Dear Editor in Chief
The educational approaches have significantly changed and facilitated the teaching and learning process through the advent of novel technologies [1]. In the last years, learning through smartphones along with web-based learning has become 2 main types of e-learning platforms, especially during the COVID-19 pandemic; however, smartphones are a more acceptable approach compared to web-based learning because of their availability and easy use. Accordingly, developing smartphone-based learning packages may promote the participation of students in learning procedures. Currently, there are 16 billion mobile phones worldwide, of which about 42% are smartphones [2].

Introduction: Identifying the currently-used outcome measures for clients with cerebral palsy (CP) in the Iranian occupational therapy (OT) research can declare the new trend of such researchers and identify the more focused domains regarding such individuals. Accordingly, this integrative review aims to define the utilized outcome measures for school-age children with CP in the Iranian OT research.
Materials and Methods: We conducted an integrated review of online Persian and English databases, namely PubMed, Web of Science, Otseeker, Cochrane, Medline, Embase, CINAHL, PsycInfo, OVID Medline, Magiran, ISC, SID, IranMEDEX, Irandoc, and IRCT, along with the Google Scholar search engine from January 2000 to March 2021.
Results: Out of 605 potentially relevant articles that were initially retrieved, 51 articles met the inclusion criteria, and their used outcome measure(s) was identified. A total of 42 identified outcome measure(s) were not diagnosis-specific and or child-report. A maximum of 15 tools, which assessed the motor components of CP children based on a biomedical bottom-up approach, was commonly used by the majority of studies.
Conclusion: Most Iranian OT studies utilized bottom-up outcome measures. Iranian OT researchers were suggested to highlight the current paradigm of OT in their research regarding school-age children with CP to comprehensively address their multiple challenges and needs according to a top-down client-centered approach.

Introduction: High-arch and flat foot deformities can negatively impact an individual’s performance in different situations. They may also balance as well as disturb postural control, which is essential for performing optimal routine and port activities, in addition to preventing injuries. This is a comparative meta-analysis of postural control in people with high-arch and flat foot deformities with normal feet.
Materials and Methods: This is a systematic review of articles published from 2004 to 2021 in Medline/PubMed, Embase/Scopus, LILACS, CINAHL, CENTRAL (cochrane central register of controlled trials), Web of Science, PEDro, and Google Scholar databases.
Results: The results revealed that the total balance score in people with high-arch and flat foot deformities was lower (P=0.001), compared to normal people. However, no significant difference was observed in the total balance of people with high-arch and flat foot deformities (P>0.05). Additionally, flat-foot people showed a weaker balance in the postural control test on a force plate, when compared to individuals with high-arch feet (P=0.001). Nevertheless, the results of dynamic balance were the same for all groups (P>0.05).
Conclusion: Our findings indicate that people with high-arch and flat foot deformities suffer from weaker postural control when compared to their normal peers. Moreover, flat-foot people showed lower scores on postural control tests on force plates, compared to subjects with high-arch feet, even though they had no significant differences for static and dynamic tests. There was no difference in the results of dynamic balance among the 3 groups.

Introduction: A robust vocabulary improves all areas of communication. Vocabulary is critical to a child’s success to think and learn about the world. Expanding a child’s knowledge of words provides unlimited access to new information. This study describes the early development of comprehension and production vocabularies in a group of Persian-speaking toddlers.
Materials and Methods: The mothers of 33 typical, Persian-speaking toddlers during 6 months (from 12-14 months to 19-21 months) completed the Persian McArthur-Bates communicative development inventories 7 times per month. The collected data were analyzed via the SPSS software, version 21, through non-parametric tests.
Results: The results indicated that the only significant increase for both vocabularies was between 15 and 16 months (P comprehension=0.045 and P production=0.027). The development of phrase comprehension showed significant increases during six months (P<0.001). Further analysis of production vocabulary growth demonstrated the word spurt in each child (in different months and with different word levels). According to the figures, the composition of vocabulary production was different during the selected 6 months. Nouns were the largest group during the 50-, 100-, and 200-word stages; however, verbs presented a faster rate of development. Both genders showed significant changes during follow-ups (P<0.001) and there were no significant differences between the vocabularies of different genders (P>0.05).
Conclusion: Persian-speaking children follow commonalities of lexical development reported for different languages; however, few differences could be traced between these children and their peers from other languages.

Introduction: Multiple sclerosis (MS) is one of the most common disabling neurologic diseases worldwide. Although occupational performance problems are reported in many people living with MS, there is little information on these problems in people with relapsing-remitting MS (RRMS). This study aims to determine occupational performance problems in people with RRMS.
Materials and Methods: The Canadian occupational performance measure was used to collect data from 58 participants in the age range of 20 to 50 years. The participants were recruited via the convenience sampling method from a neurology outpatient unit in a general hospital in Tehran City, Iran, in 2020. The data were analyzed using the Spearman, Man-Whitney, and Kruskal-Wallis tests.
Results: A total of 91 activities in self-care, 96 activities in productivity, and 67 activities in leisure were identified by the participants as their priorities. No significant difference was observed between the mean scores of occupational performance with age, gender, employment status, and marital status. Still, there was a considerable difference between occupational performance and education level.
Conclusion: People with RRMS suffer from many occupational performance problems, especially in productivity areas. Although occupational therapy interventions are essential in promoting self-care and activities of daily living, engaging in productive and instrumental activities of daily living is more cost-effective and valuable to promote independence in people with RRMS.

Introduction: Gesture is a form of non-verbal communication. Down syndrome (DS) is one of the most common congenital syndromes in which speech and language deficits are prominent. Earlier studies have revealed mixed results regarding the advanced use of gestures among children with DS in Western literature. Indian culture influences parent-child interactions and gesture use differently. This study aims to assess whether a gesture advantage exists among DS children in the Indian context.
Materials and Methods: In this case-control study, 5 Tamil-speaking children with DS and 5 typically developing (TD) language-age-matched controls were observed. Their spontaneous interactions with their mothers were analyzed for type and frequency of gestures and gesture-word combinations using a checklist.
Results: Except for the frequency of deictic (requesting, giving) gestures, all the other gestures, namely deictic (pointing, showing), symbolic and representational gestures, and word-gesture combinations (equivalent, complementary, and supplementary) were observed much less frequently in DS children, although only pointing had a statistical significance. Also, fewer types of gestures were observed among DS children.
Conclusion: Children with DS in the Indian context do not exhibit a gesture advantage. This study highlights the importance of gesture assessment and intervention among these children.

Introduction: Flexibility or the ability of a muscle to increase in length is an integral part of musculoskeletal characteristics and is essential in preventing musculoskeletal injuries and increasing functional levels. Hamstring muscles rupture is a common injury. One of the important factors in the occurrence of this injury is poor hamstring muscle flexibility, which because of its stiffened structure, has less ability to quickly increase in length. Some researchers have recently suggested that the dry needling technique could reduce the number of treatment sessions for hamstring muscle tightness and bring faster and more effective results. Accordingly, this study aims to investigate the effect of the application of dry needling through an acupuncture technique on hamstring muscle flexibility.
Materials and Methods: The present study is a single-blinded randomized controlled trial in which 16 individuals with bilateral hamstring muscle shortness were randomly allocated into dry-needling and sham-needling groups. The sampling method was non-probability convenience. The outcome measures were the right and left active knee extension range of motion, assessed before and after the first, third, and fifth sessions of intervention. A 2-factor mixed analysis of variance was applied to determine the differences between and within the two groups.
Results: Except for the group main effect, time main effect and interaction effect were statistically significant for the right and left active knee extension range of motion (P<0.001). There were differences in behavioral patterns in groups; accordingly, in the real dry-needling group, a significant difference was detected across times. However, in the sham dry-needling group, no significant difference was observed.
Conclusion: The application of dry needling into motor points of hamstring muscles in individuals with bilateral hamstring muscles shortness could improve flexibility and increase the range of knee extension after 3 and 5 sessions of intervention because of the therapeutic effects of the dry needling technique in improving the muscle flexibility.

Introduction: Language deficit is regarded as one of the most important hallmarks of primary progressive aphasia. This study aims to analyze the nature of verbal repetition ability in a group of patients suffering from the semantic variant of primary progressive aphasia and investigate their cognitive capability.
Materials and Methods: In this cross-sectional study, 12 patients of the semantic variant of primary progressive aphasia and 12 healthy individuals accomplished a set of tasks, including naming, word comprehension, digit span, repetition of multisyllabic single words, monosyllabic word span under similar or dissimilar phonological conditions, and sentence repetition.
Results: The patients exhibited some degree of impairment with diverse patterns in each task, although the accomplishment of the sentence repetition task was the most challenging activity for the primary progressive aphasic patients of the semantic variant. However, the healthy individuals performed well in all tasks.
Conclusion: The recognition of the quantity and quality of the cognitive deficit in the semantic variant of primary progressive aphasics can illuminate the nature of this disease and contribute to a better diagnosis of this disease. Furthermore, it can assist speech therapists and neuropsychologist to recruit appropriate therapies and employ better techniques for the diagnosis and cure of these patients.

Introduction: The use of the jump as a plyometric exercise is a way to improve jump performance. Additionally, as it requires abrupt stopping, starting, and changing directions, it might enhance agility. Thus, this study aims to find out the relationship between drop jump variables and agility in contact sports.
Materials and Methods: A total of 30 national-level male athletes (age=20.06±1.94 years; height=1.67±0.06 m; body weight: 58.02±8.40 kg) participated in this study. A drop jump test was performed on the Kistler force plate and agility was assessed by using the Illinois agility test along with the agility t-test. The Pearson correlation test was used to find the significant relationship between agility tests completion time and jump height from flight time, reactive strength index, average power, average force, and contact time for drop jumps.
Results: The results indicate a significant moderate negative correlation between jump height from flight time and agility test time (r=-0.501 with Illinois agility test, P=0.005, and r=-0.601 with agility t-test, P=0.001). A significant weak negative correlation was observed between average power and Illinois agility test time (r=-0.477, P=0.008).
Conclusion: These findings indicate that improved drop jumps will interpret better agility movements or vice versa; therefore, individuals who perform sports that require agile movement benefit from agility assessment and drop jump training.

Introduction: There is limited information on the status of international classification of functioning, disability, and health (ICF) framework in subjects with chronic stroke with varying duration of rehabilitation care. Accordingly, this study investigates whether the duration of rehabilitation care affects the status of ICF in subjects with chronic stroke.
Materials and Methods: This was an observational cross-section study on 58 individuals with chronic stroke. The number of subjects who received rehabilitation care for less than 3 months and more than 3 months were 22 (group A) and 36 (group B), respectively. The ICF components of impairment of body functions and structure were assessed using the clock drawing test, the Beck depression inventory, and the Fugl-Meyer assessment of motor recovery after stroke. The activity limitation and participation using timed up and go test, the community integration questionnaire, and environmental factors were assessed by the Craig Hospital inventory of environmental factors.
Results: The Fugl-Meyer assessment and the policy components of the Craig hospital inventory of environmental factors showed a significant difference between the groups. Longer duration of rehabilitation care only showed a positive effect on the Fugl-Meyer assessment scores. No other components of ICF showed any difference between the groups.
Conclusion: The duration of rehabilitation impacts the impairments of body functions and body structures of ICF components. The study findings are limited and further studies are required before generalizing the results.

Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties with language, cognition, and social interaction. The diagnostic and statistical manual of mental disorder, fifth edition used “spectrum” to show the variability in etiology and phenotypic levels. This study aims to compare nonverbal communication skills in normally developing and autistic children in Karbala City, Iraq.
Materials and Methods: This was a cross-sectional study. Two sets of children (ASD and normal) were matched in terms of age and socioeconomic state. A total of 50 individuals were recruited with 25 ASD and 25 normally developing children without any history of psychological abnormalities. The child’s parent/caregiver provided all the demographic information and medical history. The information was gathered from 10-min videos separately recorded for each child, regular contact with them, and continuous interviews with their parents and caregivers. The researchers developed a pre-designed data collection questionnaire according to the non-verbal skills of 3-5-year-olds, including body language, eye contact, and facial expressions. The questionnaire was filled out by the first author. Finally, the gathered data were analyzed by the SPSS software, version 25 (IBM Corp, Armonk, NY).
Results: Comparing the total scores revealed a significant difference between the ASD and normal group in gestures (P≤0.001), phonetics (P≤0.001), body language (P≤0.001), and artifacts (P≤0.001). Normally developed children scored significantly higher than ASD children in all 4 variables. However, in the maladaptive behavior (P≤0.001), the significant scores were for ASD children compared to normal children.
Conclusion: The results showed that ASD children experience difficulty in nonverbal communication skills. They also have maladaptive behaviors. The main reason for this behavior is their inability to communicate non-verbally.

Introduction: The world has been suffering from COVID-19 since 2020 and the disease continues up to now. COVID-19 patients are at high risk of dysphagia and dysphonia. Accordingly, this study aims to determine the prevalence of dysphonia and dysphagia and identify correlated factors to develop dysphagia and dysphonia in COVID-19 patients admitted to intensive care units (ICU).
Materials and Methods: A total of 70 patients with COVID-19 (Mean±SD age of 63.1±18.6; males=39) hospitalized in ICUs were evaluated by an expert on speech and language. The patients were evaluated for swallowing disorder via the Mann assessment of swallowing ability and the Persian version of the functional oral intake scale. The consensus auditory-perceptual evaluation of voice was also used to evaluate voice disorders.
Results: Overall, 58.6% of patients presented dysphagia and 74.3% of patients had dysphonia. Meanwhile, 34.3% of the patients were on mechanical ventilation. A correlation was detected between dysphagia severity and the number of mechanical ventilation days, the length of stay, and age (P<0.05). Dyspnea impacts the prevalence of dysphonia and dysphagia in COVID-19 patients (P<0.05). Vomiting has been effective on only the prevalence of dysphagia (P<0.05). Furthermore, a significant correlation was found between dysphagia and dysphonia (P<0.01).
Conclusion: A high prevalence rate of dysphagia and dysphonia exists in patients with COVID-19 admitted to ICUs. An early evaluation by a speech and language pathologist is essential to identify the suspected patients and provide early intervention to prevent further complications and improve their quality of life.

Introduction: Musculoskeletal asymmetries are common and have important consequences for the individual and society. This study aims to determine musculoskeletal asymmetry in healthy adults.
Materials and Methods: A total of 400 healthy individuals with no musculoskeletal pain at the time of data collection were included in the study. Two custom-made wooden devices were used to assess the asymmetry in the participants by measuring their height from the base of the device up to different levels of the body. The modified Nordic pain scale was used to take the history of any regional pain in the last 6 months.
Results: The mean age of male and female subjects was 21.69±2.19 and 23.49±1.72 years, respectively. The dominant side of the body in the majority of both genders was the right side. The most commonly reported painful site was low back with 47(23.5) males and 43(21.5) females affected, followed by neck pain in 40(20) males and 45(22.5) females. Out of 400 participants, only 31(15.5) males and 12(6) females had symmetrical shoulders and 41(20.5) males and 17(8.5) females had symmetry at the level of iliac crests.
Conclusion: Musculoskeletal asymmetries are present in healthy adults at various levels of the body with a history of musculoskeletal pain relatively more prevalent in females compared to males.

Introduction: Ultrasonography is a common tool for assessing muscle morphology. This study aims to investigate the intra-rater reliability of ultrasonography measurements of the masseter and lateral pterygoid muscles (LPM) in subjects with and without temporomandibular disorder (TMD) and to compare the measurements between the two groups.
Materials and Methods: A total of 30 individuals (15 subjects with TMD and 15 subjects without TMD) participated in the study. Imaging of the masseter muscle at rest and contraction, in addition to LPM, was performed using sonography in 2 sessions with a 2-day interval and the thickness of these muscles was measured. To assess the reliability, the intraclass correlation coefficient (ICC(3, 3)), standard error of measurement, minimal detectable change, and limits of agreement were used. Additionally, for the between-group comparison of measurements, the independent sample t-test was used. The Cohen d was used to determine the size of the differences.
Results: ICC(3, 3) for intra-rater reliability of masseter thickness in rest and clenched positions and LPM were 0.89, 0.80, and 0.86 in the asymptomatic group, and 0.88, 0.80, and 0.90 in the TMD group, respectively. The values of absolute reliability parameters, such as standard error of measurement and minimal detectable change were in a small range. Additionally, compared to the asymptomatic group, the TMD group had thicker masseter muscle in the rest position and the effect size revealed a large difference between the groups. No significant differences were found between the groups for the thickness of the masseter muscle in contraction position and LPM.
Conclusion: The results of the intra-reliability study revealed that ultrasonography is a reliable method to measure the thickness of the masticatory muscles in TMD subjects and asymptomatic subjects. Additionally, TMDs can change the thickness of the masticatory muscles.