A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients.

BACKGROUND AND PURPOSE: Emerging research suggests the use of self-regulation (SR) for improving functional regain in patients post stroke. SR is proposed to produce an added effect to effective modified constraint-induced movement therapy (mCIMT). This study aimed to examine the effect of a self-regulated mCIMT programme (SR-mCIMT) for functional regain in patients with sub-acute stroke. METHODS: Eighty-six patients completed the trial: SR-mCIMT, n = 29; mCIMT, n = 31; or conventional functional rehabilitation, n = 26. All interventions were 2-week therapist-guided training. Outcome measurements, taken by a blinded assessor, examined arm function [Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA)], daily task performance [Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)] and self-perceived arm use in functional tasks [Motor Activity Log (MAL)]. RESULTS: Significant differences were found with the SR-mCIMT outperforming the other groups after the intervention (ARAT, P = 0.006; FMA, Lawton IADL and MAL, all Ps < 0.001). In terms of the carry-over effect, the SR-mCIMT group outperformed in the hand and coordination subscales of ARAT and FMA (P = 0.012-0.013) and the self-perceived quality of arm use (P = 0.002). CONCLUSION: A combination of SR and mCIMT could produce an added effect in functional regain in patients post stroke.

Age-related effects on perceptual and semantic encoding in memory.

This study examined the age-related subsequent memory effect (SME) in perceptual and semantic encoding using event-related potentials (ERPs). Seventeen younger adults and 17 older adults studied a series of Chinese characters either perceptually (by inspecting orthographic components) or semantically (by determining whether the depicted object makes sounds). The two tasks had similar levels of difficulty. The participants made studied or unstudied judgments during the recognition phase. Younger adults performed better in both conditions, with significant SMEs detected in the time windows of P2, N3, P550, and late positive component (LPC). In the older group, SMEs were observed in the P2 and N3 latencies in both conditions but were only detected in the P550 in the semantic condition. Between-group analyses showed larger frontal and central SMEs in the younger sample in the LPC latency regardless of encoding type. Aging effect appears to be stronger on influencing perceptual than semantic encoding processes. The effects seem to be associated with a decline in updating and maintaining representations during perceptual encoding. The age-related decline in the encoding function may be due in part to changes in frontal lobe function.

Use of the Interact Short Form as a tool to evaluate emotion of people with profound intellectual disabilities.

BACKGROUND: One of the essential purposes of intervention programmes for people with profound intellectual disabilities (ID) is to enhance the desirable mood and behaviour and decrease the undesirable ones through stabilizing their emotion. There is lack of validated instrument to offer a comprehensive measure that covers the mood and behaviour, both desirable and undesirable, appropriate for people with profound ID. METHOD: This study aimed to examine the validity and reliability of the Interact Short Form for evaluating the mood and behaviour of people with profound ID, and at the same time, review their emotional profile using the Interact Short Form. Both content validity using expert panel review and construct validity by means of factor analysis were investigated. A total of 75 people with profound ID were recruited. Inter-rater reliability was tested. The results of the Interact Short Form were described to reflect the emotional profile of this group of participants. RESULTS: Using the results of expert panel review and those from factor analysis, we found three subscales representing the mood and behaviour of people with profound ID. They were: 'emotional expression', 'interests towards tasks' and 'behaviours to environment'. All three subscales were found to be internally consistent (alpha = 0.71-0.88). The Interact Short Form- People with profound ID version also showed good inter-rater reliability (mean = 0.72). The results of the Interact Short Form showed that this group of participants had fairly stable emotion under the structured setting and activities in the residential institutions where data were collected. CONCLUSIONS: The Interact Short Form- People with profound ID version serves as a helpful tool for both clinical and research use in assessing the mood and behaviour of people with profound ID in a simple, comprehensive and systematic way.

Activities of daily living performance in dementia.

OBJECTIVE: To explore the activities of daily living ADL performance profile of community-living people with dementia and to investigate its relationship with dementia severity. MATERIALS & METHODS: ADL performance of 86 subjects were evaluated using Barthel Index (BI), Lawton and Brody's Instrumental Activities Daily Living (IADL) and Assessment of Motor and Process Skills (AMPS). Dementia severity was measured by Clinical Dementia Rating (CDR). RESULTS: Subjects were able to perform most basic ADL (BI mean = 16.4) and some IADL (Lawton and Brody's IADL mean = 4.3). The AMPS process ability measure and the Lawton and Brody's IADL were significantly correlated with CDR (P < 0.01). CONCLUSIONS: Subjects with mild dementia were able to perform mostly all basic ADL and some IADL. The AMPS process ability measure and the Lawton and Brody's IADL could provide useful information on their ability to live independently in the community.

Mental imagery for relearning of people after brain injury.

OBJECTIVE: This paper reported on the application of mental imagery to the relearning of daily task performance in people with brain injury. METHOD: The changes in two subjects who had suffered from cerebral infarction shown throughout a 3-week mental imagery programme were described. The subjects' improvement in task performance and other clinical outcomes illustrated the programme's therapeutic effects on skill relearning, maintenance and generalization. RESULTS: After completing the programme, the subjects showed improvements in performance at both the trained and untrained tasks. Feedback from the patients also suggested its ability to enhance their day-to-day functioning. Clinical assessment results indicated that the subjects experienced an increase in the attention and sequential processing functions but not in the motor and other cognitive functions. CONCLUSION: Mental imagery appears to be effective at enhancing the task relearning of subjects after brain injury. The skills acquired under this treatment regime can be retained and then generalized to other tasks. Its therapeutic effect is probably mediated by the improved attention and planning and execution functions associated with the rehearsal. Further research should conduct clinical controlled trials to gather evidence on its efficacy at promoting functional regain in people suffering from neurological disorders.

Self-regulatory learning and generalization for people with brain injury.

PRIMARY OBJECTIVE: brain injury can result in the loss of previous learnt behaviours that affect an individual's daily functioning. The use of self-regulation helps the individual to relearn the lost behaviours by bringing him/her to self-conscious level through independent and reflective learning derived using a social cognitive perspective. The purpose of this paper is to report on clinical observations made with the use of self-regulation in people with brain injury during the relearning of lost functions. METHODS AND PROCEDURES: daily tasks were used to assess the relearning ability of the subjects pre- and post-programme. EXPERIMENTAL INTERVENTION: one-week self-regulatory training on five selected daily tasks. MAIN OUTCOMES AND RESULTS: these provisory observations would suggest that, with specific guidance for people with different needs, such as with impaired cognitive function and depression, self-regulation is effective in enhancing their relearning. CONCLUSION: Self-regulatory training is effective in enhancing the relearning of lost functions.