فصلنامه آرشیو توانبخشی
سال بیست و یکم شماره 1 (پیاپی 82، بهار 1399)

 The participation, Based on International Classification of Functioning (ICF), Disability And Health, is part of healthy function that leads to the development of skills and a sense of competence and confidence in them. People with multiple sclerosis experience problems in various areas of participation. Environmental factors can create serious restrictions in the level of participation of people with multiple sclerosis, in some cases, the effect of these factors on restricting the participation of people with multiple sclerosis can be more than the effects of weakness and the defects of systems and organs that result from the disease. the barriers in the physical environment can reduce mobility of people with multiple sclerosis to transfer, that leads consequences such as weakening functional status, physical and mental health, quality of life, happiness, loss of life satisfaction; Therefore, due to high prevalence of multiple sclerosis in the city of Isfahan, the aim of this study was to Identifying the environmental barriers affecting the participation of people with multiple sclerosis in Isfahan.

In this cross-sectional study, the study population was all patients with multiple sclerosis in Isfahan City in February 2018. That was conducted in Isfahan province, 96 patients with MS (22.9%male and 77.1% female) were selected with convenience sampling method. To collect the data, after informing the participants about the subject and purpose of the study, obtaining informed consent letter, and also ensuring confidentiality of the information to the researcher, a demographic questionnaire was completed. The Mini Mental State Examination questionnaire was completed by participants, and then the Expanded Disability Status Scale scores were recorded for each person by the neurologist. At the end, Craig hospital inventory of environmental factors were provided to the participants. Finally, Data were analyzed by SPSS V. 16.In order to describe the data, the mean and standard deviation were used. The normal distribution of data was done by Shapiro-Wilk test. Pearson correlation coefficient, ANOVA and post hoc by LSD method test were used to analyze the data at a significance level of 0.05. Also, considering that the ANOVA test is susceptible to variance inequality, Levin test was conducted to evaluate the equality of variances.

 Physical and structural barriers are the major barriers to participation of multiple sclerosis patients (12.05±8.62) and the field of work and school is the minor barrier of participation (2.24±4.16). Furthermore, the findings Also result showed there is no statistical relationship between the demographic variables (such as age, sex, disability status and cognitive status) and level of confrontation with the environmental barriers of participation (P>0.05). Comparison of the mean of confrontation to environmental barriers to participation Based on education level showed that there is a significant difference between the services and assistance subscale and different levels of education. The highest mean score was for the under diploma education group and the lowest was for the Bachelor's degree and higher group. There is no significant difference in other subscales of participation.

 According to this findings among the environmental factors that can potentially affect the participation of patients with MS, field of physical and structural barriers were strongest factor which can restrict their participation in personal and social activities. Physical and structural barriers have been introduced in various studies as the most important limiting factor for participation in people with disabilities, especially those with neurological disorders. Therefore, maintaining the participation of these people in the community is a priority in adopting special measures in the field of removing physical and structural barriers.

 After respiratory disorders, musculoskeletal disorders are the second prevalent cause of short-term sickness absence (less than 2 weeks). The nature of the work in physiotherapy requires physical activities, which include repetitive skills, manual techniques, putting direct pressure on a particular joint, unskilled posture during special maneuvers, and having long postural positions. Several studies have reported that physiotherapists frequently experience musculoskeletal disorders. This study aims to determine the relationship between Work-Related Musculoskeletal Disorders (WRMDs) and the common therapeutic methods used by Iranian physiotherapists.

This is a descriptive-analytical epidemiological study with a cross-sectional design. The study population consists of physiotherapists working in Iran. Data collection tools included a demographic form, as well as general Nordic questionnaire designed by Kuorinka et al. to detect the WRMD symptoms in 9 body areas in the past year. The questionnaires were distributed among participants in cooperation with the Iranian Physiotherapy Association during the 27th Iranian Physiotherapy Congress. Data analysis was performed in SPSS using the Chi-square and Fisher exact tests.

 Of 1200 questionnaires distributed among physiotherapists, 685 questionnaires were returned after completion. Of these, 16 were excluded due to missing some inclusion criteria, 4 due to having a work experience less than one year, and 11 due to having other diseases, such as neurological and rheumatic diseases, malignancies, and joint replacement. The mean±SD age of the participants was 37.9±9.91 years ranged from 22 to 69 years; 53.9% of them were female and 46.1% male. After obtaining the prevalence of WRMDs, its significant association with the type of used treatment method was examined by the Fischer exact test. The results showed a significant correlation of WRMDs with treatment methods in 7 out of 9 areas. In particular, WRMDs were associated with manual massage (P=0.001), myofascial release (P=0.011), mobilization (P=0.007), muscle energy technique (P=0.007), and dry needling (P=0.032) in the neck area; with mobilization (P=0.005) and taping (P=0.014) in the shoulder area. Also, WRMDS are associated with respiratory physiotherapy (P=0.007) in elbows. WRMDS are correlated with manual massage (P=0.027), myofascial release (P=0.001), mobilization (P=0.046), muscle energy technique (P=0.004), and taping (P=0.016) in wrists/hands. In the upper back, WRMDs are associated with manual massage (P=0.007), mobilization (P=0.014), and taping (P=0.004). In the lower back, WRMDs are seen with myofascial release (P=0.036), mobilization (P=0.015), taping (P=0.035), and muscle energy technique (P=0.044). Finally, WRDMs are observed with water therapy (P=0.037) in knees.

 There is a high prevalence of WRMDs among physiotherapists in Iran. Its rate has a significant relationship with the type of treatment methods. Some physiotherapy methods can increase the prevalence of WRMDs.

 As life expectancy increases, the incidence of degenerative diseases such as osteoarthritis also increases. Dynamic balance is one of the essential factors that affect the mobility and daily living activity of patients suffering from knee osteoarthritis after undergoing Bilateral Total Knee Replacement (BTKR) surgery. Traditional rehabilitation approaches are based on reducing pain and increasing muscle strength, which are applied topically on the knee area. One of the new methods used to improve balance is neurofeedback, which acts at the central nervous system level. This pilot study aims to examine the effect of neurofeedback on dynamic stability and sustained attention in women who underwent BTKA.

This is a quasi-experiment study with a pre-test/post-test design and no control group. The study population consisted of all patients with BTKA referred to the outpatient clinic of the Department of Occupational Therapy at Shahid Beheshti University of Medical Sciences from April 2017 to September 2017. Of these patients, 8 female patients with a mean age of 67.5 years (3 months had passed since their surgery) were selected using a convenience sampling method and based on the inclusion and exclusion criteria. 

 The inclusion criteria were being over 55 years old; having a history of BTKR surgery in the last 2 to 4 months; being able to walk independently; using a cement prosthesis; lacking a record of cognitive problems (mini-mental state exam score> 20), cardiovascular diseases, uncontrolled high blood pressure, visual impairment, drug abuse or alcohol use, vestibular disorders that can impair balance, use of neuroleptics and sedatives; not receiving neurofeedback before this study, or undergoing surgery in other joints of lower limbs, such as ankle or hip. The exclusion criteria were the absence of more than two sessions from therapeutic protocol and unwillingness to collaborate in the research process. All patients received 8 sessions of standard neurofeedback training. Assessments were done at three times: before the intervention, and at the 4th and 8th sessions using vigilance subscale of Vienna test system and Biodex balance system (dynamic stability level 6 test). Data analysis was done in SPSS V. 22 using repeated-measures ANOVA and paired-samples t test. P<0.05 was considered as the significance level. There was a significant improvement in the mean score of dynamic stability after neurofeedback training (P<0.05), but the mean scores of sustained attention did not change significantly (P>0.05). However, the mean reaction time decreased significantly (P<0.05). Moreover, a gradual increase in the beta wave was observed during treatment, but it was not statistically significant.

 Neurofeedback training can improve dynamic stability in female patients with knee osteoarthritis 4 months after BTKR surgery, but it has limited effects on their sustained attention. Therefore, this non-invasive and uncomplicated program can be used as a complementary treatment method for the rehabilitation of these patients.

 High-risk behaviors are seriously threatening health and wellbeing, and increasing the likelihood of physical, psychological, and social consequences. High-risk behaviors, such as tobacco use, drug abuse, alcohol use, or malicious behaviors can endanger the health and wellbeing of adolescents and hinder their success and future growth. Today, the prevalence of high-risk behaviors among adolescents has become one of the most important concerns in society and despite the provisions made in recent years, its rate has increased. One of the vulnerable groups is orphaned/abandoned adolescents who face various social and psychological problems during their stay in welfare bearding centers that requires special skills to deal with. This study aimed to investigate the effect of social competence training on the tendency towards high-risk behaviors in male adolescents living in welfare boarding centers.

This is a quasi-experimental study with a pre-test-post-test design. The study population included all male adolescents aged 12-18 years living in welfare boarding centers located in Sabzevar and Mashhad cities in Iran. For sampling, 15 adolescents were selected from a boarding center in Sabzevar City by census method and assigned to the experimental group, and 15 from a boarding center in Mashhad City selected randomly and assigned as controls. The experimental group received social competence training program in twelve 60-min sessions, while the control group received only two 8-hour first aid training. Iranian Adolescents Risk-Taking Scale (IARS) and a demographic form were used to collect data before and after the intervention. The collected data were analyzed by Multivariate Covariance Analysis (MANOVA) in SPSS V. 22.

 The mean IARS scores in the experimental group decreased from 93.9 to 86.81 after the intervention, and the t test results indicated a significant difference between the mean scores before and after the intervention (t=2.97, P=0.010). The MANCOVA results revealed a significant difference between the mean overall score of IARS (F=24.08, P<0.001), and between the mean scores of IARS dimensions (tendency towards dangerous driving, violence, smoking, drug abuse, alcohol use, sexual activity and behavior, and relationship with the opposite gender) in the experimental and control groups after the intervention (P<0.001). Based on Eta squared values, 47.1% of changes in the tendency towards high-risk behaviors in subjects can be explained by the social competence training program. Therefore, social competence training had a positive effect on reducing the tendency towards risky behaviors among male adolescents living in welfare boarding centers.

 The social competence training program could improve the skills and adaptive capacity of orphaned/abandoned adolescents in different situations to deal with their problems. Therefore, it is recommended that social competence training programs be provided for male adolescents living in boarding schools to effectively increase their four social competence skills and ultimately reduce their tendency to engage in high-risk behaviors.

 Spinal deformity can affect the Quality Of Life (QOL) of all people, especially young adults. Scoliosis is one of the most common types of this disorder with unknown etiology. World health organization defines QOL as the individuals’ perception of their position in life, based on individual and cultural characteristics in which they live. The right tools to assess QOL can provide valuable clinical and research results. Questionnaires are considered to be the most available and cheapest possible tool for measuring this variable. Brace Questionnaire (BrQ) is one of these tools designed for this purpose. To our knowledge, only the Italian, English, and Polish versions of this questionnaire are available. Thus, this study aimed to translate and determine the validity and reliability of the Persian version of BrQ.

Fifty subjects (Mean±SD age: 15.41±1.77 years) with scoliosis participated in this study. All of them had a history of wearing spinal braces for at least four months. They entered into the study based on the inclusion criteria and signed a written consent form. The BrQ has 34 self-reported items and eight domains of general health perception, physical functioning, emotional functioning, self-esteem and aesthetics, vitality, school activity, bodily pain, and social functioning. Participants by completing this tool express their feelings during the past one and three months. First, a confirmation email was received from the developer of the questionnaire to perform the translation and psychometric evaluation. It was translated through six stages based on Beaton’s guidelines. First, three bilingual speakers (native in English and Persian) forward translated the original version. Next, specialists and interpreters compared two translated drafts. The next steps included a backward translation of the initial translated version, sending the English version to the developer for appraisal, and receiving confirmation that it is identical to the original version. Finally, the initial Persian version was sent to 10 orthotics and prosthetists and ten patients with scoliosis (pilot study) to examine its face validity. The approved pre-version was considered as the final Persian version of BrQ (BrQ-P). Subsequently, The BrQ-P and Scoliosis Research Society (SRS-22r) questionnaire were completed by 50 participants to assess BrQ-P validity. To determine test-retest reliability, the questionnaires were completed by the same participants after seven days. The obtained data were analyzed in SPSS V. 17. The statistical significance level was set at P<0.05.

 All participants in the pilot study confirmed that all items were easy to understand. The internal consistency of BrQ-P using the Cronbach α was at an acceptable level (0.935). The intraclass correlation coefficient was obtained 0.93 at a 95% confidence interval (0.90-0.95), indicating its good test-retest reliability. Moreover, the relationship between BrQ-P and SRS-22r using the Pearson correlation coefficient was obtained 0.90, indicating a significant relationship between these two questionnaires (P<0.001).

 The BrQ-P is a valid and reliable tool to assess the QOL of people with scoliosis.

 The integration of various senses with each other in the form of perceptual-motor activities can lead to the promotion of different aspects of physical, perceptual, cognitive, and psychosocial development. Decreased visual acuity in children with visual impairment makes it difficult to develop motor skills, including gross motor skills. A few studies have used perceptual-motor interventions in these children with no specific framework. The purpose of this study is to evaluate the effect of a perceptual-motor intervention based on Johnstone and Ramon’s method on the gross motor skills of children with visual impairment.

In this randomized controlled trial, the study population consisted of children aged 7-10 years with visual impairment (blind or with low vision) studying in three schools of Narjes (Girls’ school), Shaid Mohebbi, and Shahid Khazaeli (Boys’ schools) in Tehran City, Iran in 2018 (n=140). Of these children, 24 who had met inclusion criteria were selected and randomly assigned into two intervention (n=12) and control (n=12) groups. The perceptual-motor program was designed based on Johnstone and Ramon’s method and validated by a panel of experts that included four members of the Department of Occupational Therapy, the University of Social Welfare and Rehabilitation Sciences, and one optometrist from the Baqiyatallah University of Medical Sciences. The intervention group received the perceptual-motor program for two months, three 45-min sessions per week (24 sessions in total). The gross motor skills of both groups were measured by the second edition of Movement Assessment Battery for Children (MABC-2) test (aiming/catching and balance subscales) and the second edition of Test of Gross Motor Development (TGMD-2) (locomotor and object control subscales) in three stages: Pre-test, post-test, and 1-month follow-up. Data analysis was performed using the Shapiro-Wilk test, Mann-Whitney U test, Friedman test, Bonferroni test, and generalized estimating equation in SPSS v. 22. The significance level was set at 0.05.

 The mean±SD ages of children in the intervention and control groups were 9.2±1.1 and 8.3±1.2 years, respectively. The mean±SD scores of aiming/catching skill in the intervention group reached from 4.17±2.82 in the Pre-test phase to 11.17±1.95 in the post-test and 10.92±1.62 in the follow-up phases. In the control group, the mean±SD scores were 3.83±2.79 in the Pre-test, 4.25±3.08 in the post-test, and 4.67±2.93 in the follow-up. The mean±SD scores of the balance skill increased from 6.25±2.42 in the Pre-test to 10±2.13 in the post-test and 9.92±2.19 in the follow-up phase. In the control group, the scores were 3.50±3.09) in the Pre-test, 3.83±3.46) in the post-test, and 4±3.36) in the follow-up phase. The mean±SD score of the locomotor skill was 40.92±9.34 in the Pre-test, 47.58±1.17 in the post-test, and 47.42±1.08 in the follow-up phase. In the control group, these scores increased from 35.83±12.92 in the Pre-test to 36.83±13.17 and 37.67±13.24 in the post-test and follow-up phases, respectively. The mean±SD scores of object control skill increased from 32.50±14.74 in the Pre-test to 47.50±1.24 in the post-test and 47.66±1.15 in the follow-up, while in the control group, the scores were 29.25±12.93 in the Pre-test, and 30.17±12.89 and 30.08±13.34 in the post-test and follow-up phases. The aiming/catching, balance, and object control skills of children were significantly improved after the intervention (P<0.05), and continued after one month. In contrast, the locomotor skill was not improved after the intervention (P>0.05).

 The perceptual-motor interventional program can be useful in promoting the gross motor skills of children with visual impairment. It is suggested that this program be used in other studies on visually-impaired children.

 This study aimed to investigate the effect of modified Constraint-Induced Movement Therapy (CIMT) on upper extremity function of a patient with severe Acquired Brain Injury (ABI).

This study was conducted in 2017. The patient was a 33-year-old right-handed woman with a severe ABI admitted to Rofeideh Rehabilitation Center suffering from severe hypoxia due to suicide by hanging. She had no motion limitation, no history of dislocation or fracture, and no complaints of pain in the upper extremity, at the more involved side (left). The informed consent letter was obtained from the participant. The inclusion criteria for the subject were: active wrist extension of at least 20 degrees, maintaining balance for two minutes, Ashworth scale score <3, and mini-mental state examination score >24. The intervention was performed for two weeks, five days a week, three hours a day at Rofeideh Center. For the less affected upper limb, sling and mitt were used as constraints for at least six hours a day. We first used traditional techniques to reduce muscle tone (weight-bearing through upper extremity, trunk rotation, scapular protrusion, and reflex-inhibition pattern). Then, some selected motor tasks with shaping techniques were used. These tasks included cleaning the table with a towel, flipping the pages of a book, picking up the glass and carrying it to the mouth, picking up and moving a bottle, practicing to pick up and drop different objects, reaching arm forward to move objects from one place to another, counting with fingers, picking up and rotating a card, and doing fine exercises and fine motor and in-hand manipulation tasks by using coins and cereals. Assessments were performed at 4 stages of before, and then 2, 4, and 6 weeks after the intervention using Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Motor Activity Log (MAL), and Box and Block Test (BBT). 

Improvement in the upper extremity function of a patient with chronic and severe ABI can be achieved by using the modified CIMT. According to FMA scores, an improvement was observed in four areas of motor function, balance, sensation, and range of motion. Its score increased from 24 at baseline to 56, two weeks after the intervention, and remained constant up to six weeks later. Also, manual dexterity under BBT was improved. Its score reached from 5 to 7, two weeks after, and 12, six weeks after the intervention. Moreover, the patient’s FIM score improved from 19 to 36, two weeks after, and 38, six weeks after the intervention. Furthermore, regarding MAL results, the amount of movement score increased from 0 to 1.70, and the quality of movement score increased from 0 to 1.66, six weeks after the intervention. 

 Modified CIMT can be an effective method for improving the upper extremity function of patients with chronic and severe ABI in a short period.

The current study investigated the potential acceptability and effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) in developing children’s participation and mothers’ parenting self efficacy. Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) involving contextually reflective occupational therapy combines 3 elements: parent coaching, child’s sensory processing patterns, and social support of parents. Intervention sessions comprised group parents training and (individualized) coaching sessions, which reflective questions and discussions with mothers support them in identifying best plans to achieve their therapeutic goals.

In this pilot research, we employed a single subject, A-B-A interrupted time series design across 3 participants (3 mothers of children with the diagnosis of Autism Spectrum Disorders) reffered to Navid-e-asr rehabilitation center in Tehran, in spring of 2017. The participants were selected among families who have children with diagnosis of Autism Spectrum Disorders, ages 3-10 years and had at least one sensory pattern outside typical range based on the Short Sensory Profile II. Recruitment was based upon parent reports, Short Sensory Profile II data, demographic questionnaires and informed consents. The mothers’ education participated in this research were diploma or above diploma, and they could understand and speak Persian very well.We conducted the study for eighteen weeks in 3 phases. During baseline period or phase 1, the participants received treatments as usual (TAU) for 4 weeks. During intervention period or phase 2, the participants received Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) for 10 weeks, 1 week group parents mothers training (two sessions) and 9 weeks individualized coaching sessions (1 session per week), in addition to treatments as usual (TAU). During phase 3 or follow up, participants received only treatment as usual (TAU) for 4 weeks. The intervention therapist and coach was an occupational therapist, with 20 yrs. of clinical experience in pediatric rehabilitation implemented CI-ASD sessions during the study. In this pilot research, we administered outcome measures four times: prior to the study before phase 1 (pre- intervention1), after phase 1 (pre- intervention2), after phase 2 (post- intervention) and, after phase 3 (follow- up). We measured child participation by Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), and parental self efficacy by Parent Self Efficacy Measure (PSEM). We conducted semi-structured interviews after completing the intervention period to explore acceptability of treatment and participants’ experiences of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). We used visual inspection of graphed data to identify variations between phases.

Two of three participants )two mothers( completed the program and described growth in children occupational performance (COPM1)  [13, 14, 22, 26] and [12, 12, 23, 29], satisfaction of occupational performance (COPM2) [13, 17, 22, 25] and [7, 7, 23, 29], goal attainment (GAS)  [-6, -6, +2, +6] and [-6, -6, +2, +6], and parental self efficacy (PSEM) [50, 53, 57, 57] and [44, 43, 49, 55]. Two participants (mothers) found Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) highly acceptable. Data showed development in occupational performance (COPM1), satisfaction of occupational performance (COPM2), goal attainment (GAS) and parental self efficacy (PSEM) continued after 4 weeks follow up. One of three participant (one mother) had difficulty accepting Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) and left the study after 3 coaching sessions.

On the report of two participants, Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD) was acceptable to deliver and may show promise as an intervention for children with the diagnosis of Autism Spectrum Disorders and their families. Further research is needed to determine the effectiveness of Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD). Since one family did not accept the Contextual Intervention adapted for Autism Spectrum Disorders (CI-ASD), it would be useful to identify characteristics of families who may benefit most from this intervention.