Journal of Modern Rehabilitation

Investigating the Overaction of the Inferior Oblique Muscle and Associated Vertical Strabismus: Indications, Timing, and Methods of Surgical Intervention

Masoud Khorrami-Nejad — 2024-11-10

Treatment of the vertical strabismus due to the overaction of the inferior oblique extraocular muscle usually requires surgical intervention. In addition to the cosmetic issues, the main indications for surgical treatment of the inferior oblique overaction are the presence of cyclotropia and torsional diplopia. Most procedures target the weakening of the inferior oblique muscle; however, there is the risk of some intraoperative and postoperative complications, including highly invasive procedures, difficulty of technical implementation because of the need for manipulations in inaccessible locations of the globe near the optic nerve, macular area, and large vessels, long duration of the surgery, inability to determine the dosage of the outcomes of the surgery, and poor functional outcomes. Most complications are absent in the procedure of anterior transposition in which the neuro-fibrovascular bundle serves as the axis of rotation of the inferior oblique muscle. This technique changes the inferior oblique muscle’s action field and increases treatment effectiveness. Despite the advantages of this technique, its application is still limited because of the lack of methods for controlling the amount of anterior transposition to treat inferior oblique overaction, particularly of small degrees.

A Multidimensional Investigation of Diastasis Recti Abdominis Treatment and Assessment in Postpartum Women: A Systematic Review and Meta-Analysis

Elham Soleimanzadeh — 2024-11-10

Introduction: Diastasis recti abdominis (DRA) is prevalent among postpartum women, with various physiotherapy treatments utilized. Despite the effectiveness of diverse DRA treatment methods and the importance of evaluating its levels and methods, limited attention has been given to this aspect. This study comprehensively investigates DRA, examining evaluation levels and methods, and assessing the efficacy of diverse physiotherapy interventions.

Materials and Methods: Online search was conducted in Cochrane, ProQuest, PubMed, Embase, Scopus, Web of Science, Google Scholar, and Magiran databases until the end of 2022, employing the population, intervention, comparison, and outcome framework (population = DRA, intervention = physiotherapy, comparison = control, and outcome = inter- rectus-distance [IRD]). The JBI checklist and Cochrane Collaboration RoB 2.0 tool evaluated critical appraisal and bias risk. Meta-analysis was performed using the RevMan software.

Results: The study included 16 articles with 650 postpartum women. The findings revealed no significant differences in various measurement methods (P=0.25) and levels (P=0.10). Combination therapy demonstrated greater effectiveness than exercise alone in reducing IRD (P=0.04), with tape being particularly impactful (P=0.009).

Conclusion: Although sonography evaluation of IRD above the umbilicus is recommended, the study highlights the limitation of diverse measurement methods and levels in determining the optimal physiotherapy intervention. Despite the preference for combined interventions, especially tape alongside exercise for women with DRA, further research is essential due to limited evidence, aiming to provide greater insights into this issue.

Investigating the Effect of Dry Needling on Myofascial Trigger Point in Soleus Muscle of Soccer Players with Medial Tibial Stress Syndrome

Hardik Dogra — 2024-11-10

Introduction: This study investigates the impact of dry needling on myofascial trigger points in the soleus muscles among soccer players with medial tibial stress syndrome (MTSS).

Materials and Methods: Soccer players diagnosed with MTSS were enlisted and randomly divided into two groups (11 participants in the experimental group [Group 1] and 11 participants in the control group [Group 2]). Pre-intervention measurements included repeated shuttle sprint ability, MTSS score, and pain pressure threshold (PPT) for both groups. In the experimental group, dry needling was performed on the soleus muscle, followed by active stretching and cryotherapy. The control group underwent active stretching of the soleus muscle and cryotherapy exclusively. Post-intervention measurements of repeated shuttle sprint ability, MTSS score, and PPT were taken for both groups after 2 days.

Results: The experimental group exhibited a statistically significant improvement in PPT, MTSS score, and repeated shuttle sprint ability. Conversely, within the control group, statistically significant changes were observed only in PPT values through paired t-test assessment. Between-group analysis using an independent t-test revealed significant enhancement in PPT (P=0.000) and MTSS score (P=0.01) within the experimental group compared to the control group.

Conclusion: Addressing myofascial trigger points in the soleus muscle through dry needling offers a more effective approach to treating MTSS than relying solely on muscle stretching.

Investigating the Association of Computer Vision Syndrome with Forward-Headed and Kyphotic Posture Among Undergraduate Information Technology Student

Muhammad Haris Noonari — 2024-11-10

Introduction: Computers and visual display devices have become indispensable in our daily lives. The frequent use of these devices has led to the emergence of computer vision syndrome (CVS). Coupled with poor ergonomics, musculoskeletal diseases are on the rise due to excessive computer use. Accordingly, this study investigates the association between CVS and forward-headed and kyphotic posture in undergraduate IT students.

Materials and Methods: We conducted an observational cross-sectional study involving 300 undergraduate IT students. We used a modified CVS questionnaire to assess CVS and the Kinovea software to diagnose forward head posture. We also used the occiput wall distance test to assess kyphosis.

Results: In this study, a majority of undergraduate students (88%, 264 out of 300) exhibited CVS, resulting in forward head posture and kyphosis. There was a significant association between CVS, forward head posture, and kyphosis.

Conclusion: Computer vision syndrome is strongly associated with forward head posture and kyphosis. Prolonged computer device usage leads to changes in body posture, affecting the neck, shoulders, elbows, wrists/hands, upper back, and lower back.

Investigating the Correlations between Patient Demographics and Complications Following Total Knee Arthroplasty: A Cross-Sectional Study

Navvab Farrokhi — 2024-11-10

Introduction: This study investigates the relationship between patient age, gender, and various complications, such as pain, restricted range of motion (ROM), and hemorrhage following total knee arthroplasty.

Materials and Methods: This cross-sectional study included 62 patients (Mean±SD age= 65.9±7.38 years; female participants=74.2%) who underwent total knee arthroplasty at Atieh Hospital in Tehran, Iran, between 2020 and 2021. Pain levels were assessed using the numerical pain rating score. Meanwhile, knee joint ROM was evaluated using a reliable mobile application. Hemorrhage was measured through knee joint drainage. Statistical analyses were performed to analyze the data.

Results: Women reported higher pain levels and more restricted ROM in passive knee extension and active/passive knee flexion compared to men (P<0.05). However, no significant differences were observed between genders in active knee extension and hemorrhage. A significant inverse correlation was found between pain and ROM in passive knee extension (rho=-0.41, P≤0.001), as well as in active (rho=-0.5, P≤0.001) and passive knee flexion (rho=

-0.59, P≤0.001). However, no significant relationship was observed between pain and active knee extension or hemorrhage. Age showed no statistically significant correlation with the other variables.

Conclusion: This study highlights the association between higher pain levels and greater ROM restrictions in passive knee extension and active/passive knee flexion following total knee arthroplasty; however, patient age and gender were not found to be associated with postoperative hemorrhage. These findings underscore the importance of closely monitoring pain and ROM, particularly in women undergoing total knee arthroplasty.

Investigating the Effects of Intrinsic Foot Muscle Exercises on Dynamic Balance after Sub-Acute Ankle Sprain

Sepideh Sekkehchi — 2024-11-10

Introduction: This study compares the efficacy of routine treatment plus short foot exercises (SFE) with routine treatment alone on dynamic balance and pain in subjects with sub-acute ankle sprain.

Materials and Methods: A total of 32 patients (18-45 years old) with primary ankle sprain were randomly enrolled into the control group performing routine treatment alone or the SFE group performing routine treatment plus SFE. The dynamic balance was assessed using the star excursion balance test. Pain and ankle dorsiflexion range of motion were assessed using the numeric pain rating scale and a goniometer. The outcomes were evaluated at the baseline and after the end of treatment. The groups were compared using the one-way analysis of variance/analysis of covariance test. The effect sizes also were calculated to determine the efficacy of the SFE.

Results: Dynamic balance in the SFE group had a significant increase in the anterior, lateral, medial, and anteromedial directions compared to the control group (P=0.001, P=0.002, P=0.014, P=0.0001). No significant differences were observed between the groups in other directions of the star excursion balance test (P>0.05). Additionally, pain intensity was lower significantly in the SFE group than in the control group (P=0.0001). In the SFE group ankle dorsiflexion range was significantly more than the control group (P=0.025). The effect sizes also showed a high efficacy favoring SFE.

Conclusion: The combination of routine treatment and SFE can be an effective intervention for managing ankle sprain.

Investigating the Effectiveness of Music Therapy on Anxiety Caused by Stuttering in Children Aged 4 to 12 Years in Yazd City, Iran

Fateme Moqhimi — 2024-11-10

Introduction: This study evaluates the effectiveness of music therapy on anxiety caused by stuttering in children aged 4 to 12 years in Yazd City, Iran.

Materials and Methods: This is an experimental study with a pre-test/post-test design and a control group. The statistical population of the study consisted of 4-12-year-old children with stuttering referred to speech therapy centers in Yazd City, Iran, who were selected based on available sampling and divided into two equal groups, experimental and control, using a simple random method. The instrument of this research included the Spence children’s anxiety scale, parent version (SCAS-P). Children with anxiety in the experimental group underwent music therapy for ten 1-h sessions. To analyze the data, the SPSS software, version 24, was used and the significance level of the tests was considered 0.05. The statistical method of covariance analysis was used to analyze the research data.

Results: Based on the results of the analysis of covariance between the two control groups and the music therapy experiment, there was a significant reduction in the average level of anxiety (P<0.001, F=157.045) of children in the post-test stage.

Conclusion: Music therapy is effective in reducing the anxiety level of children with stuttering; therefore, it can be considered a complementary method to reduce children’s anxiety

Association of Flat Feet with Knee Moments and Western Ontario and McMaster Universities Arthritis Index in Knee Osteoarthritis

Maryam Sohrabi — 2024-11-10

Introduction: Flat feet are prevalent among individuals with medial compartment knee osteoarthritis (KOA), showing a correlation with elevated knee pain and cartilage degeneration. This study investigates the relationship between calcaneal eversion angle (CEA) and medial longitudinal arch angle (MLAA) with knee kinetics and pain.

Materials and Methods: This analytical observational study included 30 volunteers with moderate KOA. The Vicon motion analysis system and two synchronized force plates were employed to capture level walking and the static standing position to measure CEA and MLAA. The study assessed the first and second peaks of the knee adduction moment, knee adduction moment impulse, peak knee flexion moment, and the peak knee flexion angle at heel strike (PKFA-HS). The Western Ontario and McMaster Universities arthritis index (WOMAC) pain and physical function were evaluated.

Results: A significant positive correlation was found between CEA and the knee pain sub-score (Pearson correlation [PC]=0.446, P=0.011) and WOMAC total score (PC=0.363, P=0.049). Additionally, a significant negative correlation was observed between CEA and peak knee flexion moment/PKFA-HS (PC=-0.418, P=0.022, and PC=-0.479, P=0.001, respectively). The results also indicated a negative significant correlation between MLAA and WOMAC pain sub-score (PC=-0.389, P=0.034).

Conclusion: Increased CEA and decreased MLAA are associated with elevated WOMAC pain sub-score and decreased PKFA-HS in individuals with moderate KOA. Addressing flat feet should be considered in KOA management to enhance pain relief and functional outcomes

Teamwork Skills, Satisfaction, and Knowledge Level in Rehabilitation Students Through Team Observed Structured Clinical Examination

Marzieh Amiri — 2024-11-10

Introduction: Team-observed structured clinical examination (TOSCE) is a powerful approach to formative assessment resources, regarded as an essential element of students’ performance in a team format. Considering the importance of teamwork in rehabilitation, this study implements an intervention focused on enhancing teamwork skills within diverse groups of rehabilitation students, employing TOSCE as a tool for assessment and improvement.

Materials and Methods: A total of 49 fourth-year undergraduate students specializing in audiology, physical therapy, and speech therapy constituted three groups in our study. Students in each major were randomly divided into four groups. The students were asked to complete the teamwork (19-item scale of Lencioni) and satisfaction (researcher-made scale) questionnaires after TOSCE. A knowledge assessment questionnaire was also conducted at pre- and post- TOSCE time points.

Results: There was no significant difference between the average score of the teamwork (F=1.508, P>0.05) and satisfaction (F=3.508, P>0.05) levels across different majors. All participants had high scores on both teamwork and satisfaction scales. By comparing the pre-test and post-test knowledge assessment, in all groups, there was a statistically significant difference between the pre-and post-test results (P<0.05). The students obtained a higher score after the implementation of the TOSCE.

Conclusion: The TOSCE method provides a valuable and viable educational opportunity for rehabilitation students to receive feedback on their clinical performance, enhance their knowledge, and, most importantly, lead to a positive feeling of teamwork among students.

Investigating the Effects of Nintendo Wii on Ankle Spasticity in Patients with Stroke: A Randomized Clinical Trial

Saeideh Farahmand — 2024-11-10

Introduction: Stroke is one of the most common causes of disability. Spasticity is a common clinical impairment that occurs after a stroke. This study investigates the effect of Nintendo Wii games on the outcomes of spasticity, functional mobility, and quality of life in patients with stroke.

Materials and Methods: In this single-blind clinical trial study, 30 patients with stroke were randomly assigned to one of the experimental and control groups. Subjects of both groups received conventional physiotherapy. In addition, the experimental group also received Nintendo Wii games for 30 min, three times a week for a total of 12 sessions. The primary outcomes spasticity and functional mobility that respectively evaluated using the modified modified Ashworth scale (MMAS) and the timed up-and-go test before and after the treatment. The assessor was blind about group assignment. Meanwhile, the secondary outcome included quality of life. All statistical analyses were performed using the SPSS software, version 20.

Results: The intragroup results showed that in the experimental group, spasticity was significantly reduced (P=0.001), functional mobility improved (P=0.001), and the quality of life increased significantly (P<0.001); however, in the control group, only a significant improvement in functional mobility (P=0.04) was observed. The comparison between the two groups showed that there is no statistically significant difference in the results between the experimental and control groups (P>0.05).

Conclusion: Considering these results, the use of Nintendo Wii can be suggested as a treatment modality alongside the usual treatments to achieve more and faster effectiveness in patients with stroke.

Investigating the Effects of Transcutaneous Electrical Nerve Stimulation on Lumbar Fascia Tissue and Lumbar Curvature in Healthy People

Hassan Tamartash — 2024-11-10

Introduction: Transcutaneous electrical nerve stimulation (TENS) is commonly used for pain management. Recent studies have shown that TENS can improve the condition of low back pain by influencing the elastic coefficient of the lumbar fascia and the balance status; however, the effect of TENS on the lumbar fascia of healthy people has not been investigated. Accordingly, this study examines the effect of TENS on the lumbar fascia of healthy people.

Materials and Methods: A total of 60 healthy participants in two groups, underwent 10 sessions of conventional TENS intervention. The first group (intervention group) received TENS with an intensity at the tolerance level, and the second group (control group) received sham TENS. Ultrasonography and a spinal mouse device were assessed lumbar fascia thickness and lumbar curvature before and after the TENS.

Results: Significant changes were observed after TENS in the intervention group in reducing the lumbar fascia thickness (P=0.006) and increasing the lumbar curvature (P=0.000). Between- group changes after the intervention sessions indicated a significant difference between the lumbar fascia thickness and curvature (P≤0.003).

Conclusion: TENS in healthy people can lead to a decrease in the thickness of the lumbar fascia and improve lumbar curvature. Also, a strong correlation was found between lumbar fascia thickness reduction and increased lumbar curvature.

Investigating the Effects of Shockwave and Percussion Massage Gun on Subacute Myofascial Pain in Gasterocenemious Muscle

Seyedeh Zohreh Hosseini — 2024-11-10

Introduction: Myofascial pain syndrome is a common musculoskeletal injury, especially among athletes, typically treated with symptomatic invasive and non-invasive methods. This study compares the effects of massage guns and radial extracorporeal shock wave therapies on myofascial pain syndrome symptoms in amateur athletes.

Materials and Methods: In this clinical trial, 45 amateur athletes (18-30 years old) were recruited, who were randomly assigned to 15-member groups of shock wave, massage gun, and control (routine treatment included electrotherapy and stretching, which was applied on three groups). After initial evaluations of the pain intensity, pain pressure threshold (PPT), isometric muscle strength, and range of motion (ROM), the patients received single-session treatment and were immediately reassessed.

Results: The results showed pain relief and improved PPT following shock wave plus routine treatment (P=0.03). The control group had less pain, while pain intensity and PPT did not change. The variables were not significantly different between the groups (P=0.12). Shock wave along with routine treatment increased plantar flexion ROM (P=0.00), unlike the massage gun. Additionally, dorsiflexion ROM (P=0.63) and maximal isometric gastrocnemius muscle strength (P=0.95) remained unchanged in all groups.

Conclusion: One session of massage gun therapy immediately reduced gastrocnemius muscle pain, while it failed to change PPT, maximal isometric gastrocnemius muscle strength, or dorsiflexion and plantar flexion ROM. However, shock wave therapy immediately increased plantar flexion ROM and PPT, and reduced pain intensity. These modalities led to limited changes, suggesting the need for repeated sessions and supplementary treatments.