Publications by authors named "Nader Maroufi"

30 Publications

  • Page 1 of 1

Intrarater reliability of musculoskeletal ultrasound imaging of psoas major muscle in patients with subacute low back pain and healthy controls.

Med J Islam Repub Iran 2020 28;34:145. Epub 2020 Oct 28.

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran.

Psoas major (PM) is a challenging muscle from the functional and anatomical point of view. The dysfunction of this muscle can result in low back pain (LBP). This study aimed to assess the intrarater reliability of ultrasound imaging (USI) of PM muscle thickness in subacute LBP patients and healthy participants without LBP in rest and during muscle contraction conditions. PM thickness was measured in all lumbar segments (L1-L5) using a USI device in 10 healthy and 10 subacute LBP participants. The intrarater data were assessed on the same day with 1- hour interval and after 7 days. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and independent t test were used for analyses. Significant level was set at 0.05. PM thickness in all lumbar levels had excellent reliability (ICC range 80-98) for both groups and conditions. SEM (0.42- 2.29) and MDC (1.16-6.34) were low, and PM thickness was greater than rest in contraction condition. There were no significant differences between the 2 groups in PM thickness. The USI demonstrated good intrarater reliability for assessing PM thickness in patients with subacute LBP. The thickness of PM in patients with subacute LBP was similar with that in healthy participants.
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http://dx.doi.org/10.47176/mjiri.34.145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787047PMC
October 2020

The Effects of Knee Orthosis with Two Degrees of Freedom Joint Design on Gait and Sit-to-Stand Task in Patients with Medial Knee Osteoarthritis.

Sultan Qaboos Univ Med J 2020 Nov 21;20(4):e324-e331. Epub 2020 Dec 21.

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Objectives: Knee bracing as a conservative treatment option for patients with medial knee osteoarthritis (KOA) is of great interest to health practitioners and patients alike. Optimal orthotic knee joint structure is essential to achieve biomechanical and clinical effectiveness. Therefore, this study aimed to identify the effects of a knee orthosis with a new two-degrees-of-freedom (DOF) joint design on selected gait parameters and in a sit-to-stand task in patients with mild-to-moderate medial KOA.

Methods: This study was conducted both at the Physical Medicine and Rehabilitation Clinic in Shahid Modarres Academic Hospital and the Biomechanical Laboratory of Rehabilitation Faculty of Iran University of medical Sciences in Tehran, Iran from September 2015 to October 2017. The gait performance of 16 patients was assessed without an orthosis, using a common one-DOF (DOF) knee orthosis and using the same knee orthosis with a two-DOF orthotic joint design. The interactive shearing force between limb and brace in the shell area during a sit-to-stand test was also identified. Repeated measures analysis of variance was used to analyse the data.

Results: Compared with walking with no orthosis, both orthosis conditions reduced the external knee adduction moment significantly ( ≤0.05). A significant increase between the one-DOF and two-DOF conditions in terms of walking speed ( = 0.041 and = 0.009, respectively) and stride length ( = 0.028 and = 0.038, respectively) was observed. In a sit-to-stand test, wearing the orthosis significantly decreased knee transverse plane range of motion ( ≤0.05). There was a 41.31 ± 8.34 Newtons reduction in knee flexion constraint force.

Conclusion: The two-DOF knee orthosis was more comfortable compared to the one-DOF knee orthosis during deep knee flexion. Otherwise, the one-DOF- and two-DOF-braces performed similarly.
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http://dx.doi.org/10.18295/squmj.2020.20.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757919PMC
November 2020

Effects of Different Frequencies of Whole Body Vibration on Repositioning Error in Patients With Chronic Low Back Pain in Different Angles of Lumbar Flexion.

J Manipulative Physiol Ther 2019 05 26;42(4):227-236. Epub 2019 Jun 26.

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences and Health Services, Tehran, Iran.

Objective: This study aimed to evaluate the effect of high and low frequency of whole body vibration (WBV) on repositioning error in 3 different angles of lumbar flexion in patients with chronic low back pain.

Methods: Twenty-four participants with chronic low back pain, aged between 20 and 35 years, were included in this randomized crossover trial study. Participants were randomly assigned into 2 groups as follows: (1) low frequency/high frequency, and (2) high frequency/low frequency. Participants received high-frequency (50 Hz) and low-frequency (30 Hz) WBV in a semi-squat position for 5 minutes in 2 sessions, with 2 weeks of rest. Before and after the WBV, lumbar repositioning error in 30% and 60% of lumbar full flexion and neutral position with eyes closed when standing was evaluated using an electrogoniometer.

Results: The repositioning error was decreased in neutral, 30%, and 60% of lumbar flexion after the low-frequency and high-frequency WBV. Post hoc testing revealed that the effect of angle was not significant in repositioning error changes between high-frequency and low-frequency WBV (P > .05). However, the effect of low-frequency WBV on the repositioning error was significantly higher compared with high-frequency WBV (P < .05).

Conclusion: Low-frequency WBV might induce more improvement in the accuracy of lumbopelvic repositioning compared with high-frequency WBV with the method of WBV used in this study.
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http://dx.doi.org/10.1016/j.jmpt.2018.11.006DOI Listing
May 2019

The effects of familiarization with loading, weight and size of loading on neuromuscular responses during sudden upper limb loading in chronic low back pain patients.

J Back Musculoskelet Rehabil 2019 ;32(6):847-855

Mahak Society to Support Children with Cancer, Tehran, Iran.

Background: Changes in the motor control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is supposed to be the cause of about 12% of lower back injuries. However, some aspects of this problem, such as alterations in the sensory-motor control of the spine, remain questionable.

Objective: To investigate the effects of familiarization with loading, weight and size of loading on neuromuscular responses during sudden upper limb loading in CLBP patients.

Methods: In this quasi-experimental study surface electromyography of the erector spinae (ES) and transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 7 men and 13 women with CLBP and 20 asymptomatic subjects (10 men and 10 women) aged 18-45 years from the general community familiarization. Moreover, investigating control of the posture measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t-test and independent t-test with the significance level of 0.05.

Results: Data analyses were performed using SPSS version 18. Some electromyography and force plate variables were significantly different for different conditions in each group and between the asymptomatic and low back pain groups (p⩽ 0.05).

Conclusion: Several motor control changes were observed in the CLBP patients. These patients showed decreased trunk muscle activity as well as too early and too delayed responses compared to asymptomatic subjects.
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http://dx.doi.org/10.3233/BMR-181236DOI Listing
March 2020

Comparison of Postural Balance between Subgroups of Nonspecific Low-back Pain Patients Based on O'Sullivan Classification System and Normal Subjects during Lifting.

Arch Bone Jt Surg 2019 Jan;7(1):52-60

Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Balance disorder is one of the most-studied fields in low-back pain patients (LBP). However, there is insufficient information regarding the effect of LBP subgrouping on postural control. The purpose of the present study was to compare postural control between subgroups of chronic nonspecific LBP and healthy subjects during lifting.

Methods: A total of 35 men with chronic LBP (19 active extension pattern [AEP] and 16 flexion pattern [FP]) and 15 healthy controls were enrolled in this cross-sectional study. Pooled LBP was subdivided based on the O'Sullivan's classification system (OCS). The participants were asked to lift a box from the ground to the waist level and hold it for 20 seconds. The load was 10% of the subject's weight. Force plate system was used to record balance parameters, including standard deviations (SDs) of center of pressure (COP) amplitude and COP velocity in anterior-posterior and medial-lateral directions and mean total velocity. The test was divided into two static and dynamic phases. Data were analyzed using one-way analysis of variance and independent t-test.

Results: There were no significant differences between pooled LBP and control groups in any of the variables, except for the SD of the anterior-posterior direction velocity in the X-plane in the static phase (). After classifying LBP, the results showed that the healthy and AEP groups were significantly different in SD of COP velocity in the frontal plane (), mean total velocity (), and SD of COP velocity in the sagittal plane ().

Conclusion: The present study showed that postural control was not different between the pooled LBP and normal groups. After classifying pooled LBP based on OCS, we found that the AEP showed different postural control as compared to healthy controls in the dynamic phase. The FP and AEP exhibited different postural control relative to the healthy controls in the static phase, and COP velocity was lower in those groups compared to the control group. The results of this study support the concept of LBP classification.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6372270PMC
January 2019

The Ratio of Lumbar to Hip Motion during the Trunk Flexion in Patients with Mechanical Chronic Low Back Pain According to O'Sullivan Classification System: A Cross-sectional Study.

Arch Bone Jt Surg 2018 Nov;6(6):560-569

Research performed at Physical Therapy Clinic of School of Rehabilitation, Iran Universality of Medical Sciences, Tehran, Iran.

Background: Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two important aspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare the posture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand health subjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O'Sullivan's classification system (OCS).

Methods: This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low back pain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3D motion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to full bend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion were divided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using one-way analysis of variance (ANOVA) and independent t-test.

Results: There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positions between the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significant difference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significant difference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group, and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there was statistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026). In this position, the difference in hip angles between the healthy group and FP group was statistically significant (). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBP group (), however, there was a significant difference between FP group and the healthy group in the fourth Q of the total hip range of motion. There was no statistically significant difference between the healthy group and the heterogeneous LBP group () but there was a difference between FP group and the healthy group. Lumbar/hip motion ratio (L/H ratio) was different between and within the subgroups in the second Q.

Conclusion: This study supported the subgrouping of LBP and showed that the difference between subgroups could be determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It is possible that the neuromuscular system selects different strategies to compensate and prevent further injury of the chain components (muscle, joint, nerve and etc.).

Level Of Evidence: IV.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310185PMC
November 2018

Disturbance of neck proprioception and feed-forward motor control following static neck flexion in healthy young adults.

J Electromyogr Kinesiol 2018 Aug 24;41:160-167. Epub 2018 Apr 24.

Department of Physical Therapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran.

The highly complex proprioceptive system provides neuromuscular control of the mobile cervical spine. Static neck flexion can induce the elongation of posterior tissues and altered afferent input from the mechanoreceptors. The purpose of this study was to examine the effect of prolonged static neck flexion on neck proprioception and anticipatory postural adjustments. Thirty-eight healthy participants (20 females and 18 males) between the ages of 20-35 years with no history of neck, low back, and shoulder pain enrolled in this study. Neck proprioception and anticipatory muscle activity were tested before and after 10-min static neck flexion. For assessment of neck proprioception, each participant was asked to perform 10 trials of the cervicocephalic relocation test to the neutral head position after active neck rotation to the left and right sides. Anticipatory postural adjustments were evaluated during a rapid arm flexion test. Following the flexion, the absolute and variable errors in head repositioning significantly increased (p < 0.05). The results also showed that there was a significant delay in the onset of myoelectric activity of the cervical erector spinae muscles after flexion (p = 0.001). The results of this study suggested that a 10-min static flexion can lead to changes in the neck proprioception and feed-forward control due to mechanical and neuromuscular changes in the viscoelastic cervical spine structures. These changes in sensory-motor control may be a risk factor for neck pain and injury.
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http://dx.doi.org/10.1016/j.jelekin.2018.04.013DOI Listing
August 2018

The effect of static neck flexion on mechanical and neuromuscular behaviors of the cervical spine.

J Biomech 2018 04 10;72:152-158. Epub 2018 Mar 10.

Department of Physical Therapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Occupations that involve sustained or repetitive neck flexion are associated with a higher incidence of neck pain. Little in vivo information is available on the impact of static neck flexion on cervical spinal tissue. The aim of this study was to assess changes in mechanical and neuromuscular behaviors to sustained neck flexion in healthy adults. Sixty healthy subjects aged 20-35 years participated in this study. The participants were exposed to static neck flexion at a fixed angle of full flexion for 10 min. Mechanical and neuromuscular responses of the cervical spine to sudden perturbations were measured pre- and post-exposure. Magnitude of load-relaxation during flexion exposure, stiffness, peak head angular velocity, and reflexive activities of cervical muscles were recorded. Effective neck stiffness decreased significantly, especially in female participants (P = 0.0001). The reflexive response of the cervical erector spinae muscles to head perturbation delayed significantly (P = 0.0001). Peak head angular velocity was significantly increased after exposure to neck flexion for 10 min, especially in female participants (P = 0.001). In the present study, static flexion resulted in changes in mechanical and neuromuscular behavior of the cervical spine, potentially leading to decreased stiffness of the cervical spine. The results confirm the importance of maintaining a correct head and neck position during work and improving the work environment to reduce the cervical spinal load and work-related neck pain.
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http://dx.doi.org/10.1016/j.jbiomech.2018.03.004DOI Listing
April 2018

A Preliminary Study of the Objective Measurement of Compliance Rates for Semirigid Lumbar-Support Use in Patients with Chronic Nonspecific Low Back Pain: How Important Is the Compliance Rate?

Asian Spine J 2017 Oct 11;11(5):748-755. Epub 2017 Oct 11.

Department of Orthopedic and Spinal Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Study Design: Clinical pilot study.

Purpose: To objectively evaluate the compliance rate of lumbar-support use in patients with chronic nonspecific low back pain, as well as to assess low back pain intensity, disability, and fear-avoidance beliefs.

Overview Of Literature: Wearing time is an important factor in the assessment of the efficacy of lumbar-support use in patients with chronic nonspecific low back pain. Previous studies have measured lumbar-support wearing time based on subjective assessment, and these evaluations are not easily verifiable and are usually overestimated by subjects.

Methods: Twelve subjects with chronic nonspecific low back pain who had been wearing semirigid lumbar supports for 6 weeks were evaluated. Compliance was objectively monitored using temperature sensors integrated into the semirigid lumbar supports. Subjects wore their lumbar supports for 8 hour/day on workdays and 3 hour/day on holidays during the first 3 weeks. During the next 3 weeks, subjects were gradually weaned off the lumbar supports. Pain intensity was measured using a numerical rating scale. The Oswestry disability index was used to assess the subjects' disability. Fear-avoidance behavior was evaluated using a fear-avoidance beliefs questionnaire.

Results: The mean compliance rate of the subjects was 78.16%±13.9%. Pain intensity was significantly lower in patients with a higher compliance rate (=0.001). Disability index and fear-avoidance beliefs (functional outcomes) significantly improved during the second 3-weeks period of the treatment (<0.001, =0.02, respectively).

Conclusions: The compliance rate of patients wearing lumbar supports is a determining factor in chronic low back pain management. Wearing semirigid lumbar supports, as advised, was associated with decreased pain intensity, improved disability index scores, and improved fear-avoidance beliefs in patients with chronic nonspecific low back pain.
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http://dx.doi.org/10.4184/asj.2017.11.5.748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662858PMC
October 2017

Effect of movement control and stabilization exercises in people with extension related non -specific low back pain- a pilot study.

J Bodyw Mov Ther 2017 Oct 4;21(4):860-865. Epub 2017 Mar 4.

University of Limerick, Limerick, Ireland.

Background: Exercise is considered an effective treatment strategy for non-specific chronic low back pain (NSCLBP).background In spite of the wide use of exercise protocols, it is not clear what type of exercise is more effective in decreasing pain, disability and normalizing muscle activation patterns in people with chronic low back pain.

Objectives: To assess the effects of two exercise protocols (stabilization vs movement control) on pain and disability scores and the flexion relaxation ratio (FRR) of lumbar multifidus (LM) and iliocostalis lumbarum pars thoracic (ICLT) in people with extension related non-specific chronic low back pain.

Study Design: Pilot randomized control trial.

Methods: 32 subjects with active extension pattern chronic low back pain (stabilization group = 16, movement control group = 16) participated in this study. Treatment groups received 4 weeks of exercise therapy. Outcomes were based on pain score (Numeric rating Scale-NRS), disability (Oswestry Disability Index- ODI) and FRR of the LM and ICLT.

Results: Four people dropped out of the study in each group for reasons unrelated to the protocols of the study. Pain and disability reduced in both groups, with no significant difference between the groups. The FRR of LM did not change in either treatment group after treatment. However, the FRR of ICLT was significantly increased after treatment in the movement control group.

Conclusion: Both movement control and stabilization exercises reduced pain and disability in the short-term among people with extension pattern NSCLBP, with no difference in effectiveness between the groups. However, movement control exercises were more effective in normalizing back muscle activation patterns than stabilization exercises.
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http://dx.doi.org/10.1016/j.jbmt.2017.02.005DOI Listing
October 2017

Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature.

Spine J 2017 04 14;17(4):589-602. Epub 2016 Dec 14.

Department of Physical therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Wearing lumbosacral orthosis (LSO) is one of the most common treatments prescribed for conservative management of low back pain. Although the results of randomized controlled trials suggest effectiveness of LSO in reducing pain and disability in these patients, there is a concern that prolonged use of LSO may lead to trunk muscle weakness and atrophy.

Purpose: The present review aimed to evaluate available evidence in literature to determine whether LSO results in trunk muscle weakness or atrophy.

Study Design: This is a systematic review.

Methods: A systematic search of electronic databases including PubMed, Scopus, ScienceDirect, and Medline (via Ovid) followed by hand search of journals was performed. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the effect of lumbar orthosis on trunk muscle activity, muscle thickness, strength or endurance, spinal force, and intra-abdominal pressure in healthy subjects or in patients with low back pain, were included. Methodological quality of selected studies was assessed by using the modified version of Downs and Black checklist. This research had no funding source, and the authors declare no conflicts of interest-associated biases.

Results: Thirty-five studies fulfilled the eligibility criteria. The mean and standard deviation of the quality score was 64±9.7%. Most studies investigating the effect of lumbar orthosis on electromyographic activity (EMG) of trunk muscles demonstrated a decrease or no change in the EMG parameters. A few studies reported increased muscle activity. Lumbosacral orthosis was found to have no effect on muscle strength in some studies, whereas other studies demonstrated increased muscle strength. Only one study, which included ultrasound assessment of trunk muscle stabilizers, suggested reduced thickness of the abdominal muscles and reduced cross-sectional area of the multifidus muscles. Out of eight studies that investigated spinal compression load, the load was reduced in four studies and unchanged in three studies. One study showed that only elastic belts reduced compression force compared to leather and fabric belts and ascribed this reduction to the elastic property of the lumbar support.

Conclusion: The present review showed that the changes in outcome measures associated with muscle work demands were inconsistent in their relation to the use of lumbar supports. This review did not find conclusive scientific evidence to suggest that orthosis results in trunk muscle weakness.
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http://dx.doi.org/10.1016/j.spinee.2016.12.005DOI Listing
April 2017

Goal equivalent manifold analysis of task performance in non-specific LBP and healthy subjects during repetitive trunk movement: Effect of load, velocity, symmetry.

Hum Mov Sci 2017 Jan 2;51:72-81. Epub 2016 Dec 2.

Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran. Electronic address:

Motor abundance allows reliability of motor performance despite its variability. The nature of this variability provides important information on the flexibility of control strategies. This feature of control may be affected by low back pain (LPB) and trunk flexion/extension conditions. Goal equivalent manifold (GEM) analysis was used to quantify the ability to exploit motor abundance during repeated trunk flexion/extension in healthy individuals and people with chronic non-specific LBP (CNSLBP). Kinematic data were collected from 22 healthy volunteers and 22 CNSLBP patients during metronomically timed, repeated trunk flexion/extension in three conditions of symmetry, velocity, and loading; each at two levels. A goal function for the task was defined as maintaining a constant movement time at each cycle. Given the GEM, flexibility index and performance index were calculated respectively as amounts of goal-equivalent variability and the ratio of goal-equivalent to non-goal-equivalent variability. CNSLBP group was as similar as healthy individuals in both flexibility index (p=0.41) and performance index (p=0.24). Performance index was higher in asymmetric (p<0.001), high velocity (p<0.001), and loaded (p=0.006) conditions. Performance and flexibility in using motor abundance were influenced by repeated trunk flexion/extension conditions. However, these measures were not significantly affected by CNSLBP.
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http://dx.doi.org/10.1016/j.humov.2016.11.005DOI Listing
January 2017

Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females.

J Bodyw Mov Ther 2016 Apr 29;20(2):235-42. Epub 2015 Jul 29.

Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Introduction: Neck pain is a common musculoskeletal disorder, especially among skilled workers who must keep their necks in a flexed position frequently during the day. The present study investigated changes in cervical flexion-relaxation phenomenon parameters after sustained neck flexion.

Methods: The participants were 40 healthy subjects grouped by gender (20 females, 20 males). They were exposed to static neck flexion at the full angle of cervical flexion for 10 min. Each subject underwent three trials of cervical flexion and re-extension before and after this period. Differences in onset and cessation angle of flexion-relaxation phenomenon, maximum neck flexion angle, amplitude of neck muscle activation and flexion-relaxation ratio were evaluated.

Results: The maximum neck flexion angle significantly increased after sustained flexion. The onset of flexion-relaxation was significantly delayed during flexion, but cessation angle remained unchanged. Myoelectric activity of the cervical erector spinae muscles increased significantly after maintaining flexion, especially in female subjects. The flexion-relaxation ratio also decreased significantly.

Conclusion: It was concluded that 10 min of static flexion results in a delay in flexion-relaxation phenomenon and a shortened silence period. Also the cervical erector spinae muscles are required to be active longer and generate more activity. These neuromuscular changes may be a risk factor for neck pain.
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http://dx.doi.org/10.1016/j.jbmt.2015.07.039DOI Listing
April 2016

The effects of arm movement on reaction time in patients with latent and active upper trapezius myofascial trigger point.

Med J Islam Repub Iran 2015 16;29:295. Epub 2015 Nov 16.

Assistant Professor, Physical Therapy Department, Rehabilitation Faculty, Iran University of Medical Sciences, Tehran, Iran.

Background: Myofascial pain syndrome is a significant source of mechanical pain. The aim of this study was to investigate the effects of arm movement on reaction time in females with latent and active upper trapezius myofascial trigger point.

Methods: In this interventional study, a convenience sample of fifteen women with one active MTP, fifteen women with one latent MTP in the upper trapezius, and fifteen normal healthy women were participated. Participants were asked to stand for 10 seconds in an erect standing position. Muscle reaction times were recorded including anterior deltoid (AD), cervical paraspinal (CP) lumbar paraspinal (LP), both of upper trapezius (UT), sternocleidomastoid (SCM) and medial head of gastrocnemius (GcM). Participants were asked to flex their arms in response to a sound stimulus preceded by a warning sound stimulus. Data were analyzed using one-way ANOVA Test.

Results: There was significant differences in motor time and reaction time between active and control groups (p< 0.05) except for GcM. There was no significant difference in motor time between active and passive groups except for UT without MTP and SCM (p< 0.05). Also, there were no significant differences in motor times between latent MTP and control groups. Furthermore, there was no significant difference in premotor times between the three groups.

Conclusion: The present study shows that patients with active MTP need more time to react to stimulus, but patients with latent MTP are similar to healthy subjects in the reaction time. Patients with active MTP had less compatibility with environmental stimulations, and they responded to a specific stimulation with variability in Surface Electromyography (SEMG).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764279PMC
February 2016

Changes in postural and trunk muscles responses in patients with chronic nonspecific low back pain during sudden upper limb loading.

Med J Islam Repub Iran 2015 21;29:265. Epub 2015 Sep 21.

PhD, Department of Biostatistics, School of Public health, Iran University of Medical Sciences, Tehran, Iran.

Background: Alterations in the neuromuscular control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is assumed to be the cause of approximately 12% of lower back injuries. However, some aspects of this problem, such as alterations in the sensory-motor control of the spine, remain questionable. This study investigated postural and neuro- motor changes in trunk muscles during sudden upper limb loading in patients with CLBP.

Methods: Electromyography of the erector spinae (ES) and transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 20 patients with CLBP and 20 asymptomatic individuals with eyes open (EO) and eyes closed (EC) conditions. Moreover, measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t-test and independent t-test at the significance level of 0.05.

Results: In patients with CLBP, decreased electrical activity of the ES muscle was observed under both the EO and EC conditions and that of the TrA/IO muscle was observed under the EO condition (p< 0.05). Other findings included a shorter peak latency of the ES muscle in the EO condition and a greater increase in the peak latency of the ES muscle following the EC condition (p< 0.05). No significant differences were observed in COP and GRF measurements between the groups.

Conclusion: Electrical muscle activity may indicate less stiffening or preparatory muscle activity in the trunk muscle of patients with CLBP. Altered latency of the muscle may lead to microtrauma of lumbar structures and CLBP.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715397PMC
January 2016

MR defecography: a diagnostic test for the evaluation of pelvic floor motion in patients with dyssynergic defecation after biofeedback therapy.

Med J Islam Repub Iran 2015 9;29:188. Epub 2015 Mar 9.

Assistant Professor, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Dyssynergic defecation is a major cause of chronic functional constipation as a common digestive complaint. We clinically evaluated the effects of biofeedback therapy on the pelvic floor motion indices through magnetic resonance (MR) defecography, quality of life and depression in patients with dyssynergic defecation.

Methods: In this clinical trial study, among patients referring to the Colorectal Clinic of Hazrat Rasoul Hospital, 22 subjects were randomly assigned into two equal groups (n= 11) to receive either standard only or biofeedback and standard therapy. Dynamic changes of the pelvic floor were measured by MR defecography. During the simulated defecation, two MR defecography dynamic indices including abnormal anorectal angle change and perineal descent were measured before and after treatment. The effects of biofeedback therapy on patients' symptoms, quality of life and severity of depression were assessed and compared with the standard therapy. Statistical analysis was carried out using independent _t-test and Mann-Whitney test.

Results: Paradox index (p< 0.001), perineal descent index (p< 0.001), depression (p< 0.1), physical function (p< 0.001), vitality (p< 0.001) and role emotion (p< 0.001) significantly improved in the biofeedback therapy group in contrast to the standard therapy SDT group.

Conclusion: Biofeedback therapy appears to be effective in improving symptoms of functional constipation and dysfunction of pelvic floor motion as well as patient's quality of life and depression state. MR defecography is able to show the changes in dynamic indices of the pelvic floor through biofeedback therapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431447PMC
June 2015

Lumbopelvic muscle activation patterns in three stances under graded loading conditions: Proposing a tensegrity model for load transfer through the sacroiliac joints.

J Bodyw Mov Ther 2014 Oct 20;18(4):633-42. Epub 2014 May 20.

Ezekiel Biomechanics Group, 8608 Dixie Place, McLean, VA 22102, USA.

Purpose: According to the conventional arch model of the pelvis, stability of the sacroiliac joints may require a predominance of form and force closure mechanisms: the greater the vertical shear force at the sacroiliac joints, the greater the reliance on self-bracing by horizontally or obliquely oriented muscles (such as the internal oblique). But what happens to the arch model when a person stands on one leg? In such cases, the pelvis no longer has imposts, leaving both the arch, and the arch model theory, without support. Do lumbopelvic muscle activation patterns in one-legged stances under load suggest compatibility with a different model? This study compares lumbopelvic muscle activation patterns in two-legged and one-legged stances in response to four levels of graded trunk loading in order to further our understanding the stabilization of the sacroiliac joints.

Methods: Thirty male subjects experienced four levels of trunk loading (0%, 5%, 10% and 15% of body weight) by holding a bucket at one side, at three conditions: 1) two-legged standing with the bucket in the dominant hand, 2) ipsilateral loading: one-legged standing with the bucket in the dominant hand while using the same-side leg, and 3) contralateral loading: one-legged standing using the same leg used in condition 2, but with the bucket in the non-dominant hand. During these tasks, EMG signals from eight lumbopelvic muscles were collected. ANOVA with repeated design was performed on normalized EMG's to test the main effect of load and condition, and interaction effects of load by condition.

Results: Latissimus dorsi and erector spinae muscles showed an antagonistic pattern of activity toward the direction of load which may suggest these muscles as lateral trunk stabilizers. Internal oblique muscles showed a co-activation pattern with increasing task demand, which may function to increase lumbopelvic stability (P < 0.05). No unilateral pattern of the internal obliques was observed during all trials.

Conclusions: Our results suggest that the lumbopelvic region uses a similar strategy for load transfer in both double and single leg support positions which is not compatible with the arch analogy. Our findings are more consistent with a suspensory system (wire-spoke wheel model). If our proposed model holds true, the pelvic ring can only be integrated by adjusting tension in the spokes and by preserving rim integrity or continuity. Thus, we propose that in order to restore tension integrity throughout the pelvic ring, efforts to unlock restrictions, muscular correction of positional faults and lumbopelvic or even respiratory exercises following sacroiliac joint dysfunctions must be taken into consideration. Our hypothetical model may initiate thinking and act as a guide to future work based on a biomechanical approach to the problem of sacroiliac joint dysfunction.
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http://dx.doi.org/10.1016/j.jbmt.2014.05.005DOI Listing
October 2014

Dynamic comparison of segmentary scapulohumeral rhythm between athletes with and without impingement syndrome.

Iran J Radiol 2014 May 15;11(2):e14821. Epub 2014 May 15.

Faculty of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran.

Background: Patients who have shoulder pain usually have compensatory or contributory deviation of shoulder motion during arm elevation. In the traditional scapulohumeral rhythm, the share of the acromioclavicular (AC) and the sternoclavicular (SC) joint movements and also the role of AC internal rotation angle are unknown.

Objectives: The main purpose of this study was to measure and compare the segmentary scapulohumeral rhythm (SSHR) during scapular arm elevation at a steady rotational speed in athletes with and without impingement syndrome.

Patients And Methods: Using a speedometer, the maximum speed of arm elevation was measured in 21 men in each of the involved and uninvolved groups. Using fluoroscopy on the dominant side, SSHR during scapular arm elevation at a rotational speed equal to 1/30 of maximum speed was compared between the two groups. The ratio of glenohumeral (GH) elevation angle to AC rotation angle in the scapular plane was considered as SSHR.

Results: The maximum speed of arm elevation between the two groups was significantly different (P < 0.001). The rhythm of the involved group significantly exceeded the rhythm of the uninvolved group in a part of the first quarter range of the arm elevation. SSHR during arm elevation in the uninvolved group did not change significantly (P = 0.845); however, it decreased significantly in the involved group (P = 0.024).

Conclusions: Speed differences between the two groups were probably due to the pain in some ranges of arm elevation. SSHR in the involved group probably changed in order to compensate downward rotation of the scapula in the resting position. Study of the AC upward rotation range can be misleading; therefore, the study of scapulohumeral rhythm is recommended.
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http://dx.doi.org/10.5812/iranjradiol.14821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090642PMC
May 2014

Intrarater and interrater reliability of sagittal head posture: a novel technique performed by a physiotherapist and a speech and language pathologist.

J Voice 2014 Nov 18;28(6):842.e11-6. Epub 2014 Jun 18.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Different professionals such as speech and language pathologists and voice scientists are involved in the evaluation of head and neck posture. Therefore, a reliable, time-efficient, and precise method of posture assessment is essential for use in clinical and research settings. Photogrammetry is one of the most commonly used methods to assess head and neck posture. The objectives of this study were to evaluate the intrarater reliability of the method with a large sample size and the interrater reliability by two different specialists (a physiotherapist and a speech and language pathologist).

Method: A total of three hundred four subjects (144 males and 160 females) aged between 18 and 28 years participated in the study. During the test session, a photograph was taken of the left-side profile of each subject in their ordinary and comfortable position. The head posture angle of each picture was calculated by two raters. The whole procedure was repeated in a retest session, 24 hours later. A total number of eight analyses were performed for each subject. The reliability was evaluated at several stages hierarchically and after confirming the reliability in each step, the next step was investigated. Paired t tests on the differences of scores obtained at all the aforementioned stages were used to ensure the absence of any systematic bias. To assess the reliability, intraclass correlation coefficients (ICCs) and the standard error of measurements (SEMs) were calculated.

Results: There was no significant difference between the mean values of the test and the retest angles at any stage of calculating the head posture angle in both pictures by both examiners (P > 0.05). The ICC and SEM values calculated for all stages were between 0.86-0.97 and 0.52-1.53, respectively.

Conclusion: Systematic bias has not occurred at any stage. The ICC and SEM values calculated have demonstrated that there were appropriate relative and absolute reliabilities in all stages. This method is suggested to be used simply in research and clinical areas by different specialists.
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http://dx.doi.org/10.1016/j.jvoice.2014.02.014DOI Listing
November 2014

Normal postural responses preceding shoulder flexion: co-activation or asymmetric activation of transverse abdominis?

J Back Musculoskelet Rehabil 2014 ;27(4):545-51

Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.

Background And Objectives: It is suggested that activation of the transverse abdominis muscle has a stabilizing effect on the lumbar spine by raising intra-abdominal pressure without added disc compression. However, its feedforward activity has remained a controversial issue. In addition, research regarding bilateral activation of trunk muscles during a unilateral arm movement is limited. The aim of this study was to evaluate bilateral anticipatory activity of trunk muscles during unilateral arm flexion.

Materials And Methods: Eighteen healthy subjects (aged 25 ± 3.96 years) participated in this study and performed 10 trials of rapid arm flexion in response to a visual stimulus. The electromyographic activity of the right anterior deltoid (AD) and bilateral trunk muscles including the transverse abdominis/internal oblique (TA/IO), superficial lumbar multifidus (SLM) and lumbar erector spine (LES) was recorded. The onset latency and anticipatory activity of the recorded trunk muscles were calculated.

Results: The first muscle activated in anticipation of the right arm flexion was the left TA/IO. The right TA/IO activated significantly later than all other trunk muscles (P < 0.0005). In addition, anticipatory activity of the right TA/IO was significantly lower than all other trunk muscles (P < 0.0005). There was no significant difference in either onset latency or anticipatory activity among other trunk muscles (P > 0.05).

Conclusion: Healthy subjects showed no bilateral anticipatory co-activation of TA/IO in unilateral arm elevation. Further investigations are required to delineate normal muscle activation pattern in healthy subjects prior to prescribing bilateral activation training of transverse abdominis for subjects with chronic low back pain.
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http://dx.doi.org/10.3233/BMR-140480DOI Listing
July 2015

Long-term average spectra of adult Iranian speakers' voice.

J Voice 2014 May 13;28(3):305-10. Epub 2013 Nov 13.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Introduction: Long-term average spectrum (LTAS) allows quantifying the voice quality and provides an overview of the mean spectral characteristics of a voice. The aims of this study were to survey normal spectral characteristics of Persian and investigate sex-related changes in the source characteristics of dynamic speech using LTAS.

Method: Speech samples obtained from 30 male and 30 female Persian-speaking participants reading a text in habitual pitch and loudness level. At the LTAS window and using Praat software, the amplitude values were obtained at equal intervals of 160 Hz, ranging from 0 to 8 kHz.

Results: The main features of the average spectrum were as follows: peak in the region of 480 Hz with a reduction at higher frequencies, a 20 dB decline from 480 to 960 Hz, a flat region from 960 to 1920 Hz, a further decline from 1920 to 3040 Hz, and a further flat region from 3040 to 8000 Hz. In comparison to men, women revealed significant lower levels of amplitude at frequencies of 160 and 320 Hz and higher levels of amplitude at frequencies of 960, 3360, 3520, 3680, 3840, and 5920 Hz.

Conclusion: The overall shape and gender-related energy distribution pattern of the LTAS of Persian were more similar to those of English than to those of Korean. The more phonetic differences between Persian and Korean compared with Persian and English might contribute to different spectral characteristics. The present study tried to clarify the spectral characteristics of Iranian male and female voices and focused on more breathy voice quality for women than men.
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http://dx.doi.org/10.1016/j.jvoice.2013.09.002DOI Listing
May 2014

Assessment of forward head posture in females: observational and photogrammetry methods.

J Back Musculoskelet Rehabil 2014 ;27(2):131-9

School of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.

Background: There are different methods to assess forward head posture (FHP) but the accuracy and discrimination ability of these methods are not clear.

Objectives: Here, we want to compare three postural angles for FHP assessment and also study the discrimination accuracy of three photogrammetric methods to differentiate groups categorized based on observational method.

Method: All Seventy-eight healthy female participants (23 ± 2.63 years), were classified into three groups: moderate-severe FHP, slight FHP and non FHP based on observational postural assessment rules. Applying three photogrammetric methods - craniovertebral angle, head title angle and head position angle - to measure FHP objectively.

Results: One - way ANOVA test showed a significant difference in three categorized group's craniovertebral angle (P< 0.05, F=83.07). There was no dramatic difference in head tilt angle and head position angle methods in three groups. According to Linear Discriminate Analysis (LDA) results, the canonical discriminant function (Wilks'Lambda) was 0.311 for craniovertebral angle with 79.5% of cross-validated grouped cases correctly classified.

Conclusion: Our results showed that, craniovertebral angle method may discriminate the females with moderate-severe and non FHP more accurate than head position angle and head tilt angle. The photogrammetric method had excellent inter and intra rater reliability to assess the head and cervical posture.
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http://dx.doi.org/10.3233/BMR-130426DOI Listing
January 2015

The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis.

Prosthet Orthot Int 2013 Oct 11;37(5):404-10. Epub 2013 Feb 11.

Department of Orthotics and Prosthetics, Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran.

Background: Hyperkyphosis increases the risk of falls for elderly people by reducing postural balance. Spinomed orthosis and the posture-training support are two available options for improving postural balance but have never been compared.

Objectives: To compare the effect of the Spinomed orthosis and the posture-training support on balance in elderly people with thoracic hyperkyphosis.

Study Design: This study is a clinical trial on an accessible sample of elderly people with thoracic kyphosis.

Method: Eighteen participants (16 women and 2 men), aged 60-80 years, with thoracic kyphosis greater than 50°, completed the study procedure. Subjects were randomly allocated to two groups, namely, Spinomed orthosis and the posture-training support groups. Sensory organization test and limits of stability were assessed using the EquiTest system and the Balance Master system, respectively. Balance score, directional control, and reaction time were measured to evaluate balance with and without orthosis in a random order.

Results: In the posture-training support group, significant changes were observed in the studied balance parameters: balance score (p < 0.001), directional control (p = 0.027), and reaction time (p = 0.047). There was a significant change in balance score (p < 0.001) and directional control (p = 0.032) in the Spinomed group. However, there were no significant differences in the effect of the two orthoses, the Spinomed orthosis and posture-training support, on balance factors.

Conclusion: Both Spinomed orthosis and posture-training support may improve balance in the elderly with thoracic hyperkyphosis in a similar manner.
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http://dx.doi.org/10.1177/0309364612474487DOI Listing
October 2013

Clinical care improvement with use of health information technology focusing on evidence based medicine.

Healthc Inform Res 2012 Sep 30;18(3):164-70. Epub 2012 Sep 30.

School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Healthcare institutions need timely patient information from various sources at the point-of-care. Evidence-based medicine (EBM) is a tool for proper and efficient incorporation of the results of research in decision-making. Characteristics of medical treatment processes and practical experience concerning the effect of EBM in the clinical process are surveyed.

Methods: A cross sectional survey conducted in Tehran hospitals in February-March 2012 among 51 clinical residents. The respondents were asked to apply EBM in clinical decision-making to answer questions about the effect of EBM in the clinical process. A valid and reliable questionnaire was used in this study.

Results: EBM provides a framework for problem solving and improvement of processes. Most residents (76%) agreed that EBM could improve clinical decision making. Eighty one percent of the respondents believed that EBM resulted in quick updating of knowledge. They believed that EBM was more useful for diagnosis than for treatment. There was a significant association between out-patients and in-patients in using electronic EBM resources.

Conclusions: Research findings were useful in clinical practice and decision making. The computerized guidelines are important tools for improving clinical process quality. When learning how to use IT, methods of search and evaluation of evidence for diagnosis, treatment and medical education are necessary. Purposeful use of IT in clinical processes reduces workload and improves decision-making.
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http://dx.doi.org/10.4258/hir.2012.18.3.164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483473PMC
September 2012

A comparative investigation of flexion relaxation phenomenon in healthy and chronic neck pain subjects.

Eur Spine J 2013 Jan 1;22(1):162-8. Epub 2012 Oct 1.

Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, P.O Box 15875-4391, Tehran, Iran.

Purpose: The cervical flexion relaxation phenomenon (FRP) is a neck extensor myoelectric "silence" that occurs during complete cervical and lumbar flexion. In contrast to low back pain, the changes that occur during FRP in chronic neck pain (CNP) patients are still not clear. The aim of this study was to assess the characteristics of this phenomenon in the cervical region in CNP patients and controls.

Methods: Twenty-two women (23 ± 2.62 years) with chronic non-specific neck pain and 21 healthy women (23.4 ± 1.68 years) participated in this study. They accomplished a cervical flexion and extension from neutral position. Neck angle and surface electromyographic activity of cervical erector spinae (CES) and upper trapezius muscles were recorded. Appearance, onset and offset angle of the FRP were analysed and compared between the two groups.

Results: There were significant differences in the appearance of FRP between the two groups (P ≤ 0.001). The FRP in the CES muscles was observed in 85.7 % of healthy subjects and in 36.3 % of CNP patients, and no FRP was observed in the upper trapezius. Results of this study show that the onset and offset of FRP parameters were significantly different between the two groups (P ≤ 0.001).

Conclusions: The results of the present study indicate that FRP in CNP patients was seen less than the healthy subjects, and moreover the FRP period was reduced in CNP patients. Our results also suggest that the changes in FRP of CNP patients may be due to the increased CES activity in these patients.
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http://dx.doi.org/10.1007/s00586-012-2517-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540320PMC
January 2013

Influence of modified solid ankle-foot orthosis to be used with and without shoe on dynamic balance and gait characteristic in asymptomatic people.

Prosthet Orthot Int 2013 Apr 20;37(2):145-51. Epub 2012 Aug 20.

Tehran University of Medical Sciences, Faculty of Rehabilitation Sciences, Tehran, Iran.

Background: Ankle-foot orthoses are usually used in combination with footwear. Shoe design can have a significant effect on kinematics of the lower limb joints and line of action of the ground reaction force during walking. But, ankle-foot orthosis-footwear combination is not appropriate for indoor barefoot walking in some Asian cultures. In this study, we have modified a solid ankle-foot orthosis in order to set it in the same position as a solid ankle-foot orthosis-footwear combination.

Objective: To investigate the effect of a modified solid ankle-foot orthosis; a solid ankle-foot orthosis which can be locked in different positions on gait and balance performance in comparison with a conventional solid ankle-foot orthosis, a common solid ankle-foot orthosis-shoe combination in asymptomatic adults.

Study Design: Cross sectional.

Methods: Two standard solid ankle-foot orthoses were manufactured with the ankle joint in neutral position. Then, one of these solid ankle-foot orthoses was modified in order to allow locking in a different alignment. Walk across, limit of stability, and sit-to-stand tests of the balance master system were performed while participants wore the modified solid ankle-foot orthosis aligned in 5°-7° anterior inclination without a shoe and a conventional solid ankle-foot orthosis-shoe combination.

Results: There was no significant change in walking speed, step length, and step width with the conventional and modified solid ankle-foot orthoses. In addition, movement velocity and maximum excursion of the center of gravity during the limit of stability test were not different, although the maximal forward excursion of the center of gravity was longer when wearing the modified solid ankle-foot orthosis compared to the conventional solid ankle-foot orthosis-shoe combination (P = 0.000). Sway velocity of the center of gravity did not change during the sit-to-stand test.

Conclusion: The results demonstrated that the modified solid ankle-foot orthosis had the same effects as the conventional solid ankle-foot orthosis-shoe combination on the gait and balance performance of asymptomatic adults. Clinical relevance The findings of the present study can be used as the basis for further investigations on the efficacy of the modified solid ankle-foot orthoses in different neuromuscular populations in order to help people who do not wear shoes at home, as is the custom in some Asian cultures.
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http://dx.doi.org/10.1177/0309364612454159DOI Listing
April 2013

Effect of Milwaukee brace on static and dynamic balance of female hyperkyphotic adolescents.

Prosthet Orthot Int 2013 Feb 2;37(1):76-84. Epub 2012 Jul 2.

Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.

Background: Biomechanical factors, such as spinal deformities can result in balance control disorders.

Objectives: The purpose of this study was to examine the effect of bracing on static and dynamic balance control of hyperkyphotic female adolescents.

Study Design: Clinical trial.

Methods: A force platform was employed to record center of pressure (COP) parameters. Ten adolescents undergoing Milwaukee brace for hyperkyphosis and 14 normal subjects participated in the study. The COP data were collected with and without brace immediately on first day and after 120 days of continuous brace wear.

Results: No significant difference was found in dynamic and static balance tests with and without brace on the first day (P > 0.05). After 120 days, the values of COP displacement in functional reach to the right and left for the hyperkyphotic adolescents when performing without brace enhanced significantly compared to the first day. The forward reach distance was not significantly different between the normal and hyperkyphotic subjects (P = 0.361); however, hyperkyphotic participants had significantly smaller reach distance in the functional reach to the right (21.88 vs. 25.56 cm) and left (17.04 vs. 21.25 cm).

Conclusion: It might be concluded that bracing had a possible effect on improvement of dynamic balance performance, because the subjects could reach the target in dynamic reach tests with higher displacement in sagittal plane without losing their balance control. Clinical relevance Little is known about the biomechanical aspects of brace wear in individuals with hyperkyphosis. This study investigated balance differences between the healthy and hyperkyphotic individuals, and outcomes of Milwaukee brace wear. It might provide some new insight into the conservative treatment of hyperkyphosis for clinicians and researchers.
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http://dx.doi.org/10.1177/0309364612448805DOI Listing
February 2013

Trunk muscles strength and endurance in chronic low back pain patients with and without clinical instability.

J Back Musculoskelet Rehabil 2012 ;25(2):123-9

Faculty of Rehabilitation, Tehran University of Medical Sciences, Iran.

Objectives: Previous research has shown inconsistent findings regarding muscle endurance in chronic low back pain (CLBP). Questions also remain about muscle endurance in patients with clinical instability. The aim of this study was to investigate trunk muscles strength and endurance in CLBP patients with and without clinical instability.

Methods: 32 CLBP patients (15 with and 17 without clinical instability) and 39 matched healthy subjects participated in this study. The standing extension test was performed to assess the strength and endurance of the lumbar extensors while recording their electromyographic activity. The patients' disability was evaluated using the Oswestry and Roland-Morris Disability Questionnaires.

Results: Patients with clinical instability showed lower maximal voluntary exertion (MVE) and higher time to fatigue (TTF) compared to healthy subjects (P=0.000 and P=0.008, respectively) and patients without instability (P=0.002 and P=0.02, respectively). There was no difference in these variables between patients without instability and healthy controls. A negative relationship between MVE and TTF and a positive correlation between disability and pain intensity were seen.

Conclusion: Strength training of trunk extensor muscles can be considered as part of the treatment protocol for CLBP patients with clinical instability. Although patients without instability suffered from pain or disability, they showed more similarity to healthy subjects in terms of trunk muscles strength and endurance.
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http://dx.doi.org/10.3233/BMR-2012-0320DOI Listing
October 2012

Effects of soft and semi-rigid ankle orthoses on postural sway in people with and without functional ankle instability.

J Sci Med Sport 2011 Sep 14;14(5):370-5. Epub 2011 Jan 14.

Center for Human Movement Science Research, Shiraz University of Medical Sciences, Shiraz, Iran.

Some studies have demonstrated improvement of postural control following use of ankle supports, whereas others reported no effect or even negative effects of bracing. The present study aimed to investigate the immediate effects of soft and semi-rigid orthosis on postural sway in patients with functional ankle instability (FAI). Twenty patients with unilateral FAI and twenty matched healthy individuals participated in the study. Balance in single limb stance on force platform with eyes-open was assessed for both legs while wearing no orthosis (control condition), soft or semi-rigid orthosis. The center of pressure (COP) measures derived from force platform signals were mean total velocity, standard deviation (SD) of velocity and phase plane portrait. A 2 × 2 × 3 (group by foot by orthotics) mixed model analysis of variance was used for statistical analysis. In the FAI group, there was a tendency to lower COP parameters while wearing either of the orthoses, with soft brace having a greater effect. For 2 dependent variables, significant effect of brace was found only for the injured limb. In the healthy group, postural sway increased from no-brace condition, to soft, to semi-rigid orthosis. Both injured and non-injured limbs of patients with FAI had greater postural sway compared to control limbs of healthy individuals.
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http://dx.doi.org/10.1016/j.jsams.2010.12.004DOI Listing
September 2011

Kinematic analysis of dynamic lumbar motion in patients with lumbar segmental instability using digital videofluoroscopy.

Eur Spine J 2009 Nov;18(11):1677-85

Faculty of Rehabilitation, Iran University of Medical Sciences, P.O. Box 15875-4391, Tehran, Iran.

The study design is a prospective, case-control. The aim of this study was to develop a reliable measurement technique for the assessment of lumbar spine kinematics using digital video fluoroscopy in a group of patients with low back pain (LBP) and a control group. Lumbar segmental instability (LSI) is one subgroup of nonspecific LBP the diagnosis of which has not been clarified. The diagnosis of LSI has traditionally relied on the use of lateral functional (flexion-extension) radiographs but use of this method has proven unsatisfactory.Fifteen patients with chronic low back pain suspected to have LSI and 15 matched healthy subjects were recruited. Pulsed digital videofluoroscopy was used to investigate kinematics of lumbar motion segments during flexion and extension movements in vivo. Intersegmental linear translation and angular displacement, and pathway of instantaneous center of rotation (PICR) were calculated for each lumbar motion segment. Movement pattern of lumbar spine between two groups and during the full sagittal plane range of motion were analyzed using ANOVA with repeated measures design. Intersegmental linear translation was significantly higher in patients during both flexion and extension movements at L5-S1 segment (p < 0.05). Arc length of PICR was significantly higher in patients for L1-L2 and L5-S1 motion segments during extension movement (p < 0.05). This study determined some kinematic differences between two groups during the full range of lumbar spine. Devices, such as digital videofluoroscopy can assist in identifying better criteria for diagnosis of LSI in otherwise nonspecific low back pain patients in hope of providing more specific treatment.
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http://dx.doi.org/10.1007/s00586-009-1147-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899390PMC
November 2009