مجله پژوهش در علوم توانبخشی
سال هشتم شماره 1 (فروردین و اردیبهشت 1391)

The role of joint hypermobility in musculoskeletal injuries has been emphasized. In recent studies, proprioception defects have been reported in patients with hypermobility syndrome. In contrast to patients with general hypermobility, those with joint hypermobility syndrome have musculoskeletal disorders which may themselves cause proprioception disorders. So, these reports cannot purely confirm the effect of joint hypermobility on proprioception. The objective of this study was to assess the effect of generalized joint hypermobility on knee joint position sense in subjects with generalized joint hypermobility.

In this case-control study, 20 subjects with generalized joint hypermobility who suffered from knee hypermobility in their dominant lower limb and 20 healthy subjects were recruited from available population of male and female college students through a simple convenient sampling. All subjects fell within the age range of 18 to 30 years. The position sense error was measured at three angles of knee extension -15°, -40° and -65° in sitting position via goniometry of digital pictures using Auto-CAD software. These errors were compared between two groups and also between different angles. Kolmogrov-Smirnov test confirmed the normal distribution of variables.

The results of this study showed that the position sense of knee joint in young subjects with generalized joint hypermobility was less accurate than in healthy subjects. Also the results indicated that the knee joint position sense in both groups was more accurate for angles at the end of range of knee extension that for those at inner range.

The results of this study confirmed the existence of knee joint position sense defect in subjects with generalized joint hypermobility who have knee joint hypermobility. It is recommended to evaluate position sense of these joints in such subjects especially when they intend to enter sport activities in which the risk of joint injuries may elevate. Moreover, it is required to design training protocols for improving joint position sense in such cases.

Patterns of time use provide important information about the ways in which individuals manipulate their time to contribute in daily activities. According to the World Health Organization, the proper usage of time has a positive effect on health and welfare. Having a child with cerebral palsy imposes various kinds of pressure on the family including feeling a “time pressure” for ongoing care of the affected child which may be beyond what is expected regarding the family schedule. Although mothers are usually the most affected member of the family in this dilemma as they are the main caregiver of cerebral-palsied child, less attention has been paid to them. Therefore, this study aimed at investigating the patterns of time use in mothers of children with cerebral palsy compared to those of healthy children. 30 mothers of cerebral palsied children and 37 mothers of healthy children Participated in this case-control study. The “Mother Time Use” Questionnaire along with a demographic questionnaire were used for collecting data of interest. Mothers of children with cerebral palsy spent more time to look after their children as compared to mothers of healthy children (P < 0.05). However, in other areas there were not significant differences. Satisfaction of mothers of children with cerebral palsy regarding their time management skills was significantly less than that of the other group (P < 0.05). The results of this study indicated that the mothers of children with cerebral palsy did not maintain a well-balanced daily schedule which, in return, may lead to less than satisfactory “use of time”. It is necessary to consider further resources of support for mothers of children with cerebral palsy.

Low back pain after load- holding and carrying can result in significant functional disability and financial disadvantage. Dynamic load-holding imposes varying torque on intervertebral joints and endangers the balance. The goal of the present study was to study the reliability of the postural stability during holding dynamic load for more accurate evaluation of lumbar spine injury.

Participants in this study were 12 healthy men and 12 male patients with low back pain (LBP), subjects were assessed 3 times in 8 conditions while they held dynamic loads in neutral and flexed trunk positions. Center of pressure (COP) data including displacement, velocity, path length and their respective standard deviations (SD) in anterior-posterior (AP) and medial-lateral (ML) directions were assessed. Relative reliability was measured using intra class correlation coefficient (ICC) while absolute reliability was obtained via standard error measurement (SEM) and minimal metrically detectable change (MMDC).

Healthy subjects’ velocity in ML direction (0.8-0.9), LBP patients’ velocity and its SD in AP direction (0.7-0.9) had the highest reliability among the parameters of interest. Reliability of displacement in ML direction and its respective SD yielded similar results in both groups (0.6-0.9). Reliability of displacement and its SD in ML direction and path length in healthy subjects were more than those of LBP patients.

Velocity of center of pressure in both AP and ML directions are suggested as appropriate parameters for evaluation postural stability during dynamic load- holding in subjects with and without non specific low back pain.

Several hypotheses have been proposed to explain cognitive dysfunctions in children with high-function autism including executive dysfunction hypothesis. The main goal of this study was to examine differences in executive functions (namely, sustained attention, selective attention, and response inhibition) between children with high-function autism and their normal matched peers. In this cross-sectional study, 16 children with high-function autisms were compared with 16 typically developing counterparts. Word-Color Stroop, Go/Not Go and Continuous Performance Tests were respectively administered to assess selective attention, inhibition, and sustained attention. Data were statistically analyzed via independent t test using SPSS software version 18 at the significance level of 0.01. No significant differences were found in correct responses (P = 0.65) and average reaction time (P = 0.08) between children with autism and typical developing group during Word-Color Stroop test. In Continuous Performance Test, there was no significant differences in omission (P = 0.60) and commission (P = 0.64) errors between children with autism and their typical matched peers. However, a significant difference was observed in average reaction time (P < 0.01) implying higher speed in autistic subjects. Regarding Go/No Go test, there was no significant difference between two groups in average reaction time in the Go stage (P = 0.70), correct responses (P = 0.33) and average reaction time (P = 0.52) in the No Go stage. There was, however, significant difference between two groups in correct responses of Go stage (P = 0.00) indicating better performance of typical group. Response inhibition (proponent and motor) and sustained attention are those components of cognitive executive functions which remain intact in high-function autism. Intact response inhibition in autism may be due to their week reading comprehension, specific affected brain areas and the type of task used. Intact sustained attention may imply a tendency for focusing on specific stimuli and displaying repetitive behaviours among autistic children.

To apply a comprehensive evidence-based approach to stuttering, there is a need for an instrument examining the totality of this disorder. Yaruss and Quesal (2006) published the “Overall Assessment of the Speaker’s Experience of Stuttering” (OASES) questionnaire to achieve this aim. OASES-A can be used for documenting multiple treatment outcomes of individuals with stuttering who are older than 18 years. The aim of this study was to determine the validity and reliability of Farsi version of OASES-A questionnaire. Face validity, internal consistency and reliability of OASES-A were evaluated thorough conducting a pilot study in which a semi-structural interview arranged for 10 people who stutter (PWS). 50 PWS were then asked to complete modified OASES-A and S-24 scale to determine concurrent validity. Finally, in order to determine test-retest reliability of Farsi version of OASES-A questionnaire, 5 stuttering people completed the form 2 times within a 7-to-10-day interval. Cronbach's alpha coefficient, which was calculated for entire 4 parts of the Farsi version of OASES, was 82 to 97, implying that the Farsi version of OASES-A questionnaire had a good concurrent validity, internal consistency and reliability. Finally it was shown that all the items of the questionnaire have an appropriate validity and reliability. Results of the present study indicate that the validity and reliability of Farsi version of OASES are

Low Back Pain (LBP) has been considered as a major social problem imposing high financial burden on health care costs and creating various health problems in industrial countries. There are more than 20 types of treatment for chronic LB. Developing a therapeutic/rehabilitative program for faster recovery of patients with chronic LB has always been considered. Therefore, the aim of this study was to evaluate the effects of a core stability training program on pain and performance in female patients with non-specific chronic low back pain. Thirty female non-athlete patients with non-specific chronic LB (mean age, 36.3 ± 5.2 y; mean weight 68.6 ± 8.3 kg mean height, 160.8 ± 4.6 cm) who referred to Naft Hospital (Ahwaz-Iran) participated in this study. Patients were equally randomly assigned to either experimental or control groups. At pre-test, pain and performance of patients were assessed using VAS and Oswestry questioners. Patients in experimental group participated in a 12-session core stability training program while patients in the control group did not participate in any specific program. At post-test, pain and performance of patients in two groups were re-assessed at the hospital. The results of the present study showed significant improvements of pain (T = 13; P < 0.05) for patients in the experimental group (6.5 ± 0.33 vs. 2.1 ± 0.45) following core stability training and no significant change (P > 0.05) in the control group (5.27 ± 0.46 vs. 5.3 ± 0.48). With regard to performance, a significant difference (T = 3.8, P < 0.05) between pre- and post-training was found in the experimental group (26.3 ± 3.3 vs. 14.4 ± 3.4) but in the control group (33.1 ± 4.7 vs. 33.12 ± 4.2) no significant difference was observed (P > 0.05). It can be concluded that core stability training can lead to decrease in pain and improve performance in patients with chronic LB. Therefore, this type of training is recommended to be considered as a therapeutic option for this population of patients.

Evidence-based practice incorporates research into clinical skills along with recognizing and accepting client’s ideas. In recent years, speech and language pathologists have been expected to justify their clinical decision makings on the grounds of reliable evidence-based practices. The purpose of this study was to investigate speech-language pathologists’ attitude, knowledge and behavior toward evidence-based practice and its relationships with personal and interventional variants.

In this cross-sectional, descriptive-analytic and retrospective study, 40 available speech and language pathologists in Isfahan were assessed via a checklist called “attitude, knowledge and behavior of speech and language pathologists toward evidence-based practice”.

The results showed that %79 of graduates and B.Sc. or M.Sc. students had positive attitude toward evidence-based practice. %90 of participants responded that they had not received any instruction on the subject. %32 of speech and language pathologists reported that they usually read less than 2 articles a month and one-third of respondents was found to use resource materials less than 2 times a month in order to make clinical decisions. Only half of the sample had online access to information either in home or in office.

Study results show that there is a need for teaching evidence-based practice and providing appropriate strategies to increase its application.

Low back pain due to prolonged inactivity and improper physical postures is a common problem among office staff causing them to suffer from the physical, mental, social and professional complications. The aim of the present study, in which a pictorial educational pamphlet was used, was to examine the efficacy of awareness of appropriate postures in relieving pain and disability in clerks with low back pain. 40 staffers aged 25 to 50 years (mean, 35.7 years) participated in a 3-month quasi-experimental study with a pre-post test design. All subjects had chronic low back pain and they were recruited through convenient sampling method from 6 state agencies. At the initiation of the study, pain and the level of disability were assessed via visual analog scale (VAS) and Oswestry Disability Questionnaire. Then, guidelines were instructed to them by a physiotherapist in a 20-minute session. Throughout the first two months of the study, the examinees were closely monitored in order to ensure that they followed the instructions. At the end of the third month, pain and disability level were re-assessed. All data of interest were statistically analyzed through paired t test. Regarding pain intensity, the difference between VAS mean scores obtained before and after training program was significant (P = 0.0001). Moreover, disability levels were significantly different comparing pre- and post-test mean scores (P = 0.0001). Being compliant with the guidelines of the pamphlet used in this study for three months can be associated with relieving pain and disability levels of staffers.

Decreased sense of joint movement and position (i.e., proprioceptive sense) due to peripheral neuropathy can cause such deficits as changed gait, modified foot plantar pressure distribution and, as a consequence of these processes, increased pressure beneath metatarsal bones. By the time, extra pressure may increase the risk of plantar ulcer. The aim of present study was to assess the effect of an 8-week aerobic exercise training program on foot plantar pressure distribution during gait in patients with diabetic peripheral neuropathy. 30 patients with diabetic peripheral neuropathy participated in this study. Subjects were divided into experimental (mean age: 55.85 ± 9.07 years; mean BMI: 29.50 ± 10.09 Kg/m2) and control (mean age: 54.66 ± 5.53 years; mean BMI: 31.55 ± 4.26 Kg/m2) groups. To measure maximum foot plantar pressure during gait, foot scan (RSscan) was carried out for 10 anatomical references points of foot prior to and after implementing the intervention program. Experimental group was provided with three one-hour aerobic exercise sessions a week for 8 weeks. Control group did not participate in any exercise program. Obtained data was statistically analyzed via ANOVA with repeated measures. Comparing pre- and post-test results, pressure differences were significant in the experimental group (P ≤ 0.05) while no such difference was found in the control group. Based on the study results, aerobic exercise can decrease foot plantar pressure in patients with diabetic peripheral neuropathy and may decrease the risk of developing plantar ulcer due to the abnormal distribution of pressure in metatarsal area.

The rehabilitation of children with cerebral palsy is regarded to as one the most important topics in the field of occupational therapy. During this long-term process, parents may face with many problems such as remaining on the long waiting lists, difficulty in handling and transporting the effected child, and financial problems that, in turn, can reduce the their ability to follow treatment programs and affect their confidence in the efficacy of those programs. These problems may also delay the achievement of therapeutic goals. In this study, researchers decided to implement a method of total quality management called FOCUS- PDCA to evaluate its effect on tackling the aforementioned problems during treatment programs held in affiliated occupational therapy clinic of Shiraz School of Rehabilitation Sciences.

In a quasi-experimental interventional study, 15 cerebral palsied children and their parents were first divided into two experimental and control groups and then included in a 12-session program. Control group received traditional occupational therapy services. In addition to routine clinical services, parent education was also offered in experimental group through forming promoting teams. Before and after implementing the FOCUS- PDCA, parental satisfaction was assessed via a tailor-made questionnaire. To assess children’s motor function before and after intervention, Peabody Scale was used in both groups.

Data analysis indicated the significant effect of FOCUS-PDCA on motor functions of CP children (P < 0.05) and parental satisfaction (P < 0.001).

The current study showed that the FOCUS-PDCA approach improved the motor function of CP children and parental satisfaction in occupational therapy clinics. It is suggested that researchers assess the effects of this strategy for other indexes as well as in other clinical fields of rehabilitation.

The advantages of physical activities have recently been recommended in preventing such chronic diseases as osteoarthritis. However, the risks that severe physical activity may have on musculoskeletal system of athletes are still unknown. The purpose of this study was to compare the radiographic grading scales of osteoarthritis, knee pain, existing symptoms, physical functions in activities of daily living, sports and recreation, and the quality of life of ex-elite soccer players with the same factors in non-athlete controls. 15 ex-elite male soccer athletes and 15 non-athletes were purposefully selected in this study. The clinical and radiological methods (Kellgren-Lawrence) along with an internationally-known and translated questionnaire called “Knee Injury and Osteoarthritis Outcome Score” (KOOS) were used to diagnose the disease. Statistical analysis of data was performed via independent t test at significance level of P ≤ 0.05. Mean scores of radiographic grading scales for osteoarthritis of the knee (P = 0.001) was significantly higher in ex-professional athletes than in non-athlete controls. There was, however, a significant lower mean scores of knee pain (P = 0.002), symptoms (P < 0.001), physical function in daily activities (P = 0.001), sport, recreation (P < 0.001) and quality of life (P < 0.001) in athletes as compared to non-athletes. Having a professional soccer-playing career can result in high risk of knee osteoarthritis in former elite athletes.

The main goal of the present study was to determine the effectiveness of an interventional program called “social life skills group training” to improve daily life skills of male patients with schizophrenia attending Razzi psychiatric center (Tehran-Iran). To examine the effectiveness of the intervention, a quasi-experimental study including pre-test, post test, and control group was designed. 24 schizophrenic patients were randomly assigned either to experimental (n = 12) or control (n = 12) groups. A check list of daily living skills (ADL) (Karbalaei Ismail, 1996) and a demographic questionnaire were used for data collection. All of data of interest were statistically analyzed by SPSS software version 16. The significance level was set at P = 0/05. The findings indicated enhanced communal life skills in experimental group as compared to the control group after the intervention (P < 0/05). Also, there was a significant difference between these two groups regarding daily life skills (P < 0/05). Study results revealed that a communal skills training program might improve daily life skills in schizophrenic patients. Besides, it is worthy to point out that training social and life skills can enhance communication skills. In conclusion, patients who receive these kinds of treatments are better able to handle problems they may face in the real life than those who do not.

Hamstring shortness can cause postural disorders and gait abnormality. Recently, different therapeutic interventions have been proposed to increase hamstring flexibility. The purpose of this study was to investigate the effects of Ultrasound (US) and Hold– Relax (HR) stretching techniques on hamstring flexibility. In this quasi-experimental study, thirty– six individuals with hamstring shortness were randomly assigned either to control, or therapeutic US, or HR stretching technique groups. Two groups followed their own specific treatment protocols for 8 weeks. Standard goniometer was used for measuring hip flexion and knee extension range of motion. Data were statistically analyzed via one-way ANOVA using SPSS software-version 19. Significance level was set at P < 0.05. Study results showed that both treatment protocols significantly increased passive hip flexion range of motion (ROM) and passive knee extension ROM (P < 0.001). However, the HR technique had more significant efficiency as compared to US method (P < 0.001). It can be concluded that therapists can use both US and HR to improve hamstring flexibility. However, the HR method improves hamstring flexibility better than does US technique.

Occupation includes daily tasks and purposeful activities in which people engage to fulfill their individual or subjective values. Occupation comprises the core concept of occupational therapy. Through facilitating participation in occupation, occupational therapists provide an opportunity for an individual to develop and increase his/her independency. Given the importance of occupation in occupational therapy and the lack of research on occupation in Iran, this question then arise that how much are occupational therapists committed to use occupation in their interventions in Iran? This study compared the application of occupation in interventions used by American and Iranian occupational therapists.

The instrument used in this Quantitative survey study was a modified version of “Scale of Therapeutic Occupation” developed by Sass and Nelson in 1998. A sample of occupational therapists, who were registered in Iranian Occupational Therapy Association or the Medical Council of the Islamic Republic of Iran and working in of Isfahan and Tehran cities, were recruited through accessible sampling. Data were statistically analyzed using SPSS software-version 17 at the significance level of P < 0.01.

70 occupational therapists (31 male and 39 female) with an average age of 29 years participated in this study. The results compared with those obtained in Sass & Nelson’s study (1998). T values measured in this study showed that American occupational therapists applied occupation in their interventions more than did the Iranian occupational therapists studied (P = 0.000)

According to the results of this study, there is a difference between the rate of use of occupation by American and Iranian occupational therapists; so that American occupational therapists apply occupation in their interventions more than do Iranian occupational therapists. Differences in occupational therapy history, clinical practice situation and educational context and curriculums between Iran and America are the possible reasons of the observed difference. More clinical education about occupation and providing better conditions for clinical practice seems to be essential for achieving a better status for occupational therapy in Iran.

In line with other studies on attitudes toward people who stutter, the aim of this study was to evaluate the attitudes of college students toward people who stutter. In this descriptive analytical study, 104 students studying at Golestan University of Medical Sciences filled out a questionnaire which contained 20 personality items. Each item was scored on the basis of a 1-to-7-point scale. Study results indicated that except for “aggressive” (P = 0.584) and “calm” (P = 0.151) traits, there were statistically significant differences in all personality items between people who stutter and people who do not stutter (P < 0.05). In addition, the mean scores of negative traits were higher in people who stutter. Based on the study results, college students may have more negative attitudes towards people who do stutter than people who do not.

Anterior cruciate ligament (ACL) tears are one of the most common knee injuries sustained by professional athletes in sports. Choosing the best graft for ACL-deficient athletes is of graet importance. To date, Patellar and hamstring tendons have been the most common grafts used ACL reconstruction. The aim of present study was to determine the effects of the particular grafts, namely HTG and BPTBG, on performance, balance and returning to sport events. In this quasi-experimental study, 38 athletes with ACL rupture were studied gradually. 19 athletes with patellar tendon graft (BPTBG) and 19 athletes with 4-layer hamstring grafts (HTG) underwent reconstruction. An accelerated rehabilitation program designed and provided to both groups. At the end of the 3rd, 6th, and 9th months, such variables and tests as anterior knee pain, range of motion (ROM), Lysholm Scale, single leg hop test, one repetition maximum (1RM), star excursion test, knee laxity, and the level of return to competitions were evaluated. Repeated measure ANOVA and t test used for statistical analysis of data. The significance level was set at 0.05. At the end of the 6th and 9th months, anterior knee pain in BPTBG groups was significantly more than HTG group. Kneeling for BPTBG group was associated with more severe pain and swelling at the end of 9th month (P < 0/05). Extension of BPTBG group was higher than HTG group and vice versa was true for flexion. HTG group's anterior knee laxity was higher than BPTBG group but the difference was not significant. In single leg hop and balance tests, BPTBG group had a weaker performance. HTG group's Lysholm scale scores were significantly better than the BPTBG group. HTG group returned to a higher level of competition. Study results showed that use of hamstring grafts would have fewer side effects and safer and faster return to the initial level of exercise and hence, a suitable graft for ACL reconstruction.

Based on Janda’s theory of kinetic chain, dysfunction in one joint can affect other joints of body. The aim of the present study was to determine the relationship between flat foot deformities, Q angle and knee pain in Iranian freestyle wrestlers. Twenty freestyle wrestlers (mean age, 19.11±0.86 years; mean weight,70.5 ± 18.4 kg; and mean height, 173.2 ± 9.1 cm) were recruited from Iranian national team. Navicular Drop (with Brody method), Goniometer, and either pain score or visual analogue scale (VAS) were respectively used for the assessment of flat foot, Q angle and knee pain measurement. Pearson correlation coefficient test was conducted for statistical analysis of data using SPSS software version 18. Significance level was set at P ≤ 0.05. Also Inter Class Correlation Coefficient (ICC) used to evaluate the repeatability of measurements. Results indicated that there was significant relationship between flat foot deformity and knee pain in freestyle wrestlers (r = 0.686). Although Increased Q angle and knee pain had a significant correlation in dominant leg (r = 0.949), there was a weakly significant relationship between Increased Q angle and flat foot deformity in dominant leg (r = 0.278). Considering the present study’s results and based on kinetic chain theory, flat foot deformity may result in patella lateral rotation and increase of Q angle which, in turn, may eventually cause knee pain.

The Pilates is one of the new training methods that seem to be effective in reducing weight, risk of developing cardiovascular diseases and blood pressure. The purpose of this study was to determine the effect of Pilates training on selective physiological and physical fitness in untrained overweight females. 30 female non - athlete overweight students with body mean mass index of 26/25 ± 1/84Kg/m2, volunteered in this study and were randomly assigned to either experimental or control groups. The experimental group performed Pilates training 3 sessions a week for 8 weeks, each session lasting one hour. Control group did not do any special exercise. body weight, body mass index, fat percent (sum–of-four-skin folds: triceps, supriliac, abdominal, thigh), fat body mass, lean body mass, waist circumference, aerobic power, systolic and diastolic blood pressure in resting time, excellent hand power, abdominal muscular endurance, and flexibility (sit-and-reach and shoulder-reach) were assessed before initiation and after termination of the intervention program. To measure differences between experimental and control groups regarding these variables, one-way analysis of covariance and dependent t-test were conducted at the P level of 0.05. Study Results showed that, fat percent, fat body mass and waist circumference significantly decreased in the experimental group at the end of exercising period (P < 0/05). Moreover, aerobic power, abdominal muscular endurance, flexibility (sit-and-reach and shoulder-reach) and excellent hand power significantly increased in the experimental group as compared to the control group (P < 0/05). There is no significant difference between experimental and control groups in total body weight, body mass index, lean body mass and systolic and diastolic blood pressure (P > 0/05). The result of present study proved that Pilates exercise over an 8-week period with 3 one-hour sessions per week can decrease fat percent, fat body mass and waist circumference and improve such variables as flexibility, hand power, abdominal muscular endurance and aerobic power.

Compared to healthy individuals, those with mental disability are physically less active and this may expose them to the risk of physical and motor dysfunctions. It might be possible to decrease such risks by encouraging them to participate in exercise programs. The aim of this study was to evaluate the effects of an 8-week program of combined exercise training on thoracic kyphosis and lumbar lordosis of adolescents with mental retardation. In this quasi-experimental study, 30 mentally retarded adolescents (mean age, 16.9 ± 1.21 years; mean height, 172 ± 9 cm; mean weight, 63.4 ± 16.76 kg, mean IQ, 63.07 ± 4.79) with thoracic kyphosis and lumbar lordosis were randomly assigned to one of two matched groups of control (n = 15) and experimental (n = 15) according to their IQ scores. While the controls were asked to continue their routine life as usual, subjects in experimental group participated in a combined exercise training program which was held three times a week for eight weeks with each training session last for 60 minutes. The program was consisted of physical fitness and corrective exercises. Pre and post measures of kyphotic and lordotic curves were obtained using a flexible ruler. Data were statistically analyzed via repeated measure ANOVA using SPSS software version 17. Post-test scores of lordotic curves in control and experimental groups showed +1.0 and -3.4 degrees of change, respectively. This can be interpreted as a significant statistical interaction between two groups (F (1, 28) = 35.6, P = 0.000). Kyphotic curve also showed the same interaction, and post-test score changes of +0.2 and -2.6 were respectively observed in control and experimental groups (F (1, 28) = 9.6, P = 0.014). In this study, mentally retarded adolescents were engaged in a combined exercise program consisted of physical fitness and corrective exercises. Findings revealed that the program had therapeutic effects and decreased thoracic kyphosis and lumbar lordosis. It is concluded that similar fitness and corrective exercises are possibly recommendable for mentally retarded adolescents.