مهدی عبدالوهاب

Importance of upper limb function is clear in creating individual autonomy and daily activities. In this context, the role of dexterity is debatable in meeting of this important requirement since; after stroke major problems are occurred in hand function in particular dexterity. The present study, studied the effect of progressive resistance exercise on strength and dexterity of upper limb among adult hemiplegic patients.

This interventional research was performed on 17 adult hemiplegic patients after approving by TUMS ethical committee. After consent and introducing of test method, isometric strength of shoulder extensor and abductor muscles was evaluated by manual muscle assessment (MMT) and Pinch muscles strength by Pinch Gauge and Grip muscles strength by Jamar Dynamometer in kilograms and dexterity rate was evaluated by Minnesota manual dexterity test based on number in seconds and the results were recorded. Clients benefited from 6 intervention weeks. The resistance was offered to patients was set by weights which were attached to pulley. They were evaluated every two weeks and with the isometric muscle strength development more resistant is created in sinkers weight.

Results of this study showed that, after intervention period, progressive resistance exercises led to significant improvements in shoulder abductor and extensor muscles isometric strength, Pinch and Grip muscles strength and dexterity variables (P =0 / 000).

Present study showed that in rehabilitation of hemiplegia, to increase shoulder extensor and abductor muscles isometric strengths, Pinch and Grip muscles strength and finally improvement of hand function, especially dexterity can utilize in treatment of progressive resistance exercises.

Improving the affecting factors of balance could be a critical procedure in managing the elderly''s balance dysfunction. The goal of this study is to find out how and to which amount a prolonged period of stretch and massage impact on elderly''s balance.

In this RCT study with a simple randomized case selection، 205 normal subjects screened and after that، 18 subject (74. 6 5. 45 Years) for intervention group and 17 (75. 8± 4. 27 Years) subjects for control group contributed for the study. The procedure was 15 sessions in 5 weeks (3 sessions per week). Each session last about 1 hour. Berg Balance Scale (BBS) and Timed Up and Go (TUG) were used for evaluation of balance.

Using by SPSS-19 software and after independent T-test، significant differences in balance scales were found between the intervention and the control groups (p<0. 05).

According to present evidence، stretch and massage are significantly effective on elderly''s balance function.

Cerebral palsy (CP) is a neurodevelopmental disorder caused by nonprogressive lesions. This disorder produces motor impairment deficits in early infancy. Hand function is essential in performing activities of daily living for everyone، including individuals with cerebral palsy. Adequate first web space is essential for web space expansion، thumb abduction، and a wide range of thumb mobility and hand function. The purpose of this study was to determine the effects of C-bar splint on hand function and strength and also wrist and thumb range of motion (ROM) of dominant hand of 8-12 years old children with spastic diplegic cerebral palsy.

The design of this study was before- after and quasi-experimental. According with inclusion criteria، 8 to 12 years old children with spastic diplegia from physical – motor special school at Tehran (8 boys and 5 girls)، were studied. They used a C-bar splint (40 degree of palmer abduction of thumb) for 8 weeks (6-8 hours during day and 4-6 hours at night). In this study، hand function was evaluated by Jebsen Taylor Hand Function Test، hand strength by MIE dynamometer and thumb & wrist ROM by Goniometer. During intervention، they received routine occupational therapy program.

The results of this study showed significant improvement in hand function (P=0. 001)، and thumb range of motion (P=0. 02). The data did not show any significant improvement in wrist ROM and hand strength.

According to the result of this study، it seems that using C-bar splint can be an effective method in improvement of hand function and thumb ROM in 8-12 years old children with spastic diplegia.

Rehabilitation interventions have significant role in reducing the disabilities of Down syndrome. Due to great role of balance in the function of individuals particularly in Activity of Daily Living and the effect of strength on balance، the aim of this study was to investigate the effects of Progressive Resistive Exercise on functional balance in children with Down syndrome.

Fifteen girls children aged between 8 and 12 years، with Down syndrome participated in this study by available sampling method. The subjects participated three times per week in a six-week progressive strengthening program. During intervention، 3 of them excluded. Balance were measured by Berg Balance Scale and right/left hip abductor and flexor، knee extensor and flexor muscles isometric strengths were measured by Nickolas hand-held dynamometer. Paired-sampled T-Test was used for data analysis.

The results of this study showed that the mean of functional balance and muscles isometric strengths were significantly increased after intervention (P<0. 001).

It seems that the results of this study confirm the effect of progressive resistance training on progressing functional balance، and 8-12 years old children with Down syndrome can benefit from these exercises.

The role of function of upper extremity in activity of daily living is critical and any impairment of function could cause major problems for diplegic spastic cerebral palsy (CP) patients. So, the application of rehabilitation protocols that could regain the hand function is very important.The purpose of this study was to explore the effects of simultaneous activation of exteroception and proprioception on function of upper extremity in children with diplegic spastic CP, 3-7 years old.

Thirteen CP patients (3-7 years; mean: 4.92 years; 4 boys and 9 girls) were participated in this study. Simultaneous activation of exteroception and proprioception were done 3 times a week (for 8 weeks). Function of upper extremity was evaluated by Quest Test and the degree of spasticity in wrist was evaluated by Modified Ashworth Scale.

The results of this study showed that after simultaneous activation of exteroception and proprioception, function of upper extremity was significantly improved (P<0.001). In addition, degree of spasticity in wrist muscles was significantly decreased (P<0.022).

Based on results of current study, it might be suggested that simultaneous activation of exteroception and proprioception could improve the function of upper extremity and decrease of spasticity. This in respect could reduce the disabilities of patients. So, the application of current protocols for the patients is suggested.

Physical disabilities are the most common side effects of Cerebro Vascular Accident (CVA) in adults. Hemiplegics individuals experience a wide range of functional disabilities including upper limb disabilities. Therefore, rehabilitation treatments are quit important in this regard. The aim of this study was to assess the correlation between pinch and grip strengths with dexterity in adult hemiplegia.

This cross-sectional study was carried out on 34 adult hemiplegic patients. All procedures were approved by ethical committee of Tehran University of Medical Sciences and written consents were also taken. Patients were familiarized with the procedure, pinch and grip strengths were measured by dynamometer according to the amount of kilograms and dexterity has evaluated by Minnesota manual dexterity test based on the number of seconds. Finally, the relationship of these factors was studied.

Age range of patients in this study was 50-70 years (mean= 62.4±7.2 years). The average elapsed time from stroke was 22.3±10.4 months and all of the patients were right dominancy. There was a significant relationship between dexterity with grip strength (p=0.000) and pinch strength (p=0.008) in patients. However, no significant relationship was observed between age of patient and the elapsed time from stroke.

Pinch and grip strengths have a significant relationship with dexterity in hemiplegic patients. Hence, any disturbance in dexterity could affect on the function and activity of daily living in this group of patients.

in hemiplegic children Postural tone of the two sides of body is different. Once, asymmetric stance is a typical state in individual's with unilateral pain and/or paresis and standing is with weight bearing on the stronger side. Obviously, an asymmetric stance with majority of weight bearing on the affected side can counter faces individual with the falling risk and causes instability. It seems coordinating of the two sides of body is the most vitally important therapeutic exercises in hemiplegic patients. Although stable stance is a simple postural task but it's controlled semi-automatically by cortical and spinal centers. It is established that stable standing, also demands cognition resources. So, postural control demands the interaction between musculoskeletal and nervous systems.

In this clinical trial (before-after) 17 children 5-12 years old with spastic hemiplegia were participated. The subjects stayed in the center of force plate with the most stable standing position while using /not-using lateral wedge and in each state with/without doing cognition task. Short- memory test of digit span used as dual task condition. The mean range of fore-after and mediolateral sway and velocity and area as postural control independent variables and error measures in recalling of randomized digit chain as cognition task independent variables were registered.

The wedge affected Rsw (P=0.015), Area (P=0.007) and Vm (P=0.005) significantly. Dual task also had significant effect on Rfa (P=0.014), Rsw (P=0.014), Area (P=0.002) and Vm (P=0.002). But the wedge declines its effect properly.

: The results represent that a 5º lateral wedge applied to the unaffected limb, can improve factors of postural control even in Dual tasking; thus The wedge can be used with a good effect on the posture of hemiplegic children.