Golamreza Olyaei, Ph.D.
Journal of Modern Rehabilitation is the official scholarly journal of the Rehabilitation Faculty at the Tehran University of Medical Sciences (TUMS). The purpose of publishing the MRJ is promoting depth of the relevant knowledge and providing the perfect platform to encourage researchers in the appropriate fields. The scope of the Journal emphasizes all aspects of the specialty of rehabilitation, including Physiotherapy, Kinesiology, Biomedical Engineering, Motion Control, Electrodiagnostic Medicine and gait analysis; and also relative rehabilitation specialties including Physical Medicine, Orthopedic Rehabilitation, Cardiac Rehabilitation, Respiratory Rehabilitation, Neurology Rehabilitation, Gynecology Rehabilitation, Speech Therapy, Audiology, Occupational Therapy, Optometry and prosthetics and orthotics. The practice focus is on the clinical and administrative aspects of rehabilitation. The research focus emphasizes clinical inquiry and also explores basic science. The educational focus is on the application of modern teaching techniques/technology to graduate, undergraduate, and postgraduate rehabilitation instructional programs.
Neuromuscular Adjustments of the Quadriceps Muscle After Eccentric Resistance and Concentric Resistance Training
Introduction: Deficiency in the neural control of movement is associated with poor posture and skeletal muscle injuries. Exercise training is commonly reported as an intervention to improve neuromuscular activity. However, maximizing the effectiveness of exercise interventions for improving neural control of movement has been less investigated. The purpose of the current study was to examine improvement in neuromuscular activity (e.g., muscle fiber conduction velocity) and quadriceps function after eccentric resistance training versus concentric training.
Materials and Methods: A total of 24 men participated in this study and were randomly divided into eccentric training (n=12) and concentric training groups (n=12). Maximal voluntary isometric contraction (MIVC) of quadriceps, vertical jumping, and multichannel surface electromyography (EMG) signals were recorded before and 12 weeks after resistance eccentric and concentric training. Muscle fiber conduction velocity (MFCV) and root mean square (RMS) were computed using raw EMG signals.
Results: The percentage increases in MVIC and vertical jumping after eccentric resistance training were significantly higher than those after concentric training (P<0.05). Likewise, eccentric exercise resulted in a higher increase in MFCV and RMS of EMG than concentric exercise (P<0.05).
Conclusion: A higher increase in neuromuscular activity and quadriceps performance observed after eccentric exercise may indicate that eccentric resistance training is more effective in improving neuromuscular activity and muscle function.
The Effect of Head and Neck Stabilization Exercises on Dynamic Balance in the Elderly With Forward Head Posture
Introduction: This study aimed to investigate the effect of head and neck stabilization exercises on improving balance in older adults with forward head posture.
Materials and Methods: Thirty elderly participants with forward head posture and Mean±SD age of 65.7±5.2 years were examined. The forward head posture was measured by plumb line and craniovertebral angle. Elderly balance was evaluated before and after 8 weeks of head and neck stabilization exercises with Timed Up and Go (TUG) and Functional Reach (FR) tests. The paired t-test was used to examine the changes that occurred after the intervention.
Results: The results showed that head and neck stabilization exercises in the elderly significantly changed TUG test (8.3 s before the intervention, 7.8 s after the intervention; P=0.03) and FR test (23.4 cm before the intervention, 24.7 cm after the intervention; P=0.01) omitted. No significant statistical changes were observed in the amount of the craniovertebral angle after the intervention.
Conclusion: Based on the study results, performing the head and neck stabilization exercises did not cause significant changes in the craniovertebral angle but improved the dynamic balance of the elderly.
The Immediate Effects of Two Different Exercises on Clinical Outcomes and H-reflex in Patients With Acute Lumbosacral Radiculopathy
Introduction: The evidence has shown that specific exercises effectively treat acute low back pain. This study aimed to investigate the effects of lumbar spinal loading in both directions in the sagittal plane in patients with acute lumbosacral radiculopathy.
Materials and Methods: A total of 20 patients with unilateral acute lumbosacral radiculopathy voluntarily participated in the study. The patients randomly performed flexion or extension back exercise ten times in three sets with 1-min rest between each set. Pain intensity, range of forward bending and straight leg raising (SLR), time of sit to stand, and soleus H-reflex were measured before and after the exercise.
Results: This study showed that flexion compared to extension loading exercises significantly improved pain intensity, SLR degree of freedom, forward bending range of motion, time of sit to stand, and H-reflex latency (P˂0.05). There was no significant improvement in the H-reflex amplitude of the patients doing either of the exercises (P=0.07).
Conclusion: Flexion loading exercises are recommended for reducing pain intensity and improving spinal mobility and neurophysiological function of the nerve root functional status in patients with acute lumbosacral radiculopathy. It seems that flexion exercises with the flatting of lumbar lordosis and opening intervertebral space reduce disk pressure and neural tissue tension.
Introduction: Chronic Obstructive Pulmonary Disease (COPD) impairs patients` quality of life and clinical outcomes. Pulmonary rehabilitation (PR) program can improve the functional capacity in patients with chronic lung disease. Thus, the study aimed to evaluate the effect of the PR program on the quality of life, anxiety, depression, and pulmonary function of patients with COPD.
Materials and Methods: In this single-group before-and-after clinical trial, adult patients with COPD and recent history of exacerbation were recruited. The intervention was a PR program, including training of breathing exercises at home and aerobic exercise program, twice a week about 30 to 60 min for 8 weeks. The program was prepared according to the patient’s tolerance by a sports medicine specialist in a pulmonary rehabilitation clinic. The primary outcome was quality of life measured by the St. George’s Respiratory Questionnaire (SGRQ). Secondary outcomes were assessing anxiety, depression, pulmonary function, COPD status, the ability to walk, and shortness of breathing. All outcomes were measured before and one week after the program.
Results: Twenty-two eligible patients of both genders (68% male and 32% female) with a Mean±SD age of 65.09±9.72 years finished the program. Quality of life was improved significantly following the intervention (51.49 [16.68] vs 4275 [15.63]; P<0.001]. Anxiety and depression (P<0.001), pulmonary function parameters, such as forced expiratory volume in 1 second (FEV1) (P<0.001) and FEV1/ forced vital capacity (FVC) ratio (P=0.015), COPD status (P=0.001), the ability of walk1ing (P<0.05), and shortness of breath (P=0.001) were improved significantly after the intervention.
Conclusion: The PR program resulted in clinical improvement in patients with COPD. Thus, we recommend that it be used besides medical management.
The Effects of Corrective Exercise With and Without Visual Feedback on Lower Extremity Biomechanics and Dynamic Balance in Adolescent Female Athletes With Dynamic Knee Valgus: A Pilot Study
Introduction: This study aimed to compare the effectiveness of corrective-plyometric training with and without visual feedback on landing biomechanics and dynamic balance in adolescent female athletes with dynamic knee valgus (DKV).
Materials and Methods: A total of 26 adolescent female athletes were randomly divided into feedback (n=10), exercise (n=8), and control (n=8) groups. Six weeks of training with and without visual feedback were prescribed for feedback and exercise groups, respectively. Biomechanical data were measured at initial contact (IC) and maximum knee flexion (MAX) using 8 motion analysis cameras (Vicon) and a Kistler force plate. Y-balance test was employed to evaluate dynamic balance.
Results: Based on the between-group outcomes, knee flexion-extension moment at IC (P=0.026), hip internal rotation angle at IC (P=0.016), and MAX (P=0.028) significantly changed during double-leg landing. Ankle dorsiflexion angle (P=0.05), tibial external rotation angle (P=0.012), and anterior-posterior ground reaction force (P=0.05) at IC, maximum tibial external rotation angle between IC to MAX (P=0.042), and hip internal rotation angle at MAX (P=0.022) significantly changed during single-leg landing test. Y-balance significant improvements were recorded in anterior (P=0.000), posteromedial directions (P=0.000), and composite (P=0.023).
Conclusion: Corrective-plyometric exercises without visual feedback effectively improve landing biomechanics and dynamic balance in adolescent female athletes with DKV.
Comparing Plantar Pressure Distribution and Vertical Ground Reaction Force Between Healthy Subjects and Middle-aged Adults With Leg Length Discrepancy (LLD)
Introduction: This study aimed to compare plantar pressure distribution and vertical ground reaction force between middle-aged adults with Leg Length Discrepancy (LLD) and healthy subjects.
Materials and Methods: This quasi-experimental study was conducted on 21 middle-aged adults with leg length discrepancy (1.5 to 3 cm), and 10 healthy subjects participated. The plantar pressure distribution of subjects was measured using five steps with an emed platform. The data were analyzed with paired t-test, 1-way ANOVA, and symmetry index (P≤0.05).
Results: While the symmetry index did not show much asymmetry in healthy subjects, in LLD subjects, it showed lower contact time in the heel region of short limb, lower pressure, and force of the middle region of short limb, the higher pressure of forefoot region of short limb and higher pressure and force of long limb.
Conclusion: It seems that the primary contact time and weight acceptance of short limb reduced that results in higher pressure of forefoot region of the foot before push-off phase. Therefore, to dispel this problem, the LLD subjects could use orthotics to make reasonable height to the heel region and thus increase the contact time.
Effects of Pulsed Ultrasound on Knee Joint Friction and Inflammation in Non-traumatic Experimental Osteoarthritis
Introduction: Knee Osteoarthritis (OA) is one of the most important etiologies of pain and disability among adults. The effects of pulsed Ultrasound (US) on pain reduction and joint function have been proven, but its role on joint friction and inflammatory mediators is still unclear. Therefore, this study was designed to investigate the effects of US on knee joint friction and inflammation in non-traumatic experimental knee OA.
Materials and Methods: Forty-eight guinea pigs were randomly assigned into four groups: OA+US, OA+US sham, 30 days after OA induction (OA30), and normal control (n=12 for each group). OA was induced by intra-articular injection of 3 mg/kg of Mono-Iodoacetate (MIA) in the animal’s left knee. Joint circumstance and weight of the animals were measured at baseline, before (i.e., after 30 days of MIA injection), and after US treatment. Joint friction was evaluated by a pendulum friction tester system. Cytokine levels, including Tumor Necrosis Factor (TNF)-α and Interleukin (IL)-1β, were measured by the ELISA method. The Pearson correlation coefficient was calculated to study the relationships between friction and inflammation variables.
Results: Joint circumference was increased in the OA30 group. Joint friction variables, including exponential curve fitting, cycle number, and friction coefficient, were significantly better in the US group (P<0.05). TNF-α and IL-1β cytokine levels were significantly lower in the US group. A significant positive correlation was observed between joint friction indices and TNF-α and IL-1β cytokine levels (P<0.05).
Conclusion: US was an effective approach for reducing joint friction and inflammation in OA30. Moreover, the relationship between knee joint friction and inflammation could help us better understand the etiology, mechanism, and treatment strategies of this disease.
Introduction: Narrative discourse is a crucial subset of discourse production that can be used to assess high levels of language processing like microlinguistic and macrolinguistic structures. Because patients with Multiple Sclerosis (MS) have more problems at high levels of language processing, this study aims to analyze narrative discourse in MS patients and compare it with healthy people.
Materials and Methods: This research was a descriptive-analytic study. The study participants included 15 patients with MS and 15 healthy controls matched for age and education level. For investigating the narrative discourse, we used the Persian Narrative Discourse Test (PNDT). Data analysis was performed using descriptive statistics and the independent t-test in SPSS-24.
Results: The mean values of syntactic complexity, verbal error ratio, cohesion ratio, and coherence in Persian-speaking patients with MS were 1.40, 0.42, 1.18, 2.32, respectively. Our findings indicated that regarding the macrolinguistic measures, there is a significant difference between MS patients and healthy subjects (P<0.05). However, there was no significant difference in the microlinguistic measures (P>0.05).
Conclusion: This study showed that narrative discourse analysis could help identify linguistic and communication problems in MS patients. Patients with MS had pragmatic language disorder.
Auditory and Vestibular Complaints Among COVID-19 Patients: A Descriptive Survey of 300 Young Patients Over a 3-Month Follow-up Period
Introduction: COVID-19 is a pandemic disease caused by a novel coronavirus, presenting a wide range of symptoms. Most of the reported symptoms are commonly related to the respiratory system; however, over time, the disease has shown new diverse signs and symptoms. Recent studies have suggested that COVID-19 may affect the auditory and vestibular systems. Besides, little is known about symptoms that persist after the recovery. This study aimed to investigate the general characteristics and especially auditory and vestibular symptoms in young COVID-19 patients over a 3-month follow-up.
Materials and Methods: A total of 300 participants aged 25-45 years took part in this cohort study. They were diagnosed with COVID-19, according to radiographical abnormalities on CT scan and or PCR test, and were in good health based on medical history. Patients who had a history of hearing loss, vertigo, tinnitus, or any disease associated with auditory and vestibular disorders and who were hospitalized and received drugs were excluded. We collected patients’ demographics, some common symptoms, and their complaints (acute phase), and 1 month and 3 months later (follow-up phases) using a checklist of symptoms. The participants were asked to describe their chief complaints and, in particular, whether they had any complaints of hearing problems, tinnitus, rotatory vertigo, and aural fullness, or even changes in these symptoms over these periods.
Results: Auditory and vestibular symptoms were observed in a small percentage of COVID-19 patients and were not their chief complaints. Overall, among 300 patients, only about 5% of patients (15 cases) expressed rotatory vertigo, 4% (12 cases) aural fullness, 2.66% (8 cases) tinnitus, and 2.66% (8 cases) hearing problem in the acute phase. However, these symptoms disappeared almost in all participants in the follow-up phases (0 to 3 cases). In addition, none of these symptoms were the patients’ chief complaints.
Conclusion: Only a small percentage of COVID-19 patients complained of auditory and vestibular symptoms. It needs to be determined whether these complaints are due to the effects of the virus itself, medications, or stress. The persistence of some symptoms, such as fatigue even after 3 months, indicates the long-term impact of the COVID-19 virus, which necessitates further studies.
Introduction: The present study aimed to investigate the effects of Myofascial Release Therapy (MRT) on cardiorespiratory functions in patients with COVID-19.
Materials and Methods: A total of 36 patients with COVID-19 (intervention group=20, controls=16) were included in the present study. The patients in the intervention group participated in a single session of suboccipital, anterior thoracic and sternal, anterior cervical, and diaphragm myofascial release techniques, plus respiratory physiotherapy. The controls just received respiratory physiotherapy. Before-after assessments included recording heart rate, systolic and diastolic blood pressure, respiratory rate, blood oxygen saturation, chest expansion, and breathing comfort.
Results: There was a significant reduction in the heart rate and ease of breathing in the intervention group (P=0.04, P=0.02; respectively); also, the diastolic blood pressure increased significantly in the control group (P=0.02). Compared to the controls, the ease of breathing decreased significantly in the intervention group (P=0.03).
Conclusion: Myofascial release techniques of the neck, thoracic, and diaphragm, along with respiratory physiotherapy, could immediately affect heart rate and ease of breathing and prevent increasing diastolic blood pressure. If a patient with COVID-19 is stable, pulmonary physiotherapists may consider using these techniques while monitoring cardiopulmonary function.
Satisfaction of Patients Following Online Managing and Hands-on Rehabilitation During the COVID-19 Pandemic in Pediatric Center
Introduction: This study aimed to investigate the satisfaction rate of patients referred to Bahrami Hospital, Tehran City, Iran, by telerehabilitation and hands-on provision during the COVID-19 pandemic.
Case Presentation: Six pediatric patients with torticollis’ disorders, Erb’s palsy, and muscle weakness were referred to Bahrami Hospital. All those subjects were assessed and advised with different exercises and interventions, and then the rest session followed with the online managing with videos or WhatsApp consultation. Then satisfaction rate of the patients was evaluated based on a Likert-type scale.
Results: The patients revealed low satisfaction for alone telerehabilitation. However, all patients preferred to combine teleconsultation and hands-on rehabilitation. Of course, they were all satisfied with telerehabilitation.
Conclusion: It seems that most patients are afraid of the inability to perform accurate exercises and prefer to come on face-to-face rehabilitation, sometimes used in addition to telerehabilitation and teleconsultation.
Corticomuscular Adaptations in the Single-Leg Jump Task in Response to Progressive Mechanical Perturbation Training in Individuals With Anterior Cruciate Ligament Deficiency
Introduction: Studies have repeatedly discussed the importance of training with sufficient cognitive and sensory-motor challenges in successfully transferring Anterior Cruciate Ligament Deficiencies (ACLDs) from rehabilitation centers to sports facilities. For this purpose, this study investigated the effect of mechanical perturbation training and standard training on the brain and muscle activity of these individuals while jumping on one leg.
Materials and Methods: A total of 30 athletes with unilateral Anterior Cruciate Ligament (ACL) rupture (in the coper classification) were randomly assigned to perturbation and standard training groups. To compare the effect of two types of intervention training methods, we examined the Similarity Index (SI) and Voluntary Response Index (VRI) in surface Electromyography (sEMG) tests of eight muscles in the lower extremities and relative power of alpha and beta spectra in Quantitative Electroencephalographic (QEEG) tests between two groups and between two limbs of each group members in the single-leg jump task.
Results: Both training groups showed improved neuromuscular control and increased SI on sEMG tests between the two limbs. However, this improvement in the perturbation training group showed an excellent increase in Effect Size (ES) (intra-group comparison values of SI for perturbation training group P=0.0001, ES=3.6; and P=0.008, ES=1.24 in the standard training group; and P=0.04, ES=0.87 in the inter-group comparison). Regarding the post-test of QEEG tests, no significant difference was found between the two groups (alpha P-value: 0.13, beta P-value: 0.07). However, in the intra-group comparison, the perturbation training group achieved excellent symmetry for the relative power spectrum of alpha and beta signals (the similarity values between the two limbs in the perturbation training group for alpha were P=0.92, ES=0.04 and for beta were P=0.92, ES=0.02; and these values for standard training group for alpha were P=0.07, ES=0.86 and for beta as P=0.08, ES=0.87).
Conclusion: The present study results showed that mechanical perturbation and standard training are suitable for transporting ACLDs to sports environments. Furthermore, in comparing these two training methods, mechanical perturbation training in the manner used in this study has higher adequacy to eliminate motor control and central nervous system defects.