High-intensity versus low-level laser in musculoskeletal disorders.

PURPOSE: To evaluate the current evidence comparing low level to high level laser therapy to reveal any superiorities in the treatment of musculoskeletal disorders. METHODS: Five databases were searched till September 2022 to obtain relevant RCTs comparing high intensity and low-level laser therapies in the management of musculoskeletal disorders. Two authors assessed the methodological quality of the included studies using the Physiotherapy Evidence Database scale and meta-analysis was conducted for studies that showed homogeneity. RESULTS: Twelve articles were included in this systematic review with a total population of 704 participants across various musculoskeletal pathologies including tennis elbow, carpal tunnel syndrome, chronic non-specific low back pain, knee arthritis, plantar fasciitis, and subacromial impingement. There were no statistical differences between the two interventions in pain, electrophysiological parameters, level of disability, quality of life, postural sway or pressure algometer, however, Low level laser therapy showed superiority in increasing grip strength compared to high intensity laser therapy while results were significant in favour of high intensity laser therapy regarding long head of biceps diameter and cross sectional area, supraspinatus thickness and echogenicity and acromio-humeral distance. CONCLUSION: The current literature suggests no superiority of both types of laser therapy in musculoskeletal disorders, however, more RCTs with larger sample size are required to reach a definitive conclusion regarding the superiority of either form of laser therapy in musculoskeletal disorders.

Effect of insole on postural control and gait of stroke patients: a systematic review and meta-analysis.

This systematic review aims to examine the evidence of adding postural insole to traditional physical therapy to improve weight distribution, gait, mobility, balance, and postural control in stroke survivors. Five databases were searched to retrieve all related randomized controlled trials examining the effect of insole on stroke patients. Two independent authors checked the potential articles against eligibility criteria according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was conducted for available outcomes and the statistical heterogeneity was examined using the I2 test. Of 762 articles, only 15 with 448 patients were included after they met the inclusion criteria with most of them including participants exceeding 6 months of stroke incidence. When insole was used as compelled body weight shifting method, pooled statistical analysis revealed significant improvement in gait velocity [standardized mean difference (SMD) = 0.67; 95% confidence interval (CI): 0.31, 1.02; P = 0.0003], cadence (SMD = 0.67; 95% CI: 0.16, 1.18; P = 0.01] and stride length (SMD = 1.11; 95% CI: 0.57, 1.65; P < 0.0001), while no significant effect on step length (SMD = 0.48; 95% CI: -0.37, 1.33; P = 0.27). Pooled statistical analysis of balance outcomes revealed significant improvement in weight-bearing symmetry balance (SMD = 0.82; 95% CI: 0.25, 1.39; P = 0.005) and long-term improvement in Berg Balance Scale (SMD = 1.19; 95% CI: 0.19, 2.20; P = 0.02), while no difference was observed in balance confidence (SMD = 0.44; 95% CI: -0.15, 1.04; P = 0.14) and sensorimotor functions (SMD = 0.36; 95% CI -0.39, 1.11; P = 0.35). Insoles significantly improved spatiotemporal gait parameters, gait symmetry, and static balance compared with traditional physical therapy alone.

The Efficacy of Whole-Body Vibration in Managing Postburn Victims' Complications: A Systematic Review.

Burn injury is a complicated traumatic event with both systemic and local consequences. These complications include long periods of bed rest, pain, muscle weakness, vitamin D deficiency, and bone mineral density loss. Whole-body vibration demonstrated effectiveness in improving muscle power and bone mineral density in various musculoskeletal populations. This systematic review of randomized controlled trials aims to assess evidence for the effectiveness of using whole-body vibration on postburn survivors with at least 1% total body surface area on sensory and motor outcomes. A systematic search was conducted across six databases, which are, PubMed, Cochrane, PEDro, Scopus, Web of Science, and Google Scholar, from inception till March 2022. Retrieved studies were screened by title and abstract and full-text in two stages using Rayyan web-based. Included studies were assessed for risk of bias using the Cochrane risk of bias tool ROB 2.0. Six randomized controlled trials with 203 participants were included. Five of the included studies demonstrated an overall high risk of bias. Compared to conventional physiotherapy programs, whole-body vibration demonstrated improvement in functional mobility and balance using timed up and go and Biodex balance assessment, respectively. However, there were no differences between whole-body vibration and conventional physiotherapy program alone in bone mineral density and muscle power. Although the current evidence of whole-body vibration is limited, whole-body vibration combined with traditional physical therapy programs may improve functional mobility and balance in postburn survivors compared to physical therapy programs alone.

Effect Of Brain GYM Exercises On Balance In Preschool Children: A Randomized Controlled Trail.

Objectives: To investigate the effect of Brain Gym exercise on preschool children's balance achievement. Method: The randomised controlled trial was conducted at EL-Moasis kindergarten from May to September 2021, and comprised preschool children of either gender aged 4-6 years who were randomised into intervention group A which received Brain Gym exercise for 15-30 minutes per day, three times a week, for eight consecutive weeks, and control group B which received the usual kindergarten activities. Balance was assessed by One Leg Standing Test and Functional Reach Test. Data was analysed using SPSS 20. RESULTS: Of the 30 subjects, 15(50%) were in each of the 2 groups. There were 13(43.3%) boys and 17(56.7%) girls with overall mean age 4.99±0.67 years. However, the study completed had 27(90%) subjects. Overall, there were 26(%) right-handed subjects. Post-intervention, there was significant intra-group improvements (p<0.05), but there were no significant inter-group differences (p>0.05). CONCLUSIONS: No significant benefits were seen in the balance of preschool children exposed to Brain Gym exercise. RCT registration: The RCT was registered retrospectively at The Pan African Clinical Trials Registry (PACTR) (Trial #: PACTR202208886771106 Date of Approval: 15/08/2022). Link: https://pactr.samrc.ac.za/Search.aspx.

The Efficacy of Physical Therapy Modalities in Patients With Hemophilia: A Systematic Review of Randomized Controlled Trials With Meta-analysis.

OBJECTIVE: To evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of rehabilitation of patients with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation. DATA SOURCES: Seven databases-PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence Database, Google Scholar, and Clinicaltrials.gov-were systematically searched for randomized controlled trials evaluating any physical therapy modality to manage hemophilia. STUDY SELECTION: After abstract and full-text filtration, a methodological quality assessment was performed using the Physiotherapy Evidence Database scale for the studies that met the eligibility criteria. DATA EXTRACTION: Relevant data were extracted from eligible studies and outcomes were categorized according to the ICF. DATA SYNTHESIS: Using Review Manager and Microsoft Excel, a quantitative analysis using standardized mean differences with the 95% confidence interval was completed. Statistical heterogeneity between studies was explored using the I2 test. A fixed effect model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random effects models were used instead. RESULTS: 35 randomized controlled trials with 1216 participants were included in this systematic review; 13 of them dealt with pediatric patients. Most of the studies were of good quality; 12 studies were of low quality. Meta-analysis showed a significant difference in favor of manual therapy, laser, and therapeutic exercises on selected outcomes of body function and structure, activity, and participation categories of the ICF model. CONCLUSION: This systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status in combination with educational sessions to improve the quality of life of patients with hemophilic arthropathy. For pediatric patients with hemophilic arthropathy, using laser therapy is promising for improving functional capacity.

Effect of action observation therapy on motor function in children with cerebral palsy: a systematic review of randomized controlled trials with meta-analysis.

OBJECTIVE: To evaluate the evidence of using Action Observation Therapy in the rehabilitation of children with Cerebral Palsy. STUDY DESIGN: Systematic review with meta-analysis of Randomised Controlled Trials. METHODS: For the purpose of identifying relevant studies, six databases were searched from inception until July 2020. The methodological quality was assessed by Physiotherapy Evidence Database scale. The outcomes were classified within the framework of the International Classification of Functioning. A pooled meta-analysis was performed on studies that demonstrated homogeneity. RESULTS: Twelve randomised controlled trials with 307 participants were included with six of them were included in the meta-analysis. Non-significant difference between the groups was demonstrated by meta-analysis. Results of capacity assessed in post treatment and follow up evaluation were (0.06, -0.22 to 0.34, 95% (CI); P = 0.69 and (-0.35, -0.96 to 0.27, 95% (CI); P = 0.27); respectively. Actual performance in post-treatment and follow up were (0.10, -0.22 to 0.48, 95% (CI); P = 0.62) and (0.01, -0.40 to 0.41, 95% (CI); P = 0.97); respectively. Perceived performance evaluated using (ABILHAND-KIDS) were (0.30, -0.28 to 0.89, 95% (CI); P = 0.31) and (0.15, -0.43 to 0.73, 95% (CI); P = 0.61) for post treatment and follow up; respectively. Overall effect on activity domain was (0.08, -0.11 to 0.28, 95% (CI); P = 0.86) immediately and (0.04, -0.33 to 0.26, 95% (CI); P = 0.49) at follow-up; respectively. CONCLUSION: No evidence of benefit had been found to draw a firm conclusion regarding the effectiveness of action observation therapy in the rehabilitation of children with cerebral palsy due to limitations in methodological quality and variations between studies.

Investigating fine motor deficits during maintenance therapy in children with acute lymphoblastic leukemia.

OBJECTIVES: Children diagnosed with acute lymphoblastic leukemia (ALL) in their early childhood are more susceptible to neuromuscular and musculoskeletal impairments. This cross-sectional study was designed to address different types of fine motor impairments in Egyptian children diagnosed with ALL. METHODS: Fifty-four children treated for ALL in maintenance phase aged from four to seven years were compared with an age- and sex-matched control group. Fine motor performance was assessed using the total fine motor form of the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2). Sex- and age-specific norms of BOT-2 were used to calculate scale and standard scores in both groups. RESULTS: Children with ALL had significantly impaired fine motor skills in all subtests and composites of BOT-2 compared with the typically developing group (P < 0.00001). Cumulative doses of vincristine, methotrexate, and dexamethasone revealed no significant correlation with any BOT-2 measure. Males performed significantly better than females in all BOT-2 scores except for the fine motor integration subtest and the total fine motor control composite as no significant differences were observed. The protocol risk stratum, duration of maintenance treatment, and the age at assessment did not significantly affect the BOT-2 measures. CONCLUSION: About 67% of children with ALL on maintenance treatment experienced fine motor difficulties. Periodic evaluation along the course of chemotherapy could identify specific impaired fine motor domains providing the base for a successful rehabilitation program.

Immediate effect of induced fatigue of the unaffected limb on standing balance, proprioception and vestibular symptoms in children with hemiplegia.

OBJECTIVES: To study the effect of induced fatigue of the unaffected limb on the sensory components of standing balance; proprioception and vestibular symptoms in children with hemiplegic cerebral palsy. METHODS: Setting: Outpatient Clinic of Faculty of Physical Therapy, Cairo University. PATIENTS: Twenty-nine children with hemiplegic cerebral palsy [(ages 8.9 ± 2.3 years), motor ability I/II according to the GMFCS and spasticity of I/I+ according to the Modified Ashworth Scale]. OUTCOME MEASURES: Before and after the induced fatigue of the unaffected limb, the following measures were recorded: postural balance, using the Biodex Balance System and the Timed Up and Go test; vestibular sense, using the Paediatric Vestibular Symptom Questionnaire; and proprioception measures of both knees, using the Biodex isokinetic dynamometer. RESULTS: There was a significant increase in the post-fatigue values for the overall stability index (p< 0.05), the Timed Up and Go test (p< 0.05), reposition errors of proprioception of the unaffected limb (p< 0.05) and the vestibular questionnaire (p< 0.05); there was a non-significant decrease in the post-fatigue values for reposition errors of proprioception of the affected limb (p= 0.859). CONCLUSION: Fatigue of the unaffected limb negatively affects postural balance and related sensory systems (proprioception of the fatigued limb and vestibular function) but does not have an impact on proprioception of the unfatigued limb.

Systematic review of the effectiveness of Kinesio taping for children with brachial plexus injury.

OBJECTIVE: The purpose of this systematic review was to investigate the effectiveness of Kinesio taping on upper limb motor function in children with brachial plexus injury. DATA SOURCES: Articles were identified through searches of the following databases: OVID, Web of Science, Science Direct, PubMed, Google Scholar, and the Cochrane library. METHODS: Studies were excluded if they were nonpeer-reviewed publications, opinion articles, or not reported in English. The methodological quality of the studies was assessed using the Methodological Index for Nonrandomized Studies. RESULTS: Five studies met our inclusion criteria. Two studies were included in the meta-analysis. A significant change was limited only to scapulothoracic internal rotation in three positions. CONCLUSIONS: Adding Kinesio taping to the physical therapy programme to manage children with brachial plexus injury is still questionable and may help functional improvement. However, this improvement may be limited depending on the technique or mode of application.

Noninvasive Brain Stimulation for Rehabilitation of Pediatric Motor Disorders Following Brain Injury: Systematic Review of Randomized Controlled Trials.

OBJECTIVE: To assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury. DATA SOURCES: Ovid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers. STUDY SELECTION: Randomized controlled trials (RCTs) published in English were included if they met the following criteria. POPULATION: Pediatric patients with motor disorders following brain injury. INTERVENTION: NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS). OUTCOMES: Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS). DATA EXTRACTION: Predefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used. DATA SYNTHESIS: A grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables. CONCLUSION: Pediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.

Effects of backward gait training on balance, gross motor function, and gait in children with cerebral palsy: a systematic review.

OBJECTIVE:: To investigate the effects of backward gait training on balance, gross motor function, and gait parameters in children with cerebral palsy. DATA SOURCES:: PubMed, Cochrane Library, Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), and Google Scholar were searched up to May 2018. REVIEW METHODS:: Randomized controlled trials were included if they involved any form of backward gait training for children with cerebral palsy. Two authors independently screened articles, extracted data and assessed the methodological quality using PEDro scale, with any confliction resolved by the third author. Modified Sackett Scale was used to determine the level of evidence for each outcome. RESULTS:: Out of 1492 papers screened, 7 studies with 172 participants met the inclusion criteria. The duration of treatment ranged from 15 to 25 minutes, three times a week and for 6-12 weeks. The quality of studies ranged from good (two studies) to fair (four studies) and poor (one study), with a mean PEDro score of 4.7 out of 10. All included studies showed positive effects in the measured outcomes. The results showed level 1b evidence for balance when compared to no intervention, and for gross motor function, step length and walking speed when compared to same dose of forward gait training. The clinical heterogeneity of studies makes meta-analysis inappropriate. CONCLUSION:: In children with cerebral palsy, there is moderate evidence that backward gait training improves balance, gross motor function, step length and walking velocity. More high-quality studies are needed.

Physical and cognitive consequences of fatigue: A review.

Fatigue is a common worrying complaint among people performing physical activities on the basis of training or rehabilitation. An enormous amount of research articles have been published on the topic of fatigue and its effect on physical and physiological functions. The goal of this review was to focus on the effect of fatigue on muscle activity, proprioception, and cognitive functions and to summarize the results to understand the influence of fatigue on these functions. Attaining this goal provides evidence and guidance when dealing with patients and/or healthy individuals in performing maximal or submaximal exercises.