فهرست مطالب نسرین جلیلی

 Leukemia is the most common type of cancer among children. Changes in these children’s illnesses and the adverse effects of medications on their physical conditions may cause parental depression. Also, treatment stages, continuous and long-term hospitalizations have negative impacts on the participation of these children in life activities. This study aims to evaluate the effect of maternal depression on the participation of children with leukemia in life activities.

This is a descriptive-analytical study with a cross-sectional design. The study population consists of all children aged 13-15 years with leukemia and their mothers. The children were referred to Seyed Al-Shohada Hospital in Isfahan City, Iran. Using a convenience sampling method, we selected 72 children for this study from January to June 2019. The inclusion criteria were aged 5-13 years, more than 2 months passed from leukemia diagnosis, and access to their mothers. Finally, 62 children and their mothers had the willingness to participate in the study. After explaining the study objectives, a demographic form, the Beck Depression Inventory II (BDI-II), and the short form of assessment of Life Habits (LIFE-H) questionnaire were completed through interviews with children and their mothers. Noreau et al. (2002) designed the LIFE-H questionnaire to assess the participation of people with disabilities. Mortazavi et al. (2013) assessed the validity and reliability of its Persian version. They reported an Intraclass Correlation Coefficient (ICC) >0.60 for all of its subscales and an ICC value of 0.87 for the whole questionnaire, indicating its good validity and reliability. The Beck 2 self-expression questionnaire measures the indicators of depression in individuals. Gasemzadeh et al. (2005) prepared and validated the Persian version of BDI-II. They reported its good validity and reliability to assess depressive symptoms in a normal population (The Cronbach alpha = 0.87). The collected data were analyzed using the Pearson correlation test, the Spearman correlation test, ANOVA, and independent t-test in SPSS v. 20.

 The Mean±SD ages of mothers and their children were 36.98±5.8 and 8.4±2.5 years, respectively. The Mean±SD score of BDI-II in mothers was 21.8±10.9, and more than 85% of them showed some degrees of depression. The Mean±SD score of the LIFE-H questionnaire in children was 67.7±18.8 out of 100. The results showed significant negative relationships between maternal depression and child participation in education (P=0.008) and social life (P=0.05). There were no significant relationships between maternal depression and child participation regarding nutrition (P=0.1), physical fitness (P=0.12), personal care (P=0.24), communication (P=0.4), housing (P=0.17), mobility (P= 0.13), responsibilities (P=0.45), interpersonal relationships (P=0.27), and recreation (P=0.17).

 Depression of mothers of children with leukemia, besides destructive effects on their performance, can limit child participation in education and social life.

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

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

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

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

Objective Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disorder of the Central Nervous System (CNS) and it is also the most common cause of non-traumatic neurological disability in young adults. MS in women, especially young women, is about 1.5 to 3 times more common than men all over the world. About 2.5 million people worldwide are suffering from MS. The destruction of myelin in certain areas exhibits certain signs and symptoms. Balance disorders are particularly problematic because they are associated with difficulty in moving from one position to another, sustaining an upright posture, and performing functional activities such as walking and turning, all of which predisposes people with MS to the loss of equilibrium and falls. Isfahan City in Iran suffers from a high prevalence of MS that put it amongst the regions with the highest prevalence of MS in Asia and Oceania. This study aimed to use the holistic approaches of occupational therapy to investigate the physical and cognitive factors (attention, cognition and muscle strength of lower extremities) that affect the gait of MS patients in the city of Isfahan, Iran. Materials & Methods The present study was a descriptive-correlational one and convenience sampling method was used to recruit the samples. The study population consisted of all patients with MS in Isfahan City in August 2017. A group of 70 patients (24 males and 46 females with the Mean±SD age of 32.20±7.55 y) met the inclusion-exclusion criteria and were enrolled in the study. To be eligible for the study, the patients had to meet the following inclusion criteria: having a neurologist-confirmed diagnosis of MS with MRI scan, being able to read and write, and walk at least 100 m independently. We excluded patients with cognitive impairments that might hinder understanding of the tasks to be accomplished, those with any comorbid neurologic condition other than MS, and those who are unwilling to collaborate with the research process. After providing sufficient information about the research process and getting informed consent of the patients, the questionnaires and tests were provided to the participants to be completed. The study tools were the Mini-Mental Status Examination (MMSE), 10 m Walking Test (10 MWT), Timed Up and Go test (TUG), Sit to Stand test, and Stroop test. For data analysis, the Pearson correlation coefficient and multiple regression analysis were performed in SPSS version 16. Results In this study, 70 patients suffering from MS participated. The results showed a significant negative correlation between the scores of walking speed test (10 m walking) and the scores of the functional strength of the lower extremities muscles (P<0.001) and attention (P=0.01). There is also a significant correlation between muscle strength of lower extremity and balance (P=0.01). Regression analysis shows that the muscle strength of lower extremities has the highest contributions in predicting the speed of walking in patients with MS.  Conclusion According to the study findings, among the physical and cognitive factors affecting gait and balance such as muscle strength of lower extremity or cognition and attention, the muscle strength of lower extremity is the most important factor affecting the balance and speed of walking in patients with MS that still can walk. In the process of rehabilitation, especially in occupational therapy, special attention must be paid to a muscle strengthening program for the lower extremities of patients suffering from MS.

Objective Cerebral Palsy (CP) is a group of non-progressive disorders in a developing brain that results in motor problems and other limitations in daily living activities. The presence of motor functions in these children reduces their participation in daily activities. This is one of the important aspects of the child’s health and development, especially the child’s physical and psychological development. Participation in social activities promotes life satisfaction. Besides, family has a prominent role in identifying and supplying the child’s needs. In other words, family plays an essential role in ensuring the health and well-being of their children. Thus, provisions of growth-related health services has now changed from a child-cantered model into a family-cantered model. As a result, it is very important to understand the parents’ priorities about participation of their children in the daily activities and providing appropriate client-center services.
Materials & Methods In this descriptive-analytic study, 78 children and teenagers with CP aged 3-18 years without psychiatric problems and their parents from Yazd City, Iran had participated. The samples were selected by convenience sampling method, from clients of private and public rehabilitation centers in Yazd Province. In this regard, one state and two private centers were randomly selected and the study samples were selected from the clients referred to the centers. Parents' priorities for participation of their children in activities of daily living were found through semi-structured interviews. In these interviews, we used Canadian occupational performance measure to evaluate the child's level of occupational performance and parents’ satisfaction in the three areas of self-care, productiveness, leisure from the parents’ perspective. In addition, the level of gross motor performance was evaluated based on the Gross Motor Function Classification System (GMFCS) at five levels. In the Iranian society, the validity of Canadian occupational performance measure for each of three areas of occupational performance has been reported to be between 9.75 and 3.75 and the reliability level for the three domains reported above 0.78. The statistical analysis of data was performed in SPSS V. 16. Descriptive statistics and odds ratio were used for analyzing the data.
Results the children’ Mean±SD age was 8.12±4.22 years. The first priority reported by the parents was self-care. Mobility was known as the second important priority in everyday life for children. The results obtained from the statistical analysis showed no significant relationship between age and different motor levels (P≥0.05).
Conclusion Parents reported functional priorities in similar performance aspects by all age groups and GMFCS levels in Cerebral Palsy children. The first priority was related to self-care. This reflects the desire of the parents to children’ doing self-care activities, which not only reduces care pressure, but also leads to promotion in social participation and independence in individual life. The next priority was mobility and the reason can be attributed to the fact that children with CP need mobility to manage their daily life activities

Aging in the modern society is conjoined with different diseases such as osteoarthritis (OA) which causes reduced occupational abilities for people and burden of financial and societal problems on society. Occupational risk factors are among the main risk factors for hand OA. Despite their major effects on daily living of elders, there are different results in the literature considering the occupational risk factors.

Aim of the present study was to review the present evidence on occupational risk factors effective on hand OA.

In this systematic review article, articles related to occupational risk factors in hand OA and their effects on functional capacity and occupational abilities of elders since 1980 till present were investigated in data bases including PubMed, Cochrane, Web of Science, Science Direct, Scopus, Iran Doc, and SID.

In reviewing the literature, two different but interrelated themes were explored relating to the occupational risk factors in hand OA including occupations related to the hand OA and biomechanical factors inside those occupations. People with manual occupations which needed manipulating heavy, large, and vibratory tools such as miners and farmers were at risk of OA in bigger joints of hand such as metacarpophalangeal and wrist; while people with occupations requiring precision and repetitive griping such as dentists and housewives were at risk of OA in smaller joints in the hand such as fingers’ distal interphalangeal and thumb’ carpometacarpal. Biomechanical factors inside those occupations related to the hand OA were a combination of work with heavy tools, excessive repetition, static contractions for a long period, precision grip, power grasp, low variety in tasks, vibration, high level of muscle activity, excessive use of joints, and lack of enough resting time.

A special task or occupation cannot trigger hand OA while it is the biomechanical factors inside occupations which makes a hand at risk of OA in long periods. Knowing occupational risk factors for hand OA may help and persuade health team, employers, employees, and workers in preventive screenings and better designing of work and living environments according to the ergonomic principles.

Children's disability creates undesirable effects on family function and the quality of life. The present study was carried out in order to compare effectiveness of group-based handling training and individualized handling training on the quality of life in mothers of children with cerebral palsy.
In a randomized controlled trial and single blinded study, 50 mothers of children with cerebral palsy were selected and were randomly divided into individualized handling training and group-based handling training. Data collection tools included SF-36 quality of life, depression, anxiety and stress scale (DASS-21), and knowledge of special care of children with cerebral palsy questionnaire. Data was collected prior to and after three months of intervention. Statistical analysis was carried out using SPSS, version 21.
Covariance analysis showed that there was not a significant difference in the quality of life and other dimensions except in general health and emotional health after intervention (P > 0.05).
According to the findings, effectiveness of group-based handling training and individualized handling training on the general quality of life in mothers of children with cerebral palsy are similar.

Determining the level of manual ability of children with cerebral palsy has significant role in scheduling care and providing supportive services by organizations such as the a social welfare office. Manual Ability Classification System (MACS) is responsible for this critical matter. In Mazandaran Province, the prediction of manual ability is intuitive and is done without tools. This study aimed to investigate the consistency between operational therapists prediction of future manual function of children with cerebral palsy and MACS scale.
This study was designed as a cross sectional trial. The study population consisted of 12 occupational therapists working in Mazandaran’s rehabilitation center under the social welfare office. Firstly, occupational therapists chose 100 children with cerebral palsy and classified their future manual ability into five levels according to their prediction. Then the researcher classified the children based on MACS scale. Finally, the amount of prediction consistency between therapists and researcher was statisticaly analyzed.
The weighted kappa coefficients of MACS scale were 0.671 in first level and 0.747 in fifth level that show good agreement in these two levels. This coefficient was 0.417 in third level and 0.444 in forth level that shows fair agreement. The weighted kappa coefficient was 0.358 in second level that indicates slight agreement.
With prediction consistency between operational therapists and researcher, MACS is used as a suitable means for classifying the level of manual ability in children with cerebral palsy and predicting their needs to adaptive and auxiliary devices by occupational therapists in rehabilitation centers and social welfare offices.

Children with autism have sensory processing difficulties that may affect their participation. Inadequate information exists about the impact of sensory processing abilities on participation in these children. Purpose of the study was to assess the impact of sensory processing abilities on everyday life participation in children with autism. Participants in this study were 40 children 5 to 11 years old with autism. Sensory processing abilities were evaluated by Dunn sensory profile and participation was assessed by Life Habit Questionnaire (Life-H). A significant relationship was found out between visual processing, tactile processing, Processing related to tone and endurance, sensory processing related to posture and movement, sensory processing related to tolerance and low muscle tone and sensory sensitivity with the total score of participation of children with autism (p<0.05). Among these factors, sensory sensitivity have most contributions in explaining participation rate (β= 0.49). Weakness in sensory processing, specifically sensory sensitivity, could be an important factor in limiting the participation of children with autism in activities.

The purpose of this study was to explore the impact of motor function of children with cerebral palsy on mother’s physical and mental health status.

In this analytic cross-sectional study, 135 mothers of children with cerebral palsy living in Tehran participated through a convenience sampling method. Health status of mothers was assessed using the Short Form of health survey-36 (SF-36) Questionnaire. The gross motor function and manual ability of children with cerebral palsy were assessed using the Gross Motor Function Classification system (GMFCS) and manual ability classification system (MACS), respectively. Data were statistically analyzed using ANOVA test and descriptive statistics using SPSS software version 16.

The results of ANOVA test demonstrated that there was a significant association between health status of mothers and GMFCS (P=0.001) and MACS level (P=0.000). However, there was no significant relationship with mother's mental health (P>0.05).

This study provided evidence of the poorer physical health status of caregivers of children with severe cerebral palsy.

care of cerebral palsy children take a lot of the mother''s time and energy، this problem causes mothers to not allocate enough time for their other daily activities، consequently in this research time use for mothers of cerebral palsy children is considered. case-control method is selected in this research and done at Isfahan City، there are 30 participation in the mothers of healthy children group and in the mothers of cerebral palsy children group there are 30 people too. Necessary data for this research is gathered by using the use of mother''s time questionnaire and demographic questionnaire. Mann-Whitney، Independent T test are also used for date analysis in SPSS16. statistical analysis has shown meaning full differences in caring of children; so that cerebral palsy children''s mothers spend more time on child''s affairs and also in satisfaction of time management skill، meaning full differences was obtained and healthy children''s mothers have more satisfaction than those mothers. according to the obtained information of this research، cerebral palsy children''s mothers spend more time on their children. In conclusion they spend less time on other activities such as taking care of themselves، sleeping or resting، and this matter causes less satisfaction of time spending among mothers.

Cerebral palsy is the most common chronic physical disability in childhood which may have negative effects on quality of lifeof parents. The aim of this research was to study the quality of life in mothers of children with severe cerebral palsy.

In this cross-sectional study، 70 children (aged 4 to 12) and their mothers referring to rehabilitation centers in Tehran in 2012 were selected by convenience sampling method. SF-36 was used to assess mother`s quality of life. Mother’s stress and their children gross motor function were assessed using the Resource and Stress Questionnaire and Gross Motor Function Classification System (GMFCS) respectively. Descriptive statistics and logistic regression tests were used for analyzing the data.

The mothers’ mean age was 34. 41 years (SD=5. 72). The total mean score on health survey was 53. 74. There was a statistically significant relationship between all dimensions of quality of life measures except mental health، social functioning and role limitations from emotional health problems with GMFCS level (p<0. 05). Also، it was found that there is a significant relationship between mothers’ mental health، physical health and their total score of quality of life with their level of stress (p=0. 000).

Considering the above results، parents of children with cerebral palsy describe their quality of life as moderate. Also، cerebral palsy severity and stress can negatively impact on a mothers’ life.

‪ Caregiving of a cerebral palsy child pressurizes the caregivers and this, in turn, influences their physical health. Musculoskeletal pain in mothers of children with cerebral palsy is significantly higher than in mothers of typically normal children. The purpose of this study was to investigate musculoskeletal pain in these mothers and to determine the relevant influential factors.‪ This descriptive cross sectional study was conducted in Tehran and the method of sampling was convenience sampling. In this study, 70 mothers of children with cerebral palsy completed the Nordic pain questionnaire. Data analysis was done with SPSS‒16 software using logistic regression tests.‪ According to the results, mothers of children with cerebral palsy reported musculoskeletal pain more frequently in the lumbar region, shoulders, knees, wrists and fingers respectively. The severity of musculoskeletal pain was more in the lumbar region, knees, wrists, fingers and shoulders. A significant positive relationship was observed between body mass index and GMFCS score of cerebral palsy children and the body mass index of mothers with severity of musculoskeletal pain (P<0.05). However there was no significant relationship between age and body mass index of mothers and age of children with severity of musculoskeletal pain (P>0.05).‪ Our findings suggest that the higher the body mass index of children and their mothers, and the lower the children’s gross motor function, the more severe the musculoskeletal pain in mothers.

It is common for parents with cerebral palsy children to expose further stress and affect all aspects of their quality of life. This study was carried out in order to determine the effectiveness of handling training program on the stress and quality of life of mothers with children with cerebral palsy.

This control trial study was performed with two groups of experimental (n = 29) and control (n = 25) were selected by randomized convenience sampling method. Data collection tools included demographic questionnaire، SF-36 quality of life، the Resource and Stress Questionnaires. All data collected before and after three months of intervention. Statistical analysis was carried out by SPSS، version 16.

The mother’s mean age in control and intervention groups were 32. 8 (SD = 4. 9) and 35. 3 (SD = 4. 4) years respectively. Also، children’s mean age in control and intervention groups were 6. 2 (SD = 2. 1) and 7 (SD = 2. 8) years. There was a significant difference in quality of life after intervention between two groups (P < 0. 05). However، difference was not significant in two dimensions of physical functioning and Emotional health (P > 0. 05). Also، there was a statistically significant difference between all dimensions of stress measures in two groups (P < 0. 05).

According to these findings، handling training program reduced stress and enhanced the quality of life of mothers with children with cerebral palsy in this study.

Functional impairments can reduce the child''s participation in daily routine activities for children with cerebral palsy and lead to physical and psychological stress on caregivers. This disability can، in turn، have a negative effect on quality of life of mothers. The purpose of this study was to explore the effects of assistive device on quality of life in mothers of children with cerebral palsy (CP). In this quasi experimental study، two hundreds and ninety one mothers of cerebral palsy children aged 0 to 14 residing in Tehran in 2011 were selected by convenience sampling method. Considering to the levels of gross motor function and manual ability of children with CP، assistive devices were provided for them. Then SF-36 Questionnaire was used to assess the mother`s quality of life. The severity of cerebral palsy and manual ability were assessed using the Gross Motor Function Classification system and manual ability classification system respectively. Descriptive statistics and Paired -T test were used for analyzing the data. The mothers’ mean age was 36. 69 years (SD = 6. 15). The results indicated that subjects demonstrated a significant increase from pretests to posttests in role limitations due to physical health (P = 0. 001)، Pain (P = 0. 004)، emotional well being (P < 0. 001)، vitality (P < 0. 001) As well as the overall dimensions of mental health (P = 0. 008)، physical health (P = 0. 006) and total quality of life (P = 0. 001). However، there was no significantly difference between pre-test and post-test of other subscales (P > 0. 05). According to the results، assistive devices can provide help and improve the quality of life of mothers with cerebral palsy children. It also would be considered as a support for these children and their families.

Behavioral problems constituted a wide range of childhood problems. Acquiring information regarding the behavioral problems in cerebral palsy children is essential for identification and management of this problems and improving psychological services for cerebral palsy children’s mental health. The aim of the study was to describe behavioral problems in children with cerebral palsy.

In this cross-sectional study, 90 children aged 4 to 12 referring to rehabilitation centers in Tehran in 2011, were selected by available sampling method and evaluated with parent version of Strengths and Difficulties Questionnaire. Descriptive statistics, chi-square and logistic regression tests were used for analyzing the data.

The findings showed prevalence of behavioral problems in cerebral palsy children that was about 3/43 percent. The results of prevalence according to sub-groups of diagnostic class of Strengths and Difficulties Questionnaire shown that the highest degree of prevalence belongs to peer problems(82.2%) and the lowest degree of prevalence belongs to hyper activity problems(4.4%). There was a significant difference between IQ level, GMFCS level and Total Difficulties Scores (p<0/05).

Considering the significant proportion of cerebral palsy children have behavioral problems, recommended specific educational and therapeutic programs.