mehdi abdolvahab

Cerebro-Vascular Accident (CVA) is considered to be one of the main causes of acquired motor disability in adults. Different motor rehabilitation programs are being designed in order to improve motor difficulties of patients with CVA. In the current study we aimed to assess the effect of task-based mirror therapy on upper limb functions and activities of daily living in patients with CVA.
Twenty one patients with CVA were randomly divided into two groups of intervention (mirror therapy) (11 individuals) and control (10 individuals) and the both groups were receiving the usual rehabilitation protocol. The intervention group also received mirror therapy besides the usual program. Motor functions and activities of daily living were assessed via different tests (including: Box and Block test, Jebsen Taylor test, Minnesota manual dexterity test and Barthel scale) before and after the intervention course.
The results showed that regarding the effect of task-based mirror therapy on different motor skills and activities of daily living, measured by mentioned tests, the main effect of time as well as the interaction effect of group × time was significant (p Generally, our findings in the present investigation suggest that mirror therapy has the potential to improve upper limb function and activities of daily living in patients with chronic CVA.

Splinting is the most common conservative method of treating patients with mild and moderate Carpal Tunnel Syndrome (CTS). The aim of this study was to determine the effectiveness of the limited dynamic wrist splint on the symptoms, function, and strength of women with CTS. In this controlled trial study, the subjects wore a splint of a new design called the “limited dynamic wrist splint”, which allowed the wrist motion in the range (between 15-degree flexion and 15-degree extension) that exerts minimum pressure on the median nerve and prevents extra pressure on the nerve by limiting the range of motions out of the allowed range.
In this study, 24 women diagnosed with mild to moderate CTS were initially evaluated on the basis of the Boston questionnaire, the dexterity test of the Purdue pegboard, grip and pinch strength, distal sensory latency, and sensory nerve conduction velocity. The subjects were randomly divided into two groups, control and treatment. Both groups received routine rehabilitation treatment for six weeks. The treatment group received the limited dynamic wrist splint for about six to eight hours a day. After six weeks, the initial examinations were repeated. The SPSS-16, independent t, and paired t-tests were used for data analysis.
All the variables in the treatment and the control groups showed improvement. The function test of the Boston questionnaire, the Purdue pegboard test, and the pinch strength were significantly improved in the treatment group. The “severity of the symptoms” test of the Boston questionnaire and the pinch strength in the control group showed a statistically significant difference (P This study showed that the use of the limited dynamic wrist splint for about six weeks for six to eight hours a day could have a significant effect on the function, dexterity, and the pinch strength of patients with CTS. Not only can the patients receive treatment by this method, but they can also perform their daily activities to some extent.

Chronic non-specific low back pain is one of the important health problem in military and different factors have been reported in its emergence. The aim of this study is to determine the association between low back pain and education level, Body Mass Index (BMI), exercise, smoking status, work status and bad postures in military men. In this non-experimental case-control study, 92 subjects (mean age= 29.16 year, SD= 8.55 year) with chronic non-specific low back pain and 93 subjects (mean age= 26.80 year, SD=9.22 year) without low back pain were selected by simple non-probability method from military centers in Tehran. Evaluation tools of this study included a self-administrated questionnaire, weighting scale and metal tape measure. According to the results of bivariate logistic regression, risk factors of exercise (P= 0.003), smoking status (P= 0.042), grade of BMI (P= 0.034), bad posture grades including heavy objects lifting movements (P= 0.007), bending movements (P= 0.003), rotating movements from the lumbar (P= 0.011), carrying bulky objects (P= 0.034), carrying heavy objects (P= 0.05) and working in squatting position (P= 0.005) had a significant association with low back pain. Job status (P= 0.999), education level (P= 0.056) and bad postures grades movements like wringing clothes (P= 0.958) had not a significant association with low back pain. Doing regular exercise and having normal BMI decrease the risk of suffering from low back pain in the military while smoking and doing injurious physical activities during work (lifting heavy objects, bending movements and rotating from the lumbar, carrying bulky and heavy objects, and working in squatting position for a long time) increase the risk of suffering from low back pain.

Importance of upper limb function is clear in creating individual autonomy and daily activities. In this context, the role of dexterity is debatable in meeting of this important requirement since; after stroke major problems are occurred in hand function in particular dexterity. The present study, studied the effect of progressive resistance exercise on strength and dexterity of upper limb among adult hemiplegic patients.

This interventional research was performed on 17 adult hemiplegic patients after approving by TUMS ethical committee. After consent and introducing of test method, isometric strength of shoulder extensor and abductor muscles was evaluated by manual muscle assessment (MMT) and Pinch muscles strength by Pinch Gauge and Grip muscles strength by Jamar Dynamometer in kilograms and dexterity rate was evaluated by Minnesota manual dexterity test based on number in seconds and the results were recorded. Clients benefited from 6 intervention weeks. The resistance was offered to patients was set by weights which were attached to pulley. They were evaluated every two weeks and with the isometric muscle strength development more resistant is created in sinkers weight.

Results of this study showed that, after intervention period, progressive resistance exercises led to significant improvements in shoulder abductor and extensor muscles isometric strength, Pinch and Grip muscles strength and dexterity variables (P =0 / 000).

Present study showed that in rehabilitation of hemiplegia, to increase shoulder extensor and abductor muscles isometric strengths, Pinch and Grip muscles strength and finally improvement of hand function, especially dexterity can utilize in treatment of progressive resistance exercises.

Cerebral palsy (CP) children are the most referral patients to occupational therapy centers. Hand function is important in activity of daily living. There is a hand dysfunction in most cerebral palsy children. Orthosis and splint are commonly used to improve the position، range of motion، quality of movement، arm and hand function. The aim of this study was to investigate the effects of static anti-pronation splint on dominant upper extremity function in spastic diplegic cerebral palsy children with 8 to 12 years old. This interventional study is in a before-after design for two group case and control. Thirty spastic diplegic cerebral palsy children with 8 to 12 years old who had the inclusion criteria، were randomly assigned to case and control group. Patients of case group used a static anti-pronation splint for 2 months، 8 hours daily. In this study the Jebsen Taylor test was used to evaluate upper extremity function، the Goniometer was used to measure ROM of elbow، forearm and wrist، the Modified Ashworth Scale was used to assess spasticity of elbow، forearm and wrist. Power grip and pinch were assessed with MIE device. In the case group results showed a significant improvement in upper extremity function (0. 026)، forearm supination ROM (0. 007)، wrist extention ROM (0. 005)، forearm muscle pronator spasticity (0. 001)، wrist muscle flexsor spasticity (0. 009)، power grip (0. 001) and pinch (0. 001). The data did not show significant improvement on elbow extention ROM (0. 075)، elbow muscle flexsor spasticity (0. 164). In comparison with control group، the data showed a significant improvement in upper extremity function (P=0. 001)، forearm supination ROM (p=0. 034)، wrist extention ROM (P=0. 042)، forearm muscle pronator spasticity (P=0. 009)، power grip (P=0. 001) and pinch (P=0. 001). The data did not show significant improvement on elbow extention ROM (P=0. 140)، elbow muscle flexsor spasticity (P=0. 638) and wrist muscle flexsor spasticity (P=0. 105). The findings show that using static anti-pronation splint for 2 months، 8 hours a day، can be an effective method to improve upper extremity function، range of motion of forearm and wrist، forearm spasticity and power grip and pinch in spastic diplegic cerebral palsy children with 8 to 12 years old.

Background and Functional disabilities due to stroke produce a wide range of problems in daily activities. Rehabilitation approaches focus on preventing and reducing contractures and deformities. But constraint-induced therapy focuses on improving the performance of hemiplegic patients. The purpose of this study was to investigate the effects of constraint-induced therapy on strength and dexterity in adults with hemiplegia. The study population included 17 adult hemiplegics patients aged 50-70 years. The mean age of the patients was 64.23 with RT side dominancy and the time passed from stroke was 6 months (mean time= 23.70 months). Informed consent was obtained from the patients. Abductor and extensor muscles isometric strengths were measured using MMT. Also, pinch and grip strength was measured by Pinch Gauge and Jamar dynamometer, respectively. In addition, dexterity was evaluated by Minnesota manual dexterity test. Constraint-induced therapy showed significant improvement in the performance of pinch and grip strengths, abductor and extensor muscles isometric strengths and dexterity (P=0.000). Constraining the normal limb improves the performance of other affected limbs. This study suggests that constraint-induced movement therapy is of great benefit in increasing the isometric strength of shoulder extensor and abductor muscles, pinch and grip strength and dexterity. These improvements could consequently affect hand function in hemiplegic patients.

The number of elderly population in the world and also in Iran has increased due to health improvements and therefore، the quality of life has been focused in this group of population. Physical disabilities and particularly balance disturbances are among the consequences of the ageing process and hence، would affect the quality of life in elderly population. Mental practice is in fact the cognitive review of a physical skill without performing obvious bodily movements. The purpose of this study was to investigate the effect of mental practice of a movement skill on improvement of the quality of life in elderly men (60-80 yrs). This was a Single blind Randomized controlled trial (RCT) study. The study was approved by the research ethics committee of the Tehran university of medical science (Irct ID: IRCT201107041722N3). The elderly population was 44 elderly men (60-80 yrs.) who were living in Kahrizak Nursing Home. They were randomly assigned in two groups and entered the study based on inclusion criteria. After baseline assessment، the quality of life of all of participants were assessed by SF36 test and also at 3 various stages (i. e. respectively، before the beginning of، baseline assessment; two weeks after intervention، short term follow up; and 3 months after intervention، long term follow up). Elderly population in the intervention group did mental practice of one movement skill for 4 weeks and during this periods، the control group did no mental practice. The results of our study showed the scores of SF36 in physical component، after the intervention of mental practice، have had a significant difference between the control and intervention groups. Although test scores in mental component and the whole test score showed no significant difference between the case and control groups at 3 stages of assessments. The results of this study showed the significant effects of mental practices on physical component of SF36 in elderly population. However، these results also showed that this type of mental practice had no significant effects on mental component and total score of SF36.

Cerebral palsy (CP) is a neurodevelopmental disorder caused by nonprogressive lesions. This disorder produces motor impairment deficits in early infancy. Hand function is essential in performing activities of daily living for everyone، including individuals with cerebral palsy. Adequate first web space is essential for web space expansion، thumb abduction، and a wide range of thumb mobility and hand function. The purpose of this study was to determine the effects of C-bar splint on hand function and strength and also wrist and thumb range of motion (ROM) of dominant hand of 8-12 years old children with spastic diplegic cerebral palsy.

The design of this study was before- after and quasi-experimental. According with inclusion criteria، 8 to 12 years old children with spastic diplegia from physical – motor special school at Tehran (8 boys and 5 girls)، were studied. They used a C-bar splint (40 degree of palmer abduction of thumb) for 8 weeks (6-8 hours during day and 4-6 hours at night). In this study، hand function was evaluated by Jebsen Taylor Hand Function Test، hand strength by MIE dynamometer and thumb & wrist ROM by Goniometer. During intervention، they received routine occupational therapy program.

The results of this study showed significant improvement in hand function (P=0. 001)، and thumb range of motion (P=0. 02). The data did not show any significant improvement in wrist ROM and hand strength.

According to the result of this study، it seems that using C-bar splint can be an effective method in improvement of hand function and thumb ROM in 8-12 years old children with spastic diplegia.

Cerebral Palsy (CP) children are the most clients referred to occupational therapy settings. Hand function is important in Activities of Daily living. There is a hand dysfunction in most cerebral palsy children. Orthosis and splints are commonly used to improve the position, range of motion, quality of movement and function of a person's arm or hand. The aim of this study was to investigate the effects of static cock up c-bar splint on strength,spasticity, range of motion, and dominant hand function in spastic diplegic children with 8 to 12 years old. This interventional study is in a before-after design. Thirteen spastic diplegic cerebral palsy children with 8 to 12 years old were selected through students who studied in physical disabled schools in Tehran city and had the inclusion criteria. Patients used a static cock up c-bar splint (wrist in 10 degrees of extension and thumb in palmar abduction and opposition) for two months, 2 hours daily and 4-6 hours at night. In this study the Jebsen Taylor test was used to evaluate hand function, the Modified Ashworth Scale was used to assess spasticity of thumb, wrist and elbow, ROM of thumb, wrist and elbow were tested with goniometer and power grip was evaluated with dynamometer. Results showed a significant improvement in hand function (p<0.001), in wrist`s spasticity (p<0.001), elbow`s spasticity(p<0.008), palmar abduction of thumb spasticity (p<0.002), wrist`s ROM (p<0.001), Palmar abduction of thumb ROM(p<0.001) and power grip(p<0.001). The data did not show significant improvement on elbow`s joint ROM. Information from present research shows that using static cock up c-bar splint for 2 months, 2 hours a day and 4 to 6 hours nightly, can be an effective method to improve power grip, hand function, thumb, wrist and elbow spasticity and range of motion of thumb and wrist of spastic diplegic CP children.

Cerebral Palsy (CP) is a neurodevelopmental disorder caused by non-progressive lesions in single or multiple locations in the immature brain. Lesions of motor cortex and pyramidal tracts can lead to spasticity. Inhibition of spasticity is necessary to increase extremity mobilization, prevent postural abnormalities and provide independence in daily living activities. The purpose of this study was to determine the effects of volar static splint spasticity and range of motion of upper extremity in children with Cerebral palsy in threeperiods of time. The design of this study was experimental and repeated measurements. Ten children with Cerebral palsy aging 4-6 years old were non-randomly selected among children referred to occupational therapy Clinic of rehabilitation Faculty of Tehran University of Medical Sciences. Children used dorsal static splint for three months (2 hours at day and 4 hours at night). In this study, Modified Ashworth Scale was used to evaluate spasticity and a Goniometrewas used to measure passive range of motion. The results of this study showed significant reduction in the upper limb spasticity after 2 months (p≤0.0001) and significant increase in wrist passive range of motion after one, two and three months (p=0.007, p≤0.0001 and p≤0.0001, respectively) and significant increase in elbow passive range of motion after two (p=0.009) and three (p≤0.0001) months. This study shows that use of dorsal static splint in children with Cerebral palsy for 3 months has significant effects on reduction of upper limb spasticity and increasing passive range ofmotion of the wrist and elbow joints.

Cerebral palsy is a non progressive disorder and the most common movement problem in children. Many children with cerebral palsy are of hemiplegic type. One of the important problems of this children is unilateral upper limb dysfunction, that not using the affected side causes forgetfulness and more problems on this side. In this study, effectiveness of Constraint-Induced Therapy(CIT) and the maintainance of this technique on spasticity and performance of upper extremity in hemiplegic cerebral palsy children 6 to 12 years old have been investigated. In this pretest - posttest quasi experimental study, 20 cerebral palsy hemiplegic children 6 to 12 years old (15 boys and 5 girls) with 8.7 years mean age were selected. Interventions were performed about 8 weeks and patients were followed for 4 weeks. Spasticity on the affected side in wrist and elbow were tested by Modified Ashworth Scale and upper extremity function by the Box & Block test. The data were analyzed with the Wilcoxon and paired t- tests. Constraint-Induced Therapy in the affected limb decreases significantly the spasticity of wrist (p = 0.00) and elbow (p = 0.005) and significantly increases performance score (p = 0.00), and the recovery significantly maintained one month after the interventions. Constraint-Induced Therapy of affected upper extremity could possibly decrease limb spasticity and increase function with two mechanisms: Fierstly, The reduction of not using the plegic side and secondly, neuroplasticity in CNS. This improvement may remain viable in the affected limb.

The role of function of upper extremity in activity of daily living is critical and any impairment of function could cause major problems for diplegic spastic cerebral palsy (CP) patients. So, the application of rehabilitation protocols that could regain the hand function is very important.The purpose of this study was to explore the effects of simultaneous activation of exteroception and proprioception on function of upper extremity in children with diplegic spastic CP, 3-7 years old.

Thirteen CP patients (3-7 years; mean: 4.92 years; 4 boys and 9 girls) were participated in this study. Simultaneous activation of exteroception and proprioception were done 3 times a week (for 8 weeks). Function of upper extremity was evaluated by Quest Test and the degree of spasticity in wrist was evaluated by Modified Ashworth Scale.

The results of this study showed that after simultaneous activation of exteroception and proprioception, function of upper extremity was significantly improved (P<0.001). In addition, degree of spasticity in wrist muscles was significantly decreased (P<0.022).

Based on results of current study, it might be suggested that simultaneous activation of exteroception and proprioception could improve the function of upper extremity and decrease of spasticity. This in respect could reduce the disabilities of patients. So, the application of current protocols for the patients is suggested.

The Gross Motor Function Classification System Expanded and Revised (GMFCS E&R) has been widely utilized for objective classification of gross motor function of patients with cerebral palsy (CP). The aim of this study was to evaluate the inter rater reliability of Persian version of GMFCS E&R in patients with CP. This was a descriptive analytic study, carried out in Tehran on 202 children with CP (95 girls, 107 boys), (SD =0.5). At first, patients with CP were classified by researcher, and then five occupational therapists were asked to classify patients with CP in different levels of GMFCS E&R, at least one hour, up to one week. The result of each tester was evaluated and adapted with researcher. Data analysis was performed using non-parametric McNemar and Cochran tests. The Cochran test was used for determining inter rater reliability of Persian version GMFCS E&R and it showed p< 0.05 for the total score and showed no difference between testers, so there is high repeatability of GMFCS E&R. The Persian version of GMFCS E&R is a reliable classification system to classify patients with CP by medical and rehabilitation professionals.

in hemiplegic children Postural tone of the two sides of body is different. Once, asymmetric stance is a typical state in individual's with unilateral pain and/or paresis and standing is with weight bearing on the stronger side. Obviously, an asymmetric stance with majority of weight bearing on the affected side can counter faces individual with the falling risk and causes instability. It seems coordinating of the two sides of body is the most vitally important therapeutic exercises in hemiplegic patients. Although stable stance is a simple postural task but it's controlled semi-automatically by cortical and spinal centers. It is established that stable standing, also demands cognition resources. So, postural control demands the interaction between musculoskeletal and nervous systems.

In this clinical trial (before-after) 17 children 5-12 years old with spastic hemiplegia were participated. The subjects stayed in the center of force plate with the most stable standing position while using /not-using lateral wedge and in each state with/without doing cognition task. Short- memory test of digit span used as dual task condition. The mean range of fore-after and mediolateral sway and velocity and area as postural control independent variables and error measures in recalling of randomized digit chain as cognition task independent variables were registered.

The wedge affected Rsw (P=0.015), Area (P=0.007) and Vm (P=0.005) significantly. Dual task also had significant effect on Rfa (P=0.014), Rsw (P=0.014), Area (P=0.002) and Vm (P=0.002). But the wedge declines its effect properly.

: The results represent that a 5º lateral wedge applied to the unaffected limb, can improve factors of postural control even in Dual tasking; thus The wedge can be used with a good effect on the posture of hemiplegic children.

Aging is a natural phenomenon that affects on different systems of our body. This process is not due to diseases and accidents. Activity of Daily Living (ADL) is important for elderly persons. The aims of this study are to investigate the effects of progressive resistive exercises on Activities of Daily Living of elderly persons. Fifty elder men with age above 61 years old participated in this study. Twenty five elder men in exercise group with mean age of 69.45 and 25 elder men in control group whit mean age of 72.24. Strength of shoulder and knee extensors were evaluated by Tekdyne Incentive Dynamometers (TID). Activities of Daily Living were evaluated by Barthel - Index The measurements of shoulder and knee extensors of elder men were evaluated with TID. The data showed significant differences between mean score of pre and post interventions (p ≤ 0/0001). The measurements of self care activities, mobility and total score of elder men were evaluated with Barthel-Index. The data showed significant differences between mean score of pre and post interventions (p ≤ 0.0001). Presents data showed that progressive resistive exercises could be an effective approach to increase strength upper and lower body and improve Activities of Daily Living of elder men.

Speech as a motor phenomenon requires repetitive and rapid function of articulatory organs performing extremely fine movements. Practice on motor skills results in facilitation in treatment progress of children with phonological disorders. The purpose of this study was to compare motor skills in 5-year-old children with phonological and phonetic disorders. Thirty-two children age 5 years, 16 with phonemical speech sound disorders and 16 with difficulty at a phonetic level participated in this study. TOLD Test was performed for linguistic skills investigation among children. Phonetic test, Wepman test, diadochokinesis and oral assessment was used for diagnosis between phonological and phonetic disorders. The children were also evaluated with Oseretsky motor developmental scale. In comparison, mean scores of movement skills between both groups showed significant difference (p=0.006) and children with phonetic disorder got significantly higher scores on all part of this test. The findings of this study support the idea that speech sound disorders are frequently associated with motor problems, and that type of articulation disorder affects the motor performance in a different way. Phonological disorders seem to have more impact on motor performance than phonetic disorders. The results authenticate the need to pay more attention to the motor skills of children with articulation disorders.