Duchenne muscular dystrophy (DMD) is a hereditary progressive neuromuscular disease of childhood. The survival rate of DMD patients is extremely low. In physiotherapy, electrical stimulation is frequently applied to rehabilitate these patients. The present study aimed to evaluate the effects of electrical stimulation on the muscles of patients with DMD. In this regard limited relevant studies were found, some of which reported the positive effects of low-frequency electrical stimulation on improving muscle strength. Conversely, there were reports of the detrimental effects of electrical stimulation on muscle fibers. Overall, there is no standard guideline for electrical stimulation in patients with DMD, and further research is required with adequate sample size and follow-up.

Introduction: The purpose of the present study was to determine the refractive profile of strabismic children under 8 in a tertiary referral center in Tehran, Iran.
Materials and Methods: This retrospective cross-sectional study was conducted on the medical records of 357 patients under the age of 8 who had one type of strabismus in Farabi Hospital, Tehran, Iran, between 2015 and 2019. All routine ophthalmic examinations were done for all patients. Cycloplegic refraction was performed after the instillation of two drops of cyclopentolate 1% with an interval of 5 minutes, and the refractive error was measured after 30 minutes. The diagnostic criteria were based on cycloplegic refraction in which myopia, hyperopia, and astigmatism were defined when the refractive error was -0.25, +0.75, and -0.50 diopter (D) or more, respectively. The cycloplegic results were classified into different groups with an interval of 1.00 D, and astigmatism was also assessed separately.
Results: In this study, the most common type of refractive error in esotropic patients was hyperopia, with the +2.00 to +4.00 D range having a higher prevalence. In exotropic patients, hyperopia was also prevalent; the most common range of hyperopia was between +0.75 to +1.00 D. Astigmatism had a prevalence of 37.8% in esotropic patients, and 17.2% in exotropic patients with the most common range from -0.50 to -1.00. Myopia was present in 2.8% of patients with esotropia and 3.2 % of patients with exotropia with the most common range from -0.25 to -1.00.
Conclusion: In strabismic Iranian children, hyperopia was the most prevalent refractive error in both esotropic and exotropic patients, with higher degrees of hyperopia in esotropic patients. Low astigmatism was twice as prevalent in patients with esotropia as in patients with exotropia. Low myopia was the least prevalent in both esotropic and exotropia.

Introduction: Down syndrome (DS) as a chromosomal abnormality has different symptoms including cognitive problems and language delay. Studies showed a heterogeneous profile of language skills in this group of children. This study aimed to provide further information about the most vulnerable area of language -grammatical skills- regarding the unanalyzable utterances, clauses, phrases, grammatical morphemes, and mean length of utterances (MLU) in children with DS and compare them with those of non-verbal age-matched controls.
Materials and Methods: The grammatical structures of 12 children with DS (non-verbal age=39 months) were compared to those of 50 non-verbal mental age-matched controls (non-verbal age=41 months). Clause, phrase, and grammatical morphemes were investigated through spontaneous language sample analysis according to Persian-language assessment remediation and screening procedure (P-LARSP).
Results: Children with DS had higher percentages of unanalysable text units compared with typically matched peers (P≤0.001). The MLU, number of phrases and clauses structures, and inflectional morphemes were significantly lower in children with DS compared with typical children (P<0.001).
Conclusion: Children with DS showed a noticeable gap in grammatical structures compared with typical children. The possibility of specific language problems in children with DS should be considered by future studies.

Introduction: In addition to the instability of the knee joint, injury to the anterior cruciate ligament (ACL) leads to a functional deficit in the form of diminished proprioception of the knee joint. The purpose of this study was to compare knee proprioception in athletes with an ACL injury and healthy athletes.
Materials and Methods: The participants in this cross-sectional study were 26 athletes with an ACL injury and 24 healthy athletes who were selected from the orthopedic clinic at Baqiyatallah Hospital in 2019, Tehran City, Iran. Cooper or non-Cooper subjects with ACL injury were identified via the knee injury and osteoarthritis outcome score (KOOS). The knee proprioception of all participants was recorded using a system consisting of digital photography, non-reflective markers, and Digimizer software.
Results: The results showed that there was no significant difference between groups in the absolute error of knee joint reconstruction at both 45° and 90° angles.
Conclusion: The data of the study showed that in comparison with healthy athletes, the knee joint proprioception of athletes with an ACL injury is not different and has the same function.

Introduction: Although carpal tunnel syndrome (CTS) is an incident entrapment neuropathy disorder, there has been inadequate evidence about the effect evaluation of adding low-level laser therapy to ultrasound (US) plus median nerve glide exercises in these patients. Hence, this research investigated the trace of US plus median nerve glide exercises with and without low-level laser therapy (LLLT).
Materials and Methods: Thirty-six patients with moderate CTS in two groups of intervention were assessed. One group received 10 sessions of adding LLLT to median nerve glide exercises plus US and the other group received median nerve glide exercises plus US without LLLT. Outcome measures were hand grip strength (HGS), visual analogue scale (VAS), Boston questionnaire (BQ), and cross-sectional area (CSA) of the median nerve.
Results: Baseline analysis revealed similarities between the two groups in all parameters. Statistical analysis indicated significant improvement of HGS, VAS, BQ, and CSA of the median nerve in two groups of intervention.
Conclusion: In patients with CTS, US and median nerve glide exercises with and without LLLT significantly improved without the superiority of adding LLLT to mentioned treatment.

Introduction: Chronic pain is a serious secondary problem for many individuals with disabilities.
Materials and Methods: A total of 231 disabled athletes invited to compete in a multi-sport national sports tournament for para-athletes in Ahvaz, Iran, participated in the study to be investigated whether spinal pain (SP) prevalence and characteristics are different among different sports and disabilities. Athletes’ demographic information, SP prevalence, characteristics, and disability using the athlete disability index questionnaire were obtained. SP prevalence, characteristics, and factors affecting SP intensity and disability caused by low back pain (LBP) were determined as primary outcome measures before data collection.
Results: The mean (95% confidence intervals) disability percentage and LBP intensity score were 22.2% (19.2-25.3) and 2.14(1.84-2.47) of 10, respectively. The highest LBP intensity was among physical fitness participants and patients with spinal lesions. Weightlifting athletes and athletes with arm movement limitations had the highest disability. The mean (95% confidence intervals) neck pain intensity score was 2.16(1.80-2.54).
Conclusion: A high prevalence of SP was observed among most disabilities and sports. Although its intensity is rarely severe among a population of any disability or sports, it is undeniably disabling among the vulnerable population of para-athletes.

Introduction: This study investigated the effect of change in postural stability after applying static load during internal perturbation among professional athletes with and without anterior cruciate ligament (ACL) surgery.
Materials and Methods: The participants of the present study were 20 athletes with sixteen months post ACL reconstruction surgery and 20 healthy matched athletes. Each participant performed transitional tasks from double limb stance to single leg stance (SLS) and again to double limb stance on the force plate before and after the application of 10 minutes of constant loading. Area, fore-after range (the meaning of fore-after is anterior-posterior and in articles, this term has been used instead of anterior-posterior) range fore-after (Rfa), range sideway (Rsw), mean velocity (Mv) and confidence ellipse (Ce) of the center of pressure were measured.
Results: Rsw (P=0.009) and area (P=0.009) in response to static loading in the healthy group showed a decrease and an increase of area (P=0.009) in response to static loading in the ACLR group was seen on the double limb stance phase. Mv (P<0.001) and area (P<0.001) were bigger in the ACLR group after static loaded on the integration phase.
Conclusion: Decreased capacity of passive structures to maintain postural stability against perturbation was observed due to positional change among athletes with a history of ACL reconstruction surgery.

Introduction: Chronic constipation is one of the most common complaints of patients in developed countries, which affects 2 to 28% of the world’s population and alters patients’ quality of life extensively. This study aimed to determine the validity and reliability of the Persian version of the comprehensive constipation questionnaire.
Materials and Methods: The comprehensive constipation questionnaire was translated into Persian, and its back-translation was confirmed after evaluating the content validity ratio index (CVR) based on Lawshe table (CVR≥0.62). The content validity of the questionnaire was assessed by the content validity index, followed by examining its reliability by Cronbach alpha and test-re-test reliability using the intra-class correlation coefficient (ICC). A total of 100 patients with chronic constipation completed the questionnaire.
Results: Content validity was confirmed in the range of 0.84 to 1.00, and the Cronbach alpha values in the range of 0.90-1.00 were acceptable. In this questionnaire, was ICC in the range of 0.76-0.99 which indicates a level of good to excellent reliability of the questionnaire. Also, the results of the factor analysis were confirmed at a moderate level Kaiser Meyer Olkin test (KMO>0.6) and Bartlett test (P<0.05) by extracting a 1-factor solution.
Conclusion: The Persian version of the comprehensive constipation questionnaire had acceptable validity and reliability and seems to be an effective tool to evaluate patients with constipation.

Introduction: Reaction time is an important indicator of good performance. Different types of exercises have been used by researchers to improve the reaction time of an individual. Other types of exercises still need more research to study their effect on simple reaction time, such as proprioceptive training. The purpose of this study is to examine the effect of a proprioceptive training program using the Huber machine on the simple reaction time.
Materials and Methods: Twenty-one participants from the medical staff were assigned to two groups including the experimental group (1) composed of 5 male and 5 female participants and a control group (2) including 5 male and 6 female participants. A simple reaction time (SRT) test was assigned to all participants. Only the experimental group performed a proprioceptive exercise protocol on Huber motion’s platform, while the control group was tested at identical periods without exercising before the training (T0), immediately post-exercise (T1), and twenty minutes after exercising (T2). The procedure was repeated for six sessions over two weeks.
Results: The participants of the group (1) show a decrease in the mean of RT (-43 min) immediately after proprioceptive training (T1), but they reveal a little increase (at T2) in SRT after an interval of 20 minutes (-23 min). They still prove a retention effect, while few participants in the control group show improvement at T1 or T2. Paired sample t-test was significant for the group (1) at T1 and T2 (P<0.05) while it was not significant for the control group.
Conclusion: Proprioceptive training may have a positive influence on reaction time with a retention effect. Clinicians can use proprioceptive training to improve the reaction time of their patients.

Introduction: Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-load resistance exercise (LLRE) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LLRE may help people with supraspinatus tendinopathy through proximal effects to improve strength and muscle size. The purpose of this case report is to describe the proximal effect of the LLRE+BFR program on a patient with supraspinatus tendinopathy.
Materials and Methods: The patient was a 40-year-old man with a history of shoulder pain and weakness for the past months. He received an LLRE+BFR program for his right shoulder including rotator cuff and scapular strengthening exercises and lower limbs aerobic exercises based on protocols of strengthening and aerobic exercises of BFR. Outcomes measured at baseline and 4 weeks included the 4 items: 1) Strength of supraspinatus muscle and four scapular stabilizer muscles including serratus anterior strength, middle trapezius strength, and lower trapezius strength by dynamometer, 2) supraspinatus thickness by ultrasound, 3) pain pressure threshold of supraspinatus and deltoid muscles by algometer, and 4) pain reported bay in each session based on pain numeric scale.
Results: After 6 weeks, the strength of supraspinatus and scapular stabilizers except for the lower trapezius increased. The supraspinatus thickness and pain pressure threshold in the supraspinatus and deltoid muscle also increased after 4 weeks. The mean of pain reported by the patient based on the pain numeric scale before and after each session was also decreased.
Conclusion: The patient had measurable improvements following the use of an LLRE+BFR program. LLRE+BFR program may be an option for strength training in people with supraspinatus tendinopathy; however, more research is needed to determine effectiveness across the population of people with supraspinatus tendinopathy.

A 15-year-old boy was diagnosed with Wilson disease and referred to a physiotherapy clinic for treatment. He received daily physical therapy exercises with resistance training three times a week for 70 minutes for 8 weeks. The performance of daily activities was evaluated using the Persian version of the disabilities of the arm, shoulder, and hand (DASH) questionnaire. Upper limb muscle strength was assessed using a manual muscle strength test. The DASH questionnaire score decreased from 67.24 before treatment to 46.55 after 4 weeks and 36.20 after 8 weeks. In addition, shoulder flexion and extension are improved. The analysis of resistance exercises to facilitate distal muscles through the use of manual muscle tests showed an improvement in the strength of both hands. The present study suggests that regular physical therapy and exercise may help improve daily activity and muscle strength in Wilson disease.

Introduction: Intellectual disability and specific cognition in down syndrome (DS) affect language development and processing. We assessed vocabulary and syntax reception among children with DS with typically developed (TD) Persian-speaking Iranian children. We also investigated the association between vocabulary and syntax reception in children with DS.
Materials and Methods: Using the Stanford–Binet intelligence scales test, 18 TD children (4-6 years old) and 18 DS children were matched based on non-verbal mental age. Vocabulary reception was assessed using the receptive picture vocabulary test (RPVT) and syntax reception by the Persian syntax comprehension test.
Results: Mean total vocabulary reception was lower in children with DS (P<0.001). Syntax reception was also impaired in children with DS compared to the normal values of the test. Among children with DS, vocabulary reception was positively correlated with syntax reception. Every unit increase in total vocabulary reception score was associated with 0.08 (95% confidence interval, CI: 0.04-0.12) improvement in syntax score in children with DS.
Conclusion: Vocabulary and syntax reception in DS children, especially complex syntax structures, was impaired. The observed association between vocabulary and syntax reception shows that vocabulary reception improvement might result in progressing syntax reception in children with DS.