Bilateral Transcutaneous Electrical Nerve Stimulation Improves Upper Limb Motor Recovery in Stroke: A Randomized Controlled Trial.

BACKGROUND: Recent evidence has shown bilateral transcutaneous electrical nerve stimulation (Bi-TENS) combined with task-oriented training (TOT) to be superior to unilateral transcutaneous electrical nerve stimulation (Uni-TENS)+TOT in improving lower limb motor functioning following stroke. However, no research explored the effect of Bi-TENS+TOT in improving upper limb motor recovery. This study aimed to compare Bi-TENS+TOT with Uni-TENS+TOT, Placebo transcutaneous electrical nerve stimulation (Placebo-TENS)+TOT, and no treatment (Control) groups in upper limb motor recovery. METHODS: This is a 4-group parallel design. One hundred and twenty subjects were given either Bi-TENS+TOT, Uni-TENS+TOT, Placebo-TENS+TOT, or Control without treatment in this randomized controlled trial. Twenty 60-minute sessions were administered 3× per week for 7 weeks. The outcome measure was the Fugl-Meyer Assessment of Upper Extremity, which was assessed at baseline, after 10 sessions (mid-intervention) and 20 sessions (post-intervention) of intervention, and at 1- and 3-month follow-up. RESULTS: Patients in the Bi-TENS+TOT group showed greater improvement in the Fugl-Meyer Assessment of Upper Extremity scores than Uni-TENS+TOT (mean difference, 2.13; P=0.004), Placebo-TENS+TOT (mean difference, 2.63; P<0.001), and Control groups (mean difference, 3.11; P<0.001) at post-intervention. Both Bi-TENS+TOT (mean difference, 3.39; P<0.001) and Uni-TENS+TOT (mean difference, 1.26; P=0.018) showed significant within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores. Patients in the Bi-TENS+TOT group showed earlier within-group improvement in the Fugl-Meyer Assessment of Upper Extremity scores at mid-intervention than Uni-TENS+TOT. These improvements were maintained at the 3-month follow-up assessment. CONCLUSIONS: Bi-TENS combined with TOT is an effective therapy for improving upper limb motor recovery following stroke. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03112473.

Gait speed and spasticity are independently associated with estimated failure load in the distal tibia after stroke: an HR-pQCT study.

This HR-pQCT study was conducted to examine bone properties of the distal tibia post-stroke and to identify clinical outcomes that were associated with these properties at this site. It was found that spasticity and gait speed were independently associated with estimated failure load in individuals with chronic stroke. PURPOSE: (1) To examine the influence of stroke on distal tibia bone properties and (2) the association between these properties and clinical outcomes in people with chronic stroke. METHODS: Sixty-four people with stroke (age, 60.8 ± 7.7 years; time since stroke, 5.7 ± 3.9 years) and 64 controls (age: 59.4 ± 7.8 years) participated in this study. High-resolution peripheral quantitative computed tomography (HR-pQCT) was used to scan the bilateral distal tibia, and estimated failure load was calculated by automated finite element analysis. Echo intensity of the medial gastrocnemius muscle and blood flow of the popliteal artery were assessed with ultrasound. The 10-m walk test (10MWT), Fugl-Meyer Motor Assessment (FMA), and Composite Spasticity Scale (CSS) were also administered. RESULTS: The percent side-to-side difference (%SSD) in estimated failure load, cortical area, thickness, and volumetric bone mineral density (vBMD), and trabecular and total vBMD were significantly greater in the stroke group than their control counterparts (Cohen's d = 0.48-1.51). Isometric peak torque and echo intensity also showed significant within- and between-groups differences (p ≤ 0.01). Among HR-pQCT variables, the %SSD in estimated failure load was empirically chosen as one example of the strong discriminators between the stroke group and control group, after accounting for other relevant factors. The 10MWT and CSS subscale for ankle clonus remained significantly associated with the %SSD in estimated failure load after adjusting for other relevant factors (p ≤ 0.05). CONCLUSION: The paretic distal tibia showed more compromised vBMD, cortical area, cortical thickness, and estimated failure load than the non-paretic tibia. Gait speed and spasticity were independently associated with estimated failure load. As treatment programs focusing on these potentially modifiable stroke-related impairments are feasible to administer, future studies are needed to determine the efficacy of such intervention strategies for improving bone strength in individuals with chronic stroke.

Convergent Validity and Test-Retest Reliability of Multimodal Ultrasonography and Related Clinical Measures in People With Chronic Stroke.

OBJECTIVE: To assess the test-retest reliability of diagnostic ultrasonography measurements of the bilateral biceps brachii (BB), brachial artery, medial gastrocnemius (MG), and popliteal artery in survivors of stroke and their convergent validity with related clinical comparators. DESIGN: Cross-sectional study. SETTING: All procedures were conducted in a university laboratory. PARTICIPANTS: Sixty-five community dwelling adults (N=65; 26 women, 39 men) with an average age of 60.9±7.7 years and stroke duration of 5.7±3.9 years participated in this study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measures of muscle structure (ie, thickness, cross-sectional area, fascicle length, pennation angle), stiffness, and intramuscular blood perfusion were conducted using B-mode, elastography and color flow Doppler ultrasonography modes, respectively. Convergent validity was assessed by examining correlations between ultrasonography measures and assessments of related constructs (ie, dynamic stiffness, isometric peak torque, spasticity, and systemic vascular function using myotonometry, dynamometry, the Composite Spasticity Scale, and the Ankle-Brachial Index, respectively). A 2-way random-effects intraclass correlation coefficient (ICC) model (ICC2,3) was used to determine agreement between intersession measures among a smaller cohort of participants with stroke (n=20). RESULTS: ICC estimates ranged from moderate to excellent for muscle stiffness (paretic: ICC=0.74-0.89; nonparetic: ICC=0.66-0.88), structure (paretic: ICC=0.87-0.99; nonparetic: ICC=0.81-0.98), and blood perfusion measures (paretic: ICC=0.74-0.84; nonparetic: ICC=0.73-0.88). Weak to moderate associations were found between myotonometry and elastography measures of the bilateral BB (r=0.29-0.52, P≤.05) and MG muscles (r=0.31-0.69, P≤.05). The correlations between elastography measures and spasticity scores for the paretic upper (r=0.35-0.63, P≤.05) and lower limbs (r=0.25-0.37, P≤.05) were also weak to moderate. CONCLUSIONS: Elastography demonstrated mostly weak to moderate correlation with measures of stiffness using myotonometry as well as scores of paretic upper and lower limb spasticity. The results also indicate acceptable intersession reliability for muscle and vascular measures using several ultrasonography modalities among individuals with chronic stroke.

The availability and quality of breastfeeding guidelines for women with spinal cord injury: a narrative review.

STUDY DESIGN: Narrative review. OBJECTIVES: To evaluate the availability and quality of breastfeeding guidelines for women with spinal cord injury (SCI). SETTING: International Collaboration on Repair Discoveries (ICORD), Department of Medicine, Vancouver, BC. METHODS: An environmental scan restricted to English language literature was performed to identify existing postpartum and breastfeeding guidelines. Guidelines were evaluated using a structured, validated tool (AGREE II) by 13 appraisers [medical/research experts (n = 10) and those with lived experience (n = 3)] from Vancouver and two international sites. Seven guidelines were evaluated across Domain 1 of the AGREE II tool to determine if they were applicable to mothers with SCI/physical disabilities. Domains 2 to 7 were evaluated if the guideline made mention of the SCI population. RESULTS: Of the seven guidelines evaluated, only one mentioned SCI (Postpartum Care in SCI from BC Women's Hospital). Other guidelines were excluded from further evaluation as they did not address the issue of breastfeeding in women with SCI. The overall scaled score for this guideline was 34.5%. There was significant variability between domains but no AGREE II domain scored greater than 50%, indicating substantial limitations. CONCLUSIONS: Current breastfeeding guidelines are not targeted to persons with SCI. The one guideline that made mention of women with SCI had significant global deficits. This highlights the importance of developing guidelines for health care providers focused specifically on women with SCI to support and optimize breastfeeding in this unique population for the benefit of mother and infant across the lifespan.

Cognitive and psychological interventions for the reduction of post-concussion symptoms in patients with mild traumatic brain injury: a systematic review.

OBJECTIVE: To evaluate the effects of cognitive and psychological interventions for the reduction of post-concussion symptoms (PCS) in patients with mild traumatic brain injury (MTBI). DATA SOURCES: The databases of CINAHL, Medline, PubMed, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews. REVIEW METHODS: Meta-analysis was conducted for randomized-controlled trials that have included an assessment of PCS using the Rivermead Post-concussion Symptoms Questionnaire as primary outcomes by calculating the mean difference/standardized mean difference using fixed/random effect models as appropriate. RESULTS: Systematic review with the date of the last search in Mar 2018 yielded 16080 articles, 17 articles including 3081 participants were included in the final review. Interventions included psychoeducation (n = 8), telephone problem-solving treatment (n = 4), individual-based cognitive behavioral therapy (n = 4), and cognitive training (n = 1). No intervention is effective in reducing PCS at 3 to 6 months follow-up, however, an overall small effect size was found in pooled functional outcomes at 6 months. CONCLUSIONS: There was no effect on symptom reduction at 3 to 6 months for PCS interventions but improved functional outcomes were shown for patients with MTBI at 6 months. Long-lasting effects of interventions at 12 months or after were not studied.

Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training.

Background and Purpose- Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes. Methods- Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks: (1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention. Results- Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants. Conclusions- Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals with a history of stroke. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT02937532.

The effect of a brief mindfulness-based intervention on personal recovery in people with bipolar disorder: a randomized controlled trial (study protocol).

BACKGROUND: With the advent of the recovery movement in mental health, a humanistic paradigm shift has occurred, placing the focus on personal recovery (i.e., hope, identity, and life meaning) instead of functional or clinical recovery only (i.e., symptom reduction or increases in physical function). Along the journey of recovery, people with bipolar disorder (BD) struggle to cope with recurring mood fluctuations between depression and mania. Mindfulness-based interventions (MBIs) have the potential to result in improvements in personal recovery outcomes. Thus, this protocol will evaluate the efficacy and mechanisms of a brief MBI for helping individuals with BD with their personal recovery. It is hypothesized that adults with BD randomly assigned to a brief MBI intervention will report greater improvements in personal recovery than those in a waiting list control condition. In addition, it is hypothesized that such benefits will be mediated by improvements in emotion awareness, emotion regulation, and illness acceptance. Moreover, the specific stage of BD is hypothesized to moderate the beneficial effects of the brief MBI, such that those in the early stage of BD will report more benefits regarding emotion awareness and emotion regulation, whereas those in the late stage of BD will report more advantages concerning illness acceptance. METHOD: One hundred and fifty-four adults with BD will be recruited from hospitals and community settings for this research project. This study will use a mixed methods design. A randomized-controlled trial will be conducted to compare a brief MBI (four sessions in total) group and a waiting list control group. Assessments will be made at baseline, after intervention, and at six-month follow-up. In addition, a qualitative and participatory research method called Photovoice will be employed to further understand the experiences of the participants who receive the brief MBI along their personal recovery journey. DISCUSSION: If the study hypotheses are supported, the findings from this research project will provide empirical support for an alternative treatment. Moreover, by identifying the mechanisms of the beneficial effects of the brief MBI, the findings will highlight process variables that could be specifically targeted to make MBI treatment even more effective in this population. TRIAL REGISTRATION: This study is registered with the Chinese Clinical Trial Registry ( ChiCTR- 1900024658 ). Registered 20th July 2019.

Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis.

BACKGROUND: fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed. OBJECTIVE: to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people. METHOD: randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews. RESULTS: a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance. CONCLUSIONS: CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.

The sitting and rising test for assessing people with chronic stroke.

[Purpose] To investigate the inter-rater and test-retest reliability of the sitting-rising test (SRT), the correlations of sitting-rising test scores with measures of strength, balance, community integration and quality of life, as well as the cut-off score which best discriminates people with chronic stroke from healthy older adults were investigated. [Subjects and Methods] Subjects with chronic stroke (n=30) and healthy older adults (n=30) were recruited. The study had a cross-sectional design, and was carried out in a university rehabilitation laboratory. Sitting-rising test performance was scored on two occasions. Other measurements included ankle dorsiflexor and plantarflexor strength, the Fugl-Meyer assessment, the Berg Balance Scale, the timed up and go test, the five times sit-to-stand test, the limits of stability test, and measures of quality of health and community integration. [Results] Sitting-rising test scores demonstrated good to excellent inter-rater and test-retest reliabilities (ICC=0.679 to 0.967). Sitting-rising test scores correlated significantly with ankle strength, but not with other test results. The sitting-rising test showed good sensitivity and specificity. A cut-off score of 7.8 best distinguished healthy older adults from stroke subjects. [Conclusions] The sitting-rising test is a reliable and sensitive test for assessing the quality of sitting and rising movements. Further studies with a larger sample are required to investigate the test's validity.

Meta-analysis on the effect of mental imagery on motor recovery of the hemiplegic upper extremity function.

BACKGROUND/AIM: Studies have shown that mental imagery can enhance relearning and generalisation of function after stroke. The aim of this meta-analysis was to evaluate evidence on the effects of mental imagery on motor recovery of the hemiplegic upper extremities after stroke. METHODS: A comprehensive data base search of the literature up to December 2012 was performed using PubMed, EBSCO host (Academic Search Premier, CINAHL and Educational Resource Information Center), PsycINFO, Medline, and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index). Randomised clinical trials or controlled clinical trials that included mental imagery for improving upper extremity motor function for stroke patients were located. Relevant articles were critically reviewed and methodological quality was evaluated using the PEDro Scale, and study results synthesised. RESULTS: Five randomised clinical trials and one controlled clinical trial met the inclusion criteria. Five of the six studies yielded positive findings in favour of mental imagery. Quantitative analysis showed a significant difference in the Action Research Arm Test (overall effect: Z=6.75; P<<0.001). CONCLUSION: Review of the literature revealed a trend in support of the use of motor imagery for upper extremity motor rehabilitation after stroke. Mental imagery could be a viable intervention for stroke patients given its benefits of being safe, cost-effective and rendering multiple and unlimited practice opportunities. It is recommended that researchers incorporate imaging techniques into clinical studies so that the mechanism whereby mental imagery mediates motor recovery or neural adaptation for people with stroke can be better understood.

Self-perceived upper extremity motor function predicts health-related quality of life in chronic stroke survivors.

PURPOSE: To examine whether the Upper Extremity Functional Index (UEFI) score independently contributes to the Stroke Impact Scale (SIS) score and quantified its relative contribution to SIS scores in chronic stroke survivors. MATERIALS AND METHODS: A cross-sectional study in a university-based rehabilitation centre with people with chronic stroke (N = 95) aged ≥ 50 years. The outcome measures included paretic hand grip strength, Fugl-Meyer Upper Extremity Assessment (FMA-UE), Wolf Motor Function Test (WMFT), UEFI, and SIS. RESULTS: Correlation analysis revealed that paretic hand grip strength, FMA-UE, UEFI, and WMFT scores exhibited a significant moderate positive correlation with SIS scores (r = 0.544-0.687, p < 0.001). The results of a regression model indicated that after adjustment for demographic factors and stroke-related impairments, the UEFI scores remained independently associated with SIS scores, accounting for 18.8% of the variance. The entire model explained 60.3% of the variance in SIS scores. CONCLUSIONS: Self-perceived UE motor function is a crucial component to be included in rehabilitation programmes aimed at enhancing quality of life and participation among chronic stroke survivors.

Observation-based outcome measures, e.g., Fugl­Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT) could not predict the health-related quality of life (Stroke Impact scale (SIS)) in chronic stroke survivors in our study, which was contradictory with current studies.A self-perceived outcome measure to evaluate upper extremity function (Upper Extremity Functional Index (UEFI)) could independently predict the health-related quality of life (SIS), accounting for 18.8% of the variance.Our study demonstrated that self-perceived UE motor function would be an important component to optimize the rehabilitation programmes aimed at enhancing quality of life and social participation among chronic stroke survivors.

Effects of mirror therapy with electrical stimulation for upper limb recovery in people with stroke: a systematic review and meta-analysis.

PURPOSE: To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke. METHODS: Systematic review and meta-analysis were completed. Methodological quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence. RESULTS: A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference [SMD], 1.89 [1.52-2.26]) and ES alone (SMD, 0.42 [0.11-0.73]) with low quality of evidence, or MT alone (SMD, 0.47[0.04-0.89]) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 [1.92-11.01]) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 [0.42-1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log. CONCLUSION: MT with ES may be effective in improving upper limb motor recovery in people with stroke.

Combining Mirror Therapy (MT) and Electrical Stimulation (ES) modality could improve upper limb motor control, gross gripping function, and performance in ADLs based on ICF for people with stroke.Those individuals with subacute stroke are recommended as the optimal target group for the combined MT and ES.

Knee muscle strength and visual acuity are the most important modifiable predictors of falls in patients after hip fracture surgery: a prospective study.

Our purpose was to identify risk factors for falls among older adults who had recently undergone hip fracture surgery. The subjects in this study were 69 older adults (aged 65 years or more) who had sustained a hip fracture and were admitted to an orthopedic rehabilitation ward after surgery. Potential fall risk factors were assessed using the physiological profile assessment, timed-up-and-go test, berg balance test, and activities-specific balance confidence scale at discharge from the hospital. Each individual was followed for a period of 6 months to obtain information on the incidence of falls. Receiver operating characteristic curves were constructed to determine the optimal cutoff score for each potential risk factor identified. Multivariate logistic regression was then used to identify the significant predictors of falls and their odds ratios (ORs). During the 6-month follow-up period, 10 of the 69 patients experienced one or more falls. The results showed that fallers were older than nonfallers (p=0.009). Fallers also had poorer performance in the high-contrast visual acuity test (p=0.015) and lower knee flexor (p=0.021) and knee extensor (p=0.005) muscle strength values. Multivariate logistic regression analysis showed that high-contrast visual acuity (cutoff score Z=-2.280, OR=6.14, 95% CI 1.13-33.29, p=0.035) and knee extensor muscle strength (cutoff score Z=-1.835, OR=4.81, 95% CI 1.04-22.33, p=0.045) were predictors of falls. Poor visual acuity and knee muscle weakness are modifiable predictors of falls and should be the key target areas in fall-prevention programs for older adults with hip fractures.

Using aerobic exercise to improve health outcomes and quality of life in stroke: evidence-based exercise prescription recommendations.

BACKGROUND: Stroke patients often suffer from poor cardiovascular health and deficits in physical, psychosocial and cognitive functioning. Aerobic exercise training may be a viable treatment approach to address these health issues. The objective of this systematic review was to determine the effects of aerobic exercise on various indicators of health, functioning and quality of life in stroke patients. It was hypothesized that the systematic review would reveal compelling support for the effectiveness of aerobic exercise in stroke patients, such that detailed evidence-based exercise prescription recommendations could be derived. METHODS: Major electronic databases were searched systematically to identify randomized controlled studies that examined the effects of aerobic exercise in stroke patients (last search performed in January 2012). The methodological quality of each study was evaluated using the PEDro scale (9-10 = excellent; 6-8 = good; 4-5 = fair; <4 = poor). Based on the methodological quality and sample size used, the level of evidence was determined for each study (level 1: PEDro ≥6 and sample size >50; level 2: PEDro ≤5 or sample size ≤50). Meta-analysis was performed on a given outcome when appropriate. RESULTS: Twenty-five trials fulfilled the selection criteria, of which 8 were level 1 studies. Treadmill and cycle ergometer were the two most popular modalities used to provide aerobic training. The most commonly adopted exercise session duration and frequency was 21-40 min and 3-5 days per week, respectively. The duration of the training programme varied, ranging from 3 weeks to 6 months. Over 60% of the trials used a high training intensity [60-80% heart rate reserve (HRR)]. Meta-analysis showed a significant effect on peak oxygen consumption (p < 0.001), peak workload (p < 0.001), maximal gait speed (p = 0.003) and walking endurance (p < 0.001) in favour of aerobic exercise. Meta-analysis revealed no significant effect on self-selected gait speed, Berg balance score and Functional Independence Measure score. The efficacy of aerobic exercise in improving other health outcomes in physical, psychosocial and cognitive domains as well as quality of life was inconclusive. The health risk associated with engaging in such exercise is small. CONCLUSIONS: There is strong evidence that aerobic exercise (40-50% HRR progressing to 60-80%) conducted 20-40 min and 3-5 days per week is beneficial for enhancing aerobic fitness, walking speed and walking endurance in people who have had mild to moderate stroke and are deemed to have low cardiovascular risk with exercise after proper screening assessments (grade A recommendation). The effects of aerobic exercise on other health outcomes require further study.

Combined effects of sensory cueing and limb activation on unilateral neglect in subacute left hemiplegic stroke patients: a randomized controlled pilot study.

OBJECTIVE: To compare the effects of contralesional sensory cueing and limb activation with that of sham control in the treatment of unilateral neglect after stroke. DESIGN: A randomized, single-blinded, sham-controlled pilot study. SETTING: Two rehabilitation hospitals. SUBJECTS: Forty subacute left hemiplegic stroke inpatients with unilateral neglect. INTERVENTIONS: Participants were assigned randomly to 1 of 2 groups. The experimental group wore a wristwatch cueing device over the hemiplegic arm for three hours a day, five days per week, for three weeks, and also underwent conventional rehabilitation. Patients were encouraged to move their hemiplegic arm five consecutive times after each prompt. The sham group underwent the same rehabilitation process, except they wore a sham device. MAIN MEASURES: Neglect, arm motor performance, and overall functioning were assessed pre- and posttraining, and at follow-up. RESULTS: There were no significant differences between groups in outcome measures except the neglect drawing tasks (p = 0.034) (the mean gain score from baseline to follow-up assessment was 5.2 (3.7) in the experimental group and 1.9 (3.5) in the sham group), across three time intervals. The experimental group showed greater improvement in arm motor performance than did the sham group. CONCLUSION: The results did not confirm that sensory cueing and limb activation treatment is effective when compared with those receiving placebo to reduce unilateral neglect, but it might be useful for promoting hemiplegic arm performance in stroke patients.

The perceived rehabilitation needs of people with schizophrenia in Hong Kong: perspectives from consumers and care-givers.

A quantitative survey was conducted to investigate the perceived rehabilitation needs based on people with schizophrenia and their caregivers. A total of 194 persons with schizophrenia and 83 caregivers were recruited by convenience sampling to complete the two newly developed questionnaires for this purpose which included the Perceived Rehabilitation Needs Questionnaire for People with Schizophrenia and the Perceived Rehabilitation Needs Questionnaire for Caregivers towards People with Schizophrenia respectively. The findings deepened the understanding of this area. Some policy and service development suggestions for mental health strategies in Hong Kong and the Asian-Pacific region were made.

Development and validation of perceived rehabilitation require questionnaires for caregivers of people with schizophrenia.

OBJECTIVE: This study aimed at developing and validating the Perceived Rehabilitation Needs Questionnaires for Caregivers (PRNQ-Cs) of people with schizophrenia. METHODS: The items of PRNQ-C were generated based on focus group discussion and literature review. A validation study was conducted to examine its psychometric properties among 98 caregivers who were recruited via convenience sampling. RESULTS: Through the use of direct oblique rotation, exploratory factor analysis yielded an eight-factor solution which accounted for 64.39% of the total variance. Its internal consistency and test-retest reliability were satisfactory. CONCLUSION: Through cross-cultural validation, the PRNQ-C is applicable in other Chinese communities with huge population of schizophrenia.

Factors associated with fall risk of community-dwelling older people: A decision tree analysis.

Objective: To examine the predictive attributes for accidental falls in community-dwelling older people in Hong Kong using decision tree analysis. Methods: We recruited 1151 participants with an average age of 74.8 years by convenience sampling from a primary healthcare setting to carry out the cross-sectional study over 6 months. The whole dataset was divided into two sets, namely training set and test set, which respectively occupied 70% and 30% of the whole dataset. The training dataset was used first; decision tree analysis was used to identify possible stratifying variables that could help to generate separate decision models. Results: The number of fallers was 230 with 20% 1-year prevalence. There were significant differences in gender, use of walking aids, presence of chronic diseases, and co-morbidities including osteoporosis, depression, and previous upper limb fractures, and performance in the Timed Up and Go test and the Functional Reach test among the baselines between the faller and non-faller groups. Three decision tree models for the dependent dichotomous variables (fallers, indoor fallers, and outdoor fallers) were generated, with overall accuracy rates of the models of 77.40%, 89.44% and 85.76%, respectively. Timed Up and Go, Functional Reach, body mass index, high blood pressure, osteoporosis, and number of drugs taken were identified as stratifying variables in the decision tree models for fall screening. Conclusion: The use of decision tree analysis for clinical algorithms for accidental falls in community-dwelling older people creates patterns for decision-making in fall screening, which also paves the way for utility-based decision-making using supervised machine learning in fall risk detection.

The relationship between liver function and neurophysiological factors in depressed individuals: a cross-sectional study using an integrated "East meets West" medicine approach.

Introduction: Depression is a common mental disorder worldwide. The pathology of depression may involve the dysregulation of neurotransmitters and immunity and produce genetic and environmental effects. Traditional Chinese Medicine (TCM) has been practiced for several thousand years and has a different understanding of depression compared to Western medicine. However, this approach has not been widely accepted by scientific communities as TCM mainly focuses on clinical practice. Methods: In this study, we conducted a cross-sectional study among 100 participants in a rehabilitation hospital to analyze the plausible pathways linking TCM-based liver function and depression, which we hypothesized in a prior theoretical review. Results: A significant relationship between adrenocorticotropic hormone and TCM-based liver function was found (r = 0.211, p = 0.041). Cortisol was significantly associated with norepinephrine (r = 0.243, p = 0.015) and adrenocorticotropic hormone (r = 0.302, p < 0.001). A positive significant relationship was also found between norepinephrine and adrenocorticotropic hormone (r = 0.272, p < 0.001). There was no significant relationship between the ratio from low frequency to high frequency and TCM-based liver function (p = 0.690). Discussion: These results suggest that TCM-based liver function can be interpreted using the hypothalamic-pituitary-adrenal axis. This is a pioneering study to examine the mechanisms of depression in relation to liver function by integrating Eastern and Western medical approaches. The findings of this study are valuable for a deeper understanding of depression and public education.

Sino-American employer perspective about behavioral-driven health conditions: predictive analyses.

OBJECTIVE: A large-scale quantitative study was conducted by stratified representative samples from Chicago (prototype of the United States; N = 293), Beijing (prototype of urbanized China; N = 302), and Hong Kong (prototype of East-meets-West culture; N = 284) to explore factors that might lead to their stigmatizing attitudes towards hiring individuals with (mental illness, alcohol abuse, drug abuse, and HIV/AIDS) and without (bone cancer) behavioral-driven health conditions. METHODS: Consented employers completed the Employer Survey pertaining to their attitudes towards specific health conditions, previous hiring experiences, resources, assets of applicants, and hiring concerns. RESULTS: The findings suggested that employers in Hong Kong and Beijing were more willing to hire individuals with alcohol abuse, whereas employers in Chicago were more willing to hire those with HIV/AIDS or bone cancer. Logistic regression suggested that the type of health conditions, assets of applicants, and perceived level of dangerousness of applicants were significant predictors that contributed to employers' hiring preference. CONCLUSION: Employers express different hiring preference towards individuals with or without behavioral-driven health conditions. Their hiring preference towards specific type of health conditions is discussed.