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Showing 26 results for Multiple Sclerosis

Homeira Sajjadi,
Volume 1, Issue 3 (1-2001)
Abstract

Objective: Multiple Sclerosis (M.S.) is a chronic disease which most commonly involves females. Prevalence of disease begins from adolescent, gradually increases until 35 years old and then decreases. Its geographical distribution is non homogen and prevalence changes from 5/100000 to 250/100000. Iran is a low incident region with prevalence of 5/100000 or at least 3000 patients.

Materials & Methods: This research has been done on 187 patients who admitted in Tehran university centers in 1998.

Results: Results show that 63.3% of patients were female and most of them were married. The average age at beginning was 28y.

Conclusion: Manifestation of disease were: Extremity weakness (44.2%), vision cloudiness and diplopia (33.7%) and sensory disturbances (32.2%).


Mojtaba A'zimian,
Volume 1, Issue 3 (1-2001)
Abstract

Multiple Sclerosis (M.S.) is a chronic disease of central nervous system (CNS) which locally demolishes myelin sheaths. M.S. is one of the most important debilitating factors in the youth and middle age. It mostly common between 20–30 years of age. The incidence in the age below the 10 and above the 60 years old is rare. It has been estimated nearly 1.1 million have M.S. around the world. Since M.S. affects different parts of C.N.S, so the symptoms are various. Clinical development differs from the benign to rapidly developing disease. It is mostly seen with attack and remission. First attacks usually recover but by repeating attacks, neurological defects permanently remain. Etiology of M.S. is unknown. Researches had showed the responsibility of autoimmune mechanism, viral infection and genetic in M.S. Environmental factors in onset and frequency of attacks can be effective. Incidence of M.S. in females is more than males. Geographically M.S. is seen much more in areas far from equator. Hence M.S. patients have wide spread symptoms of involvement in nervous system, is necessary during drug therapy physiotherapy and rehabilitation. These defects mostly occur in the form of cognitive and visual disorder, disarthery, dysphasia, weakness, spasticity, sensory, cerebellum and urinary and defecation disorders. In this paper I underscore the rehabilitation aspects of M.S patients.


Mohammad Mehdi Taghdiri, Mohammad Ghofrani, Mohammad Barzegar, Ali Moayedi, Hassan Tonekaboni,
Volume 2, Issue 3 (12-2001)
Abstract

Objective: Multiple Sclerosis (M.S.) is rare in less than 10 years, usually presents after menstrual age and third decay of life. Affects myelinization of central nervous system, with unknown etiology and pathogenesis, but viruses and autoimmunity may have a role. Clinical presentation is variable from mild to severe, progressive, debilitated one.

Materials & Methods: This is a prospective, descriptive, cross-sectional study on twenty patients with M.S. at neurologic ward of Mofid pediatric hospital from (1996-2000). 14 girls and 6 boys, age (4 years-13 years).

Results: Brain-magnetic resonance imaging (M.R.I) in all the patients with multiple plaques confirmed the diagnosis. Visual evoked response (V.E.R.) in most the patients showed the increased latency. The commonest clinical presentations were: increased DTR, ataxia, diplopia, decreased muscle power, walking defect, vertigo and paresthesia. For all the patients, CBC, electrolytes, CSF and analysis LE, ANA, anti dnase were done and for some of the patients if needed, auditory brain response (A.B.R.), somatosensory evoked potential (S.S.E.P.) and spinal M.R.I were done.

Conclusion: We tried to discuss about M.S. by clinical manifestation, neuroimaging and electrodiagnostic test in children.


Nasim Rasouli, Fazlollah Ahmadi, Seyyed Masoud Nabavi, Ebrahim Haji-Zadeh,
Volume 7, Issue 1 (4-2006)
Abstract

Objective: Multiple Sclerosis is one of the most prevalent central nervous system demyelinization diseuse. Fatigue is a symptom of Multiple Sclerosis (MS). But indeed for the patients sometimes is so much more destroying than that. It is expected. Fatigue underlies and influences many of the other symptoms experienced by people with MS. To determine whether MS-Related fatigue, could be reduced after applying Energy Saving Techniques.

Materials & Methods: This is a Quasi-experimental with Before-After Study design which was carried out in order to determine the effects of applying Energy Saving Techniques in the patients on MS-related Fatigue. These areas included Exercise, Rest & relaxation, Planning and Organization of daily activities, and body temperature control. Thirty nine convenient MS Patients were included and investigated over three months. Data collection tools included: demographic questionnaire, Fatigue Severity Scale (FSS), and self report checklists.

Results: Data analysis shows decline in fatigue level after applying Energy Saving Techniques. The mean level of fatique before applying techniques was 5/36 and after that decrease to 4/58.

Conclusion: According to these finding, applying Energy Saving Techniques reduces the fatigue of patients with Multiple Sclerosis.


Mahboubeh Parsaeian, Abdolrahman Najl-Rahim, Masoud Karimlou, Mohammad Mozaffari,
Volume 7, Issue 2 (7-2006)
Abstract

Objective: Multiple sclerosis (MS) is a disease of the central nervous system. The main pattern of neuropsychological impairment in M.S. patients characterized with deficits of attention and memory. Memory problem are known to occur in approximately 50% to 60% of people with M.S. The purpose of the present study is to asses memory function in M.S. patients.

Materials & Methods: 40 M.S. patients (30 patients suffering from as relapsing – remitting and 10 patients are chronic progressive M.S.) assessed using Luria – Nebraska memory scale.

Results: All of multiple sclerosis patients (without sever depresive state evaluated by BDI) exhibited significant impairments in all of memory veriable (verbal , non - verbal , delayed and whole memory performance) as compared with control groups (normal subjects). Difference of memory performance between the patients with two type of M.S. were not significant. Furthermore no significant relation was found between memory loss and MRI lesions. 

Conclusion: This study is guidedas such one can lead to a better understanding of memory deficits in M.S. patients. In addition, specific rehabilitation strategies can be planed on the patterns of memory impairment in M.S. patients.


Somayyeh Ghaffari, Fazlollah Ahmadi, Seyyed Masoud Nabavi , Robabeh Me'marian, Anoushirvan Kazem-Nejad ,
Volume 8, Issue 2 (7-2007)
Abstract

Objective: Multiple Sclerosis (MS) is one of the most common chronic unpredictable demyelinization diseases of the Central Nervous System (CNS). The aim of this study is to assess the effect of applying the Progressive Muscle Relaxation on activities of daily living of Multiple Sclerosis patients.

Materials & Methods: This is a interventional and experimental study. Sixty six Multiple Sclerosis patients were selected with non probability sampling according to specific criteria then assigned to experimental and control groups (33 patients in each group) with random allocation. Data collector tools included: demographic questionnaire, ADL-MS questionnaire and self report checklists. Progressive Muscle Relaxation (PMR) performed for 63 sessions by experimental group during two months but no intervention was done for control group. Data was analyzed by suing statistical analysis such as paired T-test, independent T-test, ANOVA and correlation coefficient determination. 

Results: The findings showed that there is no significant difference between two groups in mean scores of ADL before the study (P>0/05) but there are significant differences, within one and two months after intervention (P<0/05). ANOVA test with repeated measurements showed that there is a significant difference in mean score of social dimension of ADL between two groups in 3 times (P<0/02), but no significant difference in mean scores of another dimensions of ADL (physical, sensory, intimacy) and whole ADL (P&ge0/095).

Conclusion: The results of this study show that Progressive Muscle Relaxation (PMR) is practically feasible and may be associated with Activities of Daily Living (ADL) increase in Multiple Sclerosis (MS) patients. Therefore, applying such technique can promote Multiple Sclerosis patients Activities of Daily Living.


Somayyeh Ghaffari, Fazlollah Ahmadi, Seyyed Masoud Nabavi, Anoushirvan Kazem-Nezhad,
Volume 9, Issue 3 (12-2008)
Abstract

Objective: Multiple Sclerosis (MS) is one of the most common chronic diseases of the central nervous system (CNS), which causes important changes patient’s life, specially in adults life. MS decreases the quality of life (QOL) of patients severely and led to disability gradually. The aim of this study is to assess the effects of applying hydrotherapy on quality of life of Multiple Sclerosis patients.

Materials & Methods: In this Quasi-experimental study, 50 Multiple Sclerosis patients were selected with no probability sampling according to specific criteria and then assigned to experimental and control groups (25 patients in each group) with balanced randomized allocation. Hydrotherapy performed for 24 sessions by experimental group during three months but no intervention was done for control group. Data collector tools included: demographic questionnaire, SF8- QOL questionnaire, Self report checklists. Statistical analysis was done by use of statistical tests such as: chi square, paired t-test, student t-test, ANOVA with repeated measurements and independent t-test. 

Results: There was no significant difference between two groups in phycical and mental dimensions (P=0.04 & P=0.2) and whole (P=0.81) scores of QOL before intervention, but there were significant differences between two groups after intervention in these scores (P<0.001, P=0.003 & P<0.001). ANOVA test with repeated measurements showed that there is significant difference in mean score of whole (P=0.04) and physical (P=0.05) and mental (P=0.04) dimensions of QOL between two groups in 4 times.

Conclusion: Hydrotherapy is practically feasible and is associated with increase of MS patient ,s QOL so that applying this technique can promote MS patient ,s QOL and offered to these patients.


Reza Masoudi, Fereidoun Kheiri, Fazllollah Ahmadi, Issa Mohammadi,
Volume 10, Issue 3 (10-2009)
Abstract

Objective: Fatigue is one of the tormentest symptom of the Multiple Sclerosis that decrease self care ability and role performance of patients and potential of activity of daily living. The purpose of this study was to assess the effect of Orem self- care program on fatigue and activity of daily living (ADL) in Multiple Sclerosis clients.

Materials & Methods: This quasi experimental study was a clinical trial research that was done on seventy multiple sclerosis patients whom were selected randomly from M.S. association and assigned to experimental and control group by balanced randomized method. The experimental group was treated with 8 sessions of self-care program based on Orem self-care framework and the program belonged for three months in experimental group and followed up with self-report questionnaire. Score of fatigue and activity of daily living of two groups were assessed at first of research and three months later by Payper and Barthel scales. Data were analyzed using Chi square, Independent T and Paired T test and Variance analysis.

Results: There was no significant difference between two group in fatigue (P=0.48) and activity of daily living (P= 0.24) befor intervention, but these differences were significant after intervention (P<0.001). There were significant differences in experimental group between before and after score of fatigue and ADL (P<0.001), whereas there was no significant difference in fatigue (P=0.086) and ADL (P=0.33) of control group.

Conclusion: Utilizing self care program base on the Orem frame work and the educational needs as a safe and inexpensive nursing intervention, it might be effective on fatigue decrease and activity of daily living enhance in Multiple Sclerosis patients.


A'zam Shahvaroughi-Farahani, Mojtaba A'zimiyan, Mandana Fallah-Pour, Masoud Karimlou,
Volume 10, Issue 4 (1-2010)
Abstract

Objective: The aims of this study were to develop a culturally adapted version of the Fatigue Severity Scale in Persian (FSS–P) and to evaluate the reliability of the FSS–P in a sample of Iranians with Multiple Sclerosis.

Materials & Methods: In this non experimental and descriptive study which was done methodologically by validity testing method, “fatigue severity scale–Persian version” was developed following a forward – backward translation procedure and cultural adaptation based on guidelines. A sample of 20 patients with Multiple Sclerosis were selected conveniently. The participants were recruited from Sina rehabilitation clinic in Tehran between 2001 to 2007. The participants were asked to answer FSS item and VAS. The FSS and VAS were readministered 3 weeks after the first visit. Test–retest reliability and internal consistency were assessed, using Intraclass Correlation Coefficient (ICC), Pearson’s Correlation Coefficient and Cronbach’s alpha, respectively.

Results: All the participants found the FSS–P item to be clear and unambiguous in a pilot testing. The ICC was reported 0.93 for the total score that showed high repeatability of (FSS) and the Cronbach’s alpha was reported 0.96.
Conclusion: The Persian version of Fatigue Severity Scale (FSS) is a culturally adapted and reliable instrument to assess fatigue in Iranian persons with Multiple Sclerosis.


A'zam Shahvarughi-Farahani , Mojtaba A'zimian, Mandana Fallah-Pour, Masoud Karimlou,
Volume 13, Issue 4 (1-2013)
Abstract

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.


Nahid Zahiri, Iraj Abdollahi, Seyyed Masoud Nabavi, Amir Masoud A'rab,
Volume 14, Issue 2 (7-2013)
Abstract

Objective: The purpose of this study was studying of explicit motor learning in Relapse-Remission (RR) MS patients and compare with healthy subject.

Materials & Methods: A serial reaction time task by using software was applied for studying explicit motor learning in 15 RRMS patients and 15 matched healthy subjects. In this task four squares with different colors appeared on the computer screen and the subjects were asked to press 1 of 4 keys corresponding to the appropriately colored square immediately after observing it. In the first day subjects practiced 8 motor blocks with a retention test consisted of 2 patterned blocks, 48 hours later. Before test, the subjects were told the order of random and patterned blocks, and then RT values were calculated for each block and K-S test, paired T test and independent-samples t-test were used to analyse the measured blocks times.

Results: The patient groups performed this task slower than healthy groups (P<0.05). Blocks time difference between the first block and tenth block, were significant in both groups (P<0.05). But Explicit motor learning in healthy subjects was higher than patient groups (P<0.05).

Conclusion: Although patient groups performed this task slower than healthy subjects, there was motor learning in RRMS patient but this explicit motor learning was less than healthy matched subjects.


Samira Kamalian Lari, Hojjat Allah Haghgoo, Maryam Farzad, Samaneh Hosseinzadeh,
Volume 18, Issue 4 (1-2018)
Abstract

Objective Balance system and postural control are one of the major problems in people with multiple sclerosis. Therefore, the assessment of the balance system and postural control is very essential. Identification and use of standard tools can be a practical solution for more purposeful plan in this issue. Several tools have been used to investigate the balance disorders in these patients, which solely able to screen equilibrium problems, and only predict the risk of falling in the elderly. These questionnaires cannot help the therapist to diagnose the underlying causes of imbalance and also are not useful in directing the purposeful therapeutic process. The Balance Evaluation Systems Test (BESTest) was designed from 1990 to 1999 by Dr. Horak in the Continues Medical Education System. This questionnaire is based on the Bernstein’s theory of motor control, and the test evaluates Biomechanical, Stability Limits, Postural Responses, Anticipatory Postural Adjustments, Sensory Orientation, and Dynamic Balance through 36 questions. The objective of this study was to determine the validity and reliability of the BESTest evaluation system in patients with multiple sclerosis after providing a coherent version of the questionnaire in Persian.
Materials & Methods This is a methodological and non-experimental study. The BESTest questionnaire was translated by the researcher. The face validity of the questionnaire was evaluated by a survey of 21 patients with multiple sclerosis. The content validity of the questionnaire was further evaluated by a survey of 6 specialists in the field of rehabilitation (three occupational therapists and three specialists in the field of physiotherapy). After that, the BESTest questionnaire and Berg questionnaire were completed by two researchers (the author and another examiner) for 110 people diagnosed as multiple sclerosis, considering inclusion and exclusion criteria, from north, south, east, west, and center of Tehran in the years 2016-2017. After one week, 36 patients from the first stage were reevaluated in with a BESTest questionnaire by the researcher to evaluate the test-retest reliability. The internal consistency with Cronbach’s alpha coefficient, test-retest reliability by intra-class correlation coefficients traces, inter-rater reliability coefficients of correlation between the traces, and convergent validity between the two questionnaires (BESTest and Berg) with Pearson correlation coefficient were investigated.
Results The content validity of the questionnaire (the comprehensibility, relevance of the questions, and the cultural matching of words), which were measured by the CVR and CVI statistical methods, were approved by the specialist (CVI>0.79 and CVR>0.99). Pearson correlation coefficient between all the domains of the BESTest questionnaire (except for the second domain) with the score of the Berg questionnaire was between 0.79 and 0.93. Given that the numbers are above the minimum acceptable value of 0.70 indicates a good convergence between these two questionnaires. By removing a part of a 6th item from the second domain, the Cronbach’s alpha coefficient calculated in all domains were between 0.71 and 0.93, which were much higher than the minimum acceptable value of 0.70. These results indicate an excellent internal consistency. Correlation coefficients between two testers in six domains were reported 0.76 to 0.98. Therefore, these coefficients were above 0.70 in all domains, which indicates the good reliability between two examiners. Furthermore, the Intra-sectional correlation coefficient for two repetitions of the questionnaire for the test-retest reliability of the test were 0.84 to 0.99, which were higher than 0.70 (minimum acceptable), which shows that the questionnaire has an excellent test-retest reliability. 
Conclusion  After changing and removing part of question 6 of the second domain, results demonstrated that the questionnaire BESTest is a valid and reliable test for assessing balance performance in multiple sclerosis patients. It can be used as an accurate tool, both in the areas of clinical (to evaluate the patients’ equilibrium status and purposeful therapy planning) and to apply for scientific research in patients with multiple sclerosis.


Mansour Noori, Seyed Ali Hosseini, Vali Shiri, Nazila Akbarfahimi,
Volume 19, Issue 4 (1-2019)
Abstract

Objective Multiple Sclerosis (MS) as a progressive disease has remarkable consequences on the patient’s Quality of Life. According to the surveys, the Quality of Life in the people with MS is lower than the healthy people that is more prominent in physical, self-caring and daily performance activities. There are various reasons for this low Quality of Life such as lack of definitive treatment, relapsing-remitting periods, and unpredictable relapsing periods. Although, the effect of personal, social and economic factors on the Quality of Life has already been investigated, no study has been conducted in order to survey balance and activity of daily living on the Quality of Life in people with MS, Thus, the present study aims to investigate the relationship between balance and activity of daily living with the Quality of Life in this group of patients.
Materials & Methods This investigation is a cross-sectional study that 40 patients with the relapsing- remitting MS were selected by convenience sampling method in Isfahan City, Iran. The written consent was taken from all patients and their families. The demographic characteristics of the patients were kept private and the patients could leave the investigation whenever they wanted. The inclusion criteria were as follows: the patients’ willingness to participate in the study, verification of relapsing-remitting MS diagnosis, the patients referred to Al-Zahra and Kashani hospitals, age range 20-40 years, minimum of two attacks during the last 24 months, scored less than 505 in Expanded Disability Status Scale (EDSS), affection to MS moderate type in terms of disability diversity and the disease signs, able to cooperate with the study by means of MMSE test . The exclusion criteria were as follows: Unwillingness to continue the study, participating in the similar studies during 3 months ago which affected their Quality of Life, balance or activity of daily living, visual or auditory deficits, recurrence of the disease or worsening the disability from moderate to severe, any simultaneous disorder like seizure. The assessment tools were Expanded Disability Status Scale (EDSS), Berg Balance Scale, Barthel index, and Quality of Life Questionnaire SF-36. The collected data was analyzed by Pearson correlation and regression analyses in SPSS 20. 
Results There is a positive and significant relationship (P<0.01) between physical activity (66%), physical role functioning (98%), physical dimensional scale (93%), and the Quality of Life. There wasn’t any significant relationship between balance and other Quality of Life components. Self-care has a positive and significant relationship with physical activity (60%), and physical dimensional scale (56%) components. In addition, there is a positive and significant relationship between physical activity (75%), physical role functioning (45%) and physical dimensional scale (67%). However, there was not any significant relationship between self-care and daily performance with the other Quality of Life components.
Conclusion The results indicate that the balance and independence in the activities of daily living can predict the Quality of Life in the patients with MS. Accordingly, in the interventions done for rehabilitation of MS patients, important factors such as Quality of Life and daily living skills should be taken into account. It seems that the vestibular system rehabilitation and the instruction of activity of daily living can improve the physical dimension in the MS patients’ lives.

Amin Mahdizadeh, Somayeh Lokzadeh, Azadeh Riyahi, Seyed Ali Hosseini, Nasrin Jalili,
Volume 20, Issue 1 (4-2019)
Abstract

Objective Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disorder of the Central Nervous System (CNS) and it is also the most common cause of non-traumatic neurological disability in young adults. MS in women, especially young women, is about 1.5 to 3 times more common than men all over the world. About 2.5 million people worldwide are suffering from MS. The destruction of myelin in certain areas exhibits certain signs and symptoms. Balance disorders are particularly problematic because they are associated with difficulty in moving from one position to another, sustaining an upright posture, and performing functional activities such as walking and turning, all of which predisposes people with MS to the loss of equilibrium and falls. Isfahan City in Iran suffers from a high prevalence of MS that put it amongst the regions with the highest prevalence of MS in Asia and Oceania. This study aimed to use the holistic approaches of occupational therapy to investigate the physical and cognitive factors (attention, cognition and muscle strength of lower extremities) that affect the gait of MS patients in the city of Isfahan, Iran.
Materials & Methods The present study was a descriptive-correlational one and convenience sampling method was used to recruit the samples. The study population consisted of all patients with MS in Isfahan City in August 2017. A group of 70 patients (24 males and 46 females with the Mean±SD age of 32.20±7.55 y) met the inclusion-exclusion criteria and were enrolled in the study. To be eligible for the study, the patients had to meet the following inclusion criteria: having a neurologist-confirmed diagnosis of MS with MRI scan, being able to read and write, and walk at least 100 m independently. We excluded patients with cognitive impairments that might hinder understanding of the tasks to be accomplished, those with any comorbid neurologic condition other than MS, and those who are unwilling to collaborate with the research process. After providing sufficient information about the research process and getting informed consent of the patients, the questionnaires and tests were provided to the participants to be completed. The study tools were the Mini-Mental Status Examination (MMSE), 10 m Walking Test (10 MWT), Timed Up and Go test (TUG), Sit to Stand test, and Stroop test. For data analysis, the Pearson correlation coefficient and multiple regression analysis were performed in SPSS version 16.
Results In this study, 70 patients suffering from MS participated. The results showed a significant negative correlation between the scores of walking speed test (10 m walking) and the scores of the functional strength of the lower extremities muscles (P<0.001) and attention (P=0.01). There is also a significant correlation between muscle strength of lower extremity and balance (P=0.01). Regression analysis shows that the muscle strength of lower extremities has the highest contributions in predicting the speed of walking in patients with MS. 
Conclusion According to the study findings, among the physical and cognitive factors affecting gait and balance such as muscle strength of lower extremity or cognition and attention, the muscle strength of lower extremity is the most important factor affecting the balance and speed of walking in patients with MS that still can walk. In the process of rehabilitation, especially in occupational therapy, special attention must be paid to a muscle strengthening program for the lower extremities of patients suffering from MS. 


Farahnaz Noormohammadi, Hassan Ashayeri, Gholam Ali Afrooz, Kambiz Kamkari,
Volume 20, Issue 1 (4-2019)
Abstract

Objective Multiple Sclerosis (MS) is a chronic autoimmune, demyelinating disorder of the central nervous system. Psychological well-being often declines as a consequence of this impairment. Application of neurological musical intervention to adapt with the limitation of neurological impairments has been under investigation. This study aimed to explore the effectiveness of neurological music intervention on the psychological well-being of women with MS.
Materials & Methods Quasi-experimental study with pretest and posttest design was conducted. A total of 20 women from the Iranian MS Association, with a relapsing-remitting course, aged 20 to 30 years, were selected with the convenience sampling method. After grouping them with respect to variables such as education, age, marital status, occupation, and low Extended Disability Status (EDSS), they were randomly paired and assigned to experimental and control groups after obtaining their consent and taking the pretest. The exclusion criteria for the participants were as follows: psychological symptoms such as depression or taking other musical training during the intervention. Neurological music intervention was designed with the assistance of a musician based on Iranian culture and Musical Executive Function Training (Thaut, 2005) to affect the frontal and prefrontal lobes. The 8 designations of the training program included "executive function", "goal regulation support", "group motivation", "impulsivity control", "inhibition", "responsibility", "problem-solving creativity", and " decision making/creativity". The internal validity of program has been already validated. The experimental group received 30 sessions training, two times a week for three months in MS association center while the control group did not receive any training.  Scores were gathered using Ryff (1995) 42-item psychological well-being scale in the pretest and posttest stages. Also, the Kurtke (1983) extended disability status scale was used to evaluate the physical disabilities of MS participants.
Results The results, analyzed in ANCOVA and MANCOVA, indicated a significant improvement in psychological well-being (P<0.05) and medium effect size (0.38) according to the Cohen Scale. No significant improvement in 6 Ryff subscales was observed but a small effect was noted in self-acceptance (0.02), personal growth (0.02), the purpose of life (0.01), environmental mastery (0.07), autonomy (0.09), and small to medium size effect in positive relation (0.23). 
Conclusion According to experts, there is no cure for multiple sclerosis, there are, however, numerous treatments and rehabilitation interventions to slow down and reduce the physical and psychological symptoms. These findings suggest that neurological music intervention based on "Musical Executive Function Training” has a potential dual effect on cognitive and affective aspects of the brain. This kind of music intervention includes group and individual improvisation and composition exercises which improved the executive function skills such as organizing, problem-solving, decision making, and comprehending. Our results indicate that neurological music intervention improves psychological well-being in women with MS. Although there was no significant effect on the subscale of psychological wellbeing, a small to medium size effect was observed on different subscales of well-being. It appears that this intervention can be applied to clinical and rehabilitation settings.

Maryam Pouramiri, Mojtaba Azimian, Nazila Akbarfahimi, Ebrahim Pishyareh, Samaneh Hossienzadeh,
Volume 20, Issue 2 (7-2019)
Abstract

Objective Multiple Sclerosis (MS) is the most prevalent neurological progression that often affects young adults. Cognitive impairment is a frequent symptom of the disease. One cognitive domain is an executive function. Executive function is important in individuals’ cognitive skills, adaptive behaviors,  and life satisfaction. Thus, accurately recognizing and investigating the factors affecting it greatly helps with improving MS. The current study investigated the relationship between individual and clinical characteristics and executive dysfunction in patients with MS. 
Materials & Methods This was a cross-sectional, descriptive and analytical study conducted on MS patients referring to Rofeydeh Rehabilitation Hospital in 2017. In total, 71 patients were selected through unpredictable sampling method. MS patients and their families provided written consent forms for participation in the study, and the subjects' data were kept confidential. Moreover, the patients were allowed to discontinue study participation as desired. The inclusion criteria were a diagnosis of MS disease based on McDonald's criteria  by a neurologist, the lack of memory impairments, including Alzheimer's disease, non-congenital syndromes like Down syndrome, no thyroid dysfunction, the lack of consuming drugs that affect memory and cognitive function like benzodiazepines, and the lack of severe vision and motor impairments. Exclusion criteria included the lack of patient’s cooperation with completing the questionnaire and performing the test, dissatisfaction with continuing the collaboration, and the emergence of an acute problem in the patient that enables him/her to continue cooperation. In this research, instruments such as Pittsburgh Sleep Quality Index (PSQI), Fatigue Assessment Scale (FAS), Beck's Depression Inventory (BDI), Expanded Disability Status Scale (EDSS), and Delis–Kaplan Executive Function System (D-KEFS) test were used. The collected data were analyzed in SPSS. For data analysis, general linear regression was used.
Results The obtained results suggested that age, disease duration, and fatigue had a significant reverse relationship with executive functions (descriptive and categorical) (P>0.05). Executive function (classification) had a significant relationship with the first symptom of the onset of disease (P>0.05).  
Conclusion We investigated the relationship between individual and clinical characteristics and the executive function in MS patients. A significant relationship was observed between the first sign of the disease onset and the level of performance. People who initially demonstrated vision problems had a weaker performance than others. This can be considered as an important finding in the early stages of diagnosis and the development of therapeutic programs to postpone cognitive complications.


Nasrin Jalili, Ali Poursafa, Khadijeh Khazaali, Hamidreza Rostami, Ehsan Jamshidian, Zahra Mohammadi, Fatemeh Kamali, Nasrin Bahrani,
Volume 21, Issue 1 (3-2020)
Abstract

Objective: The participation, Based on International Classification of Functioning (ICF), Disability And Health, is part of healthy function that leads to the development of skills and a sense of competence and confidence in them. People with multiple sclerosis experience problems in various areas of participation. Environmental factors can create serious restrictions in the level of participation of people with multiple sclerosis, in some cases, the effect of these factors on restricting the participation of people with multiple sclerosis can be more than the effects of weakness and the defects of systems and organs that result from the disease. the barriers in the physical environment can reduce mobility of people with multiple sclerosis to transfer, that leads consequences such as weakening functional status, physical and mental health, quality of life, happiness, loss of life satisfaction; Therefore, due to high prevalence of multiple sclerosis in the city of Isfahan, the aim of this study was to Identifying the environmental barriers affecting the participation of people with multiple sclerosis in Isfahan.
Materials & Methods: In this cross-sectional study, the study population was all patients with multiple sclerosis in Isfahan City in February 2018. That was conducted in Isfahan province, 96 patients with MS (22.9%male and 77.1% female) were selected with convenience sampling method. To collect the data, after informing the participants about the subject and purpose of the study, obtaining informed consent letter, and also ensuring confidentiality of the information to the researcher, a demographic questionnaire was completed. The Mini Mental State Examination questionnaire was completed by participants, and then the Expanded Disability Status Scale scores were recorded for each person by the neurologist. At the end, Craig hospital inventory of environmental factors were provided to the participants. Finally, Data were analyzed by SPSS V. 16.
In order to describe the data, the mean and standard deviation were used. The normal distribution of data was done by Shapiro-Wilk test. Pearson correlation coefficient, ANOVA and post hoc by LSD method test were used to analyze the data at a significance level of 0.05. Also, considering that the ANOVA test is susceptible to variance inequality, Levin test was conducted to evaluate the equality of variances.
Results: Physical and structural barriers are the major barriers to participation of multiple sclerosis patients (12.05±8.62) and the field of work and school is the minor barrier of participation (2.24±4.16). Furthermore, the findings Also result showed there is no statistical relationship between the demographic variables (such as age, sex, disability status and cognitive status) and level of confrontation with the environmental barriers of participation (P>0.05). Comparison of the mean of confrontation to environmental barriers to participation Based on education level showed that there is a significant difference between the services and assistance subscale and different levels of education. The highest mean score was for the under diploma education group and the lowest was for the Bachelor's degree and higher group. There is no significant difference in other subscales of participation.
Conclusion: According to this findings among the environmental factors that can potentially affect the participation of patients with MS, field of physical and structural barriers were strongest factor which can restrict their participation in personal and social activities. Physical and structural barriers have been introduced in various studies as the most important limiting factor for participation in people with disabilities, especially those with neurological disorders. Therefore, maintaining the participation of these people in the community is a priority in adopting special measures in the field of removing physical and structural barriers.

Zahra Sadeghi, Mohammadreza Afshar, Abbas Ebadi, Kowsar Baghban, Zahra Sadat Qureshi,
Volume 21, Issue 2 (7-2020)
Abstract

Objective: Dysphagia is commonly encountered in Multiple Sclerosis (MS). It can consequently cause severe complications such as the increased risk of dehydration, malnutrition and aspiration pneumonia that associated with an increased risk of death in the late stages of the disease. These complications can be prevented with an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) is the only questionnaire developed specifically for patients with MS. The aim of the present study was translation and cross-culturally adaptation of DYMUS for the Persian population and estimation of the questionnaire's reliability and validity. Also, we investigated the frequency and severity of dysphagia in the patients referring to the Tehran MS Society and its association with the course of MS, disease duration, and Expanded Disability Status Scale (EDSS).
Materials & Methods: This is a methodological and descriptive-analytic study. The statistical populations consist of the patients with MS referring to the Tehran Multiple Sclerosis Society in 2018. The study sample consisted of 108 patients who were selected through a convenient sampling method. The research instruments consisted of 10-items DYMUS questionnaire (in the first part of the study, translated and its psychometric properties examined), Dysphagia Handicap Index and a demographic information questionnaire. In methodological section, translation and cross-cultural adaptation were fulfilled and the Confirmatory Factor Analysis (CFA) was used to assess the construct validity and to test the goodness-of-fit of the presented model. The association between the DYMUS and Dysphagia Handicap Index (DHI) scores investigated to convergent validity. ‏ The inter-item correlation matrix was calculated to assess the homogeneity of the questionnaire items. Kuder - Richardson (KR-20) was measured to assess the internal consistency of the questionnaire. Also, the test-retest procedure was conducted on the 19 subjects understudy to assess the reliability. Finally, the frequency and severity of dysphagia and its association with the course of MS, disease duration, and EDSS was investigated. KR-20 reliability coefficient, Intraclass Correlation Coefficient (ICC), inter-item correlation matrix, Mann-Whitney U test and rank correlation coefficient or Spearman's were used to inferential statistical analysis.
Results: Analysis of the inter-item correlations matrix indicated a positive correlation between all items, exception item 10. Based on the results of the inter-item correlation, item 10 had the lowest correlation coefficient that was deleted from the questionnaire. CFA results confirmed the two-factor model of DYMUS, “dysphagia for solids” and “dysphagia for liquids”, and revealed that the item 10 was minimally contributing to the measurement of "dysphagia of solids" and internal consistency increased after the deletion of this item. Also, the solution of the 9-item Model was the best goodness-of-fit indicator for the sample. The obtained results from the convergent validity indicated a positive significant correlation between the DYMUS and DHI (rs=0.693, P<0.001). A KR-20 reliability coefficient of the DYMUS was 0.856, indicating high internal consistency of the Persian translation of the questionnaire items. Test-retest reliability was excellent with 0.965 value. The results also showed that 65.7% of multiple sclerosis patients had a swallowing disorder. In terms of the dysphagia severity, 25.9% of participants had mild dysphagia, and 39.8% of participants had alarming dysphagia. DYMUS values were significantly correlated with disease duration (rs=0.198, P= 0.040), and EDSS (rs=0.235, P= 0.014) and significantly higher mean scores were observed in the patients with secondary progressive than the other subgroups of multiple sclerosis.
Conclusion: The Persian adjusted 9-item questionnaire was demonstrated to be a simple, consistent, valid and reliable tool for the detection of patients who need more specific instrumental evaluations of swallowing. Also, about the dysphagia is very frequent in these patients, it is important that clinicians monitor these patients carefully even in early stages of the disease‏ for early detection and planning a rehabilitation program to the prevention of serious subsequence complications.
Mohammad Taghi Mohseni Takalu, Seyed Ali Hosseini, Hamid Reza Khankeh, Ebrahim Pishyareh, Enayatollah Bakhshi,
Volume 21, Issue 3 (9-2020)
Abstract

Objective: Caring for individuals with multiple sclerosis (MS) can affect their caregivers’ occupational performance in various areas such as work, rest/sleep, and social participation. Part of the rehabilitation process is educating caregivers. Primary caregivers need knowledge and information to deliver their caring role. Although face-to-face learning is useful, it can have some limitations. For example, a caregiver should refer to a specific center to receive information and interventions, which is often time-consuming and may trouble them to perform other roles, including their occupational roles. Written health education is used for complementing or strengthening verbal education and maximizing its effectiveness. These materials play an essential role in increasing knowledge, self-management, and commitment to treatment. When health professionals and health services are not available to caregivers, written health education materials can partially answer their questions and needs. It can also help reduce the costs of health care for caregivers. The present study aims to develop and validate the appearance and content of an educational booklet to improve the occupational performance of primary caregivers of individuals with MS (PCIMS).
Materials & Methods: This is a methodological study conducted. 1. preparing the content based on grounded theory study of PCIMS and their challenges, and then preparing an initial draft, 2. examining the face validity and content validity of the initial draft according to the opinions of 22 experts in MS, and 3. examining the face validity and content validity of the initial draft according to views of 22 PCIMS. An item-level content validity index (I-CVI) value of ≥0.78 and a scale-level content validity index/average (S-CVI/Ave) value of ≥0.9 were considered as the criteria for having acceptable validity in the second and third phases. The binomial test was also used to test the statistical reliability of the I-CVIs at a significance level of 0.05 and the expected proportion of agreement (test proportion) of 0.8.
Results: The minimum I-CVI and S-CVI/Ave values for the items of a scale designed to assess the face validity and content validity of the booklet were respectively reported 0.9 and 0.97, according to the panel of experts. Also, the minimum observed proportion of agreement for items under the binomial test was obtained 0.9, which was higher than the expected proportion of agreement (0.8). I-CVIs values, S-CVI/Ave value and the observed proportion of agreement between PCIMS were equal to 1. For participating experts and PCIMS, the booklet had appropriate validity, and their comments on the appearance and content of the booklet were applied to the final version of the booklet.
Conclusion: The developed educational booklet has acceptable face validity and content validity, and specialists can use it for the rehabilitation intervention of PCIMS. Further studies are recommended to investigate the effectiveness of this booklet on improving the quality of life of PCIMS.
Fereshteh Poursaeed, Nahid Tahan, Farideh Dehghan Manshadi, Ali Reza Akbarzade Bagheban,
Volume 22, Issue 1 (5-2021)
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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