فهرست مطالب

Rehabilitation Journal - Volume:17 Issue:39, 2019
  • Volume:17 Issue:39, 2019
  • تاریخ انتشار: 1397/12/10
  • تعداد عناوین: 12
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  • Masumeh Bagherzadeh Cham, Mohammad Ali Mohseni Bandpei *, Mahmood Bahramizadeh, Saeed Kalbasi, Akbar Biglarian Pages 1-7
    Objectives
    Sensory neuropathy is the major cause of ulceration in diabetic patients. Periodical sensory examination is an appropriate method to detect neuropathy and decrease the risk of diabetic foot ulcer. Semmes–Weinstein Monofilaments (SWM) and tuning fork on/off test are widely used to assess pressure and vibration sensitivity. The present study evaluated the inter- and intra-rater reliability of SWM and tuning fork to measure pressure and vibration sensations in diabetic patients.
    Methods
    Following ethical approval, 34 diabetic patients without foot ulceration were recruited. Feet kit SWM and tuning fork were used for pressure and vibration sensation evaluation, respectively. Measurements were performed twice on the first session with an hour interval to assess within-day reliability and the third one was demonstrated 7 days later to assess between-days reliability. 
    Results
    Within-day Intra-class Correlation Coefficient (ICC) analysis indicated excellent levels of inter- and intra- rater reliability (ICC>0.75) for feet kit SWM in all foot regions and 128 Hz and 256 Hz tuning forks. Excellent between-days intra-rater reliability (ICC>0.75) was also obtained for SWM; however, the ICC of tuning fork was moderate. Between-days inter-rater reliability of SWM and tuning fork were high and poor, respectively.
    Discussion
    The obtained results indicated that SWM and tuning fork seemed to be highly reliable to measure pressure and vibration sensations in diabetic patients. However, further studies are required to support the results of current study.
    Keywords: Pressure sensation, Vibration sensation, Observer variations, Diabetes Mellitus
  • Sahar Johari, Mina Ahmadi Kahjoogh*, Fatemeh Sanei, Naser Havaei, Mostafa Daemi Pages 9-16
    Objectives
    The present study examined the effect of home-based handling training of mothers on the improvement of gross motor function of children with Cerebral Palsy (CP).
    Methods
    In this randomized control trial, 42 children with CP (5-12 years old) were randomly assigned into the intervention and control groups. Data were collected using the Gross Motor Function Classification System and Gross Motor Function Measure. 
    Results
    Gross motor function suggested significant improvement in the intervention group, in comparison with the control group (P<0.01). 
    Discussion
    Handling training of mothers could be advised as a complementary and helpful intervention for gross motor function improvement in children with CP.
    Keywords: Cerebral Palsy, Motor skills, Mothers
  • Farnaz Mobini, Mehrdad Anbarian, Leila Ghazaleh* Pages 17-21
    Objectives
    The results of a few studies about the effects of ankle brace on muscles function during the performance of different tasks are contradictory. Moreover, the effect of brace on the co-contraction of ankle muscles is undiscovered. Therefore, the present study investigated the effect of brace usage on the ankle muscles activity and co-contraction during single-leg landing.
    Methods
    Fifteen non-athletic males aged 22.3±1.09 years without any traumatic injury and abnormality of the lower limb participated in this study. Electromyography activity of the ankle muscles (tibialis anterior, lateral gastrocnemius, medial gastrocnemius, peroneus longus and soleus) and muscle co-contraction in the anteroposterior and mediolateral directions were compared between two single-leg landing conditions, in respect of braced and unbraced ankle. The subjects landed from a 60-cm height bench. For the normalization of electromyography amplitudes, maximal voluntary isometric contractions were recorded for each muscle. Paired Samples t-test was used to compare muscle activities and co-contractions between the two conditions of landing.
    Results
    In general, the activity of selected ankle muscles was reduced in braced condition, compared to the unbraced condition (P<0.001). This reduction was not significant in the gastrocnemius lateralis muscle. In addition, the muscles co-contraction decreased in both directions during landing in braced condition (P<0.05).
    Discussion
    According to the obtained results, ankle brace reduces the activity and co-contraction of ankle joint muscles during landing. These findings can be considered as advantages of using brace, because it could reduce the load imposed on joint and muscles.
    Keywords: Brace, Electromyography, Muscle activity, Co-contraction
  • Malahat Amani*, Sabra Poustinch Pages 23-29
    Objectives
    Paper and pencil exercises are extensively used to enhance children’s visual perceptual skills, while exercises involving volumetric shapes have been neglected. The present study aimed to develop a combined training package, including volumetric shapes and paper and pencil exercises, and to investigate its effectiveness in strengthening the visual perceptual skills of preschool children. 
    Methods
    This was a quasi-experimental study with pre-test post-test and a control group design. The statistical population of the study consisted of preschool children (n:30; age:5-6 years), who were randomly assigned to the control and experimental groups. In the experimental group, the training package reinforcing visual perceptual skills was presented in ten 45-minute sessions in a play and paint framework. In the pre-test and post-test phases, the Frostig developmental test of visual perception was completed by children.
    Results
    The results suggested that the post-test pre-test differences between the experimental and control groups were significant in terms of the following components: differentiation between object and background, understanding shape stability, the perception of position in space, and the total score of visual perception. 
    Discussion
    Considering the effectiveness of combined training package in strengthening visual perceptual skills, it can be used to facilitate learning in preschool children and reduce visual perceptual deficits in children with learning disabilities.
    Keywords: Visual perception, Training, Preschool children
  • Saeed Shahabi, Mohammad Kamali*, Hossein Mobaraki, Narges Shafaroodi, Hassan Saeedi Pages 31-38
    Objectives
    The present study explored challenges in orthotics and prosthetics clinical learning environments in Iran. 
    Methods
    A qualitative content analysis method was used to obtain data on orthotics and prosthetics clinical educator’s experiences. Qualitative data were obtained using semi-structured in-depth interviews involving 7 clinical educators; all selected by the maximum variation purposeful sampling method. Interviews continued until data saturation.
    Results
    During the interview sessions, notes and ideas were classified and assorted. The study themes were relationships, personal characteristics, facilities, and policies. Analysis of the qualitative data provided insights into the barriers to the desired delivery of clinical education services.
    Discussion
    The present research contributes to clinical educators’ experiences in respect of the clinical learning process. Clinical learning concerning orthotics and prosthetics education remains crucial. The findings emphasize the importance of listening to educators, and consider how relationships and contexts impact clinical learning. Understanding the challenges in clinical education environments has increased the quality of clinical education in orthotics and prosthetics field.
    Keywords: Challenges, Clinical learning environment, Clinical educator, Orthotics, Prosthetics, Qualitative study
  • Alireza Khammar, Mohsen Poursadeghiyan, Hossein Marioryad, Reza Nabi Amjad, Monir Alimohammadi, Mohammad Khandan * Pages 39-47
    Objectives
    Hospitals and clinical centers are concerned about patient safety. Safety climate is a perceived value of safety in an organization that could improve the safety of workers and patients. The present research was conducted to study the safety climate of patients in the hospitals and rehabilitation centers affiliated to the University of Social Welfare and Rehabilitation Sciences. 
    Methods
    This descriptive-analytical study was conducted on 300 nurses and nurse’s aides (healthcare staff) who were selected by stratified sampling method, from two hospitals and three clinics, in 2017. Data collection tools included Patient Safety Climate Scale presented by Kudo and a demographic data questionnaire. The obtained data were analyzed by SPSS using descriptive statics like frequencies and percentages. Furthermore, Mann-Whitney U test and Kruskal-Wallis test were used to analyze the obtained data and compare the mean scores, respectively. 
    Results
    The Mean±SD age and work experience of study participants were 36.7±6.79 and 9.46±5.8 years, respectively. The patient safety climate sub-factors were significantly different between males and females (P0.05). Patient safety climate was only different in nursing condition (P=0.013) among studied healthcare centers. Also, only fatigue reduction was different among various studied wards (P=0.035), where intensive care unit had the lowest score (2.12±2.0).
    Discussion
    Overall, the poor condition of patient safety climate was found in the studied rehabilitation centers. Therefore, it is recommended to improve nurses’ attitudes with the assistance of hospital managers, to enhance patient safety.
    Keywords: Patient safety climate, Safety culture, Safety attitude, Job satisfaction, Rehabilitation
  • Maryam Rastegar, Enayatollah Bakhshi*, Samaneh Hosseinzadeh Pages 49-52
    Objectives
    The categorical data analysis is very important in statistics and medical sciences. When the binary response variable is misclassified, the results of fitting the model will be biased in estimating adjusted odds ratios.  The present study aimed to use a method to detect and correct misclassification error in the response variable of Type 2 Diabetes Mellitus (T2DM), applying binary logistic regression. 
    Methods
    Data from the Diabetes Screening test in the Health Center of Zahedan City, Iran, were explored.  It included 819 Iranian adults with a binary response variable (T2DM). By a new method, the misclassification parameters and the estimated parameters in logistic regression were validated. Statistical analysis was performed using SAS, and P<0.05 were considered as statistically significant. Results are presented as Odds Ratio (OR) and 95% Confidence Interval (CI). 
    Results
    Increased age (OR=1.04, 95% CI=1.02-1.06), hypertension (OR=3.06, 95% CI=1.80-5.21), and obesity (OR=1.99, 95% CI=1.26-3.15), all elevated the odds of T2DM. 
    Discussion
    The method provided adjusting for bias due to misclassification in logistic regression, and using it is recommended.
    Keywords: Logistic regression, Diabetic, Odds ratio
  • Akbar Darouie, Mamak Joulaie, Farzaneh Zamiri Abdollahi*, Amy Mcconkey Robbins, Somayeh Zarepour, Tayebeh Ahmadi Pages 53-59
    Objectives
    Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) is a useful tool for the quantitative evaluation of auditory behaviors in different situations. The  present study  aimed to  develop the Persian version of IT-MAIS. 
    Methods
    There was 4 main steps in the translation and validation of the scale, as follows: forward translation, synthesis, backward translation, and expert committee discussion. Then, the final Persian version of the scale was analyzed in terms of reliability and validity. The scale was studied on the parents of 17 hearing impaired and 17 normal hearing children.
    Results
    There was a significant difference in the mean score of scale between hearing impaired and normal hearing children (P≤0.001). The internal consistency of the items was satisfactory. The Cronbach’s alpha for the overall score was 0.93. 
    Discussion
    This study suggested that IT-MAIS-F can be a reliable and valid tool for the evaluation of the auditory function of children. However, the sample size of the study was small. Thus, studies with larger sample sizes are recommended. In addition, test-retest reliability of the scale was not studied.
    Keywords: Hearing loss, Cochlear implants, Hearing aids, Infants
  • Omid Massah, Nastaran Rafiee, Ali Farhoudian, Bahman Bahmani, Elaheh Ahounbar, Seyed Hadi Mousavi*, Mohsen Roshani Pages 61-65
    Objectives
    This study aimed to compare the ratio of suicide attempts between female opium and Methamphetamine (MA) users to determine the relationship between the increased prevalence of MA and suicide risk. 
    Methods
    In this cross-sectional study, 136 drug dependent females were randomly selected from Tehran. Data gathering was performed by a demographic questionnaire and Beck Scale for Suicidal Ideation. Data were analyzed by Chi-squared test and Independent Samples t-test.
    Results
    There was no significant different in suicidal ideation between the two groups; however, the suicide attempt was significantly higher in the MA users compared to opium users (P<0.001).
    Discussion
    Suicide attempt is much higher in females who use crystal MA, compared to female opium users. This could be a warning to prevent associated risks.
    Keywords: Methamphetamine, Opium, Suicide attempt, Women, Iran
  • Fatemeh Menatnia, Shohreh Noorizadeh Dehkordi*, Mehdi Dadgoo Pages 67-73
    Objectives
    Clinical education in medical sciences is essential, because of its important role in the education of specialist skills. Physiotherapy specialization is among the main branches of medical sciences, which requires high academic and professional skills. One of the most important and effective methods to assess the quality of clinical education in physiotherapy is to review it from a student’s perspective. Therefore, this study attempted to recognize the barriers of clinical education in physiotherapy students from their own perspective. 
    Methods
    This qualitative study used content analysis method. Data were collected using semi-structured interviews and the samples were selected by purposeful sampling method. We have considered maximum variation (gender, semester, educational level, place of residence) of persons in the sample selection. The data collection continued until saturation was reached. Participants included 13 physiotherapy undergraduate students who had completed at least 6 clinical education units.
    Results
    We extracted 182 original codes from interviews analysis. By eliminating and matching the data, we finally developed 4 categories, as follows: 1. Personal and professional characteristics of clinical educators; 2. Personal characteristics of students; 3. Inadequate education system; 4. The inappropriate clinical education environment.
    Discussion
    Clinical incompetency, inadequate clinical skills, and failure to observe professional ethics are the most frequent problems of clinical supervisors. Moreover, student’s irresponsibility, inadequate participation, the lack of self-esteem in some students, and inappropriate planning and the implementation of clinical education of PT department and inappropriate interpersonal communication and facilities in clinical settings, can be considered as barriers for clinical education. Considering the obstacles and attempts to resolve them, reviewing the clinical education process can improve its quality. Reviewing the clinical education process seems to help recognize its barriers and attempt to resolving them. It seems to improve the quality of clinical education.
    Keywords: Clinical clerkship, Physical therapy specialty, Qualitative research
  • Maryam Farzad*, Mokhtar Arazpour, Erfan Shafiee, Fereydoun Layeghi, Deborah A. Schwartz Pages 75-80
    Objectives
    Flexion contractures of the Proximal Interphalangeal joint are the most frequent complications resulting from surgical procedures and traumatic events. Orthotic interventions for the treatment of contractures may include serial splinting, serial casting, dynamic or static progressive orthoses, or a combination of these orthoses. This study aimed to determine the effects of serial casting methods using thermoplastic tape in the Proximal Interphalangeal (PIP) joint flexion contracture treatment.
    Methods
    Thirty-one patients with flexion contracture of the PIP joint (mean: 32.5°, range: 10-65°) were treated by serial casting method using thermoplastic tape. Flexion contracture, total active motion, extension lag and flexion gap were evaluated in the first session. The affected joint was casted after hand therapy interventions. Patients were requested to visit the clinic every other day for recasting and receiving exercises.
    Results
    After one month, the mean range of flexion contracture decreased from 32.5° to 10.7°. The mean range of flexion gap decreased from 3.2 cm to 1.8 cm. The mean range of extension lag decreased from 2.04 cm to 0.86 cm, and the mean range of total active motion increased from 81.67° to 128.81°. All of the aforementioned changes were statically significant (P<0.05).
    Discussion
    The use of thermoplastic tape for serial casting is an effective and reliable method for the treatment of PIP joint flexion contracture.
    Keywords: Flexion contracture, Cylindrical serial casting, Thermoplastic material, Proximal Interphalangeal Joint
  • Hossein Soufi Ahmadi, Afsoon Hassani Mehraban *, Malek Amini, Maryam Sheikhi Pages 81-89
    Objectives
    Stroke is one of the main causes of disability and mortality worldwide. Most survivors experience impairments in their upper limb motor function.
    Methods
    This experimental study was performed as a clinical trial on 30 chronic stroke patients who experienced stroke from 6 to 96 months ago. Patients were non-randomly divided into the intervention (Virtual Reality besides conventional occupational therapy) and control (conventional occupational therapy) groups. Each treatment session lasted for one hour which was divided into conducting conventional occupational therapy techniques and Virtual Reality (VR) for the intervention group, and routine techniques for the control group. The intervention effectiveness was evaluated by the Fugl-Meyer Upper Extremity Scale, Stroke Impact Scale, Chedoke Arm and Hand Activity Inventory, Motricity Index, Modified Ashworth Scale and goniometer. Results were analyzed by SPSS and one-sample Kolmogorov-Smirnov, Shapiro-Wilk test, Independent Samples t-test and Mann Whitney U test were applied to assess the normality of data and to detect significant differences between study variables.
    Results
    The results suggested that investigated parameters such as upper limb motor function, muscle tone and the range of motion were significantly different in the intervention group, compared to control group; however, there was no significant changes in none of the group’s daily living activities. 
    Discussion
    VR-based computer games in combination with routine occupational therapy interventions could improve upper extremities functional impairments in chronic stroke patients. However, it seems the mechanisms behind the effectiveness of video games and their impact on brain cortex as well as upper limbs function need to be further investigated.
    Keywords: Virtual Reality, Rehabilitation, Stroke, Upper limb function