Iranian Rehabilitation Journal
Volume:22 Issue: 60, Dec 2024

The foot and ankle complex is crucial in stability, propulsion, and musculoskeletal interactions. Optimizing orthotic interventions in this anatomical region is essential to improve motor outcomes. This systematic review investigates the impact of foot orthoses (FOs) with sensorimotor bars on gait, postural control, and muscle activity in healthy individuals and those with musculoskeletal disorders. 

We conducted an electronic search in January 2024 using the PubMed, Web of Science, and Scopus databases. The article identification, screening, and selection followed the PISMA (the preferred reporting items for systematic reviews and meta-analysis) guidelines. We conducted the quality assessment using the PEDro (the physiotherapy evidence database) checklist. Data extraction and synthesis were performed using the Cochrane handbook for systematic review of interventions.

FOs with sensorimotor bars can increase foot external rotation, dorsiflexion, and abduction while decreasing foot eversion. Additionally, they can reduce anteroposterior displacement of the hip, shoulder, and head. Furthermore, significant improvements have been observed in spatiotemporal parameters such as walking speed, stride length, stance time, swing time, and kinetic parameters such as plantar pressure. These orthoses can also impact clinical tasks and decrease center-of-pressure movements.

Sensorimotor bars have demonstrated beneficial effects on gait (kinematic, kinetic, and spatial-temporal measures), balance control (clinical performance and center of pressure displacement measures), and muscle activity recording.

Children with disabilities need assistive technology (AT) to explore their surroundings, participate in social activities, and gain developmental skills. This study aimed to assess AT needs and barriers to access it for these children. 

The study participants comprised 217 children with disabilities aged 6-12 years, randomly selected from the registration list of Chaharmahal and Bakhtiari Welfare Organization, Chaharmahal and Bakhtiari Province, Iran, in 2022. After obtaining informed consent from their parents, study data were gathered by phone interview using the rapid assessment of AT (rATA) tool of the World Health Organization (WHO).

Among the 217 participants, 108(49.8%) used AT devices, and 102(47%) had unmet needs. Of the 55 AT devices named in the rATA, only 14 were used by the children. The most commonly used devices were hearing aids, glasses, and wheelchairs. Unmet needs of ‘chairs for bath/toilet,’ ‘wheelchairs,’ and ‘therapeutic footwear’ accounted for 50% of 132 unmet AT needs. The most common reasons for lacking AT were lack of financial resources (52%) and knowledge about AT devices (30.1%). Most clients were satisfied with AT-use training (92.3%), but only 20.2% were satisfied with AT device repair services.

This study highlights the need to improve AT device repair services, overcome financial challenges, and increase parental knowledge about AT devices as the most prevalent barriers to using AT devices. Developing a child-specific version of the rATA tool that includes questions about education and play engagement AT needs is suggested for better estimation of AT needs for children with disabilities in the future.

Motivation is the most influential factor in the drive and performance of adolescents with cerebral palsy (CP). As identification and analysis of volition in Iranian adolescents with CP seem to be essential, designing appropriate tools for assessing their motivation is crucial. To achieve this goal, we developed an adolescent motivation inventory-CP (AMI-CP) and evaluated its psychometric properties. 

In the first phase, item generation was conducted. Next, in the second phase, face and content validities of the items were assessed. Moreover, construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A total of 304 adolescents with CP participated in the EFA, while 210 adolescents with CP participated in the CFA. Afterward, convergent and discriminant validities of the inventory were measured. Moreover, reliability was evaluated by calculating Cronbach α, McDonald’s omega, average inter-item correlation, composite, and test re-test reliability. Lastly, the standard error of measurement (SEM) and the minimum detectable change (MDC) were applied.

Five factors with 22 items were extracted by EFA, accounting for 50.42% of the variance. The results of model fit indexes confirmed the goodness-of-fit of the final model with 20 items. In addition, the AMI-CP had a Cronbach α value of 0.75 and an intra-class correlation coefficient of 0.94. Moreover, the SEM and MDC of the inventory were 2.63 and 7.31, respectively.

The AMI-CP is a helpful measure of motivation in adolescents with CP. This inventory can enhance the assessment of the CP adolescents’ motivation by evaluating values, interests, personal causation, and physical and social environments.

Fear of falling (FOF) is common among older people and may impact normal walking in this population. This study aimed to determine the effect of FOF on cognitive-motor interference in walking among older adults.

Ninety older adults with the ability to walk 20 meters and without cognitive disorder participated in this study. Three groups of high FOF, low FOF, and no FOF were identified using the fall efficacy scale-international (FES-I). The cognitive-motor interference was determined for the completion time of three functional movements, namely forward walking (FW), timed up and go (TUG), and obstacle crossing (OC), as well as the correct answer rate in verbal fluency (VF) and mental tracking (MT) tasks. The difference in outcomes between the groups was determined using multivariate analysis of variance (MANOVA). The Pearson correlation coefficients determined the association between FES-I and cognitive-motor interference in subjects with FOF.

Dual-task cognitive performance measures, including MT + TUG, VF + OC, and MT + OC, significantly differed between the high FOF and no FOF groups (P<0.05). MT + TUG, VF + OC, and MT + OC also showed significant differences between the high FOF and low FOF groups (P<0.05). Other cognitive-motor interference measures were not significantly different between the groups. The FES-I showed a positive correlation with MT + TUG (r=0.76, P=0.001), VF + OC (r=0.72, P=0.001), and MT + OC (r=0.65, P=0.001) in individuals with FOF.

The results indicate that FOF may impair cognitive performance during dual tasks in older adults. Future studies may be needed to investigate whether reduced FOF has the advantage of dual-task improvement in older people.

Stroke is a major cause of disability in adults, necessitating consistent patient-therapist interactions and diligent adherence to home-based rehabilitation programs to achieve substantial functional recovery. This study assessed audio-based telerehabilitation's (TR) preliminary effect and feasibility in promoting home-based upper extremity exercises among stroke survivors.

A 4-week parallel two-arm pilot study design was employed. Fourteen stroke survivors (seven each in the experimental and control groups) were recruited. Individuals in the control group received standard care consisting of visits to physiotherapy outpatient clinics, while the intervention group received standard care in addition to audio-based TR. The independent t-test and chi-square test were used to analyze differences in the clinical and sociodemographic data. The independent t-test was used to measure the treatment effect on the upper limb motor function (Fugl-Meyer upper extremity [FMA-UE] and Wolf motor function test [WMFT]), quality of life (QOL) (the World Health Organization (WHO) QOL brief, [WHOQOL-BREF]), and activities of daily living (Barthel index [BI]).  

The overall Mean±SD age of the participants is 50±8.2 years. The FMA-UE and WMFT scores changed from 17.57 to 25.86 (P=0.02) and 28.14 to 43.71 (P=0.03). No significant improvements in physical health, psychological, and social relationships domains of WHOQOL-BREF were recorded after the intervention. However, the environmental domain showed significant improvement (P=0.001). Scores of BI did not change significantly (P=0.49).

The findings of this study provided preliminary evidence to support the feasibility and benefits of audio-based TR in promoting functional regain after the stroke. However, further studies with a robust design are needed to validate the reported effectiveness.

This study aimed to investigate neuropsychological rehabilitation’s effectiveness on stroke patients’ cognitive status.

This quasi-experimental study examined 22 adults with ischemic stroke of the left hemisphere (with an average age of 64.31 years) before and after the intervention. The patients had fluent aphasia (10 people) and non-fluent aphasia (12 people), along with cognitive disorders such as memory or attention disorder. Medical examination and para-clinical diagnosis of magnetic resonance imaging (MRI) with different causes, along with the Persian diagnostic aphasia battery bedside version (P-DAB-AQ1, 2016), were conducted. The severity of language disorder and type of aphasia were investigated using the Persian diagnostic aphasia battery (P-DAB-1) and Persian picture naming battery tests. Also, the mini-mental state examination (MMSE) test checked the cognitive dimensions. Verb network strengthening therapy, treatment of underlying forms, Persian verb, and sentence production protocol, and semantic feature analysis (SFA) for patients were also used.

Findings show that the participants’ average aphasia quotient (AQ1) score increased from 74.80 to 80.12, and the average MMSE score increased from 17 to 22.59. The main variables do not follow a normal distribution (P<0.05), but the difference between scores before and after the intervention follows a normal distribution (P<0.05). Both the AQ1 and MMSE variables significantly differ before and after the intervention, according to the Wilcoxon test. The non-fluent aphasia group has a higher increase in MMSE scores than the fluent aphasia group.

Neuropsychological rehabilitation interventions can effectively improve AQ1 and MMSE. In addition, further research on neuropsychological rehabilitation interventions with two intervention and control groups and the treatment methods used during this study can be suggested for the treatment of stroke patients.

The general concern about low back pain (LBP) necessitates thoroughly examining its various causes and feasible therapies. The current study investigated the causes and surgical treatments of back pain by tailoring treatments to the patient’s specific needs.

Two hundred individuals with LBP have been enrolled in this cross-sectional research. The radiological, magnetic resonance imaging (MRI) images and clinical evaluations were completed by neurosurgeons and used to categorize the selected patients from those attending neurosurgical outpatient clinics. Multiple causes of LBP, including disk prolapse, spinal stenosis, and muscular spasms, were investigated. Detailed descriptions of surgical approaches for various stages of disk prolapse and stenosis were given to help decide the optimal surgical tactics. The data were compiled into an Excel sheet, and the percentages and numbers were sorted and computed appropriately.  

The data present an extensive overview of the distribution pattern of back pain causes, disk prolapse, and spinal stenosis in the study community, along with the surgical procedures employed. Muscle spasms, disk prolapse, and spinal stenosis are the main causes of back pain (20%, 40%, and 13%, respectively). L5 and S1 are the most commonly involved in single-level disk prolapse (10%). Different spinal levels may have varying percentages of multiple-level disk prolapse (20%). There are multiple lumbar levels where spinal stenosis can occur, but the most common are L4 and L5 (20%). Distinct surgical approaches are employed for disk prolapse and stenosis at various levels of the spine, and the most frequent intervention was laminectomy in about 39% of total participants.

The study’s results demonstrate the complexity of the etiologies of back pain and the need for advanced surgical techniques. Particular emphasis is concentrated on spinal stenosis, including single- and multiple-level disk prolapse, and the relationship between surgical methods and causes. The study’s thorough comprehension is essential for tailored interventions based on patient traits, ultimately enhancing therapy and patient care.

Children with hearing loss often undergo considerable pain and distress due to their hearing impairment, leading to challenges in engaging constructively with others. Using games, mainly through play therapy, can significantly enhance interaction and adjustment in children, especially those with hearing impairments. This research seeks to evaluate the impact of play therapy on the adaptation and self-confidence of children dealing with hearing challenges.

This randomized controlled trial was conducted at a welfare center affiliated with the Hamadan University of Medical Sciences in western Iran. Sixty-two children with hearing loss were selected from the welfare center. They were then assigned to the play therapy or control group using block random sampling. The pre- and post-intervention assessments included completing demographic information, an adaptability questionnaire for elementary school children, and a self-esteem inventory. 

The implementation of play therapy led to a significant increase in adaptability immediately after the intervention and one month later (P<0.001). Moreover, a notable difference was observed between the two groups at the end of the study (P<0.001). Throughout the research, play therapy consistently elevated the self-esteem of the children. After the study, a noticeable difference was observed between the two groups (P<0.001).

lay therapy effectively increased adaptability and improved self-esteem in children with hearing loss. So, caregivers can use play therapy as therapeutic care to increase social adaptation and self-confidence in these children.

Sleep patterns significantly influence the physical, psychological, and social health of children, with irregularities correlating with behavioral issues like aggression. Studies highlight the association between disrupted sleep pattern and increased aggression in elementary school children, emphasizing the need for interventions promoting healthy sleep habits. This study aims to detect the relationship between sleep pattern habits and disruptive behaviors among children of elementary schools.

A correlational study was conducted in Al-Najaf elementary schools, focusing on disruptive behaviors among 198 children. The study data were collected through a refined Arabic questionnaire and sleep habits scale, revealing severity of disruptive behaviors and personal information variables. Tools’ validity was confirmed by experts, showing high reliability (Cronbach α=0.91). 

The study examined elementary school children diagnosed with disruptive behaviors in Al-Najaf Province, Iraq. Most participants were male (60.6%), aged 8-10 years (43.9%), and primarily in the first education grade (24.2%). Sleep patterns during weekends and holidays exceeded the normal range (47%), with disruptions reported by over half of the samples (56.1%). No significant correlation was found between disruptive behavior and personal traits, except with variable age, which had a significant correlation (P=0.003). Sleep patterns did not significantly correlate with disruptive behavior, although a weak negative correlation was found between age and education grade.

Disruptive behaviors are prevalent among elementary school children in Al-Najaf Province, albeit mildly impactful and diminishing with increasing age. According to the current result, these behaviors are not primarily linked to personal traits and show no or little significant correlation with sleep patterns.

We intend to find out current practice patterns in managing Bell’s palsy among the physiotherapists of Sargodha, Pakistan.

A cross-sectional study was conducted from May to August 2022. Data were obtained from 50 physiotherapists working in various clinical settings of Sargodha with more than 2 years of clinical experience. They were selected using convenient sampling. A self-designed questionnaire was used to gather all necessary information regarding the physical therapy practice patterns of Bell’s palsy. The obtained data were analyzed by using SPSS software, version 20.

Proprioceptive neuromuscular facilitation (PNF) was the preferred (42%) neurodevelopmental technique used in current practice patterns to manage Bell’s palsy. The most used therapeutic exercises by the physiotherapists were facial expression coordination exercises (66%). Also, 44% of physiotherapists used electrical muscle stimulation as the preferred electrotherapeutic modality in their current practice. Soft tissue release (54%) was the most preferred manual therapy technique in Bell’s palsy patients. The combination of electrical muscle stimulation, facial exercises, and biofeedback was the most used (54%) among physiotherapists. 

Current practice for Bell’s palsy treatment includes PNF techniques, facial expression coordination exercises, soft tissue release, and electrical muscle stimulation by most physiotherapists in Sargodha. The most preferred combination was facial exercises, electrical stimulation, and biofeedback.

This study aimed to assess the clinical features, Electroencephalography (EEG) findings, and brain imaging results in psychiatric patients diagnosed with epilepsy at Razi Psychiatric Hospital.

This retrospective descriptive-analytical study was carried out on patients with epilepsy and psychiatric disorders admitted to Razi Psychiatric Hospital over two years. A total of 94 patient files seizure and epilepsy comorbidity, recorded in the hospital’s health information system (HIS), were reviewed. Data collection involved a demographic checklist and an epilepsy scale; the latter, developed by DiIorio, Colleen, et al., encompassed personal characteristics, mental disorders, epilepsy, and seizures. The Kruskal-Wallis and Mann-Whitney non-parametric tests were utilized to compare the mean scores of variables, with SPSS software, version 21 facilitating the analysis.

Out of 94 patients with seizure and epilepsy, 9.6% had focal seizure, 26.6% had generalized epilepsy, 36.1% had focal-generalized seizure, and 26.8% had unknown seizure. About 12% had a structural etiology, while the remaining 88% had an etiology that remained unidentified.

The findings indicate that epilepsy, affecting individuals from adolescence through to old age, can lead to psychiatric disorders. For many patients, the etiology of their condition remains elusive, and EEG findings and brain imaging appear normal in the majority of cases.

This study detects the relationship between body mass index (BMI), selective voluntary motor control (SVMC) and functional independence in children with spastic diplegic cerebral palsy (CP).

A total of 84 children with spastic diplegic CP (levels II and III of gross motor function classification system [GMFCS]), aged 6-9 years with a mean age of 7.09±0.68 participated in this correlational study. BMI, selective control assessment of the lower extremity and pediatric functional independence measure (WEE FIM) were used to assess BMI, SVMC and functional independence, respectively.

The data demonstrated the presence of a positive strong significant correlation between selective control assessment of the lower extremity and WEE FIM. On the other hand, there was a negative, significant correlation between WEE FIM and BMI. In addition, a negative moderate considerable correlation between BMI and selective control assessment of the lower extremity was detected

Functional independence is significantly correlated with BMI and SVMC in children with spastic diplegic CP. BMI and SVMC are major factors that influence functional independence in these children. So, they are highly recommended to be part of the evaluation of the functional independence of children with spastic diplegia in clinical settings and research.

We intend to examine the effects of hallux valgus (HV) on dynamic balance in community-dwelling older adults. 

This comparative study was conducted on 29 functionally independent older adults with HV. The subjects were divided into the mild HV severity group and the moderate/severe HV severity group, determined using the Manchester scale. The 4 square step test (FSST) and timed-up and go (TUG) test were used to measure their dynamic balance. The independent t-test was performed to compare the two groups’ balance performance.

Significant differences were observed between the two groups. Participants with mild HV severity performed significantly better in the FSST (P<0.05) and TUG test (P<0.05) compared to those with moderate and severe HV severity. Regarding the normative cut-off value of FSST, all the participants were categorized as fallers.

HV negatively impacts the dynamic balance of community-dwelling older adults with moderate and severe severity grading. This finding suggests that adjusting treatment strategies may be required when managing falls and balance issues in older adults with HV deformities.

Occupational performance occurs in a dynamic interaction between the people, their occupations, and context. Stroke could affect the individual’s occupational performance, which is the basis of social life.
This study aimed to investigate the factors affecting stroke patients’ occupational performance.

In this descriptive-analytic study, 55 people with stroke participated. The patients completed the Canadian occupational performance measure (COPM), Barthel index, Brunnstrom stage, Montreal cognitive assessment, and a demographic questionnaire.

The results showed a significant correlation between occupational satisfaction and performance with cognition, the activities of daily living (ADL), and the severity of impairment in the upper and lower extremities (P <0.01). The results of linear regression show that cognition level could significantly predict occupational performance (R= 0.83, P <0.01) and satisfaction (R= 0.81, P <0.01) after stroke. 

Results show that the cognitive level could predict occupational performance in patients with stroke. Performing daily living activities and lower limb impairment could predict satisfaction with occupational performance. Therefore, it is recommended that therapists consider the cognition in stroke patients through a proper therapeutic plan to prevent participation restrictions.

About 5% of the world’s population suffer from bipolar disorder. These people, in general, and teachers in particular, have many personal, social, and working problems. Different approaches, such as positive thinking, have been suggested to cope with such issues. Moreover, professional identity, similar to general identity, has been applied in various ways in teacher and instructor training. Using a basic interpretive design, we explored perceptions of English foreign language (EFL) teachers with bipolar disorder and the effectiveness of a training course on positive thinking on their professional identity.

The participants consisted of 25 (16 males and 9 females) bipolar EFL teachers who were purposefully selected from EFL teachers teaching in private language institutes in Kerman City, Iran. A bipolar spectrum diagnostic scale and a semi-structured interview were used to collect the study data. Also, a positive thinking training course was developed to be administered in ten 60-minute sessions. 

Regarding the effectiveness of the positive thinking training course on professional identity, the output of a thematic analysis of the interviews conducted with bipolar EFL teachers were as follows: Improvement in communicative and motivational skills, enhancement of willingness to reach professional development and classroom management skills, working on English language proficiency, seeking the best teaching methods, attention to students’ needs, enhancement of verbal skills, and reducing teaching fear.

The research results help people participate in bipolar tests and psychological studies and strive for their mental health. It will also create a spirit of hope in patients. The findings have some implications for EFL teacher education administrators and bipolar EFL teachers. Training on positive thinking skills can contribute to positive changes and orientations in EFL bipolar teachers, reconstructing their professional identity.

To comprehend the kinematic effects of hallux valgus (HV) deformity on young and older people, we assessed the angular acceleration of the joints in the lower limbs of these women. 

Forty-eight women in two groups, young adults (20-30 years old) and older adults (50-60 years old), participated in this study (12 healthy and 12 with HV). We used an inertial measurement unit (IMU)-based motion capture system to measure the kinematics of motion. Biomechanical variables were assessed at an ideal speed during gait (stance and swing phases). All modules were calibrated in advance and then attached to the right thigh, shank, and foot. 

The results showed that in the young group, angular acceleration was significantly different during gait in all planes of the ankle joint, the sagittal plane of the knee joint, and the horizontal and frontal planes of the hip joint. In the older group, it was significantly different in the sagittal plane of the ankle and knee and the sagittal and frontal planes of the hip joint.

It appears that the angular acceleration of the lower limb joints was affected by HV, especially in the young group. Additionally, the angular acceleration of the knee joint was less affected in both groups.

To investigate the effects of myofascial release technique on pain and quality of life (QoL) in patients with fibromyalgia (FM). 

A quasi-experimental study was conducted to investigate the effects of myofascial release technique on patients with FM in Shalamar Hospital Lahore, Pakistan. After initial screening, 28 patients aged 25 to 45 years of both genders meeting the predetermined inclusion criteria were selected using convenience sampling. They were divided into two groups. Group A was treated with myofascial release therapy and passive stretching, while group B was treated with passive stretching alone. The McGill pain questionnaire (MPQ) was used to assess the pain, and the revised FM impact questionnaire (FIQR) was used to evaluate QoL.

Out of 28 participants, 11(39.3%) were male and 17(60.7%) were females. Pre- and post-treatment mean scores of pain rating index on MPQ were 46.76±10.47 and 23.79±7.43 for the experimental group and 43.36±12.7 and 30.0±9.89 for the control group, respectively (P>0.05). Mean pre- and post-treatment FIQR scores were 52.9±13.6 and 33.02±13.75 for the experimental group and 57.77±23.04 and 46.59±19.37 for the control group, respectively. The difference in the means of post-treatment scores of the two groups for FIQR was significant (P=0.042).

Compared with passive stretching alone, the myofascial release method for FM did not demonstrate significant improvement in alleviating pain among such patients. However, it is remarkable that myofascial release therapy unveiled a positive impact by improving the overall QoL for FM patients.

The focus of patients’ attention during the physiotherapy program has been reported to affect the rehabilitation goals. The study aimed to investigate the effectiveness of an external focus of attention (EFA) on static balance and functional ability in individuals with chronic ankle instability (CAI).

Fourteen subjects with CAI, aged from 19 to 25 years, were randomly assigned to two groups: external and internal focus of attention (IFA) group. The outcome measures of the study were static balance and functional ability. A pre-intervention evaluation was performed. Following instructions to an external or an IFA, subjects practiced on a balance board 3 times per week for 4 weeks. At the end of each week, they performed evaluation tests, including a time balance test, foot lift test, side hop test, figure-8 test, and star excursion balance test (SEBT). Parametric (mixed analysis of variance) and non-parametric analysis (the Mann–Whitney and Friedman tests) were performed between measurements and groups.

The intervention program showed a statistically significant improvement in static balance and functional ability in both groups. The results indicated the main effect of time (F(2.488, 29.855)=43.880, P<0.001). For the time in balance test, analysis of variance revealed a main effect of time (F(2.571, 30.855)=11.188, P<0.001). Regarding the SEBT, every direction indicated a main effect of time for both groups. No significant differences between the two groups were found in static balance and functional ability.

Even though there were no statistically significant differences between the two groups, both types of focus of attention contributed to the improvement of static balance and functional ability, which may reveal an increase in motor control and neuromuscular ability of the subjects with CAI.

The present research aims to highlight the impact of hyperammonemia, a common pediatric metabolic disease, on children’s language and feeding skills. This research was conducted through a literature review and the presentation of a 2.5-year-old girl diagnosed with hyperammonemia.

The research was conducted on a 2.5-year-old girl who had been diagnosed with a sudden-onset metabolic disorder that resulted in swallowing, speech, and language problems. The child’s receptive and productive language and feeding history were obtained through interviews with her mother. Formal and informal tests were used to assess the child’s language and feeding skills at two different times after the onset of symptoms.

This study presents a new and unique case of a child with very high levels of ammonia and severe clinical manifestations of cognitive, language, and motor dysfunctions. Although the child did not receive any direct interventions during the study, a secondary assessment revealed slight improvements in some language and oral motor skills, possibly due to maturation and advice provided by rehabilitation team members.