[Production of a protocol on early intervention for speech and language delays in early childhood: a novice experience in Iran]

Objective: Speech and language disorders, when happening during childhood will ultimately lead to important negative outcomes in the life of the child. The farther we move from this critical period, that is, the first 3 years of life, the less will be the positive effects of environmental stimuli on the development of speech and language. Early detection of children at risk for or in the preliminary phases of developmental delays and provision of early intervention services for them is of utmost importance. The objective of this research was to compile and produce protocols for early intervention in childhood speech and language developmental disorders in Iranian children

Materials and Methods: This study was conducted in two main phases: review phase and qualitative phase. In the review phase, all accessible search engines and databases, especially those for systematic reviews and guidelines were searched. In the qualitative study phase, several focus group discussions and rounds of Delphi were carried out with 20 experts in 7 subgroups, who were selected purposively

Results: The result of this study is presented as 7 intervention packages, including the following domains of disorders: prelingual lingual hearing impairment, speech sound disorders, dysphagia, stuttering, and dysarthria

Conclusion: Most studies have confirmed the effectiveness and need for early interventions for children with speech and language impairment. However, most do not explain the details of these interventions. Before the present study, no systematic and evidence-based protocol existed for early intervention in childhood speech and language impairments, in Iran; and due to language differences, as well as possible differences in the speech and language developmental process of children of different communities, making direct use of non-Persian references was not possible and effective. Thus, there was a clear demand for the production of such a protocol

[Developmental outcome of low birth-weight and preterm newborns: a review of current evidence]

Low birth weight [LEW] and preterm birth are one the most important causes of death in the world and therefore are considered as one of the major health problems. Global statistics demonstrates an increase in the prevalence of low birth weight in the developing countries. Low birth weight infants are exposed to complications such as major neurosensory impairements, cerebral palsy, cognitive and language delays, neuromotor developmental delay, blindness and hearing loss, behavioral and psychosocial disorders, learning difficulties and dysfunction in scholastic performances. The majority of infant's death and developmental disorders were due to disorders relating to prematurity and unspecified low birth weight. Infants weighing less than 2500 g, is a major determinant of both neonatal and infant mortality rates and, together with congenital anomalies [e.g., cardiac, central nervous system, and respiratory], contributes significantly to childhood morbidity. Various studies indicate that low birth weight infants are suffering from physiological and psychosocial disabilities, two to three times more than the other children. At school age, preterm and low birth weight infants have poorer physical growth, cognitive function, and school performance. These disadvantages appear to persist into adulthood and therefore have broad implications for society. Although the survival rates have increased dramatically and the incidence of morbidities has decreased, the complications are still considered to be associated with economical and social burdens. Most children with Low birth weight suffer from multiple disabilities. Therefore, they need special and consistent care. On demand of reducing the infant mortality rate, the need to decrease the complications in low birth weight and preterm infants should be considered by the policy makers in health care system. In this review article, we assessed current evidences on developmental outcomes of low birth weight and preterm newborns

Predicting developmental disorder in infants using an artificial neural network

Early recognition of developmental disorders is an important goal, and equally important is avoiding misdiagnosing a disorder in a healthy child without pathology. The aim of the present study was to develop an artificial neural network using perinatal information to predict developmental disorder at infancy. A total of 1,232 mother-child dyads were recruited from 6,150 in the original data of Karaj, Alborz Province, Iran. Thousands of variables are examined in this data including basic characteristics, medical history, and variables related to infants. The validated Infant Neurological International Battery test was employed to assess the infant's development. The concordance indexes showed that true prediction of developmental disorder in the artificial neural network model, compared to the logistic regression model, was 83.1% vs. 79.5% and the area under ROC curves, calculated from testing data, were 0.79 and 0.68, respectively. In addition, specificity and sensitivity of the ANN model vs. LR model was calculated 93.2% vs. 92.7% and 39.1% vs. 21.7%. An artificial neural network performed significantly better than a logistic regression model

Risk factor profiles of adverse neuromotor outcome in infants

Assessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in term and near-term infants. This case-control study was a representative sample of infants from different health-care centers of north and east of Tehran. The association between risk factors and delayed motor development [developmental quotient below 70 indicating a significant delay] was analyzed using correlating risk factors; including the perinatal and neonatal data to the developmental status. The case group consisted of 143 infants whose DQ score was less than 70 and the control group consisted of 140 infants who had a DQ score of more than 70. Neonatal seizures, Apgar score less than 3 after 5 minutes of birth [OR = 2.87 [95% CI; 1.68, 4.92]], low birth weight [OR= 5.86[95% CI; 3.07, 11.18]], preterm delivery [OR =6.17 [95% CI; 3.04, 12.52]], Premature rupture of membranes [PROM]>24 hours [OR = 6.18[95% CI; 2.07, 18.51]] and hyperbilirubinemia leading to phototherapy or exchange transfusion [OR=3.75 [95%CI; 2.12, 6.65]] were associated with an increased risk for neuromotor delay on developmental examination at 1 year. This study identified distinct risk factors for an adverse outcome in infants. In this environment, perinatal risk predictors are most important

Perinatal and neonatal risk factors for neurodevelopmental outcome in infants in Karaj

Although it is well-known that the incidence of developmental delay in high-risk infants is higher than in low-risk ones, little is known about the risk factors among Iranian infants. The objective of this study was to determine the various pre-, peri-, and neonatal factors in developmental delay in participants and to compare the incidence of each factor with that of the normal population. The Infant Neurological International Battery developmental assessment was employed as the diagnostic tool by a team of experts. Neurological examinations were performed and a questionnaire was completed as well. The subjects consisted of 6,150 infants divided into two groups respectively, with normal and abnormal scores for the evaluation over a period of 12 months in city of Karaj [Tehran Province]. The mean age of the participants was 39 weeks. Factors associated with a significant increased risk of developmental delay in the studied population included postneonatal seizures [OR=5.54, 95%CI: 3.1 - 9.6], neonatal seizures [OR=4.37, 95%CI: 1.7 - 10.8], preterm delivery [OR=2.52, 95%CI: 1.3 - 4.7], and type II pneumonia [OR=2.39, 95%CI: 1.4 - 3.8]. To increase the survival rate of neonates and effectiveness of early intervention, the above-mentioned risk factors could be considered as valuable clues. Routine neuro developmental screening for neonates and infants for early detection of neurodevelopmental delays is highly recommended. If economic limitations prevent mass-screening of neonates, at least high-risk infants should be routinely re-evaluated

Dohsa treatment to improve balance in elderly people: an evaluation of an family-based rehabilitation programme

In this research we evaluate an individually family-based Dohsa exercise programme of balance in the aged people and its effect on self confidence for performing common daily tasks with less falling could be influenced by training. From a residential care center, five aged person were participated in this study. They were trained by Dohsa method for six weeks. Two types of Dohsa-hou were used: Relaxation and Tate-kei. Tate-kei was the task which required them to control their body vertically against gravity. The results indicated that most of them had improved their balance and their confidence for doing their daily activities without falling in a better way. The Dohsa family based rehabilitation program could improve their balance and increase their activity by not falling down. The family based programme can be a useful program for rehabilitation therapists in their therapy with aged people to improve their life skills and well beings

Efficacy of prone lumbar traction on chronic discogenic low back pain and disability

To compare the outcomes of prone and supine lumbar traction in patients with chronic discogenic low back pain. Prospective, randomized control trial. Urban Physical Medicine and Rehabilitation clinic. A total of 124 subjects with chronic low back pain [LBP] and evidence of a degenerative and/or herniated inter-vertebral disk at 1 or more levels of the lumbar spine, who have not our exclusion criteria. A 4-week course of lumbar traction, prone or supine in case and control groups consecutively, consisting of six 30-minute sessions every other days, followed by four 30-minute sessions every 3 days. The numeric Visual pain rating scale and the Oswestry Disability Index [ODI] were completed at pre-intervention and discharge [within 2 weeks of the last visit]. A total of 124 subjects completed the treatment protocol. We noted significant improvements for all post-intervention outcome scores when compared with pre-intervention scores [P<0.01]. Also found significant difference between 2 groups in favor of prone traction [P<0.01]. Traction applied in the prone position for 4 weeks was associated with improvements in pain intensity and ODI scores at discharge, in a sample of patients with activity limiting LBP. However, because we lacked a reasonable long time follow-up, we cannot imply a long lasting relationship between the traction and outcome, and a long time follow-up is suggested