فصلنامه آرشیو توانبخشی
سال بیستم شماره 2 (پیاپی 79، تابستان 1398)

Objective Children with biomotor disabilities are influenced by negative social attitudes towards themselves; this is due to their problems in independence, self-reliance, and self-help skills. The people’s attitudes and children’s feedback towards their disability directly influence the adaptation of children. Some support programs can help these children to cope well with different social conditions. A behavioral support program is a new approach to promoting emotional and social competence in children. The program is adjusted as a pyramidal model to support everyone. It focuses on the promotion of health and provides services for children. Moreover, the program replaces appropriate social and communication skills with challenging behaviors (e.g. aggression and rule-breaking) and may improve effective communication and positive behaviors, and reduce negative behaviors in children. The present study aimed to determine the effect of the behavioral support program on the social skills of children with biomotor disabilities in Tehran City, Iran. Materials & Methods This was a quasi-experimental study with a pretest-posttest design and a control group. The study samples consisted of 28 children aged 5-7 years educating in the 2013-2014 academic year in special education centers in Tehran. The sample was purposefully selected. There are only three special centers in Tehran for children with biomotor disabilities. The sample (28 individuals) was selected according to the sample size formula, considering sample missing probability, and the inclusion and exclusion criteria. The subjects consisted of 14, 6 and 8 individuals from the 16th, 5th, and 3rd educational districts, respectively. The students from 16th educational district were allocated in the control group and those from the 5th and 3rd educational districts in the experimental groups. All students in the two experimental groups and control group were matched in terms of socioeconomic status and parent’s educational level. Then, the parents and teachers of all groups completed the Social Skills Rating System (SSRS). The students of two experimental groups participated in 14 training sessions (3 days/week; each session: 40 minutes) and received the behavioral support program in addition to the conventional program of the center; the controls only received the center’s routine program. Eventually, all parents and teachers of the subjects re-completed the SSRS after the last intervention sessions. The collected data were analyzed by the one-way Analysis of Covariance (ANCOVA).  Results The results of one-way ANCOVA for acquired data from SSRS (parent form) demonstrated that the behavioral support intervention significantly increased (P<0.001) social skills (cooperation, assertiveness, self-control, and responsibility) in male students with biomotor disabilities. According to eta quotients obtained from the parents’ evaluation, 82%, 63%, 82%, 66%, and 67% of variations in social skills (cooperation, assertiveness, self-control, and responsibility) of children with biomotor disabilities could respectively be explained by the behavioral support intervention. The results of SSRS (teacher form) revealed that the participation of male students with biomotor disabilities in the intervention has significantly increased their social skills, cooperation, assertiveness, and self-control (P<0.001). Furthermore, according to eta quotients, 65%, 61%, 51%, and 70% of variations in social skills, cooperation, assertiveness, and self-control of male students with biomotor disabilities could be respectively explained by participating in the behavioral support intervention sessions. Conclusion The behavioral support program is a practical strategy for parents and specialists to reduce the social adjustment issues of children with biomotor disabilities. Therefore, the intervention should be considered in planning and policymaking for family training programs. Furthermore, using the behavioral support program along with the conventional training methods can promote social skills, assertiveness, self-control, and responsibility in children with biomotor disabilities. Thus, such programs can prevent ongoing social communication, emotional and academic problems, unemployment, social isolation, and withdrawal, developed due to biomotor limitations in these children.

Objective Multiple Sclerosis (MS) is the most prevalent neurological progression that often affects young adults. Cognitive impairment is a frequent symptom of the disease. One cognitive domain is an executive function. Executive function is important in individuals’ cognitive skills, adaptive behaviors,  and life satisfaction. Thus, accurately recognizing and investigating the factors affecting it greatly helps with improving MS. The current study investigated the relationship between individual and clinical characteristics and executive dysfunction in patients with MS.  Materials & Methods This was a cross-sectional, descriptive and analytical study conducted on MS patients referring to Rofeydeh Rehabilitation Hospital in 2017. In total, 71 patients were selected through unpredictable sampling method. MS patients and their families provided written consent forms for participation in the study, and the subjects' data were kept confidential. Moreover, the patients were allowed to discontinue study participation as desired. The inclusion criteria were a diagnosis of MS disease based on McDonald's criteria  by a neurologist, the lack of memory impairments, including Alzheimer's disease, non-congenital syndromes like Down syndrome, no thyroid dysfunction, the lack of consuming drugs that affect memory and cognitive function like benzodiazepines, and the lack of severe vision and motor impairments. Exclusion criteria included the lack of patient’s cooperation with completing the questionnaire and performing the test, dissatisfaction with continuing the collaboration, and the emergence of an acute problem in the patient that enables him/her to continue cooperation. In this research, instruments such as Pittsburgh Sleep Quality Index (PSQI), Fatigue Assessment Scale (FAS), Beck's Depression Inventory (BDI), Expanded Disability Status Scale (EDSS), and Delis–Kaplan Executive Function System (D-KEFS) test were used. The collected data were analyzed in SPSS. For data analysis, general linear regression was used. Results The obtained results suggested that age, disease duration, and fatigue had a significant reverse relationship with executive functions (descriptive and categorical) (P>0.05). Executive function (classification) had a significant relationship with the first symptom of the onset of disease (P>0.05).   Conclusion We investigated the relationship between individual and clinical characteristics and the executive function in MS patients. A significant relationship was observed between the first sign of the disease onset and the level of performance. People who initially demonstrated vision problems had a weaker performance than others. This can be considered as an important finding in the early stages of diagnosis and the development of therapeutic programs to postpone cognitive complications.

Objective Diabetic foot ulcers are significant complications of diabetes that can lead to amputation. Partial foot prostheses can be used to redistribute the plantar pressure on the residual limb to alleviate local pressures and prevent re-amputation at more proximal levels. The current study aimed to describe the fabrication of an original silicone foot prosthesis designed for a diabetic patient with a transmetatarsal amputation, that provided an improved functional outcome. Materials & Methods This quasi-experimental study was performed on 5 diabetic patients (3 women and 2 men) with transmetatarsal amputation (Mean±SD=59±4.18 years). We applied the nonrandomized sampling method. The study participants were evaluated at the Walking Laboratory of Orthotics and Prosthetics Department of the University of Social Welfare and Rehabilitation Sciences. This study was conducted in three phases. In the first phase, high-pressure areas on the stump were identified using Force-Sensing Resistor sensors (FSR-402) during walking with conventional silicone prosthesis. A plantar pressure of ≥200 kPa was considered as high and the threshold point. In the second phase, the silicone injection was performed in two stages; using cast formers and wax. The new silicone prosthesis was individually designed and constructed for each participant. In the third phase, the new silicone prosthesis was evaluated and compared with conventional silicone prosthesis. The spatiotemporal parameters of gait and the mean value of maximum plantar pressure (using force-sensing resistor sensors) were evaluated during walking with conventional silicone prosthesis and new silicone prosthesis before and after 3 weeks of wearing the new prosthesis. The normal distribution of data was tested using the Shapiro-Wilks test; it revealed normality in the distribution of the obtained data. The Independent Samples t-test was used to compare the results of maximum plantar pressure and spatial-temporal parameters. All statistical analyses were performed in SPSS. The significance level was set at P<0.05.  Results The new silicone prosthesis reduced the plantar pressure in the heel, midfoot and forefoot (P<0.05) and reached below the threshold point. Moreover, it reduced pain and pressure in the line of stitches (P<0.05). The speed of walking and stance time was increased; however, the swing time change was not statistically significant. Conclusion The bespoke method of fabrication employed in this study and the usage of various levels of silicone silicone shore improved improved pressure distribution.

Objective People with disabilities are more likely to experience poorer health status, compared to the general population; however, their health issues do not receive enough attention from policymakers. This article aimed to identify the factors that hinder the health problems of people with disabilities to be on the national agenda in Iran. Materials & Methods This phenomenological qualitative research was conducted in Tehran City, Iran, from September 2015 to March 2017. We conducted 22 quasi-structured face to face interviews with relevant policymakers at the national level. Snowball sampling method was applied to identify the interviewees. The interviewees were well-informed and had long and valuable experiences in the field of policymaking for people with disabilities. The policymakers from a verity of public organizations, ministries, non-governmental organizations, Islamic Consultative Assembly, Tehran municipality and the health insurance organizations participated in the study. We used an interview guide in data collection process which covered the main study questions. On average, the interviews lasted about 30 minutes to 1.5 hours. The validity of the study was assessed through member checking. Thematic analysis was performed in three steps to identify the main concepts of the study. In open coding, identifying, naming and describing phenomena in the text were performed. Following open coding, codes were grouped into several subcategories. Then, the main concept of the study was created by formulating a general description of generated subcategories. We used MAXQDA to analyze the obtained data.  Results We found three main categories and 13 subcategories. In the influence category, three subcategories were created; low influence in the policy process, the lack of structural independence, the inferiority of associations and nongovernmental organizations’ positions for policymakers and the low ability in lobbying and networking. In the minority category, we found 6 subcategories consisting of more attention to public health issues by policymakers, neglect of the specific needs of minority groups by health policymakers, policymakers’ unattractiveness in the health problems of people with disabilities, the lack of significant financial and political benefits for policymakers, the lack of awareness about the health issues of people with disabilities, and the inferiority of disability issues for policymakers. In the category of lack of integrated voice, three subcategories were created, including a lack of integration among people with disabilities, inattention to personal and group interests and the lack of coherent communication networks.  Conclusion To meet their requirements, it is essential to enhance the influence of people with disabilities, associations and the welfare organization in the policymaking process. This can be achieved by increasing the interaction of significant individuals in the disability area with other key policymakers in other sectors. Running campaigns, engaging with celebrities as well as experienced and influential managers, and the systematic use of media and social networks may improve policymakers' attention to prioritizing health issues of people with disabilities.

Objective Rapid naming is the ability of an individual to understand a visual symbol and retrieve it rapidly and accurately. When a person is naming, he/she may make a mistake or correct her/his mistake. Rapid naming tasks are the best tools for screening, assessment and early prevention of issues in this area. The rapid naming is important in reading skills, and there is a lack of basic information about rapid naming in Persian speaking children; thus, this study investigated the relationship between this skill, and age and gender, and compared the number of errors and self-correction in the 7- and 8-year-old age groups. Materials & Methods This cross-sectional and causal-comparative study was conducted on 203 normal male and female students in Autumn 2015 for 4 months. The study participants were selected using a multistage sampling method from 5 geographic regions (north, south, east, west, center) of Tehran City, Iran. The students had no hearing impairment, intelligence, learning, and visual deficiency. They enjoyed the natural growth of language and verbal fluency. Rapid Automatized Naming (RAN) and Rapid Alternating Stimulus (RAS) tasks were performed. The children's voices were recorded during the test implementation; when we were listening to the recorded voices, the naming time of each task was separately measured and recorded using a stopwatch. In addition to naming time, the number of errors and self-correction were counted. Multivariate Analysis of Variance (MANOVA) was used to investigate the relationship between naming speed and age. This test was also used to determine the relationship between naming speed and gender. The relationship between the number of errors and self-correction and age were analyzed by the Chi-squared test. Results The MANOVA results revealed a significant difference in the mean scores of the naming time between the two age groups (f(6, 196)=9.395, P<0.05). The lowest mean score of naming time in the two age groups related to the numbers; the highest mean score of the naming time belonged to the color task. The mean score of naming time for each of the 6 tasks significantly differed (P<0.05) between the two age groups; however, in all of the tasks, the mean score of naming time in the two groups of girls and boys was not statistically significant (P>0.05). The Chi-squared test results suggested no significant difference between the frequency of a number of errors in the two age groups (x2=16.564, df=13, P>0.05). Moreover, there was no significant difference between the frequency of numbers of self-correction in the two age groups (x2=11.186, df=13, P>0.05). Conclusion With increasing age, the time of naming was reduced. However, gender has no effect on speed naming. Moreover, age has no effects on the number of errors and self-corrections. The significant difference in naming speed between the two age groups with narrow age interval indicates that this skill is very much affected by age. Thus, it is necessary to present the normative data of this skill in groups with narrow age intervals.

Objective Autism spectrum disorders are among the most prevalent developmental disorders. Diagnostic criteria for these disorders consist of the two general categories of symptoms, including deficiencies in communication and social interactions, and limited, repetitive and stereotypic patterns in behavior, interests, and activities. Routines are well-established  and the regular patterns of occupations and activities that provide structure and stability for everyday life and add meaning to it can affect health. The disabling nature of autism and its numerous associated problems unable families to develop effective and meaningful routines; consequently, the integrity and solidarity of family are lost and family is disturbed. A proper tool is required to evaluate everyday routine in the families of children with autism. The present study investigated the validity and reliability of the Family Time and Routines Index (FTRI) in the Iranian families of children with autism.
Materials & Methods This was a non-experimental methodological study. The statistical population of the study consisted of all children with autism in Tehran City, Iran. Among them, 100 parents of children with autism referring to autism centers and private clinics in Tehran were selected by the convenience sampling method; they were entered into the study, according to the inclusion criteria. Inclusion criteria were the diagnosis of autism by a child psychiatrist, based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), the age of 3-11 years, and the absence of blindness, deafness, epilepsy, and other disabilities in the child. Moreover, the subjects with no desire to cooperate or uncompleted the questionnaires were excluded from the study. The required data were collected using demographic information questionnaire and FTRI completed by parents. After obtaining the permission of the designer of the questionnaire for translation and the investigation of its psychometric properties, the questionnaire was translated according to the International Quality of Life Assessment (IQOLA) project. The face validity and content validity of the questionnaire were evaluated using experts and parents’ opinions; then, a preliminary test was conducted in which the questionnaire was completed by 10 parents of children with autism to determine the appropriate time to complete the questionnaire. Consequently, 100 parents of children with autism completed the demographic information questionnaire and FTRI. Furthermore, to determine the test-retest reliability, after 2 weeks, 33 parents of children with autism re-completed the questionnaire. To examine the face validity, item impact score was calculated. To assess the content validity, Content Validity Ratio (CVR) and Content Validity Index (CVI) was used. Internal Consistency Coefficient (ICC) was used for assessing the test-retest reliability of the scale. Moreover, the internal consistency of the whole questionnaire and its subscales was assessed by Cronbach's alpha coefficient.
Results Item impact score for all items of the questionnaire was over 1.5. The CVR for each item of the questionnaire was between 0.8 and 1 and for the whole questionnaire was equal to 0.87. The CVI for the items of the questionnaire was between 0.83 and 1 and for the whole questionnaire was equal to 0.97. Additionally, the intraclass correlation coefficient for the total score was equal to 0.96 and Cronbach's alpha coefficient was calculated as 0.88. Moreover, the lowest Cronbach's alpha coefficient related to the subscale of child routines (0.70) and the highest related to the subscale relative's connection routines (0.86).
Conclusion The obtained results indicated that FTRI has acceptable validity and reliability in the Iranian samples and can be a useful research and clinical tool for assessing the family routines.

Objective Professionals rely on the diagnostic criteria of the American Psychiatric Association (APA) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for the diagnosis of  Attention Deficit Hyperactivity Disorder (ADHD). DSM-5 recognizes three subtypes of ADHD; predominantly inattentive, predominantly hyperactive-impulsive, and the combined types. ADHD is widely recognized among the most frequent neurodevelopmental disorders, and the most frequent reason to refer children to clinics. The research suggested that ADHD children have problems with the executive functions of attention and working memory, compared with their healthy counterparts. ADHD affects all aspect of an individual's life. Unfortunately, the negative learning status experienced by ADHD children is difficult to overcome and is usually long-lasting. The cognitive rehabilitation program based on prospective memory seems to reduce executive function problems of attention and working memory and improve the educational skills of ADHD children. The present research investigated the effect of cognitive rehabilitation program based on prospective memory on the executive functions of attention and working memory in ADHD children in Kermanshah City, Iran. Materials & Methods This was a quasi-experimental study with pretest-posttest and a control group design. The study participants were 32 female children aged 8-11 years with ADHD from schools. They were selected by convenience sampling method. The subjects were divided into the experimental and control groups, each group consisting of 16 children. The experimental group participated in 18 sessions of cognitive rehabilitation program based on prospective memory and the control group did not participate in these sessions. The control group members participated in two sessions at the end of research for observing ethical considerations. The applied instruments were the revised Conners' Parent Rating Scale (CPRS-R), clinical interview, Stroop Color and Word Test (SCWT), and Working Memory Test Battery for Children (WMTB-C). SCWT and WMTB-C were completed by the researcher for all subjects in pretest and posttest phases. The required data were collected by the questionnaires before and after the training sessions. Multivariate Analysis of Covariance (MANCOVA) was used by SPSS for analyzing the obtained data. Results First, the normality of variables and contingency of variance and covariance assumptions were tested. The Kolmogorov-Smirnov test results indicated that all variables were normal (P>0.05). Moreover, the Box’s M test confirmed the contingency of variance-covariance assumption. Therefore, the assumptions of MANCOVA were confirmed and the MANCOVA test could be used for data analysis. The MANCOVA results demonstrated that cognitive rehabilitation program based on prospective memory had a significant effect on the executive functions of attention and working memory in ADHD children (P<0.0001). The obtained results also revealed that cognitive rehabilitation program based on prospective memory had a significant effect on all subscales of executive functions (correct responses, incorrect responses, no responses, the reaction time of congruent words or reaction time of incongruent words) in these children (P<0.0001). According to eta squares, 67%, 66%, 60%, 62% and 54%, of variations in components such as correct responses, incorrect responses, no responses, the reaction time of congruent words or reaction time of incongruent words, respectively, could be explained by the subjects’ participation in cognitive rehabilitation program based on prospective memory. In addition, according to eta square, 61% of variations in working memory could be explained by the subjects’ participation in the cognitive rehabilitation program based on prospective memory. Conclusion functions as well as the working memory of ADHD children. It is recommended that planning cognitive rehabilitation program based on prospective memory for ADHD children receives serious attention.

Objective Parkinson's Disease (PD) is a neurodegenerative progressive condition with a number of nonmotor symptoms such as depression, anxiety, and stress. These have the most debilitating characteristics and increase the severity and progression of the disease and often reduce functional ability in the sufferers. For this reason, they may, over time, lose their daily living activities skills (basic and instrumental) and social participation. The current study investigated the relationship between the areas of occupation and severity of depression, anxiety, and stress in PD. Materials & Methods In this cross-sectional (descriptive-analytical) study, 91 PD patients referring to rehabilitation centers and hospitals in Tehran City, Iran, were selected through convenience sampling method. After obtaining approval from the University of Social Welfare and Rehabilitation, we referred to the centers and hospitals; if managers of the centers accepted to cooperate with the research team, the study was conducted in accordance with the inclusion criteria in that center. The Assessment of Life Habits (Life-H) test was used to evaluate the areas of occupation and the Depression, Anxiety and Stress Scale (DASS-21) was applied to assess depression, anxiety, and stress. Life-H test subscales were categorized by the occupational therapists of the university, based on the classification of the areas of occupation. The obtained data were analyzed using Pearson’s correlation coefficient, Spearman's rank correlation coefficient, multiple regression analysis, focal correlation, Independent Samples t-test and Mann-Whitney U test in SPSS. Results The collected results indicated a reverse and significant correlation between the level of Activities of Daily Living (ADL)'s participation and depression. Additionally, the correlation between the levels of participation in education and leisure was inverse and significant in terms of anxiety and stress. The correlation coefficient between the areas of occupation and depression was as r=0.362, P=0.06; between the areas of occupation and anxiety was as r=0.49, P=0.001; and between the areas of occupation and stress was as r=0.5,  P=0.001. There was a significant correlation between the different areas of occupation and stress and anxiety; however, the correlation between the areas of occupation and depression was not significant. Focal correlations between the areas of occupation and nonmotor symptoms (depression, anxiety, and stress) were equal to r=0.55, P=0.05 and significant. Conclusion There was a significant relationship between the areas of occupation and the incidence of nonmotor symptoms (depression, anxiety, and stress) in people with PD. Therefore, we can facilitate the direction of rehabilitation and occupational therapy’s settings for clinicians, by identifying the areas of occupation that are more affected by the disease; this may help to provide disease-related facilities and may have economic benefits for caregivers of PD patients.