Simultaneous multidimensional impacts of active learning revealed in a first implementation in the MENA region.

Enhancing science education in developing countries has been a focal point of many studies and efforts, but reform has mainly been driven by top-down approaches that often face impediments. A shift to active learning pedagogies can potentially address these challenges, but it has thus far been predominantly implemented and understood in developed countries. Thanks to the growing accessibility of open education resources and ubiquitous technologies, education reform can now be carried out from the bottom up. Here, we present the results of a two-year implementation of active learning in five core physics and astronomy courses comprising 2,145 students from the Middle East and North Africa (MENA) region. Simultaneous improvements are observed in both students' performance and their perception of the quality of learning; means improved by 9% (0.5 SD) and 25% (1.5 SD), respectively. The performance gap between students in the bottom quartile and those in the top quartiles was narrowed by 17%. The failure rate was reduced to a third of that in traditional classes; this is 36% better than the results in developed countries, indicating a greater need for active pedagogies by MENA students. Our findings reveal a multidimensional positive influence of active learning, the viability of its grassroots implementation with open resources, and its sustainability and reproducibility. We suggest that wider implementation can boost education-driven economic growth by 1% in per capita gross domestic product [GDP], substantially cut costs of repeating courses, and produce a more competent STEM workforce-all of which are urgently needed to stimulate development and growth.

The influence of aging on the association between adiposity and bone mineral density in Jordanian postmenopausal women.

The objective of this study was to assess the relative association between body weight, body mass index (BMI), lean mass (LM) and fat mass (FM), and bone mineral density (BMD) in a group of Jordanian postmenopausal women and investigate if this possible association changes with age. A total of 3256 patients had dual-energy X-ray absorptiometry (DXA) scan in the period from January 2009 till January 2012 at the Radiology and Nuclear Medicine Department of Jordan University Hospital. Only 584 women met the selection criteria. Age has been recorded, and patients were divided into subgroups according to age. Body weight and height were measured, and BMI was calculated. Body composition (LM, FM, percentage of android fat, and percentage of gynoid fat) was assessed by DXA. BMD of the lumbar spine (L1-L4) and femoral neck was measured by DXA. Weight, BMI, FM, LM, percentage of android fat, and percentage of gynoid fat were positively correlated to BMD at both lumbar spine and femoral neck. However, this correlation disappeared at the age of 70 yr at lumbar spine and 75 yr at femoral neck. This study suggests that both FM and LM are important determinants of BMD in Jordanian postmenopausal women, and this correlation disappears after the age of 70 yr at lumbar spine and 75 yr at femoral neck.

Association of postural balance and isometric muscle strength in early- and middle-school-age boys.

OBJECTIVE: The purpose of this study was to evaluate the isometric muscle strength (IMS) and dynamic balance in early- and middle-school-age boys and to assess the strength of association between the dynamic balance scores and 6 different IMS indexes. METHODS: This is a cross-sectional study of a convenience sample of 94 boys who were 6 to 10 years of age and classified into an early school age (6-8 years) group (n = 50) and a middle school age (8-10 years) group (n = 44). Balance was tested using a Biodex Balance System. Anteroposterior Stability Index, Mediolateral Stability Index, and Overall Stability Index were recorded. IMS of 11 muscle groups was measured with a handheld dynamometer and categorized into 6 different muscle strength indices. RESULTS: The mean (SD) values of anteroposterior, mediolateral, and overall stability indexes observed for all study boys were 1.9 ± 1.0, 1.2 ± 0.7, and 2.5 ± 1.2 respectively. In the middle school age group, strong positive relationships were detected between the overall stability index and trunk, lower limb, anti-gravity, pro-gravity, and total strength indexes (r = -0.86/P < .001, r = -0.91/P < .001, r = -0.88/P < .001, r = -0.83/P < .001, and r = -0.84/P < .001 respectively), while no significant relationship was detected with the upper limb strength index (r = 0.159/P = .303). In the early school age group, moderate positive relationships were detected between the overall stability index and anti-gravity, lower limb, and total strength indexes (r = -0.404/P = .004, r = -0.356/P = .011, and r = -0.350/P = .013 respectively). CONCLUSION: Dynamic balance did not appear to be mature by the age of 10 years. Better balance skills were recorded in the mediolateral direction than in the anteroposterior direction. In the middle school age group, the overall stability index had positive relationships with almost all examined muscle strength indexes excepting the upper limb strength index.

Determinants of life satisfaction among stroke survivors 1 year post stroke.

ABSTRACT: Stroke is the major leading cause of death and severe long-term disability worldwide. The consequences of stroke, aside from diminished survival, have a significant impact on an individual's capability in maintaining self-autonomy and life satisfaction (LS). Thus, this study aimed to assess LS and other specific domains of LS in stroke survivors following their first-ever stroke, and to describe the relationship using socio-demographic and stroke-related variables.This study recruited 376 stroke survivors (244 men and 132 women, mean age: 57 years) 1 year following stroke. Data on participants' LS (measured using the Life Satisfaction Questionnaire [LiSat-11]), socio-demographics, and stroke-related variables were collected.Univariate analysis showed that LS and the 10 specific domains were not associated with the patients' gender or stroke type; however, age at onset, marital status, and vocational situation were significantly associated with some domains in LiSat-11 (Spearman's rho = 0.42-0.87; all P < 0.05). Logistic regression revealed that verbal and cognitive dysfunction were the most negative predictors of LS (odds ratio 4.1 and 3.7, respectively).LS is negatively affected in stroke survivors 1 year post onset. The results indicate that recovering social engagement is a positive predictor of higher LS in stroke survivors. More importantly, the findings revealed that cognitive and verbal dysfunctions were the most prominent negative predictors of the overall gross level of LS. Multidisciplinary rehabilitation for stroke survivors is therefore critical.

Balance and musculoskeletal flexibility in children with obesity: a cross-sectional study.

BACKGROUND: Studies on the influence of obesity on different physical parameters such as postural balance and musculoskeletal flexibility are limited and have reported varying results. OBJECTIVES: Measure effect of childhood obesity on balance and musculoskeletal flexibility in Saudi children. DESIGN: Cross-sectional. SETTING: Physiotherapy laboratory. SUBJECTS AND METHODS: The study included a representative sample of Saudi elementary school children selected from a convenience sample of 150 children. Balance was examined using the Biodex balance system. Calf muscle flexibility was measured by the weight-bearing ankle lunge test while the chest flexibility was measured by the chest expansion test. MAIN OUTCOME MEASURES: Postural stability indices and flexibility parameters. SAMPLE SIZE: 90 elementary school children aged 6 to 11 years, 47 of normal weight and 43 obese children. RESULTS: All stability indices at different stability levels were significantly impaired in children with obesity ( P≤.05). In terms of musculo-skeletal flexibility, the weight-bearing lunge test distance was shorter in children with obesity ( P=.01). In the chest expansion test, there was no significant difference between the two groups ( P=.32). CONCLUSIONS: Postural balance at different stability levels was impaired in children with obesity and in all planes. The calf muscles were less flexible in obese children. LIMITATIONS: Unblinded, convenience sample so findings are not generalizable. CONFLICT OF INTEREST: None.

Spinal direct current stimulation with locomotor training in chronic spinal cord injury.

Transcutaneous spinal direct current stimulation (tsDCS) is a non-invasive method of stimulating spinal circuits that can modulate and induce changes in corticospinal excitability (CE) in incomplete spinal cord injury (SCI). A double-blinded sham controlled study of 2 male patients (A and B) with SCI was carried out. Patient A received sham and cathodal tsDCS, while Patient B received sham and anodal tsDCS. Four baselines were recorded prior to each arm of stimulation. Outcomes were then measured post each arm of stimulation; 10-meter walk test, modified ashworth scale, berg balance scale, manual muscle testing, and spinal cord independence measure-III. Transcranial magnetic stimulation, assessed motor evoked potentials. Cathodal tsDCS increased the scores in few of the outcome measures and decreased others. Anodal stimulation increased scores in all measures. Motor evoked potentials increased in post-cathode and deteriorated in post-anode. In conclusion, tsDCS modulated gait parameters, spasticity, and CE in incomplete SCI.

Does the poor sleep quality affect the physical activity level, postural stability, and isometric muscle strength in Saudi adolescents? A comparative study.

OBJECTIVES: To  compare physical activity, postural stability, and muscle strength in Saudi adolescents with normal and poor sleep quality. Methods: This cross-sectional study investigated 62 Saudi adolescents between December 2017 and April 2018 at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Participants were classified into 2 equal groups; one with normal sleep (NS) and the other with poor sleep (PS). TecnoBody balance system was used to measure postural stability, ActiGraph to assess physical activity, and hand dynamometer and pinch gauge to assess hand grip and key pinch strength respectively. Results: At low platform stability, PS group showed poorer postural stability indices than NS group either with eyes opened or closed (p less than 0.05). ActiGraph data revealed that the physical activity parameters including the total steps count, total activities count, activity rate, and the vigorous activity time were significantly lower in PS group (p less than 0.05). The PS group had significantly more total sedentary time than the NS group. Muscle strength parameters did not show any significant difference between groups (p greater than 0.05).  Conclusion: Poor sleep significantly impaired postural stability and physical activity in Saudi adolescents. However, poor sleep had no effect on their isometric muscle strength.

Evaluation of physical growth in cerebral palsied children and its possible relationship with gross motor development.

The object of this study was to detect any possible relation between the current gross motor function score for cerebral palsy children and their physical growth parameters. We measured 71 children with spastic cerebral palsy (35 diplegic, 25 quadriplegic and 11 hemiplegic) and a control group of 80 normal children. Measures taken for cerebral palsy and normal children included stature, weight, head circumference and mid upper-arm circumference, and, additionally for the cerebral palsied children, duration of the disease, birth weight, presence or absence of orofacial dysfunction, distribution of paralysis and degree of spasticity. Motor abilities were measured using the Gross Motor Function Measure. Results showed a significant decrease in the stature, current weight, head circumference and mid upper-arm circumference of both sexes of the quadriplegic children, and significant decreases in the current weight of the diplegic girls and the head circumference of the hemiplegic girls. There were also significant decreases in all scores of the quadriplegic children compared to the diplegic and hemiplegic children. Diplegic children had significantly decreased standing, walking and running, and total scores, compared to the hemiplegic children. Total score at age of testing was independently predicted by the duration of the disease, distribution of paralysis, presence or absence of orofacial dysfunction, spasticity index and the current body weight. Our findings indicate that in spastic cerebral palsy the physical growth parameters were markedly decreased in the quadriplegic form compared to other forms. Only current body weight, from the growth parameters, in addition to other relevant clinical data, can be considered predictors of the current gross motor abilities of those children.

Evaluation of isometric muscle strength and magnitude of hand dominance in right-handed school-age boys.

The aim of this study was to examine bilateral isometric muscle strength (IMS) in right-handed boys. To determine the association between the magnitudes of right handedness (MRH) and (a) the interside difference indexes of IMS of certain muscle categories, (b) age, and (c) some anthropometric characteristics. This was a cross-sectional study. A convenience sample of 94 right-handed boys between 6 and 10 years of age was investigated. The Edinburgh Handedness Inventory was used to evaluate hand dominance and its magnitude. IMS of eight muscle groups was measured and the interside difference was determined. Five interside difference indexes were calculated for the upper limb, lower limb, hand grip, key pinch, and total side. All interside difference indexes of IMS were less than 5%, in favor of the dominant right side. The majority (86.1%) of our boys scored high to moderate MRH, whereas the minority (13.8%) scored low MRH. The hand grip interside difference index (ß=0.40, P=0.000), the key pinch interside difference index (ß=0.23, P=0.003), age (ß=0.24, P=0.034), and height (ß=0.33, P=0.039) are the best set of predictors of the dominance score and in turn the MRH. The results of this study, carried out on right-handed boys aged 6-10 years, indicated a standard difference in IMS between dominant and nondominant sides of all studied muscle strength categories. Furthermore, it was found that the hand grip interside difference index, the key pinch interside difference index, age, and height could influence the MRH.

Effectiveness of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic cerebral palsy.

AIMS: To investigate the effect of foot wedge and carrying weighted bag on loading the paretic lower limb in children with hemiparetic CP. DESIGN: Cross-sectional study. PARTICIPANTS: A convenient sample of 18 ambulant children with spastic hemiparetic CP was evaluated. Fifteen matched normal children acted as a control group. METHODS: Using two calibrated scales, measurements of weight supported on each lower limb were obtained under four different standing conditions. RESULTS: During quiet standing, the percentage of weight supported on the paretic limb was 35.59% with symmetry index equals 0.57. Standing with the non-paretic foot is placed on a lateral foot wedge, was the best condition that increased the percentage of weight supported on the paretic limb to 47.18% and improved the symmetry index to 0.90. Non-significant improvement of symmetry index 0.61 was recorded when carrying a weighted bag with the paretic hand, but carrying with the non-paretic hand unnecessarily loads the non-paretic limb and further decreases the symmetry index to 0.49. CONCLUSIONS: Using a lateral foot wedge beneath the non-paretic foot and carrying a weighted bag with the paretic hand improve the loading function of the paretic limb and relief the non-paretic limb from overloading.

Assessment of anxiety and depression after lower limb amputation in Jordanian patients.

OBJECTIVE: This study aimed to assess the prevalence of anxiety and depression among Jordanian lower limb amputees with different clinical characteristics and sociodemographic data (gender, marital status, social support, income, type and level of amputation, and occupation). METHODS: Participants were 56 patients with unilateral lower limb amputation with mean duration (8.4 +/- 5.75 years). They were recruited from inpatient and outpatient clinics of Jordan University hospital, Royal Farah Rehabilitation Center, and Al-basheer hospital in Amman, Jordan. Participants responded to a questionnaire that included a battery of questions requesting brief information about sociodemographic variables and characteristics of amputation. The level of depression and anxiety in each participating patient was assessed by the Hospital Anxiety and Depression Scale (HADS). RESULTS: The prevalence of anxiety and depressive symptoms were 37% and 20%, respectively. Factors associated with high prevalence of psychological symptoms included female gender, lack of social support, unemployment, traumatic amputation, shorter time since amputation, and amputation below the knee. These findings were confirmed by a significant reduction of anxiety and depression scores in patients who received social support, patients with amputation due to disease, and patients with amputation above the knee. Presence of pain and use of prosthesis had no effect on the prevalence. CONCLUSIONS: The findings of the present study highlight the high incidence of psychiatric disability and depression in amputees; it also showed the importance of sociodemographic factors in psychological adjustment to amputation. It is suggested that psychiatric evaluation and adequate rehabilitation should form a part of their overall management.