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Introduction: This study constitutes a methodological investigation aimed at scrutinizing the validity and reliability of the Persian version of the Pain Beliefs and Perceptions Inventory (PBPI) in individuals afflicted with chronic low back pain. Methods: To gauge reliability, both the test-retest and internal consistency methods were deployed. Furthermore, the correlation coefficient was utilized to assess discriminant validity among 118 individuals suffering from chronic low back pain. The questionnaire's construct validity was ascertained by probing the correlation between the subscales of pain persistence in the future, pain stability in the present, self-blame, and the mysteriousness of pain, with the constructs of pain catastrophizing, disability, pain-related anxiety, coping strategies, quality of life, and pain intensity. Results: Statistical analysis using the Shapiro-Wilk test revealed a non-normal data distribution. Consequently, the non-parametric Spearman's correlation coefficient was used to scrutinize construct and discriminant validity. The intraclass correlation coefficient (ICC) ranged from 0.58 to 0.78 for the subscales of pain persistence in the future, pain stability in the present, self-blame, and the mysteriousness of pain. Additionally, Cronbach's alpha coefficient ranged from 0.74 to 0.88. With the exception of the self-blame subscale, the other subscales exhibited significant positive correlations with constructs of pain catastrophizing, disability, anxiety, coping strategies, and pain intensity, as well as significant negative correlations with quality of life (correlation coefficient ranging between 0.19 and 0.49). Conclusion: The outcomes about test-retest reliability, construct validity, and discriminant validity collectively suggest that the Persian version of the PBPI possesses robust psychometric properties.

Introduction: This preliminary study investigates the effects of adding exergame (EG) training to conventional exercises on the functional activities of newly fitted patients with unilateral transtibial amputation. Materials and Methods: A total of 22 newly fitted patients with unilateral transtibial amputation were equally and randomly divided into two groups as follows: the EG group who performed exercises and EG training and the control group who performed exercise only. The 2-min walk test, timed up and go test, amputee mobility predictor with prosthesis test, and physiological cost index were assessed at baseline and after 2 and 4 weeks of the intervention. Results: Both interventions effectively improved the 2-min walk test distance, timed up-and-go test, and the amputee mobility predictor with prosthesis test scores in patients with newly fitted transtibial amputation (P

Abstract Background Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. Methods 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. Results There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, − 3.25 to − 1.15). The standardized mean difference and their 95% confidence intervals (Cohen’s d) revealed a large effect of pain at 22 weeks: (Cohen’s d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. Conclusions In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. Trial Registration ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.

Abstract Athletic women have shown a higher risk of ACL injury during jump landing compared to men. Plyometric training can be an alternative way to minimize the risk of knee injuries via the changed muscle activity patterns. Hence, the aim of this study was to determine the effects of a 4-week plyometric training program on the muscle activity pattern in different phases of one-leg drop jump in active girls. Active girls were randomly allocated into 2 groups (Plyometric training = 10, Control group = 10) where the plyometric training group (PTG) performed 60 min exercises, 2 sessions/1 week for 4 weeks while the control group (CG) had their daily activity. In the pre to post test, the sEMG was recorded from the Rectus Femoris (RF), Biceps Femoris (BF), Medial Gastrocnemius (GaM), and Tibialis Anterior (TA) muscles of the dominant leg during the Preparatory phase (PP), Contact Phase (CP), Flight Phase (FP) of one-leg drop jump. Electromyography variables (Signal amplitude, Maximum activity, Time to peak (TTP), Onset and activity time and Order muscle activity) and Ergo jump variables (Time of preparatory phase (TPP), Time of contact phase (TCP), Time of flight (jump height) phase (TFP), and Explosive power were analyzed. The Univariate ANCOVA test showed a significant difference between the two groups in Activity Time, whilst adjusting for pre-test as a Covariate, only in TA muscle (F(1,17) = 5.09, p = 0.038, η2 = 0.230). In PTG. TA (− 15%), GaM (− 19%), and BF muscles (− 9%) started their activity earlier while there was no significant difference between the two groups at the Onset time. TTP of RF was significantly different between the 2 groups only in the PR phase (0.216 ± 0.07 vs 0.153 ± 0.09 s) (p = 0.049, 95% CI = 0.001, 0.127). Results of the present study suggest that a 4-week plyometric training can improve the stability of leg joints via earlier recruitment of muscles and change activity patterns in lower limb muscles. It also recommends that the preparatory phase before landing be considered an important stage in preventing sports injuries in a training program.

Introduction: The application of Kinesio taping (KT) is a rehabilitation technique used to provide muscle and joint support and stability, without limiting the range of motion (ROM). No study evaluated the effects of KT on lumbar flexion relaxation phenomenon and kinematic details after static flexion. This study aims to find out the results of KT on erector spinae (ES) muscle activity, flexion relaxation pattern, and trunk, lumbar, and hip range of motion in healthy subjects during static flexion. Materials and Methods: This study used a two-factor within-group design. Twenty-two healthy female students participated in this study. We used surface electromyography (EMG) to assess ES muscle activity and measured kinematic information with data from the camera. Variables related to muscle activity and angles in forward bending movement before and after creep were investigated. The test was performed in two situations with and without the use of KT. Results: KT reduced the time of muscle activity during bending. Also, KT increased trunk, and hip angles at the end of forward flexion. In the lumbar extension phase, the ES muscles were activated later. Conclusion: KT can prevent the increase of lumbar spine flexion angle due to the creep effect. It can be used to protect the strained viscoelastic structures and increase the involvement of cutaneous receptors. KT can act as a protector in the dynamic stabilization system of lumbar joints in flexion positions in healthy people.

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

Objectives: The purpose of this work was to explore cervical position sense and electromyographic (EMG) responses of cervical muscles during head repositioning movements in students with and without upper trapezius muscle trigger points. Materials and Methods: Forty-six right-handed men and women subjects without upper extremity disorders participated in this study. The maximal voluntary contraction (MVC) was measured three time before the fatigue test. A force gauge was used to measure force while recording with a monitor. Measurement was initiated with a MVC force before and after fatigue pain and head positioning were measured. When the protocol was accomplished, the subjects showed signs of exhaustion; however, they were not subjectively evaluated for fatigue. As the protocol aimed at assessing muscle fatigue, a force level of 80% MVC was induced. Results: These findings support the argument that the precision of the neck position sense can be reduced by the fatigue of the neck muscle. Fatigue impaired balance in the trapezius muscles. After removing vision this resulted in an increased center of pressure excursions on a force platform. Motor control did not change significantly in this study. Conclusions: Fatigue had a more significant effect on cervical kinematics in the healthy subjects, probably due to the fact that altered neck motor control in volunteers implied that these individuals were not completely able to make up for fatigue of the neck muscle. Significant pain and head positioning changes were identified following fatigue applied to the pre-determined myofascial trigger points, but the changes were insignificant in the sham control group.

Introduction: In individuals with anterior cruciate ligament deficiency (ACLD), defective sensory and motor neuroplasticity occurs in the central nervous system (CNS) due to defects in sensory afferents. To successfully restore ACLD individuals to pre-injury conditions, it is necessary to modify the neuroplasticity created in the CNS by prescribing more appropriate training. For this aim, in this study, we used perturbation training differently. Materials and Methods: Thirty athletes with unilateral anterior cruciate ligament (ACL) rupture were randomly assigned to the perturbation and standard training groups. The training program of two groups was performed in three intermittent sessions per week for one month. The relative power spectrum of alpha of quantitative electroencephalography (QEEG) was measured in three tasks: (1) the single-leg jump-landing, (2) the single-leg stance with opened eyes, and (3) the single-leg stance with closed eyes. Results: The perturbation training group only showed significant symmetry in the relative power spectrum of alpha between the two limbs in the single-leg jump-landing test (p=0.92, ES=0.04) in comparison pre-post test. Also, this group showed high symmetry in the alpha band in the single-leg stance test with closed eyes (p=0.53, ES=0.16). Conclusion: The results of the present study showed that both mechanical perturbation and standard training are suitable for transporting ACLDs back to sports. It also seems that mechanical perturbation training had higher effectiveness in modifying the CNS alpha power.

Abstract The proprioceptive system is actually a sensory system based on an individual’s knowledge of the body. The aim of this study was to investigate the effect of estrogen and progesterone hormones on understanding and to recognize the proprioceptive sense the knee joint in healthy women during the menstrual cycle. Fifteen healthy women with regular menstrual cycles participated in this study. The estrogen and progesterone levels were evaluated during a cycle in the follicular, ovulation, and luteal phases. The effect on the sense of perception and cognition of the proprioceptive knee joint in two directions (extension and flexion), by target angle reconstruction at 30° was studied. The results showed that female sex hormones affect the knee active Joint Position Sense (JPS). In the extensions, the changes of the menstrual cycle affect the JPS in constant error during the ovulation phase. In the flexion, changes in the menstrual cycle affect the JPS in constant, absolute, and variable error during the luteal phase. The findings of this study show that the menstruation phases can change the active JPS at knee joint. Since the outbreak of joint problems, especially in the knee joint, is higher in women than in men, it was predicted that hormonal changes during the menstrual cycle affect the proprioceptive cognition of the knee joint, which in turn increases the percentage of knee injuries in women.

Introduction: Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-load resistance exercise (LLRE) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LLRE may help people with supraspinatus tendinopathy through proximal effects to improve strength and muscle size. The purpose of this case report is to describe the proximal effect of the LLRE+BFR program on a patient with supraspinatus tendinopathy. Materials and Methods: The patient was a 40-year-old man with a history of shoulder pain and weakness for the past months. He received an LLRE+BFR program for his right shoulder including rotator cuff and scapular strengthening exercises and lower limbs aerobic exercises based on protocols of strengthening and aerobic exercises of BFR. Outcomes measured at baseline and 4 weeks included the 4 items: 1) Strength of supraspinatus muscle and four scapular stabilizer muscles including serratus anterior strength, middle trapezius strength, and lower trapezius strength by dynamometer, 2) supraspinatus thickness by ultrasound, 3) pain pressure threshold of supraspinatus and deltoid muscles by algometer, and 4) pain reported bay in each session based on pain numeric scale. Results: After 6 weeks, the strength of supraspinatus and scapular stabilizers except for the lower trapezius increased. The supraspinatus thickness and pain pressure threshold in the supraspinatus and deltoid muscle also increased after 4 weeks. The mean of pain reported by the patient based on the pain numeric scale before and after each session was also decreased. Conclusion: The patient had measurable improvements following the use of an LLRE+BFR program. LLRE+BFR program may be an option for strength training in people with supraspinatus tendinopathy; however, more research is needed to determine effectiveness across the population of people with supraspinatus tendinopathy.

A 15-year-old boy was diagnosed with Wilson disease and referred to a physiotherapy clinic for treatment. He received daily physical therapy exercises with resistance training three times a week for 70 minutes for 8 weeks. The performance of daily activities was evaluated using the Persian version of the disabilities of the arm, shoulder, and hand (DASH) questionnaire. Upper limb muscle strength was assessed using a manual muscle strength test. The DASH questionnaire score decreased from 67.24 before treatment to 46.55 after 4 weeks and 36.20 after 8 weeks. In addition, shoulder flexion and extension are improved. The analysis of resistance exercises to facilitate distal muscles through the use of manual muscle tests showed an improvement in the strength of both hands. The present study suggests that regular physical therapy and exercise may help improve daily activity and muscle strength in Wilson disease.

Abstract Background Non-specific chronic low back pain (NSCLBP) is a major public health and global socioeconomic burden associated with a complex interplay of biopsychosocial factors. Despite scientific signs of progress, treatment of NSCLBP often tends to stick to a biomechanical model, without targeting psychological and social factors. To enhance the clinical efficacy of usual physiotherapy for NSCLBP, the development of clinical strategies is to be pursued. This study aims to assess the effectiveness of multidimensional physiotherapy based on a biopsychosocial approach compared to usual care physiotherapy, on clinical findings and electroencephalography spectrum in non-specific chronic low back pain. Methods This study is a triple-blind, two-arm (1:1) randomized controlled trial with a 4 months follow-up. Seventy NSCLBP patients will be randomly allocated to either the experimental (multidimensional physiotherapy) or the active control group (usual physiotherapy); each group will receive 6 weeks of physiotherapy. The main outcome is pain and secondary outcomes are brain function, quality of life, disability, lumbar flexion range of motion, and psychosocial correlates. Assessment will be performed at baseline, post-treatment, and at 1 and 4 months follow-up. Discussion Findings may provide evidence on the effectiveness of multidimensional physiotherapy on clinical findings and brain characteristics and might provide evidence towards showing the role of brain and biopsychosocial factors on chronic pain. Trial registration ClinicalTrials.gov NCT04270422 , Registered on 17 February 2020, IRCT Identifier: IRCT20140810018754N11

Background: Despite existing some research on the effects of professional cycling on cyclist’s spinal curvature angles, no research is available concentrating on possible differences in various types of professional cycling. Road (outdoor) and speed (indoor) cyclists have different anthropometric and predominant postures during cycling. The current study aims to investigate if cyclists with different types of cycling may have dissimilar spinal curvature adaptations. Objective: Forty-eight male subjects, including 16 elite road cyclists, 16 elite sprint cyclists and 16 non-athletes as the control group were recruited in this non-experimental study.Material and Methods: In this cross-sectional study, a spinal mouse was used to measure the thoracic and lumbar curvature angles in standing position. Results: The mean values of thoracic kyphosis and lumbar lordosis angles were found as follows: 48.3±7.2º & -20.3±7.2º for elite road cyclists; 46.6±8.1º & -22.5±7.7º for elite sprint cyclists; and 37.5±4.1º & -19±6.3º for the control group. The results confirmed that both the road and sprint cyclists showed significantly more hyper-kyphosis posture in their thoracic region when compared to the control group (p 0.05). However, all the cyclists and the control groups showed a normal range of lumbar lordosis angle. As a conclusion, the results of this study confirmed that an elite cyclist may predispose these subjects to the risk of hyper-kyphotic posture. The road cycling may result in more hyper-kyphosis due to the longer time, spent in flexed position.

Introduction: Neck pain is a highly prevalent disorder in developed countries. A myofascial trigger point (MTrP) is distinguished under the name of the fundamental excessive menstruation for it and certain reason for musculoskeletal dysfunction. MTrP refers to a sensitive spot in a taut band whose stretch and compression can induce pain. Modifications in the motor cortex, sensory input, irritability, and integration are the adaptive mechanisms to pain. Accordingly, this study aimed to investigate the preparatory brain activity and anticipatory postural control in chronic neck pain. Materials and Methods: The study participants included 25 women with an active MTrP in the upper trapezius muscle and 25 healthy women in the control group. We recorded the brain activities from Cz, Pz, and Fz regions and muscle activities of both sides of the upper trapezius, anterior deltoid, cervical and lumbar paraspinal, sternocleidomastoid, and medial head of the gastrocnemius. The participants had to flex their arms in reply to the second sound stimulus, followed by the first sound. Then, their reaction time and brain activity were evaluated. Results: Significant differences between the two groups were detected in brain activities’ measurements and the onset of muscle activation (P0.05). Conclusion: The current study suggests that active MTrP induces latency and lengthens the muscle reaction time; thus, the production of suitable motion after the stimulus will be affected. Brain alteration after pain damages movement changes and postural control mechanism.

Introduction: Spinal range of motion (ROM) is a potential and modifiable variable that may contribute to the maintenance of upright sagittal alignment. The present study aimed to compare spinal ROM in older females with and without hyperkyphosis and investigate associations between thoracic kyphosis and spinal ROM, back extensor strength (BES), and back extensor endurance (BEE). Materials and Methods: Sagittal spinal curvature and ROM were measured with the Spinal Mouse. Also, BES and BEE were assessed with a load cell. Variables were compared between older females with and without hyperkyphosis with the independent sample t test. We used the Pearson correlation coefficient to calculate associations between variables. Multiple linear regression was used to find which variable is best associated with kyphosis. Results: Lumbar and total spinal ROM were lower in the hyperkyphosis compared to the normal group (P

Objectives: The stability and mobility function of dominant and non-dominant limbs are different. Considering the lack of any previous investigation in this regard, this study aimed to investigate the effect of limb dominancy on anticipatory postural adjustments and reaction time (RT) during gait initiation in healthy people. Materials and Methods: Twenty healthy people with the right limb dominant participated in the study. The two stimuli of warning and response were used within a 2-second interstimulus interval. In addition, the participants were instructed to get ready to initiate walking as soon as they hear the warning stimulus and initiate gait immediately after hearing the response stimulus, followed by measuring the RT and duration of the anticipatory postural adjustment phase. Results: The RT was slower when a person initiated gait with the dominant limb as compared with the non-dominant limb and no significant differences were observed in anticipatory postural adjustment phase duration between the two limbs. Conclusions: In general, our findings demonstrated that information processing capacity for perception, motor planning, and selection of proper motor responses for movement initiation is affected by limb dominance.

Introduction: Studies have repeatedly discussed the importance of training with sufficient cognitive and sensory-motor challenges in successfully transferring Anterior Cruciate Ligament Deficiencies (ACLDs) from rehabilitation centers to sports facilities. For this purpose, this study investigated the effect of mechanical perturbation training and standard training on the brain and muscle activity of these individuals while jumping on one leg. Materials and Methods: A total of 30 athletes with unilateral Anterior Cruciate Ligament (ACL) rupture (in the coper classification) were randomly assigned to perturbation and standard training groups. To compare the effect of two types of intervention training methods, we examined the Similarity Index (SI) and Voluntary Response Index (VRI) in surface Electromyography (sEMG) tests of eight muscles in the lower extremities and relative power of alpha and beta spectra in Quantitative Electroencephalographic (QEEG) tests between two groups and between two limbs of each group members in the single-leg jump task. Results: Both training groups showed improved neuromuscular control and increased SI on sEMG tests between the two limbs. However, this improvement in the perturbation training group showed an excellent increase in Effect Size (ES) (intra-group comparison values of SI for perturbation training group P=0.0001, ES=3.6; and P=0.008, ES=1.24 in the standard training group; and P=0.04, ES=0.87 in the inter-group comparison). Regarding the post-test of QEEG tests, no significant difference was found between the two groups (alpha P-value: 0.13, beta P-value: 0.07). However, in the intra-group comparison, the perturbation training group achieved excellent symmetry for the relative power spectrum of alpha and beta signals (the similarity values between the two limbs in the perturbation training group for alpha were P=0.92, ES=0.04 and for beta were P=0.92, ES=0.02; and these values for standard training group for alpha were P=0.07, ES=0.86 and for beta as P=0.08, ES=0.87). Conclusion: The present study results showed that mechanical perturbation and standard training are suitable for transporting ACLDs to sports environments. Furthermore, in comparing these two training methods, mechanical perturbation training in the manner used in this study has higher adequacy to eliminate motor control and central nervous system defects.

Introduction: The present study aimed to investigate the immediate effects of two types of Kinesio taping on the temporal and spatial variables of gait initiation in individuals with and without Functional Ankle Instability (FAI). Materials and Methods: Thirty semi-professional athletes (15 with and 15 without FAI [control]) were recruited for this study. The gait initiation task was examined before and after the two types of Kinesio taping on a force plate. Temporal (Reaction Phase [RP], Anticipatory Postural Adjustment Phase [APAP]), and spatial variables were recorded and compared between Groups, before and after the tape application. Results: The results of multiple repeated-measure analyses of variance showed no significant differences for “factor” and “Group by factor” interaction effects for any outcome measure (P>0.05). There were no significant differences for Group effects except for the APAP (F=10.27, P=0.003). The APAA was 71.95 ms longer in the FAI Group (476.95±15.87 ms) compared to the control Group (405.04±15.87 ms). Conclusion: Kinesio taping application does not influence any of the gait initiation parameters on the force plate. Participants with FAI demonstrated longer APAP which might be due to recurrent injury and instability during sports or physical activity.

Background: The aim of the study was to investigate the reliability and agreement of the Beta-band intermuscular coherence (Bb-IMC) as a clinical assessment tool for Non-Specific Chronic Low back pain (NS-CLBP) patients and healthy subjects by studying four phases of flexion-extension task; standing, flexion, relaxation and extension phases (F-ET). Methods: Twenty-four men with NS-CLBP and 20 healthy subjects voluntarily participated in this study. All those subjects performed three trials of F-ET while the sEMG was recorded from the lumbar erector spinal, gluteus maximus and hamstring muscles of both sides. Beta-band intermuscular coherence analysis was used to calculate the pool coherence and the pairwise coherence for all mentioned muscles. Afterward, the intra-class correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) for four phases of F-ET were also used to analyze the intrarater reliability and agreement of the measurements. Results: The investigation of ICC, SEM and MDC showed that the reliability was moderate to a high level of reliability for pool and pairwise coherence of Bb-IMC in all mentioned muscles for four phases of flexion-extension task in NS-CLBP patients and healthy subjects. Yet, the agreement was low because the measurement error was relatively large. Conclusion: Up until now, no studies have used the Bb-IMC method to study Low back pain which are carried out in our study to check the reliability of this new method. Our findings revealed that pool and pairwise coherence obtained during F-ET are moderate to a high level of reliability for using Bb-IMC and could be considered as a tool for the NS-CLBP patients’ assessment. Although the small sample size investigated, in clinical practice the using this measure to conclude the interaction of corticospinal in NS-CLBP and healthy subjects should help to improve the analysis. This requires including larger sample sizes in addition to studying other circumstances and functional movements such as lifting weight. Furthermore, more research appears to be warranted by the observed effectiveness of a particular intervention in modulation mechanisms of corticospinal tract function by Bb-IMC in NS-CLBP.

Background. Illness perceptions may influence coping behaviors as well as treatment and recovery among patients with chronic pain including low back pain (LBP). These perceptions may vary across different conditions. The Brief Illness Perception Questionnaire (BIPQ) is used as an instrument to assess the patients’ perception of illness. Although the BIPQ has been previously translated into Persian, its psychometric properties have not been evaluated among patients with chronic nonspecific LBP. The aim of this study was to determine the reliability and validity of the Persian BIPQ in patients with chronic nonspecific LBP. Methods. 116 patients with chronic nonspecific LBP with a mean (standard deviation) age of 36.4 years (10.7) participated in this cross-sectional study. Fifty patients were reexamined after 10 to 12 days for test-retest reliability. Internal consistency reliability, construct validity, concurrent criterion validity, and structural validity were evaluated. The concurrent validity was examined by using the Short Form-36 Health Survey. Results. There were no floor and ceiling effects. Cronbach’s alpha for the total score was 0.90. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.90. The standard error of measurement and the minimal detectable change was found to be 3.26 and 9.04, respectively. The convergent correlations confirmed the construct validity. The concurrent criterion validity was demonstrated by significant negative correlations with the SF-36. The Exploratory Factor Analysis produced the 2 factors (emotional illness representations and cognitive illness representations) with an eigenvalue >1.0 that jointly accounted for 58.86% of the total variance. Conclusion. The Persian BIPQ is a reliable and 2-factor instrument and can be used for assessing illness perception in patients with chronic nonspecific LBP.

Introduction: Voluntary Response Index (VRI) is used as a measure of motor control to study abnormalities of voluntary movements. This study aimed to evaluate the reliability of voluntary response index analysis in subjects with Anterior Cruciate Ligament Reconstruction (ACLR). Materials and Methods: Using surface electromyography, the VRI components of both groups of 15 ACLR and 15 healthy controls were assessed during the functional task (sit-stand-sit). The outcome variables of VRI included the magnitude and similarity index. Results: In sit to stand phase, high reliability was found (ICC=0.80-0.89) for the magnitude and similarity index in both groups. In the standing phase, high to very high reliability was found for the magnitude and similarity index in both groups (ICC=0.75-0.91). In stand to sit phase, high to very high reliability was found (ICC=0.78-0.92) for the magnitude and similarity index in both groups. Conclusion: Surface electromyographic measurements of VRI analysis demonstrated high to very high reliability in athletes with ACLR during the functional task (sit-stand-sit). The results of the current study showed that the VRI analysis in athletes after ACLR was a reliable method and can be used to evaluate motor control before and after ligament injury in these patients.

Objectives: The dominant leg has always received special attention in public health practices and even in professional clinical evaluation and interventions. The aim of this research study was to methodically examine the substrate balance character of the non-dominant leg under dual task conditions and visual deprivation to increase the baseline insight for maintaining body balance and for fall prevention in aging adults. Methods: Twenty healthy senior citizens with non-dominant left leg were conscripted into a cross-sectional study, the aim of which was to examine one-legged standing balance strategy on a force plate at Motor Control Laboratory in University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Four balance conditions with varied levels of difficulty, including: (a) single left leg standing with open eyes; (b) single left leg standing with open eyes performing Stroop dual task; (c) single left leg standing with eyes shut; and (d) single left leg standing with eyes shut under dual task condition. These conditions were applied to assess balance function of the non-dominant leg of the subjects. Results: Repeated measurement tests revealed that among the six variables, namely Area, Mean Velocity, Range Fore After, Range Side Way, Entropy X, and Entropy Y, that are measured by force plate, only Entropy X did not have a significant difference between conditions (P

The reliability of surface electromyographic (sEMG) variables during swallowing determines the potential usefulness of these measures in swallowing assessment and treatment. This study aimed to establish the reliability of the sEMG measures of the swallowing function of muscles during different swallowing conditions in healthy young and old volunteers. Two groups of volunteers (24 older adults, 10 younger adults) participated in this cross-sectional study during 2014. The activity of masseter, submental, and infrahyoid groups were measured using sEMG during three repetitions of different swallowing tasks. Both the relative and absolute reliability (characterized respectively by ICC, SEM%, and SRD%) were calculated for the sEMG indices of muscle activity during swallowing events. Statistical analyses were performed by the SPSS 19.0 and Microsoft Excel 2007 software packages. Statistical significance was set at P≤0.05. The relative reliability calculations showed significant agreements between repetitions for the mean and peak amplitude and the average of median frequency (MDF) of the studied muscles function during most swallowing types in both groups. However, the duration and particularly the time to peak of muscle activity showed significant agreements during fewer swallowing conditions. Excluding MDF, we found high SEM% and SRD% for the studied measures (particularly timing measures) of muscles function during most swallowing types in both groups. The reliability of sEMG measures was influenced by the age and swallowing types. Our findings suggest that the MDF of muscle function during almost all studied swallowing types can be a reliable measure for the sEMG assessment of swallowing function in both younger and older adults.

Introduction: Position sense, one of the most accurate senses in the body, makes everyone aware of the state of the body in space. This sense is an essential ability in maintaining physical health and avoiding injury. Deficits in position sense cause balance impairments in people with mild Multiple Sclerosis (MS). Position sense requires instant and coordinated communication between the central nervous system and peripheral nervous system, while in patients with MS, communication between the brain and other parts of the body is disrupted. This study aims to compare the position sense of knee joint in people with MS and healthy subjects. Materials and Methods: Ten healthy subjects with the Mean±SD age of 27.6±3.71 years and 10 persons with MS disease and the Mean±SD age of 31.40±3.50 years participated in this study. For evaluating their position sense of knee joint, they flexed their knees (from 90 to 45 degrees) four times, and then a software calculated their repositioning errors. Results: No significant changes in repositioning errors (constant, variable, absolute) were observed in MS patients, and the control group (P˃0.05). Conclusion: The results indicate that mild MS disease cannot disturb the position sense of knee joint.

Introduction: Latent Myofascial Trigger Points (LMTrPs) are defined as certain pain-free hyperirritable spots in a taut band of muscle, which lead to alternation in muscle activation pattern in both loaded and unloaded conditions. Fatigue can alter the stability of the cervical spine because of transferring loads to the passive connective tissues and also increasing muscle activity. Few studies have investigated the effects of fatigue on the parameters of the upper trapezius muscle as a more common muscle to MTrPs. This study attempts to examine the electromyographic activity of the upper trapezius muscle fatigue during shoulder elevation. Materials and Methods: Thirty-six right-handed subjects without upper extremity disorders took part in this study. The highest measured force level was assumed to be the Maximal Voluntary Contraction (MVC) of the trapezius. A sustained submaximal contraction of the trapezius was performed. The subjects were asked to sustain a unilateral (80%) MVC isometric shoulder elevation until the force gauge monitor showed (50%) of MVC in at least three minutes. Results: The Root Mean Square (RMS norm) of the sustained trapezius contractions showed differences between the groups. The Myocardial Depressant Factor (MDF) parameters of the left and right sides of both healthy subjects and patients were significantly different (P

Introduction: Ankle sprain occurs often late in sport competitions consisting of many lateral ankle movements, jumping or landing, where peroneal muscles are fatigued. Changes in Ground Reaction Force (GRF) parameters may also be related to this injury. The present study aimed to assess the effects of peroneal muscles fatigue on GRF profile during lateral hop landing. Materials and Methods: Twenty-five recreationally active healthy males performed a lateral hop on a force plate before and after a fatigue intervention by a Biodex dynamometer using an isometric eversion at 40% of maximal voluntary isometric contraction until eversion torque decreased to 50% of its initial value. A force plate and an EMG system were used to collect data during lateral hop landing. Results: Fatigue was confirmed by a significant fall in median frequency (P

Background: In line with health promotion plans, early intervention and fall prevention in geriatric population, it is important to study healthy individuals balance mechanisms. The aim of this research was to investigate the effect of adding and removing visual input and dual task on elderly balance. Methods: Twenty healthy elderly recruited from four different senior citizen health club centers and from the University of Social Welfare and Rehabilitation Sciences (USWR) participated in this analytic cross-sectional study. At USWR’s Motor Control Laboratory, the participants’ postural sway were assessed using force plate in 4 distinct double leg standing conditions with and without presence of visual input and Stroop dual task. Postural and Stroop variables were compared. Results: Findings indicated that when the elderly encountered with either dual task or absence of visual input, they can still manage the situation in a way that changes in sway parameter would not become significant. But, when these two conditions occurred simultaneously, the participant’s balance strategy fluctuated. Therefore, the mean velocity showed a significant difference between the "single quiet standing" condition and the condition of standing with eyes closed while the participants were answering Stroop dual task (Mean difference = -0.007, 95% CI = -0.012, -0.002). Conclusion: It appears that velocity parameter is sensitive to small changes, so it is recommended that researchers include this parameter in their future analyses. Balance in elderly can be manipulated by dual task and visual input deprivation.

Background: Surface electromyography (sEMG) of muscles is a non-invasive tool that can be helpful in the assessment of muscle function and some motor control evaluations. A loss of force, known as muscle fatigue is accompanied by changes in muscle electrical activity. One of the most commonly used surface EMG parameters which reflects paraspinal muscle fatigue during different tasks and positions is median frequency. Although it is widely known that the electromyography power spectrum shifts to lower frequencies during fatiguing contraction, an opinion exists that the validity of spectral shifts in assessment of fatigue is questionable. Some researchers have examined whether other quantities derived from sEMG signals are better indicators for muscle fatigue. Following cyclic flexion/extension and consequence fatigue, variation in sEMG signals may be complex for study. The aim of this study was to determine which of the median frequency (MF) or entropic (ENTR) is more sensitive for measuring muscular fatigue in erector spinae muscles during cyclic flexion/extension. Methods: Surface electromyography of erector spine muscles was recorded in 25 healthy subjects during cyclic dynamic contractions. The experimental session consisted of two parts: measurement of Maximal Voluntary Contraction (MVC), and performing the fatigue test. All subjects performed rhythmic flexion/extension with 50% MVC loading against B-200 Isostation, about 4-6 minutes. The MF and ENTR of the muscle activities were computed to assess muscular fatigue. Results: Paired sample t-tests showed that MF and ENTR changes after fatigue test were significant (P

Introduction: Muscle fatigue is tiredness, in other words, loss of productive capacity of power in response to the activity. The development of fatigue during prolonged exercise may be evaluated by repeated assessments of maximal voluntary force. This study aimed to determine the effect of muscle fatigue on trans-tibial stump level in knee extensor muscles (vastus lateralis, vastus medialis, and rectus femoris) at 30 and 45 degree knee flexions by using surface electromyography. Materials and Methods: Forty male amputees with trans-tibial amputation, aged between 18-50 years were assigned randomly in three groups; performed three isometric contractions with extended knee at 80% of the maximal voluntary contraction. Median Frequency (MDF) and Root Mean Square (RMS) values were obtained by surface electromyography from the knee extensor muscles at 30 and 45 degree knee flexions. Force values in stump and sound sides during knee flexion at 30 and 45 degree were also compared. Results: Median frequency on sound side showed more fatigue and MDF-RMS between stump levels was short, medium, and long for knee extensor muscles at 30 and 45 degree, before and after the fatigue. No significant effect between stump and sound side was found. Vastus lateralis muscle showed more power than vastus medialis and rectus femoris muscles before fatigue. But after fatigue, rectus femoris muscle showed more power than vastus medialis and vastus lateralis. Conclusion: Results have confirmed that trans-tibial amputees with good functional ability showed more fatigability on the sound side while stump side showed more power. Vastus lateralis muscle had maximum power on both sides. Vastus medialis and rectus femoris of long stump levels and vastus lateralis muscle of short levels were more powerful.

Background: Centre of pressure displacement is an indicator of postural control. Children with cerebral palsy have poor postural control. One common intervention to enhance their balance is vestibular stimulation. The aim of this research was to investigate the effect of vestibular stimulation on COP parameters in children with cerebral palsy (3-10 years old). Methods: This study was a randomized double-blind controlled clinical trial. Twenty children with cerebral palsy received vestibular stimulation, two sessions per week with a course of twelve sessions, based on vestibular stimulation protocol including anteroposterior, lateral, ascending–descending movements and spinning. One cerebral palsy group experienced current and conventional occupational therapy while the other received a period of vestibular stimulation during treatment. Force plate outcome measures were center of pressure displacement parameters as well as velocity, area, displacement in X and Y axes. Results: According to Mann-Whitney U test, means in post-tests in two groups with both conditions of eyes open and closed were significant in velocity parameter (eyes open P=0.036; eyes closed P=0.021) while Area parameter, COP displacement in X axis (Rang fore after), COP displacement in Y axis (Rang side way) were not significant (P>0.05). Wilcoxon Test showed significant difference in the velocity parameter; eyes open (P=0.012) and eyes closed (P=0.018). Conclusion: Children who received vestibular stimulation are able to change and control COP displacement faster (according to changes in velocity parameters). So we suggest rehabilitation team members especially occupational therapist to apply vestibular stimulation during their treatment.

Purpose: In approaching full trunk flexion (75%-80% of full flexion), myoelectric activity of lumbar erector spinae muscles is reduced or silenced; this response is known as flexion-relaxation phenomenon (FRP). FRP is a shift in load sharing and spinal stabilization from active structures (erector spinae muscles) to passive ligamentous and articular structures. Static lumbar flexion under constant displacement or load, within the physiological range, elicits creep in lumbar viscoelastic tissues. During a short static lumbar flexion, significant changes are elicited in the muscular activity pattern of the FRP. Laxity in the passive tissues of the spine during prolonged spinal flexion disturbs the spinal stability. This study investigated the effects of Kinesio taping (KT) before and after periods of the static lumbar flexion on the timing of FRP for the erector spinae muscles. Methods: The research was conducted on 22 healthy female college students. The surface electromyographic silence and onset of the erector spinae muscle activities were measured in two states; before the static lumbar flexion and 10 minutes after the static lumbar flexion in two conditions (with and without KT). Results: The results indicate that KT causes erector spinae muscles relaxation earlier in the flexion and later reactivated in the extension. In other words, KT increased flexion relaxation time in erector spinae muscles (P

Background: In physical therapy, usually the effects of treatment on any condition will be evaluated based on the mode of action on the target tissue. Some treatments will have direct and indirect effects. Due to indirect effects, there may be changes in other tissues or systems in and around the target tissue. The interaction between target, effect, and action was studied under TEA model. In sacroiliac joint dysfunction, Muscle Energy Technique (MET) and Spinal Manipulation Therapy (SMT) were proved as useful treatment approaches but one is targeted on muscles (MET) the other targets on joint (SMT). The indirect effects of both the approaches can’t be neglected. This study focused on evaluating indirect effects of SMT. Methods: A pilot study was conducted to see the effect of Spinal Manipulation Therapy on muscles (Transverse Abdominus, Internal Oblique) when applied in patients with sacroiliac joint dysfunction. 44 subjects diagnosed with sacroiliac joint dysfunction were recruited in the study. Resting thickness was measured by ultrasound before and after Spinal Manipulation Therapy. SPSS version 17 was used for statistical analysis. Paired t-test compared pre and post test results. Results: After conducting Pilot study revealed that Pre resting thickness of Transverse Abdominus and Internal Oblique is (3.5±0.10) and (5.47± 0.15) Post resting Thickness of TrA (Transverse Abdominus) and Internal Oblique (IO) is (3.90±0.12) and (7.63±0.80) Results are significant as P-Value 0.000 that is

Introduction: Low back pain is the leading cause of activity limitation and work absence throughout the world among workers. Materials and Methods: Data were collected by using a self-administered questionnaire containing individual and work ergonomic items. The 11-point numeric scale (NPRS) was used to assess the pain intensity from the office workers at the time of the survey. Bivariate logistic regression analysis was used for predicting the risk factors of low back pain. Results: Demographic, personal, work ergonomic and psychosocial characteristics of office workers showed high prevalence of low back pain. The Point prevalence of LBP among the office workers of TUMS was 32.3% and the lifetime prevalence among them was 74.5%. Conclusion: High prevalence of LBP was reported among the office workers. Different individual as well as work related risk factors are worsening this condition which needs proper protective measures.

Introduction: Chronic Low Back Pain (CLBP) may be associated with impaired proprioception which can result in joint instability and balance deficit. However, wearing a lumbosacral belt may be helpful in this situation. This study aimed to identify postural control impairments in patients with CLBP and determine the effect of lumbosacral support on postural control strategies in these patients. Materials and Methods: A total of 16 patients with CLBP and 16 healthy subjects participated in this study. Center of Pressure (COP) data were recorded for 30 seconds while wearing or not wearing a belt in four standing positions; double leg with open eyes, double leg with closed eyes, single leg with open eyes, single leg with closed eyes. Postural control was assessed using range, area and total mean velocity for each experimental condition. Results: Patients with CLBP showed significantly larger mean COP range and mean area compared to the healthy controls in single leg stance with closed eyes (P

Introduction: The use of multiple cameras for motion analysis and single joint motion is very difficult and needs high technology in laboratory conditions. Detection of single joint motion in kinesthesia and analysis of its changes can be done by one camera at one direction. In this study, we present the validity and reliability of a new prototype simulator system used for motion analysis application. Material and Methods: A moveable lever arm can rotate in three dimensions (3D) and can be controlled by three goniometers separately. A special software was written for the detection of four reflective markers that fixed to moveable liver arm, by one camera in front of it. Two approaches for this study were (a) selective and (b) random 3D simulation. Three repetitions for each variation and each dimension were selected and correlation was computed between simulator and images captured by camera. Results: There are high correlations between simulator and one camera system for each condition. In addition, a minimum degree error appeared. Conclusion: Results indicated that this new approach can be useful for all clinical and research approaches in biomechanical or occupational areas. Keywords: Joint motion; Motion analysis; Three-dimensional software

Purpose: The purpose of this study was to investigate the kinematic and kinetic variables, which predict anterior tibia shear force during single-leg landing in female athletes. Methods: Forty-three subjects (mean and standard deviation for age 21.12 ± 2.00 y, height 168.58 ± 7.62 cm, and weight 60.27 ± 7.80 kg) participated in this study. Kinematic and kinetic variables of lower extremity and trunk during single-leg landing were collected by 5 Vicon cameras and Kistler force plate. Stepwise multiple regression and Pearson correlation were used to identify predictor variables of anterior shear force (P ≤ 0.05). Results: Peak of extensor moment (P = 0.004, r = -0.394) and maximum knee flexion (P = 0.007, r = -0.370) were the best predictors that explained 30% of the variance of the shear force data. Therefore, rise in maximum extensors moment of knee and knee maximum flexion causes increase and decrease in anterior shear force, respectively. In addition, a significant relationship between trunk flexion (P = 0.039) and knee flexion angular velocity (P = 0.048) at the moment of initial contact with the anterior shear force. Conclusion: On the basis of previous research, and the relationship between clinical findings, the noncontact of anterior cruciate ligament injury during landing was confirmed. These results can be used in prospective studies examining modifiable noncontact risk factors of ACL injury.

Purpose: Mechanical loading is said to be an important factor in the development of low back pain (LBP). One of the main concerns in manual material handling (MMH) tasks is lifting loads, as this activity is present in most jobs. Despite the controversy about their effectiveness, belts are used in industry as either protective or assistive devices in manual load handling. The present investigation aimed to determine whether a commonly used back belt could improve maximum center of pressure displacement (COPMD) and center of pressure velocity (COPV) as the balance parameters during each of three common styles of lifting (squat, semi-squat, stoop). Methods: Twenty healthy female subjects participated in this study who were selected by nonprobability convenience sampling. The participants stood barefoot on the force plate. They lifted a box, weighting 4.53 kg (10 pound). The subjects were instructed to bend their knees (squat) or their lumbar (stoop) or both their knees and lumbar (semi-squat), to grasp the box handles, and to lift the load to the level of greater trochanter height. Half of the subjects performed the 3 trials with wearing belt at first try and the other half performed the trials without wearing the belt at first try. Results: The mean of maximum displacement and velocity showed that there was a trend of increase in these variables in all 3 styles of lifting (squat, semi-squat and stoop) after wearing belt. One-way ANOVA with repeated measures results for COPMD and COPV showed that ‘Belt condition’ significantly affected the dependent variables. Conclusion: Wearing belt may decrease stability caused by increased COPMD and COPV.

Objectives: There are two sub systems of paraspinal muscles, the global-mobilizing system and the local stabilizing system. The multifidus muscles are assigned to the local system and stabilize the joints. In contrast, the longissimus muscles are assigned to the global system and force exertion. This study aimed to investigate the median frequency changes in mobilizing and stabilizing muscles following fatigue. Method: A cross sectional study was designed. sEMG measurements were recorded from twenty participants following a fatigue protocol in B200 dynamometer. Participants performed dynamic trunk flexion-extension against a moderate resistance while standing in a static dynamometer until they could no longer performs the task because of fatigue. Results: Statistical analyses showed significant differences between median frequencies pre and post fatigue (P

Neuromuscular electrical stimulation (NMES) for treating dysphagia is a relatively new therapeutic method. There is a paucity of evidence about the use of NMES in patients with dysphagia caused by stroke. The present review aimed to introduce and discuss studies that have evaluated the efficacy of this method amongst dysphagic patients following stroke with emphasis on the intensity of stimulation (sensory or motor level) and the method of electrode placement on the neck. The majority of the reviewed studies describe some positive effects of the NMES on the neck musculature in the swallowing performance of poststroke dysphagic patients, especially when the intensity of the stimulus is adjusted at the sensory level or when the motor electrical stimulation is applied on the infrahyoid muscles during swallowing.

The purpose of this paper is to review the methods used for the assessment of muscular tension dysphonia (MTD). The MTD is a functional voice disorder associated with abnormal laryngeal muscle activity. Various assessment methods are available in the literature to evaluate the laryngeal hyperfunction. The case history, laryngoscopy, and palpation are clinical methods for the assessment of patients with MTD. Radiography and surface electromyography (EMG) are objective methods to provide physiological information about MTD. Recent studies show that surface EMG can be an effective tool for assessing muscular tension in MTD.

Introduction: This preliminary study investigates the effects of adding exergame (EG) training to conventional exercises on the functional activities of newly fitted patients with unilateral transtibial amputation. Materials and Methods: A total of 22 newly fitted patients with unilateral transtibial amputation were equally and randomly divided into two groups as follows: the EG group who performed exercises and EG training and the control group who performed exercise only. The 2-min walk test, timed up and go test, amputee mobility predictor with prosthesis test, and physiological cost index were assessed at baseline and after 2 and 4 weeks of the intervention. Results: Both interventions effectively improved the 2-min walk test distance, timed up-andgo test, and the amputee mobility predictor with prosthesis test scores in patients with newly fitted transtibial amputation (P<0.001). Additionally, a significant improvement was observed in the timed up-and-go test time in the EG group versus the control group after the 4-week intervention (P=0.04, effect size=0.53). Conclusion: The findings of this preliminary study further support that adding EG to exercises significantly increases movement speed among amputee patients. [ABSTRACT FROM AUTHOR]