Modern Rehabilitation

Comparison of muscle activity timing during stance phase of gait cycle in chronic low back pain and healthy subjects

Saeed Talebian

Background and Aim: Low back pain (LBP) is the most common and expensive musculoskeletal problem in industrialized societies. One in ten people suffers from LBP once in his life. It is self-limited up to 90%, but it is common to repeat. By the way, sacroiliac joint (SIJ) is the origin of low back and pelvic pain in many cases and one of the most important elements in normal musculoskeletal function during gait cycle. Muscles are important to stabilize this joint plus to bones and ligaments. Some of the muscles (Gluteus Maximus, Biceps Femoris, Multi Fidus, Erector Spinae) contributing in gait cycle are important to transfer load through SIJ. The aim of this present study is to compare muscle activity timing during initial and mid stance phase of gait cycle.

Methods and Materials: Sixteen low back pain cases and fifteen healthy subjects participated in this study. A footswitch is placed beneath foot at the suffered side in LBP cases and dominant foot in control group. Two markers were on the 5^th metatarsal bone and lateral maleolus. Electrodes are placed on selected muscles according to SENIAM. Digital camera and EMG Datalink were turned on simultaneously and subject started to walk with his own favorite speed in a specific direction and path. Onset and time to peak of selected muscles were recorded during gait by Datalink and processed by its software.

Results: Low back pain cases showed delayed muscle onset, although it was not significant (P=0.4). Time to peak of all selected muscles in loading response event in LBP group was longer and significant (P=0.01). There was also significant difference in time to peak of all selected muscles during mid-stance event (P= 0.005) except biceps femoris muscle.

Conclusion: Delayed onset and longer time to peak during initial and mid stance phase of gait can be interpreted as a compensatory strategy to control trunk movements effectively, provide sufficient stability and transfer load to lumbar area efficiently.

Key words: Muscle activity, Low back pain, Gait, Trunk muscles, Lower Limb Muscles

Fasicle length and pennation angle measurements to estimate the strength of skeletal muscles by real-time ultrasonography

Asghar Rezasoltani

Background and Aim: Muscle fascicle length and pennation angle can be non-invasively studied by applying methods like ultrasonography. The aim of this study was to introduce fascicle length and fascicle angle for the estimation of the strength of skeletal muscle by using ultrasonography.

Materials and Methods: The data of this study have been driven from pubmed and authoritative references available on the internet and in libraries. In all fifteen full text articles and 30 abstracts have been collected and reviewed. Keywords such as: muscle, fascicle, pennation angle, force and ultrasonography were searched to fulfill the purpose of this study.

Results : Detailed information about the angles of pennation and fascicles length are important to predict muscle force. It has been suggested that changes in muscle pennation angles are positively correlated to the length of fascicle in a muscle contraction. While muscle thickness may in some case be remained constant in this relation.

Conclusion: Real-time ultrasonography is a noninvasive procedure to monitor the architecture of the living muscle at rest and during static and dynamic sets. It is a valuable measurement tool to estimate muscle force by measuring the muscle architecture parameters such as angle of pennation and fascicle length.

Keywords : Muscle, Fascicle, Pennation angle, Force, Ultrasonography

The effect of fatique due to plyometric training on activity pattern of rectus femoris muscle in different phases of deep jump on active girl

Somayeh Ahmadabadi

Background and Aim : The aim of this study was to determine the effects of fatigue due to plyometric training on vertical jump ability and activity pattern of rectus femoris of dominant leg of high jump of active girls .

Materials and Methods : Seventeen females , mean age (21.5 ± 0.76 years ) were randomly assigned to two experimental (n = 10 ) and control ( n = 7) groups. Experimental group performed plyometric training and control group had no activity. Before and after training , vertical jump test using Ergo jump and electrical activity of rectus femoris muscle of dominant leg using electromyography were tested . The results of vertical jump test showed a decrease in performance (p: 0.04, F: 4.5) and fatigue process was confirmed . The raw EMG signal based on deep jump phases was divided in three phases and only 2 phases of the first were analyzed . In every phase, the maximum activity , amplitude and total time were obtained .respectively. M ultivariate analysis of variance (2×2) was used to compare of post-test of two groups.

Results : After one session training , rectus femoris maximum activity of the experimental group showed a significant decrease in pre-activation phase of motor program .

Conclusion : This study showed that neural fatigue due to plyometric training can occur in motor program (especially in pre-activation phase of motor program ).

Keywords : Deep jump, Plyometric training, Vertical jump, Electromyography, Rectus femoris muscle.

Specification of the educational needs of parents with premature infants admitted to neonatal intensive care unit

Faranak Aliabadi F

Background and Aim : Birth of a premature infant can instigate emotional crisis for the parents and encounter them with a variety of needs. The aim of this study was to specify the educational needs of parents of premature infants admitted in the neonatal intensive care unit (NICU).

Materials and Methods: The study was performed by qualitative research approach. Twelve participants including 9 parents of infants in NICU, 2 nurses and 1 pediatrist were selected by purposive sampling method. Data were gathered by semi-structured interview in akbarabadi, aliasghar, firoozgar hospitals. Data were analyzed content analysis approach.

Results: Two themes emerged from data analysis which expressed educational needs of parents of premature infants admitted in NICU. These themes were: need for knowledge and information about prematurity, and need for acquiring skills for caring premature infants.

Conclusion: Most parents have not sufficient knowledge and information about premature infants and resolving these needs can help them to achieve a better sense of control over the situation. Understanding of these needs can help care team to provide better services for parents premature infants.

Keywords: Educational needs, Parents, Premature infants, Qualitative research

The relationship between shoulder pain with shoulder neuromusculoskeletal disorders in post stroke hemiparsis

Mehdi Dadgoo

Background and Aim : Hemiplegic shoulder pain is a common problem that its prevalence varies from 48% to 84%. This disorder limits the patient’s ability to achieve the optimal function. The objective of study was to assess the relationship between hemiplegic shoulder pain with neuromusculoskeletal disorders in post stroke hemiparesis

Materials and Methods: This study was an observational-analytic that fullfilled on fifty patients with acute stroke. The post stroke period was 28 days. The following items were evaluated:shoulder subluxation with X-ray, shoulder spasticity with Modified Modified Ashworth Scale (MMAS), soft tissue injury with orthopaedic tests and RSD with clinical features.

Results: Hemiplegic shoulder pain was present in 28 patients(56%). Seventeen patients (85%) showed shoulder subluxation, 18 patients (72%) had supraspinatus tendonitis ,13 patients (65%) had biceps tendinits, 4 patients (14/2%) had ACJ involvement, 3 patients (10/7%) had elbow flexor spasticity, 2 patients (7/1%) had shoulder adductor spasticity ,2 patients (7/1%)had shoulder internal rotators spsticity , 4 (14/2%) patients had RSD.

Conclusion: Results from this study show that one factor does not play role in causing hemiplegic shoulder pain and this disorder is multifactorial. Prevention of shoulder pain and performing appropriate physiotherapy can play a role in improving stroke patients’ function.

Keywords: Stroke, Shoulder pain, Sublxation, Muscle tone, Shoulder –Hand syndrone

An investigation into the vertical ground reaction force status in the coper and non-coper ACL-deficient knee subjects during walking on level ground

Abbas Rahimi

Background and Aim: An immaculate review of the literature reveals some changes on the vertical ground reaction force (VGRF) in ACL deficient knee subjects. However, the details are not clear yet. The current study aimed to study these changes in the ACL-deficient and apparently healthy knees of the coper and non-coper ACL-deficient knee subjects in comparison with the normal knees.

Materials and Methods: Sixteen unilateral ACL-torn subjects included 8 copers and 8 non-copers were recruited in this quasi-experimental study and were compared with 16 normal knee subjects (8 subjects matched to each coper and non-coper groups). All subjects walked barefoot and with their preferred speed in a 6-meter walkway and placed their wanted foot on the platform of a Zebris pedobarograph tool. The patients were asked to place their injured and healthy feet separately on the platform. The control group placed their foot matched to the ACL-deficient legs on the platform. The testes were repeated so much to have five acceptable trials. The outcome measures included the peak F1Z, F2Z, F3Z of the vertical ground reaction force values and the times to reach these peak values as well as total stance time of the tested feet.

Results: The results showed only a significant lower F₁Z value in the non-coper ACL-deficient knee subjects (p=0.008). No significant changes were shown in the F₂Z, F₃Z or the times reach to F₁Z, F₂Z and F₃Z values (p>0.05). The stance time of the coper ACL-deficient knee subjects increased significantly in the non-coper ACL-deficeint knee subjects when compared to the coper and healthy knees (p=0.005).

Conclusion: The reduced F1Z of the vertical ground reaction force at initial contact as well as increased total stance time seen only in non-coper ACL-deficient knee subjects reveals inadequate compensatory mechanism in these patients as a counter force stress at initial contact and weight bearing. However, the coper ACL-deficient knee subjects compensated these forces with good strategies and walked very similar to the control group.

Keywords: Vercial ground reaction force (VGRF), Time to peak vertical ground reaction force components, Coper & non-coper ACL-deficient knee subjects, Pedobarography.

Comparison of the immediate and short term (12 sessions) effects of whole body vibration on the spinal motor neurons excitability in healthy young men

Giti Torkaman

Background and Aim: Despite the widespread use of whole body vibration (WBV),especiallyin recent years, its neurophysiological mechanism is still unclear and the results about the facilitatory or inhibitory effects of WBV widely vary in different studies. The aim of this study was to compare between immediate (one session) and short term (12 sessions) effects of WBV on the spinal motor neurons excitability in healthy young men.

Materials and Methods: Ten voluntary non-athlete healthy young-men (mean age:26.1±2.23) were participated in this study.In the sham sessions subjects stood on the turned off vibration plate while were maintaining the semi-squat position and then after 2 weeks wash-out, vibration training sessions were done on the same position with frequency of 30 HZ and peak to peak amplitude of 3 mm training sessions (sham & vibration) consisted of 12 sessions (3 sessions per week) and 4 set in each of them, weekly one set added to the training protocol. H reflex recruitment curve of soleus muscle was recorded before and after first and also 12th sessions in both sham and vibration training protocol. Ascending slope of recruitment curve, threshold and peak amplitudes and related intensities, amplitude of Mh and Hmax/Mmax ratio were determined.

Results: Immediate effects of vibration training 12th session caused a significant decrease of threshold amplitude and an increase of peak intensity (p=0.05 and p=0.05 respectively). Short term WBV training significantly decreased the threshold intensity of soleus recruitment curve (p=0.01).

Conclusion: The results suggest the inhibitory effect of acute WBV training on the spinal motor neurons excitability. It seems that short term WBV training may be effective to facilitate the motor neurons excitability or increase the muscle spindle sensitivity.

Key Words: Whole body vibration, H reflex recruitment curve, Soleus muscle, Short term training

Investigation of electromyographic behavior of trunk muscles during prolonged load holding in subjects with hyperlordotic posture and normal subjects

Azadeh Shadmehr

Background and Aim: The curves of the spine, especially lumbar lordosis, play an important role in the maintenance of an efficient upright posture and allow efficient absorption of the loads applied to the spinal column and increase the efficiency of the spinal musculature. Excessive lumbar postures, also called “hyperlordosis” and “hypolordosis” , are thought by some researchers to be indicative of altered muscle activity and stress patterns. Therefore tolerance of particular activities of daily living (ADL) of an individual with these postures is reduced. Despite the importance of neuromuscular control at spinal column maintenance and coordination, there are little investigations about the effect of thoracic and lumbar curvatures on trunk muscles activity. Therefore, the aim of this study was to investigate electromyographic behavior of trunk muscles in lordotic posture.

Materials and Methods: Twelve subjects with lordotic posture ( mean age 23.67 years, mean weight 56.67 kg, and mean height 162 cm) and eleven subjects with normal posture ( mean age 22 years, mean weight 59.36 kg, and mean height 164.91 cm) participated in this study. Subjects were asked to hold a load equivalent of 7% of her body weight.

Results: Data analysis indicated that there is not significant statistically difference in median frequency variable between two groups (p>0.05). But there is significant statistically differences at The percentage change in RMS of erector spinae and internal oblique muscles at three time periods between two groups. The percentage change in RMS of external oblique muscle has significant statistically difference at first and third time periods between two groups.

Conclusion: These finding reveal that excessive lumbar lordosis alter the activity levels of trunk muscles. Therefore, it seems that the use of posture correction exercises in therapeutic protocols is necessary for improvement of these changes. Also, it is recommended to do this research in dynamic tasks for attain of comprehensive information about the effect of postural deviation on electromyographic behavior of trunk muscles.

Keywords: Electromyography, Hyperlordosis, Posture, Prolonged load holding

^*Corresponding Author: Dr.AzadehShadmehr, Rehabilitation Faculty, Tehran University of Medical Sciences

The investigation of spinal abnormalities & balance and relation between them in patients with Down syndrome

Pegah Rahmani

Background and Aim: The aim of this research was to study spinal abnormalities ( kyphosis, lordosis and scoliosis ) and dynamic and static balance in mentally retardation with and without Down syndrome (DS) and relation between them in DS.

Materials and Methods: Thirty mentally retardation with DS (age 13.96 ± 1.77 yr) and 30 mentally retardation without DS (age 14.30±1.96 yr) that selected randomly participated in this study. Modified single balance test for the evaluation static balance and heel-to-toe test for evaluation dynamic balance were used. Continued spinal abnormalities included kyphosis, lordosis and thoracic & lumbar scoliosis were measured by spinal mouse.

Result: The results showed a significant difference between static and dynamic balance, kyphosis and thoracic & lumbar scoliosis in mentally retarded with and without DS . There was a significant relationship between static balance and kyphosis and thoracic and lumbar scoliosis and dynamic balance with kyphosis and thoracic and lumbar scoliosis in DS . There was not a significant relationship between balance and lordosis.

Conclusion: Due to relationship between postural and balance and special needs in mentally retardation particularly Down syndrome, for optimal performance of their daily activities, it should emphasis to recognize the structural profile and prescribe postural corrective programs and improving balance.

Key words : Down syndrome, Spinal deformities, Static balance, Dynamic balance

The effect of Transcranail Magnetic Stimulation (TMS) on changing brain laterality in normal subject: using Dichotic Listening(DL)

Anahita Khorrami Banaraki

Background and Aim: Transcranial Magnetic Stimulation is a novel technique for inhibition or excitation of brain cortical area. Dichotic listening test is a simple instrument to determine dominant ear and brain hemisphere for processing of verbal stimuli. This study aimed to determine changes in right ear advantage(REA), after applying inhibitory rTMS protocol on left Broca area.

Materials and Methods: In this descriptive - cross-sectional study, we compared the performances of 14 right handed normal adult Persian speakers with normal auditory and no history of psychiatric or neurological disorders. TMS was applied at 1 Hz with 90% motor threshold, for 10 minutes (600 pulses) on left Broca's area. The right ear advantage index was assessed pre and post rTMS using dichotic listening test.

Results: Finding of the present study showed no significant difference on right ear advantage index pre and post rTMS using paired t-test.

Conclusion: According to the findings of this study, it can be concluded that the use of inhibitory rTMS protocol on the left Broca area , has no effect for shifting in the right ear advantage. For interpretation of the results, it could be stated that it may be the protocol was used in this study isn't sufficient enough to inhibit left hemisphere for linguistic processing. Another reason could be the lack of sufficient sensitivity of Dichotic Listening test to show changes in hemisphere function after TMS. However, to provide clearer description, using functional brain imaging techniques and TMS together could be helpful.

Key words: Trancranial Magnetic Stimulation (TMS), Lateralization, REA, Linguistic processing, Dichotic listening

Cultural adaptation and evaluating psychometric properties of Persian version of supports intensity scale in adult people with intellectual disability

Mohammad Kamali

Background and Aim: Shifting paradigms about how to assess the support needs of person with intellectual disability, in 1980, posed necessity of design and development of appropriate tools more than ever. In this regard, American Association on intellectual and developmental disabilities developed the supports Intensity scale to respond the lack of an appropriate tool. The aim of this study was to do the cultural adaptation and evaluation of psychometric properties of supports intensity scale in adult people with intellectual disability.

Materials and Methods: In this descriptive – analytic study, 43 adult persons with intellectual disability participated. Translation and adaptation of the SIS through International Quality of Life Assessment (IQOLA ) protocol was done. Validity of the test was evaluated by qualitative content validity. Internal consistency and test-retest reliability were used for evaluation of reliability.

Results: Based on the IQOLA protocol, The SIS had easy translation and relatively good quality. According to results, all items of the test had content validity. Cronbach's alpha coefficients fall in the range (.80-.99) and ICC ranged from .90 to .99

Conclusion: The results of this study showed that the Persian version of the SIS has good validity and reliability for identifying pattern and intensity of needed supports in adult people with intellectual disability.

Key words: Adaptation, Validity, Reliability, Intellectual disability, Supports Intensity Scale