دکتر حمیدرضا فرپور

Dysphagia can be a life-threatening issue for post-stroke patients, with aspiration pneumonia (AP) being a common risk. However, there is hope through the potential combination of transcranial direct current stimulation (tDCS) and classical behavior therapy. Our study aims to investigate the effectiveness of this combination in diminishing the risk of AP in patients with dysphagia who suffered from stroke.

In this randomized, parallel-group, blinded clinical trial, 48 patients were allocated into the sham group (speech therapy + 30 seconds of tDCS) and the real group (speech therapy + 20 minutes of tDCS). We used the Mann Assessment of Swallowing Ability (MASA) as an assessment tool. We assessed patients at baseline, one day after treatment, and at a one-month follow-up.

Groups showed no significant difference at baseline. After treatment, the real group showed a significant difference in the severity risk of AP (P = 0.02); the same was for the follow-up (P = 0.04). The number of patients showing severe risk of AP was higher in the sham group after treatment (n = 13, 54.20%) and at follow-up (n = 4, 18.20%) than the real group (n = 4, 16.70%; n = 1, 4.50%, respectively). None of the patients reported the history of AP at any stage of assessment.

Although the results were more promising in the real group than the sham group in reducing the risk of AP, both techniques can prevent AP. Therefore, we recommend early dysphagia management to prevent AP regardless of the treatment protocol.

Spinal cord injury (SCI) is a debilitating condition that imposes a significant socio-economic burden on patients and society. Secondary complications are one of the most crucial issues that may arise in these patients and contribute to the overall disease burden. This study aims to assess the knowledge, attitudes, and practices of patients with SCI concerning secondary complications.
 

In this cross-sectional study, the authors evaluated the knowledge, attitudes, and practices (KAP) of patients with spinal cord injury regarding secondary complications. Patients with SCI were identified through the hospital information system. Data were collected using a demographic and clinical information questionnaire and a three-part questionnaire covering knowledge, attitudes, and practices.

A total of 180 patients participated in this study. The findings revealed a moderate level of knowledge, attitude, and practice, with respective mean scores of 84.12, 13.62, and 21.5 in patients with SCI.

The patients' knowledge, attitude, and practice regarding potential complications of spinal cord injury was moderate. Significant relationships were found between education and knowledge, attitude, and practice. Additionally, a significant relationship was observed between knowledge and gender. While there was no significant relationship between age and knowledge or practice, a reverse relationship was identified between age and attitude.

Knee osteoarthritis (KOA) is a common public health disease with an increasing prevalence. It is one of the leading causes of disability, especially in the elderly. Intra-articular hypertonic dextrose prolotherapy is one of the therapies used for KOA. There have been some articles indicating that patients receiving intra-articular normal saline as a control group of the article had improvement as well. The aim of this randomized clinical trial study was to evaluate the efficacy of intra-articular hypertonic saline in comparison with hypertonic dextrose prolotherapy in treatment of KOA. A total of 54 patients with KOA were randomized in two groups: hypertonic dextrose (28 patients) and hypertonic saline groups (26 patients). All patients received three intra-articular injections of either hypertonic dextrose or hypertonic saline at two weeks intervals. The values obtained by visual analogue pain scale (VAS), Oxford knee scale (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC) questionnaire were the outcome measures which were evaluated before, as well as 2 and 4 weeks after the injections. The data were analyzed using t-test and repeated measurement tests. Both groups revealed improvements in outcome measures after 2 and 4 weeks of intervention. However, no statistically significant difference was found between the two groups. We concluded that the intra-articular injection of hypertonic dextrose and hypertonic saline are both effective in the management of KOA. Hypertonic saline can be considered as another medical agent in management of KOA. However, further studies are suggested to evaluate its long-term effects.

Covid-19 was reported in China for the first time. The most common manifestation of this novel infection is respiratory problems. However, it can also invade both central and peripheral nervous systems. The usual central nervous system complications were dizziness (16.8%) and headache (13.1%). The most common reported symptoms in patients with peripheral nervous system problems were taste impairment (5.6%) and smelling impairment (5.1%) due to olfactory nerve involvement.

We present a 46-year-old male who was referred to our clinic in Shiraz for electrodiagnosis and better evaluation due to paresthesia and numbness of the right 4th and 5th fingers accompanied by weakness and atrophy of the muscles in the ulnar nerve territory, which occurred during Covid-19 infection in this patient.

Severe partial involvement of the right ulnar nerve at the elbow region was detected in the electrodiagnosis, and findings in the right elbow MRI favored ulnar neuritis.

Focal neuritis of the ulnar nerve (ulnar mononeuropathy) seemed to be a new presentation of peripheral nervous system involvement in COVID-19 disease.

The use of epidural steroid injection in spinal stenosis pain management has expanded greatly. Calcitonin is also effective in relieving neuropathic pain in spinal canal stenosis through the mechanisms of arterial dilation, anti-inflammation, anti-edema, and rises in beta endorphin levels. The current study was designed to evaluate the effect of mesotherapy with calcitonin compared with epidural steroid injection for pain relief and functional improvement in patients with lumbosacral canal stenosis.

A total of 39 patients comparable in age and gender with signs and symptoms of lumbosacral canal stenosis participated in this randomized control trial. Group A comprised patients receiving mesotherapy of 100 IU Calcitonin+Marcaine 0.5% (4 mL) in three repeated injections in the lumbosacral area; group B received a single caudal epidural injection of Marcaine 0.5% (4 mL)+80 mg methyl prednisolone (2 mL) under the guide of a fluoroscope. Patients were evaluated before and 4 and 8 weeks after intervention using the visual analog scale (VAS), Oswestry Disability Index (ODI), Quebec back pain disability scale (QBPD), and Ronald-Morris Disability Questionnaire (RMDQ).

Based on the VAS, ODI, QBPD, and RMDQ scales, a significant improvement in pain and functional disability was observed in both groups 4 and 8 weeks after intervention (P<0.05), which was comparable between the two groups (P>0.05).

Mesotherapy with calcitonin Marcaine is just as effective as caudal epidural steroid injection; considering its advantages, mesotherapy can be a proper alternative method for managing pain and functional impairment in patients with lumbosacral canal stenosis.

Theory of Mind (ToM) is an essential component of communicationwith the others and social understanding. Cognitive structures, such as language,working memory, and executive functions play a special role in understandingthe others҆ minds. Thus, given importance of the role of language skills indevelopment of ToM and the previous research findings regarding the restrictedcapacity of children with cerebral palsy (CP) in development of their ability tounderstand others’ thoughts and feelings, this review study was designed tomainly evaluate the influence of language on ToM in children with CP.

For this purpose, initially, electronic databases (PubMed, Scopus,PsycINFo, MEDLINE, Embase, and Web of Science) were searched fromSeptember 1 to 30 , during 2000-2020. Search was done focusing on the Englishwrittenpapers using a combination of keywords including: “Cerebral Palsy,Theory of Mind, Mentalization, and Language” to identify relevant studies from2000 to 2020.

A total of 978 publications were identified according to the initial searchcriteria. After reviewing abstracts, titles, and references of the identified papers,10 potentially relevant papers were selected. Based on assessing their full-text, 7papers completely met the inclusion criteria.

Given that children with CP have not been addressed by numerousinvestigations to date, there is limited information about their ToM skills andthe role of other different components of ToM development. Therefore, furtherresearch should be carried out to investigate this issue. The combined findingsof the reviewed papers showed that language skills had an effect on capacity toelaborate ToM competence in children with CP. This review study paves the pathto the future common research on children with CP and underlines importanceof using a methodology, in which ToM performance is studied in concert with adetailed investigation of speech and motor impairments.2021© The Authors. Published by JRSR. All rights reserved.

Dysphagia is a difficulty transferring liquid/food from the mouth to the stomach. It has life-threatening complications which can be reduced by thickening agents. There are various thickeners such as gelatin and xanthan. Each of these have their own characteristics. As Gelatin is melt in mouth, it is not an ideal agent for patients with dysphagia. However, xanthan gum has significant advantages in most important aspects of clinical applications like pH and temperature compatibility, consistency, appearance, odor, required concentrations of adequate liquid thickening, and resistance to amylase.  Therefore, despite some issues like the interaction with some oral drugs, generally Xanthan gum is the best choice to use for improving the swallowing ability of patients. Hence, the aim of this narrative review is to report the main characteristics of xanthan gum to make researchers and practitioners familiar with it and consider it in their works.

 General practitioners (GP) are the keystones in the process of referring patients in Iran. To refer patients to rehabilitation experts effectively and accurately, GPs need to be equipped with knowledge and understanding of physical medicine and rehabilitation (PMR) and its roles and have a positive attitude toward collaborating with rehabilitation teams.

 The current study aimed at evaluating the knowledge, attitude, and practice (KAP) of GPs in Shiraz, Iran, toward the rehabilitation field and teamwork.

 The current cross sectional study assessed the KAP of GPs working in public and private health sectors in Shiraz, Iran, in 2018 via a researcher-made questionnaire. Participants were recruited using the stratified random sampling method.

 A total of 200 GPs completed the study. The mean score of knowledge was 13.54 ± 2.68 (ranging from 0 to 24), and the mean score of attitude 10.84 ± 2.47 (ranging from 0 to 20). Regarding practice, none of the participants (0%) had a monthly average of more than five referrals to a physiatrist. Thirty-eight (19%) respondents were interested in choosing PMR as a specialty.

 According to the current study findings, GPs in Shiraz, Iran, are not equipped with adequate knowledge of rehabilitation and have a moderate attitude toward collaborating with a rehabilitation team. GPs rarely use PMR consultations for their patients’ complications. Policymakers should advocate for a higher level of collaboration between GPs and rehabilitation teams and find ways to better familiarize healthcare providers with PMR.

The tongue controls the bolus during mastication, keeps the bolus in the oral cavity and generates pressure to direct the bolus through the hypopharynx. A decrease in tongue movement and strength can increase the oral and pharyngeal food residues. Food residues have the potential to increase the risk of dental caries. The aim of this study was to investigate the correlation between tongue strength and the prevalence of dental caries in individuals with Down syndrome. 

  Sixteen children with Down syndrome participated in this cross sectional study; none of them had dysphagia and they had normal diet. The tongue strength was measured using the Iowa Oral Performance Instrument (IOPI) and dental caries were assessed by Decayed – Missing –Filled Teeth Index (DMFT). A speech therapist measured and investigated tongue strength and a dentist did the dental examination and filled out the DMFT form.

The mean age of participants was 11.06 (SD=2.83). Most of the participants were female (n=14, 87.50%). All of the subjects had mixed dentition. The mean of tongue strength was 10.23KPas (SD= 7.08). There was no correlation between tongue strength and the total number of DMF plus dmf, according to Pearson correlation (p=0.96; r= -0.01).

Tongue strength was very low in these children compared with reports in the literature. There was no correlation between the tongue strength and number of DMF and dmf; the main reason is that the development of dental problems such as caries are multi factorial. In other word there are additional factors apart from poor tongue strength that can cause caries.

Cerebral Palsy (CP) is defined as non-progressive brain damage attributed to limitation in mobility, learning, language, and communication. The high prevalence of low academic achievement in learning mathematics in CP cases is related, in part, to multifactorial influences; working memory may be one of the factors which can be related to arithmetic attainment. The purpose of this article was to review the relationship of working memory with mathematical performance in children with CP.

In this Review of literature article, Five English search engines (Pubmed, Scopus, Science direct, EMBASE, and Central) were used with key words, “cerebral palsy, arithmetic, mathematical performance, and working memory”. The inclusion criteria were English relevant articles in which participants had CP and both mathematical abilities and working memory were assessed.

A total of 103 articles were screened. Twenty-five potentially relevant titles or abstracts were identified. Based on inclusion criteria, only 7 articles were found.

Given the high risk of mathematical learning difficulties in children with CP, information about mathematical skills and the role of working memory on the different components of mathematical strategies is limited. Further research should be carried out to investigate this issue. The findings in this study showed the relationship between working memory and the difficulties with mathematical and numerical learning of CP cases.

The number of elderlies in the world is increasing and healthy aging has become a salient issue. A health threatening factor quite prevalent among the elderlies is dysphagia. Dysphagia causes severe complications and may have negative effects on the functional ability of patients; therefore, it is known as a geriatric syndrome. Oropharyngeal dysphagia is a difficulty or an inability of forming the bolus in the mouth and safely moving it from the mouth to the esophagus. It is also interrelated to other health problems such as malnutrition and oral health. Dysphagia, malnutrition and oral health disorders are likely to cause life-threatening aspiration pneumonia in patients. As a geriatric syndrome, dysphagia should be diagnosed and managed by a multidisciplinary team of professionals. Beside health care professionals, other groups such as policymakers, researchers and scientists, industries, health funders, and the society can have their own unique role to improve the quality of care for the elderlies suffering from dysphagia.