فصلنامه آرشیو توانبخشی
سال دوم شماره 3 (پیاپی 5، پاییز و زمستان 1380)

Child-abuse (physical, mental and sexual) is considered as one of the important problems faced by persons specialized in behavioral Sciences and Forensic Medicine, physicians and pediatricians. This cross-sectional study was conducted to determine the status of physical child-abuse in Tehran. Forty-five pediatric residents, trained for this purpose, conducted this ten-day study in three teaching hospitals (Children's Medical Center, Bahrami Hospital, Hazrat Ali-Asghar Hospital). A questionnaire on physical child-abuse, designed and proposed by the WHO, was completed for 3019 children (male=1578, 52.3% female=1441, 47.7%) less than 18 years of age, who attended the emergency department of the above hospitals. The children and their parents were interviewed and physical examination was performed for the children. A total of 347 children (male=14.5%, female =9.6%), which is 12.2% of the total number of children studied, were physically abused. Injuries were mostly present on the face, upper extremities, back and lower extremities, among which 12.8% of the cases were severe and 87.2% were moderate in intensity. Fathers and mothers were responsible for 51.2% and 34.1% of the cases of child-abuse respectively. Among the persons responsible for causing child-abuse, 34.1% had themselves been physically abused during their childhood period and 26.4% had physically abused children before. Hyperactivity, bed-wetting and an unwanted child were among the most common causes of child-abuse. Factors precipitating child-abuse included: large numbers of children in the family drug addiction of one of the family members, and acute or severe psychological stress during the past 6 months. Using the Chi-square test, a significant relationship (P value=0.00l) was found to exist between physical child-abuse and demographic factors such as age, sex, site of residence, history of divorce or separation of the parents and history of physical abuse in the parent's childhood days.

This research was conducted in line with Consumerism viewpoint and its objective is to assess the satisfaction level of service receivers in 12 daily rehabilitation Institutions of Tehran in order to improve service supply processes based on the service receivers viewpoints, which can ultimately provide suitable backgrounds for incorporating them into the service supply process. The sample society consists of 133 people of the service receivers who were selected through ranked random sampling. Because no studies of this field had been made previously, a viewpoint assessing Questionnaire was drawn up on a scale of 5 Likert degrees containing 92 questions and one repeatedly answered question, and its average of satisfaction mark (3.71) and variance deviation (0.297) was determined. By the way after the question lacking correlation had been omitted, the number of question decreased to 68. Analyses made by use of SPSS 7.5 Win and Excel Win software not only presented a high level of satisfaction in many fields, but also distinguished cases of dissatisfaction. The age, sex and level of education were not suggestive and impact on the level of satisfaction. By the way, the service receivers made suggestion on the modification and Improvement of the processes.

This study has screened 6150 infants between 4-18 months by Infanib Scoring. In this assessment infants divided to three group Normal, Transient and Abnormal by 20 items that based on French angles, Reflexes, Tone and posture. The transient group was visited 1 month later and the abnormal group was referred to pediatric neurologist for diagnostic evaluation and to rehabilitation center for treatment. The Infanib was selected because of high validity and reliability in the previous studies, and in this study the results show that the sensitivity, specificity, positive and negative predictive value is equal to 90%, 81%, 85% and 87%. Thus the Infanib is proposed as an appropriate screening test in the developing countries because of quantified, reliable measurement of body tone and posture, short time for examination, and the ability of occupational and physical therapist, nurses and physician to perform it.

The ultimate goal of this research is determining of depression prevalence and effective factors among boys of pre university level in Kazeron city. The present research is an analytical - descriptive and cross sectional study, which was done in February 2001. In order to achieve the goal, 240 pre university boys were selected through random classified sampling and the data gathered by questionnaires and Zung depression scale. The results indicate that 42.9 percent of students suffered from depression. The rate of depression among the students is as follows: low depression 28.8%, medium depression 9.6% high depression 3.3%, and profound depression 1.3%. The statistical test, such as X2 and X2 for trend has been used. The results showed that there is a significant relationship between depression and family financial status, parents’ relations, talking about problems with others, anxiety about joining to military services, anxiety for entering to university, treatment of teachers and principals and educational level of mothers. With respect to the above mentioned variables and using a logistic regression model the following results achieved: Four variables had increasing effect on depression incidence: family financial status, parents’ relations, talking about problems with others and anxiety about going to military duty. The advantage of the above model is not only to identify the effectiveness of the variables in depression but also by understanding of the students it is likely to prevent depression incidence.

This research studies the effects of vibration stimulation on agonist muscle and electrical nerve stimulation of antagonist muscle used separately and simultaneously on the MVC (Maximal Voluntary Contraction). 45 healthy subjects participated in the study, which they were divided into three groups. MVC obtained from lateral Gastroqnemeus muscle. For the first group, the vibration (100 Hz. 0.8 mm) applied to the Achile tendon about 15 minutes. For the second group, electrical stimulation applied to the Proneal nerve (also about 15 minutes) and for the third group, vibration and electrical stimulation applied simultaneously to the Achile tendon and Proneal nerve respectively. The results of this study showed that MVC decreased after agonist vibration (p<0.005) while the results after electrical stimulation of antagonist muscle and after dual stimulation didnt change significantly. We concluded that the vibration of agonist muscle decrease MVC more than the other two modalities.

The hip fractures are the most frequent cause of traumatic death after the age of 75 years, occurring more frequently in women that will make a negative impact of the patient's life style. The purpose of this research was to evaluate the risk factors of the hip fractures in elderly hospitalized in centers of education and treatment of Kerman and Rafsanjan cities in 1998-2000. Methods and This study was a descriptive method of sampling during 27 months (from 19 April 1998 to 21 July 2000) in hospitalized patients of orthopedic wards of Ali ebne Abitaleb hospital of Rafsanjan and Shahid bahonar hospital of Kerman. 257 patients who were afflicted with hip fracture were evaluated by a questionnaire with 20 statements (risk factors of hip fractures) that was used to recorded information about this study: This risk factors were including age, sex, type of fracture, osteoporosis, milk consumption, muscle atrophy, environmental hazards, body mass index diseases, diabetes, previous fracture, smoking, antidepressant and anti convulsion drugs, heart disease, low mobility and activity perception disorders, age of menopause, impaired visual and nonuse external hip protector (padding). The results of this study showed that many of above risk factors were effective (>50%) than others. These factors were including environmental hazards (81.7%), muscle atrophy (72.8%), previous fractures (52.1%), low mobility and activity (70.8%), low milk consumption (100%), low BMI (79.8%), osteoporosis (52.1%) and nonuse external hip protector (100%). The results of this study recommend that environmental hazards of elderly should be modified (e.g. well lighted, stair case with secure hand rail) to prevent from falling Exercise and faradic current prevent muscle atrophy and improve physical fitness, muscle strength, balance and coordination. Treatment of impaired visual is important because risk of falling is decreased. Regular load-bearing exercise such as walking, adequate milk consumption and calcium intake prevent of osteoporosis so the risk of hip fracture is decreased The use of external hip protector (padding) is very important. in elderly because energy from falling is absorbed so it can decrease probability of hip fracture.

Patient's knowledge of their disorder is an essential component of their care. Studies about this issue are scanty. We report the first study in Iranian epileptic patients from the Epilepsy clinic. Seven hundred and fifty patients above 15 yr. old were selected. EPKQ (Epilepsy patients’ knowledge Questionnaire) of Ohio University is used for gathering of information. This questionnaire included demographic data-topics related seizure definition-type and dose of drugs-legal issues of driving and employment. Then information was analyzed statistically with EP16 software. Of 750 patients (280 female, 470 male) the average age and number with epilepsy were 32±10 and 12±10 years respectively. Neither age nor number of years with epilepsy correlated with scores. Years of education & sexuality (male’ scores were higher) affected scores significantly. Twenty percent believed that epilepsy is a mental disorder. Thirty-eight percent knew which factors increases seizures. The lowest scores pertained to antiepileptic drug side effects and discontinue of them (only 5% knew enough). Overall patients’ knowledge level was low. Patients with epilepsy are not knowledgeable about their disease. This causes increase of injuries during attacks, problems of treatment and finally affects quality of their lives. There is a need for educational intervention in this population. Particularly about antiepileptic drugs side effects (AED), proper time of AED discontinuation and legal issues of epilepsy.

Many investigations have documented about attentional and memorial abnormality in individuals with autism. This study is summary of recent researches about alternations of attention and memory in autism. The most important changes of attention in autism are: 1) Arousal modulatory system dysfunction, leading to fluctuations between states over and under arousal. 2) Reduction of orienting and processing of novel stimuli. 3) Over focused attention, responding to only a subset of environmental cues. 4) Deficit in shifting attention, leading to difficulty moving their attention from one special location to another. The most important changes of memory in autism are: 1) Good rote memory 2) Cued recall is significantly better than free recall 3) Deficit in working memory 4) Deficit in implicit and explicit memory 5) Deficit in verbal memory about material that requires further encoding, organization or use of meaning or semantic cues for recalling 6) High functioning memory in some of the patients for example ability to read well, singing or recognizing musical pieces.

According to Specificity and Specific Adaptation to Imposed Demands (SAID) principles, many adaptations occur in response to strength training within muscle. Three major adaptations include: neural, muscular and metabolic. The initial adaptation is neural one. At first we discuss about various theories, which are defined as probable mechanism of neural adaptation, in this article. Temporal relationship between muscular and neural adaptations and influencing factors on them in healthy and pathological conditions will be also reviewed. Furthermore, principles of strength training regarding to physiotherapy will be explained.

Multiple Sclerosis (M.S.) is rare in less than 10 years, usually presents after menstrual age and third decay of life. Affects myelinization of central nervous system, with unknown etiology and pathogenesis, but viruses and autoimmunity may have a role. Clinical presentation is variable from mild to severe, progressive, debilitated one. This is a prospective, descriptive, cross-sectional study on twenty patients with M.S. at neurologic ward of Mofid pediatric hospital from (1996-2000). 14 girls and 6 boys, age (4 years-13 years). Brain-magnetic resonance imaging (M.R.I) in all the patients with multiple plaques confirmed the diagnosis. Visual evoked response (V.E.R.) in most the patients showed the increased latency. The commonest clinical presentations were: increased DTR, ataxia, diplopia, decreased muscle power, walking defect, vertigo and paresthesia. For all the patients, CBC, electrolytes, CSF and analysis LE, ANA, anti dnase were done and for some of the patients if needed, auditory brain response (A.B.R.), somatosensory evoked potential (S.S.E.P.) and spinal M.R.I were done. We tried to discuss about M.S. by clinical manifestation, neuroimaging and electrodiagnostic test in children.