The Effectiveness of Whole-Body Vibration and Heat Therapy on the Muscle Strength, Flexibility, and Balance Abilities of Elderly Groups.

Whole-body vibration (WBV) is a novel exercise training measure that promotes the muscle strength, flexibility, and balance abilities of elderly groups. The feasibility and applicability of 20-30 min (lowering a heat pack at 73 °C by wrapping it in multiple layers of towels to 40-43 °C before it touched the skin) thermotherapy are increasingly being demonstrated by applications and clinical trials. Studies show that it increases the flexibility of macules and ligament. However, no studies have examined the interactions between the pre-exercise and post-exercise application of heat therapy (duration a training course). Therefore, this study investigates the effects of WBV and heat therapy on the muscle strength, flexibility, and balance abilities of elderly groups. Eighty middle-age and elderly participants with no regular exercise habits were enrolled in this study. They were randomly assigned to a WBV group, a WBV plus heat therapy group, a heat therapy alone group, and a control group. The WBV groups underwent 5-min, fixed-amplitude (4 mm), thrice-weekly WBV training sessions for 3 consecutive months on a WBV training machine. Participants' balance was measured using the limits of stability (LOS) test on a balance system. The pretest and posttest knee extensor and flexor strength were tested using an isokinetic lower extremity dynamometer. Pretest and posttest flexibility changes were measured using the sit-and-reach test. Significantly larger pretest and posttest differences in flexibility and muscle strength were observed in the WBV and WBV plus heat therapy groups. The addition of heat therapy to WBV resulted in the largest flexibility improvements.

Development of a Berg Balance Scale Short-Form Using a Machine Learning Approach in Patients With Stroke.

BACKGROUND AND PURPOSE: The Berg Balance Scale (BBS) is frequently used in routine clinical care and research settings and has good psychometric properties. This study was conducted to develop a short form of the BBS using a machine learning approach (BBS-ML). METHODS: Data of 408 individuals poststroke were extracted from a published database. The initial (ie, 4-, 5-, 6-, 7-, and 8-item) versions were constructed by selecting top-ranked items based on the feature selection algorithm in the artificial neural network model. The final version of the BBS-ML was chosen by selecting the short form that used a smaller number of items to achieve a higher predictive power R2 , a lower 95% limit of agreement (LoA), and an adequate possible scoring point (PSP). An independent sample of 226 persons with stroke was used for external validation. RESULTS: The R2 values for the initial 4-, 5-, 6-, 7-, and 8-item short forms were 0.93, 0.95, 0.97, 0.97, and 0.97, respectively. The 95% LoAs were 14.2, 12.2, 9.7, 9.6, and 8.9, respectively. The PSPs were 25, 35, 34, 35, and 36, respectively. The 6-item version was selected as the final BBS-ML. Preliminary external validation supported its performance in an independent sample of persons with stroke ( R2 = 0.99, LoA = 10.6, PSP = 37). DISCUSSION AND CONCLUSIONS: The BBS-ML seems to be a promising short-form alternative to improve administrative efficiency. Future research is needed to examine the psychometric properties and clinical usage of the 6-item BBS-ML in various settings and samples.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A402 ).

Postural Maintenance Is Associated With Walking Ability in People Receiving Acute Rehabilitation After a Stroke.

OBJECTIVES: The Postural Assessment Scale for Stroke Patients (PASS) assesses the ability of people post stroke to maintain or change a given posture from lying to standing, and the items on which people with different walking status perform differently may suggest potential interventions. The purpose of this study was to (1) examine the association of PASS scores at admission for acute rehabilitation with walking status at admission and 3 months post stroke (3 M), and (2) identify PASS items that discriminate walking status. METHODS: In this prospective observational study, 93 people post stroke were assessed with the PASS and a 2.44-m gait speed test at admission, with walking status assessed by telephone interview at 3 M. Those who could walk over a 2.44-m distance without the assistance of a walking aid or another person were considered to be independent in walking; others were considered to be dependent. Those who were dependent at admission were divided into the "regained independence" and "remained dependent" groups based on their status at 3 M. The association of the PASS at admission with 3 levels of walking status (independent at admission, regained independence, and remained dependent) was examined using the Kruskal-Wallis test. For those dependent at admission, the association of PASS score at admission with walking status at 3 M was examined using logistic regression and receiver operating curve analysis. RESULTS: PASS scores at admission differed significantly across the 3 walking status groups and were significantly associated with walking status at 3 M (odds ratio = 0.864; 95% CI = 0.798-0.935) over and above length of stay. People post stroke who were dependent at admission and had PASS scores ≥22 were more likely to regain independence at 3 M. Nine PASS items differed among the 3 groups. CONCLUSIONS: PASS score is significantly associated with walking status at admission and at 3 M. The identified 9 items suggest possible interventions for acute rehabilitation. IMPACT: This study identified 9 PASS items that could guide clinicians in selecting interventions for acute rehabilitation.

Is 20 Hz Whole-Body Vibration Training Better for Older Individuals than 40 Hz?

In recent years, whole-body vibration (WBV) training has been used as a training method in health promotion. This study attempted to use WBV at three different frequencies (20, 30, and 40 Hz) with subjects from different age groups to analyze the activation of the rectus femoris muscle. The subjects included 47 females and 51 males with an average age of 45.1 ± 15.2 years. Results indicated significant differences in subjects from different age groups at 20 Hz WBV. Muscle contraction was greater in the subjects who were older (F(4,93) = 82.448, p < 0.001). However, at 30 Hz WBV, the difference was not significant (F(4,93) = 2.373, p = 0.058). At 40 Hz WBV, muscle contraction was less in the older subjects than in the younger subjects (F(4,93) = 18.025, p < 0.001). The spectrum analysis also indicated that at 40 Hz there was less muscle activity during WBV in the older subjects than in the younger ones. Therefore, age was found to have a significant effect on muscle activation during WBV at different frequencies. If the training is offered to elderly subjects, their neuromuscular responses to 20 Hz WBV will be more suitable than to 40 Hz WBV.

Attentional demands of cane-free walking and cane walking in subacute stroke patients who have just learned to walk without a cane.

This study compared the attentional demands between cane-free walking and cane walking in patients with stroke during the transitional period of cane weaning. Patients with stroke who had just learned to walk cane-free were recruited. Cross-sectional measurement was scheduled within 30 days since the patients were able to walk independently without a quad cane. The dual-tasking paradigm required participants to walk with and without a cane, as well as perform continuous subtractions by 1 s (low-demand) or 3 s (high-demand). The cognitive-motor interference (CMI) of walking velocity was calculated as [(low-demand - high-demand)/low-demand] × 100%. Nine participants (average age, 53.4 ± 6.4 years; stroke onset, 38-131 days) were recruited, and eight showed positive CMI. The paired t-test confirmed a significantly smaller CMI during cane-free walking than during cane walking [t (8) = -3.168; P = 0.013]. The Pearson correlation tests revealed associations between age and CMI of cane walking (r = 0.751; P = 0.010) and CMI of cane-free walking (r = 0.584; P = 0.050). The time since independent cane-free walking was associated with CMI of cane walking (r = 0.699; P = 0.018). In conclusion, experience with cane-free walking leads to increased attentional demand for cane walking. In subacute stroke patients weaning use of a cane, the attentional demand for cane-free walking decreases to less than that of cane walking. During both cane and cane-free walking, the older the participant, the more the walking performance deteriorated due to dual-tasking.

Comparison of the Acute Effects of Kinesio Taping and Sleeper Stretching on the Shoulder Rotation Range of Motion, Manual Muscle Strength, and Sub-Acromial Space in Pitchers with Glenohumeral Internal Rotation Deficit.

BACKGROUND AND OBJECTIVES: Sleeper stretching (SS) can improve the shoulder's range of motion (ROM) for pitchers with glenohumeral internal rotation deficit (GIRD). However, no evidence has proven the effect of Kinesio taping (KT) on shoulder strength and ROM. Therefore, this study compared the effects of SS and KT on shoulder rotation ROM, muscle strength, and sub-acromial distance in pitchers with GIRD. MATERIALS AND METHODS: Thirty-one pitchers with GIRD were allocated into control, KT, and SS groups. Shoulder rotation ROM, muscle strength, and sub-acromial space were measured before and after treatment with SS or KT. RESULTS: The results revealed that KT and SS significantly enhanced shoulder rotation ROM in pitchers with GIRD. External rotator strength significantly increased following KT but significantly decreased after SS. KT and SS exerted no effects on the sub-acromial space. CONCLUSIONS: KT and SS improve shoulder rotation ROM in pitchers with GIRD. In addition, KT improves shoulder external rotator strength, and SS reduces it.

Early Rehabilitation in Acute Care Inpatient Wards May Be Crucial to Functional Recovery 3 Months After Ischemic Stroke.

OBJECTIVE: Early rehabilitation in acute care inpatient wards may maximize functional outcome at 3 months after stroke in survivors of stroke. It is unknown whether functional change during acute care hospitalization is significantly associated with functional recovery at 3 months in survivors of acute stroke. The purposes of this study were to examine the association of the Barthel Index (BI) at 3 months with functional change as measured with the Barthel Index (ΔBI) in an acute care inpatient ward and to identify the factors associated with ΔBI and who could benefit from an early rehabilitation program. METHODS: In this prospective longitudinal study, 76 patients with ischemic stroke in an acute care inpatient ward received early rehabilitation of up to 2 sessions per day for 5 d/wk during their stay. Therapy density was calculated as the proportion of total therapy sessions completed. At admission and discharge, they were assessed with the BI and the Postural Assessment Scale for Stroke Patients (PASS). Demographic and health-related information was also collected. The Barthel Index (BI) was reassessed at 3 months. RESULTS: ΔBI in the acute care inpatient ward significantly predicted the BI at 3 months, over and above the other significant variables; in addition, therapy density and change in PASS were significantly associated with ΔBI. Patients with moderate initial functional dependence had the largest ΔBI, followed by the group with a more severe condition. CONCLUSIONS: ΔBI in acute care inpatient wards may be an important predictor of the BI at 3 months. Therapy density and change in PASS were significantly associated with ΔBI. IMPACT: Survivors of acute stroke who receive up to 2 rehabilitation sessions per day for 5 d/wk early in their hospitalization have better functional recovery at 3 months after stroke.

The effect of insoles on symptomatic flatfoot in preschool-aged children: A prospective 1-year follow-up study.

Flatfoot is a common reason for parents to seek help from health care professionals, and limited evidence is available regarding the effects of insoles on preschool-aged children. This study mainly investigated the effect of insoles on symptomatic flatfoot in preschool-aged children and followed up the changes in footprints after 1 year.This study was a prospective, observational cohort study. Children aged 3 to 5 years old who exhibit the signs of flatfoot feet were recruited from the kindergartens in the central Taiwan between March 2010 and December 2013. The Chippaux-Smirak index (CSI) was used to determine whether the footprints of children were associated with flatfoot. The children were divided into an insole group and a no-insole group according to diagnoses by doctors. This study used the modified shoe insole as the intervention, and the CSI measured and followed up the changes in footprints after 1 year.A total of 466 preschool-aged children aged 3 to 5 years old with flatfoot completed the 1-year follow-up study. Of these, 123 children (men 77; women 46) were in the insole group and 343 children (men 187; women 156) were in the no-insole group. After the insoles were worn for 1 year, the CSI values of the children with symptomatic flatfoot decreased by 9.7%, and the 5-year-old children had the biggest change (effect size = 1.25). In the insole group, 34.1% of the footprints were determined as normal at 1-year follow-up, and CSI values decreased by 17.5%. High prevalence of joint laxity was found in both groups (insole group: 34.5%; no-insole group: 35.1%). Of the children in the insole group, the proportion of joint laxity was significantly higher in the flatfoot group (43.1%) than in the normal group (17.7%).This study showed that wearing insoles indeed can reduce the signs of flatfoot in preschool-aged children, and the effect is better in 5-year-old children. It is suggested that insoles can be provided as a conservative treatment for preschool-aged children with symptomatic flatfoot.

The effectiveness of rearfoot medial wedge intervention on balance for athletes with chronic ankle instability.

BACKGROUND: Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. METHODS: The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. RESULTS: The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ±â€Š25.22 to 41.24 ±â€Š21 48 (P = .015) in CAI group after medial wedge intervention. CONCLUSION: Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.

Using therapeutic ultrasound to promote irritated skin recovery after surfactant-induced barrier disruption.

BACKGROUND: Surfactant-induced skin barrier disruption can enhance blood flow and water content in the superficial skin. The effect of therapeutic ultrasound on accelerating the recovery of superficial skin after skin barrier disruption has seldom been studied. OBJECTIVE: To understand the effects of therapeutic ultrasound on barrier recovery, we used the sodium lauryl sulfate irritation model and treatment with ultrasound intervention. METHODS: The study allocated 30 healthy subjects into an ultrasound group (n = 15) and a control group (n = 15), each divided into three subgroups (sodium lauryl sulfate at concentrations of 1.0%, 0.5%, and 0%). Pulsed ultrasound (1 MHz, 0.3 W/cm2SATA) was applied to ultrasound subgroups. The treatment effect was evaluated by the recovery rate of enhanced blood flow and water content. RESULTS: The results indicated a surfactant dose-dependent effect on blood flow, but not on water content. The recovery rates of enhanced blood flow were higher in the 0.5% and 1.0% ultrasound subgroups than in the control subgroups throughout the experiment. However, recovery rates of water content were higher in the ultrasound subgroups than in the control subgroups only on Day2. CONCLUSIONS: Pulsed ultrasound accelerated the barrier recovery by reducing the enhanced blood flow and water content after skin barrier disruption.

Different weight shift trainings can improve the balance performance of patients with a chronic stroke: A randomized controlled trial.

BACKGROUND: Improving balance ability, increasing walking ability, and reducing the occurrence of falls are important objectives in the rehabilitation of stroke patients. Do the posture balance training and the intervention of lateral wedge insoles to improve of balance function and increase walking ability in patients with a chronic stroke? METHODS: A randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessors. Participants who had a chronic stroke (onset >6 months) were recruited from the rehabilitation and neurology departments of a hospital in central Taiwan. Subjects were divided into 3 groups: a visual biofeedback balance training group, a lateral wedge group, and a control group; apart from their usual rehabilitation program, and both experimental groups received a 6-week training session program. The primary outcome was the balance computerized adaptive test (balance CAT), and secondary outcome was timed up and go (TUG) test. All subjects were evaluated at the baseline, posttraining (6-week), 1st follow-up (10-week), and 2nd follow-up (18-week). RESULTS: A total of 56 subjects were participated in this study, including 38 males and 18 females. The mean age of the subjects was 59.1 years old, and the mean time was 43.7 months after the onset of the stroke. This study found the interaction in groups and measurement time points reached statistical significance of the balance CAT and TUG test (F = 5.740, P < .001; F = 2.926, P = .011; respectively). In addition, the performance of both the visual biofeedback training and lateral wedge group was superior to that of the control group. CONCLUSION: Six-week visual biofeedback training and intervention of 5° lateral wedge insoles can improve the balance ability of patients with a chronic stroke. TRIAL REGISTRY: http://www.chictr.org.cn, ChiCTR-IPR-15007092.

Validating the 6-minute walk test as an indicator of recovery in patients undergoing cardiac surgery: A prospective cohort study.

The 6-minute walk test (6MWT) has been applied to assess postsurgical recovery in cardiac populations. This study mainly investigated whether the 6MWT could serve as an indicator for physical functioning in patients undergoing cardiac surgery.Participants completed the 6MWT and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline, discharge, and 3 months postoperatively, in order to analyze the construct validity and responsiveness of the 6MWT. The participants in this study were 125 patients (92 males and 33 females) with an average age of 65.1 ±â€Š11.1 years. The mean 6MWT was 308.9 ±â€Š77.3 m in the preoperative phase, decreased to 277.3 ±â€Š85.7 m at discharge, and returned to 378.1 ±â€Š95.2 m at 3-month follow-up. The results showed that the 6-minute walk distances at baseline and at 3-month follow-up were moderately to highly correlated with the physical functioning subscale of the SF-36 (rs = .44 and .54, respectively) and had weak correlation with the nonphysical functioning subscales. The recovery level of physical functioning is meaningfully associated with the 6MWT change from baseline to discharge and from baseline to 3-month follow-up. Patients with higher New York Heart Association (NYHA) Functional Classification levels had lower 6MWT. Additionally, the 6MWT was sensitive to change during the perioperative period (effect sizes from -0.51 to 1.72).The supporting evidence includes the construct validity and responsiveness of the 6MWT. This study supports the feasibility of the 6MWT as an evaluation tool of physical functioning for assessment of postcardiac surgical recovery.

Prophylactic Kinesio taping enhances balance for healthy collegiate players.

BACKGROUND: This study was to investigate the effects of prophylactic Kinesio taping and athletic taping on the functional performance of the lower extremities in healthy collegiate players with tapes applied to the dominant leg. METHODS: The study design was a prospective, randomized, clinical trial with comparison of groups. The 32 healthy collegiate players who participated in this study were randomly assigned to 2 groups, an athletic taping group and a Kinesio taping group. Active range of motion of ankle joint, ankle plantar-flexor strength, endurance, vertical jump performance, and dynamic balance were used to measure the player's functional performance of the lower extremities. These tests were conducted 2 times at 4-hour intervals before and after different tapes were applied. The repeated measures analysis of variance was used to examine the interaction in functional performance between the groups before and after the tapes applied. RESULTS: The results found less limitation of range of motion in active ankle dorsiflexion and significant improvement in dynamic balance in the Kinesio taping group (F=5.150, P=0.031, F=18.766, P<0.001, respectively) compared with the athletic taping group. CONCLUSIONS: The prophylactic Kinesio taping could enhance dynamic balance and result in less restriction of range of motion of ankle dorsiflexion in healthy collegiate players.

Effect of Two Frequencies of Whole-Body Vibration Training on Balance and Flexibility of the Elderly: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the effects of whole-body vibration training with different frequencies on the balance and flexibility of the healthy elderly. DESIGN: The participants were recruited from hospital volunteers and the community; all of them were healthy subjects, all over 65 years of age. The study involved three randomized groups in a parallel and single-blind design. The main outcome variables included the limits of stability test and the sit and reach test, which were measured at pre-training, Month 1 (Mid-training), Month 3 (Post-training), and Month 6 (Follow-up). RESULTS: A total of 45 subjects, with a mean age of 69.6 ± 3.9 years, were randomly divided into three groups. There was significant interaction in the performance of the limits of stability and sit and reach tests in the different groups at the four different time points (F = 25.218, P < 0.001, F = 12.235, P < 0.001, respectively). There was a significant difference in balance performance between the vibration groups at the frequencies of 20 Hz and 40 Hz and the control group at Month 1, Month 3, and Month 6 (P < 0.001). CONCLUSION: Whole-body vibration training at 20 Hz has significant benefit to the balance and flexibility of the elderly who do not engage in habitual exercise.

Influence of Whole-Body Vibration Training Without Visual Feedback on Balance and Lower-Extremity Muscle Strength of the Elderly: A Randomized Controlled Trial.

The purpose of this study was to investigate the influence of whole-body vibration (WBV) training without visual feedback on balance and lower-extremity muscle strength in the elderly.Elderly subjects who did not exercise regularly participated in this study. Subjects were randomly divided into a WBV with eyes open group, a visual feedback-deprived plus WBV (VFDWBV) group, and a control group (0 Hz, eyes open). WBV training was provided over a 3-month period, 3 times per week for 5 min each session. Balance performance was measured with the limits of stability test, and muscle strength was measured with an isokinetic dynamometer.A total of 45 elderly subjects with an average age of 69.22  ±  3.97 years, divided into a WBV group (n = 14), a VFDWBV group (n = 17), and a control group (n = 14), completed the trial. Statistically significant differences were found in the balance performance of the 3 groups at different time points (time × group interaction: F = 13.213, P < 0.001), and the VFDWBV group had more improvement in balance than the WBV and control groups. The strength of the knee extensor and flexor muscles had time × group interactions: F = 29.604, P < 0.001 and F = 4.684, P = 0.015, respectively; the VFDWBV group had more improvement on lower-extremity muscle strength than the WBV and control groups. The 6-month follow-up showed that the rates of hospital visits for medical services due to falls were 0% in the WBV group (0/14), 0% in the VFDWBV group (0/17), and 28.57% in the control group (4/14).Results showed that WBV training at 20  Hz without visual feedback can significantly improve the balance performance and lower-extremity muscle strength of the elderly.

Differences Between Women and Men in Phase I Cardiac Rehabilitation After Acute Myocardial Infarction: A Nationwide Population-Based Analysis.

Although numerous studies have investigated gender-related differences in patients who have had an acute myocardial infarction (AMI), few studies have examined the gender-related differences among inpatients receiving Phase I inpatient cardiac rehabilitation following AMI.Using data from the Taiwan National Health Insurance Research Database, this study analyzed 6713 adult patients who received inpatient cardiac rehabilitation following AMI between 2002 and 2011. The differences in comorbidity, medical service use, and prognosis between the male and female patients were analyzed to determine whether the comorbidities affecting their prognoses differed.Female patients accounted for 23.18% of the sample, had a higher average age, and exhibited severe comorbidities; furthermore, they had significantly more days of hospitalization and days in an intensive care unit than did male patients. The gender-related differences in hospital mortality rate and 30-day mortality rate were nonsignificant, but female patients exhibited a significantly higher 1-year mortality rate. Moreover, the risk for 1-year mortality was higher among female patients with moderate or severe renal disease (odds ratio: 1.94, 95% confidence interval: 1.29-2.92) than among their male counterparts. However, the 1-year mortality rate for the female patients did not increase after all risk factors were adjusted.Gender-related differences in age, comorbidity, and prognosis were confirmed in AMI patients receiving Phase I inpatient cardiac rehabilitation. In addition, gender-related differences were observed in the comorbidity risk factors affecting prognosis. However, being female did not affect the prognosis.

Incidence of severe dysphagia after brain surgery in pediatric traumatic brain injury: a nationwide population-based retrospective study.

OBJECTIVES: To investigate the incidence of dysphagia and medical resource utilization in a nationwide population of pediatric patients with traumatic brain injury (TBI). SETTING: Subjects' data were obtained from the Taiwan National Health Insurance Research Database. PARTICIPANTS: Between 2000 and 2008, 6290 children less than 18 years old who had received surgery post-TBI were included in the study. DESIGN: Retrospective study. MAIN OUTCOME MEASURE: Biographic data and medical utilization results. RESULTS: Of all the children postsurgery after TBI, 12.3% were categorized as having severe dysphagia. The occurrence of severe dysphagia was not related to sex but was statistically and significantly related to a younger mean age. The relationship between age and dysphagia also showed an interestingly biphasic distribution, mostly in the subgroups of 1 to 3 and 16 to 18 years of age. The medical resource utilization was higher in severely dysphagia patients, but only 8.4% received intervention by a speech language pathologist. CONCLUSIONS: Severe dysphagia among postsurgical pediatric patients after TBI is relatively common, and those with severe dysphagia have a greater need for medical services. However, the ratio of such patients who receive swallowing treatment is still low in Taiwan. Clinicians are prompted to pay more attention to the impairment in functional oral intake of children postsurgery after TBI.

An investigation of the factors affecting flatfoot in children with delayed motor development.

This study investigated the prevalence of flatfoot in children with delayed motor development and the relevant factors affecting it. In total, 121 preschool-aged children aged 3-6 with delayed motor development (male: 81; female: 40) were enrolled in the motor-developmentally delayed children group, and 4 times that number, a total of 484 children (male: 324; female: 160), of gender- and age-matched normal developmental children were used as a control group for further analyses. The age was from 3.0 to 6.9 years old for the participants. The judgment criterion of flatfoot was the Chippaux-Smirak index >62.70%, in footprint measurement. The results showed that the prevalence of flatfoot in children with motor developmental delay was higher than that in normal developmental children, approximately 58.7%, and that it decreased with age from 62.8% of 3-year-olds to 50.0% of 6-year-olds. The results also showed that motor-developmentally delayed children with flatfoot are at about 1.5 times the risk of normal developmental children (odds ratio=1.511, p=0.005). In addition, the prevalence of flatfoot is relatively higher in overweight children with delayed motor development, and that in obese children is even as high as 95.8% (23/24). Children with both excessive joint laxity and delayed development are more likely to suffer from flatfoot. The findings of this study can serve as a reference for clinical workers to deal with foot issues in children with delayed motor development.

Grip strength measurement in older adults in Taiwan: a comparison of three testing positions.

AIM: The purpose of this study was to explore the effects of three commonly used positions on grip strength measurement in older people. METHOD: A total of 249 (113 women, 136 men) older participants, 72.8 ± 6.5 years old, participated in this study. Grip strength (kg) was measured in three positions: (i) the standard posture (sitting, elbow flexed 90°) suggested by the American Society of Hand Therapists; (ii) standing, elbow flexed 90°; and (3) standing, elbow fully extended. RESULTS: One-way repeated measures analysis of variance showed that grip strength was significantly greater in the standing position with the elbow fully extended than in the other two positions. CONCLUSIONS: The grip strengths obtained from the three positions were not all comparable in our community-dwelling older adults. Clinicians and researchers need to be cautious when choosing testing position for assessing and interpreting grip strength results obtained from these positions.

The ICF-CY-based structural equation model of factors associated with participation in children with autism.

OBJECTIVE: The aim of this study was to apply the International Classification of Functioning, Disability and Health - Child and Youth (ICF-CY) framework to identify the factors related to the participation of children with autism. METHOD: A convenience sample included 162 preschool children with autism ages 36 to 72 months. The raters collected data using the ICF-CY-based questionnaire as an instrument to construct the structural equation modeling of factors associated with participation. RESULTS: The internal structure of the model was acceptable, indicating that the observed variables would suffice in accounting for latent variables. The structural model showed that the performance of participation in children with autism was influenced by body functions and personal factors. All the variables accounted for 77% of the explained variance for activities and for participation by 71% of the children with autism. CONCLUSION: These findings may provide critical information pertaining to predictive factors of participation for parents, educators, and professionals who work with children with autism.