Golamreza Olyaei, Ph.D.
Journal of Modern Rehabilitation is the official scholarly journal of the Rehabilitation Faculty at the Tehran University of Medical Sciences (TUMS). The purpose of publishing the MRJ is promoting depth of the relevant knowledge and providing the perfect platform to encourage researchers in the appropriate fields. The scope of the Journal emphasizes all aspects of the specialty of rehabilitation, including Physiotherapy, Kinesiology, Biomedical Engineering, Motion Control, Electrodiagnostic Medicine and gait analysis; and also relative rehabilitation specialties including Physical Medicine, Orthopedic Rehabilitation, Cardiac Rehabilitation, Respiratory Rehabilitation, Neurology Rehabilitation, Gynecology Rehabilitation, Speech Therapy, Audiology, Occupational Therapy, Optometry and prosthetics and orthotics. The practice focus is on the clinical and administrative aspects of rehabilitation. The research focus emphasizes clinical inquiry and also explores basic science. The educational focus is on the application of modern teaching techniques/technology to graduate, undergraduate, and postgraduate rehabilitation instructional programs.
Myopia has become a pandemic disease in the past few years and its sight-threatening consequences associated with high myopia have been a challenging issue for most public health societies. Controlling myopia progression has also become a global concern for many people particularly, parents of myopic children. Accordingly, a large body of work has been devoted to considering different optical and non-optical methods to prevent or retard myopia progression. Different optical strategies such as sunder correction, monofocal spectacles or contact lenses, bifocal or progressive spectacle lenses, multifocal contact lenses, gas-permeable (GP) contact lenses, and orthokeratology (ortho-K) have been proposed to slow down the myopia progression. Although the effectiveness of these treatment strategies has been vastly studied, there are some debates concerning the most efficient method in controlling myopia progression. The present study reviewed the current optical therapies to control the progression of myopia. A literature review revealed that optical strategies, such as myopic under correction, monofocal spectacles or contact lenses, GP contact lenses, and bifocal and multifocal spectacle lenses did not provide a clinically significant reduction in myopia progression. In contrast, ortho-K and newly introduced multifocal soft contact lenses may significantly slow myopia progression.
Introduction: To demonstrate the effectiveness of extracorporeal shock wave therapy (ESWT) in treating active trigger points to relieve pain and increase range of motion (ROM) and improve the function of the cervical region in fewer sessions.
Materials and Methods: In this single-group, pretest-posttest study, 15 participants with active myofascial trigger points (MTrPs) in the upper trapezius muscle took part. Before and after each treatment, visual analog scale (VAS), pressure pain threshold (PPT), neck disability index (NDI) questionnaire, and range of active contra lateral flexion (CLF) were assessed. Participants were given three treatments over a week, with at least a two-day break between them, and then all outcomes were evaluated.
Results: The general results of this study demonstrate a significant reduction in pain perception in terms of VAS (P=0.0001), increased pressure pain threshold (P=0.0001), increased CLF of ROM (P=0.0001), and improved neck function by reduction of NDI (P=0.0001), after the third session of ESWT intervention in participants with MTrP in the upper trapezius muscle.
Conclusion: It reveals that ESWT has positive effects on pain reduction, cervical range of motion, and cervical function in participants treated with MTrPs in the upper trapezius muscle.
Evaluation of Trunk Muscle Activation during the Two Directions of Flexi-Bar Exercise in People with and without Low Back Pain
Introduction: The flexible-bar with a small amplitude of 5 Hz, which transmits vibrations to the trunk, enables the activation of the core muscles that can be used to rehabilitate subjects with low back pain. Two types of exercise direction that can affect trunk muscles of low back pain subjects similar control group are not known. This study aimed to evaluate and compare exercises with two directions of the oscillating flexible poles in people with and without low back pain (LBP).
Materials and Methods: Twelve women with Mean±SD age of 28.75±2.92 years, and body mass index (BMI) of 22.31±2.10 kg/m2 and a history of low back pain, and 12 healthy subjects with Mean±SD age of 28.75±2.49 years and BMI of 21.59±1.50 kg/m2 voluntarily participated in this study. The electromyography (EMG) signals of trunk muscles were measured during two handheld oscillating flexible bars in two directions. The root means square (RMS) of signals for each muscle is normalized by the maximum RMS.
Results: The results of comparing two types of exercise in two groups showed significant differences for left external oblique (P=0.017), right external internal oblique (0.002), and left internal oblique (0.008). Also, the difference in the interaction between group×exercise was significant only for left internal oblique (P=0.026).
Conclusion: Muscle activity in the low back pain group appears different while performing exercises with a flexible-bar compared to the control group. This confirms motor control impairment in these populations and having different strategies for trunk co-activation during exercise.
Hip Adductor, Abductor Muscles Strength, and Performance in Participants with and without Low Back Pain
Introduction: Weakness of hip muscles is common in individuals with chronic non-specific low back pain (CNSLBP). Also, hip joint performance can be influenced by the weakness of hip muscles. This study aimed to compare the strength and performance of hip adductor and abductor muscles between subjects with and without CNSLBP and to investigate their association with disability level.
Materials and Methods: This case-control study included 41 participants with CNSLBP and 41 healthy participants. The strength of hip abductor and adductor muscles were measured using a dynamometer and their performance was assessed using the one-leg hop test. The disability level in the CNSLBP group was assessed using the oswestry disability index (ODI). Data were analyzed using an independent sample t test and Pearson correlation coefficient.
Results: No significant differences were observed between groups for hip muscle strength. One-leg hop test scores of the left lower extremity in the lateral direction were significantly higher in the CNSLBP group compared to the control group. Also, no significant relationships were observed between the total score of ODI and hip muscle strength or performance in the CNSLBP group.
Conclusion: It’s recommended that evaluation and exercise therapy of participants with CNSLBP be performed during functional performance tasks.
Effects of Parent-Implemented Language Intervention on Communication Skills of Iranian Toddlers: A Pilot Randomized Control Trial
Introduction: In recent years, some studies have indicated that some aspects of language performance of children from low socioeconomic status (SES) families are lower in language tests. Appropriate and timely interventions can partially prevent communication problems in these children. This study aimed to investigate the effect of a parental education program on word acquisition rates in Iranian toddlers from low SES families.
Materials and Methods: Sixty-six mothers (toddlers aged 12-14 months) participated in this randomized controlled trial study. These mothers were allocated to the experimental group and control group using the randomization method of the permuted block (each block=6). After baseline assessments, mothers in the experimental group received parental education program aimed at enriching the mother-child interactions and mothers’ knowledge of communication development for 9 weeks. The control group did not receive any education. The outcome measures were children’s scores on the Persian version of the McArthur-Bates communicative development inventories and mothers’ scores in multiple-choice exams regarding workshops’ contents. Data were analyzed using of Chi-square test, independent t test and paired samples t-test, Mann-Whitney U-test, and Wilcoxon signed-rank test.
Results: Both groups had a significant increase in vocabulary size, while changes in the experimental group were more than double that of the control group (P<0.001). Other aspects of communicative behaviors, such as imitation, naming, and intentionality were changed only in the experimental group according to the course of typical development (P<0.001). Mothers significantly got higher scores after the workshops in a multiple-choice exam regarding children’s communication, language, and interaction (P<0.001).
Conclusion: The results demonstrate that mothers’ knowledge of communication development is malleable and probably has positive effects on the communication behaviors of toddlers from low SES backgrounds.
The Study of Vocal Fatigue Symptoms in Speech Therapy Students by Focusing on In-Turned and Ex-Turned Students
Introduction: The voice is a professional tool for speech-language pathologists (SLPs). Due to the daily professional use of voice, SLPs, especially novices in this profession are exposed to voice injuries and disorders. Identifying high-risk vocal behaviors in this group can prevent the spread of more serious laryngeal injuries. This study aimed to investigate voice fatigue symptoms in speech therapy students.
Materials and Methods: In this study, 129 speech therapy students were divided into two main groups of in-turns and ex-turns. In three sections of the semester (beginning, middle, and end), the vocal fatigue index (VFI) questionnaire and two auditory-perceptual voice scales were completed for both groups. The within-between comparisons were made by considering other side factors, such as gender and students’ professional knowledge status in SPSS software v. 19.0.
Results: In the in-turns group, the mean score of VFI at the middle (P=0.025) and the end (P=0.010) of the semester were significantly higher than at the beginning of the semester. Also, the mean score VFI of the in-turns at the middle and end of the semester were higher than of the ex-turned speech therapy students (P=0.011). The effects of students’ gender and their knowledge status on the findings were not statistically significant (P>0.05).
Conclusion: This study showed that new vocal-speech behaviors related to clinical activities in the clinic environment of speech therapy can increase laryngeal tensions and vocal fatigue in in-turned speech therapy students.
Introduction: This study aimed to determine the communication profile of parents of children with autism spectrum disorders (ASD) and parents of typically developing children (TDC).
Materials and Methods: Broad autism phenotype and communication skills were measured using the broad autism phenotype questionnaire (BAPQ) and the Queendom communication skill test (QCST) in parents of children with ASD and parents of TDC. Participants included 346 parents of children with ASD and parents of TDC. In the ASD group, participants included 172 parents (76 fathers and 96 mothers) of children diagnosed with ASD. The TDC parent group included parents 174 (85 fathers and 89 mothers). In the autism group, at least one child had autism and in the opposite group, the child had no psychological problems. Two-way analysis of variance (ANOVA) was performed to examine the effects of group (TDC, ASD) and gender (male, female) on study variables.
Results: A significant group-gender interaction was observed for BAPQ total scores (F(1,342)=4.28, P=0.039); Mothers of children with ASD reported higher BAPQ total scores than mothers of TDC (P=0.006), and mothers of TDC reported lower BAPQ total scores than fathers of TDC (P<0.001). A significant group-gender interaction was also observed for QCST total scores (F(1,342)=11.66, P<0.001); Mothers of children with ASD reported lower QCST total scores than mothers of TDC (P<0.001), and among parents of TDC, mothers had higher levels of QCST total scores than fathers (P<0.001). A negative significant correlation was observed between BAPQ and QCST total scores (r=-0.499, P<0.001).
Conclusion: The results of this study showed a difference between parents’ communication skills in the two groups. Parents of children with ASD have more communication characteristics of autism than the control group, Fathers in the ASD group scored higher in the total scores of autism communication traits and some subtests which require further research in this area.
Motor Control Changes in Trunk Muscles after Using Anatomical Posture Control Orthosis in the Elderly Hyperkyphotic Subjects
Introduction: Hyperkyphosis is known to interfere with the normal function of the trunk musculature in the elderly. Although the effectiveness of orthoses in improving posture and balance in hyperkyphotic elderly people has received much attention, the effect of an orthosis on motor control of muscles remains unknown. This study aimed to evaluate changes in motor control strategies of trunk muscles during walking in elderly hyperkyphotic subjects after using an anatomical posture control (APC) orthosis.
Materials and Methods: A total of 19 elderlies (11 women and 8 men) with thoracic hyperkyphosis of more than 45 degrees were enrolled in the study. Surface electromyography (EMG) signals were recorded from 6 trunk muscles bilaterally with and without orthosis. The voluntary response index (VRI) was calculated from quantitative analysis of surface electromyography (sEMG) data during level walking in those with and without orthosis. The outcome variables of VRI included the similarity index (SI) and electromyographic magnitude (MAG) of muscle groups. The effects of APC orthosis on trunk motor control were tested using a Wilcoxon non-parametric test. Cohen’s d effect sizes were also calculated.
Results: A significant improvement was observed (P<0.05) in MAG and response vector (RV) of five muscles from the right and left sides and the VRI increased significantly after using this posture control orthosis (P<0.05; effect size [ES]: 0.27).
Conclusion: Improving trunk motor control after using orthosis, with relatively medium effect sizes, was observed in the elderly with hyperkyphosis during walking.
Quantitative Changes in Gait Parameters after Cycling among Multiple Sclerosis Patients with Ataxia: A Pilot Study
Introduction: Cerebellar ataxia is a common symptom of multiple sclerosis (MS), particularly in progressive forms, where gait and balance problems are the most debilitating symptoms. Exercise training is a critical component of rehabilitation in managing equilibrium dysfunction, and stationary bicycling is a safe, feasible, and effective method to reduce the symptom. Clinical walking performance tests are typically used to assess gait in these patients. However, gait analysis technologies are more sensitive and accurate at detecting subtle and subclinical changes. The purpose of this study was to determine the changes in gait parameters in MS patients with ataxic gait after using a stationary bicycle.
Materials and Methods: Ten secondary progressive MS patients with ataxic gait and a mean expanded disability status scale (EDSS) of four were recruited. The participants cycled on a stationary bike. Gait analysis was performed before and after 12 sessions of cycling. It included spatiotemporal and balance parameter measurements.
Results: Gait analysis showed statistically significant changes in spatiotemporal parameters, including speed (P=0.02, r=-0.51), and stride length (P=0.01, r=-0.63). Of balance-related indices, the mediolateral (ML) center of pressure (COP) displacement, anterior and posterior COP overshoot, and COP velocity changes were statistically remarkable after the intervention respectively. (P=0.01, r=-0.63), (P=0.02, r=-0.51), (P=0.03, r=-0.49), (P=0.01, r=-0.54).
Conclusion: Gait analysis is applicable to track changes following rehabilitation in individuals with MS. The results indicate that using a stationary bicycle can improve some spatiotemporal and COP-related parameters.
The Effect of Sensory Diet on the Impulsivity of Children with Attention Deficit Hyperactivity Disorder
Introduction: The present study was conducted to evaluate the effect of a family-centered sensory diet program on the impulsivity in children with attention deficit hyperactivity disorder (ADHD).
Materials and Methods: This is a quasi-experimental study with a pretest-posttest design with a control group. The study population included all children with ADHD aged 6-12 years in Tehran, Iran referred to the clinics of Hasti, Bahar, and Masir-e Sabz in 2020. Of these, 30 children were selected using a convenience sampling method and randomly divided into two groups of intervention and control. The intervention group underwent 12 sessions of a family-centered sensory diet program, 3 days a week, each for 45 minutes based on the Wilbarger protocol. The used tools were the Wechsler intelligence scale for children-Fourth Edition to test intellectual ability and the Conners’ parent rating scale to diagnose ADHD in children. Independent t test and analysis of covariance (ANCOVA) were used in SPSS software v. 20 for data analysis.
Results: In this study, the mean age of participants was 9.56±4.38 years, including 11 girls (36.6%) and 19 boys (63.3%), and the mean age of mothers of these children was 34.23±6.9. The mean impulsivity scores of children in the intervention group decreased and the results of the ANCOVA showed a statistically significant difference in the mean posttest scores between the two groups (P=0.001).
Conclusion: The family-centered sensory diet program has a positive effect on the impulsivity of children with ADHD. It is recommended that therapists use the sensory diet program as a complementary therapy along with other therapeutic interventions.