Occupational Therapy in Kleefstra Syndrome.

Kleefstra Syndrome (KS) is a rare genetic neurodevelopmental disorder caused by a microdeletion in chromosomal region 9q34.3 or a mutation in the euchromatin histone methyltransferase 1 (EHTM1) gene. Patients with KS show a range of clinical symptoms, including delay in motor and speech development, intellectual disability, autistic-like features, childhood hypotonia, and distinctive facial dysmorphic features. The patient is a four-year-old girl who was initially diagnosed with developmental motor delay by a pediatric neurologist and referred to an occupational therapy clinic at the age of six months. The initial assessment showed hypotonia and difficulties with rolling. Occupational therapy intervention was based on principles of neurodevelopmental treatment and sensory integration (SI) with cognitive integration and activities of daily living (ADL) training. With continuous occupational therapy services over more than three years, she overcame many disabilities and improved in occupational performance skills such as gross and fine motor skills as well as cognitive abilities, although her verbal communication skills were not effective. The patient's progress was as follows: she began rolling over at seven months, achieved independent sitting at ten months, crawled at eighteen months, stood with support at twenty months, and took her first steps at twenty-six months. The predominant problem was speech delay, which was noticeable in this syndrome. When a patient is being referred because of KS, occupational and speech therapy assessments should be accurately implemented.

The challenge point framework to improve stepping reaction and balance in children with hemiplegic cerebral palsy: A case series study.

PURPOSE: This study investigated the effects of the challenge point framework (CPF) to improve stepping reactions and enhance balance in children with hemiplegic cerebral palsy (HCP). The CPF relates practice variables to the skill level of the individual and task difficulty. METHODS: Nine children with HCP (age: 7.7±2.4 years) completed six weeks (12 sessions) of a CPF intervention which consisted of progressively fewer sets and repetitions of a stepping reaction task wherein participants sought to improve both step length and reaction rate. Stepping reaction (step length and reaction rate) to a balance perturbation in the anterior, posterior, and lateral directions and static and dynamic balance (via the Pediatric Balance Scale) were measured at baseline, a second baseline 3 weeks later, and post-intervention. Repeated measures ANOVAs determined within-group changes. Cohen's d effect sizes were calculated. RESULTS: Participants improved balance (d = 0.948, p = 0.010), step length (forward d = 0.938, p = 0.002; backward d = 0.839, p = 0.001; and lateral d = 0.876, p = 0.002), and reaction rate (forward d = 0.249, p = 0.042; backward d = 0.21, p = 0.047; and lateral d = 0.198, p = 0.049). CONCLUSION: These findings indicate that children with HCP may benefit from completing a CPF program with a motor learning approach. This approach of retraining stepping reactions helped to improve static and dynamic balance. The CPF may aid progression of functional task training in children with HCP aged 4-12, though more studies with a long-term follow-up analysis are needed to confirm this result.

Psychometric Properties of the Persian Version of Penn Parkinson Daily Activities Questionnaire-15.

Introduction: Appropriate information about the ability of patients with Parkinson disease (PD) to perform cognitive instrumental activities of daily living (IADL) is necessary. The present study aimed to assess the psychometric properties of the Persian version of the Penn Parkinson daily activities questionnaire-15 (PDAQ-15). Methods: A total of 165 knowledgeable informants of PD patients completed the PDAQ-15. The clinical dementia rating scale, Hoehn and Yahr staging, hospital anxiety and depression scale (HADS), and Lawton IADL scale were used in the study. Internal consistency and test-retest reliability were evaluated by the Cronbach α coefficient and intraclass correlation coefficient (ICC), respectively. To examine the dimensionality of the questionnaire, exploratory factor analysis was used. The construct validity was assessed using the Spearman rank correlation test. To assess the discriminative validity, PDAQ-15 scores were compared across cognitive stages. Results: The PDAQ-15 showed strong internal consistency (the Cronbach α=0.99) and test-retest reliability (ICC= 0.99). Only one dimension was identified for the PDAQ-15 in the factor analysis. There was a strong correlation between PDAQ-15 with the depression domain of the HADS scale and the Lawton IADL scale (rs=|0.71-0.95|). The correlation of PDAQ-15 with the anxiety domain of the HADS scale was moderate (rs=0.66). Discriminative validity analysis showed that the PDAQ-15 has significant power to discriminate between PD patients across cognitive stages. Conclusion: These results suggest that the PDAQ-15 is a valid and reliable PD-specific instrument and can be useful in clinical and research settings.

Sensory Processing Patterns and Sleep Quality in Primary School Children.

OBJECTIVES: Sensory processing and sleep quality affect children's academic performance and their quality of life. This study aimed to investigate the relationship between sensory processing patterns and sleep quality in primary school children. MATERIALS & METHODS: In this cross-sectional study, 231 primary school students aged 7 to 12 years old (133 girls and 98 boys, the mean age of 8.68±1.51) who were studying in schools in Tehran were randomly selected through cluster sampling. The researchers distributed a questionnaire on children's sleep habits to assess the quality of sleep and a sensory profile questionnaire to assess the sensory processing patterns (avoidance, sensitivity, seeking, and registration) among the students. RESULTS: In this study, we found a meaningful moderate relationship between sensory processing patterns and overall scores of sleep habits (p <0.001). Moreover, each of the sensory processing patterns had a negative relationship with areas of sleep habits (p = 0.005). There was also a significant difference between children who had more challenges with sleep maintenance and children with normal sleep patterns in sensory processing; mean differences were significant in all the four sensory quadrants (registration, seeking, sensitivity, and avoiding) (p <0.001). CONCLUSION: The sensory processing patterns are moderately correlated with sleep habits in primary school children. Occupational therapists and other specialists working in the field of children's sleep should consider the relationship between sensory challenges and sleep habits while making decisions about sensory challenges and sleep problems. Better sleep may occur with attention to sensory needs in sleep routines. Better sleep may lead to improved quality of life in families and enhanced student performance at school.

Predictors of Leisure Participation in 6 to 14-Year-Old Children with Cerebral Palsy: Structural Equation Modeling.

OBJECTIVE: The aim of this study was to test a model of child, family and environment and identify factors affecting the intensity of leisure participation by children with cerebral palsy (CP). MATERIALS & METHODS: In this cross-sectional study, 232 children with cerebral palsy (141 boys and 91 girls), aged 6 to 14 years old and their parents were selected from four schools of children with special needs and five rehabilitation centers through the convenience sampling method in Shiraz, Iran. To evaluate the intensity of leisure participation, we used the Persian version of Children's Assessment of Participation and Enjoyment (CAPE) completed by the participants. Demographic form, Craig Hospital Inventory of Environmental Factors (CHIEF), Strengths and Difficulties Questionnaire (SDQ), Family Environmental Scale (FES), SPARCLE cognitive level and parents' version of Gross Motor Function Classification System, Manual Ability Classification System and Communication Function Classification System were sent to the parents with some necessary explanations. Structural equation modeling was used to test the model hypothesis. SPSS version 18 and AMOS version 16 were used for data analysis. RESULTS: Comparative fit indexes indicated a moderate to good model fit. The presented model explained 44% of the variance in the intensity of participation. Constructs such as Family Activity Orientation with standardized total effect of 0.31 and path coefficients of P< .05 showed the most significant direct effect on participation, followed by higher gross motor function (-.26), higher manual ability (-.19), communication function (-.17), higher cognitive level (-.16), more siblings in the family (.15) and less emotional-behavioral problems (-.15). Family structures and relationships (.17) and unsupportive environment constructs (-.14) demonstrated an indirect but significant effect (P< .05). The relationship of family education level and income with participation was not significant (P>.05). CONCLUSION: The intensity of CP children's participation is influenced by child, family and environmental factors. Parents' knowledge of recreational activities and their preference to participate in leisure and recreational activities provide children more opportunities to participate. Higher gross motor function, manual ability, and communication function also play an important role in their participation. Family structure means family cohesion, roles organization, and conflicts between family members and encountering physical, attitudinal and structural barriers at home and community indirectly impact children's participation pattern. To enhance children's participation, we suggest therapists to support children's behaviors, family relationships and involvement in community activities and optimize physical function of children with limitations in self-mobility.

Effect of Mirror Therapy on Dexterity and Hand Grasp in Children Aged 9-14 Years with Hemiplegic Cerebral Palsy.

OBJECTIVES: Mirror therapy using visual feedback is one of the non-invasive methods along with other commonly used rehabilitation treatments for neurological patients which therapeutic effects on the affected upper limb of children with hemiplegic cerebral palsy have also been studied. We aimed to examine the effect of mirror therapy on improving the dexterity and grasp of children with hemiplegic cerebral palsy. MATERIALS & METHODS: In this single-blind clinical trial, 30 children with hemiplegic cerebral palsy in rehabilitation centers and special schools of Tabriz, northwest of Iran were randomly divided into two intervention and control groups in 2017. The children of the intervention group were under mirror therapy for 6 weeks. Occupational therapy exercise was done routinely for both groups. The grasp with dynamometer and the dexterity with box and block was measured. Data were analyzed using independent t-test and paired t-test. RESULTS: The mean scores of the two groups in dexterity were significantly different after the intervention (P=0.008). However, there was no significant difference between the two groups in grasp. CONCLUSION: Mirror therapy in hemiplegic children is useful in improving the dexterity but not in improving of the grasp.

Test-retest & Inter-rater Reliability of Persian Version of Pediatric Balance Scale in Children with Spastic Cerebral Palsy.

OBJECTIVES: Children affected with spastic cerebral palsy suffering a lot of movement and balance difficulties. Balance is one of the essential variables of movement, which facilitates functional skills. The main purpose of this study was inter-rater & test-retest reliability of Pediatric Balance Scale (PBS) in children with spastic cerebral palsy. MATERIALS & METHODS: In this analytical-descriptive research performed in the rehabilitation centers, south of Tehran, Iran in 2016, psychometric method was used. For investigating the inter-rater reliability, two examiners performed the scale simultaneously with 50 children with spastic cerebral palsy. Moreover, to investigate the test-retest reliability, the scale was implemented by one examiner, in two different sessions, among 50 children with spastic cerebral palsy. There was a two-week period between the first and the second session. RESULTS: The inter-rater reliability (ICC=0.99), as well as the test-retest reliability (ICC=0.99), was quite high. Standard Error of Measurement (SEM) was acceptable for either test-retest or inter-rater reliability. CONCLUSION: PBS is appropriate for measuring functional balance in children with spastic cerebral palsy with mild to moderate motor impairment.

The effect of kinesiotaping on hand function in stroke patients: A pilot study.

Upper extremity motor impairment is one of the most prevalent problems following stroke. Considering the functional importance of the upper extremity in the daily life, the purpose of this study was to investigate the effect of kinesiotaping (KT) on hand function and spasticity in individuals following a stroke. Eight individuals who had experienced a stroke, with their age ranging from 47 to 66, participated in this pretest-posttest clinical study. An I- strip of tape was placed on the extensor muscles of the forearm. Primary outcome measures were the Modified Modified Ashwoth Scale, Box and Block test, and Nine Hole Peg test. At the immediate assessment, there were significant differences between two hand function tests scores. Secondary assessment was done after one week and the results showed significant differences between two hand function test scores. There was no significant change in flexor muscles spasticity after the intervention. This pilot study indicated that KT in the direction of the extensor muscles could result in better hand function in stroke patients.

The impact of Kinesio taping technique on children with cerebral palsy.

Cerebral palsy (CP) is the most common movement disorder in children that is associated with life-long disability and multiple impairments. The clinical manifestations of CP vary among children. CP is accompanied by a wide range of problems and has a broad spectrum. Children with CP demonstrate poor fine and dross motor function due to psychomotor disturbances. Early rehabilitation programs are essential for children with CP and should be appropriate for the age and functional condition of the patients. Kinesio taping (KT) technique is a relatively new technique applied in rehabilitation programs of CP. This article reviews the effects of KT techniques on improving motor skills in children with CP. In this study, we used keywords "cerebral palsy, Kinesio Tape, KT and Taping" in the national and international electronic databases between 1999 and 2016. Out of the 43 articles obtained, 21 studies met the inclusion criteria. There are several different applications about KT technique in children with CP. Review of the literature demonstrated that the impact of this technique on gross and fine motor function and dynamic activities is more effective than postural and static activities. Also this technique has more effectiveness in the child at higher developmental and motor stages. The majority of consistent findings showed that KT technique as part of a multimodal therapy program can be effective in the rehabilitation of children with CP to improve motor function and dynamic activities especially in higher developmental and motor stages.

Perception of professional ethics by Iranian occupational therapists working with children.

Ethics are related to the structure and culture of the society. In addition to specialized ethics for every profession, individuals also hold their own personal beliefs and values. This study aimed to investigate Iranian occupational therapists' perception of ethical practice when working with children. For this purpose, qualitative content analysis was used and semi-structured interviews were conducted with ten occupational therapists in their convenient place and time. Each interview was transcribed and double-checked by the research team. Units of meaning were extracted from each transcription and then coded and categorized accordingly. The main categories of ethical practice when working with children included personal attributes, responsibility toward clients, and professional responsibility. Personal attributes included four subcategories: veracity, altruism, empathy, and competence. Responsibility toward clients consisted of six subcategories: equality, autonomy, respect for clients, confidentiality, beneficence, and non-maleficence. Professional responsibility included three subcategories: fidelity, development of professional knowledge, and promotion and growth of the profession. Findings of this study indicated that in Iran, occupational therapists' perception of autonomy, beneficence, non-maleficence, fidelity and competence is different from Western countries, which may be due to a lower knowledge of ethics and other factors such as culture. The results of this study may be used to develop ethical codes for Iranian occupational therapists both during training and on the job.

Factors affecting ethical behavior in pediatric occupational therapy: A qualitative study.

BACKGROUND: It is the responsibility of each occupational therapist to always act ethically and professionally in a clinical setting. However, there is little information available concerning the factors influencing ethical behavior of occupational therapists at work. Since no study has been conducted in Iran on this topic, this qualitative study aimed to identify the factors influencing ethical behavior of pediatric occupational therapists. METHODS: Twelve pediatric occupational therapists participated in this study. The sampling was purposeful, and the interviews continued until reaching data saturation. All interviews were recorded and transcribed. The data were analyzed by qualitative content analysis, and the ethics of qualitative research was considered. RESULTS: The factors influencing ethical behavior were classified into four main categories including organizational factors, therapist related factors, client's family issues, and social factors. CONCLUSION: This study identified numerous factors influencing the ethical behavior of pediatric occupational therapists that could be used to train occupational therapists, human resources managers, professional policy makers, and could also be used to conduct future researches, and produce tools.