Comparing Sensory Processing and Perceived Motor Competence Between Three Groups of Students with Special Learning Disabilities

Introduction: Identifying the contributing factors to a specific learning disorder and comparing these factors in different types of this disorder will lead to using more proper interventions in the future. Therefore, this study aimed to compare sensory processing skills and perceived motor competence between three groups of students with specific learning disabilities (reading and writing disorders, math disorders, and combination disorders). Materials and Methods: The present study was a cross-sectional descriptive-analytical study. The participants were 48 children (16 in each group, aged 8-12 years). They were selected from Chaharmahal and Bakhtiari Province, Iran, by the simple convenience sampling method. The participants’ sensory processing was measured with sensory profile 2 and their perceived motor competency with Marsh perceived motor competence questionnaire. Results: The results showed a significant difference between the three groups in the sensory sensitivity, low registration sensory patterns and processing of tactile, and body position senses (P <0.05). However, no significant differences were observed between groups in other components of sensory processing and perceived motor competence (P> 0.05). Conclusion: The results indicate that therapeutic interventions in the group with reading and writing disorders should focus on increasing sensory registration and processing of tactile and body position senses and reducing sensory sensitivity in the mathematical group.

Prioritized Commitment-Based Clinical Assessment: A New Method for Assessment of Orthodontic Treatment Outcomes

OBJECTIVE

Quality assessment is an essential part of orthodontic treatment. Most of the current indices are essentially based on occlusal assessment. However, an ideal occlusion is only one aspect of an ideal treatment. The aim of this article is to introduce a new prioritized commitment-based clinical assessment (PCCA) method and present its reliability and linear correlation test in comparison with the comprehensive clinical outcome assessment (CCA).

METHODS

One hundred treated cases were scored with the conventional assessment tool--the CCA--and the newly developed assessment tool--the PCCA--with 2 calibrated examiners at 2 different time intervals. These cases were randomly selected including equal numbers of the main malocclusions managed with fixed conventional edgewise appliances within the past 3 years and had complete pre-treatment and post-treatment routine records. The intraclass correlation coefficient (ICC) was used to assess the intra- examiner repeatability of the total scores of both methods. Pearson's correlation coefficients were computed to assess the linear relationships between the CCA and PCCA scores.

RESULTS

The intra-examiner reliability assessed for CCA and PCCA showed high repeatability for both examiners (ICC: 0.93 and 0.945, respectively). The inter-examiner reliability values for CCA and PCCA, assessed by ICC, were 0.84 and 0.96, respectively. The linear correlation between the 2 methods, assessed by comparing the mean score of each case by the 2 examiners was significant, at 0.01.

CONCLUSION

The PCCA method can be used for quality assessment in treated orthodontic patients. The preliminary test of the new method presented good inter- and intra-observer agreements and a significant linear correlation with the CCA method.

Stroke Patients Showed Improvements in Balance in Response to Visual Restriction Exercise

OBJECTIVE

Several strategies have been designed to improve balance after stroke. Although recent studies have suggested that the balance training in stroke should include exercises that are performed in different sensory conflict conditions, little attention has been paid to manipulation of visual input. This study aimed to compare effects of balance training on an unstable surface with balance training under visual deprivation conditions in persons with stroke.

METHOD

Forty-five stroke patients were randomized into three groups: the visual deprivation- stable based training (VD-SBT); unstable based training (UBT); and control (C) groups. Subjects of the VD-SBT group performed balance training on a stable surface with closed eyes. The UBT group performed balance training on an unstable surface with open eyes. Patients were assessed before and after interventions for Timed Up and Go (TUG), Four Square Step (FSS) and Five Times Sit to Stand (FTSS) tests.

RESULT

There was a significant difference in pre- post intervention time of TUG, FSS and FTSS tests in all three groups. In a comparison of three groups, the UBT and VD-SBT groups had a significant improvement in time of all tests but significant improvement in time of all tests was observed in the VD-SBT group in comparison with the UBT group. In the field of balance training, the manipulation of visual input was more effective than the manipulation of standing surface to reweighting the sensory information.

CONCLUSION

We recommended balance rehabilitation programs after stroke performed under conditions to stimulate the use of underused sensory input.

Acceptable Noise Level in Unilateral Ménière’s Disease

Background and Aim: Noise tolerance and performance in noisy environments are influential factors of hearing aid use in people with hearing loss. One of the causes of hearing loss is Meniere’s disease (MD), which affects speech perception in noise. Acceptable noise level (ANL) is a test that measures the maximum tolerated background noise level (BNL) while listening to the running speech. Since the effect of MD on ANL needs further study, the present study aims to examine the ANL test results in people with unilateral MD, and compare the results between the two ears. Methods: This cross sectional study conducted on 33 individuals with unilateral MD (21 females and 12 males) aged 32–60 years who had the disease for at least one year, who participated in this study. Their most comfortable level (MCL), BNL, and ANL in both ears were then evaluated. Results: The mean MCL and BNL were significantly different between the two ears, where they were higher in the affected ear than in the contralateral ear. There was also a significant difference in the ANL results between the two ears. In the affected ear, a statistically significant relationship was reported between the ANL and the average hearing thresholds at frequencies of 250, 500, and 1000 Hz. Conclusion: MD affects the ANL in the affected ear and causes a deterioration in its level and speech perception in noise.

Effect of Musical Training on Temporal Resolution and Temporal Fine Structure Processing

Background and Aim: Many aspects and features of auditory system can be improved by musical training. This study aimed to investigate the effects of a stringed musical instrument playing course on temporal resolution and temporal fine structure (TFS) processing. Methods: This analytical cross-sectional study was conducted on 44 normal-hearing adults aged 20–40 years divided to two groups. The first group included 22 stringed musical instruments players (13 males) with at least three years of experience, and the second group were 22 non- players (13 males). The random gap detection test (RGDT) was used to measure temporal resolution aspect of hearing. For TFS processing, latest version of temporal fine structure-adaptive frequency (TFS-AF) test was used. Results: The TFS-AF results showed no statistically significant difference between groups in different interaural phase differences (IPDs). The RGDT results showed significant differences between groups at 500, 1000 and 2000 Hz, but not at 4000 Hz. Spearman correlation test results showed no statistically significant correlation between the results of TFS-AF and RGDT. Conclusion: Musical training has no effect on TFS processing but considerably enhances gap detection ability. Their underlying mechanisms for TFS processing and gap detection are different.

Development and Psychometric Evaluation of Persian Dynamic Spatial Quick Speech-in-Noise Test in Adults with Normal Hearing

Background and Aim: Spatial hearing is a prerequisite for the proper function of the listener in complex auditory environments. In the present study, a Persian version of the dynamic spatial-quick speech in noise (DS-QSIN) has been developed with respect to all possible factors affecting the test and to run five lists for normal hearing subjects and assessment of reliability. Methods: To construct five new lists according to the original quick speech in noise (QSIN) test, we used frequent, familiar, and difficult words to construct unpredictable sentences. After determining the content and face validity of the sentences, 30 selected sentences were played using a DS-QSIN software for 35 subjects aged 18–25 years. The reliability of the test was assessed after repeating the test after two weeks. Results: According to expert judges, these 30 sentences showed acceptable  content  and  face validity with the changes. The average signal-to-noise ratio (SNR) loss of five lists was –5.2 dB. No significant difference was seen between men and women in all lists. The results indicate no difference in the average SNR loss between the five lists. Regarding the reliability assessment, the test-retest correlation coefficient was 0.5 to 0.7 (p<0.05). The intra-class correlation coefficient between test-retest was statistically significant (p>0.001) and confirmed that the lists have high reliability and repeatability. Conclusion: DS-QSIN test showed good validity and reliability and can be helpful in diagnosis and selecting the best method for rehabilitation of people with a spatial hearing disorder.

Arm proprioception in lateral epicondylalgia; a cross-sectional study

Introduction: Lateral epicondylalgia is one of the most common injuries due to overuse with inflammation of the elbow on the lateral epicondyle. Although the clinical features of this disorder are well defined, few therapeutic intervention has been effective. Objectives: This study aimed to investigate the proprioception in the upper limb of patients with lateral epicondylalgia, using the sense of joint position and of force reproduction tests. Participants and Methods: Twenty patients with unilateral lateral epicondylalgia and 20 healthy subjects participated in this study. The evaluation of position sense of shoulder, elbow and wrist, and force reproduction sense of shoulder abductor, elbow flexor and wrist extensor were conducted. The proprioceptive performance was determined, using absolute, constant and variable error values. Results: Significant differences were found for the sense of the position of the elbow and wrist between the lateral epicondylalgia and control groups for the variables of absolute error (P=0.003 and P=0.02, respectively) and constant error (P=0.001, P=0.03, respectively). A significant difference was also observed for the sense of force of the elbow flexor and wrist extensor between the two groups for the variables of absolute error (P=0.02 and P=0.02, respectively) and constant error (P=0.016 and P=0.001, respectively). No statistical difference was found for variable errors neither in sense of position nor sense of force (P>0.05). Conclusion: The data confirmed the hypothesis of proprioception deficits in subjects with lateral epicondylalgia, compared to the healthy subjects during the evaluation of the sense of force and position.

Prevalence of refractive errors and color vision deficiency in a population of industry-workers in Abhar, Iran

Visual impairment due to refractive errors and color vision deficiency (CVD) can affect the visual abilities of workers in workplace. Identifying the prevalence of common visual problems helps us to prevent and treat occupational ocular problems.This study was conducted on 2600 males referring from companies for a routine medical exam to Occupational Medicine Center. In all subjects, visual acuity and refraction were measured. Assessment of color vision was performed by Ishihara color test. In present study, right eyes of subjects were selected to statistical analysis.The mean spherical equivalent was -0.19 ± 1.39 diopter with a range of -11.00 to +10.00 diopter. Whereas 71% of persons were emmetropic, 20% and 9% of them were myopic and hypermetropic, respectively. From a total subjects, 164 of them had CVD with prevalence of color blindness of 6.3%. In comparison with normal subjects, CVD had no significant effect on refractive findings of our subjects (P > .05).Our data present the prevalence of refractive errors and color blindness among Iranian industry-workers. Compared with other studies, our subjects have a lower prevalence of refractive errors, and similar rate of prevalence of color blindness.

The Correlation between Hypertropia and Head Tilt in Congenital Unilateral Superior Oblique Muscle Palsy

Purpose:

To evaluate the correlation between the angle of deviation in different gazes and the amount of head tilt in patients with congenital unilateral superior oblique muscle palsy (SOP).

Methods:

This case series study was performed on 20 consecutive SOP patients with head tilt. Based on the Bielschowsky three-step test, the angle of deviation was measured in different gazes. Furthermore, the hypertropia difference between the two lateral gazes (gaze difference) and the two head tilt sides (bilateral head tilt difference) was calculated. For measuring head tilt, close-up pictures from 40 cm with a habitual abnormal head position were captured and analyzed by the Corel Draw X7 software.

Results:

The mean age of patients was 13 ± 9 years (range, 2.5–31 years). The mean angle of hypertropia in ipsilateral and contralateral head tilt was 24.5 Δ ± 7.1 Δ and 6.5 Δ ± 4.2 Δ, respectively (P < 0.001), and in ipsilateral and contralateral lateral gaze positions, it was 8.2 Δ ± 5.5 Δ and 22.5 Δ ± 6.1 Δ, respectively (P < 0.001). The mean of bilateral head tilt hypertropia difference was 18 Δ ± 5.3 Δ and gaze hypertropia difference was 14.3 Δ ± 6.16 Δ. There was a positive correlation between bilateral head tilt hypertropia difference and the amount of head tilt (R = 0.609, R² = 0.371, P = 0.004, the amount of head tilt = 0.39 × [Bilateral head tilt hypertropia difference] +1.77). The amount of head tilt also had a positive correlation with the gaze hypertropia difference (R = 0.492, R² = 0.242, P = 0.028, the amount of head tilt = 0.27 × [gaze hypertropia difference] +4.81).

Conclusion:

In SOP patients, the amount of head tilt had a positive correlation with bilateral head tilt hypertropia difference and also gaze hypertropia difference.

Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy

SIGNIFICANCE

This study was conducted to evaluate facial asymmetry in unilateral congenital superior oblique muscle palsy (SOP). The results showed that all facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic individuals.

PURPOSE

This study aimed to evaluate the characteristics of facial asymmetry in unilateral congenital SOP and compare with orthotropic individuals.

METHODS

This cross-sectional comparative case series was conducted in 58 patients with ocular torticollis caused by SOP (mean ± standard deviation age, 18 ± 12 years) and 58 orthotropic individuals (mean ± standard deviation age, 19 ± 13 years). The exact form of torticollis was determined by direct observation from yaw, roll, and pitch axes. Four photographs were taken from patients: (1) with torticollis to calculate the amount of head tilt; (2) with the head in the straight position to calculate the facial angle and relative facial size (RFS); and (3 and 4) with the head positioned downward (to compare the cheek size) and upward (to assess columella deviation and nostril asymmetry).

RESULTS

Twenty-nine patients (50%) had a head tilt, 23 (39.66%) had combined head tilt and a face turn, and 6 (10.44%) had a pure face turn. The mean ± standard deviation of head tilt, facial angle, and RFS was 10.11 ± 6.31°, 1.11 ± 1.67°, and 1.003 ± 0.126 in SOP patients, respectively, and the mean RFS and facial angle were significantly higher in SOP patients compared with orthotropic individuals (both P < .001). Facial hemihypoplasia, unilateral cheek compression, nostril asymmetry, and columella deviation were observed in 43 (74.1%), 31 (53.4%), 39 (67.2%), and 38 patients (65.5%), respectively, which were all significantly more common compared orthotropic individuals (P < .001). Facial asymmetry was seen in 52 patients (91.2%) and 17 orthotropic subjects (29.3%), respectively (P < .001).

CONCLUSIONS

All quantitative and qualitative facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic subjects.

Mapping the Relative Risk of Congenital Hypothyroidism Incidence via Spatial Zero-Inflated Poisson Model in Guilan Province, Iran

Background:

Congenital hypothyroidism (CH) is one of the most prevalent preventable causes of mental retardation. Studies show that the incidence rate of CH is very high in Iran. Disease mapping is a tool for visually expressing the frequency, incidence, or relative risk of illness. The present study aimed to model CH counts considering the effects of the neighborhood in towns and perform mapping based on the relative risk.

Methods:

In this historical cohort study, data of all neonates diagnosed with CH with TSH level ≥5 mIU/L between March 21, 2017, and March 20, 2018, in health centers in Guilan, Iran were used. The number of neonates with CH was zero in most towns of Guilan Province. The Bayesian spatial zero-inflated Poisson (ZIP) regression model was employed to investigate the effect of the town's neighborhood on the relative risk of CH incidence. Then, the map of the posterior mean of the relative risk for CH incidence was provided. The analysis was performed using OpenBUGS and Arc GIS software programs.

Results:

The relative risk of CH incidence was high in the West of Guilan. Moreover, the goodness-of-fit criterion indicated that it is more appropriate to fit the Bayesian spatial ZIP model to these data than the common model.

Conclusions:

Considering the high relative risk of CH in the Western towns of Guilan Province, it is better to check important risk factors in this region.

Comparison of the effects of instrument assisted soft tissue mobilization and dry needling on active myofascial trigger points of upper trapezius muscle

Background: Myofascial pain syndrome is one of the most common complaints in patients referring to orthopedic treatment centers. The present study aimed to examine the effects of instrument-assisted soft tissue mobilization (IASTM) and dry needling (DN) on active myofascial trigger points (AMTrP) of the upper trapezius muscle (UTM). Methods: The current study was designed as a randomized clinical trial and a total of 81 patients, aged 18-40 years, with active myofascial trigger points in the upper trapezius muscle were randomly divided into 3 groups: group 1 (n = 30) received DN treatment, group 2 (n = 26) received IASTM treatment, and group 3 (n = 25) was considered as the control group (no intervention). The numeric pain scale (NPS), pain pressure threshold (PPT), active cervical contra-lateral flexion (ACLF), neck disability index (NDI), and muscle thickness (MT), according to rehabilitative ultrasonic imaging (RUSI), were measured at baseline, immediately after the last session (session 4 in week 2), and 1 month after the last session. The statistical analysis was conducted at a 95% confidence level. The P values less than.05 were considered as statistically significant. Results: Both techniques were effective in treating active trigger point of the upper trapezius (p<0.05), but there was no significant difference between the treatment groups in terms of any of the above variables except for ACLF (p>0.05) Conclusion: Both IASTM and DN were determined to improve NPS, PPT, ROM, and NDI in participants with active trigger points in the upper trapezius, although IASTM was more effective in increasing ACLF in these patients.

Effect of axial length and anterior chamber depth on the peripheral refraction profile

AIM

To evaluate the effect of axial length (AL) and anterior chamber depth (ACD) on peripheral refractive profile in myopic patients compared to emmetropic participants.

METHODS

This cross-sectional study was conducted in right eyes of 58 participants of whom 38 were emmetropic and 20 were myopic. Central and peripheral refraction were measured at 10°, 20°, and 30° eccentricities in nasal and temporal fields using an open-field autorefractor. The Lenstar LS900 was used to measure ACD and AL. The participants were divided into three groups of short (<22.5 mm), normal (22.5-24.5 mm), and long eye (>24.5 mm) according to AL and three groups of low ACD (<3.00 mm), normal ACD (3.00-3.60 mm), and high ACD (>3.60 mm) according to ACD.

RESULTS

The mean age of the participants was 22.26±3.09y (range 18-30y). The peripheral mean spherical refractive error showed a hypermetropic shift in myopic and emmetropic groups although this shift was more pronounced in the myopic group. The results showed significant changes in the spherical equivalent, J0, and J45 astigmatism in all gazes with an increase in eccentricity (P<0.001). The pattern of refractive error changes was more noticeable in long and short eyes versus normal AL eyes. Moreover, the pattern of peripheral refractive changes was much more prominent in the high ACD group versus the normal ACD group and in the normal ACD group versus the low ACD group.

CONCLUSION

Peripheral refraction changes are greater in participants with AL values outside the normal range and deeper ACD values compared to participants with normal AL and ACD.

Effect of voxel size on detection of fenestration, dehiscence and furcation defects using cone-beam computed tomography

OBJECTIVES

This study aimed to assess the effect of voxel size on detection of fenestration, dehiscence, and furcation defects using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

This in vitro, experimental study evaluated 4 sheep skulls with both the maxilla and mandible accompanied by the surrounding soft tissue. Fenestration (n = 30), dehiscence (n = 65), and furcation defects (n = 46; 18 grade I, 25 grade II, and 3 grade III) were randomly created by round and needle burs in both jaws, and 40 areas served as control sites. CBCT scans were obtained with 0.300 and 0.150 mm³ voxel sizes and 8 × 11cm² field of view (FOV), and were randomly observed by four observers (two oral and maxillofacial radiologists and two periodontists). The kappa values, sensitivity and specificity were calculated for each voxel size and compared using paired t test.

RESULTS

By an increase in image resolution, diagnostic sensitivity increased while specificity decreased. The kappa values for fenestration (0.602-0.623), and grade III furcation defects (0.903-1.00) were optimal (> 0.6), and almost similar for both voxel sizes. The kappa values for dehiscence, and grades I and II furcation defects were unfavorable (< 0.6) and almost similar for both voxel sizes, except for grade I furcation defects, which had a significant difference in kappa values between the two voxel sizes (0.014 and 0.34).

CONCLUSION

Smaller voxel size had higher sensitivity and lower specificity for detection of all defects except for grade I furcation defects, for which the smaller voxel size had higher sensitivity and higher specificity.

Combined Balance Training and tDCS Intervention for the Recovery of Postural Control Following Chronic Stroke: A Study Protocol for A Multi-Centre, Double Blind, Randomized Control Trial

Background: Stroke is one of the most debilitating diseases among the adults around the world which leads to persistent rehabilitation needs even at chronic stage. Achievement of good postural control is a critical requirement for daily activities which enhances quality of life in patients with stroke. There is increasing evidence that transcranial direct current stimulation (tDCS) may be considered as a promising adjunct technique to improve motor recovery after stroke. Evidence of augmented neuroplasticity after tDCS suggests that a paired rehabilitation followed by consecutive use of tDCS may optimize recovery outcomes. Although a few RCTs have been conducted on upper limbs rehabilitation in chronic stroke using tDCS, however no study focused on balance training in chronic stroke patients. This randomized, sham-controlled, double-blinded clinical study aims to address brain stimulation targeting postural control using tDCS in chronic stroke. Methods: The study participants will be chronic ischemic stroke individuals with postural control impairments who meet no exclusion criteria. Active or sham anodal tDCS will delivered to lesioned leg motor cortex combined with balance training. Experimental group receive active anodal tDCS stimulation (2mA) for 20 min, daily for 5 days paired with balance training. Linear and nonlinear approaches will be used to analyse postural sway changes pre and post-intervention. Postural sway fluctuation, Functional balance assessment using Berg balance scale, Timed Up-and-Go Test will be compared in active and sham groups. Conclusions: This trial could have significant implications for balance rehabilitation after stroke in the ambulatory setting. If found to be effective, this novel approach may improve rehabilitation protocol in this population.

Ocular abnormal head posture: A literature review

Purpose:

Methods:

Results:

Conclusion:

Abnormal Head Posture in Unilateral Superior Oblique Palsy

Purpose: To evaluate the manifestations and severity of abnormal head posture (AHP) in unilateral congenital and acquired superior oblique palsy (SOP) patients and to assess the effect of AHP on facial appearance. Patients and methods: This case series study was performed on 60 consecutive SOP patients, which consisted of 47 patients with congenital SOP and 13 patients with the acquired source. The exact type of AHP in congenital and acquired cases was determined based on direct observation. In addition, a close-up picture from 40 cm with habitual AHP was captured from all patients. For evaluation of the severity of AHP and measurement of head tilt, these pictures were analyzed by the Corel Draw X7 software (Corel Corp, Canada). Besides, qualitative and quantitative facial asymmetry parameters were evaluated by the assessment of pictures of patients, which were taken in different gazes. Results: Five different manifestations of AHP were observed to the contralateral side of the palsy; 1 - pure head tilt, 2 - simultaneous head tilt and turn, 3 - pure head turn, 4 - head tilt and chin down, and 5 - head tilt and turn with chin down. The frequency of these five manifestations of AHP in the congenital group were 23 (48.9%), 10 (21.3%), 4 (8.5%), 5 (10.6%), and 5 (10.6%) patients, respectively (P <.001) and in acquired patients, were 1 (7.7%), 8 (61.5%), 2 (15.4%), 2 (15.4%), and 0 (0%), respectively (P =.024). In all SOP patients, the most common manifestations of AHP were pure head tilt (40%), simultaneous head tilt and turn (30%), and head tilt with chin down (11.7%), respectively. The mean degrees of head tilt in congenital and acquired patients were 15.10° ± 9.34° and 9.61° ± 5.84°, respectively (P =.022). Conclusion: The most common type of AHP in congenital SOP patients was contralateral head tilt, but in acquired cases was simultaneous head tilt and turn. The mean amount of head tilt in the acquired group was significantly higher than congenital patients; in contrast, the frequency of facial asymmetry was higher in the congenital group compared with the acquired patients.

Postural Balance Evaluation in Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND

The risk of falling in patients with chronic obstructive pulmonary disease (COPD) is higher than healthy people, imposing a great financial burden on patients due to clinical diagnosis and treatment. This study aimed to compare static balance between two groups of healthy people and COPD patients, based on cognitive tasks and vision tests, using linear and non-linear analyses.

MATERIALS AND METHODS

A total of 15 patients with COPD and 14 age- and gender-matched healthy individuals were recruited in this study. Variations in the center of pressure were recorded in both medial-lateral (ML) and anterior-posterior (AP) directions by implementing visual feedback and cognitive tasks, with the subject standing on a force plate. Data related to the center of pressure were analyzed in the AP and ML directions by linear methods (i.e., standard deviation of displacement, standard deviation of maximum velocity, average velocity, and phase plane). Also, the nonlinear method (Lyapunov exponents) was used in both directions.

RESULTS

The cognitive tasks improved the center of pressure variables in both groups. In association with the vision tests, only lack of vision had a significant effect on the patients. The results of the linear analysis in the ML direction were significantly higher in the COPD group as compared to the healthy group; however, the results were not significant in the AP direction. Also, the non-linear analysis showed significant differences between the groups.

CONCLUSION

Use of both linear and non-linear analyses is necessary for evaluating the balance of patients with breathing difficulties. Balance disorders in COPD patients were mostly in the ML direction; therefore, postural deformities might be one of the reasons for balance problems in the AP direction.

Construct validity and internal consistency of the modified Persian version of the STarT Back Screening Tool

BACKGROUND AND AIM

Considering the importance of non-specific low back pain (NSLBP) and its increasing spread, the need for instruments for the accurate diagnosis of back pain is evident in order to offer more effective treatment. One such instrument is the STarT Back Screening Tool (STarT) which is examined by numerous studies, while some of its psychometric dimensions still require attention. Therefore, the objective of this study was to assess the internal consistency and construct validity of this questionnaire to propose a modified version.

METHOD

In this cross-sectional study, the data of 295 patients with NSLBP were analyzed. Cronbach's alpha was used to assess internal consistency, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to assess construct validity. The Χ2/df, GFI, CFI, and RMSEA indices were also utilized as the goodness-of-fit criteria. Data analysis was performed in SPSS, AMOS, and EQS programs.

RESULTS

Goodness-of-fit indicators were calculated for the original Persian version of the questionnaire, showing an improper fit (RMSEA = 0.162). According to the measures of sampling adequacy (MSA) of the questions, Questions 1 and 8 were deleted, resulting in an improved index (RMSEA = 0.062). All the regression coefficients in the CFA model were significant (p < 0.001for all 7 parameters).

CONCLUSION

Based on the results, the modified Persian version of the STarT is simpler and more practical than the previous version, serving as a valid and reliable tool for assessing patients with low back pain. With respect to the goodness-of-fit indices, we recommend that more studies with larger samples be conducted on different populations.

Effect of bleaching on color change of composite after immersion in chlorhexidine and coffee

Background:

Since the introduction of resin composites, the staining of resin-based materials by colored solutions such as coffee, tea, chlorhexidine (CHX), and other beverages has become a common concern.

Aim:

The aim of this study was to evaluate the effect of home and office bleaching as a treatment for discoloration of composite after immersion in coffee or CHX.

Materials and Methods:

A microhybrid composite (Z250), nanohybrid composite (Z550), and nanofill composite (ultimate, body shade) were selected. Forty disk shape specimens (8 mm diameter and 2 mm thickness) for each composite were prepared then divided into two groups according to staining solutions (25 g of coffee in 250 ml water, 20 min/day or 0.2% CHX, 1 min/day). Following 1 month staining, specimens were divided into two groups again. Half of the specimens was bleached with in office bleaching agent (Opalescence Boost 40% hydrogen peroxide concentration) 3 times in one visit for 15minutes and the others subjected to home bleaching agent(Opalescence 10% carbamide peroxide) 6h/day until 2 weeks both from Ultradent Products, Inc., South Jordan, UT, USA. Color of the specimens was measured with a spectrophotometer using CIELAB color space at baseline, after 1 month staining, and after ending the bleaching process.

Statistical Analysis:

Analysis of variance was used to analyze the data (P < 0.05).

Results:

Coffee and CHX provided significant color changes in all groups (P < 0.05). Z550 was the material more prone to discoloration in coffee in comparison with Filtek Ultimate (P = 0.003). After bleaching, materials showed significant reduction except stained Z550 by coffee in home bleaching groups. Both home and office bleaching provided significant color changes in all CHX groups (P < 0.05).

Conclusion:

Coffee produced more color changes than CHX. The hydrogen peroxide has the same whitening effect in comparison with carbamide peroxide.

Predictive role of individual factors in the leisure preferences of children and adolescents with cerebral palsy: a cross-sectional study in Iran

Background/Aims

The participation of children and adolescents with cerebral palsy in leisure activities is associated with their preferences. A better understanding of their leisure preferences and the factors that influence them can help therapists to promote young patients' participation in leisure activities. The aim of this study was to describe the role of individual factors in the prediction of leisure preferences of children and adolescents with cerebral palsy in Iran.

Methods

A cross-sectional study design was used. A total of 152 children and adolescents with cerebral palsy were selected to complete the Preferences for Activities of Children questionnaire. Simple and multiple linear regression analyses were performed to assess the role of individual factors in the prediction of preferences for leisure activities.

Results

Individual factors played a significant role in the prediction of leisure preferences. Their influence on the preferences for recreational, physical and self-improvement domains (r2=0.215; 0.154; 0.127, respectively) were greater than for social and skill-based domains (r2=0.045; 0.052, respectively).

Conclusions

Preferences for physical activities need to be augmented while a high preference for social and recreational activities could be used to promote participation in leisure activities. Therapists and other healthcare professionals should consider individual factors relating to leisure preferences when devising therapeutic plans that aim to promote participation in leisure activities.

Pulmonary rehabilitation and exercise therapy in a patient with COVID-19: A Case report

Dyspnea, shortness of breath, and inability to perform activities of daily living are the main complaints in patients with COVID-19 and physiotherapy has a vital role in managing such symptoms. We present a case treated with pulmonary and neurological physiotherapy, which improved symptoms and quality of life. In this case report, the importance and potential effect of concise physiotherapy on patients with COVID-19 is presented.