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Objective Cerebral palsy (CP) is the most prevalent motor disability during childhood, characterized by a range of movement and posture disorders that result in activity limitations. In children with CP, abnormal walking patterns are observed due to spasticity and contractures in the lower limb muscles. Also, an excessive flexion gait pattern of the knee presents in 66% of spastic diplegic CP children aged from 5 to 21 years. Accordingly, reducing excessive knee flexion during walking may decrease secondary compensations and enhance walking performance and quality of life. This study aims to design and evaluate a novel dynamic orthosis along with its impact on functional parameters of walking and occupation performance in a child with spastic diplegia CP. Materials & Methods This research was a fundamental and applied study of the design and fabrication. The study plan is a single subject, interaction design, conducted in two stages and implemented as A-B-BC-A. After the initial orthosis design, a second and final iteration was developed to address the limitations observed in the preliminary design. The study participant included an 8-year-old boy with spastic diplegic CP, classified as level II (according to the gross motor function classification system expanded and revised), exhibiting a crouch gait pattern. Functional variables, such as speed, balance in walking, spasticity, and occupation performance, were assessed in the study phases. Results The advantages and disadvantages of the final design were identified. Changes were made regarding manufacturing in less time, the ability to adjust the circumferential measures, ease of wearing and removing, and issues related to toileting. In comparing the baseline with intervention phases one and two regarding balance, the intervention demonstrated effectiveness (percentage of non-overlapping data [PND]=70%). According to PND values, functional speed in the second intervention phase showed significant results (PND=75%). The hamstring muscle spasticity graph analysis during intervention phases exhibited a reduction of 1 or 2 units. The occupational performance score and satisfaction with the child’s performance increased significantly after the intervention phases. Conclusion According to the mechanism of dynamic movement orthoses, as long as they are worn during the day, they are effective in modulating the tonicity of spastic muscles by exerting pressure on hypertonic muscles. This modulation improves balance, movement speed, and overall task performance. Consequently, these findings suggest that dynamic orthotic interventions may enhance functional outcomes and occupational performance, and satisfaction in children with spastic diplegic CP.

Objectives: Limitations in the ability to perform manual functions decrease the individual’s participation in activities of daily living (ADLs). Thus, it is required to study the relationship between manual skills and self-care activities in children. This study aims to investigate the relationship between manual ability and self-care in children with spastic cerebral palsy at the ages of 1 to 8 years. Methods: In this cross-sectional study, 125 children aged 1-8 years with spastic cerebral palsy who were chosen by the convenience sampling method from 8 occupational therapy clinics in Tehran City, Iran, in 2022 were studied. The evaluation tools were manual ability classification system (MACS), mini-manual ability classification system (Mini-MACS), pediatric evaluation of disability inventory (PEDI), and cognitive level form designed in the SPARCLE project. After collecting the data, Stata software, version 14 was used to analyze data using chi-square, Spearman correlation coefficient, Mann-Whitney, Kruskal-Wallis, and regression. Results: In this research, the mean age of the children was 54.2±15 months and 43.2% had a cognitive level >70. The mean self-care and mobility in children were 49.65±30.60 and 40.78±26.97, respectively. With increasing age, self-care and mobility of children showed a significant increase (P

Introduction: In 2008, Iran acceded to the convention on the rights of persons with disabilities (CRPD), including the right to health and rehabilitation. However, the goals of this convention have not yet been achieved in Iran. This study provides solutions for implementing articles 25 (health) and 26 (rehabilitation) CRPD in Iran. Materials and Methods: This was a qualitative study conducted through content analysis. A total of 21 individuals were selected via the purposive sampling method. The data were collected through semi-structured interviews. The interviews continued until we reached information saturation. Data analysis was performed manually using the MAXQDA software version 10. Results: After the interviews, 860 initial codes were obtained. After removing the unrelated codes and merging the codes by overlap, 725 codes remained. The concepts were classified into four main categories and 15 subcategories: Development of a comprehensive rehabilitation program, culture and education, capacity building, and compliance with legal requirements. Conclusion: According to the results, because of severe problems in the field of health and rehabilitation of disabled people in Iran, taking necessary measures to solve these problems is essential. Hence, a comprehensive plan should be developed. Meanwhile, proper education, culture building, talents, and opportunities should be considered more carefully. Also, by facilitating services for people with disabilities and paying attention to the importance of being demanding, we can build capacity in the country. The findings of this research will provide a bright way for policymakers, administrators, and planners of the country.

Dear Editor in Chief The educational approaches have significantly changed and facilitated the teaching and learning process through the advent of novel technologies [1]. In the last years, learning through smartphones along with web-based learning has become 2 main types of e-learning platforms, especially during the COVID-19 pandemic; however, smartphones are a more acceptable approach compared to web-based learning because of their availability and easy use. Accordingly, developing smartphone-based learning packages may promote the participation of students in learning procedures. Currently, there are 16 billion mobile phones worldwide, of which about 42% are smartphones [2].

Introduction: Parkinson’s disease is a chronic progressive neurodegenerative disorder causing impaired motor function and various non-motor symptoms. One of the most common problems in Parkinson’s patients is occupational performance problems. The cognitive orientation to daily occupational performance (CO-OP) is one of the client-centered and problem-solving approaches in occupational therapy evaluations and interventions. This study aims to determine the effectiveness of the CO-OP approach on perceived satisfaction and occupational performance in a 62-year-old woman with Parkinson’s disease. Case Description: The client was a 62-year-old woman with moderate cognitive impairment, stage 3 on the Hoehn and Yahr scale, and signs of depression. In our case study, the outcome measures were the Canadian occupational performance measure (COPM), functional independence measure (FIM), Montreal cognitive assessment (MOCA), and Beck depression inventory-II (BDI-II). We administered the CO-OP intervention for six weeks. Sessions were performed twice a week for one hour per session. Results: The results indicate that the CO-OP intervention improves the client’s satisfaction, occupational performance, and functional independence. Although the results from this single case cannot be generalized, the findings suggest that CO-OP intervention may help improve satisfaction and occupational performance in adults with Parkinson’s disease. Further investigation is necessary. Conclusion: These results suggest that CO-OP can be a valuable occupational therapy interventions for individuals with Parkinson’s disease. We recommend that occupational therapists consider using this approach in their practice to improve the occupational performance of their patients with Parkinson’s disease.

Introduction: In addition to the instability of the knee joint, injury to the anterior cruciate ligament (ACL) leads to a functional deficit in the form of diminished proprioception of the knee joint. The purpose of this study was to compare knee proprioception in athletes with an ACL injury and healthy athletes. Materials and Methods: The participants in this cross-sectional study were 26 athletes with an ACL injury and 24 healthy athletes who were selected from the orthopedic clinic at Baqiyatallah Hospital in 2019, Tehran City, Iran. Cooper or non-Cooper subjects with ACL injury were identified via the knee injury and osteoarthritis outcome score (KOOS). The knee proprioception of all participants was recorded using a system consisting of digital photography, non-reflective markers, and Digimizer software. Results: The results showed that there was no significant difference between groups in the absolute error of knee joint reconstruction at both 45° and 90° angles. Conclusion: The data of the study showed that in comparison with healthy athletes, the knee joint proprioception of athletes with an ACL injury is not different and has the same function.

Introduction: COVID-19 pandemic has affected individual lives in several aspects, including physical activity and dietary pattern, which are common challenges among children with autism spectrum disorder (ASD). The purpose of this clinical trial was to investigate the effect of functional training along with online nutritional education on physical fitness indicators in 8-12 years old children with ASD. Methods: Eighty children with ASD (age = 9.73 ± 1.29 years, weight = 49.94 ± 2.08 kg, height = 146.08 ± 40 cm, BMI percentile = 64.88 ± 2.89, fat mass percentage = 24.71 ± 1.48) were randomly divided into four groups, including: (1) functional training, (2) online nutritional education, (3) functional training + nutritional education, and (4) control group. The interventional groups received their specific interventions for eight weeks and three session per week. The control group did not receive any intervention. Physical fitness indicators were assessed prior to the intervention and at the end of eight weeks.Results: There was no significant difference between the demographic and physical fitness parameters (PFPs), including upper limb, lower limb, abdominal, trunk strength, cardio-respiratory fitness, dynamic and static balance, flexibility, speed, and 1 repetition-maximum (1RM) between the groups before the interventions (P ˃ 0.05). There was a significant improvement in physical fitness indicators in all the interventional groups in comparison with the control group (P ≤ 0.001).Conclusion: The results of this study indicated that functional training and online nutritional education may improve physical fitness indicators in ASD children, offering beneficial health outcomes during the COVID-19 pandemic.

Objectives: Musculoskeletal disorders in children with Cerebral Palsy (CP) affect the general health of the mouth and teeth. This study aimed to determine periodontal and dental diseases in children with CP based on gross motor function level, manual ability level, and subtypes of CP. Methods: This research was a cross-sectional study performed on 123 children (3-18 years old) with CP referred to dentistry and rehabilitation centers supervised by Tehran University of Medical Sciences in 2019-2020. They were selected by the convenience sampling method. The children were classified according to the gross motor function classification system: expanded and revised (GMFCS-E&R) for their gross motor function level, according to the manual ability function classification system (MACS) and mini-MACS for the functioning of their hands in handling objects, and according to the quality and topographical pattern of motor impairment for subtypes of CP. The periodontal status of children with CP was evaluated according to the recommendation of the World Health Organization using the community periodontal index and for caries according to the decayed, missing, filled index. All statistical analyses were done by SPSS v. 16. Results: The results showed significant differences between periodontal disease and sex, age, GMFCS-E&R, MACS, mini-MACS levels, and subtypes of CP (P0.05). Discussion: Periodontal disease and decayed, missing, filled teeth are common problems in CP children, and the conditions worsen with age and level IV and V of GMFCS-E&R and MACS.

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Objective: Cerebral palsy Spastic Diplegia (CPSD) is the most common motor disability in childhood. It is a neurodevelopmental condition beginning early in life and continues throughout life. In addition to mobility problems, the environment can also affect the CPSD children’s social participation. This study aims to investigate the relationship of environmental factors with the social participation of children with CPSD. Materials & Methods: This cross-sectional study was conducted on 116 parents of children with CPSD referred to the occupational therapy clinics in Tehran, Mazandaran, and Alborz provinces of Iran in 2018-2019. They were recruited using a convenience sampling method. Parents completed the European Child Environment Questionnaire (ECEQ) and the life habit questionnaire to assess their perception of the environmental factors and their children’s participation, respectively. The Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) was initially used to classify the gross motor function (walking ability) of the children with cerebral palsy living in Europe (The SPARCLE project). We used it to estimate cognitive levels in children. The Pearson correlation coefficient and linear regression of SPSS version 22 were used to analyze the results. Results: Based on the GMFCS-E&R classification, 23.3% of children were at level I, 27.6% at level II, 31.9% at level III, and 17.2% at level IV. Moreover, 89.7% of the children had an IQ>75, and 85.3% had no seizures. All domains and sub-domains of ECEQ had significantly correlated with social participation (P

Background and Aim: Musculoskeletal disorders are mainly prevalent among college students who experience direct contact with patients. This study aimed to determine the prevalence of musculoskeletal pains among Rehabilitation, Dentistry, and Nursing students at Arak University of Medical Sciences in 2017-2018. Methods & Materials: In this cross-sectional descriptive study, 538 students of Arak University of Medical Sciences were recruited using the convenience sampling approach. Variables included age, sex, body mass index, study field, hours of using smartphone per day, and nine symptom sites being neck, shoulders, upper back, elbows, low back, wrist/hands, hips/thighs, knees, and ankles/feet. The researchers assessed the musculoskeletal pain by using the Nordic questionnaire and demographic questionnaire. Statistical analysis was performed using SPSS V. 18. Ethical Considerations: The Research Ethics Committee of Arak University of Medical Sciences approved this study (Code: IR.ARAKMU.REC.1397.253). Results: In this study, 538 students (205 males and 333 females) were studied with Mean±SD age of 22.04±2.53 years old. The results showed that the prevalence of musculoskeletal pain in the spine (neck 29.4%, upper 24.3%, and lower back 37.2%) was higher than in upper and lower extremities. Musculoskeletal pain in the shoulder, upper, lower back, and thigh were significantly different based on sex. Also, musculoskeletal pain in the neck and ankle, and foot were significantly different based on age (P

Background and Aim: Feeding problems can limit the participation of children with cerebral palsy (CP) in the daily activities of life, especially feeding and eating. The aim of this study was to determine frequency of primary oral reflexes and oral motor dysfunction in children with CP. Materials and Methods: This study was a descriptive-analytic and cross-sectional study that has been done on children with CP aged 2-15 years old. The participants were chosen by a convenience sampling from the rehabilitation clinics in the city of Arak in 2017. The presence of primary abnormal oral reflexes including Bite, Rooting, and Tongue Thrust was evaluated; and Oral motor assessment scale was used to evaluate oral motor function.Data were analyzed using statistical tests including chi-squared test. Ethical Considerations: This study with research ethics code IR.ARAKMU.REC.1395.82 has been approved by research ethics committee at Arak university of medical sciences, Iran. Findings: Based on the present results, the most subjects with primitive oral reflexes (bite, rooting, tongue thrust) were found at levels of IV and V Gross Motor Function Classification System Expanded &Revised(GMFCS E&R) and at level of III Manual Abilities Classification System and type of quadriplegia spastic. The highest frequency of passive in oral motor was observed in level of V and functional in oral motor in levels of I and II GMFCS E&R. Furthermore, there was significant difference between gross motor function and oral motor function. Conclusion: The study results demonstrated a significant difference between GMFCS E&R levels and oral motor function. Therefore, it was suggested that particular attention should be paid to oral motor function in terms of evaluations of gross motor function.

Background and Aim: Children with cerebral palsy (CP) may have musculoskeletal disorder due to inappropriate position during sleep. The aim of this study was to design the equipment for sleep positioning of children with CP. Materials and Methods: This research was a designing device study for sleep positioning of children with CP. The design was carried out in three stages: needs assessment, develop an idea and final design. Seventeen children with CP aged 2-12 year olds at the levels of III to V Gross Motor Function Classification System Expanded and Revised (GMFCSE&R) were recruited from Tehran and Karaj rehabilitation clinics by a convenience sampling strategy. For data collection, some demographic questionnaire and GMFCS E&R were used. Ethical Considerations: This study was approved in Research Ethics Committee of Faculty of Applied Arts at Tehran University of Art with the code IR. ART U.REC.1394.118. Findings: In the process of needs assessment, a researcher made questionnaire and pictures of sleep positioning children with CP when they were sleeping were used. In developing an idea stage, the free and creative ideas under the name of black box, as well as, Etudes at the transparency stage were presented as the combination of creative ideas. In the final design stage, by using superior materials, positioning and packaging, we achieved a superior design. Conclusion: The proposed plan is designed as an interventional tool based on the need of Iranian children with CP and there is no similar national or international device available. The final design of the sleeping equipment includes a set of mattresses and a variety of modular styling devices based on a family centered approach, so that, allow parents to active engagement during sleep and rest of their children and can help the children to assume the proper positions.

Background: Hyperbilirubinemia is one of the most common problems in infancy in the world. The aim of this study was to compare the effect of foot therapy and body massage on physiological indicators and bilirubin levels in infants under phototherapy. Methods: This study was a randomized clinical trial that conducted on 51 infants with jaundice at Imam Hussein Pediatrics’ Medical Center, Goldis Hospital in Isfahan (Iran). The samples randomly assigned to first intervention (reflexology), second intervention (body massage) and control groups using the block randomization. In the reflexology group, the relevant area on each foot was massaged for 15 min in a relaxed position. In the massage body group, the limbs were massaged with circular motion. The massage was performed once a day for 15 min and the control group did not receive any intervention. Physiological indicators were monitored using vital sign monitoring tools, and blood bilirubin levels were measured photo metrically (intravenous blood samples from the wrist). Finally, the data were analyzed using descriptive and inferential statistics and SPSS software version 18. Results: The results showed that before the intervention there was no significant difference in the mean of physiological indicators and bilirubin level between the three groups (p > 0.05), but after the intervention the average percentage of arterial oxygen saturation and bilirubin levels were significantly improved in the intervention groups compared to the control group (p 0.05). Conclusion: The results showed that reflexology and massage therapy can be effective in improving the condition of physiological indicators and blood bilirubin levels.

Background: Providing care for children with cerebral palsy (CP) is hard, energy-consuming, and long-term. Consequently, occupational burnout is highly probable for caregivers. Objective: This study aimed to explore the perception of health caregivers regarding the causes of caregivers’ occupational burnout in institutes of children with CP. Methods: This qualitative study was conducted using content analysis methodology during an eight-month period in 2016. Nine caregivers, two managers, and one physiotherapist participated in the study. Purposive sampling method was used to select participants. In depth, semi-structure interviews were used to gather the data. All interviews were conducted at their workplace, in Tehran, Iran. The interviews were recorded, transcribed verbatim, and overviewed. Constant comparative analyses were used to analyze the interviews. Results: The results were categorized into three main categories and nine sub-categories. The main categories were as follows: care-related stress, nature of caring occupation, and organizational demands and resources. Conclusion: Results of this study showed that several factors are involved in creating burnout among caregivers. The exploration of these factors may help us in designing appropriate interventions for caregivers to correctly implement caring activities so that they less suffer from care-related pressures and also become able to allocate some time for their own activities of interest and for recreational, social, and family activities

Background and purpose: Sleep disorders in children with cerebral palsy (CP) are complex and challenging. The aim of this study was to investigate sleep disorders in children with CP based on gross motor function levels. Materials and methods: This cross-sectional study was conducted in 76 children with CP (aged 6 to 15 years old) attending rehabilitation centers in Arak, Iran 2016. The participants were recruited by convenience sampling. The Sleep Disturbance Scale for Children (SDSC) was applied. Data analysis was performed in SPSS V.18 using descriptive statistics, T-test, and Chi-square test. Results: There were no significant differences between sleep disorders and sex and types of CP (P>0.05). But, a significant difference was found between sleep disorders and gross motor function levels (P

Abstract Background: One of the problems in children with cerebral palsy is impaired eating and drinking liquids. The purpose of this study is to compare the effect of oral motor stimulations on feeding function in the children with spastic cerebral palsy by two medical and family centered approaches. Materials and Methods: This research was a descriptive-analytical cross sectional study that performed on 40 children 2-8 year olds with spastic Cerebral Palsy from the rehabilitation clinics in the city of Arak. They were selected by simple and purposeful sampling. Applied instruments were Gross Motor Measure Function Classification System Expanded & Revised (GMFCS E&R) and oral motor assessment scale(OMAS). Data were analyzed by statistical tests such as: Kolmogorov-Smirnov, reporting mean, standard deviation, data analysis frequncy distribution table, independent t-test, dependent t-test, chi-square and MANOVA. Results: The difference of swallowing function assessed by OMAS in both groups managed by family centered and clinician centered approach prior and post management statistialy was meaningful (p=0.001(. The difference between swallowing function of both groups post intervention was not meaningful in view of first and second assessor, also it had no statistical significance(p=0.89 , p=0.07) Conclusion: In general, we can conclude that oral motor stimulation is effective on swallowing function of cerebral palsy children in both treated groups. The effect of these stimulations on swallowing function in children with cerebral palsy between clinician centered and family centered approaches was equal.

Abstract Background: With regards to importance of the role of parents in children's life, imbalance in the roles of parents can lead to serious mental, emotional and physical damages of the child. The purpose of this study was to determine how to do parenting role's tasks in parents of children with disability (physical- mental) younger than 7 years in the city of Arak in 2016. Materials and Methods: In this study, the parenting role's tasks questionnaire for 120 parents of children with disability was completed. The effect of demographic characteristics on how to perform the role of parents was studied. Results: Based on data collected and analyzed using Pearson correlation coefficient for the relationship between the parents and other factors, we have found no significant relationship between role of parents with the child's age. In disabled children, between parent's role and maternal age was significant difference which its correlation coefficient was -0.18, represented the inverse association between maternal age and the parent's role with disabled children. In comparison of parent's role based on child's gender, significant difference was not seen in any of cases. The impact of the seizure on performance of parenting role's tasks implied no relationship between history of seizure and performance of parenting role's tasks. Economic situation as well as on how to do tasks was ineffective. Conclusion: Imbalance in performance of parenting role's tasks in primary care, education, leisure and cognition promotion showed that existence of a disabled child in the family had negative impact on the parenting role's tasks in different aspects, for example further focus on one of the domains lead to ignorance of other domains. Total score confirmed the negative impact of disabled children on efficient implementation of parenting role's tasks.

Objective Caregivers of children with cerebral palsy (CP) are faced with many challenges in self-care, treatment follow-up, educational care, and personal leisure time. Therefore, they should be trained for resolving their needs during caregiving. This study aimed to determine the priority of needs of mothering handling training for family caregiving of children and youth with CP at home based on the family-centered approach. Materials & Methods This cross-sectional study was performed on 186 children with CP (aged 4-12 years) from the rehabilitation clinics in the city of Arak. The participants were chosen by a convenience sampling strategy. Clinical tests such as the Manual Ability Classification System (MACS) and the Canadian Occupational performance measure were used to assess the level of fine motor function and determine the priority of needs of children with CP, respectively. The data were analyzed using statistical tests including two-way ANOVA. Results In this study, there were 89 girls and 97 boys with CP with a mean age 7.52+2.38 years. The CP types were as follows: spastic (67.7%), dyskinetic (13.9%), ataxic (5.9%), and hypotonic (4.8%). The most important priority of needs of mothering handling training was self-care and care related to children with CP in the level of V of MACS. The results showed that the priority of needs of the mothering handling training based on occupational performance (self-care, productivity and play/leisure) were toileting in the level of IV of MACS. There were no significant differences in the priority of needs of the training in the areas of sex and level of fine motor function (P>0.05); however, there were significant differences in age and self-care (P

Abstract Background: Understanding the real needs of children with cerebral palsy and their families helps the therapists to provide adequate health care service for them. This study aimed to determine the needs of mothering handling training for family caregiving of children and youth with CP at home based on the level of gross motor function. Materials and Methods: This research was a descriptive, analytical and cross sectional study that was performed on 186 children 4-12 year olds with CP from the rehabilitation clinics in the city of Arak. They were selected by simple and purposeful sampling. Clinical tests were Gross Motor Measure Function Classification System Expanded & Revised (GMFCS E&R) to assess the severity of gross motor function lesions and canadian Occupational performance measure (COPM) to determine the needs. Data were analyzed by descriptive tests such as: statistical test and two-way ANOVA. Results: The most important need of mothering handling training was self care training specially toileting, feeding, eating and functional mobility related to children with CP in the level of V of GMFCS E&R (transported in a manual wheelchair). There were no significant differences in needs of mothering handling training in areas of sex and severity of gross motor function lesions (p>0.05). Conclusion: It seems that therapists should combine maternal handling trainings with other interventions in therapy programs, especially in the area of self- care.

Abstract Background: The speech disorders may produce irreparable damage to childs speech and language development in the psychosocial view. The voice, speech sound production and fluency disorders are speech disorders, that may result from delay or impairment in speech motor control mechanism, central neuron system disorders, improper language stimulation or voice abuse. Materials and Methods: This study examined the prevalence of speech disorders in 1393 Arakian students at 1 to 6th grades of primary school. After collecting continuous speech samples, picture description, passage reading and phonetic test, we recorded the pathological signs of stuttering, articulation disorder and voice disorders in a special sheet. Results: The prevalence of articulation, voice and stuttering disorders was 8%, 3.5% and%1 and the prevalence of speech disorders was 11.9%. The prevalence of speech disorders was decreasing with increasing of student’s grade. 12.2% of boy students and 11.7% of girl students of primary school in Arak had speech disorders. Conclusion: The prevalence of speech disorders of primary school students in Arak is similar to the prevalence of speech disorders in Kermanshah, but the prevalence of speech disorders in this research is smaller than many similar researches in Iran. It seems that racial and cultural diversity has some effect on increasing the prevalence of speech disorders in Arak city.

Abstract Background: Determining the level of manual ability of children with cerebral palsy has significant role in scheduling care and providing supportive services by organizations such as the a social welfare office. Manual Ability Classification System (MACS) is responsible for this critical matter. In Mazandaran Province, the prediction of manual ability is intuitive and is done without tools. This study aimed to investigate the consistency between operational therapists prediction of future manual function of children with cerebral palsy and MACS scale. Materials and Methods: This study was designed as a cross sectional trial. The study population consisted of 12 occupational therapists working in Mazandaran’s rehabilitation center under the social welfare office. Firstly, occupational therapists chose 100 children with cerebral palsy and classified their future manual ability into five levels according to their prediction. Then the researcher classified the children based on MACS scale. Finally, the amount of prediction consistency between therapists and researcher was statisticaly analyzed. Results: The weighted kappa coefficients of MACS scale were 0.671 in first level and 0.747 in fifth level that show good agreement in these two levels. This coefficient was 0.417 in third level and 0.444 in forth level that shows fair agreement. The weighted kappa coefficient was 0.358 in second level that indicates slight agreement. Conclusion: With prediction consistency between operational therapists and researcher, MACS is used as a suitable means for classifying the level of manual ability in children with cerebral palsy and predicting their needs to adaptive and auxiliary devices by occupational therapists in rehabilitation centers and social welfare offices.

Education via smart mobile phone and mobile health applications is a key element in e-learning. For the first time and in cooperation with occupational therapists and Health Information management specialists, an applied educational smart phone-based program was designed and implemented for mothering handling of children with cerebral palsy (CP) by caregivers. For this purpose, InteliJIDe application version 13 for android was used. This application includes sections of acquaintance with children with CP, principles of motor development in children with CP, feeding, dressing, toileting, bathing, sleeping, lifting and carrying, playing, anticonvulsant drugs, and about us. It is free and can be installed on smart mobile phones and Android tablets via Bluetooth. This application is an important step in easy, fast, and free access of families of children with CP to daily care information. It is hoped that this software resolve some of these families’ problems.

Objectives: One of the most effective methods to describe speech disorders is the measurement of speech intelligibility. The speech intelligibility indicates the extent of acoustic signals that correctly speaker produces and hearer receives. The purpose of this study was to investigate the speech intelligibility in the Persian children with Down syndrome, age range was 3 to 5 years, who had spoken Persian. Methods: this cross- sectional study investigates 12 children (6 girls and 6 boys) with Down syndrome who had referred to speech therapy clinic in Hamadan city and 12 normal children (6 girls and 6 boys) who went to the kindergarten in Hamadan city. The pictures of speech intelligibility test (in Persian language) were used to collect speech samples of participants. The participant’s voice was recorded by voice recorder and was investigated in two age groups. Results: The results of this study indicated the means of speech intelligibility was 92.25 for normal children and 35.08 for children with Down syndrome. The correlation between age and speech intelligibility for normal children was 0.866 and for children with Down syndrome was 0.352. The mean of speech intelligibility 2 for normal boys was 93 and for normal girls 91.5 and for boys with Down syndrome 34.66 and for girls with Down syndrome 35.5. Discussion: The difference between normal children and children with Down syndrome was Significant. One of the factors that affects speech intelligibility for children with Down syndrome is difficulty with voluntarily programming, combining, organizing, and sequencing the movements necessary for speech.

Objective: This study aimed to analyze the concept of occupational therapy handling in the children with cerebral palsy from the perspective of occupational therapy instructors and clinicians in Iran. Materials & Methods: In this qualitative study, using hybrid model to clarify the concept of handling through three phases. For the theoretical phase, attributes of handling were recognized through a review of the literature (until February 2014), and six in-depth semi - structured interviews, two observations and one panel of experts were conducted for the fieldwork to develop attributes from the data and to verify those identified from the literature review. In the third phase attributes and final analysis of handling were extracted from the first and second phase. Results: The results were classified in five main categories that were identified as: (1) care of child, (2) management of treatment, (3) manual techniques, (4) education of activities of daily living (ADL), and (5) lifting and carrying. Core attributes of handling include "control, safety, transfer and positioning". Conclusion: It seems that the results of this study may help in clarifying the concept of handling in children with CP. In addition, by identifying the process, barriers and facilitative factors, and the concept of handling, occupational therapy instructors and therapists will be able to design and run their educational activities based on scientific findings which can provide them with the necessary conditions for education, learning and proper execution of handling in occupational therapy.

Objective: Mothers of children with spinabifida spend more time to care for their children. Doing this care, depending on the child's functional mobility level can probably cause damage to physical and mental health of mothers. This study aimed to determine the quality of life (QOL) of mothers of children with spinabifida (SB), according to the Hoffer levels using the SF-36 questionnaire. Materials & Methods: This research was a descriptive- analitical, cross-sectional study. The sample of this study was consisted of mothers of children with SB (2/5– 14 years old), in Tehran. The sample were selected by convenience sampling in the Rehabilitation Outpatient Clinics of University of Social Welfare and Rehabilitation Sciences, that 203 mothers were assessed in one clinic. Primery measures were the Hoffer criteria for grouping and determine the levels of ambulation in children with SB and the outcome measure was SF-36 questionnaire. Data were analyzed using, t test, ANOVA and MANOVA in SPSS (version 18). Results: In this study, there were significant differences in mean scores on the physical component summary (PCS) (P

Especial care is a particular and unique care of children with CP which is done in the areas of occupational performance by caregivers (mostly mothers). There is a mutual lack of knowledge both the mothers and therapists to special care. This means they not only do not have the necessary knowledge about the special care, but actually they do not have experience in this field. Special care was seen as a missing link of handling, causing hardship, stress and increases the burden of care in caregivers. It seems, through educational programs for parents and therapists, with conducting training workshops and practical acquaintance of caring for children with CP can enhance information and their experience on the special care.

Objective: The aim of this study was to determine the cumulative validity of experimental form in comparison with the Canadian Occupational Performance Measure) COPM( independently to identify occupational performance problems in the mothers of children with Cerebral Palsy (CP). Materials & Methods: This study is an item refinement for experimental form, performed in two stages: firstly designing experimental form and testing reliability secondly its item refinement. Participants were 30 mothers of children with CP in first stage and 21 mothers of children with CP in second stage from different occupational therapy clinics in Tehran. Results: In first stage, Spearman correlation coefficients showed that all the subscales had good test-retest reliability (r>0.7). There were observed significant difference in household management, quiet recreation, active recreation and socialization subscales of experimental form along COPM form compared COPM form alone in item refinement stage. Conclusion: It seems that experimental form offers to detect more important occupational performance problems of mothers. Therefore, we recommended use of experimental form for knowing changes of mothers occupational of children with CP.

Objective: The purpose of this study was to determine the impact of home adaptation on developmental level of 15-60 months old cerebral palsy children. Materials & Methods: In this experimental single-blinded study, forty children with cerebral palsy (15-60 months old) were recruited from some of Tehran public or private rehabilitation clinics based on pre-determined inclusion criteria, and after matching for child age, type of clinic referred to (public or private), type of cerebral palsy, IQ score, GMFCS level and number of occupational treatment sessions already provided at the rehabilitation clinic, the children were divided randomly in to two groups: intervention and control. For data collection, a Demographic Information Questionnaire and Ages & Stages Questionnaires ( ASQ) Test were used. Data were collected on two occasions: before the intervention and 3 months after intervention. For intervention, researcher went to the intervention group home and explained educations related to handling for caregivers and adapted home in a 4-hour session. During 3 months, researcher would follow up to implement the intervention.Finally data were analyzed. Results: there were significant differences in developmental level in total of two groups in 3 months after intervention than before intervention (P

Objective: Co-occupation is defined as engagement of two or more people in an occupation, who are acting within the same time and the nature of engagement. It involves shared physicality, shared emotionality, and shared intentionality, embedded in a shared meaning. This study was conducted in Iranian context to explore the co-occupations of mothers of children with cerebral palsy (CP) as experienced by children, mothers and occupational therapists (OT). Materials & Methods: This qualitative research is a part of a big Grounded Theory study. Three children, thirteen mothers and six OTs participated in the study. The data collected via in-depth semi- structured interviews and two observations at home and clinic and three video tapes and one diary. Participants were selected through purposeful sampling following by theoretical sampling. A qualitative content analysis approach was conducted to analyze data by using the constant comparative analysis. Results: In total, 695 initial or open codes were extracted. The results were categorized in four central themes that were identified as (1) facing with Self care problems, (2) effort to gain treatment follow-up, (3) coping challenges of educational care, and (4) parental limited personal leisure time. Conclusion: The concept of Co-occupation has extended our attitude to specific care for children with CP and has enhanced child care services and also greater awareness of barriers the mothers are faced to.

Introduction: The problems of children with Cerebral Palsy (CP) are permanent, long-term and understanding their challenges, require awareness of the environmental and cultural context. To explore the handling challenges as experienced by children, mothers and occupational therapists (OT), this study was conducted in Iranian context. Material and Methods: This qualitative research is a part of big Grounded Theory study. Two children, four mothers and four OTs participated in this study. Participants were selected using purposeful sampling followed by theoretical sampling. The data collected via in-depth semi structured individual and group interviews and two observations at home and clinic. A conventional content analysis approach was conducted to analyze data. Results: In Total, 1275 initial codes were extracted. The results were categorized in four central themes that were identified as; (1) handling at home, (2) handling at clinic, (3) handling at school (4) handling at society. And 11 sub-themes were recognized. Conclusion: Lack of practical handling training, Focus on to exercise therapy, non care centered handling and child abuse were the major challenges for participants in handling at home, clinic, school and society; respectively. More investigation will be needed about home modification, caring for children with CP and handling training at home, clinic, school and society to cover the gaps. Key words: child; cerebral palsy, challenges, qualitative content analysis

Background and Aim: Consumption of plant derived antioxidant compounds contributes to reducing risks of certain chronic and degenerative diseases. The present study aimed at comparing various antioxidative activities hydroalcholic of flaver extract (DKME) and essential oil of Artemisa persica in Lorestan province in 2012. Materials and Methods: The present experimental study was carried out in Lorestan province in 2012 . After supplying hydroalcholic extract and essential oil of Artemisa persica , radical scavenging activity of the samples was assessed by using diphenylpicrylhydrazyl (DPPH). Total antioxidant capacity of the samples was assessed through phosphomolybdat method. The amount of total phenol and flavonoid samples was assessed by means of Folin-Ciocalteu and Zhishen methods. The obtained data was analysed using Kruskal-Wallis test and SPSS software (V: 13) at the significant level (P

Introduction: It is common for parents with cerebral palsy children to expose further stress and affect all aspects of their quality of life. This study was carried out in order to determine the effectiveness of handling training program on the stress and quality of life of mothers with children with cerebral palsy. Materials and Methods: This control trial study was performed with two groups of experimental (n = 29) and control (n = 25) were selected by randomized convenience sampling method. Data collection tools included demographic questionnaire, SF-36 quality of life, the Resource and Stress Questionnaires. All data collected before and after three months of intervention. Statistical analysis was carried out by SPSS, version 16. Results: The mother’s mean age in control and intervention groups were 32.8 (SD = 4.9) and 35.3 (SD = 4.4) years respectively. Also, children’s mean age in control and intervention groups were 6.2 (SD = 2.1) and 7 (SD = 2.8) years. There was a significant difference in quality of life after intervention between two groups (P < 0.05). However, difference was not significant in two dimensions of physical functioning and Emotional health (P > 0.05). Also, there was a statistically significant difference between all dimensions of stress measures in two groups (P < 0.05). Conclusion: According to these findings, handling training program reduced stress and enhanced the quality of life of mothers with children with cerebral palsy in this study. Keywords: Quality of life, Stress, Cerebral palsy, Handling training, Caregivers

مقدمه: هدف اين مطالعه، تعيين تأثير آموزش مراقبت‌هاي ويژه روزمره زندگي به والدين، در منزل بر تکامل حرکتي ظريف در کودکان فلج مغزي 72-6 ماهه بود. مواد و روش‌ها: در اين مطالعه تجربي، 40 کودک 6 تا 72 ماهه مبتلا به فلج مغزي از بين مراجعه کنندگان به کلينيک‌هاي توان‌بخشي تهران، مطابق معيارهاي تحقيق انتخاب شدند و در دو گروه شاهد و مداخله قرار گرفتند. محقق در منزل کودکان گروه مداخله حضور می‌یافت و همراه با تطبیق منزل، آموزش‌های مربوط به مراقبت‌های ویژه روزمره زندگی را طی 1 جلسه 4 ساعته به مراقبین کودک ارایه می‌داد. ابزار جمع‌آوري داده‌ها شامل فرم مشخصات دموگرافيک، GMFCS (Gross motor function classification system) و PEABODY (Peabody developmental motor scales and activity cards test) بود. داده‌ها در 3 نوبت: قبل از دوره مداخله، 1/5 ماه و 3 ماه بعد از دوره مداخله ثبت می‌شد. یافته‌ها: تکامل حرکتي ظريف در هر دو گروه، 1/5 و 3 ماه بعد از دوره مداخله نسبت به قبل تفاوت معنی‌داري داشت (0/001 > P). ميانگين پيشرفت نمرات تکامل حرکتي ظريف 3 ماه بعد از دوره مداخله، در گروه مداخله بهتر از گروه شاهد بود (0/043 = P) و همچنین تفاوت میانگین پیشرفت نمرات تکامل حرکتی ظریف 1/5 ماه بعد از دوره مداخله، در دو گروه معنی‌دار نبود (0/19 = P). ميانگين پيشرفت استفاده از دست، دستکاري، هماهنگي چشم و دست در گروه مداخله بيشتر از گروه شاهد بود، اما تفاوت معنی‌دار نبود. در حالی که ميانگين پيشرفت "در دست گرفتن اجسام" در گروه مداخله به طور معنی‌داري بيشتر از گروه شاهد بود (0/036 = P). نتيجه‌گيري: نتایج این مطالعه این گونه نشان می‌دهد که آموزش Handling به مراقبين در منزل، در طولاني مدت (3 ماه) باعث بهبود تکامل حرکتي ظريف کودکان فلج مغزي 6 تا 72 ماهه مي‌شود. کليد واژه‌ها: کودکان فلج مغزي، مراقبت‌هاي ويژه روزمره زندگي، تکامل حرکتي ظريف، مراقبين

Objective: The goal of this study was to determine effectiveness of Bobath, conductive education (CE) and education to parents on activity daily living (ADL) in educable children with cerebral palsy, 3-5 years old. Materials & Methods: This research was a Quasi-experimental and interventional with pre - post study design that performed on 45 children with cerebral palsy from Valyasr rehabilitation foundation clinics. They were selected by simple sampling and matched from sex, age, IQ and disorder type and were assigned to three groups by simple randomize method (15 Bobath, 15 CE, 15 education to parents). Clinical tests were goodenough and client development evaluation report (CDER). The data were analyzed by statistical tests such as Wilcoxon signed, Kruskal-Wallis and Mann-whitney U. Results: Three groups had significant improved in activity of daily living (ADL) after treatment (P

Addressing patients' rights issues brings occupational therapists ethical and political responsibilities that involve patients' privileges and new facilitating factors which influence their needs. The goal of this study was to determine the level of occupational therapists' knowledge about patients' rights. The present research was a cross-sectional study which involved 125 occupational therapists chosen by a conven-ience sampling strategy in Tehran during the year of 2012. A four-part questionnaire was used for data collection, and the degree of the subjects' self-assessment of their knowledge was measured based on the obtained numbers of correct answers in the third part. The validity and reliability of this questionnaire were assessed prior to its being distributed among participants. The results demonstrated no significant association between the level of occupational therapists' knowledge about patients' rights and their existing experiences within their areas of occupational therapy (P>0.05). Based on the result, 53.6% of the respondents had high level of knowledge about patients' rights. Facilitating factors which influence the attainment of patients' rights were classified into three groups: organizations, therapists and clients. The results of the present research demonstrated that the level of occupational therapists' knowledge about patients' rights were high. Furthermore, this study showed that for optimal result, there is a need to provide milieu for observing the patients' rights in clinical occupational therapy services.

خرسندیم که در مورد دو مقاله با عنوان «بررسی تأثیر هندلینگ (مراقبت‌های ویژه کودکان فلج مغزی) بر مراقبین و کودکان فلج مغزی» که در دوره 8، شماره 3: سال 1391 مجله پژوهش در علوم توان‌بخشی به چاپ رسیده‌اند چند نکته را مورد توجه قرار دهیم که به نظر می‌رسد توضیح آن برای خوانندگان مقالات ذکر شده ضروری باشد. 1- در مقالات ذکر شده تعاریف هندلینگ و نظر خود محققین در مورد هندلینگ عنوان نشده است. 2- جایگاه هندلینگ در کاردرمانی بیان نشده است. 3- این‌که هندلینگ در چه فعالیت‌هایی دیده می‌شود، مشخص نیست و 4- به تفاوت هندلینگ با فعالیت‌های روزمره زندگی نیز اشاره‌ای نگردیده است که به نظر می‌رسد ضرورت است به اختصار در مورد هر کدام از سؤالات فوق توضیحاتی داده شود.