Comparison of the Conjunct Effects of Electrical Stimulation and Whole-Body Vibration Therapy with Transcranial Direct Current Stimulation and Whole-body Vibration Therapy on Balance and Function in Children With Spastic Cerebral Palsy.

BACKGROUND AND OBJECTIVES: Cerebral palsy is a neurodevelopmental condition that results in impaired movement and posture, often accompanied by disturbances in balance and functional abilities. Recent advances in neurorehabilitation, including whole-body vibration therapy (WBVT), functional electrical stimulation, and transcranial direct current stimulation, show promise in enhancing traditional interventions and fostering neuroplasticity. However, the efficacy of their conjunct effects remains largely uncharted territory and warrants further exploration. The objective of the study was to compare the conjunct effects of functional electrical stimulation (FES) and WBVT with transcranial direct current stimulation (tDCS) and WBVT on lower extremity range of motion (ROM), dynamic balance, functional mobility, isometric muscle strength and hand grip strength in children with spastic cerebral palsy. METHODS: A randomized clinical trial was carried out on 42 children of both genders with spastic cerebral palsy, aged 5-15 years. The children were divided at random into three groups (14 in each group). In Group A, there were three (21.42%) males and 11 (78.57%) females, in Group B, eight (57.14%) were males and six (42.85%) were females, and in Group C, six (42.85%) children were males and eight (57.14%) were females. Group A received WBVT only, Group B received WBVT and FES, and Group C received WBVT and tDCS. The intervention was applied four times a week for four consecutive weeks. The data was collected two times before and immediately after four weeks of intervention. Lower extremity ROM was measured by a goniometer, functional mobility or dynamic balance was measured by a Time Up and Go test, isometric muscle strength was measured by a digital force gauge, and hand grip strength was assessed by a digital hand-held dynamometer. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was utilized for statistical analysis. RESULTS: The mean age of the children in groups A, B, and C was 12.21±2.11 years, 11.71±2.01, and 11.07±2.01 years respectively. Intergroup analysis revealed a statistically significant difference (p<0.05) in the lower extremity range of motion, and functional mobility. Hand grip strength and isometric muscle strength between three groups. Post hoc analysis revealed that WBVT with transcranial direct current stimulation combined showed the most improvement. CONCLUSION: The study concluded that positive effects were seen in all three groups but tDCS with WBVT was found to be most effective in improving lower extremity ROM, functional mobility or dynamic balance, isometric muscle strength, and hand grip strength in children with spastic CP. The differences between the groups were statistically significant. The effect size was substantial enough to surpass established clinical benchmarks, indicating that the observed improvements are likely to have meaningful and beneficial impacts on patient outcomes.

Effects of Combining Transcranial Direct Current Stimulation With Balance Training on Anticipatory Postural Adjustments in Persons With Chronic Ankle Instability.

BACKGROUND: The combination of transcranial direct current stimulation (tDCS) with balance training could integrate central and peripheral neural mechanisms. This study aimed to investigate the effects of concurrent balance training and tDCS over the supplementary motor area (SMA) on anticipatory postural adjustments during gait initiation (GI) in persons with chronic ankle instability (CAI). HYPOTHESIS: Balance training will increase the center of pressure (COP) velocity and displacement during GI phases in all participants, and those receiving real tDCS will show greater increases. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 32 subjects were allocated to 2 groups: (1) intervention (balance training plus real tDCS) and (2) control (balance training plus sham tDCS). Outcome measures were COP-related parameters (displacement and velocity) during phases of GI (anticipatory, weight transition, and locomotor). RESULTS: The results showed that, in the anticipatory phase, the anteroposterior displacement of the COP was increased significantly at posttest relative to pretest across both groups, F(1,30) = 5.733, P = 0.02. In addition, both groups revealed an increase in the mediolateral COP velocity at posttest, F(1,30) = 10.523, P < 0.01. In the weight transition phase, both groups had higher mediolateral COP velocity at posttest, F(1,30) = 30.636, P < 0.01. In the locomotor phase, in both groups, the anteroposterior COP velocity was increased significantly at posttest compared with pretest, F(1,30) = 5.883, P = 0.02. CONCLUSION: Both groups demonstrated improvements in the anticipatory and execution phases of GI. Since no between-group difference was found, it can be interpreted that the anodal tDCS applied over the SMA has no added value over sham stimulation. CLINICAL RELEVANCE: Balance training is beneficial for persons with CAI and can improve the anticipation and execution phases of GI without the aid of brain stimulation.

Economic impact of government health expenditure: An application of the computable general equilibrium model to the Iran.

BACKGROUND: Considering the increase in health expenses and the government's role in health financing, this study investigated the economic impact of increases in the share of the health sector in the government budget while taxes remain unchanged and government spending is fixed. MATERIAL AND METHODS: The economic model used in this study was a macroeconomic Computable General Equilibrium (CGE) model. This model was calibrated using a 2011 Social Accounting Matrix (SAM) Of Iran. The CGE model was solved with non-linear programming using the General Algebraic Modeling System package, version 2.50. The effect of this simulation on the government budget deficit, the production of different sectors of the economy, and the employment rate was investigated. RESULTS: Based on our fundings the elasticity of substitution in the agricultural and industrial sectors is higher than in the health and service sector. Also, the biggest decrease in production occurred in the industry, agriculture, and service sectors, respectively. With the doubling of the share of government spending in the health sector, the employment rate of this sector has increased by 40.9%, but the highest decrease in the ignition rate is related to the service sectors (-2.7%), agriculture (-0.23%), and industry (-0.14%). CONCLUSION: Increasing the share of government spending in the health sector in comparison with other sectors of the economy, provided that government spending is maintained in general, leads to a decrease in production and economic welfare. It seems that the Iranian government should seek to increase the sources of health financing and the share of government expenditures in the health sector with other ways in order to improve the health level of the society and have a positive effect on other economic sectors.

Characterization of chitosan/Persian gum nanoparticles for encapsulation of Nigella sativa extract as an antiviral agent against avian coronavirus.

The aim of this study was to investigate the physicochemical characteristics of nanoparticles formed by the ionic gelation method between chitosan and water-soluble fraction of Persian gum (WPG) for encapsulation of Nigella sativa extract (NSE) as an antiviral agent. Our findings revealed that the particle size, polydispersity index (PDI), and zeta potential of the particles were in the range of 316.7-476.6 nm, 0.259-0.466, and 37.0-58.1 mV, respectively. The amounts of chitosan and WPG as the wall material and the NSE as the core had a considerable impact on the nanoparticle properties. The proper samples were detected at 1:1 chitosan:WPG mixing ratio (MR) and NSE concentration of 6.25 mg/mL. Fourier-transformed infrared (FTIR) spectroscopy proved the interactions between the two biopolymers. The effect of NSE on infectious bronchitis virus (IBV) known as avian coronavirus, was performed by the in-ovo method determining remarkable antiviral activity of NSE (25 mg/mL) and its enhancement through encapsulation in the nanoparticles. These nanoparticles containing NSE could have a promising capability for application in both poultry industry and human medicine as an antiviral product.

A randomized clinical trial on the changing of median nerve cross-sectional area and pain after extracorporeal shock wave and low-level laser therapy added to conventional physical therapy in patients with mild-to-moderate carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common mononeuropathy in the upper limb. It remains uncertain whether adding extracorporeal shockwave therapy (ESWT) or low-level laser therapy (LLLT) to conventional treatment benefits CTS patients. PURPOSE: This study aimed to compare the effectiveness of ESWT and LLLT in conjunction with conventional treatments (including carpal mobilization, transcutaneous electrical nerve stimulation, and ultrasound) on the cross-sectional area (CSA) of the median nerve and pain in mild-to-moderate CTS patients. STUDY DESIGN: This was a single-blinded randomized clinical trial with registration number IRCT20220504054734N1. METHODS: Thirty-six patients were randomly assigned using block balanced randomization to receive either four sessions of ESWT or 10 sessions of LLLT in addition to 10 sessions of conventional treatments over 2 weeks. Patients received numbered closed envelopes indicating their treatment group. CSA (primary) and pain (secondary) in 18 patients who completed the treatment were assessed at baseline and after 2 weeks by a blinded assessor. Paired and independent sample t-tests were used for analyses due to the normal distribution of data was checked by Kolmogorov-Smirnoff. Cohen's d effect size was used to assess the intervention's magnitude. RESULTS: Both ESWT and LLLT groups showed significant improvements in CSA (p = 0.002) and pain (p < 0.001) from baseline to posttreatment. CSA improvement was moderate for ESWT (mean difference: 1.2, 95% CI 0.51-1.9) and mild for LLLT (mean difference: 0.76, 95% CI 0.4-1.14). Conversely, pain improvement was substantial in both groups (ESWT: mean difference 4.4, 95% CI 3.6-5.3; LLLT: mean difference 4.4, 95% CI 3.7-5.2). No substantial differences between ESWT and LLLT were observed, highlighting their comparable efficacy. CONCLUSION: The addition of either LLLT or ESWT to conventional treatment effectively reduced pain and median nerve CSA in mild-to-moderate CTS. The absence of significant differences between ESWT and LLLT indicates their comparable efficacy in pain relief and CSA reduction.

Finding the PSA-based screening stopping age using prostate cancer risk.

BACKGROUND: Prostate Cancer screening was not rational for people who were suffered from other serious diseases and had a low quality of life. Biopsy and Prostate-Specific Antigen based screening also had imperfect information, pain, and costs. Finding the Prostate Cancer screening stopping age was important because after an age, Prostate-Specific Antigen test was not recommended and patients should not perform subsequent procedures. It could reduce the economic burden of Prostate Cancer. In this study, we modeled the effects of Prostate Cancer risk and comorbidities on the Prostate Cancer screening stopping age. METHODS: first, using a Markov model for PC progression, we provided a model for optimal Prostate Cancer screening stopping age. Second, we explored the relationship between comorbidities effects, Prostate Cancer risk and the stopping age. RESULTS: Our results suggest that the stopping age was an increasing function of PC risk and comorbidities effects. Screening should be stopped before 70 years. Finding showed that for men with diseases such as stroke or heart diseases, screening should not be performed at any age. CONCLUSIONS: Personalizing PC screening through paying more attention to PC risk can improve efficiency of screening. The role of personal characteristics such as race, family history, and previous PSA in PC screening decision-making was highlighted by stratifying men in different PC risk groups to find their stopping age. Incorporating comorbidity effects shows that severity of comorbidity was a crucial factor in PC screening stopping age decision-making process.

The Effect of Wii Training on Neurocognitive Function in Athletes with Functional Ankle Instability: Matched Randomized Clinical Trial.

Background: Many studies have investigated ankle sprain injury and it has been reported that in 80% of cases, ankle sprains lead to functional ankle instability (FAI). The conventional exercises for FAI rehabilitation neglect the associated neurocognitive dysfunction. Objective: This study aims to evaluate the effect of Wii Fit Plus as a virtual reality training on neurocognitive function in athletes with FAI compared to athletes without FAI. Material and Methods: In this matched randomized clinical trial study, 25 athletes with unilateral FAI and 25 athletes without FAI were assigned to two groups randomly: 1) the intervention group, subjects performed the Wii training including balance and strengthening games three times a week for 12 sessions and 2) subjects in the control group received no intervention. Before and after the training, the neurocognitive function was assessed through the computerized-reaction time test based on the detection or identification of 'X' mark on a computer monitor. Between-groups and within-group comparisons were done by the independent T-test and paired T-test, respectively. Results: A significant difference was observed in mean differences of neurocognitive function between athletes with and without FAI. Comprising before and after training was significant in the intervention group. Conclusion: Based on the results, the information-processing speed of athletes with FAI increased after the training, utilized for rehabilitation protocols.

Optimal age to stop prostate cancer screening and early detection.

BACKGROUND: Prostate Cancer screening should be discontinued at older ages because competing mortality risks eventually dominate the risk of Prostate Cancer and harms exceed benefits. We explored the Prostate Cancer screening stopping age from the patient, healthcare system, and social perspectives in Iran. METHODS: We applied Bellman Equations to formulate the net benefits biopsy and "do nothing". Using difference between the net benefits of two alternatives, we calculated the stopping age. The cancer states were without cancer, undetected cancer, detected cancer, metastatic cancer, and death. To move between states, we applied Markov property. Transition probabilities, rewards, and costs were inferred from the medical literature. The base-case scenario estimated the stopping age from the patient, healthcare system, and social perspectives. A one-way sensitivity used to find the most influential parameters on the stopping age. RESULTS: Our results suggested that Prostate Cancer screening stopping ages from the patient, healthcare system, and social were 70, 68, and 68 respectively. The univariate sensitivity analysis showed that the stopping ages were sensitive to the disutility of treatment, discount factor, the disutility of metastasis, the annual probability of death from other causes, and the annual probability of developing metastasis from the hidden cancer state. CONCLUSIONS: Men should not be screened for Prostate Cancer beyond 70 years old, as this results in the net benefit of "do nothing" above the biopsy. Nevertheless, this finding needs to be further studied with more detailed cancer progression models (considering re-biopsy, comorbidities, and more complicated states transition) and using local utility and willingness to pay value information.

Development and characterization of antimicrobial alginate hydrogel beads filled with cinnamon essential oil nanoemulsion.

The aim of the present study was to investigate the characteristics of alginate beads filled with cinnamon essential oil nanoemulsions (CEONs). The influence of the alginate and CaCl2 concentrations on their physical, antimicrobial and antioxidant properties was studied. The droplet size of CEON was 146.20 ± 39.28 nm and the zeta potential was -33.8 ± 0.72 mV demonstrating proper nanoemulsions stability. Decreasing the alginate and CaCl2 concentrations resulted in higher EOs release due to the increased pore size of the alginate beads. The scavenging activity of DPPH of beads was found to be dependent on the alginate and calcium ion concentrations which affected the pore size of the fabricated beads. The FT-IR results declared the new bands in the spectra of filled hydrogel beads, which verified the encapsulation of EOs in the beads. The surface morphology of beads was studied using SEM images which showed the spherical shape and porous structure of alginate beads. In addition, the alginate beads filled with CEO nanoemulsion demonstrated strong antibacterial activity.

Compare the Effect of Traditional and Virtual Reality Training on Subjective-sense of Instability and Balance in Basketball-players with Functional Ankle Instability: Matched Randomized Clinical Trial.

Background: Functional ankle instability (FAI) is a common injury. Traditional training improved the reported balance impairment and subjective sense of instability in athletes with FAI. Objective: This study aims to compare the effects of traditional and virtual reality training on a subjective sense of instability and balance in athlete with FAI. Material and Methods: In this single-blinded matched randomized clinical trial design, Fifty-four basketball players were randomly assigned in the virtual reality (n=27) or control (n=27) groups. All athletes performed 12 sessions Wii exercises or traditional training in the virtual reality and the control group, respectively, for three days a week. To assess the subjective-sense of instability and balance, we used Cumberland Ankle Instability Tool (CAIT) and Star Excursion Balance Test (SEBT), respectively. Measures were taken at pre- and post-test and one month after training as a follow-up. The between-group comparisons were done by the analysis of Covariance. Results: At the pre-test, the CAIT score was 22.37, 22.04 in the control and virtual reality groups, respectively and at the post-test, these scores increased to 26.63, 27.26. The involved limb showed significant differences in posteromedial and posterior directions of the SEBT and CAIT score in the post-test and in the posterior direction and CAIT score in the follow-up. The virtual reality group had better performance than the control group but the effect size is small (cohen's d<0.2). Conclusion: Based on our results, both training protocols were effective in reducing the subjective-sense of instability and improved balance in athletes with FAI. Moreover, virtual reality training was very attractive for the participants.

Efficacy of stretching exercises versus transcranial direct current stimulation (tDCS) on task performance, kinematic and electroencephalography (EEG) spectrum in subjects with slump posture: a study protocol.

BACKGROUND: Slump sitting is a common posture in workplaces. There is limited evidence that poor posture impacts the mental state. This study aims to investigate whether slump posture results in more mental fatigue during computer typing, compared with normal posture and also to compare the effectiveness of stretching exercises with tDCS in fatigue monitoring. METHODS: The sample size for this study is set at 36 participants with slump posture and 36 participants with normal posture. In the first step, to find out the differences between normal and poor posture, they will be asked to perform the typewriting task for 60 min. During the first and last 3 min of typing, mental fatigue as the primary outcome using EEG signals and further measures including kinematic behavior of neck, visual analog fatigue scale, and musculoskeletal discomfort will be assessed. Post-experiment task performance will be calculated based on typing speed and typing errors. In the next step, to compare the effect of tDCS and stretching exercises on the outcome measures, the slump posture group will receive these interventions in two separate sessions before the typing task. DISCUSSION: With the assumption of showing significant differences in terms of outcome measures between slump and normal posture groups and also by showing the possible changes of the measures, by using either tDCS as a central modality or stretching exercises as a peripheral modality; the findings may provide evidence to indicate that poor posture has adverse effect on mental state and to introduce the effective method to overcome mental fatigue and promote work productivity. TRIAL REGISTRATION: Registered on the Iranian Registry of Clinical Trials on 21 September 2022, IRCT Identifier: IRCT20161026030516N2.

Dyssynergic Defecation: A Comprehensive Review on Diagnosis and Management.

About one-third of chronically constipated patients have an evacuation disorder, and dyssynergic defecation is a common cause of the evacuation disorder. In dyssynergic defecation, the coordination between abdominal and pelvic floor muscles during defecation is disrupted and patients cannot produce a normal bowel movement. The etiology of dyssynergic defecation is still unknown. Although a detailed history taking and a careful examination including digital rectal examination could be useful, other modalities such as anorectal manometry and balloon expulsion test are necessary for the diagnosis. Biofeedback therapy is one of the most effective and safe treatments. Here, we provide an overview of dyssynergic defecation as well as how to diagnose and manage this condition.

Effectiveness of ultrasound and median nerve gliding with and without shock-wave therapy in patients with moderate carpal tunnel syndrome.

[Purpose] The aim of this research was to see how ultrasound and nerve gliding with and without shock wave therapy effects on clinical and sonographic data of patients with carpal tunnel syndrome (CTS). [Participants and Methods] Forty four patients with moderate carpal tunnel syndrome participated in this research. One group got shock-wave therapy in addition to median nerve glide exercises and ultrasound, whereas the other group received median nerve glide exercises and ultrasound alone. Hand grip strength (HGS), pinch grip strength (PGS), Visual Analogue Scale (VAS)-pain, Boston Questionnaire (BQ), and Cross-sectional area (CSA) of median nerve were examined before and after 10 sessions of treatment. [Results] HGS, PGS, VAS, BQ and CSA of median nerve improved considerably after therapy. [Conclusion] Patients with moderate CTS who received ultrasound and median nerve glide exercises with and without shock-wave therapy improved considerably without preference of adding shock-wave therapy to other treatment.

The effect of exergaming on cognition and brain activity in older adults: A motor- related cortical potential study.

Exergames have positive effects on various cognitive domains. However, to the best of our knowledge, not only have few studies investigated the exergame-induced brain changes, but also in most of them, preparatory brain activity has not been considered. Preparatory brain activity is a particularly relevant aspect for investigating the interaction between cognitive and sensorimotor functions in the brain. Accordingly, the aim of this study was to investigate the effects of an exergame protocol versus traditional motor-cognitive dual-task training on the cognition and proactive components of movement-related cortical potential. A total of 52 older adults were randomly assigned to the intervention (exergame training) and the control group (motor-cognitive dual-task training). The outcome measurements were neurophysiological data (i.e., the amplitude of the late contingent negative variation [CNV], and alpha/beta event-related desynchronization [ERD]), and neuropsychological data (rate-correct score [RCS] in go/no go task and trail-making test [TMT]). The results revealed that both groups had a decreased late CNV, and alpha/ beta ERD in post-training compared to pre-training in Cz and C3 channels. Moreover, both groups had an increased RCS and a decreased TMT-A in post-training compared to pre-training. However, for TMT-B, the results indicated a significant interaction in favor of the exergame group. These findings indicate that in older adults, both interventions may result in increasing inhibitory control, information processing speed, and preparatory brain activity. However, for cognitive flexibility, exergame has an additional effect relative to the control group.

Evaluating Oculomotor Tests before and after Vestibular Rehabilitation in Patients with Parkinson's Disease: A Pilot Pre-Post Study.

Introduction: The elderly population is commonly affected by balance and gait disorders that increase the risk of falls. Pivotal systems for efficient postural control are sensory, motor, visual, vestibular, and cognitive. Disruption in any of these systems could lead to postural instability. Vestibular rehabilitation is a set of exercises that positively affect the primary components of the central sensory-motor integration, including somatosensory, visual, and vestibular systems. Accordingly, we hypothesized that vestibular rehabilitation exercises might improve both oculomotor functions and upright postural control in patients with Parkinson's disease. Materials and Methods: 11 idiopathic Parkinson's patients voluntarily participated in this study based on inclusion criteria: central vestibular dysfunction and the Hoehn and Yahr scale scores less than or equal to 3. Videonystagmography (VNG) and the Berg Balance Scale (BBS) scores were measured at the baseline. Then, the patients underwent vestibular rehabilitation training for 24 sessions (3 sessions per week). The VNG and BBS were measured again after 48 hours of the completion of the last session of the training. Result: After completing vestibular rehabilitation sessions, there were significant improvements in balance (P ≤ 0.001). Eye-tracking and gaze function statistically improved in 7 patients and 6 patients, respectively. Conclusion: Vestibular rehabilitation produced positive effects on oculomotor function and balance in a small cohort of people with PD. Consequently, it could be considered as a possible effective intervention for Parkinson's patients. This trial is registered with IRCT201709123551N6.

The impacts of fuel price policies on air pollution: case study of Tehran.

This study aims to investigate the impacts of fuel price policies on the concentration of air pollutants in Tehran city. Autoregressive distributed lag (ARDL) estimation models were used to investigate the impacts of gasoline and diesel prices along with the weather and economic variables on the following traffic-related pollutants: carbon monoxide (CO), nitrogen dioxide (NO2), and particular matter 10 micrometers or less (PM10). In the short term, a 1% increase in gasoline prices leads to a 0.02 and 0.012% decrease in the concentration of CO and PM10, respectively. In addition, in the short term, a 1% increase in diesel prices leads to a 0.008, 0.02, and 0.015 % decrease in the concentration of CO, PM10, and NO2, respectively. Results demonstrate that a 1% increase in gasoline prices leads to a 0.011 and 0.02 % increase in NO2 concentration in the short term and long term, respectively. Fuel prices had a greater impact on air pollutant concentration in the long term than in the short term. In the long term, a 1% increase in diesel prices leads to a 0.011, 0.024, and 0.029 % decrease in the concentration of CO, NO2, and PM10, respectively. Although fuel price increases lead to a significant reduction in PM10 and CO concentrations, other factors related to weather conditions (wind speed, temperature, and rainfall) as well as economic activities have a greater impact on air pollution. Therefore, other policies such as improving fuel quality and technology along with other economic policies can be more effective.

The effect of video game-based training on postural control during gait initiation in community-dwelling older adults: a randomized controlled trial.

PURPOSE: The aim was to investigate the effect of video game training as compared to dual-task training on gait initiation (GI) which is a sensitive indicator of balance deficiency in older adults. METHOD: Sixty-six older adults were allocated to the video game-based training (intervention group) or the motor-cognitive dual-task training (active control group). The outcome measures were the mediolateral (ML)/anteroposterior (AP) displacement and velocity of COP during the phases of GI (anticipatory, weight transition, and locomotor). RESULTS: The results indicated in the anticipatory phase, the ML & AP COP displacement were significantly increased at post-training relative to pre-training across both groups (p < 0.041). In the weight transition phase, the AP COP displacement & ML COP velocity were significantly increased at post-training than pre-training (p < 0.032). However, in the locomotor phase, within the intervention group, the ML COP displacement & ML COP velocity were significantly increased at follow-up as compared to pre-training (p < 0.05), while no such differences were observed within the control group. CONCLUSION: Both treatments were effective in improving COP trajectory during the phases of anticipatory and weight transition, while the intervention group was more effective during the phase of locomotor. So, these treatments can be recommended for clinical settings.Implications for rehabilitationThe video game and dual task training were effective in improving COP trajectory during the phases of anticipatory and weight transition.The video game-based training was more effective during the phase of locomotor.The study findings could have useful implications to further introduce cognition-based rehabilitation programs such as video games for older adults.Rehabilitation professionals could use the video game to improve the postural control of older adults.

Effects of Innovative Aquatic Proprioceptive Training on Knee Proprioception in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

BACKGROUND: Proprioceptive training in the aquatic environment is more beneficial owing to water properties. The primary goal of the present study was to investigate the effectiveness of the incorporation of innovative aquatic proprioceptive training into conventional accelerated land-based rehabilitation protocol in knee function and joint position sense in male athletes after anterior cruciate ligament reconstruction (ACLR). METHODS: A total of 38 athlete male athletes with ACLR were randomly assigned to two rehabilitation groups. The conventional therapy group (CT) (n=19) received conventional rehabilitation for 6 weeks, while the hydrotherapy group (HT) (n=19) received the same conventional rehabilitation, in addition to 12 sessions of innovative aquatic proprioceptive training. The outcomes included the joint position sense (JPS) errors, visual analog scale (VAS), and international knee documentation committee (IKDC). Repeated measures analysis of variance (ANOVA) was used to compare the means between the two groups. Cohen's d from an independent t-test was used to calculate the effect sizes for all variables after the intervention for both groups. RESULTS: Base on the results, there were a significant difference in absolute errors (AE) (FAE=56.231, P<0.001) and variable errors (VE) (FVE=60.245, P<0.001) between the two groups. No significant differences were detected in constant error (CE), VAS, and IKDC between the two groups (P>0.05). Both groups displayed a significant difference in terms of AE, VE, VAS, and IKDC after the intervention (P<0.05). Percent changes after the intervention for AE(69.19%), VE (68.20%), CE (65.20%), VAS37.50%, and IKDC (38.61%) were greater in the HT group, compared to the CT group. CONCLUSION: As evidenced by the obtained results, innovative aquatic proprioceptive training incorporate into the conventional rehabilitation accelerated protocol offers the improvement of proprioception efficiency for individuals with ACL reconstruction. Therefore, it could be useful to clinicians when designing rehabilitation protocol to ensure the optimal engagement of proprioception.

Comparison of the effects of Wii and conventional training on functional abilities and neurocognitive function in basketball-players with functional ankle instability: Matched randomized clinical trial.

OBJECTIVE: To compare the effects of Wii and conventional training on functional abilities and neurocognitive function in basketball-players with Functional Ankle Instability (FAI). DESIGN: Single-blind matched randomized clinical trial study. SETTING: Outpatients setting. PARTICIPANTS: Fifty-four basketball-players were randomly assigned to the Wii and control group. INTERVENTIONS: All athletes in the Wii group (n = 27) performed Wii Fit Plus games; and in the control group (n = 27), they performed conventional training three days a week for 12 sessions. MAIN OUTCOME MEASURES: To assess functional performance and neurocognitive function, we used hop tests (8-hop, side hop, and single hop) and Deary-Liewald Reaction Time Task (DLRT), respectively. DLRT measured simple and choice reaction time and error rate. Measures were taken at baseline, four weeks, and eight weeks after baseline. RESULTS: In all 54 athletes completed the study. The results showed no significant differences for all hop tests in between-group comparison but the neurocognitive function showed significant improvements in the Wii group compared to the control group (P < 0.05). Mean (SD) for 8-hop and side hop tests for the involved limb, and simple and choice reaction time four weeks after baseline in the control group were 10.15 (1.02), 12.36 (1.31), and 339.10 (41.57), 530.52 (53.36), respectively and in the Wii group, were 10.46 (1.23), 12.40 (1.31), and 295.25 (13.16), 431.19 (33.46), respectively. CONCLUSION: Based on our results, both training protocols were equal to positively affect functional abilities. Besides, Wii training improved neurocognitive function and can be applied in FAI rehabilitation protocols.