Objective: Cerebral palsy is a non progressive disorder in body posture and movement, due to different etiologies. Different rehabilitation interventions include conductive education have been used in these children. This study was performed to determine the effect of conductive education (CE) on gross motor function in children with spastic CP (3-6 year olds).

Materials & methods: This study was Quasi-experimental and interventional. The study populations were 3-6 year olds CP spastic children in Tehran city. The reachable samples were referent to vali-e-asr rehabilitation foundation, among them 20 children acquired the entrance qualification for intervention. The clinical tests were Wechsler intelligence scale for evaluating of (IQ) and GMFM-66 (Gross Motor Function Measure) for evaluating gross motor function.

Results: There are significant difference in gross motor functional abilities after using CE (P<0.003). Evaluation of the condition before and after each of the functional levels showed that the best result of using CE is seen on children at III level. But evaluation comparing of motor performance levels showed no significant difference (P>0.466).

Conclusion: CE is an effective approach in children with CP and it could cause meaningful improvement in gross motor function of children with CP and this approach is useful for all children with CP in different levels of motor function.

Objective: The of Aim of this study was investigation modified constraint induced movement therapy on grasp in affected limb in children with hemiplegic cerebral palsy.

Materials & Methods: In this study, 21 children and available clinical criteria for entering the study were selected randomly to balance the two groups were divided into experimental and control. Common Practice in Occupational Therapy 6 weeks for both groups were equally and intervention group 3 hours daily was used constrain induced movement therapy methods. Quality of grasp based on the quality of upper extremity skills test (QUEST) was evaluated. Statistical tests Kolmogrov - Smirnoff, Chi square T test and repeated measurement to analyze the data was used.

Results: 11 children in the experimental group (7 girls, 4 boys) with mean age (47/17±55/46) months and 10 children in the control group (5 female, 5 male) with mean age (19/19±10.48) months were studied. statistical analysis between group by using independent T-test is significant difference after 6 weeks intervention(P<0.05) and repeated measurement is significant difference in 2 weeks after intervention & 2 week second (P>0.05) and statistical analysis of weight-bearing T-test was not significant (P>0.05) and repeated measure pre-test and the comparison between the first two weeks and the first two weeks and two weeks a second significant difference was observed (P0.05).

Conclusion: This study showed that modified constraint induced movement therapy could be effect weight bearing, but has no effect on the protective extens.

Objective: This study was aimed to determine visual perceptual skills of normal children aged 7 to 13 years in Tehran, comparing visual perceptual skills between boys and girls, age groups and student of different educational areas and finding the correlation among subtests with each other and subtests with total test.

Materials & Methods: In this cross sectional study 788 children aged 7 to 13 years old from 40 elementary and high schools of 5 educational areas of Tehran were selected by simple randomized and proportional to size method of sampling. Subjects were categorized in 3 age groups and then they were assessed by TVPS-R. The data were analyzed by statistical tests including Kolmogorov Smirnov, Bartllet, Analyze of variances, Independent T test, Kruskal-Wallis, U mann-whitney and Spearman correlation coefficient in SPSS software.

Results: According to results, standard scores for all visual perceptual skills were about average (Visual Perceptual Quotient=94.68). Analysis of data revealed significant differences among age groups in visual perceptual skills except Visual Memory and Visual Sequential Memory (from P=0.045 for Visual Closure to P<0.001 for Visual Form Constancy). Students of different educational areas in Tehran had significant differences in visual perceptual skills (P<0.001 for all visual skills). No significant differences were found between girls and boys in five of visual perceptual skills but there was significant difference between them in Visual Form Constancy (P=0.009), Visual Figure Ground (P<0.001) and Visual Perceptual Quotient (P=0.011). Correlation between subtests and total test was higher (Rho>0.617) but it was lower among subtests to each other (Rho<0.508).

Conclusion: The results of this study determined the visual perceptual skills scores in normal children. These scores will play as criteria for next studies especially the ones related to abnormal children.

Objective: Chronic regional pain syndrome (CRPS) is one of the most important and worst types of peripheral nervous system, especially in upper extremity. The aim of this study was determination of the effect of a combined rehabilitation program in the treatment of patients with CRPS type I.

Materials & Methods: In this quasi-experimental and before-after study, 20 patients with chronic regional pain syndrome were selected simply and their pain, range of motion, edema and muscular strength were examined and recorded before intervention. Then, patients under went a combined treatment programs included some modalities from physical and occupation therapy. Patients attended at clinic for 20 therapeutic sessions with one day intervals. Finally, data were analyzed using paired–t test.

Results: Post operatively, pain and edema were decreased and range of motion and grip strength was increased significantly (P>0.05).

Conclusion: Current study demonstrated that early and combined physical and occupational therapy efficient in the treatment of patients suffering from CRPS type I. This combined program can relieve pain and edema and increase ROM and grip strength.

Objective : The evaluation of the quality of motor abilities by the means of a standard instrument is important diagnostic parameter which leads to discovery of probable disabilities and developmental delay in childhood. Hence, to achieve a standard complete tool for measuring of indigenous children motor abilities by way of standardization of Peabody Developmental Motor Scales (PDMS) was the aim of this study.

Materials & Methods : In this descriptive study 150 normal children aged 60 - 71 months with identical gender distribution were selected by multiple cluster sampling among kindergartens of 6 urban districts of Shiraz and their gross and fine motor abilities were evaluated by PDMS. Reliability and validity of PDMS was examined initially. Afterwards, in order to standard the scale according to study population motor abilities, the raw scores which result of the evaluation of motor performance, transformed to standard scores.

Results: High correlation coefficients proved that PDMS was reliable and valid. With reference to the reliability, as a case in point, Intraclass correlation coefficient (ICC) repeated test by the same therapist was 0.987 for gross motor scale and 0.971 for fine motor scale. Compiling the standardized tables by transforming raw scores to standard scores are the other significant findings of the study.

Conclusion: Clinicians and therapists could utilize PDMS as a standard and accurate device for examining motor characteristics of 60 - 71 months children. And, they can make a correct decision by evaluating the patient first and then matching up the data with standardized table based on this study.

Objective: To determine the reliability of the Persian translation of the Manual Ability Classification System (MACS) between parents and therapists in children with cerebral palsy (CP).

Materials & Methods: After the forward and backward translation procedures and investigation of face and content validity, inter-rater reliability was assessed between parents and occupational therapists using the intra-class correlation coefficient (ICC) and the weighted kappa coefficient. 100 Children (4 to 18 years, mean age 85.15 months 63 boys, 37 girls) with various types of CP were classified according to MACS by both parents and therapists. Additional data on the Gross Motor Function Classification System (GMFCS), intellectual delay, visual acuity, auditory acuity and epilepsy were collected.

Results. The inter-rater reliability was high the ICC was 0.96 (ranged from 0.94 to 0.97) among occupational therapists and parents .Total agreement there was between the GMFCS and the MACS.

Conclusion. The Persian version of the MACS is found to be reliable between parents and therapists, and is suggested to be appropriate for the assessment of manual ability within the Iranian population.

Objective: Behavioral problems constitute a wide range of childhood problems. Acquiring information regarding the behavioral problems in children with cerebral palsy is essential to identify and manage such problems and to promote psychological and mental health services for children with cerebral palsy. The purpose of this study was to describe behavioral problems in children with cerebral palsy.

Materials & Methods: In a cross-sectional study, 90 children with cerebral palsy, aged 4 to 12 years, referred to rehabilitation centers in Tehran in 2011, were selected by convenient sampling method. Children were assessed using parent version of Strengths and Difficulties Questionnaire. Descriptive statistics, chi-square and logistic regression tests were used for analyzing the data.

Results: The findings showed that the prevalence of behavioral problems in children with cerebral palsy was about 43.3 percent. According to sub-groups of diagnostic class of Strengths and Difficulties Questionnaire, the highest prevalence belonged to peer problems (82.2%) and the lowest prevalence was related to hyper activity problems (4.4%). There was a significant difference between IQ level, GMFCS level and Total Difficulties Scores (P<0.05).

Conclusion: As significant proportion of children with cerebral palsy suffers behavioral problems, specific educational and therapeutic programs are recommended.

Objective: While the development of Attention and motor skills have great importance to learning, growth and daily living tasks of children, some significant dysfunctions can be seen in motor skills and attention of children with learning disability. The aim of this study was to investigate the effectiveness of weighted vest (sensory stimulation) on motor skills and attention of 6-10 years children with learning disorders.

Materials & Methods: This study was an experimental and a classic designed, participants were included twelve 6-10 year old children with learning disorders referred to rehabilitation centers affiliated to University of Social Welfare and Rehabilitation Sciences, and they were randomly assigned to intervention and comparison groups. The subjects selected through convenience sampling. Motor skills and attention level measured during two pre-test and post-test through an Oseretsky Motor Developmental Scale, Conner’s parent Rating Scale, and then the results were recorded. After the pre-test, intervention provide constantly sensory stimulation using weighted vests during common services Occupational Therapy was performed on the intervention group that was the 45 minutes, 3 day per week, for 12 sessions. The data were analyzed using Symbolic Wilcoxon rank and I – Whitney.

Results: There was significant difference between test scores before and after the motor skills test in the intervention group (P=0.003) and there was no significant difference in the comparison. Similarly, there was no significant difference between pre-test and post-test attention in intervention and comparison groups.

Conclusion: Our findings indicate that statistically sensory stimulation based on weighted vest on motor skills was effective, but had no significant effect on attention. Therefore, this technique can was be used to improve the development of motor skills in children with learning disorders.

Objective: Improvement in job is directly related to recognition of the experience and viewpoints of those working in the field. This research was designed to find out the job, educational and clinical experience of the occupational therapists.

Materials & Methods: This study is a qualitative research using content analysis. Data collection was done via in-depth semi -structured interviews with 15 occupational therapists working in the rehabilitation clinics in Tehran in 2009. To analyze the data, content analysis and inductive analysis were used...

Results: First, we obtained 170 key codes from data analysis .These key codes were categorized into 5 themes including ”community's attitude toward occupational therapy’s”, ”job dissatisfaction”, “a new and creative sight into occupational therapy”, “occupational therapy inappropriate educational system” and “the nature of the occupational therapy”. The themes obtained from the occupational therapists’ experience showed that how the other members of rehabilitation team, patients and patients’ family look at occupational therapy and can directly affect the occupational therapists’ job satisfaction, positive experience and sense of worth.

Conclusion: Experience of occupational therapists in their job is directly related to their patients ‘and coworkers’ ideas about their sense of worth this view passes to the occupational therapist directly and indirectly. It can affect the occupational therapists’ attitudes, satisfaction and job experience. Instructors and mentors of occupational therapy students can contribute to positive experience and satisfaction of the students from occupational therapy.

Objective: The aim of this study was to determine the effectiveness of 4 weeks ball skills training on adaptive behaviors of 14 children (12 boys and 2 girls) aged 4-7 years old with high functioning autism.

Materials & Methods: The study was designed in two phases: In the first 4 weeks (phase I), all of the children received their current therapeutic program as a control group. The second 4 weeks (phase II) intervention including ball skills training along with current therapeutic program was performed immediately. Participants received 10 sessions (3 sessions per week and each session took 45 minutes).Measurements: Vineland Adaptive Behavior Scale and Autism Treatment Evaluation Checklist (ATEC) were used to assess adaptive behavior and severity of autism respectably.

Results: There was significant difference of Mean on ATEC score in both phases using benffroni method. There was no significant difference of mean in subtests of Vineland including verbal communication, socialization and activity of daily living (ADL) in phase 1 but there was meaningful difference of mean in socialization (P<0.001) and ADL (P<0.01)in phase II.

Conclusion: Results of the study indicated that the ball skills training along with current treatment improved adaptive behaviors in children with high functioning autism. It could reduce the severity of symptoms as well.

Objective: The purposes of this study were: 1) Determination the correlation between gross motor function of children with cerebral palsy and their level in Gross motor function Classification System2) Evaluation and comparison of changes in gross motor function in children with cerebral palsy based on their severity.

Materials & Methods: In this longitudinal and in terventional study 30 children with CP (4-12 years) were recruited from some of Tehran rehabilitation clinics based on pre determined inclusion criteria. then this children based on their level in gross motor classification system were divided non randomly into three groups (mild, moderate and sever). For data collection demographic information questioner, Gross motor Classification system and Gross motor function measure were used. Data were collected before and after intervention. Intervention included two conventional occupational therapy sessions per week and lasted for three months. Data were analyzed by Spearman correlation coefficient, Wilcoxon, Man-whitney and Kruskal Wallis test.

Results : There was inverse correlation between gross motor function level and gross motor function of children in pre & post occasion. in pre test occasion the mean of gross motor function in mild group was significantly higher than moderate & sever group and there was significant difference between moderate and sever group but in the post test occasion there was no significant difference between mean of gross motor function in moderate and mild group and the mean of gross motor function in moderate group was significantly higher than severe group .The most changes in gross motor function were seen in level 3 and 4.

Conclusion: The highest increase in gross motor function after occupational therapy services was obtained by children in level 3 of gross motor classification system.

Objective: To determine the cross-cultural validation and test-retest and inter-rater reliability of the Persian translation of Parent version of the Gross Motor Function Classification System (GMFCS) for children with cerebral palsy (CP).

Materials & Methods: 90 Children (2 to 12 years, mean age 6.6 years 57boys, 33girls) with various types of CP were classified according to GMFCS by parents.After the forward and backward translation procedures, face and content validity and test–retest reliability between parents and inter-rater reliability between parents and therapists was assessed using the intra-class correlation coefficient (ICC) and the weighted kappa coefficient.

Results: The ICC was 0.92 and showedexcellent agreement and the weighted kappa coefficient was 0.61 andshowed good agreement. The inter-rater reliability was also high the ICC was 0.88 with excellent agreement and the weighted kappa coefficient was 0.68 and with good agreement.

Conclusion: The Persian translation of Parent version of GMFCS is found to be valid and reliable, and is suggested to be appropriate for the assessment of gross motor function within the Iranian population.

Today, there are several interpretations by therapists about the concept, implementation, and training aspects of handling of children with cerebral palsy (CP). This has created conflicts and differences in teaching handling for parents and caregivers. Moreover, handling is not clearly defined in the theoretical frameworks underlying occupational therapy (OT). Therefore, the main aim of this study was to provide an overview on handling in the children with CP.

This study was a two- stage review of the national and international databases between 1990 and 2012. Out of the 2657 articles Obtained, we have studied 50 relevant full texts related to the topic. Based on the exploration articles and documents, There are several different definitions about handling. It seems that, handling is a special care of children with CP in the occupational performance area and in the domains of self-care, mobility, and social function. Doing proper handling activities, not only is essential to improve the child health but also for parents. All sections of handling are placed on the activity and participation domain of ICF-CY in the domestic life chapter. Although, handling is the main component in the OT, there is no precise and comprehensive definition of the concept yet, and activities related to the handling and its position in the OT has not been clarified.

Objective: Present study compares relationship between motor performance, sustained attention and impulse control in children with Attention Deficit Hyperactivity Disorder and normal children.

Materials & Methods: In this descriptive-analytic study, 21 boys with ADHD and 21 normal boys in the age range of 7- 10 years old were participated. Motor performance by using Bruininks Oseretsky Test of Motor Proficiency and sustained attention and impulse control by using Continuous Performance Test were evaluated.

Results: Analysis by T-Test and Mann-Whitney revealed significant difference between ADHD group and normal group in gross, fine and battery motor performance also sustained attention and impulse control (P<0.0001). Analysis by Z-Fisher test indicated no significant difference between Correlation Coefficient of inattention and gross motor performance in two groups (P=0.276) but significant difference between Correlation Coefficient of inattention and fine (P<0.0001) and battery (P<0.0001) motor performance were shown. Correlation Coefficient impulsivity and gross (P=0.379), fine (P=0.92) and battery (P=0.562) motor performance shown no significant difference between two groups.

Conclusion: According to study results there was a positive relation between sustained attention and impulse control and most of motor performance in both groups. Therefore these findings help Occupational Therapist to determine rehabilitation priorities and to use exact strategies in order to enhance motor performance in children.

Objective: Case report Impact of Botulinum Toxin injection on function of affected upper extremity in a patient after 16 years since stroke (CVA). Botulinum toxin injection is one the treatments in spasticity reduction and consequently in recovery of upper limb function in stroke patients. The purpose of this case study is to report the effect of Botulinum toxin injection on upper extremity function after 16 years of stroke.

Materials & Methods: The patient was a 63-year-old man who has had a cerebrovascular accident that happened in the left hemisphere about 16 years ago, and as a result, a paresis in dominant hand and arm. Although the patient was able to perform simple movements but he was complaining about the slowness and stiffness in the movements. To treat spasticity the Botulinum toxin type A was used. Injection into selected muscles of hemiparetic upper limb was done by a specialist physician and was between 50-150IU based on specific volume of each muscle. After injection, the patient was monitored for 3 months and at the end of each month, the assessments were reevaluated. During this period, although research team suggested the patient to continue the rehabilitation but for personal reasons he didn’t participate in any treatment and didn`t receive any other antispasmodic medications.

Results: An increase in range of motion was seen in all joints but this improvement was not significant. The greatest improvement in passive and active range of motion was seen in Metacarpophalengeal joints. At the end of each month, compared to the first month the recovery of function in upper extremity was significant. Maximum recovery of upper extremity function was related to the hand section of fugl-meyer assessment. At the end of the first month, spasticity significantly decreased so that the patient was able to extend all his joints more easily than before injection. Although spasticity never reached zero.

Conclusion: Botulinum toxin injection even after 16 years of stroke may improve the function of upper extremity.

Objective: The aim of this study was to evaluate different aspects of validity and reliability of the Persian-version of Fatigue Severity Scale (FSS-P) among people with Multiple Sclerosis.

Materials & Methods: A sample of 50 people with Multiple Sclerosis and 30 healthy adults were included in this study. The participants were recruited from Sina clinic in Tehran between 2001 to 2007. The Fatigue Severity Scale (FSS) includes nine items developed to measure disabling fatigue and a Visual Analog Scale (VAS) to measure overall fatigue. All participants were asked to complete FSS and Short-form 36 Health Survey (SF-36) questionnaires. Test-retest reliability and Internal Consistency were assessed, using Intraclass Correlation Coefficient (ICC) and Cronbach's alpha, respectively. Dimensionality was assessed, using item-scale correlation after correction for overlap and convergent validity, using a priori hypothesized correlations with the SF-36.

Results: All the participants found the FSS-P to be clear and unambiguous in pilot testing. The ICC was reported 0.93 for the total score and 0.88 for VAS, The Cronbach's alpha was reported 0.96. The total score and the VAS were significantly correlated with the SF-36 vitality subscale (r=-0.69 and r=-0.73 respectively). Correlations with other SF-36 subscales were at moderate level (r=-0.43 to r=-0.65, all P<0.001).

Conclusion: Since this is the first study to translate and scale equivalent to "fatigue severity scale" in Farsi in Iran, the main features of the scale and reliability of Persian version of "fatigue severity scale" was determined and assess the validity of the study in terms of facilities and access to the sample and a preliminary report in order to design more and more research was in order next. The results of the study revealed that the FSS-P is an appropriate psychometric instrument to assess the people with Multiple Sclerosis.

Objective: Cerebral palsy is one of the most common causes of physical disability in childhood that leads to various difficulties and reduces the level of independence and participation in activities of daily living. The aim of this study was to investigate the effects of Occupational Therapy Home Program on activities of daily living of 5–12 year-old children.

Materials & Methods: In this clinical trial, 48 children were selected and randomly divided into the intervention and control groups. Common practices of occupational therapy were applied for a period of 4 months for both groups. In addition, the intervention group received the Occupational Therapy Home Program in the form of workshops and educational pamphlets with telephone follow-ups. The Activities Scale for Kids (ASK) was used to assess activities of daily living, and independent t-test, chi-square test, Fisher exact test and covariance analysis were used to analyze the results.

Results: There was significant difference in activities of daily living between the two groups (P=0.001). There were significant differences in all subtests of the activities of daily living (P<0.05), except the play subtest (P>0.05).

Conclusion: Occupational Therapy Home Program increased activities of daily living of children with cerebral palsy and can be considered useful in addition to common occupational therapy programs.

Objective: In some reviewed studies on children with dyslexia it is observed that there is a significant relationship between the ability of postural control and dyslexia. In this study, by controlling the interfering factors, we have reviewed this relation by comparing postural control and balance ability in normal and dyslexic children.

Materials & Methods: This case-control study is done on 19 boys with dyslexia (112.90±13.78) and 19 Normal boys (118.42±15.62). Normal children and children with dyslexia were matched in age, height and weight. Positioning duties included standing with adjacent feet on firm surface with open and closed eyes, and with close eyes on the foam and with internal perturbation on firm surface. Duration of each assignment was 35 seconds and the force plate device was used to evaluate the condition performance. Balances component of Bruininks Oseretsky test were take from all of the samples and correlation between functional and laboratory test were examined.

Results: The results showed that the area on firm surface with open eyes, internal perturbation dependency rate in the standard deviations of the lateral body sways (SDX) and of the antero-posterior body sways (SDY) and the surface area, there were significant differences between normal and dyslexic children, but there was not any significant difference between the two groups in path length and mean velocity in different postural control modes (foam, firm surface, open and close eyes) and visual dependence in all parameters (path length, velocity and surface area). We did not find significant correlation between Center of Pressure (COP) and the balance part of Bruininks Oseretsky test in children with dyslexia.

Conclusion: In spite of differences in some postural control parameters between normal group and children with dyslexia, it was not found significant relationship between postural control and dyslexia.

Objective: One of the most prevalent sensory problems in cerebral palsy is Astereognosis which has special importance in daily manual functions. The purpose of this study was to determine the level of hand stereognosis using common objects and geometric shapes in children with spastic hemiplegia and diplegia.

Materials & Methods: In this cross sectional study, 20 children with cerebral palsy between 3-6 years old (9 males, 11 females) with mean age (hemiplegya: 55months, diplegya: 57months) were selected through nonrandomized convinience sampling referd to Occupational Therapy centers of Shahid Beheshti University of Medical Sciences. Stereognosis was evaluated using geometric shapes (square, circle, rectangular, triangle) and common objects (pencil, key, coin, nail, teaspoon and screw) and test special board. The data were analyzed by Mixed Analysis of Variance and Regression statistical tests.

Results: There was no significant regression between common objects stereognosis score and age in hemiplegic childrenbut this regression was significant for stereognosis score of geometric shapes (P=0.027). There was no significant regression between stereognosis score of common objects and geometric shapes in diplegic children. The Main effects of gender was not significant in stereognosis of children with spastic hemiplegia and diplegia, also main effects of hand were not significant in two groups.

Conclusion: There was no significant difference between stereognosis of affected and unaffected hand in hemiplegic childrenand between right and left hands in diplegic children. Also There was no significant regression between age and stereognosis score of geometric shapes in diplegic children .

Objective: Effectiveness of Constraint Induced Movement Therapy (CIMT) has been approved in adult persons, while it seems that we need many researches with higher levels of evidences in children. This research aimed to identify the efficacy of CIMT on unimanual and bimanual functions in children with Cerebral Palsy.

Materials & Methods: In this interventional study, twenty eight participants were selected that had the inclusion and exclusion criteria and then divided into two groups ofCIMT and control. The intervention was provided on 10 out of 12 consecutive days in CIMT group and another group was received occupational therapy services. Assessment tools which were utilized in the survey were Bruininks-Oseretsky Motor Proficiency Test, Caregiver Functional Use Survey (CFUS), Jebsen-Taylor Test in Hand Function. In order to compare two groups Independent t-test was used and to compare each group from pre-test to post-test paired t-test was utilized.

Results: Data showed significant differences between two groups in dexterity, bilateral coordination, bimanual coordination, bimanual function, unimanual function and Caregiver Functional Use Survey (how well & how frequently) (P<0.05). Also comparison between pre-test and post-test in each group showed improvement in most of variables in research.

Conclusion: protocol of child friendly Constraint Induced Movement Therapywas lead to improvement in either unimanual or bimanual hand functions in children with cerebral palsy.