Development and usability of an app-based instrument of participation in children with disabilities.

BACKGROUND: Picture My Participation (PmP) is a picture-supported child-report instrument of participation of children with disabilities. AIMS: This study described the development of a mobile application of the PmP Traditional Chinese version (PmP-C) and evaluated its usability. METHODS: The PmP-C App includes features that allow the input of a child's demographics, identification of frequency and involvement of 22 culturally appropriate activities, selection of the three most important activities and the specification of the environmental facilitators and barriers. The usability test was conducted with 10 healthcare workers, who interviewed 10 children with disabilities aged 6-12 years. The healthcare workers completed a usability questionnaire and were asked to provide feedback on the ease of use, learning, satisfaction and perceived usefulness. RESULTS: The mean score for the usability questionnaire ranged from 2.7 to 4.6 out of 5.0. The feedback indicated that the interface was simple to operate by the healthcare workers and was attractive and motivating to children. Improvements of layout design, operation instructions and technical problems were recommended, which contributed to the app program optimization. CONCLUSIONS: The PmP-C App provides a practical tool with initial support for usability to enable active engagement and communication of children with disabilities with healthcare providers.

Chronic low back pain is associated with impaired bed turning ability: Evaluation by a mobility detection system.

BACKGROUND: We aimed to assess and compare kinetics and kinematic variables of bed turning ability using a mobility detection system in patients with and without chronic low back pain and to observe the impacts of the disease on bed turning kinetics and kinematics. METHODS: Thirty-five patients with chronic low back pain were enrolled and compared to healthy controls (n = 34). Pain scores and disability level were assessed by Numeric Pain Rating Scale and the function questionnaires including Oswestry Disability Index and Roland Morris Disability Questionnaire. Bed turning ability was tested using the Mobile Detection System. Univariate and multivariate regression analysis were applied to compare the differences between groups. FINDINGS: Patients with chronic low back pain had significantly lower turning over and back force/weight ratio (p < 0.001) than those healthy controls. Turning over time was significantly longer in patients with Numeric Rating Scale score 3 than in those with Numeric Rating Scale score 2 (p = 0.015). Turning over and back force were significantly higher in male patients and patients with higher BMI after adjusting BMI and sex, respectively (all p < 0.001). When turning back, chronic low back pain patients with Numeric Rating Scale scores of 3 had lower turning back force/weight ratio than those with Numeric Rating Scale scores of 2 (p = 0.014). Male patients had higher turning back force/weight ratio after adjusting pain score (p = 0.001). INTERPRETATION: The novel Mobility Detection System can provide more objective assessments of bed turning kinetics and kinematics in patients with chronic low back pain.

Feasibility of Smartphone-Based Badminton Footwork Performance Assessment System.

Footwork is the most fundamental skill in badminton, involving the ability of acceleration or deceleration and changing directions on the court, which is related to accurate shots and better game performance. The footwork performance in-field is commonly assessed using the total finished time, but does not provide any information in each direction. With the higher usage of the smartphones, utilizing their built-in inertial sensors to assess footwork performance in-field might be possible by providing information about body acceleration in each direction. Therefore, the purpose of this study was to evaluate the feasibility of a smartphone-based measurement system on badminton six-point footwork. The body acceleration during the six-point footwork was recorded using a smartphone fixed at the belly button and a self-developed application in thirty badminton players. The mean and maximum of the acceleration resultant for each direction of the footwork were calculated. The participants were classified into either the faster or slower group based on the finished duration of footwork. Badminton players who finished the footwork faster demonstrated a greater mean and maximum acceleration compared to those who finished slower in most directions except for the frontcourt directions. The current study found that using a smartphone's built-in accelerometer to evaluate badminton footwork is feasible.

Smartphone frailty screening: Development of a quantitative early detection method for the frailty syndrome.

BACKGROUND: Frailty syndrome in older population generates formidable social cost. The early detection of "prefrail" stage is essential so that interventions could be performed to prevent deterioration. The purpose of this study was to organize appropriate physical performance tests into a computerized early frailty screening platform, called frailty assessment tools (FAT) system, to detect individuals who are in the prefrail stage. METHODS: Four switches, one distance meter, and one power measure were adopted to build the FAT system that could perform six physical performance tests including single leg standing (SLS), repeated chair rise, timed up and go, self-selected walking speed, functional reach, and grip power. Participants over 65 years old were recruited and classified into three groups according to Fried criteria. The differences in variables between prefrail and robust groups were compared by the χ test, independent samples t test, and Mann-Whitney U test, for nominal variables, normal, and non-normal distributive continuous variables, respectively. The statistically significant level was set at 0.05 (α = 0.05). RESULTS: Only SLS did not reach significance to distinguish prefrail from robust. Among 35 participants (73.23 ± 5.70 years old), the FAT score predicted that 90.73 ± 19.95% of pre-frail subjects and 15.01 ± 25.25% of robust subjects were in the prefrail stage. CONCLUSION: The FAT system, which provides results immediately, is an advantageous alternative to traditional manual measurements. The use of the FAT score for predicting the prefrail stage will help to provide early intervention to prevent individuals from progressing into frailty. The FAT system provides a more convenient and comprehensive frailty screening. Using this computerized automatic screening platform, it may be possible to expand the scope of frailty prevention.

Augmented reality-assisted training with selected Tai-Chi movements improves balance control and increases lower limb muscle strength in older adults: A prospective randomized trial.

BACKGROUND: Tai-Chi benefits older adults by enhancing balance control and increasing the muscle strength of the lower limbs. However, a complete set of traditional Tai-Chi exercises is sometimes too difficult for beginners. We investigated whether practicing augmented reality-assisted training with selected Tai-Chi movements tailored to the practitioner's ability (selected Tai-Chi, or sTC) is as effective as performing a complete set of Tai-Chi sequences (complete traditional Tai-Chi, or tTC). METHODS: In this prospective randomized trial carried out in the Beitou District of Taipei City, Taiwan, community-dwelling adults aged ≥65 and without any debilitating diseases (n = 28) were included. Participants were randomly assigned to the sTC group (n = 14) or the tTC group (n = 14). Participants in the sTC group practiced selected Tai-Chi movements using the augmented reality Tai-Chi training system. Participants of the tTC group were asked to complete the 24-form Yang-style Tai-Chi following the instructions of Tai-Chi masters. Each training session lasted 30 min, with 3 sessions per week for 8 weeks. Pre- and post-intervention evaluations included functional balance tests, comprising the Berg Balance Scale (BBS), Timed Up and Go test (TUG), and Functional Reach Test (FRT), as well as muscle strength measurements of the lower extremities. RESULTS: Pre-intervention evaluations showed significant differences in FRT (p = 0.034) and left hip abductor muscle strength (p = 0.046) between the sTC and tTC groups. After 8 weeks of training, the BBS, TUG, and FRT scores in the sTC group showed significant improvement overall. Although all three functional balance test scores improved in the tTC group, only the improvement in BBS was statistically significant (p = 0.001). After 8 weeks, all muscle strength measurements increased by an average of 3.1 ± 1.0 kgw in the sTC group and 1.6 ± 0.8 kgw in the tTC group. CONCLUSIONS: The augmented reality-assisted training with selected Tai-Chi movements, designed based on objective measurements of the practitioner's capability, improved balance control and muscle strength of lower limbs at least as effectively as the complete sequence of traditional Tai-Chi exercises. TRIAL REGISTRATION: This study was approved by the Institutional Review Board of National Yang-Ming University (IRB number: 1000087). Written informed consent was obtained from all participants.

Development of a Smartphone-Based Balance Assessment System for Subjects with Stroke.

Stroke is a cerebral artery disease that negatively affects activities of daily living (ADLs) and quality of life (QoL). Smartphones have demonstrated strong potential in assessing balance performance. However, such smartphone-based tools have thus far not been applied to stroke survivors. The purpose of this study was to develop a smartphone-based balance assessment system for subjects who have experienced strokes and evaluate the system feasibility. The smartphone-based balance assessment application was developed with Android Studio, and reliability and validity tests were conducted. The smartphone was used to record data using a built-in accelerometer and gyroscope, and increased changes represented greater instability. Six postures were tested for 30 s each. Ten healthy adults were recruited in the reliability test, and the intraclass correlation coefficient (ICC) was used to analyze the within-day and between-day reliabilities. Eight subjects with chronic stroke and eight healthy adults were recruited for the validity test, in which balance performance was compared to represent the application validity. The ICC values of the reliability tests were at least 0.76 (p = 0.00). The acceleration data exhibited no difference between individuals who have experienced stroke and healthy subjects; however, all six postures were found to differ significantly between the two groups in the gyroscope data. The study demonstrates that the smartphone application provides a convenient, reliable, and valid tool for the balance assessments of subjects who have experienced chronic stroke.

Bimanual coordination deficits in hands following stroke and their relationship with motor and functional performance.

BACKGROUND: Stroke can lead to movement disorders that affect interlimb coordination control of the bilateral upper extremities, especially the hands. However, few studies have investigated the influence of a stroke on bimanual force coordination control between the hands using a quantitative measurement tool, or the relationship of force coordination with paretic upper extremity motor and functional performance. We aimed to investigate these outcomes using a novel measurement device, and analyze the relationship of bimanual force coordination control deficits in both hands with motor and functional performances of the paretic upper extremity in stroke patients. METHODS: Sixteen healthy adults and 22 stroke patients were enrolled. A novel bilateral hand grip measurement device with two embedded dynamometers was used to evaluate the grip force during a bilateral hand grip-force coordination control task. The alternating time and force applied for coordination with the grip force of both hands were calculated to analyze control of bimanual grip force coordination. Motor and functional measurements included the upper-extremity portion of the Fugl-Meyer assessment (FMA-UE), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), and Barthel Index (BI). RESULTS: Compared with the healthy group, the alternating time from the non-paretic to the paretic hand was 27.6% shorter for stroke patients (p < 0.001). The grip force generated for coordination in the healthy group was significantly greater (30-59%) than that of the stroke group (p < 0.05), and the coefficients of variation of alternating time (p = 0.001) and force applied (p = 0.002) were significantly higher in the stroke group than the healthy group. The alternating time from the paretic to the non-paretic hand showed moderately significant correlations with the FMA-UE (r = - 0.533; p = 0.011), the WMFT (r = - 0.450; p = 0.036), and the BI (r = - 0.497; p = 0.019). CONCLUSIONS: Stroke results in a decline in bimanual grip force generation and increases the alternating time for coordinating the two hands. A shorter alternating time is moderately to highly associated with enhanced motor and functional performances.

Effects of individualized Tai-Chi on balance and lower-limb strength in older adults.

BACKGROUND: To investigate whether a simplified and personalized Tai-Chi program could be beneficial for practitioners. A prospective quasi-experimental observer-blinded controlled trial was done in Beitou District of Taipei City. METHODS: Community-dwelling adults aged 65 and older without debilitating disease (N = 50) participated the study. Those who were willing to participate in exercise program were assigned to individualized Tai-Chi (iTC) group (n = 20), receiving iTC training for 8 weeks, and traditional Tai-Chi (tTC) group (n = 15), receiving tTC training for 8 weeks. Those who were not willing to participate in exercise training were included in the control group (n = 15). Functional balance tests, the Berg Balance Scale (BBS), timed up-and-go (TUG) test, functional-reach test, and measurement of lower-extremity muscle strength were conducted before and 8 weeks after the intervention. RESULTS: Significant improvements were noted in all functional balance tests and strength assessments of 16 major lower-limb muscle groups in participants of the iTC group compared to the control group, whereas only BBS and muscle strength of hips and ankles were improved in the tTC group. Practitioners of iTC outperformed tTC in BBS and strength of two major muscles. CONCLUSIONS: Personalized Tai-Chi training designed based on an objective measurement and conducted according to graded intensity and complexity benefitted practitioners after a short period. TRIAL REGISTRATION: Trial registration number: ClinicalTrials.gov ID: NCT03659396 , Unique Protocol ID: 1000087 Date of registration: 03/28/2017 The trial was registered retrospectively.

Influence of aging and visual feedback on the stability of hand grip control in elderly adults.

Aging causes a gradual decrease in maximal grip strength and leads many elderly people to have to rely on visual feedback to compensate for poorer muscle strength in performing daily activities and preventing accidents. Previous studies have investigated age and visual feedback-related changes in grip strength. However, little is known about methods of determining the quality and stability of hand grip strength control in the elderly, which is important for understanding their ability to generate grip force when handling objects with and without visual feedback in daily living. Therefore, the purpose of this study was to investigate the influence of aging and visual feedback on the stability of hand grip control in both hands in elderly adults. Forty-four healthy elderly persons (age 80.5 ±â€¯4.53 years) and 36 young adults (age 32.69 ±â€¯16.48 years) were recruited to execute grip force stability tasks using both hands at a 2 kg target force level. To perform the grip force stability task, the participants were asked to hold the dynamometer tightly in an attempt to achieve the target force level under visual and non-visual feedback conditions. Strength performances (grip force and coefficient of variation values) and stability of strength control (deviation error, variation error and force stability index values) for hand grip force stability tasks were calculated and analyzed. Compared with the visual feedback condition, the stability of grip force control in the hands of the young and elderly groups were significantly reduced in the non-visual feedback condition by 23.5%-57.1% (p < .05). The elderly group also showed significantly worse hand grip strength performances and stability of hand strength control than the young adult group (p < .05). Aging and non-visual feedback reduced the hand grip force output and stability of grip strength control of the hands. This may reveal the difficulty with manipulating hand-held objects in the absence of visual feedback while performing activities of daily living among the elderly.

Speed and temporal adaptations during nonmotorized treadmill walking in Parkinson disease and nondisabled individuals.

Few studies have explored the potential of gait analysis and training in nonmotorized treadmill (NMT) in Parkinson's disease (PD) patients. We investigated (a) the walking strategy adopted by patients with PD on NMT and (b) how balance may influence spatiotemporal gait parameters. We enrolled 12 patients with PD of modified Hoehn and Yahr stage 2-3 and 13 nondisabled individuals as controls. All participants were evaluated using Tinetti's performance oriented mobility assessment scale, freezing of gait questionnaire, modified falls efficacy scale, and the timed up and go test. They were asked to ambulate with comfortable and maximal speeds on the NMT. The gait parameters acquired on the NMT included walking speed, cadence (CAD), step length, and vertical ground reaction force, which were calculated for intragroup and intergroup comparisons. The PD group took on with higher contribution of CAD and less contribution of step length to increase walking speed as compared with control group. The postural stability is correlated significantly positively to the CAD at the setting of maximal speed in the PD group. Moreover, a significantly lower ratio of vertical ground reaction force/body weight was noted in the PD group during both comfortable and maximal walking speeds compared with the nondisabled controls. Our study outcomes clearly support the perceived benefits of NMT to differentiate spatiotemporal gait parameters between PD and controls. NMT may potentially be useful to evaluate the recovery of physical activities in PD receiving medications and/or rehabilitation.

Feasibility and outcome of an individualized Tai Chi program for improving balance and strength in the elderly: A pilot study.

BACKGROUND: Traditional Tai Chi is too complex for most elderly individuals. There have been few reports regarding the development of simplified Tai Chi programs to suit the physical needs of elderly adults. However, these programs were not individualized according to the participants' balance control abilities. OBJECTIVE: Purpose of this study is to develop an individualized Tai Chi program and report the feasibility of the program. METHODS: Phase 1: Five Tai Chi masters performed the Tai Chi movements on a force platform. Based on the results of center of pressure displacement and the individual's balance abilities, an individualized program was developed.Phase 2: Ten community-dwelling older adults received 24 half-hour-sessions, using the individualized Tai Chi exercise program. The Berg Balance Scale (BBS) score, Timed Up & Go (TUG) test, forward reach, and strength of the knee extensor were determined before and after intervention. RESULTS: Participants achieved improved performance on balance control as measured with BBS (p≤0.001), TUG (p = 0.004) and forward reach (p = 0.035) as well as knee extensor strength (p = 0.002) after the program. CONCLUSIONS: This preliminary result suggests that the individualized Tai Chi program is potentially effective to improve balance function and knee extensor strength of the elderly.

Analysis of trunk rolling in Parkinson's disease patients using a mattress mobility detection system.

BACKGROUND AND OBJECTIVE: Parkinson's disease (PD) is a neurodegenerative condition characterized by motor dysfunction and various types of non-motor impairments. The reaction time and movement time are reported to become more severe delayed in worse PD patients. Most tools for evaluating motor impairment are limited by relying on subjective observations and being qualitative in design. The aim of this study was to investigate trunk rolling performance in PD patients by using a recently developed system to detect turning in bed. METHODS: The study included 20 PD patients and 42 healthy controls. A mattress mobility detection system was employed for quantitative measurements. Each test session consisted of subjects starting by lying in a supine position on a bed and rolling 10 times onto their left side and 10 times onto their right side. Strain gauges mounted under the feet of the bed recorded changes in the center of pressure (CoP). RESULTS: For turning back, the patients compared with the controls had significantly longer movement time (P = 0.017), longer time to peak counteraction (P = 0.001), larger ratio of peak counteraction to movement time (P = 0.006), shorter CoP displacement (P < 0.0001), slower turning speed (P = 0.000), weaker peak counteraction (P = 0.013), and smaller ratio of peak counteraction to weight (P = 0.032). Results for turning over were similar except there was no significant difference in the ratio of peak counteraction to weight. CONCLUSIONS: The mattress mobility detection system was useful for objectively assessing trunk rolling performance of PD patients. Improved assessment of trunk function in PD patients could lead to better treatments and improved rehabilitation procedures.

Feasibility of a smartphone-based balance assessment system for subjects with chronic stroke.

BACKGROUND: Stroke is a cerebral artery disease that may lead to long-term disabilities or death. Patients that survive a stroke usually suffer balance impairments, which affect their performance in activities of daily living (ADLs) and quality of life (QoL). In recent years, smartphones have become very popular and have many capabilities. Smartphone built-in sensors have shown their ability and potential in balance performance assessment. However, the feasibility of smartphones on subjects with chronic strokes remains to be proved. Therefore, the purpose of this study is to evaluate the feasibility of a smartphone-based balance assessment system for subjects with chronic stroke. METHODS: Ten subjects with chronic stroke and thirteen healthy adults were recruited in the study. The smartphone HTC 10 (HTC Corporation, Taiwan) was used to perform the balance assessment, and its built-in accelerometer and gyroscope were used to record data from the subjects. Six postures were tested for thirty seconds each: shoulder-width stance (SWS) with eyes opened (E/O) and eyes closed (E/C), feet-together stance (FTS) with E/O and E/C, and semi-tandem stance (STS) with E/O and E/C. The smartphone was fixed to the back of subjects at the second sacral spine (S2) level. The changes registered in the accelerometer and gyroscope data were used to represent the balance performance, in which higher values indicate more instability. Data was analyzed using the independent t-test with the software SPSS 20, and the statistical significance level was set to α < 0.05. RESULTS AND DISCUSSION: Significant difference in the acceleration data was found among subjects with chronic stroke and healthy adults under four assessment postures: SWS with E/C (p = 0.048), FTS with E/O (p = 0.027), FTS with E/C (p = 0.000), and STS with E/C (p = 0.048). Furthermore, according to the gyroscope data, there were significant differences in how the two groups performed the postures. The results demonstrate that a smartphone with a built-in accelerometer and gyroscope can be used to classify balance performances between healthy adults and subjects with chronic stroke. CONCLUSION: This study shows that smartphones are feasible to assess balance for subjects with chronic stroke.

The Effect of a Virtual Reality Game Intervention on Balance for Patients with Stroke: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the effects of virtual reality (VR) balance training conducted using Kinect for Xbox® games on patients with chronic stroke. MATERIALS AND METHODS: Fifty patients with mild to moderate motor deficits were recruited and randomly assigned to two groups: VR plus standard treatment group and standard treatment (ST) group. In total, 12 training sessions (90 minutes a session, twice a week) were conducted in both groups, and performance was assessed at three time points (pretest, post-test, and follow-up) by a blinded assessor. The outcome measures were the Berg Balance Scale (BBS), Functional Reach Test, and Timed Up and Go Test (cognitive; TUG-cog) for balance evaluations; Modified Barthel Index for activities of daily living ability; Activities-specific Balance Confidence Scale for balance confidence; and Stroke Impact Scale for quality of life. The pleasure scale and adverse events were also recorded after each training session. RESULTS: Both groups exhibited significant improvement over time in the BBS (P = 0.000) and TUG-cog test (P = 0.005). The VR group rated the experience as more pleasurable than the ST group during the intervention (P = 0.027). However, no significant difference was observed in other outcome measures within or between the groups. No serious adverse events were observed during the treatment in either group. CONCLUSIONS: VR balance training by using Kinect for Xbox games plus the traditional method had positive effects on the balance ability of patients with chronic stroke. The VR group experienced higher pleasure than the ST group during the intervention.

Development and clinical application of a computer-aided real-time feedback system for detecting in-bed physical activities.

BACKGROUND AND OBJECTIVE: Being bedridden long-term can cause deterioration in patients' physiological function and performance, limiting daily activities and increasing the incidence of falls and other accidental injuries. Little research has been carried out in designing effective detecting systems to monitor the posture and status of bedridden patients and to provide accurate real-time feedback on posture. The purposes of this research were to develop a computer-aided system for real-time detection of physical activities in bed and to validate the system's validity and test-retest reliability in determining eight postures: motion leftward/rightward, turning over leftward/rightward, getting up leftward/rightward, and getting off the bed leftward/rightward. METHODS: The in-bed physical activity detecting system consists mainly of a clinical sickbed, signal amplifier, a data acquisition (DAQ) system, and operating software for computing and determining postural changes associated with four load cell sensing components. Thirty healthy subjects (15 males and 15 females, mean age = 27.8 ± 5.3 years) participated in the study. All subjects were asked to execute eight in-bed activities in a random order and to participate in an evaluation of the test-retest reliability of the results 14 days later. Spearman's rank correlation coefficient was used to compare the system's determinations of postural states with researchers' recordings of postural changes. The test-retest reliability of the system's ability to determine postures was analyzed using the interclass correlation coefficient ICC(3,1). RESULTS: The system was found to exhibit high validity and accuracy (r = 0.928, p < 0.001; accuracy rate: 87.9%) in determining in-bed displacement, turning over, sitting up, and getting off the bed. The system was particularly accurate in detecting motion rightward (90%), turning over leftward (83%), sitting up leftward or rightward (87-93%), and getting off the bed (100%). The test-retest reliability ICC(3,1) value was 0.968 (p < 0.001). CONCLUSIONS: The system developed in this study exhibits satisfactory validity and reliability in detecting changes in-bed body postures and can be beneficial in assisting caregivers and clinical nursing staff in detecting the in-bed physical activities of bedridden patients and in developing fall prevention warning systems.

Evaluation of a smartphone-based assessment system in subjects with chronic ankle instability.

BACKGROUND: Ankle sprain is the most common sports-related injury, and approximately 80% of patients studied suffered recurrent sprains. These repeated ankle injuries could cause chronic ankle instability, a decrease in sports performance, and a decrease in postural control ability. At the present time, smartphones have become very popular and powerful devices, and smartphone applications (apps) that have been shown to have good validity have been designed to measure human body motion. However, the app focusing on ankle function assessment and rehabilitation is still not widely used and has very limited functions. The purpose of this study is to evaluate the feasibility of smartphone-based systems in the assessment of postural control ability for patients with chronic ankle instability. METHODS: Fifteen physically active adults (6 male, 9 female; aged = 23.4 ± 5.28 years; height = 167.13 ± 7.3 cm; weight = 62.06 ± 10.82 kg; BMI = 22.08 ± 2.57 kg/ m2) were recruited, and these participants had at least one leg that was evaluated as scoring lower than 27 points according to the Cumberland Ankle Instability Tool (CAIT). The smartphone used in the study was ASUS Zenfone 2, and an app developed using MIT App Inventor was used to record built-in accelerometer data during the assessment process. Subjects were asked to perform single leg stance for 20 s in eyes-open and eyes-closed conditions with each leg. The smartphone was fixed in an upright position on the middle of the shin, using an exercise armband, with the screen facing forward. The average of recorded acceleration data was used to represent the postural control performance, and higher values indicated more instability. Data were analyzed with a paired t-test with SPSS 17.0, and the statistical significance was set as alpha <0.05. RESULTS: A significant difference was found between CAIT scores from the healthier leg and injured leg (healthier leg 23.07 ± 3.80 vs. injured leg 18.27 ± 3.92, p < 0.001). Significant differences were also found between the scores for the healthier leg and injured leg during both eyes-open and eyes-closed conditions (eyes-open: healthier leg 0.051 ± 0.018 vs. injured leg 0.072 ± 0.034, p = 0.027; eyes-closed: healthier leg 0.100 ± 0.031 vs. injured leg 0.123 ± 0.038, p = 0.001, unit: m/s2). Significant differences were also found between eyes-open and eyes-closed conditions during both single leg standing with healthier leg and injured leg (healthier leg: eyes-open 0.051 ± 0.018 vs. eyes-closed 0.100 ± 0.031, p < 0.001; injured leg: eyes-open 0.072 ± 0.034 vs. eyes-closed 0.123 ± 0.038, p = 0.001, unit: m/s2). The results demonstrate that the smartphone software can be used to discriminate between the different performances of the healthier leg and injured leg, and also between eyes-open and eyes-closed conditions. CONCLUSION: The smartphone may have the potential to be a convenient, easy-to-use, and feasible tool for the assessment of postural control ability on subjects with chronic ankle instability.

Speed and temporal-distance adaptations during non-motorized treadmill walking in stroke and non-disabled individuals.

BACKGROUND: Treadmill training has received widespread attention to facilitate gait retraining and allow gait analysis in the stroke population in recent decades. While previous studies have used motorized treadmills for gait analysis or training, no study has investigated the use of non-motorized treadmill (NMT) in a rehabilitation setting. AIM: The aim of this study was to compare the speed between overground (OG) and NMT walking and measure the adaptation of the gait pattern from comfortable to maximal walking speeds during NMT walking in participants with stroke and non-disabled individuals. DESIGN: Cross-sectional study. SETTING: Tertiary care center. POPULATION: Twenty chronic hemiplegic stroke patients and 20 non-disabled controls. METHODS: The speeds attained OG and on a NMT were compared within each group. Cadence and stride length were measured while walking on the NMT. Adaptations of the gait pattern from comfortable to maximal walking speeds during NMT walking were measured in both groups. RESULTS: In both groups, when walking on the NMT, participants walked with significantly lower speed than on the ground. While on the NMT, the non-disabled individuals significantly increased the cadence and stride length simultaneously as the speed increased. The participants with stroke significantly increased the cadence but showed little increase in stride length with increased speed. CONCLUSIONS: Participants ambulated with significantly lower speeds on the NMT than during OG. Participants with stroke use a different strategy to increase walking velocity during NMT walking, relying mostly on increasing the cadence. CLINICAL REHABILITATION IMPACT: Lower speed during NMT walking indicated that lesser total distance covered with NMT training when compared to OG gait training, which may inadvertently impact training amount. This is an important obstacle to overcome in order for NMT to be used effectively in the retraining of gait in patients with stroke.

Validity of an ankle joint motion and position sense measurement system and its application in healthy subjects and patients with ankle sprain.

BACKGROUND AND OBJECTIVE: Ankle motion and proprioception in multiple axis movements are crucial for daily activities. However, few studies have developed and used a multiple axis system for measuring ankle motion and proprioception. This study was designed to validate a novel ankle haptic interface system that measures the ankle range of motion (ROM) and joint position sense in multiple plane movements, investigating the proprioception deficits during joint position sense tasks for patients with ankle instability. METHODS: Eleven healthy adults (mean ± standard deviation; age, 24.7 ± 1.9 years) and thirteen patients with ankle instability were recruited in this study. All subjects were asked to perform tests to evaluate the validity of the ankle ROM measurements and underwent tests for validating the joint position sense measurements conducted during multiple axis movements of the ankle joint. Pearson correlation was used for validating the angular position measurements obtained using the developed system; the independent t test was used to investigate the differences in joint position sense task performance for people with or without ankle instability. RESULTS: The ROM measurements of the device were linearly correlated with the criterion standards (r = 0.99). The ankle instability and healthy groups were significantly different in direction, absolute, and variable errors of plantar flexion, dorsiflexion, inversion, and eversion (p < 0.05). CONCLUSIONS: The results demonstrate that the novel ankle joint motion and position sense measurement system is valid and can be used for measuring the ankle ROM and joint position sense in multiple planes and indicate proprioception deficits for people with ankle instability.

Analysis of Trunk Rolling Performances by Mattress Mobility Detection System in Poststroke Patients: A Pilot Study.

PURPOSE: The purpose of this study was to investigate the correlation of kinematic variables with quality of trunk control in poststroke patients. METHODS: This cross-sectional study included stroke subjects with mild to moderate motor deficit corresponding to Brunnstrom stages 3-4. Trunk functional performance was measured using bed mobility monitor system. All tasks were repeated ten times for both directions in each subject. Outcome measurements included the movement time and displacement of center of pressure (CoP) from supine to side lying and returning. RESULTS: The results revealed that a significant longer turning time was observed when turning from the paretic side toward the nonparetic side compared to the other direction, with an estimated mean difference of 0.427 sec (P = 0.005). We found a significant difference in the time of rolling back to supine position between two directions. The displacement of CoP in rolling back from side lying on the nonparetic side was smaller than that from the paretic side with an estimated mean difference of -0.797 cm (P = 0.023). CONCLUSIONS: The impaired trunk mobility was associated with increased movement time and decreased displacement of CoP in poststroke patients. Trunk rolling performance has potential in assessment of stroke patients.

Effects of Computer-Aided Interlimb Force Coupling Training on Paretic Hand and Arm Motor Control following Chronic Stroke: A Randomized Controlled Trial.

OBJECTIVE: We investigated the training effects of interlimb force coupling training on paretic upper extremity outcomes in patients with chronic stroke and analyzed the relationship between motor recovery of the paretic hand, arm and functional performances on paretic upper limb. DESIGN: A randomized controlled trial with outcome assessment at baseline and after 4 weeks of intervention. SETTING: Taipei Veterans General Hospital, National Yang-Ming University. PARTICIPANTS: Thirty-three subjects with chronic stroke were recruited and randomly assigned to training (n = 16) and control groups (n = 17). INTERVENTIONS: The computer-aided interlimb force coupling training task with visual feedback included different grip force generation methods on both hands. MAIN OUTCOME MEASURES: The Barthel Index (BI), the upper extremity motor control Fugl-Meyer Assessment (FMA-UE), the Motor Assessment Score (MAS), and the Wolf Motor Function Test (WMFT). All assessments were executed by a blinded evaluator, and data management and statistical analysis were also conducted by a blinded researcher. RESULTS: The training group demonstrated greater improvement on the FMA-UE (p<.001), WMFT (p<.001), MAS (p = .004) and BI (p = .037) than the control group after 4 weeks of intervention. In addition, a moderate correlation was found between the improvement of scores for hand scales of the FMA and other portions of the FMA UE (r = .528, p = .018) or MAS (r = .596, p = .015) in the training group. CONCLUSION: Computer-aided interlimb force coupling training improves the motor recovery of a paretic hand, and facilitates motor control and enhances functional performance in the paretic upper extremity of people with chronic stroke. TRIAL REGISTRATION: ClinicalTrials.gov NCT02247674.