Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 107 119 Yasir Adil Shakor Azadi Teaching Hospital Kirkuk, Kirkuk, Iraq. Razieh Bahreini Department of Vision Science, Pacific University College of Optometry, Forest Grove, Oregon, United States Ali Majdi Department of Optical Techniques, College of Health and Medical Techniques, Al-Mustaqbal University, Babylon, Iraq. 2024 10 29 2024 12 28 Binocular diplopia is a challenging oculomotor disorder that significantly impacts patients’ quality of life. This review provides a comprehensive overview of the etiology, diagnostic methods, and treatment strategies for binocular diplopia. Proper diagnosis begins with differentiating between monocular and binocular diplopia, followed by determining whether the cause is motor or sensory. Diagnostic methods include detailed medical history, qualitative and quantitative assessment of diplopia, analysis using tools like the Haab Grid, evaluation of ocular motility, and assessment of head postures. The level of oculomotor defect should be investigated to differentiate between nuclear and supranuclear lesions. Treatment approaches are diverse and depend on the underlying cause. Functional strategies may include prismatic correction, which can provide immediate relief from diplopia. Surgical interventions are considered for cases of paralytic strabismus or when conservative measures are insufficient. The choice of treatment is guided by factors, such as the etiology, duration, and severity of diplopia. Prismatic correction is often used as both a diagnostic tool and a treatment option, allowing for precise adjustment of eye alignment. In cases of acute diplopia, a systematic approach to diagnosis and appropriate identification of possible causes enables better patient management. This comprehensive approach to binocular diplopia, encompassing thorough diagnostic methods and a range of treatment strategies, improves functional outcomes and enhances the quality of life for affected patients. This study emphasizes the complexity of diplopia, distinguishing between monocular and binocular types, and motor and sensory forms. Management involves functional therapies, prismatic correction, and if needed, botulinum toxin or surgery. Prompt evaluation and multidisciplinary collaboration are essential, particularly for neurological causes. https://jmr.tums.ac.ir/index.php/jmr/article/view/1190

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 120 130 Yasir Shakor Azadi Teaching Hospital Kirkuk, Iraq Raheleh Moravej School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran Ali Majdi Optical Techniques Department, College of Health and Medical Techniques, Al-Mustaqbal University, 51001, Babylon, Iraq Razieh Bahreini Department of Vision Science, Pacific University College of Optometry, Forest Grove, Oregon, United States 2024 10 29 2024 12 28 The third cranial nerve (oculomotor nerve) plays an essential role in the function of ocular movement and mainly innervates the inferior oblique, medial rectus, inferior rectus, superior rectus, levator palpebrae, pupillary sphincter, and ciliary muscle. The most frequent clinical manifestations of oculomotor nerve palsy are ophthalmoplegia, ptosis, pupillary dysfunction, and diplopia. The etiology of oculomotor nerve palsy is complex, including congenital tumors, craniocerebral trauma, intracranial inflammation, diabetes, intracranial aneurysm, cerebrovascular infarction or hemorrhagic disease, myasthenia gravis, multiple myeloma demyelinating diseases, and other uncommon causes. Each etiology of oculomotor nerve palsy has its corresponding clinical features. The present study comprehensively reviews the common etiologies of oculomotor nerve palsy and the corresponding clinical manifestations and treatment methods to help practitioners with the prompt and accurate clinical diagnosis of the causes and effective management plan. https://jmr.tums.ac.ir/index.php/jmr/article/view/1192

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 131 139 Om Wadhokar Department of Musculoskeletal sciences, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India Vanshika Tandon Department of Musculoskeletal sciences, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India Sakshi Yede Department of Musculoskeletal sciences, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India Jayantika Bhardwaj Department of Musculoskeletal sciences, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India Seema Saini Department of Musculoskeletal sciences, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India Tushar Palekar Department of Musculoskeletal sciences, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India 2024 10 18 2025 02 11 Introduction: Lower extremity surgeries, such as total knee arthroplasty, total hip arthroplasty (THA), and anterior cruciate ligament reconstruction require extensive rehabilitation to restore mobility and function. Traditional rehabilitation faces various challenges, such as patient adherence and access to care. Virtual reality (VR) has emerged as a promising tool to enhance rehabilitation outcomes by offering interactive, engaging environments that improve patient motivation. Materials and Methods: A narrative review was conducted to evaluate the current literature on VR-based rehabilitation for post-operative lower extremity conditions. Relevant studies from 2019 to 2024 were selected from online databases, such as PubMed, Scopus, and Cochrane, focusing on VR’s application in patients recovering from total knee arthroplasty, THA, ACL reconstruction, and traumatic lower limb amputations. Results: VR interventions significantly improved proprioception, balance, and patient engagement compared to traditional rehabilitation methods. VR’s interactive nature provided real-time feedback and enhanced patient motivation. However, mixed results were reported regarding VR’s superiority in pain management and overall functional outcomes. VR was shown to complement traditional therapy rather than replace it. Conclusion: VR-based rehabilitation offers a promising adjunct to traditional methods, improving patient engagement and specific functional outcomes. While VR enhances recovery, further research is needed to establish standardized protocols and determine its long-term efficacy in post-operative rehabilitation. https://jmr.tums.ac.ir/index.php/jmr/article/view/1184

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 140 147 Mohammad Javaherian Neuromusculoskeletal Rehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran AND Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Ali Parouhan Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Nasiri Toosi Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Ali Jafarian Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Seyede Zahra Emami-Razavi Physical Medicine & Rehabilitation Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mohaddeseh Azadvari Physical Medicine & Rehabilitation Department, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran Sedighe Hosseini Shabanan Department of Radiology, University of California San Diego, San Diego, CA92093, USA Mohammad Eghbal Heidari Sue & Bill Gross School of Nursing, University of California, Irvine, California, United States of America. 2024 04 24 2024 10 26 Introduction: Liver transplantation can change the quality of life, physical activity, mood, and psychological symptoms in patients. Considering that exercise capacity is correlated to the level of depression and quality of life among patients, this study investigates the effect of exercise therapy on the quality of life and depression in orthotopic liver transplantation recipients (LTRs). Materials and Methods: This was a single-blinded study with randomized controlled trial parallel groups, and 30 LTRs were randomly assigned in a 1:1 ratio. The experimental group underwent a three-month home-based exercise therapy, while the control group received no exercise therapy. Assessments included short-form-36 and the Beck depression questionnaires, along with the 6-min walk test. Results: There was no significant difference between groups in demographic characteristics. Before the intervention, the mean scores of depression in the intervention and control groups were 27.87±8.68 and 25.77±6.77, respectively. After the intervention, t-test revealed a significant difference between the two groups (P=0.001). The results of the t-test indicated that the average quality of life dimensions improved post-intervention compared to the control group, with significant differences in the scores of these dimensions. After the intervention, the t-test showed a significant difference between the two groups in terms of the 6-min walk test (P=0.001). Conclusion: Rehabilitation through prescribed exercise can improve quality of life and physical activity, and alleviate depression symptoms in LTRs. As a result, incorporating physiotherapy into the post-transplantation care of transplant recipients holds potential benefits. https://jmr.tums.ac.ir/index.php/jmr/article/view/1096

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 148 163 Sara Salamat Behbahan Faculty of Medical Sciences, Behbahan, Iran. Vahideh Montazeri Smart University of Medical Sciences, Tehran, Iran. Saeed Talebian Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. 2024 09 17 2024 12 21 Introduction: Recently, machine learning adoption has significantly increased across various applications, including the prediction of diseases based on a person’s clinical profile. Accordingly, this study develops and evaluates a supervised machine learning method to predict trunk muscle activity in people with chronic low back pain. Materials and Methods: This was a secondary data analysis from a subgroup of people with nonspecific chronic low back pain. The correlation between labeled data and the output data of muscle activity level was measured through surface electromyography. The result showed a good correlation, suggesting the potential utility of this approach in distinguishing individuals with low back pain from pain-free controls. Results: To validate the performance of the developed machine learning, the results were compared with the SPSS software, version 17. The model’s predictive performance was further assessed using various evaluation methods, including the area under the receiver operating characteristics curve. The study’s findings indicate that the model achieved area under the curve values ranging from 0.5 to 0.9 across all muscles and different tasks for people with back pain. In contrast, the pain-free group exhibited area under the curve values between 0.4 and 0.8. Conclusion: The supervised machine learning approach using logistic regression may offer clinically meaningful predictions in defining the differences in trunk muscle activity between individuals with non-specific chronic low back pain and pain-free controls. While the obtained results demonstrate promise, further studies need to enhance the model’s performance and achieve a more accurate estimation of muscle activity levels. https://jmr.tums.ac.ir/index.php/jmr/article/view/1172

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 164 170 Shirley Mireya Ortiz Pérez Department of Physiotherapy, Faculty of Health Sciences, National University of Chimborazo. Riobamba, Ecuador. David Marcelo Guevara Hernández Department of Physiotherapy, Faculty of Health Sciences, National University of Chimborazo. Riobamba, Ecuador. Vanessa de los Ángeles Belloso de Norieg Department of Nursing, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela. Fernando Daniel Álvarez Maigualema Department of Physiotherapy, Faculty of Nursing, Pontifical Catholic University of Ecuador, Quito, Ecuador. 2024 08 27 2025 01 18 Introduction: Women’s soccer and preventive training strategies have gained popularity in the last decade; accordingly, this study determines the effectiveness of a dynamic balance exercise protocol in amateur soccer players. Materials and Methods: A total of 24 females participated in this study and were randomly assigned to a control (n=12) and an experimental group (n=12). The experimental group received a dynamic balance exercise intervention with three weekly sessions for six weeks, while the control group maintained regular training. Balance was assessed before and after by the Y balance test in its anterior, posterior medial, and posterior lateral directions. The data were analyzed through the t-test for independent and related samples. Results: The analysis of this study shows significant improvements in dynamic balance (P=0.000) in the experimental group after the intervention of the dynamic balance exercise program for six weeks, while in the control group, there were no significant improvements. Conclusion: Dynamic balance exercise programs can be used to increase the balance of amateur female soccer players. https://jmr.tums.ac.ir/index.php/jmr/article/view/1161

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 171 179 Pablo Mleziva Department of Physical Therapy, Loma Linda University, California 92350, USA Eric Johnson Department of Physical Therapy, Loma Linda University, California 92350, USA Everett Lohman Department of Physical Therapy, Loma Linda University, California 92350, USA Madeha Jaber Department of Physical Therapy, Loma Linda University, California 92350, USA Lillian Mleziva Department of Physical Therapy, Physical Therapist, San Gorgonio Memorial Hospital, Banning, California 92220, USA Noha Daher Department of Public Health, School of Allied Health Professions, Professor, Loma Linda University, California 92350, USA 2024 06 05 2025 01 25 Introduction: Studies on subclinical neck pain (SCNP), known as mild pain lack proper literature. This study examines the differences in anxiety, neck movement, disability, and proprioception in people with chronic SCNP (12 females and 4 males, age = 28.1±4.0 years) and people without neck pain (17 females and 6 males, age = 25.8±3.1 years). Materials and Methods: A cross-sectional study with 39 participants was conducted. The participants were instructed to score their pain using the visual analog scale (pain group: < 4/10 and normal group: 0/10), anxiety level with the state-trait anxiety inventory, and neck disability with the neck disability index. In addition, active range of motion and joint position errors were assessed in participants of both groups. Results: There was no significant difference in mean baseline characteristics between the two groups. The participants in the pain group reported significantly higher median neck disability index (P≤0.001) and higher mean current state-trait anxiety inventory state (P=0.032) scores compared to participants with no pain. No significant differences in mean flexion, extension, lateral flexion right, lateral flexion left, rotation right, or rotation left were found between groups (P=0.95, P=0.68, P=0.29, P=0.59, P=0.70, and P=0.17, respectively). In addition, there were no significant differences in mean cervical spine joint position error flexion, extension, rotation right, and rotation left by the study group (P=0.65, P=0.33, P=0.26, and P=0.23, respectively). Conclusion: SCNP can substantially influence functional ability and anxiety levels, especially among students in higher education institutions dealing with additional stressors. The interaction between pain intensity, disability, and anxiety underscores the potential for a detrimental feedback loop, underscoring the significance of early intervention. https://jmr.tums.ac.ir/index.php/jmr/article/view/1126

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 180 188 Hamid Dalvand Department of Occupational Therapy, School of Rehabilitation, Elderly Research Center, Tehran University of Medical Sciences, Tehran, Iran. Zeinab Kadkhodaei Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Zahra Vahabi Department of Geriatrics, School of Medicine; Tehran University of Medical Sciences, Tehran, Iran. Farnaz Etesam Department of Psychiatry, School of Medicine, Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Amir Almasi Hashiani Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran. 2024 11 17 2025 02 03 Introduction: This study investigates the occupational performance and life habits of elderly adults with early stages of Alzheimer disease. Materials and Methods: This was a cross-sectional study. The participants were elderly adults, aged 65-85 years with Alzheimer disease who were referred to Roozbeh and Ziaeian Hospital, in addition to Kahrizak Charity in Tehran City, Iran in 2022. A total of 70 Seventy patients (36 male, 34 female) were recruited based on the convenience sampling method. The Canadian occupational performance measure and life habits questionnaire were used to determine occupational performance and life habits. Meanwhile, the data were analyzed using the independent t-test and the Mann-Whitney test using the SPSS software, version 21. Results: The mean age of elderly males and females was 72.02±3.74 and 71.14±4.09 years, respectively. Meanwhile, 68.3% of the priorities of occupational performance were related to self-care. In the male participants, the priorities of self-care were 76.7% and in female subjects, it was 59.4%. No significant gender difference was found in satisfaction with occupational performance (P>0.05; P>0.05). In the life habit questionnaire, fitness had the highest participation level, while communication had the lowest. A significant gender difference was observed in participation levels in daily activities (P<0.05). Conclusion: The most important occupational performance priority of elderly adults with Alzheimer disease was self-care. The highest level of participation in daily activities was related to fitness and the lowest was communication. This study helps occupational therapists identify the priorities, habits, and participation levels of men and women with early Alzheimer in daily activities. https://jmr.tums.ac.ir/index.php/jmr/article/view/1205

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 189 199 Ali Honarvar Department of Sport Injuries and Corrective Exercises, Karaj Branch, Islamic Azad University, Karaj, Iran Vahid Mazloum Department of Sport Injuries and Corrective Exercises, Karaj Branch, Islamic Azad University, Karaj, Iran Mohammad Ali Soleymanfallah Department of Sport Biomechanics, Karaj Branch, Islamic Azad University, Karaj, Iran 2024 12 09 2025 02 02 Introduction: Athletes involved in sports requiring frequent cutting and pivoting movements are at increased risk of anterior cruciate ligament (ACL) injuries. This study investigates the effectiveness of neuromuscular warm-up exercises, including strength, balance, plyometric, and core stability training, in reducing ACL injury risk. Materials and Methods: A total of 30 adolescent male basketball players (age = 13-18 years) were randomly assigned to either the control group (n=15; age = 15.66±1.7 years, height = 172.7±9.6 cm, weight = 66.74±11.2 kg) or the neuromuscular training (NMT) group (n=15; age = 14.73±0.70 years, height = 174.0±6.7 cm, weight = 64.79±10.8 kg). The NMT group performed a structured injury prevention warm-up program three times a week for eight weeks before regular basketball training (20 min), while the control group followed their usual basketball practice. Measurements of knee proprioception (including specific motion directions), knee valgus and flexion torque, trunk endurance via the Biering-Sorenson test, and isometric strength of various muscle groups were taken pre- and post-intervention. Results: Significant improvements in isometric strength were observed in all assessed muscle groups in the NMT group (P<0.05); however, no significant changes were found in knee valgus, flexion torque, trunk endurance, or knee proprioception (P>0.05). Conclusion: While the NMT protocol significantly improves isometric muscle strength in adolescent male basketball players, it does not show a direct effect on other ACL injury risk factors. Therefore, incorporating NMT into training routines may support strength development but should be combined with other targeted interventions to reduce ACL injury risk more effectively. https://jmr.tums.ac.ir/index.php/jmr/article/view/1212

Tehran University of Medical Sciences Journal of Modern Rehabilitation 2538-385X 19 2 2025 04 01 200 210 Ahmad Reza Khatoonabadi Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Amin Modarres Zadeh Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Shirin Jafari Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Sasan Maroufizadeh Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. Karen Bryan Vice Chancellors Office, York St John University, York, United Kingdom. 2024 12 16 2025 02 05 Introduction: As the global population ages, the need for sensitive language assessments for dementia increases. While the Barnes language assessment (BLA) is a valuable tool in English, it has not been translated and validated for Persian-speaking populations. Materials and Methods: This cross-sectional translated and culturally adapted the BLA into Persian (BLA-Per) and evaluated its psychometric properties. The translation process followed the international quality of life assessment protocol. The BLA-Per was administered to 30 healthy older adults and 30 individuals with Alzheimer disease (AD). Test-retest reliability was assessed in the AD group. Statistical data analysis was performed using the SPSS software (version 24) at a significance level of 0.05. Results: Due to significant differences between the patients and cognitively healthy groups regarding age and education years, we used the analysis of covariance to control for these variables’ effects on between-group comparisons. Significant differences in BLA-Per scores were observed between healthy controls and AD patients in 8 out of 14 test components, demonstrating good discriminative validity. Intra-class correlation coefficients for test-retest reliability were above 0.75 for most subtests. Conclusion: The BLA-Per demonstrated good validity and reliability in assessing language impairments in Persian-speaking individuals with AD. Future research should investigate the BLA-Per in larger samples across different age groups and stages of AD. https://jmr.tums.ac.ir/index.php/jmr/article/view/1215