Journal of Rehabilitation Sciences & Research

Abstract Background: Coping refers to cognitive and behavioral efforts made to manage stressful situations. Caring for people with multiple sclerosis (MS) is associated with increased stress among caregivers. Recognizing and managing caregivers' coping strategies can facilitate the rehabilitation of people with MS and improve the quality of care. Therefore, this study was conducted to translate and evaluate the validity and reliability of the Persian version of the Coping with MS Caregiving Inventory (CMSCI).
Methods: In this methodological study, 170 caregivers of people with MS were investigated. The Persian translation of this scale was conducted using the International Quality of Life Assessment (IQOLA) method. The face validity of the CMSCI was assessed through a survey of 10 caregivers, and content validity was evaluated using both qualitative and quantitative methods, including the content validity index and the content validity ratio. To evaluate the reliability of the CMSCI, a test–retest procedure was conducted with 54 caregivers who completed the questionnaire twice at an interval of 10 days. Internal consistency was assessed using Cronbach’s alpha.
Results: The mean (SD) age of caregiver participants in this study was 42.3 (11.1) years. The mean (SD) age of people with MS under the caregivers’ care was 38.6 (9.2) years. The test–retest reliability coefficient of the CMSCI was calculated as 0.82, indicating acceptable stability. The internal consistency of the CMSCI, assessed using Cronbach’s alpha, was 0.75.
Conclusion: The Persian version of the CMSCI demonstrated good validity and reliability for assessing coping strategies among caregivers of people with MS. Considering the vital role of caregivers in the treatment team and the impact of effective coping strategies on the quality of care for people with MS, the use of the CMSCI can be beneficial for evaluating and improving the rehabilitation process for both people with MS and their caregivers.

Abstract Background: The purpose of this study was to systematically evaluate studies assessing the association between obesity and lung function in adult individuals.
Methods: This systematic review conducted a comprehensive search of databases, including PubMed, Scopus, ScienceDirect, EMBASE, ProQuest, and Google Scholar, up to 30 June 2021. Keywords used were: “obesity,” “overweight,” “breathing function,” “respiratory function,” “breathing physiology,” and “breathing disorders.” Study selection, data extraction, and quality assessment were conducted independently by two reviewers.
Results: Sixteen articles met the inclusion criteria: eight cohort studies, four case-control studies, and four cross-sectional studies.
Conclusion: Based on the Critical Appraisal Skills Programme (CASP) quality assessment tools, all included studies were rated as high quality, except for one cohort study (approximately 6% of the total), which was rated as moderate quality. According to the results of these 16 studies, there is a strong inverse correlation between obesity severity and certain lung volumes and capacities in adults.

Abstract Background: Children’s language skills develop based on physical development and experience. During pandemics such as COVID-19, numerous restrictions were imposed on people’s lives. Such restrictions may have compromised children’s life experiences. This study investigated the rate of language impairment (LI) among 5-year-old children after the COVID-19 pandemic.
Methods: This cross-sectional study examined the language skills of 340 Persian-speaking children aged 5 years. All participants had no defects identified in preschool screening, had not been recommended for speech therapy or rehabilitation services, and represented all socioeconomic levels based on maternal education and fathers’ jobs. Language skills were assessed using the Farsi Language Development Test-3. A cutoff point of 1.25 standard deviations below the mean on the spoken language composite score was considered indicative of LI. The data were analyzed using appropriate statistical tests.
Results: More than 20% of the children obtained standard scores below 6.25 on the relational vocabulary, sentence imitation, and word differentiation subtests. The children’s language age in these subtests was three years, corresponding to two years below their chronological age. Spoken language scores were significantly lower in boys, in children whose mothers had lower educational levels, and in those whose fathers were private employees compared with their counterparts (p < 0.05).
Conclusion: This study showed that the rate of language impairment (LI) among Persian monolingual individuals increased significantly at the end of the COVID-19 pandemic. This increase may be a consequence of COVID-19-related circumstances or pandemic-related effects on family life.

Abstract Background: Online training for the rehabilitation of people with spinal cord injuries (SCI) is essential. Various environmental barriers can make it challenging for individuals to attend face-to-face interventions. This study aimed to investigate the effectiveness of online group wheelchair mobility and transfer training on occupational performance and satisfaction in people with SCI.
Methods: In this single-blind randomized controlled trial, individuals with SCI were recruited from SCI association hospitals and clinics, and randomly assigned to an online training group (OTG) or a control group (CG) using blocked randomization. The OTG participated in five online training sessions over five weeks, while the CG received routine guidance via an individual online booklet. Outcomes were assessed post-intervention and at one-month follow-up immediately to evaluate changes in occupational performance and satisfaction. Treatment efficacy and between-group comparisons were analyzed using repeated measures analysis of variance (ANOVA).
Results: A total of 37 participants (CG = 18; OTG = 19) completed the 5-week intervention and follow-up assessments out of 49 enrolled. The mean age of participants was 35.0 years in the CG and 33.7 years in the OTG. Significant performance improvements (p < 0.001) and satisfaction (p < 0.001) were observed within the OTG during pre-post assessments. Additionally, significant differences between groups were found in both performance (p = 0.026) and satisfaction (p = 0.015).
Conclusion: The findings indicate that online wheelchair mobility and transfer training is an effective and feasible method for telerehabilitation in people with SCI.

Abstract Background: Specific learning disorder is an increasingly prevalent problem worldwide. It is directly associated with decreased self-confidence and higher dropout rates among affected children. Therefore, the purpose of this study is to develop a protocol for a systematic review of screening instruments for specific learning disorders in children and adolescents.
Methods: To conduct a task accurately, a precise protocol is required. This systematic review protocol will be developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. It intends to review articles that have validated different screening instruments for specific learning disorders in children and adolescents. PubMed, Web of Science, Scopus, Cochrane Library, and PsycINFO will be searched for peer-reviewed publications. Gray literature will also be reviewed. Eligible studies will be assessed using the Modified Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias checklist to evaluate their methodological quality.
Results: Many researchers and clinicians use instruments to screen for specific learning disorders. However, there is no comprehensive study that identifies the most appropriate instruments or that collectively reports their benefits, gaps, and psychometric properties.
Conclusion: This study will review these instruments to evaluate their benefits and limitations and to provide information on their psychometric indices and methodological quality, using the Modified Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This protocol, which is essential for conducting a robust review, provides a clear framework for the systematic evaluation of screening tools for specific learning disorders.

Abstract Background: Increased digital device use and reduced physical activity among students during the COVID-19 pandemic have been associated with a rise in postural problems. This study investigated the relationship between body types—ectomorph, mesomorph, and endomorph—and the duration of digital device use in relation to changes in spinal angle in female middle school students during the COVID-19 pandemic.
Methods: A descriptive-correlational study was conducted. The study population consisted of female students aged 13 to 15 from first secondary-level schools in Chenaran City during the academic year from October 7, 2021, to December 1, 2021. From a total of 10 first-grade girls’ high schools (approximately 1,000 students), four schools were randomly selected. Of these, 150 students were randomly selected and assessed using inclusion and exclusion criteria. Research tools included an informed consent form, anthropometric measurement instruments, the Smartphone Addiction Scale–Short Version (SAS-SV), a goniometer, a flexible ruler (IDIO brand), and a craniovertebral angle measurement tool. Data were analyzed using Spearman’s correlation coefficient in SPSS version 22.
Results: No significant relationship was found between body type and kyphosis angle (p = 0.651, r = 0.038), lordosis angle (p = 0.083, r = 0.147), or forward head angle (p = 0.785, r = 0.023). However, a significant correlation was observed between the duration of digital device use and both kyphosis angle and forward head angle, but not with the lordosis angle.
Conclusion: Prolonged digital device use significantly influences spinal alignment, particularly increasing kyphosis and forward head angles. Although body type did not show a significant effect, factors such as physical activity and age should be considered when addressing posture-related issues. This study highlights the importance of educating students on proper posture and limiting screen time to prevent potential spinal health problems.

Abstract Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental condition that impairs motor skills and can negatively affect attention and executive function. Additionally, the presence of comorbid neurodevelopmental disorders may further influence cognitive performance in children with DCD. This comparative study aimed to examine differences in two components of executive function between children with DCD and their typically developing (TD) peers.
Methods: In this causal-comparative study, 250 primary school students in Sepidan (mean age = 8.86 ± 0.44 years) were screened using the Movement Assessment Battery for Children–Second Edition (MABC-2) to identify children with DCD and TD children. Twenty children diagnosed with DCD were compared with their TD peers on two executive function tasks: working memory, assessed with the N-Back test, and cognitive flexibility, assessed with the Simple Stroop test. Multivariate and univariate analyses of variance were conducted to examine group differences in executive functions.
Results: Children with DCD demonstrated significantly lower accuracy on the working memory task (correct responses: 56.60 ± 21.43) compared with TD children (97.90 ± 13.42, P = 0.001). Additionally, their response times were significantly longer (910.35 ± 174.92 ms vs. 745.4 ± 164.35 ms, P = 0.004). In terms of cognitive flexibility, the interference score was significantly higher in DCD children (11.2 ± 6.32) than in TD children (5.4 ± 2.99, P = 0.001), indicating poorer performance.
Conclusion: The findings indicate that TD children outperform children with DCD in both working memory and cognitive flexibility. These deficits in multiple executive function components among children with DCD underscore the importance of early motor and cognitive interventions to support cognitive development in this population.

Abstract Background: This study investigates the effects of DIR/Floortime™ on the social skills and social adjustment of children with mild autism spectrum disorder (ASD). The aim is to evaluate whether training in Floortime™ significantly enhances the social capabilities and adjustment of children with autism spectrum disorder.
Methods: A quasi-experimental design was employed. Data were gathered using the Gresham and Elliott Social Skills Scale and Bell’s Social Adjustment Inventory. Participants included 30 children diagnosed with mild ASD and their families, who participated in eight Floortime™ intervention sessions.
Results: The results indicated significant improvements in social communication and emotional regulation among the children. Parents reported enhanced parent-child interactions and increased engagement in daily activities, highlighting the intervention's positive impact on family dynamics. Statistical analyses also demonstrated meaningful improvements in children’s ability to initiate joint attention and respond to social cues, both of which are vital for effective communication.
Conclusion: Family-oriented DIR/Floortime™ is an effective intervention for enhancing the social skills and social adjustment of children with mild ASD. The study emphasizes the importance of parental involvement and individualized interventions in supporting child development. Future research is recommended to explore the long-term effects of Floortime™ on social functioning across diverse settings.

Abstract Background: The present study aimed to evaluate differences in shoulder strength, muscle length, and proprioception between the dominant and non-dominant limbs of individuals with and without uneven shoulders.
Methods: This cross-sectional comparative study included 20 females with uneven shoulders and 20 age-matched controls (aged 20–30 years), selected through purposive sampling. Shoulder asymmetry was assessed using digital photography and analyzed with AutoCAD 2020. Muscle strength was measured using a manual dynamometer, proprioception was evaluated via joint angle reconstruction errors using a goniometer, and muscle length was assessed with standardized tests. Data were analyzed using SPSS version 22.
Results: Significant differences were observed between the groups in mean error of shoulder flexion angle reconstruction (p = 0.049, d = 0.56) and internal rotation (p = 0.037, d = 0.61), as well as in the lengths of the pectoralis minor (p = 0.036, d = 0.58) and levator scapulae muscles (p = 0.021, d = 0.64). Participants with uneven shoulders exhibited greater side-to-side differences compared to the control group. No statistically significant differences were found between groups regarding shoulder strength or upper trapezius muscle length.
Conclusion: Individuals with uneven shoulders demonstrated greater errors in joint position sense and asymmetries in specific muscle lengths. These findings suggest that uneven shoulders may be associated with impaired proprioception and altered muscle length, particularly in the pectoralis minor and levator scapulae muscles.

Abstract Background: Anterior cruciate ligament (ACL) injuries are common in soccer and can substantially impair postural stability and athletic performance. The Prevent Injury and Enhance Performance (PEP) program has been developed to reduce the risk of ACL injury. This study aimed to examine the effects of an 8-week PEP training program on time to stability (TTS) and center of pressure (COP) parameters in soccer players with and without ACL reconstruction (ACLR).
Methods: This semi-experimental study employed a pre-test–post-test design. Twenty-one male soccer players (mean age: 25.43 years) at an average of 15.12 months post-ACLR and 21 healthy male soccer players (mean age: 22.79 years) participated. Participants performed a jump-landing task, and COP variables and TTS were measured before and after the 8-week PEP training program. Within-group comparisons were conducted using paired t-tests, while between-group differences were analyzed using one-way ANOVA. Statistical significance was set at p ≤ 0.05.
Results: Within-group analyses demonstrated significant reductions in mediolateral (M-L) COP fluctuations (p = 0.018) and M-L TTS (p = 0.001) in the healthy group. In the ACLR group, significant improvements were observed in M-L COP fluctuations (p = 0.001), M-L COP variability (p = 0.034), total TTS (p = 0.015), and M-L TTS (p = 0.001) following the intervention. Pre-test between-group comparisons revealed significantly greater M-L COP fluctuations (p = 0.001), M-L COP variability (p = 0.044), and total TTS (p = 0.021) in the ACLR group. However, no significant between-group differences were observed post-intervention (p > 0.05), suggesting that the PEP program effectively reduced postural control deficits in the ACLR group to levels comparable with healthy players.
Conclusion: The 8-week PEP training program produced significant improvements in postural control in both healthy and ACLR soccer players. These findings support the potential effectiveness of structured neuromuscular training programs in reducing postural instability and possibly lowering the risk of ACL injury or re-injury.