A Comparative Evaluation of Error Processing Performance and its Relationship with Cognitive Function in Patients with Alzheimer's Disease, Individuals with Mild Cognitive Impairment, and Normal Controls Using the Event-Related Potentials.

Background: Some pathological changes occur in patients with Alzheimer's disease (AD) prior to the onset of clinical symptoms. Objective: In the present study, we aimed to investigate the potential of event-related potential (ERP) components in error processing performance as a neuromarker of mild cognitive impairment (MCI) and transition to AD and their relation with cognitive functions. Methods: We conducted an evaluation of 16 patients diagnosed with AD, 16 patients with MCI, and 15 normal controls using three subtests from the Cambridge Neuropsychological Testing Automated Battery (CANTAB). The ERP components of error processing were extracted and compared among the three groups using a modified version of the Eriksen flanker task. Additionally, we assessed the correlation between the cognitive results and the ERP components. Results: Significant differences were observed among the three groups in terms of providing correct responses following errors and the amplitude of error-related negativity (ERN). These differences were also significant between all paired groups. Regarding other ERP components of error processing and the peak latency of ERN, no significant differences were observed among the three groups. The findings revealed that the spatial working memory and new learning were correlated with the amplitude of ERN. Conclusions: In the context of error processing performance, both the accuracy of responses following an error and the amplitude of ERN can be considered as indicators of MCI and its progression to AD. The present findings do not support the use of other error processing components as differential markers in the three groups.

The Effect of Leisure Intervention on Occupational Performance and Occupational Balance in Individuals with Substance Use Disorder: A Pilot Study.

Methods: The sample for this quasiexperimental pretest-posttest with a two-month follow-up design comprised nine individuals aged between 18 and 55 years, selected using a convenience sampling method. The intervention consisted of a 2-month group leisure participation program, conducted twice a week, followed by a 2-month follow-up period. Primary outcome measures included occupational performance and occupational balance, and secondary outcome measures were leisure participation, quality of life, and drug craving. Outcome measures were assessed three times: preintervention, postintervention, and after the follow-up period. The outcome measures included the Canadian Occupational Performance Measure (COPM), Occupational Balance Questionnaire-11 (OBQ11), Nottingham Leisure Questionnaire (NLQ), 36-Item Short-Form Health Survey (SF-36), and Desire to Drug Questionnaire (DDQ). Data analysis was performed using the Friedman test and Wilcoxon signed-rank test as a post hoc procedure, with a significance level set at 5%. Results: The findings showed significant improvements in participants' occupational performance in postintervention and follow-up assessments (p < 0.01, r = 0.59) and better occupational balance from pre- to postintervention (p < 0.01, r = 0.59) and after the follow-up period (p < 0.01, r = 0.60). Furthermore, significant enhancements were observed in leisure participation, quality of life, and a reduction in drug craving. Conclusion: The findings indicate that leisure intervention positively impacted both occupational performance and occupational balance, suggesting its potential as a beneficial therapeutic approach for individuals with substance use disorder. Additional research is warranted to delve deeper into and validate the effectiveness of leisure intervention within this specific population.

Minimal and robust clinically important difference of three fatigue measures in chronic stroke survivors.

BACKGROUND: Fatigue assessment scale (FAS), fatigue subscale of the Profile of Mood States (POMS-F), and vitality subscale of the Short Form Health Survey (SF-36-VT) are among the first and most widely used adapted tools for assessing post-stroke fatigue. OBJECTIVE: To identify the minimal clinically important difference (MCID) and robust clinically important difference (RCID) of FAS, POMS-F, and SF-36-VT in stroke survivors. METHODS: Participants completed the FAS, POMS-F, and SF-36-VT before and after receiving 6-week intervention including graded activity training and pacing therapy. MCID was calculated using the distribution-based and anchor-based methods. Further, accuracy, sensitivity, and specificity of calculated values using the distribution-based method were used for determining RCID. RESULT: A total of 124 stroke survivors participated in this study. MCID for FAS, POMS-F, and SF-36-VT was found to be 4.86, 3.32, and -10.10 (using score change) and 3.5, 2.5, and -10.5 (using ROC analysis), respectively. Using the distribution-based method, the MCID value obtained for the FAS was in the range of 3.16 to 8.76, for the POMS-F was in the range of 1.49 to 5.63, and for the SF-36-VT was in the range of -15.43 to -5.58. ½SD for FAS, ½ SD and 1.96 SEM for POMS-F, and 1.96 SEM and SD for SF-36-VT showed the best discriminative ability to use as the RCID. CONCLUSIONS: The MCID and RCID were calculated for FAS, POMS-F, and SF-36-VT using different methods. The results can be used by researchers and clinicians for interpreting their findings in subjects similar to those who participated in this study.

Occupational Performance Coaching for Adults with Heart Failure: Randomized Controlled Trial Protocol.

Background: Patients with heart failure (HF) usually experience functional disabilities and face participation challenges. Self-care behavior is an essential component of long-term management of HF. Purpose: This study aims to investigate the effect of occupational performance coaching (OPC) on self-care behaviors and participation in people with HF. Method: This study is a parallel group, single-blind, randomized controlled trial of 44 adults with HF, to evaluate the efficacy of OPC. Patients will be randomly allocated (1:1) into two groups. Both groups will receive usual self-care education and the intervention group will receive eight weekly sessions of OPC as well. We will measure the primary and secondary outcomes at baseline, 8, and 12 weeks after the intervention initiation. Implications: If OPC is superior to usual self-care education on improving self-care behavior and participation, the finding will support the integration of OPC into practice to improve participation and self-care behaviors of HF patients.

Neurofeedback Training Versus Perceptual-motor Exercises Interventions in Visual Attention for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders characterized by poor attention and subsequently lower learning abilities than normal children. This study aimed to compare the effectiveness of neurofeedback and perceptual-motor exercises as two common nonpharmacological treatments for visual attention. Methods: A total of 40 combined medicated ADHD children (aged 5-12 years) were randomly allocated into two groups: neurofeedback training and perceptual-motor exercises. Visual attention and motor proficiency were assessed before and after the treatment by continuous performance test (CPT) and Bruininks-Oseretsky Test (BOT), respectively. Results: According to repeated measures analysis of variance (ANOVA), both groups showed significant improvement in three attention-related areas of CPT, including reaction time, omission, and commission errors (P<0.001), while the difference between the two groups was not significant (P>0.05). However, in the perceptual-motor exercises group, motor proficiency improved significantly (P<0.01). Conclusion: Neurofeedback training intervention, as well as perceptual-motor exercises, are effective in improving ADHD symptoms, and given the similar effect of both interventions and their lack of side effects, perceptual-motor exercises appear to be the more appropriate option for reducing symptoms of ADHD, because of its additional effect on motor proficiency, rich content of purposeful activities, and social interactions. Highlights: Neurofeedback training intervention promote attention in ADHD;Perceptual-motor exercises improve ADHD symptoms;Perceptual-motor exercises has an additional effect on motor proficiency. Plain Language Summary: The effectiveness and cost of interventions is an important issue. The result of this study revealed although neuro-feedback training intervention as well as perceptual-motor exercises are effective in improving ADHD symptoms, perceptual-motor exercises seem more appropriate option for reducing symptoms of ADHD, due to its additional effect on motor proficiency.

The Effect of Self-Determination Activities on Communication and Interaction Skills and Academic Success (Grade Point Average) of Students at Risk of Emotional-Behavioral Disorders: A Randomized Controlled Trial.

Background: Students with emotional and behavioral disorders (EBD) have lower academic efficiency than students with other disabilities and exhibit high levels of problematic behaviors and low levels of social functioning. This research aims to investigate the impact of self-determination activities on communication skills and scholastic achievement of students at risk of emotional-behavioral disorders. Methods: The study was conducted through a randomized controlled trial during the academic year 2018-2019. The samples included 54 female students (14 to 16 years) at risk of emotional-behavioral disorders from secondary schools in Tehran, Iran. The sampling was conducted through a random cluster method. The applied tools encompass Youth Self-report and Assessment of Communication and Interaction Skills. Academic success was measured by students' grade point average (GPA) in two terms. The intervention was held in 8 sessions of 90 minutes, once a week, after the first term of academic of students for the intervention group and the control group did not receive any intervention during this period. The data were analyzed by SPSS-22, MANCOVA, T-test, and Chi-Square tests. Results: The results of the multivariate analysis of covariance analysis showed self-determination has an impact on communication skills (physicality, information exchange and relations) of students at risk of emotional-behavioral disorders (p<0.05). Comparing the difference between the averages of the two students' means, it was found that there was a significant difference in the two groups after the intervention (p<0.001). Also, after the intervention, there was no significant difference between the two groups but the GPA of students in the intervention group increased from 13.19 to 15.61. Conclusion: The findings suggested self-determination is effective for academic success and communication skills of students at risk of emotional-behavioral disorders and can be used in educational programs for these students.

The Effects of Vestibular Rehabilitation on Poststroke Fatigue: A Randomized Controlled Trial Study.

Background: A major complication caused by stroke is poststroke fatigue (PSF), and by causing limitations in doing activities of daily living (ADL), it can lower the quality of life. Objective: The present study is an attempt to examine the effects of vestibular rehabilitation on BADL (Basic Activities of Daily Living), fatigue, depression, and Lawton Instrumental Activities of Daily Living (IADL) in patients with stroke. Method: Patients with a history of stroke took part voluntarily in a single-blind clinical trial. The participants were allocated to control and experimental groups randomly. The experimental group attended 24 sessions of vestibular rehabilitation protocol, while the control group received the standard rehabilitation (including three sessions per week each for around 60 min). To measure fatigue, the Fatigue Impact Scale (FIS) and the Fatigue Assessment Scale (FAS) were used. Depression, BADL, and IADL were measured using the Beck Depression Inventory-II (BDI-II), Barthel Index (BI), and Lawton Instrumental Activities of Daily Living, respectively. All changes were measured from the baseline after the intervention. Results: Significant improvement was found in the experimental group compared to the control group (p < 0.05) in FIS (physical, cognition, and social subscales), FAS, BDI-II, BADL, and IADL. Moreover, the results showed small to medium and large effect sizes for the physical subscale of FIS and FAS scores based on Cohen's d, respectively; however, no significant difference was found in terms of cognition and social subscales of FIS, BDI-II, BADL, and IADL scores. Conclusion: It is possible to improve fatigue, depression, and independence in BADL and IADL using vestibular rehabilitation. Thus, it is an effective intervention in case of stroke, which is also well tolerated.

Validation of the Persian Version of the Engagement in Meaningful Activities Survey (EMAS) in an Iranian Stroke Population: Predictors of Participation in Meaningful Activities.

IMPORTANCE: The inability to participate in meaningful activities is one of stroke survivors' main difficulties and has a negative effect on their satisfaction and quality of life. OBJECTIVE: To assess the reliability and validity of the Persian version of the Engagement in Meaningful Activities Survey (EMAS-P) and predictors of participation in meaningful activity among chronic stroke survivors. DESIGN: Cross-sectional. SETTING: Medical and rehabilitation centers. PARTICIPANTS: One hundred twenty-three people (75 men, 48 women) with chronic stroke. OUTCOMES AND MEASURES: Participants were evaluated with the EMAS-P, Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies Depression Scale, Purpose in Life Test-Short Form (PIL-SF), 36-Item Short Form Health Survey (SF-36), and Life Satisfaction Index-Z (LSI-Z). RESULTS: The EMAS-P showed good internal consistency (Cronbach's α = .95) and test-retest reliability (intraclass correlation coefficient = .87 for EMAS-P total score). Test-retest reliability for each EMAS-P item was moderate (κ = .40-.65). A significant correlation between the EMAS-P and PIL-SF (r = .86), SWLS (r = .83), LSI-Z (r = .75), and SF-36 subscales (rs = .52-.83) indicated the appropriate convergent validity. The EMAS-P's discriminative validity was also confirmed for age, depression level, and disability level among people with chronic stroke. Depression, disability level, gender, and fatigue were significant predictors of EMAS-P score. CONCLUSIONS AND RELEVANCE: The results indicate that the EMAS-P has acceptable reliability and validity among Iranian people with chronic stroke. Moreover, the EMAS-P showed good discriminant validity for age, depression, and disability level among them. What This Article Adds: The EMAS-P is a reliable and valid scale for assessing the engagement of Iranian chronic stroke survivors in meaningful activities and thus should be helpful in both clinical research and practice.

Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases.

Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.

Factors Associated with Quality of Life among Caregivers of People with Spinal Cord Injury.

PURPOSE: Often people with spinal cord injury (SCI) require help from their caregivers to carry out activities of daily living. Such assistance may affect caregiver quality of life (QoL). This study investigates the QoL and its associated risk factors among caregivers of people with SCI to find possible ways to increase their QoL. Material and Method. A convenience sample of 135 Iranian caregivers of people with SCI participated in a cross-sectional study from the Brain and Spinal Injury Repair Research Center of Tehran (BASIR), Iran, from June 2018 to October 2019. The World Health Organization's Quality of Life Questionnaire (WHOQoL-BREF), the Beck Depression Inventory-II (BDI-II), the Caregiver Burden Scale (CBS), and a demographic questionnaire were administered. Hierarchical multiple linear regression analysis was then applied to identify risk factors associated with caregiver QoL. RESULTS: Moderate to highly significant negative correlations were observed between all domains of the WHOQoL scale and subscales of the CBS and the BDI-II. After controlling for demographic and clinical variables, depression, burden, and level of injury were found to predict caregiver QoL significantly. Furthermore, QoL was lower in caregivers of people with quadriplegia than paraplegia (p < 0.05). CONCLUSIONS: The level of injury, self-perceived caregiver burden, and depression are associated with QoL for the caregivers of people with SCI. A holistic approach incorporating caregiver training, psychological interventions, and adequate support may enable better QoL for these caregivers.

Relationship between Work-Related Quality of Life and Job Satisfaction in Iranian Occupational Therapists.

OBJECTIVE: This study is aimed at exploring the relationship between the work-related quality of life and job satisfaction among Iranian occupational therapists. METHODS: In an analytical-descriptive, cross-sectional study, 322 occupational therapists were recruited through a convenient sampling. Inclusion criteria consisted of age between 22 and 50 years, at least one-year work experience, 24 hours of working per week as an occupational therapist, and membership of Iranian Occupation Therapy Association. After signing the informed consent and completing demographic information, each participant completed the Minnesota Satisfaction Questionnaire- Short Form (MSQ-SF) and work-related quality of life scale. RESULTS: The highest quality of working life belonged to occupational therapists who were female, married, with an annual salary of more than 40000$ (compared to below 20000 $), and those with work experience between 5 and 12 years. There was a positive and significant relationship between work-related quality of life and job satisfaction. Work-related quality of life scores could significantly predict MSQ-SF scores (ß1 = 0.54, p < .001). CONCLUSIONS: The significantly positive relationship between work-related quality of life and job satisfaction suggests the importance of organizational programs for enhancing factors of work-related quality of life in order to improve job satisfaction and quality of life among Iranian occupational therapists.

Effect of occupational therapy on self-determination skills of adolescents at risk of emotional and behavioral disorders: A randomized controlled trial.

Background: Self-determination skills enable to support an individual's needs and make decisions to function independently. Improvement of self-determination skills has had a positive result for adolescents at risk of Emotional and Behavioral Disorders (EBD). The aim of this study was to investigate the effect of occupational therapy interventions on the self-determination skills of adolescent girls at risk of emotional-behavioral disorders. Methods: In this single-blind control trial study, 14-16-years-old girl students (n=54) at risk of EBD were recruited by cluster sampling from secondary high schools of Tehran, Iran. Youth self-report Questionnaire (YSR) was used to include adolescents at risk of EBD in the study and were randomized into the intervention (n=27) and control group (n=27) by block randomization. The Student Self-Determination Scale (SDSS) and the Self-determination Parent Perception Scale (SDPPS) were used to collect data. Students in the intervention group participated in 8 - once a week- sessions of occupational therapy and the control group received no training. Data were analyzed by repeated-measures analysis of variance (RMANOVA), Bonferroni test and SPSS 16.0 version. The significance level was set at 0.05. Results: The score of self-determinations (SDSS) increased significantly in the intervention group after the intervention (p<0.001). Although the mean scores of self-determination at follow-up have increased in the intervention group compared to the post-test. No significant differences were found (p>0.05); also, the score of parents' perception of student self-determination (SDPPS) increased but there were not significantly different (p=0.064). Conclusion: The findings indicated self-determination skills could be taught to adolescents at risk of EBD in OT sessions. Since self-determination has been identified as the necessary skills for adolescents at-risk to transition into adulthood, occupational therapists have an important role in promoting self-determination skills in adolescents at risk of EBD.

Predictors of Instrumental Activities of Daily Living Performance in Patients with Stroke.

OBJECTIVE: Instrumental activities of daily livings are important for independent living and active participation in the community. The present study is aimed at determining factors predicting instrumental activities of daily living performance in patients with stroke. METHODS: In this cross-sectional study, a convenient sample of 90 patients with stroke entered from five occupational therapy centers, which were selected based on the cluster randomization method. Lawton IADL scale, Barthel Index, Trail Making Test (A and B), Digit span subtest of Wechsler memory scale, Motorcity index, and Beck Depression Inventory-II were used to investigate the study's aim. Statistical analyses were performed using independent sample t-test, one-way ANOVA, Pearson correlation, and multiple linear regression analysis. RESULTS: Age (r = -0.384, p < 0.001), memory (r = 0.565, p < 0.001), basic activities of daily living (r = 0.818, p < 0.001), depression (r = -0.758, p < 0.001), Trial Making Test (B-A) (r = -0.614, p < 0.001), and motoricity index (r = 0.670, p < 0.001) were significantly associated with instrumental activities of daily living performance. CONCLUSIONS: Basic activities of daily living were the strongest predictor of IADL's performance. Age, TMT (B-A), and depression were orderly the next strongest predictors. Stroke patients with more dependency in basic activities of daily living, older age, cognitive impairment, and depression are more opted to be dependent in instrumental activities of daily living and as a result, less participation in home and community affairs.

The Development and Validation of a Scale for the Activities of Daily Living in Iranian Children.

Introduction: Activities of Daily Living (ADL), as an ultimate goal of rehabilitation, rely on cultural and environmental factors. This study aimed to develop a questionnaire based on the occupational therapy practice frame to accurately evaluate Iranian children's occupational performance. Methods: This scale was developed in two phases of planning and construction. The planning phase involved a literature review and a collection of the available evaluation tools in the area. The advice of two expert panels was used to develop a preliminary 87-item questionnaire. In the construction phase, 40 parents were surveyed to assess the popularity of the activities in Iran. After a face to content validation, the final version of the questionnaire was prepared with 93 items. Results: The final 93-item questionnaire was used to assess the ADL of 3-6-year-old children. The 93 items, selected according to criteria found in the literature and the panel of experts, were categorized into six ranges of occupational therapy practice framework (bathing/washing/personal hygiene, toileting, dressing, eating/feeding, functional mobility, and others). Conclusion: The ADL in Iranian children is a practical and culturally relevant tool for measuring the occupational performance of Iranian children. It can be used in clinical and population-based research. Highlights: ADLs are essential and routine tasks required to independent and healthy living.The active participation of the child in ADL during development has a positive effect on the development of sensory and cognitive functions of the brain.ADLs are highly dependent on contextual and ecological factors, such as parenting style, the environment and given context.The ADLIC tool is a standard, culturally adapted tool that can be used by occupational therapists to assess ADLS in Iranian children. Plain Language Summary: The ADLs referred to Self Care Skills, which play a major role in a child overall functional growth, confidence and independence. The healthy individuals can perform these life skills without assistance. The inability to accomplish essential ADLs may lead to unsafe conditions and poor quality of life. Due to the importance of these activities during the development of the child, it is necessary for Iranian children to be evaluated in terms of independence in these activities so that in case of disorder, the necessary counseling and education can be provided by occupational therapists.

Exploring the contributing factors that influence the volition of adolescents with cerebral palsy: A directed content analysis.

BACKGROUND: Communication, behavioural disturbances and low motivation influence the functional potential and the effectiveness of interventions in adolescents with cerebral palsy (CP). While the model of human occupation (MOHO) is a conceptual model in occupational therapy, no research on the volition of adolescents with CP in daily activities has been undertaken. AIM: To explore the elements contributing to the volition of adolescents with CP based on their own experience. METHODS: A qualitative approach using directed content analysis with volition of MOHO as a framework was applied. Semi-structured in-depth interviews were carried out with five adolescents with CP and five parents of the same adolescents. RESULTS: In this study primary codes were categorized into eight categories: family and community-related values, individual values, individual perceptions of ability level, sense of control over conditions, enjoying performing activities, enjoying interpersonal relationships, physical context features and social context features. CONCLUSIONS: Personal causation in interaction with environmental features is strongly influenced by adolescents' motivation. SIGNIFICANCE: Occupational therapists could improve the motivation of adolescents with CP in interaction with the individual's volition with focussing on self-efficacy for promoting personal causation. Adapting to the physical environment and changing the attitudes of others to these adolescents is necessary.

Psychometric properties of Meaningful Activity Participation Assessment (MAPA) in chronic stroke survivors.

BACKGROUND: Meaningful Activity Participation Assessment (MAPA) is an appropriate tool for assessing both objective and subjective aspects of participation. OBJECTIVES: This study aimed to investigate the psychometric properties of MAPA in chronic stroke survivors. METHODS: Translation of MAPA was done according to the standard protocol of forward-backward translation. One hundred and seven chronic stroke survivors participated in this study. In addition to the MAPA, they were assessed by Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies of Depression Scale (CES-D), Life Satisfaction Index-Z (LSI-Z), Purpose in Life Test-Short Form (PIL-SF), and 36-Item Short-Form Survey (SF-36). To investigate the test-retest reliability, 37 participants were reassessed by MAPA after two weeks. Reliability, construct and known-groups validity were evaluated for MAPA. RESULTS: The results showed an acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC = 0.92) of MAPA. A significant moderate to high correlation was found between the MAPA and PIL-SF, CES-D, LSI-Z, SWLS, and different subscales of SF-36 (r = 0.32-0.65). MAPA showed good ability to differentiate between young adults (age≤ 65 years) and older adults (age> 65 years) with chronic stroke (P = .005) as well as between chronic stroke survivors with different levels of disability (P < .001). CONCLUSIONS: The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.

National Guidelines for Cognitive Assessment and Rehabilitation of Iranian Traumatic Brain Injury Patients.

BACKGROUND: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. METHODS: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients' conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). RESULTS: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. CONCLUSION: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

The Effectiveness of Occupational Therapy-Based Sleep Interventions on Quality of Life and Fatigue in Patients with Multiple Sclerosis: A Pilot Randomized Clinical Trial Study.

PURPOSE: Sleep difficulties are common in patients with multiple sclerosis (MS), which may increase feelings of fatigue, negatively interfere with daily activities, and consequently reduce their quality of life. Studies examining the effects of sleep-targeted interventions in MS are currently limited in the literature. Therefore, we aim to assess the effects of occupational therapy interventions on sleep quality, fatigue, and quality of life in patients with MS. PATIENTS AND METHODS: In a single-blind, randomized, controlled trial, which occurred between April 2018 and March 2019 in Tehran, Iran, 20 eligible patients with MS were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS), and Short-Form Health Survey (SF-36). Patients were allocated randomly into the two following groups: patients receiving care-as-usual for MS (CAU) and patients receiving care-as-usual plus intervention (CAU + intervention). Both intervention groups underwent 2-3 sessions per week lasting 30-45 minutes for 8 weeks and received follow-up assessments. Data were analyzed using independent sample t-tests and Mann-Whitney U tests using SPSS (16 ver.) statistical software. RESULTS: In the intervention group, sleep quality improved significantly across all items (p<0.001, effect size = 0.60) except for sleep efficiency and the use of sleep medications. FSS and FIS in the sleep intervention group were significantly reduced (p<0.001, effect size = 0.76 and p<0.001, effect size = 0.82, respectively). The quality of life in the intervention group improved significantly (p<0.004, effect size = 0.51-0.76) with the exception of the social functioning subgroup. CONCLUSION: Although this is the result of a pilot study and more patients should be added, this intervention program demonstrates improvement in sleep quality and quality of life while decreasing fatigue in patients with MS. Adjunction of this program, if results are similar with more patients, to routine occupational therapy (OT) interventions can help improve the rehabilitation program of MS patients.

Discriminative factors for post-stroke depression.

BACKGROUND: Depression is the most common mood disorder following stroke. It can negatively affects different domains of patient's life. The present study aimed to explore demographic and clinical predictors of post stroke depression and determine discriminative cognitive, motor, and functional factors in stroke patients with and without depression. METHODS: In a cross sectional study, 100 patients with stroke were investigated. Measurements consisted of Beck Depression Inventory-II, Trail Making Test A & B, Digit Span Subtest of Wechsler Memory Scale, Motricity Index (arm and leg motor), Trunk Control Test, Barthel Index, and Lawton Instrumental Activities of Daily Living. Demographics and clinical data including educational level, marital status, limb affected, cigarette smoking habits, diabetes mellitus, cardiac diseases, and blood pressure were also collected. RESULTS: Multivariate logistic regression revealed that college level of education (OR = 8.78, 95% CI: 2.65-29.11, P < 0.001) and cardiac diseases (OR = 3.11, 95% CI: 1.19-8.13, P < 0.001) were significant demographic and clinical predictors of post stroke depression. Using stepwise discriminant function analysis, basic activities of daily living and trunk control with 88.0% classification accuracy, 81.1% sensitivity, and 95.7% specificity were as the best discriminators of post stroke depression. CONCLUSIONS: Rehabilitation experts working with patients with stroke should pay special attention to trunk control and basic activities of daily living for preventing consequences of PSD particularly in those with higher educational level and cardiac diseases.

Correlations between developmental test of visual perception-adolescent and adult and visual evoked potential in people with multiple sclerosis.

Background: Optic neuritis (ON) is a common visual sign in multiple sclerosis (MS). Although ON is recovered in most cases, other visual functions such as visual perception are affected and are not fully recovered. The aim of this study is to investigate the relationship between visual evoked potential (VEP) P100 and N70 latencies and visual perception using the Developmental Test of Visual Perception-Adolescent and Adult (DTVP-A) in people with MS. Methods: In this cross-sectional study, 24 people with ON due to MS, aged 18-50 years old took part. In order to assess the visual perception and optic nerve conductivity, the DTVP-A and the VEP were accomplished, respectively. Pearson's product-moment correlation coefficient was used to analyze the data. Results: There was a significant negative correlation between right VEP P100 latency and total score of DTVP-A (r = -0.450, P < 0.05) as well as a significant negative correlation between right VEP P100 latency with visual-motor integration (VMI) subtest of DTVP-A (r = -0.485, P < 0.05). Conclusion: The visual perception has an important role in safety and independent daily activities. Therefore, determining the related factors is essential. Although the findings of the current study revealed a moderate statistical correlation between visual perception and right VEP P100 latency, the small sample size might limit the generalization of our findings; therefore, further study is required to confirm our results.