Role of Self-efficacy in the Predictive Relationship of Motor Ability to Functional Performance After Task-Related Training in Stroke: A Secondary Analysis of Longitudinal Data.

OBJECTIVE: To determine whether self-efficacy (SE) mediates or moderates the relationship between motor ability at pretest and functional use of the affected arm at posttest in task-related training for stroke. DESIGN: Retrospective, observational cohort study. SETTING: Outpatient rehabilitation settings. PARTICIPANTS: Eighty patients with chronic stroke (N=80). INTERVENTIONS: The training was delivered to the participants for 60-90 min/session, 3-5 sessions/wk for 4-6 weeks. The training involved specific robot-assisted, mirror, or combined therapy, followed by functional task practice for approximately 30 minutes in each session. MAIN OUTCOME MEASURES: The outcome measure was the perceived amount of functional arm use and quality of movement evaluated by the Motor Activity Log (MAL) at posttest. The predictor was scores on the Fugl-Meyer Assessment (FMA)-Upper Extremity subscale at pretest. The tested mediator and moderator were scores on the Stroke Self-Efficacy Questionnaire (SSEQ) at pretest and posttest. RESULTS: The SSEQ scores at pretest and posttest moderated the predictive relationship of pretest FMA to posttest MAL. The interaction between pretest FMA and SSEQ accounted for an additional 3.14%-5.37% of the variance in the posttest MAL. The predictive relationship between FMA and MAL was its greatest when the SSEQ was high, with a less amplified positive relationship at low levels of SSEQ. CONCLUSIONS: The results suggest the evaluation of SE at pretest for a better prediction of an individual patient's functional arm use after an intervention and recommend aiming at SE during training to make the most of motor ability transferred to functional use. Future research may compare the effectiveness of task-related training with and without SE building to verify the findings of this study.

Questionnaires on stigmatizing attitudes among healthcare students in Taiwan: development and validation.

BACKGROUND: People may be stigmatized if they have mental illness, emotional and behavioral disorders (EBD), or physical or intellectual disabilities. Being stigmatized adversely affects one's psychological well-being and quality of life. While occupational therapists frequently work with people with EBD and disabilities, all healthcare practitioners may encounter these populations, and stigmatizing attitudes of healthcare professionals towards such clients can negatively affect the therapeutic relationship, evaluation, and treatment. Therefore, understanding attitudes of healthcare students-as future practitioners in all fields of healthcare-towards people in this regard is fundamental to the future implementation of anti-stigma programs. We aimed to develop and test questionnaires for examining stigmatizing attitudes of healthcare students towards people with mental illness or disabilities and children with EBD. METHODS: A literature review was conducted to identify surveys related to attitudes towards people with mental illness, EBD, and disabilities. Items that were pertinent to the concept of stigma were selected and modified to fit into the Taiwanese context. A total of 336 students from departments of occupational therapy, physical therapy, nursing, and medicine in 7 universities across Taiwan completed the questionnaires. Item analysis and factor analysis were used to examine the reliability and validity of the questionnaires. Gender differences were also considered. RESULTS: Factor analyses of the three questionnaires yielded factor structures that explained 61.34 to 67.15% of the variance, with Cronbach's α values ranging from 0.71 to 0.89. The Questionnaire on Stigmatizing Attitudes Towards Mental Illness consisted of 16 items with 4 subscales: deviant behavior, social isolation, negative stereotype, and self-stigma. The Questionnaire on Stigmatizing Attitudes Towards Children with EBD consisted of 14 items with 3 subscales: rejective attitude, negative stereotype, and deviant behavior. The Questionnaire on Stigmatizing Attitudes Towards Disabilities consisted of 10 items with 3 subscales: positive stereotype, negative stereotype, and pessimistic expectation. In addition, men had slightly higher stigmatizing attitudes than women. CONCLUSIONS: The results showed satisfactory factor structures and internal consistency, and thus support the use of these questionnaires to understand attitudes of healthcare students towards these populations. In addition, particular attention should be paid to gender differences in stigmatizing attitudes of healthcare students.

Responsiveness of the short-form health survey and the Parkinson's disease questionnaire in patients with Parkinson's disease.

BACKGROUND: The responsiveness of a measurement instrument is important for understanding its ability to detect changes in the progression of a disease. We examined and compared the internal and external responsiveness of the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson's Disease Questionnaire (PDQ-39) in patients with Parkinson's Disease (PD). METHODS: Seventy-four patients with PD were evaluated using the SF-36 and PDQ-39 at baseline and again after one year. In addition, their motor signs, motor difficulties of daily living, and depressive symptoms were assessed as external criteria. The internal responsiveness was examined using effect size, standardized response mean, and the Wilcoxon signed rank test. The external responsiveness was examined using receiver operating characteristic curves, correlation analyses, and regression models. RESULTS: Both instruments were partially sensitive to changes during the 1-year follow-up and able to discriminate between patients with improved versus deteriorated motor signs. In addition, both were similarly responsive to changes in the motor difficulties of daily living; the SF-36 appeared to be more sensitive than the PDQ-39 to changes in depressive symptoms. CONCLUSIONS: The SF-36 and the PDQ-39 were acceptably internally and externally responsive during the 1-year follow-up.

Stigma as a key determinant of health-related quality of life in Parkinson's disease.

PURPOSE: People with Parkinson's disease (PD) may experience stigma due to their visible features of movement and communication difficulties. This paper aimed to examine the role of experienced stigma in health-related quality of life (QOL), after controlling for personal and clinical characteristics. METHODS: This is a preliminary analysis of a subset of baseline data from the Social Self-Management of Parkinson's Disease Study (SocM-PD), an ongoing 3-year prospective cohort study. Seventy-three people with PD (M age = 65.72, 29 women) participated in this study. Hierarchical multiple regression analyses were used to determine the role of stigma in QOL, after controlling for gender, disease severity, depression, and motor difficulties of daily living. RESULTS: Significant correlations were found between QOL with gender (r = .26), disease severity (r = .38), depression (r = .65), motor difficulties of daily living (r = .71), and stigma (r = .83). After controlling for the significant covariates, stigma made a significant and unique contribution to the explanation of QOL by 13.7 % (p < 0.001). A final hierarchical multiple regression with stigma and the 4 covariates revealed an overall model that explained 77.8 % of the total variance of QOL (F [5, 63] = 48.79, p < 0.001). CONCLUSIONS: Experienced stigma appears to be a key determinant of QOL in people with PD. The results suggest the importance of further understanding stigma in PD to develop possible intervention strategies. Future work is also needed to verify the results with a larger and longitudinal dataset of the SocM-PD.

Validity and Responsiveness of the Revised Nottingham Sensation Assessment for Outcome Evaluation in Stroke Rehabilitation.

OBJECTIVE: This study establishes the concurrent validity, predictive validity, and responsiveness of the Revised Nottingham Sensation Assessment (rNSA) during rehabilitation for people with stroke. METHOD: The study recruited 147 patients with stroke. The main assessment used was the rNSA, and outcome measures were the Fugl-Meyer Assessment sensory subscale (FMA-S) and motor subscale (FMA-M) and the Nottingham Extended Activities of Daily Living (NEADL) scale. RESULTS: Correlation coefficients were good to excellent between the rNSA and the FMA-S. The rNSA proprioception measure was a predictor for the FMA-S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for the FMA-M and the NEADL scale, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = .51-.83). CONCLUSION: This study may support the concurrent validity, predictive validity, and responsiveness of the rNSA for people with stroke.

Self-rated and parent-rated quality of life (QoL) for community-based obese and overweight children.

AIMS: To determine the effects of being obese or overweight on quality of life (QoL) of children from a community-based sample and to compare their self-ratings of QoL with their parents' ratings for their children's QoL. METHODS: Dyads of 8- to 12-year-old children [60 obese, 34 overweight and 127 normal weight (N = 221)] and their parents or caregivers were recruited from southern Taiwan. QoL was assessed by both parent proxy ratings and child self-ratings using the Pediatric Quality of Life Inventory (PedsQL) questionnaire. RESULTS: Obese children reported significantly lower QoL than did their normal-weight counterparts (83 ± 15 vs. 88 ± 10; p = 0.04). Obese children rated their QoL lower than did their parents in all (Cohen's d = -0.38 to -0.22) but the school domain. Overweight children's and normal-weight children's self-reported QoL was not significantly different, nor were they different from parent-reported QoL. CONCLUSIONS: Community-based obese children reported a lower QoL than did normal-weight children; however, their parents seemed unaware of their children's decreased QoL. Caution is required when using only parent proxy reports to assess the QoL of obese children. More effort is needed in Taiwan to improve parents' understanding of their obese children's QoL.

Measurement equivalence across child self-reports and parent-proxy reports in the Chinese version of the pediatric quality of life inventory version 4.0.

An important assumption for comparing children's quality of life (QoL) between children's and parents' perceptions is that measurement equivalence/invariance (ME/I) exists. The ME/I across the child- and parent-reported Chinese PedsQL was examined, and the latent means between child self-reports and parent-proxy reports were compared. Third-grade to sixth-grade children (n = 519) and their parents (n = 270) respectively completed the child- and parent-reported PedsQL. Seventy-eight parents completed parent-proxy reports twice. Full ME/I across child and parent reports was found in first- and second-order factor loadings. Partial ME/I was supported in item intercepts and item residual variances. The latent means of child self-reports and of parent-proxy reports were not significantly different, which suggested interchangeability between child- and parent-reported PedsQL. The ME/I results support the use of PedsQL scores to compare children's and parents' perceptions of children's QoL.

Indirect causal path from motor function to quality of life through daily use of the affected arm poststroke after task-specific training: a longitudinal mediation analysis.

PURPOSE: Task-specific training generally targets motor function, with the ultimate goal of improving quality of life (QoL). This study aimed to determine whether motor function indirectly affects QoL through daily use of the affected arm and activities of daily living (ADL) in patients with chronic stroke. METHODS: This was a retrospective cohort study of 155 patients who received training for 90-120 min/session, 3-5 sessions/week, for 4-6 weeks. The training involved specific mirror or robot-assisted therapy, followed by functional task practice for 15-30 min in each session. Patients were assessed before and after the intervention. RESULTS: At both pre-test and post-test, significant indirect effects of motor function on QoL through daily use of the affect arm and ADL were observed (ß = 0.087-0.124). When the change scores of the measures between the pre-test and post-test were used, significant mediating effects of daily arm use on the relationship between motor function and QoL were identified (ß = 0.094-0.103). CONCLUSIONS: Enhanced motor function after intervention may lead to an increase in arm use for daily activities and subsequently result in an improvement in QoL. These results highlight the critical role of daily arm use in task-specific training aimed at improving QoL.IMPLICATIONS FOR REHABILITATIONTask-specific training may improve motor function, daily arm use, activities of daily living, and quality of life in patients with mild-to-moderate arm hemiparesis.To improve quality of life in task-specific training, clinicians may work in sequence from motor function to daily arm use and then to activities of daily living.Emphasizing the use of the affected arm in daily life is critical to improve quality of life in task-specific training.

Psychometric properties and gender invariance of the Chinese version of the self-report Pediatric Quality of Life Inventory version 4.0: short form is acceptable.

PURPOSE: To evaluate the psychometric properties and gender invariance of the Chinese version of the Pediatric Quality of Life Inventory (PedsQL) for 8- to 12-year-olds. METHODS: Psychometric testing and confirmatory factor analysis (CFA) were used with a convenience sample of 8- to 12-year-old children (n = 479) for PedsQL full and short forms. RESULTS: The internal consistency reliability was satisfactory for all subscales and total scores (Cronbach's α = 0.73-0.90), except for the school subscale (0.68 [full form], 0.62 [short form]). Test-retest reliability was 0.67-0.84. Convergent validity was supported by the correlation between the Children's Depression Inventory and PedsQL psychosocial subscale (r = -0.69). Construct validity determined using CFA showed a better model fit in the short form (RMSEA = 0.06) than in the full form (RMSEA = 0.08). Measurement invariance across gender determined using nested CFA models showed that all absolute ΔRMSEA values were <0.01. CONCLUSIONS: The Chinese version of the PedsQL is a relatively reliable and valid instrument, and the PedsQL short form showed a better construct validity than did the full form. Measurement across gender was invariant; therefore, the comparisons of quality of life between boys and girls were appropriate.

Comparison of virtual reality versus physical reality on movement characteristics of persons with Parkinson's disease: effects of moving targets.

OBJECTIVE: To compare the performance of reaching for stationary and moving targets in virtual reality (VR) and physical reality in persons with Parkinson's disease (PD). DESIGN: A repeated-measures design in which all participants reached in physical reality and VR under 5 conditions: 1 stationary ball condition and 4 conditions with the ball moving at different speeds. SETTING: University research laboratory. PARTICIPANTS: Persons with idiopathic PD (n=29) and age-matched controls (n=25). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Success rates and kinematics of arm movement (movement time, amplitude of peak velocity, and percentage of movement time for acceleration phase). RESULTS: In both VR and physical reality, the PD group had longer movement time (P<.001) and lower peak velocity (P<.001) than the controls when reaching for stationary balls. When moving targets were provided, the PD group improved more than the controls did in movement time (P<.001) and peak velocity (P<.001), and reached a performance level similar to that of the controls. Except for the fastest moving ball condition (0.5-s target viewing time), which elicited worse performance in VR than in physical reality, most cueing conditions in VR elicited performance generally similar to those in physical reality. CONCLUSIONS: Although slower than the controls when reaching for stationary balls, persons with PD increased movement speed in response to fast moving balls in both VR and physical reality. This suggests that with an appropriate choice of cueing speed, VR is a promising tool for providing visual motion stimuli to improve movement speed in persons with PD. More research on the long-term effect of this type of VR training program is needed.

Effects of virtual reality training on functional reaching movements in people with Parkinson's disease: a randomized controlled pilot trial.

OBJECTIVE: To investigate whether practising reaching for virtual moving targets would improve motor performance in people with Parkinson's disease. DESIGN: Randomized pretest-posttest control group design. SETTING: A virtual reality laboratory in a university setting. PARTICIPANTS: Thirty-three adults with Parkinson's disease. INTERVENTIONS: The virtual reality training required 60 trials of reaching for fast-moving virtual balls with the dominant hand. The control group had 60 practice trials turning pegs with their non-dominant hand. MAIN OUTCOME MEASURES: Pretest and posttest required reaching with the dominant hand to grasp real stationary balls and balls moving at different speeds down a ramp. Success rates and kinematic data (movement time, peak velocity and percentage of movement time for acceleration phase) from pretest and posttest were recorded to determine the immediate transfer effects. RESULTS: Compared with the control group, the virtual reality training group became faster (F = 9.08, P = 0.005) and more forceful (F = 9.36, P = 0.005) when reaching for real stationary balls. However, there was no significant difference in success rate or movement kinematics between the two groups when reaching for real moving balls. CONCLUSION: A short virtual reality training programme improved the movement speed of discrete aiming tasks when participants reached for real stationary objects. However, the transfer effect was minimal when reaching for real moving objects.

An Anti-Stigma Course for Occupational Therapy Students in Taiwan: Development and Pilot Testing.

Attitudes of healthcare professionals towards people with disorders/disabilities are important for the development of therapeutic relationships, as well as to the evaluation and intervention processes. Therefore, it is critical to be aware and reduce stigmatizing attitudes in future healthcare professionals. An 18-week anti-stigma course was developed for occupational therapy students based on literature review and focus group interview. The course consisted of three components, including social contact, roleplaying, and critical reflection strategies. A quasi-experimental design was implemented to evaluate participants at three time points (i.e., pre-test, post-test, and one year after completion) using the Social Distance Scale and several questionnaires (i.e., stigmatising attitudes towards mental illness, physical disabilities, and children with emotional behavioural disorders). A total of 16 students completed the course and had significantly decreased social distance and stigmatising attitudes towards mental illness and emotional behavioural disorders in the post-test. These decreases remained one year later. The results support the provision of an anti-stigma course for occupational therapy students to reduce stigmatising attitudes. Future research should extend the anti-stigma course to occupational therapy students at other universities to increase both the sample size and overall generalisability.

The effect of eating utensil weight on functional arm movement in people with Parkinson's disease: a controlled clinical trial.

OBJECTIVE: To investigate the effect of eating utensil weight on kinematic performance in people with Parkinson's disease. DESIGN: A counterbalanced repeated-measures design. SETTING: A motor control laboratory in a university setting. SUBJECTS: Eighteen adults with Parkinson's disease and 18 age-matched controls. EXPERIMENTAL CONDITIONS: Each participant performed a food transfer task using spoons of three different weights: lightweight (35 g), control (85 g) and weighted (135 g). Kinematic variables of arm movement were derived and compared between conditions. MAIN MEASURES: Kinematic variables of arm movement, including movement time, peak velocity and number of movement units. RESULTS: Utensil weights significantly affected the movement kinematicsof all participants. Both groups had fewer movement units in the lightweight condition (Parkinson's disease group: 22.18, controls: 19.89) than in the weighted condition (Parkinson's disease group: 22.68, controls: 21.36), suggesting smoother movement in the former condition. In addition, both groups had higher peak velocity in the lightweight than in the weighted condition. CONCLUSIONS: Our findings suggest that a lightweight utensil may facilitate smoother and higher-velocity arm movement than a weighted one in people with Parkinson's disease.

Experienced facial masking indirectly compromises quality of life through stigmatization of women and men with Parkinson's disease.

This study examined the relationship between self-reported facial masking and quality of life (QoL) in people with Parkinson's disease (PD), and tested experienced stigma as a mediator and gender as a moderator of this relationship. The strength of stigma as a mediator was compared against an alternative mediator, depression. Ninety people with PD (34 women) rated difficulty showing facial expression (masking), and completed the Stigma Scale for Chronic Illness, Geriatric Depression Scale (15-item), and Parkinson's Disease Questionnaire-39. A conditional process model tested the indirect effect of facial masking on QoL through stigma, separately for women and men. A parallel indirect model included both stigma and depression to compare their statistical and clinical significance as mediators. Gender-moderated mediation of stigma reduced the association between facial masking and QoL to non-significance, suggesting stigma explained the association between facial masking and QoL. While facial masking was more stigmatizing for women than for men, stigma mediated the facial masking-QoL association for both women and men. Stigma (controlling for depression) reached a statistically and clinically significant level of mediation, whereas depression (controlling for stigma) reached a statistically yet not clinically significant level of mediation. People with PD who experience more severe facial masking feel more stigmatized, especially women. Regardless of gender, an increase in stigma from facial masking increases the likelihood of compromised QoL that reaches both statistical and clinical levels of significance.

Effects of object size and distance on reaching kinematics in patients with schizophrenia.

BACKGROUND/OBJECTIVE: Patients with schizophrenia not only have psychiatric symptoms, but also have movement problems, which might also be associated with their reduced quality of life. Little is known about how to improve their movement performance for patients. Manipulating object size and distance is common in occupational therapy practice to evaluate and optimize reaching performance in patients with physical disabilities, but effects of the manipulation in patients with schizophrenia remain unclear. The purpose of this study was to examine whether object size and distance could change performance of reaching kinematics in patients with mild schizophrenia. METHODS: Twenty-nine patients with mild schizophrenia and 15 age- and gender-matched healthy controls were required to reach for, as quickly as possible, a small or large object that was placed at a near or far distance. We measured movement time, peak velocity, path length ratio, percentage of time to peak velocity, and movement units to infer movement speed, forcefulness, spatial efficiency (directness), control strategies, and smoothness. RESULTS: Patients' reaching movements were slower (p = .017) and less direct (p = .007) than those of controls. A larger object induced faster (p = .016), more preprogrammed (p = .018), and more forceful (p = .010) movements in patients. A farther object induced slower, more feedback dependent, but more forceful and more direct movements (all p < .001). CONCLUSION: The results of kinematic deficiencies suggest the need of movement training for patients with mild schizophrenia. Occupational therapists may grade or adapt reaching activities by changing object size and distance to enhance movement performance in patients with schizophrenia.

Determinants of generic and specific health-related quality of life in patients with Parkinson's disease.

OBJECTIVES: Generic and disease-specific health-related quality of life (HRQoL) instruments may reflect different aspects of lives in patients with Parkinson's disease (PD) and thus be associated with different determinants. We used the same cluster of predictors for the generic and disease-specific HRQoL instruments to examine and compare the determinants of HRQoL. METHOD: HRQoL was measured in 92 patients with PD by the 36-item Short-Form Health Survey (SF-36) and the 39-item Parkinson's Disease Questionnaire (PDQ-39). The predictors included demographic and disease characteristics, and motor and non-motor symptoms. Multiple regression analyses were used to identify HRQoL determinants. RESULTS: Depressive symptoms and motor difficulties of daily living were the first two significant determinants for both instruments. The other significant determinant for the SF-36 was fatigue and non-motor difficulties of daily living, and for the PDQ-39 was motor signs of PD. CONCLUSIONS: The results suggest the importance of the evaluation and intervention focused on depressive symptoms and motor difficulties of daily living in patients with PD. In addition, the SF-36 seems more related to non-motor symptoms, while the PDQ-39 appears more associated with motor symptoms. This information is important for understanding results from these two instruments and for choosing which to use.

Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke: Within vs. Beyond Arm's Length.

OBJECTIVE: The aim of this study was to examine the effect of target distance (within vs. beyond arm's length) on arm and trunk movements during symmetric bilateral reaching in patients with stroke. DESIGN: Eighteen stroke patients and 18 age-matched control participants reached bilaterally to press desk bells placed at 90% and 125% of arm's length. The kinematics of paretic arm and trunk movements and trunk contribution slopes were measured in the start, mid, and end phases of reaching. RESULTS: Target distance significantly affected arm (shoulder flexion and abduction, elbow extension) and trunk (flexion, rotation, and lateral shift) movements in patients with stroke. Significant group differences were also found in trunk contribution slopes in the start and mid phases of reaching to targets beyond arm's length. CONCLUSIONS: Bilateral reaching for targets beyond arm's length may increase shoulder flexion, shoulder abduction, elbow extension, and trunk flexion, but it may also induce unsymmetric trunk rotation and lateral shift to the paretic side, as well as early and excessive trunk contributions in patients with stroke. The findings suggest that for beyond-arm-length reaching, therapists may restrain the trunk until the end phase of reaching and prevent trunk rotation and lateral shift to the paretic side.

Effectiveness of a work-related stress management program in patients with chronic schizophrenia.

OBJECTIVE: The purpose of this study was to examine the effect of a work-related stress management program on perceived work-related stress in patients with chronic schizophrenia. METHOD: A single-blind, randomized crossover design was used. Twenty-nine patients undergoing vocational training while working at paid part-time jobs in a psychiatric center were randomly assigned to receive 12 weeks of a work-related stress management program followed by 12 weeks of no treatment, or the reverse. The Work-Related Stress Questionnaire for Chronic Psychiatric Patients (WSQP) was developed for this study and used to examine the treatment effect. RESULTS: The decrease in stress was significantly greater when the participants were undergoing the program compared to the decrease of stress when they were not (t = 2.93, p = .0034, r = .49). CONCLUSION: The results show that the work-related stress management program had large short-term positive effects on the patients' perceived work-related stress. These findings support providing this type of program to employed patients with chronic schizophrenia.

Postural Stability of Patients with Schizophrenia during Challenging Sensory Conditions: Implication of Sensory Integration for Postural Control.

Postural dysfunctions are prevalent in patients with schizophrenia and affect their daily life and ability to work. In addition, sensory functions and sensory integration that are crucial for postural control are also compromised. This study intended to examine how patients with schizophrenia coordinate multiple sensory systems to maintain postural stability in dynamic sensory conditions. Twenty-nine patients with schizophrenia and 32 control subjects were recruited. Postural stability of the participants was examined in six sensory conditions of different level of congruency of multiple sensory information, which was based on combinations of correct, removed, or conflicting sensory inputs from visual, somatosensory, and vestibular systems. The excursion of the center of pressure was measured by posturography. Equilibrium scores were derived to indicate the range of anterior-posterior (AP) postural sway, and sensory ratios were calculated to explore ability to use sensory information to maintain balance. The overall AP postural sway was significantly larger for patients with schizophrenia compared to the controls [patients (69.62±8.99); controls (76.53±7.47); t1,59 = -3.28, p<0.001]. The results of mixed-model ANOVAs showed a significant interaction between the group and sensory conditions [F5,295 = 5.55, p<0.001]. Further analysis indicated that AP postural sway was significantly larger for patients compared to the controls in conditions containing unreliable somatosensory information either with visual deprivation or with conflicting visual information. Sensory ratios were not significantly different between groups, although small and non-significant difference in inefficiency to utilize vestibular information was also noted. No significant correlations were found between postural stability and clinical characteristics. To sum up, patients with schizophrenia showed increased postural sway and a higher rate of falls during challenging sensory conditions, which was independent of clinical characteristics. Patients further demonstrated similar pattern and level of utilizing sensory information to maintain balance compared to the controls.

Estimating the prevalence of cerebral palsy in Taiwan: A comparison of different case definitions.

The estimated prevalence of cerebral palsy (CP) worldwide ranged from 0.74 to 3.6 per 1000 live births according to different studies, which may be due to different data sources and case definitions used. We used a representative sample of one million patients (about 1/23 of total population) covered by Taiwan's National Health Insurance (NHI) to estimate the prevalence using different case definitions. Eight years of NHI Research Database claims data for all children born between 1996 and 2000 were reviewed for CP diagnoses. The estimated prevalence of CP (cases per 1000 live births) varied from 4.1 to 1.3 for different case definitions. For a minimum age of 4 years old at diagnosis, a diagnosis made by specialists (pediatricians and physicians of physical medicine and rehabilitation), and the CP diagnosis was mentioned at least three times in claims data, the mean estimated prevalence of CP was 3.2 (95% CI 2.8-3.7). According to this definition, which is most compatible with previous studies, the estimated prevalence in Taiwan was 3.4 (95% CI 2.8-4.0) for boys and 3.1 (95% CI 2.5-3.7) for girls, significantly higher than that in other countries. Additional studies are needed to determine the reasons of higher prevalence in Taiwan.