RESUMEN

Objectives: This study aims to design a conceptual model for the effect of various factors on walking ability, participation, and quality of life in children with spastic diplegic cerebral palsy (SDCP) and test it based on field data using path analysis. Materials & Methods: This cross-sectional study was performed on 181 children with SDCP. The following were used to measure each of the variables: the Modified Ashworth Scale, the Micro Manual Muscle Tester, the Timed Up and Go Test (TUG), the Boyd and Graham test, the goniometer, weight and height, the Gross Motor Function Classification System, the Life Habits Questionnaire, and cerebral palsy Quality of Life Questionnaire for Children. The structural model was tested in Amos 17. Results: All paths of the proposed model were significant (P <0.05). Among evaluated variables, muscle strength (B = -0.466), balance (B = 0.326), and spasticity (B = 0.143) affected walking ability. Moreover, as an intermediate factor, walking ability affected the subjects' participation (B = -0.819) and quality of life (B = -0.183). Conclusion: Muscle strength, balance, and spasticity are the most influential factors in the walking ability of children with SDCP. Furthermore, walking ability and participation are two critical factors in promoting the quality of life of these children.

RESUMEN

Objectives: The Bayley Scales of Infant and Toddler Development (3rd ed.; Bayley III) are widely used to assess cognitive, language, and motor development of children aged 1-42 months. It is unclear whether or not the reference norms of the Bayley III are acceptable for use in other populations or lead to over- or underestimating the developmental status of target children. This study aimed to compare the Tehran norms to the reference norms. Materials & Methods: We used Bayley III norms to assess cognitive, language, and motor development of 1,674 healthy children from health care centers in Tehran. Differences between the scaled scores were calculated based on the Tehran and reference norms. A one-sample multivariate analysis of variance (MANOVA) was used to control the mean difference scores over all subtests. When MANOVA showed significant differences between the scaled scores based on the Tehran and reference norms, we used univariate analysis to see which subtest and age group led to these significant differences. Finally, the proportions of children with low scores (scaled scores <7 or -1 SD and <4 or -2 SD) based on 2 norms were compared using the McNemar test to determine the over- or underestimation of developmental delay. Results: The scaled scores based on the Tehran norms varied across values based on the reference norms in all subtests. The mean differences were significant in all 5 subtests (p < .05) with large effect sizes for receptive and expressive communication, fine and gross motor subtests of .20, .23, .14, and .25, respectively, as well as with a small effect size for the cognition subtest of .02. Large effect sizes for all age groups were found for cognition, expressive communication, and fine motor subtests. More children scored below 1 and 2 SD using the Tehran norms. Using the reference norms resulted in underestimation of developmental delay regarding cognitive, receptive and expressive communication, and fine and gross motor skills. Conclusion: Population-specific norms should be used to identify children with low scores for referral and intervention. The Tehran norms differed from the reference norms for all subtests, and these differences were clinically significant.

RESUMEN

AIM: The current study was designed to provide detailed information on the prevalence of ocular abnormalities in patients with cerebral palsy (CP). METHODS: Four international online scientific databases, including Web of Science, PubMed, Scopus, and Google Scholar were systemically searched. First, the titles of the articles were evaluated, and if relevant, their abstracts and full texts were reviewed. The quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS: A total of 147 articles were found in the initial search. After applying the exclusion criteria, 65 articles were chosen for further review, from which 17 articles, comprising a total of 1734 patients with CP ranging in age from birth to 22 years, passed the STROBE quality check and were included in this review. The prevalence of ocular abnormalities in the CP patients reported in the evaluated studies ranged between 34% to 100%, with refractive error, strabismus, and nystagmus exhibiting the greatest overall prevalence at 52%, 48%, and 11%, respectively in this population. CONCLUSION: Early ocular assessment of children with CP is essential for an accurate diagnosis, personalized rehabilitation and performing early interventions to improve their visual function.

Asunto(s)

RESUMEN

INTRODUCTION: The present study aimed to investigate validity and reliability of Persian Dimensions of Mastery Questionnaire (DMQ18) in children with cerebral palsy. MATERIAL AND METHODS: The original version was carried out through back translation into Persian, and then the construct validity was assessed by confirmatory factor analysis; and reliability was evaluated through Cronbach's alpha (n=230). Intra-class correlation coefficient (ICC) was used for test retest reliability (n=32). RESULTS: 230 parents (155 (67.4%) mothers and 75 (32.6%) fathers) of children and adolescents with CP with an average age of 126.99±24.59 months participated in the present research. Non-questions excluded from the confirmatory factor analysis, and thus all questions remained. Internal consistency reliability and total score were acceptable in all domains (higher than 0.70) except for negative reactions, sadness/shame (Cronbach's alpha of 0.414). Intra-class correlation coefficient of all domains and total score were significant (p<0.001). CONCLUSION: DMQ18 (parental report) was valid and reliable for children with cerebral palsy. It also provided valuable information about different aspects of motivation in CP children according to their parents' opinion, and thus it can be used in clinical interventions.

RESUMEN

The aim of this study was to assess the reliability and validity of the Persian version of the European Child Environment Questionnaire (ECEQ) in the Iranian context. In total, 332 parents (20.2% fathers and 79.8% mothers) of children and adolescents with cerebral palsy (CP) with an average age of 12.33 years (min 7.08 to max 18.08) from three provinces in Iran participated in the study. The original version of the questionnaire was translated and back-translated. Confirmatory construct validity was assessed by factor analysis and reliability was evaluated by Cronbach's alpha (N = 332) and after two weeks' test-retest reliability (n = 51) using an intraclass correlation coefficient (ICC). Eleven questions were dropped as they did not fit well into domains in the Persian version (p > 0.05). Cronbach's alpha and intraclass correlation coefficient in all domains and overall were acceptable (higher than 0.70) and significant (p > 0.05). The Persian version of the ECEQ is suitable for assessing the needs and availability of environmental factors and is reliable and valid for children with CP, as reported by their parents.

RESUMEN

OBJECTIVE: We aimed to assess the distribution of the Bayley screening test by age, and compare developmental risk category distributions between Persian language children and reference norms. MATERIALS & METHODS: A representative sample of 417 children, 1 to 42-months-old, by consecutive sampling from health -care centers were enrolled, during 2014 to 2015 in Tehran, Iran. The cognitive, language and motor development of children were evaluated using Bayley screening test. For determining cut-off point for the subtest scores, two cut-offs were determined for each age group, that classified children to the at risk, emerging, and competent categories. We estimated the agreement of the risk categories between the two samples using weighted kappa statistics. RESULTS: About 70%-80% of all tests operated to the participating children were classified as normal by both norms. Weighted kappa coefficients for the five subtests ranged from 0.56 to 0.89 suggesting moderate agreement between two classification norms. Expressive and receptive communication had the lowest kappa scores (0.56 and 0.59, respectively), and classification of gross motor revealed the highest level of agreement (0.89). CONCLUSION: Developmental disabilities are common disorders that impose important functional limitations on the affected children. Identifying infants at risk for developmental disorders by screening is a main step to minimize complications. Dependence on reference-based norms for the Bayley screening test in Persian language children results in misclassification of risk category.

RESUMEN

INTRODUCTION: The present study aimed to compare motivation in school-age children with CP and typically developing children. MATERIAL AND METHODS: 229 parents of children with cerebral palsy and 212 parents of typically developing children participated in the present cross sectional study and completed demographic and DMQ18 forms. The rest of information was measured by an occupational therapist. Average age was equal to 127.12±24.56 months for children with cerebral palsy (CP) and 128.08±15.90 for typically developing children. Independent t-test used to compare two groups; and Pearson correlation coefficient by SPSS software applied to study correlation with other factors. RESULTS: There were differences between DMQ subscales of CP and typically developing groups in terms of all subscales (P<0.05). The lowest motivation scores of subscales obtained in gross motor persistence (2.4870±.81047) and cognitive-oriented persistence (2.8529±.84223) in children with CP. Motivation was correlated with Gross Motor function Classification System (r= -0.831, P<0.001), Manual ability classification system (r=-0.782, P<0.001) and cognitive impairment (r=-0.161, P<0.05). CONCLUSION: Children with CP had lower mastery motivation than typically developing children. Rehabilitation efforts should take to enhance motivation, so that children felt empowered to do tasks or practices.

Asunto(s)

RESUMEN

OBJECTIVE: Bayley Scales of infant & toddler development is a well-known diagnostic developmental assessment tool for children aged 1-42 months. Our aim was investigating the validity & reliability of this scale in Persian speaking children. MATERIALS & METHODS: The method was descriptive-analytic. Translation- back translation and cultural adaptation was done. Content & face validity of translated scale was determined by experts' opinions. Overall, 403 children aged 1 to 42 months were recruited from health centers of Tehran, during years of 2013-2014 for developmental assessment in cognitive, communicative (receptive & expressive) and motor (fine & gross) domains. Reliability of scale was calculated through three methods; internal consistency using Cronbach's alpha coefficient, test-retest and interrater methods. Construct validity was calculated using factor analysis and comparison of the mean scores methods. RESULTS: Cultural and linguistic changes were made in items of all domains especially on communication subscale. Content and face validity of the test were approved by experts' opinions. Cronbach's alpha coefficient was above 0.74 in all domains. Pearson correlation coefficient in various domains, were ≥ 0.982 in test retest method, and ≥0.993 in inter-rater method. Construct validity of the test was approved by factor analysis. Moreover, the mean scores for the different age groups were compared and statistically significant differences were observed between mean scores of different age groups, that confirms validity of the test. CONCLUSION: The Bayley Scales of Infant and Toddler Development is a valid and reliable tool for child developmental assessment in Persian language children.

RESUMEN

Background: Mechanical orthoses are used to assist in standing and walking after neurological injury in children with myelomeningocele (MMC). Objectives: To evaluate the influence of orthotic gait training with an isocentric reciprocating gait orthosis (IRGO) on the kinematics and temporal-spatial parameters of walking in children with MMC. Methods: Five children with MMC were fitted with an IRGO. They walked at their own comfortable cadence using the orthosis. The hip joint angle, spatial temporal parameters, and compensatory motions were measured and analyzed. Results: Significant increases in walking speed and step length were demonstrated following orthotic gait training during walking with the IRGO. The sagittal plane hip range of motion was also significantly increased; however, the vertical and horizontal compensatory motions were significantly decreased. Conclusion: This study evaluated the influence of gait training with an IRGO on the kinematics and temporal spatial parameters in MMC children. The findings showed that orthotic gait training improved hip joint range of motion, increased walking speed and step length, and decreased lateral and vertical compensatory motions during level-ground walking trials.

Asunto(s)

RESUMEN

BACKGROUND: Advances in perinatal and neonatal care have substantially improved the survival of at-risk infants over the past two decades. OBJECTIVES: The purpose of this study was to assess the reliability and validity of the Bayley Scales of infant and toddler developmental Screening test in Persian-speaking children. METHODS: This was a cross-sectional prospective study of 403 children aged 1 - 42-months. The Bayley scales screening instrument, which consists of five domains (cognitive, receptive, and expressive communication and fine and gross motor items), was used to measure infants' and toddlers' development. The psychometric properties examined included the face and content validity of the scale, in addition to cultural and linguistic modifications to the scale and its test-retest and inter-rater reliability. RESULTS: An expert team changed some of the test items relating to cultural and linguistic issues. In almost all the age groups, cultural or linguistic changes were made to items in the communication domains. According to Cronbach's alpha for internal consistency, the reliability of the cognitive scale was r = 0.79, and the reliability of the receptive scale was r = 0.76. The reliability for expressive communication, fine motor, and gross motor scales was r = 0.81, r = 0.80, and r = 0.81, respectively. The construct validity of the tests was confirmed using a factor analysis and comparison of the mean scores of the age groups. The intra- and inter-rater reliabilities of the Bayley Scales were good-to-excellent. CONCLUSIONS: The results indicated that the Bayley Scales had a high level of reliability in the present study. Thus, the scale can be used in a Persian population.

RESUMEN

BACKGROUND: People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users. OBJECTIVE: The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN: Quasi experimental study. METHODS: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate. RESULTS: Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ. CONCLUSION: Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis. CLINICAL RELEVANCE: It is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being.

Asunto(s)

RESUMEN

BACKGROUND: Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users. OBJECTIVES: To investigate the effect on kinematics and temporal-spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN: Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses. METHODS: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal-spatial parameters and lower limb kinematics were analyzed. RESULTS: Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation. CONCLUSION: Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk. CLINICAL RELEVANCE: Donning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters.

Asunto(s)

RESUMEN

INTRODUCTION: Mild cognitive impairment can be considered as an intermediate clinical state between normal cognitive aging and mild dementia. Elderly people with this impairment represent an at-risk group for the development of dementia. The aim of this study was to investigate the prevalence of cognitive impairment in community-dwelling older adults by Mini-Mental State Examination (MMSE) and its relationship with socio-demographic variables. METHODS: In this analytical-descriptive study, 212 subjects admitted to Hamadan's day care centers were selected through simple random sampling method. To gather the data, MMSE was used as well as a questionnaire containing demographic variables. Data analysis was completed through SPSS-16. RESULTS: The sample consisted of 17.9% male, 59.4% of whom were married. According to the results, 96 cases (45.3%) suffered from mild (MMSE≥22), 110 cases (51.9%) from moderate (11≤MMSE≤21) and 6 cases (2.8%) from severe cognitive disorder (MMSE≤10). As findings revealed, factors such as age (Pv = 0.005, r = -0.491) and schooling (Pv < 0.001) are of significant relationship with MMSE score. DISCUSSION: Prevalence of cognitive decline in community-dwelling older adults was of normal range. Hence, familial relations and social support can decrease mental status disorder.

RESUMEN

OBJECTIVE: To explore how the global organization or topology of the functional brain connectivity (FBC) is affected in Down Syndrome (DS). METHODS: As the brain is a highly complex network including numerous nonlinearly interacted neuronal areas, the FBCs of typically developing (TD) children and DS patients were computed using a nonlinear synchronization method. Then the differences in global organization of the obtained FBCs of the two groups were analyzed, in all electroencephalogram (EEG) frequency bands, in the framework of Small-Worldness Network (a network with optimum balance between segregation and integration of information). RESULTS: The topology of the functional connectivity of DS patients is disrupted in the whole brain in alpha and theta bands, and especially in the left intra-hemispheric brain networks in upper alpha band. CONCLUSIONS: The global organization of the DS brain does not resemble a Small-World network, but it works as a random network. SIGNIFICANCE: It is the first study on global organization of the FBC in DS.

Asunto(s)

RESUMEN

This study was carried out to determine linear and nonlinear changes of brain dynamics and their relationships with the motor dysfunctions in CP children. For this purpose power of EEG frequency bands (as a linear analysis) and EEG fractality (as a nonlinear analysis) were computed in eyes-closed resting state and statistically compared between 26 CP and 26 normal children. Based on these characteristics accuracy of the classification between the two groups was obtained by enhanced probabilistic neural network (EPNN). Severity of gross motor and manual disabilities was determined by standard systems and the relation between the deficient brain dynamics and severity of the motor dysfunctions was obtained by Pearson's correlation coefficient. A definitely higher delta and lower theta and alpha powers, and higher EEG complexity in CP patients. As such a high accuracy of 94.8% in distinguishing the two groups was obtained. Moreover significant positive correlations were found between beta power and severity of manual disabilities and gross motor dysfunctions in the boys with CP. It is concluded that the obtained brain dynamics' characteristics are useful in diagnosis of CP. Furthermore severity of the motor dysfunctions in boys with CP could be evaluated by the beta activity.

Asunto(s)

RESUMEN

To the best knowledge of the authors there is no study on nonlinear brain dynamics of down syndrome (DS) patients, whereas brain is a highly complex and nonlinear system. In this study, fractal dimension of EEG, as a key characteristic of brain dynamics, showing irregularity and complexity of brain dynamics, was used for evaluation of the dynamical changes in the DS brain. The results showed higher fractality of the DS brain in almost all regions compared to the normal brain, which indicates less centrality and higher irregular or random functioning of the DS brain regions. Also, laterality analysis of the frontal lobe showed that the normal brain had a right frontal laterality of complexity whereas the DS brain had an inverse pattern (left frontal laterality). Furthermore, the high accuracy of 95.8 % obtained by enhanced probabilistic neural network classifier showed the potential of nonlinear dynamic analysis of the brain for diagnosis of DS patients. Moreover, the results showed that the higher EEG fractality in DS is associated with the higher fractality in the low frequencies (delta and theta), in broad regions of the brain, and the high frequencies (beta and gamma), majorly in the frontal regions.

RESUMEN

INTRODUCTION: The most common problem in stroke patients is reduced balance and derangements of postural control that lead to increase the chance of falling and instability during walking. Since physical practice improves balance and postural control, it is assumed also that the application of mental practice would be useful in enhancing such balance. Mental practice is defined as the cognitive rehearsal of a physical skill in the absence of overt physical movements. Factors such as similar time between actual execution and mental performance of a task, the increase of regional cerebral blood flow and also the vegetative activation, all suggest that mental practice imitates physical performance of a task. Thus, the main purpose of this study was to investigate the effect of such mental practice on postural balance among stroke survivors. METHOD AND MATERIALS: This study was implemented as an experimental (interventional), case-control, double blind and randomized trial design. A total of 30 subjects (16 males and 14 females) with necessary arousal, attention and memory functions as their major components of mental practice, participated. Subjects' mean ages were 48.1 ± 10.5 years. They were divided randomly in two control and experimental groups. Timed Get up and Go (TUG) test was used to evaluate the balance of all participants. They were assessed before-after treatment and two weeks post-treatment as research's follow up. The two groups received the same method of occupational therapy services, but the experimental group in addition to aforementioned occupational therapy, was requested to participate in mental practice sessions. RESULTS: Mental practice had a significant effect on postural balance in stroke survivors (P=<0.001). CONCLUSION: Mental practice may improve postural balance in stroke patients and can be considered for them as a beneficial rehabilitative technique.

Asunto(s)