Modern Rehabilitation

The study of oral feeding disorders incidence in infants in NICU of Tehran University of medical sciences hospitals

Mohammad Rahim Shahbodaghi

Back ground and Aim: Feeding is the most essential behavior in infants for vitality, learning and interaction. Because of feeding importance in developmental process and its primary role in infant’s vitality, the study of dysphagia has an important role. Diagnosis, assessment and treatment of this disorder are primary professional action for speech therapists. Therefore, basic information about prevalence of such disorders can be effective in treatment planning. In this study, the number of infants with oral feeding disorders is determined in NICU .

Materials and Methods: In this descriptive-sectional study, all infants that were in NICU at Tehran University of medical sciences hospitals were evaluated in three first months of 1390 year through information from medical history, interview and observation. The data were analyzed with SPSS 16.

Results: Data analyzing of this study showed that 45 infants (27.10%) from 166 cases in NICU had oral feeding disorders. The incidence in male is more than female (91.11% versus 8.88%). Twenty two of cases feed normally, 18 cases feeding with NGT and 5 cases with OGT. The rate of difficulty in oral phase and esophageal phase were 88.88% and 2.22% respectively. No infants have difficulty in Pharyngeal phase.

Conclusion: Feeding disorder assessment by speech therapist provides essential information about feeding intervention and so early diagnosis can prevent later speech problems. Therefore, the role of a speech therapist in NICU is important.

Keywords: Incidence, Oral feeding disorders, Infants, NICU

Retrospective Investigation of the effect of exercises accompanied with a Milwaukee brace onthe cobb angle in patients with kyphoscoliosis

Mojtaba Kamyab

Background and Aim: Idiopathic scoliosis is a common orthopaedic condition affecting 1.5% to 3% of the adolescents. Conservative treatments for idiopathic scoliosis involve bracing, exercise therapy, electrical stimulation and chiropractic treatment. Bracing in association with exercise is a well known method in the treatment of scoliosis. In spite of the disagreement among researchers, no study has assessed the effect of Blount &Moe exercises accompanied with a milwaukee brace on the kyphotic and scoliotic cobb angle at the beginning of weaning phase up to now. Therefore the aim of the present study was to investigate the role of Blount &Moe exercises on improvement of kyphotic and scoliotic cobb angle at the beginning of weaning phase.

Materials and Methods: The patients were evaluated in terms of the quantity and quality of performing the exercises. Mean Cobb angle was compared before bracing and at the beginning of weaning phase.

Results: Kyphotic and scolioitic cobb angle were reduced after using the milwaukee brace(p> 0.05), but no significant difference was found among all groups for the kyphotic and scoliotic cobb angle.

Conclusion: Miwaukee brace reduces kyphotic and scoliotic cobb angle, but the quantity and quality of exercise doing before weaning phase does not affect this parameter.

Key words:Kyphoscoliosis,Milwaukee brace, Exercise, Cobb angle

Biomechanical Evaluation of Passive Resistive Torque Structure of Elbow Joint and its Application in Rehabilitation and Practical equipment

Farhad TabatabaiGhomsheh

Background and Aim: The aim of this study was to investigate the structure of passive resistive moment of elbow joint acting against movement and also to apply it in order to create a similar moment mechanism for rehabilitation and practical equipment to perform joint movements according to sports medicine and rehabilitation scopes and notifications.

Materials and Methods: Eight healthy men were recruited in order to establish the subjects group which had no history of neurological or musculo-skeletal pathology. Five cyclic passive elbow flexions were performed by a Cybex isokinetic dynamometer at 15 and 45 deg/s through 0 to 130 degree of range of motion. The experimental data was exported to the MATLAB software for analysis.

Results: Investigation of the structure of the components of the passive resistive moment showed that the most compatibility with passive resistive moment observed in the combined use of weight and pneumatic resistive moments.

Conclusion: Finally it was concluded that the possibility of reaching optimized movement, reduction of damage to the tissues and joints and also reduction of energy dissipation due to inertia were provided by the use of the function of natural resistive moment of the limbs in order to create a resistive mechanism for rehabilitation and practical equipment

Keywords: Elbow joint, Passive resistive moment, Rehabilitation equipment, Viscoelastic

Translation of Canadian Occupational Performance Measure and testing Persian version validity and reliability among Iranian mothers of children with cerebral palsy

Hamid Dalvand

Background and Aim: Mothers of children with cerebral palsy (CP) experience limitation in occupational performance because of caring of their children. It is proposed that the standard measurements need to be assessed their occupational performance problem. The aim of this study was to translate "Canadian Occupational Performance Measure (COPM) into Persian and to test its content validity and reliability in Iranian mothers of children with cerebral palsy.

Materials and Methods: It was a non experimental methodology study. After permission from innovators, COPM was translated into Persian language in three phases with respect to IQOLA project. Each of the items was validated by a panel of ten experts to review each item on “appropriate” and “not appropriate”. For examining test-retest reliability Iranians version of COPM was responded twice within at least two days or at most one week interval, by 30 Iranian mother of a child with CP in the rehabilitation clinic under the supervision of University of Social Welfare & Rehabilitation Sciences (USWR). We used to sample of convenience and non probability design for sampling. Then, data were analyzed with SPSS software from the aspects of content validity and test-retest reliability.

Results: Content validity rate of the Persian version demonstrated a high content validity (80.95±0.222). The Spearman correlation coefficients of the test and retest scores ranged from r=0.84 for performance to r=0.87 for satisfaction and this indicated a high correlation between scores and acceptable reliability of the Persian version of COPM.

Conclusion: It was concluded that the Persian version of COPM can be applied reliability to mothers of children with CP and it can be used for clinical as well as research purposes.

Key words: Canadian occupational performance measure, Mother, Cerebral palsy, Validity, Reliability

The effect of prolonged approach on working memory in 4 to 6 years old children who stutter in kerman

Saeedeh Beitollahi

Background and Aim: There are many studies about differences between children who stutter and normal pairs in language and cognition domains. On the other hand, a variety of treatment approaches is suggested for stuttering therapy in children. One of them is prolongation (a fluency shaping approach). The aim of the present study is to investigate the effect of prolongation approach on phonological working memory in children with mild and moderate stuttering.

Materials and Methods: Twenty five children who stutter 4 to 6 years old were selected according to inclusion and exclusion criteria, and then non-word repetition test, pre and post treatment were conducted. Intervention process was based on Hedge’s treatment protocol (prolongation). Their score in non word repetition test and stuttering severity was calculated by SSI, pre and post intervention and compared by SPSS soft ware (version 18) And Wilcoxon singed – rank test .

Results: Severity of stuttering was diminished significantly after and before treatment (p<0.05). In non word repetition test, the number of correct non word including single syllable, two syllable and three syllable, pre and post treatment showed significant differences (p<0.05). There was no relationship between children’s age and their improvement (p>0.05).

Conclusion: Results revealed that prolongation approach had significant effect on improving non word repetition ability and diminishing severity of stuttering. This approach as a form of fluency shaping which usually is based on motor theories had significant effect on increasing phonological working memory capacity.

Key words: Stuttering, Phonological working memory, Fluency shaping, Prolongation approach

Comparison of a Single-Item Borg Scale with the JRPD Scale for Detecting Subjects Exposed to Injurious Work Activities in Military Men with Non-Specific Low Back Pain

Ghorban Taghizade

Background and Aim: One of the main causes of chronic non-specific low back pain is inappropriate working conditions, high repetition of one activity or work heaviness. An appropriate, accurate, inexpensive and easy assessment tools is necessary for measuring intensity of exposure to injurious work activities, Identify individuals at risk and using appropriate treatment. The aim of this study is to compare the single-item Borg scale with JRPD scale to identify individuals at risk of exposure to injurious work activities in chronic non-specific LBP.

Materials and Methods: In this cross-sectional survey study, 92 subjects with non-specific low back pain by mean age of 29.16 (SD= ± 8.55) years and 93 healthy subjects by mean age of 26.80 (SD= ± 9.17) years and matched of work time, age and type of service with subjects with non-specific low back pain were selected by simple non-probability method. Single-item Borg scale and JRPD scale were used to assess the intensity of injurious work activities.

Results: Considering JRPD scale as a criterion scale, the sensitivity rate of 82% and specificity rate of 28% was obtained for single-item Borg scale at the moderate threshold. While the severe threshold for this scale, sensitivity and specificity rate were 25% and 85%, respectively. Also, the results showed that both single-item Borg scale and JRPD scale has significant ability to classify subjects with non-specific low back pain which are exposed or not exposed to injurious work ability (P<0.001).

Conclusion: The single-item Borg scale has high sensitivity and low specificity at the moderate threshold and above and high specificity and low sensitivity at severe threshold to identify individuals Exposed to injurious work activities in military with chronic non-specific LBP.

Keywords: Injurious work activities, Non-specific LBP, Single-item Borg scale, JRPD scale

Comparison of postural control between patients with patellofemoral pain syndrome and healthy subjects

Ali Amiri

Background and Aim: Patellofemoral pain syndrome (PFPS) is the most common overuse injury occurring at the knee. Reduction of proprioception, pain, changes in muscle activity patterns are seen in PFPS. Therefore these patients may demonstrate less balance. Thus the main objective of this study was to determine the postural control in patients with patellofemoral syndrome and compare it with healthy subjects.

Materials and Methods: Ten subjects (age 31.1 ± 5.31, weight 59.6 ± 8.95, height 1.62 ± 0.05) presenting with PFPS were compared with 10 matched control subjects (age 27.2 ± 1.81, weight 60.6 ± 2.36, height 1.67 ± 0.01).

Pain was measured with VAS scale and patella position was assessed using the method first described by McConnell. Force Plate was used to measures COP paths in sagittal and frontal plane with open and close eyes.

Results: The data showed that COP paths were different between PFPS and healthy subjects with open eyes in sagittal and frontal plane (P< 0.05). Means of COP paths increase in patients with PFPS. No differences were detected between PFPS and healthy subjects with closed eyes in sagittal and frontal plane.

Conclusion: Body sways increase in patients with PFPS with open eyes due to pain, lateral tracking patella and reduction of proprioception in knee.

Keyword: Postural control, Patellofemoral syndrome, Open & close eye

The anesthesia effect of vertebral column skin receptors on the motoneuron excitability and H-reflex recovery in Soleus and Gastrocnemius muscles

Giti Torkaman

Background and Aim: There are many disputes concerning the role of skin receptors on excitability of spinal motoneurons. The purpose of the present study is to evaluate the motoneuron excitability and H-reflex recovery curve of Soleus and Gastrocnemius muscles after application of local anesthesia on the skin of vertebral column.

Materials and Methods: Thirty healthy non-athlete female volunteers with a mean age of 27.20 ± 3.11 years old, were tested in two separated sessions. The H-reflex recovery curve of Soleus and Gastrocnemius were recorded before intervention and 15 minutes after the application of anesthesia (lidocaine 10%) or placebo anesthesia (water), with two excitation intensity of 30% and 100% of Hmax and interval interpulses of 1-202 ms. After extraction the amplitude of H1 and H2 response and fitting the recovery curve their amplitude and interval of the peak, area under the curve and, thresholds of the early and secondary facilitation were calculated and analyzed.

Results: After application of lidocaine, the sensory threshold of the vertebral column skin increased significantly. Due to a significant increase in H1 amplitude, peak, and area under the curve of the early facilitation showed a significant decrease (p<0.05). Threshold of the secondary facilitation showed a significant decrease in the Gastrocnemius and Soleus muscles (p<0.05).

Conclusion: The results suggest that decrease of skin receptors activity after anesthesia can facilitate motoneurons excitability and H-reflex recovery. It seems that using the method of paired stimulation and H-reflex recovery curve may be useful to investigate the effect of physical therapy modalities on the fast and slow motoneuron excitability.

Keywords: H-reflex recovery curve, Local anesthesia, Cooling, Motoneuron excitability.

Evaluation of incidence of low back pain and its relationship with ergonomic risk level of wards among nurses

Fatemeh Khayati

Background and Aim: Low back pain is the most common and most costly musculoskeletal disorder among nurses. The studies have showed that ergonomic risk factors are the main cause of back injury. Our aim in this study is to evaluate the incidence of low back pain in nurses with participating in manual handling of patients and determination of its relationship with ergonomic risk level of inpatient wards in a subspecialty hospital in Tehran.

Materials and Methods: Thirty nurses who were active in manual handling of patients, (aged between 25to43), participated in this study. The Nordic standard questionnaire and Slump clinical test were used for evaluation of low back pain and pressure on the nerve root, respectively. MAPO (Movement and Assistance of Hospital Patients) quantitative index was used for evaluating the ergonomic risk level of manual handling of patients in 16 sectors of a hospital including 174 wards.

Results: The results showed that ergonomic risk level was high. Ninety percents of evaluated wards were in red band. Based on results of Nordic questionnaire, %66.7 of nurses had experienced back pain in the past 12 months. Based on the results, 46.7% of nurses who were active in sectors with high ergonomic risk have been suffering of back pain in the past 12 months and 53.3% of theirs slump test were positive. The Chi-Square test confirmed that there is a significant relationship between low back pain prevalence and risk level from the MAPO index in parts. (p=0.004)

Conclusion: Findings from this study showed that there was a relationship between ergonomic conditions of hospital’s sectors with back pain in nurses. Therefore, it is expected to improve ergonomic conditions particularly supply of adequate human resources, supply of auxiliary equipments for patient transmission, repairs timely and implementation of reforms constructive is associated with reduced incidence of back pain in nurses.

Key words: Ergonomic risk level, MAPO index, Slump clinical test, Low back pain, Nurses.

Analysis of morphological error in conversational and story retelling of hearing impaired and typically normal children

Reyhaneh Mohammadi

Background and Aim: Hearing impaired children encounter many problems for learning language and communication skills. The aim of this research is to compare morphological skills in conversational speech and story retelling of hearing impaired with typically normal children.

Materials and Methods: In this cross sectional analytic research 16 typically normal and 9 hearing impaired children between 48 to 72 months were selected in a convenience sampling method .After considering inclusion and exclusion criteria, linguistic sampling for conversational and story retelling data was gathered. Parametric, nonparametric statistical analysis and U Mann-Whitney and t- test was performed on gathered data.

Results: In story retelling there was significant difference between using conjunction,whole free grammatical morphemes, clitics, zero morphemes (p˂0.05). There were significant differences between using conjunction, proposition, conversational grammatical morphemes, inflectional affixes, clitics zero morphemes and whole bound grammatical morphemes in conversational speech (p˂0.05).

Conclusions: Hearing impaired children have more morphological errors than typically normal children. They tend to omit lexical morpheme in story retelling, but typically normal children tend to substitute a lexical morpheme with another one in story retelling. The most kind of error in both groups was omission of morpheme in conversational speech.

Keywords: Hearing impaired children, Morphological errors, Conversational and Story retelling