The effect of rolling walker use on interpretation of Timed Up and Go test scores: a preliminary study Studies have shown that the type of assistive device used during the Timed Up and Go test impacts the time it takes to complete the test. This study examines the impact of the use of a rolling walker within individuals on Timed Up and Go scores and assessment of fall risk. The Berg Balance Scale, Timed Up and Go, and linear gait speed were used to measure balance and fall risk on 13 older adults as part of their usual reassessment in preparation for discharge. Timed Up and Go and gait speed scores were compared assistive device conditions. The Berg Balance Scale was used as a benchmark fall risk assessment. Linear gait speed was similar in both conditions. Timed Up and Go times were slower for all patients using a rolling walker versus a cane or no assistive device. Consideration for the effect of assistive device use on Timed Up and Go scores has important implications as it may influence interpretation of fall risk. Received 13 June 2019 Accepted 23 October 2019 Correspondence to Janine Hatch, DPT, MS, GCS, Department of Physical Therapy, Sacred Heart University, 514 Davis Road, Fairfield, CT 06825, USA, Tel: +1 203 365 4723; fax: +1 203 294 8705; e-mail: hatchjanine@yahoo.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Effects of transcutaneous electrical nerve stimulation on physical symptoms in advanced cancer patients receiving palliative care Transcutaneous electrical nerve stimulation (TENS) is primarily used for pain, but might be useful for various other physical symptoms, including nausea, fatigue, dyspnea, and constipation. However, few studies have used TENS for treating the physical symptoms of patients with advanced cancer. In this crossover trial, we assess the effects of TENS on pain and other physical symptoms in 20 in-patients with advanced cancer receiving palliative care. For 5-day phases between wash out periods of 5 days, patients received TENS or non-TENS. TENS was delivered at four points: the center of the back for mainly nausea and dyspnea, on the back at the same dermatomal level as the origin of the pain (100 Hz), and on both ankle joints for constipation (10 Hz). The intensity of pain and the total opioid dose used during phases were recorded. Physical symptoms were evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL). Hematological and biochemical data were recorded before and after the TENS phase. The average pain and total number of opioid rescue doses were significantly reduced by TENS. TENS tended to improve nausea and appetite loss, but not constipation. There were no effects on hematological and biochemical parameters. Use of TENS could safely improve pain, nausea, and appetite loss in patients with advanced cancer. Although it cannot be used as a substitute for opioids and other pharmaceutical treatment, it may be useful to support palliative care. Received 12 September 2019 Accepted 12 October 2019 Correspondence to Jiro Nakano, PT, PhD, Institute of Biomedical Sciences (Health Sciences), Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki 852-8520, Japan, Tel/fax: +81 95 819 7919; e-mail: nakano-j@nagasaki-u.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Look at the cognitive deficits in patients with myotonic dystrophy type 1: an exploratory research on the effects of virtual reality Myotonic dystrophy type 1 is a neuromuscular disease, characterized by a progressive loss of strength, muscle stiffness, and difficulty in relaxation. Myotonic dystrophy type 1 patients can present several neuropsychological deficits, as well as anxiety and mood disorders. Aim of this study is to evaluate the feasibility and the effect of virtual reality in the cognitive and behavioral recovery of myotonic dystrophy type 1 patients. Eleven patients (8 female and 3 male) underwent a specific cognitive rehabilitation program including a conventional neuropsychological treatment followed by a virtual reality neurorehabilitation training using the Virtual Reality Rehabilitation System (Khymeia, Italy). Virtual reality improved many cognitive domains, including executive function, attention, verbal and visuo-spatial abilities, as well as mood and coping strategies. Due to the high prevalence of neuropsychological symptoms in patients with myotonic dystrophy type 1, cognitive rehabilitation should enter into the framework of these patients to potentially boost cognitive and behavioral function and improve quality of life. Received 16 July 2019 Accepted 8 October 2019 Correspondence to Rocco Salvatore Calabrò, MD, PhD, IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Contrada Casazza, 98124 Messina, Italy, Tel: +39 090 60128840; fax: +39 090 60128950; e-mail: salbro77@tiscali.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Post-stroke dysphagia rehabilitation in the old and oldest old: outcome and relevance for discharge home We assessed the outcome of dysphagia rehabilitation in all the 139 patients with post-stroke dysphagia admitted to our Neurorehabilitation Unit during 2 years (2017 and 2018), divided into two groups: old (aged 65–84 years) and oldest-old (aged 85 or above). We studied which factors predicted dysphagia improvement in the two groups. The potential association of improvement with type of discharge was also evaluated. On admission, ‘old’ patients had more frequently aphasia (P = 0.02) and less frequently dysarthria (P = 0.03); ‘oldest old’ had more severe pressure ulcers (P = 0.008), higher levels of c reacting protein (P = 0.01) and more heart problems (P = 0.004). None of these factors was associated with the outcome of dysphagia. We found no difference between the two groups in the severity of dysphagia, as measured with Dysphagia Outcome and Severity Scale on admission and discharge, but due to minor differences, the degree of improvement was higher in the ‘old’ group (P = 0.02). The number of patients discharged with improved swallowing was also comparable. Cognitive impairment had a negative predicting role in the ‘old’ group (odds ratio 0.270, 95% confidence interval 0.101–0.725, P = 0.007). Norton Scale score predicted dysphagia improvement in the ‘oldest old’ group (odds ratio 1.611, 95% confidence interval 1.102–2.355, P = 0.007). Dysphagia improvement was associated with discharge home in general (P = 0.011) and in the ‘old’ group (P = 0.04). Our data, though preliminary, could give a contribution to implement patient-specific rehabilitation strategies; these could increase swallowing improvement in post-stroke dysphagia. Received 6 August 2019 Accepted 9 October 2019 Correspondence to Gianfrancesco Fiorini, MD, UO Riabilitazione Specialistica Neurologica, Istituti Clinici Zucchi–Gruppo San Donato, Piazza Madonnina 1, 20841 Carate Brianza, Italy. Tel: +39 0362 9861; fax: +39 0362 986513; e-mail: gianfrancesco.fiorini@grupposandonato.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

International classification of diseases/disorders diagnosis and International Classification of Functioning, Disability and Health activity/participation limitation among psychiatric patients: a cross-sectional and exploratory study To explore the relationships between international classification of diseases/disorders (ICD)-10 diagnoses and International Classification of Functioning, Disability and Health (ICF) disability dimensions – activity and participation restriction among mental health service users. Three hundred sixty patients from different health services diagnosed with diverse mental disorders (ICD-10) participated in the study. Functioning restrictions were evaluated by use of the Mini-ICF-APP. Selected sociodemographic and clinical variables were also analysed. The Mini-ICF-APP scores correlated positively with the clinical impression of disease severity and negatively with general functioning. As independent factors determining the Mini-ICF-APP score, regression analysis suggests diagnosis and severity of disorder but also contextual factors such as general functioning and active occupation. Percentage and percentile distributions of activity and participation restrictions in diagnostic sections and categories revealed noticeable variability regardless of diagnosis-related differences. The diagnosis determines them neither in an ambiguous nor an absolute manner. There is a need to further explore the covariability between clinical diagnosis and ICF activity and participation restriction, particularly in regard the rationalization of social welfare benefits. Received 26 June 2019 Accepted 30 September 2019 Correspondence to Jacek Wciórka, MD, PhD, Department of Psychiatry I, Institute of Psychiatry and Neurology, ul, Sobieskiego 9, 02-957 Warsaw, Poland. Tel: +48 224582773; fax: +48 224582818; e-mail: wciorka@ipin.edu.pl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Goal-oriented attentional self-regulation training in individuals with acquired brain injury in a subacute phase: a pilot feasibility study The primary aim of this prospective pilot study was to assess feasibility of implementing goal-oriented attentional self-regulation (GOALS) training in Slovenia with patients with multiple cognitive deficits after acquired brain injury in acute phase of recovery. Seven patients with acquired brain injury (i.e. stroke, traumatic brain injury, and subarachnoid hemorrhage) with a mean postinjury time of 4.3 months (SD = 1.25) and mean age of 34.5 years (SD = 18.6) were recruited for the study. The group program consisted of 10 sessions twice a week and included cognitive strategy training, social skills training, and psychoeducation. Structured interviews and neuropsychological tests were used before and after the training to determine the influence of the interventions on daily life tasks and attentional networks performance involving cognitive and behavioral domains. GOALS influenced self-reports of positive effect on the individual goals set by the patients. Training had a positive influence on executive control and memory. The results from the present study suggest that it is feasible to implement GOALS manualized executive function training in Slovenia, with the patients in a somewhat more acute stage than in previous studies, and that GOALS training may be a promising nonpharmacological treatment for cognitive and behavioral difficulties after acquired brain injury. Further research is needed to extend these findings in a larger sample. Received 29 May 2019 Accepted 23 September 2019 Correspondence to Urša Čižman Štaba, PhD, University Rehabilitation Institute, Republic of Slovenia, Linhartova cesta 51, 1000 Ljubljana, Slovenia. Tel: +386 1 4758196; fax: +386 1 4372070; e-mail: ursa.cizman@ir-rs.si Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Does the postural stability of patients with Parkinson’s disease affect the physical activity? Postural instability is one of the cardinal features in Idiopathic Parkinson’s disease. It is a significant factor of disability in Parkinson’s disease. We aimed to examine the physical activity levels in patients with Parkinson’s disease comparing with healthy subjects and their association with the postural stability. Fifty-six Parkinson’s disease patients and 58 healthy subjects were involved. The disease-specific disability of patients was determined by using Modified Hoehn and Yahr Scale and Movement Disorder Society Unified Parkinson’s Disease Rating Scale. The physical activity levels of participants were evaluated using SenseWear Arm Band activity monitor. The participants used the activity monitor for seven consecutive days. The postural stability was assessed using NeuroCom Balance Master system. The Parkinson’s disease group was found to take fewer steps and to have shorter duration of sleep and sedentary behavior but a higher level of energy expenditure than the healthy control group (P < 0.05). In Parkinson’s disease group, the data obtained from the activity monitor were found to be in correlation with disease-specific disability and the parameters of NeuroCom Balance Master system (P < 0.05). We found that the physical activity levels of patients with a mild or moderate stage of Parkinson’s disease were lower compared to healthy subjects and were affected by the disease-specific symptoms, dynamic postural instability, and walking function. To increase the activity level in Parkinson’s disease, these factors should be aimed to improve, as well as designing the personalized physiotherapy programs starting from the early-mid stage. Received 1 June 2019 Accepted 26 September 2019 Correspondence to Burcin Aktar, MSc, Institute of Health Sciences, Dokuz Eylul University, Izmir 35330, Turkey. Tel: +90 232 412 9396; fax: +90 232 412 4946; e-mail: burcinaktar@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Effect of intensive rehabilitation on improvement of activity of daily living after intracerebral hemorrhage: a retrospective observational study Between 2008 and 2012, the intensity of rehabilitation therapy for the recovery phase of stroke was gradually increased at our hospital in line with the policy of Japan’s National Insurance System. Training hours increased from 0.8 to 2.5 hours/day without introducing any new techniques, programs, or equipment. The aim of this study was to investigate the effectiveness of the increased intensity of rehabilitation on the improvement of activity of daily living of patients with intracerebral hemorrhage. We retrospectively compared patient outcomes for the periods 2013–2017 (N = 162) and 2003–2007 (N = 116) using the gain in Barthel Index as an indicator of improvement in activity of daily living. The median (interquartile range) gain was significantly higher in 2013–2017 than in 2003–2007 [30 (20–45) vs. 15 (5–30); P < 0.001]. A stratified analysis showed that this improvement was independent of sex, the patient’s Barthel Index on admission, or the side of the brain lesion, but it varied with age or time to admission from onset of the disease. These results, based on a considerable difference in the intensity of rehabilitation between the two periods, support the consensus that increased time spent on rehabilitation results in better functional outcome in post-stroke patients. The results also suggest that age and the timing of starting rehabilitation are important factors to examine the effectiveness of intense rehabilitation in patients with intracerebral hemorrhage. Received 25 June 2019 Accepted 25 September 2019 Correspondence to Yoshinobu Okuda, MD, PhD, Tane Neuro-Rehabilitation Hospital, 1-1-45 Minami-ichioka, Minato-ku, Osaka 552-0011, Japan. Tel: +81 6 6585 2743; fax: +81 6 6585 2048; e-mail: y.okuda@tane.or.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The influence of sleep quality and circadian preferences on upper extremity rehabilitation in stroke patients after constraint-induced movement therapy Our aim was to explore the influence of sleep and circadian preference on upper extremity (UE) rehabilitation in stroke patients after constraint-induced movement therapy (CIMT) in a cross-sectional retrospective observational study. Forty-three patients were selected to complete questionnaires on circadian preference, sleep quality, excessive daytime sleepiness, and risk of obstructive sleep apnea. They had undergone a 10-day standard CIMT program without medical complications and with normal to minimal cognitive dysfunction. All pre- and postrehabilitation scores (patient perception of the quantity and quality of use of the affected UE and self-quantification of motor ability) were analyzed retrospectively. All patients had improved perception of the quantity and quality of use of the affected UE and self-quantified motor ability. Patients with an evening-type chronotype demonstrated less improvement than those with morning and intermediate types. In addition, patients with poor sleep quality showed less improvement in functional ability than those with good sleep quality. Circadian preferences and sleep quality impacted the improvements in motor performance of patients with stroke after CIMT rehabilitation. This is the first study to suggest that rehabilitation sessions must respect the circadian preferences of patients and that sleep quality can affect outcomes. Future studies should investigate the relationship and mechanisms between circadian preference and poor sleep quality and rehabilitation outcomes on a larger scale. Received 24 June 2019 Accepted 20 September 2019 Correspondence to Fernando Morgadinho Santos Coelho, MD, PhD, Rua Pedro de Toledo, 650, Vila Clementino, São Paulo - SP, 04039-002, Brazil. Tel: +55 11 5576 4848 x2806 or 2904; e-mail: fernandomorgadinho@hotmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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.