mehdi dadgoo

Despite the breadth and diversity of physiotherapy healthcare services, the entry of physiotherapists into the field of prevention and also direct access of physiotherapists to patients in the world for 10 years ago, Iranian physiotherapists have not had direct access to clients, yet. One way to overcome the current situation and move towards the growth and development of the profession is to identify the opportunities and threats of the field. The purpose of this study is to explain the obstacles to the professional development of physiotherapy from the point of view of graduates of this field. 

In a qualitative study of the content analysis type, the experiences of 12 physiotherapy scholars in three levels of study, bachelor’s, master’s and doctorate were obtained through a structured and semi-in-depth face-to-face interview. Simultaneously, as the data was collected, the data was analyzed based on Granheim and Ludman’s content analysis method.

A total of 28 codes were extracted to explain the obstacles to the development of physiotherapy in Iran, which include “low attention to professional ethics”, “inefficient policies of the Ministry of Health, Treatment and Medical Education” and “traditional teaching methods”.

If the adherence to the principles of professional ethics is not strengthened, the policies of the Ministry of Health and Medical Education (MHTME) cannot facilitate the growth and development of the profession, and fundamental changes in the education and training of students will not take place, not only will the quality of physiotherapy services be lower than international standards, but many high medical expenses will also be imposed on people and insurances.

Despite the direct access to clients in physiotherapy worldwide, Iran has yet to achieve significant improvements in the educational standards and professional responsibilities of physiotherapists. Currently, Iranian physiotherapists do not have direct access to patients. This study aims to present solutions for the professional development of physiotherapy, based on the perspectives of scholars in this field.

This qualitative content analysis study explored the experiences of 12 physiotherapy scholars from three levels of study (bachelor’s, master’s, and doctorate) through structured and semi-in-depth face-to-face interviews. Data analysis was conducted concurrently with data collection using Granheim and Ludman’s content analysis method. 

The identified potential solutions include continuous review of the curriculum, strengthening clinical education, elevation of the basic level of physiotherapy education to a professional doctorate or master’s degree, post-graduation competency assessment, revision of educational priorities, establishing a strong presence in hospital and community departments, preventing the influence and interference of other disciplines, raising public awareness of the capabilities and potential of the profession, and paying greater attention to professional ethics.

In the absence of entry-level general doctor of physiotherapy and direct access to patients, the quality of physiotherapy services will not improve, leading to suboptimal health outcomes for clients and consequent waste of time and financial resources for both patients and insurance providers.

To evaluate patients with chronic ankle instability (CAI), copers who had a sprain without instability, and healthy controls using the Star Excursion Balance Test (SEBT). In addition, the reach distance was assessed between the both legs in terms of dominant and non-dominant in all groups. A total of 75 subjects (25 healthy, 25 CAI, and 25 Coper) participated. The maximum reach distance in SEBT was assessed in anterior (ANT), postero-medial (PM), and postero-lateral (PL) directions in both legs for each subject. All data were analyzed by SPSS version 21. Tukey post hoc test was used to compare all groups. Paired T-test was used to compare dominant and non-dominant legs in each group.  In 75 subjects have participated in the data collection, no significant differences were reported among all groups for age and BMI measurements. Significant lower reach distance in scores of ANT in the dominant leg of the CAI was demonstrated when compared with the control and the coper groups (P=0.008). No statistical significant difference was determined between the dominant and non-dominant legs in each group (P>0.05). It seems that relevant strategies for postural control should be taken into account in the rehabilitation setup of individuals with CAI.Level of evidence: II

The complications and motor disorders caused by multiple sclerosis (MS) not only affect the individual’s movement abilities but also play a crucial and valuable role in how these individuals carry out their daily activities. In this way, patients with MS use certain compensatory methods, depending on individual differences, their environment, and their family’s support, to help with the complications of this disorder. For this reason, this study aims to identify the compensatory strategies that people with MS use to adapt to their mobility limitations. 

In this study, 13 patients with MS (7 women and 6 men), with informed consent, an average age of 43 years, and a qualitative content analysis approach, were included in the study. The sampling was performed purposefully with maximum variation, and the data was collected via quasi-structured in-depth interviews. Immediately after each interview, the data was analyzed using Cheevakumjorn`s method. 

After analyzing the data and extracting the resulting codes, the codes were classified according to their similarities and differences. Ultimately, three main components of “compensatory strategies for home mobility”, “compensatory strategies for outdoor mobility”, and “compensatory strategies for carrying out daily activities” were formed. 

Although families play a major role in compensating for the mobility problems of these patients, it is necessary for health providers to reduce the burden placed on their families, and to educate MS people on self-care and adjust their living environment. Furthermore, providing mobility assistive devices for the patients should be done according to their differences and their environment.

Musculoskeletal pains due to COVID-19 have disrupted the daily activities of infected people. Investigating these complications can give us more information to diagnose and treat patients early. This study aims to investigate the effects of this virus on the incidence of musculoskeletal disorders in students or employees with COVID-19 at Iran University of Medical Sciences (IUMS), using the Extended Nordic Musculoskeletal Questionnaire (ENMQ).

This cross-sectional questionnaire-based study was conducted in 2021 on 107 people. The study participants were selected by convenience sampling from students and employees at IUMS. The inclusion criteria were testing positive for COVID-19, confirmed by a physician, and at least three weeks passed since the onset of symptoms. The exclusion criteria were having a history of an accident or events influencing the musculoskeletal system and being reluctant to participate in the study. We used a researcher-made questionnaire and ENMQ for data collection. Musculoskeletal disorders before infection and the incidence or worsening of these problems after infection were also recorded using ENMQ. Data were analyzed in SPSS software, version 26, using the Mann-Whitney U test and the Kruskal-Wallis test.

The highest pain frequencies before COVID-19 were in the shoulders, knees, and back, in this order. Also, the highest pain frequencies after COVID-19 were in the back, neck, shoulders, and leg, in this order. According to the study results, most patients had low pain in their back, mild pain in their neck and back, and severe pain in their knees before being infected with COVID-19. After the COVID-19 infection, low pain in the knee and mild and severe pain in the back were observed in most patients. In assessing the “pain impact on the functioning“ before COVID-19, the highest effects on daily activities were found in the back, neck, and pelvis, in this order. After the COVID-19 infection, the daily activities related to the back, neck, shoulders, and pelvis were reduced.

Based on this study, the difference in right elbow function by gender, the difference in the intensity of right elbow pain by age, the difference in the intensity of ankle and finger pain, and the difference in the function of ankle and fingers on both sides by age before and after suffering from coronavirus were the significant variables of this research.

Overweight is related to increased risks of cardiovascular diseases and dyslipidemia, and reduced quality of life (QOL). Exercise training improves QOL and modifies cardiovascular risk factors and lipid profile. The present study was conducted to compare three types of exercise in terms of their short term effects on QOL and lipid profile in overweight individuals with moderate hemophilia A (IWMHA).  

This study was a randomized, controlled, assessor-blinded trial (IRCT20180128038541N1). Sixty IWMHA with a body mass index (BMI) of 25-30 kg/ m2 and a mean age of 35-55 years were randomly assigned to four groups of 15, namely aerobic training (AT), resistance training (RT), combined training (CT) and control. The intervention groups participated in 45-minute exercises three days a week for six weeks. The 36-item short-form health survey (SF-36) was used to measure QOL. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), waist-to-hip ratio (WHR), and waist circumference (WC) were measured before and after six weeks of training. For the data analysis using SPSS version 20, the ANCOVA was used to determine the differences among the four groups.

A significant decrease was observed in the intervention groups compared to the control group in terms of weight, BMI, LDL-C, TC, WHR, and WC (p<0.05). Significant increase was observed in HDL-C and SF-36 subscales in the intervention groups compared to the control group (p<0.001). There was no significant difference among the intervention groups (p>0.05). In comparison with the control group, more significant improvement was observed in the TC, TG, LDL-C, HDL-L, and SF-36 subscales in the CT group compared to the RT and AT groups.

CT was the most effective training method in improving lipid profile and QOL in overweight IWMHA.

The purpose of this study was to assess the influence of the duration of smartphone usage on repositioning error in the cervical spine in forward head posture and normal posture.

Thirty subjects (normal group: mean age 22.2±.90 years, mean height 161.00±.87 cm, mean weight 56.46±1.40 kg; and FHP group: mean age 24.26±.98 years, mean height 165.80±1.69 cm, mean weight 61.66±1.52 kg) were classified into two groups (15 forward head posture and 15 normal subjects) whose used their own smartphone for 20 minutes. Cervical repositioning error (for flexion, extension, right and left rotation) was calculated for all subjects before and after use of smartphone. All statistical analyses were conducted using IBM SPSS Statistics 24.

Position sense error for flexion in normal group had a significant difference before and after using the smartphone. However, there was no significant difference in FHP groups and between the two groups. There was no significant difference either in extension and left rotation before and after use of smartphone and between two groups. Position sense error for the right rotation before and after using the smartphone in two groups had no significant difference, but after using the smartphone there was significant difference between the two groups.

There were no significant differences in cervical repositioning error before and after use of smartphone in the normal group and FHP group as well as between the two groups.

This study evaluated the acute responses to static stretching versus the proprioceptive neuromuscular facilitation stretching technique with and without applying kinesio tape on hamstring muscle flexibility, as scarce evidence exists in this field.

Twenty teenage professional black/red belt taekwondo players participated in this study. Proprioceptive Neuromuscular Facilitation (PNF) and static hamstring stretching was performed for both legs of each subject. Then a Y-shape Kinesio Tape (KT) with 30% tension was applied over one leg chosen randomly. Active Knee Extension Test (AKET) and Passive Straight Leg Raise (PSLR) were performed at base line, immediately and 24 hours after interventions.

Repeated measures ANOVA was used to statistically analyze the data. PSLR test results demonstrated a significant increase in hamstring flexibility over time, while the AKET results showed no significant changes. No significant differences were observed between PNF and Static stretch (SS) or the KT and Non-Taped (NT) groups immediately or after 24 hours.

The current study showed that there is no superiority in SS or PNF stretching techniques for increasing hamstring flexibility, and using KT over stretched muscles could not help improve flexibility.

Cervicogenic headache is a secondary headache, whose cervicogenic disorders is known as its background factor. Considering the important role of cervical spine in providing deep-feeling entrances, a change in deep-feeling entrances can lead to disorder in these individuals. The aim of this study was to investigate the relationship between stability and severity of pain, disability and duration of headache in these patients.

In this cross-sectional study, 30 cervicogenic patients, headache index, duration of illness, disability inventory and visual acuity scale were recorded. To measure the stability, stability tests were performed in four standing positions on two extremities with open and closed eyes and with low and high stability level by Biodex stability device. The overall stability index, internal-external index and anterior-posterior index were measured. Pearson correlation test was used to examine the relationship between variables.

There was a significant relationship between the history of headache reporting and most of the stability indices (p=0.002, r=0.548). There was a significant relationship between the general stability index (p=0.001, r=0.563) and internal-external index and pain severity, and no significant correlation was found between the anterior-posterior index. There was no significant relationship between disability inventory (p=0.727) and headache index (p=0.186) with stability indices.

With increasing duration of headache and increased pain intensity, stability indices increase, which can indicate a weaker stability in cervicogenic headache patients with longer illness history and more pain intensity.

This study aimed to identify the experiences of women with Multiple Sclerosis (MS) about urinary dysfunctions consequences.

This qualitative study with the content analysis approach included 10 women with MS (age range: 29 to 59 years), who were recruited using a purposive sampling method with maximum variation. Through semi-structured in-depth interviews, the participants explained their experiences of urinary dysfunctions consequences. The obtained data were analyzed based on the content analysis method of Graneheim and Lundman.

The content analysis revealed three key themes: Physical consequences, psycho-emotional consequences, and economic consequences.

Urinary dysfunctions cause widespread physical, psychological, and economic problems for women with MS. Therefore, treatment staff should address the MS patient’s concerns caused by urinary dysfunctions, in a non-threatening atmosphere, and help them to fearlessly manage their urinary problems.

Postural control is necessary for conducting all activities and is the result of corporation of somatosensory, visual and vestibular systems. Impairment in each of these systems leads to disturbance of postural control and increases the risk of falling and injury. Fatigue is one of the common conditions that can affect postural control. The aim of this study was to elucidate different effects of Electrical Stimulation (ES) and Voluntary (Vol) quadriceps fatigues on postural control.

Methods and Materials: 

This cross-sectional randomized order of testing study was performed at Biomechanics Laboratory of Iran University of Medical Sciences, Tehran, Iran from December 2014 to May 2015. Sixteen healthy active males (24.5±1.36 yr; height: 155.37±53.79 cm and body weight: 70.93±4.5 kg) participated. All the participants underwent two fatigue protocols: ES and VOL contractions. Each fatigue procedure contains isometric contraction with five seconds holding contraction, two seconds rest between each contraction and intensity of voluntary contraction was 20% of Maximal Voluntary Contraction (MVC). In each fatigue protocols, muscles MVC decreased to 30% in both ES and VOL protocols. MVC and postural control measured by using a digital dynamometer and a force plate that registered the Canter of Pressure (COP). Data collected before and after completion of each fatigue protocol. Monopedal postural control was recorded in eyes closed condition.

Results did not show significance effect of fatigue on area and mean velocity while showed significant effect on the anterior-posterior (Y-axis) and on the mediolateral direction (X-axis).

Thirty percent loss of MVC in quadriceps muscle did not impair postural control.

Clinical education in medical sciences is essential, because of its important role in the education of specialist skills. Physiotherapy specialization is among the main branches of medical sciences, which requires high academic and professional skills. One of the most important and effective methods to assess the quality of clinical education in physiotherapy is to review it from a student’s perspective. Therefore, this study attempted to recognize the barriers of clinical education in physiotherapy students from their own perspective.  This qualitative study used content analysis method. Data were collected using semi-structured interviews and the samples were selected by purposeful sampling method. We have considered maximum variation (gender, semester, educational level, place of residence) of persons in the sample selection. The data collection continued until saturation was reached. Participants included 13 physiotherapy undergraduate students who had completed at least 6 clinical education units. We extracted 182 original codes from interviews analysis. By eliminating and matching the data, we finally developed 4 categories, as follows: 1. Personal and professional characteristics of clinical educators; 2. Personal characteristics of students; 3. Inadequate education system; 4. The inappropriate clinical education environment. Clinical incompetency, inadequate clinical skills, and failure to observe professional ethics are the most frequent problems of clinical supervisors. Moreover, student’s irresponsibility, inadequate participation, the lack of self-esteem in some students, and inappropriate planning and the implementation of clinical education of PT department and inappropriate interpersonal communication and facilities in clinical settings, can be considered as barriers for clinical education. Considering the obstacles and attempts to resolve them, reviewing the clinical education process can improve its quality. Reviewing the clinical education process seems to help recognize its barriers and attempt to resolving them. It seems to improve the quality of clinical education.

Cervicogenic headache is considered to be one of the most controversial headaches because of its diagnostic challenges. It has several pathogeneses resulting in different signs and symptoms that make therapists prone to misdiagnosis. The aim of this study was to estimate the prevalence of diagnostic errors in cervicogenic headache patients.

In this study that was conducted in the physiotherapy ward of the Ministry of Cooperatives, Labour, and Social Welfare clinic in summer 2018, 60 patients with chronic headache were examined using the International Headache Society Diagnostic criteria and five physical tests. The aim of this study was to determine the number of the patients with cervicogenic headache who were not diagnosed or were misdiagnosed before this study.

Fifty-three of the volunteers had cervicogenic headache. Only four of them were diagnosed correctly before this study, indicating that 92% of the cervicogenic headache patients were not diagnosed properly in this study.

There is a significantly high rate of misdiagnosis in patients with cervicogenic headache. Because of the physical mechanisms that induce this type of headache, applying valid and reliable physical tests together with diagnostic criteria may lead to accurate diagnosis of cervicogenic headache.

The purpose of this study was to identify the experiences of people with multiple sclerosis (MS) from mobility barriers they are faced with.

This study included 13 patients with MS (7 women and 6 men), with informed consent, whose average age is 43 years. A qualitative content analysis approach was used. According to the EDSS criteria, the severity of their disability was between 8-4. The sampling was carried out purposefully with maximum variation, and the data was collected through semi-structured in-depth interviews. Immediately after each interview, the data was analyzed using the Cheevakumjorn`s method. 

After analyzing the obtained data and categorizing the resulting codes; three main categories were observed: “disease-affected barriers”, “personal barriers” and “environmental barriers”. The data of each theme were classified as subthemes. 

Based on research findings and experiences of the participants, rehabilitation specialists during the assessment, management and treatment of patients with MS should alert and educate patients about personal mobility barriers and try to help them fit in their physical environment.

Ankle Instability Instrument (AII) is a questionnaire for determination of ankle stability status. The aim of this study is to cross-culturally translate and investigate the reliability and validity of AII in a sample of Persian-speaking Iranians, suffering from ankle sprain. One hundred twenty persons with a history of ankle sprain were recruited in the study. All participants completed the Persian version of Ankle Instability Instrument, Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS) at the baseline. Out of them, 60 randomly selected subjects completed the questionnaires once more, one week later. Face validity, Test–retest reliability, internal consistency, standard error of measurement, minimal metric detectable change, spearman’s correlation coefficient and confirmatory factor analysis of AII measured. We used Lisrel v 8.80 software with significant level of p<0.05. Persian version of AII is clear and unambiguous and its qualitative face validity was confirmed in the pilot study on the 20 subjects with a lateral ankle sprain. The interclass correlation coefficient, Cronbach’s alpha, standard error of measurement and minimal metric detectable change were 0.93, 0.87, 0.81 and 2.25 (95% confidence interval, 0.85-0.96). The Spearman correlations coefficients between AII, and CAIT, FAAM and FAOS measures were 0.91, 0.71 and 0.69 respectively. The original three factor structure of AII was replicated based on the confirmatory factor analysis. Which showed an adequate fit of the model to the data and goodness-of-various fit indices. The Ankle Instability Instrument Persian Version (AII-PV) is a reliable and valid measure for assessing the ankle stability status.

Evaluating the educational programs in various Medical Science disciplines is a highly sensitive matter and of great importance. Physiotherapy (PT) is an important field of Rehabilitation Sciences, which requires distinguished scientific and professional skills. One of the practical ways to assess the quality of clinical education in PT is to study the students’ perspective in this field, because they are the main target audience for education. Therefore, this study was conducted to determine the problems in clinical training of PT students, from the medical students’ perspective, in different universities of Tehran City.
The present study was conducted using a qualitative content analysis approach, through individual interviews with 13 PT undergraduate students in Tehran. They were recruited through targeted sampling with maximum variation.
After analyzing the obtained data, a total of 4 themes were derived, which included characteristics of clinical supervision, training schedules and training, setting of clinical training, and general characteristics of the learners. Furthermore, 22 subthemes were obtained; some of them included lack of clinical teaching experience among the faculty members, no supervision in clinical teaching, for example, theory and clinical courses being held in one day, short duration of clinical teaching, inappropriate facilities, and the disorganisation and laziness of some students.
Perhaps changing the clinical teaching methods, employing experienced and effective instructors, taking courses more seriously by students, establishing appropriate facilities for clinical training, supervision of the PT department over the performance of the teachers and the events during internships, and increasing the duration of theory and clinical courses, can all be effective in improving the quality of clinical training.

Spasticity is one of the impairments in patients with stroke which cause more disability and secondary problems. Now, there are some ways to reduce spasticity such as drugs, exercise, heat, massage, and sensory level electrical stimulation. This study assessed the immediate effect of sensory level stimulation on spasticity in plantar flexor muscles in patients with post-stroke hemiplegia.
In this study, 10 patients received 10 sessions of treatment. Protocol was 30 minutes electrical stimulation and 30 minutes proprioceptive neuromuscular facilitation techniques to improve initiation and controlling of movement. Level of the spasticity was measured carefully before and after the stimulation using Modified Ashworth scale.
Findings: Electrical stimulation reduced the spasticity in two women and one man. Stimulation had not effect on seven patients. Electrical stimulation had not effect on grades one and three spasticity; it had effect on grades one-plus and two but not in all of the patients. The stimulation had effect on patients with good cognition who did their exercises carefully.
Sensory level electrical stimulation has temporary effect only on middle-grade spasticity in middle exercise sessions. There is not any effect in next session and efficacy of stimulation reduces and stops. This electrical stimulation cannot disappear the spasticity and does not have any effect on high-grade spasticity.

Evidence-Based Practice (EBP) and Research Utilization (RU) were introduced to physiotherapy more than two decades ago. Physiotherapists with their professional responsibility to provide the best care, will find practical evidence-based physiotherapy a veritable goldmine of useful information. Recently, evidence-based physiotherapy, as a means to improve the quality of physical therapy intervention, has become an interesting topic for the researchers all over the world. However, few studies have researched EBP in Iranian community of physiotherapists. This study was conducted to investigate the perceptions and experiences of EBP among Iranian physiotherapists and the resources of evidence for a duration of 8 months, from 2015 to 2016.
Material and In this qualitative study, 15 physiotherapists holding at least a BSc. degree and with two years of relevant work experience, participated. Purposeful sampling method was used to recruit the samples. The data were collected via semi-organized in-depth interviews. Content analysis was used to analyze the data according to Cheevakumjorn’s method.
The collected data were divided into two groups containing the definition of EBP and evidence resources for physiotherapists. The participants were divided into two groups. The first group contained the physiotherapists who became familiar with EBP at university. The contributors who had not passed this course at university were included in the second group. The first group provided more detailed definitions and implemented evidence into their clinical work with greater certainty. The data related to the nature of evidence were put into 4 subgroups; experiences of colleagues, acquired knowledge, therapist’s experience, and obtained knowledge through the patients.
Most physiotherapists participating in this study were somewhat familiar with EBP. Since there are some impediments such as poor clinical training, lack of role models during university education, weak research skills and critical evaluation of research, as well as ignoring the importance of life-long learning, most physiotherapists are not able to fully apply evidence in their clinical practice. A comprehensive program for educating the physiotherapists can be an effective method to improve the physiotherapists’ overall level of knowledge as well as the quality of the health care services they provide.

We aimed to investigation the intra-rater and inter-raters reliability of the 10 meter walk test (10 MWT) in adults with spastic cerebral palsy (CP).
Thirty ambulatory adults with spastic CP in the summer of 2014 participated (19 men, 11 women; mean age 28 ± 7 yr, range 18- 46 yr). Individuals were non-randomly selected by convenient sampling from the Ra’ad Rehabilitation Goodwill Complex in Tehran, Iran. They had GMFCS levels below IV (I, II, and III). Retest interval for inter-raters study lasted a week. During the tests, participants walked with their maximum speed. Intra class correlation coefficients (ICC) estimated reliability.
The 10 MWT ICC for intra-rater was 0.98 (95% confidence interval (CI) 0.96-0.99) for participants, and >0.89 in GMFCS subgroups (95% confidence interval (CI) lower bound>0.67). The 10 MWT inter-raters’ ICC was 0.998 (95% confidence interval (CI) 0/996-0/999), and >0.993 in GMFCS subgroups (95% confidence interval (CI) lower bound>0.977). Standard error of the measurement (SEM) values for both studies was small (0.02Excellent intra-rater and inter-raters reliability of the 10 MWT in adults with CP, especially in the moderate motor impairments (GMFCS level III), indicates that this tool can be used in clinics to assess the results of interventions.

Postural control is the ability of maintaining of the body posture in space. Peripheral and central factors have important role in muscle fatigue. Repetitive muscle contraction leads to muscle fatigue. If strength is educed up to 30% of maximum contraction can be disturbed stance control of subjects. The objective of the present study was to compare the effect of lumbar muscle fatigue on postural control in athlete and non-athlete subjects. Fifteen men as athlete subjects and other fifteen matched men as non- athlete subjects participated in this study. Trunk extensor muscle fatigue was produced by dynamometer. Stance postural sways were evaluated by force platform device in bipedal stance with open eye. In pre-fatigue state there is no significant difference between two groups. Fatigue had significantly effect on postural sways in both group after Lumbar muscle fatigue specially in non-athlete group (P ≥ 0.05). The postural control of athletes after muscle fatigue was better than non athlete subjects probably due to better proprioception in athlete subjects.

The objectives of this study were to compare manual dexterity (gross and fine) and coordination performance of the ipsilateral upper extremity of the right hemisphere stroke patients with the same side of a healthy group, and to determine the relationship of ipsilateral upper extremity dexterity and disability. In a non-randomized analytical study, 30 individuals with a unilateral first-ever stroke from outpatient rehabilitation clinics and 30 age and sex-matched adults without history of neurological disorders were enrolled. Purdue Pegboard, Box and Block, and Finger to Nose tests were used to measure dexterity (fine and gross) and coordination performance of the stroke group compared with the same hand of the healthy group. The Barthel index was also used to assess disability or dependency of stroke patients in basic activities of daily living. Results showed that stroke individuals with involvement of ipsilateral hand had less coordination and dexterity when compared to the same hand of normal subjects (P=0.001). In addition, the relationship of gross and fine manual dexterity performance of the ipsilateral upper extremity with disability, including dependence in basic activities of daily living, were significant respectively (r=0.376, r= 0.391). People with right stroke had significant ipsilateral upper extremity impairments (manual dexterity and coordination tasks), and this hand dexterity deterioration had an impact on their dependence in basic activities of daily living.

The complications associated with spastic cerebral palsy can affect the physical ability and quality of life of individuals suffering from this motor disorder. The aim of this study was to assess the relationship between quality of life and hypertonia in adults with spastic cerebral palsy. In an analytical cross sectional study, 70 subjects with the diagnosis of spastic cerebral palsy from three Ra’ad Rehabilitation Goodwill complexes in Tehran and Karaj cities took part in this study through convenient sampling. The severity of spasticity and contracture of the knee flexors were measured by Modified Tardieu Scale. Also the quality of life was assessed through World Health Organization quality of life-BREF questionnaire. To analyze data, Pearson and spearman correlation coefficient were used. Participants of this study were 42.90% male, 57.10% female with mean age 26.24±5 years. No correlation existed between quality of life with knee flexor muscles spasticity. However, psychological and environmental domains showed low correlations with knee extension range (respectively r=0.26 and r=0.28; P<0.05). The influences of the mechanical component of hypertonia (contracture) on the quality of life are more prominent than neural factors such as spasticity.

Hemiplegic shoulder pain is a common problem that its prevalence varies from 48% to 84%. This disorder limits the patient’s ability to achieve the optimal function. The objective of study was to assess the relationship between hemiplegic shoulder pain with neuromusculoskeletal disorders in post stroke hemiparesis This study was an observational-analytic that fullfilled on fifty patients with acute stroke. The post stroke period was 28 days. The following items were evaluated:shoulder subluxation with X-ray, shoulder spasticity with Modified Modified Ashworth Scale (MMAS), soft tissue injury with orthopaedic tests and RSD with clinical features. Hemiplegic shoulder pain was present in 28 patients(56%). Seventeen patients (85%) showed shoulder subluxation, 18 patients (72%) had supraspinatus tendonitis, 13 patients (65%) had biceps tendinits, 4 patients (14/2%) had ACJ involvement, 3 patients (10/7%) had elbow flexor spasticity, 2 patients (7/1%) had shoulder adductor spasticity, 2 patients (7/1%)had shoulder internal rotators spsticity, 4 (14/2%) patients had RSD. Results from this study show that one factor does not play role in causing hemiplegic shoulder pain and this disorder is multifactorial. Prevention of shoulder pain and performing appropriate physiotherapy can play a role in improving stroke patients’ function.

The Modified Tardieu Scale (MTS) is a clinical scale for measuring the degree of muscle spasticity. The aim of this study was to evaluate the validity of the MTS in measuring poststroke knee extensor spasticity. This was a cross-sectional study performed in 2012 at a university clinic of neurological physiotherapy in Tehran, Iran, with repeated measurements. In the present study, 15 poststroke patients with a mean age of 53.8 ± 14.0 years and mean time since stroke of 40.0 ± 32.2 months participated. The knee extensor muscle spasticity was assessed using the MTS to calculate the R2-R1 as the main clinical measure. To calculate the work, an isokinetic dynamometer was used to quantify torque-angle data during passive movements at 4 speeds (60°, 120°, 180°, and 240°/sec). The linear regression was used to calculate the slope for the work-velocity data [Joule/(degree/sec)]. There were significant differences between works done by the dynamometer at four speeds; as the speed increased the work decreased (P < 0.01). Mean (standard deviation) slope for the work-velocity data was -0.76 (0.78). There was no significant correlation between the dynamic component of MTS (R2-R1) and slope for the work-velocity data. The results indicate that the MTS might not be a valid measure for assessing knee extensor muscle spasticity in this sample of patients after stroke.

Individuals’ personal awareness and learning after spinal cord injury is one of the most important factors in patients’ confrontation with subsequent disabilities and new life style which affects their ultimate independence. This article is an abstracted result of a qualitative study on effective factors of independence among patients with spinal cord injury. This study adopts a phenomenological qualitative approach and chooses its research samples from individuals with spinal cord injury including four women and seven men with paraplegic and tetraplegic SCI who live in Tehran. The data gathered trough Indepth semi-structural interviews and interpreted using Coliazzi’s method. The data divided into 10 categories and 38 subcategories arranging in three general domains: the individual, familial and social. Knowledge and learning are important categories in the individual domain which includes five subcategories: Initial knowledge level, searching for information, learning from similar pattern, needs based learning, learning from experience and repetition. The research shows that the amount of information about the spinal cord injury before and learning more information after the injury influences on the sense of independence, and individuals who trying more to learn about their subsequent difficulties and needs are more successful in their future life.