The correlates and reference values for the 6-minute walk distance in Taiwanese adults with schizophrenia.

PURPOSE: The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan. METHODS: A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol. RESULTS: A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60. CONCLUSIONS: Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.IMPLICATIONS FOR REHABILITATIONHeight and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ).The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness.Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.

Effects of computerized cognitive training on cognitive function, activity, and participation in individuals with stroke: A randomized controlled trial.

BACKGROUND: Computerized cognitive training (CCT) is an emerging alternative intervention for stroke survivors. OBJECTIVE: This study investigated the effects of CCT on the cognition, activity, and participation of stroke survivors and compared the findings with those of match-dosed conventional cognitive training. METHODS: This randomized controlled trial included 39 patients with stroke who were divided into the intervention group (n = 19; receiving CCT with Lumosity software) and the control group (n = 20; receiving conventional cognitive training). Both the groups were trained for 20 min, twice a week, for 12 weeks. Participants were evaluated at pretest, posttest, and 4-week follow-up. Outcome measures included various cognitive function tests and the Stroke Impact Scale scores. RESULTS: The CCT group exhibited significant improvement in global cognitive function (evaluated using the Mini-Mental State Examination and Montreal Cognitive Assessment) and specific cognitive domains: verbal working memory (backward digit span test), processing speed (Symbol Digit Modalities Test), and three MoCA subtests (attention, naming, and delayed recall). CCT exerted no significant effect on activities and participation. No significant between-group differences in changes in cognitive function were noted. However, CCT significantly improved cognitive function domains immediately after training, and these effects were sustained at the 4-week follow-up. CONCLUSIONS: Cognitive function of individuals with chronic stroke could improve after administration of CCT. However, future studies with a more rigorous design and higher training dose are warranted to validate our findings.

The facilitators and barriers to physical activity scale for people with mental illness in Taiwan: development and validation.

PURPOSE: The purposes of this study were to develop a new measure, the Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (FBPAS-MI) and to validate the psychometrics. METHODS: This study included two phases. In Phase I, a literature review and five focus groups were conducted to develop an item bank. Then, expert consultation and cognitive interviews were used for content validity. In Phase II, 147 participants with severe mental illness were recruited from 10 community-based psychiatric rehabilitation centers in Taiwan to examine the psychometrics. Principal axis factoring method with direct oblique rotation was used to identify the underlying constructs of FBPAS-MI. Concurrent validity, internal consistency and test-retest reliability were examined. RESULTS: The results revealed five domains in the facilitator subscale (15 items) and two domains in the barrier subscale (11 items). Both subscales showed satisfactory internal consistency (all Cronbach's α >0.80); the concurrent validity and test-retest reliability were established. CONCLUSIONS AND IMPLICATIONS OF PRACTICE: This study confirmed that the FBPAS-MI is a valid and reliable scale to understand perceived facilitators and barriers to physical activity for severe mental illness. The FBPAS-MI can provide useful information in the development of individualized health promotion program for this population.Implications for RehabilitationThe Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (i.e., FBPAS-MI) is a valid and reliable assessment to examine key factors affecting physical activity participation among people with severe mental illness.Psychiatric rehabilitation practitioners could use the FBPAS-MI to help develop and tailor individualized physical activity promotion programs based on identified facilitators and barriers to activity.

Understanding factors relevant to poor sleep and coping methods in people with schizophrenia.

BACKGROUND: Sleep disruption is pervasive in people with schizophrenia, but few studies have explored their sleep experiences. This study aims to identify factors relevant to sleep problems and explore coping methods used by community-dwelling people with schizophrenia. METHODS: Eighteen participants with schizophrenia were recruited from three mental health centers in Taiwan. They completed a semi-structured interview and the Pittsburgh Sleep Quality Index (PSQI) assessment. The Person-Environment-Occupation model offered a framework to assess factors related to sleep. Thematic analysis was used for the qualitative data analysis. RESULTS: Factors related to sleep were classified under person, environment, and occupation domains. The person domain included three subthemes: psychiatric symptoms, unpleasant emotions, and frustration about sleep. The environment domain included three subthemes: sensory intrusions from the environment, quality of bedding, and roommates. The occupation domain included sleep interruption and sleep preparation. There were notable discrepancies in sleep quality between the participants' narratives and their PSQI global scores. Regarding coping methods for poor sleep, sleep medication was the primary strategy while some participants also used other strategies, such as modifying the environment, adjusting routines, or engaging in activities that improve sleep quality. CONCLUSIONS: Psychiatric symptoms and nightmares were identified as unique sleep disruptions in people with schizophrenia, and poor economic status was also found to impact their sleep. The sleep quality of people with schizophrenia tends to be poor, as identified by the PSQI, even though they may have positive perceptions of their sleep quality. Our participants appeared to prefer to take hypnotics to address their sleep problems, which may be due to limited knowledge about alternatives. Mental health professionals are encouraged to receive training in the application of non-pharmacological approaches to support their clients' issues related to sleep.

The determinants of motorized mobility scooter driving ability after a stroke.

PURPOSE: To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke. METHOD: The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure. RESULTS: The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = -.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R2 = .76). CONCLUSIONS: The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.

Recovery Programs for People With Mental Illness in Taiwan: A Feasibility Study.

IMPORTANCE: Most recovery programs have been developed in Western countries. This study explores the cultural adaptation of a recovery program to a non-Western country. OBJECTIVE: To test the feasibility of a recovery group developed for people with mental illness in Taiwan. DESIGN: Mixed-methods feasibility study. SETTING: Community psychiatric rehabilitation center in southern Taiwan. PARTICIPANTS: Twenty-four people with mental illness living in the community. INTERVENTION: The authors designed a recovery group based on the Pathways to Recovery program and the mental health recovery literature. The curriculum included two phases: recovery profile and recovery plan. The group gathered for a 1-hr session once a week for 18 wk. OUTCOMES AND MEASURES: Outcomes were assessed preintervention, mid-intervention, and postintervention. Data collected included Stages of Recovery Scale (SRS) scores, course assessments, and course discussions. RESULTS: Most participants were satisfied with the recovery program and its implementation. Scores on the Social Functioning/Role Performance subscale of the SRS showed a medium to large effect size (r = .36) for the Recovery Stage 1-3 subsample (n = 16). CONCLUSION AND RELEVANCE: This study affirmed the feasibility of a recovery group for people with mental illness in Taiwan. Prospective randomized controlled trials should be used to verify recovery groups' effectiveness. WHAT THIS ARTICLE ADDS: Recovery programs tailored to people with mental illness in non-Western countries may need more examples and longer sessions to enable participants to fully understand and implement the concepts of recovery.

Effect of Aerobic Exercise on Improving Symptoms of Individuals With Schizophrenia: A Single Blinded Randomized Control Study.

Introduction: Antipsychotic treatment can improve the symptoms of schizophrenia; however, residual symptoms after antipsychotic treatment are frequent. The effects of exercise on the symptoms of schizophrenic patients under antipsychotic treatment are inconclusive. The aim of this randomized case-control study was to examine the effects of aerobic exercise (AE) on the symptoms of schizophrenic patients receiving antipsychotic treatment. Methods: In total, 33 and 29 participants being treated with antipsychotics for schizophrenia were randomly assigned into the aerobic exercise (AE) group and the control group, respectively. The severities of schizophrenic symptoms were measured using the Chinese version of the Positive and Negative Syndrome Scale (PANSS) before, immediately after, and 3 months after the intervention in both groups. Results: In total, 24 participants (72.7%) in the AE group and 22 (75.9%) in the control group completed the study. The results indicated that the severities of positive symptoms and general psychopathology in the AE group significantly decreased during the 12 weeks of intervention but did not further significantly change during the 3-month follow-up period. The severities of negative symptoms in the AE group decreased significantly after 12 weeks of intervention and continued decreasing during the 3-month follow-up period. Interaction effects between time and group on the severities of symptoms on the negative and general psychopathology scales were observed. Conclusion: AE can improve the severities of symptoms on the negative and general psychopathology scales in individuals with schizophrenia being treated with antipsychotics.

The Reliability and Validity of a Modified Squat Test to Predict Cardiopulmonary Fitness in Healthy Older Men.

BACKGROUND: Shortcomings are noted in currently available cardiopulmonary field tests for the older adult and thus relevant research is still ongoing. PURPOSE: The purpose of this study was to investigate the reliability and validity of a modified squat test and to establish a regression model for predicting aerobic fitness in the older adult. METHODS: Twenty-five healthy men aged 60 to 75 years completed this study. Each subject performed two modified squat tests with a prototype testing equipment and a maximal exercise test to determine maximal oxygen consumption. Recovery heart rates (HR) (0~30, 60~90, and 120~150 seconds) were measured following the modified squat tests. The fitness indexes included the sum of recovery HR, recovery HR index, age-adjusted recovery HR index, and immediate HR. RESULTS: The results revealed that the age-adjusted recovery HR index fitness had the highest intraclass correlation coefficients (ICC) of 0.9 and Pearson's correlation coefficients of 0.71, which suggested the modified squat test can reasonably assess cardiopulmonary fitness for the older adult. The regression equation for estimating aerobic power was [Formula: see text] = 16.781 + 16.732 × (age-adjusted recovery HR index) + 0.02467 × (physical activity level). CONCLUSION: The modified squat test is a valid and reliable field test and thus can be an option to assess the cardiopulmonary fitness level of healthy older men in clinics or communities.

Association Between Smartphone Use and Musculoskeletal Discomfort in Adolescent Students.

Despite the substantial increase in the number of adolescent smartphone users, few studies have investigated the behavioural effects of smartphone use on adolescent students as it relates to musculoskeletal discomfort. The purpose of this study was to explore the association between smartphone use and musculoskeletal discomfort in students at a Taiwanese junior college. We hypothesised that the duration of smartphone use would be associated with increased instances of musculoskeletal discomfort in these students. This cross-sectional study employed a convenience sampling method to recruit students from a junior college in southern Taiwan. All the students (n = 315) were asked to answer questionnaires on smartphone use. A descriptive analysis, stepwise regression, and logistic regression were used to examine specific components of smartphone use and their relationship to musculoskeletal discomfort. Nearly half of the participants experienced neck and shoulder discomfort. The stepwise regression results indicated that the number of body parts with discomfort (F = 6.009, p < 0.05) increased with hours spent using ancillary smartphone functions. The logistic regression analysis showed that the students who talked on the phone >3 h/day had a higher risk of upper back discomfort than did those who talked on the phone <1 h/day [odds ratio (OR) = 4.23, p < 0.05]. This study revealed that the relationship between smartphone use and musculoskeletal discomfort is related to the duration of smartphone ancillary function use. Moreover, hours spent talking on the phone was a predictor of upper back discomfort.

The effects of aerobic exercise on cognition in schizophrenia: A 3-month follow-up study.

Aerobic exercise (AE) has been shown to improve cognition in patients with schizophrenia. However, it remains unclear whether these exercise-induced cognitive benefits persist beyond the training period. Accordingly, the present study sought to examine the immediate and maintenance effects of AE on a wide range of cognitive functions in 75 schizophrenia patients randomized to 12 weeks of either moderate-intensity treadmill exercise or stretching and toning exercise that served as a control. Participants completed assessments of neurocognition and cardiovascular fitness at pretest, posttest, and 3-month follow-up. The results showed that the AE group outperformed the controls on processing speed and attention at the end of intervention. The two groups did not differ significantly in any cognitive outcome measured at follow-up; however, improvement over time was noted in certain cognitive domains in AE group. The average effect sizes at follow-up were 0.53 and 0.35 for AE and control groups, respectively. There were no significant between-group differences in aerobic fitness at posttest and follow-up, and that fitness level was not related to changes in cognitive performance. These findings provide preliminary evidence for a trend towards beneficial effects of physical activity on cognition over a short follow-up period in favor of AE.

Influences of Aerobic Dance on Cognitive Performance in Adults with Schizophrenia.

Cognitive impairment is one of the core features of schizophrenia. This study examined the influences of an aerobic dance programme on the cognitive functions of people with schizophrenia. A quasi-experimental matched-control design was applied. The experimental group (n = 17) participated in a 60-minute aerobic dance group class three times a week for 3 months. The control group (n = 19) participated in colouring and handwriting activities. Cognitive functions were measured before and after the interventions for both groups. The intervention group experienced significant improvements in processing speed, memory and executive function, whereas no significant changes were noted in any measures in the control group. While there were no significant between-group differences, the data showed approximately medium effect sizes that favoured the intervention group in regard to processing speed (Cohen's d = 0.51), memory (d = 0.35-0.41) and the spontaneity and fluency aspects of executive function (d = 0.51). While the small sample size and lack of randomization were the primary methodological shortcomings, this study provides preliminary results supporting aerobic dance as an adjunct activity-based intervention to improve cognitive functions in people with schizophrenia. More rigorous studies are needed to validate the findings. Copyright © 2016 John Wiley & Sons, Ltd.

Accuracy of Wristband Activity Monitors during Ambulation and Activities.

PURPOSE: The main purpose of this study was to examine the accuracy of wristband activity monitors on measuring step counts at prescribed speeds on a treadmill and under short bouts of common daily activities. METHODS: Thirty healthy young adults wore three wristband activity monitors on both wrists while walking or jogging on a treadmill at different speeds (54, 80, 107, and 134 m·min) and performing six different common daily activities for 5 min each. The monitors included the Fitbit Flex, the Garmin Vivofit, and the Jawbone UP. The common daily activity conditions included two sitting activities (playing a tablet computer game and folding laundry), two walking activities (pushing a stroller, carrying a bag), and two stair climbing activities (down and up). Absolute percentage error (APE) scores were computed to examine the accuracy between actual observed steps and monitor-detected steps. RESULTS: Under the treadmill condition, the APE ranged between 1.5% and 9.6%. Accuracy was improved at faster speeds (134 m·min) for all the monitors (APE < 2.5%). In the common daily activity conditions, substantial step counts were registered when folding laundry. All monitors significantly underestimated actual steps (all APE >33%) when pushing a stroller. Higher APE was observed when worn on the dominant wrist under the common daily activity conditions. CONCLUSIONS: The wristband activity monitors examined were more accurate for measuring step counts between 80 and 134 m·min as compared with a slower speed. Accuracy under each common daily activity condition ranged widely between monitors and activity, with less error when worn on the nondominant wrist. These results will help to inform researchers on the use and accuracy of wristband activity monitors for future studies.

Efficacy of Baduanjin Exercise and Feasibility of Mobile Text Reminders on Follow-up Participation in People With Severe Mental Illness: An Exploratory Study.

BACKGROUND: People with severe mental illness (SMI) frequently have poor physical health, which can in part be related to a low level of physical activity. The goal of this exploratory study was to examine the efficacy of a group participating in Baduanjin (a type of traditional Chinese exercise) on the health of individuals with SMI and the feasibility/acceptability of using short message service (SMS) reminder strategies to prompt continued exercise during a follow-up period. METHOD: Participants (N=11) participated in a Baduanjin group session for 8 weeks and then maintained home-based Baduanjin with SMS reminders for another 8 weeks. Physical and psychological tests were administered to participants. RESULTS: Significant improvements were found in balance and processing speed and in some domains of the 36-Item Short Form Health Survey (SF-36) after the Baduanjin program. Participants were able to maintain engagement in 80% of the expected practice time during the follow-up period. The acceptability of strategies to support home-based exercise, including SMS reminders, was high. CONCLUSIONS: This preliminary study suggested the efficacy of Baduanjin and the feasibility of SMS reminders in maintaining follow-up participation in people with SMI. Future studies using a larger sample size and a control group are needed to confirm the findings.

Personnel attitudes toward people with mental illness at a psychiatric hospital in Taiwan.

BACKGROUND: The attitudes of psychiatric hospital personnel are critically related to the quality of mental health care, but few studies have investigated this issue. AIMS: This study is aimed at an exploration of the attitudes of psychiatric hospital personnel toward people with mental illness and at an examination of the associated factors. METHOD: A self-report questionnaire, the Mental Illness Attitude Scale (MIAS), was used to collect data from psychiatric hospital personnel in Taiwan (n = 290). The MIAS included 46 items and 4 dimensions: acceptance, rehabilitation and prognosis, social distance and recommendations for interventions. RESULTS: Rehabilitation and prognosis had the highest item average scores (4.03) and social distance had the lowest item average scores (3.22). Stigmatization and the number of different types of contacted clients were two significantly associated attitude factors. CONCLUSION: Psychiatric hospital personnel in Taiwan tend to have positive attitudes toward people with mental illness in general situations but hold less positive attitudes in terms of community integration-related issues and intimate relationships. More evidence-based community services should be conducted to decrease personnel concerns about the successful community integration of those who are mentally ill. Future studies can investigate the concept and impact of stigmatization more deeply.

The effectiveness of racket-sport intervention on visual perception and executive functions in children with mild intellectual disabilities and borderline intellectual functioning.

BACKGROUND: This study aimed to investigate the effects of table tennis training (TTT) versus standard occupational therapy (SOT) on visual perception and executive functions in school-age children with mild intellectual disabilities and borderline intellectual functioning. SUBJECTS AND METHODS: Children (n=91) were randomly assigned to intervention with either SOT (n=46, 20 females, mean age =10.9±3.9 years) or TTT (n=45, 21 females, mean age =10.6±3.6 years), while another 41 (18 females, mean age =10.7±4.0 years) served as controls. Both the SOT and TTT programs were administered 60 minutes per session, three times a week, for 16 weeks. The Test of Visual Perceptual Skill-third edition (TVPS-3) was used to evaluate visual perception, and executive functions were assessed by the Wisconsin Card Sorting Test 64-card version (WCST-64) and the Stroop test. RESULTS: At postintervention, the two intervention groups significantly outperformed the control group on all measures of visual perception and executive functions. Participants in the TTT group had significantly greater before-after changes on all measures of the TVPS-3, WCST-64, and the Stroop test compared to the SOT and controls. CONCLUSION: Table tennis could be considered a therapy option while treating cognitive/perceptual problems in children with mild intellectual disabilities and borderline intellectual functioning. Implications for clinical professionals and recommendations for further research are discussed.

Applying the transtheoretical model to promote functional fitness of community older adults participating in elastic band exercises.

AIMS: The transtheoretical model was applied to promote behavioural change and test the effects of a group senior elastic band exercise programme on the functional fitness of community older adults in the contemplation and preparation stages of behavioural change. BACKGROUND: Forming regular exercise habits is challenging for older adults. The transtheoretical model emphasizes using different strategies in various stages to facilitate behavioural changes. DESIGN: Quasi-experimental design with pre-test and post-tests on two groups. METHODS: Six senior activity centres were randomly assigned to either the experimental or control group. The data were collected during 2011. A total of 199 participants were recruited and 169 participants completed the study (experimental group n = 84, control group n = 85). The elastic band exercises were performed for 40 minutes, three times per week for 6 months. The functional fitness of the participants was evaluated at baseline and at the third and sixth month of the intervention. Statistical analyses included a two-way mixed design analysis of variance, one-way repeated measures analysis of variance and an analysis of covariance. RESULTS: All of the functional fitness indicators had significant changes at post-tests from pre-test in the experimental group. The experimental group had better performances than the control group in all of the functional fitness indicators after three months and 6 months of the senior elastic band exercises. CONCLUSION: The exercise programme provided older adults with appropriate strategies for maintaining functional fitness, which improved significantly after the participants exercising regularly for 6 months.

Sliding and lower limb mechanics during sit-stand-sit transitions with a standing wheelchair.

PURPOSE: This study aimed to investigate the shear displacement between the body and backrest/seat, range of motion (ROM), and force acting on the lower limb joints during sit-stand-sit transitions by operating an electric-powered standing wheelchair. METHODS AND MATERIALS: The amounts of sliding along the backrest and the seat plane, ROM of lower limb joints, and force acting on the knee/foot were measured in twenty-four people with paraplegia. RESULTS: Without an antishear mechanism, the shear displacement was approximately 9 cm between the user's body and the backrest/seat surfaces. During standing up, the user's back slid down and the thigh was displaced rearward, but they moved in opposite directions when wheelchair sat back down. A minimum of 60 degrees of ROM at the hip and knee was needed during sit-stand-sit transitions. The maximal resultant forces acting on the knee restraints could reach 23.5% of body weight. CONCLUSION: Sliding between the body and backrest/seat occurred while transitioning from sitting to standing and vice versa. A certain amount of ROM at lower limb joints and force acting on the knee was necessitated during sit-stand-sit transitions. Careful consideration needs to be given to who the user of the electric powered standing wheelchair is.

Rasch analysis of the Mental Health Recovery Measure.

Consumer-oriented recovery among people with mental illness has been discussed for more than two decades, but few reliable and valid recovery measurements are currently available. This study used Rasch methods to assess the Mental Health Recovery Measure (MHRM). Participants were 156 adults with mental illness who lived in the community. After the Rasch analyses, the MHRM was modified to a 26-item measure with a 4-point Likert scale. Unidimensionality was confirmed for the revised MHRM, and it also showed proper rating scale functioning and high reliability. The revised MHRM is sufficient to assess only those in the initial and middle stages of recovery. More high-recovery-level items are needed to assess people in a high-recovery stage. Occupational therapists can use the revised MHRM in future quantitative studies and program evaluation.

Recovery of people with psychiatric disabilities living in the community and associated factors.

OBJECTIVE: Consumer-oriented recovery has been discussed for more than two decades in the mental health field. Although there some qualitative recovery studies have shown important findings, few quantitative studies of this concept currently exist. This study examined the relationship between recovery and associated social-environmental and individual factors. METHOD: A total of 159 people with psychiatric disabilities receiving services from a large community mental health agency participated in the study. Participants completed a self-report survey that assessed individual recovery status, social support, perceived recovery-oriented service quality, psychiatric symptoms, and demographics. One hundred twenty-four surveys were analyzed. Hierarchical multiple regression analysis was conducted to examine the relationship between recovery and associated factors. RESULTS: Social support and perceived recovery-oriented service quality had significant positive relationships with recovery; psychiatric symptoms had a significant negative relationship with recovery. The final regression model accounted for 58% of the variance in recovery, F(9, 114) = 17.72, p < .001. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Social-environmental factors play an important role in people's recovery, even after taking into account psychiatric symptoms. Namely, people with psychiatric disabilities can pursue recovery with symptoms as long as they receive appropriate support and services. Mental health professionals should provide services adhering to recovery principles in order to help their clients achieve personal recovery.

Unilateral versus bilateral robot-assisted rehabilitation on arm-trunk control and functions post stroke: a randomized controlled trial.

BACKGROUND: Although the effects of robot-assisted arm training after stroke are promising, the relative effects of unilateral (URT) vs. bilateral (BRT) robot-assisted arm training remain uncertain. This study compared the effects of URT vs. BRT on upper extremity (UE) control, trunk compensation, and function in patients with chronic stroke. METHOD: This was a single-blinded, randomized controlled trial. The intervention was implemented at 4 hospitals. Fifty-three patients with stroke were randomly assigned to URT, BRT, or control treatment (CT). Each group received UE training for 90 to 105 min/day, 5 days/week, for 4 weeks. The kinematic variables for arm motor control and trunk compensation included normalized movement time, normalized movement units, and the arm-trunk contribution slope in unilateral and bilateral tasks. Motor function and daily function were measured by the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and ABILHAND Questionnaire. RESULTS: The BRT and CT groups elicited significantly larger slope values (i.e., less trunk compensation) at the start of bilateral reaching than the URT group. URT led to significantly better effects on WMFT-Time than BRT. Differences in arm control kinematics and performance on the MAL and ABILHAND among the 3 groups were not significant. CONCLUSIONS: BRT and URT resulted in differential improvements in specific UE/trunk performance in patients with stroke. BRT elicited larger benefits than URT on reducing compensatory trunk movements at the beginning of reaching. In contrast, URT produced better improvements in UE temporal efficiency. These relative effects on movement kinematics, however, did not translate into differential benefits in daily functions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00917605.