Effect of the Dynamic Orthotic Garment on Postural Control, and Endurance in Children with Spastic Diplegic Cerebral Palsy: A Randomized Controlled Trial.

Purpose: To investigate the effect of dynamic orthotic garments (Thera togs) on foot pressure distribution, postural control, and endurance in children with spastic diplegic CP. Patients and Methods: This is a single-blind randomized controlled clinical trial involving 34 (8-10 years) with spastic diplegic CP. The control group received conventional physical therapy (CPT), whereas the study group received CPT in addition to wearing TheraTogs. We recorded foot pressure distribution, trunk control measurement scale, trunk position sense, Pediatric Berg Balance Scale (PBS), and six-minute walking distance (6MWD). Results: Both groups showed improvement. The study group had significant improvement in foot pressure distribution (p-value 0.003, 0.001, <0.001 for forefoot, midfoot, and rearfoot mean pressures respectively, and 0.005, <0.001, and 0.005 for forefoot, midfoot, and rearfoot peak pressures respectively), Pediatric balance scale, The trunk control measurement scale, and Trunk position sense (p-value < 0.001) and six-minute walking distance (p-value 0.029). Our data suggest that adding TheraTogs to conventional physiotherapy improves foot pressure, postural control, and endurance in children with spastic diplegic cerebral palsy. Conclusion: Both TheraTogs and conventional physical therapy corrected foot pressure distribution, trunk control, improved balance, and increased 6MWD in children with spastic diplegic CP but the improvement was more significant in TheraTogs group. Clinical Trial Registration: NCT05271149.

Current Rehabilitation Practices and Return to Sports Criteria After Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists in Saudi Arabia.

CONTEXT: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. DESIGN: Online cross-sectional survey-based study. METHODS: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. RESULTS: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. CONCLUSIONS: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements.

Effect of extracorporeal shock wave therapy on spastic equinus foot in children with unilateral cerebral palsy.

Objectives: This study aims to investigate the effects of radial extracorporeal shock wave therapy on selective motor control, spasticity, gross motor function, and balance in children with unilateral cerebral palsy. Methods: This randomised controlled study recruited 34 children aged 7-9 with spastic unilateral cerebral palsy. They were randomly allocated to either the control or study group. Both groups undertook traditional exercises for 12 weeks. The study group received shock waves (one session/week) on the calf muscle (1500 shocks, frequency of 4 Hz, energy of 0.030 mJ/mm2). All children were evaluated at baseline and after 12 weeks using the Modified Ashworth Scale, a Biodex System 4 isokinetic dynamometer, dimensions D (standing) and E (walking) of the Gross Motor Function Measure - 88, the Trost Selective Motor Control test, and the single leg standing test. Results: Mixed analysis of variance and Mann-Whitney results showed significant improvement in eccentric peak torque, torque threshold angles, gross motor function, selective motor control, and balance in the study group compared with the control group (p < 0.05). Conclusions: Shock wave therapy may be a valuable instrument for reducing spasticity, improving the ability to isolate and control movement, and consequently, improving balance and gross motor function in children with unilateral cerebral palsy.

Effects of behavioural therapy versus interferential current on bladder dysfunction in multiple sclerosis patients; a randomised clinical study.

OBJECTIVES: This study examines the effect of behavioural therapy (biofeedback) and interferential current on bladder dysfunction in multiple sclerosis patients. METHODS: Fifty patients with secondary progressive type multiple sclerosis (SPMS) suffering from bladder dysfunction were divided equally into two groups randomly. Group A (GA) received behavioural therapy (biofeedback training), while Group B (GB) received interferential current training. Both groups were assessed by urodynamics for detrusor pressure and maximum flow rate before and after eight weeks of behavioural therapy and interferential training. RESULTS: Both groups, GA and GB, showed significant increase in the detrusor pressure and maximum flow rate after eight weeks of training. There was no significant difference between both methods. However, GA showed more improvement by close observation. CONCLUSIONS: Both behavioural therapy and interferential current training effectively managed bladder dysfunction in patients with SPMS, with more evident effects in behavioural therapy patients by close observation.

Isokinetic trunk muscle performance in adolescents with different body mass indices.

OBJECTIVE: This study aims to evaluate the isokinetic performance for the peak torque and average power of the spinal flexor and extensor muscles in adolescents aged 12 to 18 years. The study also analyses the differences between the trunk muscle peak torque and average power with body mass index (BMI). METHOD: The peak torque and average power of the trunk flexor and extensor muscles were measured in 180 adolescents (aged 12-18 years). The participants were classified into four groups according to BMI. The Biodex isokinetic dynamometer in concentric mode at speeds of 60° and 120°/sec was used for assessment. RESULTS: One-way multivariate analysis of variance MANOVA results demonstrated a significant difference in trunk muscle peak torque and average power with different BMI (F = 14.692, p = 0.0005). A Pearson's correlation analysis demonstrated a significantly negative correlation between weight and peak torque of trunk flexors and extensors (r = - 0.43, p = 0.0001; r = -0.31, p = 0.007, respectively). Finally, the results showed a negative correlation between weight and average power of trunk flexors and extensors (r = -0.54, p = 0.0001; r = -0.31, p = 0.007). CONCLUSION: In this study, overweight and obese adolescents are found to be correlated with decreased trunk muscle torque and power. Thus, therapeutic interventions for overweight and obese adolescents, along with exercise training programmes, may help improve muscle performance including peak torque and power. Finally, these measures may enhance the quality of life of such adolescents.

Peak torque substantially varies between patients with non-specific low back pain; belong to directional preference classification, and healthy individuals-clinical biokinesiologic perspectives.

[Purpose] To compare flexion and extension peak torque of patients with nonspecific-chronic low back pain who were classified as directional preference subgroups, and their matched healthy controls. [Participants and Methods] Fifty male volunteers (25 with non-specific chronic low back pain and 25 healthy-matched controls) consented to participate. The investigator collected all demographic data, hips, knees and spinal mobility in addition to the peak torque using the Biodex isokinetic dynamometer. The measurement protocol consisted of 2 sets of 10 consecutive flexion-extension efforts performed at 120°/sec and 60°/sec angular velocity. A two minutes rest period was given between sets. The preset 50° range of motion included 20°(+20°) of trunk extension and 30°(-30°) of trunk flexion. [Results] A 2 × 2 mixed-design ANOVA showed a significant group X isokinetic velocity interaction. The main effect of isokinetic velocity was also significant. In reference to the peak torque of the flexors of the trunk, the main effect of group was significant. [Conclusion] The extension peak torque significantly depends on the velocity of the isokinetic dynamometer; however the flexion peak torque significantly depends on the participants' group attribution.

Quinazolinone-Amino Acid Hybrids as Dual Inhibitors of EGFR Kinase and Tubulin Polymerization.

Some fluoroquinazolinones (A⁻H) were designed, synthesized and biologically evaluated for their antitumor activity against the two cell lines, MCF-7 and MDA-MBA-231. New derivative G (IC50 = 0.44 ± 0.01 µM) showed antitumor activity, better than that of the reference drug erlotinib (IC50 = 1.14 ± 0.04 µM) against MCF-7. New derivative E (IC50 = 0.43 ± 0.02 µM) showed higher activity than the reference drug erlotinib (IC50 = 2.55 ± 0.19 µM) against MDA-MBA-231. Furthermore, the EGFR (epidermal growth factor receptor) and tubulin inhibition assays were carried out for the highest active derivatives to reveal the expected mechanism of action. They exhibited significant results compared to the reference drugs. Molecular docking simulations were performed on EGFR and tubulin binding sites to rationalize the experimental results and describe their binding modes. The results of the molecular modeling study were correlated with that of the antitumor screening.

Right versus left side bridge static endurance ability among healthy collegiate students at Taibah University.

BACKGROUND: Spinal muscles endurance is fundamental for providing adequate trunk stability. OBJECTIVE: The purpose of this study was to compare the side bridge static endurance ability of the right versus left side. METHODS: Forty right hand dominant students, aged between 18 and 25 years, were recruited from Taibah University. Every participant had to lie down on his side and bear trunk weight on the arm with shoulder abducted to 90∘ and elbow flexed to 90∘. Every participant had to lift off his trunk of the supporting surface, keeping the trunk straight in neutral position, breathing normally and holding on that position as long as tolerated. RESULTS: A paired sample t test was calculated. The mean score, in seconds, for right side bridge was 41.6 (SD = 30.08), and for left side bridge was 38.00 (SD = 26.93). No significant difference was found between right and left side bridge endurance ability [t (39) = 1.67, p> 0.05]. Pearson correlation showed high positive correlation [r (38) = 0.89, p< 0.001]. CONCLUSIONS: Among healthy participants, clinicians should expect very close endurance profile for the musculature of the two sides of trunk. Clinicians should equally train both sides of trunk muscles stabilizers in order to enhance tolerance.

Incidence of First Time Stroke: A Saudi Experience.

BACKGROUND: Stroke is one of the major causes of morbidity and mortality throughout the world. A number of studies were conducted in Saudi Arabia. However, there were no studies conducted in Al-Madinah Al-Munawarah city. OBJECTIVE: The aim of this study was to ascertain the incidence rate of first time stroke and the age-specific incidence in both genders in Al-Madinah Al-Munawarah city. METHODS: A prospective hospital based study was conducted over a 1-year period (2014). The cases were included in the study when they were admitted with a diagnosis of cerebrovascular accident. RESULTS: A total 164 patients (91 men and 73 women) who had first time stroke were found in this study with no significant difference between them (p = 0.565). The crude incidence rate of stroke was 13.89 per 100,000 persons. The age-specific incidence rate increased with age in the current study, where the peak was in the age group of more than 75 years old for men and women. CONCLUSIONS: Total crude and the age-specific rates for first time stroke patients revealed in this study were markedly lower than the range reported from the developed countries. However, they were within the range that showed previously in Saudi Arabia and Arabian Peninsula countries.