Physical Occupational Therapy in Geriatrics, Jul 27, 2009
ABSTRACT The purpose of this study was to describe the point prevalence of gait limitations among... more ABSTRACT The purpose of this study was to describe the point prevalence of gait limitations among elderly women participating in community health screenings. Ninety-six community-dwelling women (mean age = 75.2 years) participated. Individuals were considered to have limitations if: (1) they self-reported their health limiting them when walking “a block,” “several blocks,” or “more than one mile,” or (2) their speed over 7.62 meters was below 1.22 meters/second. More elders were identified with limitations by self-report (n = 54) than by gait speed (n = 36). Using both methods, 66 elders (68.8%) were noted to have gait limitations. Interestingly, there was poor agreement (kappa = .152) between self-report and gait speed as indicators of gait limitations. Thirty women who reported walking limitations did not appear limited by virtue of the speed test and 12 women who reported no limitations did not surpass the speed criterion. If nonobvious limitations are to be identified in women attending health screenings, both self-report and measured speed may be better than either indicator alone.
Archives of orthopaedic and trauma surgery, Jan 19, 2015
To translate, culturally adapt, and validate the simple shoulder test (SST) and Oxford Shoulder S... more To translate, culturally adapt, and validate the simple shoulder test (SST) and Oxford Shoulder Score (OSS) into Persian language using a cross-sectional and prospective cohort design. A standard forward and backward translation was followed to culturally adapt the SST and the OSS into Persian language. Psychometric properties of floor and ceiling effects, construct convergent validity, discriminant validity, internal consistency reliability, test-retest reliability, standard error of the measurement (SEM), smallest detectable change (SDC), and factor structure were determined. One hundred patients with shoulder disorders and 50 healthy subjects participated in the study. The PSST and the POSS showed no missing responses. No floor or ceiling effects were observed. Both the PSST and POSS detected differences between patients and healthy subjects supporting their discriminant validity. Construct convergent validity was confirmed by a very good correlation between the PSST and POSS (r ...
Spasticity is a common impairment following upper motor neuron lesions such as stroke. The approp... more Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measurement of muscle spasticity using validated tools to evaluate the outcome of therapies is important in clinical and research settings. To determine the concurrent criterion-related validity of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor muscle spasticity based on its correlation with H-reflex tests. A total of 20 adult patients poststroke underwent clinical and electrophysiological assessment of wrist flexor muscle spasticity on the affected side. The primary outcome measures were: R2-R1 of the MTS; and the H-reflex indices of Hmax/Mmax ratio and Hslp/Mslp ratio. The Hslp and the latency of H-reflex were also measured. Correlations tests did not reveal significant associations between the clinical and H-reflex tests. This study suggests that the MTS may not be a valid tool to evaluate muscle spasticity in this sample of patients after stroke.
The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ash... more The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the upper limb of patients with hemiparesis and to determine the effect of pain and contracture presence on the reliability of the MMAS. For this test-retest study 30 patients with hemiparesis were included. One physiotherapist using the MMAS, randomly rated the spasticity of shoulder adductors, elbow flexors, and wrist flexors in the affected upper limb of each patient with hemiparesis twice with at least a 1 week interval between testing sessions. The presence of pain and contracture during passive stretch was recorded. The magnitude of the contracture was measured by a goniometer. The quadratic weighted kappa statistics was very good for the upper limb spasticity (κw= 0.84). Intra-rater reliability was good for shoulder adductors (κw=0.75), and very good for elbow flexors and wrist flexors (κw 0.86 and 0.90, respectively). There were no differences between the we...
The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sens... more The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sensibility in patients with Carpal Tunnel Syndrome (CTS). No study has investigated the relationship between the SWMT and sensory nerve conduction studies (SNCS) in patients with CTS. To assess the relationship between the SWMT and SNCS findings in patients with CTS. This cross-sectional clinical measurement study included 35 patients with CTS (55 hands) with a mean age of 45 ± 12 years. The outcome measures were the SWMT and SNCS measures of distal latency (DLs), amplitude (AMPs), and nerve conduction velocity (NCV). The median innervated fingers were tested using SWMT and electrodiagnostic tests. The primary outcome was the correlations between the SWMTs and NCS measures. All of the patients/hands had abnormal NCS findings. When looking at the three digits of interest (thumb, index and middle), the thumb SWMTs had the highest number of abnormal findings (58.2%), with the middle digit havi...
Spasticity is a common symptom that can be detrimental to the quality of life and daily function ... more Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke. To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic. The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax/Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2). The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax/Mm...
Spasticity is a common impairment following upper motor neuron lesions such as stroke. The approp... more Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measurement of muscle spasticity using validated tools to evaluate the outcome of therapies is important in clinical and research settings. To determine the concurrent criterion-related validity of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor muscle spasticity based on its correlation with H-reflex tests. A total of 20 adult patients poststroke underwent clinical and electrophysiological assessment of wrist flexor muscle spasticity on the affected side. The primary outcome measures were: R2-R1 of the MTS; and the H-reflex indices of Hmax/Mmax ratio and Hslp/Mslp ratio. The Hslp and the latency of H-reflex were also measured. Correlations tests did not reveal significant associations between the clinical and H-reflex tests. This study suggests that the MTS may not be a valid tool to evaluate muscle spasticity in this sample of patients after stroke.
International Journal of Therapy and Rehabilitation, 2013
). Parents and therapists classified 100 children (4-18 years, mean age of 8.13 years, SD=3.40, 6... more ). Parents and therapists classified 100 children (4-18 years, mean age of 8.13 years, SD=3.40, 63 boys, 37 girls) with various types of CP using MACS. Additional data on the Gross Motor Function Classification System (GMFCS), and accompanying conditions were also collected. Findings: The inter-rater reliability was high; the ICC was 0.96 (ranged between 0.94-0.97) among occupational therapists and parents. The ICC for the test-retest reliability was high; the ICC related to parents was 0.97 (ranged between 0.95-0.98) and the ICC related to occupational therapists was 0.97 (ranged between 0.96-0.98). Discussion: The Persian version of MACS is found to be valid and reliable, and is suggested to be appropriate for assessing the manual ability of children with CP within the Iranian population.
Journal of geriatric physical therapy (2001), 2005
There is a societal trend toward increasing obesity and a natural tendency for physical performan... more There is a societal trend toward increasing obesity and a natural tendency for physical performance to decrease with age. Our purpose was to describe the adiposity of elderly women participating in a health screening and to determine the relationship between their adiposity and both observed and self-reported physical performance. Subjects were 104 communitydwelling elderly women (74.9+/-7.5 years). Their adiposity was described using body mass index (BMI), waist circumference, and waist to hip ratio. Physical performance was characterized using timed sit-to-stand, unilateral standing, 25-foot walk and the Physical Functioning subscale of the SF-36. Habitual activity was summarized as the number of daily hours patients estimated they spent moving about on their feet. The majority of women had excessive adiposity. Greater adiposity was associated with worse physical performance. Both Pearson correlations and multiple regression revealed BMI to be significantly predictive of all physi...
This case report demonstrates that pulsed ultrasound (US), when used for a total of 20 treatment ... more This case report demonstrates that pulsed ultrasound (US), when used for a total of 20 treatment sessions, provided symptom relief to a patient with chronic rhinosinusitis (CRS). A 16-year-old boy with a 12-month history of rhinosinusitis and candidate for sinus surgery was referred for ultrasound therapy. He presented with facial pain/ pressure, nasal obstruction, and postnasal drip (total sinusitis score57). On computed tomographic (CT) scanning, the total opacification of the right maxillary sinus was observed. The ostiomeatal complex was occluded (total CT score56). Pulsed ultrasound was administered three times a week, every other day. After 10 treatment sessions, his symptoms were resolved with exception of nasal obstruction being mild (total sinusitis score52). On CT scan, right maxillary sinus showed partial improvement (total CT score52). After additional 10 treatments, the nasal obstruction was resolved, and follow-up CT scan of his sinuses showed that right maxillary sinus was clear and normal. At 6-month follow-up, the positive effects were maintained and the patient reported no recurrence of symptoms. Twenty sessions of pulsed ultrasound therapy eradicated the CRS and resolved the symptoms.
Low back pain (LBP) is a common and often disabling condition that deserves attention. Although L... more Low back pain (LBP) is a common and often disabling condition that deserves attention. Although LBP during pregnancy is a common clinical problem, only one study was found documenting prevalence of LBP during pregnancy in Iran. No investigation evaluated the diagnostic value of possible risk factors. The aims of the present, cross-sectional study were 1) to ascertain the prevalence of LBP of Iranian women during pregnancy and compare to other ethnic/cultural groups and 2) identify risk factors associated with LBP during pregnancy in Iranian women. One hundred three women were interviewed in the obstetric ward of a university hospital within 48 hours after giving birth. Possible risk factor associations were studied by using nonparametric tests, and sensitivity, specificity, positive and negative predictive, and likelihood ratio values were calculated for the interview questions about previous low back pain, LBP during menstruation, and trauma during pregnancy. The prevalence of LBP during pregnancy was found to be 57.3%, which is similar to most other countries. Pain onset was most frequently reported in the third trimester of pregnancy (40.7%) and was often reported to be in the low back area (71.2%). Almost half of the patients reported their pain as being moderate (44.1%). The logistic regression model demonstrated that the LBP during menstruation predicts a high risk for LBP during the current pregnancy. The study showed that LBP during menstruation and previous LBP may be useful tests for ruling out and ruling in LBP during pregnancy, respectively.
Physical Occupational Therapy in Geriatrics, Jul 27, 2009
ABSTRACT The purpose of this study was to describe the point prevalence of gait limitations among... more ABSTRACT The purpose of this study was to describe the point prevalence of gait limitations among elderly women participating in community health screenings. Ninety-six community-dwelling women (mean age = 75.2 years) participated. Individuals were considered to have limitations if: (1) they self-reported their health limiting them when walking “a block,” “several blocks,” or “more than one mile,” or (2) their speed over 7.62 meters was below 1.22 meters/second. More elders were identified with limitations by self-report (n = 54) than by gait speed (n = 36). Using both methods, 66 elders (68.8%) were noted to have gait limitations. Interestingly, there was poor agreement (kappa = .152) between self-report and gait speed as indicators of gait limitations. Thirty women who reported walking limitations did not appear limited by virtue of the speed test and 12 women who reported no limitations did not surpass the speed criterion. If nonobvious limitations are to be identified in women attending health screenings, both self-report and measured speed may be better than either indicator alone.
Archives of orthopaedic and trauma surgery, Jan 19, 2015
To translate, culturally adapt, and validate the simple shoulder test (SST) and Oxford Shoulder S... more To translate, culturally adapt, and validate the simple shoulder test (SST) and Oxford Shoulder Score (OSS) into Persian language using a cross-sectional and prospective cohort design. A standard forward and backward translation was followed to culturally adapt the SST and the OSS into Persian language. Psychometric properties of floor and ceiling effects, construct convergent validity, discriminant validity, internal consistency reliability, test-retest reliability, standard error of the measurement (SEM), smallest detectable change (SDC), and factor structure were determined. One hundred patients with shoulder disorders and 50 healthy subjects participated in the study. The PSST and the POSS showed no missing responses. No floor or ceiling effects were observed. Both the PSST and POSS detected differences between patients and healthy subjects supporting their discriminant validity. Construct convergent validity was confirmed by a very good correlation between the PSST and POSS (r ...
Spasticity is a common impairment following upper motor neuron lesions such as stroke. The approp... more Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measurement of muscle spasticity using validated tools to evaluate the outcome of therapies is important in clinical and research settings. To determine the concurrent criterion-related validity of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor muscle spasticity based on its correlation with H-reflex tests. A total of 20 adult patients poststroke underwent clinical and electrophysiological assessment of wrist flexor muscle spasticity on the affected side. The primary outcome measures were: R2-R1 of the MTS; and the H-reflex indices of Hmax/Mmax ratio and Hslp/Mslp ratio. The Hslp and the latency of H-reflex were also measured. Correlations tests did not reveal significant associations between the clinical and H-reflex tests. This study suggests that the MTS may not be a valid tool to evaluate muscle spasticity in this sample of patients after stroke.
The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ash... more The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the upper limb of patients with hemiparesis and to determine the effect of pain and contracture presence on the reliability of the MMAS. For this test-retest study 30 patients with hemiparesis were included. One physiotherapist using the MMAS, randomly rated the spasticity of shoulder adductors, elbow flexors, and wrist flexors in the affected upper limb of each patient with hemiparesis twice with at least a 1 week interval between testing sessions. The presence of pain and contracture during passive stretch was recorded. The magnitude of the contracture was measured by a goniometer. The quadratic weighted kappa statistics was very good for the upper limb spasticity (κw= 0.84). Intra-rater reliability was good for shoulder adductors (κw=0.75), and very good for elbow flexors and wrist flexors (κw 0.86 and 0.90, respectively). There were no differences between the we...
The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sens... more The Semmes-Weinstein Monofilament Test (SWMT) is a clinical widely used test to quantify the sensibility in patients with Carpal Tunnel Syndrome (CTS). No study has investigated the relationship between the SWMT and sensory nerve conduction studies (SNCS) in patients with CTS. To assess the relationship between the SWMT and SNCS findings in patients with CTS. This cross-sectional clinical measurement study included 35 patients with CTS (55 hands) with a mean age of 45 ± 12 years. The outcome measures were the SWMT and SNCS measures of distal latency (DLs), amplitude (AMPs), and nerve conduction velocity (NCV). The median innervated fingers were tested using SWMT and electrodiagnostic tests. The primary outcome was the correlations between the SWMTs and NCS measures. All of the patients/hands had abnormal NCS findings. When looking at the three digits of interest (thumb, index and middle), the thumb SWMTs had the highest number of abnormal findings (58.2%), with the middle digit havi...
Spasticity is a common symptom that can be detrimental to the quality of life and daily function ... more Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke. To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic. The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax/Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2). The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax/Mm...
Spasticity is a common impairment following upper motor neuron lesions such as stroke. The approp... more Spasticity is a common impairment following upper motor neuron lesions such as stroke. The appropriate measurement of muscle spasticity using validated tools to evaluate the outcome of therapies is important in clinical and research settings. To determine the concurrent criterion-related validity of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor muscle spasticity based on its correlation with H-reflex tests. A total of 20 adult patients poststroke underwent clinical and electrophysiological assessment of wrist flexor muscle spasticity on the affected side. The primary outcome measures were: R2-R1 of the MTS; and the H-reflex indices of Hmax/Mmax ratio and Hslp/Mslp ratio. The Hslp and the latency of H-reflex were also measured. Correlations tests did not reveal significant associations between the clinical and H-reflex tests. This study suggests that the MTS may not be a valid tool to evaluate muscle spasticity in this sample of patients after stroke.
International Journal of Therapy and Rehabilitation, 2013
). Parents and therapists classified 100 children (4-18 years, mean age of 8.13 years, SD=3.40, 6... more ). Parents and therapists classified 100 children (4-18 years, mean age of 8.13 years, SD=3.40, 63 boys, 37 girls) with various types of CP using MACS. Additional data on the Gross Motor Function Classification System (GMFCS), and accompanying conditions were also collected. Findings: The inter-rater reliability was high; the ICC was 0.96 (ranged between 0.94-0.97) among occupational therapists and parents. The ICC for the test-retest reliability was high; the ICC related to parents was 0.97 (ranged between 0.95-0.98) and the ICC related to occupational therapists was 0.97 (ranged between 0.96-0.98). Discussion: The Persian version of MACS is found to be valid and reliable, and is suggested to be appropriate for assessing the manual ability of children with CP within the Iranian population.
Journal of geriatric physical therapy (2001), 2005
There is a societal trend toward increasing obesity and a natural tendency for physical performan... more There is a societal trend toward increasing obesity and a natural tendency for physical performance to decrease with age. Our purpose was to describe the adiposity of elderly women participating in a health screening and to determine the relationship between their adiposity and both observed and self-reported physical performance. Subjects were 104 communitydwelling elderly women (74.9+/-7.5 years). Their adiposity was described using body mass index (BMI), waist circumference, and waist to hip ratio. Physical performance was characterized using timed sit-to-stand, unilateral standing, 25-foot walk and the Physical Functioning subscale of the SF-36. Habitual activity was summarized as the number of daily hours patients estimated they spent moving about on their feet. The majority of women had excessive adiposity. Greater adiposity was associated with worse physical performance. Both Pearson correlations and multiple regression revealed BMI to be significantly predictive of all physi...
This case report demonstrates that pulsed ultrasound (US), when used for a total of 20 treatment ... more This case report demonstrates that pulsed ultrasound (US), when used for a total of 20 treatment sessions, provided symptom relief to a patient with chronic rhinosinusitis (CRS). A 16-year-old boy with a 12-month history of rhinosinusitis and candidate for sinus surgery was referred for ultrasound therapy. He presented with facial pain/ pressure, nasal obstruction, and postnasal drip (total sinusitis score57). On computed tomographic (CT) scanning, the total opacification of the right maxillary sinus was observed. The ostiomeatal complex was occluded (total CT score56). Pulsed ultrasound was administered three times a week, every other day. After 10 treatment sessions, his symptoms were resolved with exception of nasal obstruction being mild (total sinusitis score52). On CT scan, right maxillary sinus showed partial improvement (total CT score52). After additional 10 treatments, the nasal obstruction was resolved, and follow-up CT scan of his sinuses showed that right maxillary sinus was clear and normal. At 6-month follow-up, the positive effects were maintained and the patient reported no recurrence of symptoms. Twenty sessions of pulsed ultrasound therapy eradicated the CRS and resolved the symptoms.
Low back pain (LBP) is a common and often disabling condition that deserves attention. Although L... more Low back pain (LBP) is a common and often disabling condition that deserves attention. Although LBP during pregnancy is a common clinical problem, only one study was found documenting prevalence of LBP during pregnancy in Iran. No investigation evaluated the diagnostic value of possible risk factors. The aims of the present, cross-sectional study were 1) to ascertain the prevalence of LBP of Iranian women during pregnancy and compare to other ethnic/cultural groups and 2) identify risk factors associated with LBP during pregnancy in Iranian women. One hundred three women were interviewed in the obstetric ward of a university hospital within 48 hours after giving birth. Possible risk factor associations were studied by using nonparametric tests, and sensitivity, specificity, positive and negative predictive, and likelihood ratio values were calculated for the interview questions about previous low back pain, LBP during menstruation, and trauma during pregnancy. The prevalence of LBP during pregnancy was found to be 57.3%, which is similar to most other countries. Pain onset was most frequently reported in the third trimester of pregnancy (40.7%) and was often reported to be in the low back area (71.2%). Almost half of the patients reported their pain as being moderate (44.1%). The logistic regression model demonstrated that the LBP during menstruation predicts a high risk for LBP during the current pregnancy. The study showed that LBP during menstruation and previous LBP may be useful tests for ruling out and ruling in LBP during pregnancy, respectively.
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