Effectiveness of the virtual reality on cognitive function of children with hemiplegic cerebral palsy: a single-blind randomized controlled trial Cerebral palsy is a term covering non-progressive motor and cognitive impairments caused by lesions of the brain. This study aims to evaluate the effectiveness of virtual reality-based rehabilitation program for children with hemiplegic cerebral palsy on cognitive functions. Ninety children (47 boys, 43 girls) with hemiplegic cerebral palsy were randomized to either study (n = 45; 11.18 ± 3.37 years) or control (n = 45; 11.06 ± 3.24 years) groups. The study group received virtual reality intervention in addition to Traditional Occupational Therapy intervention, and the control group received Traditional Occupational Therapy for 20 sessions. Both groups were evaluated by blinded assessors with Dynamic Occupational Therapy Cognitive Assessment for Children to collect information on cognitive functioning. Both groups' cognitive functions were improved after 10 weeks of interventions. The between-group comparison revealed significantly greater improvements in all subtest of cognitive functions in the virtual reality group than in the Traditional Occupational Therapy group (P < 0.001). Our results showed that 10 weeks of virtual reality-based rehabilitation enhanced cognitive functions in children with hemiplegic cerebral palsy. Using virtual reality applications in cognitive rehabilitation was recommended to improve spatial perception, praxis, visuomotor construction and thinking operations in children with cerebral palsy. Received 18 July 2019 Accepted 13 September 2019 Correspondence to Sedef Şahin, PhD, Hacettepe Universitesi Sağlık Bilimleri Fakültesi Ergoterapi Bölümü, 06100 Samanpazarı, Ankara, Turkey, Tel: +90 312 305 25 60; fax: +90 312 305 25 61; e-mail: sedefkarayazgan88@hotmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Effects of visual feedback training and visual targets on muscle activation, balancing, and walking ability in adults after hemiplegic stroke: a preliminary, randomized, controlled study The aim of this randomized, controlled study was to investigate the effect of visual feedback through visual targets on muscle activity, balance, and gait in stroke patients. Patients were recruited from the inpatient unit of a rehabilitation hospital. Twenty-one patients who had experienced hemiplegic stroke were randomly assigned to two groups: an experimental group (visual feedback training with visual targets on gradual weight shifting), and a control group (visual feedback training on gradual weight shifting). All patients performed 30 minutes of comprehensive rehabilitation therapy followed by an additional 20 minutes of gradual weight shifting using visual feedback training with or without visual targets: three sets per day, five times a week, for 4 weeks. Significantly larger gains were identified in the experimental group compared to the control group due to gluteus medius muscle activation and the weight-bearing ability of the paretic side. Visual feedback training with visual targets during gradual weight bearing on the paretic side appears to improve the muscle activation and balancing abilities of hemiplegic stroke patients compared to visual feedback training alone. Received 23 May 2019 Accepted 12 September 2019 Correspondence to Joon-Hee Lee, PT, PhD, Department of Physical Therapy, College of Health and Medical Science, Cheongju University, 298, Daeseong-ro, Cheongwon-gu, Cheongju 28503, Republic of Korea Tel: +82 43 229 7918; fax: +82 43 229 8635; e-mail: pieta2000@hanmail.net Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Applicability of International Classification of Functioning, Disability and Health-based participation measures in stroke survivors in Africa: a systematic review To appraise available International Classification of Functioning, Disability and Health (ICF)-based tools for the measurement of participation after stroke and to examine their applicability in the African sociocultural context. Pubmed/Medline, Science Direct, Cochrane Library, and Hinari databases were systematically searched. The literature search was limited to studies published in the English or French language from January 2001 up to May 2019. Two reviewers independently screened all identified studies and selected eligible articles. Disagreements about inclusion or exclusion of studies were resolved by consensus. Two reviewers independently extracted the psychometric properties of each instrument using the Consensus-based Standard for the Selection of Health Measurement Instruments checklist and examined the methodological quality of each selected study using the MacDermid checklist. A total of 1030 articles were systematically reviewed for relevance, yielding 22 studies that met inclusion criteria. These studies were related to nine participation tools. The MacDermid scores ranged from 13 to 21 out of 24. The number of investigated psychometric properties and the number of ICF participation domains covered by each tool varied among studies. This systematic review revealed nine ICF-based tools for the measurement of participation after stroke. We examined the content of these tools and provided valuable information that can be used to guide researchers in Africa in their selection of the most appropriate tool for the measurement of participation after stroke. Received 15 July 2019 Accepted 12 September 2019 Correspondence to Charles Sèbiyo Batcho, PhD, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval, 525 Boul. Hamel, QC G1M 2S8, Canada Tel: +1 418 529 9141; fax: +1 418 529 3548; e-mail: charles.batcho@fmed.uclaval.ca Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The effectiveness of a novel cable-driven gait trainer (Robowalk) combined with conventional physiotherapy compared to conventional physiotherapy alone following stroke: a randomised controlled trial There is increasing interest in gait training devices to improve walking ability in people following stroke. This randomised controlled trial aimed to compare the effectiveness of the Robowalk, a novel cable-driven gait trainer combined with conventional physiotherapy to conventional physiotherapy alone in improving walking speed, endurance, balance, functional outcomes, and quality of life in people following stroke. Rehabilitation inpatients within 3 months following stroke (n = 40) were randomised to standard care with conventional physiotherapy (‘control,’ n = 20) and cable-driven gait trainer combined with conventional physiotherapy (‘intervention,’ n = 20). All participants received 1 hour of physiotherapy a day, 5 days a week. The control group received conventional physiotherapy only; the intervention group received a combination of 30 minutes of conventional physiotherapy and 30 minutes of cable-driven gait trainer consecutively. Outcome measures were 10-metre walk test (primary outcome), 6-minute walk test, timed up and go, step test, Functional Independence Measure, and EuroQol five-dimension scale. Evaluation timepoints were on admission (T0), discharge (T1), and 4 weeks post discharge (T2). There were no differences between groups at T0, T1, and T2 in all outcome measures although there was a trend towards a larger and more sustained improvement in 10-metre walk test in favour of the intervention group and in Functional Independence Measure motor and self-care in favour of the control group, both at T2. The combination of cable-driven gait trainer with conventional physiotherapy appears as effective as conventional physiotherapy alone in improving gait outcomes in people following a recent stroke. Further studies are required to confirm these findings and determine optimal dosing regimens and long-term outcomes. Received 26 March 2019 Accepted 2 September 2019 Correspondence to Louisa Ng, MB, ChB, FAFRM, MD, Royal Melbourne Hospital Clinical School, Grattan Street, Parkville Victoria 3050, Australia, Tel: +61393427000; fax: +613 83872222; e-mail: louisan@unimelb.edu.au Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The effects of electromyography-triggered neuromuscular electrical stimulation plus tilt sensor functional electrical stimulation training on gait performance in patients with subacute stroke: a randomized controlled pilot trial The effects of electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation on ankle dorsiflexion during walking are unclear. This study investigated whether combined electrical stimulation training affects gait performance in patients with stroke. Thirty-six patients were randomly assigned to a control (n = 13), electromyography-triggered neuromuscular electrical stimulation training (single electrical stimulation group, n = 12), or a combined electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training (combined electrical stimulation group, n = 11) group. Both experimental groups undertook 60-minute interventions for two weeks. All patients’ gait performances were evaluated according to walking speed and trunk acceleration during 10-meter walking tests undertaken pre-intervention and at two weeks post-intervention. A wireless triaxial accelerometer measured trunk acceleration, and the root mean square values of the vertical, mediolateral, and anterioposterior planes were calculated from randomly selected 10-step sequences. Compared with baseline, the 10-meter walking tests improved significantly after two weeks in the single and combined electrical stimulation groups. In the combined electrical stimulation group, the 10-meter walking tests scores and root mean square of the mediolateral plane improved significantly compared with those in the control group. Electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training may improve body perturbation stability and walking quality. Received 3 July 2019 Accepted 28 July 2019 Correspondence to Tsubasa Mitsutake, PT, PhD, 3-6-40 Momochihama, Sawara, Fukuoka 814-0001, Japan, Tel: +092 832 1200; fax: +092 832 1167; e-mail: mitutuba1012@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pain in persons with mild-moderate Parkinson’s disease: a cross-sectional study of pain severity and associated factors The aims of this study were to determine pain severity in persons with mild-moderate Parkinson’s disease compared with healthy age- and sex-matched controls, and identify related factors, that is, demographic, disease severity, and functioning, of pain severity in the Parkinson’s disease group. A cross-sectional study design was adopted to assess pain severity in 100 persons with Parkinson’s disease and 47 healthy controls. Bodily pain was assessed using item 21 of the Short Form 36, whereas pain severity was determined using the entire Short Form 36 Bodily Pain subscale (score ranging from 0 to 100). Self-report questionnaires and clinical tests were completed to determine factors, that is, demographic and disease severity characteristics as well as physical functioning indicators, related to pain severity. Based on fulfillment of assumptions of data normality, both univariate and multivariate regression analysis were carried out. Pain severity (P < 0.001) was significantly higher in persons with Parkinson’s disease than healthy controls. Among persons with Parkinson’s disease, the multivariate predictor model, explaining 34% of the variance in pain severity scores, identified three independently associated factors. Poorer balance performance, a shorter disease duration, and poorer health-related quality of life were independently associated with pain severity. Pain severity is higher in those living with Parkinson’s disease than controls, and severity appears to be associated with disease characteristics and overall health. Further research is required to assess pain origin in Parkinson’s disease with the aim of developing targeted interventions. Received 17 June 2019 Accepted 5 August 2019 Correspondence to Conran Joseph, PhD, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, 23100, SE-141 83 Huddinge, Sweden, Tel: +46 76239 7653; fax: +46 08-31 11 01; e-mail: conran.joseph@ki.se Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Feasibility of six-point Goal Attainment Scale among subacute and chronic stroke patients Feasibility of six-point Goal Attainment Scale among stroke patients were examined. Thirty-five subacute and chronic stroke patients with upper limb function problems were included (December 2015–March 2017). Sixty-minute conventional therapy and 30-minute occupational therapy was provided on every consecutive weekday, for 4 weeks. Beside Functional Independence Measure, Action Reach Arm test, Fugl-Meyer upper extremity assessment motor function subtest and six-point Goal Attainment Scale were collected. The content of the previous tests was linked with International Classification of Functioning, Disability and Health domains. Feasibility characteristics were checked according to previous feasibility studies and the following aspects: acceptability, demand, implementation, practicality, integration, and expansion. Data analysis was done in 2018. Participants’ global functions were described with the Functional Independence Measure median points were 116.5. All of the outcome measures showed significant improvement at group level (P < 0.001). Most of the goals matched to one or more International Classification of Functioning, Disability and Health domains but were not covered with the Action Reach Arm test or the Fugl-Meyer tests. Association between clinically relevant change of the first Goal Attainment Scale and the other tests was not significant. Six-point Goal Attainment Scale proved to be a feasible outcome measure among subacute and chronic stroke participants. It completed the functional picture of a patient, beside standardized measures. Further studies needed to complete the psychometric properties of six-point Goal Attainment Scale among stroke patients and in other patient groups.. Received 21 June 2019 Accepted 26 July 2019 Correspondence to Adél Debreceni-Nagy, MD, Department of Physical Medicine and Rehabilitation, University of Debrecen, 4032 Debrecen, Nagyerdei krt. 98, Hungary, Tel: +36 702057701; e-mail: nagy.adel1108@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Effect of arm cycling and task-oriented exercises on fatigue and upper limb performance in multiple sclerosis: a randomized crossover study Rehabilitation treatments have been proven to be a viable way to reduce fatigue and upper limb impairments in people with multiple sclerosis (PwMS). Our aim was to examine which treatment has better short-term and carryover effects on fatigue and manual dexterity in multiple sclerosis population. Twenty PwMS participated in a 16-week randomized crossover study composed of 20 sessions. The participants were divided into two groups (group A and group B). Sessions containing combined arm cycling and task-oriented exercises were administered by a physical therapist in hospital setting. Each group received 20 sessions of aerobic training and task-oriented exercises and then an 8-week rest period or vice versa with group A receiving sessions first. Fatigue was assessed by using the Modified Fatigue Impact Scale (MFIS) and Motor Fatigability Index (MFI), which was assessed using an engineered glove during a fatiguing finger tapping task. To measure manual dexterity, the nine hole peg test (NHPT) and a rate of tapping at maximum velocity task (RATE-MV) were utilized. Treatment effects were assessed by t-test or Mann–Whitney test at the end of both periods checking for carryover effects. After treatment the combined (Groups A and B) between-period differences were MFIS: 5.2 (10.7) points, P = 0.05; MFI: −0.007 (<0.001)Hz/s, P = 0.05 and RATE-MV: 0.2 (0.4) Hz/s, P = 0.05 in favor of the treatment period. No statistically significant between-period differences were found for the NHPT: 3.6 (25.0) s, P = 0.63. No carryover effects (P > 0.05) were observed. In conclusion, sessions of arm cycling and tailored task-oriented exercises have shown to be a viable resource for treating manual dexterity and fatigue in PwMS. Received 1 April 2019 Accepted 19 June 2019 Correspondence to Davide Cattaneo, PhD, IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66 - 20148 Milano, Italy, Tel: + 390240308814; fax: + 390240308459; e-mail: dcattaneo@dongnocchi.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Reliability and validity of on-road driving tests in vulnerable adults: a systematic review The on-road driving test is considered a ‘gold standard’ evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions. Received 18 June 2019 Accepted 12 August 2019 Correspondence to Tatsunori Sawada, PhD, Department of Occupational Therapy, Tokyo University of Technology, 5-23-22 Nishikamata, Ohta-ku, Tokyo 144-8534, Japan, Tel: +91 3 6424 2148; e-mail: sawadatn@stf.teu.ac.jp This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Effects of adjuvant mental practice using inverse video of the unaffected upper limb in subacute stroke: a pilot randomized controlled study Mental practice has shown some positive effects on arm and hand ability and mobility after stroke. This study’s objective was to investigate the adjuvant effects of mental practice using an inverse video of the unaffected limb in subacute stroke patients with severe motor impairment on motor improvement, functional outcomes, and activities of daily living. Participants (n = 20) with severe hemiplegia after a unilateral first-ever stroke within 6 months were divided into two groups. The intervention group performed additional mental practice using an inverse video of the unaffected limb for 20 minutes before every session of their rehabilitation program. The primary outcomes were the Fugl-Meyer assessment for the upper extremity (FMA-UE) and manual function test (MFT). Assessments were performed at baseline and after 4 weeks of rehabilitation intervention. Significant differences were found from baseline to postintervention assessments within both groups on FMA-UE and FIM scores, whereas there were no statistically significant differences in mean FMA-UE, MFT, and FIM scores between groups. We cannot draw conclusions about the superiority of adjuvant mental practice training using inverse video compared with conventional occupation therapy alone in subacute poststroke patients. Received 15 April 2019 Accepted 11 July 2019 Correspondence to Hyun Im Moon, MD, PhD, Departments of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Gyeonggi-do, Seongnam 13590, Korea, Tel: +82 31 779 0063; fax: +82 31 779 0635; e-mail: feellove99@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.