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Showing 15 results for Dehghan

Ali Dehghan-Ahmadabad, Nahid Baharlouei,
Volume 6, Issue 1 (Spring 2005)
Abstract

Objective: Phonological Awareness (PA) is a extra linguistic skill and defined as individual awareness of constituent’s sounds of the word . This skill is a prerequisites of learning to Read. Many researchers suggested reciprocal relation between PA and Reading. This research determined level of PA-fundamental ability of reading-in normal first grade femal students of Isfahan & shahinshar to compare two current method of Reading that are used in educational system of Iran.

Materials & Methods: The method used in this research is cross-sectional, descriptive-analytic and was done by 106 first grade female students who were normal and selected randomly in Isfahan & shahinshar cities. 51 students had teached by phonetic method and rest of them had teached by whole word method. The selection way of children was: this children had not any articulation, vision, reading, learning and cranial nerve disorders and this children investigated by Phonological Awareness test. scores of children by test calculated and this scores analyzed by t-test in Spss software.

Results: The mean score of phonological awareness in phonetic method was 51.98 and in whole word method was 57.46. There was a significant differences between them in their scores (P=0.047). In addition,within subtests of phonological awareness task,mean score of first phoneme omission in whole word method was 4.84 and in phonetic method was 3.33. There was a significant difference between them in their scores (P=0.001). In the rest of subtests was no significant difference between them.

Conclusion: Based on this study, a significant correlation could be found in Phonological Awareness between both group and in other hand, there was a significant correlation between scores of first phoneme omission in both groups (Whole word and Phonetic method).Based on importance of phonological awareness as a predictor of reading, we suggest more research in this outline must be done.


Hamid Dalvand, Leila Dehghan, Avat Feyzi, Souzan Amirsalari,
Volume 9, Issue 1 (Spring 2008)
Abstract

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<0/001). There was significant difference in total function of activity of daily living between three groups after treatment (P<0/001). The most effective approach was conductive education (CE), then education to parent and Bobath There were significant relations between function difference of three groups in 13 sub tasks of 17 ADL subtasks (P<0/05).

Conclusion: Bobath, conductive education (CE) and education to parent’s approaches improve skills of activity of daily living, but in CE approach, group educations causes better improvement in social communication and practical educations and programs increase improvement of ADL skills.


Mehdi Dehghan, Fariba Yadegari, Tahereh Sima-Shirazi, Anoushirvan Kazem-Nezhad,
Volume 9, Issue 3 (Autumn & Winter 2008)
Abstract

Objective: Considering the fact that children with Down Syndrome have a severe delay in language development which does not appear being improved by language therapy leaning on auditory modality, this research was aimed to compare the traditional educational method and reading method effects on receptive and expressive language of 4 – 10 years old Down Syndrome children with 40 – 60 I.Q scores.

Materials & Methods: In this quasi experimental and interventional research from Navide Asr Rehabilitation clinic in Tehran, Rezvan Rehabilitation clinic in Shahriar, Ehsan Rehabilitation clinic in Karaj and Down Syndrome Association of Karaj, 20 Down Syndrome children were selected by simple and convenient sampling from 96 Down Syndrome children and were allocated into two groups by balanced randomized method. The first group was educated by whole word reading method and the other group was educated by traditional method. Both groups had three 15-minute educational sessions per week for a period of 6-month. Languages of both groups have been examined by TOLD- P: 3 test as pre and post-test. The results were analyzed by statistical tests including Kolmogoroff - Smironoff (K-S), Independent-T-Test and Paired-T-Test.

Results: Independent-T-Test in both groups revealed no significant differences before education in receptive (P=0.452), expressive (P=0.1) and speech (P=0.428) Language, but after intervention period, the groups have significant statistical differences in all language portions such as receptive (P=0.043), expressive (P<0.001) and Speech (P<0.001).

Conclusion: Reading education has more effects on receptive and expressive language in children with Down syndrome than the other educational methods (traditional ones). Thus it seems that focusing on behavioral and cognitive phenotype of Down syndrome with emphasis on visual modality facilitates language development more than auditory modality, and aptitude training may have the best effects.


Hamid Dalvand, Leila Dehghan, Awat Feizy, Seyed Ali Hosseini,
Volume 11, Issue 0 (Special Issue: Pediatric Neurorehabilitation 2011)
Abstract

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.


Hamid ِdelavand, Leyla Dehghan, Seyyed Ali Hoseini,
Volume 11, Issue 1 (Spring 2010)
Abstract

Objective: This study was aimed to determine a long-term effect of the Bobath approach (6 years) using modern tools on a child with hemiplegia.

Materials & Methods: This research is a single case study design and performed on a spastic hemiplegic child. Bobath general assessment was used for evaluating of the quality of the gross motor function and Gross Motor Function Measure tool – 66 was used for quantitative evaluation of the gross motor function. Therapeutic interventions, based on Bobath approach were done for 6 years, in every age level commensurate with their child age once a week.

Results: After therapeutic intervention, based on Gross Motor Function Classification System, the child developed from level II to I. At the entrance to the occupational therapy session, based on general assessment, the major problems included hypertonia, muscle stiffness, lack of doing various movements and disassociation movement patterns abnormal in trunk, upper and lower extremities ,and hyper lordosis and scoliosis in her left side. Also she could assume sitting, rolling from left to right and creeping. In the sixth year, she acquired walking, jumping, fast running in out door, hopping and stepping up and down alternatively. In assessing with GMFM- 66, at the beginning of intervention the score was 46/09 and the end of sixth year was 79/99.

Conclusion: Bobath treatment programs that planned based on the précis assessment, can prevent of abnormal patterns of movement and as much as possible client abilities to be close to base of natural development.


Farideh Dehghan-Manshadi, Roxana Bazaz-Behbahani, Khosrow Khademi, Maryam Rahmani, Tahereh Eftekhar,
Volume 14, Issue 4 (Winter 2014)
Abstract

Objective: Urinary Incontinence (UI) as a common lower urinary tract dysfunction , results from Pelvic Floor Muscle's (PFM) underactivity.Because of co-activation of PFM and the Lateral Abdominal Wall Muscles (LAWM), this study was aimed to investigate the changes in the ultrasonic thickness of the LAWM in response to PFM contraction in stress urinary incontinent (SUI)women with and without Chronic Low Back Pain (CLBP).

Materials & Methods: A total of 28 women, 10 healthy, 18 SUI with and without CLBP (9 in each group) participated in this quasi-experimental study. After collecting demographic information and assessment of PFM function, changes in ultrasonic thickness of right LAWM were measured in response to PFM contraction. One way ANOVA, Kruskal-Wallis and Pearson’s correlation tests were performed to analyze the data. Values of P<0.05 were considered statistically significant.

Results: No significant difference was found in thickness of the LAWM while PFM were at rest (P>0.05). There was a significant increase in thickness of the Traversus Abdominis Muscle (TrA) during PFM contraction in control group comparing experimental groups (P=0.03). Women in control group showed significantly higher PFM strength and more intravaginal pressure (P=0.001).

Conclusion: Changes in ultrasonic thickness of the TrA during PFM contraction revealed disturbance of co-activation of the LAWM and the PFM in women with and without SUI CLBP.


Leila Dehghan, Hamid Dalvand, Abbas Pourshahbaz, Seyyed Ali Samadi,
Volume 15, Issue 1 (Spring 2014)
Abstract

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.


Farideh Dehghan-Manshadi, Elaheh Miri-Ashtiani, Mohammad Mohsen Roustaei, Zinat Ghanbari, Ali Reza Akbarzadeh-Baghban,
Volume 15, Issue 2 (Summer 2014)
Abstract

Objective: Chronic Pelvic Pain (CPP), a common health problem in women, characterized by any lower abdominal pain that lasted at least six months or more, with no relation to pregnancy, menstruation and intercourse. The pain can affects on activities of daily living negatively and lead to medical or even surgical treatment. According to our knowledge, there are limited studies related to CPP in Iran. Therefore, present study was aimed to survey on CPP in women attending Pelvic Floor Clinic at the Imam Khomeini University Hospital.

Materials & Methods: This cross-sectional study was conducted on 516 married women (who were not virgin). Participants completed a designed questionnaire, which included demographic information and questions regarding involvement of gynecologic, urinary, gastrointestinal, musculo - skeletal and psychological systems. After collecting data, binary logistic regression was used to analysis the data. Values of p<0.05 were considered to be significant.

Results: 27/9% of women reported current pain in the pelvic area unrelated to menstruation and sexual intercourse, while totally 17/6% suffered from pain over the past 6-12 months or CPP .There were a significant relationship between CPP, chronic low back pain and dyspareunia (p=0.04 and p=0.03 respectively). Our data did not show significant difference between the prevalence of CPP, types of delivery and history of having trauma to the spine and pelvis.

Conclusion: This comprehensive study provided an extensive and multidimensional approach regarding to CPP in our society. As for to estimation 27.9% pelvic pain and 17.6% CPP and their relationship with gynecological, urinary, musculoskeletal and gastrointestinal systems, we suggest doing more population-based epidemiological studies ,also emphasis on multidisciplinary approach for managing these patients.


Fatemeh Sangtarash, Farideh Dehghan-Manshadi, Ali Reza Sadeghi, Seyyed Mehdi Tabatabaei,
Volume 15, Issue 2 (Summer 2014)
Abstract

Objective: Accurate measurement of thoracic kyphosis has high value in the evaluation of patients with spinal kyphosis and in assessing the effectiveness of different treatment methods. Recently, Dual Digital Inclinometer (DDI) has introduced as a non-invasive tool that can measure the kyphosis angle. According to available information there is only one published study regarding the validity and reliability of this instrument in our country. Therefore, this study aimed to evaluate the Validity and reproducibility of DDI in measuring thoracic kyphosis in women over 45 years.

Materials & Methods: In this methodological study, thorasic kyphosis was measured by DDI device three times on 20 women aged 45-70 years. The first two measurements were taken with an hour apart in same day to assess the within- day and the third measurement was taken one day later to assess the between-days reproducibility. Finally, the validity of obtained values of thorasic khyphosis by DDI compared with Cobb angle which measured by the same examiner on radiological films. ICC correlation coefficient test with 95% confidence intervals was used for data analysis.

Results: The validity of values obtained by DDI compared to the Cobb angle, as a gold standard, was high (ICC=0.86). Within-day and between-days thorasic kyphosis measurements using DDI were shown to be reproducible with high ICC values. (0.95 for within-day and 0.93 for between days respectively).

Conclusion: According to the present study, the DDI is a valid and reproducible tool for non-invasive measurement of thoracic kyphosis in women over 45 years.


Fatemeh Dehghani, Hassan Saeedi,
Volume 15, Issue 4 (Winter 2015)
Abstract

Objective: Flexible flat foot is one the most common extremities diseases happen among adults, this causes change in foot, tibia, and higher joints alignment, pain and certain complications in upper joints and soft tissues. This study aimed to investigate differences in foot direction among patients with flexible flat feet as so called foot static response to a certain prefabricated insole.

Materials & Methods: It was a quasi-experimental study and patients were consisted of 32 female with flat feet in range of 18 to 28 years old and to measure differences a laser device was used. The rear foot angle amount which is calculated by investigating the heel valgus angle and the forefoot angle amount which is calculated by investigating leg angle and forefoot, both assessed at barefoot condition and with medial flange insole mode.

Results: Results showed that by using the insole there is a significant decrease in direction of anterior line angle (P=0.003). At mean, by using medial flange insole 3.5 degrees decrease at forefoot angle and 2.5 degrees decrease at heel angle was observed (P=0.001).

Conclusion: This study showed that the prefabricated insole with high internal septum could normalize the direction of foot. Namely, it corrected the heel angle and leg deviations. Moreover, the NAS line despite of specifying the leg changes, it represents the influence of orthoses on this section.


Hamid Dalvand, Seyyed Ali Hosseini, Leila Dehghan, Avat Feizi,
Volume 16, Issue 2 (Summer 2015)
Abstract

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<0/01) and Mental component summary (MCS) of SF36 (P<0/01) in mothers of children with SB in Hoffer levels. The significant difference in PCS and MCS of SF36, was related to the level I with the other levels of Hoffer criteria, there were no Significant difference in mean score for the PCS and MCS the QOL of mothers for sex and child's age levels (P<0/05). There were a significant differences in mean PCS and MCS a QOL of mothers in different types of SB (P<0/01). This significant difference was related to aculta with meningocele and myelomeningocele (P<0/01).

Conclusion: The dimensions of PCS and MCS of SF36 of mother with SB were affected with types of SB and increasing the levels of Hoffer. In conclusion, Mothers of children with SB require paying attention to their QOL during treatment of the child. In addition, the services should be created to support the physical and psychological aspects of the QOL.


Hamid Dalvand, Leila Dehghan, Abdolreza Yavari, Azadeh Riyahi, Akram Valizadeh,
Volume 17, Issue 3 (Autumn 2016)
Abstract

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<0.05).
Conclusion The results showed that the highest priority of needs of mothering handling training was self-care, feeding, toileting, and functional mobility. However, the needs of mothering handling training enhanced with increasing severity of fine motor function lesions and age. The simultaneous relationships between age and MACS levels in children with CP have no effect on the priorities of mothering handling training. Organized training of families and caregivers about needs of mothering handling training and proper care of their children are facilitating steps in promoting the education of mothers of children with CP. It seems that the understanding and education of mothering handling for therapists responsible for managing children with CP and the education of their parents can open the way to effective caring and treatment.


Mansoureh Karimzadeh, Ali Reza Baneshi, Mahnaz Dehghan Tezerjani, Zeynab Tayyebi Sough,
Volume 19, Issue 2 (Summer 2018)
Abstract

Objective According to the Diagnostic and Statistical Manual of Psychiatric Disorders-Fifth Edition, Autism Spectrum Disorders (ASDs) are neurodevelopmental disorders associated with persistent defects in social communication and interactions, patterns, interests, behaviors, and repetitive and limited activities. In other words, ASDs are a lifelong condition characterized by widespread problems in social interaction and communication, stereotypical behaviors and limited interests. The early diagnosis of ASD can lead to early intervention and improvement of developmental outcomes. Parental screening tools are the ideal tools for the timely detection of ASD because they provide diagnostic information from the person familiar with the child and are easy to perform and score. This study aimed to standardize the Pervasive Developmental Disorder Screening Test (PDDST), which screens these disorders at an early age (12 to 48 months). This test consists of 36 questions that are answered as “Yes-No.”
Materials & Methods The population of this descriptive study included all children aged below 8 years with neurodevelopmental disorders and normal children of the same age group in Tehran. In relation to autistic children, the criteria for diagnosis were the persistent impairment of social communication and social interactions in different situations, and patterns of behavior and limited repetitive activities as assessed by a specialist and a psychiatrist. In relation to normal children, the inclusion criteria were the lack of these problems. Thus, a total of 252 children, i.e., 205 children with neurodevelopmental disorders (autism 135 and intellectual disability 70) and 47 normal children (to determine discriminant validity), were included as the sample for this study. Among them, 97 were girls and 157 were boys. The parents of the participants responded to screening tests within 10 minutes at the psychiatric clinics and hospitals in Tehran. The test validity through content by experts and the differential method with variance analysis technique, which shows the significance of the difference between the three groups of participants in the score obtained from the test, and the validity was calculated through the coefficient of internal consistency of Kuder–Richardson 20. Two criteria of validity (sensitivity and specificity) were used to determine the cutting point. Data analysis was performed using the SPSS V. 21 software.
Results The content validity of the test was confirmed according to the experts’ judgments. The results of discriminant validity revealed that there is a significant difference between groups (P=0.001). It was also found that the means of normal, intellectual disability, and autistic groups are, respectively, from the lowest to the highest. The reliability of the test was 0.73. The sensitivity of the child’s screening for ASD is indicative of the accuracy of the screening of a child without ASD. The results of this study showed that the PDDST-II screening test for both sensitivity and specificity indices were in a favorable situation and could correctly identify children with autism and children without autistic dysfunction. The two sensitivity and specificity indicators in the score of 5 reached their highest, so the cut-off point for the test was scored at 5 and more. 
Conclusion The results of this study showed that the psychometric properties of the PDDST-II screening test are suitable for discriminating between children with ASD and those with other developmental disorders such as mental retardation and normal children. This test also had a good reliability coefficient and is suitable for diagnosing children with ASD.


Mohamad Sharifpoor, Mehdi Dehghan, Shima Matloubi, Soraya Khafri,
Volume 21, Issue 2 (Summer 2020)
Abstract

Objective: One of the parameters showing the correct phonetic and phonological development is the correct and clear articulation of vowels is achieved by changing the shape of vocal cords through altering the height and position of the tongue and the movement of the lips and jaw. The tongue’s height and position are the basis of the production and difference of vowels. In other words, the raw sound produced by vocal cords, which has a base frequency, changes and intensifies according to the displacement of organs and vocal tract cavities which makes harmonies from the base sound called formats. These intensified harmonies depend on the shape, size, and material of the cavities, and can affect a person’s speech clarity and, consequently, the listeners’ perception. Due to such effects and the significant role of vowels space and formants on communicative aspects in each language, they are considered as one of the most important acoustic characteristics of any spoken language. Therefore, determining a scale as a tool to assess vowel errors and speech disorders is necessary. This study aimed to investigate vowel space and formant structure of Mazani language in adults.
Materials & Methods: This descriptive-analytical study with a cross-sectional design was conducted on 60 adults (30 males and 30 females) with Mazani language aged 18-40 years who were selected randomly and based on the inclusion and exclusion criteria (no history of respiratory diseases, verbal and auditory disorders and having at least 5 years of experience in living in Babol county. After producing the vowels by participants, the first, second, and third formants (F1, F2, and F3) of all 6 vowels were obtained in PRAAT v.6.0 program, and analyzed finally using independent t-test in SPSS v. 18 software.
Results: In men, the highest mean value for the base frequency was related to the vowels /i/ and /u/ (136 Hz), and for F1, F2, and F3, it was related to the vowels /æ/ (646 Hz), /i/ (2182 Hz), and /i/ (2888 Hz), respectively. On the other hand, their lowest mean values were related to the vowels /a/ (124 Hz), /i/ (283 Hz), /a/ (1150 Hz), and /e/ (2629 Hz), respectively. In women, the highest mean values of base frequency, F1, F2 and F3 were related to the vowels /u/ (222 Hz), /æ/ (828 Hz), /i/ (2346 Hz), and /i/ (3151 Hz), while the lowest mean values were related to the vowels /æ/ and /e/ (202 Hz), /i/ (364 Hz), /a/ (1167 Hz), and /o/ (2775 Hz), respectively.
Conclusion: There was difference in formants and vowel space between men and women with Mazani language. The /a/ was the lowest pitch vowel and /i/ and /u/ were the highest pitch the vowels in men, while /æ/ and /e/ were the lowest pitch vowels and /u/ was the highest pitch vowel in women. Furthermore, the most open, closed, backward and forward vowels were /æ/, /i/, /i/ and /a/, respectively. The /e/ in men and /o/ in women were the most rounded vowels, while the /i/ in both genders was the most unrounded vowel. The results are somewhat different from the results of studies conducted on the production of vowels in standard Persian language. Since the speech clarity and fluency can be affected by the incorrect production of vowels, the results of this study can be used to evaluate and diagnose speech disorders in Mazani language for clinical and research purposes.

Fereshteh Poursaeed, Nahid Tahan, Farideh Dehghan Manshadi, Ali Reza Akbarzade Bagheban,
Volume 22, Issue 1 (Spring 2021)
Abstract

Objective: Spasticity is one of the components of an Upper Motor Neuron (UMN) lesion that occurs usually after a period of flaccidity in the form of velocity-dependent resistance to passive stretch. Spasticity is a significant cause of limited mobility and disability in neurological diseases. There are several clinical approaches to control spasticity. Recently, Shock Wave Therapy (SWT) has been reported to be a new, safe, and effective method for reducing spasticity for people with upper motor neuron lesions. We conducted a meta-analysis of relevant clinical trials to assess the effect of applying SWT on spasticity in UMN lesions. 
Materials & Methods: An electronic search was performed in PubMed, ISI Web of Science, Scopus, Science Direct, MEDLINE, and Google scholar from January 2005 to January 2020. Studies were included if they measured spasticity with the Modified Ashworth Scale (MAS) or/and neurophysiological indices in patients with stroke, multiple sclerosis, and cerebral palsy. The keywords of muscle hypertonia or spasticity, extracorporeal shock wave therapy, stroke, multiple sclerosis, and cerebral palsy were used. Two independent researchers searched articles, screened eligible studies against the inclusion criteria, and assessed the methodological quality of included studies. The methodological quality of studies was evaluated using the Downs and Black tool. The difference between the means was considered as the effect size in the MAS and Hoffman reflex/motor response (H/M) ratio before and after the intervention with 95% CI in random-effects models. Analyzes were performed using STATA software version 11.
Results: The initial search led to the retrieval of 98 studies based on the inclusion and exclusion criteria, of which 24 full-text articles were reviewed and 14 articles were included in the meta-analysis process. All 14 articles had examined the effects of shockwave on the MAS. Four studies with 120 patients had examined the effects of shockwave therapy on the H/M ratio. Significant reduction in MAS grade was observed immediately [I2 = 100%, P<0.001, SMD=1.38 with 95%CI: (0.80, 1.87)] and three months after SWT [I2 = 100%, P<0.001, SMD=1.13 with 95%CI: (0.50, 1.76)] in comparison with the baseline values. ESWT had no significant effects on the H/M ratio [I2 = 97.5%, P<0.001, SMD=1.09 with 95%CI: (-0.54, 2.73)].
Conclusion: SWT can improve spasticity based on the MAS. The lack of SWT effects on the neurophysiological parameter of spasticity supports this opinion that SWT acts on the non-neural component of spasticity. Differences observed in studies in terms of treatment sessions, intervals of treatment sessions, energy density, number of shocks, and follow-up duration need to be examined more closely. More randomized clinical trials are needed in the future to analyze the impact of these factors on the efficacy of SWT for spastic patients.

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