Introduction: Using Simulated Patients (SPs) in clinical skills education is a common method of training students to improve their skills for future client encounters. This systematic review aims to provide an overview of the SP strategy in Physical Therapy (PT) education.
Materials and Methods: PubMed, Scopus, and Web of Science databases were searched from January 1980 up to November 2019. Different keywords related to the topic were selected using MeSH. Any types of quantitative study design which had used simulation-based learning in physical therapy were eligible for inclusion. Two reviewers read studies and appraised them critically.
Results: A total of 1049 abstracts were retrieved and after reviewing the full-text paper, 11 fulltext articles met the inclusion criteria. These studies had used simulated patients for various objectives, including replicate different aspects of knowledge, self-perceived skills, real clinical practice, attitudes, and feasibility. Based on the result of studies, SP as an educational technique can improve student’s clinical reasoning skills, communication, and motivation in a safe environment.
Conclusion: SP is a useful learning strategy to deliver learning activities in medical education and physical therapy curricula, facilitating feedback on students’ performance with opportunities to interact with real patients and environments.

Introduction: The purpose of this study was to investigate the Range of Motion (ROM) and balance symmetry between dominant and non-dominant arms in classic female wrestlers.
Materials and Methods: In this cross-sectional study, 13 members of the Iranian Women’s National Classic Wrestling Team participated voluntarily. The shoulder ROM was measured by a goniometer and dynamic balance was assessed by the Y-balance test. Data analysis was done by running a paired t-test, with a 0.95 confidence level (α<0.05).
Results: There was no significant difference between dominant and non-dominant upper extremities in flexion (P=0.162), extension (P=0.264), abduction (P=0.077), internal rotation (P=0.972), and external rotation (0.945). A significant difference was found in the Y-balance test in medial (P=0.026) and inferior-lateral directions (P=0.047), but no significant difference in superior-lateral direction (P=0.715) and composite score (P=0.071).
Conclusion: Based on the results, it seems that the balance in the dominant arm is better than that in non-dominant arm in the athletes so the non-dominant arm may be at more risk for injury development. We, therefore, recommend that the coaches and trainers pay particular attention to these findings in designing the injury prevention programs.

Introduction: To identify the type of referrals received by vestibular physiotherapists for vertigo and assess whether medical review for these patients would be appropriate.
Materials and Methods: We performed a retrospective review of referral forms, vestibular assessment forms, and vertigo clinic letters of patients referred for vertigo or vestibular physiotherapy input between July 1, 2013, to December 31, 2013.
Results: We studied 29 patients with a median age of 63 years. A diagnosis was provided in 65.5% of the referrals. Of 14 patients with possible benign paroxysmal positional vertigo (BPPV), Dix-Hallpike had been performed only for 4 patients. Almost half were seen for the medical review in the Vertigo Clinic due to the concerns of possible alternative non-vestibular diagnosis, medication issues, or syncope. Alternative diagnoses identified medically included orthostatic hypotension, stroke, vestibular migraine, medication-induced bradycardia, and phobic postural vertigo. Medication changes in vertigo clinic included treatment for heart failure, migraine, and medication optimization.
Conclusion: Medical review is appropriate for some patients referred for vestibular physiotherapy. A medical opinion should be sought by vestibular physiotherapists if there is uncertainty or concerns that the referred patients did not have straightforward vestibular problems, or there were possible alternative diagnoses, concerns with medications, or syncope.

Introduction: Musculoskeletal disorders are among the main causes of disability in modern life. Myofascial trigger points are very common among musculoskeletal disorders and may occur through ordinary common activities. This study aimed to determine the combined effects of laser therapy and Ischemic Compression (IC) on the treatment of Myofascial Trigger Points (MTrPs) at the upper trapezius muscle.
Materials and Methods: Twenty men with at least one active trigger point at their upper trapezius muscle voluntarily participated in this study. Trigger points were under treatment of laser irradiation (6 Joules per point) and also ischemic compression. Treatment approaches were applied over the pain point every other day for 5 sessions in 10 days. Neck disability index, pain intensity by visual analog scale, pressure pain threshold by algometry, and cervical lateral flexion by goniometer were assessed and recorded before the intervention, and immediately after the last session.
Results: At the end of treatment, statistically significant improvements were seen in the neck disability index, VAS value, pressure pain threshold, and cervical lateral flexion. VAS values of the treatment and control groups were compared with the baseline (P<0.001).
Conclusion: Application of combined laser and compression therapy was effective on the pain and level of disability of patients with trigger points in the upper trapezius muscle.

Introduction: Onset and offset activation of lower limb and trunk muscles may change the knee with genu varum during landing. These motor control strategies can be different from those in healthy subjects and contribute to more injuries in lower extremities. This study aimed to compare the delay time of the onset activity of the abdominal and lower limb muscles in the specific landing task.
Materials and Methods: Ten females with genu varum deformity and ten females with normal knee participated in this case-control study. Genu varum deformity was measured by a camera capturing goniometer. The subjects were informed to land by preferred lower limb from a table (30 cm high) on a force plate. Vertical Ground Reaction Force (VGRF) was measured to clarify the onset of the landing task. Surface Electromyography (sEMG) of transverse abdominal/int. oblique (TA/IO), Vastus Medialis (VM), Vastus Lateralis (VL), Lateral Gastrocnemius (LG), and medial gastrocnemius (MG) muscles were recorded during landing. The difference between the onset activity of the above muscles and onset of VGRF was calculated as delay times and compared between muscles and between two groups. Also, the offset of activities and the intensity of muscle activation (normalized RMS) were compared between the two groups.
Results: Lower limb and trunk muscles showed significantly different onset of activities in the genu varum group (P<0.05), whereas there was no significant difference in the onset of muscle activities in the healthy group. Results indicated significant differences between two groups in TA/IO, LG, and MG muscles and the genu varum group had longer delay time for motor control strategy (especially ankle strategy) in the landing task. Offset time of all muscles in the genu varum and healthy subjectshad a significant difference between muscles, especially in gastrocnemius muscles (P<0.05). Also,there were significant changes between the two groups in LG and MG muscles (P<0.05). Normalizedmuscle activities (nRMS) generally indicated an increase in muscle activation of genu varum subjects (TA/IO, LG, MG) compared with the normal subjects (P<0.05).
Conclusion: Motor control strategies in landing task is different in the genu varum group due to changes in biomechanics and properties of the knee joint. This variation may be due to changes in proprioception afferent pathways around the knee joint. An increase in muscle activation, delay, and offset time of muscle activities in these subjects, indicated that an increase in the degree of freedom may change motor control strategies. Internal anticipation and postural adjustment of the landing task in these subjects need more motor unit recruitment (an increase in nRMS). This deformity in the knee joint might affect some activities and possibly cause knee changes such as osteoarthritis.

Introduction: This study was conducted to assess the attitude and practice of general dental practitioners when dealing with Temporomandibular Disorders (TMDs) and referral to physiotherapy.
Materials and Methods: This comparative cross-sectional study was conducted with a study population of General Dental Practitioners (GPDs) of Mirpur Khas Sindh. The total study population estimated was about 55 GPDs in this district. A convenient sampling technique was used to recruit the samples. The study questionnaire was adopted from the different articles and modified as per our socio-cultural needs. The reliability and validity of the questionnaire were calculated via chrome back alpha test by doing a pilot study on 25 participants and found its validity as 80% and reliability as 75%. The questionnaire consisted of three sections of general questions regarding referral to physiotherapy, attitude, and practice of general dental practitioners in managing temporomandibular joint dysfunctions (TMD).
Results: The results showed that 57.1% of GPDs believe that 53.1% of patients had neck pain and poor posture. Also, 81.6% of patients were referred to other healthcare providers, and only 22.4% of patients were referred to a physiotherapist. About 28.6% of patients were referred to physiotherapists just because of neck pain, only 22.4% of patients with postural alterations were referred to a physiotherapist. Also, 53.1% of GPDs had little confidence in assessing, therapeutic decision, and treatment outcomes of TMDs. About 69.4% of GPDs provided medical management to the patients suffering from TMD, while 44.9% of GPDs provided pharmacological management.
Conclusion: This study concluded that there is a need for TMD experts to deal with patients suffering from TMDs. General dental practitioners of Mirpur Khas, Sindh know little about the physiotherapeutic benefits for TMD. The majority of GPDs have very little confidence in making a diagnosis and treating patients suffering from temporomandibular dysfunctions.

Introduction: In Cervicogenic Headache (CGH), motor control of muscles is impaired and deep upper neck muscles (extensor and flexor muscles) become atrophied. In this research, thickness measurement of Longus Capitis (LCap), Rectus Capitis Posterior Major (RCPM), and Obliquus Capitis Superior (OCS) muscles were conducted and intra-rater reliability of the thickness measurement of these muscles was assessed in CGH and healthy subjects.
Materials and Methods: Twenty subjects, including 10 healthy subjects (19-32 years old) and 10 CGH patients (20-35 years old) participated in this study. LCap thickness was measured at the level of C3-C4 in the supine position and posterior muscles (RCPM and OCS) thickness at the C1-C2 level in the sitting position. All ultrasound images were captured by a linear probe with a 50-mm footprint in B mode option and frequency range of 9-12 Hz. Intraclass Correlation Coefficients (ICC), Standard Error Of Measurement (SEM), and the Smallest Detectable Difference (SDD) were calculated for data analysis.
Results: The ICC for thickness measurement of LCap was from 0.70 to 0.91 (good to excellent), for RCPM thickness was from 0.69 to 0.94 and for OCS muscle thickness was from 0.87 to 0.98. SEM values for LCap were between 0.08 and 0.25 and the SDD values between 0.22 and 0.71. SEM values for RCPM were between 0.22 and 0.43 and these values were reported for OCS muscle between 0.19 and 0.45.
Conclusion: The results indicated that the presented position and the level of ultrasonography in this study are appropriate and ultrasound is a reliable tool to measure the deep upper neck muscle thickness in CGH and healthy subjects.