Review Article

Diagnostic Ultrasound Imaging in Rehabilitation

Ali Bozorgmehr, Soheila Abbasi, Javad Sarrafzadeh, Holakoo Mohsenifar, Mohammad Reza Pourahmadi

Journal of Clinical Physiotherapy Research, Vol. 2 No. 2 (2017), , Page 51-54

Muscles that are attacked by neuromuscular disorders are integral parts of the musculoskeletal system, so the evaluation of this system is very important for therapists. Measurement of muscle morphology with rehabilitative ultrasound imaging has attracted  much attention in recent years and researcher have demonstrated that it is a practical tool for physical therapists; however, far too little attention has been paid by therapists to it. This paper has tried to provide some relevant information about this method.

Keywords: Imaging, Ultrasound, Rehabilitation, Musculoskeletal

Original Articles

Introduction: Sway-Back Posture (SBP) is one of the most common poor postures especially among the female gymnastics athletes. It can result in multifidus muscles insufficiency and inability to support the spinal column. The aim of this study was to evaluate the intra-rater reliability of ultrasound imaging to measure the thickness of lumbar multifidus (LMM) muscle at different lumbar levels during both states of muscle at rest and contraction. Materials and Methods: The subjects of this study were 10 females’ gymnastics athletes among whom five had sway back posture. To have the posture assessed the plumb line and grid paper were used. The LMM thicknesses of all lumbar segments were measured thrice (with 1houre minutes interval) by the same examiner in both rest and contraction position simultaneous with arm lifts done by a real time Ultrasonography device. Results: The results of the relative and the absolute reliability of LMM thickness measurements at the state of rests were 0.97 < ICC < 0.99, 0.34 < SEM < 0.48 and 0.94 < MDC< 1.34 and at the state of contractions they were as: 0.95 < ICC < 0.98, 0.47< SEM < 0.71 and 1.31 < MDC< 1.98. The results of the Bland-Altman plotting indicated a good level of agreement between two measurements at all lumbar levels in both states of rest and contraction. Conclusion: The results of this study indicated that the method of ultrasonography had a high level of reliability and accuracy to measure the thickness of LMM in both states of muscle at rest and contraction. The method is highly recommended in physiotherapy and rehabilitation assessments.

Key words: Gymnastic, Lumbar Multifidus Muscle, Reliability, Sway-Back Posture, Thickness, Ultrasound Imaging

Introduction: To study the effects of transcutaneous electrical nerve stimulation (TENS) on postural control in chronic low back pain (CLBP) patients. Materials and Methods: The current study is an experimental one with twenty eight patients suffering from chronic LBP (25-45 Y/O). At first non-random sampling technique was used to have the study subjects selected, using block randomization, then, we assigned them to main groups known as intervention and control. The mean center of pressure (COP) velocity and displacement were measured at three time intervals; prior to the intervention, once the intervention was provided and thirty minutes after it. The tests were done with eyes open and closed on a force platform. Sensory electrical stimulation was applied through the TENS device. Descriptive statistics, independent sample test, repeated measurement and ANOVA with repeated measurement on time were used for data analysis. Results: The results of the present study demonstrated that the application of sensory electrical stimulation among patients with CLBP could improve the postural control in Medio-lateral immediately after and 30 minutes following the application of TENS among the patients with their eyes closed (P<0.05). Also, COP displacement and velocity in ML direction with eyes closed significantly decreased immediately and 30 min after application of sensory electrical stimulation in the intervention group in comparison with the control group (P<0.05). Conclusion: Low frequency TENS with contraction level amplitude seems to have positive effects on postural control in patients suffering from CLBP. So, this study showed the effectiveness of low frequency TENS to imprive postural control in patients with CLBP.

Key words: Chronic Low Back Pain, Postural Control, Transcutaneus Electrical Nerve Stimulation

Studying the Plantar Pressure Patterns in Women Adapted to High-Heel Shoes during Barefoot Walking

Abbas Rahimi, Atefeh Sayah, Seyed Majid Hosseini, Alireza Akbarzadeh Baghban

Journal of Clinical Physiotherapy Research, Vol. 2 No. 2 (2017), , Page 70-74

Introduction: The feet are the only anatomical structures of the body which are in touch with the ground and complete the lower limb chain to bear the ground reaction forces (GRFs). Inappropriate distribution of the GRF as a result of the long-term use of high-heeled shoes causes an excessive stress which results in a wide-range of musculo-skeletal disorders mainly in feet and leg areas. Due to the increased rate of using high-heeled shoes in the world and because of the lack of knowledge about feet pressure patterns in this condition, the current study focused on studying the pressure in different parts of the foot in barefoot women who used to(were accustomed to wearing) wear high-heeled shoes for a long time. Materials & Methods: In this observational analytical case-control study, two groups of 35 subjects, were recruited. The feet pressure indexes of the experimental group of women who were habituated to wearing high-heeled shoes for the last 2 years were compared with women in the control group who wore shoes with normal heel height. A Zebris pedobarograph (Zebris Company, Germany) system was used to study the subjects’ feet planter pressure during the static (double stance) and the dynamic (walking with self-selected speed) conditions. All tests were run amog subjects with their feet bare. Results: The statistical analysis showed a significantly stronger pressure on feet in participants with high-heeled shoes than the ones in the control group (P<0.001). Conclusion: The finding of this study suggested that long-term use of high-heeled shoes results in some changes on the distribution of body weight on feet even during barefoot standing and walking positions. In other words, individuals wearing high-heeled shoes involuntarily press a greater percentage of their body weight on the front part of their feet, which may results in pathological conditions of their feet such as callosity, corns or ulcers beneath their forefoot.

Keywords: High-Heel Shoes, Foot Pressure, Pedobarography, Women

Reliability of the Thickness Measurement and Histogram of Elbow Flexors by Ultrasonography in Patients with Fascioscapulohumoral Dystrophy and Healthy Subjects

Shideh Badeleh, Asghar Rezasoltani, Alireza Akbarzadeh Baghban, Mehdi Vahid Dastjerdi, Omid Aryani, Behzad Lahouti

Journal of Clinical Physiotherapy Research, Vol. 2 No. 2 (2017), , Page 75-79

Introduction: Ultrasonography is a non-invasive and available technique used to assess normal and pathological tissue in people with neuromuscular diseases. The aim of this study was to determine relative and absolute reliability of ultrasonography in evaluation of thickness and histogram of elbow flexor muscles in patients with facioscapulohumeral muscular dystrophy (FSHD and healthy subjects. Materials and Methods: The present study was carried out on an experimental group of six patients with FSHD and a control group comprising 6 healthy individuals. The thickness and histogram of elbow flexors were evaluated while subjects were in sitting position with knees bent, arms at 90 degrees abduction, elbows at 90 degrees flexion and forearms in neutral position. The probe was placed on the anterior surface of arm at 2/3 distance between the lateral tip of acromion and the lateral epicondyle of the humerus. Standard deviation of echogenicity based on histogram curve was also used to estimate the echogenic uniformity of muscle tissue (STDE), subsequently two parameters including L-mean and STDE were recorded. The intra-class correlation coefficient (ICC), standard error measurement (SEM) and minimal detectable changes (MDC) tests were applied to measure relative and absolute reliability and to estimate the measurement errors. Results: The values of the reliability of muscle thickness measurement were ICC=0.95, SEM=2.14 and MDC=5.94 and ICC=0.95, SEM=1.34 and MDC=3.72 in the experimental group and the control group respectively. Additionally, for L-mean measurements it appeared to be ICC=0.89, SEM=1.75 and MDC=4.86 among patients and ICC=0.66, SEM=1.04 and MDC=2.89 in healthy subjects. Finally, the reliability of STDE measurement was revealed to be ICC=0.98, SEM=0.18 and MDC=0.51 and (ICC=0.75, SEM=0.63 and MDC=1.74) among the participants of the experimental and the control groups. Conclusion: The results of this study showed that ultrasonography method used in this study had a high level of accuracy to measure the thickness and histogram of elbow flexors in both healthy subjects and patients with FSHD. The method can be recommended to compare or determine the effectiveness of different treatment methods in patients with FSHD.

Key words: Elbow Flexors, Fascioscapulohumoral Dystrophy Histogram, Reliability; Thickness, Ultrasonography

Introduction: Patients with ACL reconstruction often return back to activity with diminished quadriceps activity and strength.  (Patients suffering from ACL can be often rehabilitated with the help of ACL reconstruction, although quadriceps strength and muscle activity might be weak or limited after the surgery.)The present study aimed to compare the effect of Transcutaneous Electrical Nerve Stimulation (TENS), Functional Electrical Stimulation (FES) and Biofeedback Electromyography (B-EMG) on improvement in quadriceps strength and mean value of VMO activation pattern (MVVA) among patients with reconstruction of ACL. Materials and Methods: The study was designed as a randomized control trial. 102 patients, who filled a demographic questionnaire relating to important factors mainly age, height, and weight before the intervention, (all sportsmen) were randomly divided into four groups known as, FES (n=21), TENS (n=21), B-EMG (n=22) and control (n=38). In this study, hand-held dynamometry and biofeedback electromyography were used to assess Quadriceps strength and MVVA respectively. All samples were evaluated at three different time intervals, including prior to the, after and 4 weeks after the treatment.  Additionally, all four groups received Ice pack around the knee and Michle Duck exercise therapy protocol. The treatments provided totally lasted 3 to 5 weeks. The participants in 4 groups received TENS, FES and B-EMG as their main treatments 5 times a week for 45, 15 and 15 minutes successively. Results: The mean scores of MVVA and quadriceps strength after the intervention and after the follow-up increased significantly in all four groups. However the effect of FES on MVVA in comparison with TENS and control group was statistically meaningful in favor of FES group. (As instructed here the last sentence omitted) Conclusion: TENS, FES and B-EMG in combination with cryotherapy and exercise as well as cryotherapy with exercise can reduce VMO inhibition and improve quadriceps strength in patients who undergo ACL reconstruction. However FES in combination with cryotherapy and exercise can be the most effective one.

Key words: ACL Reconstruction, Biofeedback, Functional Electrical Stimulation, Quadriceps Inhibition, TENS

Evaluating the Psychometric Properties of the Persian version of Parkinson Fatigue Scale (PFS-16) in Patients with Parkinson's Disease

Delaram Baghoori, Maryam Mehdizadeh, Mehdi Rezaee, Seyed Amir Hassan Habibi, Navid Mirzakhany

Journal of Clinical Physiotherapy Research, Vol. 2 No. 2 (2017), , Page 88-93

Introduction: Parkinson’s disease (PD) is one of the common disorders in the central nervous system. Among non-motor symptoms, fatigue is the most widespread one with prevalence rates of 40-65 that can have an impact on the quality of life of patients. The aim of this study was to evaluate the validity and the reliability of the Persian version of Parkinson Fatigue Scale (PFS-16). Materials and Methods: 70 patients with PD (mean age: 62.7±11.6) participated in this study through non-probability and available sampling method. Test-retest reliability and internal consistency were used to measure the reliability and the Fatigue Severity Scale (FSS), Parkinson's disease questionnaire (PDQ-8) and Visual Analogue fatigue Scale (VAS-F) were employed to measure the criteria validity. Results: Cronbach's alpha and ICC of the Persian version of PFS-16 were both measured to be 0.97. In addition, Kappa coefficient for each item of the scale was measured to be between 0.76 and 1.00, which indicated a very good level of reliability. Correlations between PFS-16 and FSS, PDQ-8 and VAS-F were estimated to be 0.58, 0.51 and 0.49, respectively. Conclusion: Results indicated high reliability and the validity of Persian-version of the mentioned scale. Therefore, its application in related studies is highly recommended.

Key words: Fatigue, Parkinson’s disease, Parkinson Fatigue Scale (PFS-16), Reliability, Validity

Case Report

Physiotherapy Approach in Group Dysfunction: A Case Study

Sahar Zamani, Farshad Okhovatian

Journal of Clinical Physiotherapy Research, Vol. 2 No. 2 (2017), , Page 94-98

The current study was conducted on a 25 year- old man who had an experience of a car accident 3 years ago and was suffering a lot of pain in lumbar and pelvic regions during last seven months.  He was carefully examined and assessed during the study. This person who also had an experience of a car accident 3 years ago was carefully examined and assessed during the study. A multimodal physical approach based on manual therapy, electrotherapy and exercise therapy was adopted to eliminate the pain and to correct malalignments. The patient received 15 treatment sessions and depending on the patient’s status, the intervention techniques varied every session. He was re-examined to have the effectiveness of the treatment process evaluated in first, 5th, 10th and last sessions. Reassessment of the patient was done every other five sessions in order to change the treatment procedure, if there was no improvement in symptoms. This study showed that detailed assessment and re-assessment during the treatment sessions had a significant effect on improvement of the symptoms In addition, according to the patient’s needs, different interventions could be used every session. However, Patient’s satisfaction, Physician and limitations about medical insurance have to be considered. Improvement in daily life activity and function, and reduction of pain immediately after the treatment supported the beneficial response obtained by physiotherapy approach in group dysfunction of lumbar and pelvic.

Key words: Case Study, Group Dysfunction, Low Back Pain, Pelvic Pain