Fizyoterapi ve Rehabilitasyon Bölümü / Department of Physiotherapy and Rehabilitation

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    Intraoperative experiments combined with gait analyses indicate that active state rather than passive dominates the spastic gracilis muscle's joint movement limiting effect in cerebral palsy
    (2019-08) Cemre, S.Kaya; bilgili, fuat; akalan, ekin; Temelli, Yener; Ateş, Filiz; Yücesoy, Can A.
    In cerebral palsy, spastic muscle's passive forces are considered to be high but have not been assessed directly. Although activated spastic muscle's force-joint angle relations were studied, this was independent of gait relevant joint positions. The aim was to test the following hypotheses intraoperatively: (i) spastic gracilis passive forces are high even in flexed knee positions, (ii) its active state forces attain high amplitudes within the gait relevant knee angle range, and (iii) increase with added activations of other muscles. METHODS: Isometric forces (seven children with cerebral palsy, gross motor function classification score = II) were measured during surgery from knee flexion to full extension, at hip angles of 45° and 20° and in four conditions: (I) passive state, after gracilis was stimulated (II) alone, (III) simultaneously with its synergists, and (IV) also with an antagonist. FINDINGS: Directly measured peak passive force of spastic gracilis was only a certain fraction of the peak active state forces (maximally 26%) measured in condition II. Conditions III and IV caused gracilis forces to increase (for hip angle = 45°, by 32.8% and 71.9%, and for hip angle = 20°, by 24.5% and 45.1%, respectively). Gait analyses indicated that intraoperative data for knee angles 61-17° and 33-0° (for hip angles 45° and 20°, respectively) are particularly relevant, where active state force approximates its peak values. INTERPRETATION: Active state muscular mechanics, rather than passive, of spastic gracilis present a capacity to limit joint movement. The findings can be highly relevant for diagnosis and orthopaedic surgery in individuals with cerebral palsy.
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    Does clinically measured ankle plantar flexor muscle strength or weakness correlate with walking performance in healthy individuals?
    (2018) Akalan, N.Ekin; Kuchimov, Shavkat Nadir; Apti, Adnan; Temelli, Yener; Ören, Merve; Nene, Anand
    OBJECTIVE: Muscle strength is usually measured using isometric hand-held dynamometers (HHDs) in the clinic. However, during functional activities, the muscle acts more dynamically. The aim of this study was to investigate the relation between clinically measured plantar flexor (PF) muscle strength (PFMS) and laboratory measurements of peak ankle plantar flexion power generation (APFPG), peak ankle moment (PAM), peak plantar flexion velocity (PFV) and mean gait velocity in healthy participants. METHODS: The maximum PFMS on non-dominant sides in 18 able-bodied persons 23.88 (SD 3.55 years) was measured before (Pre-S) and after a stretching (Post-S) procedure (135 sec. x 13 rep. with 5 sec. rest) by using a HHD. The stretching procedure was used to generate temporary PF muscle weakness. Gait analysis was carried out for Pre-S and Post-S conditions. Normalized (by weight and height) and non-normalized HHD scores and differences for both conditions were correlated by Pearson correlation coefficient calculations (p < 0.05). RESULTS: Reduced PFMS (%23, p < 0.001) in Post-S, according to the HHD scores, has only a weak correlation with APFPG (r > 0.3, p < 0.5). Gait velocity was found to be strongly correlated with APFPG only in the Post-S condition (r = 0.68, p < 0.002). HHD scores and PAM were moderately correlated with the non-normalized Post-S condition (r = 0.44, p = 0.70) and strongly correlated with the non-normalized Pre-S condition (r = 0.62, p < 0.01). DISCUSSION: HHD scores of plantar flexor muscles give very limited information about the PF performance during walking in healthy individuals. Simple normalization did not improve the relations. Clinically measured isometric muscle strength and muscle weakness have only moderate strengths for establishing a treatment protocol and for predicting performance during walking in neurologically intact individuals.
  • Publication
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    Evaluation of the effects of neural therapy in patients diagnosed with fibromyalgia
    (2019) Altınbilek, Turgay; Terzi, Rabia; Başaran, Aynur; Tolu, Sena; Küçüksaraç, Seher
    Objectives: This study aims to compare the effects of neural therapy and exercise on pain, quality of life, depression, anxiety, and functioning status in patients diagnosed with fibromyalgia syndrome (FMS). Patients and methods: This multi-center study included a total of 72 patients (60 females, 12 males; mean age: 39.2 +/- 9.5 years; range, 22 to 53 years) who were diagnosed with FMS according to the 1990 American College of Rheumatology (ACR) criteria between January 2015 and June 2015. The patients were randomly divided into two groups: the first group (n=30) received an exercise program (strengthening, stretching, relaxation, and aerobic exercises, three days a week), and the second group (n=42) received a total of six sessions of neural therapy as one session a week in addition to the same exercise program. Pain severity was assessed with the Visual Analog Scale (VAS), emotional state with the Beck Depression Scale (BDS) and Beck Anxiety Inventory (BAI), quality of life with Short Form-36 (SF-36), and functioning status with the Fibromyalgia Impact Questionnaire (FIQ). The patients were evaluated at the end of treatment (week 6) and one month after the end of treatment. Results: The mean disease duration was 34.3 +/- 9.3 months, the mean VAS score was 7.3 +/- 2.2, and the mean FIQ score was 58.4 +/- 13.2. There were significant improvements in the VAS, FIQ, SF-36, BDS, and BAI scores after the treatment in both groups (p<0.05). Post-treatment BDS and VAS scores were significantly lower in the neural therapy group (p=0.038; p=0.049; p<0.05). There was no significant difference in any parameter one month after the treatment between the groups (p>0.05). Conclusion: When neural therapy is combined with exercise in FMS patients, it may be advantageous in terms of pain and depression, compared to exercise alone.
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    Increased femoral anteversion-related biomechanical abnormalities: lower extremity function, falling frequencies, and fatigue
    (2019-05) Leblebici, Gökçe; akalan, ekin; Apti, Adnan; Kuchimov, Shavkat Nadir; Kurt, Aslıhan; Önerge, Kübra; Temelli, Yener; Miller, Freeman
    Background: Increased femoral anteversion (IFA) is defined as forwardly rotated femoral head relative to the transcondylar knee axis which may have a potential to reduce the functional quality of adolescents. Therefore, the aim of our study was to investigate the effects of IFA on lower-extremity function, falling frequency, and fatigue onset in neurologically intact children. Research question: Does increased femoral anteversion influence lower extremity function, falling frequency and fatigue on set in healthy children? Methods: Sixty-five participants with increased femoral anteversion (IFA) and thirty-two healthy peers as control were included into the study. For the function, the lower extremity function form (LEFF) which is adapted from Lower Extremity Function Test used. Falling frequency and fatigue onset time were assessed by a Likert-type scale. In addition, the activities which cause frequently fall for the participants were questioned.Results: Lower extremity function was found deteriorated (p = 0.02) and falling frequency was higher (p = 0.00) in IFA than in controls. Fatigue onset time was not different between groups, although lower extremity function was strongly correlated with fatigue onset (rho = -0.537, p < 0.001). IFA children fall four times more during running (60%), three times more during fast walking (21.42%) than their healthy peers (14.28%, 7.14% respectively). Significance: IFA leads functional problems, especially in the form of high falling frequencies. According to the LEFF score, the most difficult functional parameters for these children were walking long distances, becoming tired, walking more than a mile, and standing on one spot. Also, shorter fatigue onset time may worsen the lower-extremity function secondarily. Because of the higher frequency of falling and functional problems, children with IFA may be more defenseless to injuries, especially in high-motor-skill activities such as running and soccer.