The Effect of Transcranial Direct Current Stimulation and Core Stability Training on the Balance and Disability of Patients With Multiple Sclerosis

Purpose: Physicians report balance disorders and fatigue as the symptoms of Multiple Sclerosis (MS) disease. The present study compares the effect of transcranial Direct Current Stimulation (tDCS) and core stability training on the balance and disability of patients with MS. Methods: This is a pre-test, post-test experiment study. The statistical population included all patients with MS who reffered to Rofaydeh Rehabilitation Hospital in Tehran City, Iran, in the winter of 2019. A total of 30 male and female patients aged 27-70 years were selected through available and purposive sampling methods and then randomly divided into experimental and control groups (each group 15 persons). The initial measurements of the participants’ kinetic variables of postural control were carried out by the posturography device, and afterward, Kurtzke Expanded Disability Status Scale (EDSS) was employed to measure disability. The participants’ training included core stability training for 8 weeks (30-40 min, 3 sessions per week) with 20 min online cerebellar transcranial direct current stimulation, 2 sessions per week (The first and third sessions). Then, the research variables were measured again. Results: The results demonstrated the significant influence of cerebellar tDCS on the variables of postural control equilibrium in the second sensory condition (P<0.001), third sensory condition (P<0.001), fourth sensory condition (P<0.001), fifth sensory condition (P=0.034), and combine equilibrium (P<0.001). Besides, the cerebellar current stimulation enhanced the sensory performance of the experimental group in using the vestibular system input data (P<0.001) and vision (P<0.001), but it had no significant effect on the ability to use somatosensory input (P=0.203) and vision preference (P=0.343). This research also revealed that the cerebellar current stimulation decreased EDSS in MS patients (P=0.026). Conclusion: The cerebellar tDCS has a beneficial effect on balance, EDSS, and modified fatigue impact scale in MS patients. The study findings also indicate that the cerebellum, vestibular system, and visual system are related, and they have an impact on balance, and cerebellar stimulation can facilitate learning motor skills.

Oral Rehabilitation Using the Lip Muscle Trainer: A Narrative Review

A lot of time is spent on exercising the body parts while the lips are neglected, despite the evidence on the wide-ranging effects of lips on overall health and quality of life. Oral rehabilitation by Patakara lip muscle trainer leads to a strong lip closure which can stand as the first-line defense mechanism against many oral dysfunctions related to aging. In the absence of a narrative review presented on this trainer, this paper focuses on the components, instructions for use, and oral health indications of the Patakara lip muscle trainer. This trainer could enhance many oral dysfunctions in the elderly as oral breathing, snoring, halitosis, dry mouth, and oral/gastrointestinal dysfunction, but future studies are needed in this field.

Neuromuscular Electric Stimulation Versus Traditional Treatment on Harris Hip Score in Cases of Avascular Necrosis of Femoral Head After Kidney Transplantation

Purpose: Usually, about 25% of the patients treated with corticosteroids after kidney transplantation suffer from the complication of Avascular Necrosis (AVN) of the femoral head. This study aims to compare the effect of Neuromuscular Electric Stimulation (NMES) and traditional treatment (infrared and decrease weight-bearing) on Harris hip score. Methods: Twenty patients who developed AVN of the femoral head after kidney transplantation were divided into two groups. The first group was treated by NMES and stretching and strengthening exercises 3 sessions a week for 3 months. The second group was treated by Traditional Treatment (TT) and stretching and strengthening exercises 3 sessions a week for 3 months. Results: Harris hip score component was measured before the intervention and then three months after the intervention using the t-test. After the intervention, significant differences were found between both groups in pain, support, distance walked, limping, putting on shoes and socks, climbing stairs, sitting, flexion (all P<0.001), external rotation (P=0.014), abduction (P=0.030), adduction (P<0.001), public transportation (P=0.010), and total hip score (P<0.001). Conclusion: TT exercises accompanied by NMES were more effective than TT alone for AVN of femoral head patients and could stop the progressive worsening of hip joint mobility.

The Relationship Between Maximum Jump Performance and Force-time Variables of Block Landing Skill in Junior Elite Volleyball Players

Purpose: Frequent and powerful jumps and landings in volleyball exert significant stresses on lower extremities which can be determinant of injury prevalence. This study aimed to investigate the possible correlation between Maximum Jump (MJ) performance and force-time variables of volleyball block landing. Methods: Thirty elite junior volleyball players (Mean±SD of age: 18.140±1.125 y, sports background: 4.390±0.957 y, and height: 197.100±3.161 cm) performed three block jumps, and best of trials was considered for further analysis. The study data were collected by the KISTLER force platform (1000 Hz). Force-time, velocity-time, and displacement-time were obtained using the Excel program. The Kolmogorov-Smirnov and Pearson correlation coefficient were used for assessing data normality and possible correlations between variables using SPSS v. 21 (P<0.05). Results: Peak vertical impact forces were reported in a range of 1.8-3.5 BW (F1, F2) during 27 to 83 ms of peak times (T1, T2). Significant positive correlations were obtained between temporal variables of time of peaks (T1, T2), the time elapsed between peaks (TP), and end of landing time (Tf). A significant negative correlation was found between F2 and T2 and a significant positive correlation between MJ performance with peak vertical forces (F1, F2). Conclusion: According to the findings, T1 has little impact on shock absorption. Coaches and volleyball players should consider the importance of soft landing through increasing T2, which decreases F2, not only for performance improvement but also for reducing injuries.

Dry Needling Plus Conventional Physiotherapy for Patients With Chronic Nonspecific Neck Pain: A Randomized Clinical Trial

Purpose: This study aimed to evaluate the effect of conventional physiotherapy plus Dry Needling (DN) technique in patients with chronic nonspecific neck pain with Sternocleidomastoid (SCM) and Upper Trapezius (UT) muscles involvement. Methods: This study was designed as a single-blind randomized clinical trial. A total of 39 patients (19 men and 21 women) with chronic non-specific neck pain with a Mean±SD age of 38.13±5.68 years, a Mean±SD height of 168.28±8.34 cm, and a Mean±SD weight of 75.78±9.02 kg participated in this study. They were randomly divided into conventional physiotherapy (control group: n=19) and conventional physiotherapy plus DN (intervention group: n=20). SCM and UT muscle pain, neck disability, and thickness were assessed for all participants in the pre-test, post-test, and follow-up periods. This study was reviewed and approved by the Faculty of Physical Education and Sport Science, University of Kharazmi, Tehran, Iran. Repeated measures analysis of variance and Bonferroni post hoc tests were used for data analysis using SPSS v. 22. Results: The results of 1-way analysis of variance showed that pain, neck disability, and SCM and UT muscle thickness in the intervention group had a significant decrease compared to the control group in the post-test and follow-up period (P<0.05). Also, according to the results of the corrected Bonferroni post hoc test, the intervention group showed a greater effect size than the control group in the post-test and the follow-up periods in the above variables. Conclusion: The present study results show that adding DN to conventional physiotherapy for neck pain can increase the effectiveness of intervention in relieving pain, disability, and SCM and UT muscle thickness in people with chronic neck pain.

The Effect of Three Methods of Kinesthetic Imagery, Active, and Combined Exercises on Electromyographic Pattern of Hip Hyperextension and the Muscle Strength of Gluteus Maximus and Abdominal in Women With Lumbar Hyperlordosis

Purpose: Mental exercise uses the same neuronal pathways involved in physical exercise to modify the pattern and function without stress caused by physical exercise. This study investigates the effect of kinesthetic imagery, active, and combined exercises (imagery and active) on the hip hyperextension and the power of selected lumbopelvic muscles in women suffering from lumbar hyperlordosis. Methods: In this quasi-experimental study, 36 women with lumbar hyperlordosis (age range: 30-40 years, non-athlete and without injury and surgery in the lumbar region) were selected and divided into three groups. The groups practiced three sessions per week for six weeks. We assessed the lumbar lordosis by a flexible ruler and the electromyographic (EMG) activity of the lumbopelvic muscles during hip hyperextension in the prone position by surface electromyogram. We also measured the power of the gluteus maximus using a dynamometer during hip hyperextension and the abdominal muscles using a goniometer during the double leg lowering test. All of the measurements were done before and after the intervention. The normality of the data was checked by The Shapiro-Wilk test, and the obtained data were analyzed by repeated-measures ANOVA test at the significant level of 0.05. Results: The variables of lumbar lordosis were significantly reduced in the active and combined groups in the post-test compared to the pre-test, and the strength of gluteus and abdominal muscles in the active and combined groups in the post-test significantly increased compared to the pre-test. However, the lumbar lordosis and strength of gluteus and abdominal muscles in the post-test were not significantly changed compared to the pre-test. Gluteus maximus and abdominis transverse muscle activity rates in the combined group increased significantly in the post-test compared to the pre-test, and gluteus maximus muscle activity rate in the active group increased significantly in the post-test compared to the pre-test. Gluteus maximus muscle activity in the imagery group increased significantly in the post-test compared to the pre-test. The activity of lumbar erector spinae and rectus femoris muscles decreased significantly in the active and combined groups in the post-test compared to the pre-test. However, the activity of the rectus femoris muscle decreased significantly in the image group in the post-test compared to the pre-test (P≤0.05). The results showed a significant difference between the three methods of kinesthetic imagery, active, and combined (P=0.001). There was a significant difference between the method of the imagery exercise and the active and combined exercise methods but no significant difference between methods of the active and combined exercise. Conclusion: Imagery exercises effectively modified the EMG of some lumbopelvic muscles (gluteus maximus and rectus femoris muscles). However, it had no significant effect on the strength and degree of lumbar lordosis. The combined exercise was as effective as active exercise in modifying the EMG activity of the lumbopelvic muscles and the strength of the abdominal and gluteus maximus muscles.

Comparison of Knee Kinematic Factors Between Ball and Rocket Athletes in Predictable and Unpredictable Cutting Maneuvers

Purpose: Anterior cruciate ligament injury is one of the most severe knee injuries that often has a non-contact mechanism and follows an incorrect knee joint alignment. The present study aimed to compare the effect of predictable and unpredictable cutting direction on knee joint kinematics in ball and racket athletes. Methods: The present study was quasi-experimental, and the subjects included 48 female adolescent athletes from badminton (n=12), table tennis (n=12), basketball (n=12), and handball (n=12). After the initial evaluations, the cutting maneuver was performed in predictable and unpredictable ways and recorded by a three-dimension motion analysis. Also, 1-way ANOVA and post hoc tests were used to compare the kinematic parameters of the knee between the ball and racket athletes. Results: The results of the statistical test showed a significant difference in the kinematic parameters of knee flexion (P=0.003), knee valgus (P=0.001), and tibia rotation (P=0.001) between the ball (basketball and handball) and racket athletes (badminton and table tennis) in the predictable cutting. But in the unpredictable cutting, there were no significant differences in the kinematic parameters of the knee flexion (P=0.86), knee valgus (P=0.56), and tibia rotation (P=0.18). Conclusion: The results indicated that ball athletes showed an increased kinematic risk factor such as decreased knee flexion, increased knee valgus, and tibia rotation more than rocket athletes. Therefore, injury prevention programs are more critical in ball athletes.

Investigating the Relationship Between Lower Limb Flexibility With Motor Function and Risk of Falling in Visually Impaired Individuals

Objective: The present study aimed to investigate the flexibility of the ankle and knee joints and to determine its relationship with balance, motor function, and risk of falling in visually impaired individuals. Methods: The sample consisted of 32 blind males, 20-30 years old. They were selected by the purposeful sampling method. We used modified stork tests, tendon gait, and Berg balance scale to evaluate their balance. The Tinetti test was used to evaluate motor performance and the Timed Up and Go (TUG) test to assess the risk of falling. The SLR test and Lunge test were used to assess the range of motion of the knee and ankle joint, respectively. This study was conducted in the men’s dormitories of Tehran University in the fall of 2019. The obtained data were normalized using the Shapiro-Wilk test and Pearson correlation coefficient at the significant level of 0.05 to investigate the relationship between the variables. Results: The results of the Pearson correlation test showed a significant relationship between balance (P=0.001), motor function (P=0.002), and TUG fall risk test (P=0.010) (ankle motor restriction). On the other hand, there was a significant relationship between balance (P=0.002), motor function (P=0.001), and TUG fall risk test (P=0.003) with hamstring flexibility test (knee motor restriction). Conclusion: Given the significant relationship between the range of motion of the lower limbs with balance and motor function, the use of stretching exercises can be an influential factor in increasing the range of motion of the ankle and knee in blind people, which improves balance, motor function, and reduced risk of falling in blindness.

Comparison Between Spatiotemporal Parameters and Vertical Ground Reaction Force in Ankle Sprain Coper and Healthy Athletes: A Cross Sectional Study

Purpose: It is essential to maintain dynamic stability during walking to perform daily tasks independently. The present study aimed at comparing the spatiotemporal parameters and the values of the vertical Ground Reaction Force (vGRF) as well as determining the time to reach them in ankle-sprain coper and healthy athletes during the stance phase of gait. Methods: A total of 28 female university athletes were recruited in this cross-sectional study and assigned into two groups: ankle-sprain coper (n=14) and healthy control (n=14). The gait cycle analysis was then performed on a 10-m path, and the information related to the stance phase was recorded by a foot scanning device. The spatiotemporal parameters (gait line and contact time) and the values of the vGRF along with the time to reach them were subsequently obtained from each test. The repeated measures Analysis of Variance (ANOVA) was additionally used to analyze the data (P≤0.05). Results: The study results revealed no differences between the injured and the healthy feet in the ankle-sprain coper group in any of the variables (P>0.05). As well, the spatiotemporal gait cycle parameters between the ankle-sprain coper group and the healthy controls were not significantly different (P>0.05). However, significant differences were observed between the ankle-sprain coper and healthy controls in terms of the variables of the vGRF in the mid-stance (F=5.25, P=0.03) and the time to reach the second peak of the vGRF (F=9.13, P=0.006). Conclusion: The spatiotemporal gait parameters were not significantly different between the ankle-sprain coper and the control groups, but the vGRF in the ankle-sprain coper was greater than that in the control group. With regard to the correlation between the reduction in the vGRF and the secondary injury, it is recommended to pay much attention to this point in rehabilitation programs following the first injury in female athletes.

Comparison of Upper Limb Disability in Overhead Women Athletes of Handball, Volleyball, Softball, and Swimming

Purpose: The shoulder joint is one of the most commonly injured joints in sports and may lead to disability, especially in the upper extremities of overhead players (handball, volleyball, softball, and swimming). Methods: This research is a causal-comparative study. After the approval of the Ethics Committee of the Medical University of Tehran, this study was conducted on 120 overhead athletes (Mean±SD height: 1.69±0.07 m, Mean±SD weight: 63.54±7.79 kg, Mean±SD age: 21.96±2.94 years, Mean±SD body mass index: 22.11±2.32 kg/m2). The inclusion criteria were elite female players in overhead sports with at least three years of experience in one of these sports (handball, volleyball, softball, and swimming). Samples with a history of surgery or cervical nerve problems, fractures in the shoulder area, and inflammatory joint disease were excluded from the study. The demographic information was obtained through a researcher-made questionnaire, and the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire was used to measure the degree of upper limb disability in daily activities. Results: In comparison between the study groups, a significant difference was observed between the dependent variable (DASH) and the research groups (F=6.067, df=3, P=0.002, Eta=0.342). Using the Bonferroni post hoc tests, the difference between volleyball and softball (P=0.44), volleyball and swimming (P=0.009), and handball and swimming players (P=0.022) were reported. In the next step, BMI characteristics, weekly training hours, and the number of training sessions per week were entered into the data analysis process as covariate variables (F=8.099, df=0.3, P=0.000, Eta=0.432). The Bonferroni post hoc test indicates the difference between volleyball and swimming athletes (P=0.001) and handball and swimming (P=0.002). Conclusion: The present study results indicate a high rate of upper limb disability in elite women athletes. The present study results showed no difference between volleyball and handball due to the nature of these two disciplines and handball, softball, and swimming.