Functional level and its relationship to upper extremity function, pain, and muscle stiffness in children with Duchenne muscular dystrophy

BACKGROUND

The progressive symptoms of Duchenne muscular dystrophy (DMD) negatively affect upper extremity skills, and this may have an effect that reduces the independence of daily life.

AIMS

The purpose of this study is to investigate the relationship between functional level and upper extremity function, pain, and stiffness in children with DMD.

METHODS

A total of 38 children with DMD were participated. The functional level of the upper and lower extremities was assessed using Brooke scale and Vignos scale. Upper extremity function, pain and stiffness were assessed using Upper Limb Short Questionnaire (ULSQ). The correlation between ULSQ and Brooke and Vignos scales was calculated.

RESULTS

A moderate positive correlation was calculated between ULSQ total scores and Vignos scale (r = 0.52, p < 0.001) and Brooke scale (r = 0.65, p < 0.001). There was a moderate positive correlation between Vignos scale scores and ULSQ subscores of function (r = 0.42, p < 0.05) and stiffness (r = 0.56, p < 0.001); no significant correlation was found between pain scores and Vignos scale (p = 0.053). There was a moderate positive correlation between the function (r = 0.54, p < 0.001), pain (r = 0.40, p < 0.05), and stiffness (r = 0.62, p < 0.001) subscores of the ULSQ with the Brooke scale.

CONCLUSION

In our study, there was a significant relationship between the functional level of patients with DMD and upper extremity function, pain, and muscle stiffness.

Factors associated with balance ability in Duchenne and Becker muscular dystrophies

BACKGROUND

Problems such as progressive muscle function loss, postural deteriorations, and contractures seen in patients with Duchenne and Becker muscular dystrophies (D/BMD) may affect children's balance ability, and impaired balance ability may lead to limitations in children's functional level.

RESEARCH QUESTION

What factors are associated with balance ability in children with D/BMD?

METHODS

Twenty participants with D/BMD were included in the study. Participants' ages were asked; height, body weight, and body mass index (BMI) were recorded. Children's functional level was assessed with the Motor Function Measurement-32 (MFM-32), Brooke and Vignos Scales. Muscle strength of hip flexion and extension, knee flexion and extension, and ankle dorsiflexion was measured with a handheld dynamometer. Balance measurements were performed using the Balance Master System. The relationship between balance and continuous independent variables was determined using Spearman's test.

RESULTS

The mean age of the participants was 8.57 ± 3.27 years. The balance abilities of children with BMD were better than those of children with DMD (p < 0.05). The balance diminished with age (p < 0.05), while there was a positive correlation between balance and weight, height, BMI (p < 0.05). There was a positive correlation between the balance and the MFM-32 total and subsection scores. Muscle strength was positively related to balance (p < 0.05).

SIGNIFICANCE

The results showed the balance ability in children with D/BMD was affected by age, height, weight, BMI, functional level, and muscle strength. Based on the results of this study, balance and strength training should be an integral part of the rehabilitation of children with D/BMD.

The psychometric properties of Turkish version of the Modified Paediatric Mini Mental Scale

BACKGROUND

Children with neurological diseases suffer from neurocognitive problems due to both the disease and the treatment processes. Therefore, it is necessary that a battery can be used to determine and track the cognitive function of these children. The aim of this study is to establish the Turkish version of the Modified Paediatric Mini Mental Scale (MPMMS), ensure its cultural adaptation, and test the validity and reliability of the Turkish version of the MPMMS.

METHODS

Sixty-five children with the neurological condition were enrolled in this methodological study. The subjects' age, height, weight, and body mass index were recorded. The MPMMS and the social function subscale of the Paediatric Evaluation of Disability Inventory (PEDI) were used to assess the participants' cognitive function. The construct validity of the questionnaire was determined by the correlation between the MPMMS and the social function subscale of the PEDI. Cronbach's alpha was calculated to determine internal consistency. To determine test-retest reliability, 32 children were assessed 7-14 days after the initial assessment, and the intraclass correlation coefficient (ICC) was calculated.

RESULTS

The mean age of the participants was 9.26 ± 3.87 years. A very strong significant correlation was found between the MPMMS and social function subscale of the PEDI (r = 0.935, p = 0.000). The internal consistency of the MPMMS was excellent (Cronbach's alpha = 0.932).

CONCLUSIONS

The Turkish version of the MPMMS has excellent validity and reliability and can be used by professionals in various health care settings to determine children's cognitive abilities.

Investigation of the relationship between physical activity, kinesiophobia and fear of falling in older adults with chronic pain

AIMS

This study aims to investigate the relationship between physical activity, fear of movement and fear of falling in older adults with chronic pain.

MATERIALS AND METHODS

The study includes 163 older adults aged 65 years and over, who live in a private nursing home. The cognitive functions of the individuals who participated in the study were evaluated with the mini-mental examination scale (MMES), fears of movement with the Tampa Scale of Kinesiophobia (TSK), fear-avoidance behaviour with the Fear-avoidance Beliefs Questionnaire (FABQ), physical activity levels with the Physical Activity Scale for Older (PASE), and the fears of falling were assessed with Tinetti's Falls Efficacy Scale (FES).

RESULTS

In the correlation analysis, there was a weak correlation between age and fall risk (r = 0.349, p < 0.001), and PASE_Total score (r = -0.020, p = 0.011). There was a weak positive correlation between Tinetti FES and FABQ scores (r = 0.349, p < 0.001), and kinesiophobia value (r = 0.259, p < 0.001), there was a weak negative correlation between Tinetti FES and PASE_Total (r = -0.241, p = 0.002). A positive mid correlation was determined between kinesiophobia and the FABQ scores (r = 0.41, p < 0.001). The established regression model was found to be significant (F = 12.175; p < 0.001). Among the independent variables included in the model, FABQ_Total (t = 3.589; p < 0.0001) and PASE_Total (t = -3.325; p < 0.0001) significantly affected the fear of falling.

CONCLUSION

The presence of chronic pain in older adults who have problems related to physical activity, fear of falling, and kinesiophobia due to advancing age may affect social participation, functional level, and quality of life significantly. Therefore, pain should be addressed in older adults and should be considered as an important issue in rehabilitation programs.

PLANTAR SENSATION AND BALANCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH AND WITHOUT PERIPHERAL NEUROPATHY

The aim of the study was to investigate the effect of diabetes on plantar sense and balance in patients with type 2 diabetes mellitus (T2DM). The study included 300 subjects divided into three groups: 100 T2DM patients with diabetic peripheral neuropathy (group 1); 100 T2DM patients without peripheral neuropathy (group 2); and 100 subjects without DM (group 3). Berg Balance Scale (BBS), Timed Up and Go test (TUG), single leg test with eyes open and closed, and plantar sensory tests were applied in the subjects. Study results showed significant differences in plantar sensory tests, BBS, TUG and single leg test among the three groups (p<0.05). In addition, duration of DM and medication were negatively correlated with single leg test both with eyes open and closed, but showed positive correlation with plantar sense and TUG test. Furthermore, the length of insulin therapy showed positive correlation with plantar sense and TUG test and negative correlation with BBS (p<0.05). In conclusion, DM has an effect on plantar sense and balance, and there is a relation between the duration of DM and balance problems. Balance problems are observed more often in patients with neuropathy.

Stimulated biofeedback training for a child with Becker muscular dystrophy and compartment syndrome in the left forearm

Background: Muscular dystrophy negatively affects ambulation, mobility, self-care, and community involvement. Neonatal compartment syndrome (NCS) causes loss of muscle strength, sensory problems, and limb dysfunction. Patients with Becker Muscular Dystrophy (BMD) and/or NCS may benefit from individualized rehabilitation to improve function.Purpose: This case report describes stimulated biofeedback training (SBT) to improve the functional level, muscle strength, balance, and hand function in a child with BMD and NCS.Case Description: An 8-year-old male patient with BMD and NCS in the left forearm received 12-weeks of SBT. The functional level was assessed by the Motor Function Measurement-32 (MFM-32), muscle strength by a hand-held dynamometer, balance by the Neurocom Balance Master, and upper limb function by the Quality of Upper Extremity Skills Test (QUEST) at the initial examination, after 6 weeks and after 12 weeks of treatment. Laboratory tests to monitor changes in serum creatine kinase were performed throughout the episode of care.Outcomes: The laboratory values remained within the appropriate range to continue SBT. Functional level, hand function, hip, and knee flexion/extension strength, and dorsiflexion strength improved.Conclusions: This case report suggests that SBT safely and effectively improved functional level, muscle strength, and hand function in this child with BMD and NCS.

Exploring the Relationship of Pain, Balance, Gait Function, and Quality of Life in Older Adults with Hip and Knee Pain

BACKGROUND

Musculoskeletal pain is a common problem in older adults and can result in disability and suffering. Uncontrolled pain leads to diminished quality of life (QoL) and places a great financial burden on the healthcare system.

AIMS

The aim of this study was to explore the relationship of pain, balance, gait function, and QoL in older adults with hip and knee pain.

DESIGN

This was a descriptive, correlational, and cross-sectional study.

METHODS

The study included 111 older adults. Knee and hip pain was evaluated with a visual analog scale (VAS). Balance and gait functions were evaluated using the Timed Up-and-Go Test (TUG) and the Tinetti Balance and Gait Test (TBGT). Health-related QoL was evaluated with the Nottingham Health Profile (NHP).

RESULTS

The TUG, pain, physical activity, and total NHP scores showed statistically significant differences between those with and without complaints of hip and knee pain (p < .05). Social isolation was more frequent in the older adults with knee pain (p < .05). Lower levels of performance were recorded in the TBGT for subjects with hip pain compared with those without hip pain (p < .05).

CONCLUSIONS

Pain in the lower extremities can play an important role in the deterioration of QoL and loss of balance and gait function. Knee pain may affect gait performance and QoL more than hip pain. Nurses and physical therapists in nursing homes should have good knowledge of pain and regularly monitor undiagnosed pain conditions in the lower extremities of older adults.

Motivation and motivation-related factors in children with disabilities

PURPOSE

Assessing motivation and motivation-related factors will contribute to a better understanding of motivation and the development of optimal rehabilitation conditions. The purpose of this study was to determine the motivation level and investigate the relationship of motivation level with socio-demographic characteristics (i.e., age, gender, comorbidities), functional level, and family satisfaction with rehabilitation centers in children with disabilities.

METHODS

Sixty-two children with disabilities were included in the study, and the socio-demographic characteristics were recorded. Children were assessed by the Pediatric Motivation Scale (PMOT) and the Pediatric Functional Independence Measure (WeeFIM). Also, parents were asked to complete a questionnaire titled, "A patient satisfaction instrument for outpatient physical therapy clinics."

RESULTS

The mean age of the children was 12.16 ± 3.19 years. Total PMOT and WeeFIM scores were found to be 93.71 ± 9.66 and 108.23 ± 22.14, respectively. There was a positive correlation between children's PMOT score and the satisfaction score of their families that was statistically significant (r= 0.602, p< 0.05).

CONCLUSION

The level of family satisfaction with rehabilitation centers was found to be positively correlated with the motivation level of children. Improving family satisfaction with rehabilitation centers, potentially through modifying the physical conditions of rehabilitation centers and focusing on the interest of the family, may increase the motivation level of children, and thus may improve rehabilitation outcomes.

Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data

BACKGROUND

There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population.

OBJECTIVES

This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference.

METHODS

Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted.

RESULTS

In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62-78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22-3.12) and IV (OR 1.77, 95% CI 1.03-4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66-84), and mean pain severity was 3.7/10 (95% CI 2.7-4.7) and pain interference 3.5/10 (95% CI 2.5-4.5).

CONCLUSIONS

This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.

THE EFFECT OF BODY AWARENESS THERAPY AND AEROBIC EXERCISES ON PAIN AND QUALITY OF LIFE IN THE PATIENTS WITH TENSION TYPE HEADACHE

BACKGROUND

This study is to investigate the effect of Body Awareness Therapy (BAT) and Aerobic Exercises on pain and quality of life in patients with Tension-Type Headache (TTH).

MATERIALS AND METHOD

Sixty individuals with TTH diagnosis who referred Neurologist were incorporated into study. The individuals were randomly grouped into 3 as BAT (n=20), aerobic exercise (n=20) and control group (n=20). Pain severity of the individuals was evaluated by Visual Analog Scale (VAS) and pain diary, disability with ache; by Pain Disability Index (PDI) and Headache Impact Tests (HIT) and quality of life was evaluated by SF-36. Subsequent to first assessments, 3 sessions of 60 minutes per week throughout 6 weeks totally.

RESULTS

When the groups were compared at the end of the study, a significant decrease was observed in VAS, PDI and HIT values in the individuals in the BAT and aerobic exercise groups. With the individuals in group BAT and aerobic exercise all parameters of quality of life were observed to be increased significantly.

CONCLUSION

BAT and aerobic exercise programs to be applied on TTH patients were concluded to be important in decreasing the pain, in increasing the quality of life and in reducing pain-related daily constraints of the individuals.

The effect of age and body mass index on plantar cutaneous sensation in healthy women

[Purpose] This study was conducted to examine the effects of age and body mass index on plantar cutaneous sensation in healthy women. [Subjects and Methods] Two hundred and three healthy female volunteers over the age of 20 were included in the study. The statistical analyses were performed by considering the age and body mass index values of the individuals. The individuals were divided according to their ages and body mass index values. Foot pain was measured with a visual analogue scale and plantar cutaneous sensation using Semmes-Weinstein monofilaments. [Results] Fifty-six (27.5%) of the participants had normal weights, 67 (33%) were overweight, and 80 (39%) were obese. Statistical analysis revealed that as age and body mass index values increased, plantar sensitivity decreased and the frequency and severity of pain increased. [Conclusion] It is possible that healthy women may experience a decrease in foot plantar sensation with increasing weight and age. If women do not have any health problems, proprioception and sensory training must be focused on in order to prevent balance and falling problems.

The effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study

OBJECTIVE

The aim of this study was to investigate the effects of Nintendo Wii(TM)-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke.

METHODS

42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (∼8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45-60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions.

RESULTS

There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05).

CONCLUSION

These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.

Desire to have other children in families with a chronically disabled child and its effect on the relationship of the parents

AIM

The aim of this study was to examine the desire of the parents who had a chronically disabled child to have other children and to investigate the effect of having a disabled child on the relationship of the parents.

MATERIAL AND METHODS

The families of 145 chronically disabled children were included in the study. After the sociodemographic information belonging to the child and family were obtained, the prepared questionnaire form was used to interrogate if the parents lived together, the number of children in the family, if they wished to have other children and the relation of the disabled child with the household. Ethics committee approval was obtained from Dokuz Eylül University (date: 18.10.2012, decision number, 2012/34-13). The data obtained in the study were expressed as figures and percentages.

RESULTS

While 91.7% of the parents continued their relationship, 2.8% were divorced and 1.4% were left by their spouses. The rate of the parents who did not wish to have (or did not have) other children after a disabled child was found to be 65.2%. The major reason for the families not to wish to have other children was found to be the fact that they thought they could not spare enough time for their disabled child. While 35.1% of the parents stated that clemped together more tightly, 35.2% stated that their concerns about the future increased further. Fifty eight percent of the parents stated that social relations and community involvements were not affected, whereas others stated that they were affected in different ways.

CONCLUSIONS

Although the relationship between the parents was not affected to a great extent in families who had chronically disabled children, it was found that parents intensively experienced concern for the future. It was found that this also affected the desire of the parents who had a chronically disabled child to have other children with the concern that the child will be disabled.

Examination of the relationship between body mass index (BMI) and functional independence level in children with spina bifida

OBJECTIVE

The aim of this study is to examine the relationship between body mass index (BMI) and functional independence level in children with spina bifida (SB).

METHODS

The study included 116 children between 5 and 18 years. Subjects' socio-demographic characteristics, BMI values and functional independence levels were recorded.

RESULTS

There was negative correlation between BMI and communication and social cognition in girls (p < 0.05). No correlation was found between BMI and WeeFIM in boys (p > 0.05).

CONCLUSION

The results indicated that body weight in children with SB affected functional independency and that precautions to control weight important in these children.

Examination of the relation between body mass index, functional level and health-related quality of life in children with cerebral palsy

AIM

The aim of this study was to examine the relation between body mass index (BMI) and functional level and health-related quality of life in children with cerebral palsy (CP).

MATERIAL AND METHODS

Two hundred seventy-eight children with CP aged between 2 and 18 years were included in the study. The sociodemographic properties of the children were recorded. Their functional independence levels were assessed with WeeFIM and their health-related quality of life levels were assessed with the Child Health Questionnaire-Parent Form (PF-50). Approval was obtained from the ethics committee of Abant İzzet Baysal University Medical Faculty for this study (Number: 2008/100-77).

RESULTS

When classified by body mass index, 26.3% of the children had a normal body weight, 5.4% were overweight, 11.5% were obese and 56.8% had a low body weight. The rate of low body weight was higher in children with moderate and severe CP (52.7% and 53.8%, respectively), while the rate of obesity was higher in children with mild CP who could walk (7.1%). A significant difference was found in children with CP with a normal body weight, overweight children with CP, obese children with CP and children with CP with a low body weight in terms of the total WeeFIM score and the variables of quality of life including physical functionality and role/social limitations because of physical health (p<0.05). In the correlation analysis, a positive correlation was found between WeeFIM and BMI and the subdimensions of role/social limitations because of emotional or behavioral difficulties, pain and discomfort and self-esteem (p<0.05).

CONCLUSIONS

Our results showed that BMI affected functional independence and health-related quality of life in children with CP and this was more prominent in children who had severe CP and low BMI values. More studies are needed in this area.

The effect of functional mobility and balance on health-related quality of life (HRQoL) among elderly people living at home and those living in nursing home

The present study examined the effect of functional mobility and balance on HRQoL among elderly people living at home and those living in nursing homes. The study included 122 elderly people aged 65 and over. With regard to the individuals whose socio-demographic data were collected in the scope of the study, balance and functional mobility levels were evaluated using the timed up and go test (TUG) and Berg balance scale (BBS); HRQoL was evaluated using the Nottingham health profile (NHP); physical independence in daily activities was evaluated using the Barthel index (BI); and basic mobility in daily life was evaluated using the Rivermead mobility index (RMI). Statistically significant differences were found between the TUG, BBS and NHP values of the elderly people living in a home environment and those living in nursing homes (p<0.05). However, no statistically significant difference could be found between the BI and RMI values (p>0.05). A statistically significant relationship was found between the NHP and TUG, RMI, BI and the use of assistive devices in daily life activities (p<0.05). It is thought that the inclusion of functional mobility and balance training in elderly care and rehabilitation programs would be useful for the elderly people to develop functional independence and in increasing their HRQoL.