فصلنامه طب توانبخشی
سال دهم شماره 2 (خرداد و تیر 1400)

Core stability and strengthening core stability muscles have become one of the new topics in the field of sports medicine. The present study aims to compare the effects of eight weeks of TRX and CXWORX exercises on core endurance, trunk muscle strength, and dynamic balance of female college students.

This quasi-experiment study was conducted on 30 young healthy female college students. They were randomly divided into two experimental groups of TRX (n=10), CXWORX (n=10) and one control group (n=10). In the pre-test phase, trunk muscle strength was evaluated by sit-up test, dynamic balance by Y-balance test, and core endurance by McGill core endurance test. Then, experimental groups performed eight weeks of selected training program, 3 sessions per week, while the control group was asked to do their daily activities. After intervention, the three groups underwent post-test assessments. Shapiro-Wilk test was used to investigate the normality of data distribution, and repeated measured ANOVA was used to compare data. The significance level was set at P≤0.05.

Both TRX and CXWORX had a positive effect on the participants’ trunk muscle strength, core endurance, and dynamic balance such that their mean scores increased after training. The TRX group performed better than the CXWORX group in all study variables (P≤0.05), except for the Y balance at the anterior direction.

Both TRX and CXWORX exercises have positive effects on the trunk muscle strength, core endurance, and dynamic balance of female college students, where the effect of TRX was greater. Therefore, occupational therapists and trainers are recommended to use both exercises, especially TRX to improve core muscle strength and endurance.

Anterior Cruciate Ligament (ACL) injury is one of the most common non-contact lower extremity injuries among athletes. Ligament dominance is considered as one of the modifiable factors of ACL injury. This study aimed to evaluate the effect of plyometric training on electromyographic activity of hip abductor and adductor muscles in women with ligament dominance.

This is a randomized clinical trial conducted on 24 female athletes with ligament dominance, (Dynamic knee valgus angle >12 degrees), who were purposefully selected and randomly divided into two groups of training (n=12) and control (n=12). The training group performed plyometric training with verbal feedback for eight weeks, while the control group performed their regular training. The feedforward and feedback activity of hip abductor (gluteus maximus, gluteus medius, and tensor fascia latae) and adductor muscles (adductor longus) were assessed during a single-leg countermovement jump task 100 milliseconds before and after foot-ground contact. Paired t-test and multivariate covariance analysis were used to analyze the collected data. The significance level was set at 0.05.

A significant increase in gluteal muscles activity and a decrease in adductor longus muscle activity was reported in the training group (p < 0.05), but not in the control group (P>0.05). In comparing the mean scores of the two study groups, a significant difference was observed in gluteal muscles’ feedforward activity (p < 0.05).

Eight weeks of plyometric training with verbal feedback can improve the electromagnetic activity of hip abductor and adductor muscles in women with ligament dominance and thus reduce the risk of ACL injury.

Flatfoot is a structural disorder in which the height of medial longitudinal arch are declined and subsequently causes biomechanical changes in foot. The common treatment method is the use of medial soles. This study aims to compare the effects of medial soles on Ground Reaction Forces (GRFs) during walking in male athletes with a flexible flatfoot.

 Participants were 15 male athletes with flexible flatfoot (Mean±SD age= 21.33±3.39 years, Mean±SD height=178.72±5.28 cm, and Mean±SD weight= 71.76±8.04 kg). Vertical and anterior-posterior GRFs were evaluated during walking in 3 conditions (barefoot, shoe without sole, and shoe with sole). Data analysis was performed in SPSS software using repeated measures ANOVA with and Bonferroni post hoc test, considering the significance level at 0.05.

GRF changed when using shoes with medical soles at both vertical and anterior-posterior directions compared to two other conditions, such that as the heel raised from the ground, GRF increased (P=0.00) and the vertical GRF decreased at mid-stance phase (P=0.02). In comparing the anterior-posterior GRF in three conditions, results showed that the posterior force was significantly higher when using shoes with medical soles compared to the barefoot condition (P=0.001), while the difference was not significant for the anterior force (P=1.16).

By controlling the amount of pronation and eversion in the foot while walking using sandals with custom medical soles, the pattern of reaction force distribution can be changed at the vertical and anterior-posterior directions compared to the barefoot condition, indicating the effect of using a custom medical sole on the force distribution in the sole of the foot and subsequently on other joints. Therefore, it is recommended to study the kinetic changes of the joints following the use of medical soles.

More than 60 % of runners suffer from overuse injuries each year. Exercise and Running surfaces can prevent injuries and/or improve performance. The present study aims to investigate the effect of three types of running surfaces (Polyvinyl Chloride (PVC), artificial turf, and sand) on the Ground Reaction Force (GRF) components in the stance phase of running.

Impact force, loading rate, and free moment of 15 men were recorded while running barefoot on three PVC, artificial turf, and sand surfaces at a speed of 3±0.2 m/s (Average of 5 correct attempts). Comparison between different conditions was performed using repeated measures ANOVA and Bonferroni’s Post-Hoc Test.

The sand surface significantly reduced the impact force compared to the PVC and artificial turf. Both sand and artificial turf caused a significant reduction in the force loading rate compared to the PVC surface. The second peak of vertical GRF (propulsive force) increased at sand (P=0.001) and artificial turf (P=0.005) surfaces compared to the PVC surface. Moreover, the sand surface reduced adductor torque compared to the PVC (p < 0.001) and artificial turf (P=0.003) surfaces, while the artificial turf reduced abductor torque compared to the PVC surface (P=0.011).

Sand is a safer surface for preventing running injuries due to eliminating impact force, reducing loading rate, and having high shock absorption. Training on a sand surface may improve performance on harder surfaces.

One of the major problems in children with Attention Deficit Hyperactivity Disorder (ADHD) is a deficiency in cognitive skills, especially executive functions. The present study aims to evaluate the effect of a positive discipline parent education program on the executive functions of children with ADHD.

The study population consists of the parents of all children aged 7-11 years with ADHD in Isfahan, Iran in 2018. Of these, 30 parents of children who met the Diagnostic and Statistical Manual of Mental Disorders criteria (fifth edition) were selected using a convenience sampling method and were randomly divided into intervention and control groups. The data collection tools were Attention Deficit Hyperactivity Disorder Diagnostic Questionnaire and the Coolidge Neuropsychological Inventory for Children (CPNI). The positive discipline program was presented at 8 sessions, each for 90 minutes.

There was a significant difference in the decision making/planning (p < 0.001) and inhibition (p < 0.001) components of CPNI between the two study groups, but the difference was no difference in the organization component. The results of repeated measures ANOVA showed that program in post-test and follow-up phases was effective in terms of decision making/planning and inhibition components.

The positive discipline parent education program has a positive effect on executive functions of children with ADHD.

Defects in the alignment of head and shoulder and consequently shoulder girdle are highly prevalent with a variety of negative effects such as cervicogenic headache. The present study aims to investigate the effect of a 12-week corrective exercise program on head and shoulder alignment and balance in women with cervicogenic headache and Forward Head and Rounded Shoulder Posture (c).

Participants were 32 women with cervicogenic headache and FHRSP who were selected purposefully. The sample size was determined using GPower software, considering a test power of 80%, a confidence interval of 95%, and an effect size of 0.9. The participants were randomly divided into two groups of exercise (n=16, Mean±SD age= 42.4±36.12 years; Mean±SD height= 49.5±162.93 cm, and Mean±SD weight=69.3±25.6 kg) and control (n=16, Mean±SD age= 44.4±93.35 years; Mean±SD height=84.3±162.12 cm, and Mean±SD weight: 58.62±68.3 kg). The balance was evaluated in four modes using the Biodex device and imaging method (lateral view) was used to measure the angles of forward head and rounded shoulder. The intervention was presented for 12 weeks. All tests were repeated after the intervention. The collected data were analyzed in SPSS v. 24 software using paired t-test and independent t-test to evaluate the within-group and between-group differences, respectively.

After completing the exercises, head and shoulder angles and balance in both groups improved significantly (p < 0.05). Between-group comparison of post-test scores showed that the three variables improved more in the exercise group compared with the control group (P=0.0001).

The corrective exercise program can improve the head and shoulder alignment and balance of women with cervicogenic headache. Therefore, these exercises are recommended to patients with cervicogenic headaches and FHRSP.

The expression of adhesion molecule such as the intercellular adhesion molecule- I (ICAM-I) and vascular adhesion molecule- I (VCAM-I) in obese people may increase atherosclerosis phenomena and cardiovascular diseases. The purpose of the current study was to investigate the effects of 10-week high-intensity and moderate-intensity aerobic trainings on plasma levels of ICAM-I and VCAM-I in obese boys.

The statistical population of the present study was obese boys of Baharestan city. The sample included 36 obese student boys aged 13.4±0.69 years old, height: 163.06±7.88 cm; weight; 85.72±8.42 kg) who were randomly assigned to three groups: high-intensity training (n=‌12), moderate-intensity training (n=‌12), and control (n=12). The training was performed at 50%-65% maximal heart rate (moderate-intensity training group) and 70%-85% maximal heart rate (high-intensity training group), three days per week for 10 weeks. The blood sample was collected 48 h before and 48 h after the last session of exercise training. The ICAM-I and VCAM-I were measured via ELISA. Data were analyzed using two-way repeated ANOVA in SPPS, version 18.

The results indicated that body weight and BMI decreased significantly after moderate- and high-intensity training (p < 0.05). VO2max value significantly increased following 10 weeks of exercise training in both groups. No significant different was observed between exercise groups for plasma levels of ICAM-I. Moreover, the plasma levels of VCAM-I decreased significantly in the high-intensity training compared to the moderate-intensity training and control groups (p < 0.05).

It seems that intensity of training may decrease plasma levels of ICAM-I and VCAM-I through decrease of body weight and BMI and increase of VO2max.

Apelin is a newly discovered adipokine whose level is high in obese people with insulin resistance. It is not clear how endurance training affects apelin plasma levels. The present study aims to investigate the plasma levels of apelin-13, insulin, and glucose in obese male rats following 12 weeks of endurance training.

Samples were 14 obese male Wistar rats who received high-fat food for eight weeks to become fat based on the Lee obesity Index. The rats were then randomly divided into control (n=7) and training (n=7) groups. The training group ran on a treadmill with zero slope for 12 weeks, 5 days per week (60-min sessions at a speed of 15-30 meters per minute). The ELISA method was used for measuring the levels of apelin-13 and insulin, while photometric glucometer was used measuring the glucose level.

The results of independent t-test showed that there was a significant difference between plasma levels of glucose (P=0.0001), insulin (P=0.0001) and apelin (P=0.041) in obese male rats of control group and endurance test. The results of independent t-test showed a significant difference in plasma levels of glucose, insulin, and apelin-13 between the two groups (p < 0.05). The glucose and insulin levels in the training group were lower than in the control group , while the apelin-13 level was higher in the training group. Pearson correlation test results showed no significant relationship between levels of apelin-13 and insulin (P=0.07) as between apelin-13 and glucose (P=0.055) after 12 weeks of endurance training.

It seems that 12 weeks of endurance training can reduce the plasma levels of insulin and glucose and increase the plasma level of apelin-13 in obese male rats.

Patients with Non-Specific Low Back Pain (NSLBP) experience impairment in proprioception and lumbar motor control which are associated with pain. This study aims to evaluate the effect of motor control exercise on proprioception and lumbar motor control of women with chronic NSLBP and motor control impairment.

Participants were 48 women with chronic NSLBP who were selected based on the Oswestry Disability Index score. They were randomly assigned into two groups of exercise (n=25) and control (n=23). The exercise group performed 8 weeks of motor control exercises, while the control group did not perform any exercises. To assess proprioception and lumbar motor control of patients, goniometer and Luomajoki’s motor control test were used, respectively. Paired t-test was used for within-group comparison of pre-test and post-test scores, and independent t-test was used for between-group comparison. The significance level was set at 0.05.

There was a significant difference between the pre-test and post-test scores in the exercise group compared to the control group in the variables of proprioception and lumbar motor control. Significant difference was also found between the two groups.

Motor control exercise is effective for the treatment of NSLBP in women by improving their proprioception and lumbar motor control.

Forward Head Posture (FHP) is one of the causes of cervical injury. The present study aims to evaluate the effect of a corrective exercise program on the electrical muscle activity in children with PHP during typing.

 This quasi-experimental study was conducted on 30 children with FHP aged 11-13 years (Mean ±SD height=153.38±1.51 cm, Mean ±SD weight= 52.51±40.1 kg). To record the electrical activity of the muscles, a electromyography system was used. For statistical analysis, the two-way ANOVA was used. For all statistical analyses, the significance level was set at 0.05.

In the exercise group, the post-test frequency spectrum in the levator scapulae and middle deltoid over the first and last 10 seconds of typing and in the sternocleidomastoid muscle in the final 10 seconds of typing were significantly different compared to the pre-test score.

The corrective exercise program can affect the frequency spectrum of the electrical muscle activity in children with FHP, which can prevent from early fatigue in the muscles.

Multiple Sclerosis (MS) is a neurological disease that cause damage to the myelin membrane of the central nervous system. The present study aims to investigate the effect of exercise with stationary bike in water with and without Blood Flow Restriction (BFR) on step frequency and step length symmetry of women with MS.

Participants were 20 women with MS and a disability degree of 1-4 who were selected purposefully and randomly divided into two groups of exercise with BFR (n=10) and without BFR (n=10). Each group performed cycling in water for 6 weeks, 3 sessions per week (3 sets each for 6 minutes with 1-minute rest interval and HRmax of 60%-65%). A cuff was used on the upper part of both legs with a pressure of 96±10 mmHg for BFR. The step frequency and step length symmetry were measured using the Casio EXILIM EX-F1 camera at 300 Hz frequency and analyzed in KINOVEA software. Collected data were statistically analyzed in SPSS software using paired t-test and ANCOVA to compare the two groups.

There was no significant difference between the two groups in the study variables (P≥0.05).

The two exercises with and without BFR have no effect on the gait parameters of women with MS, but these exercises are recommend for inactive MS patients.

 Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficit, hyperactivity and impulsivity affecting 3-7% of the children and is usually associated with defects in the executive functions. This study aims to investigate the effectiveness of the cognitive rehabilitation of memory in improving the executive functions of children with ADHD.

This is a randomized clinical trial with a quasi-experimental design and pre-test and post-test phases. The study population consists of all school students suffering from ADHD in Yazd Iran in 2019. Of these, 30 were selected using a convenience sampling method and randomly divided into two groups of intervention and control. The two groups were matched for age and practical and verbal intelligence. The intervention group received the memory rehabilitation program at 12 sessions each for 30 minutes. Both groups were evaluated at the first and last sessions of the treatment. The behavioral symptoms of the affected children were evaluated by Conners’ Parent Rating Scale. The data were analyzed using independent t-test and mixed-design ANOVA in SPSS v. 19 software.

The cognitive rehabilitation of memory significantly improved the executive functions of children with ADHD (p < 0.05).

The cognitive rehabilitation of memory by computerized tasks can improve the executive functions of ADHD children. Therefore, it is recommended that it should be used along with other educational and rehabilitation methods for children with ADHD.

Direct Observation of Procedural Skills (DOPS) is a method for objective assessment of clinical skills by providing feedback. The present study aims to evaluate the reliability and validity of the Persian version of DOPS for the assessment of clinical skills in audiology students.

In this descriptive analytical study with a cross-sectional design, participants were the students of audiology internship in the School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. According to the panel of experts, three basic skills were selected as assessment items from among the main skills of audiology. After declaring consent, the students were assessed by a trained examiner while performing clinical skills in real clinical environment, and the results were recorded in a structured checklist. Then, students received feedback in an appropriate environment. Face, content, and construct validity and reliability of the Persian DOPS were then evaluated.

The content validity index of the Persian DOPS was more than 0.79, and its Content validity ratio was more than 0.42. Spearman correlation coefficient for the relationship of pure tone assessment, tinnitus assessment, and auditory brainstem response assessment with the total DOPS score were 0.785, 0.704, and 0.742, respectively indicating its acceptable construct validity (p < 0.001). Cronbach’s alpha value for the reliability of the Persian DOPS was reported 0.788. Minimum and maximum values ​​of the correlation coefficient for the inter-rater reliability were 0.504 and 0.837, respectively which were significant in all tests. Students’ and raters’ satisfaction with the Persian DOPS was 88% and 100%, respectively ranged from satisfied to very satisfied.

The Persian DOPS is a valid and reliable tool for the objective assessment of procedural skills in audiology.

The number of Internet users and those with Internet dependence is growing worldwide. Internet dependence can cause many physical and mental problems for people. The present study aims to compare musculoskeletal disorders and pain between students with and without Internet dependence and having different levels of physical activity.

Participants were 202 university students. Young’s Internet Addiction Test and International Physical Activity Questionnaire were used to assess their Internet dependency and physical activity, respectively. Samples were divided into three groups of non-internet dependent, at risk of Internet dependence, and Internet-dependent with low, moderate, and good physical activity. Pain was assessed using the Nordic Musculoskeletal Questionnaire and the Visual Analogue Scale. Goniometer, inclinometer, flexible ruler, and caliper were used to assess musculoskeletal disorders. Kruskal-Wallis test was used to compare the research groups.

There was a significant difference between the study groups in the variable of pain in neck, shoulders, upper back, wrists, lower back, elbows and knees, and disorders of head forward angle, uneven shoulders, lateral pelvic tilt, and kyphosis. Internet-dependent group with low physical activity had higher musculoskeletal pain and disorders, whereas the non-internet dependent group had lower musculoskeletal pain and disorders.

Overuse of the Internet can cause many musculoskeletal disorders and pain. Therefore, it is necessary to inform people about its consequences, the proper posture when using the Internet, and the positive effect of physical activity on the health.

Mobile phone use has increased in recent years and there is more than 1.6 billion users worldwide. This has increased speculations about the potential dangers of high-frequency Electromagnetic Fields (EMF) on health. Mobile phones receive and transmit microwave radiation in the frequency range of 800-2000 MHz, and due to the proximity of mobile phones to the head during use, the hearing system and brain are more exposed to radiation compared to other parts of the body. The present study aims to review the studies conducted on examining the effect of EMF from mobile phones on the hearing system.

In this narrative review study, the search was conducted in Google Scholar, PubMed, and Web of Science databases on the related studies.

The studies investigating the short-term effects of EMF on the health of auditory system did not report significant effects, but most of those conducted on its long-term effects showed significant effects.

Further studies are needed to determine how long after the use of mobile phones the effects can be measured so that the necessary measures can be taken to protect the health of the hearing system.