:Neuromuscular diseases (NMDs) are a heterogeneous group of diseases including motor neurone diseases (MND), muscle diseases (MD), neuropathies and neuromuscular junction diseases (NMJD). NMDs are characterized by a wide range of symptoms and findings, depending on different underlying issues. Therefore, the literature includes specific management and/or rehabilitation recommendations for each subgroup and even for some diseases within these subgroups. Currently, neither in our country nor globally is there a comprehensive recommendation study that thoroughly addresses all aspects of NMD rehabilitation developed by experienced and specialized multidisciplinary experts in the field. The recommendations in this paper have been created by a multidisciplinary team for all patients without age limitation under the headings of peripheral neuropathy/polyneuropathy, MND, MD and NMJD using the seven-step and 3 round modified Delphi method via e-mail. The strength of agreements (SOA) was calculated for each item (recommendation) using percentages (response of between 8 and 10

BackgroundCalf muscle weakness due to neuromuscular disorders significantly impairs walking efficiency, increases energy expenditure, and limits mobility. Ankle-foot orthoses (AFOs) are commonly prescribed to improve gait biomechanics and functional mobility, but their effectiveness remains uncertain.ObjectiveTo assess the effects of AFOs on walking performance in adults with calf muscle weakness caused by slowly progressive neuromuscular disorders.MethodsA summary of the Cochrane Review by van Duijnhoven et al., with commentary from a rehabilitation perspective.ResultsThe Cochrane review included 10 studies with 186 participants. Low-certainty evidence suggests that carbon AFOs may reduce walking energy cost, increase walking speed, and enhance user satisfaction. Leather AFOs may also contribute to improved walking speed. Polypropylene and elastic AFOs appear to provide minimal to no benefit. The effects of AFOs on perceived walking effort, balance, and long-term use remain inconclusive due to very low-certainty evidence. Although adverse events were predominantly mild, conclusions regarding safety remain limited, as most studies were conducted in laboratory settings without incorporating real-life use of AFOs.ConclusionsThe evidence supporting AFO use in adults with calf muscle weakness remains of low to very low certainty. Future research should focus on individualized AFO prescription, long-term outcomes, and safety monitoring. Additionally, further investigation is needed to clarify the impact of AFO material properties on walking, mobility, and quality of life in individuals with neuromuscular disorders.

BACKGROUND:Post-stroke depression (PSD) is a prevalent condition that can significantly influence the recovery process.OBJECTIVE:To assess the effects of pharmacological, non-invasive brain stimulation and psychological interventions, and their combination on PSD.METHODS:A summary of the Cochrane Review by Allida et al. (2023), with comments from a rehabilitation perspective.RESULTS:Sixty-one studies with 5831 participants were included in the Cochrane Review. Very low-certainty evidence indicated favorable treatment effects of pharmacological interventions, psychological therapies, and the combination of pharmacological intervention and non-invasive brain stimulation on PSD. Pharmacological intervention has resulted in increased side effects associated with the central nervous system and gastrointestinal system, with very low-certainty evidence.CONCLUSION:Evidence for the effectiveness of pharmacological, psychological, and combination therapies for the management of PSD is uncertain, as the quality of the evidence has been assessed as very low. Therefore, further studies with improved methods should investigate pharmacological and non-pharmacological interventions for the treatment of depression in stroke survivors.

Objectives: This study aims to compare the efficacy of intra-articular platelet-rich plasma (PRP) injections over a saline placebo in terms of reduction of pain and impact on quality of life among patients with hip osteoarthritis. Patients and methods: A total of 60 patients (29 males, 31 females, mean age: 57.9±7.3 years; range, 47 to 69 years) with known hip osteoarthritis of Kellgren-Lawrance (KL) Grades 2/3 were randomized into placebo (n=30) and PRP groups (n=30) between June 2014 and June 2015. Both groups received intra-articular injections into the hip joint under ultrasound guidance for three consecutive weeks. The patients were followed for six months, and pain reduction was assessed using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, and Short Form Health Survey-36 (SF-36). Results: Intra-articular PRP treatment showed no advantage over a saline placebo in terms of VAS scores during activity. Both groups showed a significant improvement in VAS activity scores at one and six months. The placebo group showed improvements in VAS resting scores, whereas the PRP group did not. Both groups showed no improvement in WOMAC-total scores. Both groups showed no significant improvement across most SF-36 domains with the exception of improved physical role functioning at one month and general health at one and six months in the placebo group. Conclusion: Intra-articular injections of PRP show no significant difference compared to a saline placebo over a period of six months on pain, function, and quality of life scores in patients with hip osteoarthritis.

BACKGROUND: Many formulations and dosing regimens are available for hyaluronic acid (HA). OBJECTIVE: To compare different doses of linear, high-molecular weight (HMW) HA injections among patients with knee osteoarthritis (OA). METHODS: Hundred patients were included in this randomized, single-blinded trial and randomly divided into three HA injection groups. The first group received five weekly 20 mg HA injections, the second group received three weekly 32 mg HA injections, and the third group received a single 48 mg HA injection. Patients were evaluated at baseline, 1, 3, and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Quality of life, patient’s global assessment, and Timed Up and Go (TUG) test scores were also evaluated. RESULTS: There was significant improvement in the WOMAC, VAS-pain, quality of life, patient’s global assessment, and TUG test mean scores at all follow-up time points (p< 0.001). However, the groups showed no significant differences in WOMAC, VAS-activity pain, and patient global scores at any follow-up point. CONCLUSION: Intra-articular injections of different doses of linear HMW HA can improve pain, stiffness, function, and quality of life in patients suffering from knee OA over a six-month period.

Objective This study aimed to assess the impact of conventional rehabilitation (CR) and the combination of bodyweight-supported treadmill training (BWSTT) with CR on walking speed, endurance, balance, mobility, and the quality of life in stroke survivors. Method In this prospective, randomized, controlled, and single-blind study, 30 stroke patients were included (ClinicalTrials.gov registration number: NCT04597658 date: October 22, 2020). These patients were divided into two groups: (1) CR only (control group, n = 14) and (2) CR with BWSTT (experimental group, n = 16). Both groups received CR for 3 consecutive weeks, 5 days a week, for 30 min each day. The experimental group received an additional 30 min of BWSTT per session. Patients were evaluated using the 10-m walk test (10MWT), the six-minute walk test (6MWT), the Tinetti Balance and Gait Assessment Score, the Timed Up and Go (TUG) test, the Rivermead Mobility Index (RMI), and the Stroke-Specific Quality of Life Scale (SS-QOL) before and after the intervention. Results Both groups showed significant improvements across all scales after the intervention. The BWSTT group exhibited particularly noteworthy enhancements in comfortable 10MWT and TUG scores ( p = 0.043 and p = 0.025, respectively) compared to the CR group post-intervention. Conclusion In conclusion, a holistic approach combining conventional physiotherapy with overground gait training can enhance various aspects of mobility. This approach offers a cost-effective and equipment-free alternative to BWSTT and necessitates specialized treadmill and bodyweight support systems, incurring higher costs. However, using BWSTT as a co-therapy therapy can be costly but provides additional benefits for enhancing functional mobility.

Objective: To investigate the effects of mesotherapy in patients with mild to moderate knee osteoarthritis (KOA). Methods: The study included 43 patients (56 knees) who were randomly assigned to either the mesotherapy group (MG, n=28) or the saline group (SG, n=28) and received a total of 4 weekly mesotherapy (MG) or saline injections (SG). Pain, functional status and quality of life were evaluated by a Visual Analogue Scale (VAS), the Western Ontario Universities Osteoarthritis Index (WOMAC) and the Short Form-36 (SF-36) subscales at baseline and at 8 and 16 weeks of follow-up. Results: A total of 39 patients (52 knees) completed the study. Eight weeks after treatment, a significant improvement was found in VAS pain scores, WOMAC scores and physical component scores (PCS) of the SF-36 in both groups compared to baseline (p<0.05). The VAS activity pain score, WOMAC-pain, WOMAC-physical function and WOMAC-total scores were found to have decreased significantly in the MG compared to the SG (p<0.001) at both 8 weeks and 16 weeks. The PCS scores significantly improved in the MG compared to the SG at 8- and 16-week follow-ups (p<0.001 and p<0.001, respectively). Conclusions: Mesotherapy is a well-tolerated, safe and effective alternative treatment option in patients with mild and moderate KOA.

Objectives: The aim of this study was to evaluate the effects of low-level laser therapy (LLLT) and therapeutic ultrasound (US) combined with home-based exercise (HBE) versus HBE alone in patients with subacromial impingement syndrome (SAIS). Patients and methods: Between March 2021 and July 2021, a total of 60 patients with SAIS (19 males, 41 females; mean age: 51.3±10.4 years; range, 30 to 70 years) were included. The patients were randomly allocated to an LLLT group (LG), an US therapy group (UG), and a control group (CG). The LLLT and US therapy programs were applied five times a week, for a total of 15 sessions. Home-based exercise programs and cold-pack therapy were administered to patients in each group. The patients were evaluated at baseline and one and three months of follow-up using the Visual Analog Scale (VAS) for pain during activity, at rest, and at night, and the Shoulder Pain and Disability Index (SPADI). Results: All groups showed a significant improvement in the VAS and SPADI scores after the first month (p<0.05). The VAS activity pain score (p=0.008), SPADI pain score (p=0.003), SPADI disability score (p=0.012), and SPADI total score (p=0.003) significantly decreased in the LG compared to the CG at one month of follow-up. However, there were no significant differences in the outcome measures among the three groups at three months (p>0.05). Conclusion: The LLLT combined with HBE is more effective than HBE program alone for relieving activity pain and improving shoulder functions in the short term. However, LLLT and US therapy do not provide additional effects in terms of pain and disability at three months.

Purpose: Stroke is one of the most common causes of disability because of functional, cognitive, and psychological issues. Motor deficits in the afflicted upper extremity affect about 50% of stroke survivors. To evaluate the effects of modified constraint-induced movement therapy(mCIMT) on hemiparetic right/left upper limb functions and quality of life(QOL). Materials and Methods: In this prospective, randomized, controlled and single-blind study, 40 patients were assigned to the right-mCIMT(n=10), left-mCIMT(n=10), or control(n=20). mCIMT was applied 4h/day, 2 weeks, 10-sessions. A conventional rehabilitation program was applied to all patients. Patients were evaluated using Fugl-Meyer Motor Assessment(FMA), Motor Activity Log(MAL), Stroke Impact Scale(SIS), Box-Block Test(BBT), the number of repetitions in shaping exercises, and the duration of task exercise. Results: There was a statistically significant improvement in the FMA of the left-mCIMT group(p

The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration–aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration–aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration–aspiration and residue levels.

The aim of this commentary is to discuss from a rehabilitation perspective the Cochrane Review “Systemic therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer” 1 by Roberts et al. a , published by the Cochrane Breast Cancer Group. This Cochrane Corner is produced in agreement with Journal of Musculoskeletal and Neuronal Interactions by Cochrane Rehabilitation with views* of the review summary author in the “implications for practice” section.

Background Dysphagia is a geriatric syndrome. Changes in the whole body that occur with aging also affect swallowing functions and cause presbyphagia. This condition may progress to oropharyngeal and/or esophageal dysphagia in the presence of secondary causes that increase in incidence with aging. However, no study has been published that provides recommendations for use in clinical practice that addresses in detail all aspects of the management of dysphagia in geriatric individuals. This study aimed to answer almost all potential questions and problems in the management of geriatric dysphagia in clinical practice. Methods A multidisciplinary team created this recommendation guide using the seven-step and three-round modified Delphi method via e-mail. The study included 39 experts from 29 centers in 14 cities. Results Based on the 5W and 1H method, we developed 216 detailed recommendations for older adults from the perspective of different disciplines dealing with older people. Conclusion This consensus-based recommendation is a useful guide to address practical clinical questions in the diagnosis, rehabilitation, and follow-up for the management of geriatric dysphagia and also contains detailed commentary on these issues.

In the prospective, randomized, controlled multicenter study, 100 patients who were clinically diagnosed with sarcopenia were assigned to either a home-based exercise group or a control group. The home-based training program included exercises with gradually increasing intensity comprising posture, stretching and upper- and lower-extremity muscle-strengthening exercises, balance and coordination exercises, and gait training. Before and 3 months after the exercise program, all the patients were evaluated. The 6-min walking test and Berg Balance Scale scores increased significantly after 3 months in the home-based exercise group compared with the controls. There was also a significant decrease in timed up and go test scores and a significant improvement in quality of life in the exercise group compared with the control group. Our findings indicated that a home-based exercise program can have a positive effect on physical function, balance, and quality of life in patients with sarcopenia.

BACKGROUND: Motor imagery (MI) is a promising therapeutic technique for stroke rehabilitation. OBJECTIVE: To assess the effects of MI on gait rehabilitation after stroke. METHODS: To summarize the "Cochrane Review" by Silva et al. RESULTS: Twenty-one studies with 762 participants were included in the Cochrane review. Very low level of certainty evidence pointed to some beneficial effects of MI alone or combined with action observation or physical practice on walking speed compared to other therapies. There is uncertainty about the effect of MI compared to other therapies in terms of motor function or functional mobility. CONCLUSIONS: High-quality adequately powered studies investigating the effects of MI in individuals with stroke should be encouraged.

Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).

Purpose. The aim of this study was to investigate the association between prostanoid [thromboxane (TxA2) and prostacyclin (PGI2)] levels in synovial fluid and infrapatellar fat pad (IPFP)/ suprapatellar fat pad (SPFP) thickness as well as other clinical findings in knee steoarthritis (OA) patients. Materials and Methods: 16 patients with knee OA with effusion were included. The average pain levels were evaluated using a Visual Analogue Scale (VAS). The pain, stiffness, and physical functions were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The levels of 6-keto-PGF1α, stable metabolite of PGI2, and TxB2, stable metabolite of TxA2, were measured in synovial fluid using an enzyme immunoassay. Results: 6-keto-PGF1α levels were significantly greater than TxB2 levels in synovial fluid of patients with OA. TxB2 levels and TxB2/6-keto- PGF1α ratio were negatively correlated with SPFP and cartilage thickness, respectively. IPFP thickness was positively correlated with SPFP thickness and effusion volume. WOMAC scores were positively correlated with VAS-activity and VAC-evening scores. Conclusion: In comparison to 6-keto- PGF1α levels in synovial fluid, TxB2 levels seem to be more associated with ultrasonographic findings in patients with OA.

Objectives: The aim of this study was to investigate phantom limb pain (PLP), PL sensation (PLS), and residual limb pain (RLP) after lower-extremity amputation and their effect on patients' effective prosthesis use, body image, and quality of life in prosthetic users. Methods: Fifty-seven patients with lower-extremity amputation who used prosthesis for at least 3 months were included in our study. PLP, PLS, and RLP were evaluated through the prosthesis evaluation questionnaire (PEQ). Prosthetic use, locomotor skills, body image, and quality of life were measured by administering Houghton scale, locomotor capabilities index (LCI), amputee body image scale (ABIS), and short-form health survey (SF-36), respectively. Results: On the PEQ, 43.9% of the patients reported PLP, while 63.2% reported PLS, and 40.4% reported RLP. Correlation analyses revealed that as the frequency and duration of PLP increased, the patients' basic and advanced locomotor skills and quality of life decreased. When the intensity of PLP and the degree of distress caused by it increased, the patients' quality of life decreased, and when the frequency of PLS increased, the patients' emotional state worsened. When the intensity of PLS and the degree of bother caused by it increased, the patients' body image, emotional state, and social status worsened. There was no correlation between the rate, frequency, severity, or duration of RLP and scores on Houghton scale, LCI, ABIS, or SF-36. Conclusion: The presence of PLP and PLS decreases the use of prostheses and impairs body image and quality of life in prosthetic users.