Investigation of the effects of motor-cognitive dual-task exercises on cognitive function, balance and functional capacity in patients with liver transplantation

Investigation of the Effects of Motor-Cognitive Dual Task Exercises on Cognitive Function, Balance and Functional Capacity in Patients With Liver Transplantation, Hasan Kalyoncu University Graduate Education Institute Physiotherapy and Rehabilitation Department Doctoral Thesis Gaziantep, (2024). As a result of liver failure, many diseases ranging from mild cognitive problems to hepatic encephalopathy occur due to the inability to remove substances such as ammonia and manganese, which are important for the homeostasis of the central nervous system, from the body. Although studies revealing the positive effects of motor-cognitive dual tasking, which has important effects on cognition, in a wide range of areas, from geriatric individuals to those with neurological diseases, we could not identify studies investigating its effects after liver transplantation. Our study was conducted to investigate the effects of motor-cognitive dual-task exercises on cognitive function, balance and functional capacity in patients with liver transplantation. In the study, 63 patients who were hospitalized in the clinic and had liver transplantation were evaluated. Forty-seven patients aged 50 and over, who were able to mobilize on their own after 5 to 7 days and have their first tests performed, were included in the study. During the study, 3 people abandoned the study due to change of location. Individuals were divided into two groups by simple randomization method: routine physiotherapy group (n = 22) and motor cognitive dual task group (n = 22). Exercises; It was carried out 7 days a week, 30-45 minutes a day, as an individualized physiotherapy program appropriate to the clinical characteristics of the patients. To evaluate the patients' conditions before and after exercise; Montreal Cognitive Scale, timed up and go test, functional reaching test, one-leg standing test, 6-minute walk test, Senior Fitness Test, fatigue impact and fatigue severity scales, frailty index, oxygen saturation measurement, Tampa Kinesiophobia Scale and once before the exercises start. Charlson Comorbidity Index was applied. In addition, the fatigue status of individuals during the exercises was measured with the Modified Borg Scale. At the end of the study, an improvement was detected in all test results except the Montreal Cognitive Scale scores in the routine physiotherapy group in the pre- and post-exercise measurements of both groups (p<0.05). When the scores of the groups are compared, the Montreal Cognitive Scale score increased in favor of individuals in the motor-cognitive dual-task group; There was a decrease in the timed up and go test and eight-step walk test scores in favor of the dual task group (p < 0.05). In this study, it was predicted that motor cognitive dual-task exercises would increase cognitive function, balance and functional capacity more than the routine physiotherapy program. Although improvements were achieved in many measurements at the end of the exercises, a more significant improvement was detected in the cognitive test and timed get up and go balance test scores of the dual task group (p < 0.05). We think that a cognitive dual task should be added to the routine physiotherapy program, especially in patients with liver transplantation, to increase cognitive function and balance. Long-term follow-up studies in this field can contribute to the literature. Keywords: Balance, Functional Capacity, Liver Transplantation, Cognitive Function, Motor Cognitive Dual Task.