Journal of Modern Rehabilitation

The Genetic Basis of Auditory Neuropathy Spectrum Disorder

Majid Karimi — 2026-02-15

Introduction: Despite normal outer hair cell function, auditory neuropathy spectrum disorder (ANSD) disrupts neural coordination and impairs speech comprehension, especially in noisy environments.This review study explores the genetic mechanisms underlying ANSD.

Materials and Methods: PubMed, Scopus, and Web of Science were searched from 2010 to 2023 for studies on ANSD genetics, excluding those focused on non-genetic causes or lacking relevant data.

Results: ANSD is associated with conditions such as Brown-Vialetto-Van Laere syndrome (BVVL) and Charcot-Marie-Tooth (CMT) disease, often resulting from mutations in the auditory nerve. Nonsyndromic ANSD is associated with genes such as OTOF and PJVK, which are essential for neural function.

Conclusion: ANSD is a multifactorial condition resulting from genetic mutations in key genes, which disrupt auditory pathways and impair sound signal transmission. Further research is needed to identify additional genes and understand molecular mechanisms contributing to ANSD. This knowledge will improve diagnosis, prognosis, and therapeutic strategies, and could lead to innovative treatment approaches in the future.

Design Recommendations for User-Centered Games for Multiple Sclerosis Balance Rehabilitation: An Evidence Review

Hiyam Ibrahim — 2026-02-15

Introduction: In recent years, exergames have emerged as a potential rehabilitation tool to address balance dysfunction in patients with multiple sclerosis (PwMS). Although preliminary findings have held promises, their overall effectiveness remains inconclusive, primarily because they rely on commercial games. This issue underscores the critical need for user- centered games tailored to patients’ specific needs. Despite this necessity, the existing literature lacks established frameworks to develop such games, highlighting a gap. Therefore, the objective of this research was to propose the first evidence-based framework to create user- centered games for balance rehabilitation in PwMS.

Materials and Methods: A two-step method was used to achieve this objective. The first step involved examining commercial games used in clinical studies, identifying their mechanics and limitations. The second step involved reviewing the literature to identify relevant findings that could help the development of user-centered games.

Results: A set of targeted recommendations was proposed, emphasizing the need to develop adaptable games with focused therapeutic designs and to address the distinct balance impairments observed in PwMS effectively. A game prototype was also presented to illustrate the practical applications of these recommendations.

Conclusion: This research establishes the first structured framework to design user-centered exergames for balance rehabilitation in PwMS. In addition to its theoretical insights, this framework provides actionable guidelines for developing clinically effective exergames that align with patient impairments and therapeutic needs. Ultimately, this work will contribute to improved therapeutic outcomes, enhanced patient care, and advancements in both rehabilitation and game design fields.

Comparing Functional Movement Screen Scores and Performance between Male and Female Soccer Players

Alireza Zare — 2026-02-15

Introduction: Soccer is the most popular sport globally for both men and women. The functional movement screen (FMS) is a 7-part standardized tool created by experts to evaluate movement quality. This research compares FMS scores and performance between male and female soccer players.

Materials and Methods: A total of 60 semi-professional soccer players (30 males and 30 females) participated in this study. All participants completed the FMS test, Y-balance test, Davies test, single hop for distance, and cross-over hop test. Between-group comparisons were performed using an independent t test for normally distributed variables and the Mann- Whitney U test for non-normally distributed variables.

Results: There were no significant differences between male and female players in deep squat, hurdle step, in-line lunge, or overall FMS score (P>0.05). However, significant differences were found in shoulder mobility, active straight leg raise, trunk stability push-up, and rotary stability (P<0.05). Men performed better in trunk stability, while women excelled in shoulder mobility and active straight leg raise. Men outperformed women in the single-hop distance and the cross-over hop. In upper extremity performance, males performed better in the Davies test and dynamic balance in the superolateral direction, with no significant differences in other upper extremity dynamic balance directions.

Conclusion: The study’s findings demonstrate the necessity of gender-specific training programs to enhance performance and reduce injury risk. According to the findings, it is recommended that flexibility and mobility exercises be implemented for male soccer players and that core stability and strength training be implemented for female soccer players

Effects of Repetition Rate on Tone Burst Auditory Brainstem Responses in Normal Young Adult Wistar Rats

Akram Pourbakht — 2026-02-15

Introduction: The repetition rate of a stimulus serves as a crucial criterion in audiological assessments for differential diagnosis in certain special populations. Therefore, this study aimed to evaluate the normal variation of auditory brainstem response (ABR) parameters, including latency, amplitude, morphology, and component duration (width), using two different rates of tonal stimuli with varying frequencies in Wistar rats.

Materials and Methods: In this experimental study, 45 young adult male Wistar rats were subjected to ABR measurements using tone burst stimuli at octave frequencies ranging from 2 to 16 kHz, with two rates of 11.1 and 57.1/s, following the relevant protocols. The stimuli were delivered at an intensity of 80 dB SPL and through a speaker.

Results: At a high rate, latency changes in later waves were greater than those in earlier components, whereas amplitude changes in later waves were smaller than those in earlier ones. Rate-dependent changes, as a function of frequency, were uniform for both latency and amplitude. Morphologically, ABR components were broadened in a frequency-dependent way. The duration of wave I was shorter than that of wave IV, and the wave duration changes were influenced by frequency. These findings were statistically significant (P<0.05).

Conclusion: The results can be attributed to differences in adaptation mechanisms within the auditory system, the additive synapse theory, and desynchronization resulting from increased stimulation rates. Knowledge of the various effects of rate as a function of frequency on ABR parameters in normal rats is essential to understanding how different changes in these parameters at each wave could lead to a more precise diagnosis in neuro-pathological conditions

KineFeet,aNovel Depth Camera-BasedWebApplication for Diagnosing Foot Kinematics Alterations

Fitri Anestherita — 2026-02-15

Introduction: Altered foot kinematics during walking, including reduced tibial inclination (the angle between the tibia and a vertical line during gait), as well as medial longitudinal arch (MLA) flattening and first metatarsophalangeal (MTP1) extension angle, have been linked to various musculoskeletal disorders. Such abnormalities can have significant clinical implications; therefore, it is crucial to accurately identify them.

Materials and Methods: We aimed to assess the diagnostic accuracy of KineFeet, a web-based application that employs a depth camera technique to detect foot kinematic changes for human gait analysis. KineFeet software, version 1.3 and Kinovea gait analysis software, version 2023.1.2 were used to diagnose altered foot kinematics in 89 healthy participants in this cross-sectional study. The main kinematic parameters investigated were the ankle inclination angle at terminal stance (AI_TSt), the MLA angle at terminal stance (MLA_TSt), and the MTP1 angle 1 at maximal hallux extension (MTP_ HE). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the receiver operating characteristic (ROC) area under the curve (AUC) were computed.

Results: KineFeet showed excellent diagnostic performance. AI_TSt had a sensitivity of 88.23% and a specificity of 95.83%, with PPV and NPV values of 83.33% and 97.18%, respectively (AUC=0.97). MLA_TSt and MTP_HE also had high discriminative abilities, with sensitivities of 79.54% and 79.00%, specificities of 95.55% and 91.30%, and attributed AUCs of 0.94 and 0.91, respectively.

Conclusion: KineFeet can accurately detect foot kinematic deformities during human gait. Its high diagnostic accuracy makes it a promising screening and evaluation tool. Further studies on human gait pathologies are warranted

The Relationship between Cognitive Function, Syntax, and Severity of Dysarthria in Persian-Speaking Patients with Multiple Sclerosis

Mohsen Miarkiani — 2026-02-15

Introduction: Multiple sclerosis (MS) is a degenerative disease affecting the central nervous system. Patients with MS experience several difficulties in the fields of speech, language, and cognitive abilities. This study aimed to investigate the relationship between cognitive functions, syntax, and the severity of dysarthria in Persian-speaking patients with relapsing-remitting multiple sclerosis (RRMS), as well as comparisons with healthy non-patient individuals.

Materials and Methods: This cross-sectional study compared 31 patients diagnosed with RRMS to 31 healthy adults matched with the patient group based on age, gender, and education level. Participants were assessed using the montreal cognitive assessment (MoCA), as well as the syntax comprehension subtest from the bilingual aphasia test and the sentence production test. Additionally, the presence of dysarthria was evaluated through the Frenchay dysarthria assessment (FDA-2), and the dysarthria’s severity was determined using the visual analog scale (VAS) by three Speech and language pathologists based on the recorded speech samples.

Results: The findings revealed a significant difference between MS patients and the control group (P≤0.05). Additionally, the results showed a significant correlation between dysarthria severity and both syntax comprehension (P=0.002, Cohen’s d=0.803) and syntax production (P=0.005, Cohen’s d=0.820), as well as the MoCA (P = 0.001, Cohen’s d = 0.579). Furthermore, significant correlations were also found between the MoCA and both syntax comprehension and syntax production within the patient group (P≤0.05). The data was analyzed by SPSS software, version 26. The difference between the two groups was calculated using the independent t-test, and the correlation between them was analyzed using the Spearman test at a significance level of P≤0.05.

Conclusion: Syntactic challenges in MS patients might be linked to underlying cognitive impairments, and as the severity of dysarthria increases in patients, their syntactic problems also escalate. The results of this study can help speech and language pathologists in clinical evaluations and in providing comprehensive treatment plans for patients with MS.

Developing a Narrative Test and Determining its Psychometric Properties for Persian-Speaking Children Aged 4 to 5 Years

Fahime Ardeshiri — 2026-02-15

Introduction: Between the ages of 2 and 7, children develop the ability to narrate stories with improved detail and organization, including main characters, events, responses, efforts, and settings. Narrative assessment, a tool for evaluating language development, allows speech pathologists to examine syntax, vocabulary, and complexity. This study aimed to develop a tool for assessing storytelling skills in children aged 4-5 years.

Materials and Methods: This study was conducted in two stages. In the first stage, the story was created, images were designed, and speech therapists assessed face validity. In the second stage, a descriptive-analytical study was conducted in kindergartens in Tehran City, Iran, in 2023. Children were asked to narrate stories based on the provided images, and their narratives were scored using story grammar analysis. Psychometric evaluations included construct validity (assessed via paired t-test), inter-rater reliability (measured using Cohen’s kappa), test- re-test reliability (analyzed with the Pearson correlation), and internal consistency (evaluated using the Cronbach α).

Results: The speech therapists evaluated and confirmed the face validity of the story and images, implementing necessary adjustments. In this regard, construct validity was significant (P=0.000), indicating alignment with typical development. Inter-evaluator reliability (κ=0.712) and test-re-test reliability (r=0.591) were moderate to good. Internal consistency varied, with α>0.5 in one story and α<0.5 in others.

Conclusion: The test demonstrates validity and moderate reliability, suggesting its suitability for practical applications.

Architectural Features of Rehabilitation Environments That Affect Information Processing in Children with Attention-Deficit/Hyperactivity Disorder

Sasan Khademi Kalantari — 2026-02-15

Introduction: Numerous studies have demonstrated that physical environments play a critical role in regulating behavior and information processing in children with attention-deficit/ hyperactivity disorder (ADHD). This study aims to identify the architectural features of rehabilitation environments and examine their relationship with the information-processing abilities of children with ADHD.

Materials and Methods: A total of 35 children (mean age=7.6 years; range=5-10 years) diagnosed with ADHD from 10 rehabilitation centers in Tehran, Iran, were recruited for this descriptive-analytical study. Data were collected using a researcher-designed questionnaire to evaluate important architectural elements in rehabilitation centers and were validated for content and construct validity (Cronbach α=0.81). A professional architect evaluated the total score and the score for each item of the questionnaire. The sensory improvement of the children was also assessed using the short sensory profile (SSP) questionnaire twice: at baseline and after one month of their treatment. The correlation between each architectural item and the improvement in the children’s sensory profiles was assessed using the Pearson correlation test.

Results: A significant positive and moderate correlation between elements such as natural light (r=0.58), calming color schemes (r=0.55), and noise reduction (r=0.49), with improved information processing ability in children with ADHD (P<0.01).

Conclusion: The results suggest that carefully designed and intentional architectural environments can play a significant role in enhancing cognitive performance in children with ADHD. It is recommended that architects and rehabilitation professionals collaborate more closely to meet the perceptual and cognitive needs of these children in the design of their spaces.

Association between Signs and Symptoms of Dry Eye in Patients with and without Sjögren’s Syndrome

Mojtaba Mohammadpour — 2026-02-15

Introduction: To compare objective clinical signs and subjective symptoms of dry eye disease (DED) in patients with and without primary Sjögren’s syndrome (SS).

Materials and Methods: This study included patients diagnosed with DED due to primary SS and patients with DED without SS (non-SS DED), all meeting the inclusion criteria at Helal Hospital (Tehran, Iran). Objective clinical assessments, including tear film breakup time (TBUT), Oxford corneal staining, tear osmolarity, and Schirmer’s test I, were conducted in both groups. Subjective symptoms were assessed using the ocular surface disease index (OSDI) questionnaire. Correlation coefficients were calculated using linear regression analysis.

Results: This study was conducted from January 2023 to February 2024. Forty patients were included: 20 with SS DED and 20 with non-SS DED. The non-SS DED group had a significantly higher OSDI score (41.66±7.50) than the SS DED group (37.29±6.04; P=0.05). Tear secretion, measured by Schirmer I, was significantly higher in the non-SS DED group (P<0.01), whereas corneal staining scores were higher in the SS DED group (P<0.01). The association between OSDI scores and objective clinical test results was weak in both groups. Among SS DED patients, OSDI scores showed a moderate and significant correlation with disease duration (r=−0.529, P=0.017). Additionally, within this group, higher tear osmolarity showed a very weak correlation with lower OSDI scores (r=−0.383, P=0.096).

Conclusion: There is a weak and inconsistent association between subjective symptoms (OSDI scores) and objective clinical signs of DED in both patients with and without primary SS. Patients with SS may underreport their discomfort despite having more severe clinical signs of DED.

Neuromuscular Electrical Stimulation and Exercise for Quality of Life in Hospitalized Chronic Heart Failure

Samaneh Dezhbarar — 2026-02-15

Introduction: Heart failure (HF) is one of the most common cardiovascular diseases, which is considered a progressive and debilitating disorder. One of the main problems in these patients is frequent hospitalizations due to the exacerbation of symptoms. Therefore, this study aims to investigate the simultaneous effect of muscle electrical stimulation (ES) and exercise therapy on quality of life and functional capacity in hospitalized patients with chronic heart failure (CHF).

Materials and Methods: The present study included 40 hospitalized patients with chronic HF among the volunteers, who were randomly divided into two groups of 20 patients. The first group underwent cardiac rehabilitation that included resistance training (RT) and muscle electrical stimulation (RT+ES). The second group received only a RT program, which consisted of performing three leg presses, cuff presses, and triceps movements with a theraband. Functional capacity and quality of life were evaluated before and after the intervention.

Results: Quality of life index in the RT+ES group increased more than that in the RT group (P≤0.05). Although the functional capacity in both groups increased compared to the pre-test (P≤0.05), there were no significant differences between the two groups (P≥0.05).

Conclusion: RT with ES during hospitalization improves the quality of life and functional capacity of patients with CHF.