Mehdi Rassafiani

Depression, activities of daily living and quality of life in patients with stroke

INTRODUCTION Stroke patients are dealing with a wide variety of physical and psychological problems influencing their ability to carry out activities of daily living (ADL). The aim of the present study was to examine the relationship between the activity of daily living performances and degree of after stroke depression (ASD), as well as, the quality of life (QOL) in Iranian stroke survivors. MATERIALS AND METHOD In a cross sectional study, 40 patients with stroke in two Rehabilitation Centers for Stroke Patients, were recruited consecutively. They were assessed using the Modified Barthel Index, the Beck Depression Inventory-II (BDI-II), and a quality of life questionnaire (SF-36). Data were analyzed using Pearson and Spearman correlation coefficient. RESULTS Sixty five and one-half percent (65.5%) of the studied participants were either fully dependent or needed help in ADL. Also, 72.5% of the participants showed mild to severe ASD. There was a significant negative correlation between ADL performances and ASD and also between QOL and ASD. Furthermore a strong correlation was found between ADL and QOL. CONCLUSION ADL have a strong relationship with both level of depression and QOL in patients with stroke. It appears that motivating to perform ADL may enhance QOL. Further investigation with a larger sample size is required to better understand the causal relationship of these factors.

Why self-immolation? A qualitative exploration of the motives for attempting suicide by self-immolation

INTRODUCTION Suicide by self-immolation is one of the great health concerns in developing countries such as Iran. Exploration of motives for attempting suicide by self-immolation in different point of view of people with experience and information on can be considered as a crucial aspect in self-immolation prevention. The study aimed to explore motives for suicide by self-immolation in Kermanshah, Iran. METHODS A qualitative approach using semi-structure interview was employed to explore motives for attempting suicide by self-immolation in Kermanshah, Iran (2012). 15 participants including 9 self-immolated patients, a patients husband, and 5 members of medical staff of these patients were interviewed. The interviews were taped and transcribed. A content analysis using constant comparison was performed for transcribed interviews. RESULTS Five main categories were emerged that explore motives for suicide by self-immolation including mental health problems, family problems, cultural context, self-immolation as a threat, and the distinct characteristics of the method. All categories had their specific subcategories which had been integrated based on distinct properties in a given category. More than one motive might be addressed by study participants, which listed in the appropriate categories. CONCLUSION There are several reasons for suicide by self-immolation that should be considered in prevention programs. There may be an interactional pattern among the motives. Further study to explore process of the interactional pattern is recommended.

Occupational therapists’ decision-making in the management of clients with upper limb hypertonicity

This study applied social judgement theory to the exploration of factors influencing occupational therapists’ decision-making when they manage upper limb hypertonicity in clients with cerebral palsy. To achieve this goal, both objective and stated policies were investigated. This quantitative study drew information from a literature review and a survey with experienced occupational therapists to identify 12 factors that could influence decision-making. Based on these 12 factors 110 case vignettes of individuals with cerebral palsy and upper limb hypertonicity were generated. Intervention decisions were elicited from 18 experienced occupational therapists for each of the 110 case vignettes. Therapists were also asked to rank the factors in order of perceived importance. Occupational therapists generally used severity of spasticity, wrist and finger posture, and client and family background information to guide their clinical intervention choices. Hhowever, therapists demonstrated poor insight into the nature of their decision-making processes. This was highlighted in the disparity between their stated and objective policies. These findings have implications for both the professional development of therapists and the training of students.

Effect of Cognitive Intervention on Children with ADHD

ABSTRACT Although not considered a diagnostic criterion in DSM-IV, motor difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD) are commonly reported. Prevalence of co-morbidity of ADHD and Developmental Coordination Disorder is as high as 50%. Cognitive Orientation to daily Occupational Performance (CO-OP) is a problem-solving approach originally developed for children with Developmental Coordination Disorder. In this approach, therapists support children to use cognitive strategies in a process of guided discovery to solve occupational performance problems. A single case experimental design (multiple baselines) was used to examine the influence of a 12-week intervention using CO-OP with six children with ADHD. Outcome measures included the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling and the Bruininks–Oseretsky Test of Motor Proficiency and Performance (BOTMP). The results of this study demonstrated improvements in both goals and motor performance in the participants due to the intervention. These results provide some support for the use of CO-OP with children with ADHD. Further research into the application of CO-OP with children with ADHD is warranted based on these preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties.

The effect of floor reaction ankle foot orthosis on postural control in children with spastic cerebral palsy.

Background: Children with cerebral palsy (CP) often demonstrate postural control difficulties. Orthotic management may assist in improving postural control in these children. Objective: The purpose of this investigation was to examine the influence of floor reaction ankle foot orthosis (FRAFO) on postural flexion called the crouch position in children with CP. Study Design: Quasi-experimental. Methods: Eight children with spastic diplegic CP and eight matched typically developing children participated in this study. Postural control of children with CP was assessed in a static standing position on a force platform with/without a FRAFO. The parameters used were centre of pressure (CoP) measures, calculated from force platform signals including the standard deviation (SD) of excursion; phase plate portrait and SD of velocity in anteroposterior (AP) and mediolateral (ML) directions. Results: The maximum knee extension was statistically significant in children with CP when barefoot compared to wearing braced footwear (p < 0.05, t = 10.01). AP and ML displacement, AP velocity and AP phase plate portrait of CoP were not statistically significant between children with CP with/without a FRAFO (p < 0.05). Conclusion: FRAFO can improve the alignment of the knee, but may not be helpful in improving postural control in children with CP in a short time period. Clinical relevance This article will provide objective evidence about the effect of FRAFO on the postural control in children with CP. Therapists can use FRAFO to effectively decrease the knee joint angle in the sagittal plane in children with spastic CP, but cannot use it to improve the postural control.

Time Use in Mothers of Children with Cerebral Palsy: A Comparison Study

Objectives The main goal of this study was to measure time spent in different activities by mothers who have children with cerebral palsy (CP), in comparison to mothers of healthy children. Methods This study features a descriptive, cross-sectional and matched case control design. Sixty-seven mothers aged between 25 and 50 years based on inclusion and exclusion criteria were selected. The prototype of the Farsi translation of the Mothers’ Time Use Questionnaire was used to measure the time allocations for different activities in both groups. Results Mothers of children with CP spent more time in childcare activities and had a lower level of “satisfaction” in comparison with mothers who have healthy children (p < .05). There were no significant differences in other subtype activities between both groups, namely, paid work, leisure, household chores, and sleeping/resting (p > .05). Conclusion There was an imbalance over time use between childcare activities and other subtype activities in mothers who have children with CP as compared to mothers with healthy children. Mothers with children who have CP require more attention, support, and special assistance from the government to meet their specific roles as mothers.

Is length of experience an appropriate criterion to identify level of expertise

Clinical experience plays an important role in the development of expertise, particularly when coupled with reflection on practice. There is debate, however, regarding the amount of clinical experience that is required to become an expert. Various lengths of practice have been suggested as suitable for determining expertise, ranging from five years to 15 years. This study aimed to investigate the association between length of experience and therapists’ level of expertise in the field of cerebral palsy with upper limb hypertonicity using an empirical procedure named Cochrane–Weiss–Shanteau (CWS). The methodology involved re-analysis of quantitative data collected in two previous studies. In Study 1, 18 experienced occupational therapists made hypothetical clinical decisions related to 110 case vignettes, while in Study 2, 29 therapists considered 60 case vignettes drawn randomly from those used in Study 1. A CWS index was calculated for each participants case decisions. Then, in each study, Spearmans rho was calculated to identify the correlations between the duration of experience and level of expertise. There was no significant association between these two variables in both studies. These analyses corroborated previous findings of no association between length of experience and judgemental performance. Therefore, length of experience may not be an appropriate criterion for determining level of expertise in relation to cerebral palsy practice.

Occupational balance: A study of the sociocultural perspective of Iranian occupational therapists

Background. The concept of occupational balance has always been important to occupational therapists and occupational scientists, but it is often interpreted differently by professionals, particularly in relation to practice. Purpose. This study focused on the understanding of occupational balance of a group of experienced occupational therapists who held positions at the time in Iran. Method. A preliminary qualitative study from within an interpretive paradigm was employed. A focus group was used for data collection, and the data were analyzed using thematic networks analysis in relation to occupational science concepts. Findings. Four organizing themes were uncovered: integrity in being, equilibrium in doing, contentedness in becoming, and harmony in belonging. The global theme of “fluidity” describes the dynamic nature of occupational balance. Implications. The concept of occupational balance needs to be further explored in different communities. Identifying similarities and differences in its meaning and application will inform culturally relevant client-centred education and practice.

Factors Associated with Quality of Life in Mothers of Children with Cerebral Palsy in Iran

Objective/Background Children with cerebral palsy (CP) need more attention and care, especially from their mothers. This can affect the mothers’ quality of life (QOL) adversely. This study aimed to assess the QOL of Iranian mothers who have a child with CP, compared with mothers with a healthy child, focusing on some individual and social underlying factors. Methods Using a cluster-sampling approach, two groups of eligible mothers having children aged 4–12 years, with and without CP, from Tehrans randomly selected clinics, were chosen in a convenient way and enrolled in a cross-sectional study. A group of mothers with healthy children whose demographics closely matched with the group of mothers having children with CP were selected and recruited in the study. The group with mothers with children with CP was selected randomly from a convenience sample in 14 rehabilitation and occupational therapy clinics in Tehran, Iran. To collect data on characteristics of interest, mothers were interviewed, and the SF-36 Questionnaire was used to measure their QOL. The relationship between each characteristic and the mothers’ level of QOL was assessed, and the crude odds ratios (ORs) and adjusted ORs were measured by logistic regression. Results Sixty mothers with CP children, and 60 mothers with healthy children participated in this study. Their mean (±standard deviation) age was 33.79 (±6.02) years, and their childrens mean age was 7.11 (±2.71). The two groups were significantly different in QOL mean score (57.35 ± 18.39 vs. 71.7 ± 13.58; p ≤ .001). It was shown that having a child with CP with intellectual disability is significantly related to a worse level of QOL of mothers (adjusted OR = 5.4, p ≤ .001), whereas having full-time jobs is reversely associated with it (adjusted OR = 0.2, p = .02). Conclusion Two important factors that lead to a worse QOL of mothers with a CP child are the unemployment of mothers and having a CP child with concurrent intellectual disabilities. To diminish the adverse effects of having a CP child on QOL of mothers, unemployed women who have a CP child with concurrent intellectual disabilities need more psychological support and help.

Individualised resting hand splints for adults with acquired brain injury: a randomized, single blinded, single case design.

AIM To evaluate the effect of individualized resting mitt splints on hypertonicity (spasticity and tissue stiffness) and passive range of motion (PROM). METHODS A randomized, single blinded, single case design. Ten adults with acquired brain injury were randomized to control (no-splint) and experimental (splint) groups. The experimental group received an individualized (wrist position, wearing schedule) thermoplastic resting mitt splint. Measures included wrist and finger PROM, muscle stiffness (Modified Ashworth Scale), and spasticity (Modified Tardieu Scale) which were taken at five time points. RESULTS Between-group analyses indicated a statistically significant effect on PROM at the wrist (d = 2.14, CI₉₅ = 0.57, 3.72, p < 0.05) and clinically important effects on finger PROM, and wrist and finger spasticity and stiffness. Within-group analyses indicated that splint-wear resulted in positive clinical effects ranging from zero effect (maintenance of pre-splinting status) to a large positive treatment effect. Non splint-wear resulted in negative clinical effects ranging from zero effect to a large negative treatment effect. CONCLUSION Individualized resting splints for adults with moderate hypertonicity and no soft tissue contracture resulted in positive clinical effects to PROM, muscle stiffness and spasticity. Long-term splint-wear may be more beneficial than short-term wear, and may prevent the negative changes evident with no splint-wear. Resting hand splints should be considered for a select group where reduction in muscle stiffness and spasticity, or maintenance of PROM, is desired.