فصلنامه آرشیو توانبخشی
سال هشتم شماره 2 (پیاپی 25، تابستان 1386)

To determine intrarater reliability of clinical examinations and radiographic variables that proposed to identify patients with lumbar segmental instability. In this descriptive and methodological research, 15 patients with chronic non specific low back pain aged 22-43 years with non probability and simple selection (sample of convenience) participated. Clinical examinations included pain intensity, flexion and extension range of motion (ROM) with modified schober method, aberrant movement patterns, ito method of flexion and extension endurance test, sid support test, bilateral straight leg rising (SLR) & sit-up, prone instability test and oswestry index. Radiographic variables included: 1) Quantity of movement (sagital plane transition & rotation) measured with Dupuis and Panjabi method 2) Quality of movement (instability factor, centre of rotation & Centroid). Proposed method from Putto was used for flexion-extension radiography. Five x-rays were taken in neutral, full flexion & extension, mid range of flexion & extension positions from lateral view. We used ICC for reliability of quantitative variables, and Kappa statistic for nominal variables. Reliability of Pain intensity (ICC=0.89), flexion (ICC=0.93) & extension (ICC=0.74) ROM, Sid support test (ICC=0.85-0.86), extension (ICC=0.86) & flexion (ICC=0.82) endurance were high. Kappa value for aberrant movement patterns (k=0.66), bilateral SLR & sit-up (k=0.65), prone instability test (k=0.66) were substantial. Centre of rotation on X axis (ICC=0.99) & Y axis (ICC=0.96), rotation with Dupuis (ICC=0.83) & Panjabi (ICC=0.88) had very high reliability. Centroid length with 3 (ICC=0.60) & 5 (ICC=0.64) x-rays, instability factor with 3 (ICC=0.61) & 5 (ICC=0.72) x-rays, transition with Dupuis (ICC=0.69) & Panjabi (ICC=0.76) method had moderate to high reliability. Clinical examinations includig pain intensity, flexion & extension ROM, sid support test, extension & flexion endurance and oswestery index have high to very high reliability. Aberrant movement patterns, bilateral SLR & sit-up and prone instability test have substantial agreement. Radiographic variables have moderate to very high reliability.

Assessment of balance in children with neurological disorders is quite necessary in any rehabilitation therapy. There are various versions of balance tests for balance assessment of adults however, little has been done with regard to introducing a reliable test for evaluation of the balance in children with spastic cerebral palsy. The purpose of this study was to investigate the inter and intrarater reliability of Berg balance scale in children with spastic diplegia. In this descriptive and methodological study twenty spastic diplegia children with non probability selection participated. Children were in the range of 6-12 Yrs (Mean, SD, 7/35 &1/84 yrs, respectively). Parents were asked to sign an informed consent. Berg balance scale was tested in one session by two therapists for interrater reliability (inter-rating) and repeated tests were tested for intrarater reliability (intra-rating). Intraclass correlation coefficient (ICC) test was used for interrater (between two therapists, ICC= 0/985, P<0/001 and intra rater reliability repeated test by the same therapist, ICC= 0/994, P<0/001). The result of this study suggests that inter-rater and intra-rater reliability of Berg balance scale is acceptable. Therefore, it could be used in clinic for the assessment of children with spastic diplegia as a reliable scale.

The purpose of present study was comparatively analyze the effect of ankle taping on postural stability in patients with functional ankle instability and healthy individuals. Studied variables were the stability indices including overall stability index,antero-posterior and medio- lateral stability indices. In the first stage, a methodological research for evaluating the reliability of measurements was implemented in two groups of patients (n=8), and healthy individuals (n=8). All variables showed excellent relative and absolute reliabilities. In the second stage, a quasi-experimental case control study was conducted in two groups of patients (n=15) and healthy females (n=15). Biodex Balance System was used to measure postural sways in patients and healthy females in one and two legged stance, with and without taping. Data was analyzed by using coefficient of correlation and ANOVA. The finding showed significant improvements of postural sways in all conditions of tests after taping compared with same measurements before taping. Based on the results, postural control problems may be considered as very important aspects in evaluate and management of patients with functional ankle instability. Also taping is suggested as valuable for improving dynamic postural control via reinforcement of proprioceptive inputs in females with functional ankle instability.

The aim of this research is study of explicit learning in unilateral stroke patients and comparison with normal individuals and identify effects of age, sex and study level in this motor learning. In this case–control analytical research we used a software for studying motor learning. In this software 4 squares with different colors were appeared on the monitor and individuals should press a defined key immediately after observing it. 15 patients and 15normal matched were participate in this research. In first day individuals practiced 8 motor block (4 regular blocks, then 2 blocks in randomed manner and finally 2 regular blocks). Next day individuals practiced a retention test consist of 2 regular block. Befor starting test, individuals took complete explanation about sequence of squares. All individuals were right handed and impaired hand in patients was right side and patients practiced with impaired hand. Motor sequences and blocks were recorded with software. Data was analyzed by using Chi-square test, T-test for independent groups and ANOVA. This research revealed that performance of patients was slower than normal group (P<0/05). Difference of performance speed of men and women in normal and patient group was not significant. Age, sex and study level was not effective on research results (P>0/05). Block times were decreased from second to fourth block and time differences between second block with eight and tenth block (next day) were significant in both patient and normal groups (P<0/05). Although performance of unilateral stroke patients was slower than normal individuals, motor learning (stable decrease of block times) was similar. On the other hand in patients with unilateral stroke ability of motor learning with affected hand was preserved.

The aim of this study is provide a test to examine the effect of word length on spelling errors and determination of its validity and reliability. This study is a descriptive and validity assessment research. The samples selected by non probability sampling from the 8th territory of ministry of education (one class from girlish school and one class from boyish school). At the first, the words of Farsi book were analyzed based on word length (the number of syllables), then 241 out of 494 words were selected. They included every syllabic structure such as 1-5 syllabic words. Different experts like speech and language pathologist, linguists and teachers scored those words. Finally 40 words selected as words of test and dictated to students at first grade by 2 testers during 2 stages separately. Errors were determined and analyzed by using pearsonian correlation coefficient and paired T–test. The findings show the coefficient correlation between different performances is high. In boys there is no difference between mean of the number errors in different performances (the amounts of P are P=0/33, P=0/56 in 2 administrations by two testers) but in girls there is (the amounts of P are P=0/002, P=1 in 2 administrations by two testers). It can be because of difference between boys and girls in spelling or condition of test. These findings show this test have high validity and reliability.

In addition to memory deficits and aphasia, many patients with Alzheimer’s disease (AD) are apraxic which may bring about disturbances in their daily living. The purpose of present study was investigating the presence of any apraxic disorder in patients with senile dementia of Alzheimer type (SDAT) and comparison with normal aged people. In this case–control and analytical study 14 SDAT patients were compared with 20 normal ageing people that they were matched with patients according to age and education. Patients were selected from Iranian Alzheimer Association clients with psychiatrist diagnostic confirmation and MMSE scores between 15-27 and compared with controls with MMSE scores between 25-30. Apraxia Test was administered on both groups. The Test included 4 subtests: conceptual movements gestured conceptual movements, oral and respiratory movements & pantomime of movements of object manipulations. Data was analyzed by using Kolmogoroff – Smirnoff test, Man – Witney, T-test for independent groups and pearsonian correlation coefficient. Findings showed that apraxia scores were significantly (P<0/001) different between groups so that (SDAT) patients were diagnosed as apraxic and controls were not. Besides, comparison of subtests scores of (SDAT) patients revealed that conceptual movements scores were significantly (P<0/001) less than the other subtests (more apraxic) and oral and respiratory movements scores were significantly (P<0/001) higher than the other subtests (less apraxic). Apraxia could be considered as one of the neuropsychological signs early in the disease development. It can be applied complementarily for differential diagnosis. Also apraxia subgroup scoring could be used for apraxia categorization, understanding observed disorders and determining possible rehabilitation ways.

Visual-motor skill is a part of visual perception which can integrate visual processing skills to fine movements. Visual-motor dysfunction is often to cause problems in copying and writing. The purpose of this study is investigation of occupational therapy interventions effect on the visual-motor skill in children with learning disorders. In this interventional and experimental study, 23 students with learning disorders (2nd, 3rd, 4th grade) were selected and they were divided (through Randomized Block Method) into two groups, 11 persons as intervention group and the others as the control group (12 people). Both groups were administered the “Test of Visual-Motor Skills- Revised” (TVMS-R). Then case group received occupational therapy interventions for 16 sessions and two groups were administered by TVMS-R again. Data was analyzed by using paired T-test and independent T-test. Total mark of TVMS-R demonstrated statistically significant difference in visual-motor skills between case and control groups (P<0/001). This test has 8 categories. Total mark of 1, 3,4,6,8 categories demonstrated that occupational therapy had significant effect on visual analysis skills (P<0/005). Total mark of 2, 5, 7 categories demonstrated that occupational therapy had significant effect on visual-spatial skills (P<0/001). Occupational therapy interventions had significant effect on the visual-motor skills and its items (visual-spatial, visual analysis, visual-motor integration and eye fixation skills).

Current study took place in order to deliver a comprehensive assessment of oral and speech motor abilities in verbal and non-verbal tasks in normally children based on oral/speech motor control protocol and determination of this protocol validity and reliability after translation. First stage of this research was a descriptive study and validity assessment and in second stage it was done cross – sectional and comparatively. After translating the protocol into Farsi, some items relating to speech coordinated movements were modified to conform in Farsi. Three hundred normally Farsi speaking children were selected by radom sampling from day care centers and preschool classes. The means and standard deviations of the main variables were computed and some comparisons were analyzed by using one-way ANOVA. The scores of 5-6 years children usually was more than other groups and their difference was significant (P<0/001). Reliability coefficient of protocol in different age groups were 0/19-0/59 in TSS and 0/75-0/80 in TFS. The results imply a meaningful increase in TFS, and MPT scores by age groups and decrease in TSS and imply increase in speech functions. This protocol can be used in researches and clinical evaluations.

As it is important to localize the different models of rehabilitations, in this study we introduce the Japanese psychological rehabilitation (Dohsa-Hou) and examine the effect of Dohsa Hou on the physical and mental state of children with disability. In this Quasi-experimental with pre-post study design, totally 120 convenient children with cerebral palsy (CP) and mental retardation (MR) (60 CP and 60 MR) from rehabilitation centers in Tehran (age from 5 to 10 years old) were participated. Each child had 24 sessions of one hour therapy during 3 months (total 2880 sessions). In this interventional study, the effect of Dohsa in improvement of spinal curve situation and improvement in static stability in hip complex in children with cerebral palsy, and also the effect on the posture, movement and social interaction level of children with mental retardation were measured. The assessment package (flexible curve & clinometric device), Social interaction questionnaire and drawing devices were used as tools of study. Data was analyzed by using Willcoxon and ANONA tests. The findings showed that in children with cerebral palsy, the pre and post data analysis indicated a significant differences (P<0/05) which show the improvement of spinal curve situation and improvement in static stability in hip complex decrees of abnormal postural ton. In children with mental retardation, their posture and movement improved according to the expert’s ratings (P=0/237) and their level of social interaction changed (P<0/001), specially the level regarding parents and friends. From the clinical observation and data analysis, we can suggest that Dohsa-hou is an effective method of rehabilitation for physically and mentally disorder children and can be used beside other methods of therapy as a complementary method.

Handwriting difficulty is a common problem in mentally-retarded students. This article investigates the relationship between handwriting and spatial analysis. One hundred and twenty six mentally- retarded students (53 girls and 73 boys) ranging from 9 to 19 years old from two exceptional children schools in Shahr-e-Rey participated in this cross – sectional and descriptive survey. A handwriting check-list made by the researcher along with the subtest of designing with cubic from Wechsler scale (WISC-R) was executed on all of the students. Data was analyzed by using Independent T-test, U-Man Witeny, Kruskal-Wallis and Spearman correlation coefficient. Correlation coefficient showed that there is a significant relationship between handwriting scores and spatial analysis scores (r=0/305, P<0/0001). Also spatial analysis has significant relationship with size of letters in relation with each other (P<0/007), with size of handwriting (P<0/0001) and with writing on the line (P<0/002). In order to developing handwriting legibility of mentally- retarded students in factors: size of letters in relation with each other, size of handwriting and writing on the line, the therapists must train mentally-retarded students with spatial analysis exercises.

Stuttering is one of the most common speech disorders. However, its etiology is poorly understood, and is likely to be heterogeneous. Impairment of cognitive functions such as emotional memory and attention is one of the important factors. The aim of this research is to compare explicit and implicit memory between stutterers and normal individuals and also comparison of anxiety and depression between 2 groups. This is a case-control and analytical research.The participated individuals in this research were 30 male and female stutterers and the same number as the matched control group. The control group was matched for gender, age, education and bilingualism. The cue recall task performed to investigate explicit memory and the word stem completing task for implicit memory. The anxiety and depression of the individuals were measured by using general Hygiene Questionnaire (GHQ28) in this study. The performance of the individuals was measured based on positive and negative words in explicit and implicit memory and was compared with anxiety and depression score they obtained. Data was analyzed by using independent T-test, paired T-test, U-Man Witney and Willkaxon test. The data indicated that stutterers recognized less emotionally positive words in explicit memory as compared with nonstutterers. Also, stutterers recognized more emotionally negative words as compared with emotionally positive words in explicit and implicit memory tasks (P<0/05). Additionally, stutterers showed more anxiety and depression as compared to nonstutterers. This difference was significant except for depression (P<0/001 & P>0.05). Taking into consideration the role of cognitive functions including emotional memory in motor speech programming and the difference in the function of positive versus negative emotional memories between stutterers and nonstutterers in this research, the role of emotional memory can be considered as an important factor in stutterers.

Multiple Sclerosis (MS) is one of the most common chronic unpredictable demyelinization diseases of the Central Nervous System (CNS). The aim of this study is to assess the effect of applying the Progressive Muscle Relaxation on activities of daily living of Multiple Sclerosis patients.

This is a interventional and experimental study. Sixty six Multiple Sclerosis patients were selected with non probability sampling according to specific criteria then assigned to experimental and control groups (33 patients in each group) with random allocation. Data collector tools included: demographic questionnaire, ADL-MS questionnaire and self report checklists. Progressive Muscle Relaxation (PMR) performed for 63 sessions by experimental group during two months but no intervention was done for control group. Data was analyzed by suing statistical analysis such as paired T-test, independent T-test, ANOVA and correlation coefficient determination.

The findings showed that there is no significant difference between two groups in mean scores of ADL before the study (P>0/05) but there are significant differences, within one and two months after intervention (P<0/05). ANOVA test with repeated measurements showed that there is a significant difference in mean score of social dimension of ADL between two groups in 3 times (P<0/02), but no significant difference in mean scores of another dimensions of ADL (physical, sensory, intimacy) and whole ADL (P&ge0/095).

The results of this study show that Progressive Muscle Relaxation (PMR) is practically feasible and may be associated with Activities of Daily Living (ADL) increase in Multiple Sclerosis (MS) patients. Therefore, applying such technique can promote Multiple Sclerosis patients Activities of Daily Living.

Manipulation and mobilization are two different forms of manual therapy commonly employed in the management of musculoskeletal disorders. Spinal manipulation and mobilization are often distinguished from one another by reference to certain biomechanical parameters such as peak force, duration and magnitude of translation. However, as of yet, there is relatively little research which distinguishes between them in terms of neurological mechanisms or clinical effectiveness. Manipulation may particularly stimulate receptors within deep inter-vertebral muscles, while mobilization techniques most likely affect more superficial axial muscles.

Early Intervention services are special services for children in their early years either with known developmental disabilities or with substantial biomedical or psychosocial risk factors for abnormal development (e.g., prematurity or parental neglect). This discussion describes the varying interdisciplinary components found in such programs, and the importance of participation by parents. The efficacy of these procedures in enhancing development has been defined by research. The pediatric role is described as surveillance, referral, interdisciplinary collaboration, ongoing pediatric care responsive to the needs of the child and family, and advocacy. Keywords: Early intervention, High risk infants, Follow-up program