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Ma Y, Liu M, Liu Y, Liu D, Hou M. Exploring Physical Activity in Children and Adolescents with Disabilities: A Bibliometric Review of Current Status, Guidelines, Perceived Barriers, and Facilitators and Future Directions. Healthcare (Basel) 2024; 12:934. [PMID: 38727491 PMCID: PMC11083761 DOI: 10.3390/healthcare12090934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Physical activity contributes to both physiological and psychosocial benefits for children and adolescents with disabilities. However, the prevalence of physical inactivity is notably higher among disabled young people compared to their healthy peers. Despite this, there is a lack of constructed knowledge structure, evolutionary path, research hotspots, and frontiers in studies related to physical activity in young people with disabilities. METHODS The literature related to the research of physical activity in children and adolescents with disabilities was retrieved from the core collection of the Web of Science. The annual publication numbers and the timing, frequency, and centrality of the co-occurrence network with respect to journals, countries, institutions, authors, references, and keywords were analyzed. Additionally, clustering analysis and burst analysis were performed on the references and keywords. All analyses were conducted using CiteSpace. RESULTS A total of 1308 related articles were included. The knowledge structure of research on the physical activity of disabled children and adolescents, including annual publication numbers, influencing journals, countries, institutions, authors, references, and keywords along with their respective collaborative networks, has been constructed. Furthermore, the research foundation, current hot topics, and research frontiers have been identified by analyzing references and keywords. CONCLUSIONS Current research hotspots include interventions, therapies, and programs aimed at enhancing specific skills, as well as addressing the satisfaction of competence to improve motivation and the effectiveness of physical activity. There is also a focus on the development of scales for quantitative studies. Future directions may be toward personalized interventions or programs to enhance physical activity levels among youth with disabilities.
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Affiliation(s)
- Ye Ma
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo 315211, China; (Y.M.); (M.L.)
| | - Mengjiao Liu
- Research Academy of Grand Health, Faculty of Sports Sciences, Ningbo University, Ningbo 315211, China; (Y.M.); (M.L.)
| | - Yuwei Liu
- Auckland Bioengineer Institute, University of Auckland, Auckland 1010, New Zealand;
| | - Dongwei Liu
- School of Information Technology and Artificial Intelligence, Zhejiang University of Finance and Economics, Hangzhou 310018, China
| | - Meijin Hou
- National Joint Engineering Research Centre of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Key Laboratory of Orthopaedics and Traumatology of Traditional Chinese Medicine and Rehabilitation, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
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Erkek S, Çekmece Ç. Investigation of the Relationship between Sensory-Processing Skills and Motor Functions in Children with Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1723. [PMID: 38002814 PMCID: PMC10670370 DOI: 10.3390/children10111723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023]
Abstract
The main purpose of this study is to examine the relationship between sensory-processing skills and gross motor functions, bimanual motor functions, and balance in children with cerebral palsy (CP). A total of 47 patients between the ages of 3 and 10, diagnosed with CP, who received or applied for treatment in our physical therapy and rehabilitation unit were included in the study. Sensory profiling (SP), assisting hand assessment (AHA), the Gross Motor Function Measure-66 (GMFM-66), and the Pediatric Berg Balance Scale (PBBS) were used in the evaluation of the children with CP who participated in the study. The Gross Motor Function Classification System (GMFCS) was used to classify the children based on functional abilities and limitations, and the Manual Ability Classification System (MACS) was used to classify the children based on manual dexterity. The SP parameters were compared with AHA, GMFM-66, and PBBS results, and with GMFCS and MACS levels. Statistically significant relationships were found between AHA and SP, PBBS, and SP and between GMFM-66 and SP (p < 0.05). Our study shows that there are some disorders in sensory processing in children with CP. We think that sensory evaluations should be included in the CP rehabilitation program.
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Affiliation(s)
- Serhat Erkek
- Department of Occupational Therapy, Yalova State Hospital, Baglarbası, Yalova 77100, Turkey;
| | - Çiğdem Çekmece
- Section of Occupational Therapy, Department of Therapy and Rehabilitation, Vocational School of Kocaeli Health Services, Kocaeli University, Umuttepe Campus, Izmit 41380, Turkey
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Bania TA, Gkoutsidou P, Billis E, Lampropoulou S. Pediatric Balance Scale: Translation and Cross-Cultural Adaptation Into Greek. Pediatr Phys Ther 2023; 35:430-437. [PMID: 37747978 DOI: 10.1097/pep.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
PURPOSE Cross-cultural adaptation of the Pediatric Balance Scale (PBS) into Greek. METHODS The PBS was forward-back translated and evaluated for content equivalence. The Greek PBS (PBSGR) was administered to children with movement impairments by 2 pediatric physical therapists. The scale was readministered to the same children after 3 weeks (test-retest reliability) and to children with typical development for discriminant validity. The 1-minute walk test was administered to test the scale's concurrent validity. RESULTS Psychometric testing was completed on 26 children with movement impairments. The scale had excellent interrater and test-retest reliability and internal consistency. Moderate correlation was observed between PBSGR and 1-minute walk. Children with movement impairment had significantly lower PBSGR scores than children with typical development. CONCLUSIONS Acceptable reliability, concurrent validity, and discriminant validity were observed for the PBSGR.
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Affiliation(s)
- Theofani A Bania
- Department of Physiotherapy (Drs Bania, Billis, and Lampropoulou), University of Patras, Rio, Greece; EEΕEK Pyrgou, Vitinaiika, Pyrgos, Hleias, Greece (Ms Gkoutsidou)
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Ölçek G, Çelik İ, Başoǧlu Y, Kaymakçı S, Gürlek E. Comparison of children with and without dyslexia using functional head impulse test and pediatric balance scale. Front Neurol 2023; 14:1153650. [PMID: 37333011 PMCID: PMC10272711 DOI: 10.3389/fneur.2023.1153650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose The aim of this study is to compare functionality of vestibulo-ocular reflex (VOR) responses to evaluate the functional properties of the vestibular system and daily balance performance in children with dyslexia and children with normal development. Method Fifteen participants diagnosed with dyslexia were included in the study group (SG), and 15 healthy participants were included in the control group (CG). All groups underwent Functional Head Impulse Test (f-HIT) and Pediatric Balance Scale (PBS). f-HIT was performed with at least 15 head impulses at 4000-5000-6000°/s2 randomly to the right and left in the plane of the horizontal semicircular canal (SCC). Statistical analysis was performed using descriptive statistics and the Mann-Whitney U test. Results SG percentage values were obtained lower than CG percentage values. Comparisons between the two groups showed that there was a significant difference in all parameters (4000-5000-6000°/s2 and total) in the right-side stimulation, there was significant difference for 4,000 s2 and total correct answers in the left side. In addition, although there was no significant difference between the groups in terms of the PBS score, the SG scores were lower (p = 0.062). Conclusions As a novel test, f-HIT, revealed the difference in functionality of vestibular performance in the dyslexia group. In the dyslexia group, f-HIT may be helpful in evaluating and monitoring the vestibular system.
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Affiliation(s)
- Gül Ölçek
- Faculty of Health Sciences, Department of Audiology, Istanbul Medipol University, Istanbul, Türkiye
| | - İlayda Çelik
- Graduate School of Health Sciences, Department of Speech and Language Therapy, Istanbul Medipol University, Istanbul, Türkiye
| | - Yuşa Başoǧlu
- Graduate School of Health Sciences, Department of Audiology, Istanbul Medipol University, Istanbul, Türkiye
| | - Sude Kaymakçı
- Graduate School of Health Sciences, Department of Audiology, Istanbul Medipol University, Istanbul, Türkiye
| | - Emre Gürlek
- Graduate School of Health Sciences, Department of Audiology, Istanbul Medipol University, Istanbul, Türkiye
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Sinanoglu B, Ozdemir F. Evaluation of functional mobility, balance, and executive functions in children with epilepsy. Epilepsy Behav 2023; 143:109230. [PMID: 37146465 DOI: 10.1016/j.yebeh.2023.109230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE It is known that motor skills and executive functions are interrelated in healthy children. The study aims to evaluate the functional mobility, balance and executive functions in children who are diagnosed with epilepsy and to determine whether they are related to each other. METHODS The study included 21 children who were diagnosed with epilepsy and have no additional comorbidities and 21 healthy children who had similar age and sex to those diagnosed with epilepsy. Their demographic data were collected using a descriptive information form. In addition, the Timed Up and Go Test (TUG) and the Stair Climb Test (SCT) were used to evaluate their functional mobility, the Pediatric Berg Balance Scale (PBSS) to evaluate their balance, and the Behavior Evaluation Inventory for Executive Functions Parent Form (BRIEF-P) to evaluate their executive functions. RESULTS Our study found a statistically significant difference between the children with epilepsy and their healthy peers in terms of functional mobility and executive functions (p < 0.05). However, there was no statistically significant difference between them in terms of balance parameters (p > 0.05). In addition, a statistically significant difference was found between the executive functions and functional mobility in children with epilepsy (p < 0.05). The coefficient of determinations (R2) indicating how differences in T and SCT scores explained by executive function domains were found as 0.718 and 0.725, respectively. CONCLUSIONS Epilepsy can negatively affect several aspects of functional mobility and executive functions in childhood. According to the results of our study, it is important to recognize the motor skills and executive functions problems of children with epilepsy who do not have additional comorbidities, and to direct them to appropriate healthcare programs. Our results support the need to raise awareness in both health professionals and families to encourage children with epilepsy to be more active.
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Affiliation(s)
- Bercem Sinanoglu
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Inonu University, Malatya, Turkey.
| | - Filiz Ozdemir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Inonu University, Malatya, Turkey.
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Duray M, Dengiz A, Kavlak E, Tutar S. The Effects of Trunk Impairment on Fatigue and Balance in Children with Cerebral Palsy. Percept Mot Skills 2023; 130:1123-1138. [PMID: 36945131 DOI: 10.1177/00315125231165548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
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.
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Affiliation(s)
- Mehmet Duray
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, 52994Suleyman Demirel University, 32000 Isparta, Turkey
| | - Aziz Dengiz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mus Alparslan University, Mus, 49100 Turkey
| | - Erdogan Kavlak
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Pamukkale University, 20160 Denizli, Turkey
| | - Serife Tutar
- Department of Pediatric Nursing, Faculty of Health Science, SÜ leyman Demirel University, 32000 Isparta, Turkey
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Sugimoto D, Stracciolini A, Berbert L, Nohelty E, Kobelski GP, Parmeter B, Weller E, Faigenbaum AD, Myer GD. Assessment of Physical Tests in 6-11 Years Old Children: Findings from the Play Lifestyle and Activity in Youth (PLAY) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2552. [PMID: 36767925 PMCID: PMC9915144 DOI: 10.3390/ijerph20032552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
The purpose was to evaluate selected physical tests in children and to compare the outcomes by sex. A cross-sectional study design was used to evaluate children 6-11 years who completed five physical tests: hand grip, vertical jump, sit and reach, Y-balance, and obstacle course (time and score). The outcome measures including test results were descriptively examined and compared by sex. The study participants consisted of 133 children (62 males and 71 females, with a median age of 7.8 years). Girls showed superior sit and reach performance (p = 0.002) compared with boys. Boys demonstrated better Y-balance scores (p = 0.007) and faster obstacle time (p = 0.042) than girls. Sex comparison within three age groups (6-<8 years, 8-<10 years, and 10-<12 years) showed that girls performed better on the sit and reach compared with boys in the in 6-<8 years (p = 0.009). Boys demonstrated higher Y-balance scores (p = 0.017) and faster obstacle time (p = 0.007) compared with girls in the 8-<10-year age group. These data will serve to guide future efforts to evaluate normative measures of physical literacy and guide targeted training interventions to promote sustained physical activity in children with deficits relative to their age and sex norms.
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Affiliation(s)
- Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Faculty of Sport Sciences, Waseda University, Tokyo 202-0021, Japan
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Emergency Medicine, Department of Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Laura Berbert
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Eric Nohelty
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Greggory P. Kobelski
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Becky Parmeter
- Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Edie Weller
- Harvard Medical School, Boston, MA 02115, USA
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA 02115, USA
- Division of Hematology and Oncology, Boston Children’s Hospital, Boston, MA 02115, USA
| | | | - Gregory D. Myer
- The Micheli Center for Sports Injury Prevention, Waltham, MA 02453, USA
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA 30542, USA
- Emory Sports Medicine Center, Atlanta, GA 30329, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA 30307, USA
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Psychometric properties of functional postural control tests in children: A systematic review. Ann Phys Rehabil Med 2023; 66:101729. [PMID: 36669385 DOI: 10.1016/j.rehab.2022.101729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/10/2022] [Accepted: 11/04/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly. OBJECTIVE To facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice. METHODS Systematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted. RESULTS Seventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems. CONCLUSION Currently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.
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Tezcan S, Çankaya T. The effect of modified constraint-induced movement therapy in children with hemiparetic cerebral palsy. Consecutive or intermittent days? Disabil Rehabil 2022; 44:7500-7507. [PMID: 34775897 DOI: 10.1080/09638288.2021.2002441] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate effect of modified constraint-induced movement therapy (mCIMT) administered on consecutive or intermittent days on upper limb function in children with hemiparetic cerebral palsy (CP). MATERIALS AND METHODS Thirty-three children (age range 5-18 y) with hemiparetic CP separated into three groups: consecutive mCIMT group (n = 11), intermittent mCIMT group (n = 11), control group (n = 11). The outcome measures consist of Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Pediatric Balance Scale (PBS), Modified Tardieu Scale (MTS), Jebsen-Taylor Hand Function Test (JTHFT), Children's Hand Use Experience Questionnaire (CHEQ), Abilhand Kids Questionnaire, surface Electromyography (sEMG). The evaluations were made baseline, 10 days after, 5 weeks after the treatment. RESULTS Improvements were achieved in all groups. The use of upper extremities in daily life activities (p < 0.01), speed of performing the activities (p < 0.001), grasping efficiency (p < 0.001), the amount of a decrease in the children's sense of discomfort while performing activities (p < 0.001) on the affected side in both mCIMT groups were better than the control group. The gain levels in mCIMT groups were similar (p > 0.05). CONCLUSIONS Administration of mCIMT on intermittent days facilitate the adaptation of a child, it was concluded to be a more tolerable method and could be more effective.Implications for rehabilitationmCIMT is more effective than low-dose conventional therapeutic interventions in improving paretic upper limb functions in children with hemiparetic CP.The application of mCIMT in the child's natural environment increases the motivation to participate in the treatment.The application of mCIMT on intermittent days will be more easily tolerated in paediatric individuals and will increase participation in the treatment.
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Affiliation(s)
- Sezen Tezcan
- Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Tamer Çankaya
- Department of Physical Therapy and Rehabilitation, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Mujdeci B, Önder S, Alluşoğlu S, Boynuegri S, Kum O, Atan D. The effects of age at cochlear implantation on balance in children: A pilot study. Int J Artif Organs 2020; 44:440-445. [PMID: 33143530 DOI: 10.1177/0391398820967367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The evaluation of the effects of age at cochlear implantation on balance in children. RESEARCH DESIGN Cross-sectional study. STUDY SAMPLE Twenty children who received their cochlear implants (CI) before the chronologic age of 48 months (Early CI Group), and 20 children who received their CI at 48 months chronologic age or later (Late CI Group). INTERVENTION All children underwent Tandem Romberg (TR) test, Single-Leg stance (SLS) test, Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB), Pediatric Balance scale (PBS) and Timed Up and Go (TUG) test. DATA COLLECTION AND ANALYSIS The scores of TR, SLS and P-CTSIB and TUG tests and PBS were recorded. Mann Whitney U test and Independent-samples t-test were used to compare data between groups. RESULTS TR (eyes opened-EO), SLS (EO), PBS, and TUG scores and incidence in dizziness symptoms did not show significant differences between the groups (p > 0.05). Duration of TR and SLS tests (eyes closed-EC), P-CTSIB-positions 5, and 6 were significantly longer in the Early CI Group than the Late implanted group(p < 0.05). CONCLUSION Although the age of cochlear implantation did not affect functional balance for children, it has been found to cause impaired balance performance in difficult static conditions and increased frequency of dizziness.
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Affiliation(s)
- Banu Mujdeci
- Department of Audiology, Faculty of Health Science, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Sevginar Önder
- Department of Audiology, Ankara City Hospital, Ankara, Turkey
| | | | | | - Oguzhan Kum
- Department of Otorhinolaryngology, Ankara City Hospital, Ankara, Turkey
| | - Dogan Atan
- Department of Otorhinolaryngology, Lokman Hekim Hospital, Ankara, Turkey
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