فصلنامه آرشیو توانبخشی
سال سیزدهم شماره 4 (پیاپی 49، زمستان 1391)

The primary aim of the present study was to study the reliability of postural stability measures during whole body dynamic conditions، so they can be used in postural stability evaluations، investigations of injury mechanisms and assessments of treatment efficacy. Twelve healthy volunteers and 12 low back pain patients performed repeated trunk bending motions in eight different conditions of high and low speed، in symmetric and asymmetric planes and with or without external load. All measurements were repeated on a second session، 7-10 days later. Center of pressure (COP) data were used to calculate the standard deviation of amplitude and that of velocity in anterior-posterior and medial-lateral directions، the mean total velocity and the path length. Relative reliability was assessed using the intra class correlation coefficient (ICC) and absolute reliability using the standard error measurement، minimum detectable change and coefficient of variation. Results in both low back pain and healthy subjects revealed that the mean total velocity showed good to excellent reliability، with ICC ranging from 0. 6 to 0. 91. In the healthy group other parameters such as standard deviation of amplitude and standard deviation of velocity in the anterior-posterior direction showed good to excellent reliability (range: 0. 66-0. 97). In the low back pain group standard deviation of amplitude in the anterior-posterior direction in symmetric test conditions (range: 0. 61-0. 75) and standard deviation of amplitude in the medio-lateral direction in asymmetric test conditions (range: 0. 62-0. 81) were good or excellent. Mean total velocity is suggested as a good parameter for evaluation of postural stability in dynamic situations such as lifting and complex trunk movement and also for identifying low back pain patients from healthy subjects.

The relationship between phonological awareness and phonological disorders has been considered in recent decades. Phonological awareness deficits in children with phonological disorders could be due to a deficit in phonological abilities. The present study attempts to study the phonological awareness deficits in children with phonological disorders. This was a comparative and cross-sectional study. The research sample consisted of 25 children with phonological disorders and 25 normal children. Children with phonological disorders were selected by convenience sampling method and normal children were selected by matching with the disordered group. The research instruments consisted of the “phonetic information test” to determine the phonological disorders and the “phonological awareness test” to assess phonological awareness. The awareness of syllable blending and syllabification، rhyme and alliteration was also studied. The data were analyzed using SPSS-13، based on paired t-test، independent T-test and Chi-square. The mean score of phonological awareness in children with phonological disorders was significantly lower than normal children (P<0. 001). There was no significant difference between the two groups in terms of awareness of syllabification (P=0. 073) and syllable blending (P=0. 189). But there was a significant difference between the two groups in terms of awareness of rhyme (P<0. 001) and alliteration (P<0. 001) The findings showed that children with phonological disorders are at a lower level than normal children in terms of phonological awareness. According to the results of this study، it can be recommended that the speech-language pathologists should consider phonological awareness when treating children with phonological disorders.

Although considerable research has been conducted on awareness of and respect for patients'' rights in the country، few have been implemented in the rehabilitation field. The aim of this study was to investigate about the awareness rate of rehabilitation clients and therapists، about the “patients'' rights charter «in the phase of treatment. This descriptive-analytic study was conducted at two university-affiliated centers of the University of Welfare and Rehabilitation Sciences، in 1389-90. 103 clients and 28 therapists were recruited by convenient sampling. Data collection was carried out using 2 forms of questionnaires: that of therapists and of clients، the reliability and validity of which were confirmed. Data were analyzed using Pearson’s correlation coefficient. 44 female and 59 male clients as well as 20 female and 8 male therapists participated in this study. Awareness level of the clients about the» patients'' rights charter«was: 47/6% poor، 16/5% moderate and 35/9% good. There was no significant relationship between clients'' awareness with age، sex، and setting. However، significant relationship was found between the level of awareness and the education level، number of visits، and the rehabilitation unit (P<0/05). Awareness level of the therapists about the»patients'' rights charter«was: 32/1% poor، 14/3% moderate and 53/6% good. There was no significant relationship between therapists'' awareness with age، sex، degree level، and field of expertise. However، significant relationship was found between level of awareness and work location (P<0/01). Considering the fact that rehabilitation clients are one of the most vulnerable groups، with special needs and low awareness of their rights، improving rehabilitation performance and patient satisfaction requires improvement in public awareness about rehabilitation services and client rights. as well as research on and development of strategies for following clients’ rights، by policy makers of the health care system، especially for rehabilitation services.

The goal of the present study was to improve the extension and flexion of the elbow joint for rehabilitation purposes، in terms of energy dissipation and of injuries caused by stress imposed on connective tissue by exercise equipments during force transfer، by investigation of viscoelastic property variations during change in speed of motion. A sample of five men without any previous neuromuscular impairment of the elbow joint was chosen by the BMI factor. The passive continuous motion test (CPM) was performed by the CYBEX isokinetic system in the extension and flexion movements of the elbow joint of the left hand، at 4 different speeds (15، 45، 75 and120 Deg/s) during 5 consecutive cycles at the range of motion of about 0 to 130 degrees. The experimental data was exported to the MATLAB software for analysis. In order to determine viscoelastic property effects and biomechanical parameters، we used a passive viscoelastic mechanical model constructed by 3 elements for simulation، and also we used the curve fitting method to derive the elastic and viscose coefficients for the model.، . Results of experiments showed that by increasing the speed of motion، the value of work done، hysteresis and elastic coefficient increased and the value of viscose coefficient decreased. Also، it appeared that by increasing the speed of motion، the effect of viscose resistance on the passive torque curves increased. In addition، there was significant correlation between the action of the mechanical model and the action of the concerned limbs، during the movement. It was concluded that in order to improve motion and to reduce imposed risks and injuries to joints and limbs، rehabilitation exercises better be performed at lower speeds and with rehabilitation equipments supported by viscoelastic resistant force.

The purpose of the present research was to investigation of the effectiveness of life skill instruction on the mental health of students with hearing loss in Tehran province. The present research was an experimental study by pre-test، post-test design with control group. The study population included of male students with hearing loss from second and third level of high schools in Tehran province. Subjects were selected by in available method. Forty students participated in the study. Subjects were divided into two groups by randomly (experimental and control group)، each of group was consisted of 20 students. Experimental group received life skill training in 9 sessions while control group did not. The instruments of present research were Wechsler Intelligence Scale for adult and General Health Questionnaire. The obtained data were statistically analyzed by Mancova. The findings of this research showed that there was significant increase in mental health scores of experimental group in the post intervention in comparison with control group (P<0. 05). Also mental health scores of experimental group was significantly in somatic symptoms، anxiety، deficiency in social performance and depression (P<0. 05). The life skill instructional program led to improvement of the mental health of hearing loss students and decreased somatic symptoms، anxiety، deficiency in social performance and depression. Therefore، planning for providing of social competence instruction is of a particular importance.

About 50% of severe to profound intellectual disabilities (ID) are caused by genetic factors. In this study we decided to investigate the genetic causes of ID in 69 Bushehrian families to provide information for genetic counseling، carrier detection، and prenatal diagnosis. In this study we excluded known chromosomal abnormalities. The majority of families had more than two affected individuals. Karyotyping for each proband with physical malformations was performed. One affected member from each family was tested for FMR1 mutation and metabolic screening. Families with ID and primary microcephaly were checked for 7 known MCPH genes by linkage analysis. Chromosomal abnormality was not found in any of the families. One family had full mutation of CGG repeat of Fragile-X syndrome. Six out of 18 families with MCPH showed linkage to one of the MCPH loci. One family had a syndrome associated with microcephaly. Two families with microcephaly and one family with a non-syndromic form of mental retardation without microcephaly showed an autosomal dominant mode of inheritance. According to our results genetic causes of ID are very heterogeneous and autosomal recessive primary microcephaly has an extremely high prevalence (26. 09%) in Bushehr province of Iran.

Schizophrenia is to be emphasized due to its high prevalence، severity of symptoms and frequent recurrences. In this study the hazard of recurrence of Schizophrenia was analyzed by using recurrent events models. This study was an observational prospective study. Data was gathered from 159 registered schizophrenia patients at Razi Psychiatric Center. The type II conditional model and the frailty model were used for analyzing times of recurrence. SAS (version 9. 1) and R (version 2. 11. 0) were used for analysis of data. Significance level for the statistical tests was considered to be 0. 05. In the type II conditional model، age at onset of disease (P=0. 021) and marital status (P<0. 001) only significantly affected the hazard of the first relapse. The effects of age at onset of disease، sex، marital status، how the disease began، history of head trauma and family history of schizophrenia were not significant on the hazard of the second relapse. History of head trauma had significant effect only on the hazard of the third relapse (P=0. 020). In the frailty model only the effects of sex (P=0. 014) and history of head trauma (P=0. 014) were significant on the hazard of recurrent relapses. The effects of some covariates on the hazard of recurrent relapses were significant under type II conditional model، and some covariates had significant effect under the frailty model. Further research is needed to investigate the effect of other prognostic factors on the hazard of recurrent relapses and time of recurrent relapses.

This study was conducted to improve the body image and self-esteem among breast cancer patients after mastectomy. Our study comprised of 23 breast cancer patients in Imam Hossein Hospital، aged between 30-60 years، all of whom had undergone mastectomy and then radiotherapy. The study participants were selected through purposeful sampling and then randomly assigned to the case (10) and control (13) groups. The intervention program (cognitive behavioral group intervention) consisted of 12 sessions of intervention (2 sessions per week) each taking 90 minutes، in a 6 week process. Both group members completed the “body image and relationships scale” and the “Pope self- esteem questionnaire” before and after training. Analysis of covariance to eliminate the pretest effect on posttest results and ANOVA to determine the differences between the groups were used through SPSS 18 in this study. This intervention was significantly effective on improving the mean score of body image and self- esteem in the breast cancer/mastectomy patients of the case group compared to that of the control group (P<0. 01). Thus، cognitive behavioral group intervention can be effective in improving body image and increasing self-esteem among women with breast cancer after mastectomy.

The aim of this study was to evaluate different aspects of validity and reliability of the Persian-version of Fatigue Severity Scale (FSS-P) among people with Multiple Sclerosis. A sample of 50 people with Multiple Sclerosis and 30 healthy adults were included in this study. The participants were recruited from Sina clinic in Tehran between 2001 to 2007. The Fatigue Severity Scale (FSS) includes nine items developed to measure disabling fatigue and a Visual Analog Scale (VAS) to measure overall fatigue. All participants were asked to complete FSS and Short-form 36 Health Survey (SF-36) questionnaires. Test-retest reliability and Internal Consistency were assessed، using Intraclass Correlation Coefficient (ICC) and Cronbach''s alpha، respectively. Dimensionality was assessed، using item-scale correlation after correction for overlap and convergent validity، using a priori hypothesized correlations with the SF-36. All the participants found the FSS-P to be clear and unambiguous in pilot testing. The ICC was reported 0. 93 for the total score and 0. 88 for VAS، The Cronbach''s alpha was reported 0. 96. The total score and the VAS were significantly correlated with the SF-36 vitality subscale (r=-0. 69 and r=-0. 73 respectively). Correlations with other SF-36 subscales were at moderate level (r=-0. 43 to r=-0. 65، all P<0. 001). Since this is the first study to translate and scale equivalent to «fatigue severity scale» in Farsi in Iran، the main features of the scale and reliability of Persian version of «fatigue severity scale» was determined and assess the validity of the study in terms of facilities and access to the sample and a preliminary report in order to design more and more research was in order next. The results of the study revealed that the FSS-P is an appropriate psychometric instrument to assess the people with Multiple Sclerosis.

Anterior cruciate ligament (ACL) tear is one of the most common knee injuries. Kinesthesia after ACL tear is impaired. In this study، using hybrid generalized estimation equations (GEE) can be efficient method in analyzing correlated data، we try to evaluate the effects of reconstruction surgery and functional brace with controlled confounding factors in improving the patients’ kinesthesia with ACL tear. This Quasi-experimental study using simple non-probabilistic sampling، have been conducted on 60 patients with acute ACL tear. To evaluate of kinesthesia motion sense، continuous passive motion machine was used. The test speed was 0. 5 degrees per second. Response variable in this study was the kinesthesia motion sense. Surgical variables، brace، eyes، limbs، BMI، the dominant side، disease side and age as independent variables were considered. R 2. 13. 0 software was used for fitting hybrid GEE model. The reconstructive surgery in patients is effective in improving the kinesthesia. (OR: 13. 94، CI: 95%، 7. 486 - 25. 997، P<0. 001). But the functional brace does not improve the kinesthesia motion sense (OR: 0. 73، CI: 95%، 0. 52 - 1. 033، P=0. 076). The odds to get threshold of motion sense in patients with left dominant side in normal conditions، if the disease side is right، equal 0. 019 times the left side. (OR: 0. 019، CI: 95%، 0. 010 - 0. 035، P<0. 001)، and no significant relationship between patients’ limbs and kinesthesia motion sense indicates that affected limbs can also affect healthy limbs’ kinesthesia motion sense (OR: 0. 97، CI: 95%، 0. 806-1. 015، P=0. 728). The variables included in the study، variables of reconstruction surgery، disease side، interaction of disease side and the dominant side showed a significant relationship.

Literature survey has shown that participation in social programs can promote the mental and social health among intellectually disabled individuals. One of these programs is the Special Olympics (SO) and the programs related to it. The aim of this study was to investigate the effect of SO programs on self-efficacy among Iranian Special Olympians with Down Syndrome (DS). In this quasi-experimental research، forty DS members of Iran''s SO national team were selected as the intervention group and 37 DS non-athletes were selected as the control group. The SO group participated in 9 months of SO specific sport programs. The “Wheeler and Ladd''s Children’s Self-Efficacy for Peer Interactions Scale” was used to collect data from the two groups before and after the 9-month long athletic programs. Data were analyzed by kolmogroff-Smirnoff، paired T and independent T tests. The results showed that SO programs had significant effects on the self- efficacy of the experimental group. The SO athletes were significantly (P≤0. 001) better than the control group in all sub-scales of self-efficacy. It seems that participation in social-sport aspects of the Special Olympics programs can promote self-efficacy among this population. Generalizing such programs for DS people can help them show their abilities and provide them with self-efficacy which is necessary for living independently.

The aim of this study was to evaluate the education ergonomic principles on musculoskeletal disorders among computer users at Rasht welfare organization in 2011.

This semi-experimental study، 283 female computer users whom had musculoskeletal disorders randomly assigned into two groups. The case group were educated practically and theoretically about ergonomic issues for three months and ergonomic interventions were carried out for this group. Body map questionnaire was used for estimation of musculoskeletal disorders level and statistical analysis was performed using kolmogorov-smirnov and covariate test.

The results of the present study showed that the highest prevalence rate of musculoskeletal disorders were reported in right knee (27. 91%)، neck region (27. 20%)، lumbar and right shoulder (24. 14%)، left knee (25. 79%)، back (23. 67%). The results of this research showed that there was homogeneity of variance and the meaning of the F covariance at the level of P≤0. 05 revealed that the education of ergonomic principles leads to a reduction of Musculoskeletal Disorders among computer users.

Education of ergonomic principles for the computer users and ergonomic interventions like correction of postures، reducing of work duration، armrest، foot rest، and cushion strengthening exercise and regulating of work station application have a significant effect on the decreasing musculoskeletal disorders prevalence among computer users.

Cerebral palsy is one of the most common causes of physical disability in childhood that leads to various difficulties and reduces the level of independence and participation in activities of daily living. The aim of this study was to investigate the effects of Occupational Therapy Home Program on activities of daily living of 5–12 year-old children. In this clinical trial، 48 children were selected and randomly divided into the intervention and control groups. Common practices of occupational therapy were applied for a period of 4 months for both groups. In addition، the intervention group received the Occupational Therapy Home Program in the form of workshops and educational pamphlets with telephone follow-ups. The Activities Scale for Kids (ASK) was used to assess activities of daily living، and independent t-test، chi-square test، Fisher exact test and covariance analysis were used to analyze the results. There was significant difference in activities of daily living between the two groups (P=0. 001). There were significant differences in all subtests of the activities of daily living (P<0. 05)، except the play subtest (P>0. 05). Occupational Therapy Home Program increased activities of daily living of children with cerebral palsy and can be considered useful in addition to common occupational therapy programs.

Quality of life is affected by many factors including stressors and coping strategies. Schizophrenia patients suffer from numerous stresses and have difficulties in coping strategies against life stressors which in turn can influence their quality of life. So it is important that coping strategies in patients with schizophrenia be known. This study has been performed in order to appraise coping strategies in schizophrenia patient and their relationship with quality of life. In this descriptive- correlational study 90 schizophrenia patients referring to psychiatry clinics of educational psychiatric hospitals in Tehran during a nine-month period were evaluated with the “World Health Organization Quality of Life Scale-Brief Version” and with “The Ways of Coping Questionnaire”. Data was analyzed by Anova، Independent T test، Kruskal Wallis، Man Whitney and chi-square tests. The results showed that most of the participants (42. 1%) used the «avoidance” coping strategy. The results also showed that the majority of participants (77. 8%) had an average level of quality of life. In addition، the results showed that there was a meaningful relationship between quality of life and coping strategies (P=0. 005); such that samples who used the»avoidance” coping strategy، had lower quality of life. There was a meaningful relationship between «quality of life» and «coping strategies». Including teaching of coping skills in the treatment and rehabilitation plan of schizophrenia patients can increase their use of more effective coping strategies and to improve their quality of life.

Left ventricular (LV) remodeling is associated with increased morbidity and mortality; therefore، interventions that halt or reverse ventricular remodeling are expected to prevent these clinical outcomes. The aim of the study was to assess the effects of cardiac rehabilitation program on cardiac remodeling process in patients with coronary artery disease and then compare the results between men and women. Among 40 cardiac patients، we studied 20 patients (10 women، aged 54. 5±5. 44 yr (mean±SD)، and 10 men aged 53. 2±7. 68 yr) who were participating in the recovery phase II of a cardiac rehabilitation program. The exercise program consisted of an endurance and resistance exercise with a duration of 60 min/session and a frequency of 3 sessions/week for 2 months. All patients underwent a complete resting echocardiography study and exercise test before and after exercise training. Data were analyzed by paired T and independent T tests. EF in men increased from 52%±8 to 60. 5%±7. 36 and in women from 49%±8 to 58. 5%±8. 22. LV end-diastolic diameter in men decreased from 50. 26±6. 74 to 45. 4±5. 56 mm and from 47. 87±11. 76 to 44. 62±8. 52 mm in women. LV end systolic diameter in men decreased from 33. 7±10. 32 to 27. 86±6. 8 mm and from 33. 29±9. 52 mm to 28. 73±6. 1 mm in women. FS in men increased from 27. 8%±5. 04 to 38. 25%±5. 24 and from 27. 3%±7. 6 to 36. 15%±5. 5 mm in women (P=0/001). However، there was no difference in any of the above characteristics between the two groups. 24 sessions of cardiac rehabilitation program had a significant effect on the prevention of left ventricular remodeling in both men and women patients. This effect seems to be similar in both groups.

Opium and stimulants are two kinds of illegal substances which are different from each other in chemical structure، psychological and biological effects (material)، and their potential adverse effects on consumers. The present study compares the effect of abuse of each of the two (opium and stimulants) on violent behavior against wives. The present study was a non-experimental and comparative study. The study sample included 100 spouses of men addicted to opium and stimulants (50 opium and 50 stimulant addicts) who attended governmental or non-governmental centers or camps in Tehran city (from October 2011 to January 2012)، in order to receive professional assistances. (Both groups of subjects were selected by convenient sampling method to ensure the compatibility with input and output data. The “revised conflict tactics scale” was used to assess the rates of violence (psychological، sexual coercion، negotiation، injury and physical assault) exerted by men. Results were analyzed using multi-variety analysis of variance and covariance. Results showed that after controlling the age as a covariate، consumers of stimulants (especially methamphetamine) were more violent toward their wives than were consumers of opium (P≤0. 001). There were also significant differences between the two groups in the psychological، sexual coercion، injury and physical assault subscales، but not in the negotiation subscale (P≤0. 05). It seems that the psychopharmacological effect of stimulants leads to more violent behaviors in its consumers (especially by methamphetamine) than in consumers of opium.

Rubinstein Taybi syndrome is a rare genetic abnormality that includes such features as facial abnormalities، broad thumbs on the hands and feet، small stature، and developmental delay (including fine and gross motor، communication، problem solving، personal-social delays). This case report represents a 12 months old male baby، was referred for his Developmental Delay، and after investigations and work up، the diagnosis confirmed as the Rubinstein Taybi Syndrome (RTS) and also، the results of developmental assessment emphasizing motor portion through the Ages and Stages Questionnaires-II (ASQ-II) and the Peabody-2 Scale (PDMSII) tests have been reviewed.