aliyeh daryabor

Attention and concentration disorders, alongside tone disorders and imbalance, are among the significant challenges faced by children with cerebral palsy (CP). This study investigated the relationship between attention and balance in children with CP. This cross-sectional study included 15 children with hemiplegia (mean age: 8.8 ± 2 years) and 10 children with diplegia (mean age: 8.5 ± 1.43 years) recruited from occupational therapy clinics in Tehran, Iran. All participants were classified as level II on both the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Attention and balance were assessed using the Continuous Performance Test (CPT) and the Pediatric Balance Scale (PBS). Spearman's correlation coefficient was calculated to determine the relationship between attention and balance, with a significance threshold of α=0.05. The results showed no significant correlation between dynamic and static balance with attention (P > 0.05) in children with hemiplegia. However, in children with diplegia, there were significant correlations between dynamic balance and attention (P = 0.04), static balance and attention (P = 0.01), and total balance and attention (P = 0.02). This study found a significant correlation between attention and balance in children with diplegic CP but not those with hemiplegic CP. Given that children with diplegia exhibited weaker dynamic and static balance compared to those with hemiplegia, their balance deficits appear to demand more significant attentional resources. Due to the small sample size, further research is necessary to validate these findings.

Dynamic neuromuscular stabilization (DNS) or core stabilization exercises have been used to improve core stability, but their effect on nonspecific low back pain (NSLBP) is still not fully understood. This study aimed to investigate the effect of DNS exercises on the electromyography (EMG) activity of the external oblique muscle in people with NSLBP.

In a randomized clinical trial, 44 people with chronic NSLBP were randomly assigned to the experimental and the control groups, with 22 participants in each group. The control group received standard physical therapy exercises, while the experimental group performed DNS exercises. Each group underwent an 8-week therapeutic exercise program, 5 sessions per week, with each session lasting approximately 60 minutes. Surface EMG was utilized to assess the core muscle activity of the external oblique. The EMG activity of the external oblique was measured in both groups before and after the 8-week intervention.

Nineteen people in the control group and 21 in the DNS group were analyzed. The results showed that after the intervention, patients in the DNS group obtained, on average, an 8.82% (95% CI, 6.53%, 11.10%) higher increase in the EMG activity of the external oblique muscle compared to the patients in the control group (P<0.001, effect size: 0.622).

DNS exercises can be recommended for improving the activation of superficial core muscles like the external oblique in individuals with NSLBP.

There are ongoing debates among surgeons regarding the most effective surgical method for hip replacement, with varying preferences for the anterior and posterior approaches. Both methods have demonstrated excellent long-term outcomes, with clinical differences primarily observed in the early postoperative period.

This study aimed to compare the anterior and posterior methods of hip replacement after six months of surgery in terms of biomechanical and clinical indicators, as well as quality of life.

In this cross-sectional observational study, 42 patients who underwent hip replacement surgery using either the anterior (n = 22) or posterior method (n = 20) at least six months (and a maximum of 12 months) post-surgery, along with 20 healthy individuals, were evaluated. Biomechanical indices of the center of pressure (COP) were measured using a force plate during two-leg standing with eyes open and closed. Functional balance, independence, self-perception of performance, satisfaction, and quality of life were assessed using the timed up and go test (TUG), Barthel Index, Canadian Occupational Performance Measure (COPM), and the SF-36, respectively.

No significant differences were found between the anterior and posterior groups in terms of COP, clinical variables, and quality of life (P > 0.05). However, when compared to the control group, the anterior replacement group exhibited significantly higher COP displacement in the medial-lateral direction (P = 0.03) and COP velocity in the anterior-posterior direction (P = 0.02) during two-leg standing with eyes open. No significant differences in COP variables were observed in the posterior replacement group compared to the control group (P > 0.05).

The findings indicate no significant differences between the anterior and posterior approaches to hip replacement in terms of biomechanical and clinical indicators, as well as quality of life after six months. Therefore, the choice of surgical method can be based on the patient's condition and the surgeon’s expertise in the respective approach.

Considering the high amount of water in watermelon, this study aimed to investigate the effect of watermelon juice compared to carbohydrate drinks and water on rehydration and anaerobic performance.

In this quasi-experimental study, twelve active adolescents experienced weight loss of about 2% in three separate sessions, one week apart, by running a treadmill exercise program including two sets of 30-minute aerobic activity separated by a 10-minute rest. Then, they consumed one of the three drinks of water, carbohydrate drink, or watermelon juice at 125% of their weight loss. Two hours after each session, they performed a 300-yard shuttle run test. Urine specific gravity (USG) and participants’ weight were measured three times: before and after the dehydration protocol and before the anaerobic performance.

Data analysis showed no significant difference in USG (P=0.41) and the 300-yard shuttle run test (P=0.87) after consuming the three drinks. There was a significant difference (P=0.001) in weight gain after consuming the three drinks, with greater mean weight gain for watermelon juice and carbohydrate drinks compared to water.

The results indicated the same effect in carbohydrate drinks and watermelon juice on weight return, rehydration, and subsequent anaerobic performance. However, because watermelon juice contains vitamins and minerals compared with carbohydrate drinks, it is suggested that athletes use this drink.

This study aimed to investigate the relationship between psychological factors and clinical outcomes of therapeutic exercise after 3 months in individuals undergoing total knee arthroplasty (TKA). Another aim of this study was to evaluate the effect of 3 months of therapeutic exercise on the psychological factors of these patients.

This quasi-experimental study involved 29 patients with an average age of 62.76 years who had undergone TKA for their first knees. These patients performed therapeutic exercises for three months. Pain intensity and range of motion (ROM) of flexion and extension were assessed 3 times: before surgery, at the beginning of physiotherapy and 12 weeks after therapeutic exercises. Patients’ functional ability and psychological indicators were evaluated in two phases: Before surgery and at the end of the 12th week. Clinical outcomes, including pain, knee ROM, and functional ability, were assessed using the visual analog scale, goniometer and Oxford knee score, respectively. The depression index was assessed with the Beck depression inventory (BDI) second version, anxiety with the state-trait anxiety index, fear of movement with the tampa scale of kinesiophobia (TSK) questionnaire and pain catastrophizing with the pain catastrophizing scale questionnaire.

The results showed that two psychological indices, including trait anxiety and pain catastrophizing, had a significant negative correlation with the clinical outcomes of physiotherapy after TKA. The higher the trait anxiety before surgery was, the lower the pain reduction during the activity (r=-0.574, P=0.002) and the lower the improvement in functional abilities (r=-0.402, P=0.038). Also, the higher the index of preoperative pain catastrophizing, the lower the pain reduction during activity (r=-470, P=0.013) and the lower the improvement in functional abilities (r=-0.436, P=0.023). No significant correlation was found between other psychological indicators before surgery and the clinical outcomes of physiotherapy. On the other hand, among the psychological factors, trait anxiety (P=0.01) and fear of movement (P=0.01) were significantly improved after 3-month therapeutic exercise. 

Psychological factors can play an essential role in predicting the clinical outcomes of physiotherapy after TKA. In addition, the improvement of psychological factors after therapeutic exercises may indicate that these psychological problems can be improved by reducing pain and achieving better ROM during treatment, so psychological factors are not considered an obstacle to surgery.

Electromyography (EMG) biofeedback has been suggested as a relatively new approach to help resolve muscle disorders. This research aimed to evaluate the influence of 8 weeks of proximal pelvic muscle training and biofeedback on pain, muscle strength, and their EMG activity in individuals suffering from patellofemoral pain syndrome (PFPS).

This randomized clinical trial was performed on 30 young people aged 22 to 45 with PFPS. People in the intervention group (15 people) received EMG biofeedback of the abductor (gluteus medius) and external rotator (gluteus maximus) muscles along with routine physiotherapy treatments, including stretching exercises, isometric exercises of gluteal and quadriceps muscles, and conventional transcutaneous electrical nerve stimulation. In the control group (15 people), routine physiotherapy treatments were only performed on the patients. The participants of two groups were treated for 8 weeks, 3 sessions every week. Pain by a visual analog scale (VAS), maximal voluntary isometric strength (MVIC) of the abductor and external rotator muscles of the thigh with a dynamometer, and activity of these muscles, including maximum contraction, integrated EMG and onset EMG using EMG, were measured before and after the interventions.

MVIC and EMG of the gluteus medius muscle demonstrated that the intervention group had more maximum EMG activity (P=0.043) and MVIC (P=0.003) than the control group. MVIC and the maximum EMG activity of the gluteus maximus muscle showed no significant difference between the two groups. Still, the increase in the integrated EMG of this muscle in the intervention group indicated a greater increase than in the control group (P=0.0001). Moreover, people in the intervention group had significantly less pain than the group of routine exercises alone after 8 weeks of treatment (P=0.016). 

Adding 8 week biofeedback training of abductor and external rotator muscles to the routine therapeutic exercise in PFPS can lead to pain reduction, improvement of muscle strength and better performance of these muscles. This change could potentially slow down the degenerative process of the patellofemoral joint.

 Distal peripheral neuropathy (DPN) is a prevalent issue among patients with type 2 diabetes mellitus. Despite the widespread use of low-level laser therapy (LLLT) and limited use of Tecar therapy in physiotherapy for diabetics, the synergistic effect of these two interventions in a long-term follow-up has not yet been determined.

 This study aimed to compare the effects of Tecar therapy and LLLT separately and simultaneously over a 3-month follow-up period on clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN.

 In this double-blind, randomized clinical trial, forty-five individuals with type 2 diabetes (30 women and 15 men) with DPN were randomly assigned to three groups of 15 people: Tecar-on + laser-sham, Tecar-on + laser-on, and laser-on + Tecar-sham. The patients received ten treatment sessions and were followed up for 3-months after the last session. Health-related quality of life was assessed using the WHOQOL-BREF Questionnaire, while clinical symptoms, including pain (measured with a Visual Analog Scale), functional balance (evaluated with the timed-up and go test), and neuropathy symptoms (assessed with the Michigan Questionnaire) were also recorded.

 Inter-group comparison after ten sessions revealed that the Tecar-on + laser-sham and Tecar-on + laser-on groups exhibited significant improvement in neuropathy symptoms compared to the laser-on + Tecar-sham group. Even after the 3-month follow-up, these two groups showed lasting improvement in all variables compared to the laser-on + Tecar-sham group (P < 0.05). The Tecar-on + laser-on group demonstrated a more enduring significant effect on pain scores (P = 0.035) compared to the Tecar-on + laser-sham group after the 3-month follow-up. In intra-group comparison, all three groups showed significant improvement in clinical symptoms and health-related quality of life after ten treatment sessions compared to before treatment (P < 0.05). Moreover, after the 3-month follow-up, both the Tecar-on + laser-sham group and the Tecar-on + laser-on group demonstrated a more lasting significant effect in all variables compared to before treatment (P < 0.05). For the laser-on + Tecar-sham group, a more durable improvement in health-related quality of life (P = 0.000) and neuropathy symptoms (P = 0.011) was reported after the 3-month follow-up compared to before treatment.

 Although all three groups exhibited significant improvement in clinical symptoms and health-related quality of life in individuals with type 2 diabetes and DPN after ten treatment sessions, the synergistic use of Tecar therapy and LLLT after a long-term follow-up period could lead to more durable therapeutic effects in improving these outcomes for individuals with diabetes.

This study aimed to investigate kinematic parameters of lower limb joints during gait on inclined surfaces compared to level ground.
In this cross-sectional study, 15 healthy individuals walked at their self-selected speed on level ground with a zero slope and on two inclined surfaces. These surfaces were constructed to mimic real environments with slopes of +8 (uphill) and -8 (downhill) along an eight-meter distance. The measured variables included the angles of the ankle, knee, and hip joints sagittal plane during different phases of gait, captured through a three-dimensional motion capture system.
Significant differences were observed in uphill walking compared to level-ground walking, including an increase in ankle, hip, and knee angles at initial contact, maximum ankle dorsiflexion and plantarflexion, maximum knee flexion in the stance phase, and maximum knee extension in the swing phase. There was also a reduction in the maximum extension of the hip joint (P<0.05). In downhill walking compared to level ground, significant differences were observed in the increase of ankle and knee angles at initial contact, maximum ankle dorsiflexion, maximum knee flexion in both stance and swing phases, and a decrease in the maximum angle of hip extension. However, no significant difference was observed in the hip joint angle at initial contact maximum ankle plantarflexion, maximum knee extension in swing phase between level and downhill surfaces and at maximum knee flexion in swing phase between uphill and level surfaces (P>0.05).
Walking on inclined surfaces influences the flexion and extension angles of lower limb joints during different phases of gait, necessitating increased joint movement. These alterations are more pronounced during uphill walking than downhill, especially at the initial contact point.

Autism spectrum disorder (ASD) is a common disorder among children. The architectural design of the treatment environment can be effective in the quality of rehabilitation for these children. On the other hand, considering that an important part of treatment for children with ASD is to meet their sensory needs, there is a need for intervention and adaptation to the environment (sensory regime). The study aims to investigate the effect of the interior architecture of rehabilitation centers on the outcome of occupational therapy for children with ASD.

This is an observational cross-sectional study on 50 children with ASD aged 3-14 years, who were assigned into two groups of treatment in standard and non-standard environments, according to interior architectural factors. They were assessed before and after occupational therapy. To rank the physical space of rehabilitation centers, a researcher-made questionnaire was used with 30 criteria measuring natural light intensity, light quality (natural or artificial), visibility and view of the inside of the building, noise and visual pollution, and color of the walls. The criteria were based on the opinions of 32 occupational therapists and parents of 50 ASD children. The sensory profile 2 was used to measure sensory processing patterns (sensation seeking, sensation avoiding, sensory sensitivity, and sensory registration) of children with ASD. The paired t-test was used for within-group comparison, and the independent t-test was used for between-group comparison.

Both standard and non-standard treatment environments were effective in improving all four patterns of sensory processing (P=0.04). However, the rehabilitation center with standard design had a more significant positive effect on all four sensory processing patterns, including sensation seeking (P=0.001), sensation avoiding (P=0.001), sensory sensitivity (P=0.01), and sensory registration (P=0.001) compared to the non-standard environment.

The interior architecture of rehabilitation centers has a significant positive effect on the sensory processing patterns of children with ASD, which can affect the quality of rehabilitation services. Therefore, it is recommended to optimize the interior architecture of rehabilitation centers for ASD children.

Low back pain (LBP) represents the leading cause of disability worldwide and is a major economic and welfare problem. This study aimed to report incidence, prevalence, and disability-adjusted life years (DALY) rates of LBP in Iran by gender and different sociodemographic index (SDI) countries from 1990 to 2019.

The age-standardized LBP and incidence, prevalence, and DALY were extracted based on the Global Burden of Disease (GBD) 2019 in Iran for males and females, and low- and high-SDI countries during 1990- 2019.

GBD 2019 data for LBP in Iran indicate a significant downward trend of incidence and prevalence from 1993 to 2019 in males, females, and both, except during the 1999-2002 period for females. A sharp reduction is seen in LBP incidence and prevalence from 1996 to 1999. Gender is not a determining factor in the LBP prevalence in Iran. Regarding the SDI categories, Iran had the highest incidence rate compared to countries with low- and high SDIs. High-SDI countries had the highest prevalence and DALY compared with Iran and low-SDI countries.

The age-standardized incidence and prevalence of LBP in Iran showed a downward trend, from 1993 to 2019, especially from 1996 to 1999. Comparing Iran with low- and high-SDI countries, a heavier incidence of LBP was observed in Iran and heavier prevalence and DALY were seen in high-SDI countries. Therefore, more therapeutic healthcare interventions are required to reduce the LBP burden more effectively.

Several studies have investigated gait biomechanics in people with functional ankle instability (FAI). However, the potential role of information processing (attention) in the gait control of these patients is still unknown. Therefore, this study aimed to investigate the effect of cognitive load on the range of motion (ROM) of lower limb joints during walking in men with and without FAI.

The study was a non-randomized controlled clinical trial. Eighteen male subjects with FAI and 19 healthy subjects participated in this study and completed three randomized conditions (three trials per condition): normal walking on a treadmill (single task), normal walking while performing a cognitive task (dual task), and (3) performing cognitive task while sitting. Three-dimensional information of hip, knee, and ankle joint ROM in the sagittal, frontal, and transverse planes were measured as gait kinematic components, and the error ratio and average reaction time were measured as cognitive task indicators. The intraclass correlation coefficient (ICC) was used to determine the intrasession reliability of kinematic and cognitive measures.

The ICC of kinematic variables, including the hip, knee, and ankle joint ROM, with and without applying cognitive tasks in three planes was more than 0.70. During the single task, the group with FAI showed a significantly decreased knee ROM in the transverse plane and a decreased hip ROM in the sagittal plane compared to the healthy group. During the dual task, the group with FAI showed a significantly increased hip ROM in the sagittal plane compared to the healthy group. The results of the cognitive task showed that the group with FAI had a longer reaction time in the auditory Stroop test during dual-task walking than in the sitting position.

FAI can be an important factor in motor-cognitive interactions. Using a cognitive task may be an effective strategy in the rehabilitation program of men with FAI.

We evaluated the effect of electromyography biofeedback on proprioception and functional balance in healthy young athletes.

In this clinical trial, 24 athletes were randomly divided into two study (n=12) and control (n=12) groups. The study group received rehabilitation exercises, including one-foot standing, squatted standing, and isometric contraction of quadriceps muscle at different knee angles, including 30, 45, and 90 degrees of knee flexion along with electromyography biofeedback. The control group received only rehabilitation exercises without electromyography biofeedback. Exercises were performed by both groups for a 4-week period in three sessions per week. Functional balance and proprioception before and after exercises were measured using the star excursion balance test and a system consisting of digital photography non-reflective markers, respectively. The data of the center of pressure and time of vertical ground reaction force using a force plate was also collected to evaluate static balance and dynamic balance, respectively.

The absolute error in knee joint reconstruction for 30° (P=0.005), 45° (P=0.001), and 90° (P=0.033) angles significantly decreased after the intervention in the study group compared to the control group. Star excursion balance test scores in all directions did not show any significant differences between the two groups (P>0.05), except for the anterior-lateral direction (P=0.03). Moreover, all variables related to static and dynamic balance did not show a significant difference between two the groups after the interventions (P>0.05).

The electromyography biofeedback intervention can probably be used as a rehabilitation protocol in recovering and healing proprioception injuries resulting from sports injuries.

Some accurate tools exist to assess fear-avoidance behavior, such as the Tampa scale for kinesiophobia (TSK) in individuals with musculoskeletal problems. The current research aims to compare the psychometric characteristics of the original 17-items TSK questionnaire and its 11-item brief version in chronic non-specific low-back pain (CNSLBP).

In this test development study, 295 patients with CNSLBP referred to the physiotherapy clinic of Milad Hospital in Tehran city, Iran were evaluated. Confirmatory factor analysis (CFA) and α Cronbach was conducted to assess the validity and reliability of the original and brief version of the TSK, respectively. For goodness-of-fit, the Χ2/df, root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), and comparative fit index (CFI) indices were used.

Internal consistency specified by Cronbach’s α was 0.949 for the original version of the questionnaire and 0.927 for the brief one. Based on the CFA findings, the goodness-of-fit indices for the brief version were GFI=0.921, RMSEA=0.078 (90% confidence interval (CI), 0.062%-0.094%), comparative fit index (CFI)=0.981, and Χ2/df=2.791. These indices for the original one were 0.882, 0.066 (90% CI, 0.055%-0.076%), 0.983, and 2.270, respectively. A significant correlation was found between these two versions (P<0.001). These findings confirm the adequacy of the brief version of the TSK.

The brief version of TSK can be considered a reliable and valid tool to evaluate somatic focus and activity avoidance in patients with CNSLBP.

Due to the substantial prevalence of patellofemoral pain syndrome and the importance of quadriceps strengthening in knee rehabilitation, determining the best way to activate and strengthen the patella stabilizing muscles is considered as one of important keys of treatment. The aim of this study is to evaluate the effect of different hip rotations associated with ankle dorsiflexion during maximal straight leg raising (SLR) maneuver in the sitting position on thickness and fibers angle of vastus medialis oblique (VMO) and vastus lateralis (VL) muscles using ultrasonography.

This quasi-experimental study was performed on 40 individuals (healthy group: 20, patellofemoral pain syndrome [PFPS] group: 20). VMO and VL thickness and fiber angle were measured using ultrasonography during maximal SLR in 6 positions: hip internal, hip external, and neutral rotations with and without ankle dorsiflexion. 

In between-group comparison, no significant difference was found for all variables with different SLR maneuvers (P>0.05). In the within-group comparison, hip external rotation compared to other hip positions without ankle dorsiflexion resulted in a significant increase in VMO thickness and fiber angle in both groups (P<0.05). Also, adding ankle dorsiflexion to different hip rotations during SLR significantly increased the thickness and fiber angle of VMO and VL.

By changing hip rotations with or without ankle dorsiflexion during SLR, the trend of changes in VMO and VL thickness and fiber angle in the two groups followed the same pattern. Moreover, performing SLR in hip external rotation with ankle dorsiflexion can be recommendable for the rehabilitation of PFPS.

 Following an anterior cruciate ligament (ACL) rupture, proprioceptive deficiency may be responsible for functional balance defects and joint instability. Recently, using transcranial direct current stimulation (tDCS) or biofeedback has been recommended for athletes with ACL rupture.

 This study aimed to evaluate the effects of tDCS and biofeedback modalities while performing contraction exercises in athlete with an ACL rupture.

 Thirty-three athletes with ACL rupture were randomly divided into three groups of tDCS, biofeedback, and control, with 11 people in each group. All groups underwent a ten-session training of intermittent contractions of the lower extremity muscles in a standing position at different knee angles, including 30, 45, and 90 degrees of knee flexion during four weeks. The control group received no tDCS or biofeedback modalities except the contraction exercises. All subjects were evaluated both before and at the end of interventions. The proprioception measured as rate of absolute error in the knee joint reconstruction was assessed by the digital photography technique at knee flexion angles of 30, 45, and 90 degrees. The functional balance was assessed by the star excursion balance test in eight different directions. All measurements were carried out on the injured limb.

 The results showed no significant difference among three groups regarding all variables related to the proprioception and functional balance (P > 0.05). Intra-group comparison (before and after intervention) indicated that biofeedback significantly improved both the functional balance in all directions and the proprioception of the injured knee at three knee flexion angles (P < 0.05). Moreover, tDCS significantly improved the functional balance in six directions, except anterior-lateral and posterior, and also improved the proprioception at all angles of knee flexion.

 Although the results did not show a large difference among groups, both tDCS and biofeedback modalities, along with intermittent isometric exercises, may have reduced knee absolute error at the knee flexion angles of 30, 45, and 90 degrees as well as improved the functional balance. Therefore, it was recommended that these modalities should be included in rehabilitation program targeting ACL-deficient knee subjects.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with 2 main symptoms of social and communication deficits and stereotyped behaviors. Pretend play and theory of mind (ToM) have an essential role in a child’s cognitive and social development.

In this study, different variables of pretend play with levels of ToM were examined in 2 groups of typical children and children with autism.

In this case-control observational study, 45 typical children and 18 children with autism aged 5 to 7 years participated. For both groups, the ToM test was performed to measure the levels of ToM, and the child-initiated pretend play assessment (ChIPPA) was performed to analyze the pretend plays in both groups. Both tests were performed directly on children, and the scores were recorded by the examiner.

The results showed a significant positive relationship between the total score of ToM and pretend play. In children with autism, there was no difference between the ToM scores regarding age (P > 0.05). There was also a significant relationship between the levels of ToM, percentage of elaborate pretend actions (PEPA), and the number of object substitutions (NOS; P < 0.001). The scores of the ToM and pretend play levels of children with autism and typical children were significantly different (P < 0.001).

Based on the findings, the ToM and pretend play levels were lower in ASD children than in typical children. In addition, children who had higher PEPA scores and better NOS had higher ToM scores.

Working memory is one of the cognitive aspects that may be damaged in patients suffering from a stroke. According to evidence, repetitive Transcranial Magnetic Stimulation (rTMS) and cognitive interventions could affect cognitive function in healthy individuals or patients with neurological diseases.

This study aimed to evaluate the combined effect of high-frequency rTMS in the left Dorsolateral Prefrontal Cortex (DLPFC) region of the brain and cognitive rehabilitation on the working memory of stroke patients.

In this double-blind, randomized clinical trial with a pretest-posttest design, 18 post-stroke chronic patients aged 55 to 75 years were randomly divided into two experimental and control groups. The working memory score was measured using the N-back test in the two groups before the interventions. Then, both groups participated in rTMS intervention sessions, except that in the control group, changing the coil angle prevented the waves from reaching the brain. The rTMS interventions were performed for each patient in 15 sessions of six minutes, three days a week. In addition, both groups received computer-based cognitive rehabilitation therapy immediately after each rTMS session for 30 to 40 minutes. These practices included working memory rehabilitation in Captain's Log software used at the adult level. Each level had 15 steps, and the difficulty of the exercises increased with increasing steps. Finally, the working memory was remeasured after the intervention sessions.

The use of rTMS on the left DLPFC region significantly improved the working memory of stroke people in the experimental group compared to the control group (P = 0.027). In addition, the difference before and after the interventions in both groups was significant for this variable (P < 0.001), which indicates the positive effect of cognitive rehabilitation on reducing cognitive problems.

Although cognitive rehabilitation using software is effective on working memory, using rTMS along with cognitive rehabilitation in the left DLPFC area has a more significant effect on improving working memory in people with chronic stroke.

Upper limb function can be correlated with the self-assessment of children with hemiplegic cerebral palsy.

This study aimed to determine the correlation between fine motor skills and occupational self-assessment in children with hemiplegic cerebral palsy.

Fifty patients aged 8 - 13 with hemiplegic cerebral palsy, who had 1 of 3 levels (I to III) of hand skills based on the manual ability classification system (MACS), were selected. The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) Questionnaire for the motor skills and Child Occupational Self-Assessment (COSA) Questionnaire were given to participants. The Spearman correlation coefficient at a significance level of 0.05 was used to determine the relationship between the variables.

The mean and SD of occupational self-assessment and its subscales (i.e., occupational value and competence) at different levels of hand dysfunction (I - III) were 115.68 ± 14.04, 54.70 ± 8.83, and 60.98 ± 5.69, respectively. The mean and SD of fine motor skills and its subscales (i.e., visual-motor control, response speed, and upper-limb speed) and dexterity at different levels of hand dysfunction were 70.44 ± 14.76, 4.04 ± 2.44, 33.70 ± 6.19, and 32.70 ± 7.07, respectively. The spearman correlation showed a significant relationship between fine motor skills of hand and its subscales with occupational self-assessment and its subscales (P < 0.05).

The findings showed that to improve occupational self-assessment of cerebral palsy children, special attention should be paid to progress the function of the upper extremity through occupational therapy interventions. It can lead to improved quality of life, strong sense of self-efficacy, and greater independence.

Considering that only about a year and a half have passed since the COVID-19 epidemic and the priority of the health care system has been to pay attention to symptoms and physical problems of this disease to prevent its further spread, there is insufficient evidence about psychological issues resulting from COVID-19. The purpose of this study was to partially review psychological problems caused by COVID-19 in patients and treatment staff and rehabilitation strategies to solve this problem. 

A search through in Medline, Web of Science, PubMed, and Scopus databases was performed by combining keywords related to COVID-19 (such as coronavirus), restrictive measures (such as quarantine, segregation, social distancing), and psychological outcomes (such as psychosis, depression) and instructions (such as guidance, management, rehabilitation). All articles were written in English and aimed at the psychological disorders and factors associated with the coronavirus. Given that only about a year and a half has passed since the introduction of COVID-19, the period of the reviewed articles was selected between 2019 and 2021.

Reviewing related studies, 18 original articles were considered. Overall, the literature showed that COVID-19 had changed the lifestyle. COVID-19, in addition to physical symptoms and mortality, has adverse psychological effects such as anxiety, depression, loneliness, stress, fear, and excitement. However, these symptoms are not very severe in most cases. Psychological problems can be more severe in specific groups, such as pregnant women or people with underlying issues. In countries with a history of epidemics, internet-based systems have been developed to assess and treat psychological problems in patients with COVID-19. Rehabilitation intervention can also positively improve the patient's breathing, thereby reducing psychological issues.

COVID-19 can cause psychological problems for the patient and physical symptoms. On the other hand, changes in people's lifestyles following the outbreak of COVID-19, such as travel restrictions, quarantine, social distancing, and business sluggishness, may also contribute to the psychological disorders following the COVID-19 pandemic. The psychological problems caused by COVID-19 in some special groups, such as pregnant women, health care providers, and children, need to be addressed. Rehabilitation interventions and raising public awareness can effectively improve the psychological situation.

The Tampa Scale of Kinesiophobia (TSK) is considered a valid and reliable tool to assess the fear-avoidance behavior in patients. There is a valid and reliable Persian version of the TSK-17.

The present study aimed to assess the internal consistency as a measurement for the test reliability and factor (domain) validity of the Persian version of the TSK-17 to determine whether a modified form can be proposed.

This study analyzed the data of 295 individuals with non-specific low back pain (NSLBP). Cronbach’s alpha was used to assess internal consistency (reliability). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied to evaluate factor validity which is an aspect of the construct validity. The Chi-square divided by the degrees of freedom, the goodness of fit index (GFI), the confirmatory fit index (CFI), and the root mean square error of approximation (RMSEA) indices were utilized as the goodness-of-fit criteria. Data analysis was performed using SPSS software (version 18), AMOS software (version 20), and EQS software (version 6.2).

Two factors were extracted for the TSK-17 questionnaire using EFA, and then the structure was confirmed with CFA. Cronbach’s alpha as an internal consistency index was 0.949 for the entire questionnaire, 0.931 for the 11-item fear-of-movement factor, and 0.971 for the 6-item belief factor. The evaluation of the inappropriate items demonstrated that no items were selected for the deletion; therefore, a modified version of the TSK was not presented. The goodness-of-fit indices were reported as GFI = 0.882, RMSEA=0.066 (90% CI: 0.055-0.076), CFI = 0.983, and minimum discrepancy per degree of freedom = 2.27.

The Persian version of the TSK-17 can be considered a valid and reliable tool to assess the fear of movement and avoidance behavior in individuals with NSLBP.

 The purpose of this study was comparison of the effect of custom-molded insole and prefabricated insole with shock absorb canal on pain and function in subjects with plantar fasciitis. 

In this pilot study, fourteen patients with plantar fasciitis were non-randomly assigned to two groups of 7 people. A group received the custom-molded insoles and another group received the prefabricated insoles with shock absorb canal. Before the use of the insoles in each group, the patients ' pain and function were recorded. The pain score was measured by Visual Analog Scale (VAS). For evaluating the function, patients were asked to complete the foot and ankle ability measurement questionnaire (FAAM).Then, patients in both groups used insoles for 6 weeks. After a 6-week use of the insoles, the pain and function were recorded for the second time. Wilcoxon test was used for the effect of insoles in each group (comparison before and after the intervention) and Mann-Whitney test for comparison between two groups. 

 In comparison within each group, the findings showed that the use of both insoles after 6 weeks led to a significant decrease in pain score and a significant increase in the score of daily activities as well as sports activities compared with before use of insoles (P<0.05). There were no statistically significant differences in pain and function scores between the two groups after using the insoles (P>0.05). 

 According to the findings, there was no significant difference between the custom-molded insole and the prefabricated insole in improving pain and function of patients with plantar fasciitis. However, both types of insoles reduced pain and improved the function, with more acceptable to the prefabricated insole.

One of the disorders in stroke patients is asymmetrical posture, which leads to decreased movement and balance control. An ankle-foot orthosis (AFO) is the most common orthopedic device used in patients with post-stroke hemiplegia, and are often utilized with shoes. The purpose of this study was to investigate the effect, in stroke patients, of rocker bottom shoes on an AFO in the clinical assessments of balance compared to standard shoes on an AFO.   

This quasi-experimental study involved 10 chronic stroke patients. The evaluated individuals were under four conditions using rocker bottom shoes and standard shoes coupled with a rigid AFO immediately, and after a 3-week adaptation. The walking speed was assessed using a 10-m walk test (10 MWT), and the clinical assessments of balance were evaluated using the Timed-Up and Go test (TUG) and the Functional Reach Test (FRT).  

The findings revealed that wearing rocker bottom shoes on the AFO significantly increased walking speed, the distance on the FRT, and reduced the TUG compared to wearing standard shoes on the AFO (p < 0.05).

The study indicated that stroke patients showed an improvement in walking speed and functional balance when utilizing the AFOs with rocker bottom shoes. This outcome could be a possibility in application by doctors to prescribe this type of footwear for individuals who have had a stroke.

Plantar fasciitis is a plantar fascia inflammation and one of the most common causes of heel pain, causing pain in the inner side of the heel bone. The purpose of this investigation was to analyze the effect of different foot orthoses on the distribution of foot pressure in patients with plantar fasciitis.

The systematic search of PubMed, Science Direct and Web of Knowledge databases was conducted using keywords such as plantar pressure, plantar fasciitis, heel pain, foot orthoses, and orthotic insoles to identify published articles in this field. The statistical population was all studies that examined heel and foot pressure in patients with plantar fasciitis. In addition, studies on different perspectives were identified in plantar fasciitis. From 1999 to 2018, thirteen articles were evaluated in Persian and English, nine of which directly evaluated the effect of foot orthoses on heel and foot pressure, and were selected based on entry criteria for the final examination.

Nine articles were selected for inclusion in the study. These articles examined types of foot orthoses include, custom insole, prefabricated insole, foam insole, silicone heel cup, foam heel pad, viscoelastic heel pad, and tape and then measured heel and foot pressure using various devices. The results show that the insoles can be effective in reducing the maximum pressure and also reducing the average pressure. In one study, the maximum total pressure before using the insoles was 12 and decreased using custom insoles and prefabricated insoles respectively 7/7 and 8/7. Some studies have found little difference between these two insoles in reducing the heel and foot pressure. In one study, both insoles reduced the maximum pressure at the inside of heel to a value of 13%. Compared to the prefabricated insole with foam heel pad and silicone heel cup and heel lift, decrease pressure in prefabricated insoles was higher than other groups (P<0.001). Silicone insoles also reduce the pressure of the heel, but this is insignificant (P=1). Also, according to studies cups and pads also contribute to decreasing foot pressure (P<0.05).

Although all types of foot orthotics are effective in reducing the heel and foot pressure, the effect of custom-made and prefabricated insoles in reducing foot pressure was greater than heel orthoses. Also, in most studies, custom-made insoles were more effective than different prefabricated insoles, however, the slight difference in reducing the amount of pressure by the prefabricated and custom-made insoles makes it impossible to come to a definite conclusion regarding the superiority of the insoles.

  Equinovarus deformity and knee hyperextension are the most common problems in stroke patients. Ankle foot orthosis (AFO) is commonly prescribed to improve these disorders in these patients, as well as gait parameters that are approved. The aim of this study is to investigate the effect of ankle alignment and rigid AFO footplate length on spatiotemporal parameters and knee joint angle in hemiplegic post-stroke patients.

This quasi-experimental study was performed on 6 hemiplegic post-stroke patients using three rigid AFO modes, including neutral ankle angle with full-length foot-plate -conventionally aligned AFO (CAFO), neutral ankle angle with ¾ length foot plate (¾AFO), and 50dorsi-flexion ankle angle with full-length foot-plate (50DF AFO) to investigate the effect of the alignment and foot plate length on spatiotemporal parameters and knee joint angle. The 3D motion analysis system with a Vicon Camera was used to collect the spatiotemporal parameters data.

The mean walking speed of patients after using 50DF AFO was significantly higher compared to CAFO (P=0.036). The mean stride length, cadence and maximum knee extension angle in the stance phase during single limb support was not significantly different in the three different test modes of ¾AFO, CAFO, 50DF AFO (P > 0.05).

The DF AFO with 50ankle angle increases the walking speed and also controls knee hypertension in the terminal stance phase, which can be due to the progression of tibia in the mid to late stance phase and the alteration of ground reaction force vector.