Hasan Bingöl

Introduction: Previous studies have identified morphological alterations in spastic muscles focusing predominantly on gross motor muscles, with specific emphasis on those of the lower limbs. There is minimal information on the morphology of spastic upper limb muscles in relation to clinical deformity. Therefore, the aim of this study was to investigate the morphological parameters of the biceps brachii and forearm muscles according to the severity of forearm and wrist and finger deformities in children and adolescents with spastic cerebral palsy. Methods: A total of 87 children and adolescents with spastic cerebral palsy were recruited. The Gschwind and Tonkin and Zancolli classification systems were used to grade forearm pronation and wrist and finger deformities, respectively. Morphological parameters, including muscle thickness, anatomical cross-sectional area and pennation angle (PA) were assessed using a B-mode ultrasonographic device. Results: Significant differences in morphological parameters were observed according to the severity of upper limb deformities. Specifically, as the severity of forearm, wrist and finger deformities increased, the muscle thickness and anatomical cross-sectional area of the biceps brachii, pronator teres and flexor carpi radialis significantly decreased. In contrast, the pennation angle of the extensor digitorum increased with the severity of forearm and wrist and finger deformities. Conclusion: These findings support the role of spasticity-induced morphological alterations in the development of upper limb contractures and highlight the clinical value of muscle architecture assessment in guiding targeted therapeutic interventions. Level of Evidence: III

Objective: This study was conducted to evaluate the relationship between the risk of temporomandibular joint disorder (TMD), headache severity, ultrasonographic temporal muscle thickness, and functional jaw movements in individuals presenting with tooth loss. Methods: Thirty-eight individuals aged 21-55 years (mean 32.23±9.6) with one or more missing teeth were included in the study. TMD risk and headache intensity were documented using the Turkish-validated Fonseca Anamnestic Index (FAI) and the Visual Analog Scale (VAS), respectively. Temporal muscle thickness was assessed using a B-mode ultrasonographic device equipped with a high-frequency linear transducer in the relaxed jaw position while the participant was seated. Jaw movements were measured using a mouth goniometer. Results: A strong positive association was identified between the risk of TMD and headache severity (r=0.96, P<0.001). In contrast, TMD risk showed strong negative associations with temporal muscle thickness (r=-0.73 (left) and r=-0.82 (right), P<0.001) and maximum mouth opening (r=-0.87, P<0.001). TMD risk exhibited moderate inverse associations with both jaw protrusion (r=-0.52) and retrusion (r=-0.61), with significance levels at P<0.05). Conclusion: This cross-sectional correlational study suggests that early identification and management of biomechanical alterations associated with tooth loss may be important for reducing long-term functional complications through preventive dental care, timely prosthetic rehabilitation, and targeted physiotherapy.

Aims: This study aims to examine the associations between muscle thickness (MMT) and the risk of temporomandibular disorder (TMD), as well as the relationship between MMT and neck disability, cervical range of motion, and maximum mouth opening (MMO).Methods: Thirty adults (mean age: 30.3±7.2 years) underwent evaluation using B-mode ultrasonography (US) to measure bilateral MMT. TMD risk was assessed using the Fonseca Anamnestic Index (FAI), neck-related disability using the Neck Disability Index (NDI), and functional mobility was assessed using MMT and cervical range of motion (ROM) measurements. Spearman correlation analyses were performed.Results: MMT demonstrated positive correlations with MMO (right: r=0.91, p

Previous studies have demonstrated alterations in skeletal muscle morphology and architecture in individuals with spastic cerebral palsy (CP). However, it remains unclear whether these morphological parameters vary across different mobility levels or how they relate to walking ability. This study aimed to examine morphological parameters of calf muscle across functional mobility levels in children and adolescents with spastic CP and their relationships with walking ability. Children and adolescents with spastic CP, aged 5-17 years (mean age: 11.72 ± 4.6 years), were recruited in the study. Morphological parameters of the gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and soleus muscle in the more severely affected lower limb were assessed using a B-mode ultrasound. Walking ability (i.e. mobility and locomotion activities) was evaluated using both the Gillette Functional Assessment Questionnaire-22 item skill set (FAQ-22) and ABILOCO-Kids. Analysis revealed a significant decrease in muscle thickness (p₁ = .013; p₂ = .032; p₃ < .001) and fascicle length (p₁ < .001; p₂ < .001) with declining mobility levels, except for GL fascicle length (p = .061). Conversely, pennation angle was significantly greater in children with severe motor involvement (p < .001 for all). Moderate to very strong correlations were found between calf muscle morphological parameters and walking ability (r = -0.41 to 0.89). Notably, muscle thickness demonstrated the strongest correlation coefficients with walking ability (r = 0.83-0.89). The significant associations between GM and soleus muscle thickness and walking ability indicated that these muscles are important contributors to functional mobility in children and adolescents with CP. These findings also emphasized that musculoskeletal integrity remains a critical factor of mobility and locomotion activities, even within contemporary participation‑focused rehabilitation models.

The aim is to examine the effect of gross motor function on mental health and quality of life in individuals with spastic diplegic Cerebral Palsy (CP). This study is a cross-sectional study including 37 individuals with spastic diplegic CP aged 13-18 years. The severity of gross motor functional impairment was assessed using the Gross Motor Function Classification System scale (GMFCS), mental health using the Revised Child Anxiety and Depression Scale (RCADS), and quality of life using the Cerebral Palsy Quality of Life Questionnaire (CPQOL)-teen. It was observed that there was no statistically significant difference between the results of Social phobia, Panic disorder, Major depressive disorder, Separation anxiety disorder, Obsessive-compulsive disorder, Total Internalizing Scale (p>0.05) except for the Generalized anxiety disorder and Total Anxiety Scale scores of individuals at GMFCS levels I, II and III (p0.05). It was concluded that gross motor function had no effect on mental health outcomes and quality of life, except anxiety, in individuals with diplegic CP.

Aim: The aim of this study was to investigate the relationship between decreased chest mobility, diaphragm thickness, physical fitness, and general fatigue in children with cerebral palsy (CP). Materials and Methods: Twenty-five children with CP were included in the study. Chest mobility was evaluated using a tape. Diaphragm thickness was measured using a 6-13 Hz linear ultrasound probe. Results: Strong correlations were found between different levels of chest mobility and the physical fitness parameter (r= 0.71-0.90). Similarly, strong associations were found between different levels of chest mobility and the general fatigue (r=0.71-0.82). Diaphragm thickness was moderately associated with physical fitness (r=0.52), while it was weakly but significantly associated with general fatigue (r=0.44). Conclusion: In children with CP, physical fitness and general fatigue parameters are closely related to chest mobility and diaphragm muscle thickness/ strength. Therefore, appropriate physiotherapy approaches are needed to improve reduced chest mobility and diaphragm muscle thickness/ strength.

Serebral Palsi (SP), gelişmekte olan beyinde meydana gelen hasarın bir sonucu olarak ortaya çıkan hareket ve duruş bozukluklarıyla karakterize nörogelişimsel bir durumdur. Dünya çapında değişen manzaraya rağmen, çocukluk çağında başlayan fiziksel engelliliğin dünya çapında en yaygın nedenlerinden biri olmaya devam etmektedir. SP'li bireylerde temel motor bozuklukların yanı sıra zihinsel gerilik, epilepsi, ağrı, kas-iskelet sistemi problemleri ve diğer komorbiditeler sıklıkla görülür. Bu nedenle, SP'nin yönetimi multidisipliner bir yaklaşım gerektirir. Rehabilitasyonun temel hedefleri arasında motor ve bilişsel becerilerin geliştirilmesi, ikincil komplikasyonların önlenmesi ve ailelerin yaşam kalitesinin artırılması yer almaktadır. SP'li çocuklar için alternatif rehabilitasyon yaklaşımları, bireysel ihtiyaçlara göre uyarlanabilen çeşitli seçenekler sunmaktadır. Bazı yöntemler umut verici sonuçlar gösterse de bunların etkinliğini doğrulamak ve standart bakım uygulamalarına entegrasyonunu optimize etmek için devam eden araştırmalar ve titiz klinik çalışmalar gereklidir.

Background: Children and adolescents with childhood‐onset physical disabilities, including cerebral palsy (CP), face a significantly higher risk of developing mental health disorders due to factors such as reduced physical activity, participation limitations, sleep disturbances, pain, social isolation, rejection, bullying and victimization. Therefore, identifying mental health problems in this population is crucial for promoting their mental health and psychosocial well‐being. This study aimed to investigate the reliability and construct validity of the self‐report Strengths and Difficulties Questionnaire (SDQ) in children and adolescents with CP.Methods: The study included 120 children and adolescents with CP (mean age = 14.13 ± 2.2 years), representing the full spectrum of CP subtypes. Internal consistency was assessed using McDonald's omega (ω). Test–retest reliability was assessed using intraclass correlation coefficients (ICC) to estimate the level of consistency in scores for 50 children and adolescents who completed the SDQ again after 14 days. Three types of construct validity were assessed: factorial, convergent and known‐group validity. Factorial validity was assessed based on the model fit of structural equation model‐based confirmatory factor analysis (CFA). For CFA, the following fit indices were considered acceptable: a Root Mean Square Error of Approximation (RMSEA) < 0.08, a Goodness of Fit Index (GFI) ≥ 0.95 and a Standardized Root Mean Square Residual (SRMR) ≤ 0.08. Convergent validity was assessed by estimating correlations between the SDQ and Cerebral Palsy Quality of Life (CP QOL) scores using Pearson correlation coefficient (r).Results: Internal consistency and test–retest reliability of both SDQ Total Difficulties Scale and SDQ Prosocial subscale were found to be acceptable (ω: 0.73–0.85; ICCs: 0.77–0.96). The SDQ's factor structure showed good fit (Total Difficulties Scale: RMSEA = 0.03, GFI = 0.95 and SRMR = 0.037; SDQ Prosocial: RMSEA = 0.025, GFI = 0.97 and SRMR = 0.066). Acceptable correlations between SDQ and CP‐QOL scores (r = 0.53–0.93) supported convergent validity. Known‐groups validity was confirmed, with children with CP showing significantly different SDQ scores compared to their TD peers (p < 0.05).Conclusion: Our findings provide evidence of adequate internal consistency reliability, test–retest reliability and construct validity for scores on the SDQ for children and adolescents with CP.Trial Registration: ClinicalTrials.gov identifier: NCT06527508.Key Messages: This is the first study investigating the measurement properties of the self‐report SDQ in children and adolescents with CP This study yielded satisfactory evidence for the factorial validity, convergent validity and known‐group validity of the self‐report SDQ, supporting its suitability as a tool for assessing the mental health status of children and adolescents CP aged 11–17 years. All items in the self‐report SDQ were found to effectively measure the intended construct‐mental health‐demonstrating item homogeneity and supporting internal consistency The satisfactory agreement between SDQ scores obtained over a two‐week interval demonstrated the instrument's temporal stability, indicating strong test–retest reliability.

Aim: To investigate the association between psychological problems and health-related quality of life (HRQOL) parameters in children with cerebral palsy (CP). Method: A convenience sample size of 68 children with CP (mean age: 6.82 years and standard deviation: 1.8; 31 males and 37 females) were recruited in the study. Parent-reported versions of the Strengths and Difficulties Questionnaire (SDQ) and Cerebral Palsy Quality of Life were used to detect the presence of psychological symptoms and HRQOL outcomes in children with CP. Psychological symptoms included emotional symptoms, conduct problems, hyperactivity/inattention, peer problems, and prosocial behavior. Results: Children with hemiplegic, diplegic, and ataxic CP were mostly found to be in scoring band of close to average on SDQ-Total difficulties Scale (TDS) (SDQ-TDS20) on the SDQ-TDS. In terms of association, there were moderate to strong associations between scores for psychological symptoms and HRQOL (r=-0.45 to 0.860). Conclusion: The results suggest that the nature and extent of mental health problems vary among CP subtypes, with children with tetraplegic and dyskinetic CP more likely to experience mental health symptoms. Given the potential benefits of physical activity on both HRQOL outcomes and psychological mental symptoms, it is essential to encourage children with CP to participate in more physical activities.