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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: Health-related quality of life is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. The objective of this study was to measure health-related quality of life in stroke patients in kermanshah city and determine of impact occupation status, gender and hemiplegics side of the body on the quality of life for stroke patients.

Materials and methods: The Method was descriptive-analytic and cross sectional. Fifty one stroke patients referred to comprehensive rehabilitation centers, occupational therapy, physical therapy ,speech therapy clinics and hospital centers of kermanshah city and  there was an interview with all patient. Quality of life was evaluated by 36-item short-form health survey (SF-36).

Results: In attending to the results of recent study, quality of life affected by stroke in total subscales of the (SF-36) but this increased in Role-Physical. Quality of life in these patients is dependent to the age, level of education and post-stroke duration.  

Conclusion: It seems that quality of life improves in stroke patients by passing the time.

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Background and aim: The most prominent problems that is produced after stroke are spasticity or increase in muscle tone, decrease in range of motion and function of upper extremity. The aim of this study was to determine the effects of Volar-Dorsal Wrist/Hand Immobilization Splint on function of upper extremity, range of motion of  the elbow, wrist and metacarpophalengeal joints and spasticity of the elbow and wrist joints.

Material and methods: Fourteen patients were participated in these experiments. The patients were selected according to inclusion and exclusion criteria and they had been given the splint after primary evaluation and were reevaluated after one month. Spasticity were evaluated with Modified Ashworth Scale.Range of motion were measured by goniometer. Fugl-meyer test were used to assess function of upper extremity. The splints were used 2 hours daily and whole night (6-8 hours) in one month.

Results: Comparison of data before and aft er the experiment showed significant mprovement in upper extremity function (P=0.04). Range of motion and spasticity were not significant (P>0.05).

Conclusion: Volar-Dorsal Wrist/Hand Immobilization Splint can improve the function of upper extremity. Although spasticity and range of motion showed a little changes in short-term use (1month) but the differences were not significant that will need more studies.

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Background and aim: Altered muscle activity in the scapulothoracic and glenohumeral muscles is commonly believed to be a factor contributing to shoulder impingement syndrome (SIS), then, the aim of the study was to determine and compare the activity pattern of the shoulder muscles in subjects with and without SIS.
Materials & Methods: In this case-control study, 9 female subjects with shoulder impingement syndrome and 13 matched healthy female subjects were participated voluntarily by simple random sampling. Surface electromyography of serratus anterior, pectoralis major, upper trapezium, lower trapezium, posterior deltoid, anterior deltoid muscles of dominant side were recorded during D1ext and D1flex movement. Muscle activities were processed and compared in subjects with and without SIS. Non parametric test (Mann-Whitney Test)) was used for data analysis
Results: In both movement patterns, all muscles of the patient showed a greater normalized RMS than healthy group but this increase was statistically significant in anterior deltoid (p=0/003, p=0/04), pectoralis major (p=0/01, p=0/02), serratus anterior (p=0/01) and posterior deltoid (p=0/01) during D1ext and in lower trapezium (p=0/005,p=0/006) and pectoralis major (p=0/01) during D1flex.
Conclusion: The results of this study indicate that patients with impingement symptoms show abnormal muscle activity. The findings support the theory that shoulders impingement may be related to altered muscle activity in the scapulothoracic and glenohumeral muscles.

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Background and aim: Sensory deficits after stroke are common with prevalence rates variously reported to be 11% to 85%. In spite of the fact that Sensory deficits can decrease  the quality of upper limb's movements and result in impairments in fine motor manipulation of objects, grasp and manipulative skills and finally  decrease the patient's quality of life but commonly overlooked in stroke rehabilitation. The aim of this study was to investigate the effects of sensory retraining on upper limb recovery. 
Materials and methods: In this study we studied 5 chronic stroke patients were participated using a single-system (A-B) design. During the baseline phase patient's function and motor impairment of upper limb were measured by Fugl-Meyer and Motoricity Index and their hand dexterity were measured by Box and Block test on three days intervals. When Patients reached to a stable pattern of changes, their treatment program began. In this phase they received sensory retraining intervention for 6 weeks. Based on sensory retraining principles and according to each patient's abilities, intervention began with detection and localization of constant and moving touch and followed by higher discriminatory tasks, suchas graphestesia. Then results of evaluations of two phases were analyzed.Results: Four patients showed significant improvements in upper limb function. The data showed significant improvements in motor impairments and hand dexterity in all of them. 
Conclusion: Regarding of significant recovery of upper limb function, motor impairment and hand dexterity of patients, sensory retraining can be considered as a practical method in rehabilitation of stroke patients. However further research with larger sample size is needed.

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Background and Aim: Stroke is the third leading cause of death, second cause of long-term disability and one of the very important challenging in life. The aim of this research was to explain the barriers and facilitating factors affected on stroke patients' life, and to identify relationship among them with demographic factors and severity of disease.
Materials and methods: The descriptive-analytic technique was used. All patients who suffered from stroke were recruited in Kerman city. Finally 83 patients were selected, and data were gathered by demographic qualification questionnaire, proven questionnaire by researcher for studying barriers and facilitating factors (after testing validity and reliability), and NIHSS tools . Then, data were analyzed by using descriptive and referential statistics ANOVA test, T-Test, and Pearson coefficient correlation by SPSS software (ver. 16).
Results: The findings showed that patients had more problems in the domains of politics, environmental factors, physical, and economic status. Also, they introduced social support from friends, family and prayer as facilitating factors in their lives. There was a significant positive relationship between age and physical and economical problems. Women have used social support and religious coping more than men.  Married patients received more social support and their physical and economic problems raised less.
Conclusion: Patients with higher severity of disease had more psychological problems such as depression and worry about future and Patients with lower socio-economic status more faced with barriers.

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ckground and aim: Motor impairments, such as hemiparesis, incoordination and spasticity, are the most common deficits after stroke. Most patients show recovery in some of their lost motor function over time. Motor rehabilitation  are included mixed of combined movement therapy techniques in many occupational clinics. cerebral waves such as Theta wave can influence on patients function. There fore, the purpose of this study is to understand the influence of combined of occupational therapy and neurofeedback on motor recovery of stroke patients. 

Materials and methods :This study used a single-system (A-B) design. During the baseline phase patient's function of  upper and lowe limb were measured by Fugl-Meyer and Berg Test on three day intervals during 4 week and have occupational therapy every day. After this time, their treatment program began. In this phase they received combined of neurofeedback and occupational therapy for 4 week. Then results of evaluations of two phases were analysed. 

 Results: Both cases show significant recovery at upper limbs( case1 81.1% , case2 68.1%) and lower limbs( case1 73.1% , case2 75.4% ) in Fugel-Mayer test and Berg test( case1 51.6% , case2 68.1%).

Conclusion:Regarding the significant recovery of upper and lower limb function of patients, adding neurofeedback to routine occupational therapy  can be considered as a practical method in rehabilitation of stroke patients. However further research is needed.                                                         

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 Background and Aim: Spasticity is a motor disorder characterized by a velocity dependent increase in tonic stretch reflex and tendon jerks, due to the hyper-excitability of the stretch reflex. Modified Tardieu Scale (MTS) is a clinical tool for assessment of spasticity. The purpose of this study was to investigate intra-rater reliability of the MTS for knee extensors and ankle plantar flexors muscles in adult subjects with chronic stroke.

 Materials and Methods: In an analytical cross sectional study, 17 participants (10 men ,7 women) with age range of 40-76 years and mean time post stroke of 20/79 (SD=20/55) in a convenient sampling took part in this test-retest study. Intra-rater reliability of spasticity with MTS was investigated by one un-experienced physiotherapist for knee extensors and ankle plantar flexors in two sessions over one week. 

 Results: Interclass correlation coefficient (ICC) values for R₂-R₁ as an indicator of spasticity in knee extensor and plantar flexors was good (ICC=0/66) and very good (ICC=0/87) and for knee extensors and ankle plantar flexors quality of muscle reaction was 0.80 and 0.92 respectively.

 Conclusion: The MTS has a good reliability in spasticity assessment of knee extensors and ankle plantar muscles after stroke. Probably MTS can be used as a reliable clinical tool to measure spasticity of lower extremity muscles in adult subjects with chronic stroke.

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Background and Aim: Constraint-Induced Movement Therapy (CIMT) is a new intervention in chronic hemiplegic patients. The aim of present study is to quantify of quality of movement (QOM) and amount of movement (AOU) that assessed by motor activity log (MAL) after modified CIMT in comparison with traditional physiotherapy (TPT).

Materials and Methods: Ten patients were randomized to modified CIMT or TPT group. Five patients received training of the more affected limb fort two hours daily, three times in a week during two months of treatment. The patients are encouraged to wear an arm- hand splint in less affected hand for five hours daily for maximal using of affected limb with shaping method. The patients in TPT group received physiotherapy treatment with same intensity with other group, for two hours daily during two months. Motor Activity Log (MAL) was used to determine QOM and AOU before- after two months treatment.

Results: The data showed significant improvements in AOU and QOM in affected extremity that clarified by Wilcoxon test. Mann- Whitney test used for comparison between two groups, revealed significant difference in modified CIMT group (p=0.02).

Conclusion: Although, modified CIMT was more effective than TPT in improving QOM and AOU but, TPT as an active rehabilitation can be effective on improving of these parameters. 

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Background and Aim: Constraint-induce movement therapy is one of the treatment methods to treat those who have  stroke disorders. The aim of this study was to determine the effect of constraint-induced movement therapy(CIMT) on quality of life , function and range of motion of upper extremity of patients with stroke.

Materials and Methods: This study was conducted in 15 patients in accordance to random clinical trial during the treatment operation, the patients were asked to restrict their upper extremity movement with orthopedics sling for 3 days per week and each day for 8 hours. They were asked to practice on affected upper extremity for 2 hours
while their hands were restricted.  Additionally, the present study was conducted for 6 weeks.

Results: The statistical analysis illustrated that quality of life was significantly changed which measured by SF36 test (p=0.008). Furthermore,  the upper extremity function which was assessed by Box & Black test  was statistically analyzed by t-coupled in this regard, it showed a significant change when the treatment ended up (p=0.009). However, active range of motions in wrist extension and elbow extension did not significantly changed (p=0.227).

Conclusion: Based on the results, it can be implied that Constraint-induce movement therapy is an effective method for improvement of life quality and the upper extremity function .Three mechanisms are discussed: involvement of non used affected limbs, neural plasticity in CNS, and amelioration of mental and physical health of patients can be resulted in life quality and patients' hand improvement.

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Background and Aim: Aphasia is common symptom after acute stroke with a prevalence in earlier studies between 21 - 38% .In Iran unfortunately no investigation has been reported on the prevalence of aphasia .So the main aim of this study was to investigate the frequency of aphasia after stroke at hospitals affiliated to Tehran University of medical sciences (TUMS).

 aterials and Methods: This study is a cross-sectional design and has been done on 30 patients with brain injury who admitted to TUMS hospitals during three months. The Mississippi Aphasia Screening Test (MAST) was used to screening aphasia patients.

Results: The descriptive results indicated, from 22 patients with CVA five cases (22.7%) were aphasic. Mean age of aphasic patients (69.6 years) was more than non-aphasic patients (49.24 years) and of five aphasic patients, three cases (60%) were male and two of them (40%) were female. Also, regarding background diseases, four of five (80%) aphasic patients had history of high blood pressure and diabetes. 

Conclusion: Results of this study was consistent with prevalence of aphasia in last studies. Also results of this study confirmed other studies based on that etiology of lesion, age, and high blood pressure and diabetes history of the patients plays an important role in prevalence of aphasia.

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Background and Aim: One of the most common defects after stroke is deficit in trunk control and balance which can lead to disability or dependency in many functional activities in life. Many therapeutic approacheswere used in the stroke rehabilitation, but there is not any unique accepted approach in this field yet. However there are many evidences that show task-oriented practice for neuro-movement rehabilitation can be efficient. The purpose of this study was to examine the effect of intensive task-oriented balance practices on functional balance and mobility in patients with chronic stroke.

Materials and Methods: This was an interventional - quasi-experimental study on 13 patients (4 women, 9 men, mean age 55.07 ± 8.41) with chronic stroke which were selected according to inclusion criteria. The intervention included 10 days of intensive practice during 2 weeks ,5 days per week and 3 hours a day. The assessments (Berg Balance Scale, Time Up-Go) were performed before and after the intervention.

Results: Intensive task-oriented balance training in patients with chronic stroke significantly increased the functional balance (p=0.005) and reduced the time of functional mobility (p=0.001)

Conclusion: The results showed that intensive task-oriented balance training can improve functional balance and functional mobility. Because this study was done only in one group, conducting more studies with appropriate control group is suggested.it is recommended to follow up the long lasting effects of training.

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Background and Aim: In recent years transcranial stimulations, action observation and motor imagery training have emerged as nonaggressive and attractive choices beside the common rehabilitation treatments for neurologic patients. Mirror therapy using visual feedbacks is one of these newfound methods that its therapeutic effects on impaired upper limb of stroke patients are still under investigation. In this case report, Impact of mirror therapy in treatment of the paralyzed upper extremity in 2 stroke patients will be described. Materials and Methods: Two adult patients with hemiplegia due to cerebrovascular accident and with 1 and 5 years passed since stroke went under 12 sessions of mirror therapy. Each session of mirror therapy lasted 45 to 60 minutes in which patients have been practicing specific exercises under direct supervision of therapist. Patients were evaluated for function and motor recovery level, spasticity, range of motion and power grip before and after one month of treatment. Results: In both individual, function and motor recovery level, active range of motion, and power grip were improved and spasticity just showed a decrease in one of the patient. Conclusion: Mirror therapy for 12 sessions can be beneficial to treatment of affected upper extremity in these two stroke patients

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Background and Aim: The aim of this study was to collect and review Aphasia screening test s for speech- language pathologists .

  

Materials and Methods : Searching was done in databases of MEDLIN, SID, Magiran, IRAN MEDEX and 5 site of ASHA, Pub Med, Google Scholar, Science Direct , and Web of Science from 1949 to 2012 , and Screening tests were collected and reviewed on the basis of time of composition, subtests ,validity, and reliability.

  

Results: In this study, 14 screening tests were identified. The maximum number of items were ( 72 subtests) for screening test and the minimum number of test items were ( 4 subtests) for Franchay Aphasia Screening test (FAST). The latter is the first test which evaluated the areas of comprehension and writing in addition to reading and speech . The results indicated that 10 test s have one type of validity, and eight tests have reliability .

  

Conclusion: Considering the importance of the aphasia disorder and lack of a complete source for quick and easy identification of Aphasia, and also finding screening tests in this disorder in Persian language, the results of this study can be useful to familiarize speech and language therapists with this disorder. A pplication of these test s is recommended in various stages of rehabilitation .

  

Key words: Screening, Assessment, Stroke, Aphasia, Review article.

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Background and Aim : One of the most common defects observed after stroke is deficit in trunk control and balance which can lead to disability or dependency in many functional activities in life. Many therapeutic approaches are used in the rehabilitation of stroke patients, but there is no any unique accepted approach in this field yet. However there are many evidences that show task-oriented practice for neuro-movement rehabilitation can be efficient. The purpose of this study was to examine the effect of intensive task-oriented balance practices on functional balance and mobility in patients with chronic stroke.

  

Materials and Methods: This study was an intervention - quasi-experimental with chronic stroke on 13 patients (study on 4 women, 9 men, mean age 55/07 ± 8/41)which were selected according to inclusion criteria. The intervention included 10 days of intensive practice during 2 weeks , 5 days per week for 3 hours a day. The assessments (Berg Balance Scale, Time Up and Go) were performed before and after the intervention.

  

Results: Intensive task-oriented balance training in patients with chronic stroke significantly increased the functional balance (p=0/005) and reduced the time of functional mobility (p=0/001)

  

Conclusion: The results showed that intensive task-oriented balance training can improve functional balance and functional mobility. Because this study was done only in one group, conducting more studies with appropriate control group is suggested. Follow up were recommended in order to show durability effect for future researches.

  

Key word s: Stroke, Functional balance, Functional mobility, Task- oriented approach, Intensive practice

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Background and Aim : Hemiplegic shoulder pain is a common problem that its prevalence varies from 48% to 84%. This disorder limits the patient’s ability to achieve the optimal function. The objective of study was to assess the relationship between hemiplegic shoulder pain with neuromusculoskeletal disorders in post stroke hemiparesis

  

Materials and Methods: This study was an observational-analytic that fullfilled on fifty patients with acute stroke. The post stroke period was 28 days. The following items were evaluated:shoulder subluxation with X-ray, shoulder spasticity with Modified Modified Ashworth Scale (MMAS), soft tissue injury with orthopaedic tests and RSD with clinical features.

 

Results: Hemiplegic shoulder pain was present in 28 patients(56%). Seventeen patients (85%) showed shoulder subluxation, 18 patients (72%) had supraspinatus tendonitis ,13 patients (65%) had biceps tendinits, 4 patients (14/2%) had ACJ involvement, 3 patients (10/7%) had elbow flexor spasticity, 2 patients (7/1%) had shoulder adductor spasticity ,2 patients (7/1%)had shoulder internal rotators spsticity , 4 (14/2%) patients had RSD.

  

Conclusion: Results from this study show that one factor does not play role in causing hemiplegic shoulder pain and this disorder is multifactorial. Prevention of shoulder pain and performing appropriate physiotherapy can play a role in improving stroke patients’ function.

 

Keywords: Stroke, Shoulder pain, Sublxation, Muscle tone, Shoulder –Hand syndrone

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Background and Aim: Balance impairment in patients with stroke leads to dependence in activities of daily living. Appropriate, accurate and inexpensive tools are necessary to assess the severity of balance impairment. In order to identify individuals with chronic stroke who have balance impairment and to apply proper treatment, the aim of this study was to examine the sensitivity and specificity of Timed Up and Go (TUG) and Functional Reach (FR) tests, Bend Reach test (BRT) and Step test (ST) in functional balance assessment of patients with chronic cerebrovascular accident.

Materials and Methods: In this cross-sectional comparative study, eighty-one patients with chronic stroke by mean age of 58.82 (±13.48) years and the mean past duration of disease 36.33 (28.27) months were selected by simple non-probability method. Functional balance and mobility tests including TUG, FR, BRT and ST were used as index test and the Berg Balance Scale (BBS) was used as reference test.

Results: All of functional balance and mobility tests including TUG, FR, BRT and ST have a significant ability to identify individuals with chronic stroke subjected to the balance impairment compared with BBS(p<0.0001). Sensitivity of functional balance and mobility tests including TUG, FR, BRT and ST in intact and affected feet at the moderate or above threshold were 90, 90, 88, 88 and 90 percent respectively and at the sever threshold were 60, 85, 58, 88 and 60 percent respectively. Specificity of these tests at the moderate or above threshold were 56, 85, 65, 57 and 53 percent, respectively and at the sever threshold were 89, 90, 92, 30 and 92 percent respectively. TUG functional balance and mobility test had the highest agreement with BBS balance test.

Conclusion: TUG functional balance and mobility test are the best tool to identify chronic stroke patients with balance impairment in both moderate or above and severe threshold.

Keywords: Chronic stroke, Balance, Sensitivity, Specificity