Introduction: Earthquakes can disrupt access to healthcare and alter health-seeking behavior, potentially altering the profile of neurology outpatient referrals. Methods and materials: This retrospective study analyzed de-identified, admission-based data from Hatay Mustafa Kemal University Neurology Outpatient Clinic using ICD-10 diagnostic codes, comparing the pre-earthquake period (January 4th, 2021 - February 5th, 2023) with the post-earthquake period (February 6th, 2023 - February 14th, 2025). Results: A total of 185,329 admissions were evaluated (108,524 pre-earthquake and 76,805 post-earthquake). The gender distribution was similar between periods, while admissions among older adults declined after the earthquake. Compared with the pre-earthquake period, the post-earthquake period showed proportional increases in epilepsy, migraine, vertigo/dizziness, and polyneuropathy/neuropathy, with a slight increase in multiple sclerosis; in contrast, proportional decreases were observed for overall pain presentations, anxiety disorders, Alzheimer's disease/dementia, Parkinson's disease, and cerebrovascular diseases. Discussion and conclusions: The February 6, 2023, earthquake was associated with a measurable shift in neurology outpatient referral patterns. These findings support the need for targeted, data-informed post-disaster neurological service planning.

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For citation: Calisir, T., Tasdemir, N. (2026). Changes in Neurology Referrals Before and After the Earthquake: A Retrospective Review. Romanian Journal of Physical Therapy. 32(56),29-39.
https://www.doi.org/10.61215/RJPT.2026.32.56.29

Introduction: Children with autism spectrum disorders (ASD) frequently present deficits in balance and coordination. Objectives: To evaluate the effectiveness of a physical therapy program on balance and motor coordination in children with ASD. Method: Four children (7–11 years old) participated in a personalized program for 12 weeks. The evaluation was performed with the Berg Scale, the Romberg Test and the Pull Test. The Wilcoxon test (pre-post) and the Pearson correlation (post) were applied. Results: Berg scores increased by an average of 18%. The Romberg Test and Pull Test indicated qualitative improvements. The differences were not statistically significant (p = 0.125), but a moderate correlation was identified between the final scores (r ≈ 0.45). Conclusion: The physical therapy program led to clinically relevant functional progress, supporting the value of personalized motor interventions in ASD.

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For citation: Pop, A. C., Adumitresei, M., Cristea, D. I., Boca, I. C. (2026). The Effects of Physical Therapy on Balance and Motor Coordination in Children with Autism Spectrum Disorders: A Case Study. Romanian Journal of Physical Therapy. 31(55),21-28. https://www.doi.org/10.61215/RJPT.2026.32.56.21

Objective: With tele-rehabilitation increasingly becoming a commonly preferred approach, it has gained importance to investigate whether assessment scales traditionally used in face-to-face settings are valid and reliable when applied via tele-assessment, in order to ensure the remote and long-term sustainability of rehabilitation processes. The aim of this study was to investigate the validity and reliability of the tele-assessment of balance and mental status in individuals with stroke using the Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), Mini-BESTest, Montreal Cognitive Assessment (MoCA), Tandem Flamingo Test, and Romberg Stance Test. Methods: A total of 20 individuals with stroke were included in the study, with a mean age of 54.85 ± 15.42 years; 16 were male (80%) and 4 were female (20%). All participants were at stage 3 or higher for both upper and lower extremities according to the Brunnstrom staging system. The order of assessments (tele-assessment first or face-to-face assessment first) and the allocation of the two physiotherapists conducting the assessments were randomized based on the order of application. The BBS, MMSE, MoCA, Mini-BESTest, Tandem Flamingo Test, and Romberg Stance Test were administered to the participants using both tele-assessment and face-to-face assessment methods. Video recordings were obtained during tele-assessment, and a third evaluation was performed three weeks later by the same physiotherapists using these recordings. Results: Excellent agreement was observed between tele-assessment and face-to-face assessment, as well as between face-to-face assessment and video-based evaluation, for the MoCA, MMSE (excluding the orientation subscale), BBS, Mini BESTest, and the Tandem-Flamingo and Romberg Stance Tests (ICC> 0.90). For the orientation subscale of the MMSE, good agreement was found (0.894). Additionally, asynchronous tele-assessment conducted via video recordings three weeks later demonstrated excellent agreement with both face-to-face assessment and synchronous tele-assessment (ICC> 0.90). Conclusion: The findings indicate that the BBS, MMSE, Mini-BESTest, MoCA, Tandem Flamingo Test, and Romberg Stance Test are valid and reliable tools for the tele-assessment of balance and mental status in individuals with stroke. However, it is recommended that greater caution be exercised when conducting measurements using single-task and time-based tests, such as the Tandem Flamingo and Romberg Stance Tests, during tele-assessment.

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For citation: Kara, R., Dogru Huzmeli, E., Calisir, T. (2026). Investigation of the Validity and Reliability of the Tele-Assessment of Balance and Mental Status in Individuals with Stroke. Romanian Journal of Physical Therapy. 32(56),4-20. https://www.doi.org/10.61215/RJPT.2026.32.56.4 

Gianni HLIBOCIANU, Tudor - Andrei BARBUR, Codrut BULZ, Dorina IANC

Rectus femoris tear; rehabilitation; football; return to play; muscle injury.

Introduction: Rectus femoris muscle injuries are relatively uncommon in football compared to other lower-limb muscle strains, yet they can significantly affect athletic performance and return-to-play timelines. Aim: The main objective of this study is to analyze the effect of physiotherapy on the recovery process of a professional football player following a rectus femoris tear, with particular attention to the restoration of functional capacity and the facilitation of a safe Return-to-Play. Material and methods: An eight-week, three-phase physiotherapy program was implemented, focusing sequentially on pain and inflammation reduction, restoration of joint mobility and muscle strength, and sport-specific functional recovery. Clinical evaluations - including pain assessment, manual muscle testing, goniometry, and thigh circumference - along with functional tests such as the Active Knee Extension Test, Squat Test, Single-Leg Hop Test, Reverse Nordic Curl, and Y-Balance Test, were conducted at three time points to track progress. Results: Findings showed progressive improvement across all parameters, with complete pain resolution, normalization of muscle strength, and restoration of functional performance by the final evaluation. The athlete successfully returned to full team training and competitive play within 56 days. Conclusion: This case highlights the effectiveness of a structured, criteria-based rehabilitation approach in achieving a safe and efficient return to sport following rectus femoris muscle injury.

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Ionela-Florina TUDOSIE, Emilian TARCAU, Theodora URSU, Codrut Dan TARCAU, Adrian Titus SERSENIUC URZICA

Manual therapy, herniated cervical disk, trigger points, pain.

Introduction: Musculoskeletal disorders that affect the functionality of different body segments, associated with certain comorbidities, can lead to different imbalances in body systems and apparatus. One of the most common musculoskeletal pathologies, with a huge impact on the physical, social, psychological and quality of life aspects of the individual, as well as on society as a whole, is pain, caused by herniated cervical disc. The importance of recovery is given by the large number of people with disabilities related to neck pain, so that a total of 223 million people are affected worldwide and 22 million live with it for years. One of the most effective and important means of treating neck pain is manual therapy. The forms of manual therapy, used in the treatment of cervical hernias, are joint-oriented (mobilization, manipulation, traction), soft tissue-oriented (forms of massage), neural tissue-oriented (neurodynamic) or mixed (specific exercises). Purpose: The aim of this study was to show the effects of instrumented manual therapy and kinesiotherapy in relieving the symptoms of cervical disc herniation. Material and Method: The study was carried out over 6 weeks on a 54-year-old patient diagnosed with left latero-posterior disk herniation at C3/C4 level of 1.5 mm and at C4/C5 level of 2 mm, he also had hypertension - essential GR II, tricuspid insufficiency GR ½, mean systolic dysfunction VS, mitral insufficiency GR II and sleep apnea, obstructive form, as associated pathologies. The patient was evaluated for cervical pain using VAS scale, cervical spine mobility, functional tests (Appley Test, Spurling Test, Shoulder Abduction Test, Scalen Test, Traction Test and Barre-Lieou Test), Neck Disability Index, as well as the presence of active trigeer points and their pain intensity. The 6-week treatment plan was carried out in 2 stages, the first (for 3 weeks) consisting of relaxation massage, cervical and scapular belt mobilizations, and the second consisting of myofascial instrumented therapy, cervical manual therapy, global postural re-education exercises (Souchard Method) and cervical and scapular belt mobilizations, 3 times a week for 90 minutes. Results: In the first part of the recovery (first 3 weeks) there was little improvement in all the parameters evaluated, but with the introduction of myofascial therapy, manual therapy, postural exercises and mobilizations in the recovery program, the results were significantly improved. Conclusions: The recovery program based on manual therapy techniques had positive effects in treating neck pain, improving joint mobility, deactivation of trigger points, and positive effects on neck disability index in the cervical disc herniation patient studied.

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Shani SELA, Elisha VERED, Leonid KALICHMAN

Stroke, Kinesiotape, function, therapy, upper extremity, activities of daily living.

Introduction: Post-stroke spasticity is a prevalent motor complication leading to extremity weakness and impaired coordination, significantly affecting daily activities. This study evaluated the efficacy of combining Kinesiotape with occupational therapy in reducing spasticity and enhancing upper extremity functionality in post-stroke patients. Methods: A prospective randomized controlled trial at Shmuel Harofeh Medical Center involved 16 patients randomly assigned (1:1) to an intervention group (Kinesiotape plus occupational therapy) or a control group (occupational therapy alone). Treatment lasted four weeks, five sessions weekly. Assessments occurred pre-intervention, post-intervention, and one-week follow-up using the Modified Ashworth Scale (MAS) for spasticity, Fugl-Meyer Assessment (FMA) for motor function, handgrip dynamometer for grip strength, and Chedoke Arm and Hand Activity Inventory (CAHAI) for hand function. Results: Kinesiotape significantly reduced spasticity versus control post-intervention (u=6.00, p=0.007) and at follow-up (u=1.00, p=0.003). In the Kinesiotape group, spasticity decreased significantly (z=-2.37, p=0.018) from pre-intervention (7.89±3.79) to one hour post-application (5.33±4.06), with significant increases in upper extremity motor function (t=-4.151, p=0.003) from pre- (9.89±16.56) to post-intervention (21.67±20.70) and grip strength (z=-2.023, p=0.043). Conclusion: Combining Kinesiotape with occupational therapy limits spasticity development, improves upper extremity motor function and grip strength, and enhances quality of life in acute stroke patients.

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Denisa Ioana TIBICHI, Doriana CIOBANU, Dorina IANC

Phelan-McDermid syndrome, autism spectrum disorder, physical therapy, gross motor function, primitive reflex integration.

Introduction: Phelan-McDermid syndrome is a neurodevelopmental disorder with a neurological and psychiatric phenotype, as well as various additional features that can vary considerably between affected individuals and in the course of disease development. To date, the diagnosis of this syndrome has been based on the presence of genetic alterations on chromosome 22q13, which encodes the synaptic scaffold protein SHANK3. Aim: The purpose of this paper is to emphasize the role of physical therapy in improving gross motor function and integrating primitive reflexes in children with Phelan-McDermid syndrome, and to compare it with autism spectrum disorder. Material and methods: The study was conducted at the Mihai Neșu Foundation (Oradea) over a period of 4 months and consisted of a therapeutic program twice a week, one hour per day. Two patients aged 6 and 5 years were involved in the study, both presenting similar characteristics, however, the girl with the genetic syndrome displayed more severe features and a more pronounced symptomatology. The intervention involved physical therapy program consisting of thermotherapy and massage of the lower limbs, as well as reducing muscle shortening using the V-plus device. The program also included sensory stimulation with the Z-vibe to activate the speech center, along with kinesthetic interaction using various items such as a feather, small balls, sand, and brush. Interventions also targeted the improvement of gross motor function and the integration of primitive reflexes. Results: Application of muscle-strengthening techniques led to observable improvements in musculoskeletal development. Training of the vestibular system resulted in decreased duration and intensity of nystagmus. Exercises aimed at gross and fine motor functions, as well as daily living activities, showed promising results for future applications. The child with autism spectrum disorder demonstrated greater and more significant progress than the child with Phelan-McDermid syndrome, likely due to the higher complexity and severity of the genetic condition. Conclusion: The research hypothesis was largely confirmed: implementing a 4-month comprehensive rehabilitation program, including thermotherapy, massage, physiotherapy, hydrotherapy, ABA therapy, and speech therapy, promoted muscle development, improvement of gross motor functions and daily living skills, better balance and gait, enhanced vestibular function, and integration of primitive reflexes in children with Phelan-McDermid syndrome and autism spectrum disorder.

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Roxana-Maria GITMAN

Quality of life, physical therapy, prophylaxis, functional capacity, elite handball.

Introduction: Handball is one of the most demanding sports, where attention to the physical condition of athletes must be significantly increased. The present study aims to identify the need for prophylactic methods in athletes who play male performance handball in senior teams. Methods and materials: In this regard, we applied Quality of Life questionnaire, a questionnaire for frequency of trauma and DASH questionnaire for functionality of the upper limb, for a total of 92 performance male players. Results: Data obtained reveal a low level for quality of life, a high frequency of lesion for both upper and lower limb, with a total of 151 lesions for the upper limb and 78 lesions for the lower limb, especially for the dominant ones. Also, joint function for the upper and lower limbs was affected, mostly for dominant shoulder. Conclusions: These results indicate the necessity of physical prophylactic exercises and an organized sports training for male performance players, in order to reduce the negative effects of asymmetric training.

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Alexandra Ionela PRALA, Luminita Ionela GEORGESCU, Ion MIHAILA, Elena Ioana ICONARU, Stefan TOMA

Stroke rehabilitation, gait recovery, kinesio taping, gait balance.

Introduction: Stroke causes peroneal nerve palsy manifested by weakness in dorsiflexion of the foot. This contributes to the respective gait impairment disrupting the swing phase of the gait cycle. Purpose: Through the proposed recovery program, we want to highlight the importance of using kinesio taping therapy in the specific recovery program to correct abnormal gait patterns in people with drop foot. Materials and Methods: In accordance with the strategy of gait recovery optimization in people with drop foot we conducted a longitudinal study over a period of 4 weeks with gait balance as test parameter. For the assessment of balance, we used the Berg Balance Scale and the Four Step Square Test, and the research group comprises a total of 10 subjects. The subjects were divided into two groups: the control group that received the classic recovery program and the experimental group that received the classic recovery program and the kinesio taping therapy. Results: According to the final evaluation results, the experimental group has made greater progress. Compared to the control group, the experimental group showed a progress rate of 18.2% higher. Results support the hypothesis that the use of kinesio taping helps to optimize gait recovery in people with drop foot after stroke. Conclusions: The correct alignment of the ankle joint during walking can be stimulated and maintained by the kinesio taping technique applied as complementary therapy, and the results obtained during assessing balance while gait support our conclusion.

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Physical activities, dairy consumption, body composition.

Introduction: Milk consumption is frequently debated for its potential role in weight regulation and modulating body composition. This study aimed to investigate the association between milk intake and body composition parameters among physically untrained students, student athletes, and dialysis patients. Methods and Materials: In a cross-sectional design, 110 participants (78 physically untrained students, 17 student athletes, and 15 dialysis patients) were evaluated for body mass index (BMI), adipose tissue percentage, and muscle tissue percentage. Milk consumption frequency was assessed using a structured questionnaire, and statistical analyses - including the Kruskal-Wallis and Mann-Whitney tests, as well as Pearson correlation - were performed to examine intergroup differences and associations. Results: Significant differences in milk consumption were observed among groups, with dialysis patients reporting the lowest frequency. A positive correlation was identified between milk consumption frequency and muscle tissue percentage (r = 0.266, p < 0.01), while a negative correlation was observed between milk consumption and adipose tissue percentage (r = -0.303, p < 0.01). Discussion: These findings suggest that increased milk intake may contribute to a more favorable body composition, potentially through mechanisms related to lipid metabolism and appetite regulation. Conclusions: Although milk consumption appears to be modestly associated with increased muscle mass and reduced adiposity, further research is warranted to elucidate the underlying physiological mechanisms and to determine the long-term effects of milk intake on body composition.

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