The 20^th International Scientific Conference Faculty of Physical Therapy Cairo, 6-7 April, 2019

Conference studies

Prepared by

Nerveen Abd El Salam Abd El Kader Ahmed

Abstract

Background: Premenstrual Syndrome (PMS) is a set of physical, emotional and behavioral symptom that start during the week preceding menstruation and are alleviated when the menstrual flow begins. Reflexology is one of the most popular complementary therapies. As it stimulates the release of endorphins, the body's painkilling chemicals and diet rich in vitamins and calcium, decrease in oil and restrict caffeine also used in treatment. Purpose: This study was aimed to determine the effect of foot reflexology in the treatment of premenstrual syndrome. Subjects and methods: Fifty volunteer, single females with premenstrual syndrome (PMS) were selected randomly from outpatient clinic of obstetrics and gynecology in Abnub Hospital in Assuit to share in this study, their age ranged from 18 to 25 years old and their body mass index (BMI) did not exceed 30kg/m², the participants were assigned into two groups of equal numbers. The group (A) received therapeutic foot reflexology with dietary modification 3 times/week for8 weeks, while the group (B) received dietary modifications only for 8 weeks. All subjects in both groups were assessed through the visual analogue scale (VAS) for pain. Premenstrual Daily Symptoms Questionnaire for (PMS) related symptoms. Results: The results of the present study revealed that there was statistically significant improvement in both pain and premenstrual related symptoms in group (A) than in group (B).Conclusion: Foot reflexology with dietary modification is an effective method for reducing symptoms associated with premenstrual syndrome.

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Background: Patients with vestibular dysfunction complain of vertigo or dizziness, which may affect balance and quality of life and activities of daily living. Vestibular Rehabilitation Therapy (VRT) aims at teaching the brain to use other senses such as vision and somatosensory to compensate for vestibular damage or hypofunction to alleviate vertigo or dizziness. This therapy includes various exercises such as adaptation, habituation, sensory substitution, balance and gait training. Methods: The following five electronic databases were searched from inception to November 2018:  PEDro, PubMed, Scopus, Web of Science and Cochrane for relevant Randomized Controlled Trials (RCT). Further, manual search of bibliography and snowballing were done on eligible studies from the electronic search. Quality assessment of all eligible studies was done using the PEDro scale. The Primary outcomes were dizziness, vertigo and balance. Secondary outcomes were quality of life or any other functional outcomes. Results: Three articles with 125 patients met our inclusion criteria. Dizziness Handicapped Inventory (DHI) was the main scale that measure dizziness in all included studies. Balance was measured by Posturography, Berg Balance Scale and other scales and tests. According to PEDro scale, two studies were of high quality and one of a moderate quality. All included studies showed significant differences between VRT group and control group in favor of VRT group in dizziness, vertigo and balance. Conclusion: there is a limited evidence to support the effectiveness of VRT in treating patients suffering from central vertigo or dizziness. More high-quality clinical trials are needed to confirm this finding.

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Background: Impaired posture is strongly associated with function particularly in parkinsonian patients. Objective: to detect the effect of sensory integration training on postural instability in elderly parkinsonian patients following stereotactic surgery. Methods: The study was conducted in out-patients clinic of the Faculty of Physical Therapy, Modern University for Technology and Information, Cairo, Egypt during the period from January 2018 to august 2018. Twenty seven patient's (16 males and11 females) idiopathic Parkinson’s disease were included in the study, age 63.07 ± 2.46 years old. The duration of illness ranges from 5 years till 16 years. The patients were assessed before and after twelve weeks by the postural stability test, times up and go test and the unified Parkinson’s disease rating scale. Participants were randomly assigned into three groups each group included nine patients, Group I received sensory integration training, Group II underwent stereotactic surgery and Group III received sensory integration training after ten days postoperative to stereotactic surgery. Results: There was significant improvement in group III more than in group I and II concerning the Overall stability Index, Ant./Post. and Med./Lat. Index. Conclusion: combining sensory integration training following stereotactic surgery is effective on postural instability in elderly with parkinsonian disease.

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The application of total quality management standards in Egyptian physiotherapy colleges.

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Keywords: Parkinsonian patients, Sensory integration and Stereotactic Aerobic Versus Resisted Exercises on Glycemic Level in Juvenile.

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Background: One of the main aging biological changes is bone deterioration which affected more by estrogen deficiency in elderly women, Parathyroid hormone is one of the osteoporotic indicesand a major regulator of bone metabolism and calcium homeostasis, the objective is to determine the response of parathyroid hormone and total calcium level to moderate aerobic training in elderly. Methods: Thirty five female subjects were selected from out-patient clinic in Um El-Masryeen General Hospital /Giza/Egypt, Their age ranged between 60 to 70 years with mean age is 64.45, and study was conducted between October 2017 and April 2018. All subjects had participated in moderate intensity aerobic training calculated as 60% to 70% of their predetermined maximum heart rate. The program was applied for three times per week for 12 weeks. Parathyroid hormone and calcium level were measured before and after the training program in laboratory analysis. Results: Statistical analysis showed a significant decrease in parathyroid hormone by 5.98% and a significant increase in total calcium level in the blood by 0.44%. Conclusion: It was concluded that moderate aerobic training decrease parathyroid hormone and increase total calcium serum level in elderly.

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Background:children with spastic hemiplegia had disabilities of the upper extremities such as reaching, grasping, and object manipulation result in dependency in daily activities and a lack of successful social integration. Spasticity and decreased activity contribute to muscle weakness and imbalance, muscle atrophy resulting from disuse, muscle contracture, and a reduced range of motion in joints. Purpose: to compare muscle thickness in normal children and spastic hemiplegic cerebral palsy children. Subjects and methods:35 children from both sexes with age range from 2 to 5 years included in this study and divided into two groups. Group (A) included 15 normal children and Group (B) included 20 children with hemiplegic cerebral palsy with spasticity grade 1 and 1+ according to Modified Ashworth scale. Subjects excluded from this study whom had any problems of the following: Recent skin injury, bony joint limitation, and children who take antiepileptic drugs or peak action is at the time of assessment of spasticity. Ultrasonography used to assess muscle thickness. Results: there was statistical significant difference between normal group and spastic group regarding muscle thickness of biceps brachii. Conclusion: According to the results we can conclude that muscle thickness of biceps brachii was lower than in age-matched normal children. Furthermore, it is noted with confidence that a significant positive correlation existed between muscle thickness and functional level.

Keywords:  Cerebral palsy, Hemiplegia, Muscle thickness, Ultrasonography, Normal children.

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Background:Obesity in childhood could affect quality of life in different patterns. There is little existing information about the health related quality of life (HRQOL) of obese children in Egypt. The aim of this study was to evaluate the effect of obesity onHRQOL.Methods: This cross sectional study was carried out on 182 children aged from eleven to fourteen years selected from public governmental schools at EL-Mansoura City from September 2018 to January 2019 . They were assigned into two groups : study group (n= 102) ; boys (n=48) girls (n=54) and control group (n=80); boys (n=42) girls (n=38).Only obese children of nutritional cause of obesity were included. The body mass index of obese children ≥ 95^th percentile and that of  the normal weight children equal to 5^th percentile to less than 85^th percentileaccording to Centers for Disease Control and Prevention growth charts. Their weight and height were assessed by StandardWeight and height measuring scale and BMI was calculated by dividing weight (Kg) by height squared (m²) (kg/m²). HRQOL was assessed by Pediatric quality of life inventory Generic core scale version 4(PedsQL ™). Results: The results showed that Mean ± standard deviation of weight and BMI of study and control groups were significantly different. The scores of all domains of HRQOL between both groups were significantly different. There was a negative correlation between all the scores of HRQOL and BMI. Conclusion: The obesity in children had a negative impact on their quality of life.

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Background :Core stability training is used to improve limitations with postural control in children with cerebral palsy. It likes a corset that works to stabilize the center of the body against external perturbations. The purpose of the current systematic review was to evaluate the effectiveness of core stability training on postural control. Methods: A systematic review was conducted through Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology and American Academy of Cerebral Palsy and Developmental Medicine. Four databases (Pub Med ,Cochrane Library, Pedro and Google Scholar) were searched using the following keywords (“core stability “) AND (cerebral palsy OR hemiplegia OR diplegia) AND (Postural control OR balance OR equilibrium). Articles were assessed according to their level of evidence and conduct rating. Results: Seven articles were included in this review. The whole number of participants was 162 participants with age ranged from 1 to 18 years. Level of evidence ranged from I to V, and the conduct rating ranged from strong to weak. All studies underwent descriptive analysis due to the heterogeneity of the primary and secondary outcomes. Core stability training resulted in improvement in primary outcomes (postural control, static balance, dynamic balance), And secondary outcomes (shoulder stability, diaphragmatic motion, trunk endurance and gait. Conclusion : Core stability training could be considered for included  in rehabilitation programs for children with spastic CP as all reviewed studies showed significant improvements of all variables although of improvements we still needed more trials due to heterogeneity of  studies

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Key Words: Lung squeezing technique, Neonates, Respiratory distress syndrome , Vital signs ,X-ray findings.

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Background: Pressure sores are an important source of complications in patients who are immobilized and bedridden. The prevalence of Pressure ulcers stage two or greater is between 8.1% and 12.9%. We aimed to investigate the efficiency of magnetic field treatment in pressure sores. Methods: This was a case control study, Female of 40 years complains from ischial pressure ulcer with history of spinal cord injury, in the study magneto-therapy, once a day for 30 minutes and with 90G, magneto-therapy device’s program. The surface areas of the pressure sores were evaluated at the onset of the treatment (1st day), and on the 4th and 30th days. Results: a significant difference was observed between the 1st and 4th day. In addition, there was a significant difference in the scar area. Conclusion: The healing process of the tissue can be accelerated. With the use of magneto therapy in the treatment of pressure sores of stage IV.

Key Words: Magnetic field treatment, pressure sore, spinal cord injury.

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Background.Laser acupuncture has produced promising results in the management of many medical conditions; it has been used as a non-invasive therapy with no puncture pain which represents a major advantage over traditional acupuncture or electroacupuncture. Methods.This study aims to investigate the effect of Aluminum Gallium Arsenide (AlGaAs) LASER acupuncture on the lower limb blood supply and functional walking ability in patients with peripheral arterial disease (PAD). Thirty male patients with PAD were recruited from Kasr El-ainy Hospital, and were randomly divided into two groups: study group (n=15) and control group (n=15). Both groups received the routine medical treatment whereas study group received laser acupuncture therapy twice weekly for five weeks. Ankle brachial pressure index (ABPI), six-minute walk test (6MWT) and rating of perceived exertion using modified Borg scale were measured. Results. The results showed that laser acupuncture has induced highly statistically significant improvements in all the measured outcomes (p < 0.01). However, results revealed no significant difference between the two groups except for modified Borg scale. Conclusion. Accordingly, AlGa As Laser acupuncture could be an effective non-pharmacological intervention for improving circulation and functional walking performance in PAD patients and may be recommended as a complementary therapy in the management protocols of PAD.

Keywords: Laser acupuncture; peripheral arterial disease; ABPI; 6-MWT.

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Background: Changes in joint positions have been reported to affect nerve mobility and adaptability. Purpose: To investigate the influence of different ankle positions on tibial nerve conduction velocity. Methods: This study   was conducted on sixty healthy participants from both sexes (age30.35±6.1years, weight58.28±9.93kg, height1.67±0.11m and BMI 20.82±1.46 kg/m²). Tibial nerve motor distal latencies were recorded  using Neuropack S1MEB-9004 Nihon Koden Japan from different ankle positions (neutral,  20º ankle dorsiflexion and 40º ankle plantarflexion) Results: showed a  significant  effect for ankle positions in motor distal latency of both lateral and medial branches of tibial nerve in favor  of neutral ankle position compared with other positions  Plantarflexionand dorsiflexion, the mean values of motor   distal latency of both lateral and medial branhes for  neutral ankle position were(4.62±0.87,4.57±0.89)respectively,plantarflexion were(5.06±0.81,5.24±0.83) respectively, and dorsiflexion were(5.64±0.92,6.03±0.93) Conclusion: Ankle neutral position is the most convenient position for assessing tibial nerve conduction velocity and it is the most appropriate position for reduce tibial nerve entrapment ,while prolonged ankle dorsiflexion positionshoud be avoided to redue risk of tibial nerve entrapment . 

Keywords: Ankle positions, Nerve conduction velocity,Tibial nerve

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Background: Upper limb paresisis a common problem in patients with stroke. Although it is known that trunk control is an integral part of shoulder stability, the effect of core muscle training program on upper limb function is not well established till now so our Purpose to determine the effect of core muscle training on upper limb function in hemiparetic patients.Methods:30 patients with hemiparesis, with mean age 56.9±7.24years with mean duration of illness2.66±1.34years.They assigned into two equal groups method of allocation was concealed in sequentially numbered, sealed envelopes, the control group GA: 15patients received only conventional physical therapy program (stretching for shoulder muscles, active resisted exercises for shoulder and trunk control exercises), the study group GB: 15patients received conventional physical therapy program and additional core muscle training. Patients received 18 sessions for 6 weeks, three sessions/week. The upper limb function was assessed using Wolf motor function test with subscales (function ability scale, time and grip strength), the range of motion of shoulder flexion and abduction was measured by using goniometer. Results: There was no statistical significant difference between two groups in pretreatment assessment using wolf motor function test and shoulder range of motion. In post treatment assessment there was no statistical significant difference between group GA and GB in all the outcome measures. Conclusion: Core muscle training is similar to conventional physical therapy program in improving upper limb function in hemiparetic patients.

Key words: Hemiparesis - Upper Limb Function- Core Muscle Training

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Key words: Aerobic Exercise; Hysterectomy; Premature menopause.

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Keywords: Genu valgum, tibio femoral angle, sacral angle

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Influence Of Transcranial Direct Current Stimulation On Depression In Stroke Patient

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Keywords: Chronic low back pain; Proprioception; Reposition error; Smartphone.

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Key words: Myofascial Release Technique, Mulligan Mobilization Technique, Post-natal low back pain.

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Background: Postpartum lumbopelvic pain is a serious problem for women, as it has an effect on their performance of the daily living activities so that it has an effect on her family and society. Purpose: This study was conducted to compare the effect of Electroacupuncture and Low Level Laser Therapyon post-natal low back pain. Subjects: Fifty primegravidae or multigravidae postnatal women complained of low back pain selected randomly from physical therapy department in Al Zahraa University Hospital. Their ages ranged from 25 to 35 years old. Their body mass index was not exceeding 30 kg/m². They were medically stable and consented to participate in the study. They did not receive any medical treatment during the research period. They were divided into two equal groups (A&B).Group A: 25 women treated by Electroacupuncture three times a week for sex weeks. Group B: 25 women treated by Low Level Laser Therapy three times a week for sex weeks. Methods: Visual analogue scale (VAS) was used to measure pain intensity and Oswestry Disability Questionnaire was used to assess functional disability for both groups (A&B) before and after treatment. Results: The results of this study found that, within groups there was a statistically highly significant decrease (P = 0.001) in low back pain intensity and functional disability in both groups (A&B). Between groups the obtained results showed there was no statistically significant difference in low back pain intensity and functional disability pre treatment. But post treatment there was a statistically highly significant difference in low back pain intensity and functional disability between both groups (more decrease in group A). Conclusion: Electroacupunctureis more effective in reducing pain and improving functional status by decreasing disability of patients with post natal low back pain than Low Level Laser Therapy.

Key words: Electroacupuncture- Low level laser therapy- Post natal low back pain.

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Key words: Diabetic foot, light therapy, ulcers.

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Purpose: This study was done to investigate the effect of sustained weight on correction of drop shoulder in hemiplegic cerebral palsy children. Participant and Methods: Thirty children with spastic hemiplegia enrolled in this study, their age ranged from 3 to 8 years and being assessed by posture zone software. They were randomly assigned into two groups of equal numbers 15 children each. The control group (A) received a designed physical therapy program and the study group (B) received the same therapy program in addition to sustained weight (2% out of the total body weight) placed on top of the dropped affected shoulder.Results: Comparison of post treatment results between the control and study groups revealeda significant difference between post treatment mean values of shoulders level angle in favour of the study group.Conclusion: From the obtained results it could be concluded that sustained weight of about 2% of the total body weight has a beneficial effect on drop shoulder in children with spastic hemiplegia.

Key Words: Hemiplegia, Spastic children, Drop shoulder, Sustained weight.

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Background: Proper hand function is a must for everyday life activities. However, post stroke, muscle contracture and joint stiffness develop as a common consequence of immobility in hemiplegic hand.This study aimed to investigate the effect of adding mobilization to task oriented training to help stroke patients in reaching a satisfactory level of recovery for their hand function. Methods: Thirty stroke patients were participated in this study and randomly divided into two equal groups; group A, which received mobilization followed by task oriented training and group B, which received task oriented training only. Both groups received treatment three times per week for a period of six weeks. All patients were evaluated before and after therapy for hand function, active and passive wrist extension range of motion, and grip strength. Results: The results of this study showed that post treatment; there was a statistically significant difference (P<0.05) between both groups regarding all outcome measures in favor to the study group (A). Conclusion: The present study revealed that mobilization is effective intervention in improving hand function post stroke and the combination between mobilization and task oriented training is more effective in improving hand function post stroke than task oriented training alone.

Keywords: Hand function, Mobilization, Stroke, Task oriented training.
 

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Exercise intolerance is a symptom of heart failure and associated with increased disability and mortality. Cardiacremodeling is manifested clinically as changes in size, shape, and function of the heart. Exercise training has been shown to induce reverse remodeling in stable CHF patients. This study was aimed to determine the efficacy of different aerobic exercise training intensities on left ventricular remodeling, and Quality of Life (Minnesota Living With Heart Failure Questionnaire) in chronic heart failure patients. Forty five eligible male patients with chronic heart failure secondary to ischemic heart disease were selected from National Heart Institute, heart failure outpatient clinic. Their ages ranged from 50-60 years old and their ejection fraction ranged from 30-40%, they were randomly assigned into threeequal groups: HIT Group: High Intensity aerobic Training. (n=15) MIT Group: moderate Intensity aerobic Training. .(n=15)LIT Group: low Intensity aerobic Training. (n=15) in the form of bicycle ergometer exercise for the lower limbs three times /week for three months Before and after intervention, the following parameters were obtained: Echocardiograph parameter (EF%, LVEDD,LVESD,FS) and (MLWHFQ). The results revealed greater improvement in HIT group ( in EF%, and MLWHF).

Keywords: chronic heart failure, ventricular remodeling, aerobic exercises, Quality of Life.
 

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Background: Lateral ankle sprain is a common injury, with an incidence of 7 per 1000 exposures. Sprain may persist leading to chronic ankle instability (CAI), which is believed to arise from dysfunctional postural control, defective proprioception, muscle weakness, or reduced ankle range of motion. Thus, assessment of postural control is essential for proper clinical decision-making and treatment selection. With advances in technology, Smartphone has been used to assess the musculoskeletal system. Ithas the advantages of being portable and economic. Yet, further validation is needed to allow its use in clinical settings. Therefore, the purpose of this study was to assess the concurrent validity of a Smartphone application in assessing balance in patients with CAI. Methods: Twenty-four participants; 10 patients (14 ankles with CAI) and 14 healthy volunteers(28 ankles) were enrolled in this study. Alltesting procedures were conducted in accordance to and approved by the local ethics committee. Balance was measured during single leg stance (with eyes opened and closed) simultaneously by the Smartphone application “MyAnkle” and the Biodex balance system. Testing was done bilaterally in a random order. All data were collected by an assessor who was blind to participants’ grouping and limb condition. To establish validity, Spearman’s rank correlation coefficients was used to test the association between the application score and the overall stability index of the Biodex system. Results: For patients group, the correlation between measurements done by the two devices was insignificant weak for both limbs in both eye conditions (opened and closed). For healthy volunteers, the dominant limb showed significant correlation when the eyes were closed (r =0.56, p = 0.037), however, the relation was insignificant and weak for the eye-opened condition and for non-dominant limb in the two eye conditions (r<0.5, p>0.05). Conclusion: With the available number, the Smartphone application is not valid compared to the Biodex system in assessing balance in patients with CAI. For healthy volunteers, validity is dependent on eye-condition and limb dominance.
 

Key words: validity, balance, Smartphone.
 

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Background: Psoriasis is a chronic inflammatory skin condition that is often associated with systemic manifestations. It is considered as a genetic, immunological, systemic disorder with a prevalence of 1–3% Psoriasis Area and Severity Index is the most commonly used measure to investigate the severity and coverage of psoriasis, and the improvement after therapy. Purpose: To culturally translate and validate the Arabic version of Psoriasis Area and Severity Index scale (and evaluate the test-retest reliability , internal consistency, construct validity ceiling or floor effects of this instruments) in patients with psoraisis to measure psoriasis severity in psorisas patient and to ensure better care delivery. Subject and Methods: One expert panel (each consists of ten experts) and 50 patients with psoriasis participated in this study. Forward translation, development of preliminary initially translated version, backward translation, and development of the pre-final version and testing of pre-final version using experts then testing of the final version on patients were done. Clarity index, expert proportion of clearance, index of content validity, expert proportion of relevance, descriptive statistics, missed item index, time taken to answer the scale, Cronbach’s coefficient alpha and Spearman’s rank correlation coefficients were used for statistical analysis. Results: The scale index of clarity equaled 89%, while The S-CVI equaled 86.5%. With regard to internal consistency, the Cronbach's alpha equaled 0.598 (range from 0.487 to 0.660). In addition, the Spearman’s rank correlations were moderate to strong in the majority of items. Conclusion: The Arabic Psoriasis Area and Severity Index scale is a valid and reliable tool and is comparable to the original English version and other translated versions.
 

Keywords: Validity- Reliability- Arabic Psoriasis Area and Severity Index scale of psoriasis.
 

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Background: Low bone mineral density in children with cerebral palsy (CP) can increase risk of fracture, chronic bone pain and it can result in a significant impact on quality of life; many interventions have been intended to improve low bone mineral density. Aim of the study: To systematically review the effect of physical therapy interventions on low bone mineral density in children with CP. Methods: Articles were identified through literature search using Pub Med (MEDLINE), physiotherapy evidenced at abase (PEDro) and Cochrane database from 1999 up to December 2018 and through reference list of the included studies and library search at Faculty of Physical Therapy, Cairo University from July to December 2018.Studies were included if they were randomized trials focused on children with CP and low bone mineral density; treated with physical therapy intervention. Data from included studies was extracted and it smethodological quality was assessed using PEDro scale. The modified Sackett scale was used to assess level of evidence of each intervention. Results: Ten trials were identified with fair to good methodological quality. Studies were heterogeneous in regards to population characteristics, interventions or outcome measures; findings were qualitatively analyzed. There were strong evidence supporting the use of weight bearing and vibration; moderate evidence for magnetic and electro-therapy and suit therapy; while limited evidence about the use of virtual cycling to improve bone density in children with cerebral palsy. Conclusion: The present evidence supports the effectiveness of physical therapy interventions for improving bone mineral density in children with cerebral palsy.

Keywords: Bone Density-Cerebral palsy- Children -Systematic review.

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Background: Children with diplegic cerebral palsy commonly exhibit sensory deficiencies in their hands in addition to motor problems. Impaired sensations negatively impact on acquisition of skilled movement which decreasing daily self-care activities and school activities. So the aim of the study was to assess the effect of sensorimotor stimulation on manual dexterity and handgrip strength in diplegic cerebral palsy children. Subjects and methods: Thirty diplegic cerebral palsy children were randomly allocated into two equal groups received successive three months intervention. Control group received designed occupational therapy program only, while study group received designed occupational therapy program in addition to sensory and perceptual stimulation program. Manual dexterity and grip strength were assessed by Bruinink-Oseretsky test and hand dynamometer, respectively. Results: data analyzed by paired t-testto compare the data within group and unpaired t-testto compare the data between both groups (study and control). There was a statistically significant improvement post-treatment in manual dexterity and handgrip strength in both groups and a statistically significant improvement in study group more than in control group. Conclusion: Sensorimotor stimulation had positive significant effect on manual dexterity (117.04%-46.82%) in study and control groups respectively and positive significant effect on hand grip strength (82.5%-38.91%)in the study and control groups respectively in children with diplegia.

Key words: diplegic cerebral palsy, sensorimotor, manual dexterity, grip strength.
 

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Keywords: Scoliosis; Scoliometer HD; School screening; Forward bending.

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Background: Recently, an association between chronic neck pain and deterioration in pulmonary functions has been reported. There have been recent suggestions to add respiratory assessment to the routine physiotherapy assessment for chronic neck pain patients. The purpose of this study was to assess Diaphragmatic thickness fraction (DTF) in patients with chronic neck pain and to investigate for a correlation between DTF and neck pain symptoms or daily life disabilities caused by neck pain. Methods: Fifty subjects with chronic neck pain were recruited to this study (10 male and 40 female). The mean value of age of the subjects was 41.14±8.11 years; the mean value of BMI was 25.57±2.85,and the mean value of neck pain duration was3.62±5.3 years. The inclusion criteria were middle-aged patients, both males and females, patients with nonspecific chronic neck pain, and patients with craniovertebral angle of less than 50 degrees. The exclusion criteria were patients with neck pain due to disc prolapsed or trauma, patients with cardiopulmonary problems, or smokers. The outcome measures in this study were DTF measured by ultrasonography, Visual Analogue Scale (VAS) for pain, and Arabic version of Neck Disability Index (NDI). Results: The mean DTF was 114.8±40 % in patients with chronic neck pain. DTF had no significant correlation either with VAS for neck pain (r=0.04, p=0.781), or NDI (r=o.14, p=0.331). Conclusions: DTF is not affected in middle-aged adults with chronic neck pain, and is not correlated with neck pain and/or neck disabilities in daily life.
 

Keyword: Chronic neck pain, forward head posture, diaphragmatic function.
 

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Background and Objective: Postoperative lymphedema post mastectomy is a secondary lymphedema, that alters lymph drainage of the breast, thoracic quadrants, and upper limbs. Its signs and symptoms include increased weight of the limb; paresthesia of the hand; stiffness of fingers; reduced range of motion and muscle weakness of upper so the aim of this study was to compare the effect of Nordic walking and muscle strength of upper limb post mastectomy. Materials and Methods:forty female patients 6 months post mastectomy, their ages between 45 to 60 years old, were defined as havingupper limb lymphedema and muscle weakness. The study was conducted from February 2016 to January 2018 .The subjects recruited and underwent physical exam at surgery clinic in National Cancer Institute. The patients were randomly divided into two groups (A, B). Each group consisted of 20 patients. Group (A) received Nordic walking and traditional physical therapy for 8 weeks/ 2 sessions per week , group (B) received resistance exercise and traditional physical therapy for 8 weeks / 5 sessions per week, all patients were assessed pre and post treatment for these variables: Lymphedema measurements size and volume and Peak torque of shoulder extensors and flexors. Results: Statistical analysis revealed that there was a significant improvement in both groups in lymphedema measurement and peak torque of shoulder extensors and flexors pre and post values but group (B) which was resistance exercises had a superior effect on peak toque of shoulder extensors and flexors. There was no significant difference between both groups in lymphedema size. Conclusion: group (B) had a superior effect in muscle strength than Group (A) and no significant difference in lymphedema measurements between both groups.
Key words: Nordic walking, resistance exercises, lymphedema, upper limb muscle weakness.
 

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OBJECTIVE: The purpose of this study was to identify the difference between single and dual task outcomes and compare the dual task outcomes before and after training program. DESIGN: A randomized controlled trial. SETTING: Faculty of Physical Therapy at Cairo University. PARTICIPANTS: Twenty two females young adults with normal vision and hearing. Participant ages from 20-25 years old. INTERVENTIONS: Participants were randomly assigned to 2equal groups (control group involves single-task training, and study group involves dual-task training). The participant in the control group received balance exercise only, whereas participant in the study group received balance exercise combined with cognitive training via specific designed program. Participants received 45 minutes individualized training sessions, 5 times a week for 6 weeks. MAIN OUTCOME MEASURES: Biodex system 3 isokinetic dynamometer, was used to assess dynamic balance including one axis velocity, directional control, rhythmic weight shift, and tandem walk in addition to the Montreal Cognitive Assessment (MoCA), Maslach Burnout Inventory (MBI), and 6-miute walk test were also used. RESULTS: There was significant difference between both groups at all different tests. but the improvement was significantly higher in the study group compared to the control group (p < 0.001). CONCLUSIONS: Dual-task training is effective in improving postural control in adult females. Explicit instruction regarding intentional focus is an important factor contributing to the rate of learning and postural control.

KEYWORDS: Postural control, Single task, Dual-Task, Cognitive training, Biodex system.
 

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Background: Cerebral palsy is a common condition that has devastating effects on a child’s ability to use hands. Either static or dynamic hand splints intervention often used to address deficits in upper limb skills. Aim: the purpose of the current study was to investigate the effect of combining both dynamic and static splints on improving hand function and grip strength, in children with hemiplegic Cerebral palsy. Subjects and Procedures: Twenty-four children (8 boys and 16 girls) ranged in age between 30 to 45 months old, free from contractures at the wrist or elbow joints, were participated in this study. They were randomly assigned equally into control group ( that was treated by static splint) and study group (that received a combined dynamic and static splinting) Evaluation of hand grip strength using handheld dynamometer and hand function performance detected by Peabody was done at baseline and after 12-weeks of treatment application, Results: Post treatment mean values of grasping and object manipulation skills showed a statistically significant difference( p>0.05) within and between control and study groups while mean value of grip strength showed insignificant difference in grip strength (p<0.05) between both groups. Conclusion: Combined effects of dynamic and static splint have been appeared to be most beneficial on improving hand function in children with hemiplegic CP .
 

Keywords: static, dynamic splinting, cerebral Palsy, hand function performance, grip strength.
 

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Background: Extensive use of smart phones can be associated with physical health related problems, such as pain in the wrists and neck and exposes hands to intense stresses that may lead to hand and thumb disorders. Purpose: to investigate the effect of extensive use of smart phones on the functions of the upper extremity, median and ulnar conduction velocity and hand grip strength. Design of the study: Cross-sectional design. Methods: one hundred normal subjects with their age ranging from 18 to 25 years were divided into two equal groups. Group A represented the extensive smart phone users for minimum 3-6 hours per day while Group B represented the non-extensive smart phone users for less than 2 hours per day. Electromyography was used for measuring conduction velocities of the median and ulnar nerves, hand dynamometer was used to measure hand grip strength and disabilities of arm, shoulder and hand scale (DASH) was used for assessment of upper extremity function.
Results: The results showed that there were statistical significant decrease in conduction velocity of ulnar nerve at forearm level (p=0.0001) and prolonged motor and sensory distal latencies of median nerve (p=0.0001) in group A while there were no statistical significant differences regarding hand grip strength (p=0.999) and DASH scale (p=0.980). Conclusion: Extensive usage of smart phones affects conduction velocity of ulnar nerve at forearm and delay sensory and motor distal latencies of median nerve.
 

Keywords: DASH scale, extensive Smartphone use, hand grip strength, nerve conduction velocity.
 

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Background: The evidence of intensive intervention is not well defined while it is used by many therapists forchildren with cerebral palsy. Asthey expect some effect of intensive therapy. The aim of the study is to evaluate the short term effect of intensive physical therapy on gross motor functionsin children with spastic diaplegic cerebral palsy. Methods: 20 spastic diplegic children of 2-4 years old were randomly assigned into two equal groups (control and study).  intensive therapy program was applied to study group for four hours per day for 5days per week. The motor functions of all children were evaluated using Gross Motor Function Measure-88 (GMFM-88) scale before and after three weeks of the intervention. Results: The scores of  GMFM-88 increased in both groups when comparing between before and after intervention with significant difference between study and control groups after intervension (P < 0.001).Conclusion:  The intensive therapy might be effective on gross motor functions of children with spastic diplegic cerebral palsy.

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Background: It is observed that upper extremity lymphedema is one of the most prevalent complications following breast cancer surgery which prompts functional impairment, psychological disaster and social problems. Thepurpose of the study was to investigate the effect of Kinesio taping on secondary lymphedema of the upper extremity following mastectomy after breast cancer. Material and Methods: In this experimental study, 33women with lymphedema following mastectomy received Kinesio taping (KT). The KT application was 2 times per week for 3 weeks. All patients were evaluated to record the changes of the limb circumference, at baseline and end of intervention. Results: Sum of limb circumferences was significantly improved after treatment as compared with before treatment in the KT group (P<0.05). Conclusion: Kinesio Taping is an advanced therapeutic approach in the treatment of subjects with lymphedema after mastectomy that has problems with other modalities.  

Keywords: Kinesio taping; lymphedema; Mastectomy; Breast cancer; Limb measurement.

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Background: Shoulder disorders problem is a common, disabling condition which affects large population and causes many functional impairments. So it is important to measure the pain, satisfaction and function of the shoulder joint. Purpose: The purpose of this study was to translate and adapt the Penn Shoulder Score into Arabic and to investigate the face validity, content validity, internal consistency reliability, the feasibility and test retest reliability of Arabic version of Penn Shoulder Score as a score to assess the pain, satisfaction and functional activity of the shoulder joint in patients with different shoulder disorders, Subjects and methods: One expert panel; consists of ten experts and 250 patients with different shoulder disorders participated in this study, 510 sheets (including retest sheets) were filled out in this study. Forward translation, development of preliminary initially translated version, backward translation, development of the pre-final version and testing of the pre-final version by experts then testing of the final version on patients was done. Clarity index, expert proportion of clearance, index of  content validity, expert proportion of relevance, descriptive statistics, missed items index, time taken to answer the score and Cronbach`s coefficient alpha were applied for statistical analysis. Results: The studyshowed that score index of clarity equals 89.58%, scale-level clarity index Universal Agreement equals 75% and the mean of proportion of clearance (clear responses) equals 93.75%. Also Scale-Level Index of Content Validity equals 87.5%, Scale-Level Index of Content Validity / Universal Agreement equals 58.33% and the mean of proportion of relevance (relevant responses) equals 100%. The score items were filled out by 95.3% in all sheets and it needed an average of 4.8-14.8 minutes to be answered in about 100% of all sheets. Cronbach's alpha equals 0.955. Conclusion: The translated Arabic-Language version of the Penn Shoulder Score has a face and content validity, feasibility, internal consistency and test-retest reliability enough for research and clinical application as a score to assess the pain, satisfaction and functional activity of the shoulder joint in patients with different shoulder disorders.

Keywords: Validity  -  Reliability  -  Feasibility  -  Penn Shoulder Score.

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Background: The use of Transcranial Direct Current stimulation (tDCS) in cognition improvement in children with attention deficit hyperactivity disorder is new, and thus the scientific evidence for its effectiveness needs to be evaluated through a systematic review. Objective: To provide updated evidence-based guidance for tDCS effects on cognition in children with attention deficit hyperactivity disorder. Data synthesis: Six studies included 133 participants in total. Best evidence synthesis was applied to summarize the outcomes, which were memory performance, intrinsic alertness, performing time and commission errors. Conclusion: the available datademonstrated the efficacy of tDCS as a new modality on cognition in children with attension deficit hyperactivity disorder has an immediate and short term effect on improving cognition .Further studies are still needed, especially those involving both neurophysiological and functional evaluations and to cover further domain on attension deficit hyperactivity disorder.

Keywords:
transcranial direct current stimulation, tDCS, cognition, attention deficit hyperactivity disorder, ADHD, children and adolescents.
 

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Background:Breast feeding maintains the maternal foetus link favours the transmission of immune-competence from the mother to her infant and is considered an important contributory factor to the neo natal immune defence system.
Purpose: This study was conducted to investigate the effect of relaxation techniques on female milk secretion.
Subjects and methods:
Six weeks postpartum, 30 sedentary women whose infants, their age was ranged between 20-30 years and body mass index didn't exceed 30Kg/m2 participated in this study. They were exclusively breast-feed andrandomlyassigned to an study group (15 women) received breast feeding and nutritional advice in addition to relaxation training program for 45 minutes per day, 3 days per week, for 6 weeks or a control group (15 women) recieved breast feeding and nutritional advice only. Blood cortisol was assessed at base line and after 6 weeks.
Results: Women in group A had a lower level of blood cortisol than women in the control group (17.85 ± 0.47 vs 18.99 ± 0.58 mcg/dL).
Conclusion :relaxationtraining during lactation ,decreased blood cortisol level and enhance milk secretion.
Key Words: Relaxation Techniques, cortisol, Breast Milk
 

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Background: Dysmenorrhea is chronic, cyclical pelvic pain associated with menstruation. Typically, it is characterized by cramping lower abdominal pain occurring just before and/or during menstruation, usually starting soon after menarche once regular ovulation is established. Aim: To determine the effect of foot reflexology versus aerobic exercises on female with primary dysmenorrhea. Subjects: A sample of 40 females diagnosed with primary dysmenorrhea was selected from Gynecology department at Om El-Masryeen General Hospital. Their ages ranged between 16-23 years and body mass index (BMI) 20-25 kg/m2. They were randomly assigned into 2 groups equal in number (A&B). Group (A) performed aerobic exercises for 30 min on treadmill and group (B) recieved foot reflexology sessions for 40 min. The treatment program was performed 3 times\week for 8 weeks for both groups. Assessment of all subjects in both groups was carried out before and after 8 weeks of the treatment program throughout visual analogue scale (VAS) to measure pain intensity , analysis of blood cortisol level and Spielberger State –Trait Anxiety Inventory scale (STAI). Results: showed that post-treatment a statistical significant decrease in the median value of pain on VAS (p<0.033) STAI (p<0.0430) and serum cortisol level( p<.0038) with more decrease in group (B) than group (A). Conclusion: Both aerobic exercises and foot reflexology could decrease dysmenorrhea pain but foot reflexology is more recommended.
Keywords: Primary dysmenorrhea, Foot reflexology, Aerobic exercises.
 

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Background: The large majorities of children with cerebral palsy (CP) demonstrate poor balance, that leads to poor gait and reaching movements as the maintenance of stability is critical to all movements. There are various approaches and strategies to improve balance; virtual reality is one of them. Therefore, this study aimed to evaluate the effects of virtual reality training on balance in spastic hemiplegic cerebral palsied children. Methods: Thirty children who fulfilled the inclusion criteria were randomly allocated into two groups (control and study). Participants in both groups received a selected therapeutic exercise program. The study group additionally received balance training on Nintendo Wii device. Total treatment provided for both groups was 90 min/day, 3 days/week for 4 successive months. Baseline and post-treatment assessment for overall, anteroposterior, andmediolateral stability indices were evaluated by using Biodex balance system. Results: Children in both groups showed significant improvements in post-treatment mean values of all measured variables when compared to the pre-treatment mean values (p<0.05). Significant improvement was observed in favor of the study group when post treatment values of both groups were compared (p< 0.05). Conclusion: Balance training on Nintendo Wii device is a useful tool that can be used in improving balance in children with hemiplegic cerebral palsy.
 

Keywords: Cerebral palsy, Balance, Virtual Reality.
 

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Background: Shifting from the supine to the upright position is a great challenge to both women in labour and health workers in practice. Aim: This study was conducted to determine the effect of upright versus recumbent positions during first stage of labour on labour outcomes. Subjects: Sixty women between 37-41 weeks gestational ages in active phase of first stage of labour participated in this study. They were selective randomly from Benha University Hospital. Their ages ranged from 18-35 years old and their BMI were not more than 35kg/m2. They were with single live fetus and their fetus was in cephalic presentation. They were without any pregnancy or medical complications. Women were randomly assigned into equal groups: Group A (Upright group) consisted of thirty women who adopted the upright positions. Group B (Recumbent group) consisted of thirty women who remained in bed (supine or sidelying positions). Methods: Duration of stages of labour was assessed using stop watch. Diastolic blood pressure was assessed by using sphygmomanometer at the beginning and after 2, 4, 6, 8 hours of first stage of labour for both groups A and B. Results: revealed that duration of first, second and third stage of labour of upright group decreased significantly than recumbent group. Diastolic blood pressure was decreased significantly in (recumbent) group B than (upright) group A. All women in both groups A and B delivered normal labour with episiotomy (100%) and none of them delivered instrumental or caesarean deliveries (0%). Conclusion: Upright positions had positive effect on progress of labor and decreased duration of the three stages of labour.
 

Keywords: Upright positions, Recumbent positions, Labour, Labour outcomes.
 

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Background: Cervical radiculopathy is a sensorimotor deficit syndrome that can cause of pain, numbness, and tingling in the upper extremity to electrical type pains or even weakness. Dentistry demands high accuracy and dentists frequently assum a rotated and forward head posture. This produces high static load in the neck region; with extended work duration, this static load may result in neck pain, muscle imbalance or cervical instability. Aim of this study: was toinvestigate the effect of cervical radiculopathy on handgrip strength in egyptian dentists. Participants and method: Case control study was used. One hundred right handed dentists were selected from different hospitals with age ranging from 25 to 35 years old and with work experience from 5 to 15 years. Dentists were then stratified into two groups; cervical radiculopathy group A that was confirmed with a positive Spurling sign as well as a score above 30 of neck disability index. Both groups handgrip strength was measured by Jamar handgrip dynamometer .group B consists of normal healthy dentists have experienced no pain 3 months prior to the study. Results: There was a significant decrease of the handgrip strength in group A when compared with that of group B (p< 0.0001). Conclusion: based on the findings of this study, our results conclude that there was a significant decrease of the handgrip strength in dentists suffering from unilateral cervical radiculopathy when compared to healthy pain free dentists.
 

Keywords: cervical radiculopathy, hand grip, dynamometer
 

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Background: Menopause is defined as the permanent cessation of menstrual periods that occurs naturally or is induced by surgery, chemotherapy, or radiation. Purpose: This current study was designed to investigate and compare the effect of aerobic exercise training, isoflavone supplementation and aerobic exercise training with isoflavone supplementation on lipids in post-menopausal women. Subjects and Methods: This study was conducted in Mashtoul Hospital Central Market, El Sharkeya. And outpatient clinics from Mansoura Hospital. Sixty post-menopausal women participated in the study. Patients were randomly divided into three equal groups, for 12 weeks, post 1 after 8 weeks, post 2 after 4 weeks from post: Group (A) (aerobic exercises group), Group (B) (isoflavone supplementation group) and Group (C) (combination group). Results: The mean age of group A, B and C were 52.15 ± 4.17, 49.8 ± 5.25 and 50.9 ± 4.08 respectively, all groups showed significant improvement in low density lipoprotein, Height density lipoprotein, triglycerides and total cholesterol regarding pre-values, post 1 value and post 2 values (P> 0.05), also there is statistically significant difference between the three groups in post 1 value and post 2 values (P> 0.05) in all groups favouring group C over the others, Conclusion: we could conclude that there is statistically significant effect of exercise training, isoflavone supplementation and exercise training combined with isoflavone supplementation on lipids in postmenopausal women but combined technique express better results.

Keywords: Aerobic Exercise, Training Combined, Isoflavone Supplementation, Postmenopausal Women.
 

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Background: Irregular heart rate (HR) and heart rate variability (HRV) are common problems among children with cerebral palsy (CP) which may be associated with low physical tolerance. The aim of the current study was to investigate the response of HR and HRV at rest, during submaximal cycle ergo-meter and at first and second minutes rest post exercise in children with CP. Methods: Thirty children with spastic CP of both sexes, aged from 7 to 11 years were participated in the present cross-sectional study. They were divided into two equal groups (15 children in each group); A and B. Children with spastic hemiplegia were allocated to group A while children with spastic diplegiawere allocated to group B. HR and HRV were assessed and monitored by the Polar Advanced Heart Rate Monitor (RC800CX) at four-time intervals. Four-time intervals were; five minutes rest pre cycle ergo-meter, during last stage of submaximal cycle ergo-meter, and at first and second minutes rest post cycle ergo-meter. Results: The results of the current study revealed that, in group A there were significant difference in HR and HRV between the four-time intervals (p=0.001,0.0001) respectively. Also in group B there were significant difference in HR and HRV between four-time intervals (p=0.001, 0.0001) respectively. Conclusion: In children with CP, HR and HRV responded to submaximal cycle ergo-meter.

Keywords: Cerebral palsy, Heart rate, Heart rate variability, Submaximal cycle ergo-meter.
 

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Background: Hemiplegic children present with weakness and motor skill deficits on one side of the body. Muscle performance elements are strength, power and endurance which are affected in all cases of hemiplegia. the aim of this study is to determine the effect of whole body vibration (WBV) on quadriceps muscle performance in hemiparetic children. Methods: Forty hemiparetic children were selected from the outpatient clinic of the Faculty of physical therapy, Cairo University and private clinics. The children were grade 1to1+ according to modified ashwarth scale and their ages ranged from 4to8 years, They were assigned into two groups of equal numbers study and control groups. The control group received selected physical therapy program and study group received the same selected program as control group plus vibration programboth groups received treatment 3 times/week for two successive months, Lafayette device was used to asses quadriceps muscle strength, six minute walk test (6MWT) was used to asses endurance and vertical jump test was used to asses average power. Results: There were no significant differences in Quadriceps force, 6MWT and average power between both groups pre-treatment (p > 0.05). Comparison between the control and study groups post treatment revealed that there were significant increase in Quadriceps force, 6MWT and average power in the study group compared with that of the control group (p > 0.05). Conclusion: the study indicates that WBV has beneficial effect on quadriceps muscle performance, so its highly recommended in physical therapy treatment program.
 

Keywords: cerebral palsy, whole body vibration, muscle performance, quadriceps, children.
 

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