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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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    Relationship between sensation and balance and gait in multiple sclerosis patients with mild disability
    (Elsevier Sci Ltd, 2024) Ozkul, Cagla; Eldemir, Kader; Yildirim, Muhammed Seref; Cobanoglu, Gamze; Eldemir, Sefa; Guzel, Nevin Atalay; Irkec, Ceyla
    Background: Patients with Multiple Sclerosis (PwMS) often experience sensory, balance, and gait problems. Impairment in any sensation may increase imbalance and gait disorder in PwMS. This study aimed to (1) compare foot plantar sensations, knee position sense, balance, and gait in PwMS compared to Healthy Individuals (HI) and (2) examine the relationship between plantar sensations, knee position sense, balance, and gait in PwMS. Methods: Thirty PwMS with mild disability and 10 HI participated in this study. Light touch threshold, two -point discrimination, vibration duration, and knee position sense were examined on the Dominant Side (DS) and NonDominant Side (NDS). Balance and spatio-temporal gait analysis were evaluated in all participants. Results: PwMS had higher postural sway with eyes closed on the foam surface, longer swing phase of DS, longer single support phase of NDS, and shorter double support phase of DS compared to HI (p < 0.05). The results of regression analysis showed that the light touch thresholds of the 1st and 5th toes of the DS were associated with postural sway in different sensory conditions (p < 0.05). In contrast, the light touch thresholds of the 1st and 5th toes, two-point discrimination of the heel, vibration duration of the 1st metatarsal head and knee position sense of the NDS, and light touch threshold in the medial arch of both sides were associated with the gait parameters (p < 0.05). Conclusion: PwMS, even with mild disabilities needs neurorehabilitation to improve plantar sensation and knee position sense.
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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