[Effect of low frequency rTMS on stiffness of joints of the upper limbs in hemiplegic patients]

Disabilities of the upper limbs due to stroke can lead to more prolonged functional problems in comparison to lower limb disabilities, and fewer numbers of investigations have been performed on this problem. Use of magnetic stimulation to produce induction currents in the brain for therapeutic purposes is a new method. The aim of this study was to determine the effects of rTMS plus routine rehabilitation on hand stiffness, and compare them with pure routine rehabilitation program in hemiplegic patients. 12 hemiplegic patients were assigned randomly to two groups. Control group, received rehabilitation program with placebo magnetic stimulation, and experimental group, received magnetic stimulation with routine rehabilitation program, 3 times/week for 10 sessions. Using Wrist Robo Hab, we assessed joint stiffness during flexion-extension of the wrist, and supination-pronation of forearm before and after treatment. In the control group we did not find any significant decrease in the resistance of flexor [p=0.207] and pronator [p=0.291] muscles. But in the experimental group the resistance of flexor [p=0.009] and pronator [p=0.035] muscles decreased significantly. rTMS can decrease stiffness of the upper limb joints and can be used in chronic hemiplegic patients, when conventional treatments are not effective

[Comparision of rehabilitation plus joystick versus routine rehabilitation treatment on hand muscles stiffness in hemiplegic patients]

Disabilities in upper limb due to stroke are the major problems in hemiplegic patients. Recently, joystick method as new method is applied for the improvment of upper limb disabilities. This study was carried out to compare the effect of joystick in combination verses routine rehabilitation and routine rehabilitation program on hand muscles stiffness in hemiplegic patients. In this clinical trial study, 12 hemiplegic patients were randomly divided into two control and interventional groups. Subjects in the control group were received rehabilitation program with placebo joystick. Patients in interventional group were received joystick treatment with routine rehabilitation program for 10 sessions, 3 times a week. Pre and post-treatment evaluation was performed based on Wrist Robo Hab method. Flexion and pronation muscle stiffness in control patients showed non significant improvement, but in the interventional group, significant improvement were observed [P<0.05]. At the end of study, there was not any significant difference between control and interventional group. According to this finding, there was not any significant difference between the combination of joystick and rehabilitation treatment and routine rehabilitation program on the hand muscle function in hemiplegic patients

[Study the effect of "constraint-induced movement therapy" on symmetry of spatiotemporal gait parameters in hemiparetic patients]

Balance and gait disorders are common motor complications after stroke. Studies have revealed that conventional physiotherapy cannot manage these disorders efficiently, so more studies addressing causes of these complications and presenting efficient treatment protocols are crucial. Concerning the significant effect of Constraint Induced Movement Therapy on treatment of upper limbs motor impairments in hemiparetic patients, the goal of this study is to assess the effect of "Constraint Induced Movement Therapy" on symmetry of spatiotemporal gait parameters and velocity of gait in hemiparetic patients. Thirty hemiparetic patients [aged from 40 to 60 years] participated in this study. Patients were divided randomly into 2 groups. They received constraint induced movement therapy [group1] and mass practice [group 2] for 3 weeks. Experimental assessments of patients included stride velocity and symmetry of spatiotemporal gait parameters [spatial step symmetry, temporal stance symmetry, temporal swing asymmetry, overall temporal asymmetry] that were recorded and compared before and after treatment. In addition, the amount of weight bearing asymmetry was assessed via dual force platform. In both groups, stride velocity increased [p=0.03, p=0.01]. In group A, spatial step symmetry increased [p=0.02].Temporal swing asymmetry and overall temporal asymmetry decreased [p=0.01]. In group B, only temporal swing asymmetry decreased [p=0.02]. Physical therapy by "constraint induced movement therapy" can improve symmetry of spatiotemporal gait parameters efficiently through overcoming the "learned non use" phenomenon and improving the somatosensory deafferentation to motor controller centers

Effect of low frequency repeatitive transcranial magnetic stimulation to improve motor function and grip force of upper limb in hemiplegic patients

Disability of upper extrimity from stroke are often permanent. Despite numerous functional problems, there is less attention to upper exterimity disabilitis than lower limbs. Some new methods of treatment focuses on using the magnetic stimulation as a means brain currents to produce therapeutic effects. This study was done to evalute the effect of low frequency repeatitive transcranial magnetic stimulation to improve motor function and grip force of upper limb in hemiplegic patients. This clinical trial study was done on 12 stroke hemiplegic patients in Firoozgar hospital in Tehran, Iran during 2009-10. Patients in group I, recieved rehabilitation program with placebo magnetic stimulation, and patients in group II, received magnetic stimulation with routine rehabilitation program for 10 session, 3 times in week. Pre and post were evaluated by Barthel and Fugl-Meyer indeces and dynamometer. Data were analyzed using SPSS-15, Kolmogorov-Smirnov, paired t-test, independent t-test and Wilcoxon signed tests. According to Barthel and Fugl-Meyer indeces both groups I, II showed significant improvement [P<0.05]. Using dynamometer, it was demenstrated that grip force of upper limb in group I was not significant but this index in group II was significant after intervention [P<0.05]. This study showed that low frequency repeatitive truscrianial magnetic stimulation has therapuetic effect on grip force of upper limb

[Effect of exercises downhill and uphill running on serum adiponectin and glucose in type-2 diabetic patients]

Adiponectin is an adipocyte-secreted hormone. Low levels of Adiponectin may indicate the insulin resistance and development of diabetes. The regular exercise therapy induces insulin resistance to be reduced. Glucose uptake increase in muscles, increased adiponectin levels and decreased of HbA[1]c in diabetic patients. This study was designed to evaluated the effect of down-hill and up-hill running exercises on the adiponectin and serum glucose in type-2 diabetic patients. This clinical trial study was conducted on 28 patients [13 male and 15 female], age 40 to 60 years, with type-2 diabetes, in neuromuscular rehabilitation research center, Semnan, Iran during 2009. Participants were assigned randomly in one of the two experimental groups, eccentric or concentric exercise using treadmill. Before and after control and intervention period, glucose, HbA[1]c and adiponectin serum were measured in both groups. Data were analyzed using SPSS-18, Kolmogorov- Smirnov, Repeated Measures ANOVA, Tukey and independent t tests. Eccentric and concentric exercise significantly decreased glucose, HbA[1]c and also increased adiponectin levels [P<0.05] in type-2 diabetic patients. However, eccentric exercise also significantly reduced glucose and HbA[1]c and increased adiponectin levels compared to the concentric exercise [P<0.05]. This study showed that eccentric exercise are more effective than concentric exercise to reduce and control the blood glucose level and improve serum adiponectin in type-2 diabetes mellitus patients

[ effect of "constraint induced movement therapy" on velocity and gait kinetics in hemiparetic patients]

Balance and gait disorders are common motor complications after stroke. Studies have revealed that conventional physiotherapy cannot manage these disorders efficiently; so more studies addressing the causes of these complications and presenting efficient treatment protocols are crucial. Thirty hemiparetic patients [age range 40-60 years old] participated in this experimental study. Patients were randomly divided in to 2 groups. One group received Constraint Induced Movement Therapy [CIMT] [group1] and the other Mass Practice [group 2] for 3 weeks. Experimental assessments included stride velocity and kinetic parameters of gait [amplitude and velocity of center of pressure sways of paretic and non-paretic limbs in sagittal and frontal planes] that were recorded and compared before and after treatment. For statistical analysis of data, if distribution of data was normal, parametric tests of t and pair t-tests were used. If distribution of data was not normal, non parametric tests of Wilcoxon and Mann-Whitney were used. SPSS V.11.5 was also used for data analysis. In both groups, stride velocity increased [p=0.03, p=0.01]. In CIMT group, COP sway for paretic and non-paretic limbs decreased in frontal plane [p=0.03, p=0.008]. COP sway velocity for paretic limb decreased in both planes [p=0.01, p=0.03]. For mass practice group, only COP sway amplitude for non-paretic limb decreased in sagittal plane [p=0.03]. Physical therapy based on "Constraint Induced Movement Therapy" can more efficiently manage dynamic balance gait disorders by overcoming "learned non-use" phenomena and improving somato-sensory deafferentation to central motor controllers

[Comparison between the effect of medical training therapy and stability exercises on functional lumbar instability]

Functional instability of the lumbar spine is one of the most common disorders that occurs as a consequence of the weakness of lumbar paravertebral muscles. This type of instability can progressively produce low back pain and inability in daily living activities. To treat this type of low back pain, different methods of treatment and therapeutic exercises have been proposed, including stability exercises and medical training therapy [MTT]. The aim of this study was to compare the two above-mentioned treatment methods on reducing clinical signs and symptoms of lumbar instability. In this survey, fifty patients with chronic lumbar instability and pain were selected and treated with either medical training or stability exercises. Thirty patients had stability exercises in their daily activities and twenty patients were treated using MTT protocol. Clinical signs and symptoms were evaluated before and after treatment sessions. This study showed that there was no significant difference between our two experimental groups before and after treatment sessions in all evaluated parameters [p<0.05]. In addition a significant improvement in evaluated signs and symptoms was observed in both experimental groups. The results of this study suggest that stability exercise and MTT can reduce pain and other symptoms with a similar effect in patients suffering from functional lumbar instability