Modern Rehabilitation

The correlation between the muscle temperature and the grip force

Khosro Khademi Kalantari

Background and aim: Cryotherapy has long been introduced as a common method for preventing and reducing edema caused by traumatic injuries. Many studies have been conducted regarding other effects of cold such as its effects on muscle strength which provided controversial results over the past decades. The aim of this study is to investigate whether cold is capable of changing the muscle strength.

Materials and methods: The research was conducted on 30 volunteers with the mean age of 22 years. In a standard situation, the volunteers were asked to make their maximum grip force. Cold was applied over their anterior forearm using an ice pack for 15 minutes. The maximum grip force was measured before and within 1 to 120 minutes after cold application.

Results:The strength of the anterior forearm muscles decreased rapidly after cold application. The maximum reduction of muscle strength, in average 18% was observed after 10 minutes. This was followed by a gradual increase of grip force. After 120 minutes the force was increased to about 5% above the baseline force that was before cold application.

Conclusion: Regarding the slight increase in the muscle strength and its long delay, cryotherapy of muscles cannot be considered as a practical method in rehabilitation of patients. However, this method would be of great importance for athletes.

Comparison of hand sensory - motor skills between normal and dysgraphia children in 9 -11 ages

A Azad

Background and aim:One of the common learning disability is dysgraphia that interferes academic progressive and/or activity of daily living in children.The aim of this study was comparative assessment of hand sensory - motor skills in 9 -11 ages
Materials and Methods: 20 dysgraphia and 40 normal children were selected for comparison. Participants were evaluated by Smmes-Weinstein Monofilaments (SWMs), The Minnesota Manual Hand Dexterity Test (MMDT), Power Grip Test with Dynamometer (GS), Pinch Strength with Pinch Guage (thumb to middle-thumb to index test) and Minnesota Hand Writing Test (MHT).They were divided into A (dysgraphia) and B (normal)Groups. In this research, dominant hand was right. All Data were analyzed by T-Test and Chi – square Tests with SPSS version13.
Results:The study showed that sensory-motor skills hand writing in dysgraphia children were significantly lower than normal children. There was a significant relationship between tactile threshold and dysgraphia. (P<0.05).In children with dysgraphia, the tactile threshold was high. Hand dexterity was significantly poorer in A group than B group. (P<0.05). Grip strength and Pinch strength were significantly poorer in A group than B group. (P<0.05 for G.S and P<0.05 for P.S). There was a significant relationship between handwriting skill and dysgraphia. (P<0.05).
Conclusion: Findings of this study, could be created in the mind of experts and therapists that perhaps with determination of suitable sensory-motor evaluations of precise Prpcedure to prevent and treat children who have dysgraphia problem,

Neuroplasticity after injury

Leila Dehghan

Background and aim: There is neuroplasticity in all of life time, from newborn to elderly and neuronal connections are being created and broken by experiences and states of health or disease. The recovery of people with stroke or cerebral palsy can be a sign of neuroplasticity.

The aim of this article is to detect significance of neuroplasticity and critical period of recovery in central nervous system after stroke and cerebral palsy.

Materials and methods: This study is based on review of internal and external articles that published about neuroplasticity in central nervous system after stroke and cerebral palsy from 1987 to 2007.

Results: According to review the articles the mechanisms of neuroplasticity after stroke and cerebral palsy consist of Axonal and dendrites Sprouting, cortical reorganization and neurogenesis.

The rehabilitation protocols have a direct effect on integration and reorganization in intact areas adjacent to injured motor areas of cortex.

Conclusion: This study showed that reorganization continually occurs in response to task, behavior and learning skills.

Intra-rater, inter-rater , sensitivity and specificity of lateral scapular slide test in patients with shoulder impairment

Hosein Bagheri

Background and aim: The lateral scapular slide test (LSST) is used to determine scapular position and scapular asymmetry with the arm abducted 0, 45, and 90 degrees in the coronal plane. This test was introduced by Kibler. Assessment of scapular position is based on the derived difference measurement of bilateral scapular distances and the distance of inferior angle of scapula to spinous process of T7 vertebra. The purpose of this study was to assess the reliability of measurements (intra rater, inter rater, sensitivity and specificity) of LSST in assessment of scapular asymmetry and scapular dysfunction in patients with shoulder impairments.

Materials and Methods: Subjects: Fifty-seven subjects participated in this cross sectional study.

Twenty seven subjects in shoulder impairment group (X=47.66, SD=11.64) and thirty subjects in normal group(X=33.53, SD=11.72). Three examiners measured the distance of inferior angle of scapula to spinous process of T7 vertebra at two sides in three different positions by a caliper verneer (accuracy: 0.01 mm). Position 1 involves of the shoulder in glenohumeral joint neutral. In position 2, the humerus is placed in a position of medial rotation with 45 degrees of shoulder abduction. In position 3, the upper extremity is placed in a position of maximal medial rotation with 90 degrees of shoulder abduction. The data were analyzed with SPSS (version: 11.5). ICCs and SEMs were calculated.

Results: The ICCs for intra-rater reliability were 0.87 to 0.97 for subjects without and with shoulder impairments and 0.63 to 0.79 for inter-rater reliability in subjects with shoulder pathology (involved side). The SEMs ranged from 0.57 to 0.86 cm for intra-rater reliability and from 0.79 to 1.20 cm for inter-rater reliability. Sensitivity of the test was high(80% to 100%) but specificity was low (4% to 26%).

Conclusion : The lateral scapular slide test has high sensitivity and good to high level of intra rater reliability at three different test positions. The test showed low specificity and poor to fair inter rater reliability at three different test positions particularly at position 3.

The changes of motor control strategy following fatigue in extensor muscles of knee

Saied Talebian

Background and aim:The knee joint is one of the most important joints of human body, witch tolerates many forces while the subject is standing up or walking especially during close chain and squat positions.

Muscle fatigue may causes some modifications on effects of forces and accordingly some changes on strategy of movement, therefore the concentration in thigh muscles impression on continuous movements is a guidance that makes the investigation on these changes so important.

Materials and Methods: Fifteen healthy women in the range of 20-30 years were contributed in this study. Muscle fatigue were applied in separate sessions by maximal voluntary contraction (MVC) in both open and close chains.

Subjects were done five dynamic repetitions of flexion / extension motion of knee before and after fatigue tests. Surface electromyography (sEMG) recorded from vastus medialis (VM), rectus femoris (RF) and vastus lateralis (VL) muscles during all conditions of tests. Normalized electromyography (NEMG) of muscles activities in two conditions of concentric (Con) and eccentric (Ecc), also median frequency (MF) were calculated for fatigue index. Muscle timing or recruitment pattern indicated by onset of muscle activities for both dynamics chains.

Results: There are significant different of fatigue indexes between before and after fatigue tests (p<0.05). After fatigue muscle timing delayed in open chain (p<0.05) and recruitment patterns changed from VL- VM- RF to VL-RF-VM. Fatigue test in close chain caused increment of muscle timing (p<0.05), but it did not change recruitment patterns.

Conclusion: After fatigue tests MF reduced little than NEMG. Significant difference occurred in muscle timing. These variations were increase and delay of timing with change of recruitment in open chain. These findings suggest that motor control strategy is will change at different condirions of with and without load situations.

The short-term effect of Infrared and Ultrasound on the plantarflexor muscle spasticity in patients with aquired brain injury: A comparative study

Maryam Rastgoo

Background and aim: Ankle plantar flexor is one of the most susceptible muscles to plasticity and contracture after acquired brain injury. The application of thermal agents was introduced before muscle stretch or active exercises in spastic patients for their relaxation effects. The main aim of the present study was to compare the short-term effect of the ultrasound (US) and infrared (IR) on patients with plantar flexor muscle spasticity.

Materials and Methods: 21 patients were randomly allocated placed to either US(n=11)or IR(n=10)groups. The main outcome measures were, H _max / M _maxratio, Original Ashworth Scale(OAS), active and passive range of motion (ROM).These tests performed before, immediately after and 15 minutes after the intervention.

Results: There were no significant changes in H_max / M_max ratio and OAS after the intervention in both groups. The significant changes of the H_max / M_max were observed 15 minutes after intervention in the US group .The change in OAS was also statistical significant in IR group in this period. The changes in active and passive ankle dorsiflexion ROM after the intervention were statistically significant in US group. These changes show the significant changes for ankle passive ROM after15 minutes of the intervention in IR group.

Conclusion: Our findings demonstrate that one session application of the ultrasound and infrared are not effective in the treatment of muscle spasticity. The ultrasound improved the ankle active and passive ROM. Further research is needed.

The effect of cervical traction on soleus H reflex in healthy men

Gh Olyaie

Background and aim: Since 1998, the effect of traction on the H- reflex has been investigated by Hiraoka and the other researchers. Some of them have been done on lower extremity and the other on the upper extremity. The effect of traction was assessed by H reflex amplitude. Different results have been achieved. The new method which has been used since 2000, the effect of cervical traction on the H reflex was carried out by measuring H reflex slope .In this experiment the effect of manual cervical traction has been studied on the H slope of the upper extremity. Now we have sought to extend this work by examining the effects of cervical traction with 3 kg force on the H slope of the lower extremity

Materials and Methods: This study was administered to sixteen healthy men with a mean age 23.12 of years and SD=2.55. The parameters of H reflex were recorded before and after of cervical traction .All data were analyzed with SPSS (V: 11.5).

Results: The results showed that, there were no significant differences between before and after the application of cervical traction in H reflex parameters, ratio of H max/M max amplitude and M slope. But H slope and ratio of H slope /M slope were increased significantly after the application of traction (P<0.001).

Conclusion: The present study showed that traction with 3 Kg force can increase motor neuron excitability of soleus muscle and this result is against the previous study. This could be due to the application of the new method (H slope), which is more precise.

Comparison of iontophoretic effects of diclofenac and dexamethasone on patients with carpal tunnel syndrome

Shohreh Jalaei

Background and aim: Carpal tunnel syndrome is a common disorder, for which various conservative treatments have been suggested. The aim of this randomized clinical trial was to compare the iontophoretic effects of diclofenac and dexamethasone on patients with carpal tunnel syndrome.

Materials and Methods: Twelve hands from seven patients between 30 to 60 years of old (Mean=45.9 SD±8.3) were treated with pre-designed splint and iontophoresis. Four hands were treated with dexamethasone sodium phosphate and eight other hands had iontophoretic administration of sodium diclofenac. Cock-up splints were used for the patients during the course of treatment and 2 weeks follow up. Treatment continued for ten sessions during two weeks. They were advised not to take oral or parenteral anti-inflammatory drugs. Clinical symptom severity (SSS) and functional status (FSS) as well as visual analogue (VAS) scales were evaluated after iontophoretic treatment and two weeks follow up. Electrophysiological parameters such as distal sensory & motor latencies, amplitudes, nerve conduction velocities (NCV) were measured.

Results: Diclofenac group showed significant improvement in SSS score and sensory electrophysiological parameters of median nerve (P<0.05). Although, in dexamethasone group VAS and SSS scores decreased but there were no statistical significant differences in any intervals. With Comparison between two groups showed significant difference in distal motor latency after following up with more improvement in dexamethasone iontophoresis group (P<0.05).

Conclusion: Above findings showed efficacy of splint and iontophoretic administration of sodium diclofenac in treatment of patients with carpal tunnel syndrome. Although dexamethasone group showed no significant change, previous researches suggested the efficacy of ionophoretic administration of this anti-inflammatory medicine in clinical symptoms' improvement. Therefore, the lack of enough participants may be considered as a source for present results in this group. Although comparison between two groups, showed significant difference in distal motor latency after follow up (singnificant results in dexamethasone) but, due to small number of cases in follow up period, the validity of these results is questionable. Further researches are needed to confirm this difference.