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    Effectiveness of the Epley maneuver versus Cawthorne-Cooksey vestibular exercises in the treatment of posterior semicircular canal benign paroxysmal positional vertigo (BPPV): a randomized controlled trial
    (ELSEVIER, 2021) Taçalan, Ekin; İnal, Habibe Serap; Şentürk, M. Nafiz; Mengi, Erdem; Alemdaroğlu-Gürbüz, İpek
    Objective Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo that mainly affects the posterior semicircular canal. Studies suggest that Epley maneuver could improve balance of patients, but Cawthorne-Cooksey vestibular exercises are still scarce. This study aimed to observe the effects of Cawthorne-Cooksey vestibular exercises applied after the Epley maneuver on balance, vertigo symptoms, and quality of life in posterior semicircular canal BPPV. Methods Thirty-six patients with posterior semicircular canal BPPV were randomly assigned into Epley maneuver (EpleyM) and Epley maneuver and exercise (EpleyM&Exe) groups. All patients were treated with the Epley maneuver, while Cawthorne-Cooksey vestibular exercises were given to the EpleyM&Exe group as home exercises for 6 weeks. Their static and dynamic balance, vertigo symptoms, and quality of life were assessed at pre-, post-intervention (1st, 3rd and 6th weeks). Results Thirty-two patients completed the study (mean age: 46.91 ± 9.78 years). Epley maneuver applied alone and combined with Cawthorne-Cooksey vestibular exercises, was found to be effective in 25 patients (78.1%), 6 patients (18.8%) and 1 patient (3.1%) at the 1st, 3rd and 6th weeks, respectively. After 6 weeks, both groups had gained significant improvements in balance, vertigo symptoms, and quality of life (p < 0.001); however, there were no significant differences between the groups, except for the static dominant leg balance test (p = 0.022). Conclusions The Epley maneuver can be considered as the first option compared to Cawthorne-Cooksey vestibular exercises. Exercises do not appear to have any additional effects in improving posterior semicircular canal BPPV symptoms.
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    Efficacy of mirror therapy for improving unimanual motor skills in chronic stroke patients: a case series
    (IOS Press BV, 2020) Oktar, Hatice Nur; İnal, Habibe Serap
    BACKGROUND: Unimanual activities are suggested as an effective intervention for the moderately or severely affected chronic stroke patients and bimanual activities for mildly affected cases in mirror therapy. OBJECTIVE: To observe the feasibility of unimanual mirror therapy to improve the motor skills of the effected hand in mild chronic stroke patients. METHODS: In this is case series study, n = 20 mildly affected chronic stroke patients were screened for participation in a nursing home setting. They were 45-60 years of stroke included ischemia (n = 3) and aneurysm (n = 1) of anterior cerebral artery, median time:3 years. The gross (Fugl-Meyer Assessment test), fine motor (Box and Block Tests) skills, the tripot pinch grip power (JTech Commander PichTrack) were assessed at baseline and post intervention. The intervention supervised included unimanual activities of the non-affected hands for 30 min, 5 days/week for 6 weeks. RESULTS: N = 4 participants were recruited from a nursing home setting; median age: 45, Gender: 3M; 1W. The causes of stroke included ischemia (n = 3) and aneurysm of anterior cerebral artery (n = 1). The median years of stroke was 3 years. The improvement in the gross motor skills (25%) of affected sides after unimanual training may be considered as feasable. There were also increase in tripot pinch grip power of the non-affected (34%) and affected hands (17%). The improvement in fine motor skills were 19% in affected hands the 10% in non-affected hands. CONCLUSIONS: The unimanual mirror therapy resulted in improvements in gross and fine motor skills and tripod pinch grip power of the affected hands of mild chronic stroke patients. This case series provides further evidence that mirror therapy is effective to improve function in patients with mild chronic stroke.
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    Evaluation of immediate effect of sacroiliac joint manipulation on balance and muscle strength
    (Edizioni Minerva Medica, 2021) Toprak, Mehmet; Coşkunsu, Dilber Karagözoğlu; Alptekin, Hasan Kerem; İnal, Habibe Serap
    Background: The aim of this study was to investigate the immediate effect of chiropractic high velocity low amplitude (HVLA) sacroiliac manipulation on muscle strength and balance in healthy individuals with asymptomatic dysfunction of the sacroiliac joint. Methods: Quadriceps and hamstring muscle strength and balance were measured before and after the application in healthy individuals, using the Biodex Balance System and MicroFet 2 Hand Dynamometer (Biodex Medical Systems, Inc., Shirley, NY, USA). Balance was measured when the patients stood on their feet eyes open, and eyes closed. In total, 60 individuals were included in the study. They were divided into two groups and the experimental group had 40 individuals in total. No application was made to the control group. One-time chiropractic HVLA sacroiliac manipulation was applied to the experimental group. Results: In the control group, the quadriceps muscle strength of the right leg was 58.51 kg in the first measurement and 52.95 kg in the second measurement. The left leg yielded 57.62 kg in the first measurement and 51.06 kg in the second measurement. The Hamstring Muscle Strength of the right leg in the control group was 41.77 kg in the first measurement and 38.28 kg in the second measurement. In the left leg, it was 41.96 kg in the first measurement and 39.36 kg in the second measurement. For balance measurement, there was a significant improvement in balance in the second measurement in both eyes-closed and eyes-open positions. In the experimental group, the Quadriceps Muscle Strength of the right leg was 58.05 kg in the first measurement and 67.43 kg in the second measurement. In the left leg, it was 56.23 kg in the first measurement and 64.97 kg in the second measurement. Hamstring muscle strength increased significantly in both right and left legs after chiropractic HVLA manipulation (P<0.05). In the experimental group, the hamstring muscle strength of the right leg was 34.68 kg in the first measurement and 43.29 kg in the second measurement. In the left leg, it was 35.96 kg in the first measurement and 43.64 kg in the second measurement. Conclusions: There was no significant improvement in balance of both legs in eyes-closed and eyes-open position after chiropractic HVLAmanipulation.