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Osteoporosis is a widespread skeletal condition due to decreased muscle strength and bone density. The most common complications are fractures followed by pain and reduced quality of life (QoL). Therefore, this research aimed to examine the effect of exercise therapy on muscle strength, QoL, and bone mass in osteoporotic women.

Available literature was reviewed using ScienceDirect, PubMed, Google Scholar, and Cochrane. Studies were considered eligible if they were randomized controlled trials (RCT) conducted on postmenopausal osteoporotic women, used exercise therapy as an intervention, and investigated muscle strength, QoL, and bone mass as outcomes. Two authors independently assessed the quality of the articles using the physiotherapy evidence database (PEDro) scale. The Cohen’s d effect size was computed by dividing the mean standardized difference by the standard deviation to measure the treatment effect, which includes exercise therapy.

Seven papers were chosen to be included in this research. Their PEDro scores varied between 6 and 9 out of a possible 10. The effect size mean differences, resulting from exercise therapy, ranged from 0.32 to 0.63, indicating “small” to “moderate” effects in enhancing the condition of osteoporotic postmenopausal women. It was reported that there was a small effect size in 5 studies and a medium effect size in 2 studies. The research findings suggested the effect of balance, strengthening, stretching, stability, and motor control exercises on bone mass and muscle strength in osteoporotic postmenopausal women.

Findings indicate that exercise therapy interventions positively affect muscular strength, QoL, and bone mass in osteoporotic postmenopausal women. Additional well-conducted research is required to support this assumption further.

Balance disorder in patients with stroke can cause the loss of independence and increase possibility of falling. The olfactory stimuli can activate the brain areas involved in balance activities. This study aims to investigate the effect of balance exercises combined with olfactory stimuli on the balance of patients with stroke.

In this randomized clinical trial, 32 patients with stroke were randomly assigned into groups of balance+olfactory stimulation and balance. The first group performed the balance exercises while wearing a mask containing the lavender essential oil. The second group performed the balance exercises while wearing a mask containing distilled water. Both groups performed the exercises for 20 min at one session. The timed up & go (TUG) test, 10-m walk test with self-selected speed, and Mini-Balance Evaluation Systems Test (Mini-BEST) were used for assessments. The data were analyzed in SPSS software, version 22. P<0.05 was statistically significant.

The mean score of 10-m walk test before and after the intervention was significantly different (decreased) in the combined group (P=0.001) and balance group (P<0.001). The mean TUG score before and after the intervention was also significantly different (decreased) in the combined group (P= 0.008) and balance group (P=0.003). The mean score of mini-BEST before and after the intervention was also significantly different (increased) in the combined group (P=0.001) and balance group (P= 0.008). No significant difference was observed in the mean scores of 10-m walk test (P=0.386), TUG test (P=0.720) and mini-BEST (P=0.152) between the two groups before and after the intervention.

One session of balance exercise can improve the static and dynamic balances of patients with stroke. Including the olfactory stimulation by the lavender essential oil in the balance exercise program has no significant effect. It is recommended that the effects of long-term use of different olfactory stimuli on the balance of patients with stroke should be investigated in the future studies.

 Spasticity is one of the components of an Upper Motor Neuron (UMN) lesion that occurs usually after a period of flaccidity in the form of velocity-dependent resistance to passive stretch. Spasticity is a significant cause of limited mobility and disability in neurological diseases. There are several clinical approaches to control spasticity. Recently, Shock Wave Therapy (SWT) has been reported to be a new, safe, and effective method for reducing spasticity for people with upper motor neuron lesions. We conducted a meta-analysis of relevant clinical trials to assess the effect of applying SWT on spasticity in UMN lesions. 

An electronic search was performed in PubMed, ISI Web of Science, Scopus, Science Direct, MEDLINE, and Google scholar from January 2005 to January 2020. Studies were included if they measured spasticity with the Modified Ashworth Scale (MAS) or/and neurophysiological indices in patients with stroke, multiple sclerosis, and cerebral palsy. The keywords of muscle hypertonia or spasticity, extracorporeal shock wave therapy, stroke, multiple sclerosis, and cerebral palsy were used. Two independent researchers searched articles, screened eligible studies against the inclusion criteria, and assessed the methodological quality of included studies. The methodological quality of studies was evaluated using the Downs and Black tool. The difference between the means was considered as the effect size in the MAS and Hoffman reflex/motor response (H/M) ratio before and after the intervention with 95% CI in random-effects models. Analyzes were performed using STATA software version 11.

 The initial search led to the retrieval of 98 studies based on the inclusion and exclusion criteria, of which 24 full-text articles were reviewed and 14 articles were included in the meta-analysis process. All 14 articles had examined the effects of shockwave on the MAS. Four studies with 120 patients had examined the effects of shockwave therapy on the H/M ratio. Significant reduction in MAS grade was observed immediately [I2 = 100%, P<0.001, SMD=1.38 with 95%CI: (0.80, 1.87)] and three months after SWT [I2 = 100%, P<0.001, SMD=1.13 with 95%CI: (0.50, 1.76)] in comparison with the baseline values. ESWT had no significant effects on the H/M ratio [I2 = 97.5%, P<0.001, SMD=1.09 with 95%CI: (-0.54, 2.73)].

 SWT can improve spasticity based on the MAS. The lack of SWT effects on the neurophysiological parameter of spasticity supports this opinion that SWT acts on the non-neural component of spasticity. Differences observed in studies in terms of treatment sessions, intervals of treatment sessions, energy density, number of shocks, and follow-up duration need to be examined more closely. More randomized clinical trials are needed in the future to analyze the impact of these factors on the efficacy of SWT for spastic patients.

Patients with multiple sclerosis (MS) usually report gait and balance disorders. Exercise therapy, especially strengthening exercise, is a safe and effective treatment approach in these patients. Therefore, the aim of this review study was to determine the effect of strengthening exercises on functional ability in patients with MS. Methods and Materials: A search of databases such as PubMed, science direct, Cochrane library, and Google scholar was reviewed to determine the existing articles on the effect of strengthening exercises on functional ability in patients with MS. 

According to the evaluation of studies from 2000 to 2020, 8 articles met the inclusion criteria. These articles examined the effect of strengthening exercises on functional ability in patients with MS. The results showed that strengthening exercises improved balance variables, functional ability, strength, and quality of life. 

Various interventions including stretching, balance, strengthening exercises, and electrical stimulation have been used to treat balance disorders, decreased muscle strength, gait efficiency and quality of life in patients with MS. Among these interventions, strengthening exercises have been shown to play an effective role in improving functional ability, although more studies are needed in this area.

 The purpose of present study was to compare electromyography activity of the abdominal muscles in response to the active pelvic floor muscle contraction in individuals with and without low back pain (LBP). 

 A total of 30 female subjects (LBP=15) and (healthy=15) participated in the study. All subjects performed the active PFM contraction for three times. The correct pelvic floor muscle contraction was controlled by an ultrasound. Simultaneously, the electromyography signals of the right transverse abdominis, internal oblique and external oblique muscles were measured. Variables of electromyography amplitude were analyzed using an independent sample T-Test. 

 There was a high intra-tester reliability for electromyography measurement of abdominal muscle in LBP (ICC>90) and healthy individuals (77<ICC<96). Transverse abdominis, internal oblique and external oblique muscle electromyography activity were increased during the pelvic floor muscle contractions in both women group with and without low back pain. The results of independent sample T-Test displayed no statistically significant difference in muscle co-activation pattern of the abdominal and pelvic floor muscles between the healthy group and LBP group (P>0.05). The mean values for muscle electromyography amplitude in transverse abdominis, internal oblique and external oblique muscle were 0.37(0.41), 0.18(0.14) and 0.16 (0.10), respectively, for healthy individuals and 0.25 (0.17), 0.13 (0.19) and 0.18 (0.17) for individuals with LBP. 

 There is a recognizable co-activation between abdominal and pelvic floor muscles in healthy and low back pain women.

 The purpose of present study was to compare electromyography activity of the abdominal muscles in response to the active pelvic floor muscle contraction in individuals with and without low back pain (LBP). 

 A total of 30 female subjects (LBP=15) and (healthy=15) participated in the study. All subjects performed the active PFM contraction for three times. The correct pelvic floor muscle contraction was controlled by an ultrasound. Simultaneously, the electromyography signals of the right transverse abdominis, internal oblique and external oblique muscles were measured. Variables of electromyography amplitude were analyzed using an independent sample T-Test. 

 There was a high intra-tester reliability for electromyography measurement of abdominal muscle in LBP (ICC>90) and healthy individuals (77<ICC<96). Transverse abdominis, internal oblique and external oblique muscle electromyography activity were increased during the pelvic floor muscle contractions in both women group with and without low back pain. The results of independent sample T-Test displayed no statistically significant difference in muscle co-activation pattern of the abdominal and pelvic floor muscles between the healthy group and LBP group (P>0.05). The mean values for muscle electromyography amplitude in transverse abdominis, internal oblique and external oblique muscle were 0.37(0.41), 0.18(0.14) and 0.16 (0.10), respectively, for healthy individuals and 0.25 (0.17), 0.13 (0.19) and 0.18 (0.17) for individuals with LBP. 

 There is a recognizable co-activation between abdominal and pelvic floor muscles in healthy and low back pain women.

The current study compared the effect of pelvic floor muscle (PFM) contraction on thickness of abdominal muscles during an abdominal hollowing maneuver (AHM), which is a specific contraction of transverse abdominis(TrA)and internal oblique(IO) muscles in healthy and low back pain (LBP) subjects.

Thirty subjects (15 with LBP and 15 without LBP) participated in this study. In ultrasonographic evaluation, the thickness of the TrA and IO muscles in AHM with and without PFM contraction were measured.

No significant difference was seen in the thickness of abdominal muscles in contraction alone and in combination with PFM contraction during AHM between the two groups. No difference was seen in the thickness of abdominal muscles with and without PFM contraction between the LBP and healthy subjects in AHM.

Adding PFM contraction had no significant effect on abdominal-muscle contraction in subjects with or without LBP.

Spasticity is a common motor impairment in patients with stroke that not only has a negative impact on the patient’s quality of life but also has high economic burdens for society. Recently the application of shock wave therapy has attracted considerable attention as a safe and effective method in treatment of spasticity. The objective of the present study was to investigate the effect of application shock wave on spasticity of quadriceps femoris and triceps surae muscles in patients with stroke. This was a quasi-experimental study on 15 stroke patients which were selected according to inclusion criteria between September 2016 and May 2017. This study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences, Iran. The intervention included one session placebo shock wave and three sessions of true shock wave. Level of the spasticity was measured at quadriceps and gastrocnemius muscles by Ashworth scale (AS) and passive range of motion (PROM) of the knee and ankle joints was recorded by a manual goniometer (Enraf-Nonius Corp., Delft, Netherlands). Participants were assessed at baseline, after the placebo shock wave, after the final session of active shock wave and 4 weeks after the last treatment. Placebo shock wave had not significant effect on grade of AS of spastic muscles as well as PROM of knee and ankle joints. True shock wave induced a statistically significant reduction in AS of triceps surae and quadriceps femoris muscles and improvement of PROM of knee and ankle joints. The reduction in AS of triceps surae and improvement of ROM ankle joint continued 4 weeks after the last treatment.  However, after 4 weeks, there was a significant reduction in the PROM of knee joint compared to the last session. Three sessions shock wave therapy can reduce the tone of triceps surae and quadriceps muscles and improved the passive range of motion in the knee and ankle joints for up to 4 weeks, but these effects were not stable on the PROM knee joint.

The transverse abdominis (TrA) muscle is one of the most important muscles that contribute to the stability of the lumbar spine. Strengthening of trunk muscles that have a significant role in trunk stability is very important in the field of professional sport, sport medicine and rehabilitation of patient with low back pain (LBP). Identifying the exercises that can improve the strength and endurance of these muscles in the efficient way is an important challenge in rehabilitation of LBP patients. The aim of this study was to investigate the effect of maximum voluntary isometric contraction of upper and lower limb muscles on ultrasonic thickness of the TrA muscle. This is a pre-test post-test study. Thirty healthy young male subjects with mean age of 23 years were recruited from the university staff and student population (non probability sample). Ultrasonic thickness of the right and left TrA muscle (as an indirect measure of muscle activity) was taken at rest and during maximum isometric contraction of six muscle groups: shoulder and hip flexor, extensor and abductor muscles. Mixed-model ANOVA with repeated measures design were used to analyze data. To further analyses post hoc comparisons were performed with paired t-tests adjusted with the Bonferroni method. The significance level was set at P<0.05. The result showed that mean TrA thickness on right and left sides during maximum isometric contraction of the upper and lower limb muscles was significantly thicker than in resting position (P<0.001). The type of isometric contraction had a significant effect on the thickness of the TrA muscle on dominant side (P<0.05). As a result, the greatest change in the thickness of TrA muscle on dominant side was observed in hip isometric extension (P<0.05). There was a significant difference between the thickness of TrA during upper limb isometric contraction of dominant and non-dominant side (P<0.001). Isometric contraction of upper and lower limb muscles especially in hip extension can increase the ultrasonic thickness of the transversus abdominis muscle.

The previous studies showed that the odor can improve balance in the elderly. The purpose of the current study was to determine the effect of olfactory stimulus and its gender specific effect on the balance of young healthy people.
This is a pretest-posttest semi experimental study comprised 40 healthy volunteers (age range 18-73 years) from February 2016 through May 2017. The static balance test with one-leg standing time (OLST) and dynamic balance test using Biodex balance system to measure overall stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) and overall limit of stability index (OLOSI) randomly were performed before and after application of lavender scant as the olfactory stimuli. A two-way repeated measurement ANOVA was used to assess the effect of olfactory stimulus conditions and gender on dynamic balance indexes (OSI, APSI, MLSI, and OLOSI). Since the distribution of the OLST was not normal, the generalized estimating equations (GEE) method was used. Significance level of P The results showed that in comparison of the two different conditions (no odor/with odor), there was no significant difference in any of static and dynamic balance indexes (P>0.05). There were significant differences in relation to the interaction of the gender and odor in OSI (P=0.026), APSI (P=0.019). For gender, there were statistically significant differences in OSI (P=0.002, F (1,38) =11.649), APSI (P=0.001, F (1,38) =12.057), and MLSI (P=0.007, F (1,38) =8.228) for females.
Although there was no effect of odor on balance control of young healthy people, we found that the odor has gender specific effect. This is probably due to the more sensitivity of females to the odor.

Spasticity is a clinical deficit of upper motor neurons lesions that presented immediately or at delayed times after lesions and occurs in about 38% of stroke patients. Extracorporeal shock wave therapy (ESWT) has been recently reported as a safe and effective method for reducing spasticity in stroke patients. In the present study, we sought to investigate the impact of the ESWT on post stroke spasticity using a meta-analysis method.
All primary reports of spasticity indexed in PubMed, MEDLINE, Science Direct, Scopus and search engine of Google Scholar from January 2000 to December 2016 were searched. The following terms were used as keywords: Spasticity, muscle hypertonicity, ESWT, stroke and hemiplegia. Any report was included if it met the following criteria: involving clinical trials, full-version availability, and being written in english. Two reviewers selected articles independently and reviewed the studies considering quality and eligibility, and then they extracted general information on objectives, design, participants, and outcomes. The methodologic quality of each study was assessed using the Pedro Scale. In the statistical analyses, we considered two outcomes; Modified Ashworth scale (MAS) grade and passive rang of movement (PROM). The meta-analysis was done using random effect model in Stata, version 11 (Stata Corp., TX, USA).
Eleven studies within a total of 261 patients were included in this review. In seven studies the shock waves were applied to the upper limb muscles, and in four other studies, the effects of ESWT on the spasticity of the lower limb muscles were assessed. Immediately after applying the ESW, MAS grade was significantly decreased in comparison to the baseline values. (Standardized mean difference [SMD], -1.62; 95% confidence interval [CI], -2.2 to -1.04). The PROM was significantly increased immediately after ESWT in comparison to the baseline values (SMD, 3.23; CI 95%, 1.35 to 5.12).
The results of this study showed that ESWT can immediately improve the spasticity and increased PROM, but it seems that the mechanism of action of shock waves on spasticity is still unclear. Further clinical trial studies with higher methodological quality should be recommended.

Low back pain is one of the most important causes of disability among people around the world. Although only 2-5% of low back pain disorders resulting from herniation of lumbar intervertebral discs but surgery for lumbar disc herniation is a common procedure. The aim of this study was to determine the relation between some bio-psycho-social variables and treatment outcomes in patients who undergo first time single-level lumbar discectomy.
This is a prospective observational analytic study comprised 100 patients (age range 18-73 years) underwent single-level lumbar disc surgery. The patients who met our inclusion criteria and were willing to participate in the study were recruited from the neurosurgery ward of Logman and Imam Khomaini hospitals in Tehran, Iran, between October 2015 and March 2016. The patient completed SF-36 quality of life Questionnaires before, one and two months after surgery.
In comparison to standard values, before the surgery patients had significantly lower baseline SF-36 (36-Item Short Form Survey) Questionnaire value in all 8 domains. The role limitations due to physical health had greatest impact on quality of life. At the eight weeks’ follow-up SF-36 scores showed significant improvement in both physical and mental scales. Age had no significant impact on mental scales of weeks’ Questionnaire but in age less than 30 years there was a positive relation between the patient’s age at surgery and physical aspects of quality of life. Although there was no significant difference in physical aspects of SF-36 Questionnaire between males and females but males had a significantly higher mean mental health score than females after surgery. Smokers had lower value of mental scales of SF-36 Questionnaire than in nonsmokers.
The result of this study showed that surgery for lumbar disc herniation had a great impact on both physical and mental scales of SF-36 Questionnaire two months after surgery. Factors such as age, sex, smoking and psychological factors can play the role of predictor for patient’s outcomes after lumbar disc surgery.

Background and Balance impairment is a major cause of falls in patients with hemiplegic stroke. The purpose of this study was to compare the effects of two balance training programs in these patients.
A clinical trial with pretest–posttest design was conducted in 30 patients after a single hemisphere stroke that occurred at least 6 months before the study (2015). Patients were randomly assigned into either a control group or one of two balance rehabilitation groups. All groups received conventional physical therapy program. One group had a balance training program without visual cue while the other had balance training on unstable surface for 30 minutes 3 sessions per week. Patient performance was assessed before and one session after treatment using the time up and go (TUG) and four square steps (4SS) tests.
All the patients had a significant clinical and functional improvement (P Balance training without visual input is more effective than balance training on unstable surface. To facilitate recovery of balance following stroke, rehabilitation programs that use visual deprivation to promote somatosensory and vestibular input are recommended.

Ultrasound imaging is a non-invasive method for observing changes in muscle thickness of the abdominal muscles. Accurate measurements depend on the control of all potential sources of error. In this study we investigated whether the level of stomach fullness might be a source of error not only in the resting thickness but also in contractile thickness (abdominal hallowing maneuver) abdominal muscles.
Thirty healthy male subjects ranging in age from 18 to 26 years volunteered for this study. Ultrasound image of the four abdominal muscles on both sides were obtained at rest (at the end of exhalation) and during abdominal hallowing maneuver before and after food consumption. Abdominal muscle thickness was assessed using a 3.5 MHZ linear head transducer in B-mode condition.
The mean thickness for right and left rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles at rest before food consumption were 10.8-10.7, 6.2-6.1, 8.6-8.3, 4.1-4.1 mm, respectively and after food consumption were 10.3-10.3, 5.6-5.5, 7.3-7.3, 3.4-3.6 mm, respectively. The mean thickness for right and left rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles during Abdominal Hollowing Maneuver before food consumption were 11-10.8, 6.1-6.3, 10-10. 5.3-5.5 mm, respectively and after food consumption were 10.5-10.6, 5.7-5.7, 8.8-8.7, 4.4-4.5 mm, respectively.
After food consumption the thicknesses of all abdominal muscles in both sides are decreased, and therefore, food consumption must be considered when measuring abdominal muscle thickness using sonography

Considering the importance of spasticity in the treatment of the patients with upper motor neuron lesion, the present study was conducted to review the studies concerning measuring spasticity assessment and also methods of spasticity assessment in the patients with cerebrovascular accident so as to recommend the best method for assessment of the spasticity according to the advantages and disadvantages of each method.
A literature search for the period of 1995-2013 was performed in the databases of PubMed, Mdconsult, Sciencedirect, Pedro, SID, and Google scholar. Also, Spasticity, Ashworth, Hemiplegia, Measurement devices, Stroke, Assessment were used as key words.
Sixty nine articles were selected according to the inclusion criteria of the study. There was a wide variation among studies in terms of methodology, main outcome measures, and muscles that were evaluated. It can thus be suggested that to recognize spasticity, a combination of the different methods of spasticity measurement is required.

Background and Post stroke spasticity has detrimental effects on quality of life and functions of patients. Moreover, it causes high economic and mental burden. Recognition of factors associated with spasticity can help in its treatment and prevention. The purpose of this study was to systematically review and meta-analysis of previously published studies concerning the prevalence of post stroke spasticity and its association with age, gender, type of stroke, and location of brain lesion. A literature review was conducted in studies published between 2000-2014 in PubMed, Science Direct, Scopus, Google scholar, and Springer Link databases. The following terms were used as. We obtained 769 articles of which 42 were chosen based on their titles. After studying the abstracts and full texts, only 16 were considered that were congruent with the inclusion criteria of our study. The association between spasticity and time, age, gender, type of stroke and location was considered in 9, 9, 9, 5, and 6 articles, respectively. According to these studies the incidence rates of post stroke spasticity were 4-27% earlier than 3 months, 19-42.6% between 3 and 6 months, and 20-38% after 6 months. The intensity of the spasticity increased over time. Gender and type of stroke were not found to be significantly associated with spasticity in any study. Findings about age were contradictory in different articles. There was a significant relationship between sever upper limb spasticity and subcortical lesions. However, involved lobes or circulation sites were not significantly associated with spasticity. Time has an important role on incidence and intensity alternations of post stroke spasticity.

The purpose of this study was to determine the reliability of electromyography measurements of abdominal muscles activity during different manoeuvres (pelvic floor muscle (PFM) contraction، abdominal hollowing and abdominal bracing with and without PFM contraction) in subjects with and without chronic low back pain (LBP). In this methodology research 21 subjects (9 with LBP، 12 without LBP) who were selected simply & conveniently participated in the study. Abdominal muscle activation amplitude was assessed. Each maneuver was performed in triplicate and repeating of the test was done on the same day with a period of at least 30 minutes. Data were analyzed by Kolmogroff–Smirnoff test and Interclass correlation coefficient. The results showed high reliability for the muscle activation amplitude during abdominal hollowing with and without pelvic floor muscle contraction and isolation pelvic floor muscle contraction and abdominal bracing (ICC=80–90). Also moderate reliability in abdominal bracing with pelvic floor muscle contraction (ICC=70–80). Electromyography is a reliable method for assessment of voluntary and automatic activity of abdominal muscles during different conditions.

Background and Recent research indicated that there is a co-activation of pelvic floor muscles (PFM) and abdominal muscles during voluntary and involuntary activity as a normal function، which may be impaired in women with stress urinary incontinency (SÜÏ). The purpose of the present study was to review the previously published studies concerning co-activation of abdominal and PFM with particular attention to its clinical application in patients with SÜÏ. Â literature search for the period of 2000-2010 was performed، using PubMed، ProQuest، Science Direct، Thomson، ËMBÂSË، ÔVÏD، ÇÏNÂHL and MËDLÏNË databases. Pelvic floor muscle، abdominal muscles، transverse abdominis، Ço-activation، electromyography and ultrasonography were used as keywords. Twenty one articles were selected according to the inclusion criteria of the study. There was a wide variation among studies in terms of methodology، main outcome measures، sample size، procedure، imaging parameters and electromyography parameters، etc. Çonclusion: The results demonstrated that there is adequate evidence to support co-contraction of the PFM with abdominal muscles in voluntary، involuntary and reflex activities and this co-contraction could be lost or impaired in individuals with SÜÏ.