Review Article

The Effect of Strengthening Exercises on Functional Ability in Patients with MS: A Review Study

Narges Jahantigh Akbari, Nahid Tahan, Sedigheh Sadat Naimi , Nafiseh Momenzadeh, Saeed Mikaili

Journal of Clinical Physiotherapy Research, Vol. 5 No. 4 (2020), , Page e21

Introduction: Patients with multiple sclerosis (MS) usually report gait and balance disorders. Exercise therapy, especially strengthening exercise, is a safe and effective treatment approach in these patients. Therefore, the aim of this review study was to determine the effect of strengthening exercises on functional ability in patients with MS. Methods and Materials: A search of databases such as PubMed, science direct, Cochrane library, and Google scholar was reviewed to determine the existing articles on the effect of strengthening exercises on functional ability in patients with MS. Results: According to the evaluation of studies from 2000 to 2020, 8 articles met the inclusion criteria. These articles examined the effect of strengthening exercises on functional ability in patients with MS. The results showed that strengthening exercises improved balance variables, functional ability, strength, and quality of life. Conclusion: Various interventions including stretching, balance, strengthening exercises, and electrical stimulation have been used to treat balance disorders, decreased muscle strength, gait efficiency and quality of life in patients with MS. Among these interventions, strengthening exercises have been shown to play an effective role in improving functional ability, although more studies are needed in this area.

Case Report

Analysis and Simulation of the Effect of Knee Structure on the Condylar Forces

Farshaid Sadeghian, Mehrdad Davoudi, Narges Meftahi, Mohamad Parnianpour, Morad Karimpour

Journal of Clinical Physiotherapy Research, Vol. 5 No. 4 (2020), , Page e20

The varus deformity of the femur and the tibia leads to an increase in the medial condylar force, which may result in osteoarthritis in the medial condyle, if left untreated. Through Medial Open Wedge Osteotomy for these patients, it is possible to realign the load bearing surfaces of the knee joint which can lead to the tightening of some of the ligaments between the femur and the tibia on the medial side, and it can generate an excessive force on the medial condyle. The correction angle of osteotomy determines how much force is removed from the medial condyle, due to the realignment of the joint, and how much force is exerted due to the tightening of the Medial Collateral Ligament. If the post-surgical force exerted on the medial condyle is greater than the force was before surgery, it can cause even further damage in the medial condyle. OpenSim was utilized to simulate patients with varus deformity as well as calculating the Condylar forces during the gait cycle. The objective of this research is to find the critical correction angle in varus-aligned knee joints for specific patient; the threshold of the correction angle at which the medial condylar force increases after surgery, due to ligament tightening. Medial condylar force of the knee and tension in the Lateral Collateral Ligament (LCL) and Popliteofibular Ligament (PFL) in a specific subject show that a scenario with a 76 degree Medial Proximal Tibial Angle (MPTA) corresponding to 14 degrees of deformity is a critical point beyond which the surgeon must perform an MCL release. Without releasing of MCL during High Tibial Osteotomy (HTO), increased tension in this ligament make greater force in medial condyle after the surgery.

Original Articles

Effect of Prefabricated Insole with Shock Absorb Canal and Custom-Molded Insole on Pain and Function in Subjects with Plantar Fasciitis: A Pilot Study

Elahe Karami, Reza Vahab Kashani, Monireh Ahmadi Bani, Aliyeh Daryabor

Journal of Clinical Physiotherapy Research, Vol. 5 No. 4 (2020), , Page e25

Introduction: The purpose of this study was comparison of the effect of custom-molded insole and prefabricated insole with shock absorb canal on pain and function in subjects with plantar fasciitis. Methods and Materials: In this pilot study, fourteen patients with plantar fasciitis were non-randomly assigned to two groups of 7 people. A group received the custom-molded insoles and another group received the prefabricated insoles with shock absorb canal. Before the use of the insoles in each group, the patients ' pain and function were recorded. The pain score was measured by Visual Analog Scale (VAS). For evaluating the function, patients were asked to complete the foot and ankle ability measurement questionnaire (FAAM).Then, patients in both groups used insoles for 6 weeks. After a 6-week use of the insoles, the pain and function were recorded for the second time. Wilcoxon test was used for the effect of insoles in each group (comparison before and after the intervention) and Mann-Whitney test for comparison between two groups. Results: In comparison within each group, the findings showed that the use of both insoles after 6 weeks led to a significant decrease in pain score and a significant increase in the score of daily activities as well as sports activities compared with before use of insoles (P<0.05). There were no statistically significant differences in pain and function scores between the two groups after using the insoles (P>0.05). Conclusion: According to the findings, there was no significant difference between the custom-molded insole and the prefabricated insole in improving pain and function of patients with plantar fasciitis. However, both types of insoles reduced pain and improved the function, with more acceptable to the prefabricated insole.

Introduction: The purpose of this study was to compare the effects of Proprioceptive Neuromuscular Facilitation (PNF) exercises with mental imagery and working memory and combining these two types of exercises on dynamic balance, range of motion, and spasticity of Multiple sclerosis (MS) patients. Method and Materials: In this quasi-experimental study, 30 male MS patients were randomly assigned into three groups (n=10) of PNF, mental imagery and working memory training, and combination. The study included pre-test, intervention, and post-test. Timed Up and Go test, range of motion, and rate of muscles spasticity in active and passive extension of knee were measure in pre-test, and post-test. Intervention consisted of 6 weeks of exercise in each group. Data were analyzed using Paired Samples t-test, ANCOVA, Kruskal-Wallis, and Wilcoxon Signed Ranks Test. Results: The results showed that each of mental imagery and working memory training, and combination had a significant effect on dynamic balance (P<0.01), range of motion of passive and active knee extension (P<0.01) and spasticity of passive and active knee extension (P<0.01) in MS patients. No significant differences were found between training groups in any of the variables (P>0.05). Conclusion: Overall, the results of the present study showed that PNF, mental imagery, working memory, and combined training can be used to improve balance, range of motion, and spasticity of MS patients.

Introduction: Muscle fatigue due to exhaustive exercise is a common phenomenon that occurs during exercises and causes impaired motor function. The aim of the present study was to investigate the effect of one-stage global fatigue on the coordination and variability of joints and electrical activity of selected lower-limb muscles of elite rowers. Methods and Materials: A total of 14 rowers of the national men's rowing team participated in this quasi-experimental study. A rowing ergometer was used to induce global fatigue due to exhausting exercise. First, to measure mean power (MP), the subjects performed the 2000-m ergometer test. Fatigue protocol was performed after one week, (three 2-minute continuous tests with 60%, 90%, and 120% of MP). Electrical data of selected muscles were measured by electromyography and kinematic data were measured by IMU in 15 consecutive strokes at the beginning and end of the fatigue protocol. Shapiro-Wilk test was used to determine the normality of data distribution and dependent t-test was utilized to compare the dependent variables. P-value ≤0.05 was considered as the significant level in all tests. Results: The results showed a significant increase in the mean level of activity of biceps femoris, tibialis anterior, gastrocnemius medialis, and rectus femoris between pre-test and post-test (P≤0.05). The results also indicated a significant decrease in the coordination of ankle-knee and ankle-thigh joints in the sagittal plane and a significant increase in variability between ankle-knee joints in the sagittal plane and ankle-thigh joints in the sagittal and horizontal planes (P<0.05). Conclusion: Overall, fatigue seems to have a large effect on the mean activity and maximum activity of the muscles of the lower limbs in the sagittal and horizontal planes. Increased variability of the lower-limb joints following fatigue may be due to a decrease in strength or flexibility of the muscles in this area, which can adversely affect the performance of professional rowers and increase the risk of injury due to overactive musculoskeletal system.

The Effect of Aerobic and Parallel Exercise Methods on Selected Hematological Variables and Heart Function in Patients Aged 40 to 65 Years Following Coronary Angioplasty

Masoumeh Baghban Baghdadabad , Heydar Sadeghi, Hassan Matinhomaee, Yahya Sokhangoii

Journal of Clinical Physiotherapy Research, Vol. 5 No. 4 (2020), , Page e23

Introduction: Considering the important role of cardiac rehabilitation exercises for patients after coronary angioplasty, this study aimed to determine the effect of an eight-week parallel exercise period on hematological variables (red and white blood cells, hemoglobin, and hematocrit) and cardiac function (functional capacity, ejection fraction, and maximum oxygen consumption) in patients aged 40 to 65 years following the coronary angioplasty. Materials and Methods: In this semi-experimental study with pre-and post-test design, 90 men and women with coronary heart disease who underwent angioplasty, were randomly divided into two experimental groups (aerobic and parallel exercise) and a control group. Using the instructions of ACSM, 40 minutes of aerobic exercise in eight weeks for rehabilitate of heart patients (three times a week) in the aerobic exercise group, and 40 minutes of aerobic exercise (three times a week) and 20 minutes of resistance exercise program (twice a week) in parallel exercise group. The control group had no exercise other than the recommendation of three days of walking during the week. Kruskal-Wallis and Mann-Whitney U tests were implemented to compare pairs of groups in variables with abnormal distribution. In normal variables, the Levin test was used to check the homogeneity of variance of the data. Due to heterogeneity of variance, the Welch test and Tamhane's T2 Post-Hoc test were used for intra- and inter group comparisons at a significance level of 0.05. Results: Using parallel exercise, selected hematologic variables (hemoglobin and red blood cells) were significantly increased. Also, selected variables of cardiac function including (maximum oxygen consumption and ejection fraction and functional capacity) through aerobic and parallel exercises in middle-aged patients following coronary angioplasty, showed an increasing trend. The variable of maximum oxygen consumption in the parallel exercise group was significantly higher than the aerobic exercise group. Conclusion: According to findings, the beneficial effects of both regular aerobic and parallel exercises in appropriate intensity and duration with the priority of parallel exercise are recommended to improve hematological variables and cardiac function in patients 40 to 65 years after coronary angioplasty.