فصلنامه طب توانبخشی
سال دهم شماره 4 (مهر و آبان 1400)

Fatigue is one of the factors that can affect different movement patterns and change its nature biomechanically. Since fatigue is one of the essential issues in the study of various movements and the possibility of injury incidents, the study aimed to review the studies on effects of fatigue on the biomechanical parameters and the incidence of injury in the selected movements of healthy people.

By searching related articles in validated scientific databases and based on predetermined research criteria, 50 studies were selected as the final articles for the present systematic review.

Different articles have used different methods to apply fatigue. A review of studies has shown that, in general, fatigue can negatively affect the proprioception, coordination of movement and reaction time, and subsequent control of movement, disturbing control of the balance and making healthy people susceptible to injuries. Also, fatigue, as one of the essential factors in falling, leads to decreased muscle strength, reducing neuromuscular responses. These changes can increase the risk of falling, especially in the elderly. In the case of various sports movements, fatigue is one of the most important factors in the disorder and decreased exercise performance, which causes changes in the movement pattern and increases the likelihood of injuries, significantly lower limb lesions, such as ACL injury in movements such as jump-landing.

Considering the increased likelihood of injury following fatigue in healthy people, this factor is necessary during various movements. As the level of exhaustion may alter the biomechanical pattern of various movements, this parameter should be considered as a controlling factor at the time of data collection.

Considering that only about a year and a half have passed since the COVID-19 epidemic and the priority of the health care system has been to pay attention to symptoms and physical problems of this disease to prevent its further spread, there is insufficient evidence about psychological issues resulting from COVID-19. The purpose of this study was to partially review psychological problems caused by COVID-19 in patients and treatment staff and rehabilitation strategies to solve this problem. 

A search through in Medline, Web of Science, PubMed, and Scopus databases was performed by combining keywords related to COVID-19 (such as coronavirus), restrictive measures (such as quarantine, segregation, social distancing), and psychological outcomes (such as psychosis, depression) and instructions (such as guidance, management, rehabilitation). All articles were written in English and aimed at the psychological disorders and factors associated with the coronavirus. Given that only about a year and a half has passed since the introduction of COVID-19, the period of the reviewed articles was selected between 2019 and 2021.

Reviewing related studies, 18 original articles were considered. Overall, the literature showed that COVID-19 had changed the lifestyle. COVID-19, in addition to physical symptoms and mortality, has adverse psychological effects such as anxiety, depression, loneliness, stress, fear, and excitement. However, these symptoms are not very severe in most cases. Psychological problems can be more severe in specific groups, such as pregnant women or people with underlying issues. In countries with a history of epidemics, internet-based systems have been developed to assess and treat psychological problems in patients with COVID-19. Rehabilitation intervention can also positively improve the patient's breathing, thereby reducing psychological issues.

COVID-19 can cause psychological problems for the patient and physical symptoms. On the other hand, changes in people's lifestyles following the outbreak of COVID-19, such as travel restrictions, quarantine, social distancing, and business sluggishness, may also contribute to the psychological disorders following the COVID-19 pandemic. The psychological problems caused by COVID-19 in some special groups, such as pregnant women, health care providers, and children, need to be addressed. Rehabilitation interventions and raising public awareness can effectively improve the psychological situation.

Pelvic Floor Muscle (PFM) training is the primary therapeutic intervention of PFM dysfunctions. In addition, strengthening some other muscles such as; Gluteus Maximus, Obturator Internus, Adductor Magnus, and D2 extension PNF pattern is suggested as complementary therapeutic methods. This study aimed to investigate the synergistic relationship between these muscles and PFM function using Transabdominal Ultrasonography and bladder base displacement.

Twenty-one healthy multiparous women, aged 20-40 years, participated in this cross-sectional and analytical study. Transabdominal Ultrasonography was used to measure the bladder base displacement. The following five different interventions were randomly performed, 1) PFM contraction, 2) Gluteus Maximus contraction, 3) Obturator Internus, 4) Adductor Magnus contraction, and 5) D2 extension PNF pattern. All participants did contractions three times with a 30 second rest period between each contraction. The mean of three measurements in each position was compared with the PFM contraction. Kolmogorov-Smirnov fitness test and Repeated Measures ANOVA were used to analyze the data. A level of P≤0.05 was considered significant.

The main effect of all interventions was significant compared to the contraction of the PFM (P=0.0001 and F=392.9). The amount of the bladder wall base displacement during Obturator Internus contraction and PNF D2 Extensor Pattern was more significant than the PFM contraction and in the same direction. With the Gluteus Maximus muscle contraction, the bladder base displacement was more significant than the contraction of the PFM. Still, in the opposite direction, and with the contraction of the Adductor Magnus muscle, it was approximately equal to the contraction of the PFM (P≤0.0001).

This study showed that the contraction of Adductor Magnus, Obturator, pelvic floor muscles, and also the PNF D2 Extensor Pattern could increase the bladder base displacement, which could confirm the synergistic relationship between these muscles and the PFM. However, this relationship was not observed in Gluteus Maximus muscle contraction.

Damage resulted from two linguistic features of syntactic comprehension and grammatical judgment in patients suffering from Aphasia, weakening the linguistic function, affecting cognitive skills. Therefore, the present study has been conducted to compare the extent of syntactic comprehension and grammatical judgment in patients with Aphasia.

This study is descriptive-comparative. Forty-five patients with Aphasia were selected by a simple random sampling method. The data were collected by a researcher-developed demographic questionnaire, Persian Aphasia Battery (PAB) test, and syntactic comprehension and grammatical judgment test and were analyzed by the Chi-square test.

In general, the patients suffering from Aphasia are more affected by syntactic comprehension damage than grammatical judgment. This difference was significant in the comprehension of dative sentences than replacing complex short sentences, predicative accusative than tracing the long simple sentences, understanding of inverted sentences than tracing long, complex sentences, nominative connectives than long simple sentences, nominative predicative than long simple sentences, and inverted dative sentences than replacing long, complex sentences (P<0.05). Despite the significant difference between the damage of syntactic comprehension in patients with Aphasia and their grammatical judgment, no significant difference was seen in the comprehension of active and continuous sentences

According to the results, there was a significant difference between the extent of damage of syntactic comprehension compared to the damage of grammatical judgment in the patients suffering from Aphasia. Therefore, the grammatical judgment of the patients was better than their syntactic comprehension.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by three main characteristics, namely, attention deficit, hyperactivity disorder, and impulsivity. This study aimed to investigate the effectiveness of computer-based training of progressive cognition on the theory of mind in students with ADHD.

This study was a quasi-experimental, pretest-posttest design with a control group. The study’s statistical population consisted of all male and female elementary students of 8-12 years old with ADHD in Tabriz City in the academic year 2019. The study sample consisted of 30 boys and girls with ADHD selected by purposeful sampling and randomly divided into two experimental and control groups (n=15). Children symptom inventory-4 and theory of mind test were used for data collection. Data were analyzed using multivariate analysis of covariance by SPSS v. 22 software.

The results of covariance analysis showed that computer-based cognitive intervention had a positive and significant effect on the theory of mind of students with ADHD (P<0.001).

Modifying the theory of mind can be very effective in improving students’ problems and interactions with ADHD and reducing their academic issues.

The effects of injuries and stress from coronavirus on people in the community may affect various dimensions, including lifestyle, quality of life, mental and physical health. This study aimed to evaluate and compare the performance of static and dynamic balance, quality of life, and the rate of musculoskeletal pain between healthy and COVID-19 disease individuals.

The present study was descriptive and comparative causal. The statistical population of the present study was people with a history of coronavirus and healthy people aged 20-30 years. The subjects were selected from Qom, Tehran, and Mashhad, each of which included 40 people with coronavirus (20 males and 20 females), 40 healthy individuals (20 males and 20 females). They were divided into two groups: patient and healthy. In this study, modified stork and Y balance tests were used to evaluate the performance of static and dynamic balance, respectively. The Nordic questionnaire was used to assess the rate of musculoskeletal pain, and the SF-36 questionnaire was used to evaluate the quality of life.

The independent t-test showed a significant difference between static and dynamic balance variables and quality of life between the two groups (P<0.05), and healthy individuals showed higher scores in balance tests and better performance in the quality of life. The results of the Mann–Whitney U test showed that in the values ​​related to musculoskeletal pain in the neck, shoulders, upper back, elbows, wrist, lower back, thighs, knees, ankles in the last seven days between the two groups, there was a significant difference between men and women (P<0.05) so that people with coronavirus recorded more pain. Also, there was no significant difference between the two groups in the rate of musculoskeletal pain in the last twelve months (P<0.05).

It is suggested that the present study results be used to increase the general information of the community. People with coronavirus and even healthy people during quarantine and exposure to this disease should pay special attention to physical fitness and the amount of musculoskeletal pain in different parts of the body to keep their physical and mental fitness and quality of life at the optimal level.

Developmental coordination disorder is one of the most obvious deficiencies in the development of motor skills in primary school children. The aim of this study was to investigate the effect of perceptual skills program on improving motor problems in children with developmental coordination disorders in elementary students. 

The research was quasi-experimental with a pretest-posttest design. The statistical population includes all students (age range 7-9 years) in the city of Mashhad who had referred to rehabilitation centers in this city in 1396 and their number was 40 people. After identifying students with developmental coordination disorder, 20 of them were randomly selected to receive training and trained for 16 sessions of 30 minutes. The instruments used in the study were Developmental Coordination Disorder Questionnaire Version 7 for Parents (DCDQ-7), Wechsler Intelligence Test for Children (short form) and Broninex-Ozertsky Motor Skills Test.

Analysis of statistical results showed that reconstruction of perceptual skills had a significant effect on the growth of perceptual-motor macro performance (P<0.001, F= 51.25 ) perceptual-motor equilibrium performance (P<0.001, F= 25.11). And fine motor perceptual function( P<0.001, F= 42.32) in children with developmental coordination disorder, and the results of the study indicate a significant effect of perceptual exercises on motor skills of subjects in the experimental group compared to the group. It was control.

The present study showed that perceptual skills training can have useful and significant applications for improving motor problems in children with developmental coordination disorders and can provide various and valuable services for assessment, educational methods and treatment of these children.

 Ankle joint injuries and lateral sprains are the most common sports injuries. Understanding this injury through functional tests can reduce the risk of recurrence, and athlete's medical expenses reduce keeping athletes away from sports fields and smooth out the way of rehabilitation and return to exercise. This study aimed to collect functional tests that identify the ankle instability and the overall summary of these tests.

In this study, comprehensive search to identify articles and studies conducted on functional tests for ankle instability PEDRO, PubMed, MEDLINE, Web of Science, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and Scopus based in the period 1994 to 2020 took place. In addition, a manual search and comprehensive review of article sources were conducted.

Out of 49 different tests that studied the functional tests for ankle instability, 23 articles were selected, and their results were reported. 25 performance-related tests, 7 postural control system tests, 10 self-report tests, and 7 scoring system tests were identified for ankle function evaluation.

An analysis of studies showed that 4 different testing tools had been used in the literature to evaluate functional ankle instability in athletes. The present study identifies and explains how these tests are applied. Therefore, it performs an elaborated analysis of the 4 existing tests to see which one offers a more accurate analysis of functional ankle instability in athletes.

Diabetes is associated with dysfunction, and failure of various organs, especially the nerves, heart, and blood vessels. This study aimed to evaluate the effect of aerobic training on ankle joint co-contraction in patients with Diabetic neuropathy during walking.

The statistical sample of the present study included 20 patients (age: 54.9±7.3, Body mass index: 28.4±5.1) with diabetic neuropathy in the experimental group and 20 patients (age: 54.1±7.1, Body mass index: 28.5±5.1) with diabetic neuropathy in the control group who were selected by convenience sampling. The electrical activity of selected lower limb muscles was recorded using an electromyography system during walking. The experimental group did aerobic training for eight weeks (three sessions per week). The 2-ways ANOVA with repeated measures was used for statistical analysis.

The results demonstrated lower general ankle co-contraction in the post-test loading phase than the pre-test in the experimental group (P=0.001). Other components of directed co-contraction in all phases and general co-contraction in different phases did not demonstrate any significant differences after training protocol (P>0.05).

Damage to the peripheral nerve due to diabetic neuropathy in patients with moderate neuropathy causes abnormal co-contraction contentment of lower limb muscles during walking; therefore, lowering the general ankle co-contraction results in proper control of the lower limbs, which could decrease the likelihood of injury and falls in patients.

Due to the increasing use of backpacks among children and adolescents and conflicting reports about the advantages and disadvantages of using it in causing fatigue, pain, and some musculoskeletal injuries, the present study aimed to determine the effect of backpack carriage on selected biomechanical variables (Spatio-temporal, angular and kinetic kinematics) of the lower extremity of girls and boys with 7-10 years age during walking.

In this Quasi-experimental study, the walking test was taken from 26 students (13 boys and 13 girls) while carrying a backpack at four conditions of zero, 10, 15, and 20% of body weight to analyze selected spatio-temporal, angular kinematic and Kinetic variables. To compare the mentioned variables at the four conditions, the statistical test of analysis of variance with repeated measures test was used following the Bonferroni correction coefficient post hoc test (P<0.008).

The results showed a significant difference between zero and 20% conditions in the levels of stride length, stride width and stride rate, percentage of single and double support and sway phases, peak angles of knee flexion and ankle dorsiflexion and plantarflexion, and first and second peaks of normalized vertical force and the depth force of depression (P<0.008). In addition, a significant difference was observed between zero and 15% conditions in the level of normalized stride width and stride rate, peak angle of ankle plantarflexion, and the first and second peaks of normalized vertical force (P<0.008). Also, there was a significant difference in the peak angle of ankle plantarflexion and the first peak of normalized vertical force between 10% to 20% conditions and the second peak of normalized vertical force between zero and 10% conditions (P<0.008).

while using backpacks with different weights, awareness of various biomechanical effects can help prescribe the appropriate weight for carrying. Also, due to small biomechanical changes, it seems that the maximum backpack weight in the range of 10% of their body weight is suitable for children. However, necessary precautions should be taken due to individual differences in this regard.

The purpose of the present research was to compare the effect and follow up of eight-week corrective exercises with and without the myofascial release forward head and forward shoulder deformity in young adults.

A total of 45 male students suffering from abnormal forward head more than 46° and forward shoulder more than 52° deformity with the Mean±SD age of 22.12±2.88 years, height of 175.44±6.80 cm, and weight of 71.21±7.31 kg were selected and randomly distributed in three groups: corrective exercises, combinational exercises (corrective and myofascial release), and control. These groups performed the exercises for eight weeks under the direct observation of the researcher. Prior to starting the exercises, after the end of eighth week, and four weeks after the end of the exercises, the angles of the forward head and forward shoulder of the participants were measured using a photography method. Then, the collected data was analyzed using the variance analysis tests with repeated measurements and ANCOVA.

The results showed that the degree of forward head and forward shoulder after eight weeks of exercises in both training groups in post-test and follow-up test was significantly lower than those of the pretest. The ANCOVA test results also demonstrated that the forward shoulder degree in corrective exercises group with myofascial release in post-test and follow-up test was significantly lower than that of the corrective exercises (P≤0.05). However, the forward head degree did not show a significant difference between the intervention groups in post-test and follow-up tests (P≥0.05).

According to the results, it can be stated that the corrective exercises program with myofascial release is more effective than the corrective exercises in correcting the forward shoulder deformity.

Exercise plays an essential role in improving cardiovascular function. Due to the increasing tendency of children and adolescents to swim, this study aimed to investigate the effect of twelve weeks of endurance swimming training on structural and functional characteristics of the heart of inactive adolescents

The present study was quasi-experimental with a pre-test, post-test design. Thirty inactive male students with an age range of 13 to 15 years (age 14.1±1.7 years, height 164.5±5.26 cm, and weight 54.4±6.2 kg) were selected voluntarily. Then They were non-randomly divided into experimental (n=15) and control (n=15) groups. The subjects in the experimental group performed endurance swimming exercises for 12 weeks and three sessions per week with an intensity of 60% of maximum heart rate. Also, the duration of each training session was 75 minutes. The echocardiography measured the left ventricular end-diastolic dimension, left ventricular end-systolic diameter, septal wall thickness, stroke volume, and ejection fraction before and after the exercise protocol. Shapiro-Wilk test, paired t-test, and independent t-test were used to analyze the obtained data at a significant level of P<0.05.

In the experimental group, after 12 weeks of swimming training, there was a significant increase in the amount of left ventricular end-diastolic dimension (t=2.763, P=0.02), and the stroke volume variables (t=2.573, p=0.03) was observed in comparison with baseline (pre-test) and control groups. Also, the increase in the septal wall thickness and the ejection fraction between the two ventricles were not statistically significant (P>0.05). No significant change was observed in the control group in any of the measured indicators compared to the baseline (pre-test).

The present study results showed that 12 weeks of endurance swimming training could have beneficial effects on left ventricular end-diastolic dimension and stroke volume of the heart of inactive adolescent boys by increasing cardiac preload.

Nurses play an essential role in developing care, treatment, and community health during the outbreak of COVID-19. Also, because they are in the front line of dealing with this disease, they are more likely to suffer from psychological disorders and anxiety. Therefore, taking care of their mental health is very important. This study aimed to compare the level of professional ethics, depression, anxiety, and stress in athlete and non-athlete nurses working in selected hospitals in Tehran during COVID-19 disease in 1399.

The sample size was 80 in the athlete group and 70 in the non-athlete group. Data collection tools included a demographic questionnaire, a depression, anxiety, and stress questionnaire(DASS-42), and 21 ethics questions in the nursing profession Jahanpour et al. Also, to analyze the data, SPSS v. 22 software and descriptive statistics methods (mean, standard deviation, etc.) and Clomogrov Smirnov and T-independent test were used in inferential statistics.

The results showed that depression, stress, and anxiety were higher in non-athlete nurses compared to nursing athletes (P<0001). The results also showed improved professional ethics in athlete nurses compared to non-athlete nurses (P<0001).

Given the critical role of nurses in improving and promoting people's health in the actual situation of COVID–19 disease, encouraging them to exercise according to a regular schedule with the support of sports coaches is considered a health priority.

Visual perception skills are essential for daily life activities. The purpose of this study was to investigate the effect of eight-week Wii-Fit training on visual perception in children aged 6 to 10 years with a developmental coordination disorder

The research method was semi-experimental with pre-test and post-test with the control group. The statistical population included all children aged 6 to 10 years in Rafsanjan in the academic year of 2018-19. Of these children, 40 children with developmental coordination disorder were selected by multi-stage available sampling method and randomly assigned to experimental and control groups. Research instruments were Wilson's Developmental Coordination Disorders Questionnaire, Movement Assessment Buttery for Children (MABC), and Gardner's Visual Perception Test. Subjects in the experimental group performed the individual Wii fit training for 16 sessions (8 weeks and two sessions per week). The Shapiro-Wilk, Levin test and 95% confidence level covariance were used for data analysis.

The results showed that timely interventions based on active video games significantly affected children's visual perception with developmental coordination disorder (P˂0.05).

According to the results, the emphasis on identifying and performing appropriate interventions such as Wii Fit training may be effective in treating and developing children with developmental coordination disorder.

Due to the increasing speed of life and modernization of daily activities of human beings, physical activity seems to be necessary. Exercise and physical activity are the most critical components affecting human health and mental health. Satisfaction of basic psychological needs also provides the conditions required for growth and development, cohesion, and psychological well-being. This study aimed to investigate the effect of aerobic exercise on the psychological needs and well-being of 12-year-old female students in Tabriz.

The method of this research was quasi-experimental. The statistical population of this study included all 12-year-old female students in Tabriz. Sixty of them were selected by convenience sampling in two groups of 30 experimental and control. Participants completed questionnaires on the Reef Psychological Needs Satisfaction Scale. In data analysis, univariate and multivariate analyses of covariance were used at a significant level (P=0.05) using SPSS v. 24 software.

The results showed that aerobic exercise significantly increased the components of competence, autonomy, and the relationship between basic psychological needs (P=0.001) as well as the components of mastery of the environment, purposefulness in life, self-acceptance (P=0.001), and Independence (P=0.018) has a significant positive effect on the psychological well-being of adolescent girls.

According to the results of this study, it can be concluded that physical activity can improve the satisfaction of basic psychological needs and psychological well-being of adolescent girls. People who exercise regularly have better psychological well-being than other people.

The present study aimed to investigate the effects of 4 weeks of aquatic exercise prehabilitation pre-surgery along with eight weeks of exercise rehabilitation after laminectomy surgery on pain and core muscles electromyography in women with a chronic low back.

A total of 30 females with CLBP candidates for laminectomy surgery enrolled in this single-blind randomized controlled trial. The participants were randomly allocated into the intervention (n=15, Mean±SD age 46.2±5.45) and control (n=15, Mean±SD age 46.26±5.39). The Visual Analog Scale (VAS) was used to measure pain, and a surface Electromyography (EMG) device was also used to measure selective core muscles activity of participants. The intervention group participated in 4 weeks of aquatic therapy as a rehabilitation program pre laminectomy surgery and eight weeks of aquatic therapy as a rehabilitation program after surgery. The control group participated in the same program only eight weeks after surgery as a routine rehabilitation program. All tests and measurement procedures were done for all participants, pre-surgery and at the end of 8 weeks rehabilitation.

The findings of the presents study indicated that prehabilitation program pre laminectomy surgery in women with CLBP significantly reduced levels of pain (p<0.0001) and increased muscles strength or EMG of selective core muscles (p<0.0001) of the intervention group compared to the control group at the end of the program.

In general, the statistical analysis concluded that pre-rehabilitation exercises as a hydrotherapy protocol had significant pain intensity and main muscle activity. Therefore, a comprehensive rehabilitation program for women with chronic low back pain has more beneficial effects than a routine rehabilitation program for these patients. Therefore it is recommended it is most helpful if the healthcare system in Iran includes a rehabilitation program as part of a comprehensive program for patients with CLBP. They are a candidate to have laminectomy surgery.

Elastic walking is capable of loading from all directions, and it can adjust the intensity of the natural load, so it is helpful for low back pain in the elderly. The purpose of this study was to the effect of a selected exercise course on plantar pressure variables in older adults with low back pain during walking.

This study was a quasi-experimental design. A total of 20 Older adults with low back pain were randomly divided into experimental (n=10) and control (n=10) groups. The experimental group did elastic gait training for six weeks. Peak plantar pressure variables during pre and post-test were recorded by a foot scan system (sample rate: 300 Hz).

The results showed that the peak of the vertical component of the ground reaction force at the heel contact stage (P=0.033), the vertical loading rate (P=0.035), the degree of displacement of the center of pressure in the internal-external direction (P=0.028) and Anterior-posterior (P<0.001), the peak of force in the Toe 2-5 (P=0.005), Midfoot (P=0.009), Heel Medial (P=0.039) and Heel Lateral (P=0.006) in the experimental group was lower in the post-test compared to the pre-test.

The results showed that the ground reaction forces decreased in the older adults after a period of elastic gait exercises. This can play an essential role in rehabilitating back pain in older adults.

Aging is along with muscle weakness and musculoskeletal pain that requires attention and planning to control these changes. The purpose of this study was to investigate the effect of eight weeks of aqua therapy on back pain, body composition, and motor function in inactive elderly women.

The present study was quasi-experimental with a pre-test and post-test design of a suitable type. Thirty inactive elderly women were voluntarily and randomly assigned to two experimental and control groups. The experimental group performed combined water exercises for eight weeks, three sessions a week with a maximum intensity of 45 to 65% of the maximum heart rate. Body composition variables were analyzed using body composition analysis device, back pain analyzed by Key Star Back 9-item questionnaires, and movement control variables such as walking speed evaluated using 10 m walking test and the ability to maintain balance analyzed with stand-up and time test, tested before and after the training protocol. And the data were analyzed using the SPSS program and independent and dependent t-test.

Based on the findings of the present study, significant improvement in body composition, including weight, fat percentage, muscle tissue, and waist to hip ratio, was observed in elderly women (P=0.001), and the results of the present study showed factors affecting motor control had a significant improvement, such as balance (P=0.001), speed (P=0.001) and physical back pain (P=0.001) and mental back pain (P=0.001) after eight weeks practicing in the water.

This study showed that as the elderly live a passive and active life, their physical health improves. To increase the range of motion of the lumbar region, stabilize the trunk, and reduce back pain, trainers and officials can use this non-invasive and low-cost method in the training program and rehabilitation of the elderly individual.

One of the main problems of children with attention deficit / hyperactivity disorder is deficit in fine motor skills, especially handwriting problems. Accordingly, This study aimed to develop a training package of Physical-Motor Activities and evaluate its impact on handwriting problems of children with ADHD.

The present study was applied in terms of purpose and the method of combined type (qualitative and quantitative) as the qualitative part of treatment plan and the quantitative part of quasi-experimental method with unbalanced control group design and follow-up session. Statistical population in the qualitative section is based on the theories of Barkley (2015) and includes experts in the field of child motor skills and research published in prestigious journals from 2012 to 2020 for Persian articles and from 2000 to 2020 for the English articles in the field of motor interventions for children with ADHD. The quantitative part included all boys with ADHD aged 7-12 years in the primary schools of the 16th district of Tehran. For sampling among the schools in District 16, four schools were selected as available, and 30 children with ADHD were identified in those schools and then randomly assigned to two experimental and control groups (each group including 15 children). The instruments used in the qualitative section were extracted texts and in the quantitative section were Diagnostic Questionnaire of ADHD and Handwriting Problems Questionnaire. The children in the experimental group participated in the training program in 24 sessions of 60 minutes. Data were analyzed using a mixed analysis of variance.

In the qualitative part, research results showed that the training package had sufficient content validity in the opinion of experts. In the quantitative part, the results manifested that by controlling the pre-test, the training package of physical-motor activities caused a significant improvement in the handwriting problems in the experimental group compared to the control group (p=0.001).

Overall the result of the present study showed that physical-motor activities training program has positive effects on handwriting problems of children with ADHD.