Journal of Modern Rehabilitation

Effects of Ankle Plantar Flexion Position During Squatting on Tibialis Anterior and Triceps Surae Muscle Activity in Healthy Adults: A Systematic Review and Meta-Analysis

2026-09-12T14:05:20+0430

Background: Squatting is a fundamental movement in which ankle position is frequently modified with external tools such as shoes, insoles, or wedges. However, the effects of these modifications on shank muscle electromyographic (EMG) activity remain unclear. This systematic review and meta-analysis aimed to examine how changes in sagittal ankle position influence shank muscle EMG activity during squatting.
Material and Methods: A systematic search of six databases was conducted from inception until August 2026. Included studies reported EMG activity of the tibialis anterior (TA), gastrocnemius (GA), or soleus (SOL) during squats performed in plantar flexion or dorsiflexion, compared with a neutral ankle position.
Results: Analysis of eleven studies (141 participants) revealed that the plantar flexion position significantly decreased dorsiflexor (TA) activity (Hedges' g = -1.048; P < 0.001) but had no significant effect on plantar flexor (GA, SOL) activity (Hedges' g = 0.069; P = 0.672). High heterogeneity (I² > 75%) was observed for both meta-analyses. Limited evidence also suggested that dorsiflexed positions may reduce plantar flexor activity.
Conclusions: Ankle plantar flexion during squatting significantly reduces dorsiflexor activity without systematically altering plantar flexor activation. These findings provide preliminary support for the clinical use of heel lifts to offload the TA but question their efficacy for modifying calf muscle recruitment. Future research should prioritize standardizing EMG methodologies and investigating these effects in clinical populations.

Immediate Effect of Dual-Task Training on Brain Electrical Activity, Functional Disability, and Pain Severity in Athletes with Chronic Ankle Instability

2026-09-12T11:55:57+0430

Background: Chronic ankle instability (CAI) induces a disorder of the central nervous system, in which brain waves play an important role in regulating these factors. The aim of this study was to investigate the immediate effect of dual-task training (neuromuscular and cognitive) on brain electrical activity, pain severity, and foot and ankle disability index (FADI) in athletes with CAI.
Methods: This study a single-blind randomized control trial (RCT). Participants were 44 young male and women athletes (N=27 male: N=17 women) with CAI who were randomly divided into two groups; dual-task training group and control group. The immediate effect of dual-task training was performed for 30 minutes. Outcome measures were brain electrical activity (electroencephalography Medina Teb Company, Iran was employed), pain severity (10-centimeter visual analog scale) and disability.
Results: The results indicated that dual-task training significantly improved brain electrical activity and reduced pain severity. Significant reductions in pain were observed (P < 0.001, η² = 0.493), along with decreased theta wave activity at O1 and O2 (P < 0.001, η² = 0.837; P < 0.001, η² = 0.898). In contrast, alpha and beta wave activities significantly increased at both O1 and O2 electrodes (beta: P ≤ 0.001, η²ₚ = 0.702 and 0.898).
Conclusion: The findings of this study indicate that dual-task training has an immediate effect on enhancing brain electrical activity in the O1 and O2 regions and reducing pain severity. Based on these acute findings, physiotherapists and sports rehabilitation practitioners may consider incorporating dual-task training as a complementary approach aimed at improving central nervous system function.

Translation, Cultural Adaptation, and Validation of the Persian Lysholm Knee Scale in Iran

2026-09-12T11:54:59+0430

Background: Valid and culturally adapted patient-reported tools are essential for accurate clinical assessment of knee injury outcomes. This study aimed to translate the English Lysholm Knee Scoring Scale (LKSS) into Persian and comprehensively validate it.
Methods: This methodological study (test development) employed a cross-sectional design. The LKSS was translated using Guillemin's standard method. Validity and reliability were assessed in a sample of 182 patients with knee injuries. We evaluated content validity (Content Validity Ratio (CVR) and Content Validity Index (CVI)), face validity (impact score), convergent validity (correlation with the International Knee Documentation Committee (IKDC) form), construct validity (Exploratory Factor Analysis (EFA)), and reliability, including internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient (ICC)), and Standard Error of Measurement (SEM).
Results: All items demonstrated acceptable content validity (CVR >0.79 and CVI >0.62). All face validity impact scores were above the 1.5 threshold. Convergent validity was excellent, with a very high correlation between the LKSS and IKDC (r=0.804, p<0.001). The EFA supported a one-factor structure (KMO=0.829; Bartlett's test p<0.001), explaining 42.39% of the variance. Reliability was outstanding, with an ICC of 0.95, a Cronbach's alpha of 0.894, and an SEM of 5.14.
Conclusion: The Persian LKSS demonstrated high validity and reliability across all measured metrics. These results confirm it is a psychometrically sound and suitable instrument for assessing knee-related function and outcomes in the Iranian population, suitable for both clinical and research applications.

Effects of Computerized Vision Therapy on Developmental Eye Movement Test Test Performance in Children with Poor Reading Skills: A Pre Post Study

2026-09-12T11:53:38+0430

Background: Reading difficulties in school-aged children are frequently associated with oculomotor deficits, including prolonged fixation durations, increased saccade frequency, and frequent refixations. Given the critical role of eye movements in fluent reading, early diagnosis and targeted intervention are essential to mitigate adverse academic, social, and economic outcomes. This study aimed to evaluate pre‑post changes in Developmental Eye Movement test (DEM) test performance following a structured oculomotor training program, delivered via the Sanet Vision Integrator(SVI) system, in Iranian primary school children with reading difficulties.
Material and Methods:This single-group, pre- and post-intervention study included children recruited from primary schools in Shiraz, Iran.Training sessions of 30 minutes, incorporating saccadic and tracking exercises, were conducted three times weekly. Outcomes were assessed before and after the intervention using the DEM test.
Results: Thirty-two children aged 7–12 years with abnormal DEM scores and teacher-reported reading weaknesses participated in a 12-week intervention program. Paired t-tests revealed statistically significant improvements in vertical time, adjusted horizontal time, ratio and total errors following the intervention ( all p < 0.001), with post-treatmentt means closley approximating age-mached normative value across all age groups.
Conclusion: Oculomotor training using the SVI system was associated with improved DEM test performance in children with reading difficulties. However, the absence of a control group limits causal interpretation, as improvements may reflect practice effects, maturation, or non-specific factors. Randomized controlled trials with standardized reading assessments are needed to determine whether such training produces functional reading improvements.

Beyond the Best Exercise: A Practical Framework for Personalized Rehabilitation in Parkinson’s Disease

2026-09-12T11:52:43+0430

Exercise is established as an important adjunct in the treatment of Parkinson’s disease (PD). Yet the field has spent decades searching for a single “best” program – a quest that is fundamentally misguided. Instead, rehabilitation should be matched to each patient’s main impairments, goals, safety profile, cognitive status, and access to services. Four well-studied approaches – LSVT BIG, HiBalance, supervised therapeutic climbing, and community non-contact boxing – offer different mechanisms, expected outcomes, and practical demands. The core argument of this editorial is that optimal outcomes come from sequencing short, intensive blocks of targeted therapy followed by community‑based maintenance programs, guided by a small set of routinely collected clinical variables. Progress in PD rehabilitation will depend on patient‑centered pathways that integrate physiology‑driven treatment with sustainable community options, not on identifying a universal superior exercise.
LSVT BIG is an intensive, high‑repetition program focused on increasing movement amplitude and recalibrating sensorimotor perception. Randomized trials and meta‑analyses show improved motor scores and gait when the standard protocol is followed [1,2], with physiological studies supporting a proprioceptive recalibration mechanism [3]. These effects are most clearly reported in people with mild‑moderate PD who can tolerate an intensive, therapist‑led schedule [1,2]. The resource intensity and need for trained clinicians should be noted when LSVT BIG is recommended.
HiBalance targets balance subsystem deficits by training sensory integration, anticipatory postural adjustments, and dynamic stability. Short‑term gains in balance and gait have been reported in trials, and imaging studies suggest task‑related neuroplastic changes [4]. The magnitude of benefit has varied across studies, and non‑specific factors such as attention and group support influence outcomes in some trials [5,6]. HiBalance is therefore best used when postural instability or falls are the dominant clinical problems and when supervised, cognitively demanding training is feasible.
Supervised therapeutic climbing combines large‑amplitude limb and trunk movements, vertical loading, and complex visuomotor problem solving. Randomized trials report improvements in motor signs [7], with other controlled studies showing gains in posture and gait [8,9]. High adherence and strong patient engagement are documented in feasibility reports [10]. Notably, most climbing data originate from a single research group; independent confirmatory trials would strengthen generalizability. Proposed mechanisms include axial strengthening, transfer of vertical motor control to horizontal locomotion, and enhanced cognitive‑motor dual‑tasking. Climbing is most suitable where axial extension, posture correction, and sustained engagement are prioritized, and where safe infrastructure and trained supervision are available [7,8]. Attention to safety protocols and implementation costs is required [10].
Community non‑contact boxing programs have been widely adopted because they are engaging, socially reinforcing, and scalable. Trials and reviews report improvements in mood, motivation, and adherence, with modest gains in fitness and some motor outcomes [11,15] – though randomized trials show inconsistent effects on core PD motor signs [12,13]. The principal practical value of boxing is therefore often found in long‑term adherence and psychosocial benefit, which can support maintenance of gains achieved in targeted therapy blocks [14].
From this evidence, several practical principles emerge. Interventions should be matched to mechanism and goal: amplitude‑focused deficits → LSVT BIG; balance subsystem failure → HiBalance; axial/postural problems → supervised climbing where available; long‑term adherence and mood → community boxing when appropriate. Short, intensive blocks (typically 8–12 weeks) of targeted therapy are likely to produce focused gains that require ongoing maintenance. Community‑based or group activities are reasonable maintenance options when safety and access permit.
A critical gap in the original literature has been the absence of a simple, clinically usable decision tool. Table 1 summarizes a simple, hypothesis-generating decision framework based on five routinely collected variables: motor phenotype, fall history, cognitive status, patient goals, and access constraints. This framework is intended to support clinical reasoning and prospective validation, not to serve as a validated treatment algorithm.