Archives of Rehabilitation (Journal of Rehabilitation)
Year:2018 | Volume:19 | Issue:2 |Papers Count:12

Objective Alteration of scapular position and motion is called scapular dyskinesis. Scapular dyskinesis is a common clinical problem. Strength of shoulder girdle muscles is important in shoulder motions and stability, so their weakness may lead to scapular dyskinesis. The aim of this study was to compare the maximum voluntary isometric force of shoulder girdle movements in subjects with and without scapular dyskinesis.Materials & Methods: A case-control study was designed where the participants were selected by nonprobability sampling; 30 subjects with scapular dyskinesis and an average age of 22.95±2.62 years and 30 subjects without scapular dyskinesis and an average age of 22.43±2.50 years. The subjects were instructed to stand with their arms resting on each side of the body. The examiner stood behind them at a distance of 1.5 meter and asked them to elevate their arms to the highest level possible. Scapular dyskinesis test was used to visually examine alteration in scapulohumeral rhythm during arm elevation in sagittal and frontal planes. The shoulder flexion and abduction were repeated for 5 times. At the same time, the examiner rated the scapular movement as normal or observable dyskinesis. The maximal voluntary isometric force of shoulder internal and external rotation on both sides, such as "scaption with external rotation", "scapular abduction and upward rotation", "scapular adduction and downward rotation", "scapular adduction" and "adduction and depression of scapula" were measured with manual Dynamometer. For determining the maximal shoulder isometric rotational force, subjects were positioned prone on tables, arm brought into 90o abduction in frontal plane with 90o elbow flexion and resistance given to distal forearm into shoulder external and internal rotations. The maximal isometric force of scaption (supraspinatus strength) was measured in seated position; shoulder elevated 70o into scapular plane abduction (scaption) with external rotation. The maximal isometric force of scapular abduction and upward rotation was determined in supine position while the arm was elevated to 90o flexion with elbow extension and resistance given against forward pushing. For determining the maximal isometric force of rhomboids and middle trapezius muscles, resistance was given against scapular adduction and downward rotation, and scapular adduction, respectively. The maximal isometric force of lower trapezius was determined in prone position while the arm was elevated to 135o shoulder elevation with elbow extension. Independent t-test was performed to compare the maximal voluntary isometric force of shoulder girdle motions in individuals with and without scapular dyskinesis.Results: The mean±SD of age, weight and height of the participants without and with scapular dyskinesis were 22.43±2.50 years/ 22.95±2.62 years, 64.39±13.38 kg/ 65.67 (±12.2) kg and 171.35 (±11.29) cm/ 173.43 (±8.66) cm, respectively. No statistically significant differences were found between the participants of the two groups with regard to the age, weight and height. Our result showed that the isometric force of "scaption with external rotation", "scapular abduction and external rotation", "adduction and depression of scapula", "scapular adduction and downward rotation" and "scapular adduction" were significantly different between the two groups (P<0.05). In comparison to the control group, the individual with scapular dyskinesis had weaker supraspinatus, serratus anterior, rhomboids and middle and lower trapezius muscles.Conclusion: Scapular dyskinesia or altered kinematics of the scapula (downward rotation, anterior tilt and internal rotation) contributes to impingement syndrome by decreasing the subacromial space. The tissues that occupy the subacromial space are the supraspinatus tendon, subacromial bursa and long head of the biceps brachii tendon. The supraspinatus is the major rotator cuff muscle that is susceptible to tendinopathy in subacromial space. The inflammatory processes or tension overload during shoulder activities, which may result from altered kinematics of the scapula and decrease in the subacromial space, may lead to supraspinatus weakness. It has been shown that scapular stabilizers, such as serratus anterior, rhomboids and middle and lower trapezius muscles are more prone to weakness than the other shoulder muscles. So, the weakness in these muscles may relate to scapular dyskinesis. Scapular muscle exercises are executed in the rehabilitation of patients with subacromial impingement syndrome and scapular dyskinesis, as the muscular system is one of the major contributors to scapular positioning, both at rest and during movements. It seems that improving the strength of shoulder girdle muscles especially supraspinatus, serratus anterior, rhomboids, and middle and lower trapezius muscles would be necessary in individual with scapular dyskinesis.

Objective: Attention Deficit Hyperactivity Disorder (ADHD) is widely recognized as one of the most common neurodevelopmental disorders affecting children due to which they are frequently referred to clinics for their behavioral problems. Adding to their behavioral problems, many children with ADHD also have socialization with their parents, siblings and teachers. The long-lasting nature of ADHD easily results in social isolation. Thus, many children and adults with ADHD make few friends, even though they may desperately want to be liked.This can establish a vicious cycle in which they attempt to make new friends by latching onto people, with the least chance for interaction with others. It seems that play therapy could reduce behavioral problems and improve social skills of children with ADHD. The purpose of the present study was to investigate the efficacy of play therapy, based on the cognitive-behavioral model, on the behavioral problems and social skills of pre-school children with attention deficit hyperactivity disorder.Materials & Methods: A semi-experimental study with pre-test and post-test design was conducted with 30 male participants, aged 5–6 years. These participants with ADHD were selected using an available method from the pre-school centers of Aran and Bidgol cities. The participants were divided into experimental and control groups, each group consisting of 15 children. The experimental group received 12 sessions of play therapy based on the cognitive-behavioral model while the control group did not have any sessions. The experiments were conducted using the Rutter child behavior questionnaire for parents (1975) and social skills rating scale of Gresham and Elliott (1990). Problem behavior questionnaires were completed by parents, and social skills rating scale was completed by teachers for all subjects during pre-test and post-test. Data collected before and after the training sessions were analyzed by multivariate analysis of covariance (MANCOVA) using the SPSS software V.23.Results: Normality of variables and contingency of variance and covariance assumptions were tested. The Kolmogorov-Smirnov test showed that all variables were normal (P>0.05). The Box test confirmed the contingency of variance-covariance assumption. The results of MANCOVA showed that play therapy based on the cognitive behavioral model had a significant effect on the behavioral problems and social skills of children with attention deficit hyperactivity disorder (P<0.0001). It also had a significant effect on all the subscales of behavioral problems (aggression and hyperactivity, anxiety and depression, social maladjustment, antisocial behaviors, and attention shortage) and social skills (cooperation, self-assertiveness, and self-control) (P<0.0001) in these children. It can be stated that according to Eta square, 70%, 51%, 62%, 66%, 68%, and 67% of variations in components such as aggression and hyperactivity, anxiety and depression, social maladjustment, antisocial behaviors, antisocial behaviors, attention shortage, and behavioral problems, respectively, can be explained by the subjects’ participation in the play therapy program. Also, according to Eta square, 69%, 58%, 52%, and 61% of variations in components such as cooperation, self-assertiveness, self-control, and social skills respectively, can be explained by the subjects’ participation in the play therapy.Conclusion: Play therapy based on the cognitive-behavioral model can reduce behavioral problems and improve the social skills of children with attention deficit hyperactivity disorder. It is recommended that serious attention be paid while planning play therapy for children.

Objective: According to the Diagnostic and Statistical Manual of Psychiatric Disorders-Fifth Edition, Autism Spectrum Disorders (ASDs) are neurodevelopmental disorders associated with persistent defects in social communication and interactions, patterns, interests, behaviors, and repetitive and limited activities. In other words, ASDs are a lifelong condition characterized by widespread problems in social interaction and communication, stereotypical behaviors and limited interests. The early diagnosis of ASD can lead to early intervention and improvement of developmental outcomes. Parental screening tools are the ideal tools for the timely detection of ASD because they provide diagnostic information from the person familiar with the child and are easy to perform and score. This study aimed to standardize the Pervasive Developmental Disorder Screening Test (PDDST), which screens these disorders at an early age (12 to 48 months). This test consists of 36 questions that are answered as “Yes-No.”Materials & Methods: The population of this descriptive study included all children aged below 8 years with neurodevelopmental disorders and normal children of the same age group in Tehran. In relation to autistic children, the criteria for diagnosis were the persistent impairment of social communication and social interactions in different situations, and patterns of behavior and limited repetitive activities as assessed by a specialist and a psychiatrist. In relation to normal children, the inclusion criteria were the lack of these problems.Thus, a total of 252 children, i.e., 205 children with neurodevelopmental disorders (autism 135 and intellectual disability 70) and 47 normal children (to determine discriminant validity), were included as the sample for this study. Among them, 97 were girls and 157 were boys. The parents of the participants responded to screening tests within 10 minutes at the psychiatric clinics and hospitals in Tehran. The test validity through content by experts and the differential method with variance analysis technique, which shows the significance of the difference between the three groups of participants in the score obtained from the test, and the validity was calculated through the coefficient of internal consistency of Kuder–Richardson 20. Two criteria of validity (sensitivity and specificity) were used to determine the cutting point. Data analysis was performed using the SPSS V.21 software.Results: The content validity of the test was confirmed according to the experts’ judgments. The results of discriminant validity revealed that there is a significant difference between groups (P=0.001). It was also found that the means of normal, intellectual disability, and autistic groups are, respectively, from the lowest to the highest. The reliability of the test was 0.73. The sensitivity of the child’s screening for ASD is indicative of the accuracy of the screening of a child without ASD. The results of this study showed that the PDDST-II screening test for both sensitivity and specificity indices were in a favorable situation and could correctly identify children with autism and children without autistic dysfunction. The two sensitivity and specificity indicators in the score of 5 reached their highest, so the cut-off point for the test was scored at 5 and more.Conclusion: The results of this study showed that the psychometric properties of the PDDST-II screening test are suitable for discriminating between children with ASD and those with other developmental disorders such as mental retardation and normal children. This test also had a good reliability coefficient and is suitable for diagnosing children with ASD.

Objective: Parents with a disabled child face many challenges, including the imbalance between work and leisure, limited social life and time limitations. Social support is a multidimensional index that shows the individual’s perception of being supported, loved, and valued. Owing to the importance of social support of parents/caregivers of disabled children and its impact on their physical, psychological, social and spiritual aspects, a systematic review was conducted with an aim to assess and summarize the results of the studies already conducted in our country.Materials & Methods: The study population included all the published articles since February 1395, containing quantitative data about the social support of disabled parents from the studies conducted in Iran in Persian. In the first phase, in order to achieve related studies, four categories of related keywords were included: 1=(support, social support), 2=(father, mother, parent, caregiver), 3=(child, girl, son) and 4=(handicapped, disabled, exceptional, patient) to search in the scientific databases of Iranmedex, SID, Magiran, Noormags and Google Scholar. Specialized journals such as Archives of Rehabilitations, Journal of Modern Rehabilitation, Journal of Paramedical Science and Rehabilitation and Journal of Research in Rehabilitation Sciences were also visited to access all articles. In all, 683 studies were obtained, in this phase. In the second phase, according to the title of studies, repetitive and nonrelated subjects were excluded; thus 384 studies remained. Then, considering the inclusion and exclusion criteria, the abstracts of the remaining studies were reviewed. The quality of the methods used to search articles (based on the exact definition of the target group, type of study, sampling method, sample size, validity and reliability of the data gathering tool) were also assessed. Finally, 14 studies remained for the final evaluation. The required data were extracted from the studies according to the table of findings for the qualitative analysis of the data. To increase the validity of the study, each process of search in different databases, initial review of the articles, adaptation to the criteria and investigation of the quality of studies was done by two researchers independently; in case of any disagreement, a consensus was reached with the help of the opinion of a third researcher.Results: Based on the methodologies used and the subsequent findings, all the 14 articles were found to be cross-sectional, half of them were correlation studies, and the remaining were causal-comparative studies. In this review, 5 different tools were used for data collection; more than half of the studies (57%) used the Multidimensional Scale of Perceived Social Support, followed by the Scale of Social Support developed by Vaux et al. (14.2%).It is noteworthy that majority (64%) of the studies examined the mother and others considered both parents.Children with intellectual disabilities, such as mental retardation and Down syndrome had the highest (34.48%) support, followed by children with hearing impairments (17.24%), physical-movement disorders (17.24%) and visual impairments (13.79%). Studies that compared social support between parent/parents of ordinary children with disabled ones showed that there was a significant difference between social protections of the two groups.The relationship between social support and mental health, mindfulness, resilience, life satisfaction, marital satisfaction, psychological well-being, adaptability, stress, stress coping strategies and post-traumatic stress variables have been discussed in these studies.Conclusion: Social support of parents with a disabled child has been addressed more in recent years. The articles on social support of parents examined only the effect of taking care of these children and the decline of it. In fact, they remain largely descriptive and theoretical, and there are no operational strategies to improve social support.

Objective: Vowels are the center of syllables while formant structures are one of the most important acoustic characteristics of speech sounds that help in their articulatory and perceptual aspects. Formants represent the shape and size of the vocal tract. There exist trivial differences between the vocal tracts of different people due to which the formant structures of a vowel in one person are different from another person. Towards the end of the 20th century, advances in acoustic science and production of digital tools introduced voice acoustical characteristics analysis as another parameter of sound analysis. These voice acoustical characteristics analyses lead to better assessment of the voices. Effective treatment of speech disorders depends on accurate diagnosis by the speech-language pathologist. The relationship between the first three formants is the main component of perceptual categorization by the listener. Therefore, the aim of the current study is to determine and compare Persian vowel frequency of first, second and third formants in bilingual adults.Materials & Methods: A cross-sectional study was performed on 50 participants (25 males and 25 females) aged 18 to 24 years. Bilingual students from Tabriz University of Medical Sciences were selected by an easy and non-randomized sampling method, where the average of the first, second and the third formant frequencies for each of the six Persian vowels were taken into consideration. Data collection involved a demographic questionnaire (age, gender, bilingualism, and diseases related to the speech breathing mechanism), the consent form, a computer equipped with PRATT Software and one sound recorder set. The data were analyzed using SPSS V.18 software. When the data were normally distributed, independent t-test was used; otherwise, Mann-Whitney test was used.Results: This study showed that the maximum and minimum values of F1 in the males and females are /æ/ and /i/ vowels. The maximum and minimum values of F2 are /i/ and /o/ vowels in both the sexes, whereas, the maximum and minimum values of F3 are /i/ and /æ/ vowels in males and /i/ and /a/ vowels in the females.Conclusion: According to the results of this study, / æ/ and /i/ vowels in both the sexes are the most open and closest. /i/ and /o/ vowels in both the sexes are the most front and most back vowels. The most spread vowel in males and females is /i/ but the roundest vowel is /æ/ in the males and /a/ vowel in females.

Objective: The treatment of autism, a long-term developmental neurological disorder, is controversial. Because of the increasing trend and the lack of a known cause in this area, the treatment is complicated; obscure development of the disorder is a fundamental issue for the parents of these children. Due to the nature of the disorder and involvement of long durations of treatment, various therapeutic methods are used. In addition to the present treatments, a cost-effective and effective treatment is nature therapy (Eco therapy). Therefore, we decided to study the effectiveness of family-centered nature therapy on children with autism spectrum disorder.Materials & Methods: A quasi-experimental (pre-test/post-test) study was conducted involving children with autism spectrum disorder (3-7 years old) who were referred to Tehran’s rehabilitation and therapeutic centers.Fourteen children with autism spectrum disorder were selected by an available sampling method and randomly assigned to experimental and control groups. In each group, 7 children (6 boys and 1 girl) were placed.Ten therapeutic sessions were conducted in 3 months in the summer of 2017; each session was held for 3 hours (9 am to 12 pm) in the Nature School of Savan (located in Chitgar Forest Park) with the obligatory presence of parents (parents or at least one of them). To collect data, the Autism Treatment Evaluation Checklist (ATEC) and the Nature Therapy programs (based on the theoretical framework and relevant research findings) were used.The Autism Treatment Evaluation Checklist (ATEC) consisting of four parts, speech / language / communication, socialization, sensory / cognitive awareness, and health / physical / behavior were scrutinized three times, i.e., before the start of the session, 10 days after the last session of education and three months after the last training session. Each family was followed up by the other families. The variables studied in this study were, family-centered nature therapy (independent variable) and autism spectrum disorder syndrome (dependent variable). Data were analyzed using descriptive statistical methods (mean, standard deviation, minimum and maximum scores) and inferential methods (Leven test to assess the assumption of the equation of error variances, Kolmogorov-Smirnov test to examine the normal distribution of covariance analysis and to investigate the effect of test conditions on the dependent variable of the groups).Results: The results showed that the average score of the post-test for Autism Treatment increased in the experimental group (172.3±5.11) compared with the post-test for control (1.151±10.24), which was statistically significant.This showed that the nature therapy program brought an improvement in children with autism spectrum disorder. Also, the average follow-up scores (after 3 months) of the experimental group (173.91±12.02) indicated the efficacy of treatment. The results of covariance analysis indicated that the calculated F value (F=21.91) was highly significant (P<0.001), indicating the effectiveness of the experimental conditions on the dependent variable (improvement in syndrome).Conclusion: The findings of this study showed that family-centered nature therapy improved the syndrome in children with autism spectrum disorder. These children have shown remarkable progress, especially in the field of social and communication skills. Therefore, it is suggested that this type of treatment has positive, simple and accessible effects and can be used as a complementary method along with other treatments for these children.

Objective: Stuttering is one of the most common speech disorders that generate many complications in children and adults. This disorder involves behavioral, cognitive and emotional interactions. So, the purpose of the current study is to investigate the cognitive functions of students with stuttering.Materials & Methods: A descriptive study, comprising of 30 students (8 females and 22 males) from different educational levels (preschool, elementary and junior high school), was conducted. Study subjects were selected by an available sampling method from the students referred to speech therapy clinics and psychological counseling and rehabilitation centers in Tehran city. The subjects were assessed by using Tehran-Stanford-Binet intelligence scale. This tool consists of verbal and non-verbal domains; each of the fields has five subscales of fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing and working memory. It also has the ability to deliver 8 IQs, including IQs of fluid reasoning, knowledge IQ, quantitative reasoning IQ, visual-spatial processing IQ, working memory IQ, verbal IQ, nonverbal IQ, and general IQ in the age range of 2 to 85 years.Credit coefficients exceed 90% among the ten subscales of this intelligence test. The duration of the test for each person varied from quarter of an hour to one and a half hours. Average scores of the experiment were acquired, and data analysis was performed with SPSS software version 19. Student’s t-test was conducted to compare, review and analyze the theoretical averages obtained from standardization processes of the test.Results: The results of the study indicated that the general IQ and verbal IQ of the students with stuttering was above the average (expected level) (P<0.001) and their nonverbal IQ was average (P<0.202). The fluid reasoning IQ (P<0.001), quantitative reasoning IQ (P<0.020), knowledge IQ (P<0.037), and visual-spatial processing IQ (P<0.001) of the students were above average while the working memory IQ was average. Notably, there was no significant difference at the α=0.01 level between theoretical meanings and the experimental mean of working memory IQ and non-verbal IQ in stuttering students; these two IQs in these students were moderate in society. Children with stuttering showed a weaker performance in some aspects of working memory compared to normal children of their age. In describing the working memory of children with stuttering, we can mention the role of phonological input and output reservoirs. Children with stuttering are more likely to have phonological input reservoirs, which is very important in the speech and working memory process. Therefore, the ability of this reservoir leads to strong repetition of words, and it seems that although these children have difficulty expressing words and speech, their memory function is increased from moderate to expected level because of the frequency of words in their phonological input reservoir.Conclusion: Findings from this study showed that working memory IQ of students with stuttering is weaker than the IQs of intelligence (four constituent agents); in spite of speech disorder, general IQ and IQs of fluid reasoning, quantitative reasoning, knowledge and visual-spatial processing of these students with stuttering are above average, and they have a good background for teaching and learning.

Objective: The Bay Area Functional Performance Evaluation-Task Oriented Assessment (BaFPE-TOA) is a standard test developed by Williams and Bloomer in 1977-1978 in order to evaluate functional performance. This test consists of five tasks (sorting shells, money and marketing, home drawing, block design, kinetic person design), twelve parameters (memory for written and verbal instructions, organization, attention span, evidence of disorder, ability to abstract, completion, errors, efficiency, motivation and compliance, frustration tolerance, self-confidence, general affective impression) and three components (cognitive, affective, and performance components). The purpose of this study was to translate the BaFPE-TOA in Persian and to evaluate the face and content validity, and internal consistency in patients with severe psychiatric disorders.Materials & Methods: A non-experimental and methodological study was carried out in Tehran in 2017; the study population included adult patients diagnosed with severe psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this study, demographic questionnaire and BaFPE test were used. Convenience Sampling was done on patients who were admitted to Razi Psychiatric Hospital. In order to prepare the Persian version, the translation of the BaFPE-TOA test was carried out in accordance with the International Quality of Life Assessment (IQOLA) project, which included: 1. Translation of the original version into Persian; 2. Review by translators and professors; 3. Translation quality; 4. Translation of the Persian version into English; and 5. Comparison of the English version with the original version. The Persian version was assigned to five experts to evaluate the content validity in terms of simplicity, relevance, clarity, and necessity. The face validity of the test was performed on three patients and two healthy individuals in order to find difficulties in the understanding of words and phrases, the appropriateness of the items, the likelihood of ambiguity and inadequate perceptions of expressions or the lack of meaning in words. After confirmation, a Persian version of the test was performed on 55 patients with severe psychiatric disorders who qualified the inclusion criteria. Inclusion criteria for this study included: 1. People with psychiatric disorders based on DSM-5 and are listed in the medical records by a psychiatrist; 2. Over 18 years old; 3. Complete consent to enter the study; 4. Aability to write and read; 5. Lack of comorbidity (mental retardation, drug abuse); 6. Lack of physical constraints affecting the performance of specified tasks; 7 Lack of visual impairment or severe hearing loss. Cronbach’s alpha coefficient was used to evaluate the internal consistency with respect to the four options of the test. Data analysis was performed using SPSS v.16 software.Results: Experts’ opinions about the quality of translation and replacement of words in the translation process were according to the IQOLA method. The face validity of the test according to the experts’ opinion and its association with healthy subjects and patients showed that the clarity and implementation of common language were of good quality. The content validity of the test was performed according to the opinion of the five experts in mental health; the Content Validity Ratio (CVR) and the Content Validity Index (CVI), were equal to one for all domains. The minimum acceptable value for content validity based on CVI and CVR indices was 0.80 and 0.99, respectively, which indicated validity of the content and the lack of impact of culture on the parameters, tasks, and components of the BaFPE-TOA test. The results of the Cronbach’s alpha coefficient for all fields was related to the twelve functional parameters, the three components, and the five tasks; the efficiency parameter was above 0.7 (the minimum acceptable value), indicative of the good internal reliability of this test.Conclusion: According to the experts’ opinion, the Persian version of the BaFPE-TOA test has a proper translation, with acceptable face and content validity and internal consistency. Therefore, this test can be recommended for the evaluation of functional performance in patients with severe psychiatric disorders.