Vertical strabismus, often caused by the overaction of the inferior oblique (IO) muscle, is a common disorder of the oculomotor system. It occurs in a third of all patients with strabismus, and in 70% of these cases, it coexists with esotropia. From a clinical perspective, there is no universally accepted approach for quantifying the magnitude of inferior oblique overaction (IOOA). Existing classifications are subjective and may not be entirely appropriate. Therefore, given the need to understand the severity of this anomaly, standardizing the classification of this disorder is essential. This will aid in formulating treatment strategies and predicting the outcomes of surgical intervention. The IO muscles' mechanism of action is highly complex, and it varies depending on the position of the globe during IO contraction. Beyond their role in horizontal and vertical movements, IO muscles also participate in torsional eye movements. Any disorder of the IO muscle can contribute to not only vertical strabismus but also cyclotropia, which may limit the effectiveness of strabismus treatment. To identify all the clinical signs and symptoms resulting from IOOA, practitioners should take into account the triple action characteristics of the IO muscle. Therefore, comprehensive diagnostic examinations are necessary for patients with IOOA.

Objectives: To systematically evaluate the most recent evidence regarding the potential short-term and long-term synergistic effects of transcranial direct current stimulation (tDCS) and cognitive training (CT) on memory in individuals with mild cognitive impairment (MCI) or dementia and to explore the optimal treatment protocol.
Methods: In accordance with the PRISMA guidelines, a comprehensive literature search on PubMed, Medline, CINAHL, and EMBASE was conducted to identify eligible randomized controlled trials (RCTs) published up to December 2022. The identified studies were summarized and analyzed to examine the efficacy of the combined intervention.
Results: Ten studies involving participants with MCI or dementia were included. Four RCTs with memory-related outcomes were analyzed. A small-to-medium effect size of 0.28 was found for the short-term effect (95% confidence interval [CI], 0.02 to 0.55). However, the long-term effect was non-significant, with an effect size of 0.17 (95% CI, -0.09 to 0.44).
Conclusion: The combined intervention appears to effectively mitigate cognitive decline in the short term only. Optimal treatment protocol remains inconclusive due to heterogeneity among studies. More robust evidence is required to determine whether the combined approach can serve as an effective intervention in clinical practice.

Introduction: Upper limb motor disability, with a prevalence of approximately 77%, is the most common complication after stroke. Despite advancements in rehabilitation, many patients face persistent upper limb deficits. Adopting an approach combining top-down and bottom-up interventions may enhance neuroplasticity and improve upper limb function. This study aims to determine the effect of motor cortical trans-Cranial Direct Current stimulation (tDCs) as a top-down approach combined with Task-Oriented Training (TOT) as a down-to-top intervention on changes in Electroencephalography (EEG) spectral power in chronic stroke patients.
Materials and Methods: Thirty chronic hemiparetic stroke survivors were randomly assigned to receive real or sham stimulation targeting the primary motor cortex (C3/C4) at 2 mA for 20 minutes and TOT daily over 15 sessions. Electroencephalography was conducted pre- and post-intervention, with a 3-month follow-up, and the relative powers of delta to gamma frequency bands were recorded during the movement task with each hand (healthy and involved).
Results: Significant differences in theta (P=.000), alpha (P=0.004), beta (P=0.000), and gamma (P=0.003) relative powers were observed between groups at follow-up. Additionally, Friedman tests revealed a significant decrease in alpha and beta bands’ relative powers in the healthy hand of the control group at follow-up (P=0.001). The experimental group displayed increased alpha and beta powers and decreased theta, without statistical significance.
Conclusion: The increase in the relative power of low frequencies and the decrease in high frequencies in the sham group, which were more prominent than the increases in alpha and beta bands’ relative power and the decrease in theta in the experimental group, can indicate that the presence of real-tDCs has been able to prevent the recovery drop of relative powers. Due to the inconsistent effects of tDCs on the EEG power spectrum in stroke patients, conventional tDCs administration may require adjustments for optimal application to brain target points.

Introduction: Muscle strength strongly affects the activities of soccer players, but the presence of chronic ankle injuries can reduce the ability of athletes to achieve their best performance. Existing literatures related to the role of certain muscles in affecting the vertical jump height of soccer players has not been reported; therefore, this study was aimed at analyzing the differences in leg muscle strength that affect the vertical jump height of soccer players after chronic ankle injury.
Materials and methods: To achieve the aim of this study, a cross-sectional design was employed by involving one team consisting of 25 Surabaya Football Association (PERSEBAYA) players, who were grouped into injury and non-injury groups according to the questionnaire. The participants were determined based on their normal BMI, age (17-40 years), male gender, and PERSEBAYA players. The collected data included vertical jump, ankle muscle construction, and hamstring muscle data. The data were statistically analyzed using the t-test and Pearson’s correlation (p<0.05).
Results: There was no significant difference in leg muscle strength between the injured and uninjured players. Only the hamstring muscle significantly affected the vertical jump of soccer players after chronic ankle injury (r = 0.422, p = 0.035 with moderate influence) and was not affected by the gastrocnemius, plantar, adductor, and abductor muscles.
Conclusion: There was a correlation between eccentric contraction of the hamstring muscle and vertical jump height in soccer players after chronic ankle injury. These findings are beneficial for soccer practitioners and medical teams in designing injury management and recovery strategies for players with ankle injuries.

Introduction: Autism spectrum disorder defines a disorders in the fields of sensory processing, social communication and occupational performance. Sensory diets can have positive effects on these fields. Current research compared the effectiveness of the sensory diet program with and without tele occupational therapy on sensory processing pattern, social competency and occupational performance in autism spectrum disorder.
Methods & Material: The study population was 32 children with autism spectrum disorder 4-10 years old. They were placed in two control and intervention groups. The number of sessions for both groups was twenty 30 minutes sessions over 8 weeks. In both groups, through photos, videos and explanations, sensory problems were described, activities and environmental adaptations were presented, implemented by the mother, and the therapist supervised the implementation. In this study, three tools of sensory profile 2, Social Responsive Scale 2 and Canadian Occupational Performance Measure were used.
Results: According to the sensory profile 2, social responsiveness scale and Canadian Occupational Performance Measure, processing in the areas of auditory, visual, touch, movement, body position, oral, conduct, social emotional, attentional, sensory seeking, sensory avoiding, sensory sensitive, low registration, social awareness, social cognition, social communication, social motivation, limited interests, repetitive behaviors and occupational performance in both groups have a significant difference(P-value < 0.05).
Conclusion: It seems that providing a sensory diet program through tele occupational therapy on sensory processing pattern, social competency and occupational performance is applicable as well as face-to-face occupational therapy in children with ASD.

Purpose: Joint positioning can impact nerve function. Few studies have explored the effects of ankle positions on deep peroneal nerve conduction. This cross-sectional study aimed to investigate the influence of different ankle joint positions on distal motor and sensory onset latencies of the deep peroneal nerve.
Materials and Methods: Thirty one healthy adults (23.4 ±3.9 years) underwent deep peroneal nerve conduction study. Distal motor and sensory onset latencies were measured at neutral (0°), dorsiflexion (20°), and plantarflexion (40°) ankle positions.
Results: Changing ankle position significantly affected distal motor (p=0.001) and sensory onset latencies (p=0.001). Latencies were shortest in dorsiflexion (motor: 3.8±0.46 ms; sensory: 2.4±0.2 ms), followed by neutral (motor: 4.2±0.5 ms; sensory: 2.6±0.3 ms), and longest in plantarflexion (motor: 5±0.6 ms; sensory: 3.3±0.2 ms).
Conclusion: Ankle position impacts deep peroneal nerve conduction. Dorsiflexion and neutral positions reduced distal motor and sensory latencies compared to plantarflexion. These findings provide preliminary evidence that may help optimize ankle positioning in electrodiagnostic testing. Further blinded research with larger, more diverse samples is warranted.

Background: The dynamic neuromuscular stabilization (DNS) core stabilization exercises have been used to improve core stability, but its effect on non-specific 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.
Material and Methods: In a randomized clinical trial, 44 people with chronic NSLBP were randomly assigned to two groups: the experimental group and the control group, 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, consisting of 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 interventions.
Results: Nineteen people in the control group and 21 in the DNS group were analyzed. The results showed that after the 8-week intervention, patients in the DNS group obtained, on average, an 8.82% (95% CI: 6.53 to 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).
Conclusion: The use of DNS exercises can be recommended for improving the activation of superficial core muscle like external oblique in individuals with NSLBP.

Background: Although gait rehabilitation based on sensorimotor synchronization (auditory and visual) is interesting for other patients with neurological disorders and the elderly, there is little evidence in patients with multiple sclerosis. Therefore, this study investigates the effect of synchronization with rhythmic visual stimulus on gait Spatiotemporal parameters, bilateral symmetry, and locomotor rehabilitation index in women with multiple sclerosis.
Material and Methods: Spatiotemporal parameters, bilateral symmetry, and the locomotor rehabilitation index were obtained before and after six weeks (three times per week, 30 min) of locomotor training, comparing these findings between two groups of 10 patients, each with Expanded disability status scale (EDSS) 3-6 who performed the gait training with vs. without rhythmic visual stimulus.
Results: Time*group interaction effects indicated greater significant improvements in the group with rhythmic visual stimulus in self-selected walking speed (p=0.041), stride frequency (p=0.009), stance time (p=0.021), and locomotor rehabilitation index (p=0.036). stride length, double stance and swing time improved in the group with rhythmic visual stimulus but this change was not significant. Also, bilateral symmetry did not change significantly in the experimental group. Therefore, rhythmic visual stimulation can help improve functional mobility and locomotor rehabilitation index in patients with multiple sclerosis, especially due to the improvements in the temporal parameters of gait.
Conclusions: Therefore, synchronizing gait with a rhythmic visual stimulus can be an effective therapeutic strategy to improve gait and main temporal parameters in patients with multiple sclerosis.

Background and Objectives: Cortisol and heart rate variability (HRV) represent the activity of physiological stress axes. The depression and anxiety stress survey (DASS-42) has been widely used to assess stress. This study examines the correlations between the DASS-42 questionnaire and stress markers, salivary cortisol levels and HRV.
Methods: A total of 195 healthy volunteers (145 males and 50 females) participated in this study. At first, the DASS-42 survey form was completed. The salivary cortisol samples were collected, and the electrocardiograms were recorded, respectively. Differences in cortisol between baseline and post-trier social stress tests were recorded as changes in cortisol after stress (CCAS). Measurements were made to establish whether the overall DASS and its subscales (stress, anxiety, and depression) were correlated with baseline cortisol, CCAS, and HRV indices.
Results: The anxiety-DASS subscale score correlated negatively with the CCAS score in women (r = -0.429, P = 0.002). The DASS score was significantly correlated with heart rate (r = 0.25, P = 0.007) and SD2 of Poincare plot (r = -0.272, P = 0.004) in men. In contrast, women showed significant correlations between total DASS scores with very low-frequency power (r = -0.40, P = 0.005) and detrended fluctuation analysis-α1 (r = -0.30, P = 0.034). The anxiety-DASS subscale correlated with HRV in both genders.
Conclusion: The anxiety-DASS subscale represents the sympathetic-adrenal medulla activity. Clinicians can estimate the activity of this stress axis by using the anxiety subscale of DASS questionnaire. Meanwhile, gender differences should be noted when assessing stress.

Objective: Low back pain is a leading cause of disability worldwide. To address this prevalent issue, various treatments have been recommended, with core stability and McKenzie exercises being among the most evidence-based options. However, recent comparison studies lack mechanical assessment and functional tests. This study aims to compare the effects of core stability and McKenzie exercises on range of motion, pain, disability, and function in patients with mechanical low back pain.
Materials & Methods: In this clinical trial, 22 patients received core stability exercises, and 22 patients received McKenzie exercises based on individual mechanical assessments. Before treatment, each patient underwent mechanical assessment via the McKenzie Mechanical Assessment form, pain assessment using the Visual Analog Scale (VAS), disability evaluation with the Oswestry Disability Index (ODI) questionnaire, muscle control and function assessment with unilateral single limb stance, and range of motion evaluation using fingertip-to-floor (FTF) distance measurements. After eight sessions over two weeks of intervention, all variables were measured again.
Results: Both groups showed significant improvements in trunk flexion range of motion, disability, functional status and pain (P > 0.05). However, there were no significant differences between the two groups (P < 0.05).
Conclusion: Both core stabilization and McKenzie exercises are effective in reducing pain, disability, increasing range of motion, and enhancing functional status in patients with mechanical low back pain.

Background: The strength of inspiratory muscles is one of the important factors in preventing postoperative pulmonary complications (POPC). One of the new tools to safely measure the strength of the inspiratory muscles in heart patients, in a dynamic manner and without breath holding, is the use of strength-index (s-index).
Objective: This study aims to evaluate the immediate effects of a respiratory warm-up (RWU) session on the S-index and other lung parameters in cardiac surgery candidates, a subject with limited existing research.
Material & Methods: This study was conducted as a randomized controlled trial. Forty participants scheduled for heart surgeries were randomly assigned to either the study (RWU between two tests) or control (without RWU) groups. RWU consists of threshold loading inspiratory muscle training (TL-IMT) exercises, at 30% of S-index with 30 breathing cycles. Respiratory tests, including S-index, peak inspiratory flow (PIF), and vital capacity (VC), were assessed two times with using an electronic respiratory device (Power Breath K5).
Results: Covariance analysis showed no significant difference in the average and best values of the S-index, PIF, or VC indices, at the second tests, between two groups (P>.05), or in the independent T-test and Mann-Whitney U test for the “rate of changes”, between two tests (P>.05). Finally, intra-group changes, assessed with paired sample T-test between two tests, were mostly non-significant for these indices (P>.05), except for the Best Vital Capacity in the study group (P=.03).
Conclusions: The study results suggest that a respiratory warm-up session does not significantly impact the S-index or other respiratory parameters in cardiac surgery candidates. Thus, incorporating RWU before S-index testing may not be necessary.