Review: Osychological & Physical Rehabilitation in Multiple Sclerosis

Multiple Sclerosis (M.S.) is a chronic disease of central nervous system (CNS) which locally demolishes myelin sheaths. M.S. is one of the most important debilitating factors in the youth and middle age. It mostly common between 20–30 years of age. The incidence in the age below the 10 and above the 60 years old is rare. It has been estimated nearly 1.1 million have M.S. around the world. Since M.S. affects different parts of C.N.S, so the symptoms are various. Clinical development differs from the benign to rapidly developing disease. It is mostly seen with attack and remission. First attacks usually recover but by repeating attacks, neurological defects permanently remain. Etiology of M.S. is unknown. Researches had showed the responsibility of autoimmune mechanism, viral infection and genetic in M.S. Environmental factors in onset and frequency of attacks can be effective. Incidence of M.S. in females is more than males. Geographically M.S. is seen much more in areas far from equator. Hence M.S. patients have wide spread symptoms of involvement in nervous system, is necessary during drug therapy physiotherapy and rehabilitation. These defects mostly occur in the form of cognitive and visual disorder, disarthery, dysphasia, weakness, spasticity, sensory, cerebellum and urinary and defecation disorders. In this paper I underscore the rehabilitation aspects of M.S patients

Prevalence of Sensory and Motor Neurologic Symptoms in 309 Diabetic Patients Refered to Hammadan Diabetic Center in 1999

Objective: Diabetes is a common disease in all societies, Involving different parts of the body in which one of them is nervous system. Basically complications on nervous system are permanent and cause morbidity. In this study the main purpose is recognizing diabetic nervous symptoms in compare with global statistics in this field in order to better diagnose and control them. Materials & Methods: Through this descriptive study 309 diabetic patients who had record in Hamadan University of Medical Sciences were selected. On the basis of required information a question form was prepared, which was completed after careful examination of nervous system for every patient. Finally the information was analyzed.  Results: During the study we found out that the most sensory complain were numbness and burner feels, and the most motor complain was limb paresis. These complications were observed mainly in patients more than 50 years old, with more than 5 years diabetes experience.  Conclusion: Because diabetes is a disease with different complications such as neuropathy, which leads to patient inability, recognizing them and their causes, can help us to prevent the disease and consequently provide better life for patients

Severity and Co-occurrence of Oral and Verbal Apraxias in Left Brain Damaged Adults

Objective: Oral and verbal apraxias represent motor programming deficits of nonverbal and verbal movements respectively. Studying their properties may shed light on speech motor control processes. This study was focused on identifying cases with oral or verbal apraxia, their co–occurrences and severities. Materials & Methods: In this non-experimental study, 55 left adult subjects with left brain lesion including 22 women and 33 men with age range of 23 to 84 years, were examined and videotaped using oral apraxia and verbal apraxia tasks. Three speech and language pathologists independently scored apraxia severities. Data were analyzed by independent t test, Pearson, Phi and Contingency coefficients using SPSS 12. Results: Mean score of oral and verbal apraxias in patients with and without oral and verbal apraxias were significantly different (P<0.001). Forty- two patients had simultaneous oral and verbal apraxias, with significant correlation between their oral and verbal apraxia scores (r=0.75, P<0.001). Six patients showed no oral or verbal apraxia and 7 had just one type of apraxia. Comparison of co-occurrence of two disorders (Phi=0.59) and different oral and verbal intensities (C=0.68) were relatively high (P<0.001). Conclusion: The present research revealed co-occurrence of oral and verbal apraxias to a great extent. It appears that speech motor control is influenced by a more general verbal and nonverbal motor control

Study of Relationship between Occupation and Spinal Discopathy

Objective: Discopathy is any kind of disease in the disc and is one of the most common reasons for back pain . This research has been done in order to determine relation between job and discopathy in patients of Imam Sajad Hospital (2005) . Materials & Methods: This research had been done on medical files of 240 patients with spinal discopathy who were referred to Imam Sajad Hospital from 1996 to 2003. Data were analyses in a descriptive study. Results: Discopathy of cervical, thoracic, lumbar and more than one region, in Military job (52.9%), Medical job (8.8%), Official jobs (38.3%) personnel showed a significant difference. Therefore, the relation between site of lesion with job was signigicant. Lesion in thoracic level (T12 . L1) and job had a significant relation, too: In Military job (50%), Medical job (37.5%), Offical job (12.5%) were involved with thoracolumbar discopathy. Conclusion: Because of high incidence of discopathy in Entezami personnel and significant relationship of job with site of discopathy and in order to decreasing medical costs and minimizing length of off- days, some special methods should be considered. As different researches have shown the effect of training on improving spinal problems, posture correction methods in variable job situations and training for ergonomic principles of working are recommended for military jobs

Evaluation of Reliability and Validity of the Persian Version of Fatigue Severity Scale (FSS) among Persons with Multiple Sclerosis

Objective: The aim of this study was to evaluate different aspects of validity and reliability of the Persian-version of Fatigue Severity Scale (FSS-P) among people with Multiple Sclerosis. Materials & Methods: A sample of 50 people with Multiple Sclerosis and 30 healthy adults were included in this study. The participants were recruited from Sina clinic in Tehran between 2001 to 2007. The Fatigue Severity Scale (FSS) includes nine items developed to measure disabling fatigue and a Visual Analog Scale (VAS) to measure overall fatigue. All participants were asked to complete FSS and Short-form 36 Health Survey (SF-36) questionnaires. Test-retest reliability and Internal Consistency were assessed, using Intraclass Correlation Coefficient (ICC) and Cronbach's alpha, respectively. Dimensionality was assessed, using item-scale correlation after correction for overlap and convergent validity, using a priori hypothesized correlations with the SF-36. Results: All the participants found the FSS-P to be clear and unambiguous in pilot testing. The ICC was reported 0.93 for the total score and 0.88 for VAS, The Cronbach's alpha was reported 0.96. The total score and the VAS were significantly correlated with the SF-36 vitality subscale (r=-0.69 and r=-0.73 respectively). Correlations with other SF-36 subscales were at moderate level (r=-0.43 to r=-0.65, all P<0.001). Conclusion: Since this is the first study to translate and scale equivalent to "fatigue severity scale" in Farsi in Iran, the main features of the scale and reliability of Persian version of "fatigue severity scale" was determined and assess the validity of the study in terms of facilities and access to the sample and a preliminary report in order to design more and more research was in order next. The results of the study revealed that the FSS-P is an appropriate psychometric instrument to assess the people with Multiple Sclerosis

Late and Early Comparing Effects of Sensory Stimulation on the Level of Consciousness in Comatose Patients

Objective: Disorder of consciousness is the common problem of severe traumatic brain injury. There is controversy about the effects of sensory stimulation on the level of consciousness in comatose patients. The aim of this study was to compare the effect of early (7th days post injury) and late (15th DPI) onset sensory stimulation on the level of consciousness of the comatose patients. Materials & Methods: In this experimental and interventional study twenty – one patients with Glasgow Coma Scale (GCS) £ 8 at least be stable for 3 days post injury (DPI), Normal ICP in CT- scan, no sedation, no previous neurological disorder, aged 18-59 suffering from sever traumatic brain injury were selected and divided in to 3 groups. First group (early onset) was received intervention (tactile, acoustic, visual, R.O.M and smell as stimulation) from 7th DPI to 15th DPI. The second (late onset) was received the intervention as same as early group but from 15th DPI to 21th DPI. The last one (control group) had no intervention. Level of consciousness evaluated by GCS and CRS-R in all of them every other day during the first month after injury. Data were analyzed by use of paired T test, Pearsonian correlation and repeated measurement analysis. Results: Repeated measurement analysis showed significant increase of GCS and CRS-R scores over the time (P<0.001). Significant changes were identified in CRS-R score between early and control group by post hoc test (P<0.05). Nevertheless, the increase of GCS score was different between groups, but this increase wasn’t statically significant (P=0/15). Conclusion: One week intervention of sensory stimulation on the 7-15 DPI can accelerate the trend of improvement in these patients. One thing many experts agree on is that starting rehabilitation early is of paramount importance to increase level of consciousness