Comparison of Muscle Recruitment Patterns During Sit-to-Stand and Stand-to-Sit in “Movement System Impairment” Subgroups of Low Back Pain and Healthy Women

Background: While various studies have examined motor control differences between subjects with and without low back pain (LBP), only a few have investigated the muscle recruitment pattern in classified LBP patients during functional activity. The aim of this study was to investigate the firing pattern of the main muscles involved in sit-to-stand (STD) and stand-to-sit (STS) tasks in two prevalent LBP subgroups based on movement system impairment (MSI) classification. Methods: A total of 37 women between 18 and 50 years of age voluntarily participated in this cross-sectional study. They were divided into three groups (15 healthy, 15 lumbar extension rotation syndrome (LERS), and seven lumbar flexion rotation syndrome (LFRS)). Surface electromyography was recorded bilaterally from the trunk stabilizer muscles—i.e. the internal oblique (IO), lumbar erector spine (ES), and hip mobilizer muscles—and the medial (MH) and lateral (LH) hamstring muscles during STD and STS tasks. The variations in EMG onset muscle timing and asymmetry in side-to-side muscle timing were measured. Results: The firing sequence during the STD task showed no significant difference among groups. However, in the healthy and LFR groups the trunk stabilizer muscles were activated before the hip mobilizer muscles, and in the LERS group an insignificant delay was shown in the onset of the ES activity. There was no significant difference of bilateral muscle timing during STD. In the STS task no consistent order of pattern was found even in the healthy group. The bilateral muscle timing of IO (mean difference, -427.00; P=0.021) and ES (mean difference, 1964.57; P=0.000) had significant difference in the LFRS group during STS. Conclusion: The cumulative effects of recruitment pattern impairment may contribute to continuing the cycle of lumbar movement impairments and subsequent persistence of LBP

Impaired local dynamic stability during treadmill walking predicts future falls in patients with multiple sclerosis:A prospective cohort study

Background: Falling is a significant problem in patients with multiple sclerosis (MS) and the majority of falls occur during dynamic activities. Recently, there have been evidences focusing on falls and local stability of walking based on dynamic system theory in the elderly as well as patients with cerebral concussion. However, in patient with MS, this relationship has not been fully investigated. The aim of this study was to investigate local stability of walking as a risk factor for falling in patients with MS. Methods: Seventy patients were assessed while walking at their preferred speed on a treadmill under single and dual task conditions. A cognitive task (backward counting) was used to assess the importance of dual tasking to fall risk. Trunk kinematics were collected using a cluster marker over the level of T7 and a 7-camera motion capture system. To quantify local stability of walking, maximal finite-time Lyapunov exponent was calculated from a 12-dimensional state space reconstruction based on 3-dimensional trunk linear and angular velocity time series. Participants were classified as fallers (≥1) and non-fallers based on their prospective fall occurrence. Findings: 30 (43%) participants recorded ≥1 falls and were classified as fallers. The results of multiple logistic regression analysis revealed that short-term local dynamic stability in the single task condition (P < 0.05, odds ratio = 2.214 (1.037–4.726)) was the significant fall predictor. Interpretation: The results may indicate that the assessment of local stability of walking can identify patients who would benefit from gait retraining and fall prevention programs

Comparison of Lumbopelvic Movement Patterns in People with and Without Low Back Pain During Stair Descending Task

Background: Decreased lumbar spine control may be associated with early and/ or excessive lumbopelvic motion with trunk and lower extremity movements during functional and daily activities. This study investigated differences in lumbopelvic movement patterns in people with and without low back pain (LBP) during a stair descending (SD) task. Methods: A total of 36 subjects, 18 females with non-specific chronic low back pain (NSCLBP) and 18 healthy females, participated in this study. A threedimensional motion capture system was used to record kinematics during the SD task. Results: The results showed that in the LBP group, the start-time of the lumbar muscles occurred early in the movement (P=0.015). Additionally, subjects with LBP showed excessive lumbar spine and pelvic movement during the SD task (P<0.05). Conclusion: LBP patients make early and excessive lumbopelvic movements during a SD task, and this can be an important factor contributing to the development or persistence of their LBP problem. This finding should be considered by clinicians when evaluating functional tasks as part of movementbased examinations and rehabilitation programs for people with LB

Predicting falls among patients with multiple sclerosis:Comparison of patient-reported outcomes and performance-based measures of lower extremity functions

Background Accurate fall screening tools are needed to identify those multiple sclerosis (MS) patients at high risk of falling. The present study aimed at determining the validity of a series of performance-based measures (PBMs) of lower extremity functions and patient-reported outcomes (PROs) in predicting falls in a sample of MS patients (n = 84), who were ambulatory independent. Methods Patients were assessed using the following PBMs: timed up and go (TUG), timed 25-foot walk (T25FW), cognitive T25FW, 2-min walk (2MW), and cognitive 2MW. Moreover, a series of valid and reliable PROs were filled in by participants including the activities-specific balance confidence (ABC), 12-item multiple sclerosis walking scale (MSWS-12), fall efficacy scale international (FES-I), and modified fatigue impact scale (MFIS). The dual task cost (DTC) of 2MW and T25FW tests were calculated as a percentage of change in parameters from single to dual task conditions. Participants were classified as none-fallers and fallers (⩾1) based on their prospective fall occurrence. Results In the present study, 41(49%) participants recorded ≥ 1 fall and were classified as fallers. The results of logistic regression analysis revealed that each individual test, except DTC of 2MW and T25FW, significantly predicted future falls. However, considering the area under the curves (AUCs), PROs were more accurate compared to PBMs. In addition, the results of multiple logistic regression with the first two factors extracted from principal component analysis revealed that both factor 1 (PROs) and factor 2 (PBMs) significantly predicted falls with a greater odds ratio (OR) for factor 1 (factor 1: P = <0.0001, OR = 63.41 (6.72–597.90)) than factor 2 (P <0.05, OR = 5.03 (1.33–18.99)). Conclusions The results of this study can be used by clinicians to identify and monitor potential fallers in MS patients

Comparison of Efficacy of Nortriptyline Versus Transcutaneous Electrical Nerve Stimulation on Painful Peripheral Neuropathy in Patients with Diabetes

Background and aims: Diabetic peripheral neuropathic pain (DPNP) is one of the most common complications of diabetes and is difficult to treat. Existing treatments are often inadequate at controlling pain and limited by side-effects and drug tolerance. This study assessed the efficacy of nortriptyline versus Transcutaneous Electrical Nerve Stimulation (TENS) in patients with DPNP