursions were observed only in the anteroposterior direction in the double-leg (standard) stance with the eyes closed (p=0.003) and in both anteroposterior and mediolateral directions in tandem and single-leg stances (all p<0.05). Center of pressure excursions in standard stance with the eyes closed were negatively correlated with all muscle thickness values (all p<0.05). In the single-leg stance, CoP excursions were negatively correlated with muscle thickness of medial gastrocnemius (p=0.008) and lateral G (p=0.016) muscles. Conclusion: Early planning of exercise programs taking muscle loss into account can help improve balance and thereby prevent falls and fractures in AS patients.

Evaluation of hepatitis serology and frequency of viral reactivation in patients with inflammatory arthritis receiving biologic agents: a multicenter observational study.

To evaluate of hepatitis serology and reactivation frequency in patients with rheumatic disease receiving biologic agents. Our study included patients with inflammatory rheumatic diseases from 23 centers, who were followed up with biological therapy. Demographic and clinical characteristics of the patients, duration of drug use and hepatitis serology and the state of viral reactivation were analyzed. A total of 4060 patients, 2095 being males, were included in our study. Of the patients, 2463 had Ankylosing Spondylitis (AS), 1154 had Rheumatoid Arthritis (RA), 325 had Psoriatic Arthritis (PsA), and 118 had other inflammatory rheumatic diseases. When the viral serology of the patients was evaluated, 79 patients (2%) who were identified as HBs Ag positive, 486 (12%) patients who were HBs Ag negative and anti-HBc IgG positive and 20 patients (0.5%) who were anti-HCV positive. When evaluated on a disease-by-disease basis, the rate of HBsAg was found to be 2.5% in RA, 2% in AS and 0.9% in PsA. Viral reactivation was detected in 13 patients while receiving biologic agents. HBs Ag was positive in nine patients with reactivation and negative in four patients. Anti-HBc IgG, however, was positive. Six of these patients had AS, four had RA, and three had PsA. The development of hepatitis reactivation in 11.4% of HBs Ag positive patients and 0.82% of anti-HBc IgG positive patients due to the use of biologic agents is an important problem for this group of patients. Antiviral prophylaxis is recommended to be started especially in patients who are HBs Ag positive and who are using biologic agents due to viral reactivation. Therefore, it is important to carry out hepatitis screenings before biologic agent treatment and to carefully evaluate the vaccination and prophylaxis requirements.

Ultrasonographic evaluation of muscle thickness in female patients with fibromyalgia and its relationship with clinical parameters.

OBJECTIVE: The aim of this study was to compare the ultrasonographic thickness of selected major muscles of patients with fibromyalgia syndrome (FMS) and asymptomatic control subjects and to evaluate the relationship between muscle thickness and muscle strength, physical performance, kinesiophobia, and clinical variables. METHODS: Twenty-two FMS patients and 18 asymptomatic control cases who applied to the physical medicine and rehabilitation outpatient clinic were included. The thickness of the gastrocnemius medialis/lateralis, trapezius, and upper arm muscle was evaluated with ultrasonography. Muscle strength was evaluated with hand grip strength, muscle performance with chair stand test (CST), walking performance with 10 m walking test, disease severity with Fibromyalgia Impact Questionnaire-Revised, pain severity with VAS, and kinesiophobia with TAMPA kinesiophobia scale. RESULTS: The mean thickness values of all the muscles measured were significantly decreased in the FMS group compared with the control (p<0.05). There were positive correlations between gastrocnemius medialis/lateralis and upper arm muscle thickness with hand grip strength (p<0.01, r=0.602, r=0.663, r=0.567, respectively) and positive correlations between gastrocnemius medialis/lateralis muscle thickness with CST (p<0.05, r=0.507, r=0.512, respectively). TAMPA was significantly negatively correlated with gastrocnemius medialis/lateralis and upper arm muscle thickness. CONCLUSION: Muscle thickness, strength, and performance decrease in FMS patients. This reduction in muscle strength, performance, and size is associated with kinesiophobia. Strengthening exercises should be included in the management of FMS patients. However, caution should be exercised when prescribing exercises that require extreme muscle performance, considering that it may cause kinesiophobia.

An Uncommon Presentation of a Rare Syndrome: Parsonage-Turner Syndrome Presenting With C8 Root Involvement.

Parsonage-Turner syndrome or neuralgic amyotrophy is a rare syndrome that presents with sudden and severe pain in the shoulder girdle and may cause loss of muscle strength, atrophy, and sensory deficits. We discuss the clinical and electroneuromyographic findings in a young woman who presented with left-sided arm pain and was diagnosed with Parsonage-Turner syndrome with C8 root involvement, which is a rare presentation of the disease.

Effect of Pilates mat exercise and home exercise programs on pain, functional level, and core muscle thickness in women with chronic low back pain.

BACKGROUND: To investigate the effects of Pilates exercise in patients with chronic non-specific low back pain (CNLBP) by training core stabilization muscles in aspects such as: pain, functional level, depression, quality of life, and muscle thickness measured by Ultrasound Imaging (UI) and to compare it with home based exercise. METHODS: A prospective, randomized-single blinded study included 60 female patients with CNLBP. Patients were randomized into Pilates (group 1) or home exercise group (group 2) three times/week for eight weeks. The evaluations were made at the beginning and end of the treatment. Outcome parameters were VAS, Oswestry Disability Index, Qubec Disability Scale, Short Form-36, Beck Depression Questionnaire, sit and reach, Modified Schöber and sit up tests. Multifidus and abdominal muscle thickness were measured by UI. RESULTS: Significant improvement has been observed in all parameters in both groups. It was found that Group 1 was more effective in terms of all parameters (p < 0.05). CONCLUSIONS: Both Pilates and home exercises are effective in treating patients with chronic low back pain. UI can be useful for evaluating the core muscle thickness progression of chronic low back pain patients who are undergoing exercise therapy.

Comparison of effects of low-level laser therapy and extracorporeal shock wave therapy in plantar fasciitis treatment: A randomized, prospective, single-blind clinical study.

OBJECTIVES: The aim of this study is to compare the efficacy of extracorporeal shock wave therapy (ESWT) and low-level laser therapy (LLLT) in terms of fascia thickness, heel pain, and foot functions in patients with plantar fasciitis (PF). PATIENTS AND METHODS: Between April 2015 and October 2015, a total of 34 patients (5 males, 29 females; mean age 51.5±10.8 years; range, 18 to 65 years) with PF were randomized into two treatment groups to receive either ESWT or LLLT using closed envelope method. The patients were evaluated before and after treatment and one month after treatment using the visual analog scale (VAS)-pain, Foot Function Index (FFI), and plantar fascia thickness measured by ultrasonography. RESULTS: A significant improvement in the VAS-pain and FFI scores and plantar fascia thickness was observed in both groups after treatment and one month after treatment, compared to pre-treatment values (p<0.05). Changes over time in these outcome parameters were not different between study groups (p>0.05). CONCLUSION: Our study results suggest that both ESWT and LLLT seem to be effective on pain, foot functions, and fascia thickness in the treatment of PF.Presented at the 26th National Congress of Physical Medicine and Rehabilitation, April 25-29, 2017 Antalya, Turkey.

Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis.

OBJECTIVE: The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound (US) in the treatment of lateral epicondylosis (LE). METHODS: Our study enrolled 50 patients with LE. Patients were randomized into two groups. Group 1 underwent therapeutic US (n = 24; 5 males and 15 females; mean age: 43.75 ± 4.52) Group 2 underwent ESWT (n = 20; 8 males and 16 females; mean age: 46.04 ± 9.24). Patients were evaluated at baseline, after treatment,and 1 month following treatment. The outcome measures were the visual analog scale (VAS), algometer, grip dynamometer, quick-disability of the arm,shoulder,and hand (QDASH), patient-rated tennis elbow evaluation (PRTEE), and Short Form-36 (SF-36) health survey questionnairre. RESULTS: Both groups showed significant improvements in terms of VAS (all p values < 0.0001), dynamometer (p = 0.001 vs p = 0.015), algometer (all p values < 0.0001), PRTEE (all p values < 0.0001), QDASH (all p values < 0.0001), and SF-36 scores (p = 0.001 vs p = 0.005) within time. There was no significant difference between the two groups, except algometer scores in favor of ESWT (p = 0.029). CONCLUSION: ESWT and therapeutic US are equally effective in treating LE. ESWT is an alternative therapeutic intervention and as effective as US. LEVEL OF EVIDENCE: Level III, Therapeutic study.

The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study

Background/aim: Increased neuropathic pain (NP) symptoms are seen in rheumatologic diseases such as fibromyalgia, osteoarthritis, and rheumatoid arthritis, but no studies have demonstrated a relationship between ankylosing spondylitis (AS) and NP except for a brain imaging study. The aim of this study was to estimate the presence of NP in patients with AS and to investigate how NP was related to disease activity, functional status, and quality of life. Materials and methods: A total of 100 AS patients (71 males and 29 females; median age: 37 years, range: 18­71 years) were included in the study. Pain (visual analog scale (VAS) and the painDETECT questionnaire), disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Patient Global Assessment of Disease Activity (PGA), and Ankylosing Spondylitis Disease Activity Score (ASDAS)), functional level (Bath Ankylosing Spondylitis Functional Index (BASFI)), and health-related quality of life (36-Item Short Form Survey (SF-36)) were evaluated. Patients were divided into two groups. Group 1 included patients with possible or likely NP symptoms (painDETECT score of ≥13) and Group 2 included patients without NP symptoms (painDETECT score of <13). Results: Low back pain-VAS, peripheral joint-VAS, BASDAI, PGA, ASDAS, and BASFI scores were significantly higher in Group 1 compared to those of Group 2 (P < 0.05). The SF-36 physical component (PC) score was significantly lower in Group 1 compared to that of Group 2 (P < 0.05). There were no significant differences between the groups regarding SF-36 mental component (MC) scores, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values and MASES scores. Total painDETECT scores correlated positively with low back pain-VAS, peripheral joint-VAS, morning stiffness-VAS, BASDAI, ASDAS-CRP, ASDAS-ESR, PGA, BASFI, and MASES scores and ESR values, and inversely with SF-36 PC scores. Conclusion: Our results suggest that AS patients should be evaluated in terms of NP in order not to underestimate NP. If clinicians find evidence of likely NP, they should treat the patient with drugs that target NP.

Economic burden of stroke.

OBJECTIVES: This study aims to estimate the annual economic cost per hemiplegic patient in Turkey. PATIENTS AND METHODS: Between September 2014 and December 2014, a total of 84 hemiplegic patients (53 males, 31 females; mean age 61.4±13.5 years; range 28-89 years) with stroke for 12 months were included in the study. Type of cerebrovascular accident and complications were evaluated. Hospital records and data from the relatives of the patients were used to calculate the cost. Annual costs were evaluated starting from first hospitalization. Direct costs were calculated with the sum of hospital care (acute care, diagnostic investigations, treatment and rehabilitation), medications, medical visits, outpatient rehabilitation and orthopedic aids. Indirect costs were calculated by taking the income loss due to absence from work into consideration. Prices of medical resources were obtained from the 2014 Healthcare Implementation Notification payment list. RESULTS: At the end of the study, the average direct cost and indirect cost per patient were calculated respectively as 10,594.90±6,554.20 Turkish liras and 9,357.10±10,195.60 Turkish liras (4,606.47±2,849.65 USD and 4,068.30±4,432.86 USD). We found a negative correlation between total cost and age (p=0.001), and a positive correlation with duration of hospitalization (p=0.001) and number of complications (p=0.049). We were unable to find any relation of cost with sex and cerebrovascular accident type. Spasticity (p=0.028) and epilepsy (p=0.037) being among the complications were observed to increase the cost. CONCLUSION: Stroke is an important economic burden for Turkish population. Preventive social measures are necessary to reduce this cost.

Association of neuropathic pain with ultrasonographic measurements of femoral cartilage thickness and clinical parameters in patients with knee osteoarthritis.

[Purpose] The aim of this study was to investigate whether neuropathic pain is associated with femoral condylar cartilage thickness, electrical pain threshold, and clinical parameters in patients with knee osteoarthritis. [Subjects and Methods] Sixty patients over the age of 40 diagnosed with knee osteoarthritis were enrolled. The PainDETECT questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Hospital Anxiety and Depression Scale, and Short Form-36 questionnaire were completed for all patients. Electrical sensory threshold and electrical pain threshold measurements were obtained. Femoral condylar cartilage thickness was determined by means of ultrasound. [Results] PainDETECT scores of 13 or greater were observed in 28 (46.7%) patients, indicating the presence of neuropathic pain. These patients were found to have greater average pain severity, Western Ontario and McMaster Universities Osteoarthritis Index, and depression and anxiety scores and lower Short Form-36 scores than patients without neuropathic pain. Patients with neuropathic pain showed lower knee electrical sensory threshold and pain threshold values on average than patients without neuropathic pain. Femoral condylar cartilage thickness was not different between the two groups. [Conclusion] Neuropathic pain is associated with increased pain severity and decreased functional capacity and adversely affects quality of life and mood in patients with knee osteoarthritis.

Efficacy of kinesio tape application on pain and muscle strength in patients with myofascial pain syndrome: a placebo-controlled trial.

[Purpose] The purpose of this study was to determine the short- and mid-term effects of Kinesio taping on the trapezius muscle in individuals with myofascial pain syndrome. [Subjects and Methods] Thirty-seven patients with active upper trapezius myofascial trigger points were randomly divided to 2 groups: group 1 received Kinesio taping for the upper trapezius muscle, and group 2 received a sham Kinesio taping application. Neck pain (Visual Analog Scale and pressure algometry) and trapezius muscle strength data were collected at baseline, immediately after Kinesio taping application, and at one month follow-up. [Results] The mean changes in Visual Analog Scale scores were significantly different between groups at T2 and T1, with less pain in group 1. The mean changes in algometry scores were significantly different between groups at T3 compared with T2 in favor of group 1. The mean changes in trapezius muscle strength were significantly different between the groups at T2 compared with T1 in favor of group 1. [Conclusion] Patients with myofascial pain syndrome receiving an application of Kinesio taping exhibited statistically significant improvements in pain and upper trapezius muscle strength.

Diagnostic Significance of Ultrasonographic Measurements and Median-Ulnar Ratio in Carpal Tunnel Syndrome: Correlation with Nerve Conduction Studies.

BACKGROUND AND PURPOSE: We determined the reliability of ultrasonography (US) measurements for diagnosing carpal tunnel syndrome (CTS) and their correlation with symptom duration and electrophysiology findings. We determined whether the ratio of the median-to-ulnar cross-sectional areas (CSAs) can support CTS diagnoses. METHODS: The pisiform CSA (CSA(pisiform)), swelling ratio (SR), palmar bowing, and CSA(pisiform)/ulnar CSA (CSA(ulnar)) measurements made in two subgroups of CTS patients (having sensory affection alone or having both sensory and motor affection) were compared with controls. CSA(ulnar) was measured in Guyon's canal at the level of most-protuberant portion of the pisiform bone. RESULTS: The values of all of the measured US parameters were higher in patients with CTS (n=50) than in controls (n=62). CSA(pisiform) could be used to diagnose CTS of mild severity. All of the parameters were positively correlated with the distal latency of the compound muscle action potential, and all of them except for SR were negatively correlated with the sensory nerve conduction velocity. A CSA(pisiform)/CSA(ulnar) ratio of ≥1.79 had a sensitivity of 70% and a specificity of 76% for diagnosing CTS. CONCLUSIONS: Only CSA(pisiform) measurements were reliable for diagnosing early stages of CTS, and CSA(pisiform)/CSA(ulnar) had a lower diagnostic value for diagnosing CTS.

Pregabalin-induced hyperprolactinemia in a patient with fibromyalgia: A case report.

Several pharmacological and non-pharmacological modalities have been proposed for the treatment of fibromyalgia syndrome (FMS), a common rheumatic disease. Pregabalin is suggested as a first-step medication for FMS in the newest guidelines. Drowsiness, dizziness, and peripheral edema are well-known side effects of pregabalin; however, mastalgia is rarely seen. Presently described is a case of FMS in a patient who developed mastalgia and hyperprolactinemia (HPL) while taking pregabalin.

Relation of physical activity level with quality of life, sleep and depression in patients with knee osteoarthritis.

OBJECTIVE: In the present study, we aimed to investigate the effects of physical activity level on the quality of life, depression, sleep quality and functional capacity in elderly patients with knee osteoarthritis (OA). METHODS: Fifty-five patients over 65 years of age (age range: 65-84 years) with knee osteoarthritis were enrolled in the study. Patients were divided into two groups including Insufficient Activity Group (IAG) and Physically Active Group (PAG) according to their responses to the International Physical Activity Questionnaire. Radiological OA grading was performed using Kellgren-Lawrence classification system. Patients were evaluated using Short-Form 36 (SF-36) questionnaire, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Mean age, body mass indices, mean pain scores and gender distribution were comparable between the two groups. WOMAC physical function scores were lower in the Physically Active Group (p=0.01). Mean PSQI scores did not differ statistically significantly between the two groups (p=0.242). Mean BDI score of PAG was significantly lower compared to that of IAG (p=0.015). Mean SF-36 physical function (p=0.044), physical role (p=0.008) and physical component (p=0.016) scores of the Physically Active Group were significantly higher vs Insufficient Activity Group. CONCLUSION: Maintaining a high physical activity level reduces the possibility of depression and improves the quality of life and functional capacity in geriatric patients with knee osteoarthritis.

The effects of neuromuscular electrical stimulation on clinical improvement in hemiplegic lower extremity rehabilitation in chronic stroke: a single-blind, randomised, controlled trial.

OBJECTIVE: In this study, the effectiveness of neuromuscular electrical stimulation (NMES) was evaluated in lower extremity rehabilitation in patients with chronic stroke. METHOD: The study enrolled 40 patients with chronic stroke. Twenty patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received NMES treatment for hemiplegic foot dorsiflexor muscles for 4 weeks, 5 days a week. The sessions were performed as one session per day and added to a total of 20 sessions. Clinical parameters were evaluated before and after the treatment. RESULTS: Pre-treatment and post-treatment evaluations showed a significant increase in ankle dorsiflexion and a significant decrease in the level of spasticity in the treatment group (p < 0.05); however, there were no significant differences in the control group between the pre-treatment and post-treatment measures. Although Brunnstrom Stage, Rivermead leg and trunk score and Functional Independence Measurement motor subscore showed a significant improvement in pre- and post-treatment comparisons for both groups, the treatment group's scores were significantly higher than the control group (p < 0.05). Functional Ambulation Categories showed a significant improvement in both groups following the treatment; however, there was no significant difference between the two groups (p > 0.05). CONCLUSIONS: Use of NMES in hemiplegic foot dorsiflexion can contribute to the clinical improvement of patients when used in combination with rehabilitation programs.