فصلنامه آرشیو توانبخشی
سال بیست و دوم شماره 4 (پیاپی 90، زمستان 1400)

Specific learning disorder is a type of neurodevelopmental disorder, in which children with disabilities have difficulty understanding, or using spoken and written language. The disorder diagnoses when children have significant reading, writing, and math skills lower than expected. One of the characteristics of children with a learning disorder is the presence of anxiety symptoms, which are often chronic, and failure to address them can negatively affect the child's growth and academic performance. Assertiveness training is a structured intervention that uses to reduce the symptoms of anxiety. The present study aimed to determine the effectiveness of assertiveness training on anxiety symptoms of male school-age children with special learning disorders in Tehran City, Iran.

The present study was a quasi-experimental research in which a pre-test in addition post-test design with a control group used along with a five weeks follow-up. The population included 8-11 year-old male children who were studying in the Learning Disorders Centers in Tehran City in the school year 2019-2020. The sample consisted of 130 male school-age children who were in convenient selected from the five educational districts (2, 13, 12, 18, and 15). At first, the Colored Progressive Matrices (CPM) assessed all subjects and 72 children who got a normal intelligence quotient (≥85) completed the Child Spence Anxiety Scale (SCAS-C). The studied sample was selected according to the formula for the determining the sample size and the probability of its drop-out (34 people). After scoring the SCAS-C, 45 children received a moderate anxiety (44-88 points). Thirty-four students (19, 10, and 5, respectively with dyslexia, dysgraphia, and dyscalculia) were randomly selected among them and matched based on their age, school grade and socio-economic status. They randomly assigned to the experimental and control group with mean and standard deviation of age 10.45±2.25 and 8.87±1.89 respectively. The experimental group divided into three subgroups (six people in two groups and five people in one) due to the efficacy of training in small groups and participated in 10 assertiveness training sessions (twice a week and 90 minutes for per session) while the control group received only the mainstream programs in the Learning Disorder Center. All subjects assessed by the SCAS-C at the end of the training sessions and five weeks follow-up. The obtained data from pre-test and post-test situations analyzed by using univariate and multivariate analysis of covariance. In addition, the data were analysed by the analysis of variance with repeated measure to determine the stability of the assertiveness training after the five weeks follow-up

The results of univariate and multivariate analysis of covariance showed that there was a significant difference between the mean scores of anxiety symptoms and its components in the experimental and control groups before and after the assertiveness training sessions (p<0.01). The results based on the eta quotient show that the values of 66%, 66%, 32%, 63%, 63%, 71%, and 73% respectively of the variance of total anxiety symptoms, generalized anxiety, obsessive-compulsive disorder, personal injury fears, social phobia, separation anxiety and panic disorder/agoraphobia in students with special learning disorder can be explained by participation in assertiveness training intervention. The results of analysis of variance with repeated measure showed that the effect of assertiveness training has only lasted on reduction of generalized anxiety, personal injury fears, anxiety phobia, and obsessive-compulsive disorder after five weeks follow-up. However, the effectiveness of the intervention program not found for the total anxiety symptoms, separation anxiety and panic/agoraphobia after follow-up study.

The results indicate that the assertiveness training can reduce the symptoms of anxiety and its components in school-age male children with specific learning disorder. Therefore, we conclude that the design and implementation of similar training programs help students to strive to establish interpersonal relationships, reduce the frustration of academic failure, express their feelings, think of possible ways to deal with anxious situations, manage their negative behaviour, and be prepared to accept multiple roles in adulthood. Thus, by providing assertiveness training, maladaptive behaviors and mental health problems (especially anxiety symptoms) can be preventive in students with special learning disorder in addition to prevent ongoing problems in the fields of education and occupation.

 Moral distress may occur when people are unable to follow professional standards and ethical values in their profession. It is a significant issue in the healthcare profession and has negative consequences. In addition, there is a concern that it may adversely affect clinical performance and, in some cases, patient outcomes. Based on the evidence, occupational therapists experience moral distress, Therefore, there is a need for a tool that enables researchers to identify the extent of moral distress in each individual and to measure the effectiveness of strategies designed to reduce distress and prevent employee burnout. The aim of this study was to develop and evaluate the face and content validity of the Moral Distress Questionnaire in occupational therapists.

 This psychometric study was performed in two stages. The first stage involved preparing a pool of questionnaire items, and the second stage examined the face and content validity of the questionnaire. First, texts and related studies were reviewed to extract the questionnaire items. Searching various databases was done to find any conditions that create moral distress in occupational therapy. Three qualitative studies conducted in the field of ethical issues of occupational therapists in the field of psychiatry, children and adults were fully studied. The codes extracted from these studies and the quotations of the interviewees were read. Then the questionnaire items were extracted from the codes, sentences and phrases of the studies. The items were read several times and edited in terms of content clarity, grammar and concept comprehension, and duplicate topics were removed. After preparing the pool of items for the preliminary questionnaire, the scientific stages of face and content validity of the questionnaire were completed. The face validity of the questionnaire was measured qualitatively and quantitatively by 30 occupational therapists who were selected by available sampling from clinics, hospitals and public and private centers. Inclusion criteria were at least one year of work experience in various fields of occupational therapy. Quantitative face validity was performed by determining the impact score of the item. In order to perform qualitative content validity, experts in the field of teaching ethics in occupational therapy and familiar with tool development were invited to review the questionnaire and exchange views in a face-to-face meeting. Seven people participated in the panel of experts. Participants were told that the tool would be an Evaluative tool designed to assess the extent of moral distress among occupational therapists working in clinical settings. After carefully studying the tool, they were asked to consider and comment on the four criteria of clarity, simplicity, transparency, and relevance of items to moral distress. To assess the quantitative content validity of the questionnaire, 20 occupational therapists with doctoral degrees were asked to complete the relevant forms for assessing Content Validity Ratio (CVR) and Content Validity Index (CVI).

After reviewing the texts and related studies and analyzing the findings and concepts, a preliminary questionnaire with 50 items was extracted. The items of the questionnaire reached 22 items after completing qualitative and quantitative face and content validity. The impact score of the item was between 2.85 to 4.83. The CVR was in the acceptable range of 0.5 to 1 with an average of 0.7. The CVI of the questionnaire was 0.93.

 The Moral Distress Questionnaire in Occupational Therapists with 22 items on a four-point scoring scale has appropriate content validity and can be used to measure moral distress in occupational therapists after completing the validity and reliability steps.Temodipi ciusant. Aquiatem quae pa isciduc iliberr oritatur

 Activities of daily living are activities that are formed in order to take care of the body and are essential for life and well-being and fundamental survival. These activities begin in infancy and are modified at different stages of development. Cultural values, parental expectations, social routines, and the physical environment influence daily activities. Concerns about children's use of time and daily activities are not new, but studies on them are rare. So to have more information and knowledge about children's lives and well-being, we need to have more information about their daily activities. The aim of this study was to investigate the time allocated to daily life activities based on the day of the week, age and gender in healthy children under 5 years in Isfahan.

In this survey (descriptive-analytical) study in which healthy children under 5 years old in Isfahan were present, from different age groups according to the population of that age group, 240 girls and boys so that the number of girls and boys were equal in the age categories of less than 1 month, 2 to 3 months, 4 to 6 months, 7 to 12 months, 1 to 2 years and 3 to 5 years, were selected by multi-stage, stratified, cluster and convenience sampling . In order to collect research data, demographic questionnaire and time use diary tools were used.

The results showed that on weekdays, among the components of daily life activities, the most time with an average of 150.59 minutes per day is devoted to eating (and drinking) and the least time with an average of 0.02% per day is devoted to caring of Personal belongings, while in the last days on average the most time is spent eating (and drinking) and the least time is spent on other daily activities. In different age groups on weekdays, infants 0 to 1 month with an average of 273.35 minutes per day have the most time and children 25-60 months with an average of 154.65 minutes per day have the least time devoted to daily life activities on weekdays. Meanwhile, infants in the age group of 0-1 months on a weekend spent the most time on daily activities and children in the age group of 25-60 months spent the least time on daily activities. Girls and boys spent the most time eating (and drinking) among the activities of daily living on a weekend, while boys and girls spent the least time on other daily activities that are not categorized in this study. There was no significant difference Between the time allocated to daily life activities on weekdays and weekends and between the time allocated by girls and boys under 5 years old living in Isfahan on one day a week to activity of daily livings, both on weekdays and weekends (P>0.05). However, there is a significant difference between the time use of daily life activities in different age groups on weekdays and weekends (P<0.05), and finally, there is a difference between the time allocated to daily life activities on one day of the week and the weekend (P<0.05).

 According to the results of the present study, age groups and days of the week are influential factors on daily activities, but gender has no effect on daily activity patterns.

Students with visual impairments have built negative attitudes towards their abilities due to difficulties in achieving social skills, orientation, and independent mobility. Their negative attitude towards blindness puts them at high-risk developing loneliness, social isolation, depression, anxiety, decreased life expentancy, no participation in group activities, and low levels of social support. Lack or no social skill reduces social acceptance and real feeling about themselves, which in turn reduces self-esteem in students with visual impaiments. Using appropriate therapeutic intervention with the aim of ensuring mental health as well as promoting self-esteem can prevent many psychological problems in these people. The acceptance and commitment therapy (ACT) is one of the third wave approaches to behavioral therapy that aims to control effectively the pain, suffering and stress that a person faces in the life. The acceptance and commitment therapy helps the person increases her psychological relations with herself and her feelings, trying to adapt to the environment and community instead of changing her cognition. The present study aimed to determine the effectiveness of the acceptance and commitment group therapy on self-esteem of students with visual impairment in Tehran City. 

The present study was a quasi-experimental study in which a pretest-posttest design with a control group used along with a two-month follow-up. The sample was consisted of twenty-eight 14-20 year old female students who was selected from the population of students with visual impairment studying in the schooling year of 2019-2020 in Narjes day-and-night school for the blind individuals. In Tehran, there is only one school for female blind students and the sample purposefully selected according to the probability of sample’s dropout. At first, 50 students completed the Cooper Smith Self-Esteem Questionnaire (CSSEQ) and after scoring the CSSEQ, twenty-eigth students selected according to receiving a score of 23 or lower in the CSSEQ. All subjects matched based on their age and grade, then randomly assigned to the experimental and the control group. The experimental group (two subgroups consisted of seven people in each) participated in eight therapeutic sessions (twice a week and 75 minutes for per session) and received the acceptance and commitment group therapy while the control group participated only in the mainstream programs at the school. At the end of the therapeutic sessions all subjects completed the CSSEQ again and the experimental group completed CSSEQ after two months follow-up.The multiple analysis of covariance (MANCOVA) used for analyzing the obtained data. Furthermore, for comparing the posttest and follow-up situations in the experimental group the related t-test used. 

 The results of multiple analysis of covariance for the data obtained from the self-esteem questionnaire showed that the participation of female students with visual impairment in the acceptance and commitment group therapy sessions led to significant increase (P<0.001) in self-esteem (general, family, social, and educational) of them. In fact, according to Eta quotient, 71%, 78%, 78%, and 72% of variation in self-esteem (general, family, social, and educational respectively) of the experimental group can be explained by participating in the acceptance and commitment group therapy sessions. The results of the related t-test for comparing the self-esteem of the experimental group in post test and follow-up situations showed that the effectiveness of group therapy based on acceptance and commitment has been lasted on the self-esteem (general, family, social, and educational) of the experimental group after two months follow-up later (P>0.05). 

 We conclude according to the findings of the present study that the acceptance and commitment group therapy can use for planning and policy making instructional courses suitable for students with visual impairments. Furthermore, the specialists who are working with these children can use the ACT as a practical technique for improving self-esteem and the adaptation in many areas such as family, social and educational areas in students with visual impaiments. Additionally, the ACT recommend improving self-esteem and positive performance of students with visual impairment in social, educational and family areas along side the routin instructional couses. However, the acceptance and commitment group therapy helps the students with visual impairment know how to control their thoughts and feelings in order to prevent problems from getting worse. This therapeutic method helpls them to accept their behavioral changes through accepting the unpleasant thoughts and feelings.

Despite all advancements in hearing amplification, screening, and interventions, concerns still exist about the language outcomes in children with mild to severe hearing loss. The present study aimed to investigate the production of inflectional morphemes, phrase, and clause structures of children with Moderately Severe Hearing Loss (MSHL) and compare with those of the children with Normal Hearing (NH).

The study participants were 88 NH children, aged 2-5 years, and 10 MSHL children, aged 5-6 years. They were recruited by a convenient sampling method. Speech therapists collected language samples in a free play context of the study children, and then the language samples were transcribed and segmented according to P-LARSP (language assessment, remedy, and screening procedure). Of 100 analyzable units, the speech therapists identified, allocated, and counted 14 inflectional morphemes and all clause and phrase structures in each language sample.

Children with MSHL used significantly fewer numbers of inflectional morphemes (P=0.004), verb/complement+personal pronoun (P=0.009), and prefix/mi/as a tense marker (P=0.025), lower mean length of morpheme/analyzable utterances (P=0.003), higher percentages of one-word utterances (P=0.001), and lower numbers of clause structures in stage V (P=0.002) compared with NH children aged 4-5 years. While the types of clause structures in children with MSHL were similar to those in NH children aged 24-36 months. However, the types of produced inflectional morphemes were restricted compared with all groups of children with NH.

 The present study revealed that children with MSHL are behind younger children with NH in grammatical aspects of the Persian language. They used simpler clauses, limited numbers, and types of inflectional morphemes, as well as clause and phrase structures, and mainly relied on one-word utterances. Continued monitoring of grammatical outcomes is warranted, considering that children who are MSHL are at increased risk for language problems.

Progressive visual impairment is one of the problems that threatening the health of patients and has the negative effects on their abilities. This study aimed to explore the health concerns of patients with Retinitis Pigmentosa (RP).

 A qualitative inductive approach was used. Eleven patients with RP, participated in this study in Iran. Patients were selected through purposeful sampling. Data collection was done through two methods of in-depth semi-structured individual interviews and field notes. Data analysis was performed using approach of conventional content analysis.

 The categories of "perceived health threat" and "perceived support needs", were extracted. The category of perceived health threat included sub-subcategories of "gradual decline in physical function", "sustained fluctuations in mental health", and "weakening of social capability". "need for socio-economic support", "need for educational support", "need for psychological support", and "need for a personal assistant" were extracted as sub-subcategories of perceived support needs.

 RP Patients faced with the problem of abilities impairment in various physical, mental, and social dimensions and need for support in society. So, to improve the health of these patients, members of the health group are suggested to develop a context-based wholistic care program through multidisciplinary cooperation.

 Training capable, committed and responsive graduates to the needs of society and the health system can be considered the most important mission of medical universities. In general, accountability to the community is one of the main priorities of the health education system, so if universities want to meet the needs of the community they cover, they must design their education system based on the needs and priorities of community health. The purpose of this study is to identify the dimensions and components of Accountable education for the rehabilitation sciences Curriculum in Tehran universities of Medical Sciences.

 This study was conducted with a qualitative approach to identify the dimensions and components of Accountable education in Tehran universities of Medical Sciences in 2021 with the participation of 25 experts in the field of rehabilitation and using the method of content analysis through purposeful sampling. In order to collect data, semi-structured interviews of experts were used. The interview lasted between 45 minutes and 60 minutes and before the interview, the purpose of the study was explained to the participants. Data analysis based on Granheim method and also in order to evaluate the accuracy and robustness of the data, four criteria of acceptability, reliability, transferability and Guba and Lincoln

 The mission of Accountable education is commitment to the direction of education, research and service delivery based on the priority needs and expectations of society, which is achieved by emphasizing the direct and continuous contact of students with society at various levels. After conducting the interviews, 6 dimensions and 21 components were identified as follows and were approved by experts in the form of brainstorming. Dimensions include: 1- Society 2- Higher health education system 3- University 4- Professor 5- Student 6- Curriculum and 21 components and 136 indicators were finalized

 The present study showed 6 general dimensions 1- Society 2- Higher health education system 3- University 4- Teacher 5- Student6-Curriculum as dimensions Accountable education play an important role in fulfilling the missions of third and fourth generation universities. The results of this study are expected to be used by institutional policymakers in the field of rehabilitation sciences in order to institutionalize Accountable education in the field of higher education in order to be able to effectively guide Curriculum towards meeting the needs and expectations of society. It is suggested that due to the importance of responsive education, more extensive studies in this field should be conducted at the level of medical universities in the country.

Knee osteoarthritis is a common, progressive, and chronic disease that affects approximately 13% of the population over the age of 60. Osteoarthritis causes progressive disability and changes in gait parameters, decreased function and quality of life of patients by causing malalignment of the knee in the frontal plane following destruction of articular cartilage. Braces as a mechanical intervention are a successful treatment for osteoarthritis knee and its associated malalignment. Using a three-point pressure mechanism, braces create a natural alignment in the knee by straps attached to the thigh and shank shells, which reduce the medial knee load and correct the varus alignment. This distributes the force properly while walking. However, applying a constant force on three pressure points of the leg, thigh and affected knee joint reduces the adduction angle of the knee in all phases of gait cycle , while the correction of the adduction angle of the knee in patients is essential only in phases between 30% to 60% of the stance phase, when the knee deviation reaches its peak. The aim of this study is to design and fabricate a brace joint with a new intermittent correction mechanism for patients with osteoarthritis medial compartment knee and to investigate its effect on a patient's gait parameters.

The new joint design of the knee brace was based on the conversion of the knee extension movement at the end of the swing on the sagittal plane to the abduction movement on the frontal plate by stretching the converter piece. Participant gait was assessed in two ways with and without braces. Kinematic variables including knee joint angles in the sagittal and frontal planes and spatio-temporal variables of patient gait were measured and recorded.

 The results of the new brace joint function on the knee showed that the angle of flexion of the knee in the swing phase increased from 44.72° to 46.19° when using brace. Also, knee adduction angle in the stance phase decreased from 4.25° to 2.3° and patient's walking speed while wearing the brace increased from 0.88 m/s to 0.93 m/s. On the other hand, step length increased from 1.125 m to 1.451 m when using brace and the percentage of stance phase decreased from 63.53 to 62.68 when using brace.

 In this one-sample study, a knee brace with a new joint was able to help correct the direction of knee joint in the frontal and sagittal plane and affect the patient's gait parameters. It seems that if the same results are obtained in a large-scale clinical study, this brace could be a suitable replacement for invasive methods and inappropriate orthoses.