Journal of Research in Rehabilitation Sciences
Year:2013 | Volume:9 | Issue:3|Papers Count:29

Introduction: Fear of pain is related to disability and chronicity of low back pain. The aim of this study was to investigate the relation between fear avoidance beliefs (FAB) and postural stability and the influence of specific training on postural stability and FAB in individuals with non specific chronic low back pain (NSCLBP).Materials and Methods: Twenty seven females with NCLBP were recruited in this quasi-experimental study. Pain intensity, FAB, and disability were recorded using the questionnaires. The force plate was used to measure the postural stability. Abdominal and back muscle endurance was measured respectively by Sit Up and Biering-Sorensen tests. All tests were repeated ne week and one month after a short term specific training for FAB. Repeated measure analysis was used to compare the variables. To evaluate the association between variables Pearson correlation coefficient and mixed model analysis were used. All data were analyzed by SPSS, version16.Results: Pain intensity, FAB, and disability scores showed a significant reduction after intervention (P<0.010). The time of sit up, Sorensen and single leg stance tests prominently increased (P<0.010).Center of pressure (COP) excursion and velocity variables faced with a considerable decrease (P<0.010).Pain intensity was mainly related to cop excursion and velocity during unilateral standing (P<0.010) but there is no relation between FAB and the parameters of postural stability. However, trend of changes in FAB was related to trend of changes in cop excursion and velocity during unilateral standing in mediolateral plan (P=0.040).Conclusion: Changes in FAB was related to the changes in COP excursion and velocity during unilateral standing. Specific training for FAB resulted in pain intensity reduction, FAB, and disability scores. It also led to an improvement he postural stability as well as increasing the time of sit up, Biering-Sorensen and single leg stance tests in subjects with NSCLBP.

Introduction: Among professional voice users, teachers are more vulnerable to voice problems. Affecting other aspects of their lives, these problems may result in frequent absenteeism and occupational disabilities. Voice disorders are defined as an array of self-reported symptoms and clinically-observed signs. The degree of handicap reported by a patient depends on the occupation held, living and work-place environments and reactions brought by family members and friends to disordered voice quality. Studies that have focused on the handicap caused by voice disorders reveal contradictory and various findings. In this study, the Voice Handicap Index (VHI) scores of teachers with voice disorders and those of nonprofessional voice patients were compared.Materials and Methods: In this analytic-descriptive study, 32 teachers (of both sexes) with various voice disorders and 32 nonprofessional voice patients were evaluated. Although the participants of this study were aware of their voice problems, an acoustic analysis was conducted for each subject to prove his/her voice disorders. Both groups completed Voice Handicap Index questionnaire. Data were statistically analyzed using descriptive and analytic procedures including independent t test and Pearson’s regression coefficient.Results: VHI mean scores (`x=32.2) were significantly greater in teachers than in their nonprofessional counterparts (`x=23.3) (P=0.01).There was a correlation between the years of teaching and VHI scores.There were no sex differences between men and women in both groups.Conclusion: Voice disorders with relatively similar clinical signs may differentially affect different occupations. Teachers, who constitute one the major groups of professional voice users, may experience more limitations in their lives due to various voice disorders. Thus, paying appropriate attention to this issue is of particular importance in therapeutic programming.

Introduction: Asymmetric weight bearing is one of the prominent characteristics of impaired postural control in hemi-paresis after stroke. Considering the important effect of load exerted on limbs in correcting postural reflexes, the effect of sole on weight bearing symmetry and also the effect of increased load on paretic limb on the postural responses of lower limb muscles against an internal perturbation were investigated.Materials and Methods: 27 hemi-paretic post-stroke patients, who were able to stand independently without assistive devices for one minute, participated in this study. Evaluations included measuring symmetry index, the latency and amplitude of postural responses of lower limb muscles that was carried out before and after placing a 10-mm-thick sole under intact lower limb of patients. To measure symmetry index, the patients were asked to stand on force platform for 20 seconds. Electromyographic recordings from medial gastrocnemius, soleus and lateral hamstring muscles of paretic and non-paretic limbs were obtained for evaluating postural responses. Rapid flexion movement of non-paretic upper limb was used as an internal perturbation for exciting postural muscle responses.Results: The effect of lift on improving symmetry index was significant (P=0.001). Increasing load on paretic limb did not exert any effects on the latency and amplitude of postural responses.Conclusion: Inserting a lift improved symmetry by shifting center of gravity toward midline. The results of the present study show that decreased load on a paretic limb following stroke cannot fully explain the weak and latent responses of postural muscles.

Introduction: Stereotypy is one of the main features of children with autism. These behaviors are associated with deficit in learning processes, social skills acquisition, increased family stress, and selfinjuries behaviors. The purpose of the present study was aimed to investigate the effectiveness of two selected Karate-hand techniques on hand stereotypic movements in a boy with autism.Materials and Methods: The participant was a 10 years old boy with autism. He asked to take part in some exercise sessions. The exercise phase was preceded and followed by some baseline phases. In baseline phases, the participant did not receive any exercise. Change in the frequency of stereotypic hand movements was assessed by observations during 15 minute periods immediately before and after exercise while participant engaged in routine classroom activities. Observations also occurred in the same time periods on no-exercise days during all phases.Results: Results showed that training two karate hand techniques led to reduction of 44.12 percent in stereotypic hand movements in subject.Conclusion: The present study showed that training two karate hand techniques might reduce the stereotypic hand movements in a child with autism. Since the result has came out from a single case study, it could be suggested that more experimental studies can be carried out on autistic participants to investigate whether this technique effect on hand movements.

Introduction: Stuttering is a multidimensional disorder which may be affected by many factors including linguistic aspects. The aim of this study was to investigate the frequency of disfluencies over words and nonwords in children who stutter.Materials and Methods: 15 children with stuttering, whose age ranged from 4 to 5 years, participated in this descriptive-analytical study. They were asked to repeat words and non-words that they heard while their utterances were recorded. The statistical analysis was conducted in SPSS.Results: Disfluency frequency was significantly higher on repeating words than on repeating nonwords (P<0.05). Common disfluencies were of repetition and block types.Conclusion: According to the results of the present study, linguistic complexities can increase the occurrence of disfluency frequency.

Introduction: Shin splint is one of the common injuries in most athletes. Although the relationship between abnormal foot posture and shin splint has been reported previously but, the relation between foot posture and shin splint has not been well documented. The aim of this study was to explore the relationship between foot postures in basketball players and the history of shin splint.Materials and Methods: Thirty Iranian male basketball players who had experience of shin splint during last three months were participated in this study. Foot Posture Index (FPI-6) was used as the measure of foot posture. Talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, prominence in the region of the talonavicular joint, congruence of the medial longitudinal arch, abduction /adduction of the forefoot on the rear foot were 6 items which were assessed with FPI in the standing position. Foot posture was defined as ‘normal’, ‘supinated’ or ‘pronated. Data were collected and analyzed by SPSS, version16.Results: Most participants showed abnormal foot posture (%80). Fifty-three percent of subjects had pronated foot (%53) and 10% did hyper-pronation. The foot postures of 17% of participants were in supination. The results of this study did not show a significant difference in foot posture between right and left foot (P>0.05).Conclusion: Abnormal foot posture were common (%80) in basketball players with the history of shin splints. These findings could support this idea that the footwear and orthotic prescription both can prevent and treat basketball players with history of shin splints.

Introduction: The purpose of present research was to compare the effect of mental, physical and mentalphysical exercises on the balance ability of blind students.Materials and Methods: Subjects of this semi-experimental research were 30 daughters with the maximum visual acuity of 0.05 Diopter in the dominant eyes, who were selected through a simple non-probability sampling method. They were randomly divided into 3 equal groups of mental exercises (mean age 9.2 years); physical exercises (mean age 8.2 years) and combined exercises (mean age 9.6 years). Each group participated in an 8-week program consisted of 2 weekly sessions of 45 to 60 minutes each. The capability of static and dynamic balance was measured by Romberg and Balance beam tests respectively. Obtained data were statistically analyzed via independent t test, one way ANOVA and Post hoc Tukey test using SPSS software, version 18 (significance level was set at P£0.05).Results: Results showed that there was no significant difference between the above mentioned three practice methods considering static balance. Regarding to the dynamic balance, combined practice was the only method that resulted in a significantly improved performance. Moreover, between-group comparisons indicated significant advantage of combined method over either mental or physical practice alone.Conclusion: Based on the results of this study, it is concluded that a compensatory corrective mechanism is the possible cause of non significant differences between the static-balance performances of the three studied groups. Combined mental and physical practices may improve balance ability during execution of complicated movements.

Introduction: Decreased hip muscles strength has been implicated to lower-extremity malalignment and patellofemoral pain. Proximal muscle groups including the lumbopelvic stabilizer muscles are responsible for postural control and body stability. Strengthening in these keys muscles have not been investigated in previous studies. The purpose of this study was to compare the lumbopelvic stabilizer muscles endurance in female athletes with and without patellofemoral pain syndrome.Materials and Methods: Thirty female athletes diagnosed with patellofemoral pain syndrome (mean±SD age; 21.60±2.75 year, mean±SD weight; 60.70±8.70 kg, mean±SD height; 165±0.073 cm) and thirty asymptomatic females athletes (mean±SD age; 20.77±2.63 year, mean±SD weight; 60.53±6.66 kg, mean±SD height; 164±0.063 cm) with history of 3 years participating in volleyball, basketball or handball training were recruited in this study. The protocol established by McGill was used to determine the muscle endurance of the lumbopelvic stabilizer muscles. The protocol consists of four tests that measure all aspects of the torso via isometric muscle endurance: trunk flexor test, trunk extensor test (Biering Sorensen test), left and right lateral musculature tests (Side bridge test). Data were analyzed using the Independent samples t-test in SPSS software. The significance level set at P<0.05.Results: The results showed a statistically significant difference between two groups for lumbopelvic stabilizer muscles endurance (P=0.001). The greatest differences were found in anterior part of the lumbopelvic muscle endurance (abdominal muscles). The results indicated that young women with patellofemoral pain are less likely to demonstrate endurance in lumbopelvic stabilizer muscles than agematched control group women who are not symptomatic.Conclusion: The lumbopelvic stabilizer muscles endurance training would be proposed for prevention and treatment of patellofemoral pain.

Introduction: Children with learning disorders (LD) show difficulties in one or more than one basic psychological process involved in both understanding and using spoken and/or written language. This study compared sustained attention to visual and auditory stimuli in children with learning disability and their typical counterparts.Materials and Methods: In this study, 26 primary schoolers with learning disorder of NOS type and 40 healthy school children were examined. Wechsler intelligence test for children and the test of auditory and visual continuous performance were used for obtaining the data of interest. Paired t test or Wilcoxon’s test, Independent t test or Mann-Whitney U test were conducted for the statistical analysis of the data using SPSS 16.Results: The two groups had meaningful differences in either visual sustained attention or visual emission error (P=0.003) and also in visual and auditory reaction times (P£0.005). Moreover, neither sustained auditory attention nor auditory omission error had meaningful difference when the two groups were compared (P=0.752).Conclusion: According to the results of the present study, it seems that children with learning disorder have visual attention deficits. Children with LD have deficits in auditory selective attention and in the control of impulsivity against auditory stimulants. Finally, because of superior performance of children with LD in visual and not in auditory modality, the use of visual stimulants in the rehabilitation and training sessions is recommended.

Introduction: Subjects with Multiple sclerosis (MS) suffer from negative mood disorder due to physical- mental symptoms and failure to accept realities and chronic fatigue have negative effect on quality of life, therefore, the present research has been conducted to explore the effectiveness of Dohsa-hou psychological rehabilitation program on severity of fatigue, depression, anxiety, stress and improve the quality of life in individuals with multiple sclerosis.Materials and Methods: The present research has a semi experimental. Statistical population of the research includes all patients with multiple sclerosis in Esfahan city. Thirty participants diagnosed with multiple sclerosis were recruited using convenience sampling method. All subjects read and assigned the consent form. Then, they randomly and equally divided into two groups of experimental and control. All subjects completed Fatigue Severity Scale (FSS), Depression, Anxiety and Stress Scale (DASS-21) and quality of life questionnaire (MSQL-54). Term of Dohsa treatment was eleven sessions (three sessions per week) in experimental group. Control group did not receive any intervention. Follow-up stage was performed forty days after first evaluation for all subjects. Data obtained from the questionnaire was analyzed using SPSS, version 17.Results: Findings obtained from MANOVA showed that Dohsa-hou psychological rehabilitation program caused decrease in severity of fatigue, depression, anxiety, stress and improvement in quality of life in individuals with multiple sclerosis (P£0.001).Conclusion: Dohsa-hou program can use as an effective psychological rehabilitation technique to decrease severity of fatigue, depression, anxiety, stress. It may be put in rehabilitation programs and opt to promote the quality of life in these people.

Introduction: Return-to-play decisions have remained a matter of controversy for athletes. The aim of the present study was to explore the relationship between functional movement screen (FMS) score with history of injury and identify the predictive value of the FMS for injury.Materials and Methods: Statistical population of this study was the physical education students of Kharazmi University aged 18 to 25 years. A hundred subjects (50 females, 50 males) with the mean (±SD) age of 23.21 (±2.12) years old were recruited. All participants read and signed the consent form.The FMS tests include: Deep Squat, Hurdle Step, In-Line Lunge, shoulder mobility, straight leg raise, Trunk Stability Push-Up, Rotary Stability were used to screen all individuals. Data were analyzed by One-way analysis of variances, Pearson correlation coefficient, Kappa, t test (SPSS, version 17 and alpha level set at 0.05).Results: Subjects without history of injury had better FMS scores than who has the history of injury.There was a statistical significance between the pre-season FM scores of subjects with ankle and knee injuries history with healthy ones. For all of subjects, a cut-off score of 17 was found that maximized sensitivity and specificity. An odds ratio was calculated at 4.70, meaning that an athlete has approximately 4.7 times greater chance of suffering a lower extremity injury during a regular competitive season if they score less than 17 on the FM.Conclusion: Scores of FMS tests provides the primary injury prevention model for coaches so that they can predict athletics future injury. So, this test can be considered as a basic and key physical examination for all athletes before attending in any training sport. Coach will benefit from this accurate tool to evaluate sport performance level for all team athletes.

Introduction: Developmental dyslexia has been recognized as being one of the most common types of reading disorders. According to phonological deficit hypothesis, the main difficulties in affected children are phonological processing and making incorrect representations. Nonword repetition task taps the encoding, storage and retrieval of phonological representations, and therefore, is an appropriate tool for measuring these skills, particularly phonological working memory. This task involves a variety of underlying processes including speech perception, lexical and phonological knowledge, motor planning, and articulation. The aim of this study was to investigate the performance of dyslexic students in nonword repetition task and to analysis their errors.Materials and Methods: This was a nonexprimental analytical cross-sectional study in which a case control paradigm was adopted. Participants were 15 students with dyslexia and 35 normal students, all of whom were studying at the third grade of elementary school at the time of the study. These students did not have any gross neurological impairments, psychiatric problems or speech- language disorders and had normal intelligence and hearing acuity.40 one-to-four-syllable nonwords were used for the assessment.Broad transcription was applied for recording responses. The results were statistically analyzed using descriptive and analytic methods.Results: The dyslexic group obtained lower scores than did the control group in nonword repetition task and the difference between these two groups was statistically significant.Conclusion: The errors of dyslexic students in nonword repetition showed that they suffer some deficits in accessing, maintaining and retrieving phonological codes. Moreover, they have difficulties in distinguishing phonemes that were poorly encoded.

Introduction: Depression is one of the mood disorders in which an individual experiences unpleasant feelings of sadness and discouragement. This feeling minimizes the ability of experiencing fun and the joy of life. In previous researches the effectiveness of endurance exercises on depression and occupational performance areas have not been well documented, so this paper was aimed to investigate the effect of endurance exercises on occupational performance areas and depression severity in students of Isfahan University of Medical Sciences.Materials and Methods: Eighty subjects were participated in this quasi-experimental study. They all read and signed the consent form. Participants were randomly and equally divided in two groups of experimental and control. Endurance exercises carried out for 8-week (3 times a week, 90-minute a day).The Beck depression inventory-II (BDI-II) and Canadian occupational performance measurement were tested before and just after implementing the designed protocols. All data were compared and analyzed by SPSS, version16.Results: The paired t test showed the significant differences in occupational performance (P<0.001), satisfaction (P<0.001) and depression (P<0.001) before and after intervention. The independent t test suggested a prominent differences in performance (P<0.001) and satisfaction (P<0.001) among both groups after implementing exercise program but the difference was not significant concerning depression (P=0.070).Conclusion: Eight weeks endurance exercises can effectively reduce depression severity and could improve the performance and satisfaction among students.

Introduction: Electromyography (EMG) response of muscles to Whole Body Vibration (WBV) has most studied acutely in areas close to the vibration platform. While, chronic effects of WBV on EMG response of muscles in far areas from vibration plate and with therapeutic perspective has been neglected. This study aimed to investigate the EMG response of muscles in areas far from vibration plate and important from orthopedic view in osteoporotic fractures and at risk population like women.Materials and Methods: Twelve nonathletic healthy young women (mean age±SD; 25.66±2.71 years) were participated in the one-blind controlled trial study design. They all enrolled to the WBV (static semi squat training+vibration) (vertical vibration, 30 Hz, 3mm) and placebo (static semi squat training) groups, randomly. Training protocol was similar in both groups except of WBV machine set as off in placebo group. EMG tests of muscles (lumbar erector spine (ES), Gluteous maximus (G.max), Rectus femoris (RF)) were carried out before and after twelve sessions of training and root mean square and median frequency were extracted for statistical analysis.Results: WBV effects on RMS of ES (P=0.017) and G.max (P=0.014), as well as median frequency of ES (P=0.020) increased than before training. The net effect of WBV compared with placebo increased statistically only in RMS of G.max muscle (P<0.001) and this increase was more than other two muscles, significantly (P=0.001).Conclusion: The results indicate the positive net effect of twelve sessions of WBV training on amplitude of muscle activity in G.max. This muscle is far from vibration plate and its strengthening can impose physiologic loading on the greater trochanter, cause likely to strengthen it and prevent osteoporotic fractures in this area. However, the relevance of this finding has to be further investigated in other studies and population like the postmenopausal women.

Introduction: Previous studies have emphasized the importance of early detection of children with Developmental Coordination Disorder (DCD) to prevent the development of secondary academic, emotional and social manifestations of the disorder. A better understanding of these issues is the need for a valid measurement tool. Parent report has the potential for providing historical knowledge of the child’s motor skills and perceptions of their children’s motor difficulties. So the aim of this study was to adapt and determination of validity and reliability of a Persian version of Developmental Coordination Disorder Questionnaire (L-DCDQ) in Iran to identify children at risk for DCD.Materials and Methods: Internal consistency, construct validity and concurrent validity of the L-DCDQ using a large sample (600) of children (3-5 years) and their parent were examined. To evaluate the concurrent validity scores on the L-DCDQ were compared to performance on the Test of Gross Motor Development-2 (TGMD-2).Results: Internal consistency reliability for L-DCDQ was high (0.946). Explanatory and confirmatory factor analysis showed that the L-DCDQ was multi factorial and this version compatible with the original version of the L-DCDQ. Thus, three factors (fine motor, control during movement, general coordination) %74.22 of the total variance were explained. Also hypothesized factor structure for the sample under study was fitted well. Finally, high correlations were observed between the L-DCDQ with the TGMD-2 subscales: locomotion (0.883), object control (0.807).Conclusion: These results support the validity and reliability of the Persian version of the L-DCDQ as a screening instrument for identification of children at risk for DCD in Iran.

Introduction: The spine serves as the main support of the body. During activities, postural stability depends on the simultaneous function of the muscles, passive elements, and also the neural elements. The aim of this study was to investigate the relationship between spinal abnormalities and musculoskeletal pains in the areas related to these abnormalities in the students of Hamadan University of Medical Sciences.Materials and Methods: 241 students (157 females with the mean age of 19.42 years, SD=1.1 years; 84maleswith the mean age of 21.01 years, SD=2.25 years) voluntarily participated in this study. Spinal alignment was evaluated by posture screen, plumb line and the New York Test of the Lateral Head Deviation to determine the rates of forward head, shoulder asymmetry, kyphosis and lordosis. To determine the location and intensity of pain in the head, the left-and right-neck, the left- and right-shoulder and the low-back regions, a tailor-made questionnaire with visual analog scale was used. Finally, using the correlation coefficient, the data were statistically analyzed.Results: There was significant relationship between lateral head deviation and both headache and the leftside neck pain (P<0.05). Kyphosis was significantly correlated with feeling pain in the right and the left shoulders and also with inters scapular pain (P<0.05). Moreover, significant relationship between lordosis and low back pain was observed (P<0.05).Conclusion: The results of this study indicate a signification relationship between the presence of some postural abnormalities and the incidence of musculoskeletal pain.

Introduction: Postural control is the ability to maintain upper extremities and different parts of body during static and dynamic status in proper biomechanical alignment. Fatigue is one of the factors that can affect the posture. Muscle fatigue can reduce sensory input to the brain and finally decrease the balance.The aim of this study was to investigate the effect of erector spine muscles fatigue on balance compensation in kyphotic subjects after postural perturbations in the sagital plane.Materials and Methods: Twelve male college student with spinal curvature of more than forthy degrees (mean±SD age; 23.25±1.42 years, mean±SD height; 174.92±6.89 cm, mean±SD weight; 67.33±12.17 kg) and twelve male college student with normal curvature of the dorsal spine (mean±SD age; 23.17±1.53 years, mean ± SD height; 178.92±6.16 cm, mean±SD weight; 71.75±9.34 kg) were participated in the study. They agreed and signed the consent form. A flexible ruler was used to measure thoracic kyphosis. To assessment the balance the center of pressure (COP) displacement after sudden perturbation (by releasing a weight equivalent to 10% of the subjects that has been attached to the Foot Scan) in the anterior-posterior direction were measured by Foot Scan. Experimental procedure was measured before and just after the fatigue protocol. ANOVAs and Independent t-test were performed to data analyses.Results: The results indicated no significant differences of the COP displacement in both kyphotic (P=0.678) and control (P=0.685) groups. Our results showed that erector spine muscles fatigue could not affect the postural.Conclusion: Possibly compensation of posture after balance perturbation can not affected by erector spine muscles fatigue.

Introduction: The purpose of this study was to examine the effect of 6 weeks hopping exercises program on joint position sense in young male athletes with functional ankle instability.Materials and Methods: Thirty young male athletes with functional ankle instability (mean±SD age; 22.16±1.46 years, mean±SD weight; 73.96±11.50 kg, mean±SD height; 180.95±8.24 cm, mean±SD instability score; 20±2.31) were participated in this study. They all read and signed the consent form.Participants were equally and randomly divided into two following groups: 1) hopping exercise, and 2) control. Reproduction of ankle joint angle was used to evaluate joint position sense before and just after exercise program. Descriptive statistic, paired sample t-test and Independent sample t-test were used to analyze the data. Level of significance was set at P<0.05.Results: The results of the study showed that 6 weeks hopping exercise program had a significant decrease in average absolute error of the reproduction of ankle joint angle in inversion and plantar flexion (P<0.05). Furthermore, reduce in absolute error of joint angle reproduction was observed more in inversion than plantar flexion.Conclusion: According to the results, young male athletes with functional ankle instability need specific joint position sense in many skills. So, it could be suggested to use these selected exercise in training and rehabilitation programs to improve joint stability during fast and rapid activities.

Introduction: The significant effects of cochlear implantation on language, speech and reading skills become evident through the years following the implantation. The purpose of this study was to investigate the effects that the age at which cochlear implantation is performed has on reading skills progress.Materials and Methods: Participants were 24 children with cochlear implant from the second and the third grades of elementary education. They were all the residents of Tehran, Iran. Reading performance of the children was assessed by a recently-developed Persian tool called “Nama Reading Test”.Results: Reading skills were significantly correlated with both the age of surgery and the duration of cochlear implant use (P<0.05).Conclusion: Increased auditory input, provided by cochlear implant, improves language and reading skills. Therefore, it is necessary that implantation be performed as early as possible; long before the beginning of language acquisition.

Introduction: Through the present research, it was hoped to provide solid evidence concerning the definitions, assessments and some treatments of developmental coordination disorder (named hereafter as DCD).Materials and Methods: To locate related articles on the topic of DCD, Google scholar, Proquest, PubMed, Science Direct and Cochrane library databases were reviewed. The arrangement of the article is as follows: After introducing the disorder and discussing reasons for early identification, some treatment methods are expressed.Results: At the present state of art, no diagnostic tool has been offered for DCD. The disorder does not seem to ameliorate with time, and in long term, negative secondary consequences may occur.Conclusion: More researches for early diagnosis and appropriate treatments of this disorder are required and the professionals need to be equipped with appropriate information resources on the subject.