Assessment of Isokinetic Trunk Muscle Strength and Fatigue Rate in Individuals after Bariatric Surgery.

Background and Objectives: Lean body mass loss after bariatric surgery (BS) is remarkable, despite an effective long-term mass reduction and significant declines in comorbidities. A person's functional capacity is adversely affected when their skeletal muscle strength declines by up to 30%. This study aimed to assess the isokinetic trunk muscle strength and fatigue rate in individuals after BS. Materials and Methods: This study included fifty-eight patients, both male and female, ranging in age from 19 to 45. Twenty-seven individuals had BS and twenty-seven healthy people served as the control group. The primary outcomes were the measurement of the concentric and eccentric isokinetic muscle strength of the trunk flexor and extensor muscles. An isokinetic dynamometer (Biodex Rehabilitation and Testing System 3) was used for the assessment of the isokinetic muscle strength. Noraxon EMG was used to determine a secondary outcome, which was the median frequency slop (MF/time) and root mean square slop (RMS/time) of the lumbar erector spinea muscle at 50% of the Maximum Voluntary Isometric Contraction (MVIC). Outcome measures were assessed for both groups. Results: Compared to the control group, the bariatric group showed a lower mean value of both concentric and eccentric isokinetic muscle strength for the flexor and extensor trunk muscles (p < 0.05). In terms of the EMG fatigue rate, the RMS slope increased significantly more than that of the control group, while the MF slope decreased (p > 0.05). Conclusions: The current study found that, in comparison to the healthy subjects, the BS group showed reduced levels of fatigue and isokinetic strength in the trunk muscles. Based on these results, it is recommended that individuals who underwent BS take part in tailored rehabilitation programs to avoid potential musculoskeletal issues in the future.

Innovative Use of Biodex Balance System to Improve Dynamic Stabilization and Function of Upper Quarter in Recreational Weightlifters: A Randomized Controlled Trial.

Background and Objectives: Following an injury, upper-body strength and proprioception training is typically suggested. To our understanding, no prior research has looked into the impact of balance training on upper-body strength and stability. So, this study investigated the effects of Biodex balance training on enhancing the dynamic stability, strength, and function of the upper quarter (UQ) in recreational weightlifters. Materials and Methods: Fifty male weightlifters were randomly assigned into two groups. The experimental group received an upper-extremity Biodex balance training program three times/week for eight weeks, while the control group underwent a regular weightlifting training routine. Pre- and post-test scores of the upper-quarter dynamic stability, strength, and function were measured for both groups using the shoulder active repositioning accuracy test, two-minute push-up test, and the upper-quarter Y-balance test (UQ-YBT) and one-arm hop test, respectively. Results: Post-test values were significantly greater for the normalized UQ-YBT test than pre-test values in both groups (p < 0.05). Post-test values of the experimental group were significantly greater than the control group (p < 0.05). Regarding the shoulder active repositioning accuracy test and the time of the one-arm hop test, post-test values were significantly lower than pre-test values for both groups (p < 0.05), and post-test values of the experimental group were significantly lower than those of the control group (p < 0.05). The post-test value of the two-minute push-up test of each group was significantly higher than the pre-test value (p < 0.05), without any significant difference between both groups (p > 0.05). Conclusions: Adding upper-body Biodex balance training to a regular weightlifting training routine was effective in enhancing the upper quarter's dynamic stability and function.

The utility and outcomes of the temporalis muscle flap for palate reconstruction after maxillectomy for malignancy.

BACK GROUND: A common pedicled facial technique in head and neck reconstruction is the TMF It can be utilised to replace missing tissues in a variety of conditions, including oral deformities of the hard and soft palate. AIM: Aim of the study was to document the utility and outcomes with the reconstruction of the palate using TM flaps following Maxillectomy For maxillary sinus malignancies. METHODOLOGY: The study included 24 patients who were operated on for cancer maxilla and eligible for maxillectomy and reconstruction of the Palate using temporalis flap. Follow-up was planned for at least 12 months postoperative. Postoperative physical and speech therapy are initiated to help improve speech and swallow outcomes and to prevent trismus. RESULTS: The current study included 24 cases with Maxillary sinus cancer with a mean age of 42.34 ± 4.67. The mean operative time was 5.4 ± 1.22 h with no reported intraoperative bleeding or injury of important structures. No cases of facial palsy or trismus were reported while partial flap loss was reported in one case where oronasal fistula was evident. The donor site complications were minimal where seroma occurred in two patients and alopecia, wound infection and dehiscence were reported in one case each. The donor site depression was evident in 25 % of cases. CONCLUSION: TMF is an excellent option for the reconstruction of many craniofacial defects, it is easy to be harvested with good blood supply with minimal postoperative complications.

Balance and Fall Risk Assessment in Community-Dwelling Older Adults after Recovery from COVID-19: A Cross-Sectional Study.

BACKGROUND: SARS-CoV-2 atypical symptoms in older persons include falls, confusion, dizziness, and unusual weariness. Falls and their consequences are among the most prevalent causes of disability among older adults, significantly lowering quality of life and resulting in the loss of independence as well as impaired psychosocial functioning. The study purpose was to examine the impact of the SARS-CoV-2 infectious disease on balance in community-dwelling older adults. METHODS: Sixty-four older adults aged ≥ 60 years from both sexes, 31 treated for SARS-CoV-2 infection and 33 matched normal controls participated in the study. The Biodex Stability System (BSS) and Berg Balance Scale (BBS) were used for evaluation of balance and fall risk. The correlation between the Biodex overall stability index and the Berg Balance Scale score was investigated. RESULTS: When compared to controls, the SARS-CoV-2 group had significantly higher values of the Biodex overall stability index (OSI) (p = 0.011), anterior-posterior stability index (APSI) (p = 0.013), mediolateral stability index (MLSI) (p = 0.018), and fall risk index (FRI) (p = 0.008), as well as statistically lower scores on the Berg balance scale (p = 0.003). A moderate negative correlation was found between the two assessment tools in the SARS-CoV-2 group. CONCLUSION: Balance impairment and an increased risk of falling are among the outcomes of SARS-CoV-2 in community-dwelling older adults.

Long-Term Effect of Hyperbaric Oxygen Therapy on Gait and Functional Balance Skills in Cerebral Palsy Children-A Randomized Clinical Trial.

This study aimed to explore the long-term effects of hyperbaric oxygen therapy on spatiotemporal gait parameters and functional balance in children with cerebral palsy. Thirty-nine children with hemiplegic cerebral palsy were randomly allocated to one of two groups: control or study. The children in both groups received traditional physical therapy three times per week for six months. In addition, the children in the study group received hyperbaric oxygen therapy five times/week for eight weeks. The GAITRite system and pediatric balance scale were used to assess spatiotemporal gait parameters and functional balance at baseline, post-intervention, and six months after the cessation of hyperbaric oxygen therapy. Post-intervention means of all measured parameters were significantly higher than pre-intervention means, but only for the study group (p < 0.05). However, both groups' means at the six-month follow up were significantly greater than those at pre-intervention (p < 0.05). At the post-intervention and follow-up evaluations, comparisons between groups revealed a statistically significant difference in all measured parameters for the study group against the control group (p < 0.05). It can be concluded that adding hyperbaric oxygen therapy to physical therapy rehabilitation could be effective in improving spatiotemporal gait parameters and functional balance in children with cerebral palsy.

Efficacy of telehealth core exercises during COVID-19 after bariatric surgery: a randomized controlled trial.

BACKGROUND: Bariatric surgery (BS) is presently the most durable and effective intervention to address severe obesity. BS results in significant weight loss and body composition changes, with reductions in both fat mass and lean mass. Conequently, muscle tissue wasting and a reduction in muscle strength and endurance seem to take place. Some studies have evaluated the impact of resistance training on changes in lean body mass and muscle strength either alone or along with protein supplementation in the first year after BS. However, the effects of core stabilization training on core endurance, postural control, and aerobic capacity in patients after BS have not been evaluated. AIM: This study assessed the effect of a home telehealth core stabilization exercise program on core stability, postural control, and aerobic capacity in patients after BS. DESIGN: A single-blinded randomized controlled trial. SETTING: Home-based exercise program. POPULATION: Patients after BS. METHODS: Fifty-four patients who underwent BS randomly assigned into study and control groups. The study group followed a telehealth supervised home core stabilization program for 8 weeks, while the control group did not receive any form of exercises. Core endurance tests, postural stability, and aerobic capacity were assessed at baseline and after 8 weeks in both groups. RESULTS: No significant difference was noted between groups at baseline (P>0.05). The outcome of the group comparisons showed significant improvement in core endurance tests, postural stability, and aerobic capacity in the study group. Between groups comparision showed that the study group scores significantly higher than the control group (P<0.05). However, the control group showed non-significant changes in any measured variables after eight weeks (P>0.05). CONCLUSIONS: Eight weeks of a home-based telehealth core exercise program improves core endurance, postural stability, and aerobic capacity in patients after BS. CLINICAL REHABILITATION IMPACT: The core stabilization exercise is an important rehabilitation program that should be implemented after BS. Telehealth is an alternative rehabilitation tool during the COVID -19 pandemic.

Isokinetic Assessment of Shoulder Joint Strength Ratios in Male Recreational Weightlifters: A Cross-Sectional Study.

Background: Isokinetic strength imbalance is a risk factor for movement dysfunctions and injuries related to shoulder complex. The effects of recreational weightlifting on developing the imbalances between the shoulder muscles are not yet known. Objectives: To investigate the isokinetic concentric shoulder muscle strength values (peak torque normalized to body weight) in recreational weightlifters (RWL) and to compare the shoulder muscles agonist/antagonist ratios with nonweightlifters. Methods: Thirty male RWL with mean age, weight, height, and body mass index (BMI) of 21.56 years, 84.25 kg, 175.34 cm, and 26.51 kg/m2, respectively, matched with nonweightlifters served as a control group. The normalized concentric peak torque values of shoulder flexors, extensors, abductors, adductors, and internal and external rotators were measured at angular velocity 120°/sec by using Biodex isokinetic system. Moreover, the agonist/antagonist strength ratio for all muscle groups were calculated. Results: The normalized peak torques of RWL group were significantly greater than the control group (p < 0.05). The abductor/adductor and external rotator/internal rotator ratios of the RWL were significantly lower than the control group (p = 0.008 and 0.009, respectively). Conversely, there was no significant difference between both groups in relation to the flexor/extensor ratio (p = 0.259). Conclusion: These results suggested that the recreational weightlifting exercises place trainees at risk of muscle imbalances. Therefore, the restoration of a normal concentric abductor/adductor and external rotator/internal rotator strength ratios may decrease the risk of possible shoulder injury.

Pulmonary Function and Aerobic Capacity Responses to Equine Assisted Therapy in Adolescents with Idiopathic Scoliosis: A Randomized Controlled Trial.

BACKGROUND: Idiopathic scoliosis is a common spinal malalignment that negatively impacts the respiratory system and physical conditioning in adolescents. Equine-assisted therapy comprises therapeutic horseback riding that optimizes physical performance and mobility in a range of contexts. However, the influence of equine-assisted therapy on pulmonary function remains unclear. OBJECTIVE: To examine the impact of 10 weeks of hippotherapy combined with Schroth exercises on pulmonary function and aerobic capacity in adolescents with idiopathic scoliosis. METHODS: A randomized controlled trial including 45 patients, randomly assigned to experimental and control groups, was performed. Patients in the experimental group received 15 30-min sessions of hippotherapy over a period of 10 weeks. The 2 groups attended a 60-min session of Schroth exercises 3 times/week for 10 weeks. Pulmonary function and functional capacity were assessed before and after the intervention. RESULTS: Pre- and post-intervention variables (FVC, FEV1, FEV1/FVC, MVV and 6MWT) revealed significant improvement in both groups (p < 0.05). The improvement in the experimental group was significantly higher than in the control group (p < 0.05). CONCLUSION: The addition of hippotherapy to Schroth exercises resulted in improved pulmonary function and aerobic capacity in adolescents with idiopathic scoliosis.

Quantitative Assessment of Sensory Integration and Balance in Children with Autism Spectrum Disorders: Cross-Sectional Study.

Postural stability is dependent on the interpretation of external inputs acquired by sensory information processes, such as visual, vestibular, and proprioceptive systems, in order to accomplish neuromuscular control, balance maintenance, and appropriate motor response. A defect in any of these systems, or in the integration of information given by these systems, might threaten their capacity to maintain balance. Therefore, the purpose of this study was to investigate the sensory integration and balance using the Biodex balance system (BBS) in children with autism spectrum disorder (ASD) during the static posture. Seventy-four children from both sexes, 38 with ASD matched with 36 typically developed (TD) children as a control group, were included in the study. Using the Biodex balance system, the postural sway was evaluated through the modified Clinical Test of Sensory Integration and Balance (m-CTSIB) during quiet standing. In this test, four different situations were considered from standing position: eyes open/firm surface, eyes closed/firm surface, eyes open/foam surface, and eyes closed/foam surface. ASD children showed a significant increase in postural sway under all tested conditions when compared to the TD children group, especially for the conditions in which visual and somatosensory inputs were disrupted (p-value < 0.05). These results provide evidence that postural stability decreased in ASD children. Under static postural challenges, the current study's findings imply that children diagnosed with ASD have postural control deficiencies, especially for the conditions in which visual and somatosensory input was disrupted. Further research must be conducted to find the best balance training program for ASD cases using the Biodex balance system and considering its impact on motor skills.

The Effects of Stabilization Exercises Combined With Pelvic Floor Exercise in Women With Nonspecific Low Back Pain: A Randomized Clinical Study.

Objective: The purpose of this study was to investigate the effects of stabilization exercises (SEs) combined with pelvic floor muscle (PFM) exercises versus SE alone on pain intensity, functional disability, and static and dynamic endurance of trunk muscles in women with nonspecific low back pain (LBP). Methods: A total of 48 women with nonspecific LBP (26-45 years) participated in the study. They were randomly allocated into 2 groups. Group A received SEs combined with PFM exercises and physical therapy modalities, and group B received the same intervention without PFM exercises for 6 successive weeks (3 times/wk). Pain intensity, functional disability, and static and dynamic trunk muscle endurance were measured before and after treatment program. Results: After treatment, both groups revealed significant improvements in pain intensity and functional disability scores (P ˂ .05), and significant increases in static and dynamic endurance of trunk flexor and extensor muscles (P ˂ .05). Moreover, there was higher significance in group A compared to group B regarding pain intensity, functional disability scores, and static and dynamic endurance of trunk muscles (P ˂ .05). Conclusion: In this study, the addition of PFM exercise to the SE and physical therapy modalities was more effective in reducing pain intensity, improving functional disability, and increasing the static and dynamic trunk muscle endurance in women with nonspecific LBP compared to SE alone.

A 10-Week Program of Combined Hippotherapy and Scroth's Exercises Improves Balance and Postural Asymmetries in Adolescence Idiopathic Scoliosis: A Randomized Controlled Study.

INTRODUCTION: The most frequent type of spine abnormality throughout adolescence was adolescent idiopathic scoliosis (AIS). Hippotherapy improved posture, balance and gait of different musculoskeletal conditions. Therefore, this study aims to see how hippotherapy combined with Schroth exercises affected postural asymmetry and dynamic balance in AIS compared to traditional physiotherapy (Schroth exercises) alone. MATERIALS AND METHODS: In this randomized controlled trial, fifty-two patients with AIS (10-18 years, 37 girls and 15 boys) participated. They were arbitrarily allocated into two groups: experimental (19 female/8 male; aged 14.74 ± 1.79 years; Cobb angle 18.59 ± 2.66 degrees) and control (18 female/7 male; aged 15.04 ± 1.81 years; Cobb angle 19.32 ± 2.69 degrees) groups. Both groups received Schroth exercises for 10 weeks, three days/week. The experimental group additionally received hippotherapy training. Pre-treatment and post-treatment assessment for the scoliotic, kyphotic angle, pelvic obliquity, pelvic torsion and vertical spinal rotation and the anteroposterior, mediolateral and overall stability indices were assessed using the formetric system 4D and Biodex Balance System, respectively. RESULTS: After intervention, both groups illustrated significant improvements in all examined variables (p < 0.05). The experimental group illustrated significant improvements in scoliotic angle, kyphotic angle, pelvic obliquity, pelvic torsion and vertical spinal rotation and the stability indices compared to the control group (p < 0.05). CONCLUSION: In adolescence idiopathic scoliosis, hippotherapy training combined with Schroth exercises improves posture asymmetry and balancing ability more effectively than Schroth exercises alone.

Combination taping technique versus ankle foot orthosis on improving gait parameters in spastic cerebral palsy: A controlled randomized study.

BACKGROUND: One of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society. OBJECTIVE: To compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia. METHODS: Thirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions. RESULTS: Significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups than pre-intervention values. [AQ9] Moreover, the post--intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters. CONCLUSION: The results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.

Clinical outcomes of the liver-first approach in the management of synchronous colorectal liver metastases: a retrospective study

Introduction: Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods: This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results: Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion: Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high. (AU)