Ultrasonographic assessment in vivo of the excursion and tension of flexor digitorum profundus tendon on different rehabilitation protocols after tendon repair.

STUDY DESIGN: Interpretive description study. PURPOSE: In management of patients with flexion tendon injuries, passive, control active and active motion protocols were proposed after repair to minimize tendon adhesion. The purpose of this study was to compare the excursion distance and the tension of Flexor Digitorum Profundus (FDP) during simulated active and passive motion using ultrasonography techniques using normal subjects. METHODS: Ultrasonographic assessment of FDP tendon of the middle finger was performed at the wrist level on 20 healthy college students using 3 types of treatment protocols: modified Kleinert protocol, modified Duran protocol, and active finger flexion protocol. The excursion distance was measured following the musculotendinous junction of FDP using the B mode ultrasound system. The elasticity of FDP tendon was measured using the shear wave elastography technique. The excursion distance and the elasticity value were compared among 3 protocols using one-way ANOVA analysis. RESULTS: Twelve male and 8 female students with mean age of 22.6 ± 1.8 years were invited to join the study. The excursion distance of FDP was 21.82 ± 3.77 mm using the active finger flexion protocol, 8.59 ± 2.59 mm using the modified Duran protocol, and 12.26 ± 2.71 mm using the modified Kleinert protocol. The elasticity was significantly higher in extension position when compared to passive flexion positions, but found lower than active flexion position. DISCUSSION: The active finger protocol was found to require strongest tension of the tendon and with longest excursion. There was similar tension generated using both passive motion protocols. The modified Duran protocol appeared to create less excursion upon movements than the modified Kleinert approach using the objective ultrasonic evaluation. It is suggested that if the surgical repair was strong and without any complications, the active flexion protocol might work best to regain tension excursion. However, if there are complex problems involved, then the Kleinert approach or Duran approach would be chosen.

Measuring vascularity of hypertrophic scars by dermoscopy: Construct validity and predictive ability of scar thickness change.

BACKGROUND: Vascularity of hypertrophic scar is a key indicator of scar maturation and a vital parameter of evaluating effects of scar management interventions. This study aims to explore the construct validity of dermoscopy for measuring vascularity of hypertrophic scar and its predictive ability of scar thickness change. METHODS: Patients with hypertrophic scars were recruited for scar assessments at baseline and at one-month follow-up, which consisted of the Patient and Observer Scar Assessment Scale, DermaLab Combo, ultrasound and dermoscopy. RESULTS: Forty hypertrophic scars in the active proliferation stage were included in this study. The dermoscopic measurements based on color significantly discriminated the hypertrophic scars from the healthy skin (P < .001). In addition, they showed moderate to strong correlations with the vascularity component of the Patient and Observer Scar Assessment Scale (r = -.438, P < .01; r = -.461, P < .01; and r = -.437, P < .01) and the erythema value as measured by DermaLab Combo (r = -.474, P < .01; r = -.603, P < .01; and r = -.498, P < .01). Weak to moderate correlations of the micro-vessel percentage were observed with the vascularity of Patient and Observer Scar Assessment Scale (r = .385, P < .01) and the erythema of DermaLab Combo (r = .444, P < .01). For prediction of the scars with high risk of thickness change, the green value by dermoscopy was the strongest predictor (AUC = 0.738, P = .034, 95%CI = 0.570-0.906). CONCLUSION: Dermoscopy, which evaluates scar vascularity by measuring scar color and micro-vessel percentage, could be used as an objective assessment tool to indicate scar maturation and identify scars with active proliferation.

Vascularity and Thickness Changes in Immature Hypertrophic Scars Treated With a Pulsed Dye Laser.

BACKGROUND AND OBJECTIVES: Growth of capillaries is an essential process after a dermal injury. An immature scar with robust growth of capillaries tends to be hypertrophic. Pulsed dye laser (PDL) causes damage to microvascular structures and is increasingly used for early erythematous scars to limit scar growth. To have a better understanding of the impact of PDL on scar vascularity and to optimize the clinical use of PDL for managing hypertrophic scars, this study aimed to explore changes in scar erythema, blood perfusion, and thickness of immature hypertrophic scars in Asian patients who received PDL treatments at an early stage. STUDY DESIGN/MATERIALS AND METHODS: This was a 3-month, assessor-blinded, clinical study. There were two groups of patients, the PDL group and the control group, who had hypertrophic scars less than 1-year post-injury. Patients in the PDL group received three PDL sessions at 4-week intervals. A total of three assessments were performed, at baseline, 1 and 3 months, consisting of the Patient and Observer Scar Assessment Scale (POSAS) and objective measurements of scar erythema, blood perfusion, and scar thickness. RESULTS: A total of 45 patients were enrolled, 22 in the PDL group and 23 in the control group. After the 3-month treatment, parameters of scar vascularity (P = 0.003), pigmentation (P = 0.026), color (P < 0.001), thickness (P < 0.05), and overall scores (P < 0.01) on the POSAS significantly decreased in the PDL group. Moreover, objective measurements of scar erythema and blood perfusion showed significant improvements in the PDL group (P = 0.009 and P = 0.022, respectively) but not in the control group (P = 0.296 and P = 0.115, respectively). A stable scar thickness was maintained in the PDL group from baseline to 3 months (0.21 cm vs. 0.22 cm, P > 0.05), whereas scar thickness significantly increased in the control group (0.22 cm vs. 0.32 cm, P < 0.01). CONCLUSION: Use of PDL at an early stage controls vascularity of immature hypertrophic scar by improving its poor blood perfusion that further limits scar thickness growth and promotes scar maturation. Lasers Surg. Med. 00:00-00, 2020. © 2020 Wiley Periodicals LLC.

Developmental skills between kindergarten children with handwriting difficulties in Chinese and/or English.

AIM: This study aimed to examine the differences in developmental skills between children with and without handwriting difficulties in their last year of kindergarten education. METHODS: Standardised tests on handwriting performance and developmental skills were administered to 20 typically developing children, 21 children with handwriting difficulties in Chinese and 23 children with handwriting difficulties in both Chinese and English. We used one-way MANOVA, univariate ANOVA and post hoc comparisons, to compare the developmental skills between children with and without handwriting difficulties. Multiple regression analysis was used to identify the significant predictors of developmental skills for Chinese and English handwriting performance. RESULTS: Higher proportion of children faced handwriting difficulties in Chinese than in English. Their major problem in Chinese handwriting was on stroke formation, while the results did not indicate the key factor leading to English handwriting difficulties. The results also showed that children with handwriting difficulties had significantly poorer visual motor integration, some aspects of visual perception and fine motor skills than typically developing children. Reading skills were not a key factor contributing to handwriting performance. In addition, visual and fine motor integration and spatial relationship were the significant predictors of Chinese and English handwriting performance, which accounted for 39.7 and 43.6% of the variance respectively. CONCLUSION: First, the results suggested that more resources should be devoted to coaching children to learn Chinese than English handwriting. Second, besides direct repetitive practice on handwriting, there is a need to incorporate learning activities to facilitate the development of visual motor skills, visual perception, and fine motor skills as a preparation for learning to write or in improving handwriting performance among kindergarten children.

Computerised Handwriting Speed Test System (CHSTS): Validation of a handwriting assessment for Chinese secondary students.

BACKGROUND/AIM: Handwriting difficulties can be detrimental to students' performance in school tests and even in public examinations. It is crucial for school-based occupational therapists to identify students with handwriting difficulties and support them with appropriate adaptive strategies. The purpose of this study is to validate a computerised assessment - the Computerised Handwriting Speed Test System (CHSTS) of both Chinese and English handwriting for Chinese secondary students and provide an objective reference for extra time allowance in paper-based examinations. METHODS: The internal consistency, test-retest reliability, convergent and discriminant validity of CHSTS were examined using the data from 512 typically developing students and 64 students with special educational needs (SEN) in Hong Kong mainstream secondary schools. RESULTS: Handwriting performance of senior students was better than that of junior students. High internal consistency was shown by over 0.80 Cronbach's α in all measurement items and over 0.90 item-total correlations in temporal domain items. Intra-class correlation indicated good to excellent test-retest reliability of CHSTS (all P < 0.0001). Principal Component Analysis revealed that four components in CHSTS accounted for over 80% of the variance. Handwriting performance was positively associated with manual coordination, automaticity and oculomotor control (all P < 0.05) in linear regression analyses. Students with SEN could be effectively differentiated from typically developing students (over 75% sensitivity and specificity) based on the CHSTS items. CONCLUSION: Validation of CHSTS is the groundwork for identifying students with handwriting difficulties and providing adaptive strategies including fair special examination arrangements for these students.

Effects of repetitive transcranial magnetic stimulation combined with sensory cueing on unilateral neglect in subacute patients with right hemispheric stroke: a randomized controlled study.

OBJECTIVE: To compare the effects of rTMS combined with sensory cueing, rTMS alone, and conventional rehabilitation on unilateral neglect, hemiplegic arm functions and performance of activities of daily living. DESIGN: A single-blinded randomized controlled trial. SETTING: A convalescent hospital. SUBJECTS: Sixty inpatients with left unilateral neglect after stroke. INTERVENTIONS: Patients were randomly assigned to three groups: rTMS combined with sensory cueing, rTMS, and conventional rehabilitation alone. rTMS at 1 Hz was applied over P5 of the contralesional hemisphere while vibration cueing was emitted using a wristwatch device on the hemiplegic arm, five days per week for two weeks. The first two groups received the same dosage of conventional rehabilitation on top of their experimental interventions. Blinded assessments were administered at baseline, 2 weeks postintervention, and 6 weeks follow-up. MAIN MEASURES: Neglect and arm motor performance. RESULTS: Both rTMS combined with sensory cueing (99.6±33.0) and rTMS alone (88.2±28.7) significantly reduced unilateral neglect than conventional rehabilitation (72.7±33.1) when measured using the conventional subtests of the Behavioural Inattention Test, but the combination was better than rTMS alone. Hemiplegic arm functions and activities of daily living improved in all patients across the three groups but no significant differences were found between the groups. CONCLUSION: The combination of inhibitory P5-rTMS with sensory cueing was better than either rTMS or conventional rehabilitation alone in producing a stronger and long-lasting improvement in unilateral neglect, but the improvement was not associated with improved arm function or independence in activities of daily living.

The Effect of a Self-management Program on the Quality-of-Life of Community-dwelling Older Adults with Chronic Musculoskeletal Knee Pain: A Pilot Randomized Controlled Trial.

OBJECTIVES: To evaluate a 6-week self-management program on pain conducted in a mobile setting at the residences of older adult participants. METHODS: In this single-blinded randomized controlled trial, 46 community-dwelling older adults with chronic knee pain were randomly assigned to the experimental (n = 19) and wait-list control groups (n = 27). The experimental group engaged in the 6-week program while the control group was only given some pamphlets on exercise and joint care. The pain level, physical functions, QOL, and self-efficacy of the participants in both groups were assessed at baseline, post-program, and at the 1-month follow-up session. Both baseline and post-program (or post-control-period assessment) data were analyzed. RESULTS: The results showed that the participants in the experimental group had a higher level of self-efficacy, better performance in walking test, a higher level of quality-of-life, and less frequency of pain at the post-program follow-up as compared to the control group. The effect was maintained among the experimental group at post-4-week follow-up and further reduction in pain was detected. CONCLUSIONS: The program appeared to be effective at improving the pain status, self-efficacy, functional performance, and quality-of-life of older adults. However, as the sample size was small, further study is suggested to investigate the effects of the program.

Evaluation of a group-based sensorimotor intervention programme to improve Chinese handwriting of primary school students.

Objective: Sensorimotor performance is influential in Chinese handwriting, but few studies have examined the efficacy of sensorimotor-based interventions on Chinese handwriting among primary school students with poor handwriting performance. The study aims to evaluate a sensorimotor-based intervention to improve handwriting in the mainstream primary schools. Methods: This study adopted a two-group pretest-posttest design. An 8-session group-based sensorimotor intervention was delivered to school-aged children (mean age = 8.1, 68% male). Group A had 2 sessions every week, while Group B had 4 sessions every week. Analysis of variance with repeated measures was used to test the effects. Results: The intervention had a significant time effect (p < .05) in terms of improving handwriting process (d = 0.33-1.10), manual dexterity (d = 0.57), visual memory (d = 0.70), visual-spatial perception (d = 0.37), and motor and postural skills (d = 0.73). The effect sizes ranged from medium to large. For the handwriting process, time per character had a significant group × time interaction, with post hoc analysis showing that Group A had a significantly large effect (d = 1.89, p < .001) while Group B did not. Conclusions: The group-based sensorimotor intervention programme appeared to show improvements in students with fair skills in writing Chinese characters. It appears that the effect is better if the training sessions are spaced out in one month rather than intensively conducted within two weeks. It might be related to more involvement from parents, and students need more time for practice after the training sessions.

A systematic review assessing the effectiveness of hand therapy programmes in adults with burns using the International Classification of Functioning, Disability and Health framework.

This systematic review aimed to confirm the effectiveness of hand therapy programmes using the International Classification of Functioning, Disability and Health framework for each of the three phases of the wound healing process in adults with burns. A systematic review was conducted to determine the efficacy of different hand therapy programmes in the management of burnt hands. Two independent reviewers conducted a literature search using the PubMed and Cumulative Index to Nursing and Allied Health Literature databases for original articles reporting effectiveness of hand therapy programmes for adults with burns. Only randomized and non-randomized controlled trials were selected using the Mixed Methods Appraisal Tool. Demographic and clinical data including medical history, burn depth, and hand therapy programme were extracted. Outcome measures were reviewed based on the International Classification of Functioning, Disability and Health framework for acute, convalescence, and chronic phases of rehabilitation. Sixteen articles and 15 hand therapy programmes were identified, which included studies showing improvements in different parameters in the framework. In the acute and convalescence phases, improvements were found in health condition, body functions and structures, activities, and participation. In the chronic phase, improvements were shown only in body functions and structures. Environmental factors in the framework were not reported for all the phases. This review demonstrated the efficacy of hand therapy programmes in adults with burns in terms of the health condition, body function, activities, and participation during acute and convalescence phases but only the body function in the chronic phase.

A finite element model of the 3D-printed transparent facemask for applying pressure therapy.

BACKGROUND: Transparent facemask has been widely used for the prevention and treatment of facial hypertrophic scars all over the world. 3D printing has improved the fabrication accuracy of the traditional transparent facemasks. However, the pressure distribution pattern generated by the 3D-printed transparent facemasks has not been thoroughly investigated. The aim of this study is to develop a biomechanical model to simulate the pressure distribution of the 3D-printed transparent facemask, and to form the biomechanical basis to guide facemask design. METHODS: A finite element model comprised of the head bones, the soft tissues of the face and the transparent facemask was established in ABAQUS CAE package. The contact pressure between the facemask and the face was simulated under 7 loading conditions. The calculated results from the model were validated through comparing with the experimental pressure measurements. FINDINGS: The calculated results from the model well correlated with the experimental pressure measurements (P < 0.05). The biomechanical model is acceptable for the prediction of interface pressure between the facemask and the face. INTERPRETATION: The pressure distribution pattern showed the facial areas with thin soft tissues and bony prominence experienced concentrated pressure while areas with thick soft tissues received less or no pressure. Suggestions for future facemask design based on the biomechanical model is releasing the areas with concentrated pressure and indenting areas with insufficient pressure.

Development and psychometric evaluation of the Chinese version of the Participation and Environment Measure for Children and Youth.

Purpose: To adapt the Participation and Environment Measure for Children and Youth for use with Chinese children and youths, and to investigate its psychometric properties.Materials and methods: The Participation and Environment Measure for Children and Youth was translated into Chinese using a cultural adaptation process. Parents of 69 children aged 5-12 years with disabilities and 319 children without disabilities completed the questionnaires. Internal consistency, test-retest reliability, factorial structure, and known-group validity were examined using Cronbach's alpha, intraclass correlation coefficient, confirmatory factor analysis and t-test, respectively.Results: We added and/or replaced activities with culturally-relevant activities in the Chinese version. Internal consistency was acceptable for most of the scales (0.55-0.86). Test-retest reliability of the summary scores was moderate to high (0.70-0.84). Data-model fit was confirmed in a one-factor structure for the participation scales and a two-factor structure for the environment scales. There were also significant differences in the summary scores between 65 gender- and age-matched pairs of children with and without disabilities on the school participation scales and all the environment scales.Conclusion: This study provides psychometric evidence supporting the use of the Participation and Environment Measure for Children and Youth to assess Chinese children's participation and environmental supports/barriers.Implications for rehabilitationThe Chinese version of the Participation and Environment Measure for Children and Youth was developed through a rigorous translation and cultural adaptation process.There is evidence for the reliability (internal consistency and test-retest reliability) and construct validity (factorial structure and known-group validity) of the Chinese version of the Participation and Environment Measure for Children and Youth.The Chinese version of the Participation and Environment Measure for Children and Youth can be used to assess children's participation in home, school and community settings and to identify environmental barriers that require further intervention.

Measurement of vascularity in the scar: A systematic review.

BACKGROUND: Vascularity is an important parameter closely associated with the scar maturation. Reliable and accurate measurement of vascularity helps to monitor the scar change and adopt targeted interventions to prevent excessive scarring and achieve promising outcomes. However, there is no consensus on the assessment tools for the vascularity measurement in scars. This systematic review presents evidence on the available vascularity measurement tools. METHODS: A systematic literature search was done using PubMed, CINAHL, Embase and Science Direct databases. Studies, which used non-invasive measurement tools and explored their clinimetric properties, were identified and included in this review. RESULTS: A total of 1458 articles were obtained, and 26 articles were finally included in this review. Subjective vascularity measurement scales include the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS) and the modified Vancouver Scar Scale (mVSS) while objective vascularity measurement devices consist of the color-measuring device, the blood flow measuring device and the morphological imaging device. CONCLUSION: Subjective scales are easy to use and have acceptable reliability to give a preliminary impression of the scar vascularity. Three types of objective devices are not equivalent and are mainly based on the blood flow and angiogenesis to quantify the scar vascularity.

Measuring the tilt and slant of Chinese handwriting in primary school students: A computerized approach.

BACKGROUND: "Horizontal strokes should be level and vertical strokes should be straight" is a common guideline in the teaching of Chinese handwriting. Measuring deviations in level horizontal and straight vertical strokes in students' Chinese handwriting is usually assessed manually. However, this task is time-consuming and may have inconsistent outcomes when judged by different people. In this paper, we aim to formulate a method to automatically evaluate the tilt and slant degrees of students' Chinese handwriting using digital handwriting tablets. Furthermore, we analyze the relationship between the tilt and slant features of students' Chinese handwriting and other demographic and handwriting features. METHODS: Five hundred and ninety-one primary school students from grades 1 to 6 were recruited in Hong Kong. Before the assessment, a grid paper was attached to a digital handwriting tablet. The participants were then asked to copy 90 Chinese characters from a template to the grid paper. Their handwriting processes were recorded as two-dimensional points and then analyzed. The tilt and slant of the students' handwriting were calculated based on the inclination level of their horizontal and vertical strokes. Linear regressions between slant/tilt degree of the manuscripts and other handwriting features were performed. The students' demographic information was also explored. RESULTS: Slant was found to be significantly correlated to Gender (p < 0.001) and tilt×standard deviation of pen pressure (p < 0.001). Tilt was found to be significantly correlated to ground time (p < 0.001), slant (p < 0.001) and slant×special education need (p = 0.021). CONCLUSIONS: Our results demonstrate the relationship between slant, tilt and Chinese handwriting performance in primary school children. Slant and tilt can be adopted as an indicator in students' special education need diagnosis, as tilt level in the students' Chinese handwriting was related to ground time and slant× special education need, while slant is related to tilt×standard deviation of pen pressure and female students. These findings may also inspire ways to increase special education need students' writing speed.

Predictors for return to work after physical injury in China: A one-year review.

BACKGROUND: Several studies have explored the factors influencing patients' return to work (RTW) status. However, only few studies have tried to explore the predictors for RTW in subpopulations in terms of different levels of disability, particularly in the Chinese population. OBJECTIVE: This study describes the trends in patient's RTW and explores the predictors associated with RTW for patients with work-related injury in Mainland China. METHODS: A total of 457 patients with different types of injury were followed up for one year. Patients were stratified into three groups according to the grade of disability as follows: mild, moderate, and severe. Variables affecting RTW were then compared between the three groups, and multiple logistic regression was performed to identify the predictors for RTW. RESULTS: The RTW rates during the study period were significantly different among the three groups. RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. For the mild disability group, educational level, expectation to RTW, and other types of injury (e.g., spinal cord injury, traumatic brain injury, and burn) were significant predictors for RTW. White-collar work and better employer satisfaction were positive predictors for RTW for the moderate group. Meanwhile, no significant predictor for RTW was determined for the severe disability group. CONCLUSIONS: RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. The predictors for RTW also varied among the patients with different levels of disability. These predictors may help vocational rehabilitation service providers provide more accurate intervention.

The application of 3D-printed transparent facemask for facial scar management and its biomechanical rationale.

INTRODUCTION: Deep facial burns leave conspicuous scar to the patients and affect their quality of life. Transparent facemask has been adopted for the prevention and treatment of facial hypertrophic scars for decades. Recently, with the advancement of 3D printing, the transparent facemask could facilitate the fitting of the facial contour. However, the effectiveness of the device and its biomechanical characteristics on pressure management of hypertrophic scar would need more objective evaluation. METHOD: A biomechanical model of the transparent 3D-printed facemask was established through finite element analysis. Ten patients with extensive deep facial burns within 6 months were recruited for clinical study using 3D-printed facemask designed according to biomechanical model, and the interface pressure was measured on each patient. The patients in the treatment group (n=5) was provided with the 3D-printed transparent face mask soon after initial scar assessment, while the delayed treatment group (n=5) began the treatment one month after the initial scar assessment. The scar assessment was performed one month post intervention for both groups. RESULTS: The biomechanical modeling showed that the 3D, computer-generated facemask resulted in unbalanced pressure if design modifications were not incorporated to address these issues. The interface pressure between the facemask and patient's face was optimized through individualized design adjustments and the addition of silicone lining. After optimization of pressure through additional lining, the mean thickness and hardness of the scars of all 10 patients were decreased significantly after 1-month of intervention. In the delayed treatment group, the mean thickness of the scars was increased within the month without intervention, but it was also decreased after intervention. CONCLUSION: Facemask design and the silicone lining are important to ensure adequate compression pressure of 3D-printed transparent facemask. The intervention using the 3D-printed facemask appeared to show its efficacy to control the thickness and hardness of the facial hypertrophic scars.

The recovery of post-burn hypertrophic scar in a monitored pressure therapy intervention programme and the timing of intervention.

INTRODUCTION: Pressure therapy used to be considered as the mainstay non-invasive treatment of hypertrophic scar. However, the maturation process of hypertrophic scar during pressure therapy process has seldom be reported. Moreover, although early application of pressure therapy after burn injuries is reco6mmended, minimal evidence exists to support it. This study aimed to examine the maturation trajectory of post-burn hypertrophic scars in a 6-month monitored pressure therapy intervention programme and investigate the difference in the trajectory between patients receiving early intervention and patients receiving late intervention. METHODS: Thirty-four patients with sixty-five post-burn hypertrophic scar samples were recruited for the study. All the subjects were treated with a 6-month pressure therapy programme with the pressure dosage regulated using a newly developed pressure therapy system, the Smart Pressure Monitored Suits. The selected scars were assessed with MiniScan XE Spectrocolorimeter on scar pigmentation, and Terason t3000 portable ultrasound imaging equipment on scar thickness. The Vancouver Scar Scale (VSS) was used to evaluate pigmentation, pliability, vascularity and height of the scars. Subjects' report of pain and itch was documented. Assessments were conducted before treatment began and then monthly during the 6 month-intervention process. Patients were further divided into two groups according to the time of intervention post-burn injuries to review differences in the maturation trajectory between those who received early versus late treatment (early intervention group, prescribed within 60days after injuries; late intervention group, prescribed after 61 days). The changes of scar features were recorded to formulate the recovery trajectory of scar, and the outcomes of intervention between the early and the late groups were compared. RESULTS: Pre- and post-treatment comparison demonstrated significant improvement in scar pigmentation, thickness, VSS scores and scores of pain and itch (p<0.01) for the early intervention group. For the later intervention, only scar lightness, yellowness, VSS scores and scores of pain and itch was found with significant improvement (p<0.01). The improvement in these scar characteristics was sustained over time during the treatment process. The early group demonstrated superior effect in improving scar lightness, yellowness (p<0.01), thickness (p<0.01), pigmentation score (p<0.05) and pain score (p<0.01) than the late group in comparison between the two groups at similar post-burn timing. CONCLUSIONS: Hypertrophic scars appeared to undergo continuous improvement in the appearance, pain and itch over time during the process of a monitored pressure intervention programme. Early application of pressure therapy after burn injury may contribute to better outcomes as shown by their faster recovery than those with late intervention. In order to achieve the best outcomes, regular evaluation and adjustment for optimal interface pressure is necessary.

The Relationship Between Sensorimotor and Handwriting Performance in Chinese Adolescents with Autism Spectrum Disorder.

Impaired sensorimotor control, as a common feature of autism spectrum disorder (ASD), could be a driving factor to handwriting problems. This study examined the Chinese and English handwriting and sensorimotor skills of 15 ASD and 174 typically developing Chinese adolescents. Participants with ASD had lower writing speed and poor manual dexterity (MD) than the typically developing participants. MD was a significant mediator between ASD and handwriting speed. Ground time and airtime represent the length of time when the pen touches the paper and is held in air, respectively. Participants with ASD who had better performance in MD showed shorter ground time in Chinese handwriting and shorter airtime in English handwriting. Training for adolescents with ASD on their MD may improve their handwriting performance.

Handwriting assessment to distinguish comorbid learning difficulties from attention deficit hyperactivity disorder in Chinese adolescents: A case-control study.

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) and learning difficulties (LDs) are proposed as 2 overlapping disorders. The objective of this study was to investigate the handwriting performance in ADHD and comorbid ADHD-LD adolescents. METHODS: The study examined the Chinese and English handwriting performance and sensorimotor skills of 32 ADHD, 12 ADHD-LD, and their matched controls. RESULTS: Participants with ADHD had comparable writing time and speed, but the readability was lower than their controls. Participants with ADHD-LD had lower writing speeds in both Chinese and English handwriting than their controls. The ADHD and ADHD-LD groups also showed larger variations in either speed or pen pressure than their controls. Chinese handwriting assessment effectively classified ADHD and ADHD-LD with good sensitivity and positive predictive value. CONCLUSIONS: Clinicians should be aware of the fundamental difference between the 2 disorders and make good use of handwriting assessment as a reference to deliver effective therapies and trainings.

A 6-month follow-up of the effects of an information and communication technology (ICT) training programme on people with intellectual disabilities.

We investigated the long-term effects of an information and communication technology (ICT) training programme for people with intellectual disabilities (ID). A community-based ICT training programme was designed to enhance the computer skills of people with ID and prepare them to make use of ICT in their daily life. Of the 100 who had participated in the original ICT training programme, 59 of them and their caregivers agreed to participate in the follow-up interview. A computer skills checklist was used to assess the ICT competence of the participants before training, after training, and at the 6-month follow-up assessment. All caregivers were interviewed at the 6-month follow-up session to explore the use of ICT by people with ID and their needs for further training. Results from repeated measures ANOVA showed that participants maintained at the 6-month follow-up the basic ICT skills that they acquired during training [F=13.86, p<0.001]. Caregivers reported that participants spent more time in using the computers, but still needed occasional guidance. They also reported a need to advance their ICT skills beyond the basic computer training. We concluded that ICT training for people with ID would help them in maximizing the benefits of information technology via computers.

Robotic approaches for the rehabilitation of upper limb recovery after stroke: a systematic review and meta-analysis.

This systematic review with a meta-analysis of studies was carried out to evaluate the effectiveness of robotic training (RT) and conventional training (CT) in improving the motor recovery of paretic upper limbs in stroke patients. Numerous electronic databases were searched from January 2000 to May 2016. Finally, 13 randomized-controlled trials fulfilled the inclusion criteria and were included in the three meta-analyses. The first meta-analysis carried out for those studies using RT for stroke patients indicated a significant improvement in the RT groups. The second meta-analysis suggested that the upper limb function (measured by Fugl-Meyer test) was significantly improved when RT was used with CT compared with CT alone. The third meta-analysis noted a significant difference in motor recovery between the CT-only and RT groups (RT only or RT combined with CT) in the chronic stages of stroke, but not in the acute or subacute stages. However, the RT group also showed a higher Fugl-Meyer score in patients at both the acute and the subacute stage. RT appeared to have positive outcomes to enhance motor recovery of the paralyzed upper limb. Robotic devices were believed to provide more assistance to patients to help support the weight of the upper limb; thus, active movement training can begin in the early rehabilitation stage. These novel devices may also help those chronic patients to achieve better rehabilitation goals. As a summary, RT could be used in addition to CT to help both therapists and patients in the management of the paralyzed upper limb.