Background: Cerebral Palsy is the one of leading cause of disability among pediatric population, especially in Asia. Permanent disability is mostly due to the spasticity and poor gross motor function, adding significant socioeconomic burden on healthcare system. This study evaluate the effectiveness of Physical Therapy based interventions on improving Gross Motor Function and reducing Spasticity.
Material and Methods: A thorough search on CINAHL, PubMed, PEDro, Web of Science, and Scopus from February to July 2024 for studies assessing spasticity by Modified Ashworth Scale and gross motor function by GMFM-88 Standing/Walking dimensions in children with diplegic CP. Seventeen eligible trials were analyzed using fixed/random effects models in MedCalc.
Results: The analysis showed significant improvements in walking ability p < 0.0001 (CI 95%= (0.20. 0.50), SMD= 0.563, Q=43.9325) and standing ability p = 0.0004 (CI 95%= (0.20. 0.50), SMD= 0.187, Q=22.5239) in the experimental group, as measured by the GMFM-88. However, there was no overall significant impact on all dimensions of GMFM-88 p = 0.5821 (CI 95%= (-0.0508. 0.301), SMD= 0.125, Q=6.5843). Additionally, interventions targeting spasticity reduction showed no significant effects p = 0.1018 (CI 95%= (0.20. 0.50), SMD= 0.306, Q=10.5922) according to the Modified Ashworth scale.
Conclusion: This meta-analysis reveals that modified suit therapy, vibration therapy, and hippotherapy enhance standing and walking in the GMFM-88 but did not reveal significant effects of physical therapy interventions in improving overall gross motor function or reducing spasticity in children with diplegic cerebral palsy.

Background and Aim: Listening effort refers to the cognitive resources required to understand speech, particularly in challenging listening environments. Individuals with hearing loss experience increased listening effort due to auditory deficits, affecting their communication and cognitive load. Understanding the mechanisms behind listening effort is essential for developing effective hearing interventions. This study aims to explore the mechanisms of listening effort in individuals with hearing impairments.
Material and Methods: A narrative review was conducted using specific keywords in Google Scholar (as a search engine) and the research databases Web of Science, Scopus, and PubMed. Relevant articles were selected based on their alignment with the focus on the mechanisms of listening effort in individuals with hearing loss.
Results: Hearing loss triggers compensatory cognitive strategies, engaging prefrontal regions and working memory to process degraded auditory signals. Neural adaptations, including cross-modal plasticity and reliance on top-down processing, further elevate mental workload. Degraded temporal processing and attentional demands in noisy environments exacerbate effort, often leading to fatigue.
Conclusion: Understanding these mechanisms informs interventions such as adaptive hearing technologies, cognitive training to optimize resource allocation, and personalized communication strategies. Integrating neurophysiological insights into clinical practice can reduce cognitive fatigue and enhance real-world communication outcomes.

Background: Tinnitus, the perception of sound without external stimuli, affects approximately 14.4% of adults globally and significantly impacts mental health. It is commonly associated with anxiety, depression, and cognitive dysfunction, contributing to a decreased quality of life. Tinnitus can be classified as subjective or objective, and its severity and associated psychological distress vary widely among individuals.
Methods: A comprehensive review of literature published between 2010 and 2024 was conducted using databases such as PubMed, Scopus, Web of Science, and Google Scholar. Keywords related to tinnitus and mental health (e.g., anxiety, depression, mood disorders) were used to identify human studies exploring the psychological impact of tinnitus.
Results: Research consistently demonstrates that individuals with tinnitus experience different rates of anxiety and depression, with prevalence rates ranging from 18.5% to 48.33% for anxiety and 6% to 84% for depression. Shared neural pathways, including the anterior cingulate cortex, insula, and amygdala, contribute to both tinnitus and mental health conditions. Psychological interventions such as Cognitive behavioral therapy (CBT) and mindfulness-based therapies (MBIs) have shown effectiveness in reducing tinnitus distress and improving mental well-being.
Conclusion: Tinnitus has a significant impact on mental health, contributing to anxiety, depression, and sleep disturbances. A multidisciplinary approach addressing both auditory and psychological aspects of tinnitus is crucial for effective management. Further research is needed to optimize treatment strategies and understand the complex interplay between tinnitus and mental health.

Objectives: To systematically review and evaluate the evidence regarding the effect of sign language on language development in deaf and hard-of-hearing children.
Method: A comprehensive search of electronic databases, including PubMed/MEDLINE, Web of Science, Scopus, EMBASE, Scholar Google, and ProQuest from 1995 until April 2024., with no language restrictions, was conducted. The two authors independently assessed the risk of bias using the Newcastle-Ottawa Scale.
Results: Six studies involving 259 participants found that sign language exposure benefits language development in deaf children with hearing aids/cochlear implants. Children exposed to sign language showed similar or even better-spoken language skills than those with limited sign language exposure. Encouraging parents to learn sign language can significantly support deaf children's communication and language development.
Conclusion: Deaf children with cochlear implants benefit most from a communication approach tailored to their needs. Early intervention, parental involvement, and a rich language environment (signed or spoken) are key. While sign language exposure shows promise, more research is needed, especially on its long-term effects and use by hearing parents. PROSPERO registration ID: CRD42023402357

Background: Tension-Type Headache (TTH) is recognized as the most common type of headache worldwide causing significant psychological, physical, financial, and societal consequences. One of the activating factors of Chronic Tension-Type Headache (CTTH) is cervical dysfunction such as Forward Head Posture (FHP) leading to suboccipital muscle tenderness and Deep Neck Flexor (DNF) muscles weakness. Physiotherapy affect these patients through two mechanisms: top-down (e.g., DNF exercises) and bottom-up (e.g., suboccipital Myofascial Release (MFR)), but their relative effectiveness in reducing headache-related parameters remains unclear.
Methods: This randomized, parallel-group, assessor blind, double-dummy clinical trial includes 44 participants divided into two groups: one receiving MFR with sham exercise and the other DNF exercises with sham MFR. Interventions will be carried out over four weeks, followed by a six-week follow-up. Primary outcomes include headache intensity and craniovertebral angle (CVA), while secondary outcomes assess headache frequency, duration, pressure pain threshold, disability and quality of life.
Conclusion: This study aims to compare the effectiveness of a top-down versus a bottom-up physiotherapy approache in CTTH patients with FHP. If a significant difference is found, the study will identify the superior approach for short- and medium-term outcomes, providing valuable insights for clinicians and health managers.

Purpose: Regarding the prevalence of learning disabilities (LD) and its consequences, availability of a valid and reliable screening tool will help providing early diagnosis and intervention for at-risk students. Significant number of students with LD have a history of language problems, so it is rational to recognize them through a checklist entitled as “Language-Based Reading Disabilities Checklist”. Translation, cross-cultural adaptation, and assessment of psychometric features of mentioned checklist for Persian-speaking students were aims of present study.
Methods: Research team administered forward & backward translations, cognitive briefing, and evaluation of validity and reliability. Content validity and face validity were calculated based on Content Validity Ratio/CVR (critical value ≥ 0.42), Critical Validity Index/CVI (critical value ≥ 0.79), & Item Impact Score/IIS (critical value ≥ 1.5). The Kuder-Richardson-21 was administered to calculate internal consistency.
Result: In translation, two words needed to be equated (‘wanders’ and ‘rhymes’). Teachers assessed the checklist as an easy to understand and clear. They need about five minutes to fill the checklist for each student. The panelists removed two items with CVR ≤ 0.42 and one item based on CVI and IIS. The internal consistency of the checklist was 0.94 and ICC for items were between 0.543 and 0.885.
Conclusion: The Persian version of the language-based reading disabilities checklist is a valid and reliable tool to be applied to the Persian-speaking students in Iran. The applicability of this tool for Iranian students who are bilingual (Turkish, Kurdish, Lor, Arabic, and Baloochi) should be checked.

Background: Ankle sprain is the most common injury among the sport injuries. The purpose of this study was to assess the effects of six weeks neuromuscular training on muscle strength, balance, range of motion and proprioception in subjects with ankle sprain.

Material and Methods: Seventeen patients with ankle sprain were randomly allocated into two groups, intervention group (n=9) and control group (n=8). Intervention group followed a prescribed neuromuscular training program; control group followed their normal training routine.

Results: There was a significant difference between muscle strength of Invertor muscles before and after a training in angular velocity of 60 degree/second (deg/sec) and before and after a training program in angular velocity of 120 deg/sec in intervention group (P<0.05). There was also significant difference between muscle strength of evertor muscles before and after a training program in angular velocity of 60 deg/sec and before and after a training in angular velocity of 120 deg/sec in intervention group (P<0.05). There was a significant difference between overall balance score before and after a training in intervention group (P<0.05). There was not a significant difference between ROM before and after a training in intervention group (P>0.05). There was a significant difference between proprioception before and after a training in intervention group (P<0.05).

Conclusions: It can be concluded that six weeks of neuromuscular training improve muscle strength, balance and proprioception in patients with lateral ankle sprain.

Background: Cardiac rehabilitation is a program designed to help patients adopt healthy lifestyles. This study aims to investigate the effectiveness of the comprehensive cardiac rehabilitation program (CCRP) on anxiety, depression, perceived health status (PHS), and 90-day readmission rate for Coronary artery bypass grafting (CABG) patients.
Methods: 122 patients were randomized into two groups; the intervention group received a CCRP. The program was 12 weeks. Anxiety and depression were assessed using the hospital anxiety and depression scale, and PHS was assessed using the short form-36 health survey. The effectiveness of the CCRP was measured using ANOVA.
Results: The sample comprised 122 participants, most of them were male (n = 85; 69.7%), with a mean age of 53.01 (±7.26) years. At baseline, the groups had no significant differences. At 12 weeks and one month later, significant differences have been observed with between-group effect of (F (1) = 937.69, P <.001, partial η2 = .90), (F (1) = 1036.00, p<0.001, partial η2 = .91), (F (1) = 14.73, p <.001, partial η2 = .13), (F (1) = 13.87, p <.001, partial η2 = .121) for anxiety, depression, physical component summary and mental component summary of perceived health status respectively.
Conclusion: CCRP appeared to be an effective intervention that could significantly improve anxiety, depression, and PHS. Although the difference in the readmission rate was not significant, it may result in substantial rewards.
The protocol of the present study was registered and approved in ClinicalTrials.gov PRS
ID: NCT06118918
November /2023

Background: The inspiratory muscle strength is one of the important predictors in development of pulmonary complications after cardiac surgery. The Strength-Index (S-index), a novel non-invasive tool, dynamically assesses inspiratory muscles, which is associated with lower risks for heart patients than static tests. This study aims to investigate the reliability of the S-Index in patients preparing for cardiac surgery.
Methods: This study involved 20 preoperative cardiac surgery candidates (11 males, 9 females, mean age 56 ± 13 years). The S-Index, peak inspiratory flow (PIF), and vital capacity (VC) were evaluated using the Power Breath K5 - electronic respiratory device. These measurements were conducted by an examiner at two distinct intervals, spaced one hour apart. The average and best values for each index were evaluated for reliability using the Intra-class Correlation Coefficient (ICC).
Results: the study revealed excellent (ICC>.9) and good (ICC>.8) intra-examiner reliability, respectively for the best and average values of the S-index and PIF. Also the results of the present study showed excellent intra-examiner reliability for the best and average values of the VC (ICC>.9).
Conclusion: The ICC results of the present study showed that the S-index can be used to determine the dynamic strength of the inspiratory muscles with an Acceptable repeatability in cardiac surgery candidates. One of its advantages could be determining the appropriate load in inspiratory muscle training (IMT) exercises, during the hospitalization phase of these patients in a dynamic manner without breath holding.

Background: The older adult populations is growing worldwide, particularly in Iran, leading to a decline in cognitive functions. Cognitive training effectively enhances cognitive abilities. NEUROvitalis is a structured cognitive training program incorporating psychoeducation with individual and group cognitive tasks. It accommodates up to 8 participants aged 50 and above, spanning 12 sessions over 6 weeks. This study aims to prepare translation, cultural adaptation, and content validity of the Structured Cognitive Training Program "NEUROvitalis".
Materials and methods: To conduct this methodological study, we followed the standard forward-backward process. Then, the translation accuracy was checked by German translators, we assessed the fluency and comprehensibility of the translated material. Twelve assessors from Tehran University of Medical Sciences scored each psychoeducational component—pamphlet, group game, and individual exercise—on a 5-point visual scale. Then, the Content Validity Index (CVI) was calculated.
Results: A total of 12 participants (eight females, four males, aged 23–41, mean age 28.83 ± 6.23) took part in the evaluation of comprehensibility and fluency. CVI ranged from 0.8 to 1, indicating the successful validation of the program's comprehensibility and fluency.
Conclusion: The current study's results indicate that the Persian version of the structured cognitive training program "NEUROvitalis" can be a proper, valid, and comprehensive tool for cognitive training in Persian-speaking people aged 50 years and above.

Background: Carpal tunnel syndrome (CTS) is the most prevalent peripheral neuropathy affecting the upper limb, and Carpal Tunnel Release (CTR) is the preferred treatment for moderate to severe cases. This semi-experimental study aimed to investigate the effectiveness of an early occupational therapy intervention for post-surgery patients with CTS.
Material and methods: Twenty women with idiopathic CTS who were surgery candidates were recruited and assessed before undergoing the surgery. After surgery, they were assigned to the intervention group (n=10) or control group (n=10). The control group received standard care, while the intervention group underwent an early occupational therapy intervention (10 sessions over 3 weeks). The range of motion, hand and pinch strength, and pain level were measured using a Goniometer, Hand Dynamometer, Pinch Gauge, and Visual Analogue Scale (VAS), respectively. The Boston Carpal Tunnel Questionnaire (BCTQ) evaluated symptom severity and hand function. To compare variables between groups, we used paired sample t-tests, independent t-tests, and Fisher's exact tests.
Results: The intervention led to significant improvements in wrist active flexion, two-point, and three-point pinch strength in the intervention group. Both groups had reduced pain intensity, with a significantly greater decrease in the intervention group. The intervention group also showed better results in symptom severity and functional status, with the improvement in symptom severity being significantly greater (p≤0.05).
Conclusions: Early occupational therapy following CTR is probably more effective than routine interventions in enhancing pinch strength and alleviating pain and symptoms. Nevertheless, randomized controlled trials are necessary to determine how long these benefits last.

Objective: To determine the frequency, comorbidity, and relationship between dysarthria and dysphagia in patients with tSCI.
Methods: A descriptive-analytical cross-sectional study was conducted, enrolling 61 patients with tSCI from rehabilitation centers in Tehran, Iran, between January and September 2024. Dysarthria and dysphagia were assessed using the Persian-adapted versions of the Frenchay Dysarthria Assessment (FDA) and the Northwestern Dysphagia Patient Check Sheet (NDPCS), respectively. Logistic regression analysis was employed to evaluate the association between these conditions, with odds ratios (ORs) calculated to quantify the strength of the relationship.
Results: Dysarthria was observed in 87% of participants, with mixed dysarthria being the most prevalent subtype (34%). Dysphagia was identified in 49% of participants, of whom 49% exhibited both disorders concurrently. Logistic regression analysis indicated that patients with dysarthria were approximately nine times more likely to experience dysphagia (OR = 9.69, p < 0.05), even after adjustments for weight and gender.
Conclusion: This study underscores the high prevalence and significant comorbidity of dysarthria and dysphagia in patients with tSCI, with dysarthria identified as a robust predictor of dysphagia. These findings highlight the necessity of concurrent assessment and integrated rehabilitation approaches targeting both disorders to improve patient outcomes and quality of life.