فصلنامه آرشیو توانبخشی
سال بیست و سوم شماره 4 (پیاپی 94، زمستان 1401)

 The prevention of thumb joints flexion help cure de Quervain tenosynovitis. The thumb, therefore, is being immobilized in the abduction position by splinting. Thumb abduction can be away from the palm (palmar abduction) or from the fingers (radial abduction), which are done in two different planes. To the authors' knowledge, the literature has not specified which kind of thumb abduction has better treatment outcomes and functions. This study aimed to compare the immediate efficacy of palmar abduction and radial abduction splinting on the severity of pain, handgrip, palmar and lateral pinch strength, and hand function in people with de Quervain tenosynovitis.

In this quasi-experimental study, 30 volunteer patients (24 females) with de Quervain tenosynovitis referred to clinical centers were selected via convenience sampling. The participants were randomly assigned to three study groups (without the splint, palmar abduction splint, and radial abduction splint). The splints' height was two-thirds of the elbow. The splints were designed to immobilize the carpometacarpal and metacarpophalangeal joint of the thumb but allow the interphalangeal joint to move. One splint immobilizes the thumb in palmar abduction, while another immobilizes the thumb in radial abduction. The outcomes were studied and measured immediately after the intervention and in a single session. The intended outcomes included pain severity, handgrip strength, palmar and lateral pinch strength, and hand function measured with a visual analog scale, hand dynamometers, and the Jebsen-Taylor test, respectively. The repeated measures analysis of variance was performed for statistical analysis using SPSS software, version 16.

 All participants completed all study assessments. The results showed a significant reduction of pain, handgrip strength, lateral and palmar pinch, and hand function after using a thumb splint compared to without the splint condition (P<0.05). The pain severity in gripping objects was lower after using a palmar abduction splint than the radial abduction splint. Also, the strength reduction in taking objects by gripping, lateral pinch, and palmar was lower after using the palmar abduction splint than the radial abduction splint (P<0.05). Still, both splints were not significantly different in slowing the hand function in the Jebsen-Taylor test (P>0.05).

The positioning of the thumb in palmar abduction with splinting could be more effective for pain reduction and manipulation of objects with the hand and fingers.

Objective:

 People's lives change after unfortunate events such as spinal cord injury, and the people with this injury, as a citizen, face various obstacles and challenges to participate in society. This study explores the barriers and facilitators of social integration of patients with spinal cord injuries in Rofeideh Rehabilitation Hospital.

Materials & Methods:

 This research was conducted using Granheim and Lundman's (2004) conventional content analysis. The participants comprised 13 people with spinal cord injury, 4 family caregivers of patients, and 5 rehabilitation service providers in Rofeideh Rehabilitation Hospital, which were selected by purposive sampling. Sampling was continued until data saturation. Data were collected and analyzed using semi-structured in-depth interviews. To evaluate the stability of the data, four criteria of credibility, transferability, dependability, and confirmability proposed by Guba and Lincoln were used.

Results:

 Facilitators of social integration of people with spinal cord injury were identified in the 3 main categories and 8 subcategories. The main categories were "social support," "social participation," and "individual beliefs." The barriers to social integration were extracted from participants' experiences and consist of 3 main categories of "environmental and structural barriers," "physical and motor barriers," and "contextual factors" and 6 related subcategories.

Conclusion:

 According to the findings of this study, patients with spinal cord injuries face various barriers in order to re-integrate into the community. On the other hand, helpful factors at different levels of individual, family, and social facilitate their social integration process. Recognizing these factors, derived from the deep and rich experiences of people with spinal cord injury, family caregivers, and rehabilitation service providers, can be useful to patients, families, professionals, and policymakers. They can use these experiences to program, design, and implement related interventions to reduce barriers and strengthen facilitators to the social integration of the target group.

 Cerebral palsy refers to a group of postural and movement disorders that limit movements and can be related to a non-progressive disorder in the developing brain. The international classification of disability emphasizes the child's functional abilities and routine performance. Some classification tools have been developed to describe and evaluate child's functions in daily activities such as walking, manipulating objects, and everyday communication. The present study aimed to investigate the relationship between classification systems (gross motor function, manual ability, communication function, and eating and drinking ability) in children with cerebral palsy.

This study was performed by cross-sectional correlation method and of descriptive analytical type. Children with cerebral palsy aged 12-144 months were recruited by convenience sampling from patients referred to clinics and public and private rehabilitation centers in Tehran and Arak cities, Iran, in 2019-2020. After completing the demographic information questionnaire by the child's primary caregiver, the gross motor function classification system (GMFCS), manual ability classification system (MACS), Communication function classification system (CFCS), and eating and drinking ability classification system (EDACS) were completed by a child therapist. 

In the present study, 154 children with a Mean±SD age of 49.45±32.22 months participated. also, 87 children (56.5%) were boys, and 67(43.5%) were girls. According to GMFCS, the highest percentage distributions at levels II and IV were 31.2% and 26%, respectively. In other words, more than 57% of children were distributed in these two levels. According to MACS, the distributions of the highest percentages at levels II, III, and IV were 28.6%, 22.1%, and 20.8%, respectively. In other words, more than 70% of the children were distributed in these three levels. According to EDACS, the distribution of almost all levels was equal except the V level, with 4.3% having the lowest percentage. According to CFCS, the distribution of the highest percentage at levels V and IV was 23.5%. In examining the relationship between functional systems, significant relationships were observed in all cases: MACS and GMFCS, r=0.672; CFCS and GMFCS, r=0.581; EADCS and GMFCS, r=0.593; CFCS and MACS, r=0.555; EADCS and MACS, r=664; EADCS and CFCS, r=0. 547 (P<0.01).

It seems that children with more motor function limitations show more limitations in other performance classification systems, too. Of course, the number of studies in this field is limited and needs further investigation.

 Multiple sclerosis (MS) is a disorder that involves the central nervous system. Cognitive impairments in patients with MS have a direct and significant impact on their performance in the activities of daily living, and hence their social participation is disrupted. Thus, exploring cognitive domains can help us make clinical decisions and interventions. To cognitively rehabilitate these people and estimate the relationship between cognitive performance (computer test and performance test) and the level of participation, we should examine the correlation between these two domains. This study aims to determine the correlation between social participation and two types of cognitive assessments: computerized and functional.

The present study was a cross-sectional study, and sampling was done by available sampling. The target population was patients with MS admitted to the MS center of Isfahan City, Iran, provided that they met the inclusion criteria in the winter of 2021. Forty-five patients with MS (9 males and 36 females) with an expanded disability status scale between 1 and 5 were selected by available sampling. To assess their cognitive performance, Cambridge neuropsychological test automated battery (CANTAB) and the Lowenstein occupational therapy cognitive assessment (LOCTA) functional test were used. Also, the community integration questionnaire (CIQ) was used to determine the level of participation. The data were then processed with SPSS.

Based on the study results on the intensity and relationship between the measures, there is integration in targeted activities with all measures of LOTCA and CANTAB. This measure had a significant relationship with orientation, visual perception, and motor praxis from the LOTCA test and Delayed matching to sample test (DMS) from the CANTAB test. Notable results include a high correlation between home integration of the CIQ and the stocking of Cambridge test from CANTAB (r=0.353), and social integration of the CIQ with the DMS from CANTAB (r=0.538), integration in purposeful and productive activities of the CIQ with the motor proxy from LOTCA (r=0.422).

According to the results, both tests have a high correlation with the CIQ. So, computer test, which has a good correlation with participation, can be used alongside the performance test.

 Procedural memory is a key component of long-term memory that can be assessed in different modalities, such as verbal and motor. Learning through procedural memory occurs in three stages: initial learning, consolidation, and retention. Several tasks evaluate procedural memory, but none have concurrently studied procedural learning in various modalities and learning stages. Besides, according to the declarative-procedural model, there may be an association between the performance of individuals in procedural learning and their state of the grammar of a language. Therefore, this study aimed to design a Serial Search Task (SST) for the simultaneous evaluation of procedural memory in motor and verbal modalities during three stages of learning and determine its reliability. Moreover, the relationship between procedural memory and grammar skills was examined.

 This study is methodological research in the first stage and descriptive analytics in the second stage. First, based on the literature review and the opinions of three speech-language pathologists, some words with appropriate psycholinguistic features were chosen from the Persian picture naming set. Then, corresponding pictures were determined. The task was designed using Java programming language. The face validity of the task was evaluated, then after revisions, the reliability was determined. Face validity was assessed in 10 normal children, and the test-retest reliability was evaluated in 15 normal children aged 7-9 years; all of them were chosen using the convenience sampling method. In the second stage, to assess the relationship between grammatical skills and the SST, 20 normal children aged 7-9 years were selected by a mixed sampling method. Every child had exposed to a verbal modality in three stages: initial learning, consolidation (24 hours later), and retention (one week later). Then the same stages were performed in the motor modality. Each child's language skills were determined using the test of language development-primary (TOLD-P3), and the relationship between the two skills was determined. Statistical methods included the Pearson and Spearman correlation coefficients and repeated measures analysis of variance.

The correlation values between two performances in the initial learning stage for the reaction time variable in verbal (r=0.84, P<0.001) and motor (r=0.80, P˂0.001) modalities and the variable of response accuracy in verbal (r=0.81, P=0.011) and motor (r=0.77, P=0.026) modalities were obtained. In the consolidation and retention stages, the correlation values for the reaction time variable in verbal (r=0.737, P=0.002) and motor (r=0.743, P=0.001) modalities and the variable of response accuracy in verbal (r=0.624, P=0.013) and motor (r=0.916, P<0.001) modalities were obtained. The relationship between grammar and procedural learning in the verbal modality was significant in the consolidation stage (P=0.045, CI:0.016-0.797, r=0.491).

SST is a reliable task to assess different stages of procedural memory in both verbal and motor modalities. Therefore, this task can be used to evaluate procedural memory in normal children aged 7-9 years. The current study's findings confirmed the predictions made by the declarative-procedural model during the consolidation stage in the verbal modality.

Families with mentally-retarded children need more support than other families in overcoming crises and achieving social adjustment. So, it seems necessary to pay special attention to these families durinzg the COVID-19 pandemic and identify their experiences and challenges to provide more support for this vulnerable group. Therefore, the present study was carried out in care centers under the supervision of the Tehran state welfare organization of Iran (SWO) during the COVID-19 pandemic to identify the challenges of families with mentally retarded children.

The present study was conducted with a qualitative approach and contractual content analysis method of Granheim and Lundman (2004). The participants were 18 families with mentally-retarded children living in care centers under the supervision of the Tehran State welfare organization of Iran (SWO), who were selected by purposive sampling. Sampling was continued until data saturation. Data were collected and analyzed using in-person or online (telephone) in-depth semi-structured interviews from July 11 to September 22, 2021. To evaluate the data strength, four criteria of credibility, transferability, dependability, and confirmability of Guba and Lincoln were used.

Based on data analysis, 6 main categories and 23 subcategories were obtained. The main categories and subcategories included 1) constant worry about their children getting COVID-19 (inability of the child to protect against coronavirus, not observing protocols by the staff, underlying diseases and deficiency in immune system, few preventive measure for under 18 years people, conflicting information about children and adolescents' infection), 2) disconnection and intensification of stress (agitation and irritability of the disabled, worry about the future, parent's mental confusion, fear of losing child), 3) conflict with family tensions and contradiction (intensification of family guilt, overlooking other children, couple's self-blaming, tension in family interactions, intensification of family melancholia), 4) non-supportive community (further social stigma, social exclusion, lack of supporting vulnerable groups, the limitations of social distancing), 5) family economic crisis (costs of keeping child in the center, losing job and lower income of the family head, poverty and intensification of unstable economic conditions), and 6) care and educational concerns (decreasing the quality of care for the disabled, suspension of rehabilitation and educational activities, restrictions on leisure activities and communication for the disabled).

The results showed that the families of mentally-retarded children had encountered many challenges and concerns during the COVID-19 epidemic, some of which were related to the intensification of psychological pressures and some due to insufficient support from governmental and non-governmental institutions for these families. The study findings can be used to provide services and design support programs and policies for children with mental disabilities and their families. In this regard, it is recommended to pay special living allowances, strengthen the communication system between parents and children living in care centers, prepare a care and health packages for parents, design and implement psychological interventions to reduce parents' anxiety and stress, and provide free counseling.

 Neurogenic bladder (NB) is one of the most common causes of urinary incontinence, and its many long-term problems negatively affect patients' quality of life, especially women, due to a lack of social roles. Due to the chronic nature of this disorder, the implementation of rehabilitation nursing interventions to improve the quality of life of these patients has been recommended. Therefore, this study aimed to evaluate the effectiveness of multidimensional rehabilitation nursing intervention of urinary incontinence on the quality of life of young and middle-aged women with neurogenic bladder.

The present research was a quasi-experimental study with a pre-test-post-test design that was conducted in Rofeideh Rehabilitation Hospital, Tehran, Iran, in 2021. Data were collected from 30 young and middle-aged women aged 18 to 60 years admitted with neurogenic bladder. The samples completed the demographic questionnaire and incontinence quality of life questionnaire (I-QOL) before and 6 weeks after the intervention during follow-up. Multidimensional rehabilitation nursing intervention of urinary incontinence included two-part training sessions: 1) clean intermittent catheterization and 2) behavioral therapy (Time voiding, delaying urination, diet, and medication) in 7 30-minutes sessions of training conducted daily and individually face-to-face in the first week and then a follow-up of patients in 5 weeks (second, third, fourth, fifth, and sixth weeks), one session per week in the form of virtual classes and online video calls in WhatsApp application. The collected data were analyzed in SPSS software version 25 using one-way ANOVA and paired t-test at a significance level of 0.05.

 Most participants were 20-30 years old (30%) and married (53.3%). Before and after the intervention, the quality of life of patients with neurogenic bladder disorder increased from 46.46±11.07 to 66.23±9.46, which was statistically significant (t=14.20, P<0.0001). Also, psychosocial impacts due to the disease were reduced based on one of the three subscales of the quality of life questionnaire. In addition, quality of life was significantly lower in younger, unemployed, single, spinal cord injury, body odor, and people with a neurogenic bladder disease diagnosis period of less than one year (P<0001).

 According to our findings, clean intermittent catheterization and behavioral therapy could significantly improve patient's quality of life with NB. Therefore, it is recommended to investigate the long-term effectiveness of this intervention.

 The effectiveness of the Tipton chair on the thoracic and lumbar spine of students was evaluated in the straight upright position and careful study postures.

This study was performed on 30 students (20 women and 10 men) who had no history of musculoskeletal disorders. Evaluation of changes in the angles of the thoracic and lumbar spinal was performed using an electrogoniometer on the normal and Tipton chair in the two postures of straight upright and careful study. The participants were evaluated in each posture on each chair for five minutes. Considering the resting time and questionnaire completion, the study took 30 minutes for each person. The data recorded by the electrogoniometer were analyzed through repeated measures statistical test and data of the system usability scale (SUS) questionnaire by the paired t-test in SPSS software, version 25.

 The mean range of changes in the angles of the thoracic spine in the sagittal plane showed that the variable of chair type was not significant (P=0.072), but the variable of posture was (P=0.013). Also, regarding the mean range of change in thoracic lateral flexion, the interaction of chair and posture (P=0.048) and the chair variable with (P=0.003) had a significant difference. This difference was about a 28% reduction in the mean range of changes in the lateral flexion of the thoracic spine in the upright posture and a 10% reduction in the careful study posture in the Tipton chair compared to the normal chair. While the posture variable had no significant difference (P=0.705). Also, the mean range of changes in lumbar flexion extension showed that the chair variable (P=0.003) had a significant difference. This significant difference was about a 16% reduction in the mean range of changes in the flexion extension of the lumbar spine in the upright posture and a 43% reduction in the careful study posture in the Tipton chair compared to the normal chair. While the variable of posture (P=0.162) did not have significant differences. The study's results on lateral lumbar flexion also showed that both variables of chair and posture had a significant difference (P=0.009). The mean range of changes in lumbar lateral flexion angles in both upright and careful posture in the Tipton chair was reduced by 28% compared to the normal chair. Analysis of SUS questionnaire scores for the Tipton and normal chairs showed a significant difference between these two chairs (P=0.000). In addition, the average scores of the SUS questionnaire were 78.6 for the Tipton chair and 65.9 for the normal chair, which shows an increase of 19%.

 The results of the present study showed that the Tipton chair could reduce the average range of body angles in the thoracic and lumbar spine. Also, the study results indicated an increase in user satisfaction with the Tipton chair compared to the normal chair, in which the level of satisfaction of women is higher than men. It can be due to the difference in anthropometric dimensions between women and men.