Fizyoterapi ve Rehabilitasyon Bölümü / Department of Physiotherapy and Rehabilitation
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Publication Azaltılmış Plantar Ön-Ayak Duyusunun Taban Basıncı Üzerine Etkisinin İncelenmesi(2018) Akalan, Ekin; Sert, Rukiye; Kuchimov, Shavkat Nadir; Leblebici, Gökçe; Ertürk, Gamze; Bilgili, Fuat; ÖNERGE, KÜBRA; 283338; 176320; 229941; 268636; 237820Publication Comparison of Kinesio Taping, Trigger Point Injection, and Neural Therapy in the Treatment of Acute Myofascial Pain Syndrome: A Randomized Controlled Study(Kare Publishing, 2023) Ay, Saime; Tur, Birkan Sonel; Karakaş, Merve; Gökmen, Derya; ALTINBİLEK, TURGAY; Evcik, DenizObjectives: Myofascial pain syndrome (MPS) is a regional painful soft-tissue disorder, characterized by trigger points (TrPs) and taut bands in the muscles. In this study, we aimed to compare the effectiveness of kinesio taping (KT), TrPs injection, and neural therapy (NT) on pain and disability in acute MPS.Methods: 104 patients with MPS in the cervical region were allocated into three groups. Group 1 (n=35) were treated with KT, Group 2 (n=35) received local anesthetic (LA) (lidocaine of 0.5%) TrPs injection, and Group 3 (n=34) received NT with the same LA solution. Patients were assessed by means of pain, pressure pain threshold (PPT), and disability. Pain severity was measured by Visual Analog Scale. The neck pain disability scale was used for assessing disability. PPT was measured by using an algometer. Measurements were taken before and after treatment of 3(rd) and 7(th) days.Results: There were improvements on pain and disability in all groups at the end of treatments at 3(rd) day and during follow-up period (p<0.001) and no differences were found between the groups. There was significant difference in PPT values in TrPs injection and NT groups in comparisons between all time periods, however, the change, depending on time in the KT group, was not statistically significant.Conclusion: The results of this study show that all these three treatment methods found to be effective on pain relief and disability in acute MPS. In terms of PPT, injection treatments seem to be superior than KT.Publication Correlations Between Hypermobility, Muscle Strength and 3D Gait Parameters in Children With Increased Femoral Anteversion(2019-09) EVRENDILEK, HALENUR; 268497Introduction Increased femoral anteversion is a transverse plane problem that cause gait alterations in developing children and because of the moment arm changes produces muscle weakness around the hip (1). Especially, in addition with hypermobility, these children mostly have fatigue, additional muscle weakness and functional deterioration on lower extremity (2). Therefore, the aim of this study was to determine the relations between the hypermobility, muscle strength and gait parameters in children with IFA. Research Question Are there any correlation between the hypermobility, muscle strength and gait parameters in children with IFA? Methods 7 children with IFA (14 limbs, av.age: 9.14 ± 0.3, trochanteric prominens angle test (TPAT): 28 ± 6.2°) have participated in this study. As part of physical assessment; hypermobility, femoral anteversion angle, maximum isometric hip extensor and abductor, knee extensor and flexor muscles strengths were evaluated by Beighton test (3), TPAT (4) and hand-held dynamometer (HHD) (Lafayette Instruments,USA)(5) respectively. Furthermore, all participants' self-selected of walking were analyzed by 3D gait analysis (BTS Bioengineering). Kinematic gait parameters of pelvis, hip and knee were interested gait parameters. According to data distributions, Pearson's or Spearman's coefficient test were utilized for statistics (p<0.05) and interpreted by Cohen's classification (6). Results High-level correlation was found between Beighton scores and both hip extensor (r: -.70) and knee extensor (r: -.91) muscle strengths, and mean and minimum knee knee flexion angles. TPAT was highly correlated with only hip abductor HHD scores and mean hip rotation angle during walking (Table 1). Discussion In the literature, number of gait alterations were determined in children with IFA as increased mean hip internal rotation, pelvic obliquity range, peak knee extension at stance(7). The present study revealed that some of the kinematic alterations might be related to muscle strengths of the weak hip extensor and abductor, knee extensor and flexor muscles. Although, in agreement with the literature the mean hip internal rotation and hip abductors muscles strength were found significantly related to TPAT. In additionally, hypermobility, which is a commonly seen with the children with IFA, might have a role at the weakness of the hip and knee extensors and hyperextension at stance phase. In conclusion, it is important to strength hip extensor and abductor, knee extensor and flexor muscles to contribute to lower extremity function in children with IFA especially if the child is hypermobile.Publication Determination of Biomechanical İnfluences of İncreased Femoral Anteversion (twisted leg) on Running for Developing İndividua(2018-08) APTİ, ADNAN; ARAT, REFİK; 259584Publication Determination of Playing Related Postural Problems in Guitar Students(2019-06) AKEL, BURCU SEMİN; 114564Objective: A significant percentage (%37) of musicians suffer musculoskeletal disorders that are sufficiently serious to affect performance. A common risk factor for musculoskeletal disorders is a poor posture.ln this study, we aimed to determine of playing-related postural problems in guitar students. Materials and Methods: Nineteen guitar bachelor students participated. Demographic data were recorded and static and dynamic posture analysis were performed via observation and video recordings; which were analyzed by a physiotherapist, an occupationaltherapist and a guitarist. Awkward postures were recorded. Posture was evaluated both globally and for individual body regions. Overall posture was divided into 3 categories: rigid, slumped, physiological. Pain was assessed with The Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians. Results: Most of the individuals (55%) experienced pain or problems that might hinder their playing skills in the last year.The most common locations of pain or problems were: shoulder, wrist, scapula and neck.The overall static posture was poor in 38% of participants when standing(33%rigid, 5% slumped). During playing, the posture was more often slumped than rigid(66%). The location of the gravity axis in the sagittal plane were forward-shifted(%55), however the physiological posture was maintained at the frontal plane.The most common problems encountered were shoulder imbalance (%61), rotation of the head(%77), rotation of body(%72), right wrist excessive ulnar deviation(%33) and thumb positioning(%72). Conclusions: According to the posture analysis, rotation and slumpy positioning was the main problem. This situation puts greater problems on the muscles of the back and abdomen and may effect proper breathing. The regions that have poor posture was neck, shou Ider, wrist and thumb. Considering this, we believe that educating music students in proper playing posture and postural awareness can be beneficial in decreasing performance-related postural problems.Publication Distinguishing the Influences of Increased Femoral Anteversion From Hypermobility During Walking For Neurologically Intact Individuals(2018-09) Akalan, Ekin; Karaca, Gülşah; Kuchimov, Shavkat Nadir; Bilgili, Fuat; Temelli, Yener; Leblebici, Gökçe; Ertürk, Gamze; Evrendirek, Halenur; ÖNERGE, KÜBRA; APTİ, ADNAN; 176320; 268498; 259584; 237820; 190878; 229941; 283338; 268636; 268497Increased femoral anteversion (IFA) is a transverse plane problem that may lead to alterations on lower body kinematics during walking (1,2). IFA and hypermobility syndrome are commonly seen together in healthy individuals (3). Therefore, describing the pure effects of IFA related gait parameters is very difficult for children with hypermobility and IFA together.Publication Does clinically measured ankle plantar flexor muscle strength or weakness correlate with walking performance in healthy individuals?(2018) Akalan, N.Ekin; Kuchimov, Shavkat Nadir; Temelli, Yener; Ören, Merve; Nene, Anand; APTİ, ADNANOBJECTIVE: 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 Does hip flexor muscle weakness cause stiff-knee gait in long-term after medial open reduction surgery for children with developmental dislocation?(2019-09) EVRENDILEK, HALENUR; 268497Introduction Medial open reduction surgery (MOR) is performed as a treatment for children with developmental dislocation of the hip (DDH) by sectioning iliopsoas tendons [1]. A 10 years follow-up study of MOR was determined that hip flexor strength decreased in children with DDH [2] . Furthermore, the weakness of iliopsoas muscle was any one of the reasons of stiff knee gait pattern (SKG) [3], Therefore, the aim of the study was to determine whether the sagittal plane knee kinematics alters in long-term after bilateral MOR for children with DDH. Research Question What are the long-term biomechanical effects of bilateral MOR on sagittal plane knee kinematics in children with dislocation of the hip? Methods Five children (DDH group, 10 limbs, Av. age: 11.2 ± 2.8 y.o.) who had medial open reduction surgery bilaterally (10.4 years ago, Av. age: 9.6 ± 6 months o.) and six children without any orthopedic disorder (Control group, 12 limbs, Av. age: 10.8 ± 2.4 y.o) have participated in this study. All participants' selfselected speed of gait were analyzed by 3D gait analysis (BTS Bioengineering). The spatiotemporal parameters, sagittal plane hip and knee parameters and four defined SKG parameters (Pl: peak knee flexion angle, P2: range of knee flexion from toe-off to peak flexion, P3: total range of knee motion, P4: timing of peak knee flexion in swing, >3 significantly changed SKG parameters described as stiff knee ) [4] were examined. Independent t-test and Mann Whitney U test were used for comparison (p < 0.05) Results Between two groups, age, mean velocity were not significantly different (p>0.05). In DDH group, sagittal plane hip and knee range, P l, P2, P3,P4, maximum hip and knee flexion velocity were lower significantly than control group (Table 1). Discussion Normally, in late-stance, the iliopsoas is elongated depending on hip extension, then contracts at the beginning of the swing to initiate hip flexion. [5], Weakness of iliopsoas muscle, as a long-term effect of MOR surgery, reduces hip and knee flexion velocity at pre-swing and swing phases. This study showed that DDH altered all four SKG parameters significantly [4] relative to controls. This study also confirmed that hip flexion weakness may cause SKG pattern even neurologically intact individuals (3). Because of the SKG pattern increases not only the risk of reduced toe clearance and tripping but also energy expenditure [4], adding hip flexor strengthening exercises into rehabilitation programs might have a critical role for SKG treatment.Publication Does One Leg Standing Duration Have Relation With GMFM Scores and Stability in Stance Phase for Hemiplegic Children ?(2018-09) N. Ekin Akalan; Halenur, Evrendilek; Karaca, Gülşah; Bilgili, Fuat; Ertürk, Gamze; 268636; 176320; 268497; 268498; 237820This paper reports the results of a study to validate a measure of gross motor function in detecting change in the motor function of disabled children. Physiotherapists used this instrument to assess 111 patients with cerebral palsy, 25 with head injury and 34 non-disabled preschool children on two occasions, the second after an interval of four to six months. Parents and therapists independently rated the children's function within two weeks of each assessment, and a sample of paired assessments was videotaped for 'blind' evaluation by therapists. Correlations between scores for change on this measure and the judgments of change by parents, therapists and 'blind' evaluators supported the hypothesis that the instrument would be responsive to both negative and positive changes.Publication Evaluation of the effects of neural therapy in patients diagnosed with fibromyalgia(2019) Terzi, Rabia; Başaran, Aynur; Tolu, Sena; Küçüksaraç, Seher; ALTINBİLEK, TURGAYObjectives: 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.Publication Femoral Anteversiyon Artışı Olan Çocuklarda Hipermobilite, Kas Kuvveti ve 3 Boyutlu Yürüme Analizi Parametreleri Arasındaki İlişki(2019-10-18) EVRENDILEK, HALENUR; Karaca, Gülşah; Ertürk, Gamze; Bilgili, Fuat; AKALAN, NAZİF EKİN; ÖNERGE, KÜBRAAMAÇ Çalışmanın amacı; femoral anteversiyon artışı (FAA) olan çocuklarda hipermobilite, kas kuvveti ve 3 boyutlu yürüme analizi parametreleri arasındaki ilişkiyi araştırmaktır. YÖNTEM FAA olan 7 çocuk (14 bacak, ort.yaş:9.14 ± 0.3, trokanter prominens açı testi(TPAT):28 ± 6.2°) çalışmaya dahil edildi. Çocukların femoral anteversiyon açıları, eklem mobiliteleri ve maksimal izometrik kas kuvvetleri sırasıyla TPAT, Beighton testi ve el dinamometresiyle (Lafayette Instruments,USA) değerlendirildi. Tüm katılımcılara normal hızlarında yürürken 3 boyutlu yürüme analizleri yapılarak pelvis, kalça ve diz kinematik parametreleri incelendi. Parametreler arasındaki ilişkiler, verilerin normal dağılımlarına göre Pearson ve Spearman korelasyon testleri kullanılarak değerlendirildi. Verilerin istatistiksel olarak anlamlılık düzeyi (p<0.05) olarak kabul edildi ve sonuçlar Cohen sınıflamasına göre yorumlandı. BULGULAR Beighton testi skoru ile kalça ekstansör(r: -.70) ve diz ekstansör(r: -.91) kas kuvvetleri, minimum diz fleksiyon açısı(r: -.83) arasında yüksek korelasyon bulundu. TPAT değerleri ise kalça abduktör kas kuvveti(r: -.77) ve ortalama kalça rotasyon açısıyla yüksek korelasyon gösterdi(r: .60). TARTIŞMA Literatürde, FAA olan çocukların yürüme sırasında ortalama kalça iç rotasyon, pelvik oblikite ve duruş fazında diz ekstansiyon parametrelerinin arttığı gösterilmiştir. Bu çalışma, zayıf kalça ekstansör ve abduktür, diz fleksör ve ekstansör kaslarındaki zayıflığın kinematik değişimlerle ilişkili olabildiğini göstermiştir. Ayrıca, literatürle uyumlu olarak ortalama kalça internal rotasyon parametresiyle kalça abdüktör kas kuvvetinin TPAT açısıyla anlamlı olarak ilişkili olduğu bulumuştur. FAA olan çocuklarda sıkça görülebilen hipermobilitenin, kalça ve diz ekstansör kas zayıflığı ile duruş fazında hiperekstansiyon artışında rolü olabilir. Sonuç olarak, kalça abdüktör ve ekstansör, diz fleksör ve ekstansör kas kuvvetlerinin arttırılması, FAA olan hipermobil çocuklarda alt ekstremite fonksiyonun iyileştirilmesi için önemlidir.Publication Femoral Anteversiyon Artışı ve PesPlanovalgusu Olan Çocuklarda Tabanlığın Yürüme Kinematiğine Etkisi(2018) Evrendirek, Halenur; Akalan, Ekin; Sert, Rukiye; Kuchimov, Shavkat Nadir; Karaca, Gülşah; Ertürk, Gamze; Bilgili, Fuat; 268497; 176320; 268498; 268636; 237820Publication Fizyoterapi ve Rehabilitasyon Bölümü Öğrencilerinin Öğretim Üyesi Memnuniyeti ve Ders Memnuniyeti Arasındaki İlişkinin İncelenmesi(2019-10-17) Ertürk, Gamze; KARACA, GÜLŞAH; EVRENDILEK, HALENUR; akalan, ekin; APTI, ADNAN; AKEL, BURCU SEMİN; ÖNERGE, KÜBRA; 114564; 268636; 268498; 283338; 173320; 259584Giriş: Yükseköğretim kurumlarında akreditasyon çalışmaları Bologna sürecinin başlaması ile birlikte ağırlık kazanmıştır. Yükseköğretim Kurumu (YÖK) tarafından da eğitim-öğretimin ders süreçleri, ders yükleri, öğrencilerin katılımları, öğrencilerin ve öğretim üyelerinin memnuniyeti gibi konularda incelenmesi için gerekli çalışmaların yapılmasına hem destek hem de önem verilmektedir. Üniversitelerin iç paydaşlarından biri olan öğrencilerin öğretim üyesi ve ders memnuniyetinin değerlendirilmesi ve her iki değerlendirme parametresinin birbirleri ile olan ilişkisinin belirlenmesi önemlidir. Değerlendirme sonucunda elde edilecek sonuçlar, eğitimde kalitenin arttırılması; sağlık alanının insan yaşamı ile doğrudan ilgili olduğu göz önüne alındığında işini en doğru ve güvenilir şekilde yapabilecek donanıma sahip sağlık profesyonellerinin yetiştirilmesi; nitelikli yetişen profesyonellere bağlı olarak Türkiye'de sağlık sisteminin daha ileriye taşınması ve toplumsal refah seviyesinin arttırılması konusunda yapılması gerekenler için bir çıktı olacaktır. Amaç: Akreditasyon kapsamında öğretim üyesi ve ders memnuniyetinin değerlendirilmesi gerekmektedir. Fakat değerlendirmelerin sonucundaki memnuniyet düzeylerinin tutarlılığı konusunda net bir sonuç yoktur. Bu nedenle çalışmadaki amacımız Fizyoterapi ve Rehabilitasyon bölümü öğrencileri tarafından değerlendirilen öğretim üyesi memnuniyeti düzeyi (ÖÜMD) ve ders memnuniyeti düzeyi (DMD) arasındaki ilişkinin incelenmesidir. Gereç-Yöntem: Çalışmaya, İstanbul Kültür Üniversitesi Sağlık Bilimleri Fakültesi Fizyoterapi ve Rehabilitasyon Bölümü öğrencilerinden 34 kişi katıldı. Tüm öğrencilerin okulda geçirdikleri 2. ve 3. dönem verileri toplanarak analiz yapıldı. Her bir öğrenciden, fakülte öğretim üyeleri tarafından hazırlanan ve toplam 35 sorudan oluşan "Öğretim Üyesi ve Ders Değerlendirme Anketi"ni doldurmaları istendi. Anketin ilk 25 sorusu öğrencilerin ÖÜMD'ni değerlendiren sorulardan (öğretim elemanının öğrencilerle olan ilişkisi, kullandığı yöntemler, zaman yönetimi vb.) oluşurken diğer 10 soru ise DMD'ni değerlendiren sorulardan (dersin amaç ve içeriği, mesleki gelişime katkısı, değerlendirilme yöntemleri, ders kaynakları vb.) oluşmaktaydı. Her bir soru 0-5 puan (0=kesinlikle katılmıyorum,5=kesinlikle katılıyorum) arasında puanlandı. Anketler, öğrenciler tarafından toplam 20 ders (13 zorunlu,3 zorunlu seçmeli,4 alan içi seçmeli) ve 17 öğretim üyesi için dolduruldu. İstatiksel analiz için SPSS 25 programı kullanıldı. Veriler normal dağılımlarına göre değerlendirildikten sonra korelasyon analizi için Pearson Korelasyon Katsayısı testi kullanıldı. Korelasyon kuvvetini belirlemek için Cohen korelasyon sınıflaması kullanıldı. Sonuçlar: Öğretim üyesinden memnuniyet ortalaması 4.24±0.46, ders içeriğinden memnuniyet ortalaması ise 4.23+0.48 olarak bulundu, her iki değerlendirme arasında pozitif yönde çok yüksek dereceli korelasyon bulundu (p<0,05,r: 0,9s)1. Tartışma: Çalışmamızın sonucuna göre öğrencilerin ders memnuniyet düzeyi ile öğretim üyesi memnuniyet düzeyi birbiriyle ilişkilidir. Öğretim üyesinin öğrencilerin derse karşı olan memnuniyet düzeyini etkileyebileceği, bu durumun da öğrenci başarısında rol oynayabileceği düşünülmektedir. Bu nedenle öğretim üyelerinin yeterliliklerinin geliştirilmesine yönelik çalışmalar öğrenci memnuniyetinde rol oynayabilir. Öğrenci memnuniyetinin değerlendirilmesine ilişkin çalışmaların arttırılması yükseköğretim seviyesinde verilen eğitimin iyileştirilmesi için yararlı olabilir.Publication Hemiplejik Tip Serebral Palsili ÇocuklardaTek Ayak Üzerinde Durma Süresi İle KMFDÖ Skoru ve Stance Faz Stabilitesi Arasındaki İlişki(2018) Ertürk, Gamze; Skalan, Ekin; Evrendirek, Halenur; Karaca, Gülşah; Bilgili, Fuat; 268636; 176320; 268497; 268498; 237820Amaç: Hemiplejik-tip serebral palsili (HSP) çocukların basma fazındaki stabilite problemleri ve kaba motor gelişimindeki anormallikler çeşitli yürüyüş patolojilerine neden olmaktadır. Kaba Motor Fonksiyon Değerlendirme Ölçeği (KMFDÖ) SP'li çocuklarda fonksiyon değerlendirmesi için en sık kullanılan yöntemdir \ Yürüme stabilitesinin objektif değerlendirilmesi için pedobarografi ve 3 boyutlu yürüme analizi gibi yüksek maliyetli ve klinikte geniş alan gerektiren donanımlara ihtiyaç duyulmaktadır. Bu tür yöntemlerin uygulanması çok uzun zaman almakta, klinisyen için yorucu olmakta ve tecrübe gerektirmektedir. Tek Ayak Üzerinde Durma Testi (TADT) ise klinikte sıklıkla kullanılan, pratik ve kolay uygulanabilen ayrıca SP'li çocuklarda geçerliliği kanıtlanmış bir testtir 2. Literatürde TADT'nin KMFDÖ ve basma fazının stabilitesi arasındaki ilişkiyi değerlendiren bir çalışma yoktur. Yöntem: İstanbul Üniversitesi Çapa Tıp Fakültesi Yürüme Analizi Laboratuvarında halen takip altında olan, 7- 15 yaş arasında, Kaba Motor Fonksiyon Sınıflama Sistemine göre I ve II. seviyede, cerrahi geçmişi olmayan, 6 ay içinde Botulinium Toxin-A enjeksiyonu yapılmamış ve tek ayak üzerinde 30 saniye duramayan 18 HSP'li çocuk (yaş: 11.0812.84 yıl) çalışmaya dahil edildi. Her katılımcı TADT, KMFDÖ D / E bölümleri ile değerlendirildi ve pedobarografik ölçümleri kaydedildi. TADT sırasında katılımcılardan karşıya bakmaları ve testlenmeyen ekstremiteyi fleksiyona getirmeleri istendi (Figür 1). Test iki bacak için de 3 kere tekrarlandı ve en iyi skorlar alındı. KMFDÖ'nün D ve E bölümlerinin her bir maddesi en fazla 3 deneme yapılmasına izin verilerek değerlendirildi. En başarılı deneme 0-3 puan (0- başlatamaz, 3-tamamlar) arasında puanlandı. Pedobarografik ölçümler sırasında katılımcılar 90 BPM kadansta yürütüldü ve tepe plantar kuvvetler; T l: erken basma fazının tepe kuvveti, T2: geç basma fazının tepe kuvveti, T2-T1: tek destek fazı ( basma fazının stabilite parametresi3) olarak tanımlandı. Karşılaştırmalarda Mann Whitney - U testi, korelasyonlarda Spearman's korelasyon testi kullanıldı. Korelasyon kuvvetini belirlemek için Cohen korelasyon sınıflaması kullanıldı. Bulgular: TADT ve basma fazının stabilitesi (T2-T1) hemiplejik tarafta etkilenmemiş tarafa göre azaldı (p<0.001) (Grafik 1). Hemiplejik tarafta TADT ile basma fazı stabilitesi (T2-T1) arasında yüksek korelasyon bulundu (p=0.02, r= 0.52). Ayrıca TADT ve KMFDÖ-D arasında orta şiddetli korelasyon (p=0.05, r= 0.44); TADT ve KMFDÖ-E arasında çok yüksek korelasyon (pcO.OOl, r=0.86) bulundu. Çıkarımlar: Klinik olarak ölçülen TADT, HSP'li çocuklar için KMFDÖ D-E bölümleri ve basma fazı stabilitesi hakkında oldukça değerli bilgiler verebilir. Tek ayak üzerinde durma süresinin ölçülmesi, yürümenin basma fazı stabilitesinin anlaşılabilmesi için bilgisayarlı yürüyüş analizi, pedobarografi veya KMFDÖ 'den daha kolay ve hızlı bir yöntemdir.Publication "How Does Hypermobility Affect Lower Extremity Function for Children with Increased Femoral Anteversion? Describing Effects ofReduced Forefoot Sensation on Foot Pressure Distribution: Plot Study(2018-09) Leblebici, Gökçe; Akalan, Ekin; Kuchimov, Shavkat Nadir; Kurt, Rengin Aslıhan; ÖNERGE, KÜBRA; APTİ, ADNAN; 283338; 229941; 259584; 272694; 283338Increased femoral anteversion (IFA) and joint hypermobility are commonly seen together in pediatric clinics. Femoral anteversion and joint hypermobility may contribute falling and fatigue in activities, as well as causing abnormal gait patterns.Publication The Immediate Effect of Hanging Exercise and Muscle Cylinder Exercise on the Angle of Trunk Rotation in Adolescent Idiopathic Scoliosis(MDPI, 2024) Akçay, Burçin; Çolak, Tuğba Kuru; APTİ, ADNAN; Çolak, İlker(1) Background: Semi-hanging and muscle cylinder exercises have been defined as scoliosis-specific corrective exercises. The aim of this study was to evaluate the immediate effect of muscle cylinder and semi-hanging exercises on the angle of trunk rotation in patients with adolescent idiopathic scoliosis (AIS). (2) Methods: Twenty-seven patients with AIS with a mean age of 18.6 years were retrospectively analyzed. The angle of trunk rotation (ATR) values were measured before and after performing semi-hanging and standing muscle cylinder exercises. Both exercises were performed for three to five respiratory cycles. The semi-hanging exercise was performed first, followed by the muscle cylinder exercise, in this order, in all participants. For statistical analysis, the Wilcoxon signed-rank test was used to analyze ATR changes after the exercises, and the Kruskal-Wallis test was used to compare ATR changes according to the main curve location. (3) Results: The thoracic, thoracolumbar and lumbar maximum ATR values were significantly increased after the semi-hanging exercise (p < 0.001) and decreased after the muscle cylinder exercise (p < 0.001). The ATR change was greater in the lumbar region than in the thoracic and thoracolumbar regions. (4) Conclusion: The results of this study of a small group of patients emphasized that one of the scoliosis-specific corrective exercises, the standing muscle cylinder exercise, improved ATR, while the other, the semi-hanging exercise, worsened ATR in patients with AIS. It is recommended that each scoliosis-specific corrective exercise be evaluated and redesigned to maximize the three-dimensional corrective effect, considering the biomechanics of the spine and the pathomechanics of scoliosis.Publication Increased femoral anteversion-related biomechanical abnormalities: lower extremity function, falling frequencies, and fatigue(2019-05) Leblebici, Gökçe; akalan, ekin; Kuchimov, Shavkat Nadir; Kurt, Aslıhan; Temelli, Yener; Miller, Freeman; ÖNERGE, KÜBRA; APTİ, ADNANBackground: 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.Publication 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.Publication Investigation of The Correlation Between Ultrasonography Based Muscle Architecture Parameters and Isometric Knee Flexor Strength(2019-09) KARACA, GÜLŞAH; 268498Publication Investigation of the Relationship Between Selective Voluntary Motor Control and Static Balance in Cerebral Palsy(2019-09) Akalan, Ekin; Ertürk, Gamze; Evrendirek, Halenur; Karaca, Gülşah; ÖNERGE, KÜBRA; 176320; 268636; 283338; 268497; 268498Introduction: Cerebral palsy is a group of disorders includes spasticity, contracture, balance disorder and selective motor control impairment [1], Although the relationship between selective voluntary motor control (SVMC) and gross motor function, ROM and spasticity had been investigated in literature [1], its relationship with static balance was not investigated in these children. Research Question: The aim of the study was to investigate the relationship between selective motor control and static balance in children with CP. Secondly, if there is a relationship, determining most static balance-related parameter in Selective Control Assessment of the Lower Extremity (SCALE) test. Method: Twelve children with CP (6 hemiplegics, 6 diplegic (18 legs); age: 9±3.49 y.o.) participated in the study. One-leg-standing test (OLST) and SCALE tests were used to determine static balance and motor control respectively. Duration of OLST was assessed by a stopwatch, while the participants placed both hands on hips, looked at the wall, and kept the other leg in 90° flexion. According to the duration of OLST, participants were scored between 0-3 points (0 point: could not initiate the OLST, 1 point: 0-5 sec, 2 points: 5-10 sec, 3 points: 10+ sec). Cohen correlation classification was used to define the strength of the correlation [2]. The twelve participants were above the minimum sample size needed to ensure a power of 95% confidence level. Results: A very high-level correlation was found between OLST and total SCALE score (p=0.001, r=0.75). In addition, there was a high-level correlation between OLST and ankle (p=0.023, r=0.56), subtalar joint (p=0.013, r=0.6), and toes (p=0.004, r=0.67) parameters (Table 1). Since, all participant had a full score from SCALE (Hip section) test, statistical analysis could not be performed for hip parameters. Discussion: Our study showed that static balance and SVMC have a very high to a high level relationship. In practice, physical therapists may get benefit from improving selective motor to enhance the static balance for children with CP. On the other hand, because the OLST has a high level relationship with stance phase stability during gait (ESMAC 2018), improving selective motor control in lower extremity may assist in enhancing gait quality. In the future, similar studies should be done by using dynamic balance assessments and center of pressure range calculations during walking.