حمید دالوند

Cerebral palsy (CP) is the most prevalent motor disability during childhood, characterized by a range of movement and posture disorders that result in activity limitations. In children with CP, abnormal walking patterns are observed due to spasticity and contractures in the lower limb muscles. Also, an excessive flexion gait pattern of the knee presents in 66% of spastic diplegic CP children aged from 5 to 21 years. Accordingly, reducing excessive knee flexion during walking may decrease secondary compensations and enhance walking performance and quality of life. This study aims to design and evaluate a novel dynamic orthosis along with its impact on functional parameters of walking and occupation performance in a child with spastic diplegia CP. 

This research was a fundamental and applied study of the design and fabrication. The study plan is a single subject, interaction design, conducted in two stages and implemented as A-B-BC-A. After the initial orthosis design, a second and final iteration was developed to address the limitations observed in the preliminary design. The study participant included an 8-year-old boy with spastic diplegic CP, classified as level II (according to the gross motor function classification system expanded and revised), exhibiting a crouch gait pattern. Functional variables, such as speed, balance in walking, spasticity, and occupation performance, were assessed in the study phases.

The advantages and disadvantages of the final design were identified. Changes were made regarding manufacturing in less time, the ability to adjust the circumferential measures, ease of wearing and removing, and issues related to toileting. In comparing the baseline with intervention phases one and two regarding balance, the intervention demonstrated effectiveness (percentage of non-overlapping data [PND]=70%). According to PND values, functional speed in the second intervention phase showed significant results (PND=75%). The hamstring muscle spasticity graph analysis during intervention phases exhibited a reduction of 1 or 2 units. The occupational performance score and satisfaction with the child’s performance increased significantly after the intervention phases.

According to the mechanism of dynamic movement orthoses, as long as they are worn during the day, they are effective in modulating the tonicity of spastic muscles by exerting pressure on hypertonic muscles. This modulation improves balance, movement speed, and overall task performance. Consequently, these findings suggest that dynamic orthotic interventions may enhance functional outcomes and occupational performance, and satisfaction in children with spastic diplegic CP.

Autism spectrum disorder (ASD) is a neuro-developmental disorder which ismostly caused by deficits in social interactions. Lack of physical activity and poor nutritional habits arecommon problems in these patients which may be exaggerated by the Covid-19 pandemic. The studyaims to assess the effect of functional training along with online nutrition education on inflammatorybiomarkers in children with ASD.

In this randomized controlled clinical trial, 80 children with ASD (age=9.73±1.29years, weight=49.94±2.08 kg, height=146.08±40 cm, body mass index=24.71 ±1.48 kg/m2) were randomlydivided into four groups of training, education, training+ education, and control. The interventionslasted for 8 weeks. The inflammatory biomarkers including white blood cell (WBC) count, C-reactiveprotein (CRP) level, neutrophil count, eosinophil count, and basophil count were assessed (usingblood samples collected from antecubital vein) before and after the interventions.

There was no significant difference between the groups before the interventions (P˃0.05). Afterthe intervention, the results showed a significant decrease in WBC (P˂0.001), CRP (P=0.001), neutrophils(sig.=0.009), and eosinophil (P=0.003) in all groups. Basophil count decreased in all groups (P=0.01) exceptin the education group.

Functional training and online nutrition education are beneficial interventions for managementof inflammatory biomarkers in children with ASD which can be used during the Covid-19 pandemic.

Musculoskeletal disorders are mainly prevalent among college students who experience direct contact with patients. This study aimed to determine the prevalence of musculoskeletal pains among Rehabilitation, Dentistry, and Nursing students at Arak University of Medical Sciences in 2017-2018.

Methods & Materials: 

In this cross-sectional descriptive study, 538 students of Arak University of Medical Sciences were recruited using the convenience sampling approach. Variables included age, sex, body mass index, study field, hours of using smartphone per day, and nine symptom sites being neck, shoulders, upper back, elbows, low back, wrist/hands, hips/thighs, knees, and ankles/feet. The researchers assessed the musculoskeletal pain by using the Nordic questionnaire and demographic questionnaire. Statistical analysis was performed using SPSS V. 18.

Ethical Considerations: 

The Research Ethics Committee of Arak University of Medical Sciences approved this study (Code: IR.ARAKMU.REC.1397.253).

  In this study, 538 students (205 males and 333 females) were studied with Mean±SD age of 22.04±2.53 years old. The results showed that the prevalence of musculoskeletal pain in the spine (neck 29.4%, upper 24.3%, and lower back 37.2%) was higher than in upper and lower extremities. Musculoskeletal pain in the shoulder, upper, lower back, and thigh were significantly different based on sex. Also, musculoskeletal pain in the neck and ankle, and foot were significantly different based on age (P<0.05). There was a significant difference between musculoskeletal pain of back and ankle based on smartphone use hours per day.

 This study suggested that rehabilitation, nursing, and dentistry students are at risk for musculoskeletal pain, especially in the lumbar, cervical, and upper back.

Caring for children with Cerebral Palsy (CP) is hard, energy-consuming, and long-term, and can lead to caregivers’ burnout. The present study aimed to identify reasons for and consequences of occupational burnout among caregivers working in institutes for children with CP in an Iranian context.

The present study was carried out using qualitative approach and content analysis methodology. Nine caregivers, two managers, and one physiotherapist participated in the study. Purposive sampling method was used to select participants and in depth, semi-structure interviews were used to collect the data. All interviews were conducted in institutes. The interviews were recorded, transcribed verbatim, and overviewed. Constant comparative analyses were used to analyze the interviews.

A total of 623 initial codes were extracted from the interviews. Then, the codes were categorized into three main categories and nine sub-categories. The main categories were as follows: care-related stress, nature of caring occupation, and managerial and organizational challenges and shortcomings.

Identifying the barriers and challenges can lead to betterment of managers’ knowledge and, consequently, adoption of more proper organizational policies to increase the quality of caring services in the institutes.

Mothers of children with spinabifida spend more time to care for their children. Doing this care, depending on the child's functional mobility level; can probably cause damage to physical and mental health of mothers. This study aimed to determine the quality of life (QOL) of mothers of children with spinabifida (SB), according to the Hoffer levels using the SF-36 questionnaire.

This research was a descriptive- analitical, cross-sectional study. The sample of this study was consisted of mothers of children with SB (2/5– 14 years old), in Tehran. The sample were selected by convenience sampling in the Rehabilitation Outpatient Clinics of University of Social Welfare and Rehabilitation Sciences, that 203 mothers were assessed in one clinic. Primery measures were the Hoffer criteria for grouping and determine the levels of ambulation in children with SB and the outcome measure was SF-36 questionnaire. Data were analyzed using, t test, ANOVA and MANOVA in SPSS (version 18).

In this study, there were significant differences in mean scores on the physical component summary (PCS) (p<0/01) and Mental component summary (MCS) of SF36 (p<0/01) in mothers of children with SB in Hoffer levels. The significant difference in PCS and MCS of SF36, was related to the level I with the other levels of Hoffer criteria, there were no Significant difference in mean score for the PCS and MCS the QOL of mothers for sex and child's age levels (p < 0/05). There were a significant differences in mean PCS and MCS a QOL of mothers in different types of SB (p<0/01). This significant difference was related to aculta with meningocele and myelomeningocele (p<0/01).

The dimensions of PCS and MCS of SF36 of mother with SB were affected with types of SB and increasing the levels of Hoffer. In conclusion, Mothers of children with SB require paying attention to their QOL during treatment of the child. In addition,the services should be created to support the physical and psychological aspects of the QOL.

This study aimed to analyze the concept of occupational therapy handling in the children with cerebral palsy from the perspective of occupational therapy instructors and clinicians in Iran.

In this qualitative study, using hybrid model to clarify the concept of handling through three phases. For the theoretical phase, attributes of handling were recognized through a review of the literature (until February 2014), and six in-depth semi - structured interviews, two observations and one panel of expert s were conducted for the fieldwork to develop attributes from the data and to verify those identified from the literature review. In the third phase attributes and final analysis of handling were extracted from the first and second phase.

The results were classified in five main categories that were identified as: (1) care of child, (2) management of treatment, (3) manual technique s, (4) education of activities of daily living (ADL), and (5) lifting and carrying. Core attributes of handling include "control, safety, transfer and positioning ".

It seems that the result s of this study may help in clarifying the concept of handling in children with CP. In addition, by identifying the process, barriers and facilitative factors, and the concept of handling, occupational therapy instructors and therapists will be able to design and run their educational activities based on scientific findings which can provide them with the necessary conditions for education, learning and proper execution of handling in occupational therapy.