Journal of Clinical Physiotherapy Research

Introduction: To explore the effect of Motor Level peripheral Stimulation (MLS) on Corticospinal Excitability (CSE) in healthy participants and those with neurological disorders, and to establish stimulation parameters best suited to this purpose. Methods and Materials: A comprehensive search strategy was developed for identification of papers answering the review question. The studies identified were used to do meta-analyses. Results: Following motor-level stimulation, there was a significant change in CSE from baseline: 57.66% (95% CI). Subgroup analysis showed that there was a significant change in the 100Hz subgroup: 68.31% (95% CI) and the 20-50Hz subgroup: 80.14% (95% CI), but not in the <10Hz subgroup: 9.97% (95% CI). In addition, CSE changes was greater where intervention time = 30mins: 83.19% (95% CI), then where intervention time >30mins: 53.14% (95% CI). CSE showed no significant changes following ‘no stimulation”: 69.61% (95% CI). Conclusions: The findings indicate that MLS leads to increases in CSE; however, magnitude of change depends on the stimulation frequency and the area stimulated. It also appears that stimulation durations of longer than 30mins do not result in greater changes. Significance: The present review article hopes to catalyze further research into the determination of appropriate MLS treatment parameters for specific muscle groups.

Assessment of pain sensitivity, as an important criterion, is used in diagnosis of musculoskeletal impairments, which helps determine prognosis as well as the improvement rate after treatment interventions. Regarding the costs of modalities and treatment equipment used to reduce pain, having a reliable method to determine their efficacy is essential. The aim of the present study was to evaluate intra-examiner and between-day reliability of an accessible digital algometer to assess pressure pain threshold and for pain sensitivity for the first time. A total of 15 healthy young adult women aged 18-30 participated in the study. Three points of upper Trapezius muscle in both sides were tested in 3 repetitions with 30 seconds rest interval. The tests included PPT by controlled speed of increasing pressure and Visual Analogue Scale to evaluate local pain elicited by exertion of 2.5 kg/cm2 of pressure on the marked point. Trials were conducted on two consecutive days. Intra Class Correlation, Coefficient Standard Error of Measurement, and Minimal Detected Change were calculated to analyze the reliability of the measurements. Assessments revealed high to moderate intra-examiner reliability for pressure pain threshold (ICC>0.972) and pain sensitivity (ICC>0.707) and high to moderate between-day reliability for pressure pain threshold (ICC>0.974) and pain sensitivity (ICC>0.676). Although pressure algometer has an acceptable intra-examiner and between-day reliability for estimating the pressure pain threshold and pain sensitivity, a significant decrease was revealed in the mean values of PPT and increase in PS on the second day, as compared to that on the first day, (P<0.05) which could be related to local tissue trauma, learning effect, or central sensitization.

Introduction: Genu varum and genu valgum deformities are highly prevalent in Iran. These deformities bring about changes in the structure and function of muscles around the knees. The aim of the present investigation was to study the structure of medial and lateral gastrocnemius muscles in patients with primary genu varum and genu valgum deformities and individuals with normal knee alignment, using rehabilitative ultrasound imaging. Method and Materials: : A Honda 2100 (Honda Co., Japan) real time ultrasound scanner was used in the current the study. The dominant legs of 18 women, 6 with genu varum (mean age: 22.00±1.78 years), 6 with genu valgum (mean age: 21.67±1.03 years), and 6 with normal alignment (mean age: 21.83±1.72 years) were examined. The morphological parameters like muscle thickness, pennation angle and fascicle length of medial and lateral gastrocnemius muscle were compared among groups. Results: In participants with genu varum, the medial gastrocnemius was thinner, closer and shorter in terms of muscle thickness, pennation angle, and fascicle lengths when compared to the lateral gastrocnemius (P<0.05). However, in participants with genu valgum, it was the other way around (P<0.05). In participants with normal alignment, there was no statistically significant difference between the medial and lateral gastrocnemius muscle structures. Conclusions: The rehabilitative ultrasound imaging is highly recommended for studying the structure of gastrocnemius muscle. The structural differences between medial and lateral gastrocnemius muscles may be due to the long term neuromuscular adaptation to knee joint alignment in both genu varum and genu valgum deformities.

Introduction: Children with Attention Deficit Hyperactivity Disorder (ADHD) face many academic and training problems and also impose some problems on their teachers and classmates. Motor learning can be categorized into two main types: implicit and explicit. The main goal of the present study was to investigate the possible differences between implicit and explicit motor sequence learning in children with ADHD and normal children by using serial reaction time task. Materials and Methods: The sample consisted of 24 children with ADHD, who were equally assigned to explicit and implicit learning groups, and 24 normal children, also equally assigned to implicit and explicit learning groups. Each group, therefore, consisted of 12 participants. Repetitive Measure ANOVA was run to compare reaction time and error in different blocks, and squared t-test was used to compare regular and irregular blocks. Results: Comparison of implicit and explicit learning for accuracy (the number of reaction errors) and speed (response time) revealed the accuracy to be P=0.012 and speed P=0.012 in ADHD explicit group, and accuracy P=0.094 and speed P=0.954, in ADHD implicit group. Normal explicit group indicated accuracy of (P=0.008) and speed of (P=0.05) and normal implicit group indicated accuracy of (P=0.011) and speed of (P=0.442). Conclusion: The results of the present study indicated that explanation and description of the task was more effective in motor sequence learning in ADHD children. It is, therefore, recommended that pre-exercise training be included in the programs provided to these children.

Introduction: The aim of the present study was to determine the effectiveness of massage with camel hump oil on muscle tone in the lower limb compared with olive oil on children with spastic diplegia cerebral palsy. Materials and Methods:  The study was performed using a single subject design. Six children were selected based on available sampling. The study lasted 10 weeks for each person, which includes five phases: 1-baseline (two weeks), 2-massage with olive oil (two weeks), 3- baseline (two weeks), 4- massage with camel hump oil (two weeks), and 5- baseline (two weeks). At each stage, muscle tones of Hamstring, hip adductors, and calf muscles were evaluated using the Modified Ashworth Scale. The visual analysis and Mann-whitney U test were used to evaluate differences between phases. Results: A significant difference was observed between the adductor (in 4 cases), hamstrings (in 4 cases), and calf muscles tone (in two cases) (P<0.05), demonstrating the higher effect of massage with camel hump oil compared to that with olive oil. Conclusion: It seems that camel hump oil may be more effective in some cases than olive oil in reducing muscle tone, but the overall conclusion requires further studies.

Introduction: Chronic Neck Pain (CNP) and Forward Head Posture (FHP) are two common musculoskeletal problems of the modern society. Previous studies reported several complications both in CNP and FHP including Joint cervical position sense dysfunction, sensorimotor disturbance, and altered muscle function. However, still, the extent of cervical proprioceptive dysfunction in FHP and CNP is not well known. Therefore, the aim of the present study was to investigate the cervical position sense in individuals with FHP and patients with CNP. Method and Materials: A total of 25 individuals with FHP and 25 patients with CNP participated in the present study. Craniovertebral Angle (CVA) was measured to identify individuals with FHP. Participants’ cervical position senses were calculated performing Head Repositioning Error (HRE) test. Also, independent t-test was run to compare the HRE between the two groups. Finally, in order to evaluate the association between pain and CVA with HRE, Spearman correlation was conducted. Results: The results of the present study revealed a significant difference between the two groups in terms of HRE (p=0.02), with higher HRE in patients with CNP. A moderate positive correlation was observed for CVA and HRE. No significant relationship was found between pain and HRE. Conclusions: The results of the present study showed that patients with CNP have higher HRE, indicating more cervical proprioceptive dysfunction in such patients compared with those in individuals with FHP. This finding may be of interest for those researchers investigating the effects of pain and mechanical loads on cervical position sense.

Introduction: Postural control is necessary to carry out all daily activities. It is the result of corporation between somatosensory, visual, and vestibular systems. Disturbance of each of these systems can lead to impairment of postural control and increased risk of falling and injury. The objectives of the present study were to investigate the effect of lumbar muscle fatigue on postural sway as well as the effect of kinesiotaping on postural sway after lumbar muscle fatigue. Methods and Materials: A total of 15 healthy young men participated in the present cross-over randomized study. Participants’ mean velocity and sway area were assessed using force platform in bilateral standing position with their eyes closed and in three conditions: 1. Baseline, 2. After fatigue without taping (NT), and 3. After fatigue with kinesiotaping (KT). At baseline measurements, no intervention was carried out on the participants. For the non-taping condition, tape was not applied during postural sway measurement. For the taping condition, kinesiotape was applied on lumbar area before fatigue protocol. Lumbar extensor fatigue was produced maintaining 60% of maximum voluntary isometric contraction. Repeated measure ANOVA was used for data analysis. Results: After lumbar extensor fatigue, sway area, and mean velocity were significantly higher than baseline measurements, respectively. Sway area between KT condition and NT condition (0.63±0.19 cm₂)was not found to be significantly different (P=0.066), while velocity of sway in KT condition was significantly lower than that in NT condition (P=0.006). Conclusions: Lumbar muscle fatigue impaired postural control. Lumbar muscle kinesiotaping may be useful to reduce the negative effects of fatigue on postural control.

Introduction: The aim of the present study was to investigate the effects of Wii Sports training on balance, Walking speed, Visual-Motor Integration, and independent standing of two adolescents with spastic diplegic Cerebral Palsy (CP). Materials and Methods: Two adolescents with spastic diplegic CP who had Gross Motor Function Classification System (GMFCS) level Ш participated in intensive Wii Sports training program for two weeks. The Visual-Motor Integration (VMI), Berg Balance Scale (BBS), walking speed, and independent standing time scores were recorded before the intervention and at the end of 12 training sessions. Two adolescents with spastic diplegic CP who had Gross Motor Function Classification System (GMFCS) level Ш participated in intensive Wii Sports training program for two weeks. The Visual-Motor Integration (VMI), Berg Balance Scale (BBS), walking speed, and independent standing time scores were recorded before the intervention and at the end of 12 training sessions. Results: Both adolescents demonstrated improvements in the VMI, BBS scores, durations of independent standing, and walking speed. Conclusions: Wii is a low-cost gaming system that can be effective in adolescents with spastic diplegic CP with GMFCS level Ш, yet further studies are required for definitive claims.