Iranian Rehabilitation Journal
Volume:11 Issue: 18, Oct 2013

Iranian Rehabilitation Journal has the chance to issue a special issue on Occupational therapy and rehabilitation which has the perspective of health promotion. In this issue we will have 14 articles from the history to effectiveness of different skills/interventions of occupation therapy. We cover articles from child hood to adults to aged people. Evaluating the assessment tools such as the Parenting Self-Efficacy tool, measuring outcome of occupational therapy interventions, Autism, cerebral palsy, and aged people are the main concern of articles. Articles also discussed Fatigue, Right hand preference, Balance, Environmental barriers, Audiovisual timulation, and Craniosacral therapy issues.

Although Occupational Therapy in Iran is relatively a new profession, it has been well progressed, providing various services for people with all kinds of disabilities. As such, in the last decades, OT has been recognized as the major demand in all governmental, private and NGO sectors. Due to this demand, occupational therapy training programs have been increased from three into ten, expecting to have more Occupational Therapy graduates in the near future. Furthermore, Iranian occupational therapists established master and PhD programs to further strengthen their services as well as undergraduate trainings. Considering the number of trained occupational therapists in both undergraduate and graduate levels, Iran is located on the top rank in the Middle East countries with more than 2000 therapists. However, we still need to work hard in order to keep our progress powerful, improve our services, respond to social demands and strengthen the professional body in the future. Following issues can surely help to achieve these professional goals.

Mothers’ perception of their ability to parenting (maternal parenting self-efficacy) is a critical issue that influences their interactions with their preterm neonates. For better support of these mothers, a robust tool is needed which can measure mothers’ perception of their ability to understand and care for their preterm neonates as well as being sensitive to the various levels and tasks in parenting. This study aimed to translate and test the face validity of persian version of Perceived Maternal Parenting Self-Efficacy (PMP S-E) tool with Iranian mothers of hospitalized preterm neonates. The translation and validation was done in some steps. Forward translated by three independent translators and backward translated by two other translators who were blind to source version. Then, the face validity was evaluated by 10 mothers and the expert panel. At last, the tool adapted and approved by an expert committee. The Persian version of PMP S-E tool demonstrated good face validity regarding its items’ relevancy and clearance. The PMP S-E was successfully translated and adapted into Persian with good face validity. However, further study is needed for evaluating its reliability in Iran and for Iranian mothers of hospitalized preterm neonates.

Monitoring development in infancy results in early detection of developmental delay, and early intervention can prevent sever complications of developmental disorders. The purpose of this study was to determine quality of developmental screening of 3- 12 months infants referred to Tehran Health Centers, through comparing with screening by Bayley Infant Neurodevelopmental Screener II (BINS II). This was a cross- sectional study. 155 infants of 3-12 months old, recourse to Tehran Health Centers, screened developmentally with BINS II and its results was compared with results of routine clinical examination of Tehran Health Centers. Kappa agreement between results of BINS II and results of routine developmental screening of Tehran Health Centers’ clinical examination of 3- 12- month old infants was poor (0.18). Routine clinical examination in Tehran Health Centers, in compare with applying standard screening tools, cannot screen all infants at risk of developmental delay and ignores many of them which should be considered either for follow up or for receiving early intervention services.

This study aimed to understand the learning strategies of parents of preterm infants, hospitalized in NICU. This study was performed by qualitative research approach. Twelve participants including nine parents whose infants were admitted in NICU, two nurses and one physician, all selected by purposive sampling method were interviewed by a female expert occupational therapist. Data were gathered by semi-structured interviews. Data were analyzed by inductive content analysis approach. Three subcategories emerged from data analysis expressed learning strategies of parents of preterm infants hospitalized in NICU. These subcategories were: Asking question, Getting help, Learning caring skills. Preterm infant's parents stated that they do not have enough ability and knowledge for managing their feelings and needs. So, they seek for resources of help and apply some special strategies for playing parental roles correctly.

Measuring outcomes of intervention is one of the most important components of occupational therapy process. The Disabilities of Arm, Shoulder and hand (DASH) questionnaire is a valid and reliable instrument to measure outcomes of the occupational therapy services in the area of hand therapy. The study aims to measure outcomes from interventions of hand therapy in patients with the combined flexor tendon and peripheral nerve injuries in hand. In this cross sectional study, the Persian version of DASH questionnaire was filled by 20 patients with the combined flexor tendon and peripheral nerve injuries (17 males and 3 females with the age range of 18-58 years) referred to Asma Rehabilitation Center and it was reported that there was a relationship between variables of age, gender, literacy and accurate diagnosis (injured flexor tendon and peripheral nerve) with score calculated in DASH questionnaire. According to the variables of age, sex, education level and accurate diagnosis, patients showed that according to the DASH in calculating the mean score of questionnaire, the rate of individual's disability is reduced by increasing age, women show more disability in work performances, the individual's music and sport performances indicate more disability by increasing the educational level and finally, individuals with the combined finger flexor and ulnar nerve have the higher rate of disabilities. patients with the combined flexor tendon and peripheral nerve injuries experience many disabilities even after surgery and rehabilitation.

Complementary and alternative medicine methods (CAM) are now used for a wide range of disorders. Craniosacral therapy (CST) is one of CAM methods in which manual maneuvers with light forces are used for different aspects of health. In the present research, the effects of CST were studied for reducing symptoms of attention deficit and hyperactivity disorder (ADHD). Twenty-four children with ADHD were recruited as an available sample from Roshd Occupational Therapy Center and divided randomly into control and experimental groups. Before and after intervention, the Conner’s Parents Rating Scale as well as child's symptom inventory-4th was filled out by parents. Both groups participated in occupational therapy programs as a routine intervention, while the experimental group received an additional CST for 15 sessions, twice a week. The collected data were analyzed as the covariance method by SPSS16. CST showed significant effects on increasing attention, reducing hyperactivity, oppositional defiant, conduct disorder, anxiety and embarrassment, social problems and psychosomatic problems of the participants. CST as a type of biomechanical correction can facilitate improvement in children with symptoms of ADHD.

Autism is one subsets of pervasive developmental disorders that are characterized by abnormal behaviors and verbal communication. In recent years, the reason for this communication disorder has been developed for determining executive function. The current study investigated the feasibility of audiovisual stimulation intervention focused on enhancing executive function in children with high-functioning autism. 41 children diagnosed with high functioning autism randomly selected and assigned in to experimental (20) and control (21) group. Initially both of groups were administered by the "Behavior Rating Inventory of Executive Functioning Test".then intervention group received 18 sessions of audiovisual stimulation across 6 weeks and two groups were administered by test again. Multivariate analysis was used to compare significant advances in variables progress. Considering significance level, outcome indicates that audio visual stimulation used in the present study increased executive function (inhibition, shifting and planning ability) based on Behavior Rating Inventory of Executive Functioning measures (F= 5/55, P<0/05, F= 24/587, P< 0/05, F= 15/28, p<0/05). These findings suggest that the audiovisual stimulation platform is a promising tool for improving executive function subsets. Similarly, the use of such technology that is user friendly appears to prevent onset of early behavioral problems and executive dysfunction in children with autism.

Cerebral palsy is the most common type of permanent movement and posture disorder in children leading to activity limitations. Children's participation is influenced by their functional ability, skills, interests, and environmental factors. The objective of the study was to describe parent perception of environmental barriers to participation of children with cerebral palsy. Secondary data analysis of the study of psychometric properties of the Persian version of the Craig Hospital Inventory of Environmental Factors for use with children with cerebral palsy. The questionnaire was administered to a sample of convenience of 75 parents of children with cerebral palsy aged between 5 and 12 years. Barriers to participation most commonly reported by parents were in the services and assistance subscale and the policies subscale of the measure. Also, parents reported the greatest barriers encountered by their children were availability of transportation and availability of education and training. Findings from this study indicate the presence of multiple environmental barriers to participation of children with cerebral palsy. Enhancing participation of children with cerebral palsy by altering barriers and increasing facilitators requires further research concerning these factors. This study suggested that people with lower function in gross motor, manual ability, as well as cognition require further support to participate in social activities

This study aimed to compare the combination of CIMT and BIM training with CIMT in Fine Motor Skills of Children with Hemiplegic cerebral palsy. 24 children with hemiplegic cerebral palsy aged between 60 and 120 months participated in this RCT study. They were randomly assigned into CIMT and BIM training(n=12, four males, eight females; mean age±standard deviation =93.58±14.24) and CIMT alone (n=12, six males, six females; mean age±standard eviation = 94.00±18.97) groups. The children in the CIMT and BIM group were received a combination of CIMT and bi-manual training in addition to current occupational therapy. Each session was started with restraint on non-involved upper extremity and practicing with the involved upper extremity for three hours. This was followed with bi-manual training for another three hours. The children in CIMT group received CIMT. Each session was started with restraint on non-involved upper extremity and practicing with the involved upper extremity for six hours. This process lasted for 10 out of 12 consecutive days for both groups. Fine motor skills, upper limb function and muscle tone were assessed using Bruininks-Oseretsky Test of Motor Proficiency, Jebsen-Taylor Test of Hand Function and Modified Ashworth Scale respectively. Fine motor skills and upper limb function of these children in CIMT and HABIT and CIMT alone groups had significantly improved (P<0.05). However, these changes were not significantly different between the two groups before and after intervention (P>0.05). Results showed that these two treatment approaches improved fine motor skills in the hemiplegic children with cerebral palsy. None of the interventions are better than the other one. Therefore, it is suggested to use a combination of CIMT and BIM training instead of CIMT alone in order to make the tasks more attractive and easier for the children.

Among the most important problems of autistic children are the behavioral disorders due to sensory processing deficiency, which are typically reflected in behaviors such as impulsivity, attention and concentration disorders, undesirable emotional reactions, sensory seeking in the form of stereotype behaviors, self-injury and self-stimulating. The present study aimed at exploring the effects of a combined vestibular and tactile stimulation on behavioral abnormalities resulting from sensory processing deficiency in autistic children of an age of 3-13 years old. The study was an experimental research using a pretest-posttest design with a control group. Twelve autistic children of an average age of 8.4 year whose sensory disorders had been verified through the Winnie Dunn’s Sensory Assessment Questionnaire, were randomly selected from two school for behavioral disorders. They were randomly grouped in two groups of 6 subjects, namely the Test Group and the Control Group. Then, participants in the experimental group received vestibular and tactile stimulation for 36 sessions, 3 sessions a week, each session of 45 minutes. The subjectsin the control group were under the school’s regular schedule. After intervention, they were assessed again and the collected data obtained were analyzed through Multivariable Covariance Analysis using the SPSS software, version 20. According to the findings obtained, the vestibular and tactile stimulation significantly decreases the behavioral abnormalities of autistic children afflicted with sensory processing deficiency (p<0.01). Using the vestibular and tactile stimulation can be taken as an effective method in the treatment of autistic children.

The objective of this study was to examine the psychometric properties of the ‘physical well-being, health and motor development inventory’ used to assess school readiness in ordinary and mentally retarded pre-school children. A descriptive study examining validity was conducted using random sampling. Two hundred students (160 ordinary and 40 mentally retarded children) were randomly selected from the city of Tehran. In investigating the validity of the inventory, evidence related to content validity and construct validity were used. The evidence related to content validity showed that the questions related to the domain elements of gross motor skills, fine motor skills, nutrition and safety exercises all had high correlation coefficients with the overall elements. Some of the questions related to the domain elements of sensorimotor skills, physical fitness and activities of daily living did not have acceptable correlation coefficients. However, after removing the outliers the overall validity coefficient and subsequently that of the overall test increased. The t computed for construct-related evidence was significant too. Eventually, the validity coefficients were estimated at 0.859, 0.832, 0.671, 0.585, 0.725, 0.719 and 0.719 for gross motor skills, fine motor skills, sensorimotor skills, physical fitness, activities of daily living, nutrition and safety exercises, respectively. The results indicate that the overall inventory and its elements have good validity for assessing preschool children’s readiness in the domains of physical well-being, health and motor development.

Researchers have focused their attention on balance in the elderly because there is a significant correlation between balance and fall. Therefore, it is very important to identify the factors that can affect elderly balance. The aim of this study was to investigate relation between sustained attention and balance in elderly. This cross sectional study was conducted in 2013 in Semnan city. Convenience sampling was used to enroll 50 old people according to inclusion and exclusion criteria. Sustained attention was measured by continued performance test and static and dynamic balance was evaluated by biodex system. Data was analyzed using SPSS 16 software. Having a normal distribution via Kolmogorov smirnov test, the relationship between each characteristic was assessed through using Pearson correlation coefficient and independent t test. The participants’ mean (±SD) age was 65.48±4.36 years, static balance with eyes open 3.64±2.69, eyes closed 4.10±2.47, dynamic balance with eyes open 4.55±2, eyes closed 6.65±1.98 and omission error was 2.56±4.11. Among the four balance indexes and Sustained attention, Pearson correlation was only significant in dynamic balance with eyes closed and sustained attention. Considering the significant correlation between sustained attention and dynamic balance with eyes closed, it can be said that this correlation will become significant by increasing the difficulty level of the balance task.

Cerebral hemispheres functioning have been found to be abnormal in children with ASD. The role of lateralization in implicit and explicit motor learning has received little attention in ASD researches. The main goal of this study is investigating the differences between two hands implicit and explicit motor learning in children with ASD and typical matched group. In the present random clinical trial study, 30 boys with ASD aged 7-11 were compared with 32 typical matched boys. Typical group and the ASDs, which were screened with ASSQ, were selected from elementary schools in Najafabad (Isfahan, Iran). Participants performed a serial reaction time task (10 blocks) with each hand in implicit and explicit group with random allocation. Learning comparison between two groups showed significant difference which means explicit learning deficit in the ASDs with right (p=0.009) and left hand (p=0.004). Results also indicated no significant difference in implicit learning between ASDs and typical matched group in right (p=0.385) and left hand (p=0.18). Hands differences also showed speeded right hand in implicit learning in children with ASD (p=0.028) while no differences was seen in explicit learning and typical children. Explicit learning of right and left hand was impaired in children with ASD while implicit learning of both hands maintained intact and a right hand preference in implicit motor learning was observed in children with ASD due to left striatal system abnormality.

Occupational therapy in Iran is relatively young - established in 1971 - with a fluctuated development due to the Iranian revolution in 1979, and eight years war from 1981 to 1989. Today, there are ten Bachelor programs across the country approved by World Federation of Occupational Therapists (WFOT). Furthermore, occupational therapists have opportunities for further postgraduate training in both Master and PhD levels. Fast growing of occupational therapy due to social demands necessitated therapists to develop a professional organization. Therefore, Iranian Occupational Therapy Association (IROTA) was formally established in 1994. This paper aims to present an overview about occupational therapy in Iran. Iranian context including population, health status and culture is also reviewed. This follows with explanation about occupational therapy background, education and development. Finally, conception, development, purposes, and achievements of Iranian Occupational Therapy Association; present situation and future perspectives of occupational therapy are discussed.

This paper reviews the current literature examining the pervasive symptom of fatigue experienced in three of the most common degenerative neurological conditions: multiple sclerosis (MS), Parkinson’s disease (PD) and post-polio syndrome (PPS). The existing literature can be considered under four headings; definition and prevalence, type, cause, impact of fatigue. Fatigue is a common symptom in degenerative conditions and has physical, cognitive and psychosocial manifestations. Although the causes of fatigue seem to differ between conditions, its pattern, with few exceptions, is very similar regardless of diagnosis. The literature consistently shows that the impact of fatigue on the person’s physical and mental performance considerably increasing the risk of unemployment and reduced quality of life. Fatigue is one of the most disabling symptoms in degenerative neurological conditions. With few pharmacological solutions, non-pharmacological solutions for fatigue management should be considered when determining rehabilitation interventions for this group of people.