Ai-Wen Hwang

Relations of balance function and gross motor ability for children with cerebral palsy.

To investigate the relations between the balance function and gross motor ability, we recruited 15 children with cerebral palsy from 5 to 12 years in age. Balance function was tested by the Smart Balance Master System and by clinical tests. The Motor Age test was used to test gross motor ability. Analysis showed that postural stability in eyes open, eyes closed, and swaying vision conditions (visual surrounding swaying with body sway), the duration of one leg standing, and the duration of maintaining a heel-to-toe position were significantly correlated with gross motor ability. Postural stability in the eyes-closed condition was the best predicting factor and could explain 64% of the variability of gross motor ability. Whether the training of postural stability in eyes-closed condition can improve the gross motor function needs further study.

Test–retest reliability of balance tests in children with cerebral palsy

To investigate intrasession and intersession reliability of balance tests in children with or without disabilities, 50 children without disabilities (ND) and 36 children with cerebral palsy (CP) aged from 5 to 12 years were tested. Intrasession reliability of postural stability of the Smart Balance Master System and one-leg standing test were assessed in both groups and intersession reliability of the Smart Balance Master System and balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were assessed in ND children. Intersession reliability of the postural stability test in ND children, obtained using the Smart Balance Master System, was of moderate to good reliability in centre target (CT), sway vision (SV), eyes open and sway surface (EOSS), and sway vision and sway surface (SVSS; ICC 0.72 to 0.84). In children with CP, intrasession reliability was high in CT (ICC 1). One-leg standing tests in both groups also had moderate to good intersession reliability (ICC 0.56 to 0.99). Agreement of failure score of lateral rhythmic shifting (LRS) at 1 second and 2 seconds pace was 85% and 93% respectively in ND children. Within the balance subtest of BOTMP, only two items had 100% agreement. Results suggest that postural stability tests in four conditions (CT, SV, EOSS, and SVSS), LRS, one-leg standing, and walking on a line are reliable and can be used to monitor balance control in ND children. Postural stability in CT condition and one-leg standing test are reliable in children with CP. Further study is needed to establish more reliable balance tests for children with CP.

The Influence of Wakeful Prone Positioning on Motor Development During the Early Life

Objective: The “Prone to Play” campaign was proposed and has been ongoing since 2001, but the causal and dosage effects of wakeful prone positioning on motor development are still unclear. The purpose of this longitudinal cohort study was to investigate the effects of prone wakeful positioning at 3 to 6 months of age on motor development during the 6 to 24 months age bracket. Methods: Two hundred eighty-eight full-term newborns were recruited at birth and followed up at 4, 6, 12, and 24 months of age respectively. Data on experience, duration, and preference of prone wakeful positioning were collected at 4 and 6 months of age. The acquisition ages of prone specific and nonprone milestones were collected and analyzed to evaluate the impact of wakeful prone positioning on motor development during early life. Gross motor developmental quotients (GMDQ) and fine motor developmental quotients (FMDQ) of the Comprehensive Developmental Inventory for Infants and Toddlers were assessed at ages 6 and 24 months. Results: The prone duration significantly affected the acquisition ages of 3 prone specific milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting; without affecting the other 2 nonprone specific milestones (walking and transferring objects), GMDQs and FMDQs. The infants of prone preference achieved prone specific milestones earlier than those of nonprone preference. The prone experience affected the crawling-on-abdomen acquisition age, but not the other motor outcomes. Conclusion: Wakeful prone positioning promotes prone-specific motor milestones in early infancy. “Prone to play for a certain amount of time in an interactive and supervised environment” might be advocated.

A randomized controlled trial of routines-based early intervention for children with or at risk for developmental delay

Routines-based early intervention (RBEI) for children with or at risk for developmental delay encourages collaboration between professionals and families to enhance childrens participation in family routines with family-selected goals. We conducted the first single-blinded randomized control trial to examine the effectiveness of a 6-month RBEI vs. traditional home visiting (THV), which uses a curriculum focused on childrens developmental domains. Thirty-one families with children aged 5-30 months (mean age 17.4 months) with or at risk for developmental delay were randomly assigned to an RBEI group (n=15) or a THV group (n=16). The enrolled children were evaluated using the Chinese version of Pediatric Evaluation of Disability Inventory (PEDI-C) and the Comprehensive Development Inventory for Infants and Toddlers (CDIIT) at 5 time points. Two-way mixed analysis of variance (ANOVA) was used to examine the group by stage interactions. Goal Attainment Scaling (GAS) and the Canadian Occupational Performance Measure (COPM) were applied to explore between-group differences on individualized goal achievement. PEDI-C showed that the RBEI group had a faster progress rate in self-care functions and independence in social functions in the first 3 months of intervention and at the 6-month follow-up. The RBEI group also scored higher on the GAS in the first 3 months of intervention. However, between-group differences in changes in the developmental domains on the CDIIT were not significant. Thus, RBEI was more effective than THV in promoting functional outcomes and reaching family-selected goals, while both interventions allowed equal improvement in developmental domains.

Development of traditional Chinese version of World Health Organization disability assessment schedule 2.0 36--item (WHODAS 2.0) in Taiwan: validity and reliability analyses.

BACKGROUND World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provided a standardized method for measuring the health and disability and the traditional Chinese version has not been developed. AIMS To describe the process of developing the traditional Chinese version of the WHODAS 2.0 36-item version and to evaluate the concurrent validity and test-retest reliability of this instrument. METHODS The study was conducted in two phases. Phase I was the process of translation of WHODAS 2.0 36-item version. Phase II was a cross-sectional study. The participants were 307 adults who were tested the validity and reliability of draft traditional Chinese version. RESULTS The reliability of Cronbachs α and ICC in the WHODAS 2.0 traditional Chinese version were 0.73-0.99 and 0.8-089, respectively. The content validity was good (r=0.7-0.76), and the concurrent validity was excellent in comparison with the WHOQOL-BREF (p<0.5). The construct validity, the model was explained total variance was 67.26% by the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) illustrated the traditional Chinese version was good to assess disability. There was a valid and reliable measurement scales for evaluating functioning and disability status. CONCLUSION For disability eligibility system of Taiwan government to measure the disability, the traditional Chinese version of the WHODAS 2.0 provided valuable evidence to design the assessment instrument.

Validity and reliability of the Functioning Disability Evaluation Scale-Adult Version based on the WHODAS 2.0--36 items.

BACKGROUND/PURPOSE The disability eligibility determination system is based on the International Classification of Functioning, Disability and Health (ICF) framework in Taiwan. The Functioning Disability Evaluation Scale (FUNDES) has been developed since 2007 for assessing the status of an individuals activities and participation in the disability eligibility system. The purpose of this study was to examine the reliability and validity of the FUNDES-Adult Version (FUNDES-Adult). METHODS During 2011-2012, a total of 5736 adults with disabilities (aged 58.4 ± 18.2 years) were randomly recruited for a national population-based study. These adults were assessed in person by certified professionals in the authorized hospitals. Domains 1-6 of the FUNDES-Adult addressing the performance and capability dimensions are modified from the World Health Organization Disability Assessment Schedule 2.0-36-item version, and Domain 7 (Environmental attribute) and capability and capacity dimensions of Domain 8 (Motor action) are designed based on the ICF coding system. RESULTS The internal consistency was excellent (Cronbachs α ≥ 0.9). An exploratory factor analysis yielded a five-factor FUNDES structure with a variance of 76.1% and 76.9% and factor loadings of 0.56-0.94 and 0.55-0.94 for the performance and capability dimensions, respectively. The factor loadings for the second-order confirmatory factor analysis for the performance and capability dimensions were from 0.81 to 0.89. In Domains 1-6 and 8, the ceiling effects were from 9% to 36%, and the floor effects were from 5% to 45%. CONCLUSION FUNDES-Adult has acceptable reliability and validity and can be used to measure activities and participation for people with disabilities.

Individualized Behavioral Assessments and Maternal Ratings of Mastery Motivation in Mental Age–Matched Toddlers With and Without Motor Delay

Background Mastery motivation is a precursor of future developmental outcomes. Evidence about whether toddlers with motor delay have lower mastery motivation is inconclusive. Objective The purpose of this study was to examine differences between mental age–matched toddlers with and without motor delay on various mastery motivation indicators. Design A mental age– and sex-matched case-control study was performed. Methods Twenty-two children with motor delay, aged 23 to 47 months, and 22 children who were developing typically, aged 15 to 29 months, were recruited. Persistence and mastery pleasure were measured with behavioral tasks that were moderately challenging for each child and with maternal ratings using the Dimensions of Mastery Questionnaire (DMQ). The DMQ was rated by each childs mother based on her perception of her childs motivation. Two types of structured tasks (a puzzle and a cause-effect toy selected to be moderately challenging for each child) were administered in a laboratory setting and recorded on videos. Paired t tests or Wilcoxon signed rank tests were used to examine group differences in persistence and mastery pleasure (α=.007, 2-tailed). Results Children with motor delay were rated lower on DMQ persistence than the typically developing group, but they did not show significantly lower persistence on the structured tasks. There were no significant differences in mastery pleasure between the 2 groups on either measure. Limitations Large within-sample variability on the tasks and small sample size makes subgroup analysis (eg, different severities) difficult. Conclusions Toddlers with motor delay did not show lower persistence and pleasure when given tasks that were moderately challenging; however, their mothers tended to view them as having lower motivation. Clinicians and parents should provide appropriately challenging tasks to increase childrens success and motivation.

Psychometric properties of a Chinese version of the home environment measure for motor development

Purpose. This study examined the psychometric properties of the Chinese version of the Affordance in the Home Environment for Motor Development – Toddler version (AHEMD-Toddler-C) for children developing typically (DT) or having motor delays (MD). Methods. This was a methodology study. Parent–child dyads with DT (n  ==  106, mean age of 27.9 months) and with MD (n  ==  45, 23.6 months) were enrolled. For test-retest reliability, parents completed AHEMD-Toddler-C twice within 2 weeks. For convergent validity, correlations were analysed between AHEMD-Toddler-C and Home Observation for Measurement of the Environment Inventory (HOME), and between AHEMD-Toddler-C and family variables. Results. Test-retest reliabilities for AHEMD-Toddler-C were adequate except for Variety of Stimulation (VS) subscale. For convergent validity, the correlation coefficients between AHEMD and HOME were 0.44 (p  <0.05). Two subscales of motor toys of AHEMD demonstrated convergent validity with Learning Material subscale of HOME and some family variables in children with MD. Inside Space subscale of AHEMD correlated with family variables. Outside Space (OS) subscale of AHEMD was not significantly correlated with HOME or family variables. Conclusion. AHEMD-Toddler-C is a new measure option to explore the relationships between home environment and motor development in Chinese-speaking countries. Nevertheless, VS and OS subscales should be used cautiously.

Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan.

Abstract Purpose: To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. Methods: Subjects (≥60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. Results: More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75–376.42, p < 0.001), age (1.38–4.81, p < 0.05), and speech impairment (1.94–5.80, p < 0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. Conclusions: Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability. Implications for Rehabilitation Older adults with physical disability often experience difficulties in household activities and mobility. Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease. Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

Construct validity of the Comprehensive Developmental Inventory for Infants and Toddlers

Background:  The aim of this study was to investigate the construct validity of the diagnostic test, the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT).