Hayam Mahmoud

[Purpose] To determine which of the transcranial electromagnetic stimulation or low level laser therapy is more effective in the treatment of trigeminal neuralgia of multiple sclerosis patients. [Methods] Thirty multiple sclerosis patients of both sexes participated in this study. The age of the subjects ranged from 40 to 60 years and their mean age was (56.4-6.6). Participants were randomly selected from Dental and Neurology Outpatient Clinics at King Khalid Hospital, Najran University, Saudi Arabia. Patients were randomly divided into two equal groups of 15. The Laser group received a low level laser therapy, 830 nm wavelength, 10 Hz and 15 min duration, while the Electromagnetic group received repetitive transcranial electromagnetic stimulation at a frequency of 10 Hz, intensity of 50 mA and duration of 20 minutes. Patients were assessed pre and post treatment for degree of pain using a numerical rating scale, maximal oral mouth opening using a digital calibrated caliper, masseter muscle tension using a tensiometer and a compound action potentials of masseter and temporalis muscles. [Results] There were significant improvements after treatment in both groups, with a significant difference between the Electromagnetic and Laser groups, in favor of the Electromagnetic group. [Conclusion] Repetitive transcranial electromagnetic stimulation at 10 Hz, 50 mA, and 20 minutes duration is more effective than low level laser therapy at reducing trigeminal pain, increasing maximum oral mouth opening, masseter and temporalis muscle tension in multiple sclerosis patients.

OBJECTIVE: To compare between selected post-operatives physical therapy modalities after transverse carpal ligament release. DESIGN: Double blind, randomized controlled trial. SETTING: Health insurance hospital outpatient clinic in Cairo, Egypt. SUBJECTS: Forty-five female patients aged 25–45 years, following transverse carpal ligament release of the dominant hand, referred to the physical therapy outpatient clinic of a health insurance hospital, Egypt. INTERVENTION: Patients were randomly allocated to three equal groups of 15: Ultrasonic group received continuous ultrasound with nerve and tendon gliding exercises, Laser group received laser therapy and the same exercises, Exercise group received the same exercises only. Treatment duration was six weeks, three times per week. MAIN MEASURE: Visual analogue scale for pain intensity, pinch dynamometer for muscle strength, motor and sensory distal latencies for median nerve. RESULTS: There was significant improvement after treatment in all groups, with no significant difference between the Ultrasonic group and the Laser group; there was a highly significant difference between the Ultrasonic group and the Exercise group, and a significant difference between the Laser group and the Exercise group. CONCLUSION: Continuous ultrasound accompanied with nerve and tendon gliding exercises is considered more effective in the post-operative treatment of transverse carpal ligament release, giving best results and percentage of improvements when compared either to Laser therapy with nerve and tendon gliding exercises or nerve and tendon gliding exercises only.

Abstract
Diabetic neuropathy is the most common complication and greatest source of morbidity
and mortality in diabetic patients. Thirty male and female patients with painful diabetic neuropathy
and abnormal results from nerve conduction studies participated in this study. Their ages ranged
from 45 to 60 years with a mean of 52.1 ±SD 4.7 years. Patients were randomly assigned into
two equal groups of 15, an active laser group (laser group) and a placebo laser group (control
group). The laser group received scanning helium neon (He–Ne) infrared laser with wavelength
850 nm and density of 5.7 J/cm2, applied to the lumbosacral area and the plantar surface of the foot
for 15 min each site/session three times per week for four weeks (i.e. 12 sessions). Pain intensity via
visual analogue scale, bilateral peroneal motor nerves, sural sensory nerves conduction velocity and
amplitude and foot skin microcirculation, were measured pre- and post-treatment for both groups.
Pain was significantly decreased (p 6 0.05) and electrophysiological parameters and foot skin
microcirculation were significantly improved (p 6 0.05) in the laser group, while no significant
change was obtained in the control group. Low level laser therapy within the applied parameters
and technique could be an effective therapeutic modality in reducing pain and improving neurovascular
function in patients with diabetic polyneuropathy.
ª 2011 Cairo University. Production and hosting by Elsevier B.V. All rights reserved.

Abstract
Diabetic neuropathy is the most common complication and greatest source of morbidity
and mortality in diabetic patients. Thirty male and female patients with painful diabetic neuropathy
and abnormal results from nerve conduction studies participated in this study. Their ages ranged
from 45 to 60 years with a mean of 52.1 ±SD 4.7 years. Patients were randomly assigned into
two equal groups of 15, an active laser group (laser group) and a placebo laser group (control
group). The laser group received scanning helium neon (He–Ne) infrared laser with wavelength
850 nm and density of 5.7 J/cm2, applied to the lumbosacral area and the plantar surface of the foot
for 15 min each site/session three times per week for four weeks (i.e. 12 sessions). Pain intensity via
visual analogue scale, bilateral peroneal motor nerves, sural sensory nerves conduction velocity and
amplitude and foot skin microcirculation, were measured pre- and post-treatment for both groups.
Pain was significantly decreased (p 6 0.05) and electrophysiological parameters and foot skin
microcirculation were significantly improved (p 6 0.05) in the laser group, while no significant
change was obtained in the control group. Low level laser therapy within the applied parameters
and technique could be an effective therapeutic modality in reducing pain and improving neurovascular
function in patients with diabetic polyneuropathy.
ª 2011 Cairo University. Production and hosting by Elsevier B.V. All rights reserved.

Influence Of Early Aerobic Interval Training On Stroke Patients' Performance
Nesreen Ghareb El-Nahas * Hayam Mahmoud Sayed**
*Physical Therapy Department for Cardiovascular / Respiratory Disorder and Geriatrics -Faculty of Physical Therapy, Cairo University, **Physical Therapy Department for Neuromuscular Disorders and its surgery-Faculty of Physical Therapy, Cairo University
Abstract
Background: Secondary impairments of stroke patients, including muscle disuse and decreased control of respiratory muscles, often contribute to further functional declines in respiration and reduction of quality of life. Purpose of this study was to determine the influence of early aerobic interval training on ventilatory functions, walking speed, and functional mobility in Stroke Patients. Methods: Thirty stroke male patients participated in this study and were assigned into two equal groups according to duration of illness. Patients in both groups were matched in age and body mass index. Both groups received a conventional physical therapy program in addition to a moderate aerobic training program for twelve weeks, three days per week. A Cardiopulmonary exercise test unit was used for measuring the ventilatory functions. Six minutes walk test (6MWT), and Rivermead mobility index were used for assessing the walking speed, functional performance after a treadmill aerobic training respectively. Results revealed a statistical significant improvement of ventilatory functions and Rivermead index of Gr1 when compared to results of Gr2 after treatment. Conclusion Early treadmill interval training in addition to a conventional physiotherapy program may be valuable to improve ventilatory functions and functional capacity including ambulation and walking speed in stroke patients.
Key Words: Stroke; walking speed; Ventilatory functions; Aerobic interval training, exercise

Comparison Between Different Modulated Electrical Current on Painful Foot in Diabetic Sensorymotor Polyneuropathic Patients
Hayam Mahmoud Sayed, PH, Abeer Abdelrahman PH, Nermien khisk, MD
Department of Neuromuscular Disorders and its Surgery, Department of Basic science, Faculty of Physical Therapy, Cairo University, Neurology Department ,Faculty of Medicine, Cairo University
ABSTRACT
Purpose of the study: To evaluate the influence of three different modulated current on reducing foot pain diabetic neuropathy(DN) patients and to determine the most effective modulated current. Subjects: Twenty-eight female patients with (eight to eleven years of diabetes mellitus) painful diabetic neuropathy and abnormal results of nerve conduction studies were randomly recruited in this study. Their age ranged from 48 to 60 years old. Patients were assigned randomly into four equal groups of seven. Methods: group1 (G1) received low frequency modulated current( LFMC),group2 (G2) received high frequency modulated current (HFMC), group3 (G3) received low-high frequency modulated current (L-HFMC), and group4 (G4) received sham procedure (control group) for a period of three weeks (12 sessions).The four groups were assessed pre and post treatment for pain intensity via Visual analogue scale(VAS) and nerve conduction studies(peroneal motor conduction studies, sural sensory conduction studies) .Results: pain was significantly decreased in group1 (G1) who received (LFMC) more than both ;group2(G2) that received (HFMC)& group3 (G3) that received (L-HFMC) ,while pain in group4 (G4) was not significantly decreased. Conclusion: Low frequency modulated current is more effective in reduction of diabetic polyneuropathic pain when compared to other modulated current.
Key words: Diabetic sensorymotor polyneuropathy, modulated current, Nerve conduction studies, numerical analogue scale, painful foot.

Wrist Position as a Risk Factor of Carpal Tunnel Syndrome in Computer Users
SALAH SAWAN Ph.D. PT and HAYAM MAHMOUD SAYED PT.D
Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University

Abstract
Background: the maintenance of an awkward posture for a prolonged period of time is a significant risk factor in the development of cumulative trauma disorders (as carpal tunnel syndrome), since it poses significant biomechanical stresses on the joints of the upper extremities and surrounding soft tissues Objective: this study was designed to identify the effect of wrist extension as a risk factor for the prevalence of carpal tunnel syndrome among computer users. Subjects: forty female subjects using computer at least six hours a day participated in this study and were divided into two groups of twenty; the normal group (GA) with a mean age of 33.75 (± 6.33) years and the patients' group (GB) with a mean age of 33.65 (± 6.45) years. The patients’ group was diagnosed as clinical carpal tunnel syndrome (CTS). Patients were suffering from pain, paraesthesias and/or hypoesthesias in the hand, in the area innervated by the median nerve. Methods: median nerve sensory and motor conduction studies (distal latencies and amplitude) were performed for both groups while the subject was lying supine with the shoulder abducted 45 degrees, the forearm fully supinated, and the wrist was in the neutral (zero) position. Then each subject was asked to fully extend the wrist joint and maintain this extended position for 10 minutes. The motor and sensory median nerve conduction studies were performed after these 10 minutes, and compared with that of the nerve conduction results at the neutral position. Results: the results of the study indicated that the extended wrist position significantly increases the distal latency of the motor and sensory median nerve conduction velocity for both normal and patients’ groups. Regarding the amplitude of the median nerve motor and sensory conduction studies, the normal group revealed no significant difference in the amplitude between the neutral and the extended position. On the contrary, patients’ group showed significant decrease of the amplitude of the median motor and sensory conduction at the extended wrist position compared to the neutral position. CONCLUSION: Prolonged and sustained wrist extension more than 6 hours per day is a major risk factor of CTS prevalence, especially in computer users.

Key words: Carpal Tunnel syndrome, wrist position , computer users, EMG ,and Nerve conduction study.

Effects of Galvanic Vestibular Stimulation on Balance in Multiple Sclerosis patients.
Hayam Mahmoud Sayed,PH, D, Magdy Ahmed Arafa,PH,D.Nevin Mohieeldin Shalaby ,MD.
,Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Neurology Department , Faculty of Medicine ,Cairo University.

ABSTRACT
Purpose of the study: To determine the influence of galvanic vestibular stimulation on balance performance in multiple sclerosis patients.Subjects:Twenty four patients of both sex (16females,8males) clinically and radio logically diagnosed as multiple sclerosis(cerebello pyramidal manifestations)of relapsing remitting type, were participated in this study. Patients were assigned randomly into two equal groups of twelve,control group and study group. All patients were matched in age,weight,and height. Methods: Both groups were received a program of neuromuscular rehabilitation (Proprioceptive Neuromuscular Facilitation ,Frenkel coordination exercises, balance training),study group ,in addition received galvanic vestibular stimulation for a period of 6 weeks,3 times per week.Balance performance were assessed using Biodex Stability System, Functional reach test, Timed get up-and-go test.Results:Both groups were significantly improved in balance performance after treatment program. study group was significantly improved compared to control group.Conclusion:Galvanic vestibular stimulation in addition to neuromuscular rehabilitation program improved balance performance and postural stability in multiple sclerosis patients.

Key words: Galvanic Vestibular Stimulation, Balance, Multiple Sclerosis.