Modern Rehabilitation

Review of Finite Element Model Studies in Knee Joint Biomechanics

S.Kamal Mostafavi

Background and aim: Human knee joints experience very large loads and motions during regular daily, occupational and sport activities. Consequently, they are at high risk of being exposed to injuries and degeneration. Osteoarthritis and ligament injuries often inflict knee joints causing considerable pain and loss of productivity involving thus significant human and economic costs. Hence, biomechanics of human knee joints has been the focus of many investigations with the primary aim to improve understanding of joint function in normal and perturbed conditions. The existing prevention and treatment programs have been based on such studies.
Material and Methods: Due to inherent costs, limitations, difficulties and ethical concerns associated with in vivo and in vitro cadaveric studies, finite element model studies have been developed as effective, powerful and complementary tools to investigate knee joint biomechanics subject to internal and external mechanical conditions affecting its normal function.
Results: The advantage of finite element method in study of joint biomechanics lies in its robustness to incorporate complex 3D joint geometry, intricate boundary and loading conditions and materials with nonhomogeneous and nonlinear properties.
Conclusion:This article reviews important model studies, presents their relevant results and discusses some of the promising future directions.

Systematic review article of Berlin Bedrest studies about prolonged bedrest effects on lower limb musculoskeletal system

S.Javad Mousavi

Background and aim: Many studies have been carried out about bedrest and its effects on different systems including musculoskeletal,neuromuscular,cognition and vascular systems throughout the world.The purpose of this paper is to review systematically all Berlin Bedrest Studies on musculoskeletal system.The focus of this review is mainly Second Berlin Bedrest Study (2^nd BBRS) supported by European Space Agency(ESA).Such studies provide a chance to study the specific effects of immobilization without interference of other diseases.
Materials and Methods: A literature search was carried out using MEDLINE and ESA database to assess existing literature about the effect of bedrest on musculoskeletal system published by Berlin Bedrest Studies.It has been searched for efficacy of interventions as high load resistive exercise and whole body vibration,as well.
Results: Fourty six articles have been found from 2000 to 2011year: 2 articles in 2000 and 2003,the other ones between 2005 to 2011. Seventeen articles were related to muscle and intervention on it,three ones about bone and related intervention on it,four ones related to both bone and muscle and twenty two ones about the other systems such as heart,vesseles,sleep and cognition.
Conclusion: According‏‏‏ to study results,bedrest has widespread effects on musculoskeletal system specially in early bedrest . These effects remain up to 180 days after bedrest course.Thus,high load resistive exercise and vibration should be prescribed in early stage of bedrest to reduce the detrimential effects of prolonged bedrest.

Investigation of vocal folds contact quotient and contact index among adult stutterers and nonstutterers

S.AhmadReza Khatoonabadi

Background and aim: During the past current decades, objective measurements in general and specialy dynamic measurements had been important aspect of evaluation of stuttering. Although these measurements can not replace with perceive judgements but these measurements help us to better diagnosis and treatment. Also we can use these for give feedback of treatment results to patient. Thereforee the purpose of this study was to measure and compare some dynamics characteristics between adult stutterers and nonstutterers.
Materials and Methods: Sample of this study was 32 adult men including 16 stutterers and 16 nonstutterers. We used from Vowel /a/ prolongation was used for gathering the subjects voice sample.The data by were analysed by Dr. Speech software.
Results: According to this research there is not significant difference in average of vocal folds contact quotient and contact index among adult stutterers and nonstutterers. But there is significant difference in average of vocal folds contact quotient perturbation between adult stutterers and nonstutterers.
Conclusion: In this research we used vocal folds contact quotient and contact index as factors from occurrence and expanding of stuttering and therefore we concluded that these factors do not have significant role in stuttering occurrence and expanding.

Prediction of grip strength in Iranian young healthy population

Taher Afsharnezhad

Background and aim: Grip strength (GS) is an important measure of general health to predict mortality, disability and function of the hand. The purpose of this study was to develop equations to predict grip strength based on several anthropometric measurements using a multiple regression analysis.
Materials and Methods: Four hundred and eleven males and 671 females college students, ages 18-30 years, in good health, participated voluntarily in this study. This sample was randomly assigned to the model-development (n=867) and cross-validation (n=215) groups. Four equations were developed by using data from the model development group, then cross-validated on the second group. A hand-held dynamometer was used to measure grip strengths. All anthropometric measurements such as hand anthropometry, forearm circumference (FC), lean body mass, skeletal muscle mass and arm muscle area were taken according to standard techniques.
Results: It was found that grip strength has a significant correlation with all anthropometric measurements. Forearm length (FL) was correlated to grip (68% explained variance) in a linear relationship, followed by upper limb length and SM. All four equations were confirmed by cross-validation. Because of simplicity and easy-to-measure the following equations were selected for prediction grip: Dominant hand, A) 0.464×Age(yr)+0.392×Height(cm)+0.681×BMI-13.035×Sex(0 for men and 1 for women)-46.160, B) 0.029×FC×FL-8.634×sex+13.872 Non-dominant hand: C) 0.347×Age+0.386× Height+0.657×BMI-13.313×Sex-44.243, D) 0.029×FC×FL-8.752×sex+13.788.
Conclusion: The six easy-to-measure cofactors sex, age, height, BMI, forearm length and forearm circumference provide a highly accurate prediction of normative grip strength.

Effects of movement practices in virtual environment on upper limb function of children with hemiparetic cerebral palsy

Hamid Rostami

Background and aim: Virtual Reality is a computer technology with virtual environment and objects, which people manipulate virtual environment through active participation. The aim of this study was to determine the effect of practice in virtual environment on upper limb function of children with spastic hemiparetic cerebral palsy.
Materials and Methods: In this single blinded, randomized, controlled trial, 16 children with hemiparetic cerebral palsy were evaluated in a simple random sampling of Ahvaz city in 2 groups (virtual reality and control). Treatment protocol consisted of one and half hours sessions of practice in virtual environment for 4-week, every other day. Measures were conducted pre, post and 3-month after the treatment period by Pediatrics Motor Activity Log and Bruininks-Oseretsky Test of Motor proficiency. Sample randomization and data analysis by analysis of variance with repeated measures were conducted by SPSS-16 software in alpha level set at 0.05.
Results: Subjects in virtual reality group showed significant improvement (p<0.01) in post-test measures (bruininks-oseretsky test of motor proficiency, speed and dexterity: mean change from 0.25±0.06 to 1.22±0.23). Results were retained for both groups in follow up session.
Conclusion: Virtual reality technology through intensive and repetitive practice in an interactive and motivational environment is a promising method to improve upper limb function of children with hemiparetic cerebral palsy.

Comparative study of instrumental activities of daily living (IADLs) in patients with schizophrenia and normal matched individuals

Malahat Akbarfahimi

Background and aim: Schizophrenia is a disabling condition which affects independent functioning in instrumental activities of daily living (IALDs). Due to their importance in mental health and rehabilitation planning, this study was designed to compare functional capacity and daily life performance in IADLs in patients with schizophrenia with healthy matched individuals. The relations between capacity and performance are also considered.
Materials and methods: Thirty community dwelling patients with chronic schizophrenia and thirty healthy matched individuals were selected. After obtaining a written consent, IADLs were assessed using the Performance Assessment of Self-care Skills (PASS) and the Lawton's index of instrumental activities of daily living. Data analysis was done by SPSS, version 14.0.
Results: Comparing two groups, patients with schizophrenia scored significantly lower in independency, process, and quality in PASS, and in total score of Lawton's index (P<0.001 for all variables). No significant correlations were found between two measures.
Conclusion: It seems that functional capacity and performance in IADLs are limited in patients suffering from schizophrenia. Functional capacity was not related to daily life performance. However, further studies are needed to investigate factors affects functional outcome.

Prediction of infant motor performance through performance evaluation of behavior

Malek Amini

Background and aim: nowadays, comprehensive developmental assessment of infants is highly considered. But, some assessments, especially those which use more manipulations on high risk infants, can cause more stress on them. So sometimes it is necessary to use one group of developmental assessments to predict another developmental aspect. The aim of this study was to investigate the relationship between scores of behavioral scale and motor performance.
Materials and methods: In this cross-sectional study that was conducted in neonatal intensive care unit and pediatric clinic of Shahid Akbarabadi hospital, Tehran, 50 under 2 months low birth weight infants after met inclusion criteria were selected via convinence sampling method. The Test of Infant Motor Performance (TIMP) and the Neonatal Behavioral Assessment Scale (NBAS) was used for assessing motor performance and behavioral performance respectively. The TIMP consist of elicited and observational parts. NBAS was consisted of habituation, social interaction, motor system, state organization, state regulation, autonomic system, smile, supplementary items, and reflex items.
Results: There was not any significant relationship between habituation part of NBAS and TIMP and also between autonomus system part of NBAS and observational part of TIMP (P<0.05). Association between other variables was statistically significant (P>0.05).
Conclusion: Some items of behavioral assessment can be used to predict the motor performance in low birth weight infants.

The targeted implementation of teaching in small group discussion for second- year students in physiotherapy:A comparative assessment of teaching effect on satisfaction and learning level

Nastaran Ghotbi

Background and aim: One of the main problems in learning is ignoring the teaching in small group discussion.So, today, teaching in student-based methods such as work in small group is emphasized. Nevertheless, this method is not used for teaching physiotherapy students. This study was performed to determine the effect of teaching in small group on satisfaction and learning level of second- year students in physiotherapy in comparison with lecture teaching.
Materials and methods: An experimental study was performed on 29 physiotherapy students. The students were randomly classified into two groups lecture (14 people) and work in small group (15 people). Students were educated for 4 sessions. Two separate questionnaires were used to assess learning and satisfaction levels.
Results: Overall satisfaction in small group was significantly greater than lecture group (P<0.0001). However, there was no significant difference between learning levels of the methods (p>0.05). 86.7% of students in small groups preferred to be educated in the future semesters using this teaching method.
Conclusion: This study showed the role of small group teaching on increasing students' satisfaction level. Due to increased satisfaction in small group, despite the lack of significant difference between the two methods of learning, learning process can be facilitated .Thus this method is recommended for education of the undergraduate students.

Isokinetic extension torque summation of lower extremity and functional test in patients with anterior cruciate ligament deficiency

Ali Jamshidi

Background and aim: Knee joint has a major role in various lower extremity activities. Among different elements of knee joint complex more interest was seen to anterior cruciate ligament because of its alignment, structural complications, more nerve receptors and susceptibility to injury. After injury of this ligament, knee extensor torque decreases but it is believed that this decrease compensated for by muscles of hip and ankle joints. This suggestion has not investigated by isokinetic studies. Therefore, the aim of this research was that if quadriceps muscle torque decreases in spite of rehabilitation process and if this decrease compensated for by hip extensors and ankle plantar flexors?

Materials and methods: 10 healthy men (age: 22-35 years old) and 10 patients with ACL deficiency (age: 23-42 years old) participated in this study. Plantar flexor muscle strength, quadriceps muscle strength and hip extensor muscle strength were tested by Isokinetic Biodex System 3 at 60 and 180 degrees of angular velocities. Also functional vertical jump test was done for each lower extremity.
Results: Will coxson test and Spearman correlation coefficient were used. Results showed that there was no significant difference between mean strength of gastrosoleus, hip extensors and sum of mean strength of gastrosoleus, quadriceps and hip extensors of patient's injured and sound limbs (P>0.05). Results showed that there was significant difference between mean strength of quadriceps of injured and sound limbs (P> 0.01). There was no relationship between gastrosoleus, quadriceps and hip extensor summation and vertical jump functional test in the patients and normal subjects (P>0.05).
Conclusion: The results show that compensation occurs in the ankle plantar flexors and hip extensors of injured lower extremity. Thus in spite of significant decrease in quadriceps strength in the injured limb, sum of mean strength of gastrosoleus, quadriceps and hip extensor muscles between injured and sound limbs was not statistically significant. Also there was no relationship between functional test and isokinetic parameters. Thus functional vertical jump test can not be used instead of isokinetic test.