Archives of Rehabilitation (Journal of Rehabilitation)
Year:2016 | Volume:17 | Issue:3|Papers Count:10

Objective: The participation of children in occupations, such as self-care, home environment, play, leisure, and educational and social environments, is significantly correlated with their health and wellbeing. Therefore, the aim of this study was to compare the children with cerebral palsy (CP) and their normally developing counterparts in terms of their participation in each area of occupations.Materials & Methods: This case-control study was conducted in 2015 with 50 children (aged 4-6 years) having CP and 50 normally-developing children (aged 4-6 years) in the Tehran city. The participants were chosen by a convenience sampling strategy and examined using the Persian version of Children Participation Questionnaire. The questionnaire was completed by the parents after the necessary explanations. SPSS (version 18) was used for statistical analysis, and independent t-test was used for the comparison.Results: The mean ages of children with CP and normally-developing children were 5 years and 5.1 years, respectively. Significant differences (P<0.001) were found in diversity, intensity, enjoyment, assistance, and parent satisfaction with participation in the areas of self-care, home environment, play, leisure, education of children with CP and their peers. However, there was no significant difference in the area of social participation between the two groups (P>0.05).Conclusion: The results showed that the children with CP have a lower level of participation in occupations compared to their normally-developing counterparts. One of the reasons for the low participation level of children with CP could be the lack of goal-oriented and occupation-oriented interventions. Thus, this finding will help the healthcare providers to create and develop appropriate therapeutic and rehabilitation interventions so as to meet the needs of these children and promote their participation level and wellbeing.

Objective: Communication deficiency is one of the diagnostic criteria for autism, which leads to difficulty in learning speech and linguistic skills. Nowadays, it is common to use play therapy for supporting children with autism. Play therapy is an active approach that helps a child to reveal his conscious and unconscious feelings through playing. The present study aimed to determine the effectiveness of group play therapy on the communication skills of children with high functioning autism.Materials & Methods: The present research was an experimental study, including a pretest and posttest design with a control group. Twelve 5-8 years old boys with high functioning autism were selected purposively from the Autism Charity Foundation in Tehran in 2013. All subjects were included according to get a diagnose of high functioning autism, literacy of parents to complete the questionnaire, lack of sensory disorders such as visual or auditory disorders, lack of physical or motor disorders such as cerebral palsy, not attending to the same play therapy intervention program simultaneously. All subjects were assigned randomly to the experimental and control groups (6 children in each group). The experimental group participated in 20 sessions (three times a week; 45 to 60 minutes for each session) and received group play therapy along with the routine program (mental and physical occupational therapy, and speech therapy). However, the control group received only the routine program. The communication skills of all the children were evaluated using the Gilliam Autism Rating Scale (GARS) before, at 20th session, and 2 months after the intervention. The collected data from two situations (pre-test, post-test) were analyzed by analysis of covariance. Repeated measure test was used to determine the lasting effect of group play therapy on the communication of boys after two months follow-up.Results: The findings of the analysis of covariance showed that the group play therapy significantly influenced the communication of male children with high functioning autism. In addition, it was found that the effects of the group play therapy lasted significantly on the communication skills of the children even at two months follow-up (P<0.001).Conclusion: It is concluded that the group play therapy can help the children to understand and communicate well. This therapy can be used as a complementary training and therapeutic method for children with high functioning autism to help improve their communication deficiencies.

Objective: Caregivers of children with cerebral palsy (CP) are faced with many challenges in self-care, treatment follow-up, educational care, and personal leisure time. Therefore, they should be trained for resolving their needs during caregiving. This study aimed to determine the priority of needs of mothering handling training for family caregiving of children and youth with CP at home based on the family centered approach.Materials & Methods: This cross-sectional study was performed on 186 children with CP (aged 4-12 years) from the rehabilitation clinics in the city of Arak. The participants were chosen by a convenience sampling strategy. Clinical tests such as the Manual Ability Classification System (MACS) and the Canadian Occupational performance measure were used to assess the level of fine motor function and determine the priority of needs of children with CP, respectively. The data were analyzed using statistical tests including two-way ANOVA.Results: In this study, there were 89 girls and 97 boys with CP with a mean age 7.52+2.38 years. The CP types were as follows: spastic (67.7%), dyskinetic (13.9%), ataxic (5.9%), and hypotonic (4.8%). The most important priority of needs of mothering handling training was self-care and care related to children with CP in the level of V of MACS. The results showed that the priority of needs of the mothering handling training based on occupational performance (self-care, productivity and play/leisure) were toileting in the level of IV of MACS. There were no significant differences in the priority of needs of the training in the areas of sex and level of fine motor function (P>0.05); however, there were significant differences in age and self-care (P<0.05).Conclusion: The results showed that the highest priority of needs of mothering handling training was self care, feeding, toileting, and functional mobility. However, the needs of mothering handling training enhanced with increasing severity of fine motor function lesions and age. The simultaneous relationships between age and MACS levels in children with CP have no effect on the priorities of mothering handling training. Organized training of families and caregivers about needs of mothering handling training and proper care of their children are facilitating steps in promoting the education of mothers of children with CP. It seems that the understanding and education of mothering handling for therapists responsible for managing children with CP and the education of their parents can open the way to effective caring and treatment.

Objective: The aim of the study was to determine the effect of strength and endurance training on the pelvic floor muscles in women suffering from stress urinary incontinence using electromyography (EMG) biofeedback.Materials & Methods: Forty women volunteers suffering from stress urinary incontinence participated in this quasi-experimental clinical trial (before and after). The strength and endurance of pelvic floor muscles were evaluated before and after the intervention using EMG biofeedback (MyoTrac Infiniti). The patients performed pelvic floor exercises twice a week for a ten-week program under the supervision of a physical therapist. All data were analyzed using paired t-test, regression analysis, and Pearson correlation coefficient using SPSS (version 11).Results: It was found that the maximum strength and endurance levels in each patients’ pelvic floor muscles before and after the intervention were statistically significant (P<0.001).Conclusion: The strength and endurance training of pelvic floor muscles using EMG biofeedback increased the pelvic floor muscle strength and endurance in women with stress urinary incontinence.

Objective: Stuttering is a developmental disorder of speech fluency with unknown causes. One of the proposed theories in this field is deficits in speech motor control that is associated with damaged control, timing, and coordination of the speech muscles. Fundamental frequency, fundamental frequency range, intensity, intensity range, and voice onset time are the most important acoustic components that are often used for indirect evaluation of physiological functions underlying the mechanisms of speech motor control. The purpose of this investigation was to compare some of the acoustic characteristics of speech motor control in children who stutter and children who do not stutter.Materials & Methods: This research is a descriptive-analytic and cross-sectional comparative study. A total of 25 Azari-Persian bilingual boys who stutter (stutters group) and 23 Azari-Persian bilinguals and 21 Persian monolingual boys who do not stutter (non-stutters group) in the age range of 6 to 10 years participated in this study. Children participated in /a/ and /i/ vowels prolongation and carrier phrase repetition tasks for the analysis of some of their acoustic characteristics including fundamental frequency, fundamental frequency range, intensity, intensity range, and voice onset time. The PRAAT software was used for acoustic analysis. SPSS software (version 17), one-way ANOVA, and Kruskal-Wallis test were used for analyzing the data.Results: The results indicated that there were no significant differences between the stutters and non-stutters groups (P>0.05) with respect to the acoustic features of speech motor control.Conclusion: No significant group differences were observed in all of the dependent variables reported in this study. Thus, the results of this research do not support the notion of aberrant speech motor control in children who stutter.

Objective: Parents' satisfaction with the services for children with hearing loss is one of the most important indicators in evaluating the effectiveness of therapeutic and rehabilitation programs for such children. Accordingly, in the present study, the validity and reliability of the questionnaire for parents' satisfaction with the services provided for hearing-impaired children under the age of 6 years are examined.Materials & Methods: In this descriptive and analytical research work, the questionnaire under study was completed by 60 randomly selected parents in Tehran who had used the training and rehabilitation services of these centers for at least one year. Fifteen of these parents were re-tested to assess reliability. The questionnaire was composed of 5 subtests of satisfaction of structural facilities (7 questions), satisfaction of sanitation conditions (10 questions), satisfaction of services and performance of the center (18 questions), satisfaction of the communication and the behavior of the staffs (12 questions), and satisfaction of fees against the services (3 questions). Internal consistency in level item and scale, items correlation with the total scale, test-retest repeatability, face validity, and content validity were also evaluated. Finally, the available data were analyzed by using SPSS (version 17) software. The other statistical methods included the Cronbach's alpha coefficients, Spearman correlation, and the tests of Kolmogorov-Smirnov Friedman, Kruskal-Wallis, and U-Mann Whitney.Results: In relation to psychometric properties, 0.79 validity of the questionnaire and 90% reliability of internal consistency were obtained. Adequate correlations with the total scale were found for each item. In addition, the test-retest reliability was 75%. Most of the parents were found to be satisfied or pretty satisfied with most of the service areas of the centers, including overall satisfaction (69.5%), structural and environmental facilities (80.66%), sanitation conditions (75%), services and the performance of the center (91.66%), communication and stuff attitude (91.66%), and cost (55.5%). Among the items of the questionnaire, the greatest satisfaction was related to communication and staff attitude (SD=0.31, M=4.72), and the lowest satisfaction was with the fees of the service center (SD=0.62, M=3.27). The result of Spearman correlation between specific dimensions and overall satisfaction showed significantly positive correlation (P<0.01), which confirmed the validity of the questionnaire's structure. The satisfaction of services received, age, education, number of family members with disabilities, time to clinic and hearing parents were not significantly correlated.Conclusion: The results of this study suggest that the questionnaire has good validity and reliability. In addition, it seems that the parents' satisfaction is high with respect to the services of the centers.

Objective: Knee problems, particularly patellofemoral pain syndrome (PFPS), are one of the common complaints of adolescents and young adults. PFPS is also known as "runner's knee" or "jumper's knee" due to its high prevalence among sportspersons. Its symptoms can be aggravated by ascending and descending stairs, squatting, deep squatting, kneeling, prolonged sitting, standing up from sitting, and running. Hence, it affects many aspects of daily life, including the ability to perform pain-free exercise or work-related activities. Nonsurgical treatments such as physiotherapy, insoles, and knee orthoses are commonly used to treat people with PFPS. Insoles with medial heel skive is a new method of insole modification that can control pronation and involves the selective removal of small amounts of medial plantar heel of the positive cast of the foot. The aim of this study is to evaluate the effects of custom-made insole with medial heel skive technique on plantar pressure in PFPS subjects.Materials & Methods: In this controlled before-after study, 14 subjects with PFPS were recruited. Plantar pressure and contact area in eight areas of the foot with and without insole with medial heel skive technique were measured using the Pedar system. A paired t-test was used for statistical analysis.Results: The results of this study showed that the use of insole with medial heel skive technique resulted in decreased plantar pressure in the medial hind foot (P=0.001) compared to without insole. Also, the average plantar pressure (P=0.003) and contact area (P=0.002) in the medial mid-foot with the insole with medial heel skive significantly increased in comparison to without insole. However, no significant change was observed in other regions.Conclusion: The above-mentioned insoles managed to control pronation and alter plantar pressure distribution. However, since the insoles simply transferred the pressure from one area to another area and failed to distribute the pressure equitably over the examined regions, they cannot be considered to have improved plantar pressure distribution in patients with PFPS.

Objective: The purpose of this study is to identify the sexual and reproductive health challenges in women with physical-motor problems in five domains of sexual health, screening for common diseases, maternal health, prevention of unwanted pregnancy, and sexually transmitted diseases.Materials & Methods: This review study was conducted in 2016. Articles on the related topic were searched in the following databases: Proquest, Scopus, Springer, Cochrane, Science Direct, Iran medex, Magiran Irandoc, SID, and Ovid. A total of 61 related research papers, including quantitative and qualitative researches in English and Persian, from the last 15 years papers (from 18 different countries since 2000) were included in this study. Articles with unknown sample size and methodology or those conducted only on mentally handicapped individuals or men were excluded. In addition, articles with no full text access were also excluded.Results: It was found that, in the majority of communities, there was a lack of knowledge about disabilities and how to provide health services to women with physical-motor problems. Insurance and financial problems were the most common reasons for inaccessibility to health care. Other problems included the lack of physical access to health centers, negative attitudes of service providers, lack of effective communications, unfriendly physical structure, and lack of equipments. The Pap smear and mammography screening services were very poor; most of these services did not have the necessary approval from doctors. Other causes included lacking necessity of performing the test, physical and cognitive limitations, and lacking access to the facilities. In addition, low knowledge and poor family planning care were also evident. In Iran, people with disabilities had received significantly less care and family planning. Most of these women considered pregnancy and childbirth to be normal. Despite the differences in the provision of services in pregnancy and childbirth, the participants expressed positive experience during this period, although they did face increased complications of pregnancy and delivery. These women are at risk for sexually transmitted diseases and are provided with weak sexual counseling about sexuality because most of the doctors believed that they have no sex.Conclusion: Thus, due to the low knowledge and received sexual-reproductive health care in this group, community awareness, particularly for those related to the disabled individuals, is one of the main programs that can lead to the understanding and proper achievement of techniques for family and community adaptation. This will also improve the rehabilitation services. It is important to devise a way to increase the attention of the concerned authorities toward the people with disabilities for better implementation of health policies for such individuals.