فصلنامه آرشیو توانبخشی
سال بیستم شماره 4 (پیاپی 81، زمستان 1398)

 People with Anterior Cruciate Ligament (ACL) reconstruction need to have almost automatic postural control to focus on their athletic skills. Continuous cognitive task is a method for removing attention from postural control. The effects of continuous cognitive task on postural control of people with ACL reconstruction has been assessed by laboratory tools; however, its effect using balance error scoring system is still unknown. Therefore, the present study aimed to investigate the effects of continuous cognitive task on the postural control of individuals with ACL reconstruction using the balance error scoring system. 

The present study is a case-control study using simple non-probability sampling. Participants included 20 male football players with ACL reconstruction (13.90±4.15 months after surgery) and 20 healthy men. They were matched for age, sex, height, weight, body mass index, dominant leg, education and activity levels. Tegner activity level scale was used to determine activity level of participants. Postural control was evaluated under single-leg stance test (with treated leg) on firm and foam surfaces with and without continuous cognitive task. Balance error scoring system was used to assess the balance control. In the condition without cognitive task, no feedback was provided. Continuous cognitive task consisted of 10 three-digit numbers each presented with a 2-second interval by audio tape and headphone. In the cognitive condition, individuals were asked to focus on the preselected number and provide the sum of its repetitions in the end of the test. The dependent variable was the number of balance error in each condition. Balance errors included lifting hands from hip, opening eyes, stepping or swinging, lifting forefoot or heal, moving hip into more than 30 degrees of hip abduction or flexion, and remaining out of position for more than 5 seconds. We used SPSS v. 20 software for statistical analysis of data. Kolmogorov- Simonov test was performed to test the normality of data distribution. Intraclass Correlation Coefficient (ICC) was calculated to assess the relative  reliability of the rater for assessing the balance error. The absolute reliability of the rater was measured using Standard Error of Measurement (SEM), Minimal Metrically Detectable Change (MMDC) and Coefficient of Variation (CV). Mixed-model of ANOVA (2 groups ×4 stance conditions) was used to investigate the main effect and interaction effect of these factors. We used repeated measure ANOVA to determine the main effect of test condition in every each, and independent-sample t-test and effect size was used to determine the difference between groups.

 Distribution of data in all four test conditions was normal (P>0.05). The rater reliability was excellent for calculating the balance error in all test conditions (ICC>0.90, MMDC<%10 and CV<%5). Interaction between group and test condition was significant (F=11.59, P<0.01). Result of independent-sample t-test showed that subjects had a higher balance error than healthy subjects under  single-leg stance test on foam without cognitive task (F=2.01, p<0.01). In this condition, the effect size also showed that difference between groups was large (>0.8).The main effect of test condition in subjects showed that the continuous cognitive task reduced balance error while standing on both firm and foam surfaces (P<0.01), while in healthy subjects, the cognitive task had no effect on the balance (P>0.05).

 It can be concluded that male football players with ACL reconstruction had poorer stability compared to healthy subjects in performing single-leg stance test on foam surface without continuous cognitive task. Moreover, continuous cognitive task improved balance control in ACL subjects, while it had no effect on the balance of healthy subjects.

 Studies show that almost every country across the world will experience a remarkable increase in their healthcare costs and ageing population by 2030. Also, people with disabilities are more likely to impose considerable healthcare costs on families and governments than their counterparts. On the other hand, socioeconomic status of countries can be an important factor to predict healthcare costs. In this study, we aimed to evaluate the relationship between disability rate, ageing rate and development rate of countries with their current health expenditure.

This is a descriptive correlational study conducted based on secondary analysis of existing data of 202 countries under six different regions of African Region (AFRO), Eastern Mediterranean Region (EMRO), South-East Asia Region (SEARO), Western Pacific Region (WPRO), European Region (EURO), and Region of the Americas (PAHO) in 2016 . The linear regression analysis was applied to investigate the association between the explanatory variables of age, Years Lost due to Disability (YLD) per 100000 general population, Human Development Index (HDI), Gross Domestic Product (GDP) growth, and unemployment rate with Current Health Expenditure (CHE) per capita as the outcome variable. The costs were expressed based on Power Purchasing Parties (PPP) in USD. One-way ANOVA was applied to compare the means of YLD and CHE per capita between three levels of HDI. 

 The highest mean YLD (13272.76±1577.22 per 100000 general population) and mean CHE (2698.39± 1915.01 USD) was belonged to EURO region, while AFRO region showed the lowest mean YLD (10005.65± 847.03 per 100000 general population) and mean CHE (281.11± 335.84 USD). In Iran, the mean YLD and CHE was lower than that of EURO region but higher than that of other five regions. EURO, PAHO, and WPRO had the highest rate of ageing compared to other regions. For Iran, the rate of ageing population was higher than AFRO and EMRO. In the regression model, population aged 15 to 49 (YLD=0.167), aged >65 years (YLD=0.651), aged ≥70 years (YLD=0.359) and HDI (0.391) had a positive association with the CHE per capita. In contrast, the population aged ≤5 years (YLD=-0.585), aged 15-64 years (YLD=-0.274), and aged 50-69 years (YLD=-0.938) and the unemployment rate (-0.138) showed a negative association with the CHE per capita. Moreover, ANOVA results revealed that the rate of ageing population (P<0.001), YLD (P<0.001) and CHE per capita (P<0.001) were significantly higher in countries with higher HDI than in countries with lower HDI. 

In the study period, YLD can predict healthcare expenditure of countries better compared to HDI and ageing population. Therefore, it is suggested that cost control interventions in ageing period should be implemented through programs aimed at preventing chronic diseases.

 The puberty and adolescence period is very important for adolescents with High-Functioning Autism (HFA). They require more education than their peers to understand the puberty period and the its associated changes. Parents’ lack of knowledge of how to deal with adolescents correctly, lack of social skills and failure to provide adequate information to them  can create a variety of problems such as behavioral problems. The purpose of this study was to investigate the effect of a behavioral management and social skills training program on behavioral and adaptive problems  of male adolescent with HFA.

The present study is a single-case study with ABA design. The statistical population consisted of male school students with HFA in Yazd, Iran. Of these, 3 were selected using purposive sampling method. By reviewing various papers related to behavioral problems, cognitive-behavioral approaches, Intervention Guide for Behavioral and Emotional Issues (IGBEI) and Intervention Guide of Social Skills Improvement System (IGSSIS), a program was developed for adolescents and their mothers. To evaluate the content validity of the program and to measure its reliability, Lawshe’s method and Kappa coefficient were used, respectively. The program was presented in 37 sessions to the subjects and mothers. To collect data, the Behavior Assessment System for Children (BASC-3, parent and teacher rating scales) questionnaires was used and completed before and after the intervention. The collected data were analyzed using visual analysis indices and descriptive statistics. 

 Raw data were first obtained for each participant in three phases of baseline, intervention, and follow-up and presented in the form of charts. Then, the stability and trend were plotted for all three participants at the baseline and intervention phases. Finally, using intra-situ and inter-situ analyses, the effectiveness of the educational program was evaluated. The results showed that the educational program was effective in reducing behavioral problems with Percent Non-Overlapping Data (PND) of 62.5% for the first and third subjects and 75% for the second subject, and increasing adaptive skills with a PND of 75% for the first and third subjects, and 87% for the second subject.

 Maternal and adolescent education based on an organized program can play an important role in reducing behavioral problems and enhancing adaptive skills during adolescence. Adolescents with HFA need more education to provide appropriate behavior due to the limitations; therefore, it is necessary to develop educational programs for this groups. One of the limitations of this study was the small size of samples; hence, generalization of results should be done with caution. Although many studies have been conducted in relation to children with HFA, further studies are recommended on these adolescents (male and female) in relation to their problems.

 Anxiety is one of the important problems in the daily lives of medical emergency staff. Experiencing this state and its complications can decrease the quality of work and reduce the desire to continue serving. Mindfulness-Based Cognitive Therapy (MBCT) can be one of the effective interventions for reducing anxiety. The present study aimed to investigate the effect of MBCT on reducing the anxiety of pre-hospital emergency staff.

 This is quasi-experimental study with pretest-posttest design using control group. The statistical population consisted of all staff of the Center for Disaster Management and Emergency Response in Alborz, Iran in 2017 (n=100). Of these, 75 were selected who had a moderate to high anxiety score based on the Kettle test. In the end, 30 were entered into the study based on inclusion criteria and  then randomly assigned into two groups of control (n=15) and MBCT groups (n=15). The control group received no intervention. Having consent to participate in the study by signing a written form, having no acute physical and psychological disease, not receiving psychological and medication treatment during the past few months and no participation in any other similar studies were the inclusion criteria, while the exclusion criteria were: absence form more than three sessions and having no willingness to continue participation. The experimental group received MBCT for 8 sessions, once per week, each for 90 minutes. The data collection tool was the Cattell’s anxiety scale. Collected data were analyzed using descriptive (mean and standard deviation) and inferential statistics (ANCOVA to test the research hypotheses, Kolmogorov-Smirnov to examine the normality of data distribution, and Box’s and Levene's tests to test the quality of variances) in SPSS v. 22 software.

 MBCT could reduce the anxiety of subjects compared to controls (F=32.87, P<0.05). Moreover, it led to a significant reduction in self-sentiment development (P<0.05, F=13.32) or paranoid trend (F=9.40, P<0.05) in pre-hospital emergency staff. The ANCOVA results showed no significant difference between the MBCT and control groups in terms of guilt proneness, ego-strength, and ergic tension (P>0.05).

 It was concluded that MBCT can reduce the anxiety of emergency medical staff. It can help them identify anxious thoughts, challenges and struggles with these thoughts, and confronts and replaces them with non-anxious thoughts. MBCT, by reducing their self-sentiment development and paranoid trend, is an effective measure to reduce the anxiety and hence, increase the work efficiency and job satisfaction of pre-hospital emergency personnel and increase their resilience in emergency situations. By improving the MBCT techniques, we can hope that it can improve mental health, quality of work, job satisfaction, and resilience of this medical group.

Self-determination is the ability of recognizing, setting and achieving goals based on knowledge and self-assessment. This ability is essential for the healthy development of adolescents. Self-determination is influenced by knowledge, skills, beliefs, and contextual factors that exist in one's living environment. Since it is an essential element for having a successful life, its assessment and related skills are also important; however, there is no assessment tool for its measurement in Iranian population. The aim of this study was to translate the Self-Determination Student Scale (SSDS) into Persian and determine its psychometric properties including face, content, and construct validity as well as internal consistency and test-retest reliability in adolescents aged 14-18 years.

In this methodological study, the SSDS was translated into Persian to be used on Iranian population and validated according to the International Quality of Life Assessment (IQOLA) protocol. Samples were 498 high school students (mean age = 15.15±0.9; 227 females and 221 males) who were selected using convenience sampling technique with maximum diversity in Tehran. They were divided into two groups of with and without emotional/behavioral symptoms using the Youth Self-Report tool. The face validity of the translated SSDS was determined based on the opinions of samples and experts. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were also calculated for each items of the translated version. The construct validity was tested by comparing known groups (gender groups and groups at risk of emotional/behavioral disorders). Moreover, its internal consistency was estimated by Kuder-Richardson formula, and test-retest reliability was tested using Intraclass Correlation Coefficient (ICC) on 16 students with a time interval of 14 days.

In the Persian version of SDSS, 4 items were removed from the original version. After confirmation of its face validity after modification, it was found that its items had appropriate content validity based on CVI and CVR scores. The mean of self-determination score under all subscales and most of items was significant between the gender group and the group at risk of emotional/behavioral disorders (P< 0.001). The Kuder-Richardson coefficient was obtained 0.89 and for five subscales, it was in a range of 0.51 to 0.72. The ICC (0.98; 95% CI:0.95 to 0.98) approved the good reliability of the instrument.

The Persian version of SDSS had good validity (face, content, and construct) and reliability after testing it on the high school students. Therefore, it can be used in clinical and research studies to assess the self-determination of students. Considering the importance of self-definition in adolescence, there is a need for further studies using the SDSS to highlight the potential problems of high school students in self-determination and designing related training programs.

 Seizure is the most common neurological disorder in pediatric medicine. This disorder is often chronic and requires continuous treatment. Developmental disorders are conditions that can occur due to abnormal development or damage to the brain and central nervous periods (out-of-hospital). However, in most studies, the severity of seizure relapse is mistakenly considered the same for each period. The present study aimed to identify  factors related to the recurrence of seizure in children with developmental disorder.

In this retrospective cohort study, 228 children with developmental disorder and a history of seizures referred to the emergency department of the Children’s Hospital Medical Center in Tehran, Iran in 2016. Relapse times, admission duration and discharge time, age, sex, birth weight, type of delivery, parental relatives, maternal age during pregnancy, mother's history of medication use and disease during pregnancy, history of seizure with fever, family history of seizure, maternal delivery problems, length of pregnancy, history of admission to neonatal intensive care unit were recorded as factors affecting recurrence of seizure. Inclusion criteria were having developmental disorder and a history of seizure recurrence. The patients who were hospitalized for any reason other than seizure were excluded from the study. No intervention was performed in this study. Patients' information was recorded with their permission and based on ethical principles and the results were presented in the form of tables. Survival model was used to investigate the effect of risk factors on the seizure recurrence. If the seizure recurrence in children was controlled in hospital by medical staff, response variable (relapse time) was considered as censored. A frailty parameter was used to explain the correlation between recurrence of seizures in one subject, and a correlation parameter was used to justify the difference in in the rate of correlation between seizures in a hospital and in somewhere other than hospital. The collected data were analyzed using frailty model for recurrent event by considering restraint period. To achieve an effective and flexible approximation for estimating base intensities, the piecewise constant intensity method was used. Estimation of the parameters was performed using the Gaussian quadrature method and by NLMIXED procedure in SAS v. 9.2 software.

 Of 228 children, 125 (54.8%) were boys and half of them were under 3 years of old. The mothers of 200 children (87.72%) had age of 18-35 years at the time of pregnancy; 96 (41.67%) of these patients were admitted to neonatal intensive care unit during neonatal period. The birth weight of 199 (28.27%) children was about 2.5-4 kg and 119 did not experience any seizure during the restraint period (in the hospital). The frequency of seizure recurrence in hospital ranged from 1 (25.88%) to 16 times (0.44%), while in out-of-hospital, it ranged from 1 (7.46%) to 11 times (0.44%). The duration of seizure recurrence was between 1 to 6196 days. Furthermore, children aged 1-2 years (P<0.001) with a history of admission to neonatal intensive care unit (P<0.001) whose mothers were 18-35 years of old during pregnancy (P=0.022) experienced more out-of-hospital seizure recurrence, while children aged 1-2 years (P=0.007) with a birth weight of 2.5-4 kg (P= 0.037) experienced less seizure recurrence in hospital.

 Considering the meaningful relationships and appropriate planning, the recurrence of seizure can be reduced in children with developmental disorder during hospitalization or after withdrawal.

 The effects of voice disorders vary from person to person. Occupation, work environment, life, and family reaction are variables that affect one’s perception of his/her own as an impaired voice. Voice Handicap Index (VHI) has not yet been used to compare the degree of voice disorders. Assuming that the quality of life may be different under a variety of voice disorders and that different physical, emotional and functional aspects maybe affected differently and that each disorder has a different treatment, This stud was conducted to prioritize and propose the appropriate treatments (voice health, manual therapy of larynx, voice therapy, and referral to relevant specialists) based on VHI score.

This is a descriptive/analytic study with cross-sectional design. Firstly, voice disorder of 166 patients aged 18-60 years referred to private clinics in Tabriz city was confirmed based on the diagnosis of a otolaryngologist and laryngeal stroboscopic images. VHI test was performed and a questionnaire was used to survey them in the presence of examiner to answer their potential questions. The VHI test consists of 30 items and 3 subscales of physical (10 items), emotional (10 items) and functional (10 items) rated on a 5-point Likert scale (0=Never, 1=Almost Never, 2=Sometimes, 3=Almost Always, and 4=Always). The patient's stroboscopic samples was examined by 3 speech-language pathologists and based on their consensus, patients were assigned into functional and structural voice disorders. In the next step, values obtained from the VHI test were compared between the two groups based on three subscales. Finally, the data were analyzed in SPSS v.19 software using statistical methods such as mean, standard deviation and Multivariate Analysis Of Variance (MANOVA).

 The rate of voice impairment was significantly higher in patients with structural voice disorder than in patients with functional disorder in overall and based on functional, physical and emotional components (p<0.05). Based on Kolmogorov-Smirnov test results, the variables had normal distribution. According to the Box test results, the studied groups were homogeneous in terms of study variables. Based on Bartlett's test of sphericity results, the assumption of correlation between the variables was established, since the mean value of patients in the structural group was significantly higher than in the functional group (P<0.05). the mean scores of individuals with structural voice disorders in physical (18.7) and emotional (15.2) dimensions were significantly higher than in those with functional voice disorders (P<0.05).

 Voice impairment in the structural group was lower than in the functional group. A comprehensive treatment should be considered for patients with structural voice disorder with an emphasis on improving the psychological aspects of voice disorders.

 Subjects with migraine headache often have stiff posture, especially in the head and neck. Also, these patients often have reduced cervical range of motion, faulty posture, forward head posture, increased sensitivity on the cervical muscles, and myofascial pain syndrome. Myofascial Trigger Points (MTrPs) are considered as the contributing factors to migraine headache. They produce painful trigger points in the cervical muscles. There are different techniques for eliminating MTrPs such as soft tissue (neck muscles) release technique, Ultrasound, and deep heat therapy, laser therapy, and dry needling. The current study aimed to investigate the effects of selective neck muscle release techniques on clinical indicators (frequency/intensity/duration of headache, medication, functional disability, and pressure pain threshold) in patients with migraine headache. 

The current study is a randomized controlled trial was conducted in the physical therapy research center of Shiraz University of Medical Sciences in Iran from August 2017 to February 2018. The statistical population consisted of all patients with migraine headache. Of these, 40 patients (aged 25-55 years) with trigger points in neck muscles including sternocleidomastoid, upper trapezius, and suboccipital were selected and then randomly assigned into two groups of release (mean age, 40.4±11.2 years) and control (mean age, 37.45±8.9 years). The subjects in the release group received 6 sessions for 2 weeks (combined MTrP therapy and stretching movements), while control group received placebo superficial massage. Headache frequency/intensity/duration, medication, functional disability, and pressure pain threshold (PPT) were assessed before, immediately after intervention, and at 1-month follow-up period. For data analysis, the two-way mixed design of ANOVA was used in SPSS v.23 software to evaluate the main effects of the two factors of group and time on the dependent variables. If the group effect was significant, independent t-test was performed to evaluate the differences in study variables between the two groups after the treatment and at the follow-up period, and if the time effect was significant, the paired t-test was carried out to assess the differences between the two groups before and after treatment and at the follow-up period. The significance was considered at P<0.05.

 All the variables had normal distribution (P˃0.05); therefore, parametric tests were used for analyzing data. Based on the results, there were no significant differences between the two groups in all quantitative and qualitative variables before treatment(P˃0.05). The release group showed improvement in the headache frequency, intensity, and duration, medication use, the functional ability, and the PPT level in comparison with the control group (p<0.001). According to the paired t-test results, the release group showed a significant reduction in headache parameters, medication use and functional disability and increased PPT after the intervention and at the follow-up period (P<0.001).

 The release techniques for selective neck muscles including MTrP therapy and stretching movements were helpful in improving some clinical indicators such as headache parameters, medication use, functional ability, and PPT in a short time. Therefore, these techniques can be recommended for treating migraine headache patients with MTrPs in sternocleidomastoid, upper trapezius, and suboccipital muscles.