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.
Introduction: A new coronavirus, called COVID-19, was discovered in Hubei, China in December 2019. In just one year, COVID-19 has infected more than 81 million people (as of December 29, 2020) worldwide. People with multiple sclerosis (MS) are a particularly vulnerable group during the disease. In such a situation, telerehabilitation approaches provide the main solutions to improve the disorders caused by inactivity in people with MS. This study was conducted to review the studies performed in the field of telerehabilitation in people with MS and to evaluate the effectiveness and feasibility of using this method in the face of the prevalence of COVID-19 for people with MS.
Materials and Methods: Research studies were searched and reviewed in 4 databases, including PubMed, Science-direct, Scopus, and Web of Science in the period 1995-2020. The inclusion criteria included articles using telerehabilitation interventions in people with MS and telehealth interventions in people with MS published between 1995 and 2020. These articles have been published in peer-reviewed journals. Group or single-case intervention research has been used.
Results: A total of 261 articles were found in the initial search based on keywords. In these articles, descriptions of telerehabilitation and telehealth were presented. Initially, after reviewing the searched articles, 223 articles were removed from the study process due to a lack of inclusion criteria. After that, the full texts of the remaining 38 articles were selected, at the end, 16 articles had the inclusion criteria and were included in the study.
Conclusion: Based on our findings on the benefits of using telerehabilitation to improve the cognitive, physical, and quality of life of people with MS, as well as its cost-effectiveness, it is recommended that people with MS under the conditions of the COVID-19 pandemic stay in quarantine. It is a good way to rehabilitate these people to prevent the further progression of the disease and maintain their quality of life. Of course, this approach is growing and due to the low quality of current studies, more research is needed.
Introduction: The purpose of the present study was to investigate the effects of single-session intramuscular electrical stimulation (IMES) on pain and dysfunction following active trigger points in the upper trapezius muscle.
Materials and Methods: Volunteers (30 females) with active trigger points in the upper trapezius muscle were randomly divided into two IMES and placebo groups. For the IMES group, a needle was inserted into the trigger point, and electrical stimulation was applied to generate a pain-free contraction. For the placebo group, the intervention procedure was exactly the same, but there was no electrical stimulation. Pain by visual analog scale (VAS), pain pressure threshold (PPT), range of motion (ROM), and disability by neck disability index (NDI) were assessed as main outcome measures before, immediately after, and one week after conducting intervention by another blinded researcher.
Results: The VAS scales were improved in both groups but were significantly lower in the IMES group one week after treatment. The PPT and ROM scores were substantially higher in the IMES group one week after the treatment. The NDI indexes significantly reduced for both groups, with no significant differences between them.
Conclusion: IMES effectively improves pain, PPT, ROM, and NDI, following trigger points in the upper trapezius muscle. Further studies are required to investigate the IMES’s long-term effects.
Introduction: This study aimed to assess the satisfaction of physiotherapy students with the general structure of objective structured clinical examination (OSCE).
Materials and Methods: A researcher-made questionnaire consisting of eight items was distributed to 43 graduate and undergraduate physiotherapy students to evaluate the general structure of OSCE. Data analysis was done through SPSS software v. 20, considering a significance level of P<0.05.
Results: Among 43 participants with a mean age of 23.7±2.4 years old, the percentage of desirable attitude toward attractiveness of the OSCE was 46.6%, being fair was 21%, identifying strengths and weaknesses was 53.5%, the ability to assess knowledge and information was 11.7%, good assessment of practical skills was 30.3%, good assessment of clinical diagnosis skills was 34.9%, and appropriateness was 34.9%. In total, 88.4% of the participants believed that OSCE increases students’ stress. The total satisfaction of all the participants with the OSCE was 2.7±0.8, with last year’s students significantly less than graduate ones (2.6±0.9 vs 2.9±0.3).
Conclusion: The findings showed that the satisfaction of physiotherapy students regarding the general structure of the OSCE was not desirable, and OSCE was considered stressful. Therefore, due to the importance of OSCE in assessing clinical skills, it is better to improve the quality of holding the OSCE by fixing existent shortcomings, including shortness of time at each OSCE station and establishing training sessions.
Introduction: Pragmatics refers to how language is used in social communication. Pragmatics has different dimensions. This study investigated the turn-taking, topic maintenance, and duration of topic maintenance in children with Cochlear implants (CIs) and normal-hearing children matched with chronological age and language age.
Materials and Methods: In this cross-sectional study, pragmatics were compared in 15 CI children, 15 normal-hearing children matched with chronological age, and 15 normal-hearing children matched with language age. Pragmatic skills of subjects such as turn-taking, topic maintenance, and duration of topic maintenance in verbal conversation were observed and measured in two groups including CI children with age-matched peers and CI children with language-matched normal-hearing children. The children’s conversations were transcribed and the data were analyzed based on the normality of their distribution by independent-sample t-test and Mann-Whitney U tests.
Results: Findings showed no significant difference between the mean of turn-taking, topic maintenance, and duration of topic maintenance skills of CI children with their hearing peers (P>0.05). Also, the results obtained by comparing the mean of turn-taking, topic maintenance, and duration of topic maintenance skills in CI children with normal-hearing children matched with language age did not show a significant difference (P>0.05).
Conclusion: Children with CIs achieved a level of skills in turn-taking, topic maintenance, and duration of topic maintenance, which was similar to age-matched and language-matched normal-hearing children. Probably, the duration of auditory experience after cochlear implantation, age of implantation of the prosthesis, age of diagnosis of hearing loss, age of rehabilitation intervention, and family follow-up have been effective in achieving these skills.
Introduction: Morphological awareness (MA) refers to the ability of conscious manipulation of morphemes (minimal meaningful units of language). There is no test for assessing MA in Persian. Therefore, this study aims to develop a morphological awareness test (MAT) and determine its psychometric properties in elementary school students.
Materials and Methods: This methodological research study was performed in 2 phases. The first phase of the current study involved studying articles to extract Persian morphemes for designing a MAT. A draft of MAT was developed. In the second phase, to determine content validity, the MAT was given to 7 experts. The content validity ratio and content validity index (CVI) were calculated. Intra-class correlation and Cronbach alpha were calculated for determining test-retest reliability and internal consistency, respectively. To determine discriminant validity, 20 dyslexic students were compared with 31 normal readers using the Mann-Whitney U test.
Results: CVI was reported 0.94. Test-retest reliability results showed that there were statistically significant differences (P<0.005) between two times in 7 subtests out of 10. Internal consistency was reported as 0.70. The results of discriminant validity showed that there was a statistically significant difference between normal and dyslexia groups in all MA subtests (P<0.005).
Conclusion: The amount of CVI showed that the test can examine MA skills. The inconsistency between test-retest results proved the influence of experience. The internal consistency of the test was acceptable. The appropriate discriminant validity results showed that the test can distinguish between normal and dyslexic groups. Therefore, the Persian MAT is a valid and reliable tool for the assessment of MA skills.
Introduction: Osteoarthritis (OA) is a chronic degenerative disabling worldwide disorder in which the knee osteoarthritis range of motion (ROM) is particularly reduced. Mobilization with Movement (MWM) has shown rapid improvements in pain and functions. The muscle energy technique (MET) is claimed to be effective in muscle lengthening, strengthening, and increasing joint ROM.
Materials and Methods: A clinical trial was conducted to compare knee Mulligan (lateral, medial, and rotational glides) techniques (n=15), and post-isometric relaxation muscle energy techniques (quadriceps, hamstring, and tensor fascia latae) (n=15) on pain and function in OA.
Results: Twenty-two subjects (73.3%) were grade-II of knee OA and 8 subjects (26.7%) with grade III. The visual analogue scale (VAS) showed significant changes in the reduction of pain. In the VAS, the main effect of time of treatment shows that the mean value of the VAS score was statistically significant between at least two assessment stages (before the first session, after the third session, and after a month) (P<0.001) in each group. In knee osteoarthritis outcome score (KOOS), the main effect of time of treatment shows that the mean value of KOOS score is statistically significant in increasing KOOS between at least two assessment stages (before the first session, after the third session, and after a month) (P<0.001) in each group. KOOS showed significant changes for increasing function. Timed up and go (TUG) score showed decremental significant changes in time. In the TUG score, the main effect of time of the treatment shows that the mean value of the TUG score was statistically significant between at least two assessment stages (before the first session, after the third session, and after a month ) (P<0.008). In ROM score, the main effect of time of the treatment shows that the mean value of ROM score was statistically significant in increasing ROM between at least two assessment stages (before the first session, after the third session, and after a month) (P<0.002, observed power= 0.927).
Conclusion: Applying MWM is more functionally effective than applying the post-isometric relaxation muscle energy technique, both interventions increase functional performance in the short term in patients with chronic knee osteoarthritis, but they are not functionally effective from a single session. Applying both techniques has effects on reducing pain immediately and in the short term.
Introduction: One of the most complex problems of elders is the balance problem and the increased risk of falling. Body percussion is an effective treatment for various diseases with cognitive, physical, and psychological deficits and improves the memory, motor, and coordination skills, as well as the social interaction of patients with neurological diseases. One of the problems in the elderly is the weakness in balance skills and falling. This study aimed to investigate the effect of body percussion exercises (BPE) on the balance of the elderly.
Materials and Methods: This study was carried out as pretest-posttest research with two experimental and control groups. A 12-session therapeutic program was implemented 3 days a week each for 45-60 minutes. The subjects were evaluated using the Berg balance scale, functional reach, and timed up and go (TUG) tests. Data were analyzed by paired and independent t tests.
Results: The results of the treatment group showed a significant effect of BPE on the balance (P<0.005). A comparison of post-treatment results showed that the Berg balance scale (P=0.00), and timed up and go (P=0.023) were significantly different. The functional reach test (P=0.174) was not significantly different.
Conclusion: This study showed that BPE had a significant effect on the elderly`s balance.
Introduction: The main purpose of this study was to investigate how words are retrieved in the picture naming tasks (retrieval is discrete serial or cascading and networked) by examining the effect of word cognateness on the ability to name. Obtaining normal data on the ability to name of Mazandarani-Persian bilingual individuals with different genders, ages, and educational groups, was another goal of this study.
Materials and Methods: In this cross-sectional study, after completing the language proficiency questionnaire, 120 Mazandarani-Persian individuals named 109 nouns and 90 verbs in Mazandarani and Persian languages. The speed and voice of people were recorded by DMDX software.
Results: The results show that the accuracy of the naming cognate nouns in Mazandarani, cognate verbs in Mazandarani and Persian, and the speed of naming cognate nouns in Mazandarani is more than non-cognate (P=0.000). Cognate status, gender (men), word type (noun), level of education, and Persian language had a positive effect on naming accuracy.
Conclusion: The results of this study are an example of the effect of cognate status on naming ability and thus confirming the cascaded activation model. Also, gender (men), word type (noun), level of education, and Persian language has a positive effect on naming accuracy.
Introduction: In migraine headaches, motor control of muscles is impaired. In this research, thickness measurement of bilateral muscle thickness of upper trapezius (UT) and sternocleidomastoid (SCM) muscles was conducted and intra-rater reliability of the thickness measurement of these muscles was assessed in migraine headache and healthy subjects.
Materials and Methods: This study was a cross-sectional study to measure bilateral ultrasound images of UT and SCM muscles in 15 patients with migraine headaches and 15 healthy controls. A linear array probe with a 50-mm footprint and frequency range of 7.5 MHz measured the thickness of UT and SCM, parallel to the orientation of the muscle fibers. Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were used for data analysis.
Results: The ICC and SEM for thickness measurement of left UT were 0.88 and 0.06 (excellent) and it was 0.87 and 0.07 (excellent) for right UT thickness. The ICC and SEM for left SCM muscle thickness were 0.88 and 0.06 (excellent) and it was 0.85 and 0.08 (excellent) for right SCM thickness. Muscle thickness of the right UT muscle was 13.38±0.92 mm and 11.12±1.00 mm, in migraine and healthy groups, respectively. Also, muscle thickness of the right SCM muscle was 7.24±0.70 mm and 9.16±0.67 mm in migraine and healthy groups, respectively.
Conclusion: The present study showed that ultrasonography can be a reliable tool to measure cervical muscle thickness in migraine patients. Additionally, the ultrasonography protocol of the current study, the position, and the measurement level can be used with high reliability in future studies.
Introduction: Chronic neck pain (CNP) is of the most common symptoms of musculoskeletal disorder. Diaphragmatic exercises can reduce pain, and disability, improve proprioception, and correct forward head posture (FHP) in patients with CNP. The present study aims to determine the effect of combining diaphragmatic exercises with physiotherapy on pain, disability, and active range of motions of cervical and FHP in individuals with CNP.
Materials and Methods: Thirty women with CNP were randomly divided into two combined groups of diaphragmatic exercises and physiotherapy (DEPT) and PHYSIOTHERAPY ALONE (PT). Each person received ten sessions of treatment over two weeks. The results were assessed in the first and tenth sessions as well as two weeks later. Pain intensity was measured by visual analogue scale (VAS), disability by neck disability index (NDI), cervical active range of motions (CAROMs) by goniometry, and FHP by a lateral photograph.
Results: The VAS, neck disability index (NDI), CAROMs, and FHP were improved after the tenth session and in a two-week follow-up (P<0.001). A significant difference was observed between the groups for average changes of VAS (P=0.04) and active extension (P<0.001) after the tenth session, while the average changes between the two groups of cervical active left lateral flexion (P=0.82) and left rotation (P=0.11) in the next two weeks was not significant.
Conclusion: Both groups showed improvement in neck pain, disability, CAROMs, and FHP. However, diaphragmatic exercises and physiotherapy (DEPT) seem to have more lasting effects. Therefore, it is recommended to evaluate and modify the breathing patterns in the first line of treatment programs for patients with CNP.
Introduction: This study was conducted to evaluate the adoption of yoga techniques as an alternative therapy in the management of physical and psychological occupational hazards among physical therapists.
Materials and Methods: A validated closed-ended questionnaire was used to assess education and experience level, personal health and occupational hazards/habits, and treatment strategies used for the physical and psychological occupational hazards for participants in their current position. By e-mail, we invited 500 randomly selected physical therapists to participate.
Results: We received completed questionnaires from 119 physical therapists. Musculoskeletal pain with stress was the most common occupational hazard reported, followed by only stress, and only musculoskeletal pain. Regarding the pain, the lumbar spine, cervical spine, thoracic spine, shoulder, and knee were the most affected parts of the body. Regarding pain and stress, only a third physical therapists adopted yoga as an alternative treatment for these occupational hazards; physical therapists tended to engage in other forms of exercise, listen to music or utilize massage to treat pain and stress. Lack of time and lack of training were the most common reasons cited by physical therapists for not practicing yoga. Interestingly, 85.7% of physical therapists would recommend yoga as a treatment for their patients.
Conclusion: While musculoskeletal pain and stress were extremely common occupational hazards among physical therapists, only about a third of physical therapists adopted yoga as an alternative treatment for these occupational hazards.
Introduction: Balance screening has been identified as a major predictor of falls in the elderly. The current study compares the diagnostic accuracy of various balance instruments in community-dwelling older adults.
Materials and Methods: In this cross-sectional study, 145 older adults were recruited. The Berg balance scale (BBS), Fullerton advanced balance (FAB) scale, dynamic gait index (DGI), performance-oriented mobility assessment (POMA), timed up and go (TUG) test, gait speed, step length, step test, and single item question were administered. The receiver operating characteristics curve analysis was used to calculate diagnostic accuracy.
Results: All single-item tools had moderate diagnostic accuracy (area under the curve [AUC]=0.76-0.89) and all multi-item tools had high diagnostic accuracy (AUC=0.91-0.95) when using the recommended cut-off point of 45 for BBS. All multi-item tools maintained high to moderate diagnostic accuracy (AUC=0.85-1.00) in all thresholds while using BBS severity cut-off points. The FAB scale showed the highest diagnostic accuracy (AUC=0.95) among all assessment tools. Single-item question scores (Wald=22.61, df=1, P=0.0001, Exp(B)=8.82) were significant as covariates in the regression model.
Conclusion: For older adults with or without a history of falling, the FAB scale demonstrated the highest diagnostic accuracy. Along with single-item tools, the FAB scale may be a preferred multi-item tool.
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