Kenneth N.K. Fong

The effect of voluntary trunk rotation and half-field eye-patching for patients with unilateral neglect in stroke: a randomized controlled trial

Objective : To investigate the effectiveness of voluntary trunk rotation and half-field eye-patching to treat patients with unilateral neglect in stroke. Design : Pre—post, day 60 follow-up, single-blinded randomized controlled trial. Setting : Single-centre inpatient rehabilitation hospital. Subjects : Sixty subacute patients with right hemisphere stroke having unilateral neglect within eight weeks post stroke consented to participate between November 2003 and July 2005. They were randomly assigned to three comparison groups. Interventions : Nineteen patients received daily experimental training in voluntary trunk rotation (TR) for 1 hour five times a week for 30 days. Twenty patients received the same kind of treatment together with half-field eye-patching (TR + EP). Fifteen patients in the control group received conventional training with the same contact time. Main outcome measures : Patients were assessed on days 0, 30 and 60 using the Behavioural Inattention Test, the Clock Drawing Test, and the Functional Independence Measure. Results : No significant differences between voluntary trunk rotation (TR), voluntary trunk rotation and half-field eye-patching (TR + EP) and controls were found in functional performance and neglect measures at day 30 (P = 0.042—0.994) and follow-up (P = 0.052—0.911) at P = 0.005 using Bonferroni correction. Conclusions : The results of this study do not support the use of voluntary trunk rotation alone or with half-field eye-patching to improve functional performance or reduce unilateral neglect in subacute patients with stroke.

A Field Survey of the Expected Desirable Thermal Environment for Older People

In order to identify an indoor thermally comfortable environment for older people, this study examined the thermal acceptance of 384 older people of ages from 60 to 97 years under various thermal environmental conditions in 19 centers for older people in Hong Kong. The results were compared to those of the younger residents in Hong Kong. A probable decay of one predicted mean vote (PMV) for every 25.3 years was reported for older people beyond the age of 60 years ( p ≤ 0.05), which indicated that the older age group probably has a different expectation of a thermoneutral environment as compared with younger age groups. It was also noted that the expected PMV for a thermoneutral environment of older females was apparently higher than that for older males in the same age group. The results should be a useful reference for an acceptable thermally comfortable environment in centers for older people up to the age group over 90 years.

Systematic Review on the Effectiveness of Mirror Therapy in Training Upper Limb Hemiparesis after Stroke

Objective/Background This study aims to review the current evidence on effectiveness of mirror therapy (MT) in improving motor function of the hemiplegic upper limb (UL) among the adult stroke population in the last 12 years. Methods A systematic review of studies published in English from 1999 to 2011, retrieved from four electronic databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Sage Online, and ScienceDirect, was performed. Only articles focusing on the effects of MT to train UL motor function were included. The methodological quality of the studies was appraised based on the design and Physiotherapy Evidence Database Scale. Results Of the 1,129 articles, nine (six randomised controlled trials and three case reports) were reviewed. The majority of the studies were heterogeneous in design. The review indicated that the strength of current evidence for the use of MT with the stroke population is moderate and seemed to benefit participants with subacute stroke. Little is known about its long-term sustainability, the right target group of the stroke population, and the optimal time to start intervention. Conclusion More research is needed to determine the optimal dose of therapy, optimal time to start this intervention, and the right target group. Accordingly, no firm conclusions can now be drawn on the effectiveness of MT until more evidence is present.

Combined effects of sensory cueing and limb activation on unilateral neglect in subacute left hemiplegic stroke patients: a randomized controlled pilot study

Objective: To compare the effects of contralesional sensory cueing and limb activation with that of sham control in the treatment of unilateral neglect after stroke. Design: A randomized, single-blinded, sham-controlled pilot study. Setting: Two rehabilitation hospitals. Subjects: Forty subacute left hemiplegic stroke inpatients with unilateral neglect. Interventions: Participants were assigned randomly to 1 of 2 groups. The experimental group wore a wristwatch cueing device over the hemiplegic arm for three hours a day, five days per week, for three weeks, and also underwent conventional rehabilitation. Patients were encouraged to move their hemiplegic arm five consecutive times after each prompt. The sham group underwent the same rehabilitation process, except they wore a sham device. Main measures: Neglect, arm motor performance, and overall functioning were assessed pre- and posttraining, and at follow-up. Results: There were no significant differences between groups in outcome measures except the neglect drawing tasks (p = 0.034) (the mean gain score from baseline to follow-up assessment was 5.2 (3.7) in the experimental group and 1.9 (3.5) in the sham group), across three time intervals. The experimental group showed greater improvement in arm motor performance than did the sham group. Conclusion: The results did not confirm that sensory cueing and limb activation treatment is effective when compared with those receiving placebo to reduce unilateral neglect, but it might be useful for promoting hemiplegic arm performance in stroke patients.

Measuring processing speed after traumatic brain injury in the outpatient clinic

OBJECTIVES To evaluate processing speed performance in outpatients with moderate-to-severe traumatic brain injury (TBI). DESIGN Prospective cross-sectional observational study. PARTICIPANTS Twenty outpatients with traumatic brain injury (TBI) were compared with 20 matched healthy subjects. MEASURE Measurement by six instruments in the domains of simple reaction time (SRT), movement time (MT), and mental processing speed at a single time occasion. RESULTS Significant differences were found in speed but not accuracy of work between outpatients with TBI and healthy subjects. Simple reaction time was sensitive to predicting patients with moderate-to-severe TBI as opposed to healthy counterparts. CONCLUSION Outpatient clinics should consider measuring SRT.

Falls Among the Community-living Elderly People in Hong Kong: A Retrospective Study

Purpose To examine the base rate of falls for a group of community-living elderly people in Hong Kong. Methods This was a retrospective cross-sectional study of 554 elderly people aged 65 years or above living in various geographical regions of Hong Kong, who had completed assessments at a community centre over a period of 4 months. Participants were recruited by convenience sampling and stratified by age range according to the distribution in Hong Kong population. They were asked to report on their fall history for a period of the 12 months before joining the study. Results Of all the participants, 111 reported having fallen during the preceding 12 months. The fall rate was 29%, and the 1 -year prevalence of falls was 20%, dropping to 6.3% for two or more falls. Of all the falls, 47.7% occurred indoors whereas 52.3% occurred outdoors. Results showed female gender, Timed Up & Go Test, self-reported history of upper limb fracture, an intake of four or more types of medication, receiving rehabilitation services, and living with a couple only were independent predictors for fallers with at least one fall. There were no significant differences between the number of near-miss experienced by fallers and nonfallers in the past 12 months. Conclusion We determined the base rate of falls for a group of community-living elderly people of Hong Kong. Retrospective methods, which ask elderly people living in a community to recall their falls, may be used to identify risks preceding falls and to facilitate early intervention.

Effects of Sensory Cueing on Voluntary Arm Use for Patients With Chronic Stroke: A Preliminary Study

OBJECTIVE To investigate the effect of a 2-week program of sensory cueing in which vibration induces the use of the paretic upper extremity in participants with chronic stroke in the community. DESIGN A single-group longitudinal study. SETTING Self-help organizations. PARTICIPANTS A convenience sample of 16 community residents (N=16) with chronic unilateral stroke and mild to moderate upper-extremity impairment stratified by the severity of their paretic arm function, measured by using the Functional Test for the Hemiplegic Upper Extremity (FTHUE). INTERVENTIONS Participants engaged in repetitive upper-extremity task practice for 2 weeks while wearing an ambulatory sensory cueing device on their affected hand for 3 hours a day. MAIN OUTCOME MEASURES Evaluations were conducted on the 3 occasions of pretest (1 day before training), posttest (immediately after training), and follow-up test (2 weeks after training) by using the following behavioral measures of paretic upper-extremity performance: the Action Research Arm Test (ARAT), the Box and Block Test, the Fugl-Meyer Assessment (FMA), the FTHUE, power and pinch grips, the Motor Activity Log assessment of arm use, and kinematic data obtained from the device. RESULTS Significant differences were found in ARAT and FMA scores among the pretest, posttest, and follow-up evaluations. The lower functioning group achieved a more significant increase in overall upper-extremity score than in the hand score for the FMA. CONCLUSION A combination of sensory cueing and movement-based strategies is useful and feasible in improving paretic upper-extremity performance in participants with chronic stroke; however, additional studies with a larger sample size and longer treatment period in a randomized controlled trial would be beneficial.

Clinical Utility of the Action Research Arm Test, the Wolf Motor Function Test and the Motor Activity Log for Hemiparetic Upper Extremity Functions After Stroke: A Pilot Study

Objective To investigate the use of the Action Research Arm Test (ARAT), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL) in patients with stroke and different degrees of severity of hemiparetic upper extremity impairment in a community centre in Hong Kong. Methods Twelve participants with stroke, who resided in the community, were recruited by convenience sampling. Outcome measures included the ARAT, the WMFT, and the MAL, and were conducted on a single occasion. Results The ARAT, the WMFT, and the amount of use (AOU) and quality of movement (QOM) of the MAL were highly correlated with the hemiplegic upper limb functional levels. The ARAT and the WMFT were interrelated (r = 0.96). Both the AOU and the QOM subscales of the MAL were highly correlated with the ARAT (r = 0.91; r = 0.97) and the WMFT (r = 0.86; r = 0.92). Conclusions Occupational therapists should consider administering the WMFT first, and the ARAT can then be used to identify problems in certain areas of upper extremity function, such as grasping, gripping and pinching, in order to guide treatment. The MAL is highly recommended as an outcome measure across patients, and the results could guide treatment planning.

Air quality influence on chronic obstructive pulmonary disease (COPD) patients’ quality of life

UNLABELLED Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death. The relationship between urban air pollution and its short-term health effects on patients suffering from COPD is confirmed. However, information about the impact of air pollutants upon the quality of life (QOL) in patients with COPD is lacking. Through a cross-sectional survey, this study investigates such impact in terms of the scores of the (Chinese) chronic respiratory questionnaire (CCRQ) and the measurements of indoor air quality (IAQ), lung function and Mosers activities of daily living (ADL). Using Yules Q statistic with a cutoff |Q|>0.7 to identify the strong relationships between environmental parameters and CRQ sub-scores, this study reveals that patient emotion is strongly associated with indoor environmental quality although the evidence of a causal relationship between them needs further research. PRACTICAL IMPLICATIONS As QOL in patients with COPD and indoor environmental parameters are strongly associated, indoor air pollutants must be monitored for related studies in the future.

‘Remind to move’: a pilot study on the effects of sensory cueing treatment on hemiplegic upper limb functions in children with unilateral cerebral palsy

Objective: To investigate the effects of sensory cueing with repetitive practice on hemiplegic arm functions in children with unilateral cerebral palsy. Design: A single-group pre/post comparison. Setting: A special school for children with physical disabilities. Subjects: Eight children with unilateral cerebral palsy aged 6–18 years. Interventions: Participants were required to wear for three weeks a sensory cueing, non-activated wristwatch device and complete 5 hours of conventional therapy per week (treatment A). This was followed by three weeks of continuing conventional therapy and wearing the now activated wristwatch, which prompted the children to do predetermined exercises on the hemiplegic arm for 6 hours daily, 5 days per week, for three weeks (treatment B), and three weeks follow-up. Main measures: Assessments of arm efficiency, functional hand use and arm impairments were carried out at baseline (day before treatment A), posttest 1 (day after treatment A), posttest 2 (day after treatment B) and follow-up (three weeks after treatment B). Results: Arm efficiency as revealed by the Jebsen–Taylor Hand Function Test and the Bruininks–Oseretsky Test of Motor Proficiency – but not actual arm use and grip strength – showed significant improvement after treatment B to follow-up (from 286.0 ± 73.9 to 191.9 ± 73.5, P = 0.002, and from 15.5 ± 5.0 to 18.1 ± 7.7, P = 0.021). Conclusion: This pilot study provides proof-of-concept data showing that a wearable device might be used to remind children with cerebral palsy to perform a set of predetermined arm exercises in order to promote hemiplegic arm function.