Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial.

PURPOSE: Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. METHODS: Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. RESULTS: The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). CONCLUSIONS: Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.

Relationship Between Hamstring Flexibility and Extensor Muscle Activity During a Trunk Flexion Task.

OBJECTIVE: The purpose of this study was to investigate the relationship between hamstring flexibility and electromyography (EMG) muscle parameters in back and lower limb extensor muscles during a trunk flexion task. METHODS: Thirty healthy women aged 18 to 30 years with normal hip movement were recruited for this study. Hamstring muscle flexibility was measured with the 90-90 active straight leg raise test. Surface EMG activities were simultaneously recorded from the lumbar erector spinae, gluteus maximus, biceps femoris, semitendinosus, lateral gastrocnemius, and medial gastrocnemius muscles during forward bending. Muscle activity onset and offset, amplitude, and duration were calculated with technical computer software (MATLAB, version 1.6.0). Linear regression analysis was used to investigate the relationships between hamstring flexibility test results and EMG parameters during trunk flexion. In addition, the Friedman test was used to determine the recruitment activity pattern in women with low versus normal hamstring flexibility. RESULTS: During flexion, the back extensor muscles in individuals with lower hamstring flexibility test scores were activated and deactivated later, which can lead to delayed flexion-relaxation. Regression analysis did not disclose any significant correlations between hamstring flexibility and other EMG parameters (duration and amplitude) in back extensor muscles. Activation and deactivation recruitment patterns differed between the groups with normal and low hamstring flexibility. CONCLUSION: The findings of this study suggest that hamstring flexibility plays an important role in the patterns of trunk and lower limb muscle activity onset, offset, and recruitment.

Effects of a Virtual Reality Dance Training Program on Kyphosis Angle and Respiratory Parameters in Young Women With Postural Hyperkyphosis: A Randomized Controlled Clinical Trial.

CONTEXT: Thoracic hyperkyphosis, one of the most common spinal deformities, may lead to undesirable pulmonary outcomes. OBJECTIVE: To study, the efficacy of virtual reality exercise training on thoracic hyperkyphosis and respiratory parameters in young women. DESIGN: Randomized clinical trial. SETTING: Laboratory setting. PARTICIPANTS AND INTERVENTION: Participants were randomly assigned to one of two 4-week exercise training groups: regular training (RT), which involved stretch and strength training, or virtual reality with RT (VRRT), which involved dance training with the Xbox 360 Kinect® game in addition to the exercises, which the RT group received. MAIN OUTCOME MEASURES: The authors measured kyphosis angle with a Flexicurve ruler and recorded respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in 1 s [FEV1]) with a spirometer in each participant at baseline and postintervention. Separate 2 × 2 repeated-measure analysis of variances were used to analyze differences between means for kyphosis angle, FEV1, and FVC. Based on the significant interactions between time and group, the paired t test was used to compare the results at baseline and postintervention, and the independent sample t test was used to compare the differences in changes between groups. Level of significance was considered at P < .05 except for paired t test that was adjusted to P < .025 for each variable in 2 groups. RESULTS: The results showed statistically significant interactions between time and group for kyphosis angle, FEV1, and FVC. Postintervention thoracic kyphosis angle decreased and FVC increased significantly in both groups and FEV1 improved significantly in virtual reality with RT group. The improvements in thoracic kyphosis, FVC, and FEV1 in the virtual reality with RT group were significantly greater (P < .001) than in the RT group. CONCLUSION: Dance training with the Xbox 360 Kinect game was an effective therapy in improving thoracic kyphosis angle, FVC, and FEV1 in young women with thoracic hyperkyphosis.

The effect of combined exercise therapy on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome: A randomized clinical trial.

OBJECTIVE: Proprioception, the perception of limb movements and spatial orientation derived from body stimuli, plays a critical role in maintaining joint stability. This study aimed to investigate the effect of combined exercise therapy (closed kinetic chain exercises and proprioception exercises) on knee proprioception, pain intensity and quality of life in patients with hypermobility syndrome. DESIGN: Single-blind randomized clinical trial. SETTING: Shiraz School of Rehabilitation Sciences. PARTICIPANTS: Twenty four patients with hypermobility syndrome. INTERVENTIONS: The patients were assigned to the control (no intervention) or intervention group (exercise therapy) by random allocation. MEASUREMENTS: Knee proprioception, pain intensity and quality of life were evaluated before and immediately after the intervention. Exercise sessions were held 3 days a week for 4 weeks. RESULTS: The results showed that knee proprioception improved significantly in the intervention group compared to the control group. Quality of life increased, and knee pain intensity decreased significantly in the intervention group compared to the control group. CONCLUSION: Combined exercise therapy can reduce pain intensity and increase knee proprioception and quality of life in patients with hypermobility syndrome.

Effects of Integrated Neuromuscular Inhibition Technique on pain threshold and pain intensity in patients with upper trapezius trigger points.

INTRODUCTION: Upper trapezius trigger points are among the most common causes of neck pain. This study aimed to investigate the effects of integrated Neuromuscular Inhibition Technique (INIT) on pain intensity and threshold. MATERIALS & METHODS: Thirty two female participants with upper trapezius trigger points were recruited in this study. The participants were assigned to control (n = 16) or intervention (n = 16). The intervention group received INIT in one session, consisted of muscle energy technique, ischemic compression and strain-counter strain. Pain threshold and intensity were measured using Pressure Pain Threshold (PPT) and Numerical Pain Scale (NPS). These measurements were performed at baseline, immediately after treatment and 24 h after treatment. FINDINGS: The results showed that pain intensity significantly decreased in the intervention group immediately after treatment (P = .01) and 24 h after treatment (P = .009) in comparison with the control group. There were no significant differences in pressure pain threshold between both groups. CONCLUSION: It seems that Integrated Neuromuscular Inhibition Technique can reduce pain intensity in patients with upper trapezius trigger points.

The comparison of pinch strength among female typists and female non-typists.

BACKGROUND: Typing is a common activity involving repetitive motion that can increase the risk of work-related injuries. To the best of our knowledge, the effect of typing on the pinch strength has not been investigated so far. OBJECTIVE: To investigate the pinch strength amongst female typists and non-typists. METHOD: Thirty female typists and 30 female non-typists, aged 20-30 years old, participated in this prospective study. The pinch strength of the second, third, fourth and fifth fingers of the dominant hand was measured in a sitting position, using a pinch gauge. The data were analyzed using independent sample t-test. RESULTS: The results showed that there were significant differences in the pinch strength of the second, third and fourth fingers between the two groups. The strength of these fingers was reduced more than that in female non-typists. CONCLUSION: Our results suggest that pinch strength might have decreased in female typists due to sharing common attentional resources, muscle fiber composition, and muscle fiber fatigue.

Effect of dual tasking on anticipatory and compensatory postural adjustments in response to external perturbations in individuals with nonspecific chronic low back pain: Electromyographic analysis.

BACKGROUND: In patients with chronic low back pain (CLBP), postural control is a demanding task in terms of attention. Although the attentional demands of postural control have been investigated in these patients, the attentional demands of postural recovery during dual task performance have not been evaluated in patients with nonspecific CLBP. OBJECTIVE: To investigate the effect of dual tasking on anticipatory and compensatory postural adjustments in response to an external perturbation in patients with nonspecific CLBP. METHODS: Twenty-five patients with nonspecific CLBP of at least 3 months' duration and 25 healthy persons were exposed to predictable and unpredictable external perturbations. The attentional demands of postural adjustments were evaluated while participants simultaneously performed a cognitive task. Onset latency and integrated electromyographic activity of the trunk and leg muscles were compared between dual task (postural recovery and backward digit span memory) and single task conditions (postural recovery only). RESULTS: The results showed delayed activation of the tibialis anterior (agonist) and early activation of the gastrocnemius (antagonist) muscles during the dual task in patients with nonspecific CLBP compared to healthy participants. Integrated electromyographic activity was significantly greater in the dual task than the single task condition in the gastrocnemius (antagonist) muscle in patients with nonspecific CLBP compared to healthy persons during unpredictable perturbations. CONCLUSION: The impaired ankle muscle activities during a cognitive task suggest that postural control recovery following external perturbation requires attentional resources in patients with nonspecific CLBP. This may increase the risk of re-injury in people with nonspecific CLBP while they perform an attentionally demanding task in more difficult circumstances.

A Comparison Between the Effects of Scapulothoracic Mobilization Plus Physical Therapy With Physical Therapy Alone in Patients With Mechanical Neck Pain: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to compare the effects of scapulothoracic (ST) mobilization plus physical therapy (PT) with PT alone in patients with mechanical neck pain. METHODS: This double-blinded randomized clinical trial was conducted at Shiraz School of Rehabilitation Sciences and involved 46 patients with mechanical neck pain and scapular dyskinesia. The patients were randomly assigned to the ST mobilization + PT group (scapulothoracic mobilization and physical therapy) or the PT group (physical therapy treatment) by a computer-generated randomized table of numbers. Both groups received 5 sessions of treatment during 1 week. Pain intensity and grip strength were evaluated 3 times: baseline, after the first session, and after the fifth session. Furthermore, functional disability of the upper limbs and the neck were evaluated before and at the fifth session. RESULTS: The results showed that the pain intensity was reduced and grip strength increased significantly after the first session (P = .01) and at the end of the treatment (P = .01) in the ST mobilization + PT group in comparison with the PT group. Also, the mean difference of upper limb (P = .01) and neck disability (P = .02) decreased significantly in the ST mobilization + PT group in comparison with the PT group. CONCLUSION: Scapulothoracic mobilization in combination with physical therapy may be superior to physical therapy alone in reducing pain intensity, maximizing grip strength, and reducing upper limb and neck disability in mechanical neck pain.

Evaluation of Static and Dynamic Balance Tests in Single and Dual Task Conditions in Participants With Nonspecific Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to investigate static and dynamic balance tests in single, dual cognitive, and dual manual task conditions in participants with and without nonspecific chronic low back pain. METHODS: In this case control study, 40 patients (age range 18-50 years) with nonspecific chronic low back pain for at least 3 months and 40 healthy participants matched for age, weight, height, and sex participated in this study. Balance performance was evaluated using static (One Leg Stance) and dynamic (Modified Star Excursion Balance Test, 10-m walk test, and Timed Up and Go) balance tests. All tests were performed in three conditions: single task (balance only), dual cognitive task (balance and counting numbers backward), and dual manual task (balance and carrying a cup of water). RESULTS: The results indicated that different balance tests were impaired in dual task conditions compared with single task in each group. Cognitive and balance performances were not significantly different between nonspecific chronic low back pain and healthy participants in all clinical balance tests. CONCLUSION: It seems that the static and dynamic balance performance under dual task conditions (excluding the Modified Star Excursion Balance Test) was impaired in each group. Dual tasking did not differ between nonspecific chronic low back pain participants with low level of pain and disability compared with healthy participants.

Clinical Evaluation of Scapular Positioning in Patients With Nonspecific Chronic Low Back Pain: A Case-Control Study.

OBJECTIVE: The purpose of this study was to investigate the position of scapula in patients with nonspecific chronic low back pain. METHODS: A total of 17 participants with a history of nonspecific chronic low back pain and 17 healthy participants in the same age, sex, and weight range were enrolled in this case-control study. Lateral scapular slide test and Lennie test were used for clinical evaluation of scapular position in the frontal plane using a tape measure. The data were analyzed using an independent t test. RESULTS: The results of lateral scapular slide test indicated that there were significant differences between patients with nonspecific chronic low back pain and healthy individuals in both left and right sides in 2 positions: shoulder in neutral position and shoulder at 40°-45° abduction. Also, in the Lennie test, there was only a significant difference between groups when we measured the distances from thoracic spinous process to the inferior angle of the scapula in both left and right sides. CONCLUSION: This study indicated that upward rotation of the scapula can be seen in patients with nonspecific chronic low back pain.

Effects of Plantar Flexor Muscle Static Stretching Alone and Combined With Massage on Postural Balance.

OBJECTIVE: To evaluate and compare the effects of stretching and combined therapy (stretching and massage) on postural balance in people aged 50 to 65 years. METHODS: Twenty-three subjects participated in this nonrandomized clinical trial study. Each participant randomly received plantar flexor muscle stretching (3 cycles of 45 seconds with a 30-second recovery period between cycles) alone and in combination with deep stroking massage (an interval of at least 30 minutes separated the two interventions). The data were recorded with a force platform immediately after each condition with eyes open and closed. The center of pressure displacement and velocity along the mediolateral and anteroposterior axes were calculated under each condition. The data were analyzed with multiple-pair t-tests. RESULTS: The center of pressure displacement and velocity along the mediolateral axis increased after both stretching and the combined intervention. There were significant differences in both values between participants in the stretching and combined interventions (p<0.05). CONCLUSION: Plantar flexor muscle stretching (for 45 seconds) combined with deep stroking massage may have more detrimental effects on postural balance than stretching alone because each intervention can intensify the effects of the other.