Effect of a semi-rigid backpack type thoracolumbar orthosis on thoracic kyphosis angle and muscle performance in older adults with hyperkyphosis: a randomized controlled trial.

PURPOSE: To investigate the effect of a semi-rigid backpack type thoracolumbar orthosis (TLO) on thoracic kyphosis angle (TKA) and potentially contributing factors of hyperkyphosis, including position sense and back muscle strength and endurance. METHOD: This randomized, controlled trial was conducted on 48 older adults with hyperkyphosis, randomly allocated to an experimental or control group. The experimental group wore a semi-rigid TLO for 3 consecutive months. The control group received no external support or exercise. Thoracic kyphosis angle (TKA), joint position sense, back muscle strength and endurance were evaluated at the baseline and at the end of week 6 and week 12. RESULTS: The two-way (group × time) interactions were significant in terms of TKA (F = 37.88, p ≤ 0.001, ηp2 = 0.45), muscle strength (F = 26.005, p ≤ 0.001, ηp2 = 0.36), muscle endurance measured via load cell (F = 3.417, p = 0.039, ηp2 = 0.06), and endurance holding time of Ito test (F = 3.629, p = 0.045, ηp2 = 0.07). A further analysis using one-way repeated measures of ANOVA showed that TKA, muscle strength and endurance were significantly improved in the experimental group. Also, two-way interactions were significant for absolute error and variable error of trunk neutral repositioning test from a trunk flexed and/or extended position for global components and horizontal components trunk repositioning test. CONCLUSION: Wearing a semi-rigid backpack type TLO even from an unknown brand for short periods during the day (e.g., 2-4 h) over 3 months not only modifies kyphotic posture but also can enhance back muscle performance in older adults with hyperkyphosis. IMPLICATIONS FOR REHABILITATIONPrescription of a semi-rigid backpack type thoracolumbar orthosis for older adults has no adverse effects such as muscle weakness if it is applied for short periods during the day.A semi-rigid backpack thoracolumbar orthosis can prevent position sense degradation in older adults with hyperkyphosis.A semi-rigid backpack type thoracolumbar orthosis may counteract trunk flexion and kyphotic posture by applying the biomechanical principles of the three-point pressure system.Improvement in spinal alignment resulting from wearing thoracolumbar orthosis should not occur in exchange for muscle deconditioning.

Tele-Physiotherapy in Iran: Perceived Challenges by Physiotherapists to Its Implementation in COVID19 Outbreak.

Background: COVID-19 pandemic has brought new and fundamental challenges to the healthcare system. Physiotherapists, like other rehabilitation professionals, have been involved in this crisis. One way to protect both the clients and physiotherapists from getting infected and provide physiotherapy services effectively is tele-physiotherapy (TPT). This study investigated the physiotherapists' perception of TPT and the barriers to its practical application during the COVID-19 outbreak. Methods: This cross-sectional, descriptive study was adopted in December 2020, using a newly designed checklist. The checklist had four sections, consisting of physiotherapists' knowledge and awareness, satisfaction, attitude, and also barriers to the use of TPT during the COVID-19 outbreak. The checklist was uploaded to social physiotherapy networks across Iran, and the descriptive data were analyzed statistically. Results: In this study, 192 physiotherapists participated as follows. Before the COVID-19 outbreak, 48.96% of the participants used TPT, while this rate grew to 64.06% during the outbreak. The majority of the participants (65.1%) believed that the use of TPT would improve the relationship among the physiotherapists and their patients. They also had the lowest level of knowledge (27.08%) about one item in the checklist, i.e., "how to consult with TPT". Based on the participants' views, lack of proper familiarity with the use of this method (87.5%), a lack of high-speed internet access (86.45 %), and a lack of awareness of this method and its benefits (84.37%) had the highest frequencies compared to other barriers. Conclusion: The results indicate that during the COVID-19 pandemic in Iran, a significant increase in the use of TPT has developed. The overall physiotherapists' attitude towards TPT was positive, but it was necessary to minimize or eliminate the barriers to applying this effective method. Major recommendations from the participants were: continue to seek physiotherapists' and patients' perspectives, introduce proper educational programs for new students enrolled in professional associations and universities, and support the infrastructures, such as telecommunication and financial assistance from insurance companies.

Measuring the force perception in knee flexor/ extensor muscles in patients with anterior cruciate ligament injury and healthy subjects.

BACKGROUND: Force perception as a contributor to the neuromuscular control of the knee joint may be altered after anterior cruciate ligament (ACL) injury. OBJECTIVE: This study aimed to compare the force perception accuracy in the knee joints of patients with ACL injury and healthy subjects. METHODS: Twenty-six patients with ACL injury and 26 healthy subjects participated in this case-control study. Participants were asked to produce 50% of the maximum voluntary isometric contraction of the knee muscles as a target force and reproduce it in their limbs in flexion and extension directions. RESULTS: There were significant interactions between group and condition as well as group, condition, and limb in the force perception error respectively (P< 0.05). The highest amount of error was seen in the contralateral limb of the ACL injury group when the reference force was produced in the injured limb (P< 0.05). CONCLUSION: The findings revealed that the force perception accuracy in the knee flexor/extensor muscles of individuals with ACL injury is impaired. Moreover, error is most evident when the patient produces force in the injured limb and replicates it in the uninjured limb in both flexion and extension directions. Therefore, the rehabilitation programs should encompass neuromuscular training in both quadriceps and hamstrings after ACL injury.

Pulmonary rehabilitation and exercise therapy in a patient with COVID-19: A Case report.

Dyspnea, shortness of breath, and inability to perform activities of daily living are the main complaints in patients with COVID-19 and physiotherapy has a vital role in managing such symptoms. We present a case treated with pulmonary and neurological physiotherapy, which improved symptoms and quality of life. In this case report, the importance and potential effect of concise physiotherapy on patients with COVID-19 is presented.

Back Muscle Function in Older Women With Age-Related Hyperkyphosis: A Comparative Study.

OBJECTIVE: The purpose of this study was to compare static maximal back extensor muscle force, endurance, and characteristics of flexion relaxation phenomenon (FRP) in older women with and without age-related hyperkyphosis. METHODS: Maximum back extensor force and endurance measured in a sitting position with a designed load cell setup; appearance, onset, and offset angles of FRP; and extension relaxation ratio (ERR) during a dynamic flexion-extension task were compared between 24 older women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 65 ± 4.4 years, and 24 older women without hyperkyphosis (thoracic kyphosis angle ≪50°), mean age 63 ± 4.3 years. Variables of force, endurance, angles of FRP, and ERR were analyzed using an independent sample t test. A χ2 test was used to identify differences between groups in FRP appearance. RESULTS: Static back extensor force and endurance were significantly lower among those with versus those without hyperkyphosis (P ≪ .001). Although the 2 groups did not differ in FRP appearance and ERR in the superficial erector spinal muscles (P ≫ .05), FRP in the hyperkyphosis group started sooner and ended later than in the group without hyperkyphosis (P ≪ .05). CONCLUSION: Our study indicates that women with age-related hyperkyphosis had decreased static maximal force and endurance of the back extensor muscles and prolonged myoelectrical silence of the superficial erector spinal muscles. Reduced endurance of the superficial erector spinal muscles may trigger early onset of FRP and prolonged relaxation of these muscles.

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.

The Effect of Functional Stretching Exercises on Neural and Mechanical Properties of the Spastic Medial Gastrocnemius Muscle in Patients with Chronic Stroke: A Randomized Controlled Trial.

BACKGROUND: Following spasticity, neural and mechanical changes of the paretic muscle often occur, which affect the muscle function. The aim of this study was to investigate the effect of functional stretching exercises on neural and mechanical properties of the spastic muscle in patients with stroke. MATERIALS AND METHODS: This study was a single-blinded, randomized control trial. Forty five patients with stroke (experimental group: n = 30; control group: n = 15) participated in this study. Subjects in the experimental group participated in a functional stretching program 3 times a week for 4 weeks. Subjects in both groups were evaluated before the training, at the end of training, and then during a 2-month follow-up. Neural properties, including H-reflex latency and Hmax/Mmax ratio, were acquired. Mechanical properties, including fascicle length, pennation angle, and muscle thickness in the spastic medial gastrocnemius muscle, were evaluated. Repeated measure analysis of variance was used in the analysis. RESULTS: Time by group interaction in the pennation angle (P = .006), and in muscle thickness (P = .030) was significant. The results indicated that the H-reflex latency (P = .006), pennation angle (P < .001), and muscle thickness (P = .001) were altered after stretching training program and these changes were at significant level after 2-month follow-up. CONCLUSION: The results indicated that the use of functional stretching exercises can cause significant differences in neural and mechanical properties of spastic medial gastrocnemius muscle in patients with chronic stroke.

The reliability and validity of a designed setup for the assessment of static back extensor force and endurance in older women with and without hyperkyphosis.

OBJECTIVE: The purpose of this study was to investigate the intra-rater reliability and validity of a designed load cell setup for the measurement of back extensor muscle force and endurance. PARTICIPANTS: The study sample included 19 older women with hyperkyphosis, mean age 67.0 ± 5.0 years, and 14 older women without hyperkyphosis, mean age 63.0 ± 6.0 years. METHODS: Maximum back extensor force and endurance were measured in a sitting position with a designed load cell setup. Tests were performed by the same examiner on two separate days within a 72-hour interval. The intra-rater reliability of the measurements was analyzed using intraclass correlation coefficient (ICC), standard errors of measurement (SEM), and minimal detectable change (MDC). The validity of the setup was determined using Pearson correlation analysis and independent t-test. RESULTS: Using our designed load cell, the values of ICC indicated very high reliability of force measurement (hyperkyphosis group: 0.96, normal group: 0.97) and high reliability of endurance measurement (hyperkyphosis group: 0.82, normal group: 0.89). For all tests, the values of SEM and MDC were low in both groups. A significant correlation between two documented forces (load cell force and target force) and significant differences in the muscle force and endurance among the two groups were found. CONCLUSION: The measurements of static back muscle force and endurance are reliable and valid with our designed setup in older women with and without hyperkyphosis.

The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device.

OBJECTIVE: The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis. METHODS: Measurements were made in 19 women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 67 ± 5 years, and 14 women without hyperkyphosis (thoracic kyphosis angle <50°), mean age 63 ± 6 years. Sagittal thoracic and lumbar curvature and mobility of the spine were assessed with the Spinal Mouse during neutral standing, full spinal flexion, and full spinal extension. Tests were performed by the same examiner on 2 days with a 72-hour interval. The intrarater reliability of the measurements was analyzed using the intraclass correlation coefficient, standard error of measurement and minimal detectable change. RESULTS: Intraclass correlation coefficients ranged from 0.89 to 0.99 in both groups. The standard errors of measurement ranged from 1.02° to 2.06° in the hyperkyphosis group and from 1.15° to 2.22° in the normal group. The minimal detectable change ranged from 2.85° to 5.73° in the hyperkyphosis group and from 3.20° to 6.17° in the normal group. CONCLUSIONS: Our results indicated that the Spinal Mouse has excellent intrarater reliability for the measurement of sagittal thoracic and lumbar curvature and mobility of the spine in older women.

Reliability of new software in measuring cervical multifidus diameters and shoulder muscle strength in a synchronized way; an ultrasonographic study.

OBJECTIVES: This study was conducted with the purpose of evaluating the inter-session reliability of new software to measure the diameters of the cervical multifidus muscle (CMM), both at rest and during isometric contractions of the shoulder abductors in subjects with neck pain and in healthy individuals. METHOD: In the present study, the reliability of measuring the diameters of the CMM with the Sonosynch software was evaluated by using 24 participants, including 12 subjects with chronic neck pain and 12 healthy individuals. The anterior-posterior diameter (APD) and the lateral diameter (LD) of the CMM were measured in a resting state and then repeated during isometric contraction of the shoulder abductors. Measurements were taken on separate occasions 3 to 7 days apart in order to determine inter-session reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD) were used to evaluate the relative and absolute reliability, respectively. RESULTS: The Sonosynch software has shown to be highly reliable in measuring the diameters of the CMM both in healthy subjects and in those with neck pain. The ICCs 95% CI for APD ranged from 0.84 to 0.94 in subjects with neck pain and from 0.86 to 0.94 in healthy subjects. For LD, the ICC 95% CI ranged from 0.64 to 0.95 in subjects with neck pain and from 0.82 to 0.92 in healthy subjects. CONCLUSIONS: Ultrasonographic measurement of the diameters of the CMM using Sonosynch has proved to be reliable especially for APD in healthy subjects as well as subjects with neck pain.

Reliability of new software in measuring cervical multifidus diameters and shoulder muscle strength in a synchronized way; an ultrasonographic study

OBJECTIVES: This study was conducted with the purpose of evaluating the inter-session reliability of new software to measure the diameters of the cervical multifidus muscle (CMM), both at rest and during isometric contractions of the shoulder abductors in subjects with neck pain and in healthy individuals.METHOD: In the present study, the reliability of measuring the diameters of the CMM with the Sonosynch software was evaluated by using 24 participants, including 12 subjects with chronic neck pain and 12 healthy individuals. The anterior-posterior diameter (APD) and the lateral diameter (LD) of the CMM were measured in a resting state and then repeated during isometric contraction of the shoulder abductors. Measurements were taken on separate occasions 3 to 7 days apart in order to determine inter-session reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD) were used to evaluate the relative and absolute reliability, respectively.RESULTS: The Sonosynch software has shown to be highly reliable in measuring the diameters of the CMM both in healthy subjects and in those with neck pain. The ICCs 95% CI for APD ranged from 0.84 to 0.94 in subjects with neck pain and from 0.86 to 0.94 in healthy subjects. For LD, the ICC 95% CI ranged from 0.64 to 0.95 in subjects with neck pain and from 0.82 to 0.92 in healthy subjects.CONCLUSIONS: Ultrasonographic measurement of the diameters of the CMM using Sonosynch has proved to be reliable especially for APD in healthy subjects as well as subjects with neck pain.

The effects of isometric contraction of shoulder muscles on cervical multifidus muscle dimensions in healthy office workers.

It is argued that cervical multifidus muscles (CMM) are responsible for providing neck stability. However, whether they are actually activated during the tasks performed by the upper extremities to the neck is still unknown. Therefore, the aim of this study was to examine the effects of isometric contraction of shoulder muscles on the dimensions of CMM. Twenty three healthy males voluntarily participated in this study. Ultrasonography imaging of CMM was conducted at rest and at 25%, 50%, 75%, and 100% of maximal voluntary contraction of shoulder muscles in 6 directions of shoulder movements. Anterior-posterior dimension (APD), lateral dimension (LD), shape ratio and multiplied linear dimension (MLD) of cervical multifidus were measured. The APD of CMM was increased while LD and shape ratio were decreased by shoulder muscles contraction (P < 0.01).