Objective: Cerebral palsy (CP) is a non-progressive disorder and abnormality of the developing brain and it remains one of the main and prevalent causes of childhood developmental disorder. This study was carried out in order to recognize the types and associated disorders of children with cerebral palsy.
Materials & Methods: This study was conducted on one to six years old children with cerebral palsy in eastern and northern districts of Tehran and the European classification of cerebral palsy was used for classification. Participants were evaluated by medical and rehabilitation team and associated disorders were classified based on symptoms such as epilepsy, speech and language disorder, visual problems, hearing disorders, and cognitive developmental delay.
Results: In this study, 112 children with cerebral palsy participated. The mean age was 33.3 months for boys and 24.8 months for girls. The prevalence of cerebral palsy were 36.6% in children with unilateral - spastic cerebral palsy 43.7% in bilateral–spastic (diplegia in 31.2%, and quadriplegia in 12.5%), 13.4% in ataxia and 4.5% in dyskinesia. Speech and language disorders were observed in 33%, epilepsy in 30.4%, strabismus in 16.1%, hearing loss in 8%, and mental retardation in 7.1% of participants.
Conclusion: In this study, unilateral - spastic cerebral palsy was found as the most common type. Therefore, more evaluation to determine the about etiology of this type of cerebral palsy in our population is necessary.
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.
Objective Cerebral palsy is an example of a physical disorder that causes multiple impairments that affect function and physical performance. Hemiplegia is a physical impairment that can occur in childhood. One of the most disabling symptoms of hemiplegia is unilaterally impaired hand and arm function. Treatment options include physical therapy, occupational therapy, conductive education, neurodevelopmental therapy, peripheral splinting and casting, pharmacotherapy (e.g., botulinum toxin type A), and surgery. There is little evidence of successful treatment with any of these approaches. Thus, the study aimed at evaluating and determining the effective rehabilitation approaches on upper limb function of children with hemiplegia.
Materials & Methods A literature review was carried out. All evidences that were located in the first, second and third levels of evidence based on evidence-based practice classification and have explored the effect of any form of forced use, constraint induced movement therapy, hand-arm bimanual intensive therapy, and traditional treatments were included in this review. Patients with hemiplegic cerebral palsy and aged between 0-19 years and the researches on the treatment of the upper limbs were included in the study.
Results In this literature review, 19 articles were gathered from certain databases such as PubMed, Cochrane Library, Scopus, MeSH, and Index Medicus with key words like hemiplegic cerebral palsy, types of treatment approach, and upper limb dysfunction. Twelve articles in first level, six in second level, and one in third level were included in this study; most of these included articles were on the constraint-induced movement therapy.
Conclusion Based on the positive results of all these studies, constraint-induced therapy, forced use and hand-arm bimanual intensive therapy seemed to show effectiveness as interventions to improve involved hand and arm function in children with hemiplegia. Nevertheless, we needed to conduct researches with level 1 of evidence for each of the above treatment methods, particularly hand-arm bimanual intensive therapy for use in medical centers. Forced use was started with animal studies and then was continued on human studies of stroke patients and eventually expanded to children with hemiplegic cerebral palsy. Further research based on principles of motor learning and neuroplasticity promoted the use of forced use and developed constraint-induced movement therapy. Finally, the hand-arm bimanual intensive therapy was developed to remove constraints and difficulties of intervention in constraint induced movement therapy. Each of these interventions may be useful for hemiplegia. Comparative studies between these interventions are suggested to study their effects on the target behaviors.
Objective: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects the person’ life. The prevalence of ASD in Iran is increasing. The complicated nature of this disorder disrupts the balance and work routines in the family, which puts a lot of stress on the entire family, especially mothers. Mental health of the mother affects all family members, including a child with ASD. On the other hand, mothers’ confusion and failure in relation to their ASD child causes more stress and discomfort for them. In this study, we aimed to investigate the effect of filial therapy, as a play therapy, on the parenting stress of mothers with ASD children.
Materials & Methods: In this experimental study, participants were the mothers of 32 children with ASD (9 girls and 23 boys) aged 4-12 years referred to autism centers and occupational therapy clinics in Isfahan, Iran who were selected using a convenience sampling method. After obtaining an ethical approval from the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (code: IR.USWR.REC.1396.97), and necessary permissions, researchers referred to the clinics and after explaining the purpose of the study to the mothers, an informed consent was obtained from them. Then, they completed a demographic form, Gilliam Autism Rating Scale-2 (GARS-2), and Abidin’s Parenting Stress Index-Short Form (PSI-SF). Participants were randomly divided into two intervention and control groups after matching for the child’s age, GARS score, and the education of children and mothers. The intervention group received 10 sessions of filial therapy, once a week, each for two hours, while the control group continued routine treatment. After intervention, PSI-SF was completed by all mothers again. The collected data were analyzed by using ANCOVA, paired t-test and independent t-test. Shapiro-Wilk test was used to determine the normality of PSI-SF data distribution at Pre-test and Post-test phases.
Results: Paired t-test results showed that there was no statistically significant difference in the mean total parenting stress score between the two groups in the Pre-test phase (P= 0.679) but it was significant in the Post-test phase (P=0.010). The results of independent t-test showed that the difference between the mean Pre-test and Post-test scores of total parenting stress in the control group was not significant (P= 0.268) but it was significant in the intervention group (P=0.001). ANCOVA results showed that the Pre-test score of parenting stress had an effect on the total parenting stress score after intervention such that it could explain 82% of variations in this variable. After controlling the Pre-test score, the total parenting stress was significantly different in two groups (P=0.001). Eta squared value indicated that the intervention could explain 54% of changes in total parenting stress of mothers.
Conclusion: Filial therapy can help better acceptance of the ASD children by their parents and reduce parenting stress by improving child-parent relationships. This method can be taught as a complementary intervention to the mothers of ASD children.
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