Clinical Research Directory

"Effects of a Combined Repetitive Transcranial Magnetic Stimulation and Physical Therapy Protocol on Motor Function, Balance, and Quality of Life in Chronic Post-Stroke Hemiplegia: A Case Series"

Chronic post-stroke hemiplegia frequently results in persistent motor deficits, impaired balance, and reduced quality of life. Conventional physical therapy is fundamental for functional recovery; however, motor improvement often plateaus during the chronic phase. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has shown potential to enhance motor recovery by modulating cortical excitability and promoting neuroplasticity. This case series aims to investigate the effects of a combined protocol of repetitive transcranial magnetic stimulation and conventional physical therapy on motor function, balance, and quality of life in individuals with chronic post-stroke hemiplegia. Participants will undergo rTMS applied to the motor cortex in conjunction with a structured physical therapy program. Clinical outcomes will be assessed before and after the intervention to explore feasibility, safety, and potential functional benefits of the combined approach.

Relationship Between Gastrocnemius and Soleus Muscle Thickness Assessed by Ultrasound and Balance and Fear of Falling in Hemiplegic Patients

Structural and functional changes occurring in the lower extremity muscles of hemiplegic stroke patients play a decisive role in gait ability, balance impairment, and fall risk. In this context, the relationship between muscle architecture parameters such as the thickness of the gastrocnemius and soleus muscles and functional performance is being investigated. Ultrasonography is a reliable and accessible method for the non-invasive assessment of muscle thickness. Yakut et al. (2024) reported that in acute stroke patients, particularly the thickness and cross-sectional area of the soleus muscle were significantly associated with the Berg Balance Scale, Single-Leg Stance Test, and Timed Up and Go Test. In the same study, it was also shown that the thickness of the gastrocnemius muscle on the non-paretic side was related to balance. Onat et al. (2022) demonstrated correlations between lower extremity muscle architecture and measures such as the Timed Up and Go Test, Fugl-Meyer Lower Extremity Assessment, and Functional Independence Measure, emphasizing that the gastrocnemius and soleus muscles play a determining role in motor and functional level. Suh et al. (2022) reported that trunk muscle thickness was significantly associated with the Berg Balance Scale, Functional Ambulation Scale, and Functional Reach Test. In this study, gastrocnemius and soleus muscle thickness will be evaluated using ultrasonography in subacute and chronic stroke patients, and their relationship with balance (Berg Balance Scale), mobility (Timed Up and Go Test and Functional Ambulation Scale), and fear of falling (Falls Efficacy Scale International) will be investigated. The study aims to provide original contributions to the literature by revealing the interaction between muscle architecture and both physical and psychosocial outcomes, and to support the development of targeted rehabilitation strategies for individuals at high risk of falling.

Core Stability, Functional Capacity, Balance, Strength, and Fatigue in Pediatric Demyelinating Diseases

This study aims to evaluate balance ability, core stability, functional capacity, lower extremity muscle strength, and fatigue levels in children diagnosed with central nervous system demyelinating diseases, in order to contribute to the development of evidence-based and individualized rehabilitation strategies.

Monitoring Intensity During Balance Training in Persons With Multiple Sclerosis - a Randomized Feasibility Study

Balance training is recommended to improve gait stability and mobility. However, there are currently no clearly defined methods for controlling the intensity (challenge) of balance training. This research project aims to determine whether balance training for individuals with multiple sclerosis (MS), individually tailored to the level of difficulty and exertion, is feasible and possible within an inpatient rehabilitation setting. Participants will be randomly assigned to one of two groups: either they will complete group training focusing on strength, endurance, and balance in addition to their regular therapy program, or they will receive individually tailored balance training. Both groups will undergo an initial assessment followed by seven training sessions, each lasting approximately 45-60 minutes. Before discharge, the initial assessments will be repeated. These assessments include completing questionnaires, performing gait tests, balance tests, and a short cognitive test. Interviews will also be conducted with patients and therapists. These are intended to help better assess the feasibility of the training and to gain more insight into the experiences with the training.

Effects of Adapted Argentine Tango Training Frequency on Dual-Task Walking

This randomized controlled trial will examine whether the frequency of adapted Argentine tango training affects walking and cognitive function in adults aged 55 to 60 years when the total weekly intervention time is kept the same. A total of 270 participants will be randomly assigned in equal numbers to one of three groups. The distributed tango group will attend five 36-minute sessions per week. The concentrated tango group will attend two 90-minute sessions per week. The active control group will attend two 90-minute sessions per week consisting of health education and low-intensity stretching. All interventions will continue for 8 weeks. The adapted Argentine tango program will include low-impact multidirectional stepping, weight shifting, movement initiation and stopping, rhythmic cueing, direction changes, alternating leader-follower roles, and progressive movement-sequence learning. Jumping, rapid continuous turning, large kicks, and other high-risk movements will not be included. Assessments will be conducted at baseline, Week 4, Week 8, and 2 weeks after the intervention ends. The main outcome will be the change in dual-task walking cost at week 8. Other assessments will examine balance, walking performance, executive function, general cognitive function, lower-limb function, exercise adherence, training intensity, falls, and adverse events. The study aims to determine whether shorter, more frequent sessions or longer, less frequent sessions provide greater motor-cognitive benefits when the total weekly intervention time is equal.

The Effect of Body Weight on Physical Activity Level, Functional Capacity, Balance, and Quality of Life in Individuals With Type 2 Diabetes Mellitus

This study aims to investigate the effects of body weight on physical activity level, functional capacity, balance, and quality of life in patients with type 2 diabetes mellitus (T2DM). A total of 50 volunteer patients who meet the inclusion criteria will be recruited from the Internal Medicine and Nutrition outpatient clinics of Bezmialem Vakıf University Hospital. Participants will be prospectively evaluated through face-to-face interviews. Assessments will include body composition analysis (Omron Body Composition Monitor), waist-to-hip ratio, lower extremity muscle strength (Muscle Hand-Held Dynamometer), grip strength (Hand Grip Dynamometer), physical activity level (International Physical Activity Questionnaire-Short Form), functional capacity (6-Minute Walk Test), balance (Biodex Balance System), clinical balance (Berg Balance Scale), and quality of life (Nottingham Health Profile). All statistical analyses will be performed using IBM SPSS Statistics 20. With this study, we aim to comprehensively evaluate multiple parameters in individuals with T2DM and investigate their interrelationships, thereby contributing to the current body of knowledge in the literature.

Sensor Ankle Brace for Special Operations Rehabilitation

The primary purpose of this study overall is to validate a modified version of a commercially available ankle brace. Inertial measurement unit sensors will be incorporated into an existing ankle brace ("sXAB") by TayCo Brace, Inc. In two consecutive studies, gait metrics data collected from the sensor enabled ankle brace will be compared to data collected by the gold-standard equipment that is used in research and clinical settings to determine whether the sXAB performs adequately in terms of measurement or technical feasibility prior to further clinical evaluation. In the Phase 2 protocol, the sXAB will be validated on healthy subjects wearing combat boots performing walking, running, jumping, and stair climbing activities. These movements were selected because they simulate key movements performed during operational activities. All participants experience both conditions: with an ankle brace and without an ankle brace. Comparisons are made within-subject between brace and no-brace conditions. It is hypothesized that the sensor-enabled ankle brace will measure gait metrics with a high degree of accuracy (within 5%) when compared against the gold-standard lab equipment (i.e., motion capture and research-grade inertial measurement units).

Effects Of Otago Exercise Versus Multisensory Integration Training On Balance And Gait In Elderly With Diabetes

The goal of this clinical trial is to compare the effect of the Otago exercise and Multisensory integration training on balance and gait in the elderly with type 2 diabetes mellitus. The main question it aims to answer is: • Is there a significant difference between the effect of Otago exercise and Multisensory integration training on balance and gait in the elderly with type 2 diabetes mellitus? Researchers will compare Otago exercise to Multisensory integration training to know which one has the greatest benefit on balance \&gait in the elderly with type2 diabetes. Participants will be divided into 3 groups; each group takes a certain training program for 8 weeks: * First group: Otago exercise group plus conventional treatment for neuropathy. * Second group: Multisensory integration training group plus conventional treatment for neuropathy. * Third group: control group takes only conventional treatment for neuropathy.

Sensor Ankle Brace for Special Operations Rehabilitation - Phase 1

The primary purpose of this study overall is to validate a modified version of a commercially available ankle brace. Inertial measurement unit sensors incorporated into an existing ankle brace ("sXAB") by TayCo Brace, Inc. In two consecutive studies, gait metrics data collected from the sensor enabled ankle brace will be compared to data collected by the gold-standard equipment that is used in research and clinical settings to determine whether the sXAB performs adequately in terms of measurement or technical feasibility prior to further clinical evaluation. In the Phase 1 protocol, the sXAB will be validated in the lab on healthy subjects walking in standard tennis shoes/sneakers. All participants experience both conditions: with an ankle brace and without an ankle brace. Comparisons are made within-subject between brace and no-brace conditions. It is hypothesized that the sensor-enabled ankle brace will measure gait metrics with a high degree of accuracy (within 5%) when compared against the gold-standard lab equipment (i.e., motion capture and research-grade inertial measurement units).

Dynamic Neuromuscular Stability Exercises With and Without Rhythmic Auditory Stimulation in Lateral Ankle Sprain

To examine the effects of Dynamic Neuromuscular Stability exercises with and without Rhythmic Auditory Stimulation on balance, proprioception, and functional performance in badminton players with lateral ankle sprain.

Exopulse Mollii Suit, Motor Functions & CP Children With Cerebral Palsy

Cerebral Palsy (CP) is is estimated to be around 1.5-3 per live birth, with prenatal factors accounting for 75% of cases. CP appears in early childhood and persists with age and is characterized by permanent lesions or abnormalities affecting the immature brain. It mainly occurs as a motor system disorder (e.g., abnormal movements or posture) with the presence of hemiplegia, diplegia or tetraplegia, and spastic, dyskinetic or atactic syndromes. .This study will explore the potential clinical benefits of the Molliimethod in children with cerebral palsy. Spasticity impacts balance and mobility, halts the patients quality of life and their ability to perform their activity of daily living, and could also increase the risk of fractures and falls. Available interventions that aim on improving spasticity are facing limitations such as varios side effects. Therefore, developing novel therapies such as the EXOPULSE Mollii Suit could help to overcome such limitations and noninvasively improve balance, mobility, quality of life and reduce spasticity and pain in children with CP.

Plantar Sensation, Position Sense, and Weight-Bearing Asymmetry Related to Balance and Mobility Post-Stroke

This study aims to examine how sensory deficits and weight-bearing asymmetry affect posture, balance, and mobility in individuals with chronic stroke. The research focuses on evaluating the relationships between plantar foot sensation, lower extremity position sense, and asymmetrical weight distribution with functional abilities such as walking and postural control. Participants will undergo non-invasive assessments, including sensation tests, mobility and balance evaluations, and postural measurements. A total of 24 individuals with chronic stroke who are receiving physiotherapy at a rehabilitation center in Konya, Türkiye, will be included. The results of this observational, cross-sectional study may contribute to a better understanding of the sensory-motor interactions in stroke survivors and support the development of more targeted rehabilitation strategies.

Cawthorne-Cooksey Exercises and Frenkel Exercises on Balance and Coordination in Stroke

Stroke, often caused by cerebral circulation disruption can lead to transient or permanent brain function deficit it is a leading cause of disability and death globally, with a particularly high burden in low- and middle-income countries like Pakistan. Balance and coordination impairments are common post-stroke, severely impacting patients' mobility and quality of life. While Cawthorne-Cooksey and Frenkel exercises are low-cost rehabilitation techniques known to aid balance and coordination, there is limited evidence comparing their effectiveness in stroke patients. This study aims to evaluate and compare the effects of Cawthorne-Cooksey and Frenkel exercises on improving balance and coordination in post-stroke patients. Specific goals include determining which protocol leads to faster and more sustained improvements and providing evidence-based recommendations for stroke rehabilitation.

Acute Effects of Fibular Repositioning Taping on Balance, Jumping, and Sprint Performance

This randomized controlled trial aims to investigate the acute effects of fibular repositioning taping on balance, jumping, and sprint performance in healthy individuals. Eligible participants are randomly allocated to one of three groups: fibular repositioning taping, sham taping, or control. Physical performance and dynamic balance are assessed at baseline and after the intervention using functional outcome measures, including jumping tests, a 10-meter sprint test, and the Y Balance Test. The study is designed to determine whether fibular repositioning taping produces short-term changes in selected performance parameters compared with sham taping and no intervention.

OTAGO Exercises in Diabetes Mellitus Examining Its Effectiveness

Diabetes Mellitus (DM) is a chronic metabolic disease characterized by hyperglycemia, which occurs in insulin deficiency or when the body cannot effectively use the insulin produced. Moreover, according to the "Global Report on Diabetes" data published by the World Health Organization (WHO) in 2016, it is an important public health problem, one of the four priority non-communicable diseases (1, 2). In addition to the high mortality rates caused by complications due to DM, it is also known that it can cause low quality of life and many other additional problems in individuals. Possible complications are chronic and serious problems such as heart attack, risk of stroke, kidney failure, vision loss and nerve damage. One of the most common and most disabling complications is neuropathy. It should also be noted that approximately half of diabetic neuropathy is asymptomatic and patients diagnosed with DM may have neuropathy due to causes other than diabetes (2). These complications and damage that DM can cause can lead to decreased blood flow combined with neuropathy; As a result, foot ulcers and infections may occur; Amputation rates may increase. In addition to such additional complications that diabetic neuropathy may cause, due to all these; Loss of protective plantar sensation may also occur (3). This loss of protective sensation may lead to cutaneous deficits in the lower extremities, loss of muscle strength and reflexes, and gait and balance disorders (4). The mechanism that makes an important contribution to functional joint stability and the continuity of this stability, along with the feedback mechanisms required to ensure neuromuscular control, is proprioception, which includes joint movement (kinesthesia) and joint position sense (EPH) and is a subunit of the somatosensory system (5-7). . Rehabilitation with various injuries and other clinical conditions; Clinical studies to determine its effects on joint proprioception, neuromuscular control and balance have mostly focused on knee and ankle joints (5). The main reason for this can be attributed to the great importance of the knee and ankle joints in the lower extremities in maintaining general body kinematics and balance (8). Additionally, it has been reported in the literature that EPH and plantar sensory loss are observed in individuals diagnosed with DM, and these complications may cause additional problems (10, 12, 18-22). Additionally, many studies in the literature on this subject have been conducted in individuals with diabetic neuropathy, and changes in functional parameters such as plantar sensation, proprioception, muscle strength and balance have been examined (10, 19, 20, 22, 23). However, it has been found that not only individuals with neuropathy but also individuals diagnosed with DM without neuropathy have balance disorders (24). There are many studies in the literature about the effects of different exercise training on proprioception. In general, studies have reported that exercise training without weight bearing on the extremity has no effect on proprioception, but as a result of exercises performed with weight bearing on the extremity, a significant improvement was noted in both proprioceptive performance and muscle strength (25). In one of the most recent studies on this subject, it was stated that proprioceptive sensitivity increased in individuals with knee osteoarthritis with 8-week squat strengthening training performed by transferring weight to the extremity (26). Additionally, there are studies in the literature reporting different results regarding the effects of stretching exercises on proprioceptive performance. Some studies have reported that static stretching has no effect on proprioception, while others have reported that it has a positive effect on proprioception (27,28). The Otago Exercise Program is an evidence-based, home-based, individually tailored strength and balance retraining program. Research shows that the Otago Exercise Program is effective in reducing the risk of death and the incidence of falls in older adults over a one-year period. In one study, falls were reduced by 35% in older adults has been reported(29) This study was planned to examine the effectiveness of balance exercises given as a home program to individuals diagnosed with Type 2 DM.

Figure-of-eight Backward Walk Test in Elderly

Mobility is a fundamental element of healthy aging. Balance is a necessary function during mobility for all movements throughout life in elderly individuals. Falls due to balance disorders in elderly individuals cause a decrease in the quality of life. Studies in the literature indicate that 13% of individuals aged 65-69 experience falls, and this rate rises to 46% in individuals over 85. Lower extremity muscle volume and strength gradually decrease with aging. This decreased muscle strength directly impacts individuals' activities of daily living.Normal walking speed for elderly individuals is related to balance and overall health performance. However, walking assessments generally focus on walking activities in a forward direction and in a straight line. However, in daily life, we may need to sit on a chair, walk backward to navigate a narrow space, or change direction suddenly due to obstacles or environmental cues. Walking backward requires more complex motor control, and these gait training programs are known to be effective in improving balance and walking skills.Clinically, balance assessments in the elderly persons are commonly measured by using the TUG, 10-meter walk test, functional reach test, 4-square step test, and Berg balance scale. The methods used to assess balance are still not fully standardized. The best test for assessing dynamic balance and fall risk is still up for debate, especially when it comes to elderly individuals who live freely in the community. Further research is needed to determine whether lateral walking tests can identify those at high risk of falling in elderly adults. The purpose of this study was to determine the reliability, validity, and minimal detectable change (MDC) of the Figure-of-8 backward walking test in healthy elderly adults.

Whole-Body Vibration in Parkinson Disease

The aim of this study is to evaluate the effects of different frequencies of Whole Body Vibration (WBV) application on balance, gait, cognitive functions, and dual-task performance in patients with Parkinson's disease. Study Hypotheses: H0.1 - There is no effect of different frequencies of WBV application on balance performance in patients with Parkinson's disease. H1.1 - There is an effect of different frequencies of WBV application on balance performance in patients with Parkinson's disease. H0.2 - There is no effect of different frequencies of WBV application on gait performance in patients with Parkinson's disease. H1.2 - There is an effect of different frequencies of WBV application on gait performance in patients with Parkinson's disease. H0.3 - There is no effect of different frequencies of WBV application on cognitive functions in patients with Parkinson's disease. H1.3 - There is an effect of different frequencies of WBV application on cognitive functions in patients with Parkinson's disease. H0.4 - There is no effect of different frequencies of WBV application on dual-task performance in patients with Parkinson's disease. H1.4 - There is an effect of different frequencies of WBV application on dual-task performance in patients with Parkinson's disease. H0.5 - There is no effect of different frequencies of WBV application on reaction time in patients with Parkinson's disease. H1.5 - There is an effect of different frequencies of WBV application on reaction time in patients with Parkinson's disease. H0.6 - There is no significant difference between medium-frequency and low-frequency WBV in terms of balance performance in patients with Parkinson's disease. H1.6 - There is a significant difference between medium-frequency and low-frequency WBV in terms of balance performance in patients with Parkinson's disease. H0.7 - There is no significant difference between medium-frequency and low-frequency WBV in terms of gait performance in patients with Parkinson's disease. H1.7 - There is a significant difference between medium-frequency and low-frequency WBV in terms of gait performance in patients with Parkinson's disease. H0.8 - There is no significant difference between medium-frequency and low-frequency WBV in terms of cognitive functions in patients with Parkinson's disease. H1.8 - There is a significant difference between medium-frequency and low-frequency WBV in terms of cognitive functions in patients with Parkinson's disease. H0.9 - There is no significant difference between medium-frequency and low-frequency WBV in terms of dual-task performance in patients with Parkinson's disease. H1.9 - There is a significant difference between medium-frequency and low-frequency WBV in terms of dual-task performance in patients with Parkinson's disease. H0.10 - There is no significant difference between medium-frequency and low-frequency WBV in terms of reaction time in patients with Parkinson's disease. H1.10 - There is a significant difference between medium-frequency and low-frequency WBV in terms of reaction time in patients with Parkinson's disease.

Balance-Cognitive-Strength Training for Balance, Inhibitory Control, and Gait in Preschool Children

This randomized controlled study evaluated whether an 8-week balance-cognitive-strength training program improved balance ability, inhibitory control, and gait performance in preschool children aged 3 to 6 years. Children completed balance tests, single-task walking tests, dual-task walking tests, and an iPad-based Go/No-Go task before and after the intervention. The intervention group received exercise-cognitive integrated training 3 times per week for 8 weeks, and the control group maintained usual daily activities.

Robotic-Assisted System in Enhancing Balance, Postural Stability, Functional Gait and Fall Efficacy in Older Adults

Our study aims to investigate the effectiveness of a more individualized and personalized feedback-oriented approach using a Robotic Assisted System, the Hunova Movendo Robotic System. This system is tailored to specific needs of individuals and is dynamically adjustable relative to patients' balance and functional demands. It will be compared to Otago Exercise Programme which is more generalized. Given the generalized nature of the Otago Exercise Programme, we aim to compare it with the Robotic Assisted Systems in the enhancement of Balance, Postural Stability, Functional Gait and Fall Efficacy in older adults.

Core Endurance and Throw Performance in Young Judokas

This cross-sectional study aims to investigate the association between core endurance, medicine ball throw performance, and static balance in young male judokas aged 10-13 years. Core endurance will be assessed using McGill's isometric core endurance protocol, including trunk flexion, trunk extension, and lateral bridge tests. Explosive performance will be evaluated using the backward overhead medicine ball throw test, while static balance will be assessed using the Flamingo Balance Test. Correlation and regression analyses will be conducted to examine the relationships between core endurance and performance variables. The findings may contribute to understanding the role of core endurance in youth judo performance.

Wearable Sensory Prosthesis to Improve Coordination, Walking, and Physical Activity

The goal of this clinical trial is to investigate whether sensory stimulations from a neuroprosthesis device (Walkasins®) can increase physical activity and improve gait quality in persons with peripheral neuropathy (PN). The main question it aims to answer is whether Walkasins enhances habitual activity patterns in adults with peripheral neuropathy. Participants will do the following as part of the study: * Complete a sensation and balance assessment to determine eligibility for the study. * Answer questions about their medical history, physical function, balance confidence, and sleep. * Perform various balance and walking tasks on three separate occasions. One of the tests involves walking for six minutes without a cane or walker. * Wear an activPAL activity monitor for ten days on three separate occasions and return it to the researcher as directed. * Wear Walkasins for ten weeks as part of their daily routine. Walkasins consists of two parts: 1) an insole that fits inside the shoe and 2) a strap that secures around the ankle.

Wunda Chair vs Mat Pilates: Balance Effects

The goal of this study is to compare the acute effects of Wunda Chair Pilates and mat-based Pilates exercises on balance performance in healthy adult women. It will also examine which type of Pilates exercise provides a more immediate improvement in balance. The main questions it aims to answer are: Do Wunda Chair Pilates exercises lead to greater improvements in balance compared to mat-based Pilates after a single session? Are there differences between the two exercise approaches in terms of static balance, dynamic balance, and functional mobility? Researchers will compare Wunda Chair Pilates with mat-based Pilates to determine which method is more effective in enhancing acute balance performance. Participants will: Be randomly assigned to either a Wunda Chair Pilates group or a mat-based Pilates group Perform a single 45-minute exercise session according to their assigned group Complete balance assessments (Single Leg Stance Test, Timed Up and Go Test, and Y-Balance Test) before and immediately after the exercise session

Balance, Fall Risk, and Gait in Women With Total Knee Arthroplasty

Total knee arthroplasty (TKA) is a commonly performed surgical procedure aimed at reducing pain, restoring joint function, and improving quality of life, particularly among older women. Despite improvements in pain and functional outcomes following TKA, findings regarding balance, fall risk, and gait performance remain inconsistent. Impairments in these parameters may adversely affect daily activities, independence, and overall quality of life. Unlike previous studies that have primarily focused on one or two outcomes, this study will comprehensively evaluate balance, fall risk, gait performance, and quality of life in postmenopausal women who have undergone TKA. The findings are expected to provide a more holistic understanding of long-term functional outcomes following TKA and contribute to the planning of rehabilitation programs. Therefore, the aim of this study is to compare balance, fall risk, gait performance, and quality of life between postmenopausal women who have undergone TKA and healthy postmenopausal women.

EFFECTS OF DEEP WATER CORE EXERCİSES ON BALANCE AND MUSCLE STRENGTH İN SEDENTARY WOMEN

The aim of these clinical trials is to investigate the current effects of a 12-week deep-sea exercise program on sedentary, balance, and muscle strength. The key questions the study aimed to answer were: * Does deep-sea exercise improve the development of sedentary dynamic and static balance? * Does deep-sea exercise increase upper and lower extremity muscle strength? Researchers compared an exercise group to a control group to assess exercise performance. The experimental groups performed deep-sea exercises three times a week for 12 weeks. Dynamic balance, static balance, and muscle strength measurements were assessed at baseline, week 4, week 8, and week 12.