Publications by authors named "Salih Angin"

22 Publications

  • Page 1 of 1

The effects of gait speed on plantar pressure variables in individuals with normal foot posture and flatfoot.

Acta Bioeng Biomech 2020 ;22(3):161-168

Cyprus International University, Department of Physiotherapy and Rehabilitation, Nicosia, Cyprus.

Purpose: It is not known how gait speed affects plantar pressure characteristics in flatfoot. The aim of this work was to investigate the effects of gait speed on plantar pressure variables in flatfoot by comparing it to normal foot posture.

Methods: Thirty individuals with flatfoot and 30 individuals with normal foot posture were recruited. Plantar pressure variables were obtained by a pressure-sensitive mat at self-selected slow, normal, and fast speeds. All assessments were performed on the dominant foot, and three satisfactory steps were obtained for each gait speed condition. The order of gait speeds was randomized.

Results: In the flatfoot group, the contact area was higher in the midfoot, third metatarsal, and hallux at all speeds, also in the second metatarsal at slow and normal speeds than the normal foot posture group ( p < 0.05). The maximum force was higher in the midfoot and hallux at all speeds in the flatfoot group ( p < 0.05). Also, the maximum force was lower in the first metatarsal at normal and fast speeds, and in the lateral heel at fast speed ( p < 0.05). In the flatfoot group, the peak pressure was found to be higher in the hallux at slow speed, but to be lower in the first metatarsal at fast speed ( p < 0.05). Further, plantar pressure distribution was affected by gait speed in both feet.

Conclusions: Analysis of plantar pressure variables should be performed at different gait speeds.
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January 2020

Reliability of Different Clinical Techniques for Assessing Foot Posture.

J Manipulative Physiol Ther 2020 Nov - Dec;43(9):901-908. Epub 2020 Aug 20.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Objective: The aim was to determine the interrater and intrarater reliability of navicular drop (NDP), navicular drift (NDT), and the Foot Posture Index-6 (FPI-6), and test-retest reliability of the static arch index (SAI) and dynamic arch index (DAI).

Methods: Sixty healthy individuals were assessed for intrarater and test-retest reliability. From 60 participants, 30 individuals were assessed for interrater reliability. A digital caliper was used to measure NDP and NDT. Electronic pedography was used to calculate SAI and DAI. The FPI-6 was also performed. All assessments were performed on the dominant foot. The NDP, NDT, SAI, and DAI were repeated 3 times. The NDP and NDT were analyzed separately using both first measurement and the average, but the SAI and DAI were analyzed using only the average. The NDP, NDT, and FPI-6 were conducted by 2 raters to determine interrater reliability and were repeated by a single rater after 5 days from initial assessment to determine intrarater reliability. The SAI and DAI were also repeated after 5 days to determine test-retest reliability.

Results: Intrarater intraclass correlation coefficients (ICCs) were 0.934 and 0.970 for NDP, 0.724 and 0.850 for NDT, and 0.945 for FPI. Interrater ICCs were 0.712 and 0.811 for NDP, 0.592 and 0.797 for NDT, and 0.575 for FPI. Test-retest ICCs of the SAI and DAI were 0.850 and 0.876, respectively.

Conclusion: Navicular drop is relatively more reliable than other traditional techniques. Also, the FPI-6 has excellent intrarater reliability, but only moderate interrater reliability. The results can provide clinicians and researchers with a reliable way to implement foot posture assessment.
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http://dx.doi.org/10.1016/j.jmpt.2020.02.002DOI Listing
August 2020

Investigation of the effects of flat cushioning insole on gait parameters in individuals with chronic neck pain.

Acta Bioeng Biomech 2019 ;21(2):135-141

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Purpose: Individuals with chronic neck pain (CNP) walk with a stiffer spine known to cause an increase in dynamic loading on the spine. They also exhibit altered spatiotemporal gait variables, however, it is still unclear whether flat cushioning insole, which reduces dynamic loading on the musculoskeletal system by absorbing the ground reaction force, affects gait parameters in individuals with CNP. The aim of this work was to investigate the effects of flat cushioning insole on neck pain during walking and gait parameters in individuals with CNP.

Methods: Twenty-one individuals with CNP and 21 asymptomatic controls were included. Assessments of gait parameters and pain were conducted in two sessions, standard shoe only and standard shoe with flat cushioning. In both sessions, all participants performed the 10-meter walk test in two walking conditions: preferred walking, walking at maximum speed. The force sensitive insoles and the video analysis method were used to assess plantar pressure variables and spatiotemporal gait variables, respectively. Pain was assessed using the Visual Analogue Scale.

Results: Our results indicated that flat cushioning reduced the maximum force and force-time integral in both groups (p < 0.05). Flat cushioning increased walking speed and step length in both walking conditions and reduced neck pain during walking at maximum speed in individuals with CNP (p < 0.05). In asymptomatic individuals, no difference was found in spatiotemporal gait variables between two sessions (p > 0.05).

Conclusions: These results have suggested that the use of flat cushioning insole may improve neck pain during walking and spatiotemporal gait variables in individuals with CNP.
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April 2020

Effect of Different Insole Materials on Kinetic and Kinematic Variables of the Walking Gait in Healthy People.

J Am Podiatr Med Assoc 2018 Sep;108(5):390-396

Background: There is a lack of data that could address the effects of off-the-shelf insoles on gait variables in healthy people.

Methods: Thirty-three healthy volunteers ranging in age from 18 to 35 years were included to this study. Kinematic and kinetic data were obtained in barefoot, shoe-only, steel insole, silicone insole, and polyurethane insole conditions using an optoelectronic three-dimensional motion analysis system. A repeated measures analysis of variance test was used to identify statistically significant differences between insole conditions. The alpha level was set at < .05.

Results: Maximum knee flexion was higher in the steel insole condition ( < .0001) compared with the silicone insole ( = .001) and shoe-only conditions ( = .032). Reduced maximum knee flexion was recorded in the polyurethane insole condition compared with the shoe-only condition ( = .031). Maximum knee flexion measured in the steel insole condition was higher compared to the barefoot condition ( = .020). Higher maximum ankle dorsiflexion was observed in the barefoot condition, and there were significant differences between the polyurethane insole ( < .0001), silicone insole ( = .001), steel insole ( = .002), and shoe conditions ( = .004). Least and highest maximum ankle plantarflexion were detected in the steel insole and silicone insole conditions, respectively. Maximum ankle plantarflexion in the barefoot and steel insole conditions ( = .014) and the barefoot and polyurethane insole conditions ( = .035) were significant. There was no significant difference between conditions for ground reaction force or joint moments.

Conclusions: Insoles made by different materials affect maximum knee flexion, maximum ankle dorsiflexion, and maximum ankle plantarflexion. This may be helpful during the decision-making process when selecting the insole material for any pathological conditions that require insole prescription.
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http://dx.doi.org/10.7547/16-175DOI Listing
September 2018

Gait speed and gait asymmetry in individuals with chronic idiopathic neck pain.

Musculoskelet Sci Pract 2019 06 7;41:23-27. Epub 2019 Mar 7.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balcova, Izmir, Turkey.

Background: Recent studies have shown that individuals with chronic idiopathic neck pain (CINP) exhibit altered spatiotemporal gait parameters. Problems arising from the neck joints and related soft tissues, and most mechanical neck pain appear asymmetric. However, whether individuals with CINP have an asymmetric gait has not been clarified.

Objectives: The aim was to investigate if there was a significant difference in gait speed (GS) and gait asymmetry (GA) between individuals with CINP and healthy controls.

Design: Case-Control Study.

Method: Twenty individuals with CINP and 20 healthy controls were included. All participants performed the 10-m walking test in three walking conditions: preferred walking (PW), preferred walking with head rotation and walking at maximum speed (MAXW). The timing gate system and pressure sensitive insoles were used to calculate GS and GA, respectively. GA was calculated using the difference between right and left swing durations.

Results/findings: Individuals with CINP had slower GS in all walking conditions compared to controls (p < 0.05). In PW and MAXW conditions, gait was found to be asymmetric in individuals with CINP compared to controls (p < 0.05). There was no difference in GA between the walking conditions in either group (p > 0.05).

Conclusions: Individuals with CINP had a slower and more asymmetrical gait. GA should be evaluated as a part of the routine gait analysis since it has potential to cause asymmetric loading on joints which could cause other musculoskeletal problems in the long-term. Also, future research is needed to clarify the reasons why gait is more asymmetric in individuals with CINP.
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http://dx.doi.org/10.1016/j.msksp.2019.03.001DOI Listing
June 2019

Association of quadriceps angle with plantar pressure distribution, navicular height and calcaneo-tibial angle.

Acta Orthop Traumatol Turc 2019 Mar 9;53(2):145-149. Epub 2019 Jan 9.

School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.

Objective: The aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA).

Methods: A total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19-33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight.

Results: There were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (β = -0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (β = 0.37, p < 0.001) and MH5-MxF (β = -0.21, p < 0.037).

Conclusion: These findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered.

Level Of Evidence: Level III, Diagnostic Study.
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http://dx.doi.org/10.1016/j.aott.2018.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506805PMC
March 2019

Generalized hypermobility syndrome (GHS) alters dynamic plantar pressure characteristics.

J Back Musculoskelet Rehabil 2019 ;32(2):321-327

School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.

Background: In the relevant literature generalized hypermobility syndrome (GHS) has been shown to alter the kinetic and kinematic patterns of the human movement system. Although GHS affects the general body biomechanics of individuals, the body of knowledge in plantar pressure distribution in GHS is far from sufficient.

Objective: The aim of this study was to determine whether individuals with joint hypermobility syndrome have abnormal plantar pressure distribution during normal gait compared to healthy individuals.

Methods: A total of 37 participants (mean age: 22.16 ± 2.58 years) diagnosed with GHS and 37 aged-matched participants (mean age: 23.35 ± 2.85 years) without GHS were included in the study. Dynamic plantar pressure distribution was obtained as each participant walked in barefoot at a self-selected pace over EMED-m system (Novel GmbH, Munich, Germany). Correlations between hypermobility score (HS) (Beighton score) and plantar pressure variables, and between group differences in peak pressure (PP), pressure-time integral (PTI), average pressure (AP) and maximum force (MxF) were computed for 10 regions under the sole.

Results: HS was significantly correlated with peak pressure under the mid-foot (MF) (r= 0.24, p= 0.043), 5th metatarsal head (MH5) (r= 0.33, p= 0.001), big toe (BT) (r= 0.44, p< 0.001), and second toe (ST) (r= 0.38, p= 0.001). A similar trend was observed for pressure-time integrals under hindfoot (HF) (r= 0.24, p= 0.04), MF (r= 0.30, p= 0.009), MH5 (r= 0.25, p= 0.033), BT (r= 0.37, p= 0.001) and ST (r= 0.34, p= 0.003). The only significant MxF detected was under the ST (r= 0.23, p= 0.048), and AP was determined to be significantly higher as HS increases indicated by APs under MH5 (r= 0.24, p= 0.042), BT (r= 0.32, p= 0.005) and ST (r= 0.40, p< 0.001). Peak pressure values under HF were significantly higher in the hypermobile group (p= 0.023), MH5 (p= 0.001), BT (p< 0.001) and ST (p= 0.003). AP and PTI were also found to be significantly higher in the hypermobile group under MH5 (p= 0.009), BT (p= 0.037), and ST (p= 0.003). MxF was higher only under MF5 (p= 0.029) and SF (p= 0.041) in the hypermobile group.

Conclusion: The forefoot regions received a higher load in GHS during gait. This could be useful in clinical evaluation of the foot in GHS, preventing potential injuries of lower extremity, and also in processes related to decision making for foot orthotics and/or rehabilitation protocols.
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http://dx.doi.org/10.3233/BMR-170973DOI Listing
May 2019

Contributions of foot muscles and plantar fascia morphology to foot posture.

Gait Posture 2018 Mar 20;61:238-242. Epub 2018 Mar 20.

School of Health Sciences, University of Salford, Salford, Manchester, M6 6PU, United Kingdom.

Background: The plantar foot muscles and plantar fascia differ between different foot postures. However, how each individual plantar structure contribute to foot posture has not been explored. The purpose of this study was to investigate the associations between static foot posture and morphology of plantar foot muscles and plantar fascia and thus the contributions of these structures to static foot posture.

Methods: A total of 111 participants were recruited, 43 were classified as having pes planus and 68 as having normal foot posture using Foot Posture Index assessment tool. Images from the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles, and the calcaneal (PF1), middle (PF2) and metatarsal (PF3) regions of the plantar fascia were obtained using a Venue 40 ultrasound system with a 5-13 MHz transducer.

Results: In order of decreasing contribution, PF3 > FHB > FHL > PER > FDB were all associated with FPI and able to explain 69% of the change in FPI scores. PF3 was the highest contributor explaining 52% of increases in FPI score. Decreased thickness was associated with increased FPI score. Smaller cross sectional area (CSA) in FHB and PER muscles explained 20% and 8% of increase in FPI score. Larger CSA of FDB and FHL muscles explained 4% and 14% increase in FPI score respectively.

Conclusion: The medial plantar structures and the plantar fascia appear to be the major contributors to static foot posture. Elucidating the individual contribution of multiple muscles of the foot could provide insight about their role in the foot posture.
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http://dx.doi.org/10.1016/j.gaitpost.2018.01.022DOI Listing
March 2018

Effects of Age on Strength and Morphology of Toe Flexor Muscles.

J Orthop Sports Phys Ther 2016 Dec 29;46(12):1065-1070. Epub 2016 Oct 29.

Study Design Descriptive, cross-sectional. Background Age-related muscle atrophy is common in lower-limb muscles. We therefore speculated that foot muscles may also diminish with age. However, there is a paucity of literature characterizing foot muscle strength and morphology, and any relationship between these 2, in older people. Objective To compare the strength and size of the toe flexor muscles of older adults relative to their younger counterparts. Methods Seventeen young adults with a normal foot type were matched by sex and body mass index to 17 older adults with a normal foot type, from an available sample of 41 younger (18 to 50 years of age) and 44 older (60 or more years of age) adults. Among the matched groups (n = 34), muscle thickness and cross-sectional area for 5 intrinsic and 2 extrinsic toe flexor muscles were obtained using ultrasound. Toe strength was assessed using a pressure platform. Differences in toe flexor strength and muscle size between the young and older matched groups were determined using analysis of covariance (controlling for height). Correlations between strength and size of the toe flexor muscles of the pooled group (n = 34) were also calculated. Results Toe strength and the thickness and cross-sectional area of most foot muscles were significantly reduced in the older adults (P<.05). Hallux and toe flexor strength values were strongly correlated with the size of the intrinsic toe flexor muscles. Conclusion The smaller foot muscles appear to be affected by sarcopenia in older adults. This could contribute to reduced toe flexion force production and may affect the ability of older people to walk safely. Interventions aimed at reversing foot muscle atrophy in older people require further investigation. J Orthop Sports Phys Ther 2016;46(12):1065-1070. Epub 29 Oct 2016. doi:10.2519/jospt.2016.6597.
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http://dx.doi.org/10.2519/jospt.2016.6597DOI Listing
December 2016

The immediate effect of patellar tendon strap on weight-bearing asymmetry during squatting in patients with unilateral knee osteoarthritis: A pilot study.

Prosthet Orthot Int 2016 Dec 28;40(6):682-688. Epub 2015 Oct 28.

School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.

Background: Knee osteoarthritis has commonly been associated with a symptom of pain resulting in an inter-limb weight-bearing asymmetry during functional tasks. Patellar tendon strap is one of the non-pharmacologic interventions to alleviate knee pain.

Objectives: To investigate the immediate effect of a patellar tendon strap on weight-bearing asymmetry during squatting in people with unilateral knee osteoarthritis.

Study Design: Cross-sectional study.

Methods: Ten patients with unilateral knee osteoarthritis and 10 healthy subjects were included in the study. Weight-bearing asymmetry of patients was assessed using a weight-bearing squat test during squatting at 30° and 60° both with and without patellar tendon strap. Pain intensity was assessed during squatting in unstrapped and strapped conditions with Visual Analog Scale.

Results: The decrease in weight-bearing asymmetry values immediately after wearing patellar tendon strap during 30° (p = 0.006) and 60° (p = 0.011) of squatting tests was significantly higher in knee osteoarthritis patients than in healthy subjects. Reported pain intensity was similar in unstrapped and strapped conditions (p = 0.066).

Conclusion: The results of this study showed improved inter-limb weight-bearing symmetry during squatting. Further research with larger sample sizes investigating the effect of patellar tendon strap on weight-bearing asymmetry during functional activities in people with knee osteoarthritis is warranted.

Clinical Relevance: Patellar tendon straps (easily fit and cheap unlike knee braces) had more improvements in inter-limb weight-bearing symmetry during squatting in people with knee osteoarthritis compared to healthy subjects. This study is a new insight for future studies to investigate clinical benefits of wearing patellar tendon straps in this population.
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http://dx.doi.org/10.1177/0309364615612251DOI Listing
December 2016

Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors.

Contemp Oncol (Pozn) 2014 22;18(4):279-84. Epub 2014 Jul 22.

Dokuz Eylül University, School of Physical Therapy and Rehabilitation, Sağlık Kampusü, Izmir, Turkey.

Aim Of The Study: There is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors.

Material And Methods: Eighteen females 38-60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL).

Results: The lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions.

Conclusions: These findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance.
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http://dx.doi.org/10.5114/wo.2014.44120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171475PMC
September 2014

Ultrasound evaluation of foot muscles and plantar fascia in pes planus.

Gait Posture 2014 26;40(1):48-52. Epub 2014 Feb 26.

School of Health Sciences, University of Salford, Salford, Manchester M6 6PU, United Kingdom.

Background: Multiple intrinsic and extrinsic soft tissue structures that apply forces and support the medial longitudinal arch have been implicated in pes planus. These structures have common functions but their interaction in pes planus is not fully understood. The aim of this study was to compare the cross-sectional area (CSA) and thickness of the intrinsic and extrinsic foot muscles and plantar fascia thickness between normal and pes planus feet.

Methods: Forty-nine adults with a normal foot posture and 49 individuals with pes planus feet were recruited from a university population. Images of the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles and the plantar fascia were obtained using a Venue 40 ultrasound system with a 5-13 MHz transducer.

Results: The CSA and thickness of AbH, FHB and PER muscles were significantly smaller (AbH -12.8% and -6.8%, FHB -8.9% and -7.6%, PER -14.7% and -10%), whilst FDL (28.3% and 15.2%) and FHL (24% and 9.8%) were significantly larger in the pes planus group. The middle (-10.6%) and anterior (-21.7%) portions of the plantar fascia were thinner in pes planus group.

Conclusion: Greater CSA and thickness of the extrinsic muscles might reflect compensatory activity to support the MLA if the intrinsic foot muscle function has been compromised by altered foot structure. A thinner plantar fascia suggests reduced load bearing, and regional variations in structure and function in feet with pes planus.
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http://dx.doi.org/10.1016/j.gaitpost.2014.02.008DOI Listing
August 2015

Vestibular rehabilitation in acute central vestibulopathy: a randomized controlled trial.

J Vestib Res 2013 ;23(4-5):259-67

School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Objective: To investigate the effects of two different rehabilitation programs in acute central vestibulopathy secondary to posterior circulation stroke.

Method: A prospective randomized controlled study was conducted on 25 patients with posterior circulation stroke. Patients were instructed in routine balance and mobility exercises during the acute hospitalization period. At discharge, patients were assigned to either a rehabilitation or home exercise group. The home exercise group was instructed to perform the same exercise program provided in the course of hospitalization period. The rehabilitation group was randomized into the visual feedback posturography training or vestibular rehabilitation group. The balance and gait performance were assessed with clinical and objective measurements before and after 6 weeks of training.

Results: The balance and gait scores were significantly improved in both rehabilitation groups and in the home exercise group (p< 0.05), but no significant difference was found between the groups in terms of post-treatment values (p> 0.05).

Conclusion: The improvements of balance and gait function in rehabilitation groups did not differ from the home exercise group. Rehabilitation programs were equally effective to improve the recovery in acute central vestibulopathy.
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http://dx.doi.org/10.3233/VES-130491DOI Listing
July 2014

Prediction of postural sway velocity by foot posture index, foot size and plantar pressure values in unilateral stance.

Eklem Hastalik Cerrahisi 2013 ;24(3):144-8

Dokuz Eylül Üniversity, School of Physical Therapy and Rehabilitation, 35340 İnciraltı, İzmir, Turkey.

Objectives: This study aims to assess whether the plantar pressure, the foot posture index (FPI) and foot size can predict the postural sway velocity in terms of postural stability in unilateral stance.

Patients And Methods: A total of 236 feet of 118 participants (62 males, 56 females; mean age 22.1±3.1 years; range 18 to 36 years) were enrolled. The feet were classified as prone, normal and supine based on the FPI. Postural sway velocity during unilateral stance with eye open (US-EO) and eye closed (US-EC) condition was measured using the Balance Master. Plantar pressure for each foot was measured from 10 different areas using EMED-M pedobarography. The force-time-area (FTA) integral was calculated based on the plantar pressure values, while standardized foot size (SFS) was calculated dividing foot width by foot length. The one-way ANOVA was used to determine differences in postural sway velocity between the groups. Multiple linear regression analysis was used to evaluate the predictability of the postural sway velocity.

Results: The postural sway velocities in US-EO condition were similar among three groups (p>0.05). In the US-EC condition, the highest postural sway velocity in the prone feet and lowest postural sway velocity in the supine feet were measured (p<0.05). There was a significant relationship between the postural sway velocity which was measured in the US-EC condition and SFS (β= 0.141, p<0.05), FTA integral under the hindfoot (β= -0.127, p<0.05) and FPI values (β= 0.246, p<0.05).

Conclusion: The predictive value of FTA integral and SFS parameters for postural sway velocity is lower in unilateral stance. The postural sway velocity is rather associated with FPI and increases by pronation of the foot.
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http://dx.doi.org/10.5606/ehc.2013.32DOI Listing
February 2016

Altered movement strategies in sit-to-stand task in persons with transtibial amputation.

Prosthet Orthot Int 2014 Aug 3;38(4):303-9. Epub 2013 Sep 3.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Background: Sit-to-stand movement is an essential function for participation in many activities of daily living. Although this movement is one of the most important functional tasks, there is limited research investigating strategies of sit-to-stand movement in transtibial amputees.

Objectives: To examine movement strategies of the sit-to-stand task in persons with transtibial amputation and healthy non-amputated individuals.

Study Design: Cross-sectional study.

Methods: A total of 12 male unilateral transtibial amputees and 19 healthy male subjects participated in this study. Sit-to-stand movement was evaluated in terms of weight transfer time, weight-bearing symmetry, sway velocity, and rising index by using Balance Master System.

Results: Participants in both groups exhibited similar weight-bearing transfer time (p > 0.05). Transtibial amputees demonstrated significantly greater weight-bearing asymmetry, higher sway velocity, and lower rising index than healthy subjects during the sit-to-stand transfer movement (p < 0.05).

Conclusions: Transtibial amputees were unable to use the same movement strategies during a sit-to-stand task as healthy individuals; therefore, they had to develop new strategies to perform this task.

Clinical Relevance: Little is known about the altered movement strategies during sit-to-stand task in transtibial amputees. The results of the study might provide some new insight into the motor components of the sit-to-stand movement in persons with transtibial amputation for both clinicians and researchers.
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http://dx.doi.org/10.1177/0309364613497742DOI Listing
August 2014

Physical performance parameters during standing up in patients with unilateral and bilateral total knee arthroplasty.

Acta Orthop Traumatol Turc 2012 ;46(5):367-72

Department of Physiotherapy and Rehabilitation, School of Health, İzmir University, İzmir, Turkey.

Objective: The aim of this study was to compare quadriceps femoris muscle performance parameters of patients who underwent unilateral and bilateral total knee arthroplasty (TKA).

Methods: The study included 80 patients. Thirty-five underwent unilateral primary TKA (35 females; mean age: 67.11 ± 3.97 years) and 45 underwent bilateral primary TKA (2 males, 43 females; mean age: 67.12 ± 7.32 years). Patients were evaluated in terms of performance parameters including stand-up time, rising index, standing postural sway velocity, and symmetries of body weight distribution on the extremities while standing up using a Balance Master® balance and performance instrument in the postoperative 6th and 12th month.

Results: No significant difference was determined in body weight symmetry ratios between the operated and non-operated extremity in unilateral TKA patients in the 6th and 12th month sit-to-stand test (p>0.05) whereas there was a significant difference in bilateral TKA patients (p<0.05). There was no significant difference between unilateral and bilateral TKA patients in terms of time needed for standing up, rising index and gravity sway velocity at the postoperative 6th month and 12th month (p>0.05). Bilateral TKA patients stood up in a shorter time than unilateral TKA patients (p<0.05) although the degree of body sway was higher after standing up (p<0.05).

Conclusion: Bilateral TKA patients should be encouraged to focus on exercises with non-dominant limbs and to use them more while physiotherapy and rehabilitation programs including physical performance activities are planned.
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http://dx.doi.org/10.3944/aott.2012.2684DOI Listing
June 2013

A longitudinal study of balance in migraineurs.

Acta Otolaryngol 2012 Jan 18;132(1):27-32. Epub 2011 Dec 18.

Department of Neurology, Dokuz Eylül University, Faculty of Medicine, Inciralti, Izmir, Turkey.

Conclusion: Balance in migraineurs, even in those without vestibular symptoms, deteriorates slightly over 1 year in the most challenging test conditions, when measured with posturography.

Objective: To discover by a longitudinal study of a group of migraineurs and their controls, whether the well-known, mild imbalance found on posturography in migraineurs is static or progressive.

Methods: Posturographic measures of sway under incrementally more challenging conditions (up to eyes closed standing on a foam surface with the head extended) using the modified clinical test of sensory interaction on balance, limits of stability test, and tandem gait tests in a group of 19 migraineurs and 19 age- and gender-matched controls, all of whom who had been tested over 1 year before.

Results: After 1 year migraineurs showed a slight but statistically significant deterioration: in postural sway especially, when measured with eyes closed standing on a foam surface with the head extended backwards; in reaction time; and in maximal excursion on the limits of the stability test; and perhaps in walk speed and step width on the tandem walk test.
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http://dx.doi.org/10.3109/00016489.2011.616532DOI Listing
January 2012

Prolonged activity of knee extensors and dorsal flexors is associated with adaptations in gait in diabetes and diabetic polyneuropathy.

Clin Biomech (Bristol, Avon) 2010 Jun 5;25(5):468-75. Epub 2010 Mar 5.

Department of Human Movement Sciences, Nutrition and Toxicology Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Background: People with diabetes or diabetic polyneuropathy often experience limitations in mobility and gait. These limitations are believed to be related to disturbed muscle function and sensory information. In previous studies on diabetic gait, results were confounded by a lower, preferred walking speed in people with diabetes or diabetic polyneuropathy. This study aimed to identify gait-velocity independent effects of diabetes and diabetic polyneuropathy on lower extremity kinematics and muscle activation patterns.

Methods: Eight people with diabetic polyneuropathy, 10 diabetic controls without polyneuropathy and ten healthy, age-matched controls walked at their preferred velocity and a standard velocity of 1.4 ms(-1). Muscle activation patterns of gluteus maximus, biceps femoris, rectus femoris, vastus medialis, gastrocnemius medialis, soleus, and tibialis anterior, and spatiotemporal and joint angles characteristics were analysed.

Findings: Independent of walking speed, muscle activation differed between groups. In diabetic polyneuropathy participants activation of ankle-joint dorsal flexors was prolonged by 5-10% of the stride cycle. Activity of monoarticular knee-joint extensors lasted about 10% longer in both diabetic groups compared to healthy elderly. Initiation of muscle activity did not differ between groups. If gait velocity was controlled, spatiotemporal characteristics were similar between groups.

Interpretation: The study showed that independent of the preferred lower gait velocity, people with diabetes or diabetic polyneuropathy adjust the timing of muscle activity. Contrarily, the concurrent changes in spatiotemporal characteristics occurred to be the result of changed velocity only. The delayed cessation of muscle activity suggested a reduced rate of force development underlying the adjusted timing of muscle activation.
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http://dx.doi.org/10.1016/j.clinbiomech.2010.02.005DOI Listing
June 2010

A comparison of static and dynamic balance in patients with unilateral and bilateral total knee arthroplasty.

Eklem Hastalik Cerrahisi 2009 ;20(2):93-101

School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.

Objectives: Unilateral and bilateral total knee arthroplasty (TKA) patients were compared with respect to static and dynamic balance in the postoperative sixth and 12th months.

Patients And Methods: Eighty TKA patients 35 unilateral, 45 bilateral were assessed for static and dynamic balance using the balance master test device in sixth and 12th months after surgery. Patients were also measured with respect to Hospital for Special Surgery knee score and range of motions. Differences between groups were statistically evaluated using independent t-tests. Within-group time differences were statistically examined using paired t-tests. Correlation between the measurements was evaluated by the Pearson,s analysis.

Results: Sensory interaction balance and unilateral stance test of static balance assessment were similar in unilateral and bilateral TKA (p>0.05). Patients with bilateral TKA had statistically significantly better performance at the limits of stability of dynamic balance evaluations (p<0.05). There was no significant difference between rhythmic weight shift tests in the sixth and 12th months after surgery (p>0.05).

Conclusion: In our study we concluded that while dynamic balance parameters in the daily activities of patients with bilateral TKA were expected to be better than patients with unilateral TKA, there was no significant difference between static balance parameters between the two groups.
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February 2010

Is balance normal in migraineurs without history of vertigo?

Headache 2009 Mar;49(3):419-25

Dokuz Eylül University Faculty of Medicine Department of Neurology, Inciralti, Izmir, Turkey.

Objective: To investigate by static posturography the occurrence of balance disorder in migraineurs without a history of vertigo during the interictal period.

Background: The link between migraine and balance disorders has long been known but postural balance in migraineurs without manifest vestibulopathy has been rarely studied.

Methods: We studied 25 migraineurs and age- and gender-matched controls. With static posturography we measured: (1) postural sway with eyes open or closed on a platform or on foam with 4 different head positions; (2) limits of stability as patients change their center of gravity to reach to 8 different points; (3) tandem walking.

Results: With eyes open, sway velocity was significantly greater in migraineurs than in controls while standing on a firm surface with head backwards or on a foam surface in all head positions. With eyes closed, sway velocity was significantly greater in migraineurs than in controls only while standing on a foam surface with head backwards or turned sideways. Migraineurs also had an offset center of gravity alignment in all conditions and their average reaction time and maximal excursions were significantly greater in the limits of stability test. In tandem walking, step width was significantly wider and walk speed was significantly slower in migraineurs.

Conclusion: Our findings support the notion that there is a slight but significant postural instability in migraineurs and it is of central vestibular origin.
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http://dx.doi.org/10.1111/j.1526-4610.2008.01256.xDOI Listing
March 2009

Gait assessment in patients with thrust plate prosthesis and intramedullary stemmed prosthesis implanted to each hip.

Arch Orthop Trauma Surg 2007 Feb 10;127(2):91-6. Epub 2007 Jan 10.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciralti, 35340 Izmir, Turkey.

Introduction: There has not been any study regarding comparative gait analysis in patients with intramedullary stemmed prosthesis (ISP) and thrust plate prosthesis (TPP) implanted to each hip.

Patients And Methods: Four patients (three females and one male) who had undergone operation due to coxarthrosis were selected. The mean age was 60.5 (37-78) years. TPP and ISP had been implanted to the left and right hip, respectively, in three patients, and one patient received TPP to the right and ISP to the left hip. Gait was analyzed with a BTS Elite System consisting six cameras and two Kistler force plates using Helen Hayes marker set to assess the gait parameters. The clinical outcome was also evaluated according to Harris hip score (HHS).

Results: The average HHS was 95.0 (82-100) points after a mean follow-up of 45.0 (30-50) months for TPP and 94.5 (80-100) points after a follow-up of 60.0 (14-122) months for ISP. Neither of the HHS scores and follow-up time nor gait parameters obtained from the TPP-implanted side were statistically different when compared to those of the ISP-implanted side.

Conclusion: TPP and ISP as the implants with their own biomechanical specifications did not produce any remarkable difference in gait.
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http://dx.doi.org/10.1007/s00402-006-0281-8DOI Listing
February 2007

Comparison of two different rehabilitation programmes for thrust plate prosthesis: a randomized controlled study.

Clin Rehabil 2004 Feb;18(1):84-91

School of Physiotherapy, Dokuz Eylül University, Izmir, Turkey.

Objective: Weight bearing after total hip arthroplasty is postponed in order to prevent early loosening, but this negatively affects the rehabilitation programme. For the force transfer characteristics of thrust plate prosthesis (TPP), a new type of hip prosthesis used without cement is similar to the normal hip. We evaluated the possibilities of early weight bearing after TPP by comparing early partial with early full weight bearing.

Design: Randomized controlled study.

Setting: Department of orthopaedics and traumatology in a university hospital.

Subjects: Sixty hips of 51 patients who underwent total hip arthroplasty with TPP were randomly assigned into two groups.

Interventions: Both groups received accelerated rehabilitation programmes: group 1 with early partial weight bearing and group 2 with early full weight bearing.

Main Outcome Measures: Patients were evaluated by a blind observer preoperatively, at three months after surgery by clinical (measurement of range of hip motion (universal goniometry), muscle strength (Manual Muscle Test), functional test (6-minute walk test), hip function (Harris Hip Scoring System)) and radiographical parameters and one year after surgery by clinical (Harris Hip Scoring System) and radiographical parameters.

Results: Group 2 performed transfer activities earlier, had more walking distance at the time of discharge and shorter hospital stay than group 1. At three months, Harris Hip Score, muscle strength, 6-minute walk test, and duration of crutch use were significantly (p < 0.05) in favour of group 2. None of the patients in either group showed signs of loosening one year after the operation.

Conclusions: These results suggest that patients with TPP can tolerate an accelerated rehabilitation programme with early weight bearing and will gain the goals of rehabilitation earlier.
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http://dx.doi.org/10.1191/0269215504cr705oaDOI Listing
February 2004