Reliability of the Montreal Cognitive Assessment in people with stroke.

This study examined the relative and absolute reliability of the Taiwanese version of the MoCA (MoCA-T) in people with stroke. The study recruited 114 individuals who were at least 3 months after the onset of a first-ever unilateral stroke. The MoCA-T was administered twice, at a 6-week interval, to all participants. The relative reliability was assessed using the intraclass correlation coefficient (ICC), and the absolute reliability was assessed using standard error of measurement (SEM), the smallest real difference (SRD), the SRD percentage, and the Bland-Altman method. The ICC analysis showed the MoCA-T was highly reliable (ICC = 0.85). The absolute reliability was between an acceptable and excellent level, where the SEM and the SRD at the 95% confidence interval were 1.38 and 3.83, respectively. The Bland-Altman analyses showed no systematic bias between repeated measurements. The range of the 95% limits of agreement was narrow, indicating a high level of stability over time. These findings suggest that the MoCA-T has high agreement between repeated measurements without systematic bias. The threshold to detect real change stands between an acceptable and excellent level. The MoCA-T is a reliable tool for cognitive screening in stroke rehabilitation.

Comparative Assessment of Two Robot-Assisted Therapies for the Upper Extremity in People With Chronic Stroke.

OBJECTIVE: We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). METHOD: In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. RESULTS: The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. CONCLUSION: The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.

Synergistic effects of aerobic exercise and cognitive training on cognition, physiological markers, daily function, and quality of life in stroke survivors with cognitive decline: study protocol for a randomized controlled trial.

BACKGROUND: Aerobic exercise and cognitive training have been effective in improving cognitive functions; however, whether the combination of these two can further enhance cognition and clinical outcomes in stroke survivors with cognitive decline remains unknown. This study aimed to determine the treatment effects of a sequential combination of aerobic exercise and cognitive training on cognitive function and clinical outcomes. METHODS/DESIGN: Stroke survivors (n = 75) with cognitive decline will be recruited and randomly assigned to cognitive training, aerobic exercise, and sequential combination of aerobic exercise and cognitive training groups. All participants will receive training for 60 minutes per day, 3 days per week for 12 weeks. The aerobic exercise group will receive stationary bicycle training, the cognitive training group will receive cognitive-based training, and the sequential group will first receive 30 minutes of aerobic exercise, followed by 30 minutes of cognitive training. The outcome measures involve cognitive functions, physiological biomarkers, daily function and quality of life, physical functions, and social participation. Participants will be assessed before and immediately after the interventions, and 6 months after the interventions. Repeated measures of analysis of variance will be used to evaluate the changes in outcome measures at the three assessments. DISCUSSION: This trial aims to explore the benefits of innovative intervention approaches to improve the cognitive function, physiological markers, daily function, and quality of life in stroke survivors with cognitive decline. The findings will provide evidence to advance post-stroke cognitive rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02550990 . Registered on 6 September 2015.

Validity and Responsiveness of the Revised Nottingham Sensation Assessment for Outcome Evaluation in Stroke Rehabilitation.

OBJECTIVE: This study establishes the concurrent validity, predictive validity, and responsiveness of the Revised Nottingham Sensation Assessment (rNSA) during rehabilitation for people with stroke. METHOD: The study recruited 147 patients with stroke. The main assessment used was the rNSA, and outcome measures were the Fugl-Meyer Assessment sensory subscale (FMA-S) and motor subscale (FMA-M) and the Nottingham Extended Activities of Daily Living (NEADL) scale. RESULTS: Correlation coefficients were good to excellent between the rNSA and the FMA-S. The rNSA proprioception measure was a predictor for the FMA-S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for the FMA-M and the NEADL scale, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = .51-.83). CONCLUSION: This study may support the concurrent validity, predictive validity, and responsiveness of the rNSA for people with stroke.

Proximal Fugl-Meyer Assessment Scores Predict Clinically Important Upper Limb Improvement After 3 Stroke Rehabilitative Interventions.

OBJECTIVE: To identify the baseline motor characteristics of the patients who responded to 3 prominent intervention programs. DESIGN: Observational cohort study. SETTING: Outpatient rehabilitation clinics. PARTICIPANTS: Individuals with chronic stroke (N=174). INTERVENTIONS: Participants received 30 hours of constraint-induced movement therapy (CIMT), robot-assisted therapy, or mirror therapy (MT). MAIN OUTCOME MEASURES: The primary outcome measure was the change score of the Upper Extremity Fugl-Meyer Assessment (UE-FMA). The potential predicting variables were baseline proximal, distal, and total UE-FMA and Action Research Arm Test scores. We combined polynomial regression analyses and the minimal clinically important difference to stratify the patients as responders and nonresponders for each intervention approach. RESULTS: Baseline proximal UE-FMA scores significantly predicted clinically important improvement on the primary outcome measure after all 3 interventions. Participants with baseline proximal UE-FMA scores of approximately <30 benefited significantly from CIMT and robot-assisted therapy, whereas participants with scores between 21 and 35 demonstrated significant improvement after MT. Baseline distal and total UE-FMA and Action Research Arm Test scores could also predict upper limb improvement after CIMT and MT, but not after robot-assisted therapy. CONCLUSIONS: This study could inform clinicians about the selection of suitable rehabilitation approaches to help patients achieve clinically meaningful improvement in upper extremity function.

Psychometric comparison of the shortened Fugl-Meyer Assessment and the streamlined Wolf Motor Function Test in stroke rehabilitation.

OBJECTIVE: We aimed to compare the responsiveness, concurrent and predictive validity of the shortened Fugl-Meyer Assessment (S-FMA) and the streamlined Wolf Motor Function Test (S-WMFT) in persons with subacute stroke. DESIGN: Test-retest design. SETTING: Departments of physical medicine and rehabilitation at three hospitals. PARTICIPANTS: PARTICIPANTS with first-time stroke (N = 51; 38 men, 13 women; mean age ± SD, 55.1 ± 11.7 years) based on scores of Mini-Mental State Examination and Brunnstrom stage. INTERVENTIONS: PARTICIPANTS received one of three rehabilitation therapies for three weeks and were evaluated at baseline and end of treatment. MAIN OUTCOME MEASURES: Responsiveness was examined using the paired t-test and the standardized response mean (SRM). Criterion validity was investigated using the Pearson's correlation coefficient (r). RESULTS: Changes from baseline to end of treatment assessed by both tests were significant (P < 0.001). The value for responsiveness of the S-FMA was significantly higher than that of the S-WMFT (SRM difference, 0.48; 95% confidence interval, 0.23-0.63). There were stronger associations between the comparison scales and the S-FMA (r = 0.57-0.68) than with the S-WMFT (r = 0.39-0.58). CONCLUSIONS: The S-FMA had better concurrent and predictive validity than the S-WMFT and was more sensitive to changes caused by rehabilitation therapies. The S-FMA is recommended for expedited assessment of arm motor function outcome in stroke patients receiving rehabilitative therapy.

Comparison between hospital-based and community-based services for the special health care needs of children with developmental delays.

BACKGROUND: Recognizing special health care needs (SHCN) is obligatory for children with developmental delay (DD). The purpose of this study was to compare hospital-based and community-based services for the SHCN of children with DD. METHODS: We collected 114 children with DD. An expert-designed questionnaire was used to measure the SHCN of children in either hospital-based or community-based services. The questionnaire included the children's characteristics, family ecology and SHCN, which encompassed four categories, team assessment and counseling, rehabilitation, complementary and alternative treatment, and home care. We compared the differences and needs between the two health care services. RESULTS: More children with DD in hospital-based services had disabled certificates, catastrophic illness certificates and multiple caregivers than community based services. More children with DD in community-based services had severe-disabled certificates than those in hospital-based services (p < 0.001). Children in hospital-based services had more SHCN for some items of team assessment and counseling, rehabilitation, and complementary and alternative treatment than those in community-based services (p < 0.05). The need for home care was not significantly different between the two services except for nutrition counseling (p = 0.048). CONCLUSION: SHCN in multiple aspects imply the necessity for team assessment and counseling, rehabilitation, complementary and alternative treatments and nutrition counseling in approaching children with DD in hospital-based services.

Validity of the Loewenstein occupational therapy cognitive assessment in people with intellectual disabilities.

We examined the psychometric properties (internal consistency, concurrent criterion validity, and known-group validity) of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) in people with intellectual disabilities. A total of 111 people with intellectual disabilities and 19 people with no disabilities were included. We used Cronbach's alpha, Spearman's rho, the Kruskal-Wallis test, and one-way analysis of variance for analysis, where appropriate. Results showed good internal consistency on Orientation, Visual Perception, Spatial Perception, Visuomotor Organization, and Thinking Operations subscales (Cronbach's alphas = .82, .74, .76, .86, and .80, respectively), but not on the Motor Praxis subscale (alpha = .48). We found significant correlations between participants' performance on the Pictorial IQ test and disability level and scores on the LOTCA. The known-group validity of the LOTCA in people with intellectual disabilities was satisfactory. We concluded that the LOTCA is a suitable instrument for measuring cognitive abilities and visual perception in people with intellectual disabilities.

A review of psychometric properties of feeding assessment tools used in neonates.

OBJECTIVE: To appraise the psychometric properties of clinical feeding assessment tools used in a neonatal population. DATA SOURCES: PubMed, OvidMedline, CINHAL, and PsycINFO databases from 1980 to 2007. Reference lists of all identified articles were also reviewed. STUDY SELECTION: Research reports written in English that utilized or validated clinical feeding assessment tools. DATA EXTRACTION: In total, 941 articles were reviewed. Seven neonatal clinical feeding assessment tools were identified and categorized into three groups: tools used for assessing either bottle-feeding or breastfeeding behaviors, tools used only for assessing bottle-feeding behaviors, and tools used only for assessing breastfeeding behaviors. RESULTS: The psychometric properties of none of the seven assessment tools identified were satisfactory, and the limited representativeness of the samples of the psychometric research was noted in all assessment tools identified. The Neonatal Oral-Motor Assessment Scale appeared to have been examined more thoroughly and showed more consistent results in psychometric properties than the others, despite its own limitations. CONCLUSIONS: A psychometrically sound neonate feeding assessment tool has not yet been empirically validated. Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions. Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care.