Archives of Rehabilitation (Journal of Rehabilitation)
Year:2018 | Volume:18 | Issue:4|Papers Count:10

Objective Individuals performance at the workplace is affected by different adopted postures. Sitting postures are mostly used during office work. Improper sitting postures may cause muscle fatigue and discomfort in the spine and also result in mental workload. Poor posture may result in human errors and delay in information processing. Previous studies have demonstrated the relationship between static sitting postures and cognitive factors such as reaction time to an auditory stimulus. Also, some recent studies have demonstrated the effect of static postures on cognitive performance. To our knowledge, none of the studies had considered the sitting and standing postures effects on cognitive performance simultaneously. The aim of this study was to evaluate cognitive performance during three different static working postures: standard sitting, standing, and self-selected sitting postures.Materials & Methods This semi-experimental design study was conducted on the twenty-nine healthy students (aged 20-30 years). The non-probability sampling method was selected. All participants provided their written informed consent. Participants with no musculoskeletal disorders, heart disease, spine surgery, and history of depression and stress were selected. Their depression status and level of stress were measured using Beck questionnaire. The study was approved by the Ethics Committee of University of Social Welfare and Rehabilitation Sciences. Subjects performed complex Stroop test and typing activity in an office-like laboratory setting at the University of Social Welfare and Rehabilitation Sciences. Stroop test lasted about 9-12 minutes, and a typing task was also designed for approximately 5 minutes for all subjects. Three random postures were selected based on common postures used in the office. The effects of the postures (standard standing, standard sitting, and self-selected sitting posture) on dependent variables such as total test duration and reaction time to congruent and incongruent stimulus, number of typing words and number of typing error were assessed with Repeated Measures ANOVA. To examine the differences between groups, the paired t-test was used.Results The results demonstrated that reaction time measure and number of typing error (accuracy) were affected by postures (P=0.001). Post hoc analysis demonstrated that reaction time was significantly different between self-selected sitting posture and standard sitting posture (P=0.001), self-selected sitting posture and standard standing posture (P=0.043), standard sitting posture and standard standing posture (P=0.001). With considering the average amount of reaction time to congruent and incongruent cases, it was observed that there is less reaction time in the standardized sitting posture (M=628.67 ms) compared to the self-selected sitting posture (M=689.41 ms) and standard standing posture (M=675.16 ms). Also, among the three postures studied a significant difference was observed in the number of typing error words (P=0.001). The number of typing error (accuracy) was lower in this posture compared to the two other postures (M=1.58).Conclusion This study demonstrates that cognitive performance is affected by working postures. This study demonstrates that standard sitting posture is the best posture. Therefore, it is recommended that sitting posture can help in increasing cognitive performance in the workplace.

Objective Cognitive abilities can be affected by bilingualism because of the close relationship between cognition and language. In the current study, selective attention and intelligence profile in adolescents who were dominant learner of English with those who were not learner of English were compared.Materials & Methods This study is a retrospective analysis and conducted by the cross-sectional method. This study included all adolescent who were dominant learners in English and non-learners adolescent (aged 13-15 years) in Isfahan in 2015. Adolescent aged 13-15 years (n=64) in advanced levels of English (level RECE and REACH from the center of Iranian language and equivalent levels in other schools) and non-learner subjects (monolingual, n=51, control group) were selected from Region 3 of Isfahan. Adolescents in both groups were chosen from the same institute. Sampling was performed by non-random sampling method. To evaluate and measure adolescent’s Intelligence profile in both groups, Gardner’s multiple intelligence questionnaires were used. The classic Stroop test D-KEFS CW was used to measure the ability of selective attention of dominant learners in English and of non-learners adolescent. The data obtained by the classic Stroop test D-KEFS CW and Gardner’s multiple intelligence questionnaires were analyzed through descriptive statistics and multivariate variance (MANOVA). Data were analyzed using SPSS version 22.Results The results of the current study demonstrated that there is a significant difference between the two groups. Selective attention was different in dominant learners in English and non-learners adolescent as determined by the classic Stroop test D-KEFS CW (P<0.05). This suggests that reaction time for learners was less than the non-learners adolescent in the classic Stroop task D-KEFS CW. The result indicates their faster performance and subsequently demonstrates that learner adolescent’s functions are better than their non-learners counterparts in the classic Stroop test. Also, there is a significant difference between the scores of two groups in six components of intelligence profile including logical-mathematical intelligence and language intelligence (P<0.001) as well as in interpersonal intelligence, musical intelligence, intrapersonal intelligence, and naturalist intelligence (P<0.05). The results demonstrated that the scores of the learners were significantly higher than their peers’ non-learners adolescent in the six components of multiple intelligences. This demonstrates that the learners were better than non-learners adolescent counterparts in the six components of the intellectual profile. The learners had better performances than their non-learners adolescent counterparts in selective attention, logical-mathematical intelligence, language intelligence, interpersonal intelligence, musical intelligence, intrapersonal intelligence, and naturalist intelligence.Conclusion Learning a foreign language (e.g. English) may be an effective factor in selective attention and intelligence profile of adolescents. Therefore, the role of learning a foreign language should be considered in selective attention and intelligence profile of adolescents.

Objective Balance system and postural control are one of the major problems in people with multiple sclerosis.Therefore, the assessment of the balance system and postural control is very essential. Identification and use of standard tools can be a practical solution for more purposeful plan in this issue. Several tools have been used to investigate the balance disorders in these patients, which solely able to screen equilibrium problems, and only predict the risk of falling in the elderly. These questionnaires cannot help the therapist to diagnose the underlying causes of imbalance and also are not useful in directing the purposeful therapeutic process.The Balance Evaluation Systems Test (BES Test) was designed from 1990 to 1999 by Dr. Horak in the Continues Medical Education System. This questionnaire is based on the Bernstein’s theory of motor control, and the test evaluates Biomechanical, Stability Limits, Postural Responses, Anticipatory Postural Adjustments, Sensory Orientation, and Dynamic Balance through 36 questions. The objective of this study was to determine the validity and reliability of the BES Test evaluation system in patients with multiple sclerosis after providing a coherent version of the questionnaire in Persian.Materials & Methods This is a methodological and non-experimental study. The BES Test questionnaire was translated by the researcher. The face validity of the questionnaire was evaluated by a survey of 21 patients with multiple sclerosis. The content validity of the questionnaire was further evaluated by a survey of 6 specialists in the field of rehabilitation (three occupational therapists and three specialists in the field of physiotherapy).After that, the BES Test questionnaire and Berg questionnaire were completed by two researchers (the author and another examiner) for 110 people diagnosed as multiple sclerosis, considering inclusion and exclusion criteria, from north, south, east, west, and center of Tehran in the years 2016-2017. After one week, 36 patients from the first stage were reevaluated in with a BES Test questionnaire by the researcher to evaluate the test-retest reliability. The internal consistency with Cronbach’s alpha coefficient, test-retest reliability by intra-class correlation coefficients traces, inter-rater reliability coefficients of correlation between the traces, and convergent validity between the two questionnaires (BES Test and Berg) with Pearson correlation coefficient were investigated.Results The content validity of the questionnaire (the comprehensibility, relevance of the questions, and the cultural matching of words), which were measured by the CVR and CVI statistical methods, were approved by the specialist (CVI>0.79 and CVR>0.99). Pearson correlation coefficient between all the domains of the BES Test questionnaire (except for the second domain) with the score of the Berg questionnaire was between 0.79 and 0.93. Given that the numbers are above the minimum acceptable value of 0.70 indicates a good convergence between these two questionnaires. By removing a part of a 6th item from the second domain, the Cronbach’s alpha coefficient calculated in all domains were between 0.71 and 0.93, which were much higher than the minimum acceptable value of 0.70. These results indicate an excellent internal consistency. Correlation coefficients between two testers in six domains were reported 0.76 to 0.98. Therefore, these coefficients were above 0.70 in all domains, which indicates the good reliability between two examiners. Furthermore, the Intra-sectional correlation coefficient for two repetitions of the questionnaire for the test-retest reliability of the test were 0.84 to 0.99, which were higher than 0.70 (minimum acceptable), which shows that the questionnaire has an excellent test-retest reliability.Conclusion After changing and removing part of question 6 of the second domain, results demonstrated that the questionnaire BES Test is a valid and reliable test for assessing balance performance in multiple sclerosis patients. It can be used as an accurate tool, both in the areas of clinical (to evaluate the patients’ equilibrium status and purposeful therapy planning) and to apply for scientific research in patients with multiple sclerosis.

Objective Multiple Sclerosis (MS) is known as one of the most common neurological disorders that affect patients’ lives tremendously. These people experience various dysfunctions. One of the most common problems in patients with MS is a balance deficit, which limits the participation and increases the risk of falling. Recently various studies were focused on finding the causes of this imbalance. On the other hand, these patients experience cognitive problems, such as attention deficit and cognitive flexibility. Therefore, the aim of this study was to investigate the relationship between cognitive flexibility and selective attention with balance in patients with relapsing-remitting MS.Materials & Methods This study is a cross-sectional case study. The statistical population in this study was patients with MS who referred to Kashani Hospital and Alzahra Isfahan Hospital in 1395 for inclusion in the study, based on available sampling method. MS diagnosis was performed in these centers with the approval of at least one adult neurologist. Finally, 40 patients with MS were selected by convenient sampling. A written consent form was received from all the families and the patients with MS themselves for participation in the study. All patients were kept confidential in the study, and they were allowed to leave during the study if they refused. The inclusion criteria to participate in the study were: satisfaction of patients to participate in the plan, the individual received a diagnosis of relapsing-remitting MS from those who were referred to Al-Zahra and Kashani hospitals in Isfahan, aged 20 to 40 years, at least two attacks in last 24 months, a score of less than 5.5 in EDSS was associated with a moderate degree of MS due to the severity of the disability and the symptoms of the disease, having sufficient insight and the ability to collaborate in the study through the MMSE test. The exclusion criteria of the study were: dissatisfaction of the patients with the continuation of the study, presence and participation in similar investigations in the last three months that were performed intermittently on executive functions, the presence of visual and auditory impairment, recurrence and severity of MS, disability from moderate to severe, and any abnormalities such as seizure. After that test EDSS, Stroop color-word test, Wisconsin card sorting, and Berg Balance Scale were completed by patients with MS. The results of the tests of executive function and balance were analyzed using SPSS20 software for the presence or absence of the relationship between executive function is determined by the balance. To analyze the data, Pearson correlation coefficient and multiple regression and analysis of variance with repeated measures at the level of 0.05.Results The results of this study demonstrate a significant relationship between selective attention and balance problem (P<0.05). However, there is no significant relationship between cognitive flexibility and balance (P<0.05). As well as the selective attention can predict the balance problem (P<0.05) (P<0.01).Conclusion A significant relationship between selective attentions to balance demonstrates that appropriately designed interventions to repair the attention, can decrease the balance problem in patients with MS. One of the possible reasons for this relationship can be found in the brain system that attention circuits are interacting with equilibrium systems, and any defect in selective attention leads to a loss of balance. Patients with MS experience constant imbalance due to cerebral plaques and relapsing-remitting periods, and in addition to rehabilitation of the balance system, cognitive systems such as attention should be treated.

Objective There is a controversy regarding whether Motor Control Exercise (MCE) is more effective than General Exercise (GE) for Chronic Low Back Pain (CLBP). MCE has been compared to other exercises using outcomes such as pain, but they have not been compared with outcomes related to lumbopelvic stability. As it is claimed that MCE enhances back stability, endurance (as a component of stability) tests that assess lumbopelvic stability were selected. The aim of this study was to compare MCE and GE on CLBP patients based on lumbopelvic stability through three endurance tests.Materials & Methods This study was conducted in Rasool Akram hospital and Motor Control Lab of School of Rehabilitation Science. While being admitted, 43 people (aged 18-60 yrs) with chronic non-specific Low Back Pain (LBP) were alternately allocated to either motor control (n=22) or general exercise group (n=21). Inclusion criteria included having LBP for more than three months and pain intensity 3-6 in the Visual Analogue Scale. Exclusion criteria included having pathology or anomaly lower limb such as hyperplasia, inflammatory diseases, sever osteoporosis, arthritis or other bone diseases. Labeling patients as CLBP was based on physical examination and clinical tests. Three endurance score stability tests such as: Trunk flexor, Trunk extensor, and side bridge tests used as primary outcomes. Pain and disability were also measured as secondary variables at two levels, prior to the start and end of the program. The MCE and GE programs of 16 sessions each were provided to the two groups of participants. Both groups performed their exercises three times a week. In the MCE group, anatomy and function of local back stabilizing muscles and the way they could be activated were taught. For the GE group, exercises activating the extensor (paraspinals) and flexor (abdominals) muscle groups were used.Results At the beginning of the study, there was no significant difference in the variables of test time, pain intensity, and disability index. After the intervention, test times increased, and disability and pain decreased within the groups. There was no significant difference between two groups in increasing test times (P=0.23 to 0.36) or decreasing disability and pain, P=0.16, P=0.73 respectively.Conclusion Though it is claimed that MCE increases spinal stability, the lack of significant difference in the results of variables between the two groups may be due to our MCE not being specific for increasing spinal stability or equal effects of both interventions on increasing spinal stability and no preference of MCE. It may also be due to poor sensitivity of our outcome measures in detecting changes in spinal stability, especially with respect to the sample size. Based on these results, it could be concluded that MCE is not more effective than GE in improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.

Objective This study aims at examining the relationship between performance evaluation and therapist's job motivation based on Herzberg’s two-factor model.Materials & Methods This study was a cross-sectional study conducted in 1394 that was performed on 80 rehabilitation therapists working in rehabilitation centers and government hospitals in Tehran. Sampling was done by cluster sampling method. The data collection tool included two standard questionnaires that employed performance evaluation and Herzberg's 40 material job motivation. Before any analysis, the variables were tested for normality with the Kolmogorov-Smirnov test. Based on the normality of variables, data were analyzed using descriptive statistics, independent t-test and Pearson correlation by SPSS software.Results The results showed that from therapists’ point of view, 90% of them stated that performance of the organization was essential and 88.8% said that performance evaluation was effective on job motivation. However, 55.7% of therapists, did not like the current performance evaluation. In this study, there was no significant relationship between therapist’s job motivation and performance evaluation (P=0.47). From therapists’ point of view, the motivational factors (internal) had greater importance than hygiene factors (external). Accordingly, this study is in line with Herzberg's research. Job quality, responsibilities of job, job level, job security and salary had the highest role in motivation and effective performance. Based on the results of the statistical tests, no significant correlation was found between demographic variables such as gender, education level, marital status, place of work and rehabilitation therapists’ degree of performance evaluation. A significant correlation was observed between therapists’ work experience variable with performance evaluation and Herzberg's motivation theory (P=0.04). According to the results, the relationship between employment type of rehabilitation therapists and performance evaluation was significant (P<0.006). There was a significant relationship between age and job motivation theory of Herzberg in the therapists community (P=0.02).Conclusion It seems that with regard to the difficulty of rehabilitation therapists’ job, it is essential that necessary training for supervisors and managers and directors are organized in order to achieve organizational objectives by taking advantage of the performance standards and evaluation criteria. This will lead to an increase in the rehabilitation therapists’ job motivation and provide for them work progress and greater encouragement.

Objective Spinal cord injury is a major problem for all communities that affect personal and social aspects of the patient’s life. The most common issues that spinal cord injury patients face are paralysis, muscle atrophy, pain, and spasticity. The ability to walk also may be disrupted or lost in many of the patients with spinal cord injury. Most common approaches to rehabilitation for patients with spinal cord injury are the emphasis on healthy neuromuscular sections to promote these sectors and compensate existing defects. But recent studies have reported that the neuromuscular system is capable of plasticity and after spinal cord injury is necessary to pay attention to health and impaired neuromuscular parts of the body. Gait training is one of the rehabilitation approaches that is trying to recruit impaired neuromuscular parts and improve them. This rehabilitation is performed in different ways. In this study, the effect of body weight supported treadmill training on balance and quality of life in patients with incomplete spinal cord injury was evaluated.Materials & Methods This is a quasi-experimental study. Patients with incomplete spinal cord injury (n=15) aged 26 and 48 years with a chronic (>1 year post-injury), grade D=4 and C=11 (according to American spinal cord injury association scale [ASIA]) voluntarily participated in this study. Sampling was conducted from hospitals and spinal cord injury rehabilitation centers of Tehran. For intervention, the patient was in the body weight support system. Patients’ weight supported and suspended with harnesses and lifter of the body weight support system to the extent that knees were not bent in stance phase and fingers can’t be dragged into swing phase. Treadmill speed and amount of weight support adjusted depending on the patient’s conditions. Intervention applied for eight weeks and three sessions a week. Each session lasted 30 minutes. Outcome measures were Berg balance scale and SF-36 questioner. The quality of life evaluated before and after the intervention. Berg balance scale was evaluated at baseline and every two weeks throughout the intervention. The results were compared with each assessment. Repeated measure ANOVA test used for analysis of the scores of Berg balance scale and SF-36, paired t-test used.Results The evaluation results indicated that the scores of Berg balance scale, increased significantly compared to the previous stage in each reevaluation. Between the various stages of evaluation, the maximum difference was between the second and third stages (P=0.008) that were after two and four weeks after the first session respectively. The score of SF-36 showed no significant difference. Between 8 items that measured in SF-36 questioner, just score of »emotional roll functioning « increased significantly (P=0.006).Conclusion According to achieved results, eight weeks body weight supported treadmill training can improve the balance of the patients with spinal cord injury. It was observed that the gait training with stimulation and use of proprioceptors and increase of patient’s confidence in walking and standing positions improve the patient’s balance. The patients were also able to control the internal and external perturbations and maintain the better balance. But eight weeks gait training had no significant effect on the quality of life in patients with spinal cord injury which suggest that more extended rehabilitation is required.

Objective Developmental and behavioral problems are the most prevalent problem in pediatrics after infection and trauma. These problems can be affected by numerous factors. A range of factors is involved in behavior and development problems. Developmental problems have a massive impact on children’s health and eventually have broader scale effect on society. Because of the necessity for more and different follow-ups in children with developmental disorders in the early years of lifetime, determination of effective factors is essential in any society. Therefore, the current study was conducted with a purpose to determine the relationship between gender and developmental status in children.Materials & Methods This is a descriptive design study, performed in 12-month-old children (n=250) who were referred to health services centers affiliated to Qazvin University of Medical Sciences in 2012. Sampling was performed using a multistage method. The data gathering tool included information form and Age and Stages Questionnaire for measuring developmental status. Once parental consent was obtained, the developmental status of the children was measured in five areas, i.e., motor (gross and fine motor skills), problem-solving, personal-social skills and communication. Age and Stages Questionnaire consists of 19 questionnaires at the age of 4-60 –month old with the aim of separating inactive children from further developmental studies of healthy children. Completion of the questionnaire takes 10 to 15 minutes, and it takes about one minute to score. The validity and reliability of the Age and Stages Questionnaire have been reported in various previous studies. The data were analyzed using SPSS software version 18. In this study, statistical analyses were performed using descriptive and inferential statistics. Logistic regression model was used to determine the relationship between gender and developmental status. A P value of ˂0.05 was considered statistically significant.Results The prevalence of developmental delay was 22.4 % (CI 95%: 17–28) in children and the highest prevalence was in the area of communication (8%; CI 95%: 5–11) and the lowest was in the area of problem-solving (2%; CI 95%; 0–4).39 boys (69.6%) were in the group of developmental delay, and 102 boys (52.6%) were in normal developmental group. To check the status of development difference between groups were used chi-square test showed a significant difference between the two groups. Therefore, developmental delay is significantly higher in boys (P=0.02). By importing the variable studied in the logistic regression model, the male gender variable (P=0.055, OR=0.52) had a significant relationship with a developmental delay of children. Children with suspected developmental disorders in evolution children with normal development, chance of developmental delay in boys 0.52 times more than girls. The other variables (age, education, and occupation of parents, previous history of abortion, type of delivery, parity, spacing between births, weight and head circumference at birth and 12 months of age) did not show a significant relationship with developmental delay.Conclusion The leading causes of developmental disabilities remain unknown. It seems that gender is one of the causes of developmental delay. In this study, male gender was a factor that is associated with developmental delay. According to the incidence of developmental delay and its effect on society, it is essential that health professionals, with family, and community, monitor the development of children. Identifying the children at risk as soon as possible for diagnosis, earlier intervention, and reduced problems is essential in the future. Further studies are required to confirm the results.