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Volume 4, Issue 2 (Summer 2003)
Objective: Several studies have shown the effects of muscular fatigue on proprioception and neuromuscular control. However all available researches have studied just the effect of local fatigue in ankle joint muscles on postural control, and no study have found about the effect of fatigue in proximal muscles of the lower extremity on postural control. To compare changes in postural control parameters after isokinetic fatigue of proximal and distal muscles of lower extremity.
Materials & Methods: Subjects were twenty healthy men (age: 22.6±2.4 years, height: 173.7± 3.6 cm, weight: 63.3±7.9kg). There were 4 test sessions, with a randomized order according to site and plane of fatigue. During each session one of these muscle groups was fatigued using a Biodex isokinetic dynamometer: ankle plantar / dorsi flexors, ankle evertor / inventors, hip flexor / extensors and hip abductor/adductors. The biodex stability system was used to perform dynamic balance test before and after muscle fatigue in each session. Overall, anterior / posterior, and medial/lateral stability indices were recorded. The higher the stability indices, the lower the balancing skill.
Results: Analysis of pre-and post fatigue balance results of all sessions, demonstrated significant increase (P<0.05) in all stability indices. Repeated measures ANOVA performed on the rate of changes in stability indices during each session revealed that hip muscle fatigue caused much more increase in stability indices than ankle muscle fatigue (P<0.05).
Conclusion: Isokinetic fatigue of both ankle and hip muscles significantly decreases postural control ability in healthy young men. In addition, our findings suggest that the hip joint musculature plays a more prominent role in postural control.
Volume 11, Issue 2 (Summer 2010)
Objective: Numerous studies showed increasing incidence of acute or recurrent dislocations of the shoulder joint in people with General Hypermobility Syndrome (GHS). Given the critical role of scapular orientation in function of shoulder, the aim of this study is to compare the parameters indicating position and orientation of scapula between females with and without General Hypermobility Syndrome in frontal and sagital plane in arm elevation.
Materials & Methods: In this cross sectional and case-control study, 16 females with General Hypermobility Syndrome were selected simply and conveniently and 16 healthy females were selected and matched by age, body mass index and menstrual status. A three dimensional motion analysis system (vicon 460) was used to measure scapular position (upper-lower and medial-lateral translations) and orientation (upward rotation, posterior tilt and internal rotation angle). Measurement were taken with the arm placed in different angles of arm elevation. Date analysis was performed with Independent T test.
Results: Upward rotation angles in sagital plane in 90º (P=0.03), 120º (P=0.01) and full range of arm elevation (P=0.04) were lower in case group as compared to control group. Also patients with General Hypermobility Syndrome showed a lesser amount of lateral scapular translation in 90º (P=0.02) and full range of sagital plane arm elevation (P=0.02). In addition, lateral scapular translation in 120º (P=0.02) and full range of frontal plane arm elevation (P=0.01) was lower in case group compared with control group.
Conclusion: Altered kinematics in General Hypermobility Syndrome has a greater role in shoulder injuries and neuromuscular defect seems to be an underlying cause of scapular kinematics' changes in people with hypermobility syndrome.
Volume 12, Issue 2 (Summer 2011)
Objective: Any minimal alteration in performance and coordination of scapular and glenohumeral muscles has the potential to lead to shoulder joint dysfunction. The impingement syndrome has been reported as is the most common diagnosis of shoulder pain. The purpose of this study was to determine whether endurance deficits could be detected in patients with shoulder impingement.
Materials & Methods: By convenient sampling 15 patients with impingement syndrome at average of 45.3 years of age and 15 healthy persons (age 45.8 years) through a case–control design participated in the study. Endurance of glenohumeral and scapulothoracic muscles were tested with a hand held dynamometer. Independent t–test was used to statistically analyze different groups.
Results: Compared to non–impaired subjects, those with impingement syndrome demonstrated a significantly lower endurance of external rotation, scaption and scapular abduction and upward rotation movements (P<0.05). In impingement syndrome patients, the external–to–internal rotator muscles endurance ratio was significantly lower than the control group (P<0.05).
Conclusion: The result of the study suggests that endurance deficit of rotator cuff and scapular upward rotator muscles may be an important aspect of the impingement syndrome. Shoulder girdle muscles endurance should be considered in evaluation and physical therapy of impingement syndrome patients.
Volume 13, Issue 2 (Summer 2012)
Objective: The aim of this study was to achieve a reliable tool for measuring health related quality of life among Iranians with shoulder pain and disability.
Materials & Methods: Through a non-experimental methodology study, four shoulder patient-centered outcome scores were translated and adapted culturally to Persian language. A total of 126 male and female patients with shoulder pain and disability were selected for examination of test –retest reliability of Iranian versions of shoulder outcome scores. The data was analyzed for evaluations of test –retest reliability, subscale and item internal consistency.
Results: Internal consistency which was calculated by Cronbach &alpha was high for almost all the subscales (at least 0.7). Item internal consistency after correction for overlap was higher than optimal value (0.4), which demonstrated good item internal consistency. Test-retest reliability results showed that all the Persian versions of questioners’ subscales had good reliability.
Conclusion: With the preparation of Persian versions of shoulder pain and disability outcome scores ,some multidimensional instruments are available now to measure health status as well as therapeutic effects in patients with shoulder pain and disability.
Volume 16, Issue 3 (Autumn 2015)
Objective: Dynamic stability in shoulder is an important element in life and any disorder in muscular function which helps maintain this stability leads to shoulder pathology. One of these disturbing factors is fatigue. According to the research team information until now there has not been a study investigated systematically the effect of fatigue on shoulder girdle biomechanics. So the purpose of this systematic review is to determine the effect of muscle fatigue on normal shoulder girdle biomechanics.
Materials & Methods: This study is a systematic review based on search in PubMed, Scopus, Elsevier, Ovid, CINAHL, Science Direct, ProQuest, Thompson, EMBASE and Medline databases for the period of 1995- 2012. The keywords used were Shoulder, Muscle Fatigue, Proprioception and Kinematics. Two levels of reevaluation were used on 350 citations.
Results: The search strategy resulted in 350 results out of which 22 papers met the criteria for this study. Variation among studies in terms of sample size, fatigue protocol and method of measurement were investigated.
Conclusion: Evidences demonstrated muscle fatigue leads to change in activation pattern of muscles shoulder girdle and consequently kinematics as well as reduction in proprioception during different positions and movements in both scapulothoracic and glenohumeral joints. Generally the results indicated that there are sufficient evidences based on the effect of fatigue on the muscular fatigue has disturbance effects on shoulder girdle kinematics and could alter the normal biomechanics.
Volume 17, Issue 2 (Summer 2016)
Objective Generalized joint hypermobility predisposes some individuals to a wide variety of musculoskeletal complaints, especially in the shoulder joint. Proprioception, which includes joint position sense and sense of movement, has an important role in the functional stability of shoulder joint. Given the critical role of proprioception in the functional stability of shoulder, the primary aim of this study was to compare shoulder joint position sense and sense of movement (kinesthesia) between individuals with and without general joint hyper mobility. The secondary aim of this study was to compare proprioception between dominant and non-dominant sides in each group.
Materials & Methods In this causal-comparative study, 20 females with generalized joint laxity (Mean[SD] age=22.05[2.30] y) and 20 females without generalized joint laxity (Mean[SD] age=22.65[2.53] y) participated in the study. Testing was performed in the supine position. Prior to beginning each proprioception tests, the participants were given to practice trials to become familiar with the testing procedure. Proprioception tests were performed during passive repositioning and kinesthesia using an isokinetic dynamometer. The shoulder external rotation range was measured with a standard goniometer, and 90% of its range was considered as a target angle in passive reposition test. The kinesthetic sense of the shoulder was evaluated by measuring the threshold for passive external rotation. The speed of threshold to detection of passive motion test was at 0.5 deg/s and passive reproduction of joint position was at 2 deg/s. Both dominant and non-dominant sides of all the subjects were evaluated. Test sequences for measuring the threshold to detection of passive motion and passive reproduction of joint position, as well as dominant and non-dominant shoulder were random. The blindfold and headphones were used to remove visual and auditory feedback. The mean of three repetitions of passive reproduction of target angle and threshold to detection of passive motion were calculated. Independent t-test was used to compare joint position sense and kinesthesia between females with and without generalized joint laxity, and paired t test was used to statistically analyze differences between dominant and non-dominant sides in each group.
Results No significant difference was observed in joint position test acuity and of detection of motion in each of dominant and non-dominant sides between females with and without generalized joint laxity (dominant side: P=0.47, non-dominant: P=0.70). Females with generalized joint laxity exhibited significantly larger errors in passive joint reproduction tests in both dominant and non-dominant sides (P=0.001) compared with those without generalized joint laxity.
Conclusion The results revealed that the angle repositioning sense in the extreme range of shoulder joints in females with generalized joint laxity is reduced compared to those without generalized joint laxity. Lower joint position test acuity in females with generalized joint laxity may relate to the disturbance or loss of sensory messages from joint receptors to the central nervous system. Reduced proprioception feedback may lead to biomechanically unsound limb positions being adopted. Such a mechanism may allow acceleration of degenerative joint conditions and may account for the increased prevalence of musculoskeletal complaints seen in subjects with generalized joint laxity.
Volume 18, Issue 1 (Spring 2017)
Objective Human behavior is a function of one’s existence and interaction between body and mind. Disability is the inability to perform all or part of the normal activities of individual or social life due to congenital defects, or physical or mental faculties being subject to accidents. Mental disability rehabilitation approach consists of three categories of services: mental, emotional, and physical. Physical or motor disabilities are divided into four categories: physical, visceral, sensory and aging. The concept of disability is omnipresent in every society and culture. Its form may vary between temporary or permanent, total or partial, and fixed or variable. Side effects of disability on individuals are different according to their attitude. Their views about themselves, disability, and familial and social attitudes leads to various complications in the lives of persons with disabilities. It has been proved that endangering the physical health provides psychological reactions in people. Many physical disabilities are associated with mental health problems. Mental health problems in people with health problems are very common. For example, chronic diseases, create physical conditions and limiting long-term negative consequences for the disabled person. Quasi-physical as well as psychological problems have serious implications with respect to diseases. Psychosomatic diseases, for instance, cause different kinds of disabilities. In addition to the development of the machines, the marriage and many other issues may be associated with increased physical disability and mental illness. The importance of physical disabilities due to mental health problems that are associated with health problems treated, including psychiatric problems that disabled people face; social is the low and high social phobia. The aim of this study was to determine the effectiveness of acceptance and commitment group therapy based on social adjustment and social phobia among physically-disabled person.
Methods & Materials The study population consisted of all individuals belonging to a disability welfare organization in Qom. The sample included 30 males (15 in the control group and 15 in the experimental group) who were selected by random sampling method. In this quasi-experimental study, the participants in the experimental group underwent a 2-month intervention of eight 120-minute sessions. The research design was pretest-posttest with a control group. Data were collected from the questionnaires of Conover, social adjustment, Weisman, and social phobia. Analysis of covariance (ANCOVA) model was used for analyzing.
Results Our results showed that the acceptance and commitment group therapy increased satisfaction as far as social adjustment was concerned (P<0.001). Significant effect on the subscales of fear (P<0.001), avoidance (P<0.001), physiology (P<0.001), and the total social phobia score (P< 0. 001) was also observed.
Conclusion The acceptance and commitment group therapy increased social adjustment and decreased social phobia among physically-disabled persons.
Volume 19, Issue 2 (Summer 2018)
Materials & Methods A case-control study was designed where the participants were selected by nonprobability sampling; 30 subjects with scapular dyskinesis and an average age of 22.95±2.62 years and 30 subjects without scapular dyskinesis and an average age of 22.43±2.50 years. The subjects were instructed to stand with their arms resting on each side of the body. The examiner stood behind them at a distance of 1.5 meter and asked them to elevate their arms to the highest level possible. Scapular dyskinesis test was used to visually examine alteration in scapulohumeral rhythm during arm elevation in sagittal and frontal planes. The shoulder flexion and abduction were repeated for 5 times. At the same time, the examiner rated the scapular movement as normal or observable dyskinesis. The maximal voluntary isometric force of shoulder internal and external rotation on both sides, such as “scaption with external rotation”, “scapular abduction and upward rotation”, “scapular adduction and downward rotation”, “scapular adduction” and “adduction and depression of scapula” were measured with manual Dynamometer. For determining the maximal shoulder isometric rotational force, subjects were positioned prone on tables, arm brought into 90º abduction in frontal plane with 90° elbow flexion and resistance given to distal forearm into shoulder external and internal rotations. The maximal isometric force of scaption (supraspinatus strength) was measured in seated position; shoulder elevated 70º into scapular plane abduction (scaption) with external rotation. The maximal isometric force of scapular abduction and upward rotation was determined in supine position while the arm was elevated to 90º flexion with elbow extension and resistance given against forward pushing. For determining the maximal isometric force of rhomboids and middle trapezius muscles, resistance was given against scapular adduction and downward rotation, and scapular adduction, respectively. The maximal isometric force of lower trapezius was determined in prone position while the arm was elevated to 135º shoulder elevation with elbow extension. Independent t-test was performed to compare the maximal voluntary isometric force of shoulder girdle motions in individuals with and without scapular dyskinesis.
Results The mean±SD of age, weight and height of the participants without and with scapular dyskinesis were 22.43±2.50 years/ 22.95±2.62 years, 64.39±13.38 kg/ 65.67(±12.2) kg and 171.35(±11.29) cm/ 173.43(±8.66) cm, respectively. No statistically significant differences were found between the participants of the two groups with regard to the age, weight and height. Our result showed that the isometric force of “scaption with external rotation”, “scapular abduction and external rotation”, “adduction and depression of scapula”, “scapular adduction and downward rotation” and “scapular adduction” were significantly different between the two groups (P<0.05). In comparison to the control group, the individual with scapular dyskinesis had weaker supraspinatus, serratus anterior, rhomboids and middle and lower trapezius muscles.
Conclusion Scapular dyskinesia or altered kinematics of the scapula (downward rotation, anterior tilt and internal rotation) contributes to impingement syndrome by decreasing the subacromial space. The tissues that occupy the subacromial space are the supraspinatus tendon, subacromial bursa and long head of the biceps brachii tendon. The supraspinatus is the major rotator cuff muscle that is susceptible to tendinopathy in subacromial space. The inflammatory processes or tension overload during shoulder activities, which may result from altered kinematics of the scapula and decrease in the subacromial space, may lead to supraspinatus weakness. It has been shown that scapular stabilizers, such as serratus anterior, rhomboids and middle and lower trapezius muscles are more prone to weakness than the other shoulder muscles. So, the weakness in these muscles may relate to scapular dyskinesis. Scapular muscle exercises are executed in the rehabilitation of patients with subacromial impingement syndrome and scapular dyskinesis, as the muscular system is one of the major contributors to scapular positioning, both at rest and during movements. It seems that improving the strength of shoulder girdle muscles especially supraspinatus, serratus anterior, rhomboids, and middle and lower trapezius muscles would be necessary in individual with scapular dyskinesis.
Volume 23, Issue 2 (Summer 2022)
Objective: Down syndrome or trisomy 21 is one of the most common human chromosomal disorders that affect cognitive functions, communication and behavioral skills. At the macro level, various factors can contribute to the Down syndrome prevalence and mortality. This study aimed to investigate the association of health system functions with Down syndrome prevalence and mortality worldwide.
Materials & Methods: The study was a cross-sectional study conducted based on the secondary analysis of existing data in 2019. Data from 202 countries in six different regions (African Region [AFRO], Eastern Mediterranean Region [EMRO], European Region [EURO], South-East Asia Region [SEARO], Western Pacific Region [WPRO], and Pan American Health Organization [PAHO]) were included in the study. Data were extracted from the World Health Organization (WHO), the World Bank and the Institute for Health Metrics and Evaluation databases. The adjusted linear regression analysis was used to examine the association between health system-related factors with prevalence of, and death due to Down syndrome as the outcome variables. In the present study, two functions of health financing (domestic general government health expenditure [GGHE-D] per capita in PPP [purchasing power parity] int$, domestic private health expenditure [PHE-D] per capita in PPP int$, external health expenditure [EXT] per capita in PPP int$) and health system resources (nurse and midwifery personnel, generalist medical practitioners [GMP], specialist medical practitioners [SMP], pharmacists, dentists, physiotherapists) were included in the study as independent variables. We used the Stata software version 14 to analyze
Results: Africa and low-income countries had the highest deaths due to Down syndrome. On the other side, Europe and high-income countries had the highest prevalence of Down syndrome worldwide. According to the available data, Iran had a lower prevalence (29.31 vs 38.44 per 100,000 population) and higher deaths (0.34 vs 0.32 per 100,000 population) compared to high- income countries. The 20-year trend of prevalence of, and deaths due to Down syndrome in Iran has always been lower and higher than high-income countries, respectively. Linear regression analysis showed that GGHE-D per capita (β=0.385, P<0.001) and PHE-D per capita (β=0.354, P=0.02) could predict the prevalence of Down syndrome significantly in the study countries. On the other hand, nurse and midwifery personnel (β=-0.607, P=0.014) and number of SMP (β=0.420, P=0.025) were associated with increased deaths from Down syndrome in the included countries.
Conclusion: Our findings showed GGHE-D and PHE-D are associated with a higher prevalence of Down syndrome in health systems. On the other hand, health system resources (nurses and SMP) were the main predictors of death due to Down syndrome in the included countries. International organizations and governments need to monitor and improve the equitable access of vulnerable groups to health services in low-income countries. Improving health insurance coverage and equitable distribution of health resources is suggested to reduce deaths due to Down syndrome in Iran.
Volume 25, Issue 2 (Summer 2024)
Materials & Methods In this randomized clinical trial, the block random sampling method was used to select 84 patients who were divided into two groups. Group 1 was allowed to have full WB after surgery and Group 2 was asked to use braces after surgery, and they were divided into partial WB for one month and then full WB. Meanwhile, demographic information was recorded. The Lachman test, anterior knee pain, and kneeling pain before and one month after the surgery were also recorded. Knee function was evaluated using the international knee documentation committee, knee injury and osteoarthritis outcome score, and Lysholm scales before surgery and 1, 3, and 6 months after surgery. The data were analyzed using the SPSS software, version 20, and the Fisher exact test, the chi-square test, the Friedman test, and repeated measures analysis of variance.
Results Most of the patients were men under 30 years of age. There was no statistically significant difference in the demographic information of the patients in the two groups. Kneeling pain, anterior knee pain, and the Lachman test did not differ between the two groups one month after the surgery. There was no difference between the two groups in the scores using the international knee documentation committee, knee injury and osteoarthritis outcome score, and Lysholm score in the 6-month follow-up. All the examined indicators in each group improved over time.
Conclusion WB immediately after surgery compared to partial WB at 1, 3, and 6 months after ACLR do not differ; therefore, patients can bear full weight if they tolerate it.
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