فصلنامه آرشیو توانبخشی
سال بیست و سوم شماره 3 (پیاپی 93، پاییز 1401)

Objective:

 Identifying the factors affecting the reduction of ankle sprain complications, rapid recovery, and prevention of re-injury after an ankle sprain are essential. Therefore, the present meta-analysis investigates which training modalities have a better effect on the balance and motor function of people with chronic ankle instability.

Materials & Methods :

The relevant articles were identified by searching 8 international databases of MEDLINE/PubMed, Embase/Scopus, LILACS, CINAHL, Central (Cochrane Central Register of Controlled Trials), Web of Science, PEDro, and Google Scholar. This work was also done in Persian databases Magiran, Irandoc, Iranmedex, MedLib, and SID, equivalent to English keywords searched from 8 databases. After collecting the search results, first, the title and then the abstracts of the articles were read. If the articles met the inclusion and exclusion criteria, their results would be used in the review study, otherwise discarded. The search period comprised from the beginning to December 2021. In addition, a manual search and full review of article sources was performed. The exclusion criteria were articles whose statistical population was people other than people with chronic ankle instability, published articles other than English and Persian, and articles that examined the effect of exercise programs on factors other than balance and motor function had paid. Hedges’ effect size (ratio of the mean difference between the two groups to the mixed weight standard deviation) was used for meta-analysis. Heterogeneity between studies was assessed using the I2 index. If the heterogeneity is above 50%, the random effects model method is used, and if it is below 50%, the fixed-effects model method is used. The bias of published studies was assessed using Egger’s test. Comprehensive meta-analysis v.2.0 software was used to analyze the data.

Results :

After reviewing the full text of the found articles, 21 articles using 24 training protocols were selected. The final articles were divided into two categories for analysis: articles comparing neuromuscular exercises with other exercises and articles comparing new and combined balance exercises with other exercises with traditional balance exercises. By a superficial qualitative review of articles with the PEDro tool, the average scores that articles received from this scale were higher than 7, which shows that the articles used for the meta-analysis of this study are of high quality and the results of these studies are reliable.

Conclusion :

The results of studies showed that neuromuscular training has a better effect on static and dynamic balance in people with chronic ankle instability than other training protocols. However, there was no significant difference between the two types of training groups in motor performance. The results of studies also showed that balance-combination exercises, as well as new methods of balance exercises compared to traditional balance exercises, have a more significant effect on static balance and motor function of people with chronic ankle instability. However, no significant difference between the two types of training groups was observed in the dynamic balance. Also, the effect of new combined-balance exercises on dynamic balance was better than traditional balance exercises. It seems that the usefulness of balance-combination exercises and performing balance exercises with new methods is more useful than other training protocols on balance and postural control of people with chronic ankle instability.

Objective :

Upper limb neurodynamic tests are used to evaluate the mechanical sensitivity of the peripheral nerves. However, very little is known about the reliability of upper limb neurodynamic tests, especially for the radial and ulnar nerves. This study aimed to evaluate the reliability of neurodynamic tests of the upper extremities to test median, radial, and ulnar nerves. 

Materials & Methods:

 In this observational cross-sectional study, 25 asymptomatic subjects aged 19-45 years participated. They were selected using simple non-random sampling. Then two examiners performed the neurodynamic tests on them on two successive days. The goal was to assess the reliability of median, radial, and ulnar neurodynamic tests. During the neurodynamic tests, the participants reported the initial stretching pain and the moment of submaximal pain (substantially obvious pain) in related areas of the nerve distribution, including the anterior side of the elbow and forearm for the median nerve, posterolateral aspect of the elbow and forearm for radial nerve, and medial side of elbow and forearm for the ulnar nerve. At the starting point of painful stretching and the submaximal pain, the angle of elbow extension (for median and radial nerve tests) and shoulder abduction angle (for ulnar nerve test) were measured using a mechanical goniometer. The range between these two points was used to analyze the reliability. The intraclass correlation coefficient (ICC) and the standard error of measurement (SEM) were calculated to examine the relative and absolute reliability, respectively. Using t-test, the difference in the mean of the measurements was calculated.

Results:

 No significant difference was found between the mean measurements of the two testers in intra-session and inter-session reliability. For examiners 1 and 2, was obtained 0.94 (SEM:2ο) and 0.89 (SEM:2.85ο) for the median nerve, 0.56 (SEM:6.36˚ ) and 0.93 (SEM:1.82ο) for radial nerve, and 0.42 (SEM:3.27ο) and 0.79 (SEM:1.42ο) for the ulnar nerve. Inter-tester intra-session reliability was obtained at 0.84 (SEM: 3.44ο), 0.54 (SEM: 6.1ο), and 0.55 (SEM: 2.75ο), respectively, for median, radial, and ulnar nerves. Inter-tester inter-session reliability was obtained at 0.97 (SEM:1.43ο), 0.69 (SEM:5.06ο), and 0.51 (SEM: 2.8˚ο), respectively, for median, radial, and ulnar nerves.

Conclusion:

 The upper limb neurodynamic tests and measurement of the range between the onset of stretching pain and the point of submaximal pain have moderate to excellent reliability. Therefore, these clinical tests can be used in diagnostic evaluations and treatment interventions. Also, the median nerve neurodynamic test has higher relative reliability than radial and ulnar nerve neurodynamic tests.

Objective:

 Students’ academic success is crucial for families, educators, and the community. Specific learning disorder reduces students’ academic performance and makes education difficult. Because of the rising prevalence of learning disorders (especially dyscalculia), it is necessary to pay more attention to dyscalculia, its diagnosis, and assessment to develop new interventions and scientific strategies to reduce symptoms. Negative consequences of math problems in early childhood probably affect the individual and social aspects of life until adulthood. As far as we know, most children with dyscalculia have significant problems in executive functions, so the application of effective educational methods on executive functions will improve cognitive functions and learning. The present study was conducted to determine the effectiveness of a cognitive rehabilitation program on the executive functions of students with dyscalculia.

Materials & Methods:

 This research was a quasi-experimental study with a pre-test-post-test design with a control group. The statistical population consisted of all 8 to 12 years old students who were studying in specific schools for learning disorders in the 2020-2021 academic year in Sanandaj City, Iran. Thirty children (17 boys and 13 girls) were selected by convenience method and assessed using the Iranian Key Math Test. Then, 28 students with one standard deviation lower than the mean (≤85 points) were diagnosed as dyscalculic, and their parents signed a written consent form. Students were excluded if they had seizures and epilepsy, or other neurodevelopmental disorders or were absent more than two times from intervention sessions. All students were matched according to gender and age and randomly assigned to the experimental (7 boys and 7 girls) and control groups (8 boys and 6 girls). The executive functions of all students were assessed by the Behavioral Rating Inventory for Executive Functions (BRIEF). The experimental group individually participated in 12 sessions (twice a week; 30 to 45 minutes per session) and was trained by the cognitive rehabilitation program. However, the control group only attended the mainstream curriculum. Again, all students were assessed by the BRIEF in the last session and 5 weeks later in the follow-up. The obtained data were analyzed by using analysis of variance with repeated measures.

Results:

 The findings showed that the cognitive rehabilitation program has significantly influenced executive functions and their components (behavior regulation and metacognition) in students with dyscalculia. According to the eta quotient, 42%, 32%, and 43% of the variances of executive functions, behavior regulation, and metacognition of the experimental group, respectively, have been explained by participating in the cognitive rehabilitation program. In addition, the program’s effectiveness lasted for a 5-week follow-up later.

Conclusion:

 Considering the effectiveness of cognitive rehabilitation programs on executive functions, designing and implementing the same rehabilitative programs not only improves the executive functions of students with dyscalculia but also prevents their problems relating to learning academic skills.

Objective:

 Early language skills predict the child’s future language skills and literacy. So, screening and assessment of speech and language at an early age are important. One cost-effective way of assessing a child’s communication is through parents reporting tools. MacArthur-Bates Communicative Development Inventories (CDIs) are the most widely used forms by professionals in more than 70 live languages worldwide to screen children’s communication skills. The main purpose of this study was to provide the Persian version of the third form of CDI (CDI-III) and determine its psychometric properties, including face and content validity and internal consistency in 30 to 37 months old Iranian Persian-speaking children.

Materials & Methods:

 In a cross-sectional methodological study of instrument validation, a Persian-adapted form of CDI-III was developed. At first, the English form was adapted to Persian, and a Delphi method was used to provide the initial list of the items. The face and content validity rates were examined by asking the opinion of ten Persian-speaking speech and language pathologists with at least three years of clinical experience in the field of child speech/language development and disorders. The final form was compiled based on the results of the content validity ratio (CVR) and content validity index (CVI) of the items. The final form consisted of three sections, including vocabulary, sentences, and use of sentences. The parents of 356 Persian-speaking children aged 30 to 37 months recruited by multi-stage cluster random sampling from health centers in Isfahan City were asked to complete the form. The Kuder-Richardson coefficient assessed internal consistency, and the Spearman coefficient examined correlation.

Results:

 The items with CVIs≥0.7 and CVRs≥0.6 remained, and other items were reviewed or removed based on the suggestions of panelists and developers. The final form included 100 words, 22 pairs of sentences, and 16 questions about using sentences. A total of 356 children (mean±SD age: 34.03±2.12 months) were included in the study. According to the English CDI-III guidelines, the data were divided into four age groups with two-month intervals: 30-31, 32-33, 34-35, and 36-37. The internal consistency of the whole form was 0.97, and internal consistency values of vocabulary, sentences, and sentence usage were calculated as 0.98, 0.88, and 0.88, respectively. The Spearman correlation values between the scores of the form sections and each section with age indicated a significant positive correlation between all sections of the form. Also, the significant positive correlation between age and all three parts showed that the number of expressive words, the grammatical complexity of sentences, and the proper use of sentences increase with age.

Conclusion:

 The Persian CDI-III form possesses a good face and content validity and internal consistency to be used as a valid tool for screening language competence of 30-37 months old Persian-speaking children. The results of the mean and standard deviation of the current study can be used as a comparison for screening children suspected of being language deficient.

Objective:

 Phonological Mean Length of Utterance (PMLU), a quantitative measure for assessing phonological skills, is a diagnostic and clinical criterion in phonological development. Moreover, it is an indicator showing the efficacy of the intervention. The PMLU is a word level measure that can be calculated on the child’s transcribed speech sample (transcription). To calculate PMLU, all consonants and vowels of the child’s produced words, and target words (standard production of words in native adults) are individually scored. The proportion of Whole-Word Proximity (PWP), another phonological quantitative measure, includes the ratio of the produced PMLU to the targeted word PMLU. PWP indirectly reflects the intelligibility of speech.Since languages are distinctive in syllabic and phonological structures, PMLU should be studied as a language-specific measure. PMLU has specifically been designed to assess phonological skills in spontaneous speech. Spontaneous speech sampling methods are advantageous since they consider the effect of morphological and syntactic skills, length, and complexity of words, and they could show the normal development of word complexity. This study was conducted to determine PMLU and PWP in 48 to 60 months old Persian-speaking children with Isfahani accents and to compare them in story generation and conversation sampling methods. The potential sensitivity of PMLU to growth was also examined.

Materials & Methods :

This is an observational and cross-sectional study that was conducted for one year in 2016 in Isfahan City, Iran. A total of 100 children (51 boys and 49 girls) aged 48-60 months participated in story generation sampling, and 67 children (32 boys and 35 girls) participated in conversation sampling. The participants were selected from 261 kindergartens under the supervision of the Welfare Organization of Isfahan Province using the convenience sampling method. After completing the consent form and considering the inclusion criteria, conversation and story-generation samples were collected. Audio samplings were done in the same room using the same software (Clear Record Litev. 2.1). Raters transcribed the first 50 words of the recorded speech samples. Finally, we used the formula to calculate the target PMLU and child PMLU based on the normal production of an adult who speaks Persian with an Isfahani accent and the child’s production, respectively. To evaluate inter-rater reliability, raters randomly transcribed 20% of all samples to recalculate values. Participants’ story generation and conversation scores were entered into SPSS16 separately. The Kolmogorov-Smirnov test was used to examine the data distribution. Based on the data distribution, paired t-test and Wilcoxon test were used to compare measurements, and the Pearson and Spearman tests were used to investigate the associations.

Results :

Child PMLU, target PMLU, and PWP measures of the story generation method were 8.794, 8.811, 0.998, and those of the conversation method were 9.068, 9.093, and 0.998, respectively. Correlation test results showed significant relationship between age and PWP in story generation (r=0.308) and conversation (r=0.313). Comparing child PMLU in story generation and conversation showed a significant relationship between child PMLU in both sampling methods (P=0.000). The result of the target PMLU comparison in two methods of story generation and conversation (P=0.000) was significant. PWP did not significantly differ between the two sampling methods (P=0.973). The inter-rater reliability was calculated at 0.70.

Conclusion:

 This study can be used as a basis for quantitative studies in the field of children’s phonological assessment using Persian whole words. However, longitudinal studies in different age groups with a high level of evidence in this field can convince therapists to use whole-word measures in clinics.

Objective:

 Despite the evidence that rehabilitation interventions are effective for spinal cord injury (SCI) patients, these interventions usually impose costs on the health system. Therefore, it is necessary to examine the cost-effectiveness of these interventions for the health system of countries through economic evaluation. In this study, we examined the cost-effectiveness and net financial benefits of rehabilitation services in treating spinal cord injuries in Iran.

Materials & Methods:

 Considering that this research is the first economic evaluation study related to spinal cord injury rehabilitation, the first stage of the economic evaluation was dedicated to designing an economic evaluation model. The model was designed based on disease groups, the natural course of the disease, the details of rehabilitation interventions for spinal cord injury patients in different disease groups, clinical outcomes, probability of occurrence of outcomes, and related costs. The structure of the economic evaluation model of this study is based on the design of a lifetime Markov model with a 1-year cycle length for each strategy and two groups of patients (paraplegia and tetraplegia). In this study, we also used the incremental cost-effectiveness ratio (ICER) to determine the cost of the most effective strategy. All findings were analyzed using Excel 2016 and TreeAge 2011 software.

Results:

 According to the annual incidence of spinal cord injury patients in need of rehabilitation services in the country, which is about 2000 people, based on public sector tariffs, the total annual cost of SCI rehabilitation in Iran in the paraplegia group ranges from 32997 to 40200 million Iranian Rials (IRR) and in the tetraplegia group from 25476 to 26119 million IRR in mild to very severe conditions. Also, the total rehabilitation costs of SCI patients based on public sector tariffs in one year were calculated to equal 256847 million IRR. Similarly, based on private sector tariffs, the total annual costs of SCI rehabilitation in the paraplegia group were estimated from 86374 to 103122 million IRR and in the tetraplegia group from 67509 to 68997 million IRR in mild to very severe cases. Meanwhile, the total rehabilitation costs of SCI patients were calculated based on private sector tariffs in one year, equivalent to 668847 million IRR. Also, the average lifetime of SCI patients undergoing rehabilitation is lower compared to non-rehabilitation and also has higher QALY (The quality-adjusted life year) values, which indicates the dominance of the rehabilitation strategy. The amount of ICER, in this case, is estimated based on public sector tariffs equal to negative 674 million IRR and based on private sector tariffs equal to negative 629 million IRR per QALY unit. Possible sensitivity analysis of the results and Monte Carlo simulation in both scenarios confirmed the initial analysis findings with high probability. Based on the public sector tariff, the net amount of incremental financial benefits of rehabilitation for the total annual incidence is estimated at 8991 billion IRR. These amounts were calculated based on private sector tariffs of 8579 billion IRR.

Conclusion :

Generally, the results of this economic evaluation showed that the rehabilitation of spinal cord injury patients in Iran, based on public and private sector tariffs, is quite cost-effective and has significant net positive financial benefits. The results of the sensitivity analysis also confirmed this finding.

Objective:

 Having a child with a disability profoundly affects the family and can impose many problems and challenges on parents. Children with Down syndrome (DS) are a large group with special needs at risk for chronic physical illness, developmental problems, and behavioral and emotional problems. These problems create more health and care needs in these children. Therefore, the present study aimed to investigate the caregiver burden and related factors in parents of 4 to 12 years old children with DS living in Tehran City, Iran, in 2020.

Materials & Methods:

 In this cross-sectional study, 150 parents (91 females and 59 males) of children with DS participated. They were referred to rehabilitation centers and Down Syndrome Center in Tehran City, Iran, and were selected using a convenience sampling method. The demographic information questionnaire and Novak caregiver burden questionnaire (1989) were used to collect the study data. The participants were asked to complete these questionnaires carefully. The non-parametric tests, including the Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests, were used to analyze the data in SPSS v. 21 software.

Results:

 Based on data analysis, the Mean±SD age of the parents was 38.78±7.92 years. Sixty percent of children with DS were boys, and 40% were girls with a Mean±SD age of 7.14±2.38 years. The mean and standard deviation of the total parental care burden score and its subscales were as follows: overall care burden, 68.12±17.51; temporal care burden, 15.95±5.2; developmental care burden, 15.46±4.84; mental care burden, 12.22±4.85; physical care burden, 11.24±4.47; and social care burden, 11.18±4.94. There was a significant relationship between care burden and the following variables: age of parents (r=-0.66, P=0.001), parents’ income (r=-0.6, P=0.001), number of children (r=0.55, P=0.001), and age of the child (r=0.6, P=0.001). While factors such as parents’ gender, child gender, parents’ marital status, receiving special education, care needs, and care status did not affect the amount of parental care burden (P>0.05).

Conclusion:

 The results of the present study showed that parents of children with DS experience moderate care burden in caring for their child. The findings of this study provide the opportunity for relevant government agencies, specialists, and health centers to understand the needs of children with DS and their parents at different stages of the disease, treatment, and care. So they can develop appropriate strategies to reduce the caring stress of their caring parents.

Objective:

 Loss of all or part of the ear is one of the significant defects in the head and neck area (regardless of the cause) that can result from trauma, cancer, congenital diseases, or surgery to remove benign tumors. These defects can be reconstructed with the help of surgical procedures or cosmetic prostheses. However, due to the complex structure of the ear, reconstructive surgery is one of the most challenging surgeries for plastic surgeons. Choosing between surgical methods and prosthesis use is problematic for those with a significant lesion and depends on the etiology and the patient’s wishes. If the patient is a candidate for a silicone ear prosthesis, the most critical challenge is the suspension and ease of using the prosthesis. The conventional suspension method (unique adhesive) will present several challenges to the patient. Thus, we report using the implant suspension method for an ear prosthesis in this study.

Materials & Methods:

 A 35-years-old male patient with a congenital ear defect and no history of prosthesis use was referred to the Dentistry School of Shahid Beheshti University, Tehran City, Iran and was studied to make an ear prosthesis based on an implant. To make a prosthesis, the general steps were alginate molding from both healthy and involved parts of the patient, alginate molding from the donor, positive wax mold making, negative gypsum mold making, silicone casting, and prosthesis attachment using implants on the patient’s stamp.

Results:

 In this method, we used silicone and implant-based reconstruction of ear defects. An attempt has been made to provide ease of wearing and removing the prosthesis, proper grip, natural appearance, and finally, patient satisfaction.

Conclusion:

 In this method, we used silicone and implant-based reconstruction of ear defects. An attempt has been made to provide ease of wearing and removing the prosthesis, proper grip, natural appearance, and finally, patient satisfaction