Publications by authors named "Malahat Akbarfahimi"

13 Publications

  • Page 1 of 1

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

Arch Iran Med 2020 12 1;23(12):813-820. Epub 2020 Dec 1.

Department of Neurotrauma, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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.
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December 2020

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

Top Stroke Rehabil 2020 Oct 20:1-10. Epub 2020 Oct 20.

Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS) , Tehran, Iran.

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 ( = .005) as well as between chronic stroke survivors with different levels of disability ( < .001).

Conclusions: The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.
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October 2020

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.

Neuropsychiatr Dis Treat 2020 29;16:1369-1379. Epub 2020 May 29.

Clinical Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA.

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 (<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 (<0.001, effect size = 0.76 and <0.001, effect size = 0.82, respectively). The quality of life in the intervention group improved significantly (<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.
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May 2020

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

Scand J Occup Ther 2020 Feb 23:1-11. Epub 2020 Feb 23.

Department of Public Health Nursing, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran.

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. To explore the elements contributing to the volition of adolescents with CP based on their own experience 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. 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. Personal causation in interaction with environmental features is strongly influenced by adolescents' motivation. 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.
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February 2020

Discriminative factors for post-stroke depression.

Asian J Psychiatr 2020 Feb 5;48:101863. Epub 2019 Nov 5.

Department of Occupational therapy, Musculoskeletal Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

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.
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February 2020

Practical points for brain-friendly medical and health sciences teaching.

J Educ Health Promot 2019 24;8:198. Epub 2019 Oct 24.

Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran.

Background: Special learning outcomes are considered for medical and health sciences education which can be acquired by some interactive learning systems in the human brain. Given the importance of this issue, based on literature, we attempted at mentioning certain practical points for medical and health sciences educators to employ in preclinical and clinical teaching.

Materials And Methods: We searched databases of PubMed, Proquest, Scopus, ERIC, and ISI Web of Science for relevant literature from January 2010 to January 2019.

Results: From a total of 1029 records, 30 articles along with 35 papers from snowballing and hand searching were included in this study. The following 12 main items were encompassed: teaching students the basic neuroscience of learning and set individual learning goals, "just right challenge" heeding the balance between supervision and autonomy, brain-friendly coaching, repetition with spaced learning, visualization as a powerful learning tool, multimodal teaching, cognitive learning and mental model, cognitive-emotional learning, active and social learning, creativity and art, sleep, medical faculty's participation regarding the courses of "neuro-education studies," and "neuro-myths" were suggested for brain-friendly medical and health sciences teaching.

Conclusions: We considered 12 practical points for brain-aware medical and health sciences teaching according to the recent literature on the basis of the association between education, cognitive science, neuroscience, and psychology. Interdisciplinary research and practice regarding this issue can improve teaching-learning quality, students' well-being, and ultimately patient outcomes.
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October 2019

The Relationship between Auditory Sensory Gating and Cognitive Functions on Auditory and Visual Modalities in Primary School Children.

Iran J Child Neurol 2019 ;13(4):53-65

Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Objectives: Considering the common neurological origins, there is a relationship between the sensory gating and cognitive functions. However, there is no adequate information on this issue. In this study, auditory event-related potentials and the sensory gating performance were assessed in P50, N100 and P200 waves. Besides, their relationship with cognitive performance in auditory and visual modalities was investigated.

Materials & Methods: Nineteen normal primary school students (14 boys) were tested in Tehran, Iran from 2017 to 2018. In the auditory modality, the Persian version of the non-word repetition test and monaural selective auditory attention test (mSAAT) were used for assessment of the working memory and selective attention, respectively. In order to evaluate the visual working memory and visual selective attention, Rey-Osterrieth complex figure, selective and divided attention test were used, respectively. A 32-channel EEG system was used for electrophysiological assessment.

Results: The P50 sensory gating was negatively correlated with the visual selective attention (=0.034, r=-0.49) and N100 sensory gating was negatively correlated with the auditory working memory (=0.043, r=-0.48) as well as visual selective attention (=0.039, r=-0.47). For P200, there was a significant negative relationship with auditory selective attention in the right ear (=0.034, r=-0.49).

Conclusion: Sensory gating in children is not a modality-specific phenomenon. Sensory gating in a modality could be associated with cognitive functions in other modalities.
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January 2019

Psychometric properties of Persian version of the Caregiver Burden Scale in Iranian caregivers of patients with spinal cord injury.

Disabil Rehabil 2018 Feb 21;40(3):367-372. Epub 2017 Feb 21.

d Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences , Tehran , Iran.

Purpose: To investigate the psychometric properties of the Persian version of Caregiver Burden Scale (CBS) in caregivers of patients with spinal cord injury.

Methods: This is a cross-sectional study. After a forward-backward translation, the CBS was administered to 110 caregivers of patients with spinal cord injury (men = 60, women = 50). Factor structure was evaluated by confirmatory factor analysis. The Internal consistency and test-retest reliability of the CBS were examined using Cronbach's α and the intraclass correlation coefficient, respectively. Construct validity was assessed by examining the relationship among CBS and the World Health Organization Quality of Life, and the Beck Depression Inventory.

Results: The results of confirmatory factor analysis provided support for a five-factor model of CBS. All subscales of CBS revealed acceptable internal consistency (0.698-0.755), except for environment subscale (0.559). The CBS showed adequate test-retest reliability for its subscales (0.745-0.900). All subscales of CBS significantly correlated with both Beck Depression Inventory and World Health Organization Quality of Life, confirming construct validity.

Conclusions: The Persian version of the CBS is a valid and reliable measure for assessing burden of care in caregivers of patients with spinal cord injury. Implications for Rehabilitation Spinal cord injury leads to depression, high levels of stress and diminished quality of life due to the high physical, emotional, and social burdens in caregivers. Persian version of the Caregiver Burden Scale is a valid and reliable tool for assessing burden in Iranian caregivers of patients with spinal cord injury.
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February 2018

Assessment of Executive Functions in Methamphetamine-addicted Individuals: Emphasis on Duration of Addiction and Abstinence.

Basic Clin Neurosci 2017 Mar-Apr;8(2):147-153

Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Several studies have conducted on impairments of executive functions in individuals with methamphetamine addiction; however, only a few have investigated the relationship between executive functions and duration of addiction or abstinence. This study was designed to assess the executive functions in methamphetamine-addicted individuals in relation to the duration of addiction or abstinence.

Methods: A total of 161 subjects aged between 20 and 45 years were categorized into three subgroups: currently abusing (n=41), abstinent (n=60), and control healthy individuals (n=60). A battery of standardized executive function tasks, including Stroop test, Wisconsin Card Sorting test, and Tower of London task, were administered. Data were analyzed using Pearson correlation coefficient, analysis of variance, and post hoc Bonferroni test with SPSS16.0.

Results: Methamphetamine-addicted and abstinent subjects performed worse than the controls. Methamphetamine-abstinent subjects performed better than the currently methamphetamine abusers in most executive functions. Duration of addiction and abstinence were correlated with executive dysfunctions.

Conclusion: This study revealed that although executive functions may be improved by protracted abstinence, executive dysfunctions are not completely relieved, and specific attention to planning and implementation of intervention programs are necessary.
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May 2017

Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial.

Clin Rehabil 2017 Aug 28;31(8):1087-1097. Epub 2016 Sep 28.

4 Cognitive Research Centre, Shahid Beheshti University, Tehran, Iran.

Objective: To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries.

Design: A prospective, single-blinded, randomized controlled clinical trial.

Setting: Participants' private home.

Subjects: A convenience sample of 36 outpatient participants allocated randomly to three equal groups.

Interventions: Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand.

Main Measures: A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up).

Results: Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P< 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P< 0.001), it was significant just at follow up for box and block and static two-point discrimination.

Conclusions: Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.
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August 2017

Can hand dexterity predict the disability status of patients with multiple sclerosis?

Med J Islam Repub Iran 2015 30;29:255. Epub 2015 Aug 30.

Professor, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran.

Background: Multiple Sclerosis (MS) is the most common disabling neurological disease. Hand dysfunction is one of the main complaints of patients with MS. The present study aimed to compare hand dexterity of MS patients with low Expanded Disability Status Scale (EDSS) scores and healthy adults. It also sought to identify the predictors of disability status of patients with MS based on their manual dexterity and demographic characteristics.

Methods: In this cross-sectional study, 60 (16 male/44 female) patients with MS and 60 (19 male/41 female) healthy people, who matched in terms of age and sex, were recruited. Their hand dexterity was evaluated by the Purdue Pegboard Test. The disability status of the MS group was determined by the Expanded Disability Status Scale. The data were analyzed using SPSS15.

Results: The hand dexterity in MS group even with low EDSS score (1.5 ± 1.07) was weaker than control group. Moreover, the dexterity of dominant hand and alternating two hands coordination subtests of the PPT was a good discriminator between two groups (p<0.001). The results of linear regression analysis suggested dominant hand dexterity and disease duration as predictors of disability status that predict 60.5 per cent of the variation in EDSS scores in patients with MS (p<0.001).

Conclusion: Reduced dominant hand dexterity in patients with MS is a disabling factor. Further research is recommended to determine if early hand rehabilitation can reduce the severity of disability in Patients with MS.
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January 2016

A computer-based selective visual attention test for first-grade school children: design, development and psychometric properties.

Med J Islam Repub Iran 2015 23;29:184. Epub 2015 Feb 23.

Assistant Professor, Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Visual attention is known as a critical base for learning. The purpose of the present study was to design, develop and evaluate the test-retest and internal consistency reliability as well as face, content and convergent validity of the computer- based selective visual attention test (SeVAT) for healthy first-grade school children.

Methods: In the first phase of this study, the computer-based SeVAT was developed in two versions of original and parallel. Ten experts in occupational therapy helped to measure the content validity using the CVR and CVI methods. Face validity was measured through opinions collected from 10 first-grade children. The convergent validity of the test was examined using the Spearman correlation between the SeVAT and Stroop test. In addition, test-retest reliability was determined by measuring the intra-class correlation (ICC) between the original and parallel versions of the SeVAT in a single session. The internal consistency was calculated by Cronbach's alpha coefficients. Sixty first grade children (30 girls/30boys) participated in this study.

Results: The developed test was found to have good content and face validity. The SeVAT showed an excellent test-retest reliability (ICC= 0.778, p<0.001) and internal consistency (Cronbach's Alpha of original and parallel tests were 0.857 and 0.831, respectively). SeVAT and Stroop test demonstrated a positive correlation upon the convergent validity testing.

Conclusion: Our results suggested an acceptable reliability and validity for the computer-based SeVAT in the assessment of selective attention in children. Further research may warrant the differential validity of such a test in other age groups and neuro-cognitively disordered populations.
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June 2015

Validity and reliability of the persian version of lawton instrumental activities of daily living scale in patients with dementia.

Med J Islam Repub Iran 2014 3;28:25. Epub 2014 May 3.

4. Lecturer, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

Unlabelled: Background Appropriate information about the functional capacity of patients with dementia disease plays an important role in assessment of their health status and functional independence. The purpose of the present study is to investigate the reliability and validity of the Lawton IADL Persian version in patients with dementia.

Method: International Quality Of Life Assessment (IQOLA) approach was used for translation process and then content validity was assessed by five experts. To evaluate the reliability of the scale, test-retest, inter-rater reliability and items' internal consistency methods were used. To analyze the construct validity, the Functional Assessment Staging Test (FAST) was used. The results were reported based on the data collected from the Iranian Alzheimer Associations of 60 patients with dementia. (53.3% female, 46.7% male, Mean age=75.91 (SD=7.72)) RESULTS: No significant statistically differences were observed in the distribution of the experts' opinions (p>0.05). The correlations between first and second administrations of the test (SEM=0. 238, r=0.993, CI: 0.988-0.996) and first and second raters (r=0. 961, p<0.001) were very high. Internal consistency between items and the total score (0.606 >r>0.427) had almost an average power. There was a significant negative relationship between the participants' score in IADL and FAST (p<0.001).

Conclusion: These results confirm that the Persian version of the Lawton IADL Scale has excellent reliability and validity for dementia patients. And it can be used as clinical and research tool for assessment IADL and determine disease progression by professionals.
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September 2014