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Background Despite the high prevalence of anxiety among chronic stroke survivors and evidence of its negative effects on postural control in healthy subjects, it is unclear whether anxiety also affects postural control in these patients. Recent evidence of improved postural control of healthy subjects by distracting the attention using an external focus (EF) or cognitive task, raises the question of whether similar benefits would be observed in stroke survivors. Thus, the current study aimed to investigate the effects of anxiety and distracting the attention on postural control of chronic stroke survivors in terms of both postural sway measures and neuromuscular regulation. Methods Postural sway measures and ankle muscle activity of chronic stroke survivors with the high and low level of anxiety (HA-stroke (n = 17), and LA-stroke (n = 17), respectively) and age-, sex-, height-, and weight-matched healthy subjects (n = 17) were assessed while standing on rigid and foam surfaces under following conditions: baseline, internal focus (IF), EF, simple and hard cognitive tasks (SC and HC, respectively). Results Stroke survivors, particularly HA-stroke participants, showed greater postural sway measures (i.e. postural instability) and enhanced co-contraction of ankle muscles (i.e. stiffening of the neuromuscular system) compared with healthy subjects. As opposed to baseline and IF conditions, postural instability and neuromuscular stiffening significantly reduced in EF condition and decreased more in cognitive task conditions, particularly HC condition. Conclusions The results suggest that anxiety enhances stroke-induced postural instability promoting improper neuromuscular control of posture with stiffening strategy, which can be alleviated by EF and cognitive tasks.

Objectives: This study aimed to investigate the effect of upper extremity coordination exercises based on fatigue prediction on fine and gross manual dexterity, upper limb motor function, shoulder and elbow proprioception, occupational performance, and activities of daily living in chronic stroke survivors. Methods: In this pilot double-blind randomized clinical trial, 24 chronic strokes were enrolled using the non-probability sampling method. Participants were randomly allocated to the control (received routine occupational therapy) and intervention (received upper extremity coordination exercises based on fatigue prediction using the Kinect) groups. Before and after the interventions (six weeks, three sessions/week, 45 min/session), as well as six weeks after completion of interventions, participants were assessed using the following tools: Box-Block Test, Purdue-Pegboard Test, Wolf-Motor Function Test, Action Research Arm Test, Manual Ability Measure-16, Grip Dynamometer, Shoulder Position Sense Test (SPST), Elbow Position Sense Test (EPST), Canadian Occupational Performance Measure, Shah-Barthel Index (SH-BI), and Multi-dimensional Fatigue Inventory. This project was carried out in the rehabilitation department of Shafa-Yahyaeian Hospital from May 2019 to June 2020. Results: The results showed a significant improvement in all assessments of both control and intervention groups (P≤0.05), except for SH-BI. Further, the improvement of EPST and SPST scores in the intervention group was significantly greater than the control group (P≤0.05). Also, a significant decrease in fatigue severity was observed in both control and intervention groups (P≤0.05). Conclusion: These results suggest that upper extremity coordination exercises based on fatigue prediction in combination with routine occupational therapy could lead to improvement of upper extremity sensory-motor functions and power grip and caused a decrease in fatigue severity in chronic stroke.

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Introduction: Hookah use has been increasing among students in recent years. Despite the effect of health literacy skills on smoking prevention and cessation, investigating the relationship between health literacy skills and hookah use is still neglected. Therefore, the present study aimed at determining the relationship between hookah use and health literacy skills among university students. Materials and methods: This was a descriptive-cross-sectional study conducted at Esfarayen Medical Sciences University in 2022, in which 214 university students were selected by a simple random sampling method. The data collection instrument was a questionnaire that had two parts: the first part was related to demographic and background characteristics and determined using or not using hookah. The second part was an adult health literacy questionnaire (HELIA). The data were analyzed using SPSS 23 software and descriptive statistics and logistic regression. Findings: The frequency of hookah use was 17.3% (37 people). Among the five health literacy skills, the two skills of comprehension and access had the highest average score and the two skills of decision-making and application of health information and reading had the lowest average score. According to the results of the logistic regression, gender, amount of physical activity per week, smoking, decision-making skills, and the use of health information, understanding and evaluation were the factors affecting the use of hookah. Conclusion: The use of hookah was more among male students, students with less physical activity, smoking students, students who had weaker decision-making skills, and those who used less health information, understanding, and evaluation. Therefore, it is necessary to pay more attention to these students in designing educational programs to prevent and quit hookah use.