Multimodal training with dual-task enhances immediate and retained effects on dual-task effects of gait speed not by cognitive-motor trade-offs in stroke survivors: a randomized controlled trial.

PURPOSE: Individuals who have experienced stroke may benefit from dual-task related training to improve gait speed performance. Whether noted improvements reflect true effects on gait or cognitive-motor trade-offs still remains unclear. Therefore, this study aimed to investigate the effects of dual-task training on dual-task effects of both walking and cognitive domains in stroke survivors. MATERIALS AND METHODS: Forty-four individuals with stroke were randomized to dual-task or single-task training groups. Both groups exercised three 60-minute sessions per week for 4 weeks. The primary outcomes were dual-task effects on gait speed and cognitive score. Outcomes were assessed before and after the intervention and 1-month follow-up. RESULTS: While both groups exhibited improvement in absolute gait speed under dual-task conditions, the dual-task training group demonstrated superior results by providing an additional gain on dual-task effects of gait speed. Compared to single-task training, dual-task training exhibited a significant improvement in dual-task effects of gait speed at post-treatment and follow-up. Regarding the dual-task effects on cognitive scores, no significant differences within and between groups after training were observed. CONCLUSION: Dual-task training enhances immediate and retained effects on the dual-task effects of gait speed in individuals with stroke, not by cognitive-motor trade-offs. TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. CLINICALTRIALS.GOV IDENTIFIER: NCT02686515.

Dual-task interference during walking has important consequences for stroke survivors to walk safely.Multimodal training with dual-task enhances immediate and retained effects on the dual-task effects of gait speed in individuals with stroke, not by cognitive-motor trade-offs.Clinicians are encouraged to incorporate multimodal training with dual-task into the exercise routines to enhance walking under dual-task conditions in stroke survivors.

Psychometric comparisons of four disease-specific health-related quality of life measures for stroke survivors.

OBJECTIVE: To examine psychometric properties of four stroke-specific health-related quality of life (HRQoL) measures, including original Stroke-Specific Quality of Life Scale (12-domain SSQoL), modified 8-domain SSQoL, Stroke Impact Scale (SIS 3.0), and modified SIS-16 focused on physical domains. DESIGN AND SETTING: Prospective repeated measures study conducted in rehabilitation and wards in hospitals. SUBJECTS: Study cohort was recruited with 263 patients in the first administration and 121 in the second administration, an average of two weeks later. To investigate discriminant validity, the same number of patients (i.e., 52) was grouped for each of 3 levels of stroke severity. MAIN MEASURES: Outcome measures, including National Institutes of Health Stroke Scale, Mini-Mental State Examination, and Barthel Index. Patients completed HRQoL self-reports. RESULTS: Domains of four measures showed (1) good reliability, except 12-domainSSQoL family roles (Cronbach's α = 0.68) and personality domains (Cronbach's α = 0.65) and SIS 3.0 social participation (ICC=0.67) domain; (2) acceptable precision, except 12-domain SSQoL family role domain and SIS 3.0 social participation domain; (3) good convergent validity, except 12-domain SSQoL/8-domain SSQoL vision domain (r = 0.19), (4) good discriminant validity, except 12-domain SSQoL and 8-domain SSQoL thinking domains (P = 0.365); and (5) acceptable floor effects and strong ceiling effects. The 12-domain SSQoL and 8-domain SSQoL met scaling assumptions better than SIS 3.0 and SIS-16. CONCLUSIONS: Four measures showed acceptable psychometric properties with some domains slightly less satisfactory. Overall, use of 8-domain SSQoL and SIS 3.0 are feasible for clinical practice to monitor HRQoL of stroke survivors.

Motion analysis of throwing Boccia balls in children with cerebral palsy.

Boccia is a sport suitable for children with cerebral palsy (CP). Throwing Boccia balls requires upper extremity and torso coordination. This study investigated the differences between children with CP and normally developed children regarding throwing patterns of Boccia balls. Thirteen children with bilateral spastic CP and 20 normally developed children participated in this study. The tests in this study were a pediatric reach test and throwing of Boccia balls. A 3D electromagnetic motion tracking system and a force plate were synchronized to record and analyze biomechanical parameters of throwing Boccia balls. The results of the pediatric reach test for participants with CP were significantly worse than those for normally developed participants. The 2 groups of participants did not significantly differ regarding the distance between a thrown Boccia ball and a target ball (jack). Participants with CP demonstrated significantly longer movement duration, smaller amplitude of elbow movement, greater amplitudes of shoulder abduction and flexion, slower maximal velocity of torso flexion and the linear velocity of moving the wrist joint forward, faster maximal velocity of head flexion, and smaller sway ratio compared with normally developed participants when throwing Boccia balls. Participants with CP seemed to mainly use head and shoulder movements to bring the Boccia balls forward with limited torso movement. Normally developed participants brought the Boccia ball forward with faster torso and greater elbow movement while stabilizing head and shoulder movements. Nevertheless, participants with CP did not demonstrate significantly worse performance in the throwing accuracy of Boccia balls.

Development of a set of functional hierarchical balance short forms for patients with stroke.

OBJECTIVE: To develop a set of 3 hierarchical balance short forms (HBSF; containing sitting, standing, and stepping forms) to measure balance function in patients with stroke. DESIGN: First, we developed the HBSF, based on a previous data set, with each short form containing 6 items. Second, we examined the psychometric properties and efficiency of the HBSF. SETTING: Six teaching hospitals. PARTICIPANTS: Patients with stroke (n=764) for the first part of this study; inpatients and outpatients (n=85) for the second part of this study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We used the item bank (9 sitting-related, 14 standing-related, and 13 stepping-related items) from the Balance Computerized Adaptive Test to develop the HBSF. Both the HBSF and the Berg Balance Scale (BBS) were administered to patients, to determine the concurrent validity and time needed for administration of both measures. Each patient was assessed by 1 of the 3 short forms selected by a rater. RESULTS: The reliability of the HBSF was relatively high (reliability coefficients, .94-.95). The scores of the HBSF were highly correlated with those of the BBS (Spearman ρ=.80-.91), supporting the concurrent validity of the HBSF. The average time needed to administer the HBSF was 122 seconds (ie, about 40% of that for the BBS). CONCLUSIONS: Our results provide sufficient evidence that the HBSF is an efficient, reliable, valid, and practical way to measure balance function in patients with stroke.

Excellent reliability of the Sollerman hand function test for patients with burned hands.

The purpose of this study was to identify the minimal detectable change (MDC) of the Sollerman hand function test (SHT) for patients with burned hands. Twelve subjects were studied, giving a total of 21 burned hands (10 right hands and 11 left hands). Each subject received two sessions of SHT assessment, held at 7- to 10-day intervals. Three raters were recruited to observe and assign scores for the patients' performance during the tests. The MDC was calculated based on standard measurement error, and the intraclass correlation coefficient was applied to examine relative reliability. Results showed that both intra- and interrater MDCs were acceptable (6.7 and 6.9 points, respectively) and that both intra- and interrater relative reliabilities were excellent (intraclass correlation coefficients = 0.98). According to this study, the SHT was found to have appropriate MDC and relative reliability in monitoring changes over time for patients with burned hands. The MDCs of SHT calculated in this study are useful in determining whether any change in score is the result of more than random error.

Shape modification of the Boston brace using a finite-element method with topology optimization.

STUDY DESIGN: Using a finite-element (FE) method to reshape the Boston brace, and evaluating the correction effect of the modified Boston brace in terms of Cobb angle. OBJECTIVE: This study aimed to reduce the weight of the Boston brace using a FE method with topology optimization. SUMMARY OF BACKGROUND DATA: The Boston brace is widely used to correct an abnormal spinal curve in adolescent idiopathic scoliosis. However, patients wearing the brace usually complain about discomfort caused by its bulkiness. METHODS: An FE model of a traditional Boston brace was constructed using the software ANSYS 9.0. The loading condition was taken from an X-sensor measuring contact pressures between torso and brace. Topology optimization was conducted to modify the Boston brace. Three patients wearing a traditional brace and then the modified brace were examined in terms of Cobb angle. RESULTS: For the patient with King Type III scoliosis, this modified brace was able to offer the same correction effect as the traditional brace, but the modified brace was lighter by about 12.4%, with the potential to be up to 18% lighter. CONCLUSION: Based on the traditional Boston brace, this FE model, combined with topology optimization, can effectively estimate redundant material distribution and accordingly custom-design a lighter brace without any loss of its corrective effect.

Effects of age and sex on the results of an ankle plantar-flexor manual muscle test.

BACKGROUND AND PURPOSE: The ability to perform 20 or more one-leg heel-rises is considered a "normal" grade for muscle strength (force-generating capacity of muscle) of the ankle plantar flexors, regardless of age and sex. Because muscle strength is closely related to age and sex, the "normal" test criterion was re-evaluated in different groups categorized by age and sex. SUBJECTS AND METHODS: One hundred eighty sedentary volunteers (21-80 years of age) without lower-limb lesions performed as many repetitions of one-leg heel-rise as possible. Lunsford and Perry criteria were used to determine completion of the test. RESULTS: The age and sex of the participants influenced the maximal repetitions of heel-rise, and the repetitions decreased with age and in female subjects. DISCUSSION AND CONCLUSION: The muscle strength of the ankle plantar flexors, as measured by manual muscle testing, varied with age and sex. Clinicians should consider the variances of age and sex when they perform manual muscle testing of the ankle plantar flexors.