فصلنامه آرشیو توانبخشی
سال بیست و سوم شماره 2 (پیاپی 92، تابستان 1401)

The present study aimed to investigate the effect of brain neuroplasticity on the incidence of anterior cruciate ligament (ACL) injury and on brain function and structure before and after ligament reconstruction and after a period of rehabilitation exercises.

In this review study, a search was conducted in PubMed, Scopus, Web of Science, Google Scholar, ScienceDirect, MedLine, Pedro, CINAHL, SPORTDiscus, and Cochrane Databases as well as national databases on related studies published from 1970 to 2021 using keywords in Persian and English related to the research topic.

The initial search yielded 65 articles. Based on the inclusion and exclusion criteria, 24 articles were selected for review of which 5 articles prospectively examined the effect of brain neuroplasticity on the incidence of ACL injury. Their results showed that the brains of people with ACL injury was different from the uninjured people, especially in the motor-sensory part of the cerebral cortex and cerebellum, which caused errors during movement planning of these persons. Ten articles examined the effect of ACL injury before reconstruction on brain function and structure and reported that changes occur in the level of motor-sensory cortex of the brain at least two weeks after the injury; after one year, these structural and functional changes were widely increased in injured people compared to healthy people. These studies also showed that the ligament dysfunction and the damage to mechanical receptors cause the reorganization of the central nervous system. In injured people, the control activity of motor-visual areas and their need for visual feedback have increased. Seven articles examined these changes after ligament reconstruction and showed that the brain neuroplasticity or functional and structural changes resulting from the injury not only did not return to normal conditions, but also increased after a while despite the reconstruction. Two articles examined these changes after a period of rehabilitation exercises and showed that functional and 

The changes in the brain after ACL injury not only persist after ligament reconstruction, but also increase after reconstruction. The common rehabilitation exercises whose main focus is not on eliminating these functional and structural changes in the brain cannot overdrive this negative neuroplasticity after injury which is one of the important causes of secondary injury and subsequent complications. In developing exercises to prevent ACL injury and for rehabilitation, it is better to use the new principles of motor learning and exercises related to visual feedback along with conventional exercises to overdrive negative neuroplasticity created in the brain and create positive neuroplasticity to support ACL.

Down syndrome or trisomy 21 is one of the most common human chromosomal disorders that affect cognitive functions, communication and behavioral skills. At the macro level, various factors can contribute to the Down syndrome prevalence and mortality. This study aimed to investigate the association of health system functions with Down syndrome prevalence and mortality worldwide.

The study was a cross-sectional study conducted based on the secondary analysis of existing data in 2019. Data from 202 countries in six different regions (African Region [AFRO], Eastern Mediterranean Region [EMRO], European Region [EURO], South-East Asia Region [SEARO], Western Pacific Region [WPRO], and Pan American Health Organization [PAHO]) were included in the study. Data were extracted from the World Health Organization (WHO), the World Bank and the Institute for Health Metrics and Evaluation databases. The adjusted linear regression analysis was used to examine the association between health system-related factors with prevalence of, and death due to Down syndrome as the outcome variables. In the present study, two functions of health financing (domestic general government health expenditure [GGHE-D] per capita in PPP [purchasing power parity] int$, domestic private health expenditure [PHE-D] per capita in PPP int$, external health expenditure [EXT] per capita in PPP int$) and health system resources (nurse and midwifery personnel, generalist medical practitioners [GMP], specialist medical practitioners [SMP], pharmacists, dentists, physiotherapists) were included in the study as independent variables. We used the Stata software version 14 to analyze 

Africa and low-income countries had the highest deaths due to Down syndrome. On the other side, Europe and high-income countries had the highest prevalence of Down syndrome worldwide. According to the available data, Iran had a lower prevalence (29.31 vs 38.44 per 100,000 population) and higher deaths (0.34 vs 0.32 per 100,000 population) compared to high- income countries. The 20-year trend of prevalence of, and deaths due to Down syndrome in Iran has always been lower and higher than high-income countries, respectively. Linear regression analysis showed that GGHE-D per capita (β=0.385, P<0.001) and PHE-D per capita (β=0.354, P=0.02) could predict the prevalence of Down syndrome significantly in the study countries. On the other hand, nurse and midwifery personnel (β=-0.607, P=0.014) and number of SMP (β=0.420, P=0.025) were associated with increased deaths from Down syndrome in the included countries. 

Our findings showed GGHE-D and PHE-D are associated with a higher prevalence of Down syndrome in health systems.  On the other hand, health system resources (nurses and SMP) were the main predictors of death due to Down syndrome in the included countries. International organizations and governments need to monitor and improve the equitable access of vulnerable groups to health services in low-income countries.  Improving health insurance coverage and equitable distribution of health resources is suggested to reduce deaths due to Down syndrome in Iran.

Plantar fasciitis is the most common cause of heel pain. The night splints are used to prevent nocturnal contractures happening in the calf muscles and plantar fascia. The objective of this study was to investigate the effects of using a tension night splint for calf and plantar fascia on the range of motion of foot and ankle complex, pain severity, and quality of life. 

30 people (27 female) with plantar fasciitis volunteered in a parallel-group clinical study. Participants were allocated to three study groups: a tension calf splint, a tension plantar fascia splint, and a control group (heel pad). The study outcomes were the range of motion of foot and ankle complex, pain severity, and quality of life measured with a goniometer, visual analog scale, and 36-Item Short Form Survey (SF-36) questionnaire, respectively. The post-session was four weeks after participants received their interventions. The analysis of covariance statistical test was used to analyze the within and between-group differences. 

The analysis of covariance test showed statistically significant differences for pain (F=9.35, P=0.001, η2=0.44) and extension of the first metatarsophalangeal (F=4.76, P=0.017, η2=0.27). There was no statistically significant difference in the quality of life and the ankle dorsiflexion range between groups (P>0.05). The Bonferroni post-hoc showed a significant reduction of the reported pain post-session in all study groups (P<0.05). The calf tension splint caused a greater extension of the first metatarsophalangeal post-session (P=0.02).

All three orthoses used in this study significantly reduced pain in people with plantar fasciitis. The results also suggest that a tension calf splint has greater effectiveness in improving pain severity and soft tissue flexibility than a tension fascia splint.

Nowadays, organizations and institutions evaluate their performance to ensure that they are taking the right steps towards their goals and missions. In this regard, universities and research institutes assess their success in achieving their goals by analyzing their scientific outputs and productions. This study aims to investigate the scientific productions and collaborations of the authors affiliated with the University of Social Welfare and Rehabilitation Sciences (USWRS) in Scopus database in comparison with five medical universities.

This study, using scientometric techniques, was conducted on June 5, 2021. The information about scientific productions of the USWRS and other five universities of Golestan University of Medical Sciences, Qazvin University of Medical Sciences, Semnan University of Medical Sciences, Hamedan University of Medical Sciences, Zanjan University of Medical Sciences were identified were extracted from the Scopus database and then converted into scalable format in Sci2 software. The output was then plotted in VOSviewer software.

The mean number of authors for the USWRS in each article was 9, and the highest scientific collaborations was with the authors from United States, United Kingdom and Sweden. The authors for the USWRS also had a significant co-authorship with each other. According to the national ranking, this university was ranked 23 lower  than Hamedan University of Medical Sciences and Golestan University of Medical Sciences. In terms of the number of published papers, it was in the second place after Hamadan University of Medical Sciences. The level of international cooperation of this university was more than other compared universities.

It seems that the USWRS’s scientific policy has been successful in increasing the scientific productions. More efforts should be made in this university to establish scientific collaborations with other universities at the national and international levels for encouraging authors.

Intellectual disability is a common neurodevelopmental disorder. Working memory deficit can affect children. One of the effective methods in the field of learning is playing games and the application of play therapy techniques. In this method, children are allowed to practice useful social behaviors and experience new thoughts and feelings in a safe environment with supportive relationships. This study aimed to examine the effectiveness of Adlerian play therapy on the working memory of female students aged 7 to 12 years with mild intellectual disability.

Out of 60 female students aged 7 to 12 years with a diagnosis of mild intellectual disability in Fatemeh Zahra Special School in Qom, 28 students met the inclusion criteria. They were divided into the experimental and control groups by 1: 1 random allocation. The experimental group received the Adlerian therapy protocol for ten weeks in three 45-minute sessions (30 sessions) every week. The working memory of both groups was examined in three stages, including pre-test, post-test, and one month later, without receiving any intervention for follow-up, by the fourth version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). Data analysis was done by Shapiro-Wilk, Friedman, Mann-Whitney, and Bonferroni tests and generalized estimation equation by SPSS software v. 22 at the significance level of 5%.

Most of the subjects in each group were aged 7 years (first grade) with six people (43%), whereas the lowest frequency was related to the age of 9 years (third grade) with two people (14%) per group. The mean and standard deviation of the working memory subtest in the experimental group increased from 6.28 3.66 in the pre-test to 10.4 86 in the post-test and increased to 12.64 5.25 in the follow-up stage. However, in the control group, the mean and standard deviation changed from 5.92 3.19 in the pre-test to 5.64 3.17 and 5.85 3.41 in the post-test and follow-up, respectively. In the experimental group, there was a significant difference in the mean score of working memory in all stages of measurement (p< 0.05). In the pre-test stage, there was no significant difference in the mean score of working memory in the experimental and control groups (p>0.05). In the post-test stage, because the P was very close to 0.05, we can ignore it and consider it significant. In the follow-up stage, there was a significant difference in the mean score of working memory in the experimental and control groups (P<0.05).

It seems that child-centered Adlerian play therapy has a persistent effect on the working memory of students with mild intellectual disabilities. Therefore, Adlerian play therapy can be used in educational planning to enhance the working memory of these students

Stuttering is a speech disorder that occurs with frequent and abnormal disruptions in speech, such as sound repetition, sound prolongation, and sound or airflow blockage. Despite the many theories, the cause of stuttering has not been entirely determined, and various factors have been proposed for its etiology. According to the vicious circle hypothesis, increased speech disfluency results from hypervigilance to speech. This study aimed to measure the effect of reduced attention on speech through verbal and non-verbal dual tasks among school children with stuttering. Furthermore, the effect of dual tasks on the severity of stuttering was investigated among them.

In this cross-sectional study, the participants included 39 children (5 girls, 12.8%) and (34 boys, 87.2%) aged 8-12 years (10.25±1.35) with developmental stuttering selected via convenience sampling from primary schools in districts four and eight and speech therapy clinics in Tehran, Iran. Dual tasks were designed using the Visual Basic program. During the study, four speech samples were recorded for each participant. The second and third samples were designed as a dual task (addition of verbal or non-verbal tasks), while the first and fourth samples were designed as a single task. The participant’s severity of stuttering in each sample was calculated based on the number of stuttered syllables (SS%), and data were analyzed by SPSS 20 software. Given the non-normal distribution of data, the generalized linear model with the Generalized Estimating Equation (GEE) and Bonferroni test were used to determine the difference in stuttering severity among speech samples.

The GEE results showed that the severity of stuttering was different among the four speech samples (P=0.015). The lowest and highest mean stuttering severity among the 39 participants pertained to the non-verbal dual task (14.85) and the single initial task (17.11), respectively. A pairwise comparison of stuttering severity showed that the mean severity in the final single task was significantly lower than in the single initial task (P<0.05). However, mean stuttering severity was not significantly different between verbal and non-verbal tasks (P>0.05).

The findings showed that stuttering severity reduces when children with stuttering perform dual tasks. In other words, focusing children’s attention on verbal and non-verbal tasks while talking reduced their dysfluency.

The Lidcombe therapeutic program is one of the treatments for stuttering in preschool children whose effectiveness on improvement in stuttering has been confirmed. Some families have no access to care centers due to different reasons and as such, they are deprived of treatment. Distant treatment would be a proper solution for this issue, in which all people can reach their needed treatment without being concerned over their geographical locations. Because some research has been conducted on telepractice for speech and language disorders in different ways in different countries, regarding the cultural differences that influence the duration of the Lidcombe program as well as its distant implementation, we investigated the extent of the stuttering effect in telepractice program on preschool children in Iran.

In this single-subject study, the Lidcombe program was implemented through live video communication between the therapist in a clinic and the subjects at home for 15 weekly sessions on five 4-6-year-old children, including three boys and two girls. To investigate the progress of the effect, the percentage of stuttered syllables, which were recorded by the therapist as well as the 9-score stuttering severity scale, which was recorded by the parents at home, were employed. During the first base line, which had been considered as three weeks, 21 times the severity rating were recorded, while 3 times the percentage of stuttered syllables were recorded. In the treatment phase, which lasted 15 weekly sessions, 105 and 15 times the score of severity and the percentage of stuttered syllables were recorded respectively. In the second base line, which had been considered as three weeks, 21 and 3 times the score of severity and the percentage of stuttered syllables were recorded respectively.

To analyze the data of this study, Z-index and diagram plotting were used. The investigation of the stuttering severity scores and the percentage of stuttered syllables before and after the treatment suggest diminished severity and percentage of the stuttered syllables in children. After 15 sessions, two subjects approached the final criteria of the first phase of the Lidcombe program (scores with intensities one and two); however, they did not achieve the criteria. Other subjects did not achieve the final criteria in the first phase either, in spite of the diminished severity and percentage of stuttering.

The results obtained from this research suggest the effects of the Lidcombe telepractice program on the reduction of stuttering in the subjects. The results of this study showed that after 15 treatment sessions, the other subjects did not manage to achieve the final criteria of the first phase of this program.The outcome of this research indicates a positive effect of the Lidcombe telepractice program on the reduction of stuttering severity in the subjects. Nevertheless, they did not manage to approach the final criteria in the first phase of this program after joining 15 sessions.Based on these results, it can be concluded that the presentation of the Lidcombe telepractice program can be effective in reducing the severity of stuttering. However, more sessions may be required in this type of treatment, compared to the in-person one.

We investigated the combined effect of Radial Shockwave Therapy (RSWT) and muscle energy technique (MET) on pain, range of motion (ROM), and neck function in people with active trigger points (ATrPs) of the upper trapezius muscle.

Fifty-four participants with ATrPs of the upper trapezius muscle were randomly divided into three groups. Group A (n=18) received only MET, group B (n=18) received only RSWT, and group C (n=18) received both RSWT and RSWT. Pain intensity using the Visual Analog Scale (VAS), pressure pain threshold (PPT), neck function using the Neck Disability Index (NDI) questionnaire, and lateral-flexion range of movement (LF ROM) were measured before and after the intervention. The participants were treated for three sessions in one week with at least two days of rest between sessions.

All three intervention groups showed pain reduction (p<0.001), an increase in PPT (p<0.001), counter-lateral flexion (CLF) (p<0.001), and also improvement in neck function (p<0.001). The combined group showed a more obvious improvement than the other two groups in PPT (p<0.001). There was no difference between the three groups in terms of VAS and NDI scores and CLF (p>0.05).

The results of this study showed that all three interventions used in the upper trapezius trigger points therapy were effective; however, the combined group showed a significant difference in PPT. Therefore, combined therapy is superior to MET and RSWT alone in improving pressure pain relief in individuals with upper trapezius trigger points.