Effectiveness of Early Multimodal Non-pharmacological Interventions in Cognitive Preservation in the Elderly.

INTRODUCTION: Multimodal non-pharmacological interventions (MNPI) have been determined as effective in delaying cognitive deterioration. The effectiveness of timing of such interventions in elderly is less discussed. We compared the different effectiveness of MNPI in cognitive preservation in elderly subjects with and without dementia. METHODS: We enrolled volunteer the elderly subjects. Subjects were classified as dementia group and non-dementia group by instrument of ascertainment of dementia 8. All were assigned to attend 3 hours of MNPI (physical fitness training, Chinese capillary, and Chinese drawings and paintings) twice a week over a 16-week period. Neuropsychiatric tests, including Mini-Mental State Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), clinical dementia rating (CDR), and neuropsychiatric inventory (NPI), were administered before and 1 year after MNPI. We demonstrated the changes of cognition and behavioral and psychological symptoms of dementia (BPSD) before and after MNPI. We compared the different effectiveness of cognition preservation between two groups. RESULTS: In total, there were 43 participants in our study, including 18 with non-dementia and 25 with dementia. The non-dementia group had a significantly higher proportion of cognitive preservation in remote memory (100.0% vs 68.0%, P = .007), orientation (94.4% vs 48.0%, P = .001), drawing (94.4% vs 64.0%, P = .021) and language (77.8% vs 48.0%, P = .049) than the dementia group. The highest proportion of preserved cognition after MNPI was remote memory (100%), followed by orientation (94.4%) and drawing (94.4%) in the non-dementia group. The highest proportion of preserved cognition after MNPI was attention (72%) followed by remote memory (68%), recent memory (64%) and drawing (64%) in the dementia group. Overall, their improved rate in behavioral and psychological symptoms was 55.6%. CONCLUSION: Our study concluded the benefits of early MNPI in cognition preservation in the elderly, especially in the field of remote memory, orientation, drawing and language.

Trunk Muscle Function and Core Stability in Women Who Had Muscle-Sparing Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction.

OBJECTIVE: The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core stability were investigated in women with breast cancer. METHODS: Forty women (mean age = 42.6 years) who had received breast reconstruction with the unilateral TRAMmsp flap procedure no less than 6 months earlier (mean = 10.3 [standard deviation, SD = 4.9] months) (TRAM group) participated, and 30 women who were healthy and matched for age (mean age = 41.2 years) served as controls (control group). Their abdominal and back muscle strength was assessed using the curl-up and prone extension tests, respectively, and their static abdominal muscle endurance and back extensor endurance were assessed using the sit-up endurance test in the crook-lying position and the Biering-Sørensen test, respectively. Core stability strength was assessed using a 4-level limb-lowering test (abdominal muscle test), and core stability endurance was assessed while lying supine with both flexed legs 1 inch off the mat while keeping the pelvis in a neutral position with a pressure biofeedback unit. RESULTS: Compared with the control group, trunk muscles of the TRAM group were weaker, showing less endurance, as were their core stability strength and endurance. Static trunk muscle endurances and trunk flexion strength were associated with core stability in both groups. CONCLUSIONS: Women exhibit trunk flexor and extensor weakness along with poor endurance and impaired core stability even after an average of 10 months from receiving the TRAMmsp flap procedure. Immobilization after surgery, with possible systemic inflammatory effects from surgery and chemotherapy, might have further contributed to the generalized weakness subsequent to the partial harvesting of the rectus abdominis. IMPACT: Women after breast reconstruction with the TRAMmsp flap procedure show long-lasting deficits of strength and endurance in abdominal muscles, back extensors, and core stability. Proactive measures including early detection and evaluation of impairments as well as timely intervention targeting these clients are important to minimize the dysfunction and support their return to community participation.

Characterizing the Validity of the Inverted Pendulum Model for Quiet Standing.

By assuming that the human body rotates primarily around the ankle joint in the sagittal plane, the human body has been modelled as a single inverted pendulum (IP) to simulate the human quiet stance. Despite its popularity, the validity of the IP model has been challenged in many studies. Rather than testing the validity of the IP model as a true or false question, this work proposes a feature to quantify the degree of validity of the IP model. The development of the proposed feature is based on the fact that the IP model predicts that the horizontal acceleration of COM is proportional to the COP error which is defined as the difference between the center of pressure (COP) and the vertical projection of the center of mass (COM). Since the horizontal components of the acceleration of COM and the ground reaction force (GRF) are always proportional, the proposed feature is the correlation coefficient between the anterior-posterior (AP) components of GRF and the COP error. The efficacy of the proposed feature is demonstrated by comparing its differences for individuals in two age groups (18-24 and 65-73 years) in quiet standing. The experimental results show that the IP model is more suited for predicting the motion of the older group than the younger group. Our results also show that the proposed feature is more sensitive to aging effects than one of the most reliable and accurate COP-based postural stability features.

Gender differences and site-specific incident risks of musculoskeletal disorders among 224 506 workers in the food and beverage service industry in Taiwan: A 15-year Nationwide Population-Based Cohort Study.

OBJECTIVES: Occupational characteristics in the food and beverage service industry (FBSI) have been found to be associated with musculoskeletal disorders (MSDs). This study aimed to examine gender and site-specific incident risks of MSDs among FBSI workers in Taiwan using a national population-based database. METHODS: We conducted a 15-year population-based cohort study among 224 506 FBSI workers in Taiwan using data from five large nationwide databases to estimate direct standardized incidence ratios (SIRs) for identifying specific MSDs related to overexertion and repetitiveness during work. Overall, MSDs risks were also investigated by gender, sub-industrial categories, and certificate types. RESULTS: We found SIRs for overall MSDs for male and female workers of 1.706 (95% CI, 1.688-1.724) and 2.198 (95% CI, 2.177-2.219), respectively. Our findings indicate significantly increased WMSD risk for both men and women, including median/ulnar nerve disorders (ICD-9 354.0-354.2); spondylosis and allied disorders (ICD-9 721); intervertebral disc disorders (ICD-9 722); disorders of the back (ICD-9 724); peripheral enthesopathies and allied syndromes (ICD-9 726); synovium, tendon, and bursa disorders (ICD-9 727); and soft tissues of the peripheral system disorders (ICD-9 729). Food stall workers and workers with Chinese cuisine or baking licenses were at higher risk among sub-industrial categories and certificate types. CONCLUSION: This large-scale study revealed that FBSI workers were at higher risk for several MSDs than the general population. This information could help prioritize MSD problems and identify a high-risk population. Relevant policy and ergonomic improvements and interventions could be implemented for health promotion in this industry.

Backward Walking Induces Significantly Larger Upper-Mu-Rhythm Suppression Effects Than Forward Walking Does.

Studies have compared the differences and similarities between backward walking and forward walking, and demonstrated the potential of backward walking for gait rehabilitation. However, current evidence supporting the benefits of backward walking over forward walking remains inconclusive. Considering the proven association between gait and the cerebral cortex, we used electroencephalograms (EEG) to differentiate the effects of backward walking and forward walking on cortical activities, by comparing the sensorimotor rhythm (8-12 Hz, also called mu rhythm) of EEG signals. A systematic signal procedure was used to eliminate the motion artifacts induced by walking to safeguard EEG signal fidelity. Statistical test results of our experimental data demonstrated that walking motions significantly suppressed mu rhythm. Moreover, backward walking exhibited significantly larger upper mu rhythm (10-12 Hz) suppression effects than forward walking did. This finding implies that backward walking induces more sensorimotor cortex activity than forward walking does, and provides a basis to support the potential benefits of backward walking over forward walking. By monitoring the upper mu rhythm throughout the rehabilitation process, medical experts can adaptively adjust the intensity and duration of each walking training session to improve the efficacy of a walking ability recovery program.

Effects of multiple training modalities in the elderly with subjective memory complaints: A pilot study.

BACKGROUND: This study investigated the effects of multiple training modalities (MTM) on senior fitness and neuropsychiatric function in the elderly with subjective memory complaints (SMC). METHODS: This study was conducted in 24 elderly subjects with Clinical Dementia Rating (CDR) score of 0 and instrument of ascertainment of dementia 8 (AD8) score of <2. The participants were classified into SMC (n = 7) and non-SMC (n = 17).All were assigned to receive multiple training modalities (1 hour for each training: physical fitness activities, calligraphy or drawing, and meditation) twice a week over a 16-week period.A series of senior fitness test, and neuropsychiatric tests, namely the Traditional Chinese version Mini-Mental Status Examination (MMSE), Cognitive Assessment Screening Instrument (CASI), and the Center for Epidemiologic Studies Depression Scale (CESD), were conducted before and after the intervention. We compared the differences of pre/posttest-MTM and SMC/non-SMC in senior fitness and the neuropsychological tests. RESULTS: There was no significant difference between SMC and non-SMC groups in demographic characteristics. MTM showed significant improvement in senior fitness and CESD, but not in CASI and MMSE. Significant change in recent memory subscale of CASI was only observed in SMC group, whereas improvement of partial senior fitness and CESD were observed in both groups. CONCLUSION: MTM had effects in enhancing senior fitness and improving depressive syndromes in the elderly. MTM contributed to greater improvement in recent memory function in the SMC group than in the non-SMC group.

Test-retest reliability and minimal detectable change of two simplified 3-point balance measures in patients with stroke.

BACKGROUND: The 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) were simplified from the BBS and PASS to overcome the complex scoring systems. The BBS-3P and PASS-3P were more feasible in busy clinical practice and showed similarly sound validity and responsiveness to the original measures. However, the reliability of the BBS-3P and PASS-3P is unknown limiting their utility and the interpretability of scores. AIM: We aimed to examine the test-retest reliability and minimal detectable change (MDC) of the BBS-3P and PASS-3P in patients with stroke. DESIGN: Cross-sectional study. SETTING: The rehabilitation departments of a medical center and a community hospital. POPULATION: A total of 51 chronic stroke patients (64.7% male). METHODS: Both balance measures were administered twice 7 days apart. The test-retest reliability of both the BBS-3P and PASS-3P were examined by intraclass correlation coefficients (ICC). The MDC and its percentage over the total score (MDC%) of each measure was calculated for examining the random measurement errors. RESULTS: The ICC values of the BBS-3P and PASS-3P were 0.99 and 0.97, respectively. The MDC% (MDC) of the BBS-3P and PASS-3P were 9.1% (5.1 points) and 8.4% (3.0 points), respectively, indicating that both measures had small and acceptable random measurement errors. CONCLUSIONS: Our results showed that both the BBS-3P and the PASS-3P had good test-retest reliability, with small and acceptable random measurement error. These two simplified 3-level balance measures can provide reliable results over time. CLINICAL REHABILITATION IMPACT: Our findings support the repeated administration of the BBS-3P and PASS-3P to monitor the balance of patients with stroke. The MDC values can help clinicians and researchers interpret the change scores more precisely.

Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients.

[Purpose] To explore the differences in bilateral trunk muscle activation between chronic stroke patients and healthy controls, this study investigated the symmetry index and cross-correlation of trunk muscles during trunk flexion and extension movements. This study also assessed the differences in trunk reposition error between groups and the association between trunk reposition error and bilateral trunk muscle activation. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Bilateral trunk muscle activations were collected by electromyography during trunk flexion and extension. Trunk reposition errors in trunk flexion and extension directions were recorded by a Qualisys motion capture system. [Results] Compared with the healthy controls, the stroke patients presented lower symmetrical muscle activation of the bilateral internal oblique and lower cross-correlation of abdominal muscles during trunk flexion, and lower symmetry index and cross-correlation of erector spinae in trunk extension. They also showed a larger trunk extension reposition error. A smaller trunk reposition error was associated with higher cross-correlation of bilateral trunk muscles during trunk movements in all subjects. [Conclusion] Trunk muscle function during symmetrical trunk movements and trunk reposition sense were impaired in the chronic stroke patients, and trunk position sense was associated with trunk muscle functions. Future studies should pay attention to symmetrical trunk movements as well as trunk extension position sense for patients with chronic stroke.

The effect of six weeks of sling exercise training on trunk muscular strength and endurance for clients with low back pain.

[Purpose] The purpose of this study was to investigate the effects of 6 weeks sling exercise training for clients with low back pain on the levels of pain, disability, muscular strength and endurance. [Subjects and Methods] Twelve chronic LBP subjects participated in this study. Subjects were randomly divided into a control group and a training group. Subjects in the training group performed sling exercise training for six weeks, and participants in the control group did not perform any exercise. [Results] Pain, disability levels and muscular strength significantly improved in the training group, but not in the control group. The left multifidus showed a significant improvement in muscular endurance, measured as the slope of the median frequency after training. [Conclusion] Six weeks of sling exercise training was effective at reducing pain intensity, and improving the disability level and trunk muscular strength of subjects with low back pain.

Relationship between trunk stability during voluntary limb and trunk movements and clinical measurements of patients with chronic stroke.

[Purpose] The purposes of this study were to investigate differences between patients with chronic stroke and age matched healthy controls in trunk stability, by assessing the kinematics of the center of mass and moving body segments during voluntary limb and trunk movement, and the relationship between trunk stability and clinical measurements. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Each subject performed flexion of the hip and shoulder of the non-paretic or matched side as fast as possible, as well as trunk flexion and extension at a self-selected speed. A Qualisys motion system was employed to track the kinematics of the trunk and limbs. [Results] Patients presented larger mediolateral displacement of the center of mass during all limb and trunk movements, and larger velocity of center of mass during hip flexion movement. Healthy subjects showed greater movement velocity during shoulder flexion, trunk flexion and extension. Patients' clinical measurements only correlated with movement characteristics during voluntary trunk motions. [Conclusion] Trunk stability in patients with chronic stroke was compromised during voluntary trunk as well as non-paretic limb movements, and the voluntary trunk movements reflected the trunk deficits measured using clinical measurements. Rehabilitation of patients with chronic stroke should include programs to improve trunk stability.

Influence of working memory task and time on postural control of children with attention deficit hyperactivity disorder.

[Purpose] To investigate how balance changes develop across time under different conditions (with or without a memory task) for children with Attention Deficit Hyperactivity Disorder (ADHD). [Subjects and Methods] The participants were 11 children with ADHD and 12 normal children. To determine their static balance ability, a force plate was used to measure the center of the pressure trajectory. [Results] The length of the sway path became slightly greater in both groups when an additional memory task was added, but the difference was not statistically significant. However, it was interesting to note a significant difference in memory task ability across groups with increasing time. The ADHD group showed a decrease sway path with increasing time for the memory task, but in the control group it increased. [Conclusion] At first, the memory task interfered with ADHD children's performance; however, the memory task may improve their performance after a few seconds.

Ultrasound imaging evaluation of abdominal muscles after breast reconstruction with a unilateral pedicled transverse rectus abdominis myocutaneous flap.

BACKGROUND: A muscle-sparing (MS) procedure using a full-width pedicled transverse rectus abdominis (RA) myocutaneous (TRAM) flap was developed to reduce abdominal morbidities after breast reconstruction. However, the effects of this procedure on the morphology of the remnant RA muscle and other abdominal muscles remain unclear. OBJECTIVE: Ultrasound imaging was used to evaluate the morphology of the remnant RA muscle and other abdominal muscles in women with the MS pedicled TRAM flap procedure. DESIGN: A case-control, cross-sectional design was used. METHODS: Thirty-four women with an MS unilateral pedicled TRAM flap procedure after mastectomy (TRAM group) and 25 women who were healthy and matched for age (control group) participated. The curl-up test measured trunk flexor muscle strength. Ultrasound imaging measured the thickness of all abdominal muscles in all participants and the cross-sectional area of the RA muscle at rest and in an isometric position with the head raised in women in the TRAM group. Acoustic echogenicity and border visibility assessed the tissue composition of the remnant RA muscle. RESULTS: Trunk flexor muscle strength was weaker in the TRAM group than in the control group. Compared with the remnant RA muscle in the contracted state, the remnant RA muscle in the relaxed state was thinner and had a smaller cross-sectional area. The remnant RA muscle in the relaxed state also was thinner, more echoic, and less visible than its contralateral counterpart. No differences in the thickness of the other abdominal muscles were found between the sides. The abdominal muscles in the TRAM group were smaller than those in the control group. LIMITATION: Because a prospective, longitudinal design was not used, a definite cause-effect relationship could not be determined. CONCLUSIONS: In women with an MS unilateral pedicled TRAM flap procedure, the remnant RA muscle retains its ability to change in size during contraction, albeit at reduced levels. Muscular atrophy occurs in other ipsilateral and contralateral abdominal muscles as well as the remnant RA muscle. Postoperative immobilization is the most likely cause of generalized weakness of the abdominal musculature.

Timing perception and motor coordination on rope jumping in children with attention deficit hyperactivity disorder.

OBJECTIVES: To evaluate timing perception ability and motor coordination in children with ADHD (Attention Deficit Hyperactivity Disorder) while rope jumping at different rates. DESIGN AND SETTING: Rope jumping at (1) a constant tempo of 100 for 15 s (RJ-C) and (2) two randomly permutated tempos (80, 100, or 120) for 15 s (RJ-V). MAIN OUTCOME MEASURES: The "timing variation while jumping", "timing variation while whirling", and "hand-foot deviation time" in each rope jumping cycle were recorded, to assess the time estimation ability. PARTICIPANTS: 10 children with ADHD (9.65 ± 1.27 years) and 10 children without ADHD (9.93 ± 1.54 years) were recruited. RESULTS: The ADHD group showed greater variation in time between the foot jumping and the rope whirling tasks. Also, the median value of hand-foot deviation time was greater in the ADHD group (3.34 ms) than in the control group (1.75 ms). In RJ-V, the control group was able to modify their pace and respond to the target speed in the post-phase, while the ADHD group could not. CONCLUSION: Impaired timing perception leads to less accurate performance during rope jumping for ADHD children. The findings also reveal that poor hand-foot coordination results in poor control of simultaneous movements of the upper and lower limbs during rope jumping.

Test-retest reproducibility of two short-form balance measures used in individuals with stroke.

The aim of this study is to determine the test-retest reproducibility of the seven-item Short-Form Berg Balance Scale (SFBBS) and the five-item Short-Form Postural Assessment Scale for Stroke Patients (SFPASS) in individuals with chronic stroke. Fifty-two chronic stroke patients from two rehabilitation departments were included in the study. Both balance measures were administered twice 7 days apart. Test-retest reliability was analysed using the weighted κ (κ(w)) statistic for each item and intraclass correlation coefficients (ICC(2,1)) for the total scores of both measures. Agreement was expressed as the SEM, minimal detectable change and limits of agreement by Bland and Altman analysis. Test-retest agreements were good to very good for SFBBS and SFPASS, with weighted κ values ranging from 0.75 to 0.89 and 0.66 to 0.84, respectively. The ICCs for the total SFBBS and SFPASS scores were excellent (ICC(2,1): SFBBS=0.99; SFPASS=0.93). The SEMs for both measures were less than 10% of the score range; the minimal detectable changes of the SFBBS and SFPASS were 2.83 and 2.16, respectively, indicating that both measures had a small and acceptable measurement error. Both measures showed good reproducibility. These results indicate that the SFBBS and SFPASS are useful for clinicians and researchers for the evaluation of balance performance and to determine whether the change score of an individual with stroke is real.

The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study.

STUDY DESIGN: A prospective longitudinal study. BACKGROUND: Diastasis recti abdominis (DRA) is defined as an increase in the inter-recti distance (IRD), or width of the linea alba. It is a common occurrence in women postpartum. Little information exists on the short- and long-term recovery of IRD and the relationship between changes in IRD and the functional performance of the abdominal muscles. OBJECTIVES: To investigate the natural recovery of IRD and abdominal muscle strength and endurance in women between 7 weeks and 6 months postpartum, and to examine the relationship between IRD and abdominal muscle function. METHODS: Forty postpartum (25-37 years of age) and 20 age-matched, nulliparous females participated. IRD was measured at 4 locations (upper and lower margin of the umbilical ring, and 2.5 cm above and below the umbilical ring) with a 7.5-MHz linear ultrasound transducer. Trunk flexion and rotation strength and endurance were measured with manual muscle testing and curl-ups. Evaluation was conducted at 4 to 8 weeks and 6 to 8 months after childbirth in postpartum women, and only once for the nulliparous female controls. RESULTS: During follow-up, the IRD at 2.5 cm above the umbilical ring and at the upper margin of the umbilical ring decreased (P = .013 and P = .002, respectively). The strength and static endurance of the abdominal muscles improved over time (P<.05). A negative correlation between IRD and abdominal muscle function at 7 weeks and 6 months postpartum was found (r = 0.34 to 0.51; P<.05, except for trunk flexion strength at 6 months postpartum [P = .064]). In addition, IRD changes between 7 weeks and 6 months postpartum were correlated with improvement in trunk flexion strength (Spearman rho = 0.38, P = .040). At 6 months after childbirth, postpartum women had greater mean ? SD IRDs at all 4 locations (from cranial to caudal: 1.80 ± 0.72, 2.13 ± 0.65, 1.81 ± 0.62, and 1.16 ± 0.58 cm) than those of nulliparous females (0.85 ± 0.26, 0.99 ± 0.31, 0.65 ± 0.23, and 0.43 ± 0.17 cm) (all P<.001). All abdominal strength and endurance measurements were less than those of nulliparous females (all P<.001). CONCLUSIONS: The IRD and abdominal muscle function of postpartum women improved but had not returned to normal values at 6 months after childbirth. Future research is essential to explore the need for intervention and, if needed, the effectiveness of specific intervention to reduce the size of IRD in postpartum women.

Lower-limb adaptation during squatting after isolated posterior cruciate ligament injuries.

BACKGROUND: While many studies point out that posterior cruciate ligament plays an important role in squatting, not many, if any, have looked into knee kinematics or kinetics for isolated posterior cruciate ligament injuries. This study explores lower-limb adaptation during squatting for asymptomatic patients with isolated chronic posterior cruciate ligament injuries. METHODS: Thirteen research subjects or test participants with isolated chronic posterior cruciate ligament injuries were recruited to analyze the kinematics and kinetics on both sides of their hip, knees and ankle joints during squatting. We adopted ExpertVision™ motion analysis system and two Kistler force plates to record the three-dimensional trajectories of the reflective markers used and the ground reaction forces respectively. FINDINGS: The peak vertical ground reaction force exerted on the participants, their peak support moment and the knee-joint peak extension moment exhibited at their non-involved side are significantly greater than that at their involved side. We also find that the involved side's knee joint (extension moment) exhibits a reduced percentage on the peak support moment contributed by the individual joints, while the joints of the hip and ankle signify increased percentages. INTERPRETATION: In this study, the asymptomatic participants having isolated chronic posterior cruciate ligament injuries tend to shift their weight to their non-involved side, and part of their injured knee-joint load to their ipsilateral joints of the hip and ankle. The causes seem to be a habitual gravity center shift, insufficient muscle strength at the involved side, and a reduced mechanical efficiency in their extensor mechanism.

The relative and absolute reliability of two balance performance measures in chronic stroke patients.

PURPOSE: To examine the relative reliability and absolute reliability of the Berg Balance Scale (BBS) and the Postural Assessment Scale for Stroke Patients (PASS) in chronic stroke patients. METHOD: A total of 52 mild to moderate stroke patients, who had a stroke more than 6 months previously, participated in the study. Both balance measures were administered twice, seven days apart, to the patients. A relative reliability index (intra-class correlation coefficient, ICC2,1) was used to examine the level of agreement between test and retest. Absolute reliability indices, including the Bland and Altman method, the standard error of measurement (SEM), and the smallest real differences (SRD), were used to define the extent to which a balance score varies on test-retest measurements. RESULTS: Test-retest agreements were high (ICC2,1: BBS = 0.98; PASS = 0.97), indicating excellent agreement from a relative perspective. The SEM of the BBS and PASS, representing the smallest change threshold that indicates a real improvement for a group of individuals, were 2.4 and 1.1, respectively. The SRD of the BBS and PASS were 6.7 and 3.2, respectively, exhibiting the smallest change threshold that indicates a real improvement for a single individual. CONCLUSIONS: The test-retest agreements of the BBS and PASS were high in mild to moderate chronic stroke patients. The thresholds of both measures to detect real change are acceptable in research and clinical settings.

The test-retest reliability of 2 mobility performance tests in patients with chronic stroke.

OBJECTIVE: This study examined test-retest agreement and measurement errors for the Rivermead Mobility Index (RMI) and the Mobility subscale of the Stroke Rehabilitation Assessment of Movement (M-STREAM) in patients with chronic stroke and mild to moderate disability. The authors aimed to determine the level of agreement between test and retest as well as the extent to which a mobility score varies on test-retest measurements. METHODS: Both mobility measures were tested on 50 chronic stroke patients twice, 7 days apart. Intraclass correlation coefficient (ICC(2,1)), a relative reliability index, was used to examine the level of agreement between test and retest. Absolute reliability indices, including the standard error of measurement and the smallest real differences, were used to determine the extent to which the mobility scores varied due to chance variation in measurement. RESULTS: Test-retest agreements were excellent for both mobility measures. The standard errors of measurement of the RMI and the M-STREAM, representing the smallest change threshold that indicates a real improvement (beyond measurement error) for a group of individuals, were 0.8 and 1.5, respectively. The smallest real differences of the RMI and the M-STREAM, exhibiting the smallest change threshold that indicates a real improvement for a single individual, were 2.2 and 4.2, respectively. CONCLUSION: The RMI and the M-STREAM have high agreement between the test-retest measurements with acceptable measurement errors due to variation in measurement. The 2 measures can be used by clinicians and researchers to assess the mobility performance and monitor changes over time in stroke patients.

Psychometric properties of the modified Emory Functional Ambulation Profile in stroke patients.

OBJECTIVE: To examine the test-retest reliability, convergent and predictive validity and responsiveness of the modified Emory Functional Ambulation Profile (mEFAP) in assessing gait function in stroke patients undergoing rehabilitation. SUBJECTS: Forty subacute stroke inpatients were enrolled in the validity and responsiveness study. Twenty chronic patients participated in the reliability study. SETTING: Rehabilitation department of a medical centre. DESIGN: In the validity and responsiveness study, patients were tested using the mEFAP, 10-m walking speed test, Barthel Index and Rivermead Mobility Index at admission and at discharge. For the reliability study, the patients completed the mEFAP twice one week apart. RESULTS: The patients' performances on the mEFAP were moderately to highly correlated with results of the 10-m walking speed test and Rivermead Mobility Index (absolute correlation coefficients > or = 0.67), indicating good convergent validity. Patients' performance on the mEFAP at admission was moderately correlated with the Barthel Index and Rivermead Mobility Index scores at discharge (Spearman's rank correlation coefficients = -0.52 and -0.78, respectively), indicating good predictive validity. The standardized response mean of the mEFAP was 1.1 (P < 0.0001), suggesting good responsiveness. The intraclass correlation coefficient ICC(3,1) for the mEFAP was 0.997, indicating excellent test retest reliability. CONCLUSIONS: Our results provide strong evidence that the mEFAP has good reliability, validity and responsiveness for assessing stroke patients undergoing rehabilitation. The mEFAP is a useful scale for measuring walking function and recovery in stroke patients.