Introduction: This study systematically evaluates the effect of telerehabilitation on improving physical activity, physical function, and quality of life (QoL) in individuals with multiple sclerosis (MS).
Materials and Methods: Studies were obtained by searching the title, abstract, and keywords without time limit in the Scopus, PubMed, Embase, and Web of Science databases. The quality of the included studies was assessed using the Joanna Briggs institute checklist. The same checklist was used for data extraction.
Results: A total of 16 eligible articles were found. In 12 studies, the results showed significant performance improvement, reduced fatigue, improved physical activity, and general balance in the telerehabilitation approach. Furthermore, of the 16 included studies, 5(31) reported an improvement in individuals’ QoL, two of which showed a significant improvement in the individuals’ QoL in the intervention group compared to the control group.
Conclusion: The findings of this review showed that telerehabilitation services for MS individuals’ precautions are comparable to or better than conventional services. Telerehabilitation is an effective educational instrument to restitute and maintain physical activity and balance in individuals with MS; however, no considerable improvement in individuals’ QoL was reported.

Introduction: Competitive swimming is one of the most popular Olympic sports. Although studies indicate that explored flat feet improved running performance, research on foot types and their impact on swimming is scarce and unexplored. This study investigates the difference between flutter kicking speed among competitive swimmers with flat and standard feet.
Materials and Methods: A total of 78 competitive swimmers in the age range of 13 to 19 years were recruited from Pusat Akuatik Darul Ehsan swimming training using a purposive sampling method and a cross-sectional study design. Based on their navicular drop test scores, the participants were categorized as flat-footed (group A) and normal-footed (group B). An independent t-test was applied to compare the kicking speeds between flat-footed and normal-footed swimmers. The swimmers in group A and group B were instructed to perform a standard 50-m kicking front crawl performance with the upper limb placed over the sliding board individually in a swimming pool, and their reaching time was recorded using a stopwatch.
Results: The results indicated flat-foot swimmers’ front crawl kicking performance was faster than normal-foot swimmers’ (P=0.03) with a medium effect size (d=0.50).
Conclusion: This study concludes that flat-footed competitive swimmers have an advantage in reaching 50 m in less time than normal-footed swimmers.

Introduction: Forward head posture (FHP) is one of the most common positional deviations. Frequent users often exhibit incorrect posture because of the rising popularity of media devices, such as smartphones and computers. This posture leads to changes in muscle activity in cervical flexion and extension. It is defined by hyperextension of the upper cervical vertebrae and forward translation of the cervical vertebrae. This study evaluates the effect of dry needles as a new method in the upper trapezius muscle on the neck’s angles and range of motion (ROM) in individuals with FHP.
Materials and Methods: In this quasi-experimental interventional study, 18 women with FHP underwent a dry needle session. The photogrammetry of the cranio-vertebral angle measured the degree of FHP. Visual analog scale (VAS), pain pressure threshold (PPT), cranio-vertebral angle (CVA) and cranio-horizontal angles (CHA), ROM, scapular index (SI), and forward shoulder translation (FST) were assessed before and after the intervention.
Results: The results demonstrated that after the intervention, right and left PPT, flexion, and proper neck rotation, right and left SI, CVA, and CHA were significantly improved (P<0.05).
Conclusion: The results showed that one session of dry needling with stretching exercises intervention could improve PPT, ROM, SI, CVA, and CHA and consequently improve FHP.

Introduction: Broca and Wernicke’s patients perform satisfactorily regarding the processing of canonical syntactic structures, as maintained by previous studies; however, there has been a gap in the literature because no particular research has yet investigated the performance of these patients in the Persian circumstances once they were required to analyze sentences which would demand extra-semantic processing. This study clarifies the role of two critical semantic operations demanding extra-semantic processing at the sentential level: Aspectual coercion. It complements to provide some evidence on the localist view of the brain. Our rationale for selecting these operations was their pure semantic nature, not relying on morphosyntactic properties.
Materials and Methods: Having recruited two age- and education-matched Broca, two Wernicke, and four healthy controls, we conducted a semantic judgment task in which the participants were asked to express their correct semantic judgment in the two coercion and two normal conditions.
Results: Our results showed an approximately above-chance performance of the Broca group for all conditions; however, in the Wernicke group, the same result was not observed due to their poor performance in coercion conditions, though in ordinary sentences, they performed much better.
Conclusion: Our findings, along with similar off-line and imaging studies, corroborate the view of localism, based on which Wernicke’s area is mainly responsible for the primary semantic operations while Broca’s area predominantly takes over syntactic parsing.

Introduction: This study compares the effect of postural restoration (PR) exercises with and without core stability exercises on the pain, intensity, function, quality of life (QoL), and passive range of motion (PROM) at lumbo pelvic-femoral complex in patients with non-specific chronic low back pain.
Materials and Methods: This was an interventional type of randomized clinical trial study. The participants were 45 female patients (48.1±6.11 years, 161.4±5.06 cm height, 65.08±6.9 kg weight, and 24.9±2.8 body mass index). They were randomly divided into three equal groups: Group 1=PR exercises and core exercises, group 2=PR exercises, and group 3=control group. Pain intensity, function, QoL, and PROM were measured with the visual analog scale, Oswestry disability index, short form-36 questionnaire, and goniometer. The analysis of covariance was used to compare the means in the study groups before and after the intervention. The intervention groups performed the exercises for six weeks.
Results: The results showed a significant difference between the QoL, pain intensity, function, and PROM of left hip adduction in the group with PR exercises with and without core exercises and control (P=0.000). In the PR group with core exercises (P=0.001) and without core exercises (P=0.001), a significant increase was observed in the adduction of the left hip. There was no significant difference between the function (P=0.850), pain (P=0.120), QoL (P=0.328), and PROM (P=0.094) in the intervention groups.
Conclusion: PR exercises with and without core stability are equally effective in reducing pain and improving function, QoL, and hip adduction range of motion in women with left anterior interior chain patterns.

Introduction: Using personal protective equipment, especially face masks, in the COVID-19 pandemic era may make verbal communication difficult. Furthermore, acoustic changes in mask-wearing conditions may affect speech audiometry results. This study investigates the effect of wearing a face mask on the word recognition score and the role of speech frequency content in this effect.
Materials and Methods: This study was planned and conducted in two phases. In the first phase, the validity and reliability of two speech material lists, high-pitch and low-pitch, were determined. In the second phase, the word recognition score was measured for “mask-wearing” and “covering mouth without a mask.”
Results: The statistical analysis showed that the content validity ratio was 0.92, and the content validity index was 0.8. Therefore, both speech lists were valid. For these lists, the mixed analysis of variance analysis showed that the scores for “mask-wearing” were significantly lower than “covering mouth without a mask,” and there was more reduction in scores for the high-pitched list (F=8.7, df=1, P<0.005).
Conclusion: In terms of the impact of a face mask on speech, explaining how speech audiometry is performed, especially in monitoring treatments, may help limit the probability of misinterpretation of speech test findings. Furthermore, understanding the impact of face masks on word recognition scores in adopting sufficient auditory rehabilitation procedures is necessary.

Introduction: Teamwork is an essential component of delivering successful physiotherapy services to patients; therefore, the education of physiotherapy students should be directed toward strategies that promote interaction between classmates. A flipped classroom (FC) is a pedagogical strategy that promotes active learning. The present study aimed to design, implement, and evaluate the FC for postgraduate physiotherapy students.
Materials and Methods: A total of 44 postgraduate general and sport physiotherapy students participated in this study from 2016 to 2019. Two theoretical courses were designed and delivered based on the FC approach. The data were collected using a questionnaire that contained 12 items based on the 5-point Likert scale. The data were analyzed using descriptive statistics, Mann-Whitney, and Fisher exact tests.
Results: The students’ familiarity with FC was 2.52±1.51 (median=3). The total agreement with FC was 3.42±0.92 (median=3). Only 22.7% of the students reported no increase in motivation. Meanwhile, 71% of the students agreed with a blended classroom, while only 52% preferred to teach only with FC.
Conclusion: Most students preferred a blended classroom combining in-class and home activities. Also, the FC could augment the interaction and motivation of the students. Accordingly, FC is a valuable teaching strategy for postgraduate physiotherapy students.

Introduction: Simulation-based teaching is a technique for imitating a situation’s behavior or process via a suitable analog situation for training or teaching purposes. Simulation-based teaching is widely used in various domains; however, there is limited literature on evaluating the role of simulated-based teaching in physiotherapy. This study investigates the effect of simulation-based teaching on learning domains for traumatic brain injury topics framed for final-year physiotherapy students.
Materials and Methods: A total of 51 final-year physiotherapy students were randomly selected and allocated into two groups. Group A (n=25) includes didactic with PowerPoint presentation teaching session. Group B (n=26) includes simulated-based teaching sessions. There were eight simulators selected and trained for the Ranchos Los Amigos stages. The students were assessed using a self-designed pre-post multiple-choice questions (MCQ) test for knowledge and a clinical evaluation exercise for affective and psychomotor skills.
Results: This study showed that group B significantly improved in the pre-post self-made MCQ test (t=17.34, P=0.00), and in the clinical evaluation exercise, group B performed 43.66% better than group A.
Conclusion: The study concludes that simulation-based teaching significantly improves cognitive, affective, and psychomotor skills compared to traditional methods for traumatic brain injury topics framed for final-year physiotherapy students.

Objectives: Having a child with cerebral palsy (CP) is a stressful experience for the family specially mothers. Caring of this children take a lots of time and energy from family. The balance of life may be decreased by the influence of factors related to the child or mother. Therefore, the present study intended to investigate the predictive factors affecting the life balance of mothers with CP.
Methods: This study was a cross sectional descriptive-analytical research that conducted in Ahvaz in 2021. A total of 135 mothers (mean age= 33.37(7.93)) with at least one children under the age of ten CP participated in this research. Data were collected using life balance index, general health questionnaire, time management quality, and demographic information checklists. GMFCS E&R and MACS were used to determine the level of gross motor and manual ability function. To investigate the effect of predictor variables on the quantity of life balance, generalized univariate linear models were used.
Results: Life Balance of mothers of children with CP was very unbalanced (45.2%) or unbalanced (35.6%). Based on regression coefficient of each variable, it was determined that MACS (B = 0.192), comorbidity in the children with CP (B= 0.187), gross motor function (B= 0.137), general health (B= 0.024) and maternal age (beta = 0.01), respectively, contributed the most in the prediction of life balance variances.
Conclusion: Life balance is a serious affected domain in mothers caring CP children. Child-related factors had a more effective role in predicting the life balance of mothers of CP children than mother-related factors.

Introduction: In 2008, Iran acceded to the convention on the rights of persons with disabilities (CRPD), including the right to health and rehabilitation. However, the goals of this convention have not yet been achieved in Iran. This study provides solutions for implementing articles 25 (health) and 26 (rehabilitation) CRPD in Iran.
Materials and Methods: This was a qualitative study conducted through content analysis. A total of 21 individuals were selected via the purposive sampling method. The data were collected through semi-structured interviews. The interviews continued until we reached information saturation. Data analysis was performed manually using the MAXQDA software version 10.
Results: After the interviews, 860 initial codes were obtained. After removing the unrelated codes and merging the codes by overlap, 725 codes remained. The concepts were classified into four main categories and 15 subcategories: Development of a comprehensive rehabilitation program, culture and education, capacity building, and compliance with legal requirements.
Conclusion: According to the results, because of severe problems in the field of health and rehabilitation of disabled people in Iran, taking necessary measures to solve these problems is essential. Hence, a comprehensive plan should be developed. Meanwhile, proper education, culture building, talents, and opportunities should be considered more carefully. Also, by facilitating services for people with disabilities and paying attention to the importance of being demanding, we can build capacity in the country. The findings of this research will provide a bright way for policymakers, administrators, and planners of the country.

Introduction: Exercise tolerance, an important factor affecting life prognosis and rehospitalization in patients with chronic heart failure, is a major outcome of cardiac rehabilitation. Heart failure with preserved ejection fraction (HFpEF) from reduced diastolic capacity has recently increased among patients with chronic heart failure. This study evaluated and clarified the factors indicating exercise tolerance in patients with HFpEF from various perspectives, including cardiac and skeletal muscle functions.
Material and Methods: The subjects were 31 patients with HFpEF who underwent cardiac rehabilitation. Exercise tolerance was assessed using a 6-minute walking test. Physical function, physical activity, body composition test, baseline characteristics, blood data, and echocardiography results were extracted from medical records to identify the indicators of exercise tolerance.
Results: Gait speed was significantly different in exercise tolerance for HFpEF patients (β=0.75, p<0.01). Unlike HFrEF, HFpEF were no significant differences in brain natriuretic peptide (BNP) levels and cardiac function.
Conclusion: Gait speed is an indicator of exercise tolerance in HFpEF patients. However, its pathological course differs from HFrEF, indicating that it is poorly related to BNP, a biomarker for heart failure and cardiac function.

Introduction: The skeletal muscle’s echo intensity (EI) is a measurement that can be used to assess the quality of the muscle and any muscle damage caused by training or activity. To determine its reliability, a limited number of studies have investigated the measurement of cervical muscles’ EI. This study determines whether the EI of the cervical muscles can be reliably quantified using the Adobe Photoshop software.
Materials and Methods: The mean EI of the cervical muscles was measured using the standard histogram function of Adobe Photoshop CS6 in 20 healthy women.
Results: The measurement of EI of cervical muscles using Adobe Photoshop CS6 is reliable in healthy women (intra-class coefficient >0.9). The values of the standard error of measurements of longus coli, sternocleidomastoid, levator scapula, semispinalis capitis, rectus capitis posterior, and oblique capitis superior muscles were 1.81, 2.09, 1.46, 2.02, 1.47 and 1.26, respectively. The values of the smallest detectable difference of longus coli, sternocleidomastoid, levator scapula, semispinalis capitis, rectus capitis posterior, and oblique capitis superior muscles were 7.11, 8.22, 5.74, 7.93, 5.79, and 4.97, respectively. 
Conclusion: Assessing the EI of the cervical muscles with Adobe Photoshop software is a viable method to determine the quality of the muscles.

Introduction: Traumatic brain injury (TBI) is one of the leading causes of long-term disability worldwide. Occupational therapy interventions in these patients are mainly focused on improving patients’ ability to perform daily occupations. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique whose potential for motor and cognitive recovery of patients with TBI has been investigated; however, its effect on functional outcomes following TBI is unknown. This study aims to determine the effectiveness of tDCS combined with routine occupational therapy on the activities of daily living in patients with TBI.
Materials and Methods: This was a single-blind, randomized clinical trial. A total of 24 patients with TBI were recruited using the convenience sampling method and were randomly assigned to the experimental (n=12) and control groups (n=12). Both groups underwent routine occupational therapy for 10 sessions (3 days per week), and the experimental group received tDCS (20 min) in addition to routine occupational therapy. Activities of daily living were assessed using the functional independence measure (FIM) at the baseline and the day after the end of the intervention.
Results: After a 10-session intervention, both groups experienced significant improvements in the cognitive subscale and the FIM total score (P<0.001). Additionally, the findings showed that these improvements were significantly higher in the experimental group (P<0.001).
Conclusion: According to the findings, although routine occupational therapy can effectively improve the ability of patients with TBI to perform daily living activities, adding tDCS as a complementary intervention can accelerate recovery in these patients.

Introduction: Orofacial clefts are one of the most common congenital anomalies involving the craniofacial region. An isolated cleft palate is the rarest (33% of all orofacial clefts) among individuals with female predominance. Individuals born with these clefts manifest craniofacial, functional, and psychological anomalies. Sometimes, patients cannot receive the required therapies due to a lack of awareness and lack of medical access or economic factors. Untreated clefts may adversely impact the patient’s life both physically and psychologically.
Case Description: This study presents a case report of a 45-year-old male with an untreated cleft palate since birth due to a low socioeconomic background, leading to several oro-dental anomalies, speech defects, and psychological and social challenges.
Results: Extraoral examination revealed mild facial asymmetry, dry and incompetent lips, and underdeveloped philtrum. Intraorally, there was a cleft palate, macroglossia, soft and edematous gingiva with bleeding on probing, gingival recession, and periodontal pockets, along with various dental anomalies. Full mouth orthopantomogram showed discontinuity of the palatal line, collapsed maxillary arch, root stumps, and crowding. The final diagnosis of isolated cleft palate was made. The patient was advised for surgery regarding the cleft palate, dental treatment, speech therapy, and psychological counseling. However, the patient refused all treatments except a few dental aids due to economic difficulties.
Conclusion: The present case report highlights the need for these patients to receive particular concerns. Patients must be motivated to get proper treatment at a suitable stage to prevent future complications. Cleft teams must be advised to initiate some encouraging steps in imparting treatment aids to such patients, especially in rehabilitation therapy, considering their surrounding environment, psychological makeup, socioeconomic status, and motivation. In addition, social groups should also treat these patients with a positive approach, helping them to live healthy and normal lives just like any other individual.

Introduction: Hamstring injuries are one of the most common tendon injuries, especially in sports that require running and jumping. A comprehensive training program can help athletes to prevent this injury. Among suggested exercises, the Nordic eccentric training can reduce the injury rate by up to 50%; however, it is a high-load exercise that cannot be prescribed in the first stages of rehabilitation. Here, we describe a football player who used low-load resistance exercise with blood flow restriction as an alternative method to strengthen their hamstring after nine months of anterior cruciate ligament reconstruction surgery.
Case Description: A 19-year-old non-professional footballer with a body mass index of 22.18 kg/cm2 was invited to participate in this study. The variables examined included strength and cross-sectional area of the hamstring muscles (mean and maximum strength) and the cross-sectional area of the hamstring tendons at their origin. The treatment program included a seated hamstring curl with a load of 30% 1 RM with blood flow restriction for four weeks (thrice a week).
Results: The hamstring muscle strength improved by 6.54%, and the cross-sectional area of the muscles and tendons changed as follows: Semimembranosus (tendon=0.07%, muscle=2.57%), semitendinosus (tendon=0.00%, muscle=-4.04%), and biceps-femoris (tendon=5.5%, muscle=4.34%).
Conclusion: Low load resistance training with blood flow restriction in this athlete improved the strength and cross-sectional area of the hamstring muscles as well as the cross-sectional area of the tendons. The changes observed in tendon, and muscle cross-sectional areas were more prominent for biceps-femoris. This case showed that a training program with blood flow restriction may be a good alternative for people who cannot tolerate high-load exercises in the early stages of their rehabilitation. Doing more extensive studies with more cases and a control group in the future can help our knowledge in giving the best exercise prescription to our patients.