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    Comparing the acute effect of myofascial release techniques and passive stretching on hind foot dynamic loading in patients with multiple sclerosis: A cohort-blinded study
    (Walter De Gruyter Gmbh, 2020) Balkan, Ayla Fil; Keklicek, Hilal; Salci, Yeliz; Altinkaynak, Umut; Armutlu, Kadriye
    Study aim: It is important for therapists to incorporate new practical methods into therapy programs when they have demonstrable efficacy in the treatment of multiple sclerosis. Investigating the acute effects of myofascial release techniques (MFR) and passive stretching (PS) on hind foot loading and the severity of spasticity in individuals with multiple sclerosis (MS) was the aim of the study. Material and methods: Following the initial evaluation. 10 participants with MS (n = 20 feet) were given MFR for the plantar flexor muscle group. After the day following the first visit, participants were asked to come again and PS was applied to the plantar flexor muscle groups after the evaluation. The severity of spasticity was assessed with the Modified Ashworth Scale (MAS). Dynamic loading parameters of the hind foot - medial and lateral maximum pressure (N/cm(2)), active contact areas (cm(2)), contact percentiles (%) - were evaluated with dynamic pedobarography. Participants of the study were evaluated four times: (1) at the initial evaluation. (2) after MFR application, (3) 24 hours after the initial evaluation (pre-PS), (4) after PS. Results: There were no differences in MAS (p > 0.05) according to time-dependent analyses (p > 0.05). After MFR, the maximum pressure of the medial heel and active contact area were increased (p < 0.05) and there was a carryover effect on the maximum pressure of the right foot. Conclusions: This study showed that MFR was an effective method for management of plantar flexor spasticity in patients with multiple sclerosis in the short term and there was a carryover effect in favor of MFR. There was no additional effect of PS.
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    Investigating the dynamic plantar pressure distribution and loading pattern in subjects with multiple sclerosis
    (Elsevier Sci Ltd, 2018) Keklicek, Hilal; Cetin, Baris; Salci, Yeliz; Balkan, Ayla Fil; Altinkaynak, Umut; Armutlu, Kadriye
    Background: Multiple sclerosis (MS) is a complex disorder affecting subjects by multiple system impairments. Gait problems are common in subjects with MS and various factors such as; ataxia, hypertonic muscles or/and seconder musculoskeletal system deformities affect the normal plantigrade contact by disturbing accommodation of foot to the ground while walking. The aim of this study was investigating the dynamic plantar pressure distribution and time of maximum pressure in subjects with MS and determining the differences from healthy subjects (HS). Methods: Fifty-five subjects with MS (110 foot) and 20 HS (40 foot) were the participants of the study. The dynamic pedobarograph was utilized for evaluation of dynamic loading parameters; maximum pressure (N/cm2) and time of maximum pressure (ms) collected from heel medial, heel lateral, midfoot, heads of first, second, third, fourth and fifth metatarsal bones. Results: There were differences between the groups in maximum pressure of heel medial (p < .001) and heel lateral (p < .001) was higher in HS. Also, there were differences between the groups the time of maximum pressure of all metatarsal head areas, midfoot, heel medial and heel lateral (p < .001). Subjects with MS spent lesser time to reach maximum pressure for forefoot loading and longer time for hindfoot loading. Conclusion: The study provided basic data about foot pressure distribution and time of maximum pressure in subjects with MS. Results of the study showed that the hindfoot loading was disrupted and inappropriate timing during load transfer from hindfoot to forefoot is exist in subjects with MS.
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    The trunk control: Which scale is the best in very acute stroke patients?
    (Taylor & Francis Ltd, 2019) Balkan, Ayla Fil; Salci, Yeliz; Keklicek, Hilal; Cetin, Baris; Adin, Ridvan Muhammed; Armutlu, Kadriye
    Background: It is important to evaluate trunk control, given that it is one of the indicators of adequate functional and motor recovery in patients following a stroke. The assessment should be feasible and adequate in clinical conditions in the acute phase.Objectives: The aim of this study was to detect the most appropriate scale used for trunk control assessment in very acute stroke patients in terms of time and ease of implementation.Methods: Sixty-five patients with very acute stroke were included in the study. The patients were assessed with the Trunk Impairment Scale-1 (VTIS), the Trunk Impairment Scale-2 (FTIS), the Motor Assessment Scale trunk subscale (T-MAS) and the Trunk Control Test (TCT), and Functional Impairment Measure (FIM). Floor/ceiling effects, reliability, validity responsiveness of all trunk control scales analyzed. The correlation between all scales and FIM were calculated.Results: All scales had similar reliability, responsiveness and construct validity level. T-MAS and TCT were more advantageous than other scales according to time. TCT and VTIS showed floor effect. The best predictive validity values were observed for the T-MAS and TCT.Conclusions: Four scales investigated in this study can also be used to evaluate the patients with very acute stroke. On the other hand, the advantages and disadvantages of the scales should be thoroughly assessed and researchers can use one of four scales considering their aim, patient populations and clinical characteristics of patients