Articles in Press

Review Article(s)

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    Duchenne muscular dystrophy (DMD) is a hereditary progressive neuromuscular disease of childhood. The survival rate of DMD patients is extremely low. In physiotherapy, electrical stimulation is frequently applied to rehabilitate these patients. The present study aimed to evaluate the effects of electrical stimulation on the muscles of patients with DMD. In this regard limited relevant studies were found, some of which reported the positive effects of low-frequency electrical stimulation on improving muscle strength. Conversely, there were reports of the detrimental effects of electrical stimulation on muscle fibers. Overall, there is no standard guideline for electrical stimulation in patients with DMD, and further research is required with an adequate sample size and follow-up.

Research Article(s)

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    Purpose: To determine the refractive profile of strabismic children under 8 in a tertiary referral center in Tehran, Iran.
    Methods: This retrospective cross-sectional study was conducted on 357 patients’ medical records under eight years of age who had one type of strabismus in Farabi hospital, Tehran, Iran, between 2015 and 2019. All routine ophthalmic examinations were done for all patients. Cycloplegic refraction was performed after the instillation of two drops of cyclopentolate 1%with an interval of 5 minutes, and the refractive error was measured after 30 minutes. The diagnostic criteria were based on cycloplegic refraction in which myopia, hyperopia and astigmatism were defined when the refractive error was -0.25, +0.75 and -0.50 diopter (D) or more, respectively. The cycloplegic results were classified into different groups with an interval of 1.00D, and astigmatism was also assessed separately.
    Results: In this study, the most common type of refractive error in esotropic patients was hyperopia, with +2.00 to +4.00 D range had a higher prevalence. In exotropic patients, hyperopia was also prevalent; the most common range of hyperopia was between +0.75 to +1.00 D. Astigmatism had a prevalence of 37.8% in esotropic patients, and 17.2% in exotropic patients with the most common range of 0.50-1.00 D. Myopia was present in 2.8% of esotropic patient and 3.2 % of exotropic patients with the most common range of 0.25-1.00 D.
    Conclusions: In strabismic Iranian children, hyperopia was the most prevalent refractive error in both esotropic and exotropic patients, with higher degrees of hyperopia in esotropic patients. Low astigmatism was twice as more prevalent in esotropic patients than in exotropic patients. Low myopia was the least prevalent in both esotropic and exotropia.

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    Background: Down syndrome (DS) as a chromosomal abnormality has different symptoms including cognitive problems and language delay. Studies showed heterogeneous profile of language skills in this group of children. This study aimed to provide further information about the most vulnerable area of language -grammatical skills- regarding the unanalyzable utterances, clauses, phrases, grammatical morphemes, and mean length of utterances (MLU) in children with DS and compared them with those of non-verbal age matched controls.
    Material and Method: The grammatical structures of 12 children with DS (non-verbal age = 39 months) were compared to those of 50 non-verbal mental age matched controls (non-verbal age = 41 moths). Clause, phrase and grammatical morphemes were investigated through spontaneous language sample analysis according Persian-Language Assessment Remediation and Screening Procedure (P-LARSP).
    Results: Children with DS had higher percentages of unanalysable text units compared with typical matched peers (p = < 0.001). The MLU, number of phrases and clauses structures, & inflectional morphemes were significantly lower in children with DS compared with typical children (p < 0.001).
    Conclusion: Children with DS showed a noticeable gap in grammatical structures compared with typical children. The possibility of specific language problems in children with DS should be considered by future studies.

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    Introduction: Injury to the anterior cruciate ligament (ACL), in addition to instability of the knee joint, leads to a functional deficit in the form of diminished proprioception of the knee joint. The purpose of this study was to compare the knee proprioception in athletes with anterior cruciate ligament injury and healthy athletes.
    Materials and Methods: In a cross sectional study, 26 athletes with ACL injury and 24 healthy athletes participated in this study. Subjects were selected from the orthopedic clinic at Baqiyatallah Hospital in 2019, Tehran City, Iran. Cooper or non-Cooper subjects with ACL injury were identified via the Knee Injury and Osteoarthritis Outcome Score (KOOS). Knee proprioception all participants were recorded using a system consisted of digital photography, non-reflective markers, and Digimizer software.
    Results: The results showed that there was no significant difference between groups in absolute error of knee joint reconstruction at both 45° and 90° angles.
    Conclusion: The data of the study showed that in comparison with healthy athletes, the knee joint proprioception of athletes with anterior cruciate ligament injury is no different and has the same function.

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    Background: The reaction time is an important indicator for a good performance. Different types of exercises have been used by researchers to improve the reaction time of an individual. Other types of exercises still need more researches to study their effect on simple reaction time, such as proprioceptive training.
    Objective: The purpose of this study is to examine the effect of proprioceptive training program using Huber machine on the simple reaction time.
    Methods: Twenty-one participants from medical staff were assigned in two groups; experimental group (1) composed of 5 male and 5 female participants and a control group (2) also including 5 male and 6 female participants. A simple reaction time (SRT) test was assigned for all participants. Only the experimental group performed a proprioceptive exercise protocol on Huber motion’s platform, while the control group was tested at identical time periods without exercising; before the training (T0), immediately post-exercise (T1) and twenty minutes after exercising (T2). The procedure was repeated for six sessions over two weeks.
    Results: The participants of group (1) show a decrease in mean of RT (-43ms) immediately after proprioceptive training (T1), but they reveal a little increase (at T2) in SRT after an interval of 20 minutes (-23min). They still prove a retention effect, while few participants on the control group show improvement at T1 or T2. Paired T-test was significant for group (1) at T1 and T2 (P < 0.05) while it is not for the control group.
    Conclusion: Proprioceptive training may have a positive influence on reaction time with retention effect. Clinicians can use proprioceptive training to improve the reaction time of their patients.

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    Introduction: Intellectual disability and specific cognition in Down syndrome affects language development and processing. We assessed vocabulary and syntax reception among children with Down syndrome (DS) with typically developed (TD) Persian speaking Iranian children. We also investigated the association between vocabulary and syntax reception in children with DS.
    Materials and Methods: Using the Stanford–Binet Intelligence Scales test, 18 TD children (4-6 years old) and 18 DS children were matched based on non-verbal mental-age. Vocabulary reception was assessed using the visual reception test and syntax reception by using Persian syntax comprehension test.
    Results: Mean total vocabulary reception was worse in children with DS (p-value<0.001). Syntax reception was also impaired in children with DS compared to the normal values of the test. Among children with DS, vocabulary reception was positively correlated with syntax reception. Every unit increase in total vocabulary reception score was associated with 0.08 (95% confidence interval-CI: 0.04 - 0.12) improvement in syntax score in children with DS.
    Conclusion: Vocabulary and Syntax reception in DS children, especially complex syntax structures, was impaired. The observed association between vocabulary and syntax reception shows that vocabulary reception improvement might result in progressing syntax reception in children with DS.

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    Background: Chronic pain is a serious secondary problem for many individuals with disabilities.
    Materials and methods: 231 disabled athletes invited to compete in a multi-sport national sports tournament for para-athletes in Ahvaz, Iran, participated in the study to be investigated whether spinal pain (SP) prevalence and characteristics are different among different sports and disabilities. Athletes’ demographic information, SP prevalence and characteristics, and disability using Athlete Disability Index (ADI) Questionnaire were obtained. SP prevalence, characteristics, and factors affecting SP intensity and disability caused by low back pain (LBP) were determined as primary outcome measures before data collection.
    Results: The mean disability percentage and LBP intensity score were 22.2% (19.2-25.3) and 2.14 (1.84-2.47) of 10, respectively. The highest LBP intensity was among physical fitness participants and patients with spinal lesions. Weight lifting athletes and athletes with arm movement limitation had the highest disability. The mean neck pain intensity score was 2.16 (1.80-2.54).
    Conclusion: A high prevalence of SP was observed among most disabilities and sports. Although its intensity is rarely severe among a population of any disability or sports, it is undeniably disabling among the vulnerable population of para-athletes.

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    Aim: The aim of this study was to determine the validity and reliability of the Persian version of the Comprehensive Constipation Questionnaire.
    Background: Chronic constipation is one of the most common complaints of patients in developed countries, which affects 2 to 28% of the world's population and alter patients' quality of life extensively.
    Methods: The comprehensive constipation questionnaire was translated into Persian, and back-translation confirmed it after evaluating the content validity ratio index (CVR) based on the Lawshe table (CVR≥ 0.62). The content validity of the questionnaire was assessed by the content validity index, followed by examining its reliability by Cronbach’s alpha and test-retest reliability using intra-class correlation coefficient (ICC). A total of 100 patients with chronic constipation completed the questionnaire.
    Results: Content validity was confirmed in the range of 0.84 to 1.00, And Cronbach's alpha values in the range of 0.90-1.00 were acceptable)In this questionnaire, ICC in the range of 0.76-0.99 was used, which indicates a level of good to excellent reliability of the questionnaire. Also, the results of the factor analysis was confirmed at a moderate level Kaiser Meyer Olkin test (KMO> 0.6 and Bartlett test P <0.05) by extracting 1 factor solution.
    Conclusion: The Persian version of the comprehensive constipation questionnaire had an acceptable validity and reliability and seems to be an effective tool to evaluate patients with constipation.

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    Background: To know the effect of change in postural stability after applying static load during internal perturbation among professional athletes with and without anterior cruciate ligament surgery.
    Materials and Methods: In present study, 20 athletes with sixteen months’ post ACL reconstruction surgery and 20 healthy matched athletes were included. Each participant performed transitional task from double limb stance to single leg stance (SLS) and again to double limb stance on force plate before and after the application of 10 minutes constant loading. Area, fore-after range (The meaning of fore-after is anterior-posterior and in articles this term (fore-after) has been used instead of anterior-posterior) (Rfa) , side way range (Rsw), mean velocity (Mv) and confidence ellipse (Ce) of center of pressure were measured.
    Results: Rsw (p=0.009) and area (p=0.009) in response to static loading in healthy group showed decrease and increase of area (p=0.009) in response to static loading in ACLR group was seen on double limb stance phase. Mv (p<0.001) and area (p<0.001) were bigger in ACLR group after static loaded on integration phase.
    Conclusion: Decrease capacity of passive structures to maintain postural stability against perturbation was observed due to positional change among athletes with history of ACL reconstruction surgery.

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    Introduction: Although carpal tunnel syndrome (CTS) is aincident  entrapment neuropathy disorder, there was inadequate evidence about effect evaluation of adding low level laser therapy to ultrasound(US)plusmedian nerve glide exercises in this patients. hence, the main purpose of this research was to investigate the trace  of USplusmedian nerve glide exercises with and without low level laser therapy (LLLT).
    Materials and Methods: Thirty- six patients with moderate CTS in two groups of intervention were assessed. One group received 10 sessions of adding LLLT to median nerve glide exercises plusUS and other group received median nerve glide exercises plus US without LLLT.Outcome measures  were hand grip strength (HGS), Visual Analogue Scale (VAS), Boston Questionnaire (BQ), and Cross- sectional area (CSA) of median nerve.
    Results:Baseline analysis revealed similarity between two groups in all  parameters . Statistical  analysis indicated  significantly improving of  HGS, VAS, BQ, and CSA of median nerve in two groups of intervention.
    Conclusions: In patients with CTS, US and median nerve glide exercises with and without LLLT had significantly improvement without superiority of adding LLLT to mentioned treatment.

Case Report(s)

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    Background and Purpose: Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-load resistance exercise (LLRE) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LLRE may help people with supraspinatus tendinopathy through proximal effects to improve strength and muscle size. The purpose of this case report is to describe the proximal effect of LLRE+BFR program for a patient with supraspinatus tendinopathy.
    Methods: The patient was a 40-year-old man with history of shoulder pain and weakness since past month. He received a LLRE+BFR program for his right shoulder included rotator cuff and scapular strengthening exercises and lower limbs aerobic exercises based on protocols of strengthening and aerobic exercises of BFR. Outcomes measured at baseline and at 4 weeks included the 4- items: 1) Strength of supraspinatus muscle and four scapular stabilizer muscles included, serratus anterior strength, middle trapezius strength, lower trapezius strength by dynamometer. 2) Supraspinatus thickness by ultrasound. 3) Pain pressure threshold of supraspinatus and deltoid muscles by algometer. 4) Pain reported bay patient in each session based on Pain Numeric Scale.
    Results: After 6 weeks, the strength of supraspinatus and scapular stabilizers except lower trapezius increased. The supraspinatus thickness and pain pressure threshold in supraspinatus and deltoid muscle also increased after 4 weeks .The mean of pain reported by patient based on pain Numeric Scale before and after each session was also decreased.
    Conclusion: The patient had measurable improvements following the use of a LLRE+BFR program. LLRE+BFR program may be an option for strength training in people with supraspinatus tendinopathy; however, research is needed to determine effectiveness across the population of people with supraspinatus tendinopathy.

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    Case Description: A 15-year-old boy was diagnosed with Wilson and referred to a physiotherapy clinic for treatment. He received daily physical therapy exercises with resistance training three times a week for 70 minutes for 8 weeks. The performance of daily activities was evaluated using the Persian version of the DATH questionnaire. Upper limb muscle strength assessment were assessed using a manual muscle strength test.
    The DASH questionnaire score decreased from 67.24 before treatment to 46.55 after 4 weeks and 36.20 after 8 weeks. In addition, shoulder flexion and extension are improved.
    In the analysis of resistance exercises to facilitate distal muscles the use of manual muscles test showed an improvement in the strength of both hands.
    The present study suggests that regular physical therapy and exercise may be helpful in improving daily activity and muscle strength in Wilson's disease.