Modern Rehabilitation

A systematic review of work-related problems among occupational therapists and physical therapists

Arian Shamili

Background and Aim: Work related injury (WRI) can cause problems such as change or loss in job, fatigue and burnout. Injury prevalence has increased from 10.2% to 13.5% in the U.S. therapists since 2004 to 2006. At least 3,700 physiotherapists and 900 occupational therapists membership in Iranian Medical Council and developments of occupational therapy and physical therapy domains are involved in our country and the growing trend of student admissions in these fields and also limited researches in work-related problems of therapists, there would be a challenge in research studies. The overall goal of this systematic review was to survey the prevalence of work-related problems, predisposing factors and causes of these problems among therapists and finally predict problems of Iranian occupational therapy and physiotherapy population.
Materials and Methods: By performing the five stages of an evidence based systematic review with regard to the selection criteria obtained from related articles, looking for articles were done through using internet databases, reference books and Citation review. At first, 50 articles were obtained. Finally, this study reviewed 25 articles in the last two decades in different parts of Iran and the world (1990-2010)
Conclusion: It was clarified that muscular injuries were of the most common types of damages caused by these works. Injuries were seen in most particularly in public, orthopedic and acute settings. Low back pain was remarkably reported. Age under30 years, inexperience and heavy work were some of the risk factors. Improper handling was determined as the main cause of injuries in therapists. Besides musculoskeletal injuries, common psychosocial problems were depression, anger and job frustration. Finally, considering culture and job characteristics of the Iranian therapists, the data and results were compared and discussed to predict different aspects of WRI in Iranian therapists.

The effect of modified constraint induced movement therapy on quality and amount of upper limb movements in chronic hemiplegic patients in comparison with traditional rehabilitation

Khadijeh Otadi

Background and Aim: Constraint-Induced Movement Therapy (CIMT) is a new intervention in chronic hemiplegic patients. The aim of present study is to quantify of quality of movement (QOM) and amount of movement (AOU) that assessed by motor activity log (MAL) after modified CIMT in comparison with traditional physiotherapy (TPT).

Materials and Methods: Ten patients were randomized to modified CIMT or TPT group. Five patients received training of the more affected limb fort two hours daily, three times in a week during two months of treatment. The patients are encouraged to wear an arm- hand splint in less affected hand for five hours daily for maximal using of affected limb with shaping method. The patients in TPT group received physiotherapy treatment with same intensity with other group, for two hours daily during two months. Motor Activity Log (MAL) was used to determine QOM and AOU before- after two months treatment.

Results: The data showed significant improvements in AOU and QOM in affected extremity that clarified by Wilcoxon test. Mann- Whitney test used for comparison between two groups, revealed significant difference in modified CIMT group (p=0.02).

Conclusion: Although, modified CIMT was more effective than TPT in improving QOM and AOU but, TPT as an active rehabilitation can be effective on improving of these parameters.

The effect of lateral wedge insole with and without sub-talar strap on pain, function, and quality of life in medial knee osteoarthritis

Mojtaba Kamyab

Background and Aim: The effects of lateral wedge insole with and without sub-talar strap on pain, arthritic symptoms, functional performance, sports and recreational activities, and knee related quality of life in patients with medial compartment knee osteoarthritis were compared.

Materials and Methods: Community-dwelling men and women aged over 40 years with medial compartment knee osteoarthritis, grades I or II based on Kellgrene and Lawrence grading system were participated in this study. They were randomly allocated in two different groups lateral wedge insole with and without sub-talar strap. Both groups were required to wear the insoles at home for the duration of four weeks, approximately 5 to 10 hours per day. Participants were asked to complete the Farsi version of Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at baseline and at follow-up. The reliability of KOOS for measuring short term and long term symptoms and function in Iranian patients with knee injuries and osteoarthritis has been reported previously.

Results: The changes in KOOS subscales were significantly different in both groups over time. Contrary to our hypothesis, the interaction effect was significant between the two groups following our intervention in terms of symptoms, daily living functions, sports and recreational activities, and knee related quality of life, unless pain score.

Conclusion: The result of this study suggests that both of the insoles improved pain, symptoms, function in daily living, sports and recreation activities and knee related quality of life in patients with mild medial compartment knee osteoarthritis. However, use of sub-talar strap with lateral wedge insole would be the better prescription for insoles in these patients.

Investigating the effects of wrist Kinesio Taping on hand function of children with spastic diplegic cerebral palsy

Laleh Lajvardi

Background and Aim: Cerebral palsy is characterized by non-progressive abnormalities in the developing brain that creates a cascade of motor deficits and finally affects functional activities. Limited hand function is a characteristic of the movement disorders in children with cerebral palsy which leads to disability in performing activities of daily living, work and play. The purpose of this study was to investigate the effects of wrist Kinesio Taping on hand function of children with spastic diplegic cerebral palsy.

Materials and Methods : In this randomized clinical trial and single-blind study, 26 children (3-6 years old) with spastic diplegic cerebral palsy were selected by convenient and simple sampling and randomly divided into two intervention and control groups. During the study for 12 days ,control group received only common occupational therapy treatment or Neuro-Developmental Treatment (NDT). Intervention group received both NDT and wrist Kinesio Taping for 24 hours a day on both wrists. Assessment tool was QUEST for evaluating quality of upper extremity skills and Modified Ashworth Scale for assessing spasticity of wrist before and after intervention in both groups. Data were analyzed by independent t-test and Wilcoxon rank sum.

Results : The results showed significance increase of total QUEST score (P=0.029) and significance difference in domains of dissociated movements (P=0.003) and grasp (P=0.008) in Kinesio Taping group. However, there were no significant differences in weight bearing (P=0.46) and protective extension (P=0.89) domains. The data showed that wrist Kinesio Taping was effective in reducing spasticity of right wrist(P=0.004) but no significant difference for left wrist(P=0.06).

Conclusion: Wrist Kinesio Taping technique revealed to be effective in increasing quality of upper extremity skills of spastic diplegic cerebral palsy children in domains of dissociated movements and grasp. Moreover, it was concluded that this technique can be effective in reducing spasticity of right hand due to more active use of dominant hand.

Test-retest reliability of lower extremity spasticity assessment with modified Tardieu scale in hemiparetic patients after chronic stroke

Shohreh Noorizadeh

Background and Aim: Spasticity is a motor disorder characterized by a velocity dependent increase in tonic stretch reflex and tendon jerks, due to the hyper-excitability of the stretch reflex. Modified Tardieu Scale (MTS) is a clinical tool for assessment of spasticity. The purpose of this study was to investigate intra-rater reliability of the MTS for knee extensors and ankle plantar flexors muscles in adult subjects with chronic stroke.

Materials and Methods: In an analytical cross sectional study, 17 participants (10 men ,7 women) with age range of 40-76 years and mean time post stroke of 20/79 (SD=20/55) in a convenient sampling took part in this test-retest study. Intra-rater reliability of spasticity with MTS was investigated by one un-experienced physiotherapist for knee extensors and ankle plantar flexors in two sessions over one week.

Results: Interclass correlation coefficient (ICC) values for R₂-R₁ as an indicator of spasticity in knee extensor and plantar flexors was good (ICC=0/66) and very good (ICC=0/87) and for knee extensors and ankle plantar flexors quality of muscle reaction was 0.80 and 0.92 respectively.

Conclusion: The MTS has a good reliability in spasticity assessment of knee extensors and ankle plantar muscles after stroke. Probably MTS can be used as a reliable clinical tool to measure spasticity of lower extremity muscles in adult subjects with chronic stroke.

Effect of plantar flexion and eversion on mediolateral ground reaction force in subjects with functional ankle instability

Ali Amiri

Background and Aim: The common mechanism for lateral ankle sprain is inversion, plantar flexion, or the combination of both, if untreated successfully can lead to chronic ankle instability. It seems that the foot position, while touching the ground, has an effective role to cause ankle sprain. Thus it is possible to prevent ankle sprain through limiting foot position. Therefore the aim of this research is to study the effect of plantar flexion and eversion on mediolateral ground reaction force while landing in individuals who suffering from functional ankle instability.

Materials and Methods: In this case-control research study 32 subjects (17 subjects with unilateral functional ankle instability (FAI) and 15 control subjects), aged from 18 to 35 years, were tested. All subjects in instability group were selected by the orthopedic physician, then the anterior drawer and talar tilt tests were performed for diagnosis of functional ankle instability and other physical examinations. Control group were matched with instability group by age, weight, height, gender and body mass index. The subjects standing with single leg on a 40 cm high platform in 25 cm front of a force-plate while the test leg relaxed and non-weight bearing. The subject landed on the test leg on the center of the force-plate. The subjects landed according to four types of position: A: neutral position of ankle and lateral foot wedge, B: neutral position of ankle, C: positive heel and lateral foot wedge and D: positive heel.

Results: Among control group, medial ground reaction force increased in the "C" position relative to "B" position (p=0.007) and "C" position relative to "D" position (p=0.018). In FAI group, lateral ground reaction force increased in "C" position relative to "B" position (p=0.001) and "C" position relative to "A" position (p=0.002). Also in FAI group medial ground reaction force decreased in "D" position relative to "A" position (p=0.014).

Conclusion: According to the findings, applying lateral foot wedge, while the ankle is in plantar flexion, increases the mediolateral ground reaction forces. Based on the results, position of plantar flexion is more possibly effective than inversion in ankle sprain. According to the study, the lateral foot wedge in ankle plantar flexion position may be more effective than in neutral one to change mediolateral ground reaction forces.

The relationship between balance disorder, muscular strength and disability rate in Iranian patients with multiple sclerosis

Nastaran Ghotbi

Background and Aim: Multiple sclerosis (MS) is a demylinating disease that due to the involvement of multiple areas in central nervous system, including sensorimotor system can impair the patients' balance. The aim of the present study was to determine the balance, extremities muscular strength and disability rate in Iranian patients with MS and to investigate the relationship between these parameters.

Materials and Methods: Sixty eight patients with MS participated voluntarily in this study. The berg balance scale (BBS), Motricity index (MI) and self report patient determined disease steps (PDDS) were used for assessing the balance, extremities muscular strength and patients' disability rate, respectively

Results: Fifty six of patients showed balance impairment. Balance values were significantly correlated with muscular strength of upper (p=0.011) and lower (p<0.001) extremities in patients with balance impairment. But, the relation between balance and muscular strength in patients without balance impairment was not significant (p>0.05).There was a negative correlation between balance and disability rate (p<0.001).

Conclusion: The results of this study showed that more than 50% of patients have balance impairment. Furthermore, the importance of evaluating muscle strength in order to predict the falling risk in MS patients were identified.

The immediate effects of whole body vibration on timing parameters in the upper extremity muscles of healthy young women

Azadeh Shadmehr

Background and Aim: Whole Body Vibration (WBV), as a new exercise modality, can improve neuromuscular performance but, there is no study to assess the effects of WBV on the reaction time as an indicator of muscular performance especially in upper extremity muscles. Therefore, the aim of the present study is to investigate the immediate effects of WBV on timing parameters of upper extremity muscles.

Materials and Methods: Forty healthy young women were randomly assigned in two groups of intervention (with WBV) and control (without WBV). In the intervention group, timing parameters (Reaction time (RT), Premotor time (PMT), Motor time (MT)) were measured by using EMG before and after the vibration (5 sets of 30seconds at 5 mm amplitude and 30 Hz frequency) session. The same protocol but without vibration was used for control group.

Results: Whole body vibration did not alter the RT significantly (P=0.253). Premotor time was increased significantly only in the triceps muscle (P=0.006). There was also a significant difference (P=0.003) in MT of the serattus anterior muscle between two groups.

Conclusion: It seems that WBV can induce different effects on upper extremity muscles. Whole body vibration has not any significant effects on the total RT

Effect of lumbo-pelvic belt on motor control strategy of trunk muscles during lifting and lowering of different loads symmetrically

Gholam Reza Olyaei

Background and Aim: In spite of massive knowledge increase and ergonomic correction, lumbar disorders extremely prevail in working environments. Efforts have been made in order to decrease prevalence of musculoskeletal disorders caused by lifting, carrying and pulling down objects by using some belts. The purpose of this research is to determine the effect of lumbo-pelvic belt in symmetrical load lifting on one of motor control indexes.
Materials and Methods: In this research twenty men were asked to lift objects with different weights of 5.5, 7.5, 9.5 and 12.5 kg in position of complete trunk and hips flexion and knees extension using and not using belt and put them on the target desk. Surface Electromyography has been recorded from two pairs of back muscles and three of abdominal muscles.
Results: Lifting different loads with belt showed significant increase in symmetrical index (p<0.05).
Conclusion: Using belt brings about more coordination in trunk agonist and antagonist muscles activity while lifting the loads.

Neurophysiological changes following muscle fatigue in healthy subjects and patients with anterior knee pain syndrome

Saeed Khatamsaz

Background and Aim: Muscle fatigue is a factor that caused muscle injuries. Ability to perform movement without error and controllability has important role in reduction of injuries. Reproduce ability of motion is reduced after muscle fatigue. Evaluation of motor control can produce suitable conditions for assessment of these changes and help us treatment guide lines for prevention of injuries. The aim of this study was to evaluate motor control changes following onset of fatigue in patients with anterior knee pain as a physiological aspect.
Materials and Methods: Fifteen voluntary female (10 healthy, 5 patients with bilateral syndromes) participated in this study. During dynamic fatigue test (open and closed chain movements), muscle activities were recorded from bilateral vastus medialis, vastus lateralis and rectus femoris (20 healthy and 10 patients quadriceps muscles) by surface electromyography (sEMG). Five dynamic cycles of motions were selected before and immediately after fatigue and then average of three middle cycles were compared for Symmetry Index (SI) as motor control assessment. Also Median Frequency (MDF) were computed as an indicator for onset of fatigue.
Results: MDF reduced significantly in both groups. This reduction was markedly showed in patients group. Reduction of SI was significant after fatigue test. Comparison of SI between groups indicated that before fatigue there was significant difference but after fatigue test was not significant.
Conclusion: Dynamic motions can produce muscle fatigue and reduction of MDF. High central control system used different synergies following pain and functional impairment. Synergy patterns change after dynamic motions fatigue and cause reduction of SI. This change is dependent to pain and functional impairment and has not a stable pattern.