Self-reported prospective memory after stroke.

Prospective Memory (PM) is the memory for completing future intentions. This study aimed to compare self-reported PM of individuals with stroke to healthy controls, to determine if PM is impaired after stroke. Additionally, self-reported PM for individuals with stroke was compared to significant-other reports, ascertaining a level of self-awareness of PM function. Twenty-eight individuals with stroke, 25 significant-others, and 27 healthy controls completed the Brief Assessment of PM (BAPM) and the Prospective and Retrospective Memory Questionnaire (PRMQ) as part of a larger study. Individuals with stroke reported significantly more Basic Activities of Daily Living (BADL) PM failures compared to controls on Part A of the BAPM. On Part B, individuals with stroke reported BADL PM failures to be less problematic/important than controls, suggesting a lack of self-awareness into the consequences of PM failure. Individuals with stroke also reported significantly more PM and RM failures compared to controls on the PRMQ. No significant differences were found between individuals with stroke and their significant-others on both the BAPM and PRMQ. Results of this study helped to clarify the previous research and highlighted that individuals with stroke reported more PM failures than controls but underestimated the importance of such memory lapses.

Virtual reality-based cognitive training for drug abusers: A randomised controlled trial.

Non-pharmacological means are being developed to enhance cognitive abilities in drug abusers. This study evaluated virtual reality (VR) as an intervention tool for enhancing cognitive and vocational outcomes in 90 young ketamine users (KU) randomly assigned to a treatment group (virtual reality group, VRG; tutor-administered group, TAG) or wait-listed control group (CG). Two training programmes with similar content but different delivery modes (VR-based and manual-based) were applied using a virtual boutique as a training scenario. Outcome assessments comprised the Digit Vigilance Test, Rivermead Behavioural Memory Test, Wisconsin Cart Sorting Test, work-site test and self-efficacy pre- and post-test and during 3- and 6-month follow-ups. The VRG exhibited significant improvements in attention and improvements in memory that were maintained after 3 months. Both the VRG and TAG exhibited significantly improved vocational skills after training which were maintained during follow-up, and improved self-efficacy. VR-based cognitive training might target cognitive problems in KU.

Bibliometric study of research productivity in occupational therapy and physical therapy/physiotherapy in four Western countries and five Asian countries/regions.

INTRODUCTION: High-quality research is the foundation of occupational therapy and physical therapy/physiotherapy. A bibliometric study on the research productivity of occupational therapy and physical therapy/physiotherapy scholars in different Western and Asian countries/regions could provide a snapshot of current research achievement in rehabilitation science. METHOD: On the basis of an understanding of the leading role of rehabilitation research in Western countries and a recognition of achievements made by Asian occupational therapy and physical therapy/physiotherapy scholars, the current bibliometric study examined the research productivity of occupational therapy and physical therapy/physiotherapy professors and associate professors from four Western countries (Australia, Canada, the United States and the United Kingdom) and five Asian countries/regions (Hong Kong, Japan, Taiwan, Singapore and South Korea). The h-indices of these scholars were retrieved online and aggregated to quantify the research productivity of institutions and countries/regions. RESULTS: Australia, Canada, Hong Kong and the United States were identified as countries/regions with higher research productivity in occupational therapy and physical therapy/physiotherapy. The institutions were ranked on the basis of the median h-indices of their professors and associate professors; the top 20 productive institutions with occupational therapy programmes had a median h-index of 17.5 or higher, whereas the benchmark of the top 20 institutions with physical therapy/physiotherapy programmes was 25. CONCLUSION: Professors and associate professors in Australia, Canada, Hong Kong and the United States are productive in occupational therapy and physical therapy/physiotherapy research. The number of faculty members and university connections are regarded as important for research achievement. Recommendations for various levels of collaboration are provided.

Validation of the virtual-reality prospective memory test (Hong Kong Chinese version) for individuals with first-episode schizophrenia.

This study was performed to examine the psychometric properties of a Virtual-Reality Prospective Memory Test (Hong Kong Chinese version; VRPMT-CV). The VRPMT was administered to 44 individuals with first-episode schizophrenia. The test was administered again 2 weeks later to establish test-retest reliability. The concurrent validity of the VRPMT was evaluated by examining the correlations between the VRPMT score and the score on the Chinese version of the Cambridge Prospective Memory Test (CAMPROMPT-CV). The performance of individuals with schizophrenia on the VRPMT was also compared with that of 42 healthy control subjects to examine the test's sensitivity and specificity. The intraclass correlation for test-retest reliability of the total VRPMT-CV score was 0.78 (p = .005). A significant correlation was found between the total VRPMT-CV score and the total CAMPROMPT-CV score (r = 0.90; p < .001). Comparison with the healthy control subjects revealed that the total VRPMT-CV score was a sensitive (92.9%) and specific (75%) measure of prospective memory deficits in individuals with schizophrenia. The VRPMT-CV is an assessment of prospective memory that has good construct validity, test-retest reliability, sensitivity and specificity in the context of first-episode schizophrenia.

Validation of the Cambridge Prospective Memory Test (Hong Kong Chinese version) for people with stroke.

This study aimed to develop and evaluate a Hong Kong Chinese version of the Cambridge Prospective Memory Test (CAMPROMPT-HKCV). Thirty-three subjects at least one year post-stroke participated in the study. They were simultaneously rated on version A of the CAMPROMPT-HKCV by two testers to establish its internal consistency and inter-rater reliability. Raters used the parallel versions of the test (A and B), in rating 10 patients within 2 weeks to establish the parallel form reliability. Another 10 were also assessed on the same day using both version A of the CAMPROMPT-HKCV and the Rivermead Behavioural Memory Test-Chinese version (RBMT-CV) to establish concurrent validity. A new group of 40 stroke patients and 44 healthy controls was recruited to establish its sensitivity and specificity. Results indicated that test-retest reliability on time-based, event-based and total scores, and inter-rater reliability for versions A and B of the test were high. Cronbach's alpha of the event-based score was higher than that of the time-based score. The reliability and concurrent validity of the parallel forms were established. There was a significant difference in performance on CAMPROMPT-HKCV (version A) between the stroke group and the healthy control group. ROC analysis showed that the ability of the cut-off CAMPROMPT-HKCV (total score) to differentiate PM problems was 20.5 (out of 36) with sensitivity at 95.5% and specificity at 55.9%. Further study in developing stratified norms across different age groups in Chinese-speaking stroke patients is recommended.

Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer's disease in Hong Kong: a pilot study.

BACKGROUND: Improving the situation in older adults with cognitive decline and evidence of cognitive rehabilitation is considered crucial in long-term care of the elderly. The objective of this study was to implement a computerized errorless learning-based memory training program (CELP) for persons with early Alzheimer's disease, and to compare the training outcomes of a CELP group with those of a therapist-led errorless learning program (TELP) group and a waiting-list control group. METHODS: A randomized controlled trial with a single-blind research design was used in the study. Chinese patients with early Alzheimer's disease screened by the Clinical Dementia Rating (score of 1) were recruited. The subjects were randomly assigned to CELP (n = 6), TELP (n = 6), and waiting-list control (n = 7) groups. Evaluation of subjects before and after testing, and at three-month follow-up was achieved using primary outcomes on the Chinese Mini-Mental State Examination, Chinese Dementia Rating Scale, Hong Kong List Learning Test, and the Brief Assessment of Prospective Memory-Short Form. Secondary outcomes were the Modified Barthel Index, Hong Kong Lawton Instrumental Activities of Daily Living Scale, and Geriatric Depression Scale-Short Form. The data were analyzed using Friedman's test for time effect and the Kruskal-Wallis test for treatment effect. RESULTS: Positive treatment effects on cognition were found in two errorless learning-based memory groups (ie, computer-assisted and therapist-led). Remarkable changes were shown in cognitive function for subjects receiving CELP and emotional/daily functions in those receiving TELP. CONCLUSION: Positive changes in the cognitive function of Chinese patients with early Alzheimer's disease were initially found after errorless training through CELP. Further enhancement of the training program is recommended.

Virtual reality-based prospective memory training program for people with acquired brain injury.

Acquired brain injuries (ABI) may display cognitive impairments and lead to long-term disabilities including prospective memory (PM) failure. Prospective memory serves to remember to execute an intended action in the future. PM problems would be a challenge to an ABI patient's successful community reintegration. While retrospective memory (RM) has been extensively studied, treatment programs for prospective memory are rarely reported. The development of a treatment program for PM, which is considered timely, can be cost-effective and appropriate to the patient's environment. A 12-session virtual reality (VR)-based cognitive rehabilitation program was developed using everyday PM activities as training content. 37 subjects were recruited to participate in a pretest-posttest control experimental study to evaluate its treatment effectiveness. Results suggest that significantly better changes were seen in both VR-based and real-life PM outcome measures, related cognitive attributes such as frontal lobe functions and semantic fluency. VR-based training may be well accepted by ABI patients as encouraging improvement has been shown. Large-scale studies of a virtual reality-based prospective memory (VRPM) training program are indicated.

A virtual reality-based vocational training system (VRVTS) for people with schizophrenia in vocational rehabilitation.

Employment provides schizophrenic patients with a positive identity and hope. Cognitive impairments have been suggested to slow down the progress in work rehabilitation. The purpose of this study was to investigate the efficacy and effectiveness of VR as a cognitive intervention for enhancing vocational outcomes. 95 inpatients with schizophrenia were randomly assigned to a virtual reality-based vocational training group (VRG), a therapist-administered group (TAG) and a conventional group (CG). Twenty-five of them in each group had completed the study. Their performances were evaluated, before and after interventions, by Brief Neuropsychological Cognitive Examination, Digit Vigilance Test, Rivermead Behavioural Memory Test, Wisconsin Card Sorting Test (WCST) and Vocational Cognitive Rating Scale. Patients in the VRG were found to perform better than patients in the TAG and CG in cognitive functioning, as shown by the WCST-percentage of error (F (2, 72)=7.146, p<0.001) and the WCST-percentage of conceptual level response (F (2, 72)=8.722, p<0.001). The post-hoc test revealed that the VRG showed a better performance than both the TAG (p=0.03) and the CG (p<0.001) in the WCST-percentage of error. The VRG also showed a better performance than patients in both the TAG (p=0.01) and the CG (p<0.001) in the WCST-percentage of conceptual level response. The VRG also showed a better self-efficacy score than CG. Both VRG and TAG showed a better work performance as reflected by the on-site tests. Further studies on the use of VR in schizophrenia rehabilitation and for vocational success are discussed.

Evaluation of a virtual reality-based memory training programme for Hong Kong Chinese older adults with questionable dementia: a pilot study.

BACKGROUND: Older adults with questionable dementia are at risk of progressing to dementia, and early intervention is considered important. The present study investigated the effectiveness of a virtual reality (VR)-based memory training for older adults with questionable dementia. METHODS: A pre-test and post-test design was adopted. Twenty and 24 older adults with questionable dementia were randomly assigned to a VR-based and a therapist-led memory training group, respectively. Primary outcome measures included the Multifactorial Memory Questionnaire and Fuld Object Memory Evaluation. RESULTS: Both groups demonstrated positive training effects, with the VR group showing greater improvement in objective memory performance and the non-VR group showing better subjective memory subtest results in the Multifactorial Memory Questionnaire. CONCLUSION: The use of VR seems to be acceptable for older adults with questionable dementia. Further study on the effect of educational background and memory training modality (visual, auditory) is warranted.

Development of the Brief Assessment of Prospective Memory (BAPM) for use with traumatic brain injury populations.

Impairment of prospective memory (PM) is a common problem following traumatic brain injury (TBI) which can affect functional outcomes. PM failures in everyday life can be assessed using self-report questionnaires; however, existing measures tend to be lengthy, which may be problematic for individuals with fatigue and other cognitive impairments. This study aimed to develop a short form of the Comprehensive Assessment of Prospective Memory (CAPM) and examine its psychometric properties. Using theoretical and statistical considerations, the number of items on the CAPM was reduced to 16 including equal numbers representing the basic activities of daily living (BADL) and instrumental activities of daily living (IADL) subscales. The psychometric properties of the new measure, named the Brief Assessment of Prospective Memory (BAPM), were examined by secondary analysis of data from two samples of community dwelling adults (aged 17 to 91 years, n = 527, and 15 to 60 years, n = 95) with no history of brain injury, and a sample of rehabilitation patients with moderate to severe TBI (n = 45). Results indicate that the BAPM has a robust factor structure, strong agreement with the original CAPM, acceptable internal consistency and test-retest reliability, and evidence of criterion-related validity with psychosocial integration as the point of reference for people with TBI.

Do older t'ai chi practitioners have better attention and memory function?

OBJECTIVES: Cognitive declines are common in older people and can be a major health issue in an aging world. One type of body-mind exercises, t'ai chi, can be a possible means to help maintaining older adults' cognitive abilities, in addition to beneficial effects of physical exercises. The purpose of this study was to investigate whether t'ai chi practitioners had better attention and memory functions than older people with or without regular exercises. METHODS: A cross-sectional study examining the relationship between t'ai chi practice and age-, gender- and education-similar older peoples' attention and memory functions. Forty-two (42) community-dwelling elderly subjects, aged 60 or older, recruited from t'ai chi clubs in Hong Kong formed the t'ai chi group. Another 49 elderly having regular exercise habits were recruited from community centers for inclusion in the exercise group. A nonexercise group (normal healthy control) consisting of 44 subjects were also recruited by random selection and through contacting local elderly centers. They were also screened by the Modified Barthel Index, Chinese Mini-mental Status Examination, Geriatric Depression Scale, and evaluated by attention tests (Color Trail Form A-1 and 2) and memory tests (including Rivermead Behavioral Memory Test and The Hong Kong List Learning Test). RESULTS: The main finding was that the three groups differed in attention and memory functions, and the t'ai chi group had demonstrated better performance than the other two groups in most subtests. CONCLUSIONS: As a causal relationship cannot be assumed in the present cross-sectional study, future research is required to examine how t'ai chi can improve cognitive function using a randomized control trial as well as determining whether t'ai chi practice can lead to better health status among elderly people.

Validation of the Intelligent Cognitive Assessment System (ICAS) for stroke survivors.

PRIMARY OBJECTIVE: To investigate the internal consistency, test-re-test reliability of an Intelligent Cognitive Assessment System (ICAS) and its optimal cut-off score for stroke patients with or without cognitive impairment. METHOD: A prospective cohort study design was adopted. Sixty-six post-stroke patients of aged 60 or above were recruited. They were screened by the Chinese version of Mini Mental State Examination (MMSE-CV) and assessed by the Intelligent Cognitive Assessment System (ICAS) consisting of 65 testing items which could be presented at a level according to stroke patient's response. It was administered to examine the internal consistency and test-re-test reliability (by repeating within a 7-day interval). The optimal cut-off score to screen stroke patients having cognitive impairment was determined by the receiver operating characteristics (ROC) curve. RESULTS: The internal consistency of the ICAS (Cronbach's alpha = 0.878) and its test-re-test reliability (rho = 0.789; p < 0.001) were demonstrated. The cut-off score for the ICAS to determine cognitive impairment was found to be 3.02, with a sensitivity of 80.5% and specificity of 96%. CONCLUSION: Preliminary results suggested that ICAS was a valid and reliable cognitive screening tool for stroke survivors. The ICAS can be further developed by studying its norms for stroke patients. It is also programmable for potential application to different countries by changing ICAS to other language versions and including other culturally relevant content.

Virtual reality (VR)-based community living skills training for people with acquired brain injury: A pilot study.

PRIMARY OBJECTIVE: The purpose of the present study was to test the usability and effectiveness of a newly-developed virtual reality (VR)-based community living skills training program for people with acquired brain injury (ABI). METHOD: A small-sample, pre- and post-quasi experimental design was adopted to initially study the efficacy of the VR-based training program. Its usability was also investigated through interviewing subjects. Outcomes were documented in terms of subjects' skills acquisition, self-efficacy in applying the learnt skills and the transfer ratio of the learnt skills to the real environment. Global cognitive ability and the functional independence level were also assessed. RESULTS: Four subjects with ABI (one traumatic brain injury and three stroke subjects) were successfully recruited and received 10 sessions of VR-based community living skills training. All four subjects showed improvement in skills acquisition and memory performance, while three out of four also showed improvement in self-efficacy and demonstrated transfer of skills to the real environment. Usability was initially supported. CONCLUSIONS: Preliminary results suggested positive changes in ABI subjects. The proposed virtual reality (VR) community living skills training software will be further investigated in a randomized controlled trial.

Validation of a computerized cognitive assessment system for persons with stroke: a pilot study.

This study investigates the validity of a newly developed computerized cognitive assessment system (CCAS) that is equipped with rich multimedia to generate simulated testing situations and considers both test item difficulty and the test taker's ability. It is also hypothesized that better predictive validity of the CCAS in self-care of persons with stroke can be obtained. The CCAS has been constructed and validated by an expert review panel. The system was pilot-tested with 14 patients who had suffered a stroke and fulfilled specific selection criteria. In addition, data on patients' performances in the Mini-Mental State Examination (MMSE) and Neurobehavioral Cognitive State Examination (NCSE) or Cognistat, Modified Barthel Index, Functional Test for the Hemiplegic Upper Extremity were collected. Their demographic characteristics were also collected. Correlation coefficients of the scores among the CCAS, MMSE, and NCSE were used to show the concurrent validity of the former. With regard to the content validity, the intraclass correlation coefficient [model 2, ICC(2,k)] among the panel members was 0.972 with a P value of less than 0.01. The scores of the CCAS correlate with MMSE (r = 0.676, P = 0.011) and with the four subtests of the NCSE (repetition, naming, construction, and calculation). The content and concurrent validity as well as the predictive abilities in self-care function of the CCAS were initially established. The degree of the usefulness and accuracy of the new computerized system in measuring the cognitive performance in persons with stroke remains to be determined.

Development and validation of the Online Rivermead Behavioral Memory Test (OL-RBMT) for people with stroke.

The purpose of this paper was to examine the reliability and validity (concurrent and construct) of a newly developed online Chinese version of the Rivermead Behavioral Memory Test (OL-RBMT) and its equivalence with the face-to-face version (FTF-RBMT). The OL-RBMT and FTF-RBMT were administered to 30 subjects with stroke in a two-week interval to establish their test-retest reliability, as well as to compare the two tests' equivalence. The OL-RBMT was further compared with another 30 age- and gender-matched, non-stroke patients to establish its construct validity. Its concurrent validity was established by computing scores with that of the Chinese version of Neurobehavioral Cognitive Status Examination (NCSE or Cognistat). The intra-class correlation for test-retest reliability of the OL-RBMT was 0.94 (P < 0.01). Pearson's correlation coefficients between the subscores of OL-RBMT and FTF-RBMT ranged from 0.84 to 0.93 (P < 0.01). Statistically significant correlation was found between OL-RBMT and NCSE scores (R = 0.797, P < 0.001), as well as in the differences in OL-RBMT scores between the stroke and non-stroke groups (Z = -4.041, P < 0.001). We consider that the reliability and validity of this newly developed online version of RBMT was established. Usability of the OL-RBMT was also discussed.

Self-appraised, informant-reported, and objective memory and cognitive function in mild cognitive impairment.

BACKGROUND/AIM: The current knowledge of how self-appraised memory and cognitive function relates to informant reports and neuropsychological performances in mild cognitive impairment (MCI) is limited. METHODS: Sixty-nine older community-dwelling subjects with MCI and 86 adults with normal cognition (NC) were evaluated on self-appraised (Multifactorial Memory Questionnaire) and objective performance of memory and cognitive function (Mini-Mental State Examination, Fuld Object Memory Evaluation, Digit Span tests, Rivermead Behavioral Memory Test). Informant ratings on the subjects' cognitive and memory functioning (Informant Questionnaire on Cognitive Decline in the Elderly) were also obtained. The two groups (MCI, NC) did not significantly differ in mean age (79 +/- 5.29 vs. 77 +/- 5.33) and mean years of education (2.8 +/- 3.03 vs. 3.7 +/- 4.18). RESULTS: Self-appraised satisfaction and ability of memory and cognitive functions did not correlate with informant reports and neuropsychological performances, but self-reported strategy use correlated with list recall and everyday memory tests in MCI. CONCLUSION: Persons with MCI may show signs of diminished awareness towards their subtle impairments of memory and cognitive function, as indicated by informant reports and neuropsychological tests.

Evaluation of computer-access solutions for students with quadriplegic athetoid cerebral palsy.

People with multiple physical impairments are not capable of using proper pointer devices, thus diminishing their opportunities to communicate and learn through computers. This research design used a replicated single-case experimental approach to compare the individual performance of two students with speech impairments and quadriplegic athetoid cerebral palsy in using four different computer-access solutions (the CameraMouse, the ASL Head Array mouse emulator, the CrossScanner, and the Quick Glance Eye Tracking System). The results demonstrate statistical significance in the correlation of movement time and accuracy to the level of comfort and satisfaction, which was used to guide the selection of computer-access solutions for clinical interventions. The WinFitts and Assessment of Comfort tests used in this study can be replicated for further clinical research into computer-access systems.

A randomized clinical trial study on the effectiveness of a tele-analogy-based problem-solving programme for people with acquired brain injury (ABI).

PRIMARY OBJECTIVE: The present study reports the results of 103 persons with acquired brain injury who were randomly assigned to one of three 20-session analogy problem-solving skill training groups, namely: online training (through computer video conferencing with interactive software); computer-assisted training (through interactive patient-directed software); therapist administered training (face-to-face therapist guided training activities); and a "no-treatment" control group. RESEARCH DESIGN: Pre- and post-test quasi-experimental design. MAIN OUTCOME AND RESULTS: Individuals' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period. Overall, the training methods were found to be effective in improving problem solving skills regardless of the modes of delivery (except in the case of the control group). The continuous "human touch" characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving. CONCLUSION: The statistically significantly improvement in problem solving skills in the online-group suggests that this approach could effectively improve cognitive functions of person with ABI and yield training outcomes comparable to other modes of delivery such as the face-to-face training. The conceptualization and applicability of tele-cognitive rehabilitation, its implications for persons with ABI, and future studies in this research area are also discussed.

Virtual reality training for stroke rehabilitation.

OBJECTIVE: To evaluate the effectiveness of a 2-D virtual reality (2DVR) programme in the training of people with stroke on how to access and use the station facilities of the Mass Transit Railway (MTR). METHOD: A flat-screen 2DVR based training programme and a corresponding, typical psycho-educational programme with video modelling were developed for comparison through a research design that involved a randomised control group pre-test and post-test. RESULTS: Twenty and sixteen subjects respectively received 10 training sessions using the 2DVR strategy and a video-based psycho-educational programme. An additional 22 subjects formed the control group. They were assessed by using a behavioural checklist of MTR skills and a newly validated MTR self-efficacy scale. The subjects of both training groups showed a significant improvement in their knowledge, skills and self-efficacy in using the MTR (p<0.01), whereas, the MTR skills and self-efficacy of the control group remained stable over a four-week interval. CONCLUSION: Though both training programmes were effective in training the patients with stroke, they demonstrated differential improvements in MTR skills and related self-efficacy. Additional studies are recommended to identify the most effective training procedures for maintaining these skills and the best transfer ratio in the training of VR-based community living skills of people with stroke.

Cognitive functions among Hong Kong Chinese people with schizophrenia.

Persons with schizophrenia show deficits in a variety of cognitive domains including executive function, attention, memory and language. Similar interest in studying the impact of cognitive deficits on the everyday functioning of people with schizophrenia has been documented. This study examined the cognitive functioning among Hong Kong Chinese schizophrenic patients compared with other patient groups, and its relationship with functional outcome, especially in the social aspect. Results indicated that schizophrenic patients presented with mild cognitive problems compared with neurosurgical and demented patients. Initial support was found in relating cognitive functions, as measured by Neurobehavioral Cognitive Status Examination, with functional outcome as measured by Functional Independence Measures. The implication for community rehabilitation is also discussed.