Introduction: We aimed 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 the memory of individuals with mild cognitive impairment (MCI) or dementia and to explore the optimal treatment protocol.
Materials and Methods: Following the preferred reporting items for systematic reviews and meta-analyses (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 (ES) of 0.28 was found for the short-term effect (95% CI, 0.02%, 0.55%). However, the long-term effect was non-significant, with an ES of 0.17 (95% CI, -0.09%, 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: Vertical strabismus, commonly caused by the overaction of the inferior oblique (IO) muscle, is a frequent oculomotor disorder. It affects one-third of all patients with strabismus, with 70% of these cases coexisting with esotropia. Currently, there is no universally accepted method for quantifying the magnitude of IO overaction (IOOA), as existing classifications are subjective and may not be entirely appropriate. Standardization of IOOA classification is crucial to better understand its severity, develop effective treatment strategies, and predict surgical outcomes. The mechanism of action of the IO muscle is complex and varies with the globe's position during contraction. Beyond horizontal and vertical movements, the IO muscle also contributes to torsional eye movements, impacting the diagnosis and treatment of vertical strabismus and cyclotropia.
Materials and Methods: The biomechanical properties of the IO muscle and its triple-action characteristics (horizontal, vertical and torsional movements) were analyzed. A review of current diagnostic practices was conducted, emphasizing the need for comprehensive clinical examinations to identify the signs and symptoms of IOOA and determine its severity.
Results: Disorders of the IO muscle often result in vertical strabismus and cyclotropia, complicating strabismus treatment. The variability of the IO muscle's mechanism of action highlights the inadequacy of subjective classification systems. Incorporating the triple-action characteristics of the IO muscle into diagnostic evaluations enables a more accurate understanding of IOOA and its clinical manifestations.
Conclusion: Standardizing the classification of IOOA is essential for accurately assessing its severity, guiding treatment strategies, and predicting surgical outcomes. Comprehensive diagnostic examinations that consider the triple-action nature of the IO muscle are necessary to improve the management and treatment of patients with IOOA.

Introduction: Muscle strength strongly affects soccer players’ activities, but chronic ankle injuries can reduce the ability of athletes to achieve their best performance. No report exists in the literature about the role of certain muscles in affecting the vertical jump height of soccer players. Therefore, this study aimed to analyze 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. They were divided into injury and noninjury groups, according to the questionnaire. The participants were determined based on their normal body mass index (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 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 soccer players’ vertical jump 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 a chronic ankle injury. These findings benefit soccer practitioners and medical teams in designing injury management and recovery strategies for players with ankle injuries.

Introduction: Autism spectrum disorder (ASD) is a sensory processing, social communication, and occupational performance disorder. Sensory diets can have positive effects on these fields. Current research compared the effectiveness of the sensory diet program with and without teleoccupational therapy on sensory processing patterns, social competency and occupational performance in children with ASD.
Materials and Methods: The study sample comprised 32 children with ASD 4-10 years old. They were placed in the control and intervention groups. The number of sessions for both groups was 20 30-minute sessions administered over 8 weeks. Through photos, videos, and explanations, sensory problems were described in both groups, the mother presented and implemented activities and environmental adaptations, and the therapist supervised the implementation. This study used three tools—sensory profile 2, social responsive scale 2 and Canadian occupational performance measure.
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<0.05).
Conclusion: It seems that providing a sensory diet program through teleoccupational therapy on sensory processing patterns, social competency, and occupational performance is applicable, as well as face-to-face occupational therapy in children with ASD.

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 discrepancies. Adopting top-down and bottom-up interventions may enhance neuroplasticity and improve upper limb function. This study aims to determine the effect of motor cortical transcranial direct-current stimulation (tDCS) as a top-down approach combined with task-oriented training (TOT) as a bottom-up 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. EEG was conducted before and after the 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 the theta (P=0.000), alpha (P=0.004), beta (P=0.000) and gamma (P=0.003) relative powers were observed between groups at follow-up. Additionally, the Friedman test 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 real-tDCS can 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: Joint positioning can impact nerve function. Few studies have explored the effects of ankle positions on deep peroneal nerve conduction. This cross-sectional study investigated the influence of different ankle joint positions on the deep peroneal nerve’s distal motor and sensory onset latencies.
Materials and Methods: A total of 31 healthy adults (23.4±3.9 years old) underwent a deep peroneal nerve conduction study. Distal motor and sensory onset latencies were measured at neutral (0°), dorsiflexion (20°) and plantar flexion (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; sensory: 2.4±0.2 ms), followed by neutral (motor: 4.2±0.5; sensory: 2.6±0.3 ms) and most prolonged in plantar flexion (motor: 5±0.6; 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 plantar flexion. These findings provide preliminary evidence that may help optimize ankle positioning in electrodiagnostic testing. Further blinded research with larger, more diverse samples is warranted.

Introduction: Low back pain is a leading cause of disability worldwide. Various treatments have been recommended to address this prevalent issue, with core stability and McKenzie exercises being among the most evidence-based options. However, recent comparative studies lack mechanical assessment and functional tests. This study compares the effects of core stability and McKenzie exercises on the range of motion, pain, disability, and function in patients with mechanical low back pain.
Materials and Methods: In this clinical trial, 22 patients received core stability exercises, and 22 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, disability evaluation with the Oswestry disability index questionnaire, muscle control, as well as function assessment with unilateral single limb stance, and range of motion evaluation using fingertip-to-floor distance measurements. All variables were measured again after 8 sessions over two weeks of intervention.
Results: Both groups showed significant improvements in trunk flexion range of motion, disability, functional status, and pain (P>0.05). However, the two groups had no significant differences (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.

Introduction: Although gait rehabilitation based on sensorimotor synchronization (auditory and visual) is stimulating for patients with neurological disorders and older people, there is little evidence in patients with multiple sclerosis (MS). 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 MS.
Materials and Methods: Spatiotemporal parameters, bilateral symmetry and the locomotor rehabilitation index were obtained before and after 6 weeks (three times per week, 30 min each session) of locomotor training. We compared these findings between two groups of 10 patients, each with an expanded disability status scale (EDSS) of 3-6, who performed the gait training with or without rhythmic visual stimulus.
Results: Time×group interaction effect indicated greater significant improvements in the group with rhythmic visual stimulus in self-selected walking speed (SSWS) (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 were 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 MS, especially due to the improvements in the temporal parameters of gait.
Conclusion: Therefore, synchronizing gait with a rhythmic visual stimulus can be an effective therapeutic strategy to improve gait and main temporal parameters in patients with MS.

Introduction: Cortisol and heart rate variability (HRV) represent the activity of physiological stress axes. The depression and anxiety stress survey (DASS-42) is widely used to assess stress. This study examines the correlations between the DASS-42 questionnaire and stress markers, salivary cortisol levels and HRV.
Materials and 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. Differences in cortisol levels 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 the 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 (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 (SAM) activity. Clinicians can estimate the activity of this stress axis by using the anxiety subscale of the DASS questionnaire. Meanwhile, gender differences should be noted when assessing stress.

Introduction: Dynamic neuromuscular stabilization (DNS) or core stabilization exercises have been used to improve core stability, but their effect on nonspecific 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.
Materials and Methods: In a randomized clinical trial, 44 people with chronic NSLBP were randomly assigned to the experimental and the control groups, 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, 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 intervention.
Results: Nineteen people in the control group and 21 in the DNS group were analyzed. The results showed that after the intervention, patients in the DNS group obtained, on average, an 8.82% (95% CI, 6.53%, 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: DNS exercises can be recommended for improving the activation of superficial core muscles like the external oblique in individuals with NSLBP.

Introduction: The strength of inspiratory muscles is one of the essential factors in preventing postoperative pulmonary complications (POPC). One of the new tools to safely measure the strength of the inspiratory muscles in heart patients dynamically and without breath holding is the strength-index (S-index). 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.
Materials and 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 the S-index with 30 breathing cycles. Respiratory tests, including S-index, peak inspiratory flow (PIF) and vital capacity (VC), were assessed twice using an electronic respiratory device.
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>0.05), or in the independent t test and Mann-Whitney U test for the “rate of changes,” between two tests (P>0.05). Finally, intra-group changes, assessed with paired sample t test between two tests, were mostly non-significant for these indices (P>0.05), except for the best VC in the study group (P=0.03).
Conclusion: The study results suggest that a RWU session does not significantly impact cardiac surgery candidates’ S-index or other respiratory parameters. Thus, incorporating RWU before S-index testing may not be necessary.