Ming-Hsia Hu

Psychometric Comparisons of the Timed Up and Go, One‐Leg Stand, Functional Reach, and Tinetti Balance Measures in Community‐Dwelling Older People

Objectives: To compare the practicality, reliability, validity, and responsiveness of the timed up and go (TUG), one‐leg stand (OLS), functional reach (FR), and Tinetti balance (TB) performance measures in people aged 65 and older.

Effects of Virtual Reality-Augmented Balance Training on Sensory Organization and Attentional Demand for Postural Control in People With Parkinson Disease: A Randomized Controlled Trial

Background There is a lack of studies related to virtual reality (VR)–augmented balance training on postural control in people with Parkinson disease (PD). Objective The purposes of this study were: (1) to examine the effects of VR-augmented balance training on the sensory integration of postural control under varying attentional demands and (2) to compare the results with those of a conventional balance training (CB) group and an untrained control group. Design A longitudinal, randomized controlled trial was used. Setting The intervention was conducted in the clinic, and the assessment was performed in a research laboratory. Patients Forty-two people with PD (Hoehn and Yahr stages II–III) were recruited. Intervention The VR and CB groups received a 6-week balance training program. Measurements The sensory organization tests (SOTs) of computerized posturography with single- and dual-task conditions were conducted prior to training, after training, and at follow-up. Equilibrium scores, sensory ratios, and verbal reaction times (VRTs) were recorded. Results There were no significant differences in equilibrium scores or VRTs between the VR and CB groups. However, the equilibrium scores in SOT-6 (ie, unreliable vision and somatosensation) of the VR group increased significantly more than that of the control group after training. The equilibrium scores in SOT-5 (ie, unreliable somatosensation with eyes closed) of the CB group also increased significantly more than that of the control group after training. Limitations The functional significance of the improvements in equilibrium scores in the SOTs was not known, and the sample size was small. Conclusions Both VR and CB training improved sensory integration for postural control in people with PD, especially when they were deprived of sensory redundancy. However, the attentional demand for postural control was not changed after either VR or CB training.

THE RELATION BETWEEN STANDING BALANCE AND WALKING FUNCTION IN CHILDREN WITH SPASTIC DIPLEGIC CEREBRAL PALSY

To establish and compare the relationship between standing balance and walking performance, eight children with spastic diplegic cerebral palsy (CF) and 16 non‐disabled, age‐ and sex‐matched children were studied. The results showed that the children with CP had worse static balance stability in various sensory environments and dynamic balance (rhythmic shifting ability) than the non‐disabled children. Moreover, the children with CP walked at a slower speed but at a greater physiological cost than the non‐disabled children. In the children with CP, dynamic balance significantly correlated with walking function. It is suggested that rhythmic weight‐shift training should be encouraged to improve the walking performance of children with CP.

Early and intensive rehabilitation predicts good functional outcomes in patients admitted to the stroke intensive care unit

Purpose. Earlier and more intense rehabilitation benefit stroke patients. Yet, studies have caution intensive therapy during acute brain injury. This study examined the rehabilitation commencement time and intensity as predictors of functional outcomes in acute stroke patients admitted to the stroke intensive care unit (ICU). Method. Sociodemographic, medical, rehabilitative and functional data were collected on 154 acute stroke patients. Regression analyses were used to identify predictors for the basic activities of daily living (Barthel Index, BI) and the walking ability at discharge. Result. Rehabilitation commencement time and intensity significantly predicted the BI score at discharge after adjusting for initial severity (National Institute of Health Stroke Scale, NIHSS) and age (p < 0.05). For the walking function at discharge, only the rehabilitation intensity was a significant predictor after adjusting for initial severity and age (p < 0.05). Furthermore, with increasing rehabilitation intensity, patients with severe stroke benefited more than those with moderate stroke. Conclusion. Rehabilitation commencement time and intensity, after adjusting for admission functional status and severity of stroke, remained to be important predictors of stroke functional outcomes. This study supported the recommendation to commence rehabilitation early and intensively and provided evidence that this claim can be extended to acute stroke patients admitted to an ICU.

Dose-Response Relation Between Neuromuscular Electrical Stimulation and Upper-Extremity Function in Patients With Stroke

Background and Purpose— The purpose of our study was to investigate the effects of different doses of neuromuscular electrical stimulation (NMES) on upper-extremity function in acute stroke patients with severe motor deficit. Methods— Sixty-six acute stroke patients were randomized to 3 groups: high NMES, low NMES, or control. The low-NMES group received 30 minutes of stimulation per day, and the high-NMES group received 60 minutes per day, for 4 weeks. The Fugl-Meyer Motor Assessment Scale, Action Research Arm Test, and Motor Activity Log were used to assess the patients at baseline, 4 weeks, and 12 weeks post baseline (follow-up). Results— Both NMES groups showed significant improvement on Fugl-Meyer Motor Assessment and Action Research Arm Test scales compared with the control group at week 4 and follow-up. The high-NMES group showed treatment effects similar to those of the low-NMES group. Conclusions— Higher and lower doses of NMES led to similar improvements in motor function. A minimum of 10 hours of NMES in combination with regular rehabilitation may improve recovery of arm function in stroke patients during the acute stage.

Immediate Effect of Lateral-Wedged Insole on Stance and Ambulation After Stroke

Chen C-H, Lin K-H, Lu T-W, Chai H-M, Chen H-L, Tang P-F, Hu M-H: Immediate effect of lateral-wedged insole on stance and ambulation after stroke. Objective:To perform kinematic and kinetic analyses on the static standing and ambulation in subjects after stroke with and without wearing a 5-degree lateral-wedged insole. Design:Ten hemiparetic individuals with unilateral stroke were recruited. Participants performed quiet stance and ambulation with no insole wedge, paretic side wedged, and nonparetic side wedged in a random order. The vertical ground reaction force and temporal-spatial parameters of gait were measured. Symmetry index was also calculated. Results:During quiet stance, the symmetry index of weight bearing improved significantly with nonparetic side-wedged (P < 0.017), but not with paretic side-wedged insoles. During ambulation, the symmetry indices of kinematic and kinetic measurements in the frontal plane were not significantly different among the three conditions. However, the contralateral knee abductor moment was significantly (P < 0.05) less than that of the nonparetic limb during nonparetic side-wedged ambulation. The ipsilateral hip and knee abductor moments were significantly (P < 0.05) less than the nonparetic limb during paretic side-wedged ambulation. Conclusions:Application of nonparetic side wedge insole can improve stance symmetry and tends to reduce the paretic knee abductor load during ambulation. The effects of paretic side-wedged insole are different. The present results provide guidelines for the placement of wedges in the shoes of individuals after stroke.

DOSAgE OF NEUROMUSCULAR ELECTRICAL STIMULATION: IS IT A DETERMINANT OF UPPER LIMb FUNCTIONAL IMPROvEMENT IN STROkE PATIENTS?

OBJECTIVE To investigate the predictors related to upper extremity functional recovery, with special emphasis on neuromuscular electrical stimulation dose-response in patients after stroke. SUBJECTS Ninety-five patients with stroke who received a 4-week neuromuscular electrical stimulation intervention. DESIGN Prospective predictive analysis. METHODS The change score of the Action Research Arm Test (ARAT) was used as the main outcome. Baseline subject characteristics, stroke-related data, and intervention-related data were collected. Multiple linear regression analysis was applied to identify the potential predictors related to main outcome. RESULTS The regression model revealed that the initial Fugl-Meyer upper limb score was the most important predictor for ARAT change score post-test, followed by time since stroke onset and location of stroke lesion. At 2-month follow-up, the neuromuscular electrical stimulation dosage became a significant determinant in addition to the above predictors. CONCLUSION Initial motor severity and lesion location were the main predictors for upper limb functional improvement in stroke patients. Neuromuscular electrical stimulation dosage became a significant determinant for upper limb functional recovery after stroke at 2-month follow-up. More intensive neuromuscular electrical stimulation therapy during early rehabilitation is associated with better upper limb motor function recovery after stroke.

Low-intensity task-oriented exercise for ambulation-challenged residents in long-term care facilities: a randomized, controlled trial.

ObjectiveThe aim of this study was to investigate the effects of a taskoriented ambulation training program in regaining walking, balance, and activity of daily living performance for ambulation-challenged residents with walking potential in long-term care facilities. DesignFifty ambulation-challenged residents with walking potential were randomly assigned to an individualized task-oriented ambulation training group (30–45 mins, three times a week) or a routine nursing care control group for 4 wks. Each subject was evaluated by a blind evaluator before and after training. Walking function was assessed using walking speed, the Timed Up and Go Test, and the 6-Minute Walk Test. Balance and activities of daily living were measured using the Berg Balance Scale and the Barthel Index, respectively. ResultsThe training group showed significantly more improvement in walking speed, time to complete the Timed Up and Go Test, and the total score of Berg Balance Scale from baseline to posttest than the control group did. No significant difference between groups was observed on the 6-Minute Walk Test or the Barthel Index. ConclusionsAmbulation-challenged residents with walking potential, as defined by slowing of walking speed with concomitant knee muscle weakness and joint range limitation, showed significant improvement in walking function and balance after a 4-wk task-oriented ambulation training in long-term care facilities.

Effect of a cane on sit-to-stand transfer in subjects with hemiparesis.

ObjectiveThe aim of this study was to determine the effect of using a cane on movement time, joint moment, weight symmetry, and muscle activation patterns during sit-to-stand (STS) transfer in healthy subjects and subjects who have had a stroke. DesignNine subjects with hemiparesis (mean [SD] age, 61.11 [12.83] yrs) and nine healthy adults (mean [SD] age, 63.11 [10.54] yrs) were included. The subjects with hemiparesis performed STS transfer in two randomly assigned conditions: (1) without a cane and (2) with a cane. The healthy subjects performed only STS transfer without a cane. A three-dimensional motion system, force plates, and eletromyography were used to examine STS transfer. The symmetry index between the two limbs was calculated. ResultsThe movement time of the subjects with hemiparesis in both conditions without a cane and with a cane was longer than that of the healthy subjects without a cane (P < 0.025). However, STS transfer with a cane in the subjects with hemiparesis resulted in shorter movement time, greater knee extensor moment of the paretic limb, and more symmetry of weight bearing than in those without a cane (P < 0.05). The sequence of muscle onset tended to improve with a cane in the subjects with hemiparesis. ConclusionsCane use may promote more symmetrical STS transfers rather than compensation by the unaffected limb.

Effects of fall injury type and discharge placement on mortality, hospitalization, falls, and ADL changes among older people in Taiwan

A longitudinal study was conducted to investigate the effects of injury type and discharge placement on mortality, falls, hospital admissions, and changes in activities of daily living (ADLs) over a 12-month period among older fallers. Of 762 community-dwelling people aged 65 years or older who visited an emergency department (ED) of a general hospital in Taiwan due to a fall, 273 sustained a hip fracture, 157 had a vertebral fracture, 47 had a distal forearm fracture, 102 had a traumatic brain injury, and 183 had soft-tissue injuries. Results showed that, compared to patients with a soft-tissue injury, those with TBI had significantly higher risks of dying (rate ratio (RR)=3.59) and hospital admissions (RR=3.23) and better improvement in ADLs (1.93 points) at 6 months post-injury, and those who sustained a hip fracture (4.26 and 4.41 points), a vertebral fracture (3.81 and 3.83 points), or a distal-forearm fracture (2.80 and 2.80 points) had significantly better improvement in ADLs at 6 and 12 months post-injury. Patients discharged to a nursing home had a significantly increased risk of death (RR=2.08) and hospital admission (RR=2.05) than those returning to their usual residence during the first year post-injury. No significant differences in the occurrence of falls during the first post-injury year were found among patients with different injury types or between those with different discharge placements. In conclusion, among the five major fall injury types in older people, TBIs result in the highest risk of death and hospital admissions, while hip and vertebral fractures exhibited the largest improvement during the first year after injury. Additionally, nursing home care may be associated with increased risks of death and hospital admissions than home care. In addition to primary prevention of falls, further research to investigate mechanisms leading to TBIs during a fall is needed to facilitate effective secondary fall-prevention programs for older people.