Chun-Hou Wang

Trunk Control as an Early Predictor of Comprehensive Activities of Daily Living Function in Stroke Patients

Background and Purpose— Prediction of activities of daily living (ADL) functions at an early stage after a stroke is critical because it enables clinicians to set treatment programs and goals. The objective of this study was to assess the relationship between trunk control at an early stage and comprehensive ADL function (as assessed by combining basic ADL and instrumental ADL [IADL]) in patients at 6 months after stroke. Methods— A total of 169 stroke patients participated in this prospective study. Trunk control was measured with the use of the trunk control items of the Postural Assessment Scale for Stroke Patients (PASS-TC). In addition to the PASS-TC score, age, sex, type of stroke, side of hemiparesis, urinary incontinence, limb paresis (measured by the Fugl-Meyer motor test), balance (measured by the Fugl-Meyer balance test), and basic ADL (measured by the Barthel Index) were also selected as predictor variables. These variables were assessed at 14 days after stroke or earlier. The Barthel Index and Frenchay Activities Index (measuring IADL) were administered at 6 months after stroke. The sum of the standardized Barthel Index and standardized Frenchay Activities Index scores was used to assess comprehensive ADL function. Results— Multivariable stepwise linear regression analysis showed that PASS-TC score, age, Fugl-Meyer motor test score, and Barthel Index score (listed by the order of forward selection) were the strongest predictors of comprehensive ADL function. These results were internally validated with the use of the bootstrap resampling technique. The PASS-TC score alone accounted for 45% of the variance in predicting comprehensive ADL function. Results also indicated that the PASS-TC score had slightly more power in predicting comprehensive ADL function than either the Fugl-Meyer motor test score or Barthel Index score. Conclusions— The findings of this study provide strong evidence of the predictive value of trunk control on comprehensive ADL function in stroke patients. The results imply that early assessment and management of trunk control after stroke should be emphasized.

Psychometric Properties of Functional Balance Assessment in Children With Cerebral Palsy

Background. Children with cerebral palsy often suffer from a lack of balance compared with typically developing children. Because balance capacity is relevant to functional activities, reliable and valid functional balance measures are crucial for the pediatric clinical setting. Objective. This study examined the reliability and validity of 3 functional balance measures. Methods. Thirty children aged 60 to 142 months with Gross Motor Function Classification System (GMFCS) levels of I to IV were recruited. For test-retest reliability, the same physical therapist administered the Functional Reach Test (FRT), Berg Balance Scale (BBS), and Timed Up and Go (TUG) twice. For interrater reliability, the testing processes were video recorded and later scored by another therapist. For convergent validity, children with cerebral palsy received the Gross Motor Function Measures (GMFM), walking speed, and 10-second sit-to-stand test within 1 week and the results evaluated. Results. The 3 functional balance measures had excellent test-retest reliability (intraclass correlation coefficient [ICC] >0.95) and interrater reliability (ICC = 0.98-1.00). With regard to convergent validity, the BBS and the TUG were highly correlated with GMFM total score, walking speed, and the 10-second sit-to-stand test. The discriminate validity indicates that the FRT can distinguish children with cerebral palsy with different GMFCS levels, whereas the BBS total score and TUG failed to distinguish between children with cerebral palsy with GMFCS levels of I and II. Conclusion. The 3 functional balance measures are simple, valid, and reliable for examining children with cerebral palsy and are thus suitable for clinical practice.

The Relationship Between Sitting Stability and Functional Performance in Patients With Paraplegia

OBJECTIVES To compare sitting stability between patients with high and low thoracic spinal cord injury (SCI), to determine the factors that can predict sitting stability, and to examine the relationship between sitting stability and functional performance. DESIGN Cross-sectional assessment was performed on subjects with paraplegia. SETTING Rehabilitation hospital affiliated with a medical university. PARTICIPANTS Convenience sample of 30 adults with complete chronic thoracic SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES (1) Postural sway during quiet sitting over 30 seconds was recorded as static sitting stability, and composite maximal weight-shift during leaning tasks over 30 seconds was measured as dynamic sitting stability; (2) age, body weight, trunk length, trunk strength, postonset duration, injury level, and presence of spasticity were examined as predictive variables for sitting stability; and (3) the time for completion of upper- and lower-body dressing and undressing and transfer was measured as functional performance. RESULTS A significant difference in composite maximal weight-shift was found between high and low thoracic SCI subjects (t=2.90, P<.01). Injury level and trunk length were 2 important predictive factors for dynamic sitting stability, and they explained 43.5% of the variance. Only the completion time of upper-body dressing and undressing correlated significantly with static (r=.465, P=.01) and dynamic (r=-.377, P<.05) sitting stability. CONCLUSIONS The subjects with low thoracic SCI showed better dynamic sitting stability than those with high thoracic SCI. Injury level and trunk length, not trunk flexion or extension strength, predicted the outcome of dynamic sitting stability. Measures were not precise enough to predict functional performance from the viewpoint of injury level and sitting stability. The underlying premise that a reduction or increase in trunk strength is indicative of poorer or better sitting stability in SCI individuals is questioned, and implications for problem identification and treatment planning are discussed.

Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients

OBJECTIVES To evaluate the effects of an anterior ankle-foot orthosis (AFO) on static and dynamic postural stability in hemiplegic patients. DESIGN A cross-sectional assessment of hemiplegic subjects with and without an AFO. SETTING Outpatient department of a rehabilitation hospital. PATIENTS A convenience sample of 24 subjects who had been prescribed an anterior AFO. OUTCOME MEASURES Postural sway index and postural symmetry (body weight distribution through the affected leg) when standing were measured as static postural stability. Maximal balance range in anterior-posterior and lateral directions and the affected legs weight bearing after weight shift to affected side were measured as dynamic postural stability. RESULTS When wearing the anterior AFO, there was no significant difference and small effect size (r<0.3) in postural sway index (p = .35), postural symmetry (p = .21), and maximal balance range in anterior-posterior direction (p = .46). There was a significant improvement and large effect size (r>0.5) in lateral weight shifting (p<.01) and weight bearing through the affected leg after weight shifted to the affected side (p<.01). CONCLUSIONS The significant effects of the anterior AFO in long-term hemiplegic patients were on lateral weight shifting and weight bearing through affected leg after weight shifted to the affected side. Postural sway, postural symmetry, and anterior-posterior weight shifting were not significantly affected.

Comparison of Psychometric Properties of Three Mobility Measures for Patients With Stroke

Background and Purpose— This study compared the validity, responsiveness, and interrater reliability of 3 mobility measures in stroke patients from the acute stage up to 180 days after stroke onset. The 3 measures were the Rivermead Mobility Index (RMI), a modified RMI (MRMI), and the Mobility Subscale of the Stroke Rehabilitation Assessment of Movement (STREAM). Methods— The validity and responsiveness of the 3 mobility measures were prospectively examined by monitoring 57 stroke patients with the measures and the Barthel Index at 14, 30, 90, and 180 days after stroke onset. Two individual raters used the 3 measures to evaluate a different sample of 40 patients on 2 separate occasions to determine the interrater reliability. Results— The Spearman &rgr; between STREAM and MRMI was ≥0.92; the intraclass correlation coefficient (ICC, a measure of agreement) between them was ≥0.89, indicating high concurrent validity of both measures. RMI showed a moderate to high relationship and agreement with STREAM and MRMI (&rgr;≥0.78, ICC≥0.5). Responsiveness of the 3 measures was high before 90 days after stroke onset (standardized response mean ≥0.83) and low at 90 to 180 days after stroke onset (0.2≤standardized response mean≤0.4). The score changes of the 3 measures at each stage were significant (P ≤0.05), except for RMI and MRMI at 90 to 180 days after stroke onset. The interrater agreement of the 3 measures was high (ICC≥0.92). Conclusions— All 3 measures examined showed acceptable levels of reliability, validity, and responsiveness in stroke patients. The psychometric characteristics of STREAM were slightly superior to those of the other 2 measures among our patients. We prefer and recommend STREAM for measuring mobility disability in stroke patients.

Psychometric Properties of the Berg Balance Scale in a Community-dwelling Elderly Resident Population in Taiwan

BACKGROUND/PURPOSE To investigate the psychometric properties (acceptability, internal consistency reliability, interrater reliability, construct validity) and identify the most challenging items of the Berg Balance Scale (BBS) for elderly people living in the community. METHODS A total of 268 community-dwelling adults 65 years of age or older volunteered to participate in this study. Each subjects performance was assessed with the BBS, timed up and go (TUG) test, and usual gait speed. For testing interrater reliability, the other 68 community-dwelling older adults who met the criteria were also recruited. RESULTS The BBS demonstrated good internal consistency reliability (Cronbachs alpha = 0.77), good interrater reliability (ICC(2,1) = 0.87), and moderate correlation with the TUG and usual gait speed (Spearmans rho = -0.53 and 0.46, respectively). The BBS score of the mobility/IADL (instrumented activities of daily living) able group was also significantly higher than that of the disabled group. Among all items on the BBS, tandem stance (item 13) and one-legged stance (item 14) were found to be the most challenging items for the subjects in the sample. CONCLUSION The results of this study suggest that the internal consistency reliability, interrater reliability, and construct validity of the BBS are adequate for measuring balance in community-dwelling older adults. Among all items in the BBS, the tandem stance and one-legged stance are the most challenging items. Further study of their applicability for screening use in the community is warranted.

Effect of 6 months of whole body vibration on lumbar spine bone density in postmenopausal women: a randomized controlled trial

Background The issue of osteoporosis-induced fractures has attracted the world’s attention. Postmenopausal women are particularly at risk for this type of fracture. The nonmedicinal intervention for postmenopausal women is mainly exercise. Whole body vibration (WBV) is a simple and convenient exercise. There have been some studies investigating the effect of WBV on osteoporosis; however, the intervention models and results are different. This study mainly investigated the effect of high-frequency and high-magnitude WBV on the bone mineral density (BMD) of the lumbar spine in postmenopausal women. Methods This study randomized 28 postmenopausal women into either the WBV group or the control group for a 6-month trial. The WBV group received an intervention of high-frequency (30 Hz) and high-magnitude (3.2 g) WBV in a natural full-standing posture for 5 minutes, three times per week, at a sports center. Dual-energy X-ray absorptiometry was used to measure the lumbar BMD of the two groups before and after the intervention. Results Six months later, the BMD of the WBV group had significantly increased by 2.032% (P=0.047), while that of the control group had decreased by 0.046% (P=0.188). The comparison between the two groups showed that the BMD of the WBV group had increased significantly (P=0.016). Conclusion This study found that 6 months of high-frequency and high-magnitude WBV yielded significant benefits to the BMD of the lumbar spine in postmenopausal women, and could therefore be provided as an alternative exercise.

The minimal detectable change of the simplified stroke rehabilitation assessment of movement measure

OBJECTIVE To help clinicians and researchers interpret change scores of the simplified Stroke Rehabilitation Assessment of Movement measure, we estimated the minimal detectable change of the 3 subscales (including upper-limb movements, lower-limb movements, and mobility) of the measure. DESIGN AND PATIENTS The measure was tested on 102 patients with chronic stroke by a single rater twice, with a 7-14-day interval for the test-retest study, and on 54 patients with sub-acute stroke by 2 raters twice, with a 2-day interval for the inter-rater study. METHODS The minimal detectable change was calculated on the basis of standard error of measurement. Furthermore, the intraclass correlation coefficient was used to examine the agreement between test and retest and between different raters. RESULTS The minimal detectable changes were from 12.5 to 13.2 points for the 3 subscales in the test-retest study and from 16.6 to 18.5 points in the inter-rater study. The test-retest agreement and the inter-rater agreement were sufficient (intraclass correlation coefficient = 0.88-0.96). CONCLUSION The minimal detectable changes of the simplified Stroke Rehabilitation Assessment of Movement measure are useful for both clinicians and researchers to determine whether the change score of an individual patient is real.

Could forearm Kinesio Taping improve strength, force sense, and pain in baseball pitchers with medial epicondylitis?

Objective:To determine short-term effects of applied forearm Kinesio Taping (KT) on pain, wrist flexor strength, and force sense for baseball players with medial epicondylitis (ME). Design:Case-control repeated measures study. Setting:Clinical sports medicine research laboratory in a medical university. Participants:A group of 10 baseball players with ME (ME group) and another group of 17 healthy collegiate athletes (healthy group). Intervention:Three taping conditions were applied in both groups: (1) no taping applied, (2) placebo taping applied (PT), and (3) KT applied. Main Outcome Measures:Three variables were measured including maximal wrist flexor strength, related/absolute force sense errors, and pain scale (pressure pain and pain tolerance) under 3 taping conditions. Results:No significant relationship was found either in maximal wrist flexor strength or in related force sense errors between the 2 groups with taping applied, except absolute force sense errors (P = 0.037). Both the healthy group and the ME group in absolute force sense measurement significantly decreased the errors in PT and KT conditions. Also, the tolerance of pressure pain also improved in both the healthy group and the ME group when performing PT and KT conditions. Conclusions:Forearm KT may enhance absolute force sense and improve pain condition for both healthy athletes and athletes suffering from ME when placebo and KT applied. However, KT did not result in significant changes in maximal wrist flexor strength for either group.

Developing a Short Form of the Postural Assessment Scale for People With Stroke

Objective: To develop a Short Form of Postural Assessment Scale for Stroke patients (SFPASS) with sound psychometric properties (including reliability, validity, and responsiveness). Methods. This study consisted of 2 parts: developing the SFPASS and cross-validation. In the 1st part, 287 people with stroke were evaluated with the PASS at 14- and 30-day post-stroke intervals. The authors reduced the number of test items that constitute the PASS by more than half (i.e., making 5-, 6-, and 7-item sets) and simplified the scoring system (i.e., collapsing the 4-level scale in the original PASS into a 3-level scale [PASS-3L]), making both 4-L and 3-L versions available. Thus, a total of 6 SFPASSs were generated. In addition, 2 external criteria, the Barthel activities of daily living index and the Fugl-Meyer motor test, were used to examine the validity of the 6 SFPASSs. The psychometric properties of the new 6 SFPASSs were compared with each other as well as with those of the original PASS to determine which scale outperformed the others. In the 2nd part of the study, the authors cross-validated the best SFPASS using another independent sample of 179 people with stroke. Results. All 6 SFPASSs demonstrated good reliability, validity, and responsiveness. However, the Bland-Altman plots showed that only the 5-item PASS-3L demonstrated no systematic trend between the difference and mean score of the 5-item PASS-3L and the original PASS. The 5-item PASS-3L also had psychometric properties similar to those of the original PASS, as demonstrated in a cross-validation sample. Conclusion. The authors’ results provide strong evidence that the 5-item PASS-3L has sound psycho-metric properties in people with stroke. The 5-item PASS-3L is simple and fast to administer and is thus recommended.