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    Effects of modified-constraint induced movement therapy based telerehabilitation on upper extremity motor functions in stroke patients
    (Wiley, 2024) Saygili, Fettah; Guclu-Gunduz, Arzu; Eldemir, Sefa; Eldemir, Kader; Ozkul, Cagla; Gursoy, Gorkem Tutal
    Introduction: The aim of this study is to investigate the effects of Modified-Constraint Induced Movement Therapy (m-CIMT) based telerehabilitation on upper extremity motor functions in stroke patients. Methods: Eighteen stroke patients were included and randomly allocated into two groups. The Tele-CIMT (modified-constraint induced movement therapy-based telerehabilitation) (n = 10) group received m-CIMT based telerehabilitation for 90 min a day, 5 weekdays for 3 weeks at home. Additionally, both the Tele-CIMT group and the control group (CG) (n = 8) underwent the home exercise program aimed at improving range of motion, active movement, balance, and walking every weekday for 3 weeks at home. The outcome measures were the Stroke Rehabilitation Assessment of Movement Scale (STREAM), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FM-UE), Wolf Motor Function Test (WMFT), 9-Hole Peg Test (9-HPT), grip strengths, pinch strengths, Motor Activity Log-28 (MAL-28), and Functional Independence Measure (FIM). Results: Significant group-by-time interactions on STREAM, FM-UE, WMFT, grip strength, pinch strengths, MAL-28, and FIM were found to be in favor of the Tele-CIMT group. Additionally, post hoc analyses revealed that the Tele-CIMT group significantly improved in terms of these parameters (p > .05). Conclusion: This is the first randomized controlled trial showing that Tele-CIMT improved upper extremity motor functions and activities of daily living in stroke patients. Tele-CIMT can help improve the upper extremities in stroke survivors who have difficulties reaching rehabilitation clinics.
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    Effects of Pilates-based telerehabilitation on physical performance and quality of life in patients with multiple sclerosis
    (Taylor & Francis Ltd, 2024) Eldemir, Kader; Guclu-Gunduz, Arzu; Eldemir, Sefa; Saygili, Fettah; Ozkul, Cagla; Irkec, Ceyla
    PurposeIt is known that clinical Pilates improves strength, core stability, balance, gait, fatigue, and quality of life (QOL) in patients with multiple sclerosis (PwMS). On the other hand, there is insufficient information about whether similar benefits can be achieved with Pilates-based telerehabilitation (Pilates-TR). We aimed to investigate the effects of Pilates-TR on physical performance and QOL in PwMS.MethodsThirty PwMS were recruited and randomly allocated into two groups. The Pilates-TR group received Pilates-TR via videoconferences three days per week during six weeks at home. The control group (CG) was a waitlist with no Pilates-TR treatment. Physical performance measures included extremity muscle strength, core endurance and power, balance, gait analysis, and functional exercise capacity. In addition, fatigue and QOL were evaluated.ResultsExtremity muscle strength, core endurance and power, balance, walking speed, cadence, distance, functional exercise capacity, and QOL were improved after Pilates-TR (p < 0.05). Fatigue level and the effects of fatigue on functions decreased in Pilates-TR, while fatigue level increased in CG (p < .05). The CG showed no changes in any other measurements (p > .05).ConclusionPilates-TR was effective in improving physical performance and QOL in PwMS. Pilates-TR can be recommended as an effective option, especially for patients with barriers to reaching the clinic.
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    Relationship between lower extremity sensation, physical activity, cognition, body awareness, and fatigue in people with multiple sclerosis: a cross-sectional study
    (Springer Heidelberg, 2025) Eldemir, Kader; Ozkul, Cagla; Yildirim, Muhammed Seref; Eldemir, Sefa; Saygili, Fettah; Irkec, Ceyla; Guclu-Gunduz, Arzu
    Background Multiple sclerosis (MS) is a chronic autoimmune disease causing sensory and motor impairments due to central nervous system demyelination. Sensory feedback, essential for balance and gait, is often disrupted in people with MS (PwMS). However, its relationship with fatigue, physical activity, cognitive function, and body awareness remains unclear. Aim To investigate the relationship between plantar sensation, knee position sense, and clinical factors in PwMS compared to healthy controls (HC). MethodsThirty-three PwMS and 11 HC participated in this study. Foot sensations including light touch threshold, two-point discrimination, vibration duration, and knee position sense were assessed. In addition, physical activity level, cognitive function, body awareness, and fatigue were assessed as clinical factors. Results No significant differences were found between PwMS and HC in most sensory measures, except for body awareness, which was higher in HC (p:0.029). In PwMS, light touch thresholds correlated with age (r = 0.454, p = 0.008), vibration duration with walking and physical activity levels (r = 0.392-0.396, p < 0.05), two-point discrimination with EDSS score (r = 0.474, p = 0.005), knee position sense with EDSS (r = 0.385, p = 0.027) and cognitive function (r = 0.382, p = 0.028). In HC, vibration duration correlated negatively with age (r=-0.834, p:0.001), and knee position sense correlated with body mass index (r = 0.764, p:0.006) and cognitive function (r = 0.609-0.736, p < 0.05). Conclusion These findings highlight the relationship between sensory function and clinical factors in PwMS, emphasizing the importance of age, disability level, physical activity, and cognitive function in preserving the sensory functions of the lower extremity.
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    Reliability and validity of the L test in people with multiple sclerosis
    (Elsevier Sci Ltd, 2025) Eldemir, Kader; Eldemir, Sefa; Ozkul, Cagla; Irkec, Ceyla; Guclu-Gunduz, Arzu
    Objectives: Functional mobility is an essential factor affecting the activities of daily living in people with multiple sclerosis (PwMS). The L test is a comprehensive assessment tool for functional mobility that incorporates sit-to-stand, transfers and bidirectional turning. The purpose of this study was to determine the psychometric properties of the L test in PwMS. Design: Cross-sectional study. Participants: Thirty-four PwMS [Expanded Disability Status Scale (EDSS) score 0 to 5] and 34 healthy controls were included in this study. Main outcome measures: The L test was administered along with the timed up and go (TUG) test, 10-m walk test (10-MWT), 6-minute walk test (6-MWT), timed 360 degree turn test, and EDSS by the same rater. Fall history was recorded to categorize PwMS with and without a history of falls. The L test was repeated after 1 week to determine test-retest reliability. Results: The L test showed excellent test-retest reliability (intraclass correlation coefficient 0.995). The minimum detectable change for the L test time was 1.4 seconds. The L test demonstrated significant positive correlations with the TUG test, timed 360 degree turn test and EDSS score, and significant negative correlations with the 10-MWT and 6-MWT (P < 0.001). Significant differences in the L test times were found between PwMS and healthy controls, and between PwMS with a history of falls and those without a history of falls (P < 0.05). The cut-off time of 14.7 seconds on the L test was found to best discriminate between PwMS and healthy people, while 16.4 seconds was found to best discriminate between PwMS with a history of falls and those without a history of falls. Conclusion: The L test is a reliable and valid tool for the assessment of functional mobility in PwMS.
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    The effects of online pilates training on cognitive functions and dual task performance in people with multiple sclerosis: A randomized controlled study
    (Elsevier Sci Ltd, 2025) Eldemir, Kader; Eldemir, Sefa; Ozkul, Cagla; Irkec, Ceyla; Guclu-Gunduz, Arzu
    Background: Cognitive impairments in people with multiple sclerosis (PwMS) are common and aggravate dualtask (DT) performance. This study aimed to investigate the effectiveness of online Pilates training on cognitive functions and the DT performance of balance, walking, and functional mobility in PwMS. Method: In this randomized controlled trial, forty-six PwMS were recruited and randomly allocated into two groups. The Online Pilates group (OPG) received Pilates training via videoconferences three days per week during six weeks at home. The control group (CG) was a waitlist with no Pilates treatment. Cognitive Functions were assessed with Montreal Cognitive Asssessment (MoCA), The Trail Making Test (TMT), and The Stroop Test (ST). DT performance was assessed with mental tracking and verbal fluency during postural stability (PS), walking, and functional mobility. Results: At the end of six weeks, the interaction effects (time x group) revealed significant differences for MoCA (p = 0.024), TMT-B (p = 0.012), ST (p <= 0.012), PS-with mental tracking (p = 0.004), PS-with verbal fluency (p = 0.003), cadence-with mental tracking (p = 0.048), and functional mobility-with mental tracking (p = 0.043) in favor of the OPG. Additionally, MoCA, TMT, ST, and DT performance during balance and functional mobility significantly improved in after six-week online Pilates training, but did not in CG. Conclusion: Pilates training via videoconference was effective in the improvement of cognitive functions and DT performance in PwMS. Online Pilates may be considered for improving cognitive impairments and DT performances in PwMS with barriers to accessing clinics. Trial registration: ClinicalTrials.gov: NCT06462339
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    The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial
    (Wiley, 2024) Eldemir, Sefa; Eldemir, Kader; Saygili, Fettah; Ozkul, Cagla; Yilmaz, Rezzak; Akbostanci, Muhittin Cenk; Guclu-Gunduz, Arzu
    Background: Lee Silverman voice treatment (LSVT) BIG is an exercise program developed for patients with Parkinson's disease (PwPD), consisting of sets of exercises performed for 4 consecutive days a week for 4 weeks. However, the standard protocol suggests a treatment frequency difficult to follow for most patients who have difficulties reaching rehabilitation clinics. Our aim was to compare the standard LSVT BIG protocol with a modified LSVT (m-LSVT) BIG protocol (twice a week in the clinic for 4 weeks and twice a week at home for 4 weeks). Methods: In this randomized controlled trial, 16 PwPD (aged 18-80 years, Hoehn and Yahr stages I-III) were recruited into two groups. The LSVT group received standard LSVT BIG training (four times per week for 4 weeks at the clinic). The other group was given m-LSVT BIG exercises, but unlike the LSVT group, the m-LSVT group exercised twice a week at the clinic and twice a week at home for 4 weeks. The Berg Balance Scale was used to assess functional balance. Biodex Balance System was used to assess laboratory balance measures. Timed Up and Go test and G-Walk sensor system were used to assess functional mobility and spatiotemporal gait analysis. Results: Significant group-by-time interactions on the eyes open-firm surface score of the modified clinical test of sensory integration of balance (F = 10.138, p = .007) and gait cycle symmetry index (F = 10.470, p = .010) were found to be in favor of the LSVT group. Additionally, post hoc analyses revealed that both groups significantly improved postural stability, gait speed, motor symptoms, and functional mobility (p < .05). Conclusion: The results revealed the beneficial effects of the modified protocol on balance and gait in PwPD, as well as the superiority of the standard LSVT BIG protocol. The m-LSVT BIG protocol may be an effective intervention method, especially for PwPD who have difficulty adapting to the treatment frequency of the standard protocol.
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    The immediate efficacy of the spinomed orthosis and biofeedback posture orthosis on balance and gait in older people with thoracic hyperkyphosis
    (Elsevier Ireland Ltd, 2024) Eldemir, Kader; Eldemir, Sefa; Ozkul, Cagla; Guclu-Gunduz, Arzu
    Background: Increased kyphosis is a common condition among older people that may, directly or indirectly, be a risk factor for poor balance and gait. Spinomed and Biofeedback Posture Trainer (BPT) orthoses is an effective treatment approach for hyperkyphosis. This study aimed to compare the immediate effects of the Spinomed and BPT orthoses on balance and gait in the older population. Methods: A total of 52 volunteer older people with hyperkyphosis (kyphosis angle>40 degrees) participated in this study and were randomly allocated into two groups, to either the Spinomed orthosis (n = 26, mean age = 65.50 +/- 5.50) or the BPT (n = 26, mean age = 65.38 +/- 5.69) orthosis. All participants were asked to wear the orthoses for 1.5 h to get used to them. Balance parameters, which are Postural Stability Test (PST), Limits of Stability (LOS), and Clinical Test of Sensory Integration for Balance (m-CTSIB) were assessed using the Biodex Balance System, while walking parameters were assessed using the G-Walk with and without orthosis. Results: The Spinomed had a positive effect on balance parameters (p < 0.05) except for the closed eyes firm surface and the opened eyes foam surface conditions of the m-CTSIB (p > 0.05). BPT had a significant impact on the PST score, LOS, and the closed eyes firm surface condition of the m-CTSIB (p < 0.001). Spinomed had a significant effect on cadence, speed, gait cycle duration, elaborated steps, and symmetry index of pelvic angles (p < 0.05), while the BPT had a significant effect only on step length and rotation symmetry index. No significant difference was detected between the two types of orthoses in the balance and gait parameters (p > 0.05). Conclusions: Spinomed and BPT were both effective in improving balance performance, with similar improvements demonstrated by both orthoses. Additionally, Spinomed may provide significant improvements in cadence, speed, gait cycle duration, elaborated steps, and all symmetry indexes of pelvic angles in the short term.