Case Report: Impact of Botulinum Toxin Injection on Function of Affected Upper Extremity in A Patient, 16 Years after Stroke

Objective: Case report Impact of Botulinum Toxin injection on function of affected upper extremity in a patient after 16 years since stroke (CVA). Botulinum toxin injection is one the treatments in spasticity reduction and consequently in recovery of upper limb function in stroke patients. The purpose of this case study is to report the effect of Botulinum toxin injection on upper extremity function after 16 years of stroke. Materials & Methods: The patient was a 63-year-old man who has had a cerebrovascular accident that happened in the left hemisphere about 16 years ago, and as a result, a paresis in dominant hand and arm. Although the patient was able to perform simple movements but he was complaining about the slowness and stiffness in the movements. To treat spasticity the Botulinum toxin type A was used. Injection into selected muscles of hemiparetic upper limb was done by a specialist physician and was between 50-150IU based on specific volume of each muscle. After injection, the patient was monitored for 3 months and at the end of each month, the assessments were reevaluated. During this period, although research team suggested the patient to continue the rehabilitation but for personal reasons he didn’t participate in any treatment and didn`t receive any other antispasmodic medications. Results: An increase in range of motion was seen in all joints but this improvement was not significant. The greatest improvement in passive and active range of motion was seen in Metacarpophalengeal joints. At the end of each month, compared to the first month the recovery of function in upper extremity was significant. Maximum recovery of upper extremity function was related to the hand section of fugl-meyer assessment. At the end of the first month, spasticity significantly decreased so that the patient was able to extend all his joints more easily than before injection. Although spasticity never reached zero. Conclusion: Botulinum toxin injection even after 16 years of stroke may improve the function of upper extremity

Electrical Muscle Strengthening and Electromyographical Analysis

Objective: A common form of therapy in physical therapy is the strengthening of muscles. As regards the probability of increasing muscular strength by electrical stimulation, we have tested the effect of that on muscle strength and endurance. Materials & Methods: 34 healthy male students of rehabilitation Sciences College (29-31 old) were subjected to two weeks of interferential current stimulation program, consisting of 7 sessions per week, each of 15 minutes duration. The stimulation was a 40-60 Hz beat with 25 seconds on and 35 seconds rest time. We were tested all of subjects before and after the program. Assessment parameters were: 1) Maximum circumference of right arm at rest (cm) 2) Maximum circumference at maximum isometric contraction 3) Maximum time (sec.) that he can hold a constant weight. 4) Integral of interference pattern at Max. contraction (µv.s) 5) Amplitude of the M. response (mAmp) 6) Duration of the M. response (ms.). Results: T-Pair test employed to data processing, confirm significant changes on l) rest arm circumference 2) contracted arm circumference 3) Muscle Endurance 4) IEMG 5) M. response Dur. Conclusion: In conclusion we can develop muscle strength and endurance by specific program mentioned above

The Effect of Mental Practice on Coordination of Upper Limb Movements in Hemiplegic Patients

Objective: Mental Practice (MP) can be defined as the symbolic, covert, mental rehearsal of a task in the absence, overt physical rehearsal. Elements such as similar time between actual execution and mental performance of a task, the increase of regional cerebral blood flow, vegetative activation, and enhancement in muscle electromyographic (EMG) activity during mental practice suggests that mental practice imitates physical performance of a task. Since physical practice (PP) can, to some extent, improve movement coordination in stroke patients, it is assumed that the application of MP would be beneficial to enhance movement coordination in such patients. The purpose of this study was to investigate the effect of MP on coordination of upper limb movements in hemiplegic patients. Materials & Methods: Fifteen hemiplegic patients (age range 20-70 yrs) were participated in this study. All patients were selected of the following criteria: absence of aphasic, apraxia and cognitive problem. The patients were randomly assigned to three groups, MP, PP, and PP+MP. Results: l. PP and MP Significantly improved movement coordination. 2. PP did not give different results when compared to MP. 3. PP Combined with MP Produced Significantly higher scores than each one alone. Conclusion: In spite of the small size in this study, the efficacy of MP shown here. Therefore MP Similar to PP should he used in physiotherapy

Language Disorders Comparative Study in Patients with Paranoid and Non-Paranoid Schizophrenia

Objective: The main purpose of this study was the assay of language disorders in paranoid and non – paranoid long-stay Schizophrenic patients in Razi Psychiatric Center. Materials & Methods: Language disorders in 40 Schizophrenic Patients who were divided in 2 groups (paranoid and non – paranoid No: 20) male and female and studied by using Farsi Aphasia Test. All of the subjects were matched on the basis of gender, age, education, duration of illness and length of stay in hospital. The evaluated language skills were composed of Spontaneus Verbal Fluency, Descriptive Verbal Fluency, Quality of Spontaneus Speech, Quality of Descriptive Speech, Listening Comprehension, Oral Reading (Expression), Written Comprehension, Writing, (words), Repetition and Number of Words. Data were analysed by using of SPSS windows analysis. Results: show a global reduction in scores of skills compared with normal subjects and the most reduction is seen in Quality of Descriptive Speech, Fluency of Descriptive speech and Number of Words Skills. Conclusion: Paranoid patients versus non paranoids show significant differences in Fluency of Descriptive Speech, Listening Comprehension, Oral Reading and Number of Words, and global score of the test. among demographic variants, only educational situation has significant relevance with some items of the test

The Role of Cognitive Rehabilitation in Reduction of Executive Function Deficits and Obsessive-Compulsive Symptoms in Schizo-Obsessive Patients

Objective: Some studies have found that schizo – obsessive patients have more deficits in cognitive functions. "Pathophysiological double jeopardy" theory suppose that in schizo – obsessive patients, cognitive impairments of obsessive – compulsive (OC) disorder are added to cognitive deficits of schizophrenia. The aim of the present study was determining that is there inter – relationship between OC symptoms and executive functions (EF)? If so improvement of EF may result to improvement of OC symptoms. Materials & Methods: Thus in a exploratory study and by a multi case design with multiple baseline, 4 inpatient with schizo – obsessive diagnosis were treated by cognitive rehabilitation to improve EF. Their clinical and cognitive changes were measured weekly. Results: The results demonstrated that cognitive rehabilitation reduced OC symptoms in at least two patient and improved their performance on EF tests. Furthermore a significant association was observed between the rate of improvement in EF and reduction OC symptoms. Conclusion: The results provide evidence for supporting of inter – relationship of OC symptoms and EF

The Comparison of Postural Control Ability in Children with/without Dyslexia

Objective: In some reviewed studies on children with dyslexia it is observed that there is a significant relationship between the ability of postural control and dyslexia. In this study, by controlling the interfering factors, we have reviewed this relation by comparing postural control and balance ability in normal and dyslexic children. Materials & Methods: This case-control study is done on 19 boys with dyslexia (112.90±13.78) and 19 Normal boys (118.42±15.62). Normal children and children with dyslexia were matched in age, height and weight. Positioning duties included standing with adjacent feet on firm surface with open and closed eyes, and with close eyes on the foam and with internal perturbation on firm surface. Duration of each assignment was 35 seconds and the force plate device was used to evaluate the condition performance. Balances component of Bruininks Oseretsky test were take from all of the samples and correlation between functional and laboratory test were examined. Results: The results showed that the area on firm surface with open eyes, internal perturbation dependency rate in the standard deviations of the lateral body sways (SDX) and of the antero-posterior body sways (SDY) and the surface area, there were significant differences between normal and dyslexic children, but there was not any significant difference between the two groups in path length and mean velocity in different postural control modes (foam, firm surface, open and close eyes) and visual dependence in all parameters (path length, velocity and surface area). We did not find significant correlation between Center of Pressure (COP) and the balance part of Bruininks Oseretsky test in children with dyslexia. Conclusion: In spite of differences in some postural control parameters between normal group and children with dyslexia, it was not found significant relationship between postural control and dyslexia

The Correlation of Cognitive Status and Activities of Daily Living Performance in Right-Handed Stroke Clients

Objective: It is so important to evaluate the effects of symptoms caused by stroke on activities of daily living. The purpose of this study was to determine the correlation of cognitive status and independence in activities of daily living (ADL) after stroke. Materials & Methods: This descriptive-analytical and cross-sectional study was done on 25 stroke clients whom were selected from 3 hospitals and one rehabilitation centre by simple sampling method and from available society according to inclusion criterias and assessed through Barthel index (independence index) and LOTCA (cognitive assessment). Then the correlation of cognitive and activities of daily living performance was determined by correlation and regression statistical analysis. Results: No relation was found between general cognitive function (total score of LOTCA) and individual independence (total score of BI) (P=0.087). Although some areas from LOTCA were correlated to Barthel index. Conclusion: Although the lake of correlation between BI and LOTCA to some extent is caused by low intensity of cognitive impairment in sample size. It suggests that, BI just proceeds to independency in ADL. It has no emphasize on activity analysis. Therefore it is needed to use ADL assessments which stress on activity analysis for evaluating ADL performance in stroke patients

Effects of Mental Practice on Balance in the Elderly

Objective: Mental practice refers to "The symbolic rehearsal of a physical activity in the absence of any gross muscular movements." It has been shown in a remarkable number of studies that the use of mental practice like physical practice can produces significant improvements in motor skills. Thus this therapeutic technique can be used in elderly rehabilitation. The purpose of this study was to investigate the effects of mental practice on balance in the elderly. Materials & Methods: Thirty healthy old subject over the age of 60 years took part in this study. Subjects solicited from two senior-citizen centers in Tehran and randomly assigned to experimental and control groups. Balance of subjects was assessed in four stage include baseline, pre-treatment, post-treatment and follow-up. Subjects in experimental group performed mental practice of a motor and balance skill for 3 weeks and control group did not perform any practice in that period. Results: The results of this study indicate significant improvement in the motor skill that mentally performed and also in balance of subjects. Conclusion: Mental Practice that performed on the mental skill not only was mentaly effective but also meaningly cause the improvement of balance in elderly

Inreraction of Syntactic Comprehension and Ability of Cognitive Sequence Processing in Persian Speeking Broca Aphasic Patients

Objective: Recent studies shown that related or common neuro-physiological processes are required for processing non-linguistic structures (e.g. cognitive sequencing) and some aspects of syntactic structure in language .As there has not been such research in Iran .this study surveys the relationship between the ability to process cognitive non-linguistic abilities and comprehension of non-canonical syntactic structures in broca aphasic patients. Materials & Methods: A pre test and post test quasi experimental design was chosen in this study. The syntactic comprehension of 10 aphasic patients (6 men and 4 women) who according to the Farsi aphasic test (Nilipour.1993). Have been recognized to be broca aphasics. Was assessed before and after a training period of 10 weeks (a session every week) on cognitive sequencing. The syntactic comprehension was assessed using a test which was designed for Persian language on the basis of  test for comprehension in aphasia. The ability to process cognitive sequences was assessed using lelekov test. The subjects were selected in a purposeful manner from among the broca aphasics who were under therapy in the state speech therapy centers in Tehran. The percent of the correct answers to every syntactic structure and to the cognitive sequence for each person was measured before and after a training period of 10 weeks data were analyzed by paired-t-test.  Results: The findings showed that there is a direct relation between the ability of the patients for comprehending the non-canonical syntactic structures and their ability for processing cognitive sequencing.(R=0.50).After the training period. The ability of the patients for understanding syntactic structures with non-canonical word order improved significantly (p0.05).Their ability for processing cognitive sequencing increased significantly during the training period (P<0.05). Conclusion: Reinforcement of the ability to process complex cognitive sequences in broca aphasic patients improves their comprehension of syntactic structures with non-canonical word order but it has no effect on their comperehension of structures with canonical word order