Physiotherapy Approach in Group Dysfunction: A Case Study

The current study was conducted on a 25 year- old man who had an experience of a car accident 3 years ago and was suffering a lot of pain in lumbar and pelvic regions during last seven months.  He was carefully examined and assessed during the study. This person who also had an experience of a car accident 3 years ago was carefully examined and assessed during the study. A multimodal physical approach based on manual therapy, electrotherapy and exercise therapy was adopted to eliminate the pain and to correct malalignments. The patient received 15 treatment sessions and depending on the patient’s status, the intervention techniques varied every session. He was re-examined to have the effectiveness of the treatment process evaluated in first, 5th, 10th and last sessions. Reassessment of the patient was done every other five sessions in order to change the treatment procedure, if there was no improvement in symptoms. This study showed that detailed assessment and re-assessment during the treatment sessions had a significant effect on improvement of the symptoms In addition, according to the patient’s needs, different interventions could be used every session. However, Patient’s satisfaction, Physician and limitations about medical insurance have to be considered. Improvement in daily life activity and function, and reduction of pain immediately after the treatment supported the beneficial response obtained by physiotherapy approach in group dysfunction of lumbar and pelvic.Key words: Case Study, Group Dysfunction, Low Back Pain, Pelvic Pai

Assessment of energy expenditure during upper body exercise in paraplegics

Assessment of energy expenditure is helping the design of wheelchairs and walking aids for paraplegic locomotion. During exercise in able-bodied subjects a redistribution of blood takes place to increase cardiac output and to supply the blood for exercising muscles. But in paraplegics, the impaired sympathetic innervation and lack of muscular pump disturb the redistribution of blood and diminish venous return (Hopman et al., 1992b). In upright arm activity particularly, venous return may be much poorer in paraplegic, than in able-bodied subjects. However, up to now the same indicators as in able-bodied subjects have been used for assessment of energy expenditure in paraplegics. The aim of this project was to assess the energy expenditure during arm crank ergometry and crutch walking in paraplegic and able-bodied subjects. The experiments can be divided into 4 phases i.e.: 1) assessment of energy expenditure during seated arm crank ergometry in 10 sports-active paraplegics and 20 able-bodied subjects 2) comparison of the effect of posture on the oxygen consumption, heart rate and perceived exertion in 7 sports-active paraplegics and 20 able-bodied subjects 3) A comparison of assessment of energy expenditure between sports and non-sports persons with spinal cord injury during arm crank ergometry 4) assessment of energy expenditure during crutch walking in 5 sports- active paraplegics and 10 able-bodied subjects

Dry Needling: An Invasive Physical Therapy Technique

Myofascial trigger points (MTrPs) of the upper trapezius muscle causes impairment of functional activity and reduces the quality of life. Several physical therapy interventions can be used to treat myofascial trigger points. Currently, dry needling (DN) is emerging as a physical therapy technique for use in treating MTrPs. The aim of this narrative review was to evaluate the effectiveness of dry needling in treating myofascial trigger points of the upper trapezius muscle. The PubMed database was searched for articles published through December, 2018. The main problem of most articles exists in the methods section; therefore, their results may be affected by bias. A standardized guideline for both the training and practice of using DN to treat MTrPs should be developed to minimize the risk of DN complications.Keywords: Dry needling, Physical therapy, Myofascial Trigger Point

Physical Therapy Approach in Shoulder Impairment Along With Lymphedemea after Breast Cancer Surgery: A Case Study

A 52-year-old woman with a history of breast cancer and mastectomy surgery and axillary lymph nodes dissection was referred to a physical therapy clinic. Lymphotherapist assessment revealed that there was a grade II upper limb lymph edema; pitting and palpable fibrotic tissue existed in volar side of forearm. Water displacement measurement to assess the limb volume in affected and unaffected side indicated an obvious difference. In physical examination, there was a significant limitation in shoulder range of motion (ROM) and tightness in shoulder girdle muscles. A multimodal physical approach based on manual therapy, electrotherapy and exercise therapy was conducted to eliminate shoulder impairment along with Manual Lymph Drainage (MLD) and lymphological compression bandage to eliminate lymphedema. The results of final re- assessment indicated that combination of lymphatic massage and compression bandage can lower the lymph edema following the mastectomy. Also, physical therapy approach can reduce the symptoms of shoulder disability caused by mastectomy and lymph nod dissection surgery. It should be taken into account that in patients who are suffering from lymph edema, recovering the shoulder movements and early return to normal function are very effective in improving lymph flow and reducing edema. Therefore, by restoring shoulder movement, in addition to reducing shoulder pain and increasing performance, can improve lymph flow as well among these patients.Key words: Breast Cancer, Lymph Edema, Physiotherapy, Shoulde

Narrative Review: Effects of manipulation and mobilization techniques of cervical spine on pressure pain threshold in neck and shoulder muscles

Neck pain is one of the most common problems seen in medical practice. There are various factors that can cause or provoke neck pain. Myofascial trigger points in shoulder and neck regions are among the most effective factors that may provoke neck and head pain. Recently, it has been revealed that there is a clinical relationship between myofascial trigger points and joints dysfunction. Accordingly, different studies have been conducted in order to evaluate therapeutic effects of different manual approaches including mobilization and manipulation on improving Pressure Pain Threshold (PPT) as an indicator of changes in sensitivity of muscles. The aim of the present study was to conduct a narrative review to evaluate effects of manipulation and mobilization techniques of cervical spine on PPT in neck and shoulder muscles. From among different studies which have assessed the effectiveness of manual techniques directed on cervical spine, 10 most related studies were selected and the therapeutic approaches and results of these studies were studied. Review of these studies indicated that the application of manual techniques on cervical spine, such as manipulation and mobilization, could increase range of motion in cervical spine and even mouth opening according to relationship between cervical spine and tempromandibular joints. On the other hand, according to the relationship between joints and muscles, applying these techniques on cervical spines could improve PPT.Keywords: Manipulation, Mobilization, Pressure Pain Threshold, Cervical Spin

Mapping the Scientific Outputs in the Field of Physiotherapy: A Co-Word Analysis

Introduction: Evaluation and analysis of scientific outputs and between-keywords relationship could provide the investigators with useful information. The aim of this study was mapping of scientific outputs in the field of physiotherapy, with applying the co-word analysis in the ISI Web of Science database. Methods and Materials: This study was a scientometric approach using the co-word and network analyses in the field of physiotherapy. Published papers from 2000 to 2018 were reviewed and the results were analyzed by Excel, UCINET, Netdraw and VOSviewer. Results: Results showed an increasing trend of scientific outputs in the field of physiotherapy. United States of America (USA) achieved the first rank (7400 documents) followed by England and Australia. Among the Middle East countries, Turkish with 981 documents achieved the first rank while Iran with 235 documents owned the third rank. Regarding the frequently used subjects, the most scientific outputs in the field of physiotherapy were shared with Physical medicine and Rehabilitation, Orthopedic, Neuroscience, Sport medicine, Internal medicine, Surgery, Rheumatology, Health medicine, Pediatrics, and Pulmonology. Results revealed rehabilitation, physiotherapy, exercise, physical therapy, and management based on degree centrality and disability, therapy, physiotherapy, outcome based on both of the betweenness and closeness centrality had the most impact on the network. Conclusion: Regarding the trend of scientific outputs, physiotherapy is most related to orthopedic, neuroscience, and pediatric. Moreover, scientific interaction to increase scientific outputs in Iran and other Middle East countries seems to be essential. Additionally, mapping of co-word analyses could provide the policy makers with information regarding the research, key words, and the relationship between key words in the field of physiotherapy. Therefore, they can plan essential and appropriate programs to improve both the quality and quantity of the scientific outputs in this field

Comparison of Combined and Conventional Rehabilitation with Virtual Monitoring Method on Impulsivity in Parkinson's Patients

Introduction: Parkinson's disease is a chronic multisystem disease that can cause motor and non-motor symptoms and cognitive changes. One of the most important conservative treatments for Parkinson's disease is physiotherapy. Lack of simultaneous attention to the cognitive aspect of rehabilitation consistent with its physical aspect may be one of the effective reasons for the ineffectiveness of Parkinson's exercise therapy, which has not been considered before. Therefore, the purpose of this study was to compare the effect of fifteen sessions of combined rehabilitation (cognitive and exercise therapy) and conventional rehabilitation (exercise therapy) with virtual monitoring method on the impulsivity of Parkinson's patients. Materials and Methods: This pretest-posttest study had two groups of intervention. The patients were of both sexes and between 50 and 75 years old. The two groups of combined rehabilitation (n=32) and conventional rehabilitation (n=31) were examined for 15 sessions. Before and after the interventions, the level of impulsivity was determined by Barratt questionnaire. The method of measuring and monitoring the interventions in virtual space was designed and implemented. The scores obtained from the questionnaire were analyzed using SPSS 26 software. Mann-Whitney test was used to analyze the mean scores due to the abnormality of the variables. Results: The results showed that after 15 sessions of intervention, there was a significant difference between the two groups of samples in the impulsivity scores of unplanning and coping stability. Combined rehabilitation intervention (cognitive and exercise therapy) had a greater effect on patients' impulsivity than conventional rehabilitation (exercise therapy). Conclusion: Performing both combined and conventional rehabilitation interventions reduced the impulsivity of Parkinson's patients. However, in the group that received combined rehabilitation, the rate of this reduction was significant in most cases. Further interdisciplinary research between physiotherapy and cognitive rehabilitation is recommended, especially for neurological patients such as Parkinson's disease

Spinal Stabilization Exercise with and without Whole–Body Vibration: A Randomized Controlled Clinical Trial

Introduction: The present study aimed to compare the impacts of core stability exercises with and without Whole Body Vibration (WBV) training sessions lasting two weeks on trunk muscle endurance in patients with non-specific chronic low back. Methods and Materials: Thirty participants were randomly placed into either a WBV group or a spinal stabilization group at Shahid Beheshti University of Medical Sciences, Tehran, Iran, in 2013. The dependent variables manipulated included the abdominal and spinal muscular endurance, assessed prior to, midway through, and after two weeks and the WBV or spinal stabilization intervention program implemented using stabilizer pressure biofeedback unit and Biering Sorensen test. Results: Changes in transverse abdominal and internal oblique muscle endurance in prone position were statistically significant among the participants in both groups (P<0.05). However, changes in transverse abdominal muscle endurance in supine position and multifidus muscle endurance were not observed to be statistically significant in both groups. In addition, inter-group analysis showed that except for the percentage of changes of multifidus muscle endurance, the vibration group demonstrated significant improvement over the non-vibration group. Conclusion: As no significant difference was observed between the two treatment methods, none of treatment methods was more effective comparatively in terms of improving mid-term trunk muscle endurance.Keywords: Whole body vibration, Trunk muscle endurance, Non-specific chronic low back pain, Core stabilit

Intra-Examiner and Between-Day Reliability of Algometer for Pressure Pain Threshold and Pain Sensitivity in Upper Trapezius Muscle in Asymptomatic Young Adult Women

Assessment of pain sensitivity, as an important criterion, is used in diagnosis of musculoskeletal impairments, which helps determine prognosis as well as the improvement rate after treatment interventions. Regarding the costs of modalities and treatment equipment used to reduce pain, having a reliable method to determine their efficacy is essential. The aim of the present study was to evaluate intra-examiner and between-day reliability of an accessible digital algometer to assess pressure pain threshold and for pain sensitivity for the first time. A total of 15 healthy young adult women aged 18-30 participated in the study. Three points of upper Trapezius muscle in both sides were tested in 3 repetitions with 30 seconds rest interval. The tests included PPT by controlled speed of increasing pressure and Visual Analogue Scale to evaluate local pain elicited by exertion of 2.5 kg/cm2 of pressure on the marked point. Trials were conducted on two consecutive days. Intra Class Correlation, Coefficient Standard Error of Measurement, and Minimal Detected Change were calculated to analyze the reliability of the measurements. Assessments revealed high to moderate intra-examiner reliability for pressure pain threshold (ICC>0.972) and pain sensitivity (ICC>0.707) and high to moderate between-day reliability for pressure pain threshold (ICC>0.974) and pain sensitivity (ICC>0.676). Although pressure algometer has an acceptable intra-examiner and between-day reliability for estimating the pressure pain threshold and pain sensitivity, a significant decrease was revealed in the mean values of PPT and increase in PS on the second day, as compared to that on the first day, (P<0.05) which could be related to local tissue trauma, learning effect, or central sensitization.Key words: Reliability; Intra-Examiner; Between-Day; Algometer; Pressure Pain Threshold; Pain Sensitivity; Upper Trapeziu

Duchenne muscular dystrophy (DMD) protein- protein interaction mapping

ObjectiveDuchenne muscular dystrophy as one of the mortal diseases is prominent to study in terms of molecular investigation. In this study, the protein interaction map of this muscle-wasting condition is generated to gain a better knowledge of interactome profile of DMD.Materials & Methods Applying Cytoscape and String Database, the protein-protein interaction network was constructed and the gene ontology of the constructed network was analyzed for biological process, molecular function, and cell component annotations.ResultsThe results indicate that among 100 proteins that are related to DMD, Dystrophin, Utrophin, Caveolin 3, and Myogenic differentiation 1 play key roles in DMD network. In addition, the gene ontology analysis showed that regulation processes, kinase activity and sarcoplasmic reticulum are the highlighted biological processes, molecular function, and cell component enrichments respectively for the proteins related to DMD.  ConclusionIn conclusion, the central proteins and the enriched ontologies can be suggested as possible prominent agents in DMD; however, the validation studies may be required