Efficacy analysis of virtual reality-based training for activities of daily living and functional task training in stroke patients: A single-subject study.

INTRODUCTION: Virtual reality (VR)-based training for functions such as cognition, upper extremities, balancing, and activities of daily living (ADL) has been used on stroke patients, and its efficacy has been reported. However, no comparison has been made between the efficacy of VR-based training for daily activities that exactly reproduces ADL and functional training. Therefore, this study sought to analyze the difference in independency enhancement of VR-based training for daily activities compared to cognitive and motor functional training. PATIENT CONCERNS AND DIAGNOSIS: This study was conducted on 4 patients who have been diagnosed with stroke and are currently receiving rehabilitation therapy in G hospital located in the city of Gwangju, using A-B-A'-B' design from single-subject experimental designs. INTERVENTIONS: Intervention was performed in 2 ways: application of VR-based training for daily activities after the application of cognitive and motor function training; and application of cognitive and motor function training after the application of VR-based training for daily activities. The Assessment of Motor and Process Skills, Computer Cognitive Screening Assessment System, Box and Block Test, and Grip and Pinch Strength Test were used to measure the changes in the performance of daily activities, cognitive function, and upper extremities function. OUTCOMES: The results confirmed that the performance of daily activities, cognitive function, and upper extremities function was improved after the application of VR-based intervention. In addition, the efficacy of independency enhancement was maximized by the early approach of training for daily activities at the time of VR-based intervention in stroke patients. CONCLUSIONS: VR-based intervention of training for daily activities and functional training can be considered to benefit the improvement of the performance of daily activities, cognitive function, and upper extremities function in stroke patients. In addition, although functional training was also effective in enhancing independency and functional improvement in stroke patients, an early approach to training for ADL based on tasks with objectives was deemed to be more effective.

Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study.

BACKGROUND: Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. OBJECTIVE: This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. METHODS: In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. RESULTS: In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of -0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. CONCLUSIONS: In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver's licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers.

Criteria to assess tongue strength for predicting penetration and aspiration in patients with stroke having dysphagia.

BACKGROUND: Instrumental assessments are typically used to assess swallowing function in stroke patients with dysphagia, but these tests cannot be used for all patients or for continuous monitoring. Hence, an adjunctive method is necessary for screening patients who may require such tests. AIM: The purpose of this study was to analyze tongue strength with respect to the presence or absence of penetration and aspiration, using instrumental assessments, to provide a basis for clinical decision-making. DESIGN: Prospective observational study. SETTING: University Hospitals in Gwangju, South Korea. POPULATION: Seventy-nine subjects with dysphagia underwent video fluoroscopic swallowing study (VFSS) and Iowa Oral Performance Instrument evaluations. METHODS: VFSS results were assessed for the presence of penetration and aspiration, according to the penetration-aspiration scale. Receiver operating characteristic curve analysis was conducted with tongue strengths based on penetration and aspiration. RESULTS: During the swallowing of pureed, liquid, and solid foods, cut-off values of tongue strength for the anterior and posterior elevation and for the protrusion of tongue were suggested in cases of penetration and aspiration, among patients with dysphagia. These criteria had positive and negative predictive values of 54.6-90.2% and 57.5-96.9%, respectively. CONCLUSIONS: This study found that tongue strength has predictive abilities similar to clinical and bedside tests to screen penetration and aspiration in stroke patients with swallowing disorders. Therefore, it is a new screening test that clinical practitioners can choose to reduce the risk of pneumonia caused by post-stroke disorders. CLINICAL REHABILITATION IMPACT: As a new screening tool, tongue strength can be combined with other clinical and instrumental assessments to predict penetration and aspiration in stroke patients with dysphagia.

The job competency of radiological technologists in Korea based on specialists opinion and questionnaire survey.

PURPOSE: Although there are over 40,000 licensed radiological technologists (RTs) in Korea, job competency standards have yet to be defined. This study aims to clarify the job competency of Korean RTs. METHODS: A task force team of 11 professional RTs were recruited in order to analyze the job competency of domestic and international RTs. A draft for the job competency of Korean RTs was prepared. A survey was then conducted sampling RTs and the attitudes of their competencies were recorded from May 21 to July 30, 2016. RESULTS: We identified five modules of professionalism, patient management, health and safety, operation of equipment, and procedure management and 131 detailed job competencies for RTs in Korea. "Health and safety" had the highest average score and "professionalism" had the lowest average score for both job performance and importance. The content validity ratios for the 131 subcompetencies were mostly valid. CONCLUSION: Establishment of standard guidelines for RT job competency for multidisciplinary healthcare at medical institutions may be possible based on our results, which will help educators of RT training institutions to clarify their training and education.

Cognitive basis about risk level classifications for the self-assessment of older drivers.

[Purpose] This study analyzed the cognitive functions according to risk level for the Driver 65 Plus measure, and examined the cognitive basis of self-assessment for screening the driving risk of elderly drivers. [Subjects and Methods] A total of 46 older drivers with a driver's license participated in this study. All participants were evaluated with Driver 65 Plus. They were classified into three groups of "safe," "caution" and "stop," and examined for cognitive functions with Trail Making Test and Montreal Cognitive Assessment-K. The cognitive test results of the three groups were compared. [Results] Trail Making Test-A, Trail Making Test-B, and Montreal Cognitive Assessment-K showed a significant difference between the three groups. The safe group showed significantly higher ability than the caution and stop groups in the three cognitive tests. In addition, cognitive functions of naming, attention, language, and delayed recall were significantly different between the three groups. [Conclusion] Self-assessment of older drivers is a useful tool for screening the cognitive aspects of driving risk. The cognitive functions, such as attention and recall, are the critical factors for screening the driving risk of elderly drivers.

Cut-off point for the trail making test to predict unsafe driving after stroke.

[Purpose] This study examined the cut-off point of the Trail Making Test in predicting the risk of unsafe driving in stroke patients. [Subjects and Methods] A total of 81 stroke patients with a driver's license participated in this study. The DriveABLE Cognitive Assessment Tool, Trail Making Test-A, and Trail Making Test-B evaluations were conducted in all participants. All participants were classified into the safety or risk groups based on the DriveABLE Cognitive Assessment Tool evaluation results. The Trail Making Test results underwent a receiver operating characteristic analysis in each group. [Results] The results of the receiver operating characteristic curve analysis showed that the cut-off point for Trail Making Test-A was 32 seconds and the cut-off point for Trail Making Test-B was 79 seconds. The positive predictive values of the Trail Making Test-A and Trail Making Test-B were 98.3% and 98.3%, respectively, and the negative predictive values of the Trail Making Test-A and Trail Making Test-B were 81.0% and 73.9%, respectively. [Conclusion] The Trail Making Test is a useful tool for predicting the risk of unsafe driving in stroke patients. This tool is expected to be used more actively for screening stroke drivers with respect to their cognitive function.

Usefulness of the driveABLE cognitive assessment in predicting the driving risk factor of stroke patients.

[Purpose] This study examined the usefulness of the DriveABLE cognitive assessment tool (DCAT) in predicting the driving risk factor of stroke patients, and compared the cognitive and driving functions of two groups discriminated by DCAT. [Subjects and Methods] A total of forty-two stroke patients with a driver's license participated in this study. Two participants with communication problems were excluded. DCAT was used to evaluate the risk potential to the driver, and the subjects were classified into two groups according to the probability of driving risk estimated by the DCAT evaluation. The safe driver group (SDG) and unsafe driver group (USDG) underwent a driving simulator and cognitive function assessments. [Results] The results of the SDG and USDG were compared. The SDG showed higher cognitive function than the USDG. In addition, the SDG showed higher ability than the USDG in most of the tests associated with the driving function (pedal reaction time, average reaction time, centerline crossing, road edge excursion, off-road accidents, collisions). [Conclusion] DCAT is a useful tool for predicting the risk of driving. In addition, it can predict the driving ability of stroke patients related to the cognitive function. Nevertheless, a multi-faceted study of associated with driving and cognitive functions for safe driving will be needed.