Stroke survivors exhibit stronger lower extremity synergies in more challenging walking conditions.

The aim of this study was to examine how kinematic synergies are utilised as compensatory movements to stabilise foot positions under different walking task constraints in people with stroke. Ten (Males = 6, Females = 4) hemiplegic chronic stroke survivors volunteered to participate in this study, recruited from a rehabilitation centre. They completed a consent form and participated in treadmill walking tasks; flat, uphill, and crossing over a moving obstacle. The uncontrolled manifold method was used to quantify kinematic synergies in the paretic and non-paretic legs during their swing phase. The results of this study showed the strength of synergies was significantly greater in the obstacle task than in the uphill walking tasks at mid and terminal swing phases. In conclusion, the results suggest that walking in the challenging situations caused people with stroke to control step stability with greater compensation between lower extremity joints. Participants adapted to the increased challenge by increasing the amount of 'good variability', which could be a strategy to reduce the risks of falling.

Mountain Biking Injuries.

With the increasing popularity of mountain biking, also known as off-road cycling, and the riders pushing the sport into extremes, there has been a corresponding increase in injury. Almost two thirds of acute injuries involve the upper extremities, and a similar proportion of overuse injuries affect the lower extremities. Mountain biking appears to be a high-risk sport for severe spine injuries. New trends of injury patterns are observed with popularity of mountain bike trail parks and freeride cycling. Using protective gear, improving technical proficiency, and physical fitness may somewhat decrease the risk of injuries. Simple modifications in bicycle-rider interface areas and with the bicycle (bike fit) also may decrease some overuse injuries. Bike fit provides the clinician with postural correction during the sport. In this review, we also discuss the importance of race-day management strategies and monitoring the injury trends.

The Impact of Repetitive Transcranial Magnetic Stimulation on Affected and Unaffected Sides of a Child with Hemiplegic Cerebral Palsy.

The purpose of this study was to investigate the therapeutic effects of neuro-navigated repetitive transcranial magnetic stimulation (rTMS) combined with occupational therapy (OT) on gait impairment of a child (male, age: 13.2) with spastic hemiplegic cerebral palsy (CP). The treatment included 4 days a week of rTMS sessions for 3 weeks and 4 days of rTMS and OT sessions per week for 3 weeks. Transcranial magnetic stimulation (TMS) was used to evaluate corticospinal tract (CST) activities and H-reflex test was used to assess reflex hyper-excitability. Common clinical tests demonstrate the clinical status of the patient. Evaluations were performed in 4 time steps: baseline, 3 weeks after the beginning of the treatment, at the end of the treatment, and 1 month after the end of the treatment. The patient did not receive any specific treatment after the end of the treatment up to the follow up evaluations. The tests' results were compared between the affected and unaffected legs of the patient. Four parameters of the TMS test were calculated (motor evoked potential (MEP) latency, MEP peak-to-peak amplitude, cortical silent period (cSP), and stimulation intensity). These parameters were all improved for the affected side and cSP improved for the unaffected side, but MEP p-p amplitude and intensity got worse slightly for the unaffected side. Recruitment curves of H response and M-wave of the H-reflex test for both sides were obtained. Improvements could be seen after the treatment for both sides. Max H response on max M-wave (H/M) and H response latency got better after the treatment for both sides. Walking speed for self and fast velocity, timed up and go, and walking endurance improved during and after the treatment. All the improvements persisted after one month of the end of the treatment in the follow up evaluations. These findings indicate that rTMS combined with OT can have effective and long-lasting impact on neuromuscular impairments in spastic CP children.

A Subtle Threat to Urban Populations in Developing Countries: Low Back Pain and its Related Risk Factors.

STUDY DESIGN: A cross-sectional, population-based survey. OBJECTIVE: The aim of this study was to estimate the prevalence, and biological and psychological correlates of low back pain (LBP) in large, populated urban areas. SUMMARY OF BACKGROUND DATA: LBP is a common and costly medical problem all around the world. Currently, there are limited data available on prevalence as well as biological and psychological correlates of LBP in large urban populations in developing countries. METHODS: Here, in a cross-sectional, population-based survey, we analyzed data obtained from 22,952 subjects living in Tehran. RESULTS: Chronic, 1-year, and point prevalence of LBP among subjects were 12.2%, 42.1%, and 36.2%, respectively. LBP was more prevalent among older population, women, housewives, and obese people after adjustment for confounding factors using logistic regression models. In addition, persons with a general health questionnaire (GHQ-28) score ≥6 were about 2 times more likely to experience LBP in comparison with others. Both subjects with higher educational levels and those who were never married reported significantly less LBP. Furthermore, we could not find any significant correlation between smoking and physical activity level with LBP. CONCLUSION: LBP is prevalent among the general population of Tehran. Our findings can help health care providers regarding logical assignment of limited resources, in order to create multidimensional prevention plans according to potentially modifiable associated factors. LEVEL OF EVIDENCE: 3.

Association Between Hearing Loss And Cauliflower Ear in Wrestlers, a Case Control Study Employing Hearing Tests.

BACKGROUND: According to anecdotal findings, some wrestling coaches and wrestlers believe that cauliflower ear might lead to hearing loss. Our preliminary study showed that the prevalence of hearing loss reported by the wrestlers with cauliflower ear is significantly higher than this rate among wrestlers without cauliflower ear. To the best of our knowledge, no other study has confirmed this finding employing hearing tests. OBJECTIVES: To evaluate and to compare the prevalence of hearing loss among wrestlers with and without cauliflower ears employing hearing tests. PATIENTS AND METHODS: The subjects were randomly selected form 14 wrestling clubs in Tehran. Subjects were 201 wrestlers with cauliflower ears (100 wrestlers with one cauliflower ear and 101 wrestlers with two cauliflower ears) and 139 wrestlers without cauliflower ears. All the participants in this study were interviewed to collect information on demographic factors and medical history of risk factors and diseases related to hearing loss. The subjects in both groups underwent otoscopic and audiologic examinations. RESULTS: Audiometric examination results at the frequency range of 0.5 - 8 KHz showed that the prevalence of hearing loss among cauliflower ears was higher than this rate among non-cauliflower ears. Also, the percentage of positive history of ear infections among cauliflower ears (8.4%) was about two times more than this finding among non-cauliflower ears (4.9%). This difference tended to be significant (OR: 1.86, P = 0.06, 95% CI: 0.98 - 3.53). CONCLUSIONS: To the best of our knowledge, this is the first study showing that the prevalence of hearing loss among cauliflower ears is higher than this rate among non-cauliflower ears confirmed by audiological tests. This emphasizes that, more preventive measures such as mandatory ear gear for wrestlers are required.

Reversal time of postprandial changes of the thickness of abdominal muscles employing ultrasound measurements.

OBJECTIVES: Low thickness of Transversus Abdominis, Internal Oblique and External Oblique muscles may play a role in development of low back pain. Ultrasonography is increasingly utilized to measure the thickness of these muscles. Prandial state has recently been proposed as a confounding factor in such measurements. We aimed to compare the reversal time of the postprandial thickness of these muscles with preprandial values. The measurement errors of ultrasonographic values were also assessed in both immediate preprandial and postprandial states. DESIGN: Interventional cross-sectional study. METHODS: The ultrasonographic thickness of lateral abdominal muscles was measured at rest and during abdominal drawing-in maneuver in 20 healthy participants before and after consumption of a specific meal. Postprandial ultrasound measurements continued every 15 min until their thickness reached 95% of their preprandial values. RESULTS: There was a statistically significant reduction in postprandial thickness of these muscles (all p-values <0.001 on both sides). The reversal times were 1.5, 1.3 and 1.2 h for Transversus Abdominis, Internal Oblique, and External Oblique muscles, respectively. Standard Error of Measurement and Smallest Detectable Change were in the range of 0.007-0.013 mm and 0.020-0.035 mm, respectively. CONCLUSIONS: To limit the effects of prandial state on the sonographic thickness of lateral abdominal muscles, we recommend measuring these values at least 1.5-2 h after food consumption. For the future studies, controlling the participants according to their prandial state is recommended.

Comparison of the thickness of lateral abdominal muscles between pregnant women with and without low back pain.

OBJECTIVES: To compare the thickness of the external oblique, internal oblique, and transversus abdominis muscles in pregnant subjects with and without low back pain (LBP) by the use of ultrasound to measure thickness. DESIGN: A case-control study. SETTING: An academic and tertiary care referral spine and sports medicine center. PARTICIPANTS: Fifty pregnant women with LBP during pregnancy and 54 pregnant control subjects. METHODS: Case and control subjects were matched for body mass index, gestational age, and number of previous pregnancies. A multiple linear regression model with adjustment for the gestational age of the subjects, as the potential confounder of the primary outcomes, was used to evaluate the association between LBP appearance and abdominal muscles thickness of the subjects. MAIN OUTCOME MEASURES: The thickness of lateral abdominal muscles was measured by ultrasound with the subject in a hook-lying position on the examination table. RESULTS: We found that there was no significant difference between pregnant subjects with and without LBP in terms of the thickness of external oblique, internal oblique, and transversus abdominis muscles. CONCLUSION: These findings suggest that other factors rather than the thickness of core stabilizing muscles are influential in the etiology of LBP during pregnancy. We hypothesize that enlargement of uterus during pregnancy might influence the thickness of the lateral abdominal muscles.

Low back pain functional disability in athletes; conceptualization and initial development of a questionnaire.

BACKGROUND: Low Back Pain (LBP) is one of the most prevalent causes of disability not only in the general population but also in athletes. Despite a large number of self-reported back specific disability questionnaires, there is no specific, well documented, outcome measure for athletes suffering from back pain. OBJECTIVES: This study aimed to identify the main descriptive themes representing functional disability in athletes due to LBP. PATIENTS AND METHODS: We conducted a qualitative study using in-depth interviews to characterize the experiences of athletes with LBP. Twenty athletes with LBP were recruited and the main descriptive elements of their LBP related disability were extracted. Then a preliminary questionnaire using these themes was proposed. RESULTS: The main disability indicators were pain intensity; stretching exercises, strengthening exercises, sport specific skills, back range of motion (ROM), sitting, walking, sleep patterns, self-care, and recreational activities, fear of pain and avoidance behavior, and changes in sexual activity. CONCLUSIONS: The findings of this study suggest that apart from non-sports items, some sport related items should be included in the assessment of LBP disability levels in athletes. Our results have also been organized as a preliminary LBP disability questionnaire for athletes.

Percentage of body fat and weight gain in participants in the tehran high school wrestling championship.

PURPOSE: Weight loss in wrestling has been found to be an interesting issue for researchers. In this regard, complications of weight loss in wrestlers before the competitions and their weight gain in course of competitions have been debated in previous studies. The objective of this study was to investigate the extent of weight gain and to estimate the percentage of body fat in participants in the Tehran high school male wrestling championship. METHODS: This study was a cross sectional survey. Subjects were participants of the Tehran high school male wrestling championship (n = 365). Weight gain in course of competitions and body fat levels (based on skin fold measurements) of subjects were measured. RESULTS: Between the first weigh-in of the wrestlers which was done one day before the competitions and the second weigh-in which was conducted immediately before the first round of their first competition (20 hours), 69% of subjects gained on average 1.3±0.9 kg (range: 0.1 to 6.10 kg) or 2.2±1.7% of the wrestler's weight (range: 0.1 to 9.3). Among the subjects, the mean of fat body percentage was found to be 15.2%. CONCLUSIONS: Rapid weight loss for matches was prevalent among subjects. It was also found that Iranian wrestlers have a relatively higher body fat percentage in comparison to American wrestlers. Therefore, it can be concluded that weight loss behavior of these wrestlers should be changed from using dehydration methods to using gradual methods of weight loss such as fat reduction methods.

Development and evaluation of a basic physical and sports activity program for preschool children in nursery schools in iran: an interventional study.

OBJECTIVE: The objectives of this study were a) to develop a physical activity program for nursery schools, and b) to evaluate the effects of this program on fundamental movement skills of preschool age children in Iran. METHODS: In this quasi-experimental study 147 children from five nursery schools in five different cities in Iran were enrolled. A physical activity program was developed for nursery children. Trained nursery physical activity instructors conducted the program for 10 weeks for all subjects. The levels of gross motor development of all subjects were measured before intervention and after 10 weeks physical activity program employing the Test of Gross Motor Development-edition 2 (TGMD-2). FINDINGS: The participants in this study had a mean (SD) age of 4.95 (0.83) years. At the end of the study, scores of subjects at all components of TGMD-2 (including locomotor, object control, sum of standard scores and gross motor quotient) were significantly improved compared to the baseline scores (P<0.001). Based on descriptive rating of the "Gross Motor Quotient" in the base line, 11.5% of subjects were superior/very superior (GMQ >120) and after 10 weeks intervention this rate was increased to 49.7% of all subjects. CONCLUSION: It seems that the developed physical activity program conducted by trained nursery physical activity instructors could be an effective and practical way of increasing levels of fundamental movement skills of preschool children in Iran.