The Effects of Physical Activity and Exercise Therapy on Pediatric Brain Tumor Survivors: A systematic review.

Pediatric brain tumors are commonly established with late effects such as poor Gross Motor ability, cerebellar motor dysfunction and cognitive deficits that can significantly affect the children's physical and mental ability as well as their quality of life. The aim of the present systematic review is to investigate the effects of exercise therapy on the complications and late effects arising from the nature of brain tumor and its different treatments in survivors from pediatric brain tumors. Six databases, of Embase, Med line, Cochrane Central Database, PubMed, CINAHL and Elsevier from 2000 up to October 2020 were searched for the studies focusing on the effects of exercise therapy in pediatric brain tumor following different treatment procedures. After applying the inclusion and exclusion criteria, nine out of 224 articles were included for the present systematic review. The articles were rated based on PEDro scales for methodological assessment. The study revealed that the children who survived from brain tumors commonly suffer from damage to hippocampus, cortex and the white matter. The results of systematic analysis also showed that physical exercises would likely help the formation of normal sensorimotor experiences, justifying children's better performance in cognitive tests and eventually promoting their quality of life. The literature also indicated that improvements in motor proficiency and physical fitness after exercise therapy were consistent with such MRI results as increase in the right somatosensory cortical thickness, increased FA in corpus callosum, in the right corticospinal pathway as well as in cingulum. Research voids and recommendations for further investigations were finally presented.

The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies.

Dual-task conditions are commonly experienced in daily routines. The aim of the present systematic review is to investigate the effect of dual-task conditions on gait and balance performance in children with cerebral palsy (CP) and to perform meta-analyses where applicable. Five databases, "ProQuest", "PubMed", "OTSeeker", "Scopus", and "PEDro" from the incipient date of databases up to Aug 24, 2020 were searched for studies focusing on the effects of dual-task conditions on gait and balance performance in children with CP. After removing irrelevant articles and applying inclusion and exclusion criteria, nine articles were included in the present systematic review and meta-analysis. The results of the meta-analysis showed that walking speed was slower during dual-task conditions compared to single-task conditions in children with CP (WMD = -0.29 m/s, 95% CI = -0.34, -0.24, P ≤ 0.001) and walking speed decreased in children with CP during dual-task conditions in comparison with the typical development (TD) control group (WMD = -0.19 m/s, 95% CI = -0.23 to -0.15, P ≤ 0.001). The results of subgroup analysis based on the type of task indicated that adding concurrent tasks to walking degrades walking speed under varied dual-task conditions. Additionally, theoretical synthesis of the literature demonstrated that other gait and balance variables are changed by performing cognitive and motor secondary tasks differently. Although these changes may be compensatory strategies to retain their stability, there was not sufficient evidence to reach a firm conclusion. Research gaps and recommendations for future studies are discussed.

Intra tester reliability of sympathetic skin responses in subjects with primary palmar hyperhidrosis.

BACKGROUND: Primary palmar hyperhidrosis (PPH) is a disorder related to sympathetic dysfunction. Iontophoresis can be used to reduce sweating rate. Sympathetic skin response (SSR) is commonly used to evaluate the sympathetic system. However, scarce evidence exists about the reliability of SSR parameters. OBJECTIVE: To assess the relative and absolute reliability of SSR before and after the application of iontophoresis with aluminum chloride hexahydrate (ACH) gel or tap water in subjects with PPH. METHODS: Twenty subjects were randomized to receive either iontophoresis with ACH gel or tap water. Three SSRs (amplitude and latency) with 5 s intervals from both hands in both groups were recorded before and after the application of iontophoresis for 30 min. Reliability of amplitude and latency of the SSR was assessed using intraclass correlation coefficient (ICC) with 95% confidence intervals, standard error of measurement (SEM), and minimal detectable change (MDC). RESULTS: Amplitudes and latencies of SSR showed good to excellent test-retest reliability for ICC in both groups before iontophoresis. Except for right hand latency which was moderate (0.5-0.75). After iontophoresis, the ACH gel group still showed good to excellent agreement for SSR parameters, while the reliability of SSR parameters in the tap water group was reduced. CONCLUSION: Subjects with PPH showed high intra-rater reliability for SSR parameters which was maintained after ACH gel iontophoresis and decreased after tap water iontophoresis. It seems that media used for iontophoresis or the state of media (gel vs liquid) may affect the reliability of SSR. Further research is recommended.

The effect of functional stretching exercises on functional outcomes in spastic stroke patients: A randomized controlled clinical trial.

BACKGROUND: Stroke is the biggest cause of disability in adults. Spasticity is a primary impairment of stroke with a highly variable prevalence. In the present research, we aimed to determine the impact of functional stretching exercises on functional outcomes in stroke patients. METHODS: Thirty stroke patients were randomized into two groups-Experimental group and control group for the purposes of the study. The subjects in the experimental group participated in a functional stretching training program at the rehabilitation center thrice a week for four weeks. The subjects in both groups were evaluated in 3 intervals, once at baseline, once at the end of the program, and once at 2 months following the program. Clinical assessments, such as measuring spasticity, were conducted using the Modified Modified Ashworth Scale (MMAS). Functional outcomes were also evaluated, using the Timed Up and Go (TUG) test, as well as the Timed 10-Meter Walk Test (WTT). Friedman test in SPSS version 22.0 was used to analysis the response variables with respect to each stage of evaluation. Spearman rank correlation was also used to measure correlation among clinical assessments and functional outcomes. RESULTS: The comparison between two groups showed significant differences only in the Modified Modified Ashworth Scale and Visual Analogue Scale (VAS) post treatment. The experimental group showed significant differences in the MMAS (p = 0.002), WTT (p < 0.001), and TUG (p < 0.001) scores. Nevertheless, the scores of the control group were not significantly different in different stages of evaluation. CONCLUSION: The findings of the study suggest that using functional stretching exercises can improve functional outcomes in chronic spastic stroke patients.

Quadriceps force production during straight leg raising at different hip positions with and without concomitant ankle dorsiflexion.

OBJECTIVE: Due to the significant prevalence of knee disorders and patellofemoral pain syndrome, as well as the importance of quadriceps strengthening in knee rehabilitation programs, it is necessary to specify the best method to activate and strengthen the quadriceps muscles. The current study aimed at comparing the maximum generated isometric force during an active straight-leg-raising (SLR) maneuver in a sitting position by changing the hip rotational position with and without the simultaneous contraction of the ankle dorsiflexor muscles. METHODOLOGY: The current study was performed on 30 healthy males recruited with a non-random and available sampling method. The maximum generated force was measured during the SLR maneuver in six compound internal and external rotations and in a neutral position with and without ankle dorsiflexor contraction. The obtained generated force was analyzed using repeated measures ANOVA. RESULTS: The generated forces in the SLR with and without contracting the ankle dorsiflexors were significantly different (p = 0.001), and taking different positions of hip rotation led to significant changes in the generated force (p = 0.005). CONCLUSION: The adoption of external hip rotation with the contraction of ankle dorsiflexors during the SLR maneuver generated the most force. Based on the interaction of these conditions, the general recommendation is to perform the SLR exercise in an external hip rotation with the simultaneous contraction of the ankle dorsiflexors in subjects with quadriceps muscle weakness.

A comparison of lower limb muscle activation pattern using voluntary response index between pronated and normal foot structures during forward jump landing.

BACKGROUND: Pronated of the foot is one of the important factors contributing to musculoskeletal problems affecting the lower extremities. It is known that in a pronated foot, excessive mechanical load is applied to the lower limb structures which may result in altered biomechanics and muscle activation patterns. The aim of this study was to determine changes in the muscle activation pattern of the lower extremities in individuals with pronated, compared to normal, feet, using the voluntary response index (VRI). METHODS: In this cross sectional study, 15 asymptomatic pronated foot individuals (mean age 23.27 ± 3.28 years) and 15 normal subjects (mean age 23.40 ± 3.11 years) were recruited by simple non-random sampling. Electrical activities of gluteus medius (GM), vastus lateralis (VL), vastus medialis (VM), biceps femoris, semitendinosus (ST), and medial gastrocnemius (MG) muscles were recorded during a forward jump landing task. Voluntary response index (VRI) variables, included similarity index (SI) and magnitude (Mag) were also evaluated. RESULTS: Muscle activity of VM (p < 0.001) and ST (p = 0.010) were significantly higher but VL (p = 0.039) and MG (p = 0.001) were significantly lower in pronated foot, compared to normal subjects. Similarity index was found to be different (p < 0.001) between pronated foot and healthy individuals. No significant difference was found in terms of Mag between the two groups (p = 0.576). CONCLUSION: The altered pattern of lower limb muscle activation identified in the pronated foot during landing may be attributed to the different activation involving VL, VM, MG and ST muscles. Adaptations to the biomechanical effects, due to the pronated foot causing altered activation of VL, VM, MG, and ST muscles, results in an altered pattern of muscle activation. This change in activation pattern may harm the effectiveness of movement control processes; and might also predispose individuals with pronated feet, to injuries. It seems that an altered motor strategy with the aim of minimizing biomechanical changes, predisposes individuals to injuries. However, further large scale studies are needed to support the findings of the present study.

Electromyographic changes in muscles around the ankle and the knee joints in women accustomed to wearing high-heeled or low-heeled shoes.

OBJECTIVES: This study aimed to investigate muscle activities in the muscles around the ankle and knee joints in women accustomed to wearing high-heeled or low-heeled shoes. METHODOLOGY: Forty young women (age: 18-40 years) participated in this comparative clinical study. Twenty of the recruited subjects were accustomed to high-heeled shoes and the other half to low-heeled shoes. Electrical activities of the ankle and knee muscles in both groups with and without wearing their accustomed shoes were studied during walking. RESULTS: Tibialis anterior and the medial gastrocnemius muscles started contraction earlier in the high-heeled shoe group. The duration of medial gastrocnemius activity and the intensity of proneus longus activity were significantly more in the high-heeled shoe group. CONCLUSION: Wearing high-heeled shoe for a long time could result in over work of muscles such as medial gastrocnemius and proneus longus by increasing the duration or the intensity of their contractions during walking.

Immediate effect of common peroneal nerve electrical stimulation on quadriceps muscle arthrogenic inhibition in patients with knee osteoarthritis.

OBJECTIVE: To investigate the immediate effect of electrical stimulation of the common peroneal nerve on the maximum voluntary activation of the quadriceps muscle in patients with knee osteoarthritis. METHODOLOGY: Fifteen subjects with knee osteoarthritis (mean age: 50.5 ± 13 years) participated in this study. To measure the arthrogenic inhibition ratio of quadriceps, a burst of electrical stimulation was superimposed on the maximum voluntary contraction, and the percentage of change in the force production was computed. The same measurement was also performed with concurrent electrical stimulation of the common peroneal nerve. RESULTS: All the patients with knee osteoarthritis showed significant arthrogenic inhibition of the quadriceps muscle. The stimulation of the common peroneal nerve was able to reduce this inhibition and increase the capacity of the muscle to produce a significantly higher knee extension force (p = 0.028). CONCLUSIONS: Electrical stimulation of the common peroneal nerve concurrent with the maximum voluntary effort can remove the arthrogenic inhibition of the quadriceps muscle in patients with knee osteoarthritis. This finding could have clinical implications in the management of patients with knee disorders.

Lower limb muscular activity during walking at different speeds: Over-ground versus treadmill walking: A voluntary response evaluation.

OBJECTIVE: To evaluate the overall lower limb muscular activity pattern during treadmill walking compared to over-ground walking. METHODOLOGY: The study was conducted on 25 healthy young females. Surface electromyography was recorded from gastrocnemius, hamstrings, vasti and gluteus medius muscles during walking over-ground and treadmill at 3 different speeds (comfortable, slow and fast). The pattern of muscle activity was compared between two walking conditions at different speeds by the voluntary response index method. Voluntary response index is composed of two numeric values: magnitude which represents the strength of overall muscular activity, and similarity index which represents the resemblance of overall muscle activity. RESULTS: The main effect of walking conditions and speed as well as their interaction effect (P < 0.001) on magnitude of muscle activity were significant but not for similarity index. CONCLUSIONS: The pattern of muscular activity during walking on treadmill and over-ground was similar but walking on treadmill induced higher muscular activity in the lower limb musculature.

Effects of non-surgical joint distraction in the treatment of severe knee osteoarthritis.

PURPOSE: The aim of this study was to evaluate the clinical results of non surgical knee distraction in patients with severe knee osteoarthritis. METHOD: forty female patients with severe knee osteoarthritis were randomly divided in two groups. A standard physiotherapy treatment was applied to both groups and in one group it was accompanied with 20 min knee joint distraction. The patients were treated for 10 sessions. Clinical examination consisted of functional examination, completion of a quality of life questionnaire, pain scale, and assessment of joint mobility and joint edema. RESULT: The standard physiotherapy treatment accompanied by knee distraction resulted in significantly higher improvement in pain (P = 0.004), functional ability (P = 0.02), quality of life (P = 0.002) and knee flexion range of motion (p = 0.02) compared to the standard physiotherapy treatment alone post treatment and after 1 month follow up. CONCLUSION: Adding knee distraction to standard physiotherapy treatment can result in further improvement in pain relief, increased functional ability and better quality of life in patients with severe knee osteoarthritis.

The effect of base of support stability on shoulder muscle activity during closed kinematic chain exercises.

METHOD: A total of thirty eligible subjects (17 female and 13 male, age = 22.26 ± 0.99 years, height = 170.96 ± 8.42 cm, weight = 61.63 ± 9.92 kg) were tested in six different randomly ordered positions. Surface Electromyography (EMG) was recorded from the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), long head of the biceps (LB), teres major (TM) and posterior deltoid (PD) muscles in the dominant shoulder in 6 different closed kinetic chain (CKC) positions. OBJECTIVE: To investigate changes in muscular activity of the shoulder muscles at different base of support stability levels. RESULTS: Muscle activity was greater in the most stable position for all muscles except UT (P < 0.01). CONCLUSION: Shoulder muscle activity did not increase in parallel with a reduction in base of support stability in the present study.

The effect of fatigue and velocity on the relative timing of hamstring activation in relation to quadriceps.

Inter-muscular coordination has an important role in proper function and prevention of injuries in the knee joint. The purpose of this study was to characterize the effect of velocity and fatigue on the relative activation onset of hamstring to quadriceps muscles during knee extension. Thirty one healthy and non-athletic volunteers (24 women, 7 men) were recruited for the study. The onset time of vastus medialis, vastus lateralis, rectus femoris, medial and lateral hamstring were measured during maximum voluntary extension of the knee joint at velocities of 45° /s, 150° /s & 300° /s before and after fatigue and the mean delay onset of all pairs of H-Q were measured. A two-way repeated measures ANOVA test was used to compare across the mean delayed onset of hamstring related to quadriceps muscles at various velocities. Hamstring muscle showed a delayed activation related to quadriceps and increasing the velocity of shortening has a prominent effect on the inter-muscular coordination with early activation of hamstring related to quadriceps muscles (F = 6.7, p < 0.002 for Biceps-rectus femoris, F = 6.31, p < 0.003 for semitendinosus-rectus femoris, F = 6.26, p < 0.003 for biceps-vastus lateralis, F = 5.98, p < 0.004 for semitendinosus-vastus lateralis, F = 3.19, p < 0.04 for biceps-vastus medialis and F = 3.2, p < 0.04 for semitendinosus-vastus medialis). This could predispose these muscles to over strain and possible injuries. The main effect of fatigue condition and its interaction with velocity however, showed statistically nonsignificant result.