Measurement Properties of the Stroke-Predischarge Occupational Therapy Assessment.

There is no comprehensive predischarge occupational therapy assessment tool in South Korea. The objective of this study was to determine Stroke-Predischarge Occupational Therapy Assessment (S-POTA) validity and reliability. Twenty-seven occupational therapists (OTs) assessed 97 patients with stroke. Concurrent validity was evaluated by comparing S-POTA scores with stroke-specific quality of life (SS-QOL). Discriminant validity was evaluated by comparing S-POTA scores between outpatient and readmitted groups, and a receiver operating characteristic analysis was conducted. The test-retest was conducted twice in 20 patients, and the inter-rater test was conducted with two OTs per patient. S-POTA positively correlated with SS-QOL. S-POTA rating differs significantly across outpatients and readmitted groups. All S-POTA areas under curve values ranged from .70 to .85, and cut-off points were derived. Cronbach's α for internal consistency was .953, the intraclass correlation coefficient for test-retest was .990, and .987 for inter-rater reliability. The results suggest S-POTA is a reliable tool for efficient implementation of discharge planning.

Predictive factors associated with trajectory of job satisfaction of workers with physical disabilities: A latent growth curve analysis.

BACKGROUND: Job satisfaction is a highly useful factor in maintaining a successful work life for the disabled. OBJECTIVE: This study aimed to evaluate how job satisfaction among workers with physical disabilities evolves over time, and to identify predictive factors that influence the trajectory of job satisfaction. METHODS: A longitudinal data analysis using the three-year databases of the 2016-2018 Employment Panel Survey for the Disabled (n = 693). A latent growth curve model analysis was conducted to determine the trajectory of the job satisfaction among workers with physical disabilities, as well as the predictive factors affecting it. RESULTS: Job satisfaction among workers with physical disabilities increased over time, and there were substantial individual differences in the trajectory of the job satisfaction. The significant predictors for the job satisfaction over the three years were degree of disability, computer usage ability, employment support services, and experience of discrimination. Gender, educational background, interpersonal relationship/organizational adaptability, convenience facilities for the disabled, job suitability, disability acceptability, and self-esteem had a considerable impact on the intercept of the job satisfaction, but not on the slope. CONCLUSION: The findings would inform healthcare providers to establish mid-to-long-term vocational rehabilitation intervention plans that could increase the job satisfaction among workers with physical disabilities.

Applying Latent Profile Analysis to Identify Lifestyle Profiles and Their Association with Loneliness and Quality of Life among Community-Dwelling Middle- and Older-Aged Adults in South Korea.

This study aimed to examine the multi-faceted lifestyle profiles of community-dwelling middle- and older-aged adults based on their physical activity, participation in various activities, and nutrition. It identified the association of lifestyle profiles with demographic variables, quality of life, and mental health. The analysis included 569 participants (mean age = 60.2; SD = 4.3). Latent profile analysis identified three distinctive lifestyle profiles: "inactive and unbalanced" (36.4%), "basic life maintenance" (54.6%), and "active and balanced" (9.1%). Sex (p < 0.001), age (p < 0.001), and regular medication intake (p < 0.01) were statistically significantly different among the three profiles. Of the "inactive and unbalanced" lifestyle group, 63.3% of it was comprised of by females, and a relatively large distribution was aged over 65. In the "basic life maintenance" subgroup, males showed a relatively large distribution, and 92.6% of participants were aged 55-64. People with active and balanced lifestyles demonstrated high quality of life levels (p < 0.001) and low loneliness levels (p < 0.01). Multinomial logistic regression revealed a statistically significant positive association between lifestyle profiles and quality of life (p < 0.001) as well as mental health (p < 0.01). Therefore, health promotion that considers multi-faceted lifestyle factors would need to improve health and quality of life among community-dwelling middle- and older-aged adults in South Korea.

Effects of occupational balance on subjective health, quality of life, and health-related variables in community-dwelling older adults: A structural equation modeling approach.

Occupational balance is an important variable associated with health and quality of life. This study aimed to investigate the influence of occupational balance on health, quality of life, and other health-related variables using structural equation modeling. We analyzed data from 208 adults over 55 years old. Mean age of the participants was 70.21 years (SD 7.22). The research model for analysis was based on the results of previous studies addressing occupational balance and related variables such as stress, leisure satisfaction, life satisfaction, subjective health, quality of life, and participation. General fit indices of the final model were acceptable (x2/df = 1.708, p < .001, RMSEA = .058, TLI = .923, CFI = .929, and SRMR = .067). Although the size of effect was small to medium (.157-.249), occupational balance was identified as an independent variable directly or indirectly affecting subjective health, quality of life, and health-related variables in the final model. Our results showed that it is possible to improve subjective health and quality of life by promoting better occupational balance. Further studies developing an intervention program based on occupational balance are required to confirm the feasibility of the intervention and its effect on older adults' health and quality of life in real-life circumstances.

Effects of a Cognitive-Functional Intervention Method on Improving Executive Function and Self-Directed Learning in School-Aged Children with Attention Deficit Hyperactivity Disorder: A Single-Subject Design Study.

BACKGROUND: School-aged children with attention deficit hyperactivity disorder (ADHD) face many difficulties with self-directed learning because of their poor executive function. This leads to secondary problems such as learning disabilities and depression, so the role of intervention to improve executive function in school-aged children with ADHD is important. OBJECTIVE: The present study is aimed to investigate how cognitive-functional (Cog-Fun) intervention affected executive function of school-aged children with ADHD and the sustainability of these effects. To investigate the effects of changes in the executive function of school-aged children with ADHD through Cog-Fun intervention in self-directed learning. METHOD: A single-subject A-B-A research design was employed in this study. Three children aged 9-10 years who were diagnosed with ADHD were selected. A total of 17 experimental sessions were conducted. The Cog-Fun intervention program was implemented during the intervention phase. To measure dependent variables, Behavior Rating Inventory of Executive Function (BRIEF) and Homework Problems Checklist (HPC) were used. Significant changes in executive function assessed by the Children's Color Trails Test (CCTT) and Stroop test were analyzed through two-standard deviation band analysis. Additionally, video clips of task performance were analyzed to examine qualitative performance changes in self-directed learning. RESULT: All three participants presented statistically significant changes with a number of near-misses of CCTT and color words score of Stroop test during the intervention. T-scores of the Global Executive Composite (GEC) decreased after the intervention, indicating improvement in executive function. The follow-up period revealed retention of the improved executive function. Additionally, self-directed learning improved in all participants after the implementation Cog-Fun intervention. CONCLUSION: The study supports the effectiveness of Cog-Fun intervention in improving executive function in school-aged children with ADHD and confirmed that the improvement of executive function ultimately leads to the improvement of self-directed learning performance.

The Development of Leisure Participation Assessment Tool for the Elderly.

OBJECTIVES: This study is aimed at developing multidimensional leisure participation assessment tool for the elderly to achieve quantitative and qualitative assessment of leisure participation and leisure exploration. METHODS: This study collected preliminary items through literature review, statistical office data, and survey of the elderly's leisure activities and considered the list of leisure activities as assessment items by conducting a Delphi survey. Reliability was verified through internal consistency and test-retest reliability. The assessment tool was finally confirmed using content validity and discriminant validity. RESULTS: A total of 81 leisure items classified into 8 categories and 22 subcategories were obtained through data collection and Delphi survey. Cronbach's α value was 0.939, and Intraclass Correlation Coefficient was 0.941. A content validity test was confirmed by validating that I-CVI was 0.78 or more and the S-CVI was 0.95. According to the result of discriminant validity, there was a difference in the number of participating leisure activities and leisure activities with participation intention by age. CONCLUSION: The leisure participation assessment tool for the elderly developed in this study can obtain information on the overall view of the leisure of the elderly by measuring leisure exploration, leisure participation, and interference factor affecting leisure participation.

Safety and Efficacy of Radiofrequency Ablation for Nonfunctioning Benign Thyroid Nodules in Children and Adolescents in 14 Patients over a 10-Year Period.

PURPOSE: To evaluate the efficacy and safety of radiofrequency (RF) ablation for nonfunctioning benign thyroid nodules in children and adolescents. MATERIALS AND METHODS: Fourteen pediatric patients (10 female, 4 male; mean age 15.7 ± 2.3 years, range 12-19 years) with nonfunctioning benign thyroid nodules (mean longest diameter 3.7 ± 1.1 cm, range 2.0-5.6 cm) treated with the use of RF ablation from 2005 to 2015 were evaluated. The inclusion criteria for RF ablation therapy were (i) age <20 years, (ii) benign cytological confirmation by ≥2 separate fine-needle aspiration or core needle biopsies, (iii) pressure symptoms or cosmetic problems caused by thyroid nodules, (iv) absence of any suspicious feature as determined with the use of ultrasound (US), (v) normal serum levels of thyroid hormone and thyrotropin, and (vi) follow-up of >6 months. RF ablation was performed with the use of an RF generator and an 18-gauge internally cooled electrode. RF ablation was performed under local anesthesia without conscious sedation or general anesthesia. Changes in nodules on follow-up US, changes in symptomatic and cosmetic scores, and complications arising during or after RF ablation were evaluated. RESULTS: Mean follow-up period was 36.9 ± 21.7 months (range 6-69 months). At last follow-up visits, mean longest nodule diameter and volume had decreased significantly (3.7 ± 1.1 cm vs 1.4 ± 0.9 cm and 14.6 ± 13.3 mL vs 1.7 ± 4.4 mL; P < 0.001). Both cosmetic and compressive symptoms significantly improved (3.8 ± 0.6 vs 1.4 ± 0.6 and 3.4 ± 1.0 vs 0.1 ± 0.4; P < 0.001). The mean number of ablation sessions was 2.1 ± 1.2 (range 1-5 sessions) and no major complication was encountered during or after RF ablation. CONCLUSIONS: RF ablation might be a safe and effective treatment modality for nonfunctioning benign thyroid nodules in children and adolescents.

Agreement between MRI and pathologic analyses for determination of tumor size and correlation with immunohistochemical factors of invasive breast carcinoma.

Background There may be discordance between tumor size determined by magnetic resonance imaging (MRI) and that observed during pathologic analyses. Purpose To evaluate MRI-pathology concordance of tumor size in patients with invasive breast carcinoma. Material and Methods Data from 307 invasive breast carcinomas were analyzed retrospectively. Preoperative breast MRI was reviewed for size, lesion type, morphology, and dynamic contrast-enhanced tumor kinetics. MRI tumor size was compared with tumor size measurements from the pathologic analysis. Concordance was defined as a difference in diameter of ≤ 0.5 cm. MRI-pathology concordance was compared according to clinical and histopathologic features. Results The mean tumor size on MRI was 2.48 ± 1.41 cm. Tumor measurements determined by MRI were not significantly different from those recorded in the pathologic reports (2.56 ± 1.61 cm, P = 0.199). MRI-pathology concordance was found in 229/307 (74.6%) cases; the size was overestimated in 36 (11.7%) tumors and underestimated in 42 (13.7%). On univariate analysis, MRI-pathology discordance was associated with larger tumor size ( P < 0.001), estrogen receptor (ER) negativity ( P = 0.006), and lymphovascular invasion ( P = 0.003). Human epidermal growth factor receptor 2 positive molecular subtype showed worse correlation between the tumor size measured by MRI and pathology compared with luminal A and luminal B subtypes ( P = 0.008 and 0.007). On multivariate analysis, tumor size and ER status significantly influenced MRI-pathology concordance ( P < 0.05). Conclusion ER negativity and larger tumor size were strongly associated with MRI-pathology discordance in invasive breast carcinomas. Awareness of these factors might improve surgical planning.

Development and Validation of the Activities of Daily Living Short Form for Community-Dwelling Korean Stroke Survivors.

This study developed and validated a short form (SF) using activities of daily living (ADL) outcome measures from the Korea National Health and Nutrition Examination Survey (KNHANES) that can minimize survey administration burden for clinicians. This study utilized secondary data from the 2005 KNHANES with 422 community-dwelling stroke survivors. The KNHANES data were collected from April to June 2005 in South Korea. We created a 7-item SF from the 17 ADL questions in the survey using item response theory (IRT) methodologies. The precision and validity of the SF were compared to the full questionnaire of ADL items and the EuroQol-5D total score. Among the 17 ADL questions, 14 questions demonstrated unidimensional construct validity. Using IRT methodologies, a set of 7 items were selected from the full bank. The 7-item SF demonstrated good psychometric properties: high correlation with the full bank ( r = .975, p < .001), good internal consistency (Cronbach's α = .93), and a high correlation with the EuroQol-5D total score ( r = .678, p < .001). These findings indicate that a well-developed SF can precisely measure ADL performance capacity for stroke survivors compared to the full item bank, which is expected to reduce the administration burden of the KNHANES.

The effects of mental practice combined with modified constraint-induced therapy on corticospinal excitability, movement quality, function, and activities of daily living in persons with stroke.

PURPOSE: Studies on to what extent the combined therapy of modified constraint-induced movement therapy and mental practice is more effective than modified constraint-induced movement therapy alone are lacking. This study aims to compare the effects of the combined therapy with modified constraint-induced movement therapy alone on corticospinal excitability, quality of the movement of the affected upper extremity, upper motor functions, and performance of the affected arm in daily life of hemiplegic stroke patients. METHODS: The participants comprised 14 people who had suffered stroke and were randomly divided into two groups. All participants participated in modified constraint-induced movement therapy, while only the experimental group partook in additional mental practice. Both groups were tested for corticospinal excitability, quality of movement, hand function, and activities of daily living. RESULTS: Both groups showed significant improvement in the movement quality of reaching and performance of activities of daily living. In the experimental group, functional improvement of the upper limb was also observed. The improvements in corticospinal excitability, upper extremity function, and performance in daily activities were significantly greater in the experimental group compared to the control group. CONCLUSIONS: This study confirmed that the combined therapy produces more effective improvement in corticospinal excitability, upper limb function, and performance in daily activities. The combined therapy of mental practice and modified constraint-induced movement therapy could be used as a clinically useful intervention. Implications for rehabilitation Modified constraint-induced movement therapy could be used as an intervention method for people with stroke to make improvements in the quality of movement and performance in activities of daily livings with the affected side. With additional mental practice, upper extremity functions improve, and changes in neurological, functional and performance in daily lives are greater compared to modified constraint-induced movement therapy without mental practice. Impact of mental practice has on rehabilitation should not be underestimated.

Comparison of Cognitive Orientation to daily Occupational Performance and conventional occupational therapy on occupational performance in individuals with stroke: A randomized controlled trial.

BACKGROUND: Cognitive Orientation to daily Occupational Performance (CO-OP) approach based on cognitive strategy in occupational therapy. OBJECTIVES: To investigate the effects of CO-OP approach on occupational performance in individuals with hemiparetic stroke. METHODS: This study was designed as a 5-week, randomized, single-blind. Forty-three participants who had a diagnosis of first stroke were enrolled in this study. The participants were randomly assigned to the experimental group (n = 20) or the control group (n = 23). The experimental group conducted CO-OP approach while the control group conducted conventional occupational therapy based on occupational performance components. This study measured Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Outcome measurements were performed at baseline and post-intervention. RESULTS: After training, the scores of COPM and PQRS in trained task were significantly higher for the score in the experimental group than the control group. In addition, the non-trained task was significantly higher for the score in the experimental group than the control group in COPM and the PQRS. CONCLUSIONS: This study suggests that the CO-OP approach is beneficial effects on the occupational performance to improvement in individuals with hemiparetic stroke, and have positive effects on generalization and transfer of acquired skills.

The effects of virtual reality-based bilateral arm training on hemiplegic children's upper limb motor skills.

BACKGROUND: Hemiplegic cerebral palsy is a neurological symptom appearing on the unilateral arm and leg of the body that causes affected upper/lower limb muscle weakening and dysesthesia and accompanies tetany and difficulties in postural control due to abnormal muscle tone, and difficulties in body coordination. OBJECTIVES: The purpose of this study was to examine the impact of virtual reality-based bilateral arm training on the motor skills of children with hemiplegic cerebral palsy, in terms of their upper limb motor skills on the affected side, as well as their bilateral coordination ability. METHODS: The research subjects were three children who were diagnosed with hemiplegic cerebral palsy. The research followed an ABA design, which was a single-subject experimental design. The procedure consisted of a total of 20 sessions, including four during the baseline period (A1), 12 during the intervention period (B), and four during the baseline regression period (A2), For the independent variable bilateral arm training based on virtual reality, Nintendo Wii game was played for 30 minutes in each of the 12 sessions. For the dependent variables of upper limb motor skills on the affected side and bilateral coordination ability, a Wolf Motor Function Test (WMFT) was carried out for each session and the Pediatric Motor Activity Log (PMAL) was measured before and after the intervention, as well as after the baseline regression period. To test bilateral coordination ability, shooting baskets in basketball with both hands and moving large light boxes were carried out under operational definitions, with the number of shots and time needed to move boxes measured. The results were presented using visual graphs and bar graphs. RESULTS: The study's results indicated that after virtual reality-based bilateral arm training, improvement occurred in upper limb motor skills on the affected sides, and in bilateral coordination ability, for all of the research subjects. Measurements of the effects of sustained therapy after completion of the intervention, during the baseline regression period, revealed that upper limb motor skills on the affected side and bilateral coordination ability were better than in the baseline period for all subjects. CONCLUSION: This study confirmed that for children with hemiplegic with cerebral palsy, bilateral arm training based on virtual reality can be an effective intervention method for enhancing the upper limb motor skills on the affected side, as well as bilateral coordination ability.

Effects of Task-Oriented Training as an Added Treatment to Electromyogram-Triggered Neuromuscular Stimulation on Upper Extremity Function in Chronic Stroke Patients.

The purpose of the present study was to investigate the effects of electromyogram-triggered neuromuscular stimulation (EMG-stim) combined with task-oriented training (TOT) on upper extremity function in chronic stroke patients. Twenty chronic stroke patients were randomly assigned to either the intervention (n = 10) or control (n = 10) group. The intervention group conducted TOT with EMG-stim on the wrist and finger extensor of the affected arm for 30 minutes per day, 5 days per week, for 4 weeks. The control group was provided EMG-stim for 20 minutes per day for the same duration. The intervention group exhibited significant improvement relative to the control group in muscle activation, motor recovery (Fugl-Meyer assessment) and dexterity (Box and Block Test) (p < 0.05). Significant differences in hand function between the groups were detected in the writing of short sentences and in stacking checkers (p < 0.05). It is concluded that EMG-stim in combination with TOT may be better than EMG-stim alone for the treatment of arm paresis in stroke patients. Further research with a larger sample is recommended to examine neurologic changes or cerebral cortex reorganization. Copyright © 2016 John Wiley & Sons, Ltd.

Relationship between Quantified Instrumental Swallowing Examination and Comprehensive Clinical Swallowing Examination.

The aim of this study was to identify the correlation between the Mann Assessment of Swallowing Ability (MASA) and the Videofluoroscopic Dysphagia Scale (VDS) to investigate the applicability of the MASA as a follow-up test of swallowing function. Criterion validity was assessed for MASA results versus VDS scores of tests administered to 54 patients who had a stroke and dysphagia. A significant correlation was found between the MASA and the VDS (correlation coefficient = -0.509). In analyses of test-re-test reliability and inter-rater reliability of the scoring scale, intraclass correlation coefficients (2, 1) were high (0.98, 0.99). In conclusion, the results of the present study indicate that the MASA holds adequate clinical test-re-test and inter-rater reliabilities and criterion validity for measuring the swallowing abilities of Korean patients who had a stroke and dysphagia. The MASA could contribute to more systematic management of swallowing problems and efficient therapeutic service.

Reliability and Validity of the Activity Participation Assessment for School-age Children in Korea.

OBJECTIVE: This pilot study examined the internal consistency, test-retest reliability, construct validity, and discriminant validity of the Activity Participation Assessment (APA) for school-age children in Korea. METHODS: The construct validity of the APA was first established by factor analysis on the response of 134 nondisabled children. Internal consistency was evaluated for each of the factors. A test-retest study was conducted on 22 nondisabled children. Discriminant validity was established by comparing the participation of 56 nondisabled children and 56 children with intellectual disabilities and examining sex differences of 61 boys and 61 girls. RESULTS: Analysis of the APA revealed five factors, which were labeled as instrumental activities of daily living (IADL), sports and outdoor activities, hobbies and school activities, social activities, and personal care. The factors showed acceptable levels of internal reliability (Cronbach's alpha = .63-.89). The intraclass correlation coefficient (ICC) for the five factors were all in the good range (ICC = .86-.92). We found statistically significant difference between nondisabled children and children with intellectual disabilities in five factors. We also found that girls participated in significantly more IADL, hobbies and school activities, and social activities. However, boys participated in significantly more sports and outdoor activities. CONCLUSION: The APA shows good internal reliability, test-retest reliability, discriminant validity, and construct validity. However, evidence of psychometric properties was limited by a small sample size. Psychometric properties such as interrater reliability as well as concurrent validity and construct validity need to be tested using a larger sample size with representative demographics.

Psychosocial predictors of participation restriction poststroke in Korea: A path analysis.

OBJECTIVE: The present cross-sectional study tested a hypothetical path model consisting of psychosocial factors in relation to activity participation restriction in chronic stroke. Motor and cognitive functions and age; psychological factors consisting of depressive symptoms, hopeful thinking, and self-esteem; and activities of daily living and social support served as psychosocial factors. METHOD: Data were collected from 171 community-dwelling individuals with chronic stroke in Korea. Path analysis was conducted to test the model fit between the obtained data and the hypothetical model to examine the direct and indirect effects of variables on participation restriction. RESULTS: Among the psychosocial factors, psychological factors and activities of daily living played the most significant role in predicting the degree of participation restriction, as well as mediating the relationship. Motor and cognitive functions were mediated by activities of daily living, and social support was mediated by psychological factors to affect participation restriction. Among the psychological factors, hopeful thinking exhibited the strongest relationship. CONCLUSION: To increase stroke survivors' participation during the course of rehabilitation, psychosocial factors as well as biological factors should be included in a multidimensional treatment approach.

Effects of mental practice with action observation training on occupational performance after stroke.

BACKGROUND: Studies on whether mental practice (MP) in patients with stroke using action observation training (AOT) is effective in improving physical performance are still insufficient. To examine the effects of MP on both occupational performance and motor function to complement studies relevant to MP with AOT. METHODS: Subjects of this study were 3 individuals who were diagnosed with stroke. We used an A-B-A study design with follow-up evaluation, which is a type of reversal single experimental research design. A total of 20 experimental sessions were conducted. To assess the long-term effect of MP with AOT, follow-up baseline measurements were made after 2 weeks without MP. Three-dimensional motion analysis and electromyography were conducted during each of the 20 sessions. The Motor Activity Log and Assessment of Motor and Process Skills were measured 3 times: in the pre-MP phase, the post-MP phase, and the 2-week follow-up phase. RESULTS: Occupational performance improved after intervention in all 3 subjects when applying an MP task using AOT. All subjects showed improvement of motor functions, including smoothness of movement, agonistic muscle activation, and co-ordination. The treatment effect continued after 2 weeks. CONCLUSIONS: MP using AOT in patients with stroke is an effective treatment protocol to improve occupational performance and motor function. Thus, MP using AOT may be applicable for treating stroke patients with stroke not only while they are in the hospital but also at home or in the community.

A comparison of hemisphere-specific training pattern in Inter-limb Learning Transfer (ILT) for stroke patients with hemiparesis.

BACKGROUND: Stroke patients have major problems with impaired upper-extremity function. Unfortunately, many patients do not experience a full recovery from movement deficits in the upper extremities. OBJECTIVES: The purpose of this study was to compare the effectiveness of inter-limb learning transfer (ILT) to the contralateral upper limb after both hemisphere-specific and -unspecific ipsilateral upper limb training for stroke patients with hemiparesis. METHODS: Twenty-four stroke patients with hemiparesis participated. The hemisphere-specific training group performed reaching movements in a customized training setting in which non-dominant limb training participants began from a single starting location and proceeded to one of three target locations (1S3T condition); the dominant limb training participants started from one of three starting locations and proceeded to a single target location (3S1T condition). The hemisphere-unspecific training group performed these movements starting under reverse-start and target conditions. RESULTS: The non-dominant to dominant limb transfer, the hemisphere-specific training group performance time decreased significantly as compared with the pre-training session (p < 0.05). Also, the isolation contraction ratio was decreased significantly from that of the pre-training session in the biceps brachii muscles and increased significantly in the upper trapezius muscles (p < 0.05). And, dominant to non-dominant limb transfer in the hemisphere-specific training group significantly increased RMS amplitudes from the pre-training session in the biceps brachii and triceps muscles (p < 0.05). Also, the isolation contraction ratio was increased significantly from that of the pre-training session in the biceps brachii muscles and decreased significantly in the upper trapezius muscles (p < 0.05). However, the hemisphere-unspecific training group showed no significant differences in inter-limb learning transfer (ILT). CONCLUSION: The transfer of hemisphere-specific training from one arm to the other had a more positive influence on functional recovery than did hemisphere-unspecific training for patients with stroke and hemiparesis.

Detectability and clinicohistological characteristics of small (≤1 cm) invasive breast cancer.

PURPOSE: To investigate the detectability and imaging characteristics of primary tumors according to imaging modalities and to identify clinical features and histological prognostic factors for axillary metastases in patients with small (≤1cm, T1a and T1b) invasive breast cancer. MATERIALS AND METHODS: A total of 221 patients with histologically confirmed small invasive cancers were included for the statistical analysis. At mammography, ultrasonography and MRI, the detectability, and imaging characteristics of primary tumors were compared in patients with or without axillary metastases. Clinical features and histological prognostic factors for axillary metastases were investigated. RESULTS: Of 221 patients examined, axillary metastasis was found in 42 (19%) at the time of surgery. There was no significant difference in detectability of small tumors using ultrasonography and MRI between patients with and without axillary metastasis. However, mammography had a higher positive rate of primary tumors in patients with axillary metastasis than without metastasis (92.9% vs. 77.1%, p=0.023). Patients with axillary metastasis in small cancers showed more common architectural distortion than negative (p=0.0147) or mass (p=0.0356) on mammography. Clinical features were not different in the two groups. Only lymphovascular invasion was independently associated with axillary metastasis (p=0.0051, 95% CI, 1.527-11.597). CONCLUSION: The detectability of small invasive breast cancers among patients with and without axillary metastasis is different with mammography, but not with US and MRI. Lymphovascular invasion is only a predictor for axillary metastasis in small invasive cancers.