فصلنامه طب توانبخشی
سال هشتم شماره 4 (زمستان 1398)

The aim of this study was to investigate the sensory processing status of children with autism from 3 to 14 years old based on the children sensory profile 2.

In this descriptive study, 43 children with autism disorder participated. After completing the demographic questionnaire and obtaining consent, parents of children with autism were asked to complete the children sensory profile 2. Participants' demographic information and sensory processing status were analyzed by SPSS software version 22 based on the cut-offs of the 13 sections of the questionnaire.

In this study, 25.6% of the children were female and 74.4% of them were boys. Frequency of sensory processing disorder based on cut of point the children sensory profile 2 (seeking: 37.2%, avoiding: 53.6%, sensitivity: 55.8%, registration: 60.5%, auditory: 28.8%, visual: 39.6%, touch: 58.2%, movement: 44.2%, body position: 53.5%, oral: 39.6%, conduct: 48.9%, social emotional: 67.6% and attentional: 44.2%).

Awarding to the findings, it can be concluded that increasing the frequency of registration as a sensory processing disorder leads to affecting social emotional responses.

The purpose of the present study was to investigate the effect of six weeks of CX WORX training on core muscles endurance, balance, and upper extremity function in athletic girls with trunk deficiency.

Participants of the study were 30 female athletes with trunk deficiency (mean age:  23.26±2.54; height: 1.60± 0.05; weight: 58.26± 7.03 and BMI: 22.79± 3.23) volunteered to participate in the study and were randomly divided into control and experimental groups. Trunk deficiency in participants was evaluated using Tuck Jump test. In pre-tests, the static and dynamic balances were evaluated using BESS and Y tests, respectively. Y-test was also used to evaluate upper extremity function. Core muscles endurance was also assessed using the McGill Endurance Test. The experimental group then performed six weeks of CX WORX exercises. At the end of the training, the control and experimental groups performed post-test. In order to compare within and between groups, paired t-test and covariance analysis were used at the significant level of P

The results showed a significant effect of CX WORX training on endurance of core muscles (p<0.05), static balance (p <0.05), dynamic balance (p <0.05), and Upper extremity Function (p<0.05) in experimental group in comparison with the control group.

According to the results of the study, it is recommended that this training be used as an effective method to improve the present components.

Children with autism spectrum disorder use different questions in social interactions in a restricted way. Since asking questions is a pivotal skill which is associated with language skills and learning opportunities, it is crucial to consider this skill as a treatment objective. Accordingly, the present study examined the effectiveness of Pivotal Response Treatment (PRT) on the correct use of different questions in the context of social interactions of children with autism spectrum disorder.

The present study was a single subject study with an A-B design. The population consisted of the children with ASD in Kahrizak maintenance, training, and rehabilitation center in Alborz Province. From this population, three children were selected using purposive sampling method. The research instruments were the diagnosis scale of autism spectrum disorder (ASDDS) and a researcher-made checklist. For this purpose, after the baseline condition, the intervention began and the pivotal response treatment was provided to participants for 10 weeks. The dependent variable (the correct use of different questions in the context of social interaction) was carefully measured by two observers. For data analysis, charting and stability envelop and the process for graphing, using within and between condition analyses, were employed to investigate the effectiveness of the independent variable on the dependent variable.

The mean scores of 39.59, 41.38, and 39.55 for the three participants in the baseline changed to 51.38, 49.71, and 50.61 after the intervention. In the visual analysis of the data graph, the intervention was shown to be effective for all three participants. The percentages of non-overlapping data (PND) in the two baseline and intervention conditions for the three participants were 90, 80, and 90, respectively. This effectiveness remained visible in the follow-up condition.

The results of the current study indicated that the use of Pivotal Response Treatment (PRT) improves the correct use of different questions in the context of social interaction in children with autism spectrum disorder. Accordingly, this method can be used in training and rehabilitation of this group of children.

The present study was conducted to compare the effectiveness of eight weeks of core stability and acupuncture on pain and disability in middle age females with non-specific chronic low back pain.
A total of 45 females with non-specific chronic low back pain participated in the current semi-experimental study and were randomly divided into three groups: acupuncture, core stability training, and control. Before and after the intervention, visual analogue scale and the QUEBEC disability index were used to assess pain intensity and disability, respectively. The differences between and within groups were analyze running ANOVA and pair t-test, respectively.
The results showed that the disability and intensity pain decreased significantly in the acupuncture and stability training groups [P≤0.05], yet no significant difference was found between the two interventions in the post-test [P≥0.05].
According to the results, it seems that both acupuncture and core stability training can decrease pain and functional disability intensity in females with non-specific chronic low back pain. However, still, we cannot claim on the superiority of one of them, and thus further studies are needed.

Numerous studies have been conducted on muscular fatigue and its impact on balance movements, but limited information is available on tiredness and fine motor skills. Therefore, the current study was carried out to investigate the effect of shoulder muscle fatigue on fine (pencil drawing) and gross (paw pass) skills of professional volleyball players.
A total of 31 skilled volleyball players (16 girls and 15 boys) were selected using available sampling method. Research variables were evaluated before and after fatigue. Independent and dependent t-test were used to analyze the data in SPSS. The significance level was set at p <0.05.
The results showed that speed and pressure of hand was reduced in girls after fatigue (p <0.05), while it increased the hands speed in boys. Variability of hand performance in both groups did not changed significantly after fatigue (p >0.05). The speed and precision of volleyball overhand pass was similar before and after fatigue.
According to the results, the fatigue of the shoulder complex muscle decreased the performance in the fine skills of the fingers of girls, but it did not affect the performance of the two groups regarding the hand gross skills.

The global epidemic of obesity has affected the general health. The aim of the present study was to compare the effects of low and moderate intensity circuit resistance trainings on the levels of adiponectin and lipid profiles in overweight women.

A total of 54 overweight women [31.56±2.24 years, 80.45±9.4 kg, 28.3±6.21 kg/m2] were randomly assigned into three groups of moderate intensity circuit resistance training (MICT), low intensity circuit resistance training (LICT), and control. Exercise training program was conducted for eight weeks, three sessions per week. Before and after the exercise training program, the levels of adiponectin and lipid profiles were measured. For data analysis, descriptive statistics, analysis of covariance test and Bonferroni post hoc test were used. Data analysis was performed in SPSS, version 20, with the significance level set at p≤0.05.

At the beginning of the study and before applying the exercise protocol, there was no difference in baseline adiponectin between the groups (p>0.05). The results indicated that adiponectin levels significantly increased after eight weeks of moderate-intensity circuit resistance training as compared with control group (p=0.027), but changes in adiponectin levels were not statistically significant in low intensity group (p=0.14). Decrease in the levels of LDL-c (p=0.001), cholesterol (p<0.001), and TG (p<0.001) and increase the levels of HDL-c (p<0.001) were significant in moderate intensity group compared to those of the control group.

According to the results obtained in the present study, moderate-intensity circuit resistance training has been shown to be effective in increasing adiponectin, therefore, the lipid profiles in this group had a significant improvement related to these changes.

Genu Varum is one of the most common malalignments of lower limb but not a lot of attention have been paid to the biomechanics of lower extremities and the muscle activities while performing the sport specific tasks in the persons. The aim of the present study was to compare the Electromyographic activity of trunk and hip muscles during the single leg jump-landing in men with and without Genu Varum.

A total of 30 athletes (15 with genu Verum and 15 without this malalignment) participated in the current cross-sectional study. Genu Varum was assessed using Bone Caliper with the accuracy of 0.01 mm. Participants performed the jump-landing on a forces Plate (Model ver 3.0.2, Danesh Salar Iranian Co.). The electromyography activities of muscles were recorded using the EMG and 100 milliseconds before and after the initial contact. MATLAB software was used for data analysis. For the statistical analysis, the independent t-test with the significance level of o≤0.05 was used.

There were no significant differences in the activity of biceps femoris and semitendinosus muscles between the two groups, but there were significant differences in the mean values of gluteus Medius (P=0.001) and quadratus lumborum (P=0.002) activity between the groups (P<0.05).

According to the results, it seems that the Genu Varum is effective on the biomechanics of jump-landing and it is associated with reduced activity in the gluteus Medius and quadratus lumborum muscles. These changes may be associated with reduced lateral stability and increased risk of injuries in the athletes.

Ankle instability is one of the most commonly encountered injuries in emergency centers and those with postural stability deficits are sustainable. The purpose of the present study was to compare the time to achieve stability and ankle muscle activity during landing in individuals with functional ankle instability and healthy controls.

In the current descriptive study, 15 students with ankle instability and 15 healthy participant were recruited as targeted and available sample in Karaj city. A force plate and surface electromyography to calculate the time to stabilization and medial gastrocnemius muscles, soleus, the tibialis anterior, and peroneus lunges were used.

There was a significant difference between experimental group and control group in the time to achieve the stability of the anterior-posterior direction during the landing movement between the experimental and the control groups (P = 0.001), and this difference was significant in the internal-external context (P = 0/000). Also, statistical results regarding comparison of the electrical activities of the selected muscles showed no significant difference between the experimental and the control groups during the landing movement in the medial gastrocnemius, but there was a significant difference in soleus, tibialis anterior, and peroneus lunges muscles.

According to the results obtained in the present study, it seems that ankle instability can decrease stability and reduce the stability and alteration of the activity of soleus, tibialis anterior muscles, and peroneus lunges. Decrease in the time to reach stability and muscle disfunction in the group with ankle instability force us to use joint rehabilitation with proprioception exercises and concentration on soleus, peroneus lunges, and Tibialis anterior in these individuals.

Backgrounds and Low back pain is one of the most common occupational injuries, and teaching is one of the jobs that is associated with the risk of developing low back pain due to the nature of the work. The purpose of the present study was to investigate the prevalence of the back pain and its relevance to physical activity and body mass index in teachers.
In the current field study, 289 female teachers, aged between 24 and 60, with average body mass index of 26.88, were selected using random and cluster sampling methods. The VAS scale and Baecke questionnaire, respectively, were used to measure the rate of low back pain in different periods of life and physical activity in the participants. Spearman correlation test was used for data analysis.
The results showed that there was a strong and negative relationship between the prevalence of low back pain and physical activity in different life periods (P <0.05). Also, there was a significant relationship between current low back pain and physical activity (ICC=-0.244, P=0.001). The same relationship also was found between low back pain in the past six months and physical activity (ICC=-0/239/0 and P=0.001), between low back pain in the past year and physical activity (ICC=-0.264, P=0.001), and between low back pain during the life expectancy and physical activity (ICC=-0.269; P=0.001). In addition, there was a significant relationship between BMI and prevalence of low back pain during the life (P <0.05).
Conclusion Given a strong relationship between the prevalence of low back pain in different periods of life and physical activity, as well as the positive relationship between low back pain and BMI, it seems that having a regular exercise can lead to better health in the lumbar region of female teachers.

People with Intellectual Disability are a vulnerable social group whose physical health is also important. The purpose of the present study was to compare quality of life and physical fitness in male and female athletes with Intellectual Disability participating in Iranian Special Olympics.

The research sample included 126 individuals with Intellectual Disabilities: 70 males with Intellectual Disability with and without Down Syndrome and 56 females with Intellectual Disability without Down Syndrome, aged 18 to 30 years participating in Iranian Special Olympics. As for assess, a set of Eurofit Special tests, including explosive leg strength (standing broad jump), arm strength (pushing a 2 kg ball), abdominal muscle endurance (Sit-up), speed (20 meter run), flexibility (sit and reach), and balance (walk on a bench) for physical fitness, and Schalock’s and Keith’s Quality of Life Questionnaire for quality of life were used. To compare the two groups, SPSS software was used running independent T-test and Mann-Whitney U statistical methods at the significance level of =α0/05.

There was a significant difference in variables Competence/Productivity (P=0.010), Empowerment/Independence (P=0.001), total score of the Quality of Life (P=0.037), body mass index (P=0.008), abdominal muscle endurance (P=0.010), speed (P=0.001), and arm strength (P=0.001) between males with Intellectual Disability with Down Syndrome and females with Intellectual Disability, and also Competence/Productivity (P=0.036), Empowerment/Independence (P=0.001), total score of the Quality of Life (P=0.021), flexibility (P=0.003), balance (P=0.001), speed (P=0.001), and arm strength (P=0.001) between males with Intellectual Disability without Down Syndrome and females with Intellectual Disability.

According to the results, it can be concluded that male athletes with Intellectual Disability have higher quality of life and physical fitness than females with intellectual disability. As for the little information on this issue, it is necessary to examine more accurately the content of programs of the Iranian Special Olympics.

Excessive foot pronation is one of the major risk factors for anterior cruciate ligament's injuries.The purpose of the present study was to investigate the immediate effects of anti-pronation foot orthoses with various angles on ground reaction force components during walking.
A total of 15 healthy volunteers (age: 28.2±8.8 years; height: 179.5±8.4 cm; weight: 76.3±13.5 kg; BMI: 23.7±9.1 kg/m2) participated in the study. A Vicon motion analysis system, including four cameras, and two Kistler force plates were used to measure the ground reaction force components in walking with shoes without foot orthoses as well as walking with shoes and three different foot orthoses (10º, 15º, and 20º of lateral inclinations).
In foot orthoses with 20º inclination, the ground reaction force in vertical and medial-lateral directions at initial heel contact was greater than those without foot orthoses by 5% (p=0.02) and 110% (p=0.02), respectively. Impulse, loading rate, and free moment were not different between walking with different foot orthoses compared with those of walking without foot orthoses (p>0.05).
The application of anti-pronation foot orthoses (20º inclination) can reduce the loading rate at propulsion; however, it may impose loads to the knee which consequently place the knee on genu varum position, facilitating medial knee osteoarthritis.

Vaspin and Omentin are adipokines and seem to be related to metabolic risk factors. The purpose of the present study was to investigate the effects of continuous endurance training (CET), circuit resistance training (CRT), and high intensity interval training (HIT) on plasma levels of Omentin and Vaspin in obese young men.

A total of 44 obese young men voluntarily participated in the present study and were randomly divided into continuous endurance training (CET; n=11), circuit resistance training (CRT; n=11), high intensity interval training (HIT; n=11), and Control (Con; n=11) groups. CET was done with 70% VO2max. Also, HIT was performed with six three-minute sets of running at 90% of VO2max, while CRT was done at 11 stations with 20% 1RM, three times a week for 12 weeks. Blood samples were collected before and after training protocols and Omentin-1 and Vaspin were measured in the plasma. To compare between-group data, two-way ANOVA with repeated measurements and Bonferron's post hoc test were run.

The results showed that there is no significant difference between CET, HIT, and CRT in the Omentin-1 and Vaspin after training (p˃0.05). However, Omentin-1 increased significantly in the CRT (p=0.002) and HIT (p=0.011) compared with the controls. Also, Vaspin significantly decreased in the CRT compared with that in the control group (p=0.029).   

Finally, it can be stated that none of the continuous endurance, circuit resistance, and high intensity interval trainings is preferable to improve Vaspin and Omentin-1 although they can improve hormone levels after 12 weeks of exercise training.

Tennis elbow is one of the most common injuries due to overuse in athletes and even non-athletes. The purpose of the present study was to compare the effect and durability of four weeks of eccentric and stretching exercises with dry needle therapy on pain (pain during rest and pain during activity) of athletes suffering from tennis elbow.

The statistical samples of the study consisted of 20 patients with tennis elbow who were randomly divided into two groups of combined exercises (10 participants including 5 women and 5 men) and dry needling (10 participants including 3 women and 7 men). The combined exercises group did tensile and eccentric exercises three days a week, and dry-needling was performed for the other group three days a week. In the present study, intra-group changes in the variables of the research were measured from pre-test until the end of the fourth week. Regarding the normal distribution of data, paired t-test was used to examine intra-group variation and ANCOVA test was used to examine intergroup differences.

The results of paired t-test and covariance analysis showed that four weeks of combined eccentric and tensile training as well as dry-needling significantly reduced pain (pain during rest and pain during activity) of patients with tennis elbows (P ≥0.05).

According to the results, both methods of combinational training and dry needling significantly reduced pain in athletes suffering from tennis elbow after four weeks of intervention, but the effect size in dry needling was larger.

Various factors can affect athletes’ performance one of which is over pronation of the foot. The purpose of the present study was to investigate the effects of long-term use of motion control shoes on the frequency spectrum of ground reaction force during running in runners with pronated feet.

The current study was a semi-experimental and laboratory investigation. The sample consisted of 30 male runners with pronated foot who were divided into experimental and control groups. The Bertec force plate was used to record ground reaction forces. Control group used normal shoes (Supernova control, Adidas) and experimental group used the motion control shoes (Supernovacushion, Adidas) during five months in their training sessions. Non-parametric Wilcoxon test was used for statistical analysis at the significance level of 0.05.

The results of the experimental group showed that the frequency component with a power of 99.5% in vertical direction during the post-test compared with the pre-test was significantly decreased (P=0.023). In the medio-latral direction, the frequency band component during the post-test showed a significant increase compared to the pre-test (P=0.041).Other components of the frequency spectrum of ground reaction forces have no significant difference in the experimental group (P<0.05).

Regarding the results, it can be argued that long-term use of motion control shoes can help maintain lower limb stability and balance in runners, as well as improve performance in them. Also, the frequency band showed a significant increase, which increased the pain in motor components and connective tissues, and this increase could be due to the increase in using these components in motion. Therefore, it can be described as a negative effect on the long-term use of motion control shoes.

Impingement syndrome is the most common injury and cause of pain and limitation of movement in the shoulder area. The purpose of the present study was to compare the electromyographic activity of selected shoulder muscles and scapulohumeral rhythm in elite male swimmers with and without shoulder impingement syndrome.         

In the present study, 30 elite 18-25 year-old male swimmers, including 15 patients with shoulder impingement syndrome and 15 healthy individuals (age 22.15±1.23 years; height 179.40±5.59 cm; weight 78.35±7.37 kg) were selected as the statistical sample. To collect data, a goniometer to assess the scapulohumeral rhythm in the 90 ° abduction in frontal plans and American noraxon wireless surface EMG device to assess the electromyographic activity of muscles in the 90 ° abduction and recovery in sagittal, frontal, and scapular plans and the dominant sides were used. For data normalization, Shapiro–Wilk test and for data analysis independent t-test were used (P> 0.05).

The results indicated that with regard to mean scapular rotation start (P<0/001), scapular rotation (P = 0.001) and scapulohumeral rhythm ratio (P = 0.001), there were significant differences between the patient and healthy groups. Also, there was a significant difference between the mean onset and offset of Serratus anterior and lower trapezius muscles in all three plans and upper trapezius muscles in the sagittal and scapular plans of the patient group compared with healthy group (P> 0.05), and the swimmers with impingement syndrome had a lower onset (delayed activation) and higher offset (early termination of activity) compared with the healthy group. Moreover, the sequence of muscle recruitment to be active and inactive had undergone a change in the patient group.  

Therefore, swimmers with impingement syndrome have higher scapular rotation start, lower scapular rotation, and higher scapulohumeral rhythm ratio compared with the healthy groups, and the regular coordination of scapulohumeral rhythm in the shoulder compartment has been disrupted in the patient group. Swimmers also exhibit abnormal activity and increased latency in the muscles, meaning lower onset (delayed activation), and higher offset (early termination of activity. Therefore, the theory that the shoulder impingement may be related to changes in the level of activity and recruitment of the scapulothoracic muscles is generally acknowledged as a sign of the change in neurovascular control.

The frequency domain analysis of ground reaction forces is one of the mechanical parameters that can be distinguished by comparing the differences between healthy and patient groups. The purpose of the current study was to compare the frequency domain analysis of ground reaction forces in deaf and healthy control people during running.

The present study was a quasi-experimental design. A total of 30 male individuals were equally divided into two groups of normal hearing and hearing loss (Deaf group). Peak plantar pressure variables in deaf people and healthy control were recorded using a foot scan system (sample rate: 300 Hz). The multivariate ANOVA test was used to compare the ground reaction force frequency domain data during running in deaf and healthy participants.

The results showed that frequency content with the number of essential harmonies in the Toe area (P= 0.012) and fingers 2 to 5 (P=0.035) in deaf was smaller than that of healthy control group. Also, the frequency content with power of 99.5% in the fourth metatarsal (P=0.038) and fifth metatarsal (P=0.019) in deaf group was greater than that of healthy control ones. Stance time during running was more in deaf group than in healthy control group (P=0.032).

According to the results of the present study, it can be stated that deaf people are likely to be exposed to the damage caused by the ground reaction force frequency domain during running.

The final outcome of cleft palate surgery on communication impairments of people with cleft palate mostly depends on nasal emission correction and hypernasality in these patients. However, articulation errors work as a barrier for velopharyngeal valve to show its real movement in instrumental assessment which are done as a diagnostic tool in order to determine the need for secondary surgeries. The aim of the present study was to determine the effect of articulation therapy on nasometery and perceptual assessments in a cleft palate patient.

A single-subject study with A-B-A design was carried out to study the effect of articulation therapy on a child with unrepaired submucosal cleft palate, hypernasality, and nasal turbulence. The participant received articulation therapy for 24 sessions (each session for half hour) during 3 months in order to eliminate non oral compensatory articulation errors. Perceptual assessment and nasometery were performed at baseline, during intervention, and in follow up phases. Visual analysis and improvement rate difference (IRD) were used to analyze data. Also, videofluoroscopic and nasoendoscopic assessments were described before and after intervention.

Articulation therapy was effective in this case and decreased the hypernasality and nasalance scores (IRD=0/75). Also, the velopharyngeal gap size decreased and velopharyngeal closure ratio has increased.

The present study showed that articulation therapy seems to reduce velopharyngeal gap size and increase the valve closure ratio. It shows that articulation therapy with correcting the phonetic placement of sounds during the speech makes the velopharyngeal valve show its real movement and has positive effect on its function. Velopharyngeal changes in this patient led to reduction in hypernasality and nasalance scores, but nasal turbulence increased. In addition, the achievements were remained unchanged for three weeks after intervention.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common disorders in children affecting three to seven percent of children. It is a neuro-developmental disorder with three major criteria: attention deficit, hyperactivity, and impulsiveness. Executive function deficits hamper academic achievement and create high risk behaviors. Children with ADHD have neuropsychological findings in the assessment of executive functions. The ain of the present study was to examin the effect of cognitive rehabilitation therapy on the performance (memory and problem solving) of children with ADHD.
The present study followed a quasi-experimental randomized clinical trial design (pretest-posttest with control group). A total of 30 children, aged 7 to 9, who were referred to the clinic at the Ministery of Education, Destrict 1, in Shiraz in 1397-98, were recruited and the diagnosis was made using CSI-4 diagnostic test. Next, they were homogenized using Raven's Intelligence Test and selected as targeted sampling. Then, they were randomly divided into experimental and control groups. The experimental group received cognitive rehabilitation trainings for 10 sessions (two sessions per week). Children were identical in terms of intelligence capability based on Raven's test. Statistical analyses were done using SPSS, version 23. Descriptive statistics and standard deviation were used for data analysis. Data were analyzed using a clinical trial with pretest and post-test design with control group. Assessment of active memory was done using 1Beck, 2Beke, and memory fragmentation tests, which are accurate tools for evaluation of memory disorders. Also, the Wisconsin Cards was used for evaluation of problem solving.
The results showed that there is a significant difference between the performance scores of memory performance in pre-test and post-test in children with ADHD (P<0.001). There was also a significant difference between the performance scores in pre-test and post-test in problem solving skills (P<0.001).
It was found that cognitive rehabilitation is effective in improving memory performance and problem solving in male children with ADHD. Cognitive rehabilitation can help children with ADHD so that they can perform their functions (memory and problem solving) more efficiently and it can be used as a substitute for mental stimulus for children with ADHD.

Performance of an athlete reduces as the time of activity increases; consequently, his landing quality is influenced by fatigue. In particular, fatigue has effects on the sportsman’s control posture and the biomechanics of his lower limbs. Moreover, landing puts more stress on these joints than jumping does, and leads to much more possibility of injury. The main objective of the present study was to investigate the effect of one stage of exhaustive local fatigue on the mechanics of the joints of the lower limb in semi-professional sportsmen during their single-leg landing.
A total of 30 young, semi-professional basketball players in Alborz, Iran, aged between 16 and 26 years, participated in the study. The biomechanical data were recorded using motion analyzer and force plate tools. To process the collected data, the numerical computing environment MATLAB was employed to extract the angles of the lower limb joints when the foot touches the ground, the maximum flexion of the knee, and the maximum normal force in the three planes of motion. The descriptive statistics is based on the mean and the standard deviation of data and the test of normality is based on the Shapiro-Wilk test. Homogeneity of data was tested using Levene’s test. The collected sets of data were compared using the repeated measures analysis conducted in SPSS, version 20.0, at the significance level of P≤0.05.
The results did not reveal a significant difference between the angles of the ankle and of the knee in sagittal and frontal planes, nor do they show a significant difference in the maximum normal force and the maximum flexion of the knee before and after fatigue (P≤0.05). The results, however, showed a significant difference between the horizontal angular changes of the ankle joint in the maximal flexion of the knee after fatigue (P≤0.000).
Fatigue may change the strategy of landing, thereby increasing the likelihood of putting more stress on the lower limb joints, especially the ankle. This may in turn harm the other joints. The horizontal angular change of the ankle joint in the maximal flexion of the knee changes the layout of these joints, particularly the knee. A deeper investigation of the effect of fatigue on the layout of the joints may help one prevent injuries resulting from exhaustive local fatigue.

Cochlear implant canenable hearing impaired children in acquiring speech, language, and communication skills through hearing sense.  The aim of the present study was to evaluate the development of auditory and speech skills of children using cochlear implant.
In the current study, 50 children with an average cochlear implant age of 40 months were evaluated with the collection of periodic assessment scales including the time they received the device and 3, 6, and 9 months after cochlear implantation. Data were analyzed using descriptive methods, visual analysis, and analysis of variance with repeated measurements in SPSS, version 20.
Data analysis showed increase in the mean scores of children in all scales during evaluation times of receiving the devise, 3, 6, and 9 months after transplantation. The differences between participants' mean scores were statistically significant between the first to fourth evaluations (P<0/001).
According to the results, children showed significant improvement in auditory performance and meaningful use of speech and speech intelligibility during the nine months after cochlear implant.

Postural and balance control is essential for almost all daily activities. The purpose of the present study was to investigate the effect of cerebellar transcranial direct current stimulation (tDCS) on balance and somatosensory, vision, and vestibular systems function of the elderly.
An experimental, pre- and posttest design study was carried out on 20 elderlies (60-75 year olds) of both sexes who referred to Tehran Rehabilitation Center of Red Crescent Society in the summer of 1396. They were selected based on inclusion criteria and available and targeted sampling method, and were randomly assigned to two “Intervention” (real) and “control” (Placebo) groups (n=10). After a preliminary assessment of equilibrium parameters using Computerized Dynamic Posturorghraphy, “Intervention” group received direct current stimulation over the cerebellum at 2mA and “Placebo” group received sham stimulation, for 20 minutes in five sessions. At each session, immediately after stimulation, participants performed half-hour equilibrium exercises on the Huber apparatus. After completing five sessions, the variables were re-measured. Shapiro–Wilk, Levene's Test for Equality of Error Variances, the homogeneity of slope regression, and covariance analysis (MANCOVA and ANCOVA) were used to analyze the data.
The results of the current study showed that direct electric stimulation of the cerebellum has significant effects on the postural control equilibrium variables in the first sensory condition absent vision and fixed support (P = 0.036), and the fifth sensory condition with absent vision and sway support (P = 0.034). Also, the electrical stimulation of the cerebellum increased the ability of the elderly group to use vestibular system input to maintain balance (P = 0.014), but did not have a significant effect on the ability to use the somatosensory, vision, and vestibular systems inputs (P>0/05).
The results of the present study showed that cerebellar TDCS with balance has beneficial effects on postural control and balance of elderly people probably by improving the processing of vestibular inputs and can improve motor adaptation and facilitate motor skills learning.

The relationships with the opposite sex in adolescence can often lead to some implicit or explicit harm, especially for female adolescents. Accordingly, the aim of the present study was to determine the effectiveness of matrix intervention program and harm reduction training on suicidal tendency among female students harmed from their relationship with opposite sex.
The research method was semi-experimental and the research design was three groups with two stages (pre-test and post-test). Among 60 female students who were harmed from their relationships with opposite sex in Shahinshahr in Isfahan, in the autumn of 2018, 36 were selected based on the inclusion and exclusion criteria and then randomly assigned into three groups (each group 12 participants). Multi-attitude suicide tendency scale for adolescents was used to measure the dependent variable in the pretest and post-test. The group of matrix intervention program and harm reduction training received 10 sessions of treatment and the control group did not receive any treatment. The data were analyzed running multivariate analysis of covariance and post-hoc Bonferroni test.
The results of multivariate analysis of covariance showed that in the post-test phase after the pretest control there was a significant difference between the matrix intervention group compared with the harm reduction training group and the control group in attraction toward life (P <0.01). Also, there was a significant difference between the matrix intervention group and the harm reduction training group, as compared to the control group, in the repulsion by life (P <0.01). Moreover, there was a significant difference only between the matrix intervention group and the control group in attraction toward death (P <0.01).
According to the results, the matrix intervention program can be used to reduce the suicidal tendency of female students who are harmed from their relationship with the opposite sex.

Cancer is an abnormal growth of cells that is capable of attacking or spreading to other parts of the body resulting in many physical and psychological side effects. Colon cancer is the development of cancer from the colon or rectum and exercise is used as a promising strategy to treat some of these psychological and physical complications during and after cancer. The aim of the present study was to investigate six weeks of mixed exercises on improving quality of life and physical performance after chemotherapy in patients with colon cancer.

In a semi-experimental study with pretest-posttest and control group, 14 individuals aged 50-70 years with colon cancer were present. The participants were randomly divided into two groups of exercise (n=7) and control (n=7). Before and after six weeks of relaxation and aerobic training for 40-70 minutes, three sessions a week, improving quality of life was assessed using World Health Organization Quality of Life questionnaire and physical performance with Rockport Test.

The results of t-test showed a significant difference in improving the quality of life (physical dimension ( t=-10. 13), psychological (t=-16.86), social relationship (t=-14. 49), environment (t=- 8.62), and physical function (t=-6.72) in the pre-test and post-test of the training group and independent t-test results showed a significant difference in the improvement of quality of life (physical dimension (t=-9.38), Psychological (t=-15. 80), social relationship (t=-10.98), environmental (t=-8.62), and physical function (t=-5.24) between the two groups (P=0.001).

It seems that mixed training leads to improve the quality of life and physical functioning of patients with colon cancer. Professionals are recommended to improve the quality of life and physical functioning of the patients in sports exercises.

Plantar pressure variables and their measurement and comparison can be considered as a useful tool for assessing the effectiveness of motion, especially in patients with low back pain. The aim of the present study was to investigate the effects of walking with internal and external attention on the balance and foot pressure patterns in patients with low back pain.
The sample of the present trial study included 15 women (Age: 22.86±1.15 years, Height: 162.53±1.54 cm, Weight: 61.06±2.42 kg) with low back pain. Plantar pressure values were recorded during normal walking, internal, and external attention walking using a foot scan system with 300 Hz sample rate. All analyses were performed using SPSS, version 22. A repeated measures ANOVA was used for statistical analysis.
The results showed an increase in the time to peak of ground reaction force values during heel-contact, mid-stance, and push-off phases in the internal attention walking compared to normal walking conditions and increased walking with internal attention compared to walking with external attention conditions. The ground reaction force and the plantar pressure peak values on the Metatarsal 2 region increased in normal walking compared to walking with internal attention conditions and increased in walking with external attention as compared to walking with internal attention conditions. The ground reaction force peak values on the lateral heel region increased in normal walking compared to internal attention walking conditions and increased in external attention walking compared to internal attention walking conditions.
Internal and external attention walking conditions do not have significant effects on stance time. Also, the loading rate of ground reaction force values decreased in internal attention walking as compared to external attention walking conditions.

Attention Deficit Hyperactivity Disorder is one of the most common disorders in primary school children, which affects their motor, educational, and psychological functioning. The purpose of the current study was to determine the effect of rhythmic motor games on motor proficiency, aggression, and academic achievement in children with hyperactivity/attention deficit.
The present study was an experimental and pre-test post-test design. A total of 40 children, aged 8 and 9, with hyperactivity/attention deficits participated in the study from among the second and third grade students of Poldokhtar city. First, students were identified using the Conners Questionnaire for parenting forms and clinical interviews. Then, to assess motor proficiency, aggression, and academic achievement tests, we used the short form of Bruininks-Oseretsky test 2nd version (bot-2), Aggression Scale Shahim, and the participants' average scores for Mathematics, Science, and Farsi courses, respectively.
Statistical analyses showed that rhythmic motor games had a significant positive effect on motor proficiency (P = 0.001, F=189.3), aggression (P = 0.001, F=6/10), and academic achievement (P=0.004, F =4/30) in children with hyperactivity/deficiency (P>0.05).
Regarding the attractiveness and the variety of motor games, it is suggested that teachers and rehabilitation trainers use these music, lyrics, and songs to increase the skillfulness of motor, aggression, and academic achievement in children with hyperactivity/attention Disorder.

The wrong posture of head in patients with Forward Head Posture (FHP) could affect their visual and attention demands of postural control. The present study was carried out to investigate the effects of cognitive loading and visual occlusion on the static stability in patients with FHP compared to healthy participants.

A total of 17 individuals with FHP and 15 healthy people participated in the study. The center of pressure parameters were evaluated, including the standard deviation of displacement and velocity in anteroposterior and mediolateral directions, mean velocity, 95% Confidence Ellipse Area, and displacement range in anteroposterior and mediolateral directions. The postural task was conducted in eight conditions, two cognitive conditions (with and without cognition task), two postural task difficulties (standing on one foot and both feet), and two visual conditions (open and closed eyes) in both groups.

The main effects of group and cognitive conditions had no significant effect on almost none of the dependent variables, but the main effects of visual and postural conditions showed significant effects on all the dependent variables (p<0.05). The interaction effects of group and other factors, including visual, postural difficulties, and cognitive conditions, showed no significant effect on any of the center of pressure variables. On the other hand, the interaction of all factors together showed significant effects in some of the postural sway parameters.

The visual demand of postural control is not different in the people with forward head posture. The attention demand in these individuals, however, is higher when a difficult postural task is coincided with a cognitive task.

Down syndrome as a genetic disorder is one of the major causes of intellectual disability, which leads to delays in motor skill. Since dysplasia of the internal ear structure is common in these individuals, and internal ear abnormalities have been observed in about 75% of patients, the present study was conducted to investigate the effect of vestibular stimulation exercises on motor proficiency in Down syndrome children.

The statistical sample was 20 girl student’s with Down syndrome (age=10/2±2 years, height =125/1±9/4 cm, weight=32±5/8 kg, and BMI=20/5±3/5 kg/m2) who were randomly divided in to two groups. The intervention of the research, Mind in Motion Maze program, specifically aimed at vestibular stimulating in the form of the game, consisting of 15 exercise stations, performed 3 times per week for 8 weeks. Bruininks-Oseretsky test was used to assess motor Proficiency. Data analyses were conducted using SPSS, version 20. For all statistical tests, the level of significance was set at P ≤ 0.05 using two-way Analysis of Variance.

The results of the study showed that at the end of the intervention period, there was a significant difference in the factors of running speed and agility (P ≤ 0.05), balance (P ≤ 0.05), bilateral coordination (P ≤ 0.05), Response speed (P ≤ 0.05), upper-limb speed and dexterity (P ≤ 0.05), and in total, gross motor skill (P ≤ 0.05) and fine motor skill (P ≤ 0.05) in the experimental group.

Assessment of motor proficiency in children with Down syndrome showed improvement in their motor abilities after eight weeks of vestibular stimulation exercises. According to the findings, it is recommended that vestibular stimulation exercises can help improve and increase the motor proficiency in children with Down Syndrome. However, more studies are needed to be able to conclude definitively.

Foot function depends on its shape. Flat Foot is one of the longitudinal arch changes of the foot that is involved in maintaining body balance. Whole Body Vibration is an effective method for applying sinusoidal mechanical oscillations. The purpose of the present study was to investigate the effects of whole body vibration on static balance in flat foot during and after the developing age after fatigue. In the current study, 80 patients with Flat Foot (40 females and 40 males) including 40 females and males under 18 with the mean age of 15±1/24 and 40 females and males over 20 with the mean age of 22/57±2/48 were randomly divided into intervention and control groups. Intervention group received four weeks of WBV training. In the control group, including both under 18 and over 20-year-old participants, no intervention was carried out. In this group, the participants followed their daily activities. The fatigue protocol performed on the treadmill and Static balance tests was assessed using Biodex Balance System indices including total, anterior-posterior, and medial-lateral. The results of between group analyses indicated that for the group under 18, all aforementioned variables significantly improved in comparison with those over 20. Whole Body Vibration can be used to improve the static balance of flat foot even after fatigue.

During and after pregnancy, many women experience an increase in the inter-recti abdominal muscle due to increased uterine volume as well as stretching and thinning of the linea alba. This disease, on average, affects 66% of women and is associated with spinal pain and instability, pelvic floor muscle weakness, abdominal muscle weakness, and abdominal hernia. The aim of the present review article was to study the effectiveness of abdominal strengthening exercises in the treatment of diastasis recti in postpartum period, based on the results of the recent studies.

Google scholar, EM base, Medline, and PubMed databases as well as Google search were searched using the following keywords: pregnancy, diastasis rectus, diastasis recti, linea alba, rectus abdominal muscles, and strengthening exercises. Our study includes different researches on abdominal muscle strengthening exercises in the treatment of diastasis recti.

Generally, 800 articles were found in the field of case studies, pilot studies, and clinical trials. From among these studies, only 11 studies were selected according to the inclusion criteria. The results of these studies showed that abdominal strengthening exercises have been effective in minimizing low back pain and decreasing functional, postural instability as well as muscle weakness.

According to the results and quality of the studies, abdominal muscles strengthening exercises can be an effective method in the treatment of diastasis recti in postpartum period.

Using the model in clinical reasoning of rehabilitation practitioners creates a mental framework and the ability to organize the variables involved in the rehabilitation process. The broadest model of occupational therapy, called the "Model of Human Occupation" (MOHO), is based on the open systems theory. This model can be used extensively in rehabilitation and even education. However, there are a few sources to show that it has been used in children. Since existing knowledge is a prerequisite for clinical use of a conceptual model, the present study seeks to provide the information needed to use the MOHO in children.

The present study was conducted by searching several sources including the related websites, books, and Google Scholar, PubMed, Science Direct, and Magiran databases since developing the MOHO (since 1985).

The concepts of MOHO are definable with regard to children’s activities such as play, schoolwork, etc. Parent’s role and the phenomenon of development are integral parts of these definitions. This model has six assessment tools for children two of which have been translated and validated as the Persian versions, which include the "Child Occupational Self-Assessment" (COSA) and the "Pediatric Volitional Questionnaire" (PVQ). Six studies have were found using the MOHO as the framework of intervention program for children. Information on evaluation tools and interventional evidence are presented in the Tables.

The MOHO analyzes the transaction among the individual's internal factors (volition, habituation, and performance capacities), the activity that is taking place, and the environmental conditions. To define the applications of the MOHO in children, it is necessary to consider the specific issues such as growth and development phenomenon. The active involvement of the child in treatment is a feature of this model. The availability of valid assessment tools in this model facilitates its use in rehabilitation. Considering specific points in using these assessments in children is discussed in this article.

Benign Paroxysmal Positional Vertigo (BPPV) is a common cause of disabling vertigo with a high rate of occurrence. Today it is accepted that it is caused by dislodged otoconia, which falls from the uticular macula and float in to the semicircular canals thereby making them sensitive to gravity. BPPV is not easy to diagnose and usually it takes a couple of months of the specialist's time and mostly patients face some issues in terms of wrong treatment.
Vitamin D is one of the many nutrients our body need to stay healthy. It may also play a role in muscle function and immune system. You can get vitamin D via sun exposure, your diet and supplements. In early 80s, researchers showed that people who are living in big cities have low levels of vitamin D. A review of the relationship between vitamin D status and the rate of BPPV will definitely help understand the status of patients who are suffering from this kind of vertigo.

In order to review the relatiopship between BPPV and Vitamin D deficiency in patients, all of the articles in this field published between 1952 - 2017 in Ovid, ProQuest, and Google Scholar databases were searched.

More than 200 articles on the topics related to BPPV and Vitamin D deficiency were available in these databases among which 36 full articles and 7 abstracts were used in the present study.
Conclution: The persent study showed that patients with BPPV had low vitamin D serum and thyroid hormone levels.

Non-specific low back pain (NLBP) is one of the most common musculoskeletal disorders and the International Association for Pain and Anatomical Diagnosis has defined it as a lumbar or sacrum pain. According to the results of the previous studies, 84% of people has experienced back pain and 23% of these pains become chronic. The purpose of the present review study was to investigate the relationship between lumbopelvic motor control disorders and chronic non-specific low back pain.

In the current review paper, a comprehensive search was conducted in PubMed, Science Direct, Google Scholar, Elsevier, Springer, IEEE, EBSCO, and Scopus databases from 2000 to 2018, using the following keywords lumbopelvic control, lumbopelvic, trunk stability, lumbopelvic motor control, trunk control, and spinal stability. A total of 1900 articles were found after reviewing the abstract and titles. Next, based on the main subject of the present study as well as inclusion and exclusion criteria, seven articles were selected for the final analysis.

All studies selected for the final review were case-control studies. Five articles investigated the kinematic aspects of lumbopelvic movements control two of which, in addition to the kinematic evaluation of lumbopelvic movements control, assessed the activity of the lumbopelvic region muscles.

According to the results reported in these seven papers, we showed that lumbopluvic movement control disorders are commonly reported in patients with chronic low back pain. So, more studies should be conducted to better understand the issue.