Chiung-Yu Cho

Detecting Balance Deficits in Frequent Fallers Using Clinical and Quantitative Evaluation Tools

OBJECTIVE: This investigation sought to determine whether older idiopathic frequent fallers could be distinguished from healthy older adults on the basis of balance and movement coordination tests. A secondary objective was to determine the relationships among clinical balance test scores, balance performance data obtained by accelerometry, and quantitative motor coordination tests.

Musculoskeletal symptoms and associated risk factors among office workers with high workload computer use.

OBJECTIVE Although the prevalence of reported discomfort by computer workers is high, the impact of high computer workload on musculoskeletal symptoms remains unclear. The purpose of this study was to investigate the prevalence of musculoskeletal symptoms for office workers with high computer workload. The association between risk factors and musculoskeletal symptoms was also assessed. METHODS Two questionnaires were posted on the Web sites of 3 companies and 1 university to recruit computer users in Tainan, Taiwan, during May to July 2009. The 12-item Chinese Health Questionnaire and Musculoskeletal Symptom Questionnaire were chosen as the evaluation tools for musculoskeletal symptoms and its associated risk factors. Chinese Health Questionnaire greater than 5 and computer usage greater than 7 h/d were used to as the cutoff line to divide groups. Descriptive statistics were computed for mean values and frequencies. χ(2) Analysis was used to determine significant differences between groups. A 0.05 level of significance of was used for statistical comparisons. RESULTS A total of 254 subjects returned the questionnaire, of which 203 met the inclusion criteria. The 3 leading regions of musculoskeletal symptoms among the computer users were the shoulder (73%), neck (71%), and upper back (60%) areas. Similarly, the 3 leading regions of musculoskeletal symptoms among the computer users with high workload were shoulder (77.3%), neck (75.6%), and upper back (63.9%) regions. High psychologic distress was significantly associated with shoulder and upper back complaints (odds ratio [OR], 3.46; OR, 2.24), whereas a high workload was significantly associated with lower back complaints (OR, 1.89). Females were more likely to report shoulder complaints (OR, 2.25). CONCLUSIONS This study found that high psychologic distress was significantly associated with shoulder and upper back pain, whereas high workload was associated with lower back pain. Women tended to have a greater risk of shoulder complaints than men. Developing an intervention that addresses both physical and psychologic problems is important for future studies.

A Comparison between young and old adults in their ability to rapidly sidestep during gait when attention is divided.

Background: The incidence of falls among older adults is high and the risk factors are often complex in nature. Considerable research has been done in the area of age-related changes of balance in an attempt to better understand the increased risk of falls. Studies of cognitive changes, however, suggest that the elderly are less able to divide their attention between two or more activities. This inability to divide attention could explain the increased risks of falls in the elderly. Objective: To investigate the effects of divided attention, age and prior knowledge of movement path, on kinetic measures and the position of the sacral marker relative to the center of pressure (COP) when individuals perform a rapid sidestep during walking. Methods: 32 young and 32 old adults participated in this study. Subjects walked and took a sidestep without interrupting forward progression. An arithmetic task was performed during half of the walking trials with the sidestep direction preplanned or unknown. Peak lateral ground reaction force, mean distance between COP and sacrum, walking velocity, performance speed and accuracy of the cognitive task were measured. Results: Both groups significantly decreased their mediolateral distance between the sacral marker and the COP in the dual-task trials (p = 0.04). Both groups significantly decreased their walking speed in the dual-task trials (p < 0.0001). Prior knowledge of the sidestep direction significantly affected the peak lateral ground reaction force and the sacral marker to COP distance but the differences were age-dependent. Young adults had a larger value in the unknown condition than in the preplanned condition (p < 0.0001). For the cognitive task, both groups decreased their performance speed (p < 0.0001) but maintained their performance accuracy as compared to the baseline data (p > 0.05). Conclusions: Our results revealed that old adults tended to be conservative, when facing the dual-task trials or unknown test condition. The fact that the older adults in the current study did not perform similarly to the younger adults suggests that they might have a fear of fall when facing a challenging balance task.

Higher prevalence of autism in Taiwanese children born prematurely: A nationwide population-based study

The reported prevalence of autism in preterm and full-term children varies partially because of small sample sizes. Moreover, little is known about the specific factors that contribute to the risk of autism in preterm children. We aimed to compare the prevalence of autism in preterm and full-term children and to identify neonatal risk factors for autism in preterm children using a large national health system database. We analyzed data from 1078 early preterm (<28 weeks of gestation or birth weight<1000 g), 28,947 later preterm (28-36 weeks), and 1,104,071 full-term (≥ 37 weeks) children who were 8-11 years old in 2009. The descending order of prevalence was early preterm (2.2%), later preterm (1.3%), and full-term (0.6%). The prevalence of autism was approximately 2-4 times higher in preterm children than in children born at full-term. The male-female ratio (4:1) in preterm and full-term children was not significantly different. Most of the children were first diagnosed with autism between 3 and 6 years old. Preterm children with autism were not diagnosed earlier than were full-term children. Regression analysis showed that male gender, a very low birth weight, and neonatal cerebral dysfunction were risk factors for autism in the preterm group. We conclude that autism is more prevalent in preterm children. Preventing extremely preterm birth and significant early brain insults may be helpful in reducing the risk of autism in preterm children.

The effect of aging on muscle activation and postural control pattern for young and older computer users

A lot of older adults try to learn to use computers and might use different ways to perform a computer task compared to younger people. Fifteen healthy young and 15 healthy older adults participated in this study and all performed a series of mouse tasks. A three dimensional motion capture system and electromyographic analysis were used to obtain kinematic and kinetic data during performing the computer tasks. Three-way analysis of variance with repeated measures on task and time factors was used to analyze all dependent measurements. Older adults had higher RMS of forearm muscles compared to the young adults. The RMS of the finger extensor was highest when performing a dragging task. Compared with young adults, the older adults had greater cranial-cervical angle and neck flexion, but smaller head flexion, shoulder angle, elbow angle and ulnar deviation. Consequently, the older adults might have a greater risk of developing musculoskeletal disorder.

Age-related changes of arm movements in dual task condition when walking on different surfaces

The purpose of this study was to investigate whether the dual task paradigm would influence arm movements during walking. Furthermore, we examined the effects of different walking surfaces on arm movements while performing dual tasks. The effects of age and gender were also investigated. Fifteen young adults and 15 older adults were included in this study. Subjects were asked to perform the walking task alone (single-task trial) and walking in combination with a cognitive task (dual-task trial). Four walking conditions (1 single task and 3 dual task trials)×two walking surfaces were encountered. Both age groups had greater elbow and trunk movement in the sagittal plane under the dual task trials as compared to the single task trial (p<.05). Subjects had greater upper extremity and upper body movement on the soft floor than on the hard floor (p<.05). Subjects had greater movement amplitude when confronting a challenging environment, especially in the contralateral side. Among gender, there was a group-gender interaction: the older females had smaller upper extremity movement than the older males (p<.05) but the opposite was true for the young adults. The results suggest that different age groups of males and females use different balance control strategy to deal with the challenging conditions.

Effect of Exercise Therapy for Mild Functional Scoliosis

Scoliosis is frequently found among general population, especially for female adolescent group. Patients with scoliosis may be treated by exercise therapy. However, the effect of exercise is always a controversial topic. The purpose of this study was to examine the effect of a three-month exercise therapy program for patients with mild scoliosis. Fourteen volunteers with mild scoliosis served as subjects of the study (6 males, 8 females). They were randomly divided into two groups: supervised exercise group and home program group. There was no significant difference in demographic characteristics between these two groups. Physical assessments included clinical evaluation of posture, and Metrecom 2000 postural analysis. Both of them were conducted during the initial patient interview. Physical therapist designed exercise for each individual. All participants were informed to conduct the exercise at least two times a week. The supervised exercise group performed their exercise under the supervision of a licensed physical therapists, and the home program group conducted their exercise at home after the inital interview. The second set of physical assessments was conducted after three months of exercise therapy. Descriptive statistic and paired t-test were used for data analysis. Nearly all patients performed better in the clinical evaluation results, however, the differences between these two groups were not significant (p＞0.05). As for scoliotic curve analysis, there was a significant improvement of scoliotic angle in the supervised exercise group (p＜0.05), but no significant difference in the home program group. The results of this study showed that exercise therapy might improve scoliotic patients posture, such as more symmetric shoulder, and pelvic level. However, for the quantitative evaluation such as forward bending and side-bending test, the researcher did not find any significant difference between pre-and post exercise measurements. Our results suggested that improvement of scoliotic curve in the exercise group may be due to better compliance and supervision.