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Background and aim: There is neuroplasticity in all of life time, from newborn to elderly and neuronal connections are being created and broken by experiences and states of health or disease. The recovery of people with stroke or cerebral palsy can be a sign of neuroplasticity.

The aim of this article is to detect significance of neuroplasticity and critical period of recovery in central nervous system after stroke and cerebral palsy.

Materials and methods: This study is based on review of internal and external articles that published about neuroplasticity in central nervous system after stroke and cerebral palsy from 1987 to 2007.

Results: According to review the articles the mechanisms of neuroplasticity after stroke and cerebral palsy consist of Axonal and dendrites Sprouting, cortical reorganization and neurogenesis.

The rehabilitation protocols have a direct effect on integration and reorganization in intact areas adjacent to injured motor areas of cortex.

Conclusion: This study showed that reorganization continually occurs in response to task, behavior and learning skills.

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Background and aim: The present study evaluates spatial working memory and strategy use, that are from the most important executive functions in performing the learning tasks and intellectual actions in children with cerebral palsy ( spastic diplegia ).

Materials and methods: For this cross sectional/analytical study, 40 children between 7 and 12 were recruited by random sampling into 2 groups: twenty children with cerebral palsy ( spastic diplegia ), with mean age of 8.94 years and 20 normal children with mean age of 8.86 years. Data were collected using Strengths and Difficulties Questionnaire ( SDQ ), CANTAB and Raven test of intelligence. Data were analyzed using t-test.

Results: Children with cerebral palsy differ from the normal children in spatial working memory. Comparing of the means of errors, were illustrated in 3 distinct features, demonstrated meaninngful difference between 2 groups ( p<0.05 ),except in double error ( p>0.05 ) however there was no significant difference in function of strategy use between 2 groups ( p>0.05 ).

Conclusion: In regard with these findings, cognitive rehabilitation with focus on executive skills can be useful in clinical treatment, parallel to the traditional methods, for spatial working memory in children with cerebral palsy.

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Background and aim: Cerebral palsy (CP) is a common disorder in human society with many somatosensory problems that affects on functional capability. Dexterity affects activity of daily activity. The aim of this study was to investigate the effects of Progressive resistive exercises on strength and dexterity of cerebral palsy persons.

Materials and methods: Twelve CP persons between 8 to 16 years old (10 boys and 2 girls) with mean age of 11.9 years old participated in this study.

Progressive resistive exercises (PRE) protocols were done on upper extremity of  study group 3 times a week for 6 weeks.  Strength of shoulder abductors and extensors were evaluated by MMT NICHOLAS apparatus. Grip strength and dexterity were evaluated by Jammar Dynammometer and Purdue peg board respectively.

Results: Shoulder abductors and extensors strength increased %29.4 (p=0.0001) and %30.1 (p=0.014). Grip strength and dexterity improved %9.8 (p=0.048) and dexterity %23 (p= 0.016) respectively.

Conclusion: PRE increase muscle strength of upper extremity and may improve dexterity in children with cerebral palsy.

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Background and aim: Spasticity cause abnormal patterns in upper limbs of cerebral palsy children .It restricts hand function in grasp and release movement. In occupational therapy, neurophysiologic approaches include motor techniques, training and treatment for decreasing hypertonicity and biomechanical approach includes use of splint. In present study the effects of volar and dorsal splint were determined in decreasing of spasticity in upper limbs of quadriplegia cerebral palsy children with four up to six years old

Materials and methods: Twenty quadriplegia spastic children (4-6 years old) were participated in this study. They were classified in two groups. One group wears volar splint and the other group wears dorsal splint for two hours per days and four hours at night up to twelve weeks. Spasticity and passive range of motion were measured by modified  Ashworth scale and goniometry respectively

Results: The mean of wrist spasticity was 2.5 in volar splint group before intervention and 1.9 after intervention. The mean of wrist passive range of motion was 93.50 before intervention and 123.50 after intervention. Elbow passive range of motion was 113 in pre intervention and 135.50 in post intervention. The mean of wrist spasticity was 2.6 in dorsal splint group before intervention and 2.00 after intervention. The mean of wrist passive range of motion was 89.5 before intervention and 118.50 after intervention. Elbow passive range of motion was 110.50 in pre intervention and 135.50 in post intervention. Statistical Analysis of t-student and paired t-tests showed significant differences between the pre and post intervention in all parameters (p<0.05)

Conclusion:  The result of present study showed that both of the splints affected to decrease spasticity of wrist and increase wrist and elbow passive range of motion of hand. Based on this evidence, both of the splints would be suggested for spastic`s hand treatment. Due to major problem in making dorsal splint, we suggest volar splint for  reducing  spasticity in cerebral palsy children.

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Back ground and aim: The present study evaluates attentional set shifting, that is from the most important executive functions in performing the learning tasks and intellectual actions in children with cerebral palsy (spastic diplegia).
Materials and Methods: For this cross sectional/analytical study, 40 children between 7 and 12 were recruited by random sampling into 2 groups: 20 children with cerebral palsy (spastic diplegia), with mean age of 8.94 years old and 20 normal children with mean age of 8.86 years old. Data were collected using Strengths and Difficulties Questionnaire (SDQ), CANTAB and Raven test of intelligence. Data were analyzed using independent t-test.
Results: Children with cerebral palsy did not differ from the normal children in attentional set shifting. Comparing of the means of errors, trials and complete stages, with 18 outputs over all, demonstrated no significant difference between 2 groups (p>0.05).
Conclusion: In regard with these findings, it seems that children with cerebral palsy are not weak in attentional set shifting in comparing with peers, while in some other metacognitive functions such as spatial planning, working memory capacity and spatial working memory, these children are more retarded than normal children.

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Background and Aim: Muscle weakness can be a major problem for many young people with spastic diplegic cerebral palsy (CP). Strength affects on gross motor function. The aim of this study was to determine the effectiveness of loaded forward and lateral step up resistance exercises on Gross Motor Function in children with cerebral palsy of spastic diplegia.

Materials and Methods: Twenty CP persons between 5 to 12 years old (11 boys and 9 girls) with mean age of 8.15 years old were participated in this study. Loaded forward and lateral step up resistance exercises protocols were done 3 times a week for 6 weeks. Isometric strength of hip abductor, hip extensor, knee extensor and ankle plantar flexor were evaluated by MMT NICHOLAS apparatus. Gross Motor Function were evaluated by GMFM.

Result: The strength of Hip abductor, hip extensor, knee extensor and ankle plantar flexor increased (p < 0.05). The scores of GMFM dimensions D and E improved (p < 0.05).

Conclusion: Loaded forward and lateral step up resistance exercises increased muscle strength of lower extremity and improved scores in GMFM. 

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Background and Aim: in hemiplegic children Postural tone of the two sides of body is different. Once, asymmetric stance is a typical state in individuals' with unilateral pain and/or paresis and standing is with weight bearing on the stronger side. Obviously, an asymmetric stance with majority of weight bearing on the affected side can counter faces individual with the falling risk and causes instability. It seems coordinating of the two sides of body is the most vitally important therapeutic exercises in hemiplegic patients. Although stable stance is a simple postural task but it's controlled semi-automatically by cortical and spinal centers. It is established that stable standing, also demands cognition resources. So, postural control demands the interaction between musculoskeletal and nervous systems.
Material and method: In this clinical trial (before-after) 17 children 5-12 years old with spastic hemiplegia were participated. The subjects stayed in the center of force plate with the most stable standing position while using /not-using lateral wedge and in each state with/without doing cognition task. Short- memory test of digit span used as dual task condition. The mean range of fore-after and mediolateral sway and velocity and area as postural control independent variables and error measures in recalling of randomized digit chain as cognition task independent variables were registered.
Results: The wedge affected Rsw (P=0.015), Area (P=0.007) and Vm (P=0.005) significantly. Dual task also had significant effect on Rfa (P=0.014), Rsw (P=0.014), Area (P=0.002) and Vm (P=0.002). But the wedge declines its effect properly.
Conclusion: The results represent that a 5º lateral wedge applied to the unaffected limb, can improve factors of postural control even in Dual tasking thus The wedge can be used with a good effect on the posture of hemiplegic children.

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Background and Aim: Cerebral palsy is a non progressive disorder and the most common movement problem in children. Many children with cerebral palsy are of hemiplegic type. One of the important problems of this children is unilateral upper limb dysfunction, that not using the affected side causes forgetfulness and more problems on this side. In this study, effectiveness of Constraint-Induced Therapy(CIT) and the maintainance of this technique on spasticity and performance of upper extremity in hemiplegic cerebral palsy children 6 to 12 years old have been investigated. 

Materials & Methods: In this pretest - posttest quasi experimental study, 20 cerebral palsy hemiplegic children 6 to 12 years old (15 boys and 5 girls) with  8.7   years mean age were selected. Interventions were performed about 8 weeks and patients were followed for 4 weeks. Spasticity on the affected side in wrist and elbow were tested by Modified Ashworth Scale and upper extremity function by the Box & Block test. The data were analyzed with the Wilcoxon and paired t- tests.

Results: Constraint-Induced Therapy in the affected limb decreases significantly the spasticity of wrist (p = 0.00) and elbow (p = 0.005) and significantly increases performance score (p = 0.00), and the recovery significantly maintained one month after the interventions.

 conclusion: Constraint-Induced Therapy of affected upper extremity could possibly decrease limb spasticity and increase function with two mechanisms: Fierstly, The reduction of not using the plegic side and secondly, neuroplasticity in CNS. This improvement may remain viable in the affected limb. 

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Background and Aim: Upper limb dysfunction is a common and disabling consequence of cerebral palsy. Any functional disorder in the hand can cause a person's independence to be disrupted and therefore his or her social independence is threatened. The purpose of this study was to determine the effects of volar static splint on hand function, spasticity and wrist and elbow range of motion of 8 to 12 years old spastic children.
Materials and methods: The design of this study was clinical trial and before_ after. Fourteen 8 to 12 spastic cerebral palsy children that have the inclusion criteria of study were selected from rehabilitation clinics of Tehran. The patient used a volar static splint (10 degree of wrist extension, full extension of fingers and abduction and opposition of thumb) for 2 mounts (2 hours during day and 4 to 6 hours at night). In this study Jebsen Taylor Hand Function Test was used to evaluate hand function. Modified Ashworth Scale was used to evaluate spasticity. A Goniometer was used to measure range of motion.
Results: The results of this study showed significant improvement in hand function  ,significant reduction in wrist spasticity  and elbow spasticity  and significant increase in wrist range of motion The data did not show any significance in elbow range of motion .
Conclusion: Our findings suggested that 2 months using of volar static splint in children with spastic cerebral palsy can improve hand function, wrist and elbow spasticity and wrist range of motion.

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Background and Aim: Cerebral palsy (CP) is the most common motor impairment in childhood and affects 2 in 1000 live births, in which postural and motor control involved. In hemiplegic type, two sides of the body have differences in postural tone that cause weight shift to the intact side. In these children postural disorders appear as postural stability disorder. The aim of this study is to assess the effect of lateral wedge insole on postural control in cerebral palsy children.
Materials and Methods:  Sixteen hemiplegic children attended in this program and stood in two conditions on the force plate with and without lateral wedge on the hard plate. Center of pressure displacement measured for medio-lateral and antro-posterio directions. Every test took 20 seconds. It was repeated 3 times.
Results: Range of sideways decreased significantly with use of 5º wedge. Also a shoe wedge of 5º provided symmetrical weight distribution.
Conclusion: The results represent that a 5º lateral wedge applied to the unaffected limb, can improve factors of postural control and gain the symmetry in hemiplegic children

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Background and aim: Virtual Reality is a computer technology with virtual environment and objects, which people manipulate virtual environment through active participation. The aim of this study was to determine the effect of practice in virtual environment on upper limb function of children with spastic hemiparetic cerebral palsy.
Materials and Methods: In this single blinded, randomized, controlled trial, 16 children with hemiparetic cerebral palsy were evaluated in a simple random sampling of Ahvaz city in 2 groups (virtual reality and control). Treatment protocol consisted of one and half hours sessions of practice in virtual environment for 4-week, every other day. Measures were conducted pre, post and 3-month after the treatment period by Pediatrics Motor Activity Log and Bruininks-Oseretsky Test of Motor proficiency. Sample randomization and data analysis by analysis of variance with repeated measures were conducted by SPSS-16 software in alpha level set at 0.05.
Results: Subjects in virtual reality group showed significant improvement (p<0.01) in post-test measures (bruininks-oseretsky test of motor proficiency, speed and dexterity: mean change from 0.25±0.06 to 1.22±0.23). Results were retained for both groups in follow up session.
Conclusion: Virtual reality technology through intensive and repetitive practice in an interactive and motivational environment is a promising method to improve upper limb function of children with hemiparetic cerebral palsy.

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 Background and Aim: Cerebral palsy is characterized by non-progressive abnormalities in the developing brain that creates a cascade of motor deficits and finally affects functional activities. Limited hand function is a characteristic of the movement disorders in children with cerebral palsy which leads to disability in performing activities of daily living, work and play. The purpose of this study was to investigate the effects of wrist Kinesio Taping on hand function of children with spastic diplegic cerebral palsy.

 Materials and Methods : In this randomized clinical trial and single-blind study, 26 children (3-6 years old) with spastic diplegic cerebral palsy were selected by convenient and simple sampling and randomly divided into two intervention and control groups. During the study for 12 days ,control group received only common occupational therapy treatment or Neuro-Developmental Treatment (NDT). Intervention group received both NDT and wrist Kinesio Taping for 24 hours a day on both wrists. Assessment tool was QUEST for evaluating quality of upper extremity skills and Modified Ashworth Scale for assessing spasticity of wrist before and after intervention in both groups. Data were analyzed by independent t-test and Wilcoxon rank sum.

 Results : The results showed significance increase of total QUEST score (P=0.029) and significance difference in domains of dissociated movements (P=0.003) and grasp (P=0.008) in Kinesio Taping group. However, there were no significant differences in weight bearing (P=0.46) and protective extension (P=0.89) domains. The data showed that wrist Kinesio Taping was effective in reducing spasticity of right wrist(P=0.004) but no significant difference for left wrist(P=0.06).

 Conclusion: Wrist Kinesio Taping technique revealed to be effective in increasing quality of upper extremity skills of spastic diplegic cerebral palsy children in domains of dissociated movements and grasp. Moreover, it was concluded that this technique can be effective in reducing spasticity of right hand due to more active use of dominant hand.

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Background and Aim: Spasticity is one of the symptoms that contributes to functional limitation in adults with cerebral palsy and characterized by a velocity dependent increase in tonic reflex due to the hyperexcitability of the stretch reflex. Modified Tardieu Scale (MTS) is a valid clinical tool for assessment of spasticity. The purpose of this study was to investigate Inter-rater reliability of the Modified Tardieu Scale (MTS) for hip adductors, knee extensors and ankle plantar flexors muscles in adult subjects with cerebral palsy.

 Materials and Methods: In an analytical cross sectional study, 30participants (11 men ،21 women, age range 20 to 40 years, mean age (26.57±4.8) with spastic cerebral palsy from Ra'ad Rehabilitation Goodwill Complexes in Tehran city in a convenient sampling took part in this study. Spasticity was measured by two physiotherapist for hip adductors, knee extensors and ankle plantar flexors with MTS during same session with ten minutes interval between assessment of two raters.

 Results: ICC values for R₂-R₁ as an indicator of spasticity in hip adductors, knee extensor and plantar flexors were 0.97, 0.88 and 0.81 respectively. Also ICC Values for quality of muscle reaction was 0.89 in hip adductors, 0.96 in knee extensors and 0.92 in ankle plantar flexors

Conclusion: MTS has a high reliability in spasticity assessment of adductors, knee extensors and ankle plantar flexors muscles, Probably MTS can be used as a reliable clinical tool to measure spasticity of lower extremity muscles in adult subjects with cerebral palsy.

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Background and Aim: Cerebral Palsy (CP) children are the most clients referred to occupational therapy settings. Hand function is important in Activities of Daily living .There is a hand dysfunction in most cerebral palsy children. Orthosis and splints are commonly used to improve the position, range of motion, quality of movement and function of a person's arm or hand. The aim of this study was to investigate the effects of static cock up c-bar splint on strength,spasticity, range of motion, and dominant hand function in spastic diplegic children with 8 to 12 years old. 

Materials and Methods: This interventional study is in a before-after design. Thirteen spastic diplegic cerebral palsy children with 8 to 12 years old were selected through students who studied in physical disabled schools in Tehran city and had the inclusion criteria. Patients used a static cock up c-bar splint (wrist in 10 degrees of extension and thumb in palmar abduction and opposition) for two months, 2 hours daily and 4-6 hours at night. In this study the Jebsen Taylor test was used to evaluate hand function, the Modified Ashworth Scale was used to assess spasticity of thumb, wrist and elbow, ROM of thumb, wrist and elbow were tested with goniometer and power grip was evaluated with dynamometer.  

 Results : Results showed a significant improvement in hand function (p<0.001), in wrist`s spasticity (p<0.001), elbow`s spasticity(p<0.008), palmar abduction of thumb spasticity (p<0.002), wrist`s ROM (p<0.001), Palmar abduction of thumb ROM(p<0.001) and power grip(p<0.001). The data did not show significant improvement on elbow`s joint ROM. 

Conclusion: Information from present research shows that using static cock up c-bar splint for 2 months, 2 hours a day and 4 to 6 hours nightly, can be an effective method to improve power grip, hand function, thumb, wrist and elbow spasticity and range of motion of thumb and wrist of spastic diplegic CP children.

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Background and Aim: Children's participation in leisure and recreational activities is associated with their well-being. The Purpose of this study was to compare of participation between children with cerebral palsy and typically developing peers 8-14 years old.

Materials and Methods: In this cross sectional study, 30 children with cerebral palsy (mean age: 11 years  and 1 month) from special education school and 30 typically developing peers (11 years  and 6 months) from typical schools through convenient nonprobability sampling were selected. Participants were evaluated with the Children's Assessment of Participation and Enjoyment (CAPE).The data were analyzed by spss17.

Results: There were significant differences between children with cerebral palsy and typically developing peers (p= 0.000) in diversity scale. The intensity of participation in peer group was more than children with cerebral palsy )p=0.000). No significant differences were found between the groups in the enjoyment. There were no significant main effects of gender, also significant interaction effect between group type and gender for CAPE variables.

Conclusion: The participation of peer group in most activities was more than children with cerebral palsy. Physical disability can affect participation of children in everyday activities and socialization. Knowledge about participation of cerebral palsy children can help to health care professional to establish interventions that fit with children's preferences and can promote their health and participation.

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Background and Aim: Cerebral palsy (CP) is a neurodevelopmental disorder caused by nonprogressive lesions. This disorder produces motor impairment deficits in early infancy. Hand function is essential in performing activities of daily living for everyone, including individuals with cerebral palsy. Adequate first web space is essential for web space expansion, thumb abduction, and a wide range of thumb mobility and hand function. The purpose of this study was to determine the effects of C-bar splint on hand function and strength and also wrist and thumb range of motion (ROM) of dominant hand of 8-12 years old children with spastic diplegic cerebral palsy.
Materials and Methods: The design of this study was before- after and quasi-experimental. According with inclusion criteria, 8 to 12 years old children with spastic diplegia from physical – motor special school at Tehran (8 boys and 5 girls), were studied. They used a C-bar splint (40 degree of palmer abduction of thumb) for 8 weeks (6-8 hours during day and 4-6 hours at night). In this study, hand function was evaluated by Jebsen Taylor Hand Function Test, hand strength by MIE dynamometer and thumb & wrist ROM by Goniometer. During intervention, they received routine occupational therapy program.
Results: The results of this study showed significant improvement in hand function (P=0.001), and thumb range of motion (P=0.02). The data did not show any significant improvement in wrist ROM and hand strength.
Conclusion: According to the result of this study, it seems that using C-bar splint can be an effective method in improvement of hand function and thumb ROM in 8-12 years old children with spastic diplegia. Key words: C-bar splint, Hand function, Diplegia cerebral palsy

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Background and Aim: Cerebral palsy is the most common chronic physical disability in childhood which may have negative effects on quality of lifeof parents. The aim of this research was to study the quality of life in mothers of children with severe cerebral palsy.

Materials and Methods: In this cross-sectional study, 70 children (aged 4 to 12) and their mothers referring to rehabilitation centers in Tehran in 2012 were selected by convenience sampling method. SF-36 was used to assess mother`s quality of life. Mother’s stress and their children gross motor function were assessed using the Resource and Stress Questionnaire and Gross Motor Function Classification System (GMFCS) respectively. Descriptive statistics and logistic regression tests were used for analyzing the data.

Results: The mothers’ mean age was 34.41 years (SD=5.72). The total mean score on health survey was 53.74. There was a statistically significant relationship between all dimensions of quality of life measures except mental health, social functioning and role limitations from emotional health problems with GMFCS level(p<0.05). Also, it was found that there is a significant relationship between mothers’ mental health, physical health and their total score of quality of life with their level of stress (p=0.000).

Conclusion: Considering the above results, parents of children with cerebral palsy describe their quality of life as moderate. Also, cerebral palsy severity and stress can negatively impact on a mothers’ life.

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  Background and Aim: Cerebral palsy is an umbrella term used to describe disorders of motor function, emerge on early years of life , resulting from a brain injury or malfunction. These disorders may be accompanied by speech, auditory and visual disorders, seizure, learning disabilities , mental retardation and so on. Due to all these disorders, it seems that people with cerebral palsy have some special needs that understanding them are essential. As a result, it was done a study to understand the rehabilitation needs of people with cerebral palsy. One part of these requirements was social needs which are presented in this article separately because of its importance.

  

  Materials and Methods: This research was done as a qualitative type and with phenomenology method and sampling was purposeful. Participants were 17 cerebral palsy people (6 female and 11 male, with aged 15 to 43 years old). Data were collected by observation and deep interview with open-end questions and analyzed by Collaizi method.

  

  Results: S ocial needs domain of participants was appeared in 12 sub-themes and 7 themes. Themes were consisted of: to help and companionship with others, social acceptance , marriage, work, access to urban facilities , education and supportive organization.

 

  Conclusion: Social needs are an important and great part of cerebral palsy people's needs. So, it is necessary that organizations , institutes, families and all community members related to cerebral palsy people, consider this group's needs, especially their social needs and try to provide them .

  

  Key words: Cerebral palsy, Social needs, Qualitative study

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Background and Aim: Oral feeding difficulties are common in children with cerebral palsy. Early oral motor interventions may improve oral feeding skills in these children. The purpose of this study is to evaluate the effect of intervention duration of oral motor stimulation on feeding skills in spastic cerebral palsy.

  

Materials and Methods: Twelve children with spastic cerebral palsy 2-7 years aged were participated into two groups A and B. Children in the group A received oral-motor stimulation for 12 session(3 days per week) and group B received stimulation program for 24 session(3 days per week).Feeding skills was assessed using Oral Motor Assessment Scale (OMAS). Data were analyzed using Friedman and Mann-Whitney tests.

  

Results : The results of the study revealed a significant improvement in feeding skills for both groups. The B group had significantly advanced in mouth closure, lip closure on utensil and sucking straw than children in group A (P<0.05). The difference between two group in control of food during deglutition, mastication and control of liquid during deglutition was not significant (P>0.05).There was difference in the total score of feeding skills was not significant between the two groups (P>0.05).

  

Conclusion: Oral-motor intervention might be improved feeding performance in children with cerebral palsy but continuation (increased duration) of intervention improved specific components of feeding behaviors.

  

Key Words: Spastic cerebral palsy, Feeding skills, Oral motor stimulation

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  Abstract

  

Background and Aim: Cerebral palsy is a sensory and motor disease that affected control of posture and movement. Children with cerebral palsy show dysfunction in body such as spasticity, decreased muscle strength and selective control of movement that may limit functional activity and participation in daily life . The purpose of this study is to investigate effects of 8-Weeks progressive resistance training program on physical and motor status in children with hemiplegic cerebral palsy.

  

Materials and Methods: This study was semi-experimental with the interventional approachon16children of 4-12 years old with hemiplegic cerebral palsy in the first and second level of GMFCS classification that referred to rehabilitation center in Ilam city . Protocol of training was consisted of 16 one-hour sessions progressive resistance training in the case muscle group s ( 8 subjects) . Upper extremity muscles strength were measured by digita l dynamometer and gross motor function were evaluated by Gross Motor Function Measure (GMFM-88) at before and after intervention.

  

Results: The strength of dominant hand muscle groups was improved significantly after the intervention , also the scores of stand ing, walking , running and jumping were increased (p<0.05). There was no significant effect in strength of involved hand.

  

Conclusion: The results of this study indicate that progressive resistance training improve gross motor function and increase isometric strength in the dominant hand

 

Keywords: Hemiplegic cerebral palsy, Physical status, Motor function, Progressive resistive excercises (PRE).