فصلنامه آرشیو توانبخشی
سال بیست و یکم شماره 4 (پیاپی 85، زمستان 1399)

 Cerebral palsy Spastic Diplegia (CPSD) is the most common motor disability in childhood. It is a neurodevelopmental condition beginning early in life and continues throughout life. In addition to mobility problems, the environment can also affect the CPSD children’s social participation. This study aims to investigate the relationship of environmental factors with the social participation of children with CPSD.

This cross-sectional study was conducted on 116 parents of children with CPSD referred to the occupational therapy clinics in Tehran, Mazandaran, and Alborz provinces of Iran in 2018-2019. They were recruited using a convenience sampling method. Parents completed the European Child Environment Questionnaire (ECEQ) and the life habit questionnaire to assess their perception of the environmental factors and their children’s participation, respectively. The Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) was initially used to classify the gross motor function (walking ability) of the children with cerebral palsy living in Europe (The SPARCLE project). We used it to estimate cognitive levels in children. The Pearson correlation coefficient and linear regression of SPSS version 22 were used to analyze the results.

 Based on the GMFCS-E&R classification, 23.3% of children were at level I, 27.6% at level II, 31.9% at level III, and 17.2% at level IV. Moreover, 89.7% of the children had an IQ>75, and 85.3% had no seizures. All domains and sub-domains of ECEQ had significantly correlated with social participation (P<0.01), where the physical environment had the highest correlation (r=-0.811, P<0.01). Based on the linear regression model, physical environment (β=-0.475, P<0.01) and attitudinal environment (β=-0.285, P<0.05) were the predictors of social participation (adjusted R2=0.71).

 Physical and attitudinal environments are predictors of social participation in children with CPSD. Environmental modifications and adaptations at home, community, school, and especially transportation system can increase the social participation of these children.

 This study aimed to design a “gait enhancer” and investigate its effect on standing ability and gait speed of children with cerebral palsy spastic diplegia.

A new gate trainer was designed based on Theo Johnson mechanism. Johnsonchr('39')s two separate movement chains were placed on either side of the gate trainer body and attached to the lower limbs by a foot plate. To investigate the effect of the designed device, a single-item experimental study with baseline design, treatment and maintenance (ABA) was performed on four children with available spastic diplegia cerebral palsy. These children received routine occupational therapy sessions.

 The designed “gait enhancer” increased standing ability and gait speed scores in all subjects. Non-overlapping measures also indicated the improvement in both variables. Measured by Cohen’s d, the effect size for standing ability were 1.95, 2.29, 1.83, and 2.3 for the child No. 1, 2, 3, and 4, respectively. Regarding walking speed, the effect size for these children, No. 1 to 4, were 1.13, 3.37, 2.15, and 2.21, respectively. Cohen’s d values were greater than 0.8, indicating the considerable effect of the intervention. Hedges’ g was also calculated due to the small sample size, which was greater than 0.8 for all subjects in standing ability and gait speed.

 Following the use of Gait Enhancer along with conventional occupational therapy, we observed an increase in the ability to stand and walk at children with cerebral palsy. Findings showed that the change in standing ability and walking speed occurred more during the period of using the designed device than other stages, which could be a consequence of using Gait Enhancer along with routine occupational therapy sessions at this stage of the study. However, it should be noted that this study was only a single case study and to prove the effectiveness of this tool in children with cerebral palsy, it is necessary to conduct clinical trial studies.

 This study aims to identify the challenges for public participation in health legislation in Iran.

This is an exploratory and qualitative study. The study data were collected by using semi-structured interviews. The participants were experts in the field of health law with at least ten years of work experience. They had both experience and enough knowledge about the country’s health system. All interviews were transcribed verbatim after recording and then analyzed using thematic analysis.

 We identified five main categories (themes) and 26 subcategories related to challenges. The main themes included legal barriers, infrastructure barriers, sociocultural barriers, people’s barriers, and legislators’ barriers. The legal barriers had three subcategories of parliament’s structure, legal requirements for participation, and facilitating laws. The infrastructure barriers had seven subcategories of the existence of mass media and communication networks, informing, ability to access to/meet the legislators, ability to categorize opinions, the possibility of electronic participation, financial resources, and structural facilities. The sociocultural barriers had three subcategories of people’s desire to participate, belief in teamwork, and social capital. Barriers related to people included eight subcategories of access to information, access to legislators, getting answers or feedback from legislators, feeling safe after participation, people’s awareness of their rights, education, ability to exchange views, and the existence of a highly-skilled expert team. Barriers related to legislators had nine subcategories of the desire to use others’ opinions, capacity to accept different opinions, party-related factors, regional factors, administrative health, education, opportunity, priorities, and motivational factors.

 Iranian citizens have several challenges to participate in health legislation. Regarding legal challenges, it is necessary to determine the participation right of citizens in the legal system. Besides, members of parliament should be educated to use the capacity of public participation. On the other hand, people should speak freely with the legislators and gain health knowledge as well.

 Patellofemoral Pain Syndrome (PFPS) is one of the most common disorders of the knee joint. It is characterized by pain, reduced proprioception, and altered pattern of vastus muscle activation, which effectively maintain the balance needed for performing daily living activities such as walking and running. One treatment method that can reduce pain and improve balance in people with PFPS is Kinesiology Taping (KT). Considering the physiological and anatomical differences in the knee structure of men and women and the importance of studying the effect of KT on the dynamic balance of men with PFPS, this study aims to compare the effect of KT on dynamic balance and pain of men and women with unilateral PFPS.

This is a quasi-experimental and non-randomized clinical trial. The participants were 30 males and 31 females aged 18-40 years suffering from unilateral PFPS. They were recruited using a convenience sampling method. First, the subjects performed the Y-balance test three times in each of the anterior, posteromedial, and posterolateral directions. The maximum score obtained from the three repetitions in each direction was divided by the limb length and recorded in percentage as a dynamic balance score. After 5 minutes of rest and performing initial tests, the subjects performed the intervention. In this stage, KT with a tension equal to 50%-75% of its initial length was applied on the patella of the involved limb to cause medial glide. The effectiveness of KT was examined under a single-leg squat-test. For this purpose, all subjects performed unilateral squatting on their affected leg for 10 seconds with 45 degrees of knee flexion before and after KT, while their pain level was recorded using the visual analog scale. In case of a 50% reduction in pain, the subjects were allowed to enter the final stage (performing the Y-balance test); otherwise, patellar taping was repeated to obtain the appropriate pain reduction.

 Within-group comparison of balance parameters before and after KT using the paired t-test showed an increase in the reach distance at three directions in the Y-balance test, revealing a significant improvement in the dynamic balance following KT (P<0.05). According to the independent t-test results, there was no significant difference in balance parameters between males and females before and after the intervention (P>0.05). Moreover, the pain was significantly reduced in both genders after KT (P<0.05), but its difference between men and women was not statistically significant (P>0.05).

 KT is an appropriate therapeutic intervention for improving dynamic balance and reducing pain in people with PFPS. It seems that KT has the same effect on dynamic balance and pain of women and men with PFPS.

Objective :

The present study aimed to investigate the effect of scapular stability-based corrective exercise program on scapular upward rotation and scapulohumeral rhythm in Wheelchair Basketball (WB) players with bilateral scapular downward rotation syndrome.

According to the research conditions, 24 wheelchair basketball athletes with spinal cord injury voluntarily participated in this study. Initially, eight players were selected from each sport class (1 to 1.5 class, 2 to 2.5 class, and 3 to 4.5 class). Then, four subjects in each group were randomly assigned to each group (12 control subjects with Mean±SD age of 43.23±11.0 years and 12 experimental subjects with Mean±SD age of 39.08±5.08 years). Thus, the control and experimental groups were present in an equal number of three sport classes. WB athletes were professional players in Mashhad City league, Iran. The participants were classified according to the Classification Committee of the IWBF, as well as the corresponding national classification from the Islamic Republic of Iran Sports Federation for the Disabled (IRISFD). Two digital inclinometers were used to measure the humeral range of motion and scapular upward rotation and scapulohumeral rhythm in resting position, 45°, 90°, and 135° shoulder abduction in scaption plane. The exercise group performed scapular stability-based corrective exercises based on the Gym training principles and following ACSM guidelines for eight weeks. The independent t-test, analysis of variance, and analysis of covariance were used for statistical analysis at the significant level of less or equal to 0.05. 

 The results showed no significant asymmetry between dominant and non-dominant shoulders in the scapula’s upward rotation at different angles of shoulder abduction. Contrary to the non-dominant shoulder, the dominant shoulder’s scapula had a less downward rotation at the resting position and a higher upward rotation at 45° of shoulder abduction. Also, in 45° humeral abduction, the dominant shoulder has a less scapulohumeral rhythm ratio than the non-dominant shoulder. WB athletes’ dominant shoulders in lower classes (2-2.5 and 3-4.5) have less scapular downward rotation in scapular resting position and more scapular upward rotation in 45°, 90° 135° humeral abduction. There was no significant difference in scapulohumeral rhythm ratio between WB players with different classes. Scapular upward rotation increased significantly after eight weeks of scapular stability-based corrective exercise program (P≤0.05). Also, a significant decrease in the scapular upward rotation was observed at post-program in resting position (P=0.001) and significantly increased in 45° (P=0.01), 90° (P=0.001), and 135° (P=0.001) humeral abduction compared with pre-program in dominant and non-dominant shoulders. However, the ratio of scapulohumeral rhythm in the dominant shoulder did not improve significantly, and the ratio of scapulohumeral rhythm in the non-dominant shoulder improved at 90° and 135°.

 Scapular stability-based corrective exercises can be used as one of the training methods to restore muscle balance, prevent and correct scapular upward rotation and scapulohumeral rhythm in wheelchair basketball athletes. Therapists should know that some degrees of scapular upward rotation and scapulohumeral rhythm asymmetry may be common in WB players. This asymmetry should not always be considered a pathological symptom but may be an adaptation to exercise training and frequent use of the upper extremity.

 Aging is one of the stages of life that needs special attention due to the special conditions of this period of life. Inactivity and myasthenia due to aging are important factors in reducing the physical and functional activities in the elderly, which can affect their quality of life. On the other hand, electromyostimulation (EMS) is one of the modern training methods that can be suitable for disabilities in the elderly. Also, the training sequence in concurrent training is one of the variables of training that can affect its adaptations. This study aimed to compare the effect of exercise sequence in concurrent training with EMS on the motor performance of elderly women.

In this semi-experimental single-blinded study, 50 healthy elderly female volunteers, age range of 60-70 years, were selected by random sampling divided randomly into the following groups (each group of 10 people): Aerobic-resistance training with EMS, resistance-aerobic exercise with EMS, rotational exercise (change of priority periodically in training sessions) with EMS, and rotational and control (without training) groups. The training protocol consisted of twelve weeks of exercise, three sessions per week, and each session three stages of warm-up (10-15 minutes), main exercises (20 minutes) and cooling (10 minutes). The main training program consisted of 20 minutes of parallel combination exercises, which were two 10-minute steps with a 3-5 minute intervals. Aerobic exercises were performed with the intensity of 70%-50% of maximum oxygen consumption and resistance exercises using body weight and elastic bands for different muscle groups. The training schedule was the same for all groups in terms of volume and intensity, with the only difference being in the exercise sequence and EMS presentation. Strength of the upper and lower torso muscles were measured with chest press and seated leg extension, respectively, maximum oxygen consumption (VO2 max) with a one-mile Rockport walking test, muscular endurance with a 2-minute marching on a spot-test and lower torso strength with a walking test on the slope in two stages before and after the intervention. Statistical analysis was performed using dependent t-tests and Covariance Analysis (ANCOVA) and Bonferroni post hoc test using SPSS software V. 22 and P≥0.05 was considered statistically significant.

 Significant increase was observed in all measured dependent variables relative to the baseline values (P<0.001). In the study of intergroup changes, a significant increase was observed in VO2 max level, upper and lower torso strength, and muscular endurance in all of the intervention groups compared to the control group (P<0.001), but lower torso strength was significant only in the intervention groups with EMS compared to the control group (P<0.001). VO2 max changes and the lower torso strength in training groups with EMS were significantly higher than the groups without EMS (P<0.01). Also, the upper torso strength and the endurance of the lower torso muscles in the group with the priority of resistance training with EMS were higher than the combination group without EMS (P<0.01).

 Based on the results, it can be said that combined concurrent exercises are a useful method in promoting physical fitness and physical performance of elderly women, and the use of EMS can increase the effectiveness of adaptations resulting from exercise, especially lower torso strength in the elderly and can prevent complications associated with myasthenia. On the other hand, the training sequence with the priority of resistance training can be effective in increasing the effect of exercise on the variables of upper torso muscle strength and muscular endurance, but it does not have a significant effect on lower torso strength, cardiorespiratory endurance and lower torso strength.

 The elderly population in Iran is growing. Aging is a natural phenomenon that causes changes in brain structures, including the frontal lobe and its connections, which are responsible for the brain’s executive functions. These structural changes lead to problems in cognitive and physical functioning. Older people face problems such as decreased performance in daily activities of life and participation in social activities. In cognitive orientation to the daily occupational performance approach, the participants learn to improve their motor performance using cognitive strategies. The effectiveness of this approach has been reported in stroke, Traumatic Brain Injury (TBI), and some childhood disorders. This study aimed to investigate this approach’s feasibility and its effect on the Iranian elderly without cognitive problems.

A single-subject study A-B design with follow-up was conducted. The participants were two older adults referred to Ramsar Health Center, Ramsar City, Iran. Before the intervention, to examine the participants’ cognitive status, we used Digit Span Forward to measure attention and Digit Span Backwards and Digit Symbol to measure working memory. The participants’ executive function was also assessed by the Wisconsin Card Sorting Test and Independence in Activity of Daily Living (ADL) with Functional Independent Measure (FIM). Each participant selected three functional goals by Canadian Occupational Performance Measure (COPM) for the focus of the Cognitive Orientation to daily Occupational Performance (CO-OP) intervention. After two weeks of evaluating participants’ performance on selected goals using the Performance Quality Rating Scale (PQRS) to determine baseline performance, the intervention period began. During this period, a total of 8 to 10 sessions were held for each participant. In these sessions, the participants were first taught global problem-solving strategies (Goal, Plan, Do, Check), and then they were introduced to domain-specific strategies and their importance in executing activities. Afterward, through guided discovery during implementation, they were directed to use these strategies in their execution by guided discovery. During this period, the participant’s performance on the selected goals was assessed five times by the PQRS. At the end of the intervention, to evaluate the long-term impact of the intervention, the participant’s performance on the selected goals was re-evaluated by the PQRS three times.

 The PQRS results showed that the performance of the first participant in each of the three selected activities improved. The results of the PQRS for the second participant showed a significant improvement in performance on the two selected goals. However, one of the selected goals did not show a significant change, which may be related to this goal’s nature. Participants’ net scores in FIM and COPM showed improved performance and satisfaction on selective goals, and performance independence remained constant.

 The CO-OP approach is feasible in the Iranian elderly population, and the preliminary results indicate the positive impact of this approach on improving the performance in the trained goals. However, given the study limitations in interpreting the results, it is recommended that future studies with a larger sample size be conducted to evaluate the effectiveness and efficacy of this approach. It is also recommended to use alternative tools instead of PQRS to evaluate the results, given the different cultural contexts.

 Providing desirable rehabilitation services to people with disabilities has always been one of the most critical concerns of the health system in all countries. Today, it is crucial for policymakers and health care providers to recognize the different systems for providing rehabilitation services to people with disabilities. In this regard, it is beneficial to conduct comparative studies and use successful countries’ experiences in this subject. This comparison-analytical study aimed to compare the systems for providing rehabilitation services to people with disabilities.

This comparative study was conducted in nine countries in 2020. To determine the comparison framework in this research, four dimensions of health systems’ functions were used based on the 2000 report of the World Health Organization. The countries were compared in dimensions of stewardship, resource production, financing, and service provision. Findings obtained from each country were presented separately in the comparative tables. The model used in this comparative study was based on the Beredy Model that contains four stages of description, interpretation, proximity, and comparison. In the present study, the purposive sampling method was used. The statistical population included rehabilitation systems globally, and the research examples were Iran, China, Turkey, India, the USA, Mexico, Germany, England, and South Africa. Criteria for entering the research according to the functional model of the World Health Organization were the availability of data and selecting at least one country from each continent of America, Europe, Asia, and Africa.

 The findings showed that in Iran, the Welfare Organization was responsible for providing rehabilitation services for people with disabilities, while in other countries, it was the Ministry of Health. Also, to compare resource production, two staff training indicators and access to comprehensive national data were used. In all countries studied, the training of specialized human resources is done through the university system. Iran, India, and Mexico did not have full access to comprehensive national data, but the United States, Germany, China, South Africa, and Turkey provided the platform for planning and policy-making. Moreover, funding in Germany, the United States, China, and Turkey is mainly provided through the insurance system. In the United Kingdom, it is mainly provided through tax, but in Iran, it is provided through subsidies from the public revenues and taxes. Finally, besides the private sector, rehabilitation services in Iran’s public sector were provided incoherently by various organizations. Some of these organizations are the Ministry of Health and Medical Education, the Exceptional Education Organization, the Red Crescent, the State Welfare Organization, and the Martyrs and Veterans Affairs Foundation, while in other countries, these services are often provided through hospitals and the private sectors.

 Despite the numerous strengths in the system of providing rehabilitation services to the disabled in Iran, the integration of the rehabilitation sectors of various organizations within the Ministry of Health not only increases the inter-sectoral and intra-sectoral coordination, the coherence of management, and unified policy, but also leads to reduced costs, proper allocation of resources and increased financial resources in this sector. Besides, it leads to a reduction in overlapping tasks and responsibilities and prevention of duplication of work, training of specialized personnel based on the needs, and finally providing more desirable services. Therefore, policymakers and planners must review and reform the laws and processes to form a system for providing rehabilitation services to the disabled in Iran.