فصلنامه آرشیو توانبخشی
سال هفدهم شماره 1 (پیاپی 65، بهار 1395)

Executive functions are referred to higher and self-tuning cognitive processes that help managing behaviors and thought controls. Executive functions in children are assessed in different ways. The most prestigious and valuable way is using daily functions reports on a child's natural environment. This study aimed to prepare the Persian version of behavior rating inventory of executive function-preschool (BRIFF-P) and study of its face and content validity among Iranian children. The questionnaire completed by parents of 2-5 years old children.
This study has methodological and psychometric design. We studied the Persian version of tests using standard protocols IQOLA and determined its validity. This protocol includes translation, evaluation of translation quality, backward translation, and comparing the English version with its Persian one. Face validity was determined by 20 samples (parent) and the impact score was measured. Content validity index (CVI) and ratio of the content validity (CVR) was determined by asking the opinions of 15 experts. Moreover, the simplicity, relevance, and transparency of each item was evaluated.
Based on the simplicity and clarity of questionnaire items, over 80% agreement of the sample group indicated the simplicity and clarity of the items. also the difficult and complex items were discussed among experts in several sessions and as a result the simpler and clearer concepts took the place of difficult and ambiguous items. Then, the score of proportion index effect and relation of items for each of 63 items of questionnaire was calculated. the results showed that all items of questionnaire were simple and clear, also all items except 7 achieved impact score of higher than 1.5. To evaluate the content validity of the questionnaire, we used ratio of content validity and index calculation. Content validity showed that almost all items of the questionnaire achieved CVI score of higher than 0.79 (The lowest score was 0.8 and highest one was 1); however, as regards the index of relatedness, 3 items got scores lower than 0.79 The scores of the content validity ratio were more than 0.49, except the fifth item.
The Persian version of this questionnaire possesses a good match in terms of cultural and face validity. The results of content validity confirms that the Persian version is clear, simple, and understandable for the target society. However, 7 items of the questionnaire got scores lower than 1.5. of course, as in this study, the parents of normal children were investigated, the importance of these items in evaluation of abnormal children must be considered, because in many abnormal growth development of children (like attention deficit/hyperactivity, autism) such behaviors are clearly considered problematic. Therefore, the importance of these items are seen in final questionnaire and in spite of low score of 1.5 of some items, in the sample group (normal children), these items were kept and inserted in the final questionnaire. The results of content validity were also indicative of different cultural assumptions from some items of this questionnaire. We suggest that in future studies, the content validity of the Persian version was estimted with regard to opinions of parents of abnormal children with growth development problems and then the results were compared. We also suggest examining the other kinds of reliability and validity of this test.

Bender-Gestalt is one of the well-known neurocognitive tests designed by Lorta Bender to evaluate perceptual-motor development level in children. Besides its principle application in evaluation of cerebral damage, Bender test has other important applications, such as evaluating children for entering school, anticipating educational progress, diagnosing children with reading and learning disorders, studying growth retardation, as well as a nonverbal intelligence test to evaluate children’s reading readiness to enroll in elementary school. Because of the importance of this test in many diagnostics aspects, it is necessary to prepare a normalized form of this test. In this study, we tried to provide this form in a more comprehensive and updated form compared to previous studies.
This is a descriptive-analytic research. The study population comprised all preschool children in Tehran. In this research, we surveyed 523 (271 boys and 252 girls) preschool children in 3 groups of 4-5 years old (200 children, 95 boys and 105 girls), 5-6 years old (199 children, 112 boys and 87 girls), and 6-7 years old (124 children, 64 boys and 60 girls) who were selected by cluster sampling method from some preschools centers in south, north, and center of Tehran during the spring of 2012. The inclusion criteria were having normal intelligence quotient and being in the range of preschool age. Obtained protocols were numbered on the basis of expanded Koppitz scoring system, and finally were analyzed using the Chi-squared test.
Data analysis for 4-5 years old group revealed the result of M(SD) as 14.75(1.82). The most frequent errors belonged to distortion in plans A, 7, and then 8. Also, the least frequent errors belonged to linear drawing of plans 3 and 6. With regard to misproportion error in plan A and repetition error in plan 2, girls made significantly less errors than boys, while with regard to spin errors of plan 7 and misproportion in plan 7, boys got the higher scores. In 5-6 years old group of children, M(SD) was 9.67(4.38). Also, the most frequent errors belonged to distortion in plans 8 and A. Furthermore, the least frequent errors belonged to linear drawing in plan 3, distortion in plan 7, and isproportion of components in plan 5. With regard to inappropriate composition and linear drawing of plan 5, boys made significant higher errors than girls. For children of 6-7 years old, M(SD) was 8.14(4.17). The most common errors in drawing belonged to first distortion errors in plans A and 8, and then spins in plans 7 and 3, and lastly to misproportion in plan 7. The least frequent errors belonged to linear drawing of plans 5 and 3, spin in plans 8 and 1, and finally distortion in plan 1. Male gender was effective in committing errors of wrong composition of plans A and 3, spin in plan 1, figure distortion in plans 6 and 7, also female gender in errors of wrong composition of plan 2, spin in plans 2 and 8.
Consistent with Koppit’z maturational hypothesis and previous studies (Iranian and foreign), our results showed visual-motor improvement of perceptual performance with increasing age. In conclusion, koppitz scoring system is applicable to Iranian children protocols.

The birth and presence of a child with mental-retardation in any family causes stress, hopelessness, and disappointment, as well as social, economic, and emotional problems. These problems lead to mental health reduction and using inefficient approaches in family. This research aimed to study the effect of education on mental health and stress rate. Also, it examined the effect of several styles of contrasting stress and stress management program on decreasing stress of parents with mentally-retarded children.
Parents of children with intellectual disabilities in Rafsanjan, Iran (2 health centers) completed Harry stress inventory (HIS) and general health questionnaire (GHQ). A total of 60 couples with high scores in these tests were selected and randomly assigned into 2 groups. Experimental group passed stress management course in 6 sessions for 3 weeks (two sessions per week). The educational contents in 6 sessions were as follows: teaching pathology, semiology, and mental health to parents, then 4 ways of therapeutic approaches of opposition, evasion, continence, and social support, and finally problem solving and practicing those skills. Control group did not receive any treatment. After final session, and then 1 month later, 2 groups completed GHQ and HIS (posttest and follow up). Data were analyzed with repeated measures test.
Average scores of stress rate in pretest and posttest in the experimental group had a significant difference (P=0.001), but this difference was not significant in follow up test (P=0.659). Average scores of mental health in pretest and posttest of experimental group had significant difference (P=0.001), but this difference was not significant in follow up test (P=0.646). With regard to different aspects of general health, the difference between mean scores of physical signs and depressive signs in pretest and posttest of intervention group was significant (P Educating stress management with cognitive–behavioral style could increase the mental health index of parents with mental-retarded children, decrease mothers’ physical and depressive signs, and improve their sleep and social performance. However, in this study, anxiety signs and social activities of parents did not improve. To explain this finding, it can be said that several variables affect the anxiety and social activities of people. And those factors are out of control of this study. These factors are in direct relation with economic situation of people that were not examined in the present research. Also, education stress management with cognitive–behavioral style could reduce perceptive stress of parents. Finally, education causes people, including
mothers of mentally-retarded children to know themselves better, recognize their strength and weak points, and reach a level of self-recognition that proceed improving their weak points and promoting their strong points. As a result, parents accept better the reality of their mentally-retarded child and better adapt to this situation. This will in turn reduce the mental stress and increase their health status.

Joint attention refers to person’s ability in focusing on the present information in his or her visual attention, along with existing information on other’s visual attention. In this process, 2 people actively pay attention to a thing, situation, or event. Defects in joint attention is considered one of the first diagnosable signs in children with autism spectrum disorder (ASD). This skill has considerable effect on growth and development of social, cognitive, and verbal skills. In other words, joint attention may act as a key skill, i.e. achieving this area of growth, brings several by-products for children. Therefore, using therapeutic early interventions in order to improve the joint attention of children with ASD is necessary. The present study aimed to investigate the effectiveness of family-based early intervention on the improvement of joint attention of the children with ASD.
The research population included 57 children who had referred to Ordibehesht Autism Center in Isfahan. Because the present research sought for special cases, the purposeful sampling method was used. In this regard, the research sample comprised 3 children of 3-5 years old who had symptoms of autism spectrum disorder by the diagnosis of specialists, and had difficulties regarding joint attention. The research instrument was the Gilliam Autism Rating Scale (GARS) and Early Social Communication Scales (ESCS). In the present study, the single-subject study with the A-B design was used. In this method, after 5 baseline sessions, intervention was started and during 12 individual sessions, the joint attention skill is taught to children. To analyze the obtained data, at first the raw data were converted to standard T scores and the situation of baseline, intervention, and follow up of every subject was drawn on the diagram. To interpret and infer from the diagrams, we used visual analyses, trending, and stability, as well as percentages of non-overlapping data and overlapping data.
According to the visual analyses of the data diagrams, the intervention was effective on the 3 subjects. The mean scores of 3 subjects in the baseline have increased from 39.92, 37.30, and 38.89 to 52.04, 52.79, and 51.69, respectively. The percentage of non-overlapping data (PND) in the two baseline
and intervention situations for the 3 subjects was 83%, 100%, and 91%. This effectiveness was observable in the follow-up stage.
The findings of the present study indicated that the family-based early intervention can be an effective educational program for improvement of joint attention of the preschool children with ASD. Because defects in joint attention is one of the main features of children with ASD and joint attention brings improvement in other aspects of growth, we suggest that improving joint attention be considered as a main objective in rehabilitation and educational interventions in children with autism.

Family member caregivers of patients with spinal cord injuries experience varying degrees of burden because of the long process in the care of their patients. These conditions have different negative consequences for the family caregivers. One of the most important protective factors against the suffering of the caregivers is their knowledge about care giving process. Therefore, the aim of the present study was to evaluate the effect of educational intervention based on Orem self-care model on family caregiver's burden of patients with spinal cord injuries.
This was a quasi-experimental study with pretest and posttest design and control group. It was conducted on patients with spinal cord injuries at South Khorasan Province. Research units purposefully selected and then were randomly allocated to experimental and control groups. Experimental group received educational intervention based on Orem self-care model for patients with spinal cord injuries consisted of eight 40-minute teaching sessions at the center. To measure the burden of caregivers, 22-item Zarit questionnaire was used with content validity index of 80% and Cronbach α of 0.79. The questionnaire was completed before and after the intervention in experimental and control groups. The results were analyzed by SPSS version 16 using descriptive (frequency, mean and standard deviation) and analytical (t-test, ANOVA and Pearson correlation coefficient) statistics.
Mean of burden in caregivers was not significantly different between the 2 groups before The intervention. But, we observed significant differences between the 2 groups after the intervention. The difference between mean of burden before (3.2±0.33) and after (3.11±0.66) the intervention was significant (P0.05).
The results of this study suggest that education of family caregivers of patients with spinal cord injuries based on Orem self-care model can reduce their experienced burden resulted from chronic and long term caregiving involvement. Moreover, the financial situation and occupation of caregivers could be a positive relational factor in their burden. Therefore, we suggest that the family of caregivers be under support and supervision of social and therapeutic supportive organizations. Also, with regard to long-term care of these patients, some measures like caring the patient at home with support and backing of spinal-cord injury centers to reduce the pressure on the family of caregivers are recommended.

Weight-bearing asymmetry is one of the main causes of balance disturbances in patients with hemiparesis and could cause standing problems and gait abnormalities for them. The purpose of this study was to investigate the immediate effects of wearing unilateral textured insoles on the symmetry of weight bearing during standing and gait parameters of patients with chronic stroke.
In this quasi-experimental study, 16 patients with hemiparesis were selected by simple non-probability sampling method. These patients had an average age(SD) of 52.12(6.94) years and their average(SD) post-injury duration was 33.12(16.4) months. Symmetry index during standing position (by using 2 equal weighting scales), step length symmetry, step length, and walking velocity (by using NeuroCom Balance Master Device) was measured in 3 conditions: without insole (barefoot), wearing textured insole with shore A-80 hardness, and textured insole with shore A-60 hardness.
In this study, we conducted the multivariate analysis of variance for comparing 3 test conditions and Bonferroni test for paired comparing. The symmetry of step length showed a significant difference between no insole condition and using insole with A-80 hardness (P=0.004), as well as using A-80 hardness insole with A-60 hardness insole (P=0.011). However, there was no significant difference between using no insole and using insole with A-60 hardness (P=0.325). The results of symmetry index likened
the step length results. This means that there was a significant difference between not using insole and wearing insole with A-80 hardness (P=0.022), also between the results of wearing 2 different insoles (P=0.019). However, no significant difference was observed between using no insole and using insole with A-60 hardness in spite of improvement in step length (P=0.325). Velocity of walking and step length was not meaningfully improved in any of the conditions.
The current study showed that obligatory use of affected limb side could improve symmetry of weight bearing in walking and standing position of patients with chronic stroke by overcoming the phenomenon of learned lack of using and correcting the failure of sending sensory signals to centers of movement controls. The results of this study showed that unilateral use of textured insole with shore A-80 in the unaffected side could immediately improve weight bearing symmetry and step length symmetry in patients with hemiparesis, but it has no effect on their walking speed and step length. Using insole with A-60 hardness did not significantly change any variables of tests. Considering the results of this study, these insoles can be used in balance exercises and walking of hemiparetic patients.

Osteoarthritis is a degenerative disease of joints that causes degeneration and corrosion of joint surface. Because of osteoarthritis, the smooth and even movemvement of joints get interrupted. Osteoarthritis is the most common kind of arthritis and its prevalence is 19.3% in Iran. Patients with knee osteoarthritis usually have geno varum and hyperpronation of foot. The purpose of the current study was to evaluate the effect of lateral wedge and medial arch support on displacement of ground reaction force in knee osteoarthritis in static state.
The current study is a quasi-experimental study. A total of 13 patients (9 women and 4 men) with an average(SD) age of 63.08±7.7 years with knee osteoarthritis were selected from available community. Four different test conditions, including 1) barefoot, 2) lateral wedge, 3) medial wedge, and 4) arch support and lateral wedge were conducted. L.A.S.A.R Posture was used to assess the changes of ground reaction force from knee center and the comfort level after the intervention was measured on a visual analog scale. The changes of lever arm were measured with the instrument and the obtained data were analyzed by SPSS version 20, through multivariate analysis and Bonferroni tests.
The result indicated that lateral wedge caused a significant decrease in ground reaction vector from knee center in barefoot condition (P=0.005). The average distance of weight line from knee center were -13.6 in without arthritis condition, -0.8 with lateral wedge, -11.8 with medial arch, and -7 with lateral wedge with medial arch. Therefore, using the lateral wedge with 7 mm thickness displace the path of ground reaction force on the knee, in such a way that the lever arm of ground reaction force from knee center (which produces adductor torque on the knee) with putting 12.8 mm lateral wedge has become smaller that of barefoot condition. With regard to comparing different conditions, no significant differences were observed between barefoot, medial arch, and combination of medial arch with lateral wedge. However, there was a significant difference between lateral wedge and medial arch (P=0.013), so that the lever arm of ground reaction force with lateral wedge is 11 mm shorter. Also, comparing lateral wedge with arch and lateral wedge showed that lateral wedge is 6.2 mm shorter or it creates 88.5% shorter lever arm (P=0.001). No significant difference was seen between conditions of medial arch and combination of arch with lateral wedge.
Given the results, using the lateral wedge decreases the lever arm of ground reaction force to the knee center in people with knee osteoarthritis and geno varum and hyperpronation of foot. Moreover, adding medial arch reduces the effect of lateral wedge on shortening lever arm of ground reaction force on the knee and as a result reduces knee adductor torque in patients with knee osteoarthritis. However, lateral wedge, medial arch, or their combination have no statistically significant effect on the comfort of these patients.

Non-progressive cerebral palsy (CP) is due to abnormal development of brain and or brain damages before, during, or after birth. The reason of cerebral palsy is brain damage or its abnormal development. Most of these problems happen when the child is in mother’s womb, but the chance is high that it happens in the first 2 years of life, when the brain develops. One of the commonest and most important debilitating signs of cerebral palsy is damage to higher functions, in such a way that the control of moves in grasping and leaving get damaged and in the end, the strength of hand for planning of movement decreases. Several studies have examined the effect of resistance training on muscle strength of patients with CP, while none of them has examined the effect of progressive resistance and balance training in children with CP. This study aimed to investigate the effects of progressive resistance and balance training on upper trunk muscle strength of children with CP.
Three boys with cerebral palsy (two patients who were 7 years old and one who was 6) participated in this research. In this study, single subject research method with A-B-A plan was used. Progressive resistance and balance training were administered for 3 days per week for 8 weeks. Wrist and elbow flexor muscles strength was measured by PowerTrack Õ dynamometer (manufactured by JTECK with 4.4 N threshold).
According to visual analysis of data diagrams and based on descriptive statistical indexes and visual analyses, the results showed that resistance and balance training in intervention situation compared to baseline increased the strength of elbow flexor (percentages of non-overlapping data for the first and second participants were 75% and for the third participant, 100%). The strength of upper trunk muscles after intervention hve improved compared to baseline; however, one month after intervention,
the trend was pretty stabilized.
The results of this study showed that 8 weeks of progressive resistance and balance training (in combination) has increased muscle strength in children with cerebral palsy. The present research showed that resistance and balanced trainings have significant effects on muscle strength of children with CP. It seems that these practices have been effective, especially for the wrist flexor and elbow flexor muscles. It can be said that the increase in the muscles of children with CP was due to practice principle along with increase in neuronal compatibility. One of the important points in the effectiveness of resistance training is the intensity of training. The results showed that resistance and balanced trainings increase the muscle strength of children with CP. This power could be partly due to increase in muscle volume and partly due to anabolic hormones.