فصلنامه طب توانبخشی
سال پنجم شماره 4 (زمستان 1395)

Lack of balance in pattern and activity of quadriceps and hamstring muscles increases the risk of Anterior Cruciate Ligament injury (ACL). The purpose of the present study was to investigate the changes in pattern and activity of vastus medialis and semitendinosusmuscles in landing from different heights and to understand if these changes will increase the risk of ACL injury or not.
Following a semi-experimental method, in the present study, 16 athletes (from volleyball, handball, and basketball sports), 23/1±1/2 years, 178±4/5 cm height, and 64/8±2/4 kg weights, did jump-landing from 20, 40, and 70 cm heights. The results of activity in feed forward and feedback phases and pattern were investigated using ME6000. To compare pattern and activity of each muscle in the three heights use, one way repeated measures ANOVA and to compare pattern and activity between vastus medialis and semitendinosus, independent T test were run in SPSS (version 20) (p≤0/05).
Feed forward activity (p=0/001) and onset time (p=0/014) of vastus medialis in 70-cm height were found to be significantly more than those of 20- and 40-cm heights, but in activity and onset time of semitendinosus,no significant difference was observed (p>0/05). The results of independent T showed that feed forward and feedback activity of semitendinosusis significantly fewer than those of vastus medialis (p Increase in landing height can increase the quadriceps to hamstring activity ratio and onset time of vastus medialis. These negative changes in pattern and activity of muscles increase the shear forces on ACL and the risk of injury.

One consequence of aging is decline of executive functions. Different, factors such as exercise, have effects on executive function. The aim of tthe present study was to answer the question whether the individuals who are consistently engaged in occupations of sport and reading have better executive functions.
The current retrospective study was performed on 100 participants aged between 50-95 years old. Cluster layer sampling was conducted in four districts of Tehran. Initially, participants were included in four groups of only reading, only sports, both, and none according to demographic questionnaire. Next, they performed three tests of Stroop, Tower of London, and Wisconsin for evaluating the executive functions. To examine the difference between the average scores of executive functions in the four groups, one-way analysis of variance and to examine the difference between groups, paired t-test with Bonferroni correction were run.
The results of the present study showed that there is a significant difference between people who have no continuous occupations (sports and reading) from adolescence to the present and the other three groups in executive function tests. But no significant difference was observed between the other groups.
People who are doing one of the occupations of sport, reading, or both have better executive functions compared with those who do not do any of these occupations. It seems that early enagagement in sport and reading in younger years and continuing it until aging could prevent a sharp drop in executive functions in aging. But further longitudinal studies are needed to investigate this theory.

Musculoskeletal pain in mothers of children with Cerebral Palsy (CP) is significantly higher than that in mothers of typically normal children. The purpose of the present study was to evaluate the effect of eight weeks core stabilization exercises on trunk flexor and extensor musculature endurance as well as quality of life in mothers of children with CP.
In the current quasi experimental study, 30 mothers of children with CP who had low back pain, aged 6 to 18 years, were selected in Isfahan based on targeted and convenience sampling methods according to the criteria of the study. Next, they were randomly divided into two groups of experimental and control, each containing 15 mothers. The experimental group performed core stabilization exercises for 8 weeks, three days a week, each session lasting 20 minutes, while the control group did not do any regular exercise. Quality of life and trunk flexor and extensor musculature endurance were respectively measured using SF-36 questionnaire and trunk flexor and trunk extensor endurance tests prior to and after the eight weeks of exercise program.
Finding revealed significantl improvement in the quality of life (p=0.001), trunk flexor (p=0.002), and extensor musculature endurance (p=0.040) after implementing the core stabilization exercises intervention.
Based on the results, core stabilization exercise program can improve quality of life and trunk flexor and extensor musculature endurance in mothers of children with CP. Therefore, considering the importance of the health of mothers with CP children, their low levels of quality of life, and positive effect of core stability exercises on the quality of life and trunk muscle endurance, this exercise is recommended for mothers of children with Physical disability who have chronic low back pain.

Considering the significance of investigating the factors affecting occupational therapist's job satisfaction, the present study was conducted to study the relationship between clinical competency and job satisfaction of occupational therapists in Tehran.
A total of 62 occupational therapists (18 males and 44 females), aged between 23-48 (M=29.58, SD=6.96), employed in governmental organizations and private sectors, participated in the present study on a voluntary basis. Herzberg's Scale of Job Satisfaction and Occupational Therapists Clinical Competency Scale were used for data collection. SPSS (v. 18) was utilized for data analysis running Two-Independent-Samples test, Spearman correlation, and multiple regression analysis.
The results of Pearson correlation test revealed that there is no significantrelationship between clinical competency and job satisfaction (p=0.234). No significant difference was found between areas of clinical competency, i.e. professional responsibility (p=0.335), functional knowledge (p=0.194), performance process (p=0.124), critical thinking (p=0.127), effective communication (p=0.161), professional development (p=0.932), management of practice environment (p=0/309), and job satisfaction, either. Multiple regression analysis showed that only professional responsibility (p=0.001) had a significant role in predicting job satisfaction of occupational therapists, and other areas of clinical competency, including functional knowledge (p=0.119), performance process (p=0.289), critical thinking (p=0.960), effective communication (p=0.169), professional development (p=0.091), and treatment environmental management (p=0.316) had no significant effect.
Paying attention to the professional responsibility of occupational therapists was demonstrated to have the most important role in the improvement of their job satisfaction.

One of the most common sport injuries is Anterior Cruciate Ligament (ACL) rupture. Despite high amounts of expentiduture on ACL reconstruction, the rate of return to Pre-Injury Level (RTP) is low. One of the hindrances to RTP is fear of movement/re-injury (kinesiophobia) in the patients. The purpose of the present study was to measure kinesiophobia levels before and after doing functional tests in ACL deficient (ACLD) patients and to compare it with those of the healthy participants.
A cross-sectional research was carried out on 16 ACLD patients with injury during the past 3 months to 2 years who had taken physical therapy treatment and 16 healthy participants. Cross over hop, six-meter timed hop score indexes, and kinesiophobia scores were compiled. Patients (n=16) were randomly divided into two groups: one group (n=8) took the Tampa Scale of Kinesiophobia (TSK-17) questionnaire before functional tests (group one) and the other (n=8) took and filled it after functional tests (group two). TSK-17 was used to measure kinesiophobia. An analysis of variance was run to compare TSK-17 and other clinical measures between groups.
Comparison of kinesiophobia level between groups one and two showed a significant difference (p=0/004). However, no statistically significant difference was found between group control and group two. Scores of functional tests between the three groups revealed no significant differences either. In addition, no significant difference was found between activity level and injury time past between the two groups of patients.
It can be cocluded that doing functional tests by ACLD patients could be effective to decrease kinesiophobia as an important hinderance to return to pre-injury level. It seems that this reduction is the result of patient’s more recognition of her/his abilities and functional status.

Children who suffer from Developmental Coordination Disorders (DCD) have weaker situation control and are more prone to falls and damages compared with their healthy peers. Exercise may improve balance capability in this population. The aim of the current study was examining the impacts of selected physical exercises on children suffering with DCD.
The study followed a semi-experimental method. A total of 20 testees, boy children in the age range of 7-10 referring to two private and public psychological centers for child and adolescent outpatients, were randomly chosen and divided into two experimental and control groups. A pretest was administered for the two groups using the revised version of Stroke Stand for measuring standing balance and tandem walk test for measuring dynamic balance. The experimental group participated in a selected program of physical exercises for eight weeks (three sessions a week, 45 minutes each session). At the end of the treatment period, items related to balance test were administered for the two groups again. Data was analyzed using Kolmogorov Smirnov test and T test.
The results showed that in the pretest, there was no staitstifcal difference between average scores of experimental and control children, but in posttest, the statistic and balance average in the experimental group was significantly more than those of the control group (P The present study showed that doing selected physical exercises will improve balance in children with DCD.

Selection of contraction type to achieve muscle strength and fitness is very important, especially when the main goal is improvement of certain parts of quadriceps. Thus, the purpose of the current study was to compare the quadriceps muscles activity among three types of knee extensor contractions with different loads in young females.
A total of 20 healthy females with the mean age of 24.7±4.5 years, heaight 168.3±9.4 cm, and weight 62.6±7.2 kg, volunteered to participate in the study and performed isometric, concentric, and eccentric contractions with loads weighing 30-80% 1RM weight using isokinetic dynamometer. Measurement of vastus medialis, vastus lateralis, and rectus femoris activity was carried out using 8-channels electromyography. Data analysis was performed running repeated measures analysis of variance and bonferroni tests.
There was no difference observed between dominant and non-dominant lower limb in muscle activity (p>0.05). Quadriceps activity in eccentric contraction was less than concentric and isometric contractions (P=0.000), and vastus medialis and vastus lateralis activities were more than that of rectus femoris (P=0.002). In the lighter loads, vastus lateralis was more active than the other two muscles (P The results of the current study suggest that quadriceps group has the most activity during concentric contraction. The more interesting result is that by changing the contraction type from eccentric to concentric, recruitment of vastus medialis increases. These results are very important for chronic pathological conditions of the patellofemoral joint since these disorders are often attributed to the weakness of quadriceps, especially its medial part.

Learning disorder has a heterogeneous nature reflected in the educational patterns, strengths, and weaknesses of information processing. Children with learning disabilities present high levels of alpha and beta wave activities which harm development of their mental activities. Neurofeedback helps to reduce the proportion of alpha and theta waves and thus can result in improving the reading, writing, and mathematics skills. Further investigation of the various aspects of neurofeedback, as a relatively new methods of therapy, can lead to its improvement and effective use in treating learning disorders. The aim of the present study was to determine the effect of neurofeedback on the speed and accuracy of reading skill in 7-10 year-old children with learning disabilities.
The present study was carried out following quasi-experimental design of the pre-test and post-test in one group. The sample, selected based on convenient sampling, consisted of 15 children with learning disabilities with the age range of 7-10 years old. Participants received 15 sessions of neurofeedback. Next, they were evaluated and compared in terms of reading and dyslexia tests of NAMA in two stages, before and after neurofeedback sessions. Data was analyzed using paired t-test and Wilcoxon test.
Findings revealed that the difference between pretest and posttest, in terms of mean and standard deviation, was statistically meaningful (p

Critical Thinking is the ability of problem solving and decision making. It is the goal of learning and necessary for clinical reasoning. Rehabilitation has an important role in health care process. Rehabilitation specialists’ critical thinking skills directly influence the services they provide. The present study aimed to assess occupational therapy BSc students’ critical thinking skills in different years.
Methods and Materials: In the present descriptive-analytic study, 72 occupational therapy students were selected from Shahid Beheshti University of Medical Scineces based on Census and filled in the demographic sheet and California Critical Thinking Skills Test-B.
The mean score for students’ critical thinking was 11/60±3/15 in the first academic year, 12/56±3/73 in the second year, 13/56± 4/35 in the third year, and 11/68± 4/41 in the fourth year. However, there was no significant difference in the total Critical Thinking and skills scores among students of different academic years.
Despite the importance of Critical Thinking, it seems that it is not well-developed during their studies at Shahid Beheshti University of Medical Sciences, Tehran. Two important factors might be the potential insufficiency of educational system and the occupational therapy curriculum. Thus, revising teaching methods and the occupation therapy curriculum seems necessary and beneficial.

The purpose of the present study was to identify the effect of speed and incline on Rear Foot Angle (RFA) during treadmill jogging in people with pronate foot.
A total of 15 male students were purposefully selected using navicular drop index. After measuring RFA according to Clarke (1983), each participant walked on the treadmill in three slopes (0°, 5°, and 10°), and three speeds (1/25 m/s, 2/2 m/s 5, 3/25 m/s), without shoes. The RFA angles were recorded during walking using two-dimensional motion caption system (Hp cosmos Para motion) making use of two cameras (125 Hz).
The results of Analysis of Variance with repeated measures showed that the RFA decreased with increasing inclination and speed of running in all phases of running, except for during toe-off the ground. Moreover, the results also showed that increase in the speed of running significantly increased the RFA angle in all phases of walking and running (p≤0/001).
Based on the results of the current research, according to the slope and speed variables, it seems that the speed variable could be considered as a more important factor for untoward oscillations in people with pronate foot than inclination variable.

Functional training is becoming a more practical method to improve muscular fitness in people with mental disability. The purpose of the present study was to determine the effect of functional training on the speed of wrist and total movement time of reaching to objects with different shapes (cylinder, cube, and pyramid) and different sizes (small, medium, and large) in a six-years old girl with Down Syndrome.
Material and The current study is a single subject experimental study. One girl with down syndrome with no physical or motor disorder was introduced by Down Syndrome Association (age: six years old) participated in the study. The participant was selected based on availablity sampling. The pretest and posttest of reaching to objects with different shapes and sizes were recorded using motion analysis device. The participant took part in 24 sessions of functional training of eye-hand coordination program, each lasting about 60 minutes (five days a week). Each session of training consisted of three 15-minute parts with five-minute breaks.
The mean of the movement time of reaching to medium cylinder was lower (MT=1200.17) and the effect size (D= 0.89) was higher than those of the other shapes and sizes. The mean of the velocity of reaching to medium cylinder was higher (V=596.83) and the effect size (D= 0.94) was higher than those of other shapes and sizes. The mean of movement time and velocity in the posttest showed that the subject had better performance compared with pretest performance.
The results revealed that the functional training decreased movement time and increased the speed of reaching. These findings support previous results stating that task-oriented training, with respect to the principle of specificity of training, promotes movement patterns in individuals with Down Syndrome.

One of the most important capabilities of central auditory nervous system is dichotic listening processing, which undergoes changes with aging, similar to peripheral hearing. The results of the studies about comparison of functional asymmetry of cerebral hemispheres between musician and non-musician elderlies reveal advantages of musician old age in dichotic listening processing. In the present investigation, functional asymmetry of cerebral hemispheres is investigated in dichotic listening musician and non-musician elderlies with normal hearing using dichotic digit test.
Material and The current cross-sectional study was performed on 40 right-handed musician (N= 20) and non-musician (N= 20) elderlies aged 60 to 80 years with normal hearing using the Persian version of the dichotic digit test. Data was analyzed running independent t test and man-whitny test. Finally, the results of right and left ears were compared in Non-Forced Attention (NF), Forced Right (FR), and Forced Left (FL) attention conditions.
Comparison of dichotic digit test results in divided attention condition showed significant difference between the two groups (p-value The results of the present study confirmed better function in musician elderlies compared with non-musician elderlies in divided attention and competitive environment particularly in FL attention condition. In fact, musician elderlie's desire to acquire information through both ears in noisy places, unlike their non-musician counterparts. Finally, musician elderlies showed lower hemispheric asymmetries with higher scores obtained in dichotic digit test.

Children with Autism Spectrum Disorder (ASD) have various problems, including difficulties in social communication skills and presence of repetitive behaviors. The plurality of these problems can affect their abilities to participate in school and community. The variety of these difficulties make it difficult and confusing for the therapists, teachers, and parents to select the most appropriate type of rehabilitation service for these children. The purpose of the present study was translating and assessing face and content validity of a questionnaire developed by Jeff Sigafoos in New Zealand to investigate educational needs and intervention priorities for parents of children with ASD. The results of the study can be used to facilitate designing and planning of rehabilitation interventions for children with ASD.
In the present descriptive-analytic study, psychometric methods were employed. Firstly, Assessment of Educational Needs and Intervention Priorities questionnaire and the permission for its translation were obtained from the developer. Then, it was translated following the forward-backward process. Next, the translated questionnaire was evaluated in terms of face validity by 10 parents of children with ASD. Also,the content validity was assessed by 10 professionals in Psychology who had clinical expertise in working with children with ASD. Content Validity Ratio (CVR) and Content Validity Index (CVI) were determined, as well.
After the translation process, one item was removed. A very high face validity index was obtained for the new questionnaire (0.97). CVR (1-0.8) and CVI (0.99) were found to be in acceptable ranges.
The new Assessment of Educational Needs and Intervention Priorities questionnaire enjoys high face and content validity making it appropriate for assessing educational needs and intervention priorities for parents of children with ASD.

Menopause transition is accompanied with undesirable changes in body composition, fat distribution, increased visceral fat, and prevalence of nonalcoholic fatty liver disease. But limited studies have examined the effects of physical activity on liver function in post-menopausal climacteric. The purpose of the current study was to investigate the effects of nonlinear resistance training on levels of alanine aminotransfrase, aspartate aminotransfrase, alkaline phosphatase, Gamma-glutamyl transferase, total bilirubin, and platelet count in post-menopausal women with obesity and nonalcoholic fatty liver disease.
A total of 23 post-menopausal women with non-alcoholic fatty liver disease, between 60 to 71 years old, were randomly assigned to resistance training (n=12) and control (n=11) groups. The experimental group received 12-weeks of the resistance training with different intensities and the participants in control group continued their normal sedentary life. Blood samples were obtained before and after the protocol. Data was analyzed running one-way ANCOVA and paired t test using SPSS (version 22) (p Alanine aminotransfrase (p=0.013) and aspartate aminotransferase (p=0.000) levels significantly decreased in resistance training group but not in control group (p>0.05). Alkaline phosphatase, Gamma-glutamyl transferase, total bilirubin, and platelet counts did not significantly change in the two groups (p>0.05), while muscle strength was improved in resistance training group (p=0.000).
The results showed that with aging, menopausal transition, inactivity, weight gaining, and prevalence of non-alcoholic fatty liver disease were evident. These factors would endanger the health of post-menopausal women. But nonlinear resistance training is helpful to improve liver function and muscle strength. These findings can be helpful for physicians, coaches, and designers of training plans to reduce the side effects of drug therapy.

Despite special benefits of the theraband resistance in rehabilitative exercises for patients suffering from Multiple Sclerosis (MS), only a few studies have been reported investigating this method of therapy. Thus, the current study was conducted to investigate the effect of eight weeks of theraband resistance training on the fatigue severity, the quality of life, and muscular strength of the lower extremity in men with MS.
A total of 30 patients from Tehran National MS Society (with the disability scale of 1 to 4, aged 25-35, and the ability to walk) participated in the present study on a voluntary basis and were randomly assigned to experimental and control groups, 15 each. Next, patient participants took part in eight weeks of resistance training, three times a week. Fatigue and the quality of life were assessed using the fatigue and 36-item questionnaires, respectively, and muscular strength was measured using a dynamometer. For data analysis, t-tests were run with the significance level set at P≤0/05.
Independent samples t-test showed a significant difference between the post-tests of the experimental and control groups (FSS: P=0/029, QOL: P=0/000, Plantar flexors: P=0/007, and Extensors of the knee and hip: P=0/000 and P=0/001, respectively), whereas no significant difference was observed between the pre-tests. Also, dependent samples t-test revealed a significant difference in the means of the pretest-posttest comparisons for the experimental group (FSS: P=0/019, QO: P=0/000, Plantar flexors: P=0/010, and Extensors of the knee and hip: P=0/000 and P=0/002, respectively), while comparison of pretest-posttest means did not reveal a meaningful difference in the control group.
Eight weeks of resistance training can significantly improve the fatigue, the quality of life, and muscular strength of patients with MS.

Changes in horizontal velocity are known to influence many biomechanical characteristics of walking. The aim of the present study was to investigate the influence of movement velocity on lower-limb symmetry in normal walking.
A total of 11 angular and eight temporal parameters from sagittal plane angle-time curves of both lower limbs joints of 10 young able-bodied males were collected at each of the three relative velocity conditions (slow, normal and fast) using a six-camera motion capture system. Data was analyzed using a series of 2×3 repeated measures ANOVAs at the significance level of 0.05.
The results revealed that in all the four angular parameters and the six temporal parameters, on which speed and lower-limb had significant influence, asymmetry was found between the limbs in slow-velocity walking. However, in normal-velocity walking, the two angular parameters and the four temporal parameters and in fast-velocity walking only one of the temporal parameters demonstrated asymmetry between the limbs.
Analysis of interaction effects of walking velocity and lower-limb showed the greater asymmetries at the slow velocity condition with a trend toward improved symmetry at higher velocities. Considering the possibility of the effect of movement velocity, it is recommended that this factor be controlled during investigating the walking behavior in clinical and research settings.

Changes in lower extremity alignment are considered as a risk factor for the injuries in this area together with Q angle. The purpose of the present study was to examine the relationship and affecting anatomical factors of lower extremity alignment on the Q angle.
A total of 120 male students from Tehran University participated in the study and their lower extremity alignments were investigated in these factors: hip anteversion, internal and external rotation of the hip, valgus and varus of knee, hyperextension of the knee, tibia rotation, tibiavara, and arch index.
The results showed that the variables of plantar arch index, varus and valgus of knee, hip anteversion, and tibial torsion had maximum effect on the predicted value of the Q angle (p≤0/05) and the most influence was found to be respectively related to plantar arch index, anteversion of hip, tibial torsion, and varus and valgus of knee.
The results showed that the changes in the lower extremity anatomical alignment can affect the amount of Q angle. Among the variables studied, the plantar arch index was noted to have the greatest impact due to the influence of the three-point constituent of this angle. Changes in this angle can put the person at the risk of various injuries in the segments of the lower limb.

Demographic studies have shown that Attention Deficit Hyperactivity Disorder (ADHD) is more prevalent in children with convergence insufficiency than in normal children. The purpose of the present study was to compare ADHD symptoms in Iranian children with convergence insufficiency and normal children.
In the current descriptive-comparative study, 47 children diagnosed with convergence insufficiency were compared with 61 normal children in Borujen city. Complete ocular exams were performed by an Optometrist. Children with a history of ocular trauma or surgery and developmental and psychiatric disorders were excluded. After obtaining the informed consent, the Persian translation of Child Symptom Inventory (CSI-4): Parent Checklist was usedto evaluate ADHD symptoms in these children. Data was analyzed using SPSS 19 software.
Data was analyzed for 61 normal children and 47 cases with convergence insufficiency. The mean age of children with convergence insufficiency and normal ones were 10.7 (SD=1.6) and 10.7 (SD=1.8), respectively.No statistically significant difference was found between the two groups on inattention, hyperactivity-impulsivity, and oppositional behavior scales (p>0.05).
No significant difference was observed in ADHD symptoms between children with convergence insufficiency and normal children.

To determine agreement between the aberrometry parameters of iTrace and Zywave in patients with keratoconus.
In the present cross-sectional, comparative, and observational study, optical aberrations of 51 eyes of 40 patients with keratoconus, aged between 19 to 27 years old, refering to Farabi Eye Hospital in Tehran, were measured using iTrace and Bausch & Lomb Zywave II at a single visit without pupil dilation. The results were compared and analyzed with regards to the sphere, cylinder, as well as lower and higher order aberrations of the two devices considering for 0.5 mm pupils. The statistical analyses used included paired t-test, Pearson correlation coefficient, and the Bland-Altmann plot.
The results obtained from Zywave and iTrace showed no significant differences when paired t-test was used (except of Trefoil (3, 3)) and the Bland-Altmann agreement range was (LoA = -0.51 to 0.53) in the sphere and (LoA = -1.29 to 1.19) in cylinder. Also, the agreement on lower order aberrations, including defocus (2, 0) (LoA = -2.5 to 3.07), astigmatism (2, 2) (LoA = -1.22 to 1.56), and oblique astigmatism (2, -2) (LoA = -1.11 to 0.92). Also, higher order aberrations included horizontal coma (3, 1) (LoA = -0.48 to 0.48), vertical coma (3, -1) (LoA = -0.77 to 0.92), Trefoil (3, -3) (LoA = - 0.57 to 0.49), spherical aberration (LoA = -0.41 to 0.33), total higher order aberration (LoA = -0.73 to 0.64), and total aberration (tRMS) (LoA = -3.11 to 2.87). The findings of the two devices in lower and higher order aberrations showed good correlation, except in Trefoil (3, 3) that showed a weak correlation.
In both iTrace and Zywave devices, agreement was observed in lower order and higher order aberrations in patients with keratoconus. These results can prove the reliability of iTrace device findings compared with B & L Zywave II.