فصلنامه آرشیو توانبخشی
سال بیست و چهارم شماره 3 (پیاپی 97، پاییز 1402)

One of the important factors in choosing purposeful activities and defining the occupational performance of people is the cultural context in the society, which may have different effects in the lives of clients in Islamic countries. This cultural structure in Islamic countries is largely influenced by the religious beliefs that govern the society. The effect of Islamic culture on the occupational performance of clients has been studied less. This study deals with the review of articles related to the relationship between the context of Islamic culture and the occupational performance of clients in Islamic countries using the explicit content analysis method. Therefore, the purpose of this study is to explain the effects of Islamic culture on the occupational performance of occupational therapy clients in Islamic countries.

The number of 46 studies using the keywords occupational therapy, Muslims and Islamic culture were initially selected until 2022 and the articles that were unrelated to occupational therapy and were not about Islam and Islamic culture were removed which finally reduced to 20 studies and then, they were subjected to qualitative analysis.

The analysis of extractive studies has led to the emergence of different themes and categories, the theme of positive points has categories (importance of united family structure), (importance of religion in helping clients), (importance of pray as a purposeful activity) and theme challenges have categories (traditional treatments without clinical evidence), (importance of respecting the principle of Mahram in interpersonal communication), (specific beliefs in the cause of illness), (restrictions on praying), (cultural and local challenges), (hesitation in accepting occupational therapy philosophy).

In fact, Islam, with its influence on the family structure and the creation of positive beliefs and beliefs among the society, has been able to facilitate the process of occupational therapy and rehabilitation of clients to a great extent, but in the context of Islamic culture, there are many obstacles that unfortunately cause limitations. They are in interpersonal communication and acceptance of occupational therapy philosophy. Occupational therapists can use the opportunities to improve the client's performance, and in order to solve the challenges, it is necessary to do a lot of research to provide the necessary solutions.

Multiple sclerosis (MS) is a neurological disease in which the myelin lining the central nervous system is damaged. The complex nature of the disease making the diagnosis more difficult for the patient to face. This study explored the experiences of facilitators and barriers adjustment to MS by Iranian patients.

This study was conducted by using descriptive phenomenological approach. The participants included 14 patients (8 women and 6 men) referred to Rafideh Hospital in Tehran. The participants were selected by purposive sampling and maximum variety. Data collection continued through semi-structured interviews until theoretical saturation. The duration of the interviews was between 30-60 minutes. Data analysis was done with MAXQDA software and using the 7-step descriptive collaizzi,s method continuously and simultaneously with data collection. In order to check the robustness of the results, Lincoln and Goba criteria of validity, reliability, transferability and verifiability were used.

The 5 main themes related to facilitators of adaptation that emerged included religious strategies, receive emotional and professional support, search and find information, psychological coping strategies, and life style (and 18 subcategories). Also the three main themes related to barrier of adaptation that emerged included health-related, patient-related and social-related barriers (and 8 subcategories).

These themes represent the perceived characteristics, facilitators and barriers of adaptation to Multiple Sclerosis by patients. Therefore, it is necessary to design or implement therapeutic interventions based on these findings by psychologists and counselors for patients to reduce psychological problems.

One of the basic challenges of health care centers is the inflation of the costs of services. Rehabilitation services play a significant role in restoring disabled people's functional ability. Having knowledge of the unit cost of rehabilitation services can be useful in optimal allocation of resources and budget. This study aims to calculate the unit cost of outpatient rehabilitation services provided by the Nezam-Mafi Rehabilitation Center (NMRC) in Tehran, Iran. 

This is a descriptive, retrospective study with a cross-sectional design. The time-driven activity-based costing (TDABC) method was used to determine the unit cost for 9 outpatient rehabilitation services related to speech therapy, occupational therapy, physiotherapy and audiology provided by the NMRC in 2019. In the first step, the sequence of each activity was mapped in one code (service). Then, the resources needed to perform each activity were identified and the source of cost for each activity was specified. In the next step, the cost driver for each specific sources and the amount of their use in each activity were determined. Due to the importance of personnel costs, this stage was done with more attention on the time required to provide each activity. In this regard, the cost of each minute of service compensation  was calculated by considering the annual attendance time of personnel and their salary expenses. Finally, the costs of each unit of the production factor and the total cost for each code (service) were determined.

In the NMRC, the costs of renting (47.9%), consumable materials and supplies (11.6%), and contracted services (10.5%) made up the highest percentage of costs. The costs of outpatient rehabilitation services (except for speech therapy) were higher than official tariffs for these services. The cost of specialized personnel for physiotherapy services and the cost of building in occupational therapy, speech therapy, and audiology services had the highest share in their unit costs. The total cost of staff personnel was estimated at 3.904 Rials per minute (RPM), which was higher than the specialized professional for pediatric occupational therapy (2046 RPM), occupational therapy (1929 RPM), speech therapy (1899 RPM), and audiology (1974 RPM). The high overhead costs of outpatient rehabilitation services (24.5% of the total cost( were one of the primary reasons for the gap between the average costs and tariffs. 

There is a considerable gap between the cost of some services in the NMRC and the related tariffs. Due to the low capacity of service provision in the NMRC, overhead costs have led to the inflation of the cost of services in this center. Therefore, the consolidation of small institutions and improving the referral system for people with disabilities from medical centers can reduce the unit cost of services. Considering that most rehabilitation services are not covered by the social security insurance and are not affordable for patients, a national-level reform should be prepared in the healthcare system. In addition, using the TDABC method in rehabilitation service centers can be a solution to identify the main sources of costs and control price inflation in the health sectors.

Having a child with speech and language disorders, while creating a sense of great therapeutic responsibility towards them, will significantly affect the psychological dimensions of parents, especially mothers as the primary caregiver. They are more exposed to the pressures and stress that result from the sense of responsibility towards their children. The aim of this study was to compare the level of stress, depression, and quality of life (QoL) among mothers of children with speech and language disorders whose children have received rehabilitation services for different periods of time.

The current descriptive-analytical cross-sectional study was conducted on 185 mothers of children with speech and language disorders who needed to receive rehabilitation services. Data collection was done using: a short form of parenting stress index (PSI-SF) to measure stress, the Beck depression inventory-2nd edition (BDI-II) to measure maternal depression rate, a health survey questionnaire (a 36-item short form) (SF-36) to measure the QoL. Based on the duration of receiving rehabilitation services, mothers participating in this study were divided into four groups: 1) For less than one month, 2) Between 1 to 6 months, 3) Between 7 to 11 months, and 4) For more than 12 months. The data were analyzed by one-way repeated measures analysis of variance and multivariate ANOVA.

Comparing the mean scores of PSI, BDI-II, and SF-36 between four groups of mothers was significant (P<0.001). The results showed that mothers whose children had received rehabilitation services for a longer period of time had lower mean stress and depression scores and higher mean QoL scores (P<0.001). The factor of the type of child's disorder had a significant effect on the results (P<0.05).

The lowest score of stress and depression and the highest score of QoL in mothers who had received rehabilitation services for more than 12 months can indicate that mothers who receive rehabilitation services for a longer period of time see the improvement of their children. They are also better able to use stress coping strategies to deal with their child's problem.

Musculoskeletal pain syndrome (MPS) is one of the main causes of functional disability. Although the symptoms and complaints of patients with MPS are often related to their musculoskeletal structures, repeated microtraumas and overuse (the main causes of musculoskeletal pain) may also lead to abnormal neurodynamics. Abnormal neurodynamics refers to mechanical dysfunction in the movement of nerve structures related to the surrounding tissues or disruption in the normal elongation of the nerve. Some recent studies have suggested the possibility of abnormal neurodynamics in patients with MPS. Therefore, this study aims to determine the frequency of abnormal neural tension and its association with functional disability in patients with MPS of the upper extremity.

A hundred participants with MPS (78 women and 22 men) participated in this study. Median, radial and ulnar nerve neurodynamic tests were performed according to Butler & Shacklock’s approach. There was a five-minute rest between each test to avoid the therapeutic effects of neurodynamic maneuvering. To quantitatively measure the intensity of the abnormal tension in the peripheral nerves in case of a positive neurodynamic test, the angle of the elbow joint in extension (for the median and radial nerves) and the angle of the shoulder joint in abduction (for the ulnar nerve) were measured using a standard goniometer. The association between abnormal neural tension and functional disability was investigated using Pearson's correlation test. The statistical significance level was set a t 0.05.

Regardless of the type of disorder, 112 patients had abnormal neural tension (some participants had more than one disorder) and underwent the neurodynamic test. Based on the results, 50 patients (50%) had at least one median, radial, or ulnar nerve tension dysfunction. There was no significant association between the degree of functional disability and the severity of abnormal neural tension according to the joint angle.

In many patients with MPS of the upper extremity with no obvious symptoms of neurological dysfunction, the nerve neurodynamic test is positive. Therefore, it is recommended that in all patients diagnosed with MPS, nerve neurodynamic test and, if necessary, neurodynamic therapy should be included in the routine physiotherapy.

Reviewing the literature related to the use of polysyllabic words in the assessment of speech sound disorders (SSD) in children have indicated the necessity of using these words for providing additional information such as prognostic information. Despite strong literature in other languages, there is scant research on examining the production of these words in the Persian language among children aged 4-7 years. Therefore, this study aims to design and assess the psychometric properties of the Persian version of the polysyllabic words test (PWT) for measuring production skills in Iranian preschool children.

In this cross-sectional study, First, 532 polysyllabic words with 3, 4, 5, and 6 syllables were selected from preschool children's books, which was reduced to 66 words after agreement among authors in three rounds. The content validity of the items was examined according to the opinions of five experts in typical speech development and SSD in terms of four criteria: Appropriateness for producing polysyllabic words, appropriateness for children aged 4-7 years, imageability, and cultural fit. After selecting pictures, face validity of items was examined by implementing the test on eight 4-7-year-old children (at least one child from each age group). Finally, 40 items were considered as the final words of PWT. For measuring psychometric properties, 120 children with normal development (60 males, 60 females), and 20 children with SSD (10 males, 10 females) participated. The control children were divided into 6 age groups with a 6-month interval (10 males and 10 females in each age group). Their inclusion criteria were age 4-7 years, not being bilingual, and passing the Persian diagnostic evaluation of articulation and phonology test (DEAP; Zarifian, 2014) and informal language screening test successfully. Because of the COVID-19 pandemic and the closure of most schools, the sampling of control children was done using a convenience method from two cities (Tehran and Karaj). The inclusion criteria for SSD children were: Inability to pass the DEAP test, not being bilingual, and having SSD. Their sampling was also done using a convenience method. For evaluating construct validity, the differences among six age groups, between males and females, and between control and SSD children were examined in terms of total score, percent consonants correct (PCC), percent vowels correct (PVC), and percent phonemes correct (PPC). Test-retest reliability was determined using 20 children at a one-week interval, and inter-rater reliability was determined by investigation of relations between scores of two independent raters for 20 children using the intra-class correlation coefficient (ICC). The internal consistency was determined by measuring the Cronbach's alpha coefficient. Descriptive statistics, ANOVA, independent t-test, Tuckey’s post hoc test, were used for data analysis in SPSS software, version 26.

In comparing the age groups, the results showed a significant difference in terms of total score, PCC and PPC (P<0.001), but not significant difference was found in PVC (P=0.23). No significant differences were found between males and females in total score, PCC, PPC, or PVC. In comparing control and SSD children, the results showed a significant difference between the two groups in total score, PCC, PPC (P<0.001), and PVC (P=0.02). The ICC was reported 0.98 for test-retest reliability and 0.79 for intra-rater reliability. The internal consistency was 0.75 for 3-syllable words, 0.65 for 4-syllable words, and 0.63 for 5-syllable words.

The Persian PWT can be used as a valid and reliable instrument for measuring speech production ability of Iranian children with SSD aged 4-7 years in clinical settings or for research. This test is consistent with other tests such as Baker (2013)’s test in terms of considering methodological principles such as inclusion words with different lengths, phonetic forms, and stress patterns, high imageability, using common words for preschool children, and providing opportunities for eliciting common error patterns of the target language.

Myofascial pain syndrome (MPS) is a clinical disorder with a prevalence of 85%. It is characterized by the presence of trigger points, and all people experience it at least once in their lives. Different physiotherapy and medical methods are used to manage MPS. Intramuscular electrical stimulation (IMES) is a relatively new treatment option for MPS. This study aims to examine the effect of IMES on clinical and ultrasound imaging parameters related to trigger points in patients with MPS.

This is a case series clinical trial. Twelve participants with trigger points in their upper trapezius muscles participated in this study. They were treated three times per week with IMES. Before and after the intervention, pain and cervical spine range of motion (ROM) were measured with the visual analog scale and goniometry. Ultrasonic parameters (longitudinal diameter and the area of trigger points, and the thickness of the upper trapezius muscle) were assessed with B-mode ultrasound imaging technique. The pre-test and post-test values were compared using the paired t-test. The significance level was set at 0.05.

After three sessions of IMES, pain and cervical spine ROM improved significantly (P<0.05). All ultrasound imaging parameters, including trigger points’ longitudinal diameter and area and upper trapezius muscle thickness, decreased significantly compared to baseline (P<0.05).

IMES seems to have promising effects on clinical and ultrasound imaging parameters of patients with MPS. Further studies with larger sample sizes are recommended to investigate the long-term effects of IMES with the inclusion of a matched control group.

Deafness is one of the most complex sensory disorders that leads to a major decline in auditory and verbal skills. Research shows that reading books has provided patterns of communication and preverbal skills to deaf children. The aim of this study was to investigate the effect of online parent-child dialogic book reading on pre-verbal and listening skills of deaf children under three years of old.

In this one-group quasi-experimental study with pre-test-post-test design, 10 hearing parents with deaf children under 3 years old with a child from the Deaf Family Association of Iran and the Deaf Center of Iran participated. The group of 10 people (parent and child) was first purposefully identified (based on inclusion criteria) and then from all the people with criteria, the people who declared their readiness to participate in the study were selected as study samples. Before starting the distance parent-child conversation reading program, the pre-verbal skills test (which included pointing, shared attention, imitation, and timing) and listening skills (small corners) were administered as a pre-test. Online reading sessions were held. For 20 sessions, three days a week, parents went online at a specific time (10 a.m. on Saturdays, Mondays, and Wednesdays), and each day a book with pictures and story-related content, book descriptions, and questions, and more WhatsApp activities. Created, placed. After the distance parent-child conversation book reading program, the test of pre-verbal skills and listening skills (small corners) were performed as a post-test for the sample group. Paired t-test was used to analyze the data.

The results of this study showed that the online parent-child dialogic book reading program caused a significant increase (p <0.005) in the post-verbal skills test score (imitation, shared attention, pointing and turning) and listening skills (p <0.005). 005) In comparison with the pre-test score of the sample group.

Parent-child dialogic book reading is one of the parent-centered programs that are important for deaf toddlers. The results showed the applicability of parent-child dialogic book reading in improving listening skills and preverbal skills of deaf children.