The Effect of Resistance Exercises Using an Elastic Band on Balance and Fear of Falling in Older Adults With Diabetic Peripheral Neuropathy: A 16-week Randomized Controlled Trial.

OBJECTIVE: The current study aimed to investigate the effect of resistance training using an elastic band on balance and fear of falling in older adults with diabetic peripheral neuropathy. DESIGN: The study was a clinical controlled trial with a repeated measure design. SETTING: Iranian Diabetes Foundation of Mashhad. PARTICIPANTS: The participants were 51 older adults with diabetic peripheral neuropathy and balance impairment (N=51). INTERVENTIONS: Participants were randomly assigned to 2 groups; 1 group received balance training using an elastic band and the other group just received balance training. MAIN OUTCOME MEASURES: The main outcomes were balance and fear of falling that were measured using Berg Balance Scale and a short version of the Fall Efficiency Scale-International, respectively. RESULTS: The results showed that balance resistance training with and without using an elastic band significantly enhances balance and reduces fear of falling in diabetic older adults suffering from balance issues. However, balance resistance training using an elastic band had a significantly better effect on the balance and fear of falling in the participants. The best results were obtained after week 12 (48 sessions of balance training). CONCLUSION: Balance rehabilitation programs may include an elastic band in balance resistance training for 12 weeks (3-4 sessions a week) for enhancing balance in diabetic older adults suffering from balance impairment.

Cross cultural adaptation, reliability and validity of the Persian version of the university of Wisconsin running injury and recovery index.

BACKGROUND: The University of Wisconsin Running Injury and Recovery Index (UWRI) was developed to evaluate running ability after a running-related injury. The aim of this study was to translate and cross-culturally adapt the UWRI into Persian (UWRI-Persian) and to investigate its psychometric properties in patients with a running-related injury. METHODS: The UWRI-Persian was translated using the Beaton guidelines. One hundred and seventy-three native Persian patients with running-related injuries were participated in the study. The exploratory factor analysis was carried out using the principal component analysis method with Varimax rotation. The construct validity of the UWRI-Persian was evaluated using the Pearson correlation with the pain self-efficacy questionnaire (PSEQ), Tampa scale for Kinesiophobia (TKS), and visual analogue scale (VAS). Test-retest reliability was tested among 64 patients who completed the form again after seven days. RESULTS: The UWRI-Persian showed excellent internal consistency for total score (α = 0.966). An excellent internal consistency (α = 0.922) was shown for psychological response and good internal consistency (α = 0.887) for running progression. The interclass correlation coefficient for the UWRI-Persian total scores was 0.965 (95% CI, 0.942 to 0.979), indicating high intra-rater reliability. The UWRI-Persian showed a moderate correlation with the PSEQ (r = 0.425) and the TSK (r = 0.457) and a weak correlation with the VAS (r = 0.187). These findings suggest no floor or ceiling effects. CONCLUSIONS: The UWRI is a reliable and valid tool for Persian-speaking patients with running-related injuries. The UWRI was successfully translated from English to Persian and demonstrated good to excellent internal consistency, validity and reliability with no floor or ceiling effects.

The comparison of the effects of neuromuscular electrical stimulation and Kinesio Taping on ankle swelling in athletes with lateral ankle sprain.

PURPOSE: Ankle swelling (AS) is one of the main complaints in athletes with a lateral ankle sprain (LAS) in the acute phase. Reducing AS may help the athlete to return to training faster. The purpose of this study was to evaluate the efficacy of Kinesio Taping® (KT) and neuromuscular electrical stimulation (NMES) in reducing AS in athletes with a LAS. METHODS: Thirty-one athletes with a unilateral ankle sprain from various sports were allocated to either KT (N = 16; mean age of 24.1 years) or NMES (N = 15; mean age of 26.4 years) groups. KT was applied over the medial and lateral ankle surfaces in the Fan cut pattern for five consecutive days; however, NMES was applied to the tibialis anterior and gastrocnemius muscles for 30 min. Outcome measures to assess the extent of AS included volumetry, perimetry, relative volumetry, and the difference in both ankles' volumetry and perimetry at baseline, after the interventions, and 15 days following the treatment completion. RESULTS: The results of the mixed model repeated measures ANOVA demonstrated no significant difference between the two groups in mean changes in outcomes over pre- and post-interventions as well as follow-up periods (P > 0.05). CONCLUSIONS: None of the KT and NMES methods could reduce acute AS in athletes with LAS. Further studies are needed in this area of research that consider changes in treatment protocol given the variety of NMES approaches and KT applications that can be used in recovery from an ankle sprain.

Effect of Heading a Soccer Ball as an External Focus During a Drop Vertical Jump Task.

Background: Research has demonstrated that performing a secondary task during a drop vertical jump (DVJ) may affect landing kinetics and kinematics. Purpose: To examine the differences in the trunk and lower extremity biomechanics associated with anterior cruciate ligament (ACL) injury risk factors between a standard DVJ and a DVJ while heading a soccer ball (header DVJ). Study Design: Descriptive laboratory study. Methods: Participants comprised 24 college-level soccer players (18 female and 6 male; mean ± SD age, 20.04 ± 1.12 years; height, 165.75 ± 7.25 cm; weight, 60.95 ± 8.47 kg). Each participant completed a standard DVJ and a header DVJ, and biomechanics were recorded using an electromagnetic tracking system and force plate. The difference (Δ) in 3-dimensional trunk, hip, knee, and ankle biomechanics between the tasks was analyzed. In addition, for each biomechanical variable, the correlation between the data from the 2 tasks was calculated. Results: Compared to the standard DVJ, performing the header DVJ led to significantly reduced peak knee flexion angle (Δ = 5.35°; P = .002), knee flexion displacement (Δ = 3.89°; P = .015), hip flexion angle at initial contact (Δ = -2.84°; P = .001), peak trunk flexion angle (Δ = 13.11°; P = .006), and center of mass vertical displacement (Δ = -0.02m; P = .010), and increased peak anterior tibial shear force (Δ = -0.72 N/kg; P = .020), trunk lateral flexion angle at initial contact (Δ = 1.55°; P < .0001), peak trunk lateral flexion angle (Δ = 1.34°; P = .003), knee joint stiffness (Δ = 0.002 N*m/kg/deg; P = .017), and leg stiffness (Δ = 8.46 N/kg/m; P = .046) compared to those in standard DVJs. In addition, individuals' data for these variables were highly and positively correlated between conditions (r = 0.632-0.908; P < .001). Conclusion: The header DVJ task showed kinetic and kinematic parameters that suggested increased risk of ACL injury as compared with the standard DVJ task. Clinical Relevance: Athletes may benefit from acquiring the ability to safely perform header DVJs to prevent ACL injury. To simulate real-time competition situations, coaches and athletic trainers should incorporate such dual tasks in ACL injury prevention programs.

Ankle dorsiflexion range of motion and landing postures during a soccer-specific task.

INTRODUCTION: Ankle dorsiflexion range of motion (DF-ROM) has been shown to be associated with poor landing posture. However, previously used tasks have been controlled, and it is unclear whether clinical measurements of the ankle DF-ROM, are associated with landing positions during sport-specific task. This study sought to determine the relationship between ankle DF-ROM and landing positions. METHODS: Thirty male soccer players participated in this study. The ankle DF-ROM was measured by the weight bearing lunge test in degrees using a cell phone app (TiltMeter). Landing patterns were assessed during a soccer-specific task using landing error scoring system items using Kinovea software. Simple correlations were used to evaluate the relationships between ankle DF-ROM and landing error scores. RESULTS: Significant correlations were found between ankle DF-ROM and landing errors (r = -0.450, P = 0.006). A decreased ankle DF-ROM was associated with greater landing errors in a soccer specific situation. CONCLUSION: These results suggest that ankle DF-ROM may serve a useful clinical measure for identifying poor landing posture in the real-world environment. Therefore, assessment of ankle DF-ROM could be included in the screening process, which could help identify the cause of the faulty motion.

The Effect of 12 Weeks of Cawthorne-Cooksey Exercises on Balance and Quality of Life in Patients with Parkinson's Disease.

Background: Parkinson's disease (PD) is known as the second most destructive central nervous system (CNS) disorder, which leads to movement slowness, tremors, decreased balance, instability, and CNS disorders in affected patients. This study aimed to investigate the effect of 12 weeks of Cawthorne-Cooksey exercises on the balance and the quality of life in patients with PD. Methods: This was a quasi-experimental study, and the research population consisted of PD patients in Zahedan City who were present at the Zahedan Elderly Center during May, June, and July 2022. Twenty-four individuals who were 53 to 69 years old volunteered to participate in this study and were assigned to the experimental (N = 12) and control (N = 12) groups. In addition to the usual treatment, the experimental group performed Cawthorne-Cooksey exercises (CCE) exercises for 12 weeks, while the control group only received the usual treatment during this period. The CCE exercises were performed for 60-minute sessions, three days a week, for twelve weeks. The Berg Balance Scale (BBS) was used to evaluate balance, and the Parkinson's Disease Quality of Life Questionnaire (PDQL 37) was used to assess the QOL of PD. The data were analyzed using Wilcoxon and Mann-Whitney U tests. Results: The Mann-Whitney U test results revealed that the experimental group exhibited significantly higher scores in all factors of QOL and balance during the post-test when compared to the control group ( P < 0.05). Moreover, the outcomes of the Wilcoxon test demonstrated significant improvements in all components of QOL and balance for the experimental group from pre-test to post-test ( P < 0.05), whereas the control group experienced a notable decline in both balance and QOL during the same period ( P < 0.05). Conclusion: The study demonstrates that CCE exercises positively influence the balance and quality of life of Parkinson's disease patients, suggesting their potential as complementary therapy in the treatment of PD.

Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment.

PURPOSE: Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment. DESIGN/METHODS: The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis. RESULTS: Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors ( p < .001). CONCLUSION: Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment. CLINICAL RELEVANCE: Balance training combined with mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.

What are gender differences in lower limb muscle activity during jump-landing tasks? A systematic review and meta-analysis.

BACKGROUND: Gender differences in muscle activity during landing have been proposed as a possible contributing factor to the greater incidence of anterior cruciate ligament injuries in women. Conflicting results among a few studies in this regard makes it impossible to reach correct conclusions. OBJECTIVES: The aim of this study was systematic review and the meta-analysis of previous studies which have compared the electromyographic activity of lower limb muscles in gluteus muscles (maximus and medius), quadriceps (rectus femoris, vastus medialis and lateralis), hamstrings (biceps femoris and semimembranosus), and gastrocnemius in men and women in jump-landing task. METHODS: A systematic search of the PubMed, SCOPUS, Science Direct databases was performed for eligible articles in October 2020. Cross-sectional studies that compared the muscle activity of male and female athletes without a history of previous injury in the jump-landing task were included. Unisex and non-athlete's studies were extracted from the included studies. The data were synthesized using a fixed and random effects model. RESULTS: Eight studies involving 145 participants were included. All participants were people who participated in regular exercises. The meta-analysis of timing and muscle activity was performed in the feedforward (pre contact) and feedback (post contact) stages. There were no significant differences in the muscle activity of biceps femoris (MD = -12.01; 95% CI - 51.49 to 27.47; p = 0.55; I2 = 87%), vastus medialis (MD = -53.46; 95% CI - 129.73 to 22.81; p = 0.17; I2 = 91%), semimembranosus (MD = 1.81; 95% CI - 6.44 to 10.07; p = 0.67; I2 = 0%), gluteus medius (MD = -3.14; 95% CI - 14.24 to 7.96; p = 0.58; I2 = 48%), and rectus femoris (MD = -5.83; 95% CI - 14.57 to 2.92; p = 0.19; I2 = 87%) in the pre contact phase between two sexes. There was a significant difference between men and women in the activity of vastus lateralis muscle in the post contact phase (MD = -34.90; 95% CI - 48.23 to - 21.57). No significant difference was observed between the men and women in the timing of semimembranosus (MD = 23.53; 95% CI - 14.49 to 61.54; p = 0.23; I2 = 56%) and biceps femoris muscle activity (MD = -46.84; 95% CI - 97.50 to 3.83; p = 0.07; I2 = 82%). CONCLUSION: The results showed that in all lower limb muscles except vastus lateralis there were no significant differences between muscle activity and muscle contraction timing in both sexes before and after foot contact. Therefore, it can be concluded that the reason for the greater susceptibility of ACL injuries in women than men is maybe related to other factors such as biomechanical and hormonal. Additional good quality research in this regard is required to strengthen these conclusions.

Evaluating the Effect of Quran Memorizing on the Event-related Potential Features by Using Graphs Created from the Neural Gas Networks.

Background: Quran memorizing causes a state of trance, which its result is the changes in the amplitude and time of P300 and N200 components in the event related potential (ERP) signal. Nevertheless, a limited number of studies that have examined the effects of Quran memorizing on brain signals to enhance relaxation and attention, and improve the lives of patients with autism and stroke, generally have not presented any analysis based on comparing structural differences relevant to features extracted from ERP signal obtained from the two groups of Quran memorizer and nonmemorizer by using the hybrid of graph theory and competitive networks. Methods: In this study, we investigated structural differences relevant to the graph obtained from the weight of neural gas (NG) and growing NG (GNG) networks trained by features extracted from the ERP signal recorded from two groups during the PRM test. In this analysis, we actually estimated the ERP signal by averaging the brain background data in the recovery phase. Then, we extracted six features related to the power and the complexity of these signals and selected optimal channels in each of the features by using the t test analysis. Then, these features extracted from the optimal channels are applied for developing the NG and GNG networks. Finally, we evaluated different parameters calculated from graphs, in which their connection matrix was obtained from the weight matrix of the networks. Results: The outcomes of this analysis show that increasing the power of low frequency components and the power ratio of low frequency components to high frequency components in the memorizers, which represents patience, concentration, and relaxation, is more than that of the nonmemorizers. These outcomes also show that the optimal channels in different features, which were often in frontal, peritoneal, and occipital regions, had a significant difference (P < 0.05). It is remarkable that two parameters of the graphs established based on two competitive networks, i.e. average path length and the average of the weights in the memorizers, were larger than the nonmemorizers, which means more data scattering in this group. Conclusion: This condition in the mentioned graphs suggests that the Quran memorizing causes a significant change in ERP signals, so that its features have usually more scattering.

The effect of footbath on the quality of sleep in older adults: A pilot study.

This pilot study was a randomized controlled trial that aimed to investigate the effect of the warm footbath on the sleep quality of Iranian older adults. Males and females aged over 60 were randomly divided into three groups (footbath group with water at 40°C, footbath group with water at 37°C, and one control group) using the permutation block method. Repeated measures design was used to compare the groups after week two and week four to study the effects of footbath on sleep quality. Footbath with water at 40°C and 37°C caused significant improvement in the participants' sleep quality. No significant difference was found between the participants' sleep quality treated with water at 40°C and 37°C. Future studies with larger samples are recommended for assessing the effectiveness of warm footbath in enhancing sleep quality in older adults.

Effect of the FIFA 11+ on Landing Patterns and Baseline Movement Errors in Elite Male Youth Soccer Players.

CONTEXT: There is no evidence regarding the effect of the FIFA 11+ on landing kinematics in male soccer players, and few studies exist regarding the evaluating progress of interventions based on the initial biomechanical profile. OBJECTIVE: To investigate the effect of the FIFA 11+ program on landing patterns in soccer players classified as at low or high risk for noncontact anterior cruciate ligament injuries. DESIGN: Randomized controlled trial. SETTING: Field-based functional movement screening performed at the soccer field. PARTICIPANTS: A total of 24 elite male youth soccer players participated in this study. INTERVENTION: The intervention group performed the FIFA 11+ program 3 times per week for 8 weeks, whereas the control group performed their regular warm-up program. MAIN OUTCOME MEASURES: Before and after the intervention, all participants were assessed for landing mechanics using the Landing Error Scoring System. Pretraining Landing Error Scoring System scores were used to determine risk groups. RESULTS: The FIFA 11+ group had greater improvement than the control group in terms of improving the landing pattern; there was a significant intergroup difference (F1,20 = 28.86, P < .001, ηp2=.591). Soccer players categorized as being at high risk displayed greater improvement from the FIFA 11+ program than those at low risk (P = .03). However, there was no significant difference in the proportion of risk category following the routine warm-up program (P = 1.000). CONCLUSIONS: The present study provides evidence of the usefulness of the FIFA 11+ program for reducing risk factors associated with noncontact anterior cruciate ligament injuries. The authors' results also suggest that soccer players with the higher risk profile would benefit more than those with lower risk profiles and that targeting them may improve the efficacy of the FIFA 11+ program.

The impact of type D personality on self-care of patients with type 2 diabetes: the mediating role of coping strategies.

PURPOSE: As a chronic disease, Diabetes requires special self-care behaviors until the end of life. Psychological factors play an important role in following the self-care plans among patients with diabetes. The present study was designed to examine the relationship between type D personality and self-care with the mediating role of coping strategies in patients with type 2 diabetes. METHODS: This cross-sectional study was carried out on a sample of 361 patients with type 2 diabetes from Ale-Ebrahim Diabetes Charity Center in Isfahan, Iran. Type D personality, coping strategies and self-care were measured by validated questionnaires. The data were analyzed through Structural Equation Modeling (SEM). RESULTS: The results indicated that type D personality affects the self-care behaviors indirectly via emotion-oriented coping. Problem and avoidant oriented coping strategies did not significantly mediate the effect of type D personality on self-care. CONCLUSION: In general, assessing psychological background (such as personality traits and coping strategies) can facilitate the treatment of patients with diabetes by means of self-care enhancement.

Tumor necrosis factor alpha and high sensitivity C-reactive protein in diagnosis of exudative pleural effusion.

BACKGROUND: Differentiation between exudative and transudative pleural effusions is the initial step in assessment of pleural effusion. The aim of this study was to determine whether high sensitivity C-reactive protein (hsCRP) and tumor necrosis factor α (TNFα) are diagnostic utilities for exudative pleural effusion. METHODS: This experimental study assessed 79 patients with pleural effusion who underwent diagnostic evaluations at Imam Reza hospital, Mashhad, Iran in 2009-2010. The complete biochemical analysis of pleural fluid, pleural fluid culture, and pathological examination of pleural fluid and tissue were performed. Moreover, hsCRP and TNFα concentrations were measured in pleural fluid samples. The data was analyzed by student's t-test and Mann-Whitney test. RESULTS: According to Light's criteria, 50 patients (63.30%) had exudative effusions while 29 subjects (36.70%) had transudative effusion. The pleural fluid concentrations of hsCRP and TNFα were significantly higher in the exudative group than the transudative group (p < 0.05). At a cutoff value of 5 mg/L for hsCRP, the results showed 94% sensitivity and 96.6% specificity. Regarding TNFα, a cutoff value of 12.9 ng/dl represented 96% sensitivity and 93% specificity. CONCLUSIONS: HsCRP and TNFα levels may be considered as beneficial diagnostic factors for detecting exudative effusion in patients with pleural effusion.

Malignant superior vena cava syndrome: is this a medical emergency?

BACKGROUND: Superior vena cava syndrome (SVCS) is an association with a variety of benign and malignant etiologies. The aim of this study was to evaluate if malignant SVCS is a real medical emergency or if we are able to obtain a definite histological diagnosis before chemoradiotherapy. MATERIALS AND METHODS: In this prospective case series study, we have evaluated epidemiological characteristics and the ability to obtain a definitive histological diagnosis before chemoradiotherapy and the role of chemoradiotherapy prior to obtaining tissue specimens on the results of diagnostic interventions in patients with malignant SVCS who came to thoracic surgery wards of Imam Khomeini (Tehran) and Ghaem and Imam Reza (Mashhad) hospitals in Iran from 2001 to 2006. RESULTS: Among 50 patients with SVCS, the M/F ratio was 32/18. Mean age was 61.7 years, and the most common symptom was dyspnea (86%). We performed successful tissue sampling before chemoradiotherapy in 44 cases (88%), and histological diagnoses in 100% of these cases were established, but among the other 6 patients (12%) who received chemoradiotherapy first because of unstable general conditions, histological diagnoses were obtained in only one patient (16.7%) after chemoradiotherapy (P<0.01). No in-hospital deaths were reported among our cases. CONCLUSION: Because we are able to establish tissue specimens by minimally invasive methods in most SVCS cases and because chemoradiation may preclude obtaining an exact pathological diagnosis, we suggest performing diagnostic interventions prior to chemoradiation in patients with SVC syndrome and without emergent clinical conditions.