Mahmood Bahramizadeh

Background: Individuals with spinal cord injury (SCI) frequently experience chronic pain, trunk instability, and respiratory dysfunction. This pilot trial investigated the synergistic effects of a combined neuro-orthotic approach (thoracolumbosacral orthosis (TLSO) plus transcutaneous electrical nerve stimulation (TENS)) versus TLSO alone on pain, trunk control, and respiratory function in chronic incomplete SCI. Methods: Twelve adults with chronic incomplete SCI (T6–T12) were randomized to a combined group (TLSO + TENS) or a control group (TLSO alone) for a four-week intervention. Outcomes included pain (Visual Analogue Scale), trunk control (Trunk Assessment Scale), and respiratory function (tidal volume [VT], respiratory rate [RR], oxygen uptake [VO₂], ventilatory equivalent for oxygen [VE/VO₂], and inspiratory duty cycle [Ti/Ttot]) assessed at three time points (before intervention, immediately after intervention, and after one month). Results: The combined group demonstrated a significant reduction in pain (47.8% vs. 10.4%, p = 0.01) and an improvement in Ti/Ttot (33.3% vs. 4.9%, p = 0.008) compared to the control group. Both groups showed significant improvements in VT and RR over time (p < 0.05), reflecting the biomechanical benefits of TLSO. Conclusions: Integrating TENS with TLSO offers a non-invasive strategy for managing chronic pain and improving respiratory pattern coordination in incomplete SCI. While TLSO optimizes basic ventilatory mechanics, adding TENS significantly enhances neural drive for efficient breathing and pain gating. Future large-scale trials incorporating active task-specific training are needed to restore functional trunk control.

Background/Objectives: Chronic ankle instability (CAI) is a common sequela of lateral ankle sprain and is characterized by recurrent episodes of giving way, sensorimotor deficits, impaired postural control, and diminished functional performance. While exercise-based rehabilitation, including neuromuscular training and proprioceptive exercises, remains the gold standard for managing CAI, patients often require additional support during daily activities. Orthotic interventions predominantly address mechanical instability, yet there is a clinical gap in providing integrated solutions that simultaneously offer mechanical support and sensory feedback to enhance postural control. This study aimed to investigate the effects of a semi-rigid ankle brace combined with vibro-stimulation on tactile sensation and center of pressure excursion in individuals with CAI. Methods: A randomized clinical trial was designed with two parallel groups and repeated measurements over time. Thirty adults (n = 15 per group) aged 18–35 years, who met the International Ankle Consortium criteria for CAI, were recruited. Participants in the experimental group received a semi-rigid ankle brace integrated with a wearable vibro-stimulation system, whereas those in the comparison group used the ankle brace alone. Outcome measures were collected at baseline, after 10 min, and after 2 and 4 weeks. Primary outcomes included Vibration Detection Rate and phase plane portraits assessed using a 128 Hz tuning fork and a force plate. Results: The ankle bracing plus vibration band group demonstrated significantly greater improvement at 4 weeks than the orthosis group in Vibration Detection Rate (F (3,26) = 31.93, p < 0.001, η² = 0.78). Also, the largest effect was observed for the anteroposterior phase plane portrait at 4 weeks (MD = −2.10 ± 0.42, 95% CI: −2.96 to −1.23, p < 0.001, d = −1.79). Conclusions: The findings suggest that combining a semi-rigid ankle bracing with vibro-stimulation provides additional benefits over the use of bracing alone in individuals with CAI.

Background and Aims: Knee osteoarthritis (OA) is a common degenerative joint disease affecting 22.9% of individuals over 40 years of age, causing pain and functional impairment. Orthotic devices and physiotherapy are standard treatments, but their combined effectiveness compared with that of monotherapy is unclear. This systematic review aimed to evaluate the effectiveness of combined orthotic and physiotherapy interventions versus monotherapy in improving clinical (e.g., pain, function) and quality of life (QOL) outcomes in knee OA patients. Methods: Following the PRISMA 2020 guidelines, a comprehensive search was conducted across four databases for studies published until September 7, 2025. The review included Randomized Controlled Trials (RCTs) that specifically compared the outcomes of combined orthotic and physiotherapy interventions versus monotherapy. A narrative synthesis was performed due to the heterogeneity among the studies. Results: Four RCTs involving 240 participants were included. Monotherapy with orthotics or physiotherapy significantly improved clinical parameters such as pain and function. Combined interventions showed enhanced benefits in some cases, although the results varied. The risk of bias ranged from low to moderate in RCTs. Conclusion: Both orthotic and physiotherapy interventions are effective for knee OA, with combined approaches potentially offering additional benefits. However, heterogeneity and bias limit the certainty of the evidence. Future research should focus on large‐scale, stratified RCTs to enhance the generalizability of the findings and inform personalized treatment strategies.

Background: Lateral ankle instability (LAI) frequently arises from deficits in sensorimotor function. Orthotic devices are regularly used to yield mechanical support, but the use of sensory‐enriching modalities such as local vibration with these supports has not been explored. Objective: This study was conducted to examine the effect of adding vibration to an orthotic device on postural stability in LAI. Methods: In this parallel randomised controlled trial, 32 adults with LAI were entered into a trial group who received an ankle‐foot orthotic device incorporating a vibratory strap or into a control group receiving the same orthosis without a vibration strap. Postural stability was evaluated with centre of pressure (COP) velocity on a force plate at four time points: baseline, immediately following intervention, 2‐week follow‐up, and 4‐week follow‐up. Finally, 29 participants completed the study protocol. Results: There was a significant group × time interaction on COP anteroposterior velocity (F (3, 25) = 39.44, p < 0.001, η ² = 0.82). The trial arm had a greater decrease in this outcome at 4‐week follow‐up compared with controls (MD = −0.90 mm/s, p < 0.001, d = −1.59). No differences were found for COP mediolateral velocity or COP resultant velocity, but there was a general trend of reduction in both groups. Conclusion: The addition of sensory stimulation to orthotic devices significantly enhances anteroposterior postural stability in LAI subjects, suggesting a synergistic effect of mechanical support and sensory augmentation.

Functional ankle instability (FAI) is a common consequence of lateral ankle sprains, characterized by impaired sensorimotor control. While orthoses and localized vibration have shown individual benefits for FAI, their combined application in a wearable device has not been previously investigated. This pilot randomized trial compared the effects of a vibrotactile foot orthosis (VFO) and a vibrotactile ankle orthosis (VAO) on joint position sense (JPS) and postural control in individuals with FAI. Sixteen participants were randomized to receive either a VFO or a VAO, both delivering 30–50 Hz pulsed vibration in 20 min sessions, three times a week, for two weeks. Outcome measures included joint position sense (JPS) error (°), center of pressure (COP) velocity (mm/s), the Star Excursion Balance Test (SEBT), and the Six-Meter Hop Test (SMHT), which were assessed pre-intervention, immediately post-intervention, and after two weeks of use. The analysis showed a statistically significant interaction between time and intervention group for JPS error (p = 0.02, η² = 0.42). Specifically, the VFO group improved JPS significantly more than VAO at two weeks follow-up (MD = −1.75°, p = 0.005, d = −1.68). Both groups significantly reduced in anteroposterior COP velocity after two weeks (VFO: MD = 1, p = 0.003, d = 1.47; VAO: MD = 1.39, p ˂ 0.001, d = 2.05) with no between-group differences. No changes were observed in the SEBT or SMHT. Plantar-based vibrotactile stimulation was more effective than ankle-based stimulation in enhancing proprioceptive acuity in individuals with FAI. Both interventions improved static postural stability, supporting the potential of integrated vibrotactile orthoses in FAI rehabilitation. No major practical issues were reported during the intervention. Two participants experienced minor discomfort related to the electronic housing bulk in the first week, which was resolved by week two. No further complaints regarding device weight or usability were observed.

Similar to many other nations, Iran is committed to achieving universal health coverage, which includes the provision of accessible and high-quality rehabilitation services. Consequently, several legislative measures have been enacted to regulate the sector. However, a closer examination of these laws reveals numerous systemic challenges that impact critical health system functions, ...

Background: Chronic neuropathic pain (CNP) is a common consequence of neurological conditions such as spinal cord injury (SCI), complex regional pain syndrome (CRPS), and phantom limb pain (PLP). These conditions are often associated with distorted body representation (BR) and altered sensory processing. Virtual reality (VR) offers immersive, multisensory experiences that can modulate attention, recalibrate BR, and potentially alleviate pain. Objective: This systematic review aims to synthesize evidence on the use of VR-based interventions for managing CNP in patients with neurological conditions. It explores how VR can influence pain perception through body remapping. Furthermore, this review seeks to identify gaps in current research, offering recommendations for future research directions and clinical applications. Methods: We performed a comprehensive literature search in PubMed, Web of Science, and Scopus for studies published between January 2014 and December 2024. We included original studies that examined VR interventions in patients with neurological conditions and CNP, assessing pain reduction, improvements in BR, or functional recovery. We excluded reviews, animal model studies, migraine-related studies, and those lacking a clear VR intervention or relevant clinical outcome data. The quality of the included studies was evaluated using the revised Cochrane Risk of Bias Tool for Randomized Trials and the Cochrane Risk of Bias in Nonrandomized Studies of Interventions tool. Given the heterogeneity in study design, VR protocols, and outcome measures, a qualitative synthesis approach was adopted based on the synthesis without meta-analysis framework. Results: Ten studies—both randomized controlled trials and uncontrolled experimental designs—met the inclusion criteria. These studies focused on the application of VR in SCI (n=4, 40%), CRPS (n=4, 40%), and PLP (n=2, 20%), using interventions such as immersive VR, mirror visual feedback, visuotactile stimulation, and virtual body illusions. Sample sizes ranged from 9 to 70 participants, with varying degrees of neurological impairment. Most of the studies (n=7, 70%) reported substantial reductions in pain intensity and improvements in embodiment and perceived body ownership. In SCI, combining VR with neuromodulation techniques enhanced analgesic effects. In CRPS, modifying the visual appearance of the affected limb improved body image and decreased pain perception. In PLP, kinesthetic and visual feedback delivered through VR environments significantly reduced PLP and improved movement representation. Conclusions: Overall, the quality of evidence ranged from moderate to low, mainly due to small sample sizes, protocol heterogeneity, and risk of bias. Evidence regarding adherence to VR therapy was particularly limited. Nonetheless, VR shows strong potential as a noninvasive, patient-tailored therapeutic tool for CNP. VR could provide innovative and engaging strategies to reduce pain and enhance functional outcomes in populations with neurological conditions. Future research should focus on developing standardized protocols and conducting large-scale, high-quality trials to validate VR’s long-term efficacy and integration into routine clinical practice. Trial Registration: PROSPERO CRD42024606150; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024606150