مجله پژوهش در علوم توانبخشی
سال نهم شماره 6 (بهمن و اسفند 1392)

There are various types of clefts of the primary and secondary palate and various degrees of severity. Despite the relatively long history of palatal surgery, little consensus has been reached regarding the best surgical techniques, and even less regarding optimal timing. There are still no standard protocols to address the issues of ideal timing for cleft palate repair to attain optimal speech. This study was conducted to examine the frequency of preschoolers with cleft palate who demonstrate hypernasality. The impact of the time of primary palatal surgery and cleft type on moderate to severe hypernasality was also examined. A group of 46 preschoolers aged 3-6 years with repaired cleft palate was assessed using Universal Parameters for Reporting Speech Outcomes in Individuals with Cleft Palate – Farsi Edition. Cleft types were bilateral cleft lip and palate (BCLP; n=5, 10/9%), unilateral cleft lip and palate (UCLP; n=20, 43/6%), complete cleft palate (CP; n=10, 21/7%), cleft of the soft palate only (SPO; n=6, 13%) and submucous cleft palate (SubMC; n=5, 10/9%). Judgments of hypernasality were made by a certified speech and language pathologist and were made using a 4-point rating scale. 32 Had a primary palatal surgery prior to 12 months of age, 8 had surgery at 12-18 months of age, and 6 had surgery after 18 months. 78/3 percent of the children demonstrate moderate to severe hypernasality. There were no significant differences between 5 groups for hypernasality based on cleft type. The analysis, also, revealed no significant relationship between age of primary palatal surgery and number of children with significant hypernasality. Because of the high amount of hypernasality in all children, the need for research documenting the efficacy of surgeries employed with these children is essential. In this study the age range was wide, and there was the small number of children in each cleft palate group. The Additional research is needed to determine if there are variables that might have masked the influence of timing of primary surgery and cleft type(should be deleted).

Headache is one of the most complaints of patients and 47% of headaches are tension type. This type of headache is associated with skeletal muscles condition. Tightness of muscles in head and neck regions can lead to tension type headache. The purpose of this study was to compare the cervical active range of motion and muscular endurance in flexion and extension directions, in patients suffer from tension type headache with healthy subjects. fifty two healthy girls and 52 girls with tension type headache between 20 to 25 years old participated in this study. The active flexion & extension range of motion and the endurance of flexor & extensor muscles were measured. There were no significant differences between patients and healthy subjects in active range of motion or neck muscles endurance (P>0.05). Patients between 20-25 Y/O with tension type headache and match healthy ones are similar in cervical active range of motion and muscle endurance. Likely, changes in muscles and vertebral column in these patients may occur gradually over the time.

Aging has been associated with increasing foot pronation and changes in foot mobility which may influence standing balance. Orthotic interventions change foot posture and load distribution under the foot and therefore may have important effects on balance in older people. To investigate whether a pronated foot posture is associated with poorer standing balance in older people and whether medial heel and sole wedge orthoses affect their standing balance. Nine healthy older people with a pronated foot posture (age 67.1± 5.7 years) and Fourteen healthy elderly with normal foot posture (age 67.1± 6.4 years) were recruited.The Foot Posture Index was used to determine the pronated (FPI 7.5 ± 0.7) and normal (FPI 3.8 ± 1.5) foot posture. Static balance in double limb stance was assessed using Kistler force plate measures during four random shod conditions:1) 5° medial heel and sole wedge; 2) 8° medial heel and sole wedge; 3) 5°flat EVA base insole; 5) 8°flat EVA base insole. Each of the four cases was completed with eyes open (three trials) and eyes closed (three trials). The center-of-pressure (COP) mean excursion, total path length of COP, mean velocity of COP and area of 95% confidence ellipse were derived as measures of standing balance. Participants with a pronated foot type demonstrated higher total and mean velocity excursion data in AP and ML directions, and larger ellipse, during normal standing, but this did not reach statistical significance (P>0.05). There were no statistically significant effects from the four orthoses designs in the pronated nor the normal foot types (P<0.05). Main effects for eye conditions were significant for center-of-pressure excursion and mean velocity in medial-lateral directions (P <0.001) also for total excursion and mean distance in anterior-posterior direction. Also there were no significant differences in interaction of all conditions (foot posture × eye condition × orthoses) (P<0.05). A trend towards less stable balance was observed in pronated foot type but this was not significant. Use of orthoses had no effect on balance parameters including negating the effects of eyes closed. Orthoses showed no negative effects on standing balance and therefore do not pose a threat to balance (e.g. if they are used for another purpose).

Self-esteem play essential roles in all of life aspects of peoples, particularly adolescents with intellectual disablity. Therefore, emphasized on instruction of programs that led to improvement of self-esteem. This study was aimed to investigate of the effctiveness of social skills training on self-esteem of adolescents with intellectual disability in Mazandaran province. In this semi-experimental study with pretest and posttest design with control group, were selected fourty girls adolescents with intellectual disablity of 14-18 years old through multi–stage cluster sampling method. Subjects allocated randomly into two groups (experimental and control) and each group consist of 20 individuals. Experimental group attended in social skills training in the 8 sessions lasting for 90 minutes, but control group did not. All the participants were assessed through Cooper Smith’s self-esteem questionare. The obtained data were statistically analyzed by MANCOVA using SPSS software (version 16, SPSS Inc., Chicago, IL). The results of MANCOVA for subscales of self-esteem showed that experimental and control group had significant difference, At least in one of the subscales of the self-esteem of self, social, familly or academic (P= 0/0027). The final results of MANCOVA showed that social skills training had significant and positive effect on the self-esteem of self (P= 0/0033), self-esteem of social (P= 0/0041), self-esteem of familly (P= 0/0039) and self-esteem of academic (P= 0/0026). Social skills training program led to improvement of the self-esteem and their subscules on adolescents with intellectual disability. So planning for Social skills training is of particular importance for adolescents with intellectual disability.

Stability is the ability of subjects to keep their upright posture, which is enhanced by combination strategies of various musculoskeletal systems. Various methods have been used to evaluate the abilities of subjects during standing, including linear and nonlinear methods. It is not clear that which one of these two methods has more ability to represent stability of subjects with various neurological and musculoskeletal disorders. Therefore, the aim of this study was to investigate the stability of the subjects with various neurological and musculoskeletal disorders using linear and nonlinear methods. Four groups of subjects including, normal subjects and subjects with three different disorders of flatfoot, Parkinson`s Disease (PD), and Perthes were recruited in this study. A Kistler force plate was used to evaluate the stability of the subjects. The difference between the linear (Center of Pressure Excursion, Velocity and Path Length) and nonlinear (Approximate Entropy = ApEn) parameters was evaluated by two sample t test. The mean value of COP velocity of flatfoot and perthes subjects were 1621/5±405/6 and 878/4±195 mm/min in the medio lateral direction, respectively (P < 0/05). The mean value of ApEn in the anteroposterior direction was 0/94±0/16 in flatfoot subjects and 0/99±0/21 in those with perthes. However, it was 0/45±0/06 in the subjects with PD. The difference between normal subjects and all other groups of participants was significant (P < 0/05). It seems that nonlinear method is more sensitive to represent the difference between stability of subjects with different neurological and musculoskeletal disorders. However when linear approach is selected for data analysis it is suggested to use a group of parameters instead of only one parameter. Depending on the kind of diseases, increasing and decreasing the value of Approximate Entropy represent the instability situations.

to study the differences between effect of errorless and errorful learning on performance kinematic parameters. 24 female students involved in three errorless, errorful and constant groups. The throwing instruction was not given to the groups. Errorful group practiced respectively at 2.5, 2.75, 3, 3.25, 3.5 meters, errorless group practiced in contrast with errorful group and constant group only from 3 meter began to practice. After three days of practice, acquisition, retention and transfer tests were done. Motion analysis machine was used to collecting the kinematic data in all periods. in the retention test, the errorless group performance was significantly better than other two groups and in transfer test, the errorful group performance decreased. In performing of secondary cognitive task was not found significant differences between errorless and constant groups. In kinematic data analysis, the errorless group reached to the motor task skilled model but the errorful group was far from performance of motor task skilled model. The errorless learning is an efficient method in throwing skill learning of this study.

Fear-avoidance beliefs (FAB) are one of the important psychologic factors related to disability and work abcence. The aim of this study is to investigate the association of FAB with disability and postural stability in patients with non specific chronic low back pain (NCLBP)and impact of short specific training on FAB in patients with NCLBP. In this semi experimental study, 51 subjects with NCLBP were evaluated. Pain intensity, FAB and disability were measured using questionnaires and Postural stability was measured using force plate. Abdominal and back muscle endurance was measured respectively by sit up and surensen tests. The association of FAB and pain intensity with parameters of postural stability was analyzed using multivariate general linear modle with adjusting for age, body mass index, physical activity, back and abdominal muscle endurance and sex. pain intensity and FAB (physical activity) were related to postural stability in unilateral standing (p<0.01). FAB (work) was related to disability and backmuscle endurance (p<0.01). In quiet standing FAB was not related to any parameter of postural stability. The exictance of association of FAB (physical activity) with center of pressure excursion and velocity in unilateral standing may help in applying a simple sterategy for evaluating patients with NSCLBP focusing on their psychosocial condition such as fear avoidance believes.

Studies have shown that stress fracture is one of the most common injuries among recreational runners. The purpose of this study was to investigate the effect of two different shoe types on variables related to tibia stress fracture injury during running. Twenty fivehealthy young men (21±2.27 years old) participated in this quasi-experimental study. Subjects all ran on the force plate in barefoot, with unstable and control shoe conditions. Unstable shoes increased vertical loading rate significantly compared to control shoe by 80% (p=0.001). In addition, peak passive force significantly increased in unstable shoe compared to control shoe (p<0.05)and barefoot condition (p=0.039,). However, control shoe decreased peak passive force and loading rate compared to barefoot condition (p=0.002, p=0.001, respectively). Using unstable shoe compared to control shoe could increase the variables related to stress fracture injuriy during stance phase of running.

Despite many research on foot deformities (flat foot & pes cavus), still There isn’t any public agreement about the range of them. So the aim of this present study was " Determination of foot arch index in deferent ages groups for men and women in Esfahan city. Pupulation of this study were all of the people from Esfahan city, 250 female and 250 male were randomly selected between healthy subjects, in 5 geographic regions (north, south, east, west, center) and 5 age groups from Esfahan city. The foot print was recorded by arch index of Staheli and (AI) was calculated. Data analysis was done by determining mean and standard deviation for desired ages and sexes and confidence interval ٪95. All dada were analyzed by SPSS version 18. 0 (P ≤ 0. 05). AI respectively is (& (in boys and girls 9 to 14 y. AI respectively is (& (in boys and girls 15 to 24 y. AI respectively is (& (in men and women 25 to 44 y. AI respectively is(& (in men and women 45 to 64 y. AI respectively is (& (in men and women 65 y & above. According to the results of this study foot arch index in men and women were determined and also, in age groups of 14 in boys and 65 & above in women, increasing was seen in mean of AI. Without attention to the age, the mean AI of the men is a little higher than the women (But were not significant statistically (p< 0. 05).

One of the most common behavioral problems in children with intellectual disability is physical aggression. Physical aggression is described as behaviors such as hitting, kicking, throwing object and threatening with the intent to harm others. Physical aggression is related to the different factors such as language skills, which has been examined among intellectually disabled children in the present study. In a descriptive cross-sectional survey, 102 intellectually disabled children of 6 and 8 years old (51 girls and 51 boys) who satisfied the inclusion criteria were recruited from educational centers for children with intellectual disability in Shiraz by stratified sampling method (age and gender). The Test of Language Development-Primary: 3rd Edition (TOLD-3) and Overt and Relational Aggression Questionnaire were used to assess children. Data was analyzed by Pearson’s correlation coefficient and independent t-test. Significance level was set at less than 0.05. There was a negative and significant correlation between physical aggression and expressive language (p=0.008) and receptive language (p=0.019). Intellectually disabled children with the low level of expressive and receptive language skills are likely to express physical aggression. Furthermore, more boys than girls expressed physical aggression (p=0.014). There was no a significant difference among boys and girls in expressive and receptive language skills. There was a negative and significant correlation between physical aggression and expressive language and receptive language. In addition, poor expressive language skills among intellectual disabled girls can be considered as a facilitative factor in expressing their physical aggressive behaviors. However, there was no any relation between language skills and physical aggression among boys with intellectual disability.

The aim of this study was to investigate facilitating and deterrent factors in learning practical skills from the viewpoints of the rehabilitation students of Isfahan University of medical sciences, third year onwards. In this descriptive cross-sectional study, 100 senior students (third year onwards) of Orthotics and Prosthetics; Physiotherapy; Speech therapy and Occupational therapy selected through census sampling method. The data collection tool was a questionnaire consisted 62 questions related to facilitating and deterrent factors in learning practical skills which contained 8 general areas. Questions were scored based on a five point likert scale. The data was analyzed by SPSS 18 software. 100 senior students were recruited who had a mean age of 22.2 ± 0.8 years. In terms of facilitating factors, students rated the areas of “Individual positive features of clinical teachers (85%)” and “Clinical teacher-student effective relationship (85%)” more effective in learning practical skills comparing to other facilitating areas. In terms of deterrent factors, students rated the areas of “Inadequate teaching resources of clinical departments (76%)” more deterrent in learning practical skills comparing to other deterrent areas. The most important facilitating factor in learning practical skills from the viewpoints of the rehabilitation students of Isfahan University of medical sciences was individual positive features of clinical teachers. Therefore planning to use experienced teachers for providing clinical training and also to develop structured continuing education programs for new clinical teachers is advised. The most important deterrent factor from the viewpoints of the rehabilitation students was inadequate teaching resources of clinical department and therefore planning to provide necessary equipments and other required teaching resources is crucial.

Hippotherapy is a physiotherapeutic method that has gained substantial attention in recent years. The aim of this study was to perform a systematic review on the topic in order to descriptively summarizing the current state of knowledge in the field. In this Systematic review study, PubMed, Medline, CINAHL, Web of Knowledge, Science Direct and SID databases were searched from 1990 to 2012 using keywords "hippotherapy", "equine- assisted therapy ", "horseback riding", "horse riding", and "therapeutic riding" and their Persian equivalents. 35 articles were finally included in the study and all of them reviewed by two of the authors. The results were extracted, summarized and reported in table format. The mean of sample size of studies were 22.5. Mean length of the intervention period among the interventional studies was 13.16 week. Children comprised the most commonly recruited age group. The most commonly evaluated disability was cerebral palsy. In 33 studies (about 94%of all articles), hippotherapy was shown to be an effective intervention. According to results of this study, hippotherapy appears to be an effective rehabilitative modality. It may be applicable for managing various conditions such as cerebral palsy, trunk/head stability, multiple sclerosis and physical disabilities. Nevertheless, studies in this area are limited and further large-scale studies are recommended.

Disorders that occur after stroke or nervous system diseases restrict the motion and speech ability in patients for long time. Developments in the field of brain computer interface (BCI) make it possible to identify and classify electrical and metabolic brain activities and convert them to control commands for computer or specific equipment. General purpose of BCI is to create a lost ability or improve a depleted ability for human. So three major application of BCI system are: create the possibility of limbs motion, speech ability and controlling different equipment for daily tasks. In order to assess the progress in these areas, relevant papers to this subject that have been presented in prestigious journals and conferences have been studied. Concepts and fundamental principles of brain computer interface (BCI) beside the technologies that used in this field and recent advances in BCI system performance improvement is presented in this paper. And finally potential of using BCI system is presented and some works that is important for enhance BCI usage in rehabilitation has been discussed. In the last 20 years, many efforts have done for improving efficiency and data transformation rate in BCI systems based on EEG. In order to achieve to this goal a high-speed data exchange system between brain and computer is needed. So far, various approaches for building a communication without delay between brain commands and generated control commands are introduced.