Mei-Hsiang Chen

A controlled pilot trial of two commercial video games for rehabilitation of arm function after stroke

Objectives: To investigate the acceptability and potential efficacy of two commercial video games for improving upper extremity function after stroke in order to inform future sample size and study design. Design: A controlled clinical trial design using sequential allocation into groups. Setting: A clinical occupational therapy department. Subjects: Twenty-four first-stroke patients. Interventions: Patients were assigned to one of three groups: conventional group, Wii group, and XaviX group. In addition to regular one-hour conventional rehabilitation, each group received an additional half-hour of upper extremity exercises via conventional devices, Wii games, or XaviX games, for eight weeks. Main measures: The Fugl-Meyer Assessment of motor function, Box and Block Test of Manual Dexterity, Functional Independence Measure, and upper extremity range of motion were used at baseline and postintervention. Also, a questionnaire was used to assess motivation and enjoyment. Results: The effect size of differences in change scores between the Wii and conventional groups ranged from 0.71 (SD 0.59) to 0.28 (SD 0.58), on the Fugl-Meyer Assessment of motor function (d = 0.74) was larger than that between the XaviX and conventional groups, ranged from 0.44 (SD 0.49) to 0.28 (SD 0.58) (d = 0.30). Patient enjoyment was significantly greater in the video game groups (Wii mean 4.25, SD 0.89; XaviX mean 4.38, SD 0.52) than in the conventional group (mean 2.25, SD 0.89, F = 18.55, p < 0.001), but motivation was not significantly different across groups. Conclusion: Patients were positive to using video games in rehabilitation. A sample size of 72 patients (24 per group) would be appropriate for a full study.

Improving the utility of the Brunnstrom recovery stages in patients with stroke: Validation and quantification

Abstract The Brunnstrom recovery stages (the BRS) consists of 2 items assessing the poststroke motor function of the upper extremities and 1 assessing the lower extremities. The 3 items together represent overall motor function. Although the BRS efficiently assesses poststroke motor functions, a lack of rigorous examination of the psychometric properties restricts its utility. We aimed to examine the unidimensionality, Rasch reliability, and responsiveness of the BRS, and transform the raw sum scores of the BRS into Rasch logit scores once the 3 items fitted the assumptions of the Rasch model. We retrieved medical records of the BRS (N = 1180) from a medical center. We used Rasch analysis to examine the unidimensionality and Rasch reliability of both upper-extremity items and the 3 overall motor items of the BRS. In addition, to compare their responsiveness for patients (n = 41) assessed with the BRS and the Stroke Rehabilitation Assessment of Movement (STREAM) on admission and at discharge, we calculated the effect size (ES) and standardized response mean (SRM). The upper-extremity items and overall motor items fitted the assumptions of the Rasch model (infit/outfit mean square = 0.57–1.40). The Rasch reliabilities of the upper-extremity items and overall motor items were high (0.91–0.92). The upper-extremity items and overall motor items had adequate responsiveness (ES = 0.35–0.41, SRM = 0.85–0.99), which was comparable to that of the STREAM (ES = 0.43–0.44, SRM = 1.00–1.13). The results of our study support the unidimensionality, Rasch reliability, and responsiveness of the BRS. Moreover, the BRS can be transformed into an interval-level measure, which would be useful to quantify the extent of poststroke motor function, the changes of motor function, and the differences of motor functions in patients with stroke.

DEVELOPMENT OF A COMPUTERIZED DIGIT VIGILANCE TEST AND VALIDATION IN PATIENTS WITH STROKE

OBJECTIVES To develop a computerized Digit Vigilance Test (C-DVT) with lower random measurement error than that of the DVT and to examine the concurrent validity, ecological validity, and test-retest reliability of the C-DVT in patients with stroke. DESIGN A cross-sectional study. PATIENTS Forty-four patients with stroke. METHODS We developed and tested the C-DVT. To examine the psychometric properties, the participants completed both the C-DVT and DVT twice with a 14-day interval. RESULTS We developed the C-DVT on the basis of expert input and examinee feedback. C-DVT scores were highly correlated with DVT scores (ρ = 0.75), supporting the concurrent validity. The C-DVT scores were moderately correlated with the scores of the Barthel Index and the Activities of Daily Living Computerized Adaptive Testing system (ρ = -0.60~-0.57), supporting the ecological validity. The test-retest agreement of the C-DVT was excellent (intra-class correlation coefficient = 0.92). The random measurement error of the C-DVT (minimal detectable change percent change (MDC%) = 15.4%) was acceptable and lower than that of the DVT (33.0%). The practice effects of the C-DVT were statistically significant, but the effect size d was small (0.15). CONCLUSION A C-DVT with a limited amount of random measurement error was developed. These preliminary findings show that the C-DVT demonstrates satisfactory concurrent validity, ecological validity, and test-retest reliability in patients with stroke.

Refining 3 Measures to Construct an Efficient Functional Assessment of Stroke

Background and Purpose— The Fugl-Meyer Assessment motor scale, Postural Assessment Scale for Stroke patients, and Barthel Index are widely used to assess patients’ upper extremity and lower extremity motor function, balance, and basic activities of daily living after stroke, respectively. However, these 3 measures (72 items) require a great amount of time for assessment. Therefore, we aimed to develop an efficient test, the Functional Assessment of Stroke (FAS). Methods— The FAS was constructed from 4 short-form tests of the Fugl-Meyer Assessment-upper extremity, Fugl-Meyer Assessment-lower extremity, Postural Assessment Scale for Stroke patients, and Barthel Index based on the results of Rasch analyses and the items’ content. We examined the psychometric properties of the FAS, including Rasch reliability, concurrent validity, convergent validity, known-group validity, and responsiveness. Results— The FAS contained 29 items (10, 6, 8, and 5 items for the 4 short-form tests, respectively). The FAS demonstrated high Rasch reliability (0.92–0.94), concurrent validity (r=0.90–0.97 with the original tests), convergent validity (r=0.62–0.94 with the 5-scale Fugl-Meyer Assessment), and known-group validity (significant difference in the FAS scores among 3 groups of disability levels; P<0.001). In addition, the responsiveness of the FAS (standardized response mean=0.55–1.93) was similar or significantly superior to those of the original tests (standardized response mean=0.46–1.39). Conclusions— The FAS contains 29 items and has sufficient Rasch reliability, validities, and responsiveness. These findings support that the FAS is efficient for reliably and validly assessing upper extremity/lower extremity motor function, balance, and basic activities of daily living and for sensitively detecting change in those functions in patients with stroke.

Development of a Tablet-based symbol digit modalities test for reliably assessing information processing speed in patients with stroke.

Abstract Purpose: To develop a Tablet-based Symbol Digit Modalities Test (T-SDMT) and to examine the test–retest reliability and concurrent validity of the T-SDMT in patients with stroke. Methods: The study had two phases. In the first phase, six experts, nine college students and five outpatients participated in the development and testing of the T-SDMT. In the second phase, 52 outpatients were evaluated twice (2 weeks apart) with the T-SDMT and SDMT to examine the test–retest reliability and concurrent validity of the T-SDMT. Results: The T-SDMT was developed via expert input and college student/patient feedback. Regarding test–retest reliability, the practise effects of the T-SDMT and SDMT were both trivial (d=0.12) but significant (p≦0.015). The improvement in the T-SDMT (4.7%) was smaller than that in the SDMT (5.6%). The minimal detectable changes (MDC%) of the T-SDMT and SDMT were 6.7 (22.8%) and 10.3 (32.8%), respectively. The T-SDMT and SDMT were highly correlated with each other at the two time points (Pearson’s r=0.90–0.91). Conclusions: The T-SDMT demonstrated good concurrent validity with the SDMT. Because the T-SDMT had a smaller practise effect and less random measurement error (superior test–retest reliability), it is recommended over the SDMT for assessing information processing speed in patients with stroke. Implications for Rehabilitation The Symbol Digit Modalities Test (SDMT), a common measure of information processing speed, showed a substantial practise effect and considerable random measurement error in patients with stroke. The Tablet-based SDMT (T-SDMT) has been developed to reduce the practise effect and random measurement error of the SDMT in patients with stroke. The T-SDMT had smaller practise effect and random measurement error than the SDMT, which can provide more reliable assessments of information processing speed.

Developing a Digital Game for Domestic Stroke Patients' Upper Extremity Rehabilitation - Design and Usability Assessment

Digital games have been proven effective in upper extremity rehabilitation for stroke patients in addition to arousing higher motivation and feelings of pleasure. A well designed upper extremity rehabilitation digital game should intentionally meet the purpose of rehabilitation. Therefore, it is desirable to dmestically develop digital upper extremity rehabilitation games for the local hospitals as well as individual users. We are proposing this research to develop such digital games for rehabilitation and their feasibility assessment. A questionnaire was designed to evaluate the usability and feasibility associated with using this game. The results of this study can be summarized as follows: (1) the set of upper extremity rehabilitation game was named as upper extremity rehabilitation gardening game (UERG game). It is special designed for domestic stroke patients. (2) This UERG game uses Kinect’s skeletal tracking features and motion sensor to interaction with patients. (3) design features are as following: game contents include three difficult levels according to different upper limb motor function recovery stages; to record user’s motor performance; to provide feedback information (for example: to record the completed the task time and to detect whether the user has compensatory action, etc.). (4) A total of 10 patients to assess this set of games. The results showed that 90 % of patients reported that using UERG game in treatment increased their treatment motivation.; 70 % of them reported that this games is very interactive; 80 % patients considered this game is conducive to recovery their upper extremity functions; 80 % patients considered the feedback information provided help them to understand their performance in each session after training; 60 % patients indicated the game interfaces were easy to operate and learning; 90 % of patients reported that this game is enjoyment and satisfied with this game for rehabilitation. They are willing to continue to use.

Improvement Design of the Clinical Upper Extremity Rehabilitation Product for Stroke Patients

The purpose of this study was to survey the usage problems and needs of the traditional UERE and commercial digital videogames applied in rehabilitation, and summarize a guideline for improvement design of the digital UERP. According to the guideline, this study was to design a Hand-rehab product design with treatment needs, and evaluate its acceptability with a questionnaire. The hardware design features includes: (1) the shapes and sizes of the operation objects can be chosen by the users to fit their own hand dimensions, (2) weight of the object can also be adjusted accordingly. The software design features are: (3) it displays visual and verbal cues, game scores, and operation times to the patients in each stage, notifying whether or not their action succeeded, (4) it allows adjustments of the reaction time to movements and the scope of sensing area of the objects. (5) The scope size of sensing area of the object can be adjusted. A total of 52 post-stroke patients were invited to assess the acceptability of Hand-rehab product. For the acceptability, most patients, after a trial with this product, reported had a positive and high satisfaction (mean 6.7, SD 0.6) with Hand-rehab product for rehabilitation.

Design Improvement Requirements for the Upper Extremity Rehabilitation Devices in Taiwan

This study aims to survey the most frequently used upper extremity rehabilitation devices (UERD) in Taiwan and how well their design meet the practical requirements of rehabilitation therapy. A questionnaire was prepared and sent to a sample of therapists in Taiwan hospitals. Analysis of the replied questionnaires can be summarized as follows: 1) The 185 respondents consisted of 68 males (37%) and 117 females (63%), with average age 31.3 yrs and work experience 7.2 yrs. 2) Therapists thought that the better ones of the existing UERD are Vertical tower, Stacking cones, Climbing board and bar, and Incline board. These devices are mainly used to treat patients’ movements of upper extremity in vertical stretching, flexion, and lifting. 3) The most common problem of the existing UERD is instability of the base. The most required improvement in design features is the adjustability of the functions.