Abstract

Background: Diabetes mellitus is a chronic metabolic disorder with a wide profile of complications. One of the complications is the diabetic peripheral neuropathy, which is associated with disorders in equilibrium and postural instability. The Purpose: The aim of study was to investigate the effect of task-oriented approach on balance in Diabetic Neuropathy patients. Methodology: Sixty diabetic patients with neuropathic complications were assigned into two equal groups (group I and II): Group (I) received task-oriented approach in addition to selected physical therapy program, while group (II) received selected physical therapy program only. Patients in both groups received three months of training, three times per week. Patients were assessed using Biodex stability system including postural stability test and clinical tests (Berg balance scale, and time up and go test). Results: The study findings revealed that postural stability is significantly improved in both groups with the best results for group I. Conclusion: Task-oriented approach could be considered a valuable and non-invasive treatment method for improving postural stability in patients with type II diabetic neuropathy.

Keywords: Diabetic peripheral neuropathy, Postural stability, Task-oriented approach.

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Background: A systematic review is the application of scientific strategies that limit bias by the systematic assembly, critical appraisal and synthesis of all relevant studies on a specific topic. Purpose: To systematically review the effectiveness of aquatic interventions on motor function in children with cerebral palsy. Subjects: Children with spastic CP of any severity, aged 1 to 18 years. Design: A search of electronic databases that included, PubMed, Physical therapy Evidence Database , Google scholar and Cochrane between 2005 and November 2017 was conducted using the following keywords: ‘hydrotherapy’, ‘aquatic therapy’, ‘water exercise’, ‘aquatics’, ‘adapted aquatics’, ‘aquatic exercise’ and ‘swimming “cerebral palsy ","motor function", "walking ","gait ".Results: Eleven articles that were retrieved met the inclusion criteria: meta-analysis was done for five studies and descriptive analysis was applied for the other six. Conclusion: It appears to be a strong evidence of aquatic therapy in treatment of motor functions of cerebral palsy. Keywords: Aquatic therapy, Hydrotherapy, Water exercises, Cerebral palsy, Motor function, Gait, Systematic review.

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Background: Mechanical neck dysfunction (MND) with impaired axioscapular muscles functions is a major health burden. While postural correction exercises (PCEs) are common treatment option, efficacy of kinesio tape (KT) has received considerable attention. Purpose:to investigate efficacy of KT with or without PCEs on pain, disability and upper trapezius (UT) kinesiological electromyography (EMG) in MND patients. Subjects and Methods: Ninety chronic MND patients aged 18–40 years were randomly and equally assigned into 1 of 3 groups received 4 weeks treatment; group A received KT, B (control) received PCEs and group C received both modalities. Neck pain, disability, UT root mean square (RMS) and median frequency (MDF) were measured pre and post-treatmentby visual analogue scale, neck disability index and EMG respectively. Between groups comparisons were performed using 2 ways MANOVA while intra-group comparisons were performed using paired t test. Results: MANOVA indicate a statistically significant group-by-time interaction (P=0.00). There were statistical significant pain reducion in group C more than B (p = 0.025), disability was reduced in groups A and C more than B (p < 0.01 and 0.034). While RMS was reduced in group C when compared to B (p= 0.037), MDF was increased in group C when compared to groups A and B (P =.001 0.00). Paired t tests were significant for all outcomes in all groups (p= 0<01).Conclusion: Although KT is promising for MND treatment, its integration with PCEs would have more beneficial outcome related to pain, disability and upper trapezius functions.

Key words: Cervical pain, exercises therapy, athletic tape, electromyography.

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Background: it is well documented that the effect of exercise on the physiological and immunological functions depends on its intensity, duration and regularity However, few studies had analyzed the impact of aerobic and anaerobic exercise on the menstrual and immunological functions in female athletes. purpose: To evaluate the effect of different types of exercise on menstrual and immunological functions in female athletes. Subjects and Method: Twenty-eight female athletes participated in this study. Fifteen of them participated in aerobic exercise, while thirteen of them participated in anaerobic exercise. Their ages ranged from 16 to 20 years old and their body mass index (BMI) ranged from 16 to 25 kg/m². The menstrual function was evaluated through a self–administered questionnaire and serum estradiol while the immunological function was assessed through serum immunoglobulin A (IgA). Results: There were non-significant differences between the aerobic and anaerobic groups regarding the percentage of eumenorrhea and menstrual dysfunction, menarche age, number of menstrual cycles in the last year, menstrual cycle length, serum estradiol and serum IgA (P>0.05). Additionally, there were non-significant correlations between serum estradiol and serum IgA in both aerobic and anaerobic groups (P>0.05). Conclusion: Both aerobic and anaerobic exercises have the same impact on menstrual and immunological functions in female athletes.

Keywords: aerobic, anaerobic, menstrual function, immunological function, female athletes.

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Purpose: This study was conducted to assess the balance in children with acute lymphoblastic leukemia within a year from termination of chemotherapy. Methods: Six children with acute lymphoblastic leukemia participated in the study, their ages between 5 to 11 years, being assessed by Humac balance system and their balance scores were compared with thirty age and gender matched normal children. Results: There was no significant difference (p >0.05) in balance scores in children with acute lymphoblastic leukemia while open eyes or closed eyes along with no significant difference between groups. Conclusion: From the obtained results of the study it can be concluded that children with acute lymphoblastic leukemia have no balance affection when compared with age and gender matched children.

Keywords: Acute lymphoblastic leukemia, Chemotherapy, Balance, Humac balance system

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Background: long duration of computer work could result in pain and weakness associated with decreased nerve conduction velocities (NCV) of peripheral nerves. Purpose: 1)To investigate the effect of different elbow joint angles(0º, 45 º, 90º, 120º) on ulnar NCV across elbow to identify the optimum elbow positions for computer users during work. 2)Tocompare ulnar NCV across elbow between the limited and extensive computer users. Design of the study: cross- sectional study design .Subjects: Fifty computer users from both sexes, Their age ranged from  20 to 40 years old were selected from the smart village and were assigned into two equal study groups. Group A consisted of limited computer operators who worked a maximum of 2 hours per day while Group B consisted of extensive computer operators who worked on the computer for a minimum of 6 hours per day as a part of regular work for at least 1 year. Subjects were using the computer devices with a postion of elbow flexion ranged from 90 to 120 degrees. Method: EMG was used for measuring ulnar NCV acrosselbow in both groups.Results: Mixed design ANOVA was used and revealed that there was a significant increase (p <0.05) in nerve conduction velocity at zero elbow flexion compared with  other positions(45, 90, and 120 degrees of elbow flexion) in both groups, As well there was a significant increase (p <0.05) in nerve conduction velocity at 45 degrees of elbow flexion than 90 and 120 degrees in both groups. Regarding between subject effects multiple pair wise comparisons revealed that there was significant increase (p< 0.05) in nerve conduction velocity of ulnar nerve at all angles in group A compared with group B (p> 0.05).Conclusion:1)Zero elbow extension showed the most significant increase in ulnar nerve motor conduction velocity compared to 45, 90 and 120 degrees of elbow flexion.2)Extensive Computers users who workfor more than6 hours showed decrease in ulnar nerve conduction velocity than the limited computer users.

Keywords: Ulnar nerveconduction velocity, elbow joint angles,  computer users.

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Background: Low back pain (LBP) during pregnancy is the most common musculoskeletal problem that affects pregnant women. 50–70% of pregnant women have experienced some form of LBP during pregnancy. Purpose: This study was conducted to determine the effect of therapeutic exercises on low back pain and the degree of pelvic inclination during pregnancy. Subjects and methods: Forty primigravida  women in the 3^rd trimester shared in this study. They were diagnosed as having pregnancy related low back pain and were selected fromthe outpatient clinic, Al Zahraa University Hospital in Cairo. Their ages were ranged between 20-35 years. Their body mass index did not exceed 35 Kg/m². They were assigned randomly into two groups equal in number (A&B):Group A: (Control group): 20 primigravida received superficial heat application at the lumbosacral area using an electric heating pad for 15 minutes from side lying position 3 times/week for 6 weeks and advice concerning low back pain during pregnancy. Group B: (Study group): 20 primigravida received the same treatment as group A in addition to specific exercises for low back pain 3 times/week for 6 weeks. Intensity of low back pain and pelvic inclination angle were evaluated by VAS and Palpation Meter respectively before and after treatment program for both groups (A&B).Results : Results showed that there is a statistically significant decrease in intensity of low back pain and a statistically highly significant increase in the degree of anterior pelvic tilt angle after treatment in both groups (A&B).When comparing both groups together after treatment, there is a statistically highly significant decrease in low back pain in group B more than group A, while there was statistically significant increase in the degree of anterior pelvic tilt anglein group A more than group B. Also, there is a positive correlation between intensity of low back pain andthe degree of anterior pelvic tilt angle during pregnancy. Conclusion: This study concluded that therapeutic exercises are considered an effective method for reducing low back pain and lessen the rate of increasing in the angle of pelvic inclination during pregnancy and confirmed that there is a positive correlation between intensity of low back pain andthe degree of pelvic inclination angle during pregnancy.

Key words: Therapeutic exercises- Pelvic inclination- Low back pain- Pregnancy.

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Background Diabetic neuropathy is long-term complication of diabetes, can affect almost half of the diabetic population, and is associated with higher morbidity and mortality. There is no optimal intervention universally accepted by clinicians. Monochromatic infrared photo energy (MIPE) and Low Level Laser Therapy (LLLT) are a relatively new light modality used to improve nerve conduction velocity, reduce pain and increase circulation. Purpose: This study was conducted to compare MIRE versus LLLT on nerve conduction velocity, pain and functional activity of daily living in patients with diabetic foot neuropathy (DFN). Material and Methods: Thirty patients with peripheral neuropathy type 2 diabetes and suffering from neuropathic pain especially in lower limbs, main age (56.29 ± 2.98) years, all patients have diabetes for more than 10 to 15 years. They were divided into two equal groups: Group (A) consisted of 15 patients received MIRE for 40 minutes to each limbs. Group (B) consisted of 15 patients received LLLT for 20 minutes to each limb. All patients who participated in the study had been subjected to various physical assessment procedures including: Nerve conduction velocity, Pain intensity and Quality of Life that all measured before and after four weeks of treatment. Results: Statistically there was statistical significant improvements in nerve conduction velocity, pain intensity and functional activity (P <0 .05) in both group. However, there was no significant statistical difference between both groups (P > 0.05).Conclusion: both monochromatic infrared energy  and low level laser therapy were effective in improvement of neuronal activity to deep peroneal nerve, decrease pain intensity and improve functional activity of daily living in patients with diabetic neuropathy.

Keywords: Diabetic neuropathy, Low level laser Therapy, Monochromatic infrared energy,

Nerve conduction velocity

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Background: Cellulite as changes in surface contour of the skin can lead to cosmetic and health problems. Liposuction actually worsens the dimpled skin appearance and cellulite. Purpose of the study: To differentiate between effect of planar waves and radial waves on cellulite post liposuction. Subjects and methods: Sixty female patients with cellulite grade 3 post-liposuction were randomly divided into two equal groups (planar group and radial group). The methods of assessment included cellulite grading scale and skin fold caliper. Planar group received planar waves,2 times/week for 12 weeks while Radial group received radial waves, 2 times/week for 12 weeks .Results: The results of this study showed a significant improvement in cellulite grading scale and skin fold caliper in the radial groupin comparing to planar group. Conclusion: It was concluded that radial waveswere more effective than planar waves in controlling of cellulite in expression of decreasing degree of cellulite and improving the appearance.

Keywords: Cellulite, Acoustic Wave Therapy, Planar Waves, Radial Waves.

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Background: Myofascial pain syndrome (MPS) is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. Purpose: The aim of this study was to investigate the effect of ischemic compression (IC) on muscles of mastication and upper trapezuis musclemyofascail trigger points (MTrPs) on masticatory myofascial pain syndrome. Subjects and Methods: Thirty two Masticatory MPS patients of both sexes, with their age ranged from 20 to 35 years were randomly divided into two groups. Both groups have been evaluated for maximal mouth opening (MMO). Patients in Group A (control group) have received IC on masseter and lateral pterygoid MTrPs followed by exercise programme, whereas patients in Group B (Exprimental group)  received the same treatment in addition to upper trapezuis MTrPs ischemic compression, Also all patients received 2 sessions per week for 2 weeks. Results: Both groups shared significant increase in MMO without significant difference between groups. Conclusion: Ischemic compression and exercises are effective in improving MMO significantly in patients suffering from Masticatory MPS without a significant effect of adding upper trapezuis active MTrPs.

Key words: Myofascial trigger points, Ischemic Compression Upper Trapezuis, masticatory muscles, maximal mouth opening, temporomandibular joint,.

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Down syndrome, which is characterized by trisomy of chromosome 21, is the most common chromosomal abnormality that affects live-born infants, with a birth-rate prevalence that varies between 1:500 and 1:1,000. Thyroid dysfunction is the most typical endocrine abnormality in patients with Down syndrome, the established risk factors for which are old age and female sex. Purpose: The purpose of this study was to investigate the relationship between upper extremity muscle forces and thyroid function   in obese down syndrome children. Material and methods: The present study was conducted on 78 down children of  both sexes (42 females and 36 males) aged from 6 to 8 years ( mean age was 7.32 ±6.09) were diagnosed as Down syndrome children with hypothyroidism and obesity by pediatrist  and referred to participate in this study. Written informed consent was obtained from each child mother. Thyroid hormone T 3 and hand flexor muscle force were measured for each child pre and post treatment.  Results: Pearson correlation coefficient revealed that there was there was positive statistically significant correlation between hand flexors muscle force and thyroid function   (p<0.05). Conclusion: there was positive statistically significant correlation between hand flexors muscle force and thyroid function.

Key words :Down syndrome, Obesity, Hypothyroidism, Aerobic exercises.

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Background: Obesity represents an important cardiovascular risk factor. Body mass index may be associated with higher resting cardiac troponinI (cTn I) levels. It is unknown whether obesity alters the exercise-induced troponinI release, this is of special importance as exercise training is routinely prescribed as an effective strategy to lose weight of individuals with obesity. The current study was carried out to determine the cardiac troponinI acute response to aerobic versus resisted exercises in obese women. Patients and method: This study  included 40 obese women, their age ranged from 30 to 40 years, their BMI ranged from 30-34.9kg/m². Subjects were randomly selected from the employers of Kasr Al Ainy teaching hospital. They divided  into two groups equal in number ( A&B). Group (A)  performed a single bout of aerobic exercises and group( B)  performed single bout of resisted exercises. Serum ( cTn I) were analyzed before the exercise session and three hours from the end of exercise session. The study was done from march 2017 till January 2018 . Results: Comparing pre and post exercise values revealed an increase in cTnI in both groups, However there was a statistical significant difference between both groups in post exercise values. Conclusion: The magnitude of cardiac troponin I elevation in aerobic exercises is less than that of resisted exercises which suggest that aerobic exercises are more suitable and safe than resisted exercises for obese women .

Key words: Obesity, cardiac troponin, resisted exercise , aerobic exercise

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Background: Osteoarthritis (OA) is known as a degenerative joint disease, characterized by joint pain and stiffness. Knee OA is considered an active disease process with joint destruction driven by both biomechanical and pro inflammatory factors. In vitro and in vivo animal models elucidate specific mechanical and biological factors that affect cartilage degradation and tissue changes associated with cartilage growth and remodeling. Purpose of the study: to compare the effect of lateral wedge with subtalar strapping combined with conventional exercise program versus mulligan taping combined with conventional exercise in treating knee osteoarthritis. Methodology: Forty five KOA grade 2,3 (26 male and 19 female) participated in this study, their age ranged from 45 to 60 years and their body mass index ranged from 30.27 to 33.07kg/m2.They were divided randomly into three equal groups: group (A) treated with lateral wedge with subtalar strapping combined with conventional exercise, group (B) treated with mulligan taping combined with conventional exercise and group (c) treated with conventional physical therapy program only. All patients in all groups were assessed pre- and post-treatment through measuring of pain intensity using visual analogue scale, knee function through step test and total WOMAC score. Results: revealed that pre-treatment, there was a non-statistical significant difference between three groups in mean value of pain, tenderness step test and total WOMAC score symptoms where the p-value was (>0.05). Comparison between pre and post treatment showed a statistically highly significant improvement in pain intensity and knee function in group (B&C) than in group (A). Conclusion: Mulligan taping combined with exercise was more effective than lateral wedge with subtalar strapping in decreasing pain intensity and improving function in knee osteoarthritis.

Key Words: knee osteoarthritis- lateral wedge with subtalar strapping- mulligan taping-conventional physical therapy program.

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Background and purpose: Postural instability and muscle fatigue are one of the elementary causes of deteriorations in children with hemiplegic cerebral palsy. The purpose of this study was to investigate the immediate effect of maximal treadmill walking on muscle fatigue and posture stability in children with hemiplegic cerebral palsy. Patients and methods: Thirty hemiplegic children of both sexes (17 boys and 13 girls) participated in this study with their mean ± SD ages, weights, and heights were 8.25 ± 1.77 years, 26.83 ± 5.77 kg, and 118.13 ± 7.45 cm respectively. They were selected at level I and II according to Gross Motor Function Classification System (GMFCS). Muscle fatigue of quadriceps and hamstring muscles were assessed by using isokinetic dynamometer while postural stability was assessed by pediatric reaching test immediately before and after treadmill walking. Results: The results showed that there were no significant differences in the fatigue index and peak torque of quadriceps and hamstring muscles(p = 0.33, p = 0.1) and (p = 0.52, p = 0.14) respectively, also no significant differences were found in the anterior and lateral reaching of postural stability (p = 0.46 and p = 0.63) respectively between pre and post treadmill walking test .Conclusion: The current study of maximal treadmill walking test is tolerated and didn’t cause muscle fatigue or postural instability in children with hemiplegia. It may be helpful in the evaluation and treatment procedures for children with cerebral palsy.

Keywords: Cerebral palsy, Hemiplegia, Maximal treadmill walking, Muscle fatigue, Posture stability

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Background: Vaginal Noise (VN) is an embarrassing symptom of pelvic floor dysfunction which creates social and psychological problems. objective: This report studied the efficacy of physical therapy rehabilitation program in hindering VN in a virgin 10 yrs old had Rectocele. Subjects & Methods: A female virgin,10yrs old, BMI=26 kg/m² suffering from aterrible complain of VN countless times a day since 3 yrs. Her prolonged suffering from VN was exceptionally embarrassing caused school absenteeism, social and psychological problems. Evaluation was done before the start of the study and every month for 5 months using: VN questionnaire regarding frequency, severity of VN and its effect on QOL, in addition to Dynamic trans-perineal ultrasound before the start of the study and after 5 months of treatment. Intervention: Pelvic floor electrical stimulation and Biofeedback were applied 3 sessions per week for 6 months in addition to Pelvic floor exercises. Results: A significant improvement was noticed in all measuring variables for physical therapy program. Conclusion: The results of this report testified that the constructed physical therapy program was very effective in hindering VN and confirmed the safety and the aptness of this modalities for women especially virgins who distressed deeply from vaginal noise.

Key Words: Vagina, noise, Electrical stimulation, Biofeedback, Pelvic floor exercises.

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Background: Rectus Diastasis (RD) is a commonly occurring problem during pregnancy and immediate puerperium. It causes an increase in abdominal circumferences ,low back pain together with dissatisfaction about body shape, altered self-esteem, and disadvantage in interpersonal relationships. Purpose: The study was designed to compare the efficacy of different techniques of kinesiotaping (KT) in treating postpartum RD. Subjects & Methods: 45 women suffering from RD, their age ranged from 24 and 40 years, their BMI between26 and 44kg/m². Patients were randomized equally into 3 groups : Group A (15women received KT-I technique),Group B (15 women received KT-X technique) in addition to group C (15women received KT-I-X techniques) for 4 consecutive weeks. Evaluation of waist circumferences and the distance between 2 Recti was done before the start of the study and after 4 weeks. Results: A highly significant improvement was noticed in all measuring variables for the 3 KT techniques but the IX-technique was the best one, followed by the X- technique, and the I- technique was the least one. Conclusions: Abdominal KT in the form of IX-technique is the most effective technique in reducing abdominal circumferences and the treatment of postpartum rectus diastasis.

Key Words: Kinesiotaping, Abdominal circumferences, Diastasis, Rectus abdominis.

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Background: Cervical traction consists of administering a distracting force that separate the cervical segments and relieve compression of nerve roots caused by intervertebral discs. There is lack of knowledge that neither supports the proper angle of pullamong different angles of decompression system for cervical radiculopathy nor   comparing different angles of traction decompression with ipsilateral neck muscles stretching.Purpose: The purpose of the study was to compare FCR HR, NDI, and VAS among groups with different angles of decompression system for cervical radiculopathy in C5-6-7, disc protrusion and comparing it with using ipsilateral neck muscles stretching protocol.Methods:Fifty-eight patients with cervical radiculopathy caused by cervical disc prolapse C5-C6) participated in the study. Their mean ± SD age, body mass, and height were 35.05 ± 7.43 years, 72.84 ± 12.14 kg and 169.32 ± 10.35 cm respectively. They were randomly divided into four groups, Patients within Group (A) received stretching protocols to the cervical musculature at the side of symptoms. Patients within group (B), (C) and (D) received traction therapy (Triton DTS) from different positions. Group (B) was treated with traction therapy from neutral position with rope angle 0 degree. Group (C) was treated with traction therapy from 30-degree lateral bending toward the opposite side of radiculopathy. Group (D)was treated with traction from 15-degree flexion with lateral bending 30-degree and 15-degree rotationtoward the opposite side of radiculopathy. Patients of all groups underwent initial pretreatment and posttreatment measurements after 6 weeks of H-reflex, visual analogue scale (VAS) pain score, and neck disability index (NDI) score.  Findings: Mixed design MANOVA revealed that the H-Reflex increased significantly (p < 0.05) after treatment in Group (A), (B) and (D). Moreover, the H-reflex post-treatment values increased non-significantly (p > 0.05) in patients within group (C). However, the VAS scores and neck disability index (NDI) decreased significantly after treatment in all tested groups.Interpretation:Using decompression traction from retracted neutral position with rope angle 0 degree and foraminal opening directions either uniaxial or multiaxial has a significant effect on cervical radiculopathy as well as stretching of ipsilateral neck muscles.

Keywords: Cervical radiculopathy, Traction decompression, H reflex, Neck disability index, Stretching.

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Background: Stress urinary incontinence (SUI) is the symptom of any involuntary leakage of urine on effort or exertion, or on sneezing or coughing. The purpose of this study was to determine the effect of pulsed electromagnetic field on stress urinary incontinence by using biofeedback . Forty multiparous women were participated in this study and randomly divided into two equal groups; group A, which received PEMF two times per week with pelvic floor exercises, group B, which received pelvic floor exercises only.  Both groups were evaluated before and after therapy (8weeks). The results of this study showed that there was a statistically significant difference (P<0.05) in vaginal squeeze pressure in favor to group (A).On conclusion the present study revealed that pulsed electromagnetic field are effective in improve female stress urinary incontinence.

Key words: Stress urinary incontinence, Pulsed Electromagnetic, biofeedback.

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Background: Good balance in the activation of the Vastus Medialis Obliques and Vastus Lateralismuscles is necessary in order to keep the normalalignment of patellofemoral joint. Therefore, the abnormal relation in the activation pattern of these muscles could alter the dynamics of the patellofemoral joint. The purpose: to investigate the effect of different surfaces and different squat depths on Vastus Medialis Obliques and VastusLateralis muscles activities in healthy males. Subjects and methods: Thirty healthy males with the following Inclusion Criteria: Subject’s age ranged from 18-30 years and body mass index from 25 kg/m² to30 kg/m².the participates performed body weight squat exercise on stable surface and unstable surface with squat depth 50 ^o and 80 ^o knee flexion. EMG study by using amplitude potential to detect the vastus medialisobliques and vastuslateralis muscles activities on different squat depths that detected by universal goniometer and unstable surface that is used to detect effect of unstable surfaces on vastus medialisobliques and vastuslaterlais muscles activities. Results There was a significant increase in the Vastus Medialis Obliques EMG amplitude at 80° knee flexion compared with that at 50° knee flexion (p = 0.0001) and There was a significant increase in the VastusLaterlais EMG amplitude at 80° knee flexion compared with that at 50° knee flexion (p = 0.0001).There was no significant difference in the Vastus Medialis Obliques EMG amplitude at 50° knee flexion between stable and unstable surfaces (p = 0.11). Also, there was no significant difference in the mean Vastus Medialis Obliques EMG amplitude at 80° knee flexion between stable and unstable surfaces (p = 0.23).There was no significant difference in the mean Vastus Laterlais EMG amplitude at 50° knee flexion between stable and unstable surfaces (p = 0.47). Also, there was no significant difference in the mean Vastus LaterlaisEMG amplitude at 80° knee flexion between stable and unstable surfaces (p = 0.52).  .Conclusion: squat exercise on squat depth 80^oknee flexion increases the Vastus Medialis Obliques and Vastus Laterlais muscles activities, unstable surfaces don’t change the Vastus Medialis Obliques and Vastus Laterlais muscles activities during squat exercise.

Keywords: vastusmedialisobliques, vastuslateralis, squat depths, unstable surfaces.

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Background: Visouspatial neglect (VSN) is a debilitating, attentional disorder that affects approximately 40–81% of patients after stroke. It interferes with the rehabilitative process and is associated with poor functional outcome.Objective: The aimof this study was to assess the influence of repetitive transcranial magnetic stimulation on unilateral visuospatial neglect in stroke patients.Patients and Methods: Thirty ischemic stroke patients from both sexes represented the sample of the study. Their age ranged from 45 to 65 years. The patients were assigned into two equal groups; control group (G1) and study group (G2). The control group treated with a designed physical therapy program and the study group treated with the same program in addition to low frequency repetitive transcranial magnetic stimulation (rTMS) over the posterior parietal cortex (PPC). The treatment was conducted three times per week, for two weeks. Line bisection and Bell cancellation tests were used to assess visuospatial neglect. Barthel index was used to assess functional activities pre and post treatment.  Results: There was a significant improvement in scores of Line bisection and Bell cancellation tests in both groups with more favorable effect in G2 (p<0.05) and a significant improvement in scores of Barthel index scale in both groups however the difference between the two groups was not significant (p>0.05). Conclusion: Repetitive transcranial magnetic stimulation over contralesional posterior parietal cortex added to the designed physiotherapy program has a positive effect in improving visuospatial neglect in post-stroke patients.

Key Words: Repetitive transcranial magnetic stimulation, visuospatial neglect, stroke,Barthel index, Line cancellation test, Bells cancellation test .

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Background: Children with diaplegia commonly develop knee recurvatum in both lower limbs. Orthotic management can help in controlling the recurvatum as knee cage or ankle foot orthoses (AFO). Purpose: To compare the effect of posterior knee cage and long AFO in management genu recurvatum in children with spastic diplegia. Methods: Six children with spastic diplegia having knee recurvatum in both limbs enrolled in the study, their ages between 4 to 8 years. They were divided randomly into two equal groups; Group (A) received traditional physical therapy program for such cases while wearing knee cage for three months. Group (B) received traditional physical therapy program for such cases while wearing long ankle foot orthoses for three months. Stress X ray was used to evaluate the degree of recurvatum pre and post study. Results: There was no significant difference between both groups regarding right knee recurvatum while there was a significant difference between groups regarding the left knee recurvatum in favor to AFO. Conclusion: From the obtained results it can be concluded that long ankle foot orthoses achieve more improvement of the knee recurvatum when compared with knee cage in some cases.

Key Words: Diplegia, Recurvatum, Long AFO, Knee Cage, Stress X ray.

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Background:  Neck pain  causes pain and disability in approximately 30% of the adult population worldwide .The  zygapophyseal joints and myofascial trigger points can be cause of chronic non specific neck pain. Mulligan technique and integrated neuromuscular inhibition technique may decrease pain intensity and improve neck function .Purposes: 1-To investigate the efficacy of a multimodal treatment program that consisted of Mulligan (SNAG, NAGS)  with isometric exercises in subjects with chronic non specific neck pain (CNSNP) on pain intensity and neck function. 2-To investigate the efficacy of adding  integrated neuromuscular inhibition technique( INIT) to a multimodal treatment program in subjects with CNSNP on pain intensity and neck function Method: Thirty patients with chronic non specific neck pain (15 females and 15 males), their age ranged from 18 to 26 years. Patients were divided into three equal groups A, B &C. Group A received a multimodal treatment program that consist of Mulligan (SNAG, NAGS)  with isometric exercises  .Group B received integrated neuromuscular inhibition technique (ischemic compression, positional release and muscle energy technique)and a multimodal treatment program .Group C (control group) received isometric exercises . Visual analogue scale (VAS) and Neck disability index (NDI) were used to evaluate pain intensity and neck function at two intervals (pre treatment, post treatment )before treatment and after 6 sessions through 2 weeks. Results: Within-group analysis there was a significant difference of VAS and NDI pre-post treatment at groups A, B and C (p˂0.05).Percentage of improvement in mean values of VAS was 62.5%,82.53%,36.2% in 3 groups respectively(p = 0.0001) . Percentage of improvement in mean values of neck function was 38.6%, 60%,10.2%  in 3 groups respectively(p = 0.0001).Between-groups analysis at VAS there was no significant difference at pre-treatment (p˃0.05).While there was a significant decrease in VAS of group B compared with that of group C post treatment (p = 0.0001). There was no significant difference in VAS between group A and B, and between group A and C post treatment (p = 0.11). At NDI there was no significant difference at pre-treatment (p˃ 0.05).) while there was a significant decrease in NDI of group B compared with that of group A and C post treatment (p = 0.0001). There was no significant difference in NDI between group A and C post treatment (p = 0.28). Conclusion: A multi modal treatment program that consisted of Mulligan (SNAG, NAGS)  and isometric exercises improve pain intensity and neck function . Adding   INIT that consisted of ischemic compression, strain–counter strain and muscle energy technique to a multimodal treatment program (Mulligan (SNAG, NAGS)  with isometric exercises) improve neck function .

Key words: SNAG, NAGS, INIT.

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Background: There is a great deal of variability in cortisol level with regard to  type, intensity, volume and frequency of exercise. Purpose: to compare the effect of aerobic versus resistive exercises on serum cortisol level in hypertensive patients. Methods: Forty mild essential hypertensive male patients with age range from 40-50years, with SBP ranged from (140-159) mm Hg and DBP from (90-99) mm Hg (Class I HTN), participated in this study .They were chosen from out patients clinic of faculty of physical therapy, Cairo university. Subjects were assigned randomly into two groups, equal in number. Their cortisol level was measured before , after 1^st session and  after 8 weeks of training program for both groups. Group A :20patients performed aerobic exercises in form of treadmill walking exercise for 40 minutes at Intensity which was detected by “Karvonen equation". Group B :20 patients  performed  resistive exercises at intensity : 40 %to 60% of 1-RM.. All patients  perform 3 sessions per week for 8 weeks. Results: Serum cortisol level before training in comparison to post1 (after 1^st session) show no significant difference in both groups. Serum Cortisol level after training (post2-after 8 weeks) in comparison to before training significantly decreased in Group A and in Group B and this decrease in favor of group A ,and  there was significant difference in post training serum cortisol level between two groups. Conclusion: Aerobic exercise can lower serum cortisol level more than resistive exercise  in hypertensive patients  after 8 weeks of training and both of them has no effect on acute response to exercises in hypertensive patients.

Key words: ( Serum Cortisol level, Hypertension, Aerobic exercise, resistive exercise ).

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Background: Gait improvement is one of the most important goals of physical therapy program in cases of cerebral palsy (CP) because as much as 90% of those children have difficulty in walking. Purpose: this study was conducted to investigate the effect of aerobic gait training on pulmonary functions and functional capacity of children with CP. Subjects and Methods: Thirty children diagnosed as hemiparetic CP participated in this study. They were selected from outpatient clinic of Faculty of Physical Therapy, Cairo University and Abo El – Reesh pediatrics hospital with age range between 5 and 9 years. The selected sample was divided into two groups of equal number. Group A (control group) that was treated by traditional gait training while group B (study group) received aerobic gait training. All participants were evaluated by Six minute walk test for detecting the functional capacities and impulse oscillometry device that was used for detecting lung functions before and after three successive months of treatment application. Results: There was a statistically significant improvement of all measuring variables in each group after treatment and also between both groups after treatment in favor to the study group (p<0.05).  Conclusion: It was concluded that the aerobic gait training improve the functional capacity and pulmonary functions in children with hemiplegic CP.

Key words: Aerobic gait training- Cerebral palsy - Pulmonary functions- Functional capacity

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One percent of middle aged and elderly population is affected by leg ulceration ,costs can rise to 10,800 dolars per pateint.  The primary risk factor are older age, obesity,previous leg injury, deep venous thrombosis and philipitis.Sever complications include; cellulitis,risk of infection, loss of mobility,osteomylitis.Purpose:Our study was conducted to evaluate the effectiveness of implementation of a  new trend  protocol guide lines treatment applied on venous ulcer.Subject and methods:Case report of pateint who has 37 years old with venous ulcer at lateral surface of left lower leg, more than one year ago, due to venous thrombosis led to massive ulcer wound, without effect of traditional methods. Treatment started with ultraviolet, then cold laser and followed byiontophorasis using zinc sulfate 2% for fifteen sessions. Assessment icluded measuring the size of ulcer and the morfology of the ulcer before treatment,after three, six,eigth fifteen sessions using digitalcamerawith high resolution.Results: there was significant improvement to venous ulcer by decreasing their size and improving their morphology.Conclosion: new trend protocol treatment guid line applied on venous ulcer is effective and has significant improvement on venous ulcer,saving money,time and efforts.

Key word; Venous Ulcer, Iontophorasis, Cold laser, Ultraviolet

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Background: The main goal of a rehabilitation program after an ACL reconstruction is to regain mobility and muscle function and ultimately to return to sports participation. Purpose of the study: to investigate the effect of goal based rehabilitation program on knee pain, range of motion (ROM) and function in patients with post ACLR surgery. Methodology: Thirty four adult males who underwent ACLR surgery participated in this study, their age ranged from 18 to 40 years and their body mass index (BMI) was ranged from 18 to 25 kg/m2.They were randomly assigned into two equal groups. Group (A) received goal based rehabilitation protocol and group (B) received conventional physical therapy program. Treatment sessions were conducted 5 times per week for 22 weeks for both groups. All patients assessed pre and post treatment for pain intensity using visual analogue scale (VAS), knee range of motion using universal goniometer (UG) and knee function using Arabic version of knee injury and osteoarthritis outcome score (KOOS). Results: Post treatment results revealed that there was a significant improvement in pain, ROM and function in both groups but, there was a significant superior improvement in group A than in group B. Conclusion: Both protocols were effective, but goal based was more effective than conventional program.

Key Words: Post ACLR rehabilitation, Conventional physical therapy program, Goal based rehabilitation.

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Background; One of the most critical important points to be determined in different medical fields are the assessment of pain. Adequate and accurate rehabilitation program requires a precise assessment of pain by an objective method. Objective; Evaluate the objectivity of using Visual Analogue Scale as an objective method in quantitating pain intensity for the patients with chronic low back pain and sciatica. Methods; Sixty chronic low back pain male patients with sciatica and twenty healthy subjects represent study group one and control group two respectivily, participated in this study. Blood analysis for β-endorphin was done to objectivly determine the intensity of pain .Pain intensity was recorded also by visual analogue scale for each subject then it was correlated with  the level of β-endorphin. Results; showed no significant correlation between Visual Analogue Scale and β-endorphin level and the normal level of β-endorphinin the Egyptian male subjects of the fourth decade of life ranges from 1.4 ng/ml to 6.9 ng/ml. Conclusion; Visual Analogue Scale is a subjective method in the assessment of pain intensity of chronic low back pain patients due to disc bulge.

Key words:   Chronic Low Back Pain-   β-endorphin- Visual Analogue Scale.

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Objective: To evaluate the effect of aerobic exercise on inflammatory cytokine levels in post- menopausal women. Methods: Thirty post-menopausal women were selected from Ain shams University. Their ages ranged from 44 to55 years, they were divided randomly according to closed envelop into two groups equal in number, study group (group A) who performed aerobic exercises in form of walking on treadmill for 30 min/day, 3 times per week for 12 weeks, at 55% of maximum HR. And control group (group B) who didn't perform any kind of aerobic exercise and instructed to maintain their current physical activity levels during the study. Before starting and at the end of study, all participants were assessed by measuring the level of pro-inflammatory IL6 and FSH levels. Results: Pretreatment, there was a non statistical significant difference in the IL6 and FSH levels between both groups (A&B). While, post treatment there was a highly statistical significant difference in IL-6 and FSH between both groups (A&B), where the p value was 0.001, in favor of group (A). Conclusion: Aerobic exercise is effective in decreasing pro-inflammatory cytokine levels in postmenopausal women.

Keywords: postmenopausal, inflammatory cytokine levels, aerobic exercise.

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Background: The use of Transcranial Direct Current stimulation (tDCS) in the motor rehabilitation of children with cerebral palsy 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 functional motor skills of children with cerebral palsy. Data sources:  Ovid, Medline, Cochrane, Pedro, Science direct, Web of science, EPSCOhost, PubMed and Google scholar website were searched from their earliest records up to August. Data extraction: Template was created to systematically code the demographic, methodological, and miscellaneous variables of each RCT. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the study quality. Data synthesis: Nine studies included 192 participants in total. Best evidence synthesis was applied to summarize the outcomes, which were  balance ,gait parameters  , spasticity and upper limb function .Conclusions : However researches on tDCS is still preliminary , the available data demonstrated the efficacy of tDCS as a new modality on rehabilitation of motor disorders in cerebral palsy children with immediate and long term effect on improving  motor disorder. Further studies are still needed, especially those involving both neurophysiological and functional evaluations and to cover further domain on cerebral palsy.

Key wards: Transcranial Direct Current Stimulation-Motor Disorders –Rehabilitation- Cerebral Palsy- Systematic review.

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Background: It has been observed that out of all visits to the clinics by the young and middle age men for grievances including the genital and urinary frameworks, about 25% of the visits accounts for Prostatitis.  Significant number of men, aged less than 50, visits to urologist due to Interminable prostatitis. Nevertheless just 5 to10% of "prostatitis" cases are really caused by a bacterial contamination.The purpose wasto investigate thoroughly the effect of pumpkin seeds oil phonophoresis among males who are diagnosed with chronic non-bacterial prostatitis. Subjects and Methods: The study population composed of sixty male outpatients diagnosed with chronic non-bacterial prostatitis. Through sample random sampling procedure the total study population was categorized in to three treatment groups; Group A, wherein patients received phonophoresis treatment using pumpkin seeds oil; Group B, where members of the group received trans-perineal continuous low-intensity ultrasound; and Group C, in which the participant received placebo low- intensity ultrasound. All of The three groups of the organized trail received their corresponding treatment daily up-to 3 weeks. The well-defined parameters of NIH Chronic Prostatitis Symptom Index (NIH-CPSI), urodynamic measurements of residual urine, and flow rate measures were utilized to analyze the outcome of the trail. White blood cell (WBC) was determined from prostatic secretion. Results: Both for Group A and B the study has observed significant difference in before and after treatment results  measured in terms of values of urodynamic residual urine, urine flow rate, white blood cells, and NIH chronic prostatitis symptom index among group A and group B, where’s no change has been observed in before and after treatment results for group C. the exact probability statistic, P-value suggests a statistically insignificant difference (P > 0.05) between Group A and B except for white blood cells, while group A and C, and group B and C as well differ significantly with the probability value of (P<0.05). Conclusion: with the carful treatment procedures carried out during the organized trail the current study has significantly proved that pumpkin seeds oil phonophoresis can produce a tremendous effect in the management of nonbacterial prostatitis, hence can be considered as a safe, noninvasive method for the treatment of nonbacterial prostatitis.

Keywords: Pumpkin seeds oil, Phonophoresis, Ultrasound, Physiotherapy, Cucurbitapepo, Chronic non-bacterial prostatitis.

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Background:  The aim of this work was to investigate the efficacy of transcranial magnetic stimulation versus electrical galvanic vestibular stimulation on balance in geriatrics parkinsonian patients. Subjects and Methods: sixty geriatrics Parkinsonism male patients represent the sample of this study. The patients' ages≥ 70 years with a mean value of 65.983 ± 2.76 years. They were assigned randomly into three equal groups; the study group one (G1) and the study group two (G2) and the control group (G3). The control group G3 treated by selected therapeutic physical exercise program. The study group G1 treated by the same program of treatment as the control group in addition to Transcranial magnetic stimulation TMS. The study group (G2) treated by the same program of treatment as G3 in addition to galvanic vestibular stimulation (GVS). The duration of treatment was three months, three times per week.  The different aspects of dynamic balance (overall stability, anteroposterior stability and mediolateral stability indices) were assessed pre and post treatment objectively by Biodex balance system and clinically by Short Form of Berg Balance Scale (SFBBS) in all groups. Results: Comparison of each variable pre and post treatment in each group revealed a significant improvement in all different parameters in study groups (G1 & G2) P ≤ 0.05; however the control group showed a significant improvement only in anteroposterior stability index. Conclusion:Transcranial magnetic stimulation and GVS have significant effect on treatment of balance disorders in geriatrics Parkinsonism patients.

Key words: Parkinsonism, Transcranial magnetic stimulation, galvanic vestibular stimulation, Balance.

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Background: Cervicogenic headache is a major problem in many people  suffering from upper cervical dysfunction with a great conflict in its  physical therapy  management. Objectives: To determine the effect of C1-C2 Mulligan SNAGs Mobilizations on Cervicogenic headache and associated dizziness symptoms. Methods: Forty eight patients with cerviocgenic headache included in the study; from outpatient clinic of Faculty of Physical Therapy, Cairo University & New Cairo outpatient clinics, were  randomly assigned  into three equal groups; group A (Headache SNAG), group B (C1-C2 SNAG rotation) and group C (combined). Their mean age was (29.37±2.6), (29.31±2.54) & (29.68±2.65). Neck Disability Index used to examine neck pain intensity & CEH symptoms. 6 Items Headache Impact test "6-HIT" scale used to examine headache severity and its adverse effects on social life & functions. Flexion-Rotation Test "FRT" also used to assess rotation ROM at level of C1-C2 by "CROM" device. Dizziness Handicap Inventory "DHI" scale was used to evaluate   dizziness symptoms. Evaluation done  pre& post treatment and comparison between  groups were quantified. Correlations between the examined parameters were also measured. Headache SNAG and C1-C2 Rotation SNAGs were done separately in group (A- B) and combined in group C as a treatment intervention.  Results: Group C has Significant improvement in whole parameters compared to group A &B.. Conclusion: SNAGs mobilizations used in the study were effective in reducing cervicogenic headache & dizziness symptoms in groups with noticeable improvement in favor of group C.

Key words: cervicogenic headache, cervical headache snag, cervical snag half rotation, cervical dizziness.

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 The purpose of this study was to investigate the effect of Upsee mobility device on hip joint angles in diplegic cerebral palsied children. Subjects: Thirty spastic diplegic cerebral palsied children of both sexes participated in this study, they were divided randomly into two groups of equal numbers (control and study). Materials: The children in the control group received the traditional physical therapy program for diplegic cerebral palsy for one hour including gait training. Children in study group received the same physical therapy program for thirty min in addition to gait training using the Upsee mobility device for thirty min. Children in both groups received sessions three times/week for three successive months. Methods: Both groups were evaluated before and after the treatment programs by Tracker Video Analysis and Modeling Tool. Results: The results of the current study revealed that there was statistically significant improvements in hip joint angles pre and post treatment at different measuring periods during gait cycle subphases in both groups. Improvements in post treatment results were in favor of study group compared with control group. Conclusion: Upsee is a clinically feasible approach for improving gait in children with spastic diplegia through providing increased free opportunities for walking via supporting biomechanical alignments.

Key Words: Diplegic Cerebral Palsy, Upsee mobility device, Gait.

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