[ effect of neurofeedback therapy accompanying conventional occupational therapy on improving hand function in stroke patients: a pilot study]

Hand dysfunction after stroke is among the most frequent disabilities which adversely affects many aspects of post stroke patients' life. Routinely, patients receive physical therapy and then occupational therapy in the setting of rehabilitation medicine. Neurofeedback therapy is a new modality based on biofeedback therapy principles to train the brain. The aim of the present study was to evaluate the effect of neurofeedback on improving hand function after stroke. This study was designed as a pilot randomized controlled clinical trial. Fourteen post stroke patients entered the study. Hand function was evaluated by Jebson hand function test pre and post intervention. Patients were randomly allocated into two intervention groups of occupational therapy [OT] and occupational therapy + neurofeedback therapy [NF]. All patients received 10 sessions of therapy. Neurofeedback training was performed to enhance sensorimotor rhythm [SMR]. Mean age of patients was 60 +/- 7 years. Hand function was improved significantly in both groups according to general jebson test. Some functional tasks of Jebson test improved more significantly in NF group, compared with OT group. Mean SMR increased significantly, by the end of 10 session neurofeednack therapy. Most of the patients found neurofeedback accompanying OT more enjoyable than OT alone. Drop out was more in OT group compared to NF group. Neurofeedback therapy is suggested as a complementary therapy to conventional OT with additional improvement in some aspects of hand recovery. Furthermore, it can increase patients' compliance to rehabilitation program, and improve their satisfaction from therapy protocol

Therapeutic effects of low level laser therapy [LLLT] in knee osteoarthritis, compared to therapeutic ultrasound

Low-level laser therapy [LLLT] is thought to have analgesic and biomodulatory effects. Our objective was to assess the pain-relieving effect of LLLT and possible changes in joint stiffness and disability of patients with knee osteoarthritis [KOA] and compare it to the more commonly used modality; therapeutic ultrasound[US]. 37 patients with mild or moderate KOA were randomized to receive either LLLT, placebo LLLT or US. All patients received a common treatment including acetaminophen [up to 2gr/d] and medical advices for lifestyle modification and exercise. Treatments were delivered 5 times a week over a period of 2 weeks. Active laser group was treated with a diode laser [wavelength 880 nm, continuous wave, power 50 mW] at a dose of 6 J/point [24 J/knee]. The placebo control group was treated with an ineffective probe [power 0 mW] of the same appearance. The third group received pulsed ultrasound with an intensity of 1.5-2 w/cm2, and for 5 minutes per knee. Visual Analogue Scale [VAS] and Western Ontario MacMaster [WOMAC] questionnaires were used for data gathering before,1 and 3 months after completing the therapy. Pain reduced in all 3 groups but laser was superior in comparison. Stiffness improved 1 mo after therapy in the laser group but not in the others. Disability decreased in both laser and US groups [more significantly in the laser group] but not in the placebo group. Our results show that LLLT reduces pain, joint stiffness and disability in KOA and is superior to placebo and US

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EMG needling is not a painless procedure. In recent studies it has been shown that a form of lidocaine has the efficacy which is similar to EMLA, for prevention of pain associated with EMG needling. The aim of this study was to evaluate the efficacy of Lidocaine H ointment in alleviating the pain caused by EMG needling. This study was performed on patients referred to Shohadaye Tajrish Hospital for EDx study in APR 2009- APR 2010. A double blinded, placebo controlled study was performed in 47 adult patients [94 lower limbs] to compare the pain of EMG needling into the tibialis anterior muscle after application of lidocaine-H ointment or placebo. Pain scores were obtained by using visual analog scale [VAS]. Experimental and placebo groups were compared with Mann-U-Whitney and Chi-square tests. The study was performed on 47 patients, 38.3% male and 61.7% female, mean age being 45.5 +/- 16.4years. Median VAS score was 4.66 +/- 2.14 vs. 6.11 +/- 2.07, [P<0.05]. 51.1% of patients in experimental group as compared to 21.3% in controls reported mild pain [VAS < 4], [P<0/01]. It seems that lidocaine-H ointment has beneficial effects in prevention of the pain associated with EMG needling

[Comparison of dry needling and physical therapy modalities in treatment of myofascial pain of upper trapezius muscle]

Myofascial pain syndrome of upper trapezius muscle is common; reports about successful treatment with dry needling and physical therapy have been published. This study was performed with the objective of comparing the efficacy of these two treatment modalities in relieving the symptoms in patients with myofascial pain in the trapezius referred to the Physical Medicine and Rehabilitation Center at the Shohadaye Tajrish Hospital from Apr 2009 to March 2010. It was a randomized controlled trial performed on 28 patients. After matching age, sex, duration of symptoms, pain severity, pain pressure threshold of trigger point and quality of life measures, subjects were randomly put in to subgroups of case [dry needling] or control [physical therapy]. One week and one month after receiving treatment, outcomes and intra and inter group changes in pain severity, pain pressure threshold of trigger point and quality of life measures were evaluated and compared. 28 subjects in two 14 patients groups took part in this study. After one month of both physical therapy and dry needling, there was a decrease in resting, night and activity pain levels, [p<0.05]. Pain pressure threshold of trigger point, scores of physical functioning, role limitation due to physical problems, social functioning and bodily pain were improved [p<0.05]. Results were similar in the two groups, [p<0.4]. It seems that both physical therapy modalities and dry needling have equal effect in decreasing myofascial pain of upper trapezius muscle