فصلنامه طب توانبخشی
سال یکم شماره 2 (تابستان 1391)

Osteoarthritis (OA) is the most prevalent joint disease in adults around the world and its incidence rises with age. Patients with severe knee osteoarthritis often complain of pain and severe functional disability. Most of conservative treatments used in this group of patients induce poor improvements. This study evaluated the effect of joint traction on quality of life of patients with severe knee osteoarthritis.

In this clinical trial study, forty female patients with severe knee OA were randomly assigned to two following groups; common physiotherapy treatment and common physiotherapy treatment accompanied by knee distraction. Quality of life was evaluated pre- and post-treatment and also one month follow-up using the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire.

Common physiotherapy treatment accompanied by knee distraction resulted in significantly better quality of life post-treatment and at 1month follow-up, compared to common physiotherapy treatment alone (P<0.01).

Common physiotherapy treatment accompanied by knee distraction induces significant improvement in quality of life in patients with severe knee osteoarthritis compared to common physiotherapy treatment alone.

Schizophrenia is a severe psychiatric disorder and characterized by impairments in a wide range of cognitive domains. Allen Cognitive Level Screen has been used extensively by occupational therapists as a quick screening tool to derive a view of cognitive function in people with psychiatric disabilities. Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerized neuropsychological assessment battery which is commonly used to assess an executive functioning. The purpose of this study was to examine the relationship between two measures of executive function used by different disciplines (Allen cognitive level test and CANTAB) when assessing persons with schizophrenia. In this cross-sectional study, the relation between Allen cognitive level test`s outcome and subtests of CANTAB (SWM, SSP & IED(were investigated in 30 patients with chronic schizophrenia (Mean age= 39, man=80%,woman=20%). Allen cognitive level test was used to measure cognitive level and Spatial Span (SSP) to measure working memory capacity, Spatial Working Memory (SWM) to evaluate working memory and its strategy of usage and Intra/Extra dimensional Set Shift (IED) to assess attentional set shifting. All the data was analyzed by SPSS-16. No Significant correlation was found between cognition levels of Allen test and SWM subtest (rS= -0/046; P=0/811), SSP (rS=0/009; P= -0/024) and IED (rS= -0/074; P=0/699). The findings of this study suggest that although patients with schizophrenia might have problems in cognitive component, they may show less problem in performing goal directed activities. In addition, the approaches of evaluation based on which the tests have been planned should be considered for investigating the correlation between two tests. It seems that the results of a top-down approach may be different from those of a bottom-up approach.

Reviewing the literature reveals a possible correlation between the obesity and the potential foot, spine and stability problems. Investigating the important parameters affecting the balance of obese people and prevention from falling are of high importance to reduce the resulting expenditures. This study aimed to assess the acts and the counter acts between the medial longitudinal arch (MLA) and the thoracic and lumbar curvatures with the static and dynamic stability in obese females. Twenty eight obese females (age= 25±8 years old, BMI=37±4) and twenty nine non-obese females (age= 23±4 years old, BMI=23±3) were recruited in this case-control study with the cross-sectional technique. The MLA, spinal curve angles and the static or dynamic balance index of the subjects were measured using the navicular drop, flexible ruler and Biodex balance system tools, respectively. The static balance test was carried out using a modified Clinical Test of Sensory Interaction and Balance (CTSIB) test in both the open and closed eyes while the subjects stood on their dominant legs. The order of the dynamic and static tests was selected randomly. The findings of this study showed that in closed eye condition, most changes happened between the global Stability Index (SI) and BMI; while in open eye condition, most changes occurred between the lateral-medial stability index and BMI (r=0.5). Also during an open eye condition, a moderate correlation was found between the navicular drop and lateral-medial stability index (r=0.05). In closed eyes condition, no significant changes were found between the SI and lumbar lordosis (r=0.0004); while a weak correlation was found between the thoracic curve angle and lateral-medial stability index (r=0.04). The dynamic stability is not only correlated to their BMI, but is highly dependent on their foot curvature types and slightly on their thoracic curve angle. Abdominal obesity always played a significant role in antero-posterior stability index. Lumbar curvature showed a minor effect on static index value.

Visual system has a major role in balance control and provides information about the position of body and head in relation to surrounding objects and in the space. One of the health problems, especially in developing countries, is the high incidence of low vision in different age groups (3.1%). The visual deficit in these patients may affect their balance during daily activities which usually involve concomitant tasks such as walking and speaking. Therefore, the effect of concurrent cognitive activity on the postural control of patients with low vision was investigated. twenty low vision volunteers (age 32±5, weight 71±17 kg, height 167±14 cm) and twenty normal subjects (age 33±4, weight: 72±14 kg, height: 170±9 cm) were recruited in this study. The dynamic stability score was evaluated by Stabilometer (Biodex, England) in three different standing positions (eyes open, eyes closed and eyes open with a cognitive task). Lower stability score represents better stability. The stability score in open eyes condition with or without dual task in normal group was lower than low vision group (P=0.04). However, in closed eyes condition, it was lower in low vision group compared to normal group (P=0.03). Dual task resulted in increase in the stability score in both groups; however, the changes were only significant in low visions (P=0.04). The results represent the higher reliance of normal subjects to visual inputs for balance control. The decreased balance control in low vision groups during dual task suggests the higher usage of their limited central integration capacity in balance control. This may predispose this group of patients to falling accidents during daily activities which may involve several concomitant tasks.

Autism is a developmental disorder that is characterized by delays in communication skills, social interaction, participation, accountability and behavioral symptoms such as repetitive and stereotyped behavior. The most common purposes of occupational therapy in these children is improving verbal and non verbal communication and social skills which lead to increase their participation and they will be more independent in their daily life. One of the most effective interactions in autism is music therapy. The objective of the present study is to investigate the effectiveness of musical activities on participation and preference of autism children. This investigation was a randomized controlled trial. 20 autistic boys with no other differential diagnosis, the age of 6-12 and IQ of 50-70 were selected from autism schools in Tehran and randomly assigned in two groups of intervention and control. Then they were participated in musical activities for 24 sessions. Participation of these children was evaluated with children’s assessment of participation and enjoyment and preference for activities of children. The data was analyzed with the independent T-TEST using SPSS 17. The findings show that the mean score of participation and preference at formal and informal activities of autistic children, before and after musical activities were not significant except for preference of informal activities. Participation of autistic children at formal and informal activities before and after musical activities sessions was not significant except for preference of informal activities.

Cervical multifidus is considered as one of the most important neck stabilizers. Weakness and muscular atrophy of this muscle were seen in patients with chronic neck pain. Ultrasonographic imaging is a non-invasive and feasible technique that commonly used to record such changes and measure muscle dimensions. Therefore, the aim of this study was to evaluate the reliability of ultrasonographic measurement of cervical multifidus muscle’s dimensions during isometric contraction of neck muscles. Ten subjects (5 patients with chronic neck pain and 5 healthy subjects) were recruited in this study. Cervical multifidus muscle’s dimensions were measured at the level of forth cervical vertebrae. Ultrasonographic measurement of cervical multifidus muscle at rest, 50% and 100% of maximal voluntary contraction (MVC) were performed by one examiner within 1 week interval. The dimensions of cervical multifidus muscle including cross-sectional area (CSA), anterior posterior dimension (APD), and lateral dimension (LD) were measured. Intraclass correlation coefficients (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were computed for data analysis. The between days reliability of maximum strength of neck muscles and multifidus muscle dimensions at rest, 50% and 100% of MVC of neck muscles were good to excellent (ICC=0.75-0.99). The results of this study showed that ultrasonographic measuring of cervical multifidus muscle’s dimensions during isometric contraction of neck muscles at the level of C4 in females with chronic neck pain and healthy subjects is a reliable and repeatable method.

The dramatically increased incidence of hallux valgus (HV) deformity is more related to the cultural rather than genetic parameters. Due to the lack of reliable information about the rate of this disorder in Iraninan societies, the researchers of the current study aimed to find out the incidence of this disorder in Iranian university students as a sample of Iranian youngsters.

This descriptive study was carried out using a self-constructed and the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaires among 290 university students with the mean age of 21±2 years old. The HV angles (HVA) was described as normal for up to 20º, mild for angles between 21º and 25º, moderate for angles between 26º and 40º, and severe for angles higher than 40 º. Then, the HVA of the subjects of this study was compared with the data from other societies.

The results of this study showed a 34.1% involvement of the participants (30% females and 41% males). 58% of the subjects showed a bilateral hallux valgus involvement. No significant differences were found between the males and females in terms of the severity of the deformity and the right or left side involvement (P>0.05). 71% of the involved subjects showed a mild degree and 29% showed a moderate degree of deformity. No severe deformity (above 40º) was found in this study. In terms of the associated deformities, in subjects with mild deformity, 25% showed flat foot and 69% showed bunion disorder; While these were 21% and 82% in subjects with moderate deformity, respectively. In terms of inheritance correlation, while this deformity was shown in only 7% of normal subjects’ first degree relatives (father, mother, brothers or sisters), it increased to 21.1% in mild degree and 46.4% in moderate degree groups.

This study revealed a very high incidence of HV deformity in Iranian university students as a sample of Iranian youngsters, which is much higher than those in some Western societies. This deformity showed to be highly inherent due to the increasing level of this deformity among first degree relatives. Routine use of high heel or round tip shoes showed no influence on the rate of HV deformity.

The purpose of the present research was to investigate the effect of selected stretch- strength exercises on forward shoulder deformity in primary school girls. Twenty girl students with forward shoulder posture were randomly selected from four primary schools of Noorabad city, using a posture grid. They signed the informed consent prior to participation in the study. After measuring forward shoulder posture by the double square, the participants were divided into control and experimental groups according to the shoulders distance from the wall. The subjects in the experimental group, then, were asked to perform a 6-week stretch-strengthening treatment protocol. The dependent and independent sample t-tests were used to find the differences at significance level of 0.05. The results showed a significant 12% decrease in forward shoulder posture (p= 0.008) and a significant 9% decrease in the inter-scapular distance (p= 0.001) in the experimental group post-treatment. However, there was no significant difference in the control group for either of the variables (p >0.05). The results showed that the selected corrective exercise protocol led to improve forward shoulder posture in primary school girls.