Shoulder Joint Range of Motion Related to Dementia.

Dementia is caused by various diseases, including Alzheimer's disease dementia (ADD) and dementia with Lewy bodies (DLB). We often encounter patients with dementia who have limited shoulder joint range of motion (ROM), especially those with behavioral and psychological symptoms of dementia (BPSD). But the relationship between the diseases of dementia and restricted shoulder joint ROM is currently unclear. We examined cognitive function and shoulder joint ROM in 234 new outpatients at 7 memory clinics in Japan. We assessed cognitive function using the Mini-Mental State Examination (MMSE) and Revised Hasegawa Dementia Scale (HDS-R) and BPSD using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Patients were categorized by dementia diagnosis (ADD, DLB, other dementia, and control). Right, left, and total shoulder joint ROM was assessed using validated the Japanese Orthopaedic Association (JOA) score. We found significant associations of lower right, left, and total shoulder joint ROM scores with male sex, advanced age, higher NPI-Q score, lower HDS-R, and MMSE scores. Little difference was found between right and left shoulder joint ROM scores. Restricted shoulder joint ROM was related to serial 7, verbal frequency domain scores on the HDS-R and repeat score on the MMSE. It was also related to the hallucinations, irritability/lability and nighttime disturbances scores on the NPI-Q. Furthermore, the dementia groups, especially the DLB group, showed worse shoulder joint ROM than the control group. Dementia was significantly related to restricted shoulder joint ROM. Maintaining communication and social interaction may help maintain shoulder joint ROM.

Honjo Y ，Nagai K ，Yuri T ，Nakai H ，Kawasaki I ，Harada S ，Suganuma I ，Ogawa N ... -  《-》

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

《Jove-Journal of Visualized Experiments》

The Turkish validity and reliability of Addenbrooke's Cognitive Examination III.

Addenbrooke's Cognitive Examination III (ACE-III) was developed as a screening tool for cognitive disorders. Many countries have proven the cultural adaptation, reliability and validity of ACE-III. To make cultural adaptations of ACE-III for the Turkish population and to examine its validity and reliability. First, ACE-III was translated and adapted into Turkish (ACE-III-TR), then its validity and reliability were examined. The study included 234 people: 93 with dementia (78 Alzheimer's disease (AD) and 15 frontotemporal dementia (FTD)), 46 with mild cognitive impairment (MCI) and 95 healthy. Two blinded speech and language therapists rated the ACE-III-TR simultaneously for interrater validity. The same practitioner retested the same participants 2 weeks later for test-retest reliability. The construct validity of the culturally adapted test was assessed by analysing subsection correlations with the ACE-III-TR total score. The association between the Mini-Mental State Examination (MMSE) total score, relevant subsections and ACE-III-TR total score was examined for criterion validity. Intergroup differences for healthy, MCI and dementia were studied for ACE-III-TR subsections and total score, and cut-off scores were calculated for total score with sensitivity and specificity in differential diagnosis. Attention, memory and ACE-III-TR total scores showed a statistically significant difference between the three groups of dementia, MCI and healthy (p < 0.001). Statistically significant positive correlations ranging from 0.571 to 0.929 were found between ACE-III-TR subsections and total scores (p < 0.05). A highly significant positive correlation was found between MMSE total score and ACE-III-TR total score (r = 0.870). Between the second and first measurements, positive, moderately significant correlations were found for all subsections and ACE-III-TR total (ICC = 0.508-0.784, r = 0.477-0.646). A high level of agreement was found between two raters for all ACE-III-TR subsections and the ACE-III-TR total score (alpha = 0.9296-0.99995). The total ACE-III-TR cut-off score was 79.5 for healthy and MCI and 69.5 for MCI and mild stage dementia. This study found that ACE-III-TR is a sensitive and specific screening test for the diagnosis of MCI and dementia that has high validity and reliability. ACE-III-TR was found to be a valid and reliable tool in dementia, including AD and FTD, and in mild, moderate and advanced dementia. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes. What is already known on the subject ACE was used as a screening tool to detect MCI and to differentiate AD from FTD. ACE was revised by Hsieh et al. in 2013 and updated as ACE-III, which has the advantages of assessing five cognitive domains, not requiring the use of additional materials, and providing an effective and sensitive measurement in a short time. However, the validity and reliability study of the ACE-III in Turkish has not been conducted. What this study adds to the existing knowledge This study demonstrates the validity and reliability of the Turkish ACE-III (ACE-III-TR), which is a sensitive and specific screening test for the diagnosis of MCI and dementia. What are the practical and clinical implications of this work? The ACE-III-TR can provide clinicians and patients with a quick and brief general cognitive screening, indicating both the patient's overall cognitive profile and the measures of each of the assessed domains. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes.

Parlak MM ，Bizpınar Munis Ö ，Köse A ，Yıldırım C ，Ülker CA ... -  《-》

Additive effect of glenohumeral joint hydrodilatation applied in addition to suprascapular nerve blockage in patients with adhesive capsulitis.

We aimed to investigate the efficacy of shoulder hydrodilatation (HD) applied in addition to suprascapular nerve blockage (SSNB) on severity of pain, shoulder joint range of motion (ROM), functional status, handgrip (HG) strength in patients with adhesive capsulitis (AC). Forty-eight patients who were diagnosed with AC based on physical examination findings included in the study. The patients were randomized into two groups as combination of SSNB + HD and SSNB alone. Injections were performed under ultrasonography guidance. Shoulder ROM angles were measured with a goniometer. Pain intensity was evaluated with visual analog scale. Functional status was evaluated with Quick Disability of Arm, Shoulder, and Hand (QDASH). HG strength was measured by a Jamar dynometer. After the injection, a home-based exercise program was given to all patients. Patients were evaluated at baseline, 1st and 3rd month. Abduction and external rotation ROM angles were statistically significantly limited in SSNB group, at baseline (p = 0.020, p = 0.018, respectively). In terms of other parameters, both groups were similar at baseline (p > 0.05). At comparison of baseline-1st month, a significant improvement was observed in VAS score, abduction and flexion ROM and QDASH score, in both groups (p < 0.05), however, there was no statistically significant difference between the groups. There is a statistically significant decrease in VAS score in both groups, at all times, but, no significant difference between the groups. At the comparison of baseline-3rd month measurements, it was observed that all of the parameters significantly improved in both groups, and there was no statistically significant difference between the groups except for abduction and external rotation ROM (p > 0.05). Abduction ROM and external rotation ROM were significantly higher in the SSNB group than SSNB + HD group at 3rd month. Both SSNB + HD and SSNB alone provide significant improvement clinically especially in shoulder pain. HD added to SSNB does not seem to provide any additional benefit. SSNB is an effective treatment option for up to 3 months in patients with AC, mainly in abduction and external rotation limitation.

Mülkoğlu C ，Tiftik T ，Deniz AB ，Kandaşoğlu H ，Genç H ... -  《BMC MUSCULOSKELETAL DISORDERS》

Does Integration of Graded Motor Imagery Training Augment the Efficacy of a Multimodal Physiotherapy Program for Patients With Frozen Shoulder? A Randomized Controlled Trial.

Despite the availability of numerous treatment modalities for frozen shoulder, spanning from nonsurgical approaches to surgical interventions, a consensus regarding the most effective treatment remains elusive. Current studies emphasize that pain in frozen shoulder affects central nervous system activity and leads to changes in cortical structures, which are responsible for processing sensory information (like pain) and controlling motor functions (like movement). These cortical changes highlight the importance of including the central nervous system in the management of frozen shoulder. It is therefore recommended that treatment should provide more effective management by focusing not only on the shoulder region but also on the cortical areas thought to be affected. Among patients treated nonsurgically for frozen shoulder, is graded motor imagery added to a multimodal physical therapy program more effective than multimodal physical therapy alone in terms of (1) Shoulder Pain and Disability Index (SPADI) scores, (2) pain with activities and QuickDASH (Q-DASH) scores, and (3) ROM after 8 weeks of treatment? In this randomized clinical trial, we considered the following as eligible for inclusion: (1) ROM < 50% compared with the unaffected shoulder, (2) clinically and radiologically confirmed primary frozen shoulder, and (3) 30% loss of joint ROM in at least two planes compared with the unaffected shoulder. Diagnosis of patients was based on patient history, symptoms, clinical examination, and exclusion of other conditions. A total of 38 patients with frozen shoulder were randomly assigned to either the graded motor imagery group (n = 19) or the multimodal physiotherapy group (n = 19). The groups did not differ in age, height, weight, gender, and dominant and affected side. In both groups, there were no losses to follow-up during the study period, and there was no crossover between groups. The multimodal physiotherapy program encompassed a variety of treatments, including stretching exercises, ROM exercises, joint-oriented mobilization techniques, scapular mobilization, strengthening exercises, and the application of cold agents. The graded motor imagery program, as an addition to the multimodal physiotherapy program, included the following steps: (1) left-right discrimination (identifying left and right body parts), (2) motor imagery (mentally visualizing movements), and (3) mirror therapy training (using mirrors to trick the brain into thinking the affected part is moving). Both groups of patients participated in a program of 12 sessions, each lasting approximately 45 minutes, twice a week for 6 weeks. Participants were assessed at baseline, after 6 weeks, and at 8 weeks. The primary outcome was the SPADI score, which ranges from 0 to 100, with higher values denoting greater disability. The minimum clinically important difference (MCID) for SPADI scores is reported to be 13.2 points. Secondary outcomes were shoulder ROM, Numeric Pain Rating Scale activity score (scored from 0 points, indicating "no pain," to 10 points, indicating "worst pain imaginable"), and Q-DASH score (ranging from 0 to 100 points, with a higher score indicating higher functional disability). Repeated-measures analysis of variance was used to compare means between one or more variables based on repeated observations. After 8 weeks of treatment, patients treated with graded motor imagery plus multimodal physical therapy experienced greater mean ± SD improvement from baseline in terms of SPADI scores than did the multimodal physical therapy group (65 ± 9 versus 55 ± 12, mean difference 10 points [95% confidence interval 4 to 17 points]; p = 0.01). Graded motor imagery when added to standard therapy did not produce a clinically important difference in pain scores with activity compared with physical therapy alone (7.0 ± 1.3 versus 5.9 ± 1.4, mean difference 1 point [95% CI 0.2 to 2.0 points], which was below our prespecified MCID; p = 0.04). However, improvements in Q-DASH score at 8 weeks were superior in the graded motor imagery group by a clinically important margin (58 ± 6 versus 50 ± 10, mean difference 9 points [95% CI 3 to 14 points], which was below our prespecified MCID; p = 0.01). ROM was generally better in the group that received the program augmented by graded motor imagery, but the differences were generally small. Adding graded motor imagery to a multimodal physiotherapy program was clinically superior to multimodal physiotherapy alone in improving function in patients with frozen shoulder. However, no clinically superior scores were achieved in ROM or activity-related pain. Additionally, the follow-up period was short, considering the tendency of frozen shoulder to recur. Although adding graded motor imagery provides superiority in many scores and does not require high-budget equipment, the disadvantages such as the difference in some scores being sub-MCID and the need for expertise and experience should not be ignored. Consequently, while graded motor imagery shows promise, further research with longer follow-up periods is recommended to fully understand its benefits and limitations in the treatment of frozen shoulder. Level I, therapeutic study.

Yasaci Z ，Celik D 《-》