Discussion
osteonecrosis, stroke, osteoporotic, pain, Osteoporosis, femoral head osteonecrosis, osteoporosis
OSTEONECROSIS, STROKE, NON-UNION FRACTURE, OSTEOPOROSIS, NEOVASCULARIZATION, OSTEOPOROSIS
In order to assess the effectiveness of HILT and ESWT in treating osteoporotic long-term hemiparetic patients, this study was carried out. Outcome measures were visual analog scale (VAS), fall risk which was assessed using two different techniques: the overall stability index (Biodex Balance Master, USA) and the Short Form of Berg Balance Scale (SFBBS).A valid and reliable quality of life questionnaire to measure health-related quality of life was carried out by the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41).The primary conclusion is that combining HILT and ESWT with traditional physical therapy is more effective in increasing the overall stability index, (SFBBS), quality of life questionnaire, and lowering the VAS scores following a 12-week physical therapy alone. The results showed that although both HILT and ESWT were effective in improving the overall stability index (SFBBS) (QUALEFFO-41) and lowering the VAS ratings after receiving therapy for 12 weeks than traditional physical therapy alone in osteoporotic long-term hemiparetic patients, HILT was more effective than ESWT except for VAS.Improving the overall stability index, (SFBBS), quality of life questionnaire, and VAS scores after treatment with the modalities used in this study was reflected on the stroke patients, their ADL scores, and activity as observed in their quality of life questionnaire.The best course of treatment for osteoporotic long-term hemiparetic patients was high-intensity laser therapy (HILT) in conjunction with conventional physical therapy. Patients with the osteoporotic bone are currently treated with low-intensity laser therapy. It is a valuable physical treatment technique for enhancing range of motion [Shortly, HILT and ultrasonic wave therapy for patients with low back discomfort were compared by Fiore et al. Participants in the study underwent HILT for three weeks in a row. They demonstrated a substantial reduction in pain that was greater than ultrasound therapy [Since human skin lacks enough endogenous chromophores to absorb laser wavelength (1064 nm) effectively, the pulsed Nd: YAG laser operates in a therapeutic model that enables it to be absorbed and propagated by tissue more rapidly [Thermal build-up happens when the Nd: YAG laser is utilized continuously. HILT employed a specific waveform. 3 kW of power was reached, with frequent peaks of high amplitude for a minimal period and ultra-short duty cycle to quickly initiate photochemical and photothermal effects while reducing the thermal build-up in deep tissues [By varying the pulse frequency and strength, the photothermal effect might be managed for patient comfort and safety [The sedation impact of HILT depends on various modes of action, such as its ability to decrease the velocity of pain stimuli and boost the body’s creation of morphine-like compounds [In a study involving rabbits, it was found that the application of ESWT enhanced neovascularization and the expression of osteogenic and angiogenic growth factors at the bone junction of the Achilles tendon, including proliferating cell nuclear antigen (PCNA), endothelial nitric oxide synthase (eNOS), bone morphogenic protein-2 (BMP-2), and vessel endothelial growth factor (VEGF2 [This was further corroborated by the fact that PCNA was still elevated 12 weeks after treatment, although eNOS, VEGF, and BMP-2 effects had mostly reverted to their pre-treated levels. The biological reactions have been demonstrated in the literature for the first time. Several investigations, including non-union fractures, showed comparable findings [ESWT was used to treat individuals who had femoral head osteonecrosis. In particular research, the biological basis for ESWT’s use in treating osteonecrosis of the hip joint was investigated [In a different research, six individuals with osteonecrosis had their bone marrow stromal cells (BMSCs) removed from the femur [Extraneous factors may be corroborated to current study limitation which may have interfered with our results, such as variations in life style between patients as activity level, and psychological factor of the participants during the period of application of the study. Regarding to osteoporosis duration, it was difficult to be declared from the patients due to economic and social reasons. Analysis of gender differences on different responses of High-Intensity Laser Therapy and Shockwave Therapy on osteoporotic long-term hemiparetic patients could be a recommended future research.