Amira Hussin Draz

Effect of isokinetic training on muscle strength, size and gait after healed pediatric burn: A randomized controlled study

OBJECTIVE The aim of this study was to investigate the effects of isokinetic training program on muscle strength, muscle size and gait parameters after healed pediatric burn. DESIGN Randomized controlled trial. SUBJECTS Thirty three pediatric burned patients with circumferential lower extremity burn with total body surface area (TBSA) ranging from 36 to 45%, and ages from 10 to 15 years participated in the study and were randomized into isokinetic group and a control group. Non-burned healthy pediatric subjects were assessed similarly to burned subjects and served as matched healthy controls. METHODS Patients in the isokinetic group (n=16) participated in the isokinetic training program for 12 weeks for quadriceps dominant limb, 3 times per week, at angular velocity 150°/s, concentric mode of contraction, time rest between each set for 3 min, 3 sets/day and control group (n=17) participated in home based physical therapy exercise program without isokinetic. MAIN MEASURES Assessment of quadriceps strength by isokinetic dynamometer, quadriceps size and gait parameters were performed at baseline and at the end of the training period for both groups. RESULTS Patients in isokinetic group showed a significant improvement in quadriceps strength, quadriceps size and gait parameters as compared with those in the control group. Quadriceps strength and percentage of improvement was 79.25 ± 0.93 Nm (68.40%) for isokinetic group and 51.88 ± 1.31 Nm (9.84%) for the control group. Quadriceps size and percentage of improvement was 31.50 ± 0.89 cm (7.47%) for isokinetic group and 29.26 ± 1.02 cm (1.02%) for the control group. Stride length, step length, velocity and cadence and percentage of improvement for isokinetic group was 135.50 ± 2.82 (53.97%), 63.25 ± 2.97 (63.77%), 135.94 ± 1.65 (81.42%), 137.63 ± 1.36 (66.96%) and for the control group was 94.00 ± 2.69 (6.68%), 43.76 ± 1.34 (15.15%), 81.11 ± 1.91 (8.6%), 90.35 ± 1.32 (9.01%) respectively. CONCLUSIONS Participation in the isokinetic training program resulted in a greater improvement in quadriceps muscle strength, size and gait parameters in pediatric burn.

Chronic ankle instability alters eccentric eversion/inversion and dorsiflexion/ plantarflexion ratio

OBJECTIVE To determine if the eccentric evertor/invertor and dorsiflexor/plantar-flexor ratio are altered in subjects with chronic ankle instability. METHODS Twenty chronic ankle instability (CAI) subjects as an experimental group, and twenty healthy subjects as a control group, were matched in age, gender, and activity level. CAI subjects have a history of at least one ankle sprain and repeated episodes of giving way were included in CAI group. Subjects with no prior history of ankle injury were included in the control group. Ankle evertor/invertor and dorsiflexor/plantar-flexor muscles eccentric torque ratios were measured using the eccentric muscle contraction at angular velocities 60 and 120°/s. RESULTS Analysis of variance revealed that the eccentric contraction eversion/inversion ratio of CAI group was significantly lower than normal group ratio at angular velocities 60 and 120°/s (p=0.041 and 0.012) respectively. The eccentric contraction dorsiflexion/plantarflexion ratio of CAI group was significantly higher than normal group ratio at both angular velocities (p=0.036 and 0.013) respectively. Moreover, at angular velocities of 60°/s and 120°/s a deficit in inversion and eversion eccentric torques were identified in CAI group (p=0.000), plantarflexion torque deficit of CAI group (p=0.034 and 0.028), respectively, and no deficit was identified for dorsiflexion torque of CAI group (p=0.595 and 0.696) respectively. CONCLUSION Chronic ankle instability increases the dorsiflexion/plantarflexion muscles torque ratio and decreases the eversion/inversion ratio at angular velocities 60 and 120°/s. Therefore, the restoration of a normal eccentric inversion, eversion, and plantarflexion strength may prevent recurrent lateral ankle ligament sprain.

The effect of knee osteoarthritis on ankle proprioception and concentric torque of dorsiflexor and plantar-flexor muscles

BACKGROUND: Muscle function and functional performance are affected in patients with osteoarthritis (OA). PURPOSE: To assess the relationship between knee OA and ankle proprioception and concentric peak torque of the dorsiflexor and plantar-flexor muscles in older patients. METHODS: Forty participants took part in the study; 20 participants with chronic unilateral knee OA and a control group of 20 healthy participants. Ankle proprioception and concentric peak torque were measured by an isokinetic dynamometer (Biodex). MAIN RESULTS: There was a significantly greater absolute error at the ankle among the knee OA group (p= 0.0001). The concentric peak torque value of dorsiflexor and plantar-flexor muscles of the control group was significantly higher than the knee OA group (p= 0.003, p= 0.008) respectively. CONCLUSION: Those with OA of the knee displayed deficits in ankle proprioception and concentric peak torque of the dorsiflexor and plantar-flexor muscles.

Effect of Ultrasound Combined with Conventional Therapy on Neck Pain, Function, and Disability in Patients with Cervical Spondylosis: A Randomized Placebo-Controlled Trial

Abstract Objective: The purpose of this study was to evaluate the effect of continuous ultrasound [US] compared with placebo US combined with conventional physiotherapy program for patients with cervical spondylosis. Methods: This was a randomized placebo-controlled trial. Patients, diagnosed with cervical spondylosis, were randomly assigned to one of two groups in an orthopedic physical therapy clinic: a group that received electrotherapy, exercise, hot packs, and therapeutic US [True US group] and a group that received electrotherapy, exercise, hot packs, and sham US [Sham US group]. Patients were treated, on average, three times per week for 4 weeks. Outcome measurements were collected at baseline and after 4 weeks using the Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index. Results: Analysis of variance showed that both groups had improved regarding Numeric Pain Rating Scale, Patient-Specific Functional Scale, and Neck Disability Index [p < 0.05]. There was no significant difference between both groups for pretest and post-test values [p > 0.05] for all measures. Conclusions: The addition of US to conventional physiotherapy program of electrotherapy, exercise, and hot packs yields no additional benefit to neck pain, function, or disability in patients with cervical spondylosis.

Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities

[Purpose] To examine the effect of physiotherapy rehabilitation program on moderate knee osteoarthritis in patients with different pain intensities. [Subjects and Methods] Sixty subjects (37 men and 23 women) with moderate knee osteoarthritis participated in the current study. Randomization software was used to select the participating subjects’ numbers from the clinic records. They were classified into three groups according to pain intensity: mild, moderate, and severe pain groups. All groups underwent a standard set of pulsed electromagnetic field, ultrasound, stretching exercises, and strengthening exercises. Pain intensity, knee range of motion, knee function, and isometric quadriceps strength were evaluated using the visual analogue scale, universal goniometer, Western Ontario and McMaster Universities osteoarthritis index, and Jamar hydraulic dynamometer, respectively. The evaluation was performed before and after a 4-week rehabilitation program. [Results] All groups showed significant differences in pain intensity, knee range of motion, isometric quadriceps strength, and knee function. The score change in moderate pain group was significantly greater than those in mild and severe pain groups. [Conclusion] Pain intensity is one of the prominent factors that are responsible for the improvement of knee osteoarthritis. Consequently, pain intensity should be considered during rehabilitation of knee osteoarthritis.

Isokinetic assessment of ankle dorsiflexors and plantarflexors strength in patients with knee osteoarthritis

Purpose: To evaluate the ankle concentric dorsiflexors and plantarflexors’ strength in patients with knee osteoarthritis (OA). Methods: Forty subjects with knee OA were included in the study. The first group consisted of 20 subjects suffering from unilateral tibiofemoral knee OA, with mean age (57.60 ± 4.50 years), mean weight (88.95 ± 11.93 kg), and mean height (169.95 ± 5.84 cm). The second group consisted of 20 subjects with no prior history of knee pain or injury, forming a control group, with mean age (58.70 ± 5.15 years), mean weight (91.10 ± 10.23 kg), and mean height (171.25 ± 6.41 cm). Dorsiflexors and plantarflexors’ concentric peak torque was measured at angular velocities 60 and 120°/second by using an isokinetic dynamometer. Results: At angular velocity 60°/second, the peak torque of dorsiflexors and plantarflexors of the control group was significantly higher than that of the knee OA group (P = 0.001, 0.040, respectively). At angular velocity 120°/second, the peak torque of dorsiflexors and plantarflexors of the control group was significantly higher than in the knee OA group (P = 0.001, 0.010, respectively). At angular velocities 60 and 120°/second, the dorsiflexion/plantarflexion ratio of the knee OA group was significantly lower than of the control group (P = 0.003, 0.010, respectively). Conclusions: The knee OA group displayed weakness in ankle dorsiflexor and plantarflexor muscles and a decrease in the dorsiflexion/plantarflexion strength ratio. Clinicians should consider exercises to increase ankle dorsiflexor and plantarflexor muscles’ strength when developing rehabilitation programs for patients with knee OA.