mehri ghasemi

Posturography is a method in which the postural stability of adults is evaluated by measuring the center of pressure sway. This study aims to evaluate the reproducibility of measuring the center of pressure oscillation in standing position with internal perturbation in healthy young women with and without hyperkyphosis.

Ten women with dorsal hyperkyphosis with the mean age of 23.5±2.65 years and 10 healthy women with the mean age of 21.9±1.3 years (October 2018 to February 2019) were recruited for the study. Subjects were asked to perform rapid bilateral arm elevation while standing on a force plate. Standard deviation of the amplitude and The standard deviation of the velocity of the center of pressure sway in anterior-posterior, Medio-lateral directions and the area of sway were used for statistical analysis. Measurements were carried out by one examiner with a 1-day interval in The Biomechanics laboratory of The School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences. The relative reproducibility of the measurements was calculated by Intra-class Correlation Coefficient (ICC), standard error of measurement (SEM) and minimal detectable changes (MDC).

The intra-rater reliability of standard deviation of the center of pressure sway velocity and amplitude of both directions in both groups were more than 0.75. The intra-rater reliability of the area of the center of pressure sway in the healthy and hyperkyphosis group were 0.42 and 0.38 respectively.

Standard deviation of the amplitude and standard deviation of the velocity of the center of pressure sway can be considered as reliable variables for assessing static balance in young women with and without dorsal hyperkyphosis in future studies. However, the inconsistency of sway area especially in women with hyperkyphosis suggests that the use of it for differentiation between subjects and the assessment of the outcome of any interventions on the postural stability should be considered with caution.

An essential principle that constantly implies a two-way relationship between subject and rule is the proportion principle of the subject and commandment that is obtained as a result of mental concentrations and traditions of understanding. The wise legislator, in the position of expressing rulings in common and understandable language has expressed its instructions in terms of the proportion of the subject and ruling as a proof and validity of the legislator, has created this capacity for jurisprudential rulings to maintain their effectiveness over time. As a method of inference, this principle has also been considered by jurists. Several articles have been written on the proportion principle. The main question is that are there any reasons that have led to the discussion on the proportion of the subject and ruling? What has happened in our religious literature in the context of time that we have been allowed to enter the discussion of the proportion of the subject and ruling? In this paper, the origin of the proportion of jurisprudential subject or ruling is discussed. The openness of this discussion has been presented in our jurisprudential, principled and sometimes legal assemblies to factors such as the passage of time and the semantic evolution of evidence words of rulings, separation in jurisprudence as an example of "it is up to us to state the principles for you and it is up to you to extract the branches, the presence of clues generating evidence rulings, the existence of a free area in evidence of rulings, especially in governmental political rulings and the accuracy and depth of Shiite jurisprudence through inference.

Peripheral neuropathy is one of the major complications of type II diabetesmellitus. Lower limb proprioceptive impairments due to neuropathy can lead to balance disorders in these patients.

The present study aimed to investigate postural stability and neuropathic changes following ankle proprioceptive training in type II diabetic patients with moderate neuropathy.

The present study was conducted on24 type II diabetic patients with moderate neuropathy (9 females and 15 males) aged 40-65 years (with a mean age of 57.25 years). The treatment consisted of ankle proprioceptive training by the balance board and rocker for10 consecutive days. Balance indices, including Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI), and Medial-Lateral Stability Index (MLSI), were measured withBiodex system before and after the treatment, as well as two weeks after treatment in two conditions: condition1: Eyes open, head straight, without using trunk, pelvis, thigh, and knee constrained orthosis. Condition 2: Eyes closed, head back (hyperextension), with using trunk, pelvis, thigh, and knee constrained orthosis. Plate-basedBiodexstability was fixed at levels 6 and 8 for condition1 and level 8 for condition 2. The severity of neuropathy was assessed using Valk and Michiganquestionnaires, as well as light touch sensation. The analysis of variance with repeated measure was used to evaluate alterations in the stability of patients. Furthermore, the correlation of neuropathic changes and stability parameters were assessed by the Pearson correlation coefficients.

Significant improvements were observed in OSI inall tests of condition 1 (Biodex Balance System (BBS) at level 8 (P=0.001) and level 6 (P=0.017), as well as test conditions 2 (level 8; P=0.004). After the treatment, at stability level 8, a significant improvement in the mean values of postural sways inthe Anterior-Posterior (AP) direction demonstrated that the ankle strategy was improved in the patients. After the treatment, the scores of the Valk (P=0.02) and Michigan (P=0.001) questionnaires were significantly decreased. After two weeks of follow-up,the observed improvement was maintained in the mean values of balance indices (OSI, APSI) and neuropathy due to treatment.

As evidenced by the obtained results, 10 sessions of targeted ankle proprioceptive training improved stability, neuropathy, and light touch sensation of the foot in type II diabetic patients with moderate neuropathy. Foot somatosensory information is one of the most important causes of balance alterations in these patients.

Dimethylsulfoxide is a potent solvent which is used to increase the transdermal transport of medicines. The aim of this study was to examine the effects of phonophoresis with hydrocortisone alone and in combination with dimethylsulfoxide on the upper trapezius trigger points. Sixty patients were divided into three groups and received ten treatment sessions with different protocols using ultrasound: 1% hydrocortisone gel, a solution of 10% dimethylsulfoxide and 1% hydrocortisone gel, and a neutral ultrasound gel. The pain, pressure pain threshold, and the range of motion of the neck were assessed at four intervals in all three groups. The results revealed that phonophoresis with the two treatment gels and ultrasound with neutral gel significantly reduced the pain and the pressure pain threshold (P=0.01). The range of ipsilateral lateral flexion and contralateral lateral flexion of the neck was significantly improved following phonophoresis with 10% DMSO and 1% hydrocortisone gel (P=0.01 and P=0.02, respectively). Thus, it was concluded that the addition of 10% DMSO to 1% hydrocortisone gel enhanced the persistence of the beneficial effects of hydrocortisone on the pain, pressure pain threshold, and the range of motion of the neck.

 Patellofemoral Pain Syndrome (PFPS) is known as one of the most frequent knee diseases in athletic and non-athletic people and the most frequent cause of anterior knee pain. Despite the high prevalence of PFPS, its predisposing factors are not known. Among the potential factors, neuromuscular control disorders of lumbopelvic hip complex or core have been recently focused because the stability of this complex is vital for movements of limbs and the instability of core redounds to the instability of whole movement chain. The knee is the most prevalent joint influenced by core disorders; it seems that knee is a victim of core stability disorders. 

 This is a descriptive-analytic case-control study. Thirty-two subjects including 17 patients with PFPS (10 female, 7 male) and 15 healthy subjects (8 female, 7 male) participated in this study. Electrical activity of vastus medialis obliqus, adductor longus, gluteus maximus, external oblique abdominus (EOA), internal oblique abdominus (IOA) and transverse abdominus (TA) and multifidus was recorded during the stair-stepping activity. All statistical analyses were performed with the SPSS version 20.0 software. 

 The results showed there was a significant difference (P=0.026 for EOA, P=0.03 for IOA and TA) between the offset time of electrical activity of core abdominal muscles in patients with PFPS and healthy subjects during stair-stepping. However, there were no significant differences in other parameters. 

 The end of electrical activity of abdominal muscles in patients with PFPS during stair-stepping was longer than healthy subjects. However, managing patients with PFPS is challenging because there is no consensus regarding its predisposing factors and treatment. Therefore, more accurate recognition of this syndrome is needed to develop an appropriate treatment.

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.

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.

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 subjects had 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). Normalized muscle 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).

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.

Rotator cuff injuries are the most common causes of shoulder pain and supraspinatus muscle is usually involved. Clinical tests are available and inexpensive tools for assessment of shoulder dysfunctions. The empty can (EC) and full can (FC) tests are considered as shoulder gold standard tests. Recently, hug up (HU) test has been developed to assess the supraspinatus. So far, no ultrasonographic study has compared supraspinatus muscle thickness in these testing positions. The present study aimed to compare the supraspinatus muscle thickness in the hug up testing position with the full can and empty can testing positions in young and healthy women.

Forty healthy women (mean age 21.62±2.4 years) participated in this cross-sectional-comparative study from April to June 2018 in the Biomechanic Laboratory of Rehabilitation School, Shahid Beheshti University of Medical Sciences in Tehran, Iran. The supraspinatus muscle thickness was scanned during rest and contracted states with a 0.5 Kg weight cuff. For contracted states, (A) EC testing position: the arm was at 90º abduction in the scaption plane with the thumb-down, (B) FC testing position: the arm was maintained at 90º abduction in the scaption plane with the thumb-up, (C) HU testing position: the palm of hand was placed on the opposite shoulder with the elbow flexed.

The Bonferroni test showed significant differences (P<0.001) between the muscle thickness in the rest and the testing positions. The muscle thickness in the empty can testing position was significantly less than the full can testing position (P=0.001), no significant difference was found between the muscle thickness in the hug up testing position compared to the full can and empty can testing positions.

All of the empty can, full can and hug up testing positions demonstrated increased mean muscle thickness when compared to the rest position and the greatest muscle thickness was in the full can testing position. It seems that supraspinatus muscle thickness in hug up testing position is similar with empty can and full can testing positions.