Binocular diplopia is a challenging oculomotor disorder that significantly impacts patients' quality of life. This review provides a comprehensive overview of the etiology, diagnostic methods, and treatment strategies for binocular diplopia. Proper diagnosis begins with differentiating between monocular and binocular diplopia, followed by determining whether the cause is motor or sensory in nature. Diagnostic methods include detailed medical history, qualitative and quantitative assessment of diplopia, analysis using tools like the Haab Grid, evaluation of ocular motility, and assessment of head postures. The level of oculomotor defect should be investigated to differentiate between nuclear and supranuclear lesions. Treatment approaches are diverse and depend on the underlying cause. Functional strategies may include prismatic correction, which can provide immediate relief from diplopia. Surgical interventions are considered for cases of paralytic strabismus or when conservative measures are insufficient. The choice of treatment is guided by factors such as the etiology, duration, and severity of diplopia. Prismatic correction is often used as both a diagnostic tool and a treatment option, allowing for precise adjustment of eye alignment. In cases of acute diplopia, a systematic approach to diagnosis and appropriate identification of possible causes enables better patient management. This comprehensive approach to binocular diplopia, encompassing thorough diagnostic methods and a range of treatment strategies, aims to improve functional outcomes and enhance the quality of life for affected patients.
This study emphasizes the complexity of diplopia, distinguishing between monocular and binocular types, and motor and sensory forms. Management involves functional therapies, prismatic correction, and, if needed, botulinum toxin or surgery. Prompt evaluation and multidisciplinary collaboration are essential, particularly for neurological causes.

The third cranial nerve (oculomotor nerve) plays an essential role in the function of ocular movement and mainly innervates the inferior oblique, medial rectus, inferior rectus, superior rectus, levator palpebrae, pupillary sphincter, and ciliary muscle. The most frequent clinical manifestations of oculomotor nerve palsy are ophthalmoplegia, ptosis, pupillary dysfunction, and diplopia. The etiology of oculomotor nerve palsy is complex, including congenital tumors, craniocerebral trauma, intracranial inflammation, diabetes, intracranial aneurysm, cerebrovascular infarction or hemorrhagic disease, myasthenia gravis, multiple myeloma demyelinating diseases, and other uncommon causes. Each etiology of oculomotor nerve palsy has its corresponding clinical features. The present article comprehensively reviews the common etiologies of oculomotor nerve palsy and the corresponding clinical manifestations and treatment methods in order to help practitioners for the prompt and accurate clinical diagnosis of the causes and effective management plan.

Background: Lower extremity surgeries, such as total knee arthroplasty (TKA), total hip arthroplasty (THA), and anterior cruciate ligament (ACL) reconstruction, require extensive rehabilitation to restore mobility and function. Traditional rehabilitation faces challenges such as patient adherence and access to care. Virtual reality (VR) has emerged as a promising tool to enhance rehabilitation outcomes by offering interactive, engaging environments that improve patient motivation.
Methods: A narrative review was conducted to evaluate the current literature on VR-based rehabilitation for post-operative lower extremity conditions. Relevant studiesfrom 2019 to 2024were selected from databases such as PubMed, Scopus, and Cochrane, focusing on VR's application in patients recovering from TKA, THA, ACL reconstruction, and traumatic lower limb amputations.
Results: The review found that VR interventions significantly improved proprioception, balance, and patient engagement compared to traditional rehabilitation methods. VR's interactive nature provided real-time feedback and enhanced patient motivation. However, mixed results were reported regarding VR's superiority in pain management and overall functional outcomes. VR was shown to complement traditional therapy rather than replace it.
Conclusion: VR-based rehabilitation offers a promising adjunct to traditional methods, improving patient engagement and specific functional outcomes. While VR enhances recovery, further research is needed to establish standardized protocols and determine its long-term efficacy in post-operative rehabilitation.

Background: Liver transplantation can change the quality of life, physical activity, mood, and psychological symptoms in patients. As exercise capacity is correlated to the level of depression and quality of life among patients.
Objective: This study aimed to investigate the effect of exercise therapy on the quality of life and depression in Orthotopic liver transplantation recipients (LTRs).
Methods: This study was a single-blinded, randomized controlled trial parallel groups, and thirty LTRs were randomly assigned in a 1:1 ratio. The experimental group underwent a three-month home-based exercise therapy, while the control group received no exercise therapy. Assessments included Short Form-36 (SF-36) and Beck Depression questionnaires, along with the 6-Minute Walk Test (6MWT). 
Results: There was no significant difference between groups in demographic characteristics. Before the intervention, the mean score of depression in the intervention and control groups were 27.87 (8.68) and 25.77 (6.77), respectively. After the intervention, t-test revealed a significant difference between the two groups (p = 0.001). The results of t-test indicated that the average quality of life dimensions improved post-intervention compared to the control group, with significant differences in the scores of these dimensions. After the intervention, the t-test showed a significant difference between the two groups in terms of 6MWT (p = 0.001).
Conclusion: According to the findings of this study, rehabilitation through prescribed exercise can improve quality of life and physical activity, and alleviate depression symptoms in LTRs. As a result, incorporating physiotherapy into the post-transplantation care of transplant recipients holds potential benefits.

Background: Recently the adoption of machine learning has significantly increased across various applications, including prediction of diseases based on person’s clinical profile. This study aimed to develop and evaluate a supervised machine learning to predict trunk muscle’s activity in people with chronic low back pain.
Methods: This was a secondary analysis of data from a subgroup of people with nonspecific chronic low back pain. The correlation between labeled data and the output data of muscle activity level was measured through surface electromyography. The result showed a good correlation, suggesting the potential utility of this approach in distinguishing individuals with low back pain from pain-free controls.
Results: to validate the performance of the developed machine learning, the results were compared with SPSS. The model’s predictive performance was further assessed using various evaluation methods including area under the receiver operating characteristics curve. The study's findings indicate that the model achieved Area Under the Curve (AUC) values ranging from 0.5 to 0.9 across all muscles and different tasks for people with back pain. In contrast, the pain-free group exhibited AUC values between 0.4 and 0.8.
Conclusion: The findings suggest that the supervised machine learning approach using logistic regression may offer clinically meaningful predictions in defining the differences in trunk muscle activity between individuals with non-specific chronic low back pain and pain-free controls. While the obtained results demonstrate promise, further studies need to enhance the model's performance and achieve a more accurate estimation of muscle activity levels.

Background: Women's soccer has gained popularity in the last decade as well as preventive training strategies, therefore the present research aims to determine the effectiveness of a dynamic balance exercise protocol in amateur soccer players.
Materials and Methods: Twenty-four females participated in this study and were randomly assigned to a control group (12) and an experimental group (12). The experimental group received a dynamic balance exercise intervention with three sessions per week for six weeks, while the control group maintained their regular training. Balance was assessed before and after by the Y Balance Test in its anterior, posterior medial and posterior lateral directions. Data were analyzed through the T-test for independent and related samples.
Results: The analysis of this study shows significant improvements on dynamic balance p=0.000 in the experimental group after the intervention of the dynamic balance exercise program for six weeks, while in the control group there were no significant improvements.
Conclusions: Dynamic balance exercise program can be used to increase the balance of amateur female soccer players.

Background. Studies on subclinical neck pain (SCNP), known as mild pain, are lacking in literature. The purpose of this study was to examine the differences in anxiety, neck movement, disability, and proprioception in people with chronic SCNP (12 females and 4 males, Age: 28.1±4.0) and people without neck pain (17 females and 6 males, Age: 25.8±3.1).

Background. Studies on subclinical neck pain (SCNP), known as mild pain, are lacking in literature. The purpose of this study was to examine the differences in anxiety, neck movement, disability, and proprioception in people with chronic SCNP (12 females and 4 males, Age: 28.1±4.0) and people without neck pain (17 females and 6 males, Age: 25.8±3.1).

Methods. A cross-sectional study with thirty nine participants was conducted. Participants were instructed to score their pain using the visual analog scale (VAS) (pain group: <4/10 and normal group: 0/10), anxiety level with the State-Trait anxiety inventory (STAI), and neck disability with the neck disability index (NDI). In addition, active range of motion (AROM) and joint position error (JPE) were assessed in participants of both groups.

Results. There was no significant difference in mean baseline characteristics between the two groups. Participants in the pain group reported significantly higher median NDI (p=<0.001) and higher mean current STAI_S (p=0.032) scores than participants with no pain. No significant differences in mean flexion, extension, lateral flexion right, lateral flexion left, rotation right, or rotation left were found between groups (p=0.95, p=0.68, p=0.29, p=0.59, p=0.70, and p=0.17, respectively). In addition, there were no significant differences in mean cervical spine joint position error flexion, extension, rotation right, and rotation left by study group (p=0.65, p=0.33, p=0.26, and p=0.23 respectively.
Conclusion. SCNP can substantially influence functional ability and anxiety levels, especially among students in higher education institutions dealing with additional stressors. The interaction between pain intensity, disability, and anxiety underscores the potential for a detrimental feedback loop, underscoring the significance of early intervention.
Methods. A cross-sectional study with thirty nine participants was conducted. Participants were instructed to score their pain using the visual analog scale (VAS) (pain group: <4/10 and normal group: 0/10), anxiety level with the State-Trait anxiety inventory (STAI), and neck disability with the neck disability index (NDI). In addition, active range of motion (AROM) and joint position error (JPE) were assessed in participants of both groups.
Results. There was no significant difference in mean baseline characteristics between the two groups. Participants in the pain group reported significantly higher median NDI (p=<0.001) and higher mean current STAI_S (p=0.032) scores than participants with no pain. No significant differences in mean flexion, extension, lateral flexion right, lateral flexion left, rotation right, or rotation left were found between groups (p=0.95, p=0.68, p=0.29, p=0.59, p=0.70, and p=0.17, respectively). In addition, there were no significant differences in mean cervical spine joint position error flexion, extension, rotation right, and rotation left by study group (p=0.65, p=0.33, p=0.26, and p=0.23 respectively.
Conclusion. SCNP can substantially influence functional ability and anxiety levels, especially among students in higher education institutions dealing with additional stressors. The interaction between pain intensity, disability, and anxiety underscores the potential for a detrimental feedback loop, underscoring the significance of early intervention.

Background: Athletes involved in sports requiring frequent cutting and pivoting movements are at increased risk of anterior cruciate ligament (ACL) injuries. This study investigates the effectiveness of neuromuscular warm-up exercises—including strength, balance, plyometric, and core stability training—in reducing ACL injury risk.
Methods: Thirty adolescent male basketball players (ages 13-18) were randomly assigned to either the control group (CON, n=15; age: 15.66 ± 1.7 years, height: 172.7 ± 9.6 cm, weight: 66.74 ± 11.2 kg) or the neuromuscular training (NMT) group (n=15; age: 14.73 ± 0.70 years, height: 174.0 ± 6.7 cm, weight: 64.79 ± 10.8 kg). The NMT group performed a structured injury prevention warm-up program three times a week for eight weeks before regular basketball training (20 minutes), while the CON group followed their usual basketball practice. Measurements of knee proprioception (including specific motion directions), knee valgus and flexion torque, trunk endurance via the Biering-Sorenson test, and isometric strength of various muscle groups were taken pre- and post-intervention.
Result: Significant improvements in isometric strength were observed in all assessed muscle groups in the NMT group (p < 0.05). However, no significant changes were found in knee valgus, flexion torque, trunk endurance, or knee proprioception (p > 0.05).
Conclusion: While the NMT protocol significantly improves isometric muscle strength in adolescent male basketball players, it does not show a direct effect on other ACL injury risk factors. Therefore, incorporating NMT into training routines may support strength development but should be combined with other targeted interventions to more effectively reduce ACL injury risk.

Background and aim: The aim of this study was to investigate the occupational performance and life habits of elderly adults with early stages of Alzheimer’s disease.
Methods: This study was cross-sectional research. Participants were elderly adults, aged 65-85 years with Alzheimer's disease that refer to Roozbeh and Ziaeian Hospital and Kahrizak Charity in Tehran, Iran in 2022. Seventy patients (36 male, 34 female) were recruited based on convenience sampling method. The Canadian Occupational Performance Measure and Life Habits Questionnaire were used to determine the occupational performance and life habits. Data were analyzed using t independent T test and Mann-Whitney test using SPSS₂₁.
Result: The mean age of elderly male and female was 72.02 ± 3.74 and 71.14 ± 4.09 years, respectively. 68.3% of the priorities of occupational performance was related to the self-care. In male the priorities of self-care were 76.7% and in female it was 59.4%. No significant gender difference was found in satisfaction with occupational performance (P>0.05). (P>0.05). In the Life Habit Questionnaire, fitness had the highest participation level, while communication had the lowest. A significant gender difference was observed in participation levels in daily activities (P<0.05).
Conclusion: The results showed that the most important occupational performance priorities of elderly adults with Alzheimer's disease was self-care. The highest level of participation among the daily activities was related to the fitness and the lowest was communication. This study could help occupational therapists identify the priorities, habits, and participation levels of men and women with early Alzheimer's in daily activities.

Background: As the global population ages, the need for sensitive language assessments for dementia increases. While the Barnes Language Assessment (BLA) is a valuable tool in English, it has not been translated and validated in Persian-speaking populations.
Methods: This cross-sectional study aimed to translate and culturally adapt the BLA into Persian (BLA-Per) and evaluate its psychometric properties. The translation process followed the International Quality of Life Assessment (IQOLA) protocol. The BLA-Per was administered to 30 healthy older adults and 30 individuals with Alzheimer's disease (AD). Test-retest reliability was assessed in the AD group. Statistical data analysis was performed using SPSS software (version 24) at a significance level of 0.05.
Results: Due to significant differences between the patients and cognitively healthy groups regarding age and education years, we used ANCOVA to control for these variables' effects on between-group comparisons. Significant differences in BLA-Per scores were observed between healthy controls and AD patients in 8 out of 14 test components, demonstrating good discriminative validity. Intra-class correlation coefficients for test-retest reliability were above 0.75 for most subtests.
Conclusion: The BLA-Per demonstrated good validity and reliability in assessing language impairments in Persian-speaking individuals with AD. Future research should investigate the BLA-Per in larger samples across different age groups and stages of AD.

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.