فصلنامه طب توانبخشی
سال دوازدهم شماره 4 (مهر و آبان 1402)

The importance of participatory health governance has been acknowledged by the World Health Organization. Studies have shown the positive effects of participation in occupation-based intervention in patients with severe mental disorders, including schizophrenia, in outpatient and inpatient wards. The purpose of this article is to review the studies on occupation-based interventions in patients with severe mental disorders.

This is a narrative review study. A search for related articles was conducted in PubMed, Google Scholar, Cochrane, ScienceDirect, Scopus, OTseeker, PsycInfo databases using the keywords “severe mental disorder”, “serious mental illness”, “schizophrenia”, “Major depression disorder”, “Bipolar disorder”, “Occupational therapy”, Occupation”, and “Occupation-based intervention” without the time limitation. Titles and abstracts of 480 yielded articles were examined.

Twelve articles were reviewed; Two were related to occupation-based interventions in psychiatric inpatients, five were related to occupation-based interventions in outpatients, and five were related to occupation-based interventions in both inpatients and outpatients. Among these articles, one studied the challenges of using occupation-based interventions.

It seems that occupation-based interventions in inpatients and outpatients with mental illness have been used more to reduce symptoms, and less attention has been paid to the effectiveness of these interventions in maintaining and or improving occupational performance in these patients. The Canadian model of occupational performance and the recovery framework have been used in the design of these interventions. To achieve better results in psychosocial rehabilitation where occupation-based interventions lead to an increase in quality of life, the challenges in this area should be solved.

Nowadays, lifestyle changes have led to non-structural musculoskeletal disorders. Various methods are used to correct these disorders, such as techniques with a local perspective on the disorder and its correction and techniques focused on the cerebral cortex. This study aims to review the studies that have addressed the role of the cerebral cortex, postural awareness, and used methods in correcting postural disorders.

In this review study, the search was conducted for relevant papers published from 2005 to 2020 in Scopus, PubMed, ScienceDirect, Google Scholar, SID, and Academic Search. Of 70 papers found in the initial search, 20 met the inclusion and exclusion criteria and were reviewed.

In the present study, Some studies examined the cortical map and body representation in the brain (BRIB), muscle behavior, and movement patterns and suggested a reciprocal relationship between BRIB and muscle behavior. According to some studies, the inconsistency of BRIB with the actual state of the body led to improper control of posture and, consequently, poor posture. Some other studies suggested a relationship between postural awareness and muscle dysfunction, followed by poor posture.

Although studies have acknowledged the role of the cerebral cortex and body representation (Homunculus) in correcting and achieving an optimal posture, there are lack of studies on the techniques for improving this representation and its effect on correcting postural abnormalities.

Blood flow restriction (BFR) training has been suggested as an effective method to improve muscle hypertrophy and for rehabilitation. The present study aims to investigate the effect of resistance training (RT) with BFR on serum levels of sirtuin-1 (SIRT-1), visfatin, and nitric oxide (NO) in elite male athletes after anterior cruciate ligament (ACL) reconstruction.

Twenty elite male athletes voluntarily participated in the study and were randomly divided into two groups of RT-BFR (n=10) and RT (n=10). Subjects in both groups participated in 12 weeks of RT at an intensity of 30-70% of 10-repetition maximum (2-4 sets). The subjects in the RT-BFR group performed resistance training by placing a blood pressure cuff in the upper thigh with a pressure of 120-180 mm Hg. Blood samples were collected before and 48 hours after the last training session to measure serum levels of blood markers. Data analysis was done by the analysis of covariance (ANCOVA) and paired t-test. P<0.05 was considered statistically significant.

Twelve weeks of RT-BFR significantly increased serum levels of SIRT-1 (P<0.001(, visfatin (P=0.02), and NO (P=0.01) in the post-test phase, compared to the pre-test phase. Furthermore, the between-group analysis results showed that RT-BFR significantly increased serum levels of SIRT-1 (P<0.001) and NO (P=0.002) compared to the RT group.

The RT combined with BFR can increase the serum concentrations of SIRT-1 and NO in elite athletes after ACL reconstruction, compared to the RT alone

Adolescent idiopathic scoliosis (AIS) is one of the spinal deformities with unknown causes that contributes to 80-85% of scoliosis cases. This study aims to evaluate the effect of an integrative corrective exercise program on the severity of scoliosis in girls with AIS.

This is a quasi-experimental study with a pretest/posttest/follow-up design. Thirty-two girls (Mean age: 13.97±2.25 years; mean height: 153.97±7.978 cm, mean weight: 52.03±6.23 kg) with AIS (C-shaped thoracic deviation in the frontal plane) participated in the study. They were randomly divided into the exercise and control groups. The Cobb angle was measured by the radiography method. All measurements were performed before, immediately after, and 12 weeks after the exercise. Multivariate analysis of variance was used to examine within-group differences, and analysis of covariance was used for between-group differences.

The mean Cobb angle at the pre-test, post-test, and follow-up phases were 15.8, 16.60, and 16.85 degrees in the control group and 16.04, 11.26, and 11.01 degrees in the exercise group, respectively, indicating a significant improvement in the Cobb angle in the exercise group compared to the control group over time (P<0.05); this improvement maintained for 12 weeks.

The integrated corrective exercise program, by using selected exercises, can reduce the degree of Cobb angle in females with AIS. The use of this program is recommended for adolescents.

Several studies have investigated gait biomechanics in people with functional ankle instability (FAI). However, the potential role of information processing (attention) in the gait control of these patients is still unknown. Therefore, this study aimed to investigate the effect of cognitive load on the range of motion (ROM) of lower limb joints during walking in men with and without FAI.

The study was a non-randomized controlled clinical trial. Eighteen male subjects with FAI and 19 healthy subjects participated in this study and completed three randomized conditions (three trials per condition): normal walking on a treadmill (single task), normal walking while performing a cognitive task (dual task), and (3) performing cognitive task while sitting. Three-dimensional information of hip, knee, and ankle joint ROM in the sagittal, frontal, and transverse planes were measured as gait kinematic components, and the error ratio and average reaction time were measured as cognitive task indicators. The intraclass correlation coefficient (ICC) was used to determine the intrasession reliability of kinematic and cognitive measures.

The ICC of kinematic variables, including the hip, knee, and ankle joint ROM, with and without applying cognitive tasks in three planes was more than 0.70. During the single task, the group with FAI showed a significantly decreased knee ROM in the transverse plane and a decreased hip ROM in the sagittal plane compared to the healthy group. During the dual task, the group with FAI showed a significantly increased hip ROM in the sagittal plane compared to the healthy group. The results of the cognitive task showed that the group with FAI had a longer reaction time in the auditory Stroop test during dual-task walking than in the sitting position.

FAI can be an important factor in motor-cognitive interactions. Using a cognitive task may be an effective strategy in the rehabilitation program of men with FAI.

Genu varus is one of the most common lower limb deformities that can affect a person’s daily activities and sports performance. This study aims to investigate the effect of the 8-week use of knee braces on the electrical activity frequency of muscles in men with genu varus during walking.

This is a quasi-experimental study on 30 male college students with genu varus (aged 20-30 years) who were randomly divided into control and intervention groups. Corrective exercises were performed for 8 weeks using knee braces in the intervention group. The electrical activity of selected muscles was recorded by an electromyography system. For statistical analysis, ANCOVA was used. The significance level was set at 0.05.

During the loading phase, the results showed a lower frequency of biceps femoris muscle in the intervention group compared to the control group (P=0.041). The frequency of muscles did not show any significant difference between groups in the mid-stance and push-off phases (P>0.05).

Given the decrease in the frequency of biceps femoris muscle activity in men who used knee braces, it can be concluded that the 8-week use of these brace can be effective in reducing shock absorption in the lower extremity.

The use of medical insoles is one of the non-surgical treatment methods for improving the gait pattern of individuals with leg length discrepancy (LLD). However, the long-term effect of insoles on lower limb joint dynamics in these individuals is still unclear. This study aims to investigate and compare the long-term effect of inner and outer insoles on selected dynamics variables of the lower limb joints in men with LLD during the stance phase of gait.

This is a randomized clinical trial with a pre-test/post-test design on 18 men with mild LLD, randomly divided into two parallel groups of inner insole and outer insole. Selected dynamics parameters were measured by six cameras and a force plate during the stance phase of gait. Both groups used the insole for 12 weeks for at least four hours per day. Repeated-measures ANCOVA was used to test the hypothesis. P≤0.05 was statistically significant.

After 12 weeks of using insoles, the peak lateral pelvic tilt decreased significantly in the inner insole group (P=0.041 for short leg, and P=0.008 for long leg) and outer insole group (P=0.026 for short leg, P=0.007 for long leg). The peak knee abduction moment (P=0.022 for inner insole, P=0.007 for outer insole) and peak hip abduction moment (P=0.006 for inner insole, P=0.005 for outer insole) also decreased significantly. In the outer insole group, the peak anterior pelvic tilt showed a significant change in the post-test stage compared to the pre-test stage (P=0.014 for short leg, and P=0.033 for long leg). There was no significant difference between the two groups in the selected dynamics variables (P>0.05).

The long-term use of inner and outer medical insoles, by causing a change in the lower limb joint dynamics, can lead to a positive adaptation in men with mild LLD. There is no significant difference in the long-term effect of inner and outer insoles.

Postural sway is evaluated based on changes in the body's center of pressure and is directly related to postural control and balance. Several factors are involved in the proper control of postural sways and, as a result, proper maintenance of balance, the most important of which is core stability. Weakness of core muscles causes an interruption in the transfer of energy from the trunk and limbs to each other, and this leads to decreased sports performance and increased risk of injury. Hyperlordosis is one of the disorders that can affect the endurance of core muscles. In some sports, such as taekwondo, this is of great importance. The present study aims to assess whether there is any difference in postural sway and core muscle endurance between taekwondo female athletes with or without hyperlordosis in Iran.

The study population consists of all professional Iranian female taekwondo athletes, of whom 60 were purposefully selected and divided into two groups of 30: With hyperlordosis (Mean age: 22.17±2.35 years, mean height: 166±3.95 cm, mean weight: 55.37±5.53 kg) and without hyperlordosis (Mean age: 20.63±2.38 years, mean height: 165±4.23 cm, mean weight: 53.7±4.91 kg). Postural sway was measured by the foot pressure distribution on a single leg. The core muscle endurance was measured by the McGill test. Independent t-test was used for examining the difference in the results. The significance level was set at 0.05.

Independent t-test results showed a significant difference between the two groups only in endurance of abdominal flexor muscles (P=0.013). No significant difference in endurance of other core muscles (P>0.05), postural sway based on two factors of path length (P=0.30) and movement area (P=0.16) were observed between the two groups.

The endurance of the abdominal flexor muscles in taekwondo female athletes with hyperlordosis is poor. Considering the possibility of further changes in the core muscles which can affect other areas of the body, longitudinal and follow-up studies are recommended on this group of athletes.

Non-specific chronic low back pain (LBP) is one of the most common types of LBPs. Due to the complexity of the injury mechanism in this condition, combined interventions and treatments have been suggested. People’s attitudes towards pain and the interaction between biological characteristics of people and social/psychological factors should be considered. Due to the high cost of face-to-face therapy and the difficulty of access to subjects, recent studies have used online methods. So far, the effectiveness of online interventions in the treatment of chronic LBP has not been studied. Therefore, this study aims to investigate the effect of an online cognitive-motor control training program on pain and its related psychological factors in people with non-specific chronic LBP.

This is a randomized clinical trial conducted on 44 female and male patients with non-specific chronic LBP aged 25-55 years, selected from the physiotherapy clinics in Tehran and Karaj provinces of Iran based on the inclusion and exclusion criteria, and randomly divided into two groups of 22 including training and control. The intervention was provided at 18 sessions for 12 weeks. Pain and its related psychological factors were assessed by the visual analog scale, fear-avoidance belief questionnaire, and pain self-efficacy questionnaire. For statistical analysis, repeated measures analysis of variance, independent t-test, and paired t-test were used. The significance level was set at 0.05.

There was a significant difference between the pre-test and post-test scores of the training group in pain, pain self-efficacy, avoidance of physical activity, and avoidance of work (P<0.001). In the control group, no significant difference was reported in these variables between the pre-test and post-test scores.

The online cognitive-motor control training program can relieve pain and improve the pain-related psychological factors of people with non-specific chronic LBP. It can be used for this purpose in these people.

Major changes to lifestyle due to the COVID-19 pandemic increased the potential risk of psychological disorders among pregnant women. This study aims to investigate the general health status of pregnant women in Bojnord, Iran, and assess its relationship with their physical activity level.

This is a descriptive-correlational study. The statistical population consists of all pregnant women referred to prenatal care centers in Bojnord city, of whom 55 were selected as the study samples. The instruments were the pregnancy physical activity questionnaire and the 28-item general health questionnaire (GHQ-28). Spearman correlation test was used to analyze the correlation between the two variables.

The mean scores for the GHQ-28 subscales of somatic symptoms, severe depression, social dysfunction, and anxiety/insomnia were 11.90, 11.91, 12.97, and 16.49, respectively. There was a significant positive correlation between general health status and level of physical activity (r=0.54; P<0.001). Regarding the four dimensions of GHQ-28, the results showed that physical activity had a negative and significant relationship with somatic symptoms (r=-0.61) and severe depression (r=-0.33), but it had no significant relationship with anxiety/insomnia and social dysfunction.

Pregnant women in Bojnord, Iran, are at risk of problems in several domains of general health during the COVID-19 pandemic. It is recommended that they stay active or engage in physical activity to regulate the psychological effects of the pandemic and quarantine.

Psychological disorders such as autism spectrum in children can cause decreased awareness and performance in different areas. The present study aims to investigate the effect of sensory integration-based training on the sensory profile of male children with high-functioning autism.

This is a quasi-experimental study with a pretest/posttest design. The study population consists of all male children with high-functioning autism referred to Kahrizak Rehabilitation Center in Mohammad Shahr, Karaj, Iran, in 2019-2020, from whom 30 were selected using a purposive sampling method and equally divided into training and control groups. The training group received twelve 90-minute sessions of sensory integration-based training, while the control group did not receive any training. the Gilliam autism rating scale and short-form sensory profile (Dunn, 1999) were used to collect data. The data were analyzed using ANCOVA in SPSS software, version 23. 

The sensory integration-based training had a significant effect on the improvement of the sensory profile of children with high-spectrum autism spectrum.

Sensory integration-based training is effective in improving the sensory profile of male children with high-performance autism and can be used for this purpose.

The present study aims to investigate the effect of the SPARK training program on some neuropsychological and motor performance variables in the Movement Assessment Battery for Children - Second Edition (MABC-2) in male children with developmental coordination disorder (DCD).

This is a quasi-experimental study with a pre-test/post-test design. Participants were 28 school-aged boys diagnosed with DCD (based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders) from elementary schools (1-4th grades) in District 22 of Tehran, Iran. They underwent the MABC-2 tests as a pretest assessment. Then, they were divided randomly assigned to training (n=14, mean age: 8.6±1.39 years) and control (n=14, mean age: 8.11±1.15 years) groups. The training group performed the SPARK training program at 16 sessions of 45 minutes, three sessions per week. At the end of the training sessions, participants completed the posttest assessment. Data analysis was performed using analysis of covariance. 

The training significantly improved motor performance in domains of manual dexterity (Placing pegs, drawing a trail), ball skills (catching with both hands, throwing a bean bag onto mat), and balance (One-board balance, heel-to-toe walking forwards, hopping on mats) (P<0.05), but there was no significant change in manual dexterity test of threading lace (P>0.05). 

It seems that the SPARK training program can improve some neuropsychological and motor performance indices in male children with DCD.

Alzheimer’s disease (AD) is a common neurological disorder that begins with mild memory loss and progresses to severe impairment of executive and cognitive functions. This study aims to investigate the effect of repeated transcranial magnetic stimulation (rTMS) on the working memory of patients with AD.

In this quasi-experimental study with a pre-test/post-test design, 30 patients with AD aged 55-75 years referred to neurology clinics in Yazd, Iran participated, who were selected using a convenience sampling method and divided into two groups of intervention (n=15) and control (n=15). Active memory was measured by a computerized n-back test, both in terms of reaction time and percentage of accuracy before and after treatment. In the control group, each patient received 10 sessions of inactive rTMS for 20 minutes, while the intervention group received 10 sessions of active rTMS for 20 minutes at a frequency of 10 Hz over the left dorsal lateral prefrontal cortex. Data analysis was performed using analysis of covariance.

Data analysis results showed that the reaction time significantly decreased, and the percentage of accuracy significantly increased in the n-back test in the intervention group after receiving rTMS compared to the control group (P= 0.001).

It seems that rTMS over the left dorsal lateral prefrontal cortex can improve the working memory in patients with AD.