Modern Rehabilitation

Effects of a 8-weeks selected training program on physical and motor status in children with hemiplegic cerebral palsy in Ilam city

Ali Heirani

Abstract

Background and Aim: Cerebral palsy is a sensory and motor disease that affected control of posture and movement. Children with cerebral palsy show dysfunction in body such as spasticity, decreased muscle strength and selective control of movement that may limit functional activity and participation in daily life . The purpose of this study is to investigate effects of 8-Weeks progressive resistance training program on physical and motor status in children with hemiplegic cerebral palsy.

Materials and Methods: This study was semi-experimental with the interventional approachon16children of 4-12 years old with hemiplegic cerebral palsy in the first and second level of GMFCS classification that referred to rehabilitation center in Ilam city . Protocol of training was consisted of 16 one-hour sessions progressive resistance training in the case muscle group s ( 8 subjects) . Upper extremity muscles strength were measured by digita l dynamometer and gross motor function were evaluated by Gross Motor Function Measure (GMFM-88) at before and after intervention.

Results: The strength of dominant hand muscle groups was improved significantly after the intervention , also the scores of stand ing, walking , running and jumping were increased (p<0.05). There was no significant effect in strength of involved hand.

Conclusion: The results of this study indicate that progressive resistance training improve gross motor function and increase isometric strength in the dominant hand

Keywords: Hemiplegic cerebral palsy, Physical status, Motor function, Progressive resistive excercises (PRE).

The effectiveness of floor-time intervention on emotional functions of children with autistic spectrum disorders

Samaneh Esmaeili

Background and Aim: Children with autistic spectrum disorders (ASD) represent some difficulties in their socio-communicative and play skills, and also have restricted interests and stereotyped patterns of behaviors that effect on their daily living. Floor-time technique is a play–based intensive intervention that deals with communication, emotion, play, and imagination. The aim of this study is to determine the effectiveness of Floor-time technique in emotional functions of children with ASD.

Materials and Methods: A quasi-experimental study was conducted on children with ASD (2.5-4 years-old) who were selected by non-randomized sampling. Ten children, as case group, received Floor-time and 10 subjects were matched with them as control group. Pretest and posttest were conducted using Functional Emotional Assessment Scale (FEAS) to measure emotional functions with an interval of six months. The data were analyzed by paired and independent samples T-test.

Results: Statistical analysis indicated a significant difference between pre and posttest of FEAS in the case group (P=0.017). But the difference between pre and post test in the control group was not significant. In addition, the differences of pre and posttest scores between two groups were showed significant difference (p=0.041).

Conclusion: This study provided preliminary evidences for the use of Floor-time technique for increasing communicative, emotional, imaginative, and play skills in the children with ASD.

Key words: Autistic spectrum disorders, Floor-time, Play.

Comparison of cervical repositioning error between basketball and badminton players and control group

Amir Ahmadi

Background and Aim: Proprioception is a type of feedback from limbs to CNS which defines a sensory tools to contribute position sense and movement sense.

Precise and controlled movements are important sections of sports and activity daily living which needs to accurate information of proprioception.

High concentration of proprioceptors are reported in cervical spine, sacroiliac and ankle joint. The purpose of this study was to compare repositioning error of cervical spine on high level badminton and basketball players and healthy subjects.

Materials and Methods: Twenty female basketball players (23.40 years old), 20 female badminton players (24.81years old) and 20 healthy female (24,95years old) subjects were recruited to participate in this study. Cervical total range of motion (ROM) and repositioning error in target angle (30% of full ROM in each movement) of flexion, extension, right and left lateral flexion and rotation were measured by CROM apparatus.

Results : Our results indicate that two groups of athletes has significant differences with non-athletic subjects in flexion, extension, left lateral flexion and ro tation and there were significant differences in right lateral flexion and right rotation between badminton players and non-athletic subjects (P<0.005).

Conclusion : Cervical proprioception may improve with specific sport movements. Basketball and badminton are non-contact sports that needs to eye and hand coordination, as our results showed that the cervical repositioning error was decreased in athletics related to non-athletic subjects, the mentioned sports may improve proprioception.

Key Words: Proprioception, Cervical, Repositioning error, Basketball, Badminton

Evaluation andComparison of Hip Joint Muscles Strength in Female Athletes with and without Non-specific Chronic Low Back Pain

Javad Sarrafzadeh

Background and Aim: Regarding to high prevalence of low back pain (LBP) in athletes and its effect on their athletic function, an accurate evaluation before planning the rehabilitation program seems necessary in athletes with LBP. It should be considered that human movements are like as a kinetic chain. It means that any problems in every parts of this chain can cause dysfunction in the other parts of the chain. Not taking attention to the relationships between different parts of this chain may result in suboptimal rehabilitation. Therefore, focusing treatment on the entire parts of the kinetic chain besides the injured part, may prevent recurrenceof the dysfunction. Since in the kinetic chain hip muscles act as a link between lower extremities and trunk, the purpose of the present study was to evaluate and compare muscles strength of hip joint in female athletes with and without non-specific chronic LBP.

Materials and Methods: Fifteen healthy female athletes and 15 female athletes with non-specific chronic LBP participated in this study. Their age was between 18-30 years. Hip extension, abduction and external rotation strength in all participants were measured. A hand-held dynamometer (HHD) was used to measure muscle strength. Since fixing HHD by examiner’s hand is fraught with error, it is fixed by a stable frame.

Results: The maximum strength value of hip extension and abduction in female athletes with LBP were significantly lower than these measures in healthy group (P < 0.05). No significant differences were seen in the maximum value of hip external rotation strength between two groups (P > 0.05).

Conclusion: The results of the present study show that hip extension and abduction strength in female athletes with LBP were lower than these measures in healthy group. Therefore, hip strength measurements besides the examination of the spinal column seem to be necessary in evaluation and rehabilitation of the patients with LBP.

Key Words: Non-Specific Chronic Low Back Pain, Hip Muscles Strength, Athlete

Risk factors of re-treatment after photorefractive keratectomy in patients with myopia and astigmatism

A Mirzajani

Background and Aim: Residual refractive error is one of the most common complications of keratorefractive surgeries including laser assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). This study aimed to determine the incidence rate and risk factors for re - treatment following photorefractive keratectomy (PRK) in patients with myopia and myopic astigmatism.

Materials and Methods: A case control study was performed on the surgical records of all eyes that underwent PRK from May 2009 to May 2012 at Farabi Eye Hospital by one surgeon. During this period, 70 eyes with indication for retreatment (cases) and 158 control eyes were identified. All of the eyes included in the study had refraction data at least 9 months post-operatively. Student t, Man-Whitney U and chi-square tests were used for univariate analysis of presumed associations. All variables with a P value of < 0.2 on univariate tests were entered in a multiple logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of interest.

Results: Pre-op (pre-operative) manifests refraction spherical equivalent ≥-5.00 diopter, intended/nominal optical zone diameter of<6 mm and ocular fixational instability during surgery were associated with an increased risk of retreatment (all P values <0.001) and maintained their significance on multiple logistic regression with strong odd ratios of 6.12, 6.71 and 7.89 respectively. No statistically significant association was found between cases and controls in variables of age, sex, follow-up time, pre-op astigmatism, pre-op keratometry reading, pre-op pachymetry reading, pupil diameter and Kappa angle (all P values>0.05).

Conclusion: Small optical zone, deep ablation and unstable fixation during laser ablation are strong predictors for retreatment after photorefractive keratectomy.

Keywords: Re-treatment, Photorefractive keratectomy, Myopia, Myopic astigmatism

Comparison of the hip, ankle and back extensor muscle strength and its correlation with functional balance in healthy and osteoporotic postmenopausal women

Giti Torkaman

Background and Aim: According to the further tendency of osteoporotic people to use the hip strategy to maintain stability, in present study, the relationship between hip, ankle and back extensor muscles strength and functional balance in healthy and osteoporotic postmenopausal women were evaluated.

Materials and Methods: Forty-five volunteer postmenopausal women were divided into two normal and osteoporosis groups according to their bone mineral density. Maximal isometric strength of hip, ankle, and back extensor muscles were assessed by a hand-held digital dynamometer. Functional balance was assessed by Near Tandem Stand (NTS), Star excursion (SE) and Figure of 8 walking (F8W) tests.

Results: In osteoporosis group, all muscle groups were significantly weaker than the normal group (P<0.05), and the time of F8W test was significantly more than normal group (P=0.031). Also, in osteoporosis group, hip adductors and extensors showed a significant correlation with three functional balance tests (P<0.05).

Conclusion: Regarding to decrease of muscle strength in osteoporotic women and its relationship to declining of functional balance in ADL, strengthening of hip and ankle muscle groups should be considered in their rehabilitation programs.

Keywords: Muscle strength, Functional balance, Postmenopausal women, Osteoporosis.

The effect of sensory information on knee dynamic balance after anterior cruciate ligament reconstruction in comparison with normal people

Behrooz Attar bashi Moghadam

Background and Aim: Anterior Cruciate Ligament (ACL) is responsible for physical and somatosensory function. It is expected that additional sensory information improves dynamic balance of ACL reconstruction patients. This study is aimed to determine the effect of sensory information on knee dynamic balance after ACL reconstruction in comparison with normal people.

Materials and Methods: The study was designed as a randomized clinical trial. Thirty two men (16 men with unilateral ACL reconstruction and 16 healthy men), assigned in three groups: ACLR, reconstructed knee ACLR, non-reconstructed knee and normal. All participants received tactile information during functional tests. Dynamic postural stability was assessed by two functional tests including: Star Excursion Balance test and Cross over Hop for distance. The functional tests scores were conducted both pre and post applying sensory information in ACLR and normal people.

Results: The data showed that tactile information improves functional performance of ACLR patients. There were significant difference in reconstructed knee’s SEBT scores in medial (p=0.005) and posteromedial (p=0.034) directions by adding touch information. Significant difference in dynamic balance by addition of touch sense, in COH scores of ACLR people and normal population was found.

Conclusion: The findings of this study showed that additional sensory information improves dynamic balance in ACLR patients. The positive effect of tactile information supports to apply additional sensory information as a new method for increasing dynamic balance.

Key words: Anterior cruciate ligament, Sensory information, Dynamic balance.

The effect of Open-design collar on user’s acceptance and cervical range of motion in asymptomatic adults

Mojtaba Kamyab

Background and Aim: Neck pain is one of the most prevalent disorders in the world and became a major public health problem. It is a common condition affecting as much as two-thirds or more of the general population at one point of time during their life. Cervical collars have been approved to be effective on neck pain and disability as a conservative treatment. Actually most of patients refused to use them because of their appearance and raise temperature by wearing them. So we introduced a new design of cervical collar called Open-design collar, it seems that could be accepted better by patients because of its different appearance. The purpose of the current study was to investigate the effect of Open-design collar on user’s acceptance and cervical range of motion in asymptomatic adults.

Materials and Methods: Seventy-two healthy subjects (36 women and 36 men) aged 18 to 29 years oldwere recruited for this study. Neck movements were measured using JTECH Medical Dual Digital Inclinometer . Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject 3 times with and without Open-design collar. To assessthe acceptance of wearing Open-design collar, each subject was asked to fill an acceptance questionnaire of five criteria about the Open-design collar.

Results: Open-design collar significantly reduced cervical motions. It reduced flexion and extension on average by 78.24 ± 8.03%, 79.91 ± 8.02%, and right lateral flexion and left lateral flexion by 56.70 ± 13.91%, 54.34 ± 13.39% and right axial rotation and left axial rotation on average by 82.22 ± 5.48 and 82.60 ± 6.77.

Conclusion: Based on the data of the 72 subjects presented in this study, the Open-design collar adequately immobilized the cervical spine as a semi-rigid collar while the subjects accepted it by a good score.

Keywords: Neck orthoses, Collar, Range of motion, Acceptance

Intraocular pressure after photorefractive keratectomy in myopic eyes

Ebrahim Jafarzadepur

Background and Aim: Determination of intra ocular pressure is one of the most important ophthalmic dilemmas. This study compares pre and post photorefractive keratectomy (PRK) measures of intraocular pressure (IOP).

Materials and Methods: Simple myopic subjects were selected for this study from "Jomhuri" educational hospital in Erbil. All myopic PRK candidates were referred for IOP measurement. IOP was measured by noncontact tonometer (NCT) in all myopic cases pre and 3 months after PRK at the same diurnal time. Pachymetry was done for all participants.

Results: Two hundred and twelve participants were evaluated. The IOP was 15.12 ± 1.8 (mean ± SD) before surgery and 12.16 ± 1.9 after surgery (p<0.0001). The residual corneal depth was significantly determining the IOP result (p<0.0001).

Conclusion: Apparently, IOP significantly decreases after PRK however, some ocular diseases that are diagnosed according to the IOP may be missed. Therefore, specific concern should be considered for IOP measurement after refractive surgery.

Keywords : PRK, IOP. Refractive error, CCT

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