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.

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.

Everyday memory problems in alcohol abuse and dependence: Frequency, patterns and patient-proxy agreement.

Using self-report to assess everyday memory in alcoholics presents challenges given the presence of both memory and metamemory deficits. Accordingly, evaluation of the reliability and validity of proxy ratings as well as the frequency of these memory lapses are of clinical importance. In the present study, 180 patient-proxy dyads completed the Prospective and Retrospective Memory Questionnaire (PRMQ). 31.7% of proxy-rated versus 2.8% of patient-rated prospective memory scores fell in the impaired to below average range. 15% of proxy-rated retrospective memory scores were below average, whereas none of the patients reported problems in this regard. Longer delays between intention formation and action yielded better prospective memory performance, while the opposite was true for retrospective memory. Agreement between patients and proxies was generally poor to fair across severity levels and the magnitude of observed differences was large (standardized response mean > 0.8). For all PRMQ items, exact agreement occurred in 45.3% of the cases. Larger patient-proxy discrepancy was associated with older age, less education and greater disease severity. Proxy ratings were internally consistent, significantly correlated with objective memory performance, and were sensitive to differences in overall PRMQ performance between severity groups. Caution should be used in the interpretations of patients' reports.

Sensitivity and specificity of executive function tests for Alzheimer's disease.

Decline in executive function (EF) occurs early in Alzheimer's disease (AD) and can interfere with daily functioning. Unfortunately, little is known about the relative ability of traditional EF tests to detect these cognitive changes. Given that timely diagnosis and intervention are essential to improving functional outcome in this population, our aim was to identify the specific EF measures that best differentiated mild dementia from normal aging. Thirty-one patients with mild AD and 31 controls were administered 7 EF tests. Findings indicated significant between-group differences on all measures except Wisconsin Card Sorting Test. The remaining 6 tests displayed fair to good accuracy discriminating between AD cases and controls. Only category fluency and Tower of London test remained in the final regression model that yielded the highest AUC of 0.90, which was not statistically different from that of either test alone. Overall, most of the tests employed were valid for assessing mild EF disturbances. Specifically, the two measures can be used in isolation for quick screening or in combination to facilitate a more in-depth evaluation of EF performance. This study contributes to clinical field by testifying to the validity of various EF tests to identify AD-related compromises in this cognitive domain.

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.

The role of processing speed in post-stroke cognitive dysfunction.

The association between speed of information processing and cognition has been extensively validated in normal aging and other neurocognitive disorders. Our aim was to determine whether such a relationship exists in stroke. Thirty patients and 30 age- and education-matched healthy individuals were administered a comprehensive battery of neuropsychological tests divided into the following six cognitive domains: processing speed (PS), verbal memory, visual memory, visuoperceptual function, language, and cognitive flexibility. The results demonstrate that stroke patients were characterized by cognitive deficits in almost all of these domains, but have the most pronounced deficits in PS. After adjusting for symbol digit modalities test score, all significant group differences in cognitive functioning disappeared. However, group differences remained significant after controlling for the influence of other cognitive factors. These findings suggest that decreased PS appears to underlie post-stroke cognitive dysfunction and may serve as a potential target for intervention.

Predictors of memory and processing speed dysfunctions after traumatic brain injury.

BACKGROUND: The aims of this study were to evaluate the predictive value of admission Glasgow Coma Scale (GCS) scores, duration of unconsciousness, neurosurgical intervention, and countercoup lesion on the impairment of memory and processing speed functions six months after a traumatic brain injury (TBI) based on a structural equation modeling. METHODS: Thirty TBI patients recruited from Neurosurgical Department at the Kaohsiung Medical University Hospital were administered the Wechsler Memory Scale-III (WMS-III) and the Wechsler Adult Intelligence Scale-III processing speed index to evaluate the memory and processing speed functions. RESULTS: The study showed that GCS scores accounted for 40% of the variance in memory/processing speed. No significant predictive effects were found for the other three variables. GCS classification at the time of TBI seems to correspond moderately to the severity of memory/processing speed dysfunctions. CONCLUSIONS: The present study demonstrated that admission GCS score is a robust predictor of memory/processing speed dysfunctions after TBI. The results should be replicated with a large sample of patients with TBI, or be extended by examining other potential clinical predictors.

Development of the Chinese version of the Hooper Visual Organization Test: normative data.

The present study consisted of two phases: development and psychometric validation of a Chinese version of the Hooper Visual Organization Test (HVOT) using Rasch analysis and the provision of normative data on the basis of a representative sample of the Chinese-speaking population. The HVOT was administered to 1008 healthy adults aged 15-79 years, 60 patients with stroke, and 60 patients with schizophrenia. The results indicated that with 12 items removed, the resulting 18-item scale was found to be unidimensional, with satisfactory internal consistency and no evidence of differential item functioning or bias for age, sex and educational level. There were significant differences between each of the two patient groups and normal controls on the scores of the Rasch-developed measure. All test-retest coefficients exceeded 90 in patient samples. As performance on the Chinese version decreases with age and lower years of education, regression-based normative data that took age and education into account were established. A cut-off score of 21.5, out of an x-y range, the higher the better, resulted in a sensitivity of 0.86 and a specificity of 0.68. The normative data presented here will enable clinicians to determine different levels of visuosynthetic impairments more precisely.

Occupational therapy home program for children with intellectual disabilities: a randomized, controlled trial.

This study aimed to investigate the effectiveness of a proposed occupational therapy home program (OTHP) for children with intellectual disabilities (ID). Children with ID were randomly and equally assigned to OTHP or to no OTHP groups. The primary outcome measures were Canadian Occupational Performance, Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, and The Children's Assessment of Participation and Enjoyment scores at 10 and 20 weeks. The 20-week OTHP produced significant difference in fine motor function, activity participation, and parent satisfaction with performance, compared to those of no OTHP. Pediatricians can advise families to implement 20 weeks of OTHP with an average 15 min per session to facilitate functional changes of children with ID.

Psychometric validation and normative data of a second Chinese version of the Hooper Visual Organization Test in children.

The Hooper Visual Organization Test (HVOT) is a measure of visuosynthetic ability. Previously, the psychometric properties of the HVOT have been evaluated for Chinese-speaking children aged 5-11 years. This study reports development and further evidence of reliability and validity for a second version involving an extended age range of healthy children and children with developmental disabilities (DD) from 5 to 14 years of age. Rasch analysis revealed that after deletion of 6 items, a 24-item version conformed to a unidimensional scale. The test showed satisfactory internal consistency; 3-week test-retest coefficients all exceeded .85 for three DD subsamples. The second version was able to successfully differentiate between the three DD subgroups (attention-deficit hyperactivity disorder, autism spectrum disorders, and mental retardation) and the healthy control group, with correct classification rates ranging from 86.6% to 94.1%. Its construct validity was supported by expected correlations. Accordingly, age-based normative data were established as a basis for interpretation of performance. In sum, the second Chinese version of the HVOT has good psychometric properties and norms that are suited for use in clinical practice.

Processing speed mediates gender differences in memory in schizophrenia.

The primary aim of this study was to examine whether processing speed mediates the association between gender and episodic memory in schizophrenia. Participants were 51 female and 51 male outpatients comparable on demographic, clinical, and cognitive variables. Memory tests included both verbal and visual measures. Both groups scored below the normative mean of the memory and processing speed tests, except that females performed slightly above the mean on face recognition. Females outperformed males on verbal memory, visual recognition, and processing speed. Mediation regression analyses showed processing speed mediated immediate and delayed recall for both verbal and visual memory measures. Thus processing speed appears to be a critical variable for understanding cognitive deficits in schizophrenia and may be an important target for cognitive rehabilitation.

Reliability and responsiveness of the Movement Assessment Battery for Children-Second Edition Test in children with developmental coordination disorder.

AIM: To examine the internal consistency, test-retest reliability, and responsiveness of the Movement Assessment Battery for Children-Second Edition (MABC-2) Test for children with developmental coordination disorder (DCD). METHOD: One hundred and forty-four Taiwanese children with DCD aged 6 to 12 years (87 males, 57 females) were tested on three separate occasions: two baseline measurements with a 20-day interval before the intervention, and a follow-up measurement after 6 months of rehabilitation. The therapists rated the performance of children in school-related physical tasks at baseline and after intervention. RESULTS: Internal consistency for the MABC-2 Test was α = 0.90. Test-retest reliability for the total score was excellent, with an intraclass correlation coefficient of 0.97. A small to medium magnitude of treatment effect was captured by the MABC-2 Test. The minimal detectable change (MDC) was 0.28 points whereas the minimal important difference (MID) values were from 2.36 to 2.50. All subscales except balance showed acceptable validity in differentiating groups of children whose physical performance had improved or remained stable. INTERPRETATION: The MABC-2 Test is a reliable and valid measure to assess motor competence in children with DCD. The MID and MDC scores provide the reference point for clinical decision-making in managing the individual child.

Patterns of participation and enjoyment in adolescents with Down syndrome.

This study aimed to determine participation and enjoyment in young people with Down syndrome (DS) in Taiwan and to assess how participation varies across gender, cognitive, and motor function variables. Using the Children's Assessment of Participation and Enjoyment, data on participation were collected from 997 adolescents with DS and their families. Findings indicated limited diversity and intensity of participation, with proportionately greater involvement in informal activities. Youth with better cognitive and motor functions participated more often in activities and reported higher enjoyment and social engagement with these. These findings provide a foundation for an improved understanding of activity participation of youth with DS. Service providers and families could provide and plan activities to ensure more satisfying and meaningful participation.

Cognitive profile difference between Allen Cognitive Levels 4 and 5 in schizophrenia.

OBJECTIVE: We compared the pattern of cognitive deficits exhibited by people with schizophrenia at Allen Cognitive Level (ACL) 4 with that of people at Level 5. METHOD: Participants were classified into two groups on the basis of their ACL Screen scores: ACL 4 (n = 35) and ACL 5 (n = 41). We assessed cognitive functions and psychotic symptoms in all participants. RESULTS: Multivariate analysis of covariance controlling for gender and negative symptoms revealed that people at ACL 4 performed significantly worse than those at ACL 5 on processing speed, verbal memory, and working memory. The discriminant analysis with all cognitive variables produced a classification accuracy of 78% in differentiation of cognitive levels. CONCLUSION: We verified the validity of the hierarchy of cognitive disability for ACLs 4 and 5 in people with schizophrenia.

Correlations of sensory processing and visual organization ability with participation in school-aged children with Down syndrome.

Previous work has highlighted delays and differences in cognitive, language, and sensorimotor functions in children diagnosed with Down syndrome (DS). However, sensory processing and visual organization abilities have not been well-examined in DS to date. This study aimed to investigate the developmental profile of sensory processing and visual organization abilities, body functions classified by the World Health Organization's ICF model, and their impacts on participation in DS to guide research and evidence-based practices. Two hundred and six children (101 boys, 105 girls) with DS (age range = 6 years 1 month to 12 years 10 months; mean age = 8 years 1 month) were assessed on measures of sensory processing (Sensory Profile), visual organization ability (Hooper Visual Organization Test), and activity participation (Vineland Adaptive Behavior Scale, School Function Assessment). Our findings characterized the developmental continuum of body functions (sensory processing and visual organization) of children with DS, and revealed their correlations with activity participation. Interventions focused on improving body functions is needed while stressing the acquisition of functional skills that increase participation in age-appropriate activities.

Wisconsin Card Sorting Test performance in children with developmental coordination disorder.

The primary purpose of this study was to investigate and compare the executive functions measured by the Wisconsin Card Sorting Test (WCST) between children with developmental coordination disorder (DCD) and age-matched normal controls. A second purpose was to examine the relations between executive functions and school functions in DCD children. Seventy-one children with DCD and 70 children without motor problems were recruited from 14 public schools. Executive functions and school functions were assessed using the WCST, and the School Function Assessment--Chinese Version (SFA-C) respectively. Univariate analyses demonstrated significant between-group differences in five WCST measures. The logistic regression analysis showed differences between two groups on eight SFA-C subscales, and significant correlation between items measured on WCST and SFA-C was also found. The result of the study provides further evidence of impaired sub-domains of executive functions (i.e., mental shifting, flexibility) in children with DCD. The finding also adds to recent investigations into the relationship between executive functions and school functions in DCD. Implications for rehabilitation professionals and recommendations for further research are discussed.

The association between verbal memory, processing speed, negative symptoms and functional capacity in schizophrenia.

The aim of this paper is to explore the links among verbal memory, processing speed, negative symptoms, and functional capacity, using structural equation modeling techniques. Model A is a multiple regression model with cognitive and symptom variables as predictors and functional capacity as the latent outcome variable. Model B consists of three two mediator models that assess the ability of each variable to mediate the effect of the other variable on outcome conditional on the inclusion of the other mediator in the model. Ninety-eight community-dwelling patients with schizophrenia (mean age=35.8years, S.D.=10.1) participated in the study. Results indicate that verbal memory, processing speed and negative symptoms significantly contributed to functional status. Verbal memory was at least partially mediated by processing speed in its effect on outcome, while the impact of processing speed on outcome was mediated by both verbal memory and negative symptoms. The influence of negative symptoms on functional capacity was partially mediated by processing speed. These findings enrich our understanding of the direct and indirect effects of these three interrelated variables and provide a basis for the development of intervention strategies.

Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome.

This quasi-experimental study compared the effect of standard occupational therapy (SOT) and virtual reality using Wii gaming technology (VRWii) on children with Down syndrome (DS). Children (n = 105) were randomly assigned to intervention with either SOT or VRWii, while another 50 served as controls. All children were assessed with measures of sensorimotor functions. At post-intervention, the treatment groups significantly outperformed the control group on all measures. Participants in the VRWii group had a greater pre-post change on motor proficiency, visual-integrative abilities, and sensory integrative functioning. Virtual reality using Wii gaming technology demonstrated benefit in improving sensorimotor functions among children with DS. It could be used as adjuvant therapy to other proven successful rehabilitative interventions in treating children with DS.

A Rasch-based validation of the Hooper Visual Organization Test in Chinese-speaking children.

The aim of this study was to examine the validation of the Hooper Visual Organization Test (HVOT) for use in children by testing for item fit, unidimensionality, item hierarchy, reliability, and screening capacity. A modified scoring system was devised for the HVOT so that children received some credit for being able to describe the function of objects. The HVOT was administered to 630 typically developing school-aged children and 210 children with Down syndrome matched for age and education. Rasch analysis and receiver operating characteristic curve were applied. Rasch analysis of data from typically developing children showed that twelve items were candidates for deletion due to poor fit to the Rasch model, violation of normality and age-related item bias. Removing these items resulted in a shortened version with 18 items that forms a reliable and strong unidimensional, hierarchical scale. The items were well targeted to the ability level of the children tested. Area under the curve for HVOT-18 was 0.84, indicating very good ability to identify visual integration deficit in children with Down syndrome. The 18-item HVOT can be summed to produce an overall index of visual synthetic ability. Subsequent work is needed to validate its use in other childhood disabilities.

The effectiveness of simulated developmental horse-riding program in children with autism.

This study investigated the effectiveness of a 20-week Simulated Developmental Horse-Riding Program (SDHRP) by using an innovative exercise equipment (Joba) on the motor proficiency and sensory integrative functions in 60 children with autism (age: 6 years, 5 months to 8 years, 9 months). In the first phase of 20 weeks, 30 children received the SDHRP in addition to their regular occupational therapy while another 30 children received regular occupational therapy only. The arrangement was reversed in the second phase of another 20 weeks. Children with autism in this study showed improved motor proficiency and sensory integrative functions after 20-week SDHRP (p < .01). In addition, the therapeutic effect appeared to be sustained for at least 24 weeks (6 months).