Iman Akef Khowailed

Electroencephalography to Assess Motor Control During Balance Tasks in People with Diabetes

BACKGROUND Balance is sensed through peripheral and central receptors and mediated by central control through the brain and spinal cord. Although some evidence exists as to the areas of the brain involved and how processing of data occurs in young individuals, nothing has been published on people with diabetes. The purpose of this study was to examine the electroencephalogram (EEG) during common sensorimotor and balance training tasks and to relate these to task difficulty. SUBJECTS AND METHODS Postural sway and EEG change of alpha, beta, and sigma wave bands were measured in 17 young subjects, 10 older subjects, and 10 subjects with diabetes during eight progressively more difficult balance tasks with eyes open and closed, feet in tandem or apart, and on foam or a firm surface. RESULTS EEG power of beta and sigma wave bands showed significant increases on the cortical and parietal areas of the brain relative to the control tasks when eyes were open (P<0.05). The cortical involvement decreased as the task became more difficult with vision and somatosensory information reduced, whereas that of the parietal area increased with task difficulty. The greatest increase was in subjects with diabetes, and the least was in younger people. Individuals with diabetes had increased sigma and beta EEG power in all regions of the brain examined with increased complexity of the balance task. CONCLUSIONS This study demonstrated cortical and parietal involvement in static balance tasks commonly used in sensorimotor training. The results support the proposal that there was increased subcortical control with increase in task difficulty in the young subjects, but in subjects with diabetes, there was a major increase in activity across the brain.

Six Weeks Habituation of Simulated Barefoot Running Induces Neuromuscular Adaptations and Changes in Foot Strike Patterns in Female Runners.

Background The aim of this study was to examine the effects of a 6-week training program of simulated barefoot running (SBR) on running kinetics in habitually shod (wearing shoes) female recreational runners. Material/Methods Twelve female runners age 25.7±3.4 years gradually increased running distance in Vibram FiveFingers minimal shoes over a 6-week period. The kinetic analysis of treadmill running at 10 Km/h was performed pre- and post-intervention in shod running, non-habituated SBR, and habituated SBR conditions. Spatiotemporal parameters, ground reaction force components, and electromyography (EMG) were measured in all conditions. Results Post-intervention data indicated a significant decrease across time in the habituation SBR for EMG activity of the tibialis anterior (TA) in the pre-activation and absorptive phase of running (P<0.001). A significant increase was denoted in the pre-activation amplitude of the gastrocnemius (GAS) between the shod running, unhabituated SBR, and habituated SBR. Six weeks of SBR was associated with a significant decrease in the loading rates and impact forces. Additionally, SBR significantly decrease the stride length, step duration, and flight time, and stride frequency was significantly higher compared to shod running. Conclusions The findings of this study indicate that changes in motor patterns in previously habitually shod runners are possible and can be accomplished within 6 weeks. Non-habituation SBR did not show a significant neuromuscular adaptation in the EMG activity of TA and GAS as manifested after 6 weeks of habituated SBR.

Cold Vs. Heat after Exercise—Is There a Clear Winner for Muscle Soreness

Abstract Petrofsky, JS, Khowailed, IA, Lee, H, Berk, L, Bains, GS, Akerkar, S, Shah, J, Al-Dabbak, F, and Laymon, MS. Cold vs. heat after exercise—is there a clear winner for muscle soreness. J Strength Cond Res 29(11): 3245–3252, 2015—Because of the differences in the exercise type, temperature, and timing of the use of cold and heat after exercise in different studies, there is no clear conclusion as to the efficacy of either modality on reducing delayed onset muscle soreness. One hundred subjects at similar fitness levels were examined. They accomplished leg squats for 15 minutes and heat and cold were applied after or 24 hours after exercise using ThermaCare heat or cold wraps. Measurements obtained were strength, the force to passively move the knee, analog visual pain scales, and blood myoglobin. Control subjects lost 24% strength after exercise. Subjects with heat or cold just after exercise only lost 4% strength (p < 0.01). For strength recovery, cold applied after 24 hours was better than heat at 24 hours. Heat or cold applied after exercise was significantly better to prevent elastic tissue damage (p < 0.01), whereas heat and cold immediately after exercise caused no loss in muscle myoglobin and heat or cold after 24 hours showed no less muscle damage from myoglobin than in control subjects. Myoglobin in the control and heat and cold 24-hour groups averaged 135.1% of the baseline data but averaged 106.1% of baseline in the immediate heat and cold groups. For reducing pain, control subjects showed a significant amount of pain the days after exercise. But cold immediately after exercise or 24 hours later was superior to heat in reducing pain. In conclusion, both cold and heat appear to be efficacious in reducing muscle damage after exercise.

The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness.

Objective: To assess the impact of heat applied for 8 hours immediately after or 24 hours after exercise on delayed-onset muscle soreness (DOMS) in large skeletal muscle groups measured by subjective and objective means. Design: Cross-sectional repeated measure design study. Setting: Research laboratory. Subjects: Three groups of 20 subjects, age range 20 to 40 years. Intervention: Squats were conducted in three 5-minute bouts to initiate DOMS; 3 minutes of rest separated the bouts. One group had heat applied immediately after exercise, and a second group had heat applied 24 hours after exercise. A third group was the control group where no heat was applied. Main Outcome Measures: Visual analog pain scales, muscle strength of quads, range of motion of quads, stiffness of quads (Continuous Passive Motion machine), algometer to measure quadriceps soreness, and blood myoglobin. Results: The most significant outcome was a reduction in soreness in the group that had low-temperature heat wraps applied immediately after exercise (P < 0.01). There was benefit to applying heat 24 hours after exercise, but to a smaller extent. This was corroborated by myoglobin, algometer, and stiffness data. Conclusions: Low-level continuous heat wraps left for 8 hours just after heavy exercise reduced DOMS in the population tested as assessed by subjective and objective measures. Clinical Relevance: Although cold is commonly used after heavy exercise to reduce soreness, heat applied just after exercise seems very effective in reducing soreness. Unlike cold, it increases flexibility of tissue and tissue blood flow. For joint, it is still probably better to use cold to reduce swelling.

Evidence Based use of Heat, Cold and NSAIDS for Plantar Fasciitis

Plantar Fasciitis is a possible complication in runners and even people who walk a lot. There have been numerous proposed therapies to treat this disorder but the independent effect of heat, cold and NSAIDS have not been examined without the concomitant use of other modalities. Here we examined the effect of heat, cold and Advil independently of other therapies on plantar fasciitis. Objective: Subjects with plantar fasciitis either had no intervention, cold applied 20 minutes at night before bed, or 20 minutes in the morning upon wakening or either moist heat at night or in the morning (1 hour) or dry heat (4 hours) at night for 1 day or 3 days with and without Advil. Plantar fascia swelling, tenderness and pain were evaluated. Methods: Visual analog pain scale, plantar facial thickness was measured by ultrasound as a measure of inflammation, the pressure tolerated by force on the plantar fascia from an algometer were measured first thing in the morning. An activity of Daily Living Subscale of the Foot and Ankle Ability Measure (FAAM-ADL) questionnaire was used for assessing disability. There were 99 subjects in 9 groups. All post intervention measurements were taken first thing in the morning before activity. Results: The greatest relief of symptoms was with the application of cold used at bedtime the night before the measurements, cold used in the morning was not as effective as was heat. Cold use reduced the thickness of the plantar fascia and pain. Cold plus Ibuprofen were significantly better at reducing plantar fascia symptoms than cold alone. Conclusion: Cold applied for 20 minutes prior bedtime was the most effective treatment for reduced symptomology caused by plantar fascia inflammation. Advil further reduces pain when used with cold.

Balance and Pressure Distribution under the Foot during Standing and Walking with no Orthotics Compared to Custom and off the Shelf Orthotics, A Pilot Study

Objective: Potential pain relief from foot pain can come from a shoe insert foot orthotic. This study assessed foot pressure distribution and balance in off the shelf foot orthotics versus a custom made foot orthotic compared to no orthotic. Methods: The subjects (8) were both men and women. The average age was 25.1 ± 2.8 years, the average weight was 68.8 ± 13.7 kg, and BMI 24.5 ± 6.4. Each patient was fit for both off the shelf and custom shoe insert foot orthotics and needed orthotics to reduce pain. Once fit, they were evaluated by standing and then walking 12 meters on a level surface while being monitored by a Tactilus Pressure Mapping system. Balance was also evaluated with a pressure platform during 8 balance tests. Results: With the subjects accomplishing quiet standing, the average pressure and peak pressure was shifted from the hind foot and forefoot to the mid foot when wearing foot inserts (p<0.05). During walking, the average pressure was significantly shifted from the forefoot and hind foot to the mid foot in both orthotic groups with the greatest reduction in forefoot pressure in the off the shelf orthotic group (p<0.05). This is especially seen when measuring the peak pressures on the foot, where, during standing the peak pressures on the fore foot were 20% higher with no orthotic than seen for the 2 orthotics tested here. Balance was best in the custom orthotic group while both orthotic groups had better balance than the no orthotic studies for the most difficult balance tests. Conclusion: At least in this small group of subjects, off the shelf foot orthotics help gait or balance but custom orthotics are better.

Synergistic Effects of Continuous Low Level Heat Wraps and Vitamins in Improving Balance and Gait in Adults

Ageing is associated with a loss of balance and mobility. This study was conducted to determine if the use of heat, vitamins alone or heat with vitamins could increase mobility and balance in adults with mobility impairments. Eighty adults in the age range between 55 and 64 were randomly divided into 4 different groups; low level continues heat (LLCH), vitamins (VT) alone, vitamins combined with heat (VT + H), and control group. Subjects were sedentary individuals that were not participating in any balance or walking exercises regularly and were not taking vitamins for at least 1 year. 4000 units vitamin D, 1000 units vitamin E, 300mg CoQ10, 600 mg Calcium, 1 tablet multivitamin were taken each day in the VT and VT + H groups. LLCH was applied with a dry chemical heat wrap, average temperature 42°C for 4 hours per day over the upper leg. The outcome was assessed through postural sway and tremor during standing, tremor, gait speed, symmetry, ground reaction force, and muscle activity during gait. All experimental groups showed significant improvement in balance and walking ability after 4 months of interventions (p < 0.05) but no significant changes were found in the control group. The difference between the control group and all other groups was significant (p < 0.05). The greatest improvements were found in VT + H group after 4 months. This is evidenced by better balance, less muscle tremor and faster and more stable gait, especially with the heat and vitamins used together. Heat and vitamins used together were synergistic.

Use of low level of continuous heat and Ibuprofen as an adjunct to physical therapy improves pain relief, range of motion and the compliance for home exercise in patients with nonspecific neck pain: A randomized controlled trial

BACKGROUND It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.

Sudomotor and vasomotor activity during the menstrual cycle with global heating

Many studies have reported that there are changes in sympathetic activity throughout the menstrual cycle as there are oestrogen receptor in the hypothalamus and all other parts of the sympathetic nervous system. The purpose of this study was to see whether there were variations in sympathetic activity, skin vasomotor and sweat gland sudomotor rhythms during the menstrual cycle. Eight young female subjects with a regular menstrual cycle participated in the study. Subjects were tested once during the follicular phase and once during the luteal phase. Skin blood flow and sweat rate were significantly higher in the luteal phase compared with the follicular phase (p < .05), but the frequency and magnitude of sudomotor and vasomotor rhythms were significantly greater in the follicular phase (p < .05). In contrast, spectral data showed less sympathetic activity in the luteal phase. A significant finding here is that the sudomotor rhythm of sweat glands is altered by the menstrual cycle.

Effect of Cold Wraps on Muscle Recovery after Exercise Induced Muscle Soreness

. ABSTRACT Aims: Numerous studies have been conducted on the effects of cold on muscle soreness; however, few agree on the measureable benefits of col d after exercise. Different studies apply different temperatures to the skin, for different lengths of time, and then differ greatly in how the effects of cold are evaluated. The purpose of this study was to assess the effect of a standardized cold wrap