Journal of Paramedical Science and Rehabilitation
Year:2017 | Volume:6 | Issue:2|Papers Count:10

Purpose: Impairment means a deficit in the body structure such as the musculoskeletal system. Functional disability refers to the defective interactions between the individual and the environment. Examining the relationship between impairment and disability determines the role of impairment in making disability. The aim of this study was to estimate the prevalence of upper extremity musculoskeletal impairments and the relationship between such impairments and upper extremity functional disability of registered hospital nurses.Methods: This cross-sectional observational study conducted at three affiliated hospitals of Shiraz University of Medical Sciences. Seventy two qualified nurses that were available in nurses’ station of hospitals at the time of sampling were studied. Data were collected by two self-reported questionnaires: Nordic and Disabilities of the Arm, Shoulder and Hand (DASH). The prevalence of impairments in different areas of upper extremity were estimated. Level of disability between two groups of cases with and without impairment were tested by T-test. Correlation between impairment and disability was assessed using Eta correlation coefficient.Results: Having impairments in at least one area of the upper extremity were observed in 70.8% of study population. The mean score of DASH was 19.2±15.7. The level of disability was significantly higher in people with impairment than those without impairment (p=0.018). However, Eta correlation coefficient equated to 0.28 showed weak correlation between impairment and disability in the present study.Conclusion: While the prevalence of upper extremity musculoskeletal impairments was relatively high, the score of 19.2 in DASH questionnaire implied the low level of disability. Weak correlation between impairment and disability in this study may be due to a nonlinear relationship between these two factors that necessitates more precise inspections and further studies.

Purpose: Naturally, a normal child learns speech and language communication in a language-rich environment. However, hearing-impaired children have difficulties for language acquisition. Therefore, learning these skills on the golden time with appropriated approach seems very important. This study aimed to intervene a rehabilitation integrated approach (including language, development, motivation and musical dimensions which suited language and speech natural development patterns) and to compare it with conventional and traditional methods.Methods: In this clinical trial study, 52 below 3 years-old hearing-impaired children were selected during the six months period and divided into two groups based on the principle of the right choice references. The samples were severe to profound hearing-impaired children who were passing the elementary rehabilitation training courses using hearing aid. If they did not respond correctly to the hearing aid training course after 6 months, they would be considered as a candidate for a cochlear implant. These 2 groups were examined by 2 different methods: the first one is a common method of Auditory Training (AT) alone and the second one is Auditory-Verbal Music Play Therapy (AVPMT) as an integrated approach. All samples were evaluated before and after intervention. The data were assessed by Newsha Language Development Scale. The scores of perceptive and expressive language skills of 2 groups were analyzed by statistical methods using SPSS software ed. 18.Results: The results showed a significant difference between the scores of the perceptive and expressive language skills of the hearing-impaired children who were exposed by the auditory-verbal music play therapy compared with those who were exposed by pure auditory training, and language skills of these children showed a significant growth (p<0.05).Conclusion: The hearing-impaired children, if intervened in the critical period of language acquisition and rehabilitation interventions, will have the opportunity to take the stages of language development children spend faster and nearby their hearing counterparts.

Purpose: Proprioceptive receptors transfer joint and muscle information through sensory nerves to the central nervous system; and neuromuscular coordination improves the stability and the prevention of injury. Therefore, the aim of this study was to investigate the effect of eight weeks of training with balance board on proprioception range of motion and muscle strength of karate girls` ankle.Methods: In the present quasi-experimental study, 25 karate girls of Kerman province were selected voluntarily and were divided into experimental group (13 subjects) (age 2.2±8.12 years, height 1.15±150 cm, and weight 2.7±3.40 kg) and control group (12 subjects) (age 1.2±5.13 years, height 2.12±6.154 cm, and weight 7.10±2.44 kg). Proprioception (pedal Goniometer), range of motion (universal Goniometer), muscle strength (Lafayette Manual Muscle Testing System) and Karate girls` ankle were evaluated in four directions (dorsal, plantar, inversion, Eversion) 8 weeks before and after the experiment. Control group continued Kata training, while the experiment group did balance board exercises and kata trainings for 3 times a week for 30 minutes. Chi-square test, T-test and covariance analysis at a significance level of less than (p≤0.05) were used for data analysis.Results: The results showed a significant improvement in proprioception (dorsal, plantar, inversion, eversion), range of motion (Dorsal, inversion, eversion), muscle strength (Dorsal, plantar, inversion, eversion) of the experimental group after eight weeks of training (p≤0.05). However, significant improvement was not observed in the control group (p≤0.05). In addition, significant improvement in the range of motion of ankle plantar flexion was not observed between the experimental and control groups before and after eight weeks of training (p≤0.05).Conclusions: According to the findings of the study, it seems that balance board training is effective in improving neuromuscular factors and can be used as an effective intervention for prevention and harm reduction.

Purpose: To investigate and determine the values of corneal elevation, astigmatism and best fit sphere (BFS) in anterior and posterior surfaces of the cornea in different stages of keratoconus (KCN) and to determine their differences and correlations.Methods: In this retrospective study, 161 eyes of 161 KCN patients with mean age ± SD of 22.35 ± 6.10 years were examined using Pentacam HR (Oculus, Germany). Corrected distance visual acuity, spherical refractive error, astigmatism and outcomes of Scheimpflug-based imaging system were assessed based on the Amsler-Krumeich KCN classification.Results: The mean corrected distance visual acuity was different between all stages of KCN (Kruskal-Wallis, p≤0.001). Magnitude of corneal anterior and posterior BFS, elevation and astigmatism were different in 4 stages of KCN (Kruskal-Wallis test, P≤0.5). There were strong correlations between anterior and posterior astigmatism in grade 1 (p≤0.001, r=0.924), anterior and posterior elevation in grade 2 (p≤0.001, r=0.903) and anterior and posterior BFS in total group of KCN (p≤0.001, r=0.923).Conclusion: This study showed the values of corneal elevation, astigmatism and BFS in anterior and posterior surfaces of the cornea in different stages of KCN. Also, we determined strong correlation between some anterior and posterior parameters but not for all. Our findings can be used in clinical assessment of KCN.

Purpose: In deformed spine of adolescent patients with idiopathic scoliosis, the interaction between the deformity and kinetic aspects during gait has not been well understood. The aim of this study was to analyze the ground reaction force (GRF) during gait in adolescent idiopathic scoliosis (AIS) and healthy control group.Methods: Nineteen adolescent female patients with right thoracic idiopathic scoliosis of between 11-16 years of ages as well as 18 healthy females with similar age-matched, height and mass were studied.Using two Kistler force plates (1000 Hz) and a Vicon system with 4 T series cameras (100 Hz), the GRF and kinematic aspects of subjects’ gait were simultaneously recorded. GRF forces in x (Fx), y (Fy), and z axes (Fz), together with impulse, loading rate, and the asymmetry index (AI) for all variables were evaluated. AI index was calculated with [(Right X – Left X)/ ((Right X + Left X)*0.5)]*100. MANOVA was used to assess the between group differences, Also, repeated measure analysis of variance was used for within group comparisons. Significance level was set at p<0.05.Results: In the right foot, all parameters of GRF were similar in AIS and control groups (p>0.05). In the left foot also, Fy and Fx components of GRF were similar between groups (P>0.05). However, the Fz1 parameter of the left foot in scoliosis group was significantly smaller than that of in control group (p=0.03). In the right and left feet, the impulses, loading rate and time related GRF variables were not different between two groups (p>0.05). The AI for all variables were similar in both groups (p<0.05).Conclusion: AIS patients demonstrated reduced vertical GRF in left heel contact phase with respect to the control group. Unilateral alteration of the muscle function in the lower limb might be a possible explanation to this abnormality. Further more complex studies are needed to evaluate the origin and consequence of this observation.

Purpose: Defensive medicine is concerned with decisions made to avoid errors that could result in serious consequences in terms of quality of care and efficient use of scarce health resources. This study aimed to assess the experience and etiology of defensive medicine from the perspective of residents in Mashhad University of Medical Sciences.Methods: This descriptive cross-sectional study was conducted with all residents in Mashhad University of Medical Sciences in 2016. The questionnaire was designed to collect data. Data were recorded in SPSS software version 20. Using descriptive statistics and the statistical method of inferred, Friedman's test at a significance level of 0.05, was used.Results: Experiencing defensive medicine was reported by 100% of the participants, such that 149 people 38.3% reported high level and 11 people 2.8% reported low level of experience. Defensive medicine was mostly adopted to avoid being sued by patients 87.2% and least due to lack of liability insurance and reduce the risk of loss of financial capital doctor, %43.7 have been reported.Conclusion: The results obtained suggest a high level of defensive medicine among residents in Mashhad University of Medical Sciences. Accordingly, it is recommended that training be provided to eliminate this phenomenon, and doctors be steered toward its positive aspects. And while that with quite simple measures will reduce this phenomenon.

Purpose: One of the most efficient technologies in management of medication orders is barcode medication administration (BCMA). This study conducted to assess the readiness of nurses for application of BCMA systems.Methods: We surveyed 28 nursing managers, and 283 randomly selected nurses working in teaching hospitals affiliated with Iran University of Medical Sciences. To evaluate readiness of nurses, we examined “nurses’ competency” and “training of nurses” in attitude of nurse managers, also nurses’ attitude about BCMA. We used two questionnaires to gather data. Data were analyzed using SPSS by descriptive statistic methods (frequency, mean, standard deviation).Results: The most readiness rate of hospitals was associated with nurses’ attitude about BCMA application (76.2%), and the lowest rate was referred to training level (23.1%).Conclusion: Nurses’ attitude about BCMA was in good level, however, there were issues such as lack of training and absence of training plans related with barcodes and BCMA which could obstruct implementation of the system.

Purpose: The role of auditory working memory in children’s language acquisition is important. In addition, its connection with development of important language parts such as word acquisition has been well investigated. The present study aimed to develop a suitable tool by use of non-words which reflect the real performance of audithory working memory for evaluation of this system’s performance in such a way that it would be possible to determine its capacity as well as its capability to manipulate information.Methods: The current study has a cross-sectional and tool-making design. Words and non-words were first determined and after designing the task, questionnaire that contained 16 words for word level and 16 non words for non-word level were presented to the specialists for validity determination. Statistical population consisted of 9 to 14 years-old Persian language children of elementary (classes three to six) and Secondary school (classes seven and eight) of which 96 subjects were selected by a multistage method. Test was performed in two levels.Results: Results showed that words and non-words have content validity. Mean score of the subjects in words and non-words parts was calculated as 8.49 and 7.76, respectively and mean of total scores was 16.25. There was also a correlation coefficient of coefficient 0.952 in word and 0.729 in nonword section in the significance level of p<0.001.Conclusion: According to the results, we concluded that achieved auditory memory is valid and reliable for the subjects of the present study.

Purpose: Knee Osteoarthritis is considered as one of the most prevalent musculoskeletal disorders which leads to joint degeneration and consequently deterioration of function and balance. Imbalance in the elderly is a factor for falling and consequently complications. Therefore, preventing these problems is essential. The aim of this study was to investigate the effect of eight weeks exercise on balance indexes in elderly patients with Knee Osteoarthritis.Method: Twenty-four elderly males with knee osteoarthritis in the age range of 55 to 65 years were selected through non-probability inconvenient sampling and divided randomly into two groups; experimental group (n=12, weight 79.16 ± 11.98 Kg and height 169.16± 7.01 Cm) and control group (n=12, weight 77.08 ± 9.31Kg and height 167.66 ± 5.03 Cm). The balance indexes were examined before and after eight weeks of exercise by using the biodex system (postural stability test). Repeated measures analyze of variance were used for data analysis. Dependent and independent t-tests were used to examine differences within and between groups (p>0.05).Results: Our finding showed significant difference in experimental group between pre and post tests in AP (p=0.003), ML (p=0.006), and overall (p=0.001) indexes. However, there were no significant difference in control group between pre and post tests (p>0.05 for all indexes). There were significant differences between two groups in AP (p=0.03), ML (p=0.04), and overall (p=0.01) indexes.Conclusion: The findings showed that eight weeks exercise could significantly improve all balance indexs, therefore, it may could consider as an effective method to improve balance and to prevent falling down in patients with knee osteoarthritis.

Vertigo and imbalance are common problems that may affect many aspects of patients’ life. Dizziness handicap inventory is an instrument for physical, emotional and functional assessment of these patients and frequently used in research and clinical setting. This questionnaire is quite helpful for patients’ assessment and follow-up. In this review article, considering all of the translations, different psychometric properties especially in Persian language will be discussed. The DHI showed high validity, reliability and internal consistency, however, factor analysis showed different results.