Journal of Rehabilitation Sciences & Research

Abstract Background: Stroke is considered a common and major problem in the field of 
healthcare because of its high prevalence and long-term disabilities. The main
aim of rehabilitation is to increase the participation of stroke patients in different
areas of life. The current study purposed to review the factors influencing the
participation of Iranian stroke patients in life areas.
Methods: Databases including ISI-Web of Knowledge, PubMed, Google Scholar,
and Scopus were searched using keywords such as occupational therapy,
participation, activities of daily living (ADL), instrumental activities of daily
living (IADLs), work, play, leisure, education, social participation, sleep, and
rest in combination with Iranian stroke patients and CVA. The quality of the
studies was evaluated using the PEDro scale. All papers reviewed in this study
concerned factors influencing the participation of Iranian stroke patients and
were published from 2000-2020.
Results: In total, 178 articles were identified as eligible for an Iranian stroke
study. Of these, 104 articles were discarded, and an additional 38 were removed
because of repetition and duplication. After careful evaluation of the papers, 34
were selected for final analysis. Most of the included studies concerned the ADL
area of participation (N=32), and the lowest number of articles were in the areas
of play (N=1), sleep/rest (N=2), and health management (N=3).
Conclusion: In Iran, researchers have not paid enough attention to the
participation of stroke patients in areas of life. Most studies focus mainly on
patient’s performance components, such as sensory and motor skills.

Abstract Background: The acquisition of reading skills is one the most important 
challenges a cochlear implanted child faces in his/her life. Although cochlear
implants can improve speech, language, and reading skills, some children
continue to experience reading difficulties. Some studies have reviewed the
reading skills in English-speaking children with cochlear implants; however,
language and cultural discrepancies may result in diverse aural rehabilitation
programs and varying effects of factors on reading in these children. The aim
of the present study is to review evidence regarding reading skills, including
phonological awareness, reading comprehension, vocabulary, and story retelling
in preschool and school-aged children with unilateral cochlear implants in Iran.
Results: Overall, the findings of studies in this area suggest that Persianspeaking
preschool and school-aged children with unilateral cochlear implants
show worse reading performance compared with their normal hearing peers.
Conclusion: Impaired reading skills in children with cochlear implants
necessitates the identification of reading problems and targeted aural
rehabilitation programs to improve reading skills in these children. Future
studies over longer periods are necessary in order to determine the reading
developmental trajectory of children with cochlear implants in Iran. In addition,
investigating the precise role of underpinning abilities such as language and
hearing skills in reading development can help children with cochlear implants
achieve age-appropriate reading skills.

Abstract Background: Anxiety disorders have high prevalence in diabetes patients and
low-middle income countries like India. Research has provided evidence about
biofeedback effectiveness on stress-related psychophysiological parameters. This
study aimed to verify the impact of GSR biofeedback relaxation on stress-related
psychophysiological parameters (galvanic skin resistance, stress, and anxiety)
among type II diabetes patients with high levels of anxiety.
Methods:  The present study was a single-blinded
randomized controlled trial. Initially, 228 type II diabetes patients were assessed
with the state trait anxiety inventory (STAI). Seventy participants identified as
having high anxiety with STAI scores above the 75th percentile were invited to
participate. Patients were randomly divided into a biofeedback relaxation and a
sham-control group. Participants of the biofeedback group received training on
how to use the GSR biofeedback device for management of stress parameters for
twenty 30-minute sessions. The sham-control group received no intervention.
Both groups were assessed before and after the biofeedback relaxation training
program. The results of the STAI, GSR, and the inventory of stress for type II
diabetes patients were compared. SPSS 16 version was used for analysis.
Results: The biofeedback group reported a significant change in the state of
anxiety (t=5.089; p <0.001), GSR (t=-2.199; p <0.035), and stress (F=46.850;
p <0.001) post-test. The control group reported a moderate increase in stress and
trait anxiety at the same time. These results are consistent with previous studies.
Conclusion: Biofeedback relaxation is a useful technique for managing stress
and anxiety in diabetes type II patients. During an emotional disturbance, it
may also be helpful in promoting overall psychological health. Further research
is necessary to determine the long-term effects of GSR biofeedback relaxation
and the effects of cortisol on mood among diabetes patients.

Abstract Background: The use of epidural steroid injection in spinal stenosis pain
management has expanded greatly. Calcitonin is also effective in relieving
neuropathic pain in spinal canal stenosis through the mechanisms of arterial
dilation, anti-inflammation, anti-edema, and rises in beta endorphin levels. The
current study was designed to evaluate the effect of mesotherapy with calcitonin
compared with epidural steroid injection for pain relief and functional
improvement in patients with lumbosacral canal stenosis.
Methods: A total of 39 patients comparable in age and gender with signs and
symptoms of lumbosacral canal stenosis participated in this randomized
control trial. Group A comprised patients receiving mesotherapy of 100 IU
Calcitonin+Marcaine 0.5% (4 mL) in three repeated injections in the lumbosacral
area; group B received a single caudal epidural injection of Marcaine 0.5%
(4 mL)+80 mg methyl prednisolone (2 mL) under the guide of a fluoroscope.
Patients were evaluated before and 4 and 8 weeks after intervention using the
visual analog scale (VAS), Oswestry Disability Index (ODI), Quebec back pain
disability scale (QBPD), and Ronald-Morris Disability Questionnaire (RMDQ).
Results: Based on the VAS, ODI, QBPD, and RMDQ scales, a significant
improvement in pain and functional disability was observed in both groups 4
and 8 weeks after intervention (P<0.05), which was comparable between the two
groups (P>0.05).
Conclusion: Mesotherapy with calcitonin Marcaine is just as effective as caudal
epidural steroid injection; considering its advantages, mesotherapy can be a
proper alternative method for managing pain and functional impairment in
patients with lumbosacral canal stenosis.

Abstract Background: Thoracic hyper-kyphosis is one of the most common postural
disorders of the spinal column. Decreased strength of spinal extensor muscles
and range of motion of joints such as the shoulder is associated with hyperkyphosis,
which can affect the physical function and life of an individual. The f
present study aimed to investigate the effect of thoracic hyper-kyphosis on upper
extremity function among female students.
Methods: The current cross-sectional study included a population consisting
of 226 female students aged 13-18 years old divided into two groups: 113
participants with normal and 113 with abnormal thoracic hyper-kyphosis. The
kyphosis angle was measured using a flexible ruler, and the Y test, Davis test, and
disabilities of the arm, shoulder, and hand (DASH) questionnaire were used to
measure upper extremity function. Independent t-test and Pearson’s correlation
were employed for data analysis.
Results: The Davis, Y, and DASH test results showed a significant difference
in upper extremity function between subjects with and those without thoracic
hyper-kyphosis (P<0.05), with the abnormal thoracic hyper-kyphosis group
showing poorer function than the normal group. The results also demonstrated
a significant relationship between the kyphosis angle and the Davis, Y, and
DASH tests (P<0.05).
Conclusion: Overall, kyphosis abnormality was found to lead to weak upper
extremity function, and an inverse relationship was observed between the
kyphosis angle and the Davis test and Y balance test. Moreover, a direct
relationship was found between the kyphosis angle and DASH test.

Abstract Background: The Covid-19 pandemic has led to the largest disruption in
education systems in human history. The use of online teaching increased daily,
finally affecting more than 200 million students worldwide. The aim of the
present study was to compare the prevalence of musculoskeletal pain in female
students during the Covid-19 pandemic with the pre-pandemic period.
Methods: This cross-sectional study was performed in two stages: before
the Covid-19 pandemic (October to December 2019) and during the
Covid-19 pandemic (January to February 2020). The Nordic Musculoskeletal
Questionnaire (NMQ) was used to determine the musculoskeletal pain points.
Data was analyzed using the t-test, McNemar test, and logistic regression in
SPSS ver. 22, and a P<0.05 was considered as the significance level.
Results: A significant decrease in the hours of physical activity (PA) was observed
during the pandemic (3.17±2.17 hours/week) (P<0.001) compared to the prepandemic
period (4.76±4.92 hours/week), and a significant increase in hours of
using e-learning aids was seen during the pandemic (45.29±23.24 hours/week)
compared to the pre-pandemic period (13.01) (P<0.001). The McNemar test
revealed a significant difference in musculoskeletal pain in nine areas before and
during the Covid-19 pandemic (P<0.001). The results of the regression test also
showed that increasing the hours of online teaching and decreasing the hours of
PA increased the odds ratios of increasing musculoskeletal pain.
Conclusion: Based on the present results, changing the teaching method during
the Covid-19 pandemic and reducing physical activity has led to an increase in
musculoskeletal pain in students.

Abstract Background: Coronary Artery Bypass Graft (CABG) surgery is associated
with several complications. Balance disorders have been reported in patients.
The impairments were associated with fall-related injuries and increase the
possibility of morbidity, mortality, and healthcare costs. The present study
aimed to compare postural balance before and after CABG surgery in patients
with established coronary artery disease.
Methods: This cross-sectional study was conducted on 87 patients aged 45-65
years who had undergone CABG surgery through the great saphenous vein.
Participants were enrolled into the study by convenience sampling. To assess
static balance, individuals were asked to perform the Single Leg Stance Test
(SLST). In addition, dynamic balance was measured by the Y-balance test, and
the Functional Reach Test (FRT) was conducted before and after CABG surgery.
These clinical tests were performed during the week before surgery and repeated
one month after that. Paired t-test was used to compare the Y-balance scores,
and Wilcoxon test was used to compare the mean values of other outcomes
before and after CABG surgery. A level of P<0.05 was considered statistically
significant.
Results: The results revealed a significant decrease in static and dynamic balance
after CABG surgery (P<0.001). A significant reduction was also observed in the
mean FRT scores in the postoperative period (P<0.001).
Conclusion: CABG surgery through the great saphenous vein influenced
balance in patients with coronary artery disease.

Abstract Background: The objective of this study was to whether handgrip and
quadriceps strength can predict post-stroke depression (PSD) and post-stroke
anxiety (PSA).
Methods: This cross-sectional study involved sixty-six consenting stroke
patients whose symptoms of depression and anxiety and affected handgrip and
quadriceps strength were assessed by the Hospital Anxiety and Depression Scale
(HADS) and handheld dynamometers. Data was analyzed using descriptive and
inferential statistics. Alpha level was set at P<0.05.
Results: The participants’ mean handgrip and quadriceps strength were 19.03
kg and 20.70 kg, respectively, while the prevalence of PSD and PSA were 33.4%
and 42.4%, respectively. PSD was significantly correlated with PSA (r=0.61;
P<0.001), handgrip strength (r=-0.24; P=0.049), functional independence
(r=-0.26; P=0.036), and stroke severity (r=0.26; P=0.039), while PSA was
significantly correlated with stroke severity (r=0.25; P=0.046) and age (r=-
0.25; P=0.048). Multiple linear regression results indicate that handgrip and
quadriceps strength were not independent predictors of PSD and PSA (P>0.05);
however, the presence of PSA was an independent predictor of PSD (B=0.590;
P<0.001), while the presence of PSD (B=0.621; P=0.001) and younger age (B=-
0.307; P<0.001) were independent predictors of PSA.
Conclusion: Handgrip and quadriceps strength are not significant predictors of
PSD and PSA in stroke survivors; however, PSD and PSA can predict each other,
indicating a bi-directional relationship, while age is a negative predictor of PSA.

Abstract Ethics and law studies examine several issues in the field of medicine, one of which is the legal aspects related to patients living with mental disability. In a previous article, we introduced a 24-year-old female patient living with mental disability, diagnosed with large tumor growth in her right breast. Inadequate self-care as well as lack of breast self-examination were the causes of delayed referral and late diagnosis. The patient's family stated that no periodic breast examination was performed by the family or health centers. The patient's family did not have sufficient knowledge about caring for patients with mental disabilities. The question that will then arise under such circumstances is, will the legal system protect the incapacitated individuals if they or their family cannot provide for themselves? In this article, we discuss this issue and the existing legal vacuum.