Background and Aim: scapular position is one of the most important parts of a comprehensive approach to evaluation of patients with suspected shoulder dysfunction.Muscular imbalance has further been suggested to be a leading cause of asymmetrical motions and positions of scapula.

Kibler Introduced Lateral scapular slide test (LSST) quantitatively measures scapular symmetry, scapular stabilizer strength and shoulder girdle dysfunction threshold .

The literature recommends a further study on the reliability of LSST by using precise instrument such as caliper. Therefore, the main goal of present study was to determine the inter rater reliability of the LSST by using the caliper in comparison with the tape in patients with shoulder pathology

Material & Method: The LSST was administered to twenty men patients with a mean age 37.19 of years.(SD:12.42).The distances between the inferior angle of scapula &T7 were recorded. Subjects were tested with arm in neutral, hands on hips and 90 degrees of abduction full internal rotation. All data for tape and caliper in 0,45 and 90 degrees of shoulder abduction  were analyzed with SPSS (V:11.5).

Results: The ICCs range of inter- rater reliability were respectively (0.56-0.76) and (0.73-0.88) for tape and caliper in 0,45 and 90 degrees of abduction. Differences between ICCs for caliper and tape are not statisticaly significant. The SEM range was from 6.78 to 9.29 mm for tape and from 4.33 to 8.19 mm for caliper.  

Conclusion&Discusion:  This study showed that inter rater reliability of LSST is questionable. Although ICCs for caliper are better than tape but in third position of the test in both measurement method ICC were low. Further research is needed.

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 _max  ratio, 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.

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.

Background and aim: Stroke is one of the main reasons that would cause disability in adult population. The patient prefers to use his non-involved limb for self-care activities that called disuse learning of involved upper extremity.Constraint-induced therapy is one of the rehabilitative intervention that seems to improve motor ability and functional use of involved upper extremity in some of patients with hemiparesis after stroke. The aim of this study was to investigate the time effects of constraint-induced therapy on functions, coordination and movements of upper extremity of adult patients with hemiplegia.

Materials and methods: In present study, 15 patients with stroke participated in structured therapy sessions (CIT) emphasizing more affected upper extremity in different activities five times a week for 12 weeks and 2 hours a day and non-involved upper extremity were also restrained five times a week for 12 weeks and 5 hours a day

Results: The data was analyzed with paired t-test. The scores  of different  subtests of Fugl-Meyer test  such as shoulder and forearm, wrist and hand movements, coordination and speed of involved upper extremities showed significant differences between pre and post interventions in different time periods (p>0.05). Test scores increased up to 8 weeks but no significant increase was seen after 8^th week .Dexterity measurements by Minnesota Manual Dexterity test  showed significant differences between pre and post intervention in different time periods ( p  < 0.05) with maximum increase up to 10 weeks

Conclusion: The present data showed that constraint-induced therapy could be an effective approach to improve function and overcome disuse learning. The results of this study revealed that scores of Fugl-Meyer and Minnesota Manual Dexterity test  would reflect functional skills improvement.

Background and aim: Down's syndrome is the most common chrosomal disorder in which the fine and gross motor skills due to lack of proper sensory experience are disturbed. the role of dexterity in Activity of daily living, interaction with environment and independency is quiet crucial in Down's syndrome. Therefore, the aim of this study was to investigate the effects of simultaneous application of exteroceptive and proprioceptive stimuli on the dexterity of 6-7 year old educable children with Down's syndrome.  

Materials and methods: 33 Educable children with Down's syndrome were assigned in three groups (i.e. extercoceptive, proprioceptive, simultaneous application respectively) and participated in this study. In the first group, children received only exteroceptive stimulation for 30 minutes, 3 times a week. Children in the second group received only proprioceptive stimulation in the same period. Children in the third group received both stimulations simultaneously. Dexterity was evaluated through purdue peg bourd test after 5^th, 10^th, 15^th, 20^th, 25^th, and at 30^th sessions.

Results: Dexterity changes were significantly differed in all 3 groups (p<0.05) using repeated measurement test. In order to assess the improvement process of dexterity, every group was evaluated separately with dexterity test ( purdue peg board). Third group showed significant improvement in comparison with other groups (p<0.05). There was no significant improvement in dexterity in first and second groups (p>0.05).  

Conclusion: The findings of current study suggest that simultaneous application of exteroceptive and proprioceptive senses could be used for improvement of dexterity in children with Down's syndrome and perhaps in children with motor control problems.  

Background and aim: The presence of the flexion relaxation phenomenon (FRP) during trunk flexion represents myoelectric  silence consistent with increased load sharing of the posterior discoligamentous passive structures. A number of studies have shown differences in the FRP between patients with chronic low back pain and healthy individuals, Persistent activation of the lumbar erector spinae musculature among patients with back pain may represent the body's attempt to stabilize injured spinal structures via reflexogenic ligamentomuscular activation for protecting them from further injury and avoiding pain.

Materials and methods: Two groups of female subjects ((20 - 40 years old) were participated in this study. First group consisted of 10 subjects with chronic low back pain (CLBP) and second group consisted of 10 healthy ones as control group. Both groups have performed 5 cycles of trunk flexion - extension . The speed of the movement repetition controlled by an electronic metronome . The EMG signals recorded from T12 and L3 paravertebral muscles and bisepse femoris on the right side. The lumbar flexion motion degree has been measured by the digital flexible goniometry.  All subjects have done Sorenson Back Endurance test in prone laying position. The subjects have extended their trunk up to the horizontal position and sustained in this position up to fatigue level .The subjects leave the table and asked to do 5 more cycle of trunk flexion - extension.

Results:  In patients group there is an increment and significant differences in lumbar flexion degree at the time of muscle EMG off  in comparison with healthy subjects after fatigue test (p<0.05). In both groups, the myoelectric silence period showed a significant change with respect to the pre- fatigue (p<0.05). The median frequencies shifted to lower frequencies after fatigue protocol (p<0.05).

Conclusion: Muscle reflexive responses would change following fatigue protocol. Therefore, the muscle activity will increase after the fatigue period. In the other hand, in patient group the role of the muscles as a stabilizer seems to be increased to enhance the stability at the injured segment after fatigue protocol .This protects the segment against pain and disability.

Background and aim: Chronic ankle instability (CAI) is a current disability that can affect on activity daily living of the patients. Many studies have indicated postural control deficits in these patients but the effect of a dual task on postural control has not been examined yet.

Materials and methods: Postural stability in CAI patients and healthy subjects was measured using the Force Plate. Eight positions concluded two different stances (double & single) with closed or opened eyes. All positions concurrently were done with a cognitive task. Anterior/posterior (Rfa) and medial/lateral (Rsw) mean sway quantified static postural stability.

Results: Mean sway significantly increased in patients in the anterior/posterior (single and double leg stance) and medial/lateral (single leg stance) directions (P<0.05). While performing a dual task anterior/posterior mean sway decreases within the patients group on the impaired leg stance (P<0.05). No difference is seen in the healthy subjects.

Conclusion: Postural control deficits were identified in participants with chronic ankle instability. In view of the fact that a cognitive task resulted in decreasing displacement of center of pressure in patients, this method may identify as an examination and a plan of treatment for affecting on ankle stabilizing factors.

Background and aim: Cognition of fatigue effects on motion response can improve treatment approaches. Determination of mechanism (maximal voluntary contraction and repetition of movement) that cause change of central responses and neuromuscular transmission have specific emphasis in evaluation and treatment of patients. Following fatigue it is arguable which is more important, neural or osteo-ligamental components. Behavior of para spinal muscles due to their roles in control of posture and spinal alignments are more importance. Gesture and motion pattern of neck and lumbar column following fatigue is due to accession of disorder in neuromuscular junction (NMJ) or limitation in reflex response at this system. Reflex influence is not just for muscle fatigue but also it appeared in synergic muscles. It is clear that stimuli and inhibitory ways have important role in this process.
Materials and Methods: Twenty normal subjects (10 female and 10 male) contributed in this study. Tests were including: 1- Training and warm up 2- Placement of recording electrodes on neck extensor muscles at second and forth spinal vertebra of dominant side. 3- Five motion of neck flexion and extension in sitting position at full range without external load. 4- Fatigue test, contain A- Maximal isometric contraction at middle range about 3 minute, which were controlled by a dynamometer until onset of fatigue. B- Fifty dynamic and cyclic motions of neck flexion and extension in full range of it. 5- Perform five motions similar stage 3 immediately after muscle fatigue. Three middle cycles were chosen for evaluation. Degree of off activities in flexion, degree of onset of activities in extension, silent period and mean of muscles activities (RMS), before and after fatigue selected for analysis.
Results: Comparison of two type of fatigue indicated that there are significant differences between them. Range of motion and eccentric activity were similar for two conditions. Isometric fatigue showed more effect than cyclic condition.
Conclusion: In neck motions flexion relaxation occurred. Dynamic motion and isometric activities caused muscle fatigue and changed silent period. This period reduced and it means that onset of extensor muscle activities occurred very soon and moved to middle and outer ranges. In this manner, naught privilege mechanical of non contractile elements in neck region is cause of this reduction. On the other hand extensor muscles have more responsibility for control and preservation of posture. Comparison of two approaches indicated that isometric activity produce more fatigue and spectral indexes such as median and mean frequency reduced markedly.

Background and Aim: Upper limb dysfunction is a common and disabling consequence of cerebral palsy. Any functional disorder in the hand can cause a person's independence to be disrupted and therefore his or her social independence is threatened. The purpose of this study was to determine the effects of volar static splint on hand function, spasticity and wrist and elbow range of motion of 8 to 12 years old spastic children.
Materials and methods: The design of this study was clinical trial and before_ after. Fourteen 8 to 12 spastic cerebral palsy children that have the inclusion criteria of study were selected from rehabilitation clinics of Tehran. The patient used a volar static splint (10 degree of wrist extension, full extension of fingers and abduction and opposition of thumb) for 2 mounts (2 hours during day and 4 to 6 hours at night). In this study Jebsen Taylor Hand Function Test was used to evaluate hand function. Modified Ashworth Scale was used to evaluate spasticity. A Goniometer was used to measure range of motion.
Results: The results of this study showed significant improvement in hand function  ,significant reduction in wrist spasticity  and elbow spasticity  and significant increase in wrist range of motion The data did not show any significance in elbow range of motion .
Conclusion: Our findings suggested that 2 months using of volar static splint in children with spastic cerebral palsy can improve hand function, wrist and elbow spasticity and wrist range of motion.