Fizyoterapi ve Rehabilitasyon Bölümü / Department of Physiotherapy and Rehabilitation
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Publication 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 Covid-19 ve Ergoterapi: Salgın Hastalıklara Hızlı Cevap Verme ve Hazırlıklı Olma Boyutuyla Bir Gözden Geçirme Çalışması(Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi, 2020) Salar, Sinem; AKEL, BURCU SEMİNDünya’nın globalleşmesi salgın hastalıkların yayılmasını kolaylaştırırken toplum sağlığını korumada da birlik içinde olmayı öğretmektedir. Bu nedenle, sağlık sisteminin parçası olan her profesyonel gibi ergoterapistlerin de salgın hastalık gibi halk sağlığını etkileyen durumlarda hazır olması gerekmektedir. Ergoterapistlerin, anlamlı ve amaçlı aktiviteler yoluyla sağlık ve iyi olmayı desteklemek için koruyucu ve destekleyici yaklaşımları uygulama sorumluluğu bulunmaktadır. Bu derlemenin amacı; yeni koronavirüs hastalığı olan, sağlıklı ve dezavantajlı tüm grupları kapsayacak şekilde COVID-19 sürecinde ergoterapinin rol ve sorumluluklarına yönelik bir bakış açısı sunmaktır. Bu süreçte kişilerin okupasyonlarını yürütme ve okupasyonlara ulaşma sırasında yaşadığı değişimler, adaptasyonlar ve bunların sonuçları ergoterapi açısından önemlidir. COVID-19 pandemisi ile ortaya çıkan ihtiyaçlara yönelik ergoterapistlerin hazır olması gereken alanlar bu derleme ile sıralanmıştır. Bireyi bütüncül değerlendiren ergoterapistler güvenli ve sağlıklı kalmak için enfeksiyon kontrol önlemlerine uyma, erişme ve kullanma sırasında hayati ihtiyaçları mental sağlık, irade, psikolojik-fiziksel boyutları ile anlayabilir. Pandemiden en fazla etkilenen ülkelerden gelen yayınlar, Dünya Sağlık Örgütü, Dünya Ergoterapistler Federasyonu, Amerikan Ergoterapi Derneği bazı temel konular üzerinde durmaktadır. Kaynaklara ulaşma, günlük yaşam aktiviteleri, akut bakım, iletişim, mobilite, stigma, sosyal izolasyon, mental sağlık ve iyi olma hali bu konular arasındadır. Bu derlemede, bahsedilen durumlara yönelik hizmet verilmesi için gerekli olan telesağlık, mental sağlık çalışmaları, bireysel/aile/toplum çalışmaları, yardımcı teknoloji, akut bakım konuları ele alınmıştır.Publication Determination of Somatotypes of Children With Adolescent Idiopathic Scoliosis and Its Relationship With Scoliosis(Bayrakol Medical Publisher, 2023) APTİ, ADNAN; Çolak, Tuğba Kuru; Akçay, Burçin; Çolak, İlkerAim: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. In adolescence, body morphology can change for various reasons such as genetics, nutrition, and level of physical activity. It has been reported that there are differences in the normal physical growth pattern in children with AIS, which may be due to hormonal changes. The relationship between body morphology and scoliosis is questionable because of the differences that scoliosis creates in the spinal structure. The aim of this study was to define the somatotype characteristics of children with AIS and compare the somatotypes with healthy, age and sex-matched controls.Material and Methods: A retrospective evaluation was performed on 38 children with AIS and 27 age-matched healthy control subjects. Cobb angles and angle of trunk rotation (ATR) values were used to determine scoliosis and trunk gibbosity. Cobb angles were measured on standing anterior-posterior radiographs and the ATR using Adam's forward bending test with a scoliometer. Somatotypes were defined according to the Heath-Carter method and body morphology was categorized into three different components: endomorphy, mesomorphy, and ectomorphy.Results: Ectomorphy was the dominant type in the AIS group, and endomorphy was the dominant type in the control group. The endomorphic somatotype in individuals with scoliosis was determined at a statistically significantly lower rate than in the control group (p=0.048). There was a moderate negative correlation (p=0.001, r=-0.466) between the Cobb angle and the values of the endomorphy component, and between the ATR and the endomorphy values (p=0.010, r=-0.318).Discussion: The lower rate of endomorphic somatotype was an evident difference in children with scoliosis. These differences may cause problems in the growth and development of the spine and the skeletal structures attached to the spine during adolescence when rapid growth and development occur. Whether this difference is related to nutrition, genetic and hormonal factors, or psychosocial factors remains to be determined.Publication Does Increased Femoral Anteversion Can Cause Hip Abductor Muscle Weakness?(MDPI, 2023) APTİ, ADNAN; AKALAN, NAZİF EKİNBackground: Increased femoral anteversion (IFA) causes functional problems (i.e., tripping, frequently falling, and fatigue) by affecting the pelvis and lower extremity biomechanics. In the frontal plane, increased contralateral pelvic drop and ipsilateral hip adduction, which are mainly considered deteriorated hip abductor muscle mechanisms, are associated with hip and knee injuries. Aims: The aim of this study was to examine the effects of femoral anteversion on hip abductor weakness and frontal plane pelvis-hip biomechanics during walking. Methods: The study included nine subjects with increased femoral anteversion and a control group of eleven subjects. Maximum isometric voluntary contraction (MIVC) values of the hip abductor muscles were measured with a handheld dynamometer. Three-dimensional gait analysis was performed for kinetic, kinematic, and temporo-spatial gait parameters. Non-parametric tests were used for statistical analysis (p < 0.05). Results: There was no significant difference found between the MIVC values of the IFA and control groups (p = 0.14). Moreover, no significant difference was determined between the ipsilateral peak hip adduction (p = 0.088) and contralateral pelvic drop (p = 0.149) in the stance phase. Additionally, there was no correlation between the peak hip adduction angle in the stance phase and normalized MIVC values in the IFA group (r = -0.198, p = 0.44), or in the control group (r = -0.174, p = 0.55). The deviations of pelvic rotation (p = 0.022), hip internal rotation (p = 0.003), and internal foot progression (p = 0.022), were found to be higher in the IFA group than in the controls. Conclusions: IFA may not be associated with hip abductor muscle weakness, and it may not lead to the hip adduction and pelvic depression that can be seen in hip abductor weakness. Increased pelvic rotation and internal hip rotation during walking might be considered as a compensation for the femoral head-acetabulum alignment mechanism in the frontal plane.Publication The Effectiveness of the Schroth Best Practice Program and Cheneau-Type Brace Treatment in Adolescent Idiopathic Scoliosis: Long-Term Follow-Up Evaluation Results(MDPI, 2023) Çolak, Tuğba Kuru; Akçay, Burçin; APTİ, ADNAN; Çolak, İlkerBackground: Although the number of studies showing the efficacy of conservative treatment in adolescent idiopathic scoliosis has increased, studies with long-term follow-up are very limited. The aim of this study was to present the long-term effects of a conservative management method including exercise and brace in adolescent idiopathic scoliosis patients. Methods: This retrospective cohort study included patients with idiopathic scoliosis who presented at our department and were followed up for at least 2 years after completing the treatment. The main outcome measurements were the Cobb angle and angle of trunk rotation (ATR). Results: The cohort participants were 90.4% female, with a mean age of 11 years and the maximum Cobb angle was mean 32.1 degrees. The mean post-treatment follow-up period was 27.8 months (range 24-71 months). The improvements after treatment in mean maximum Cobb angle (p < 0.001) and ATR (p = 0.001) were statistically significant. At the end of treatment, the maximum Cobb angle was improved in 88.1% of the patients and worsened in 11.9% compared to baseline. In the long-term follow-up evaluations, 83.3% of the curvatures remained stable. Conclusions: The results of this study showed that moderate idiopathic scoliosis in growing adolescents can be successfully halted with appropriate conservative treatment and that long-term improvement is largely maintained.Publication Effects of Arm Swing on Plantar Pressure Behavior During Walking(İstanbul Üniversitesi-Cerrahpaşa Sağlık Bilimleri Fakültesi, 2023) Leblebici, Gökçe; AKALAN, NAZİF EKİN; ÖNERGE, KÜBRA; KUCHIMOV, SHAVKAT; Ören, MeryemObjective: This study aimed to investigate the influence of different arm swing conditions on plantar pressure behavior during walking in healthy individuals. Methods: The study included 29 healthy (22.55 ± 1.02 years) volunteers. The foot pressure was analyzed under 3 conditions: both arms should be freely swinging and the dominant arm should be restricted and should be held. Time and magnitudes of peak forces, gait velocity, duration of stance subphases, peak forces for 5 different areas in foot-sole, accelerations of the center of pressure, and mediolateral displacements of center of pressure were the interesting parameters. Results: When the arm swing was held, the onset of terminal stance was earlier and the anterior-posterior center of pressure acceleration decreased at the midfoot on the affected side (0.32 ± 0.04 seconds, 2.96 ± 0.27 m/ms 2) than on the contralateral side (0.34 ± 0.05 seconds, 3.12 ± 0.28 m/ms 2) (P = .04, P = .02). The differ- ences in anterior-posterior center of pressure acceleration between heel and forefoot and the mediolateral displacements of center of pressure were lower on the affected side at held (3.75 ± 0.31 m/ms 2, 0.06 ± 0.02 m, respectively) compared to the free swing (3.82 ± 0.30 m/ms 2, 0.07 ± 0.02 m) (P = .02, P = .01), while the peak force at the medial forefoot was lower on the contralateral side when the arm was held (28.87 ± 6.22 N) compared to the free swing (30.54 ± 5.86 N) (P= .01). Conclusion: The lack of arm swing may interact with ipsilateral early onset and longer late stance phase during walking in healthy individuals. The foot pressure behaviors during walking should be investigated for unilaterally affected patients.Publication Examination of Fatigue, Well-Being and Life Habits in Children with Cancer Diagnosis(Bezmiâlem Vakıf University, 2021) Sevgili, Sümeyye; Şahin, Sedef; AKEL, BURCU SEMİNObjective: In this study, it was planned to examine fatigue, well-being and life habits in children with cancer. Methods: This cross-sectional analytical study was conducted between September 2019-January 2020. "24-Hour Child Fatigue Scale", "Child Well-being Assessment" and Child Life Habit Questionnaire (LIFE-H for Children 1.0)" were administered to 20 children with cancer aged 5-15 years. Pearson's correlation coefficient was used to determine the statistical relationship between life habits, fatigue and well-being. Statistical significance level was accepted as p<0.05. Results: There were significant relationships between fatigue and personal care, shelter and mobility parameters of life habits (r=-0.66, r=0.54, r=0.45, p<0.01, respectively) and there were significant relationships between fatigue and negative emotions (r=0.46), overall life satisfaction (r=-0.52), general happiness (r=-0.49) and positive emotions (r=-0.44 *) parameters of well-being assessment. Life habits scale was found to be related with nutrition, physical fitness and communication parameters of Child Life Habit Questionnaire were found to be most related with the meaning and purpose parameter of the well-being assessment (p<0.01). There were significant relationships between positive emotions and recreation (r=0.45, p=0.04); optimism and communication (r=-0.44, p=0.04); personal care (r=-0.49, p=0, 02), social life (r=-0.46, p=0.04) and autonomy; and mobility and negative emotions (r=-0.45, p=0.04). Conclusion: Considering the relationships determined in this study, the evaluation of the children with cancer and treatment approaches can be shaped. The fact that fatigue affects all aspects of children's life reveals the importance of dealing with fatigue. It is recommended to focus on the meaning and purpose and regain autonomy for children in order to rearrange the life habits of the children and ensure their well-being.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 Normative Values for Cervical and Lumbar Range of Motion in Healthy Young Adults(Galenos Publishing House, 2023) APTİ, ADNAN; Çolak, Tuğba Kuru; Akçay, BurçinObjective: The cervical and lumbar spines are the more mobile parts of the spinal column than the thoracic spine. Reference range of motion (ROM) measurements is one of the important clinical outcome measures used in patient assessment and follow-up of treatment efficacy. The aim of this study was to obtain normative values of cervical and lumbar ROM in young adults. Materials and Methods: The sample comprised 300 healthy volunteers (198 female, 102 male, mean age: 21.4±1.9 years, range, 18-29 years). Cervical (C) and lumbar (L) ROM values were measured in three planes with a two-arm digital goniometer according to the American Academy of Orthopaedic Surgeons (AAOS) criteria. The mean ROM measurements were analyzed according to gender using the Mann-Whitney U test. Results: Cervical ROM values were determined to be: cervical flexion 57.7±8.2º, extension 59.1±10.2º, right-left lateral flexion 42.1±7.9º-41.4±7.7º, and right-left rotation 71.1±10.5º-70.2±9.7º. There was no statistically significant difference between the genders with respect to the cervical ROM (p>0.05). The lumbar ROM values were determined to be lumbar flexion 69.9±14.5º, extension 40±10.2º, right-left lateral flexion 36.3±6.4º-36.2±6.6º, and right-left rotation 38.4±8.7º-38.6±9.4º. The lumbar flexion ROM values were statistically significantly higher in females than in males (p=0.043). Conclusion: The flexion and extension angles of the lumbar spine in the sagittal plane were higher in females than in males, and there was no difference between the genders regarding all the other cervical and lumbar joint ROM values. These goniometrically measured cervical and lumbar ROM values were found to be generally similar to the widely used reference values of AAOS and Kendall McCreary. Further research is needed on the effects of individual differences such as physical activity or inactivity.Publication The Reliability of the Augmented Lehnert-Schroth and Rigo Classification in Scoliosis Management(AOSIS, 2021) Akçay, Burçin; Çolak, Tuğba Kuru; APTİ, ADNAN; Çolak, İlker; Kızıltaş, ÖnderBackground: In pattern-specific scoliosis exercises and bracing, the corrective treatment plan differs according to different curve patterns. There are a limited number of studies investigating the reliability of the commonly used classifications systems. Objective: To test the reliability of the augmented Lehnert-Schroth (ALS) classification and the Rigo classification. Methods: X-rays and posterior photographs of 45 patients with scoliosis were sent by the first author to three clinicians twice at 1-week intervals. The clinicians classified images according to the ALS and Rigo classifications, and the data were analysed using SPSS V-16. Intraclass correlation coefficients (ICCs) and standard error measurement (SEM) were calculated to evaluate the inter-and intra-observer reliability. Results: The inter-observer ICC values were 0.552 (ALS), 0.452 (Rigo) for X-ray images and 0.494 (ALS), 0.518 (Rigo) for the photographs. The average intra-observer ICC value was 0.720 (ALS), 0.581 (Rigo) for the X-ray images and 0.726 (ALS) and 0.467 (Rigo) for the photographs. Conclusions: The results of our study indicate moderate inter-observer reliability for X-ray images using the ALS classification and clinical photographs using the Rigo classification. Intra-observer reliability was moderate to good for X-ray images and clinical photographs using the ALS classification and poor to moderate for X-ray and clinical photographs using the Rigo classification.Publication Skolyoz Tedavisinde Schroth Yöntemi(Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi, 2020) Çolak, Tuğba Kuru; Akçay, Burçin; APTİ, ADNANSchroth egzersizleri dünyada fizyoterapistler tarafından en yaygın olarak kullanılan skolyoza özel egzersizlerdir. Skolyoza özel üç boyutlu egzersiz yöntemi olan Schroth tedavisi 1900’lü yılların başında Almanya’da Katharina Schroth tarafından geliştirilmiştir. Günümüze kadar yöntem Schroth’un kızı Christa Lehnert-Schroth ve torunu Hans R. Weiss tarafından güncellenerek geliştirilmiştir. Tüm dünyada fizyoterapistler tarafından skolyoz tedavisinde yaygın olarak kullanılan bir tedavi yöntemidir. Güncel literatür Schroth yönteminin adolesan idiopatik skolyozda Cobb açısını azaltmada ve yaşam kalitesini geliştirmede seviye II düzeyinde bilimsel kanıt olduğunu ortaya koymuştur. Bu derleme makalesi skolyoz tedavisinde kullanılan Schroth yönteminin tarihçesini, temel egzersiz prensiplerini ve bu konudaki literatür araştırmalarına gözden geçirmek amacıyla yazılmıştır.Publication Time Difference Between Onsets of Lateral and Medial Hamstring Muscles During Gait in Patients With Patellofemoral Pain: A Preliminary Study(Marmara Univ., Inst Health Sciences, 2022) Coşkunsu, Dilber Karagözoğlu; Can, Filiz; Kuchimovs, Shavkat; AKALAN, NAZİF EKİN; Kılıçoğlu, İ. Önder; Öztürk, NeclaObjective: Early activation of lateral hamstrings (LH) relative to medial hamstrings (MH) has been thought to be the cause of abnormal knee abduction and external rotation of the tibia, which affects the orientation of patellar tendon and increases lateral patellofemoral compression. Therefore, early activation of LH relative to MH is considered to have a role in the patellofemoral pain (PFP). The aim of this study was to investigate the time difference between MH and LH onsets in patients with PFP during gait. Methods: Thirteen patients with bilateral PFP (mean age 28.73 +/- 7.44 years) and 13 asymptomatic subjects (mean age 30.47 +/- 6.22 years) were recruited in the study. Gait analysis was performed using the ELITE system (BTS, Milano-Italy) with video cameras (TVC, BTS, Milano-Italy). Participants were requested to walk at a self-selected speed on a force platform, and EMG data were recorded from MH and LH muscles for 10 initial contacts by using TELEEMG (BTS, Milano-Italy). Time difference between the onsets of the MH and LH was calculated for each initial contact by using moving averaging method, then their mean was obtained for each participant. Results: The time difference between onsets of MH and LH was - 26.9 +/- 22.2 ms for PFP subjects and - 11.2 +/- 14.2 ms for control subjects, and LH mainly became activated earlier compared to MH in most of the subjects in both groups. There was a statistically significant difference between the time differences of the groups (p=0.041). Conclusion: Our findings suggest that LH displayed an earlier activation in subjects with PFP compared to control subjects during gait.Publication What Information Do Teenagers with Idiopathic Scoliosis and Their Families Need When First Diagnosed?(Erkan Mor, 2021) Çolak, Tuğba Kuru; Akçay, Burçin; APTİ, ADNAN; Çolak, İlker; Bettany-Saltikov, JosetteObjective: The aim of this study was to determine the information needs of individuals with adolescent idiopathic scoliosis (AIS) and theirfamilies when the disease was first diagnosed.Materials and Methods: A total of 117 patients with AIS and their parents volunteered to participate in this study. A survey developed specificallyto assess the information needs of AIS patients and their families was sent by e-mail. Of the AIS patients, 59.8% were aged >16 years andcompleted the survey alone, and 40.2% were aged <16 years and they completed the survey together with their parents.Results: The results of this study demonstrated that in the initial diagnosis, scoliosis could be observed even if the angle was <20°. Generally,scoliosis was first noticed by the child’s mother. As expected, at the time of the initial diagnosis, the children diagnosed as having scoliosis wereupset and confused and their parents also felt upset and worried. The information most needed was reported to be answers to the questions of“Will it get better, what are the causes of scoliosis?”, “What is scoliosis and what are the possible treatment options?”, and the least frequentlyasked question was “Will surgery be needed?”.Conclusion: Clear, accurate, complete, and personalized information is required by patients and their families. This information is essential inenabling patients to make major decisions and to take ownership and responsibility for the decision. Involvement in decision-making helps toimprove compliance with treatment and finally also improves satisfaction with the agreed treatment method used.