Application of remodeled glove puppetry for children with developmental disabilities: a randomized controlled trial.

This study aimed to improve hand performance and play behavior in children with developmental disabilities (DD) using a remodeled glove puppetry approach. Overall, 62 children with DD were randomly assigned to experimental and control groups (n = 31 each). The experimental group underwent a 12-week rehabilitation program by playing with the remodeled glove puppetry, while the children in the control group played with non-remodeled glove puppetry. The Chinese puppet was remodeled using a Lego EV3® robot. Hand kinematics were analyzed through the Siliconcoach® Pro 7 software, which measured the force produced by the baseline ® hydraulic pinch gauge. Play behavior was measured using the Knox Preschool Play Scale-revised (KPPS-r). The experimental group exhibited significant improvements compared to the control group in hand kinematics (wrist range of motion [ROM], p < .05; metacarpophalangeal ROM, p < .05; proximal interphalangeal ROM, p < .05) and KPPS-r scores (space management, p < .05; material management, p < .05; pretense-symbolic, p < .05; participation, p < .05). After the 12-week rehabilitation with the remodeled glove puppetry, the experimental group exhibited significant improvement in kinematics and KPPS-r scores.

Dynamic white lighting to aid sleep and vision for persons living with dementia using off-the-shelf LED strips.

Alzheimer disease and related dementias affect 15-20% of elderly people, and 60-70% of these suffer from sleep disturbances. Studies suggest that lighting can improve sleep. The key challenge is how to deliver light effectively. We have designed a lighting system that adjusts spectrum and irradiance on a 24-hour timetable to provide spatially uniform, shadow-free white light with CRI>85 and up to 1000 Lux for day vision and amber light for night vision. To aid sleep, melanopic illuminance varies over 3 orders of magnitude to enable strong suppression of melatonin in the morning/early afternoon, moderate suppression in the evening, and no suppression at night.

Analyses of EEG Oscillatory Activities during Slow and Fast Repetitive Movements using Holo-Hilbert Spectral Analysis.

Neural oscillatory activities existing in multiple fre-quency bands usually represent different levels of neurophysiolog-ical meanings, from micro-scale to macro-scale organizations. In this study, we adopted Holo-Hilbert spectral analysis (HHSA) to study the amplitude-modulated (AM) and frequency-modulated (FM) components in sensorimotor Mu rhythm, induced by slow- and fast-rate repetitive movements. The HHSA-based approach is a two-layer empirical mode decomposition (EMD) architecture, which firstly decomposes the EEG signal into a series of frequency-modulated intrinsic mode functions (IMF) and then decomposes each frequency-modulated IMF into a set of amplitude-modulated IMFs. With the HHSA, the FM and AM components were incor-porated with their instantaneous power to achieve full-informa-tional spectral analysis. We observed that the instantaneous power induced by slow-rate movements was significantly higher than that induced by fast-rate movements (p < 0.01, Wilcoxon signed rank test). The alpha-band AM frequencies induced by slow-rate movements were higher than those induced by fast-rate move-ments, while no statistical difference was found in beta-band AM frequencies. In addition, to study the functional coupling between the primary sensorimotor area and other brain regions, spectral coherence was applied and statistical difference was found in frontal area in slow-rate versus fast-rate movements. The discrep-ancy between slow- and fast-rate movements might be owing to the change of motor functional modes from default mode network (DMN) to automatic timing with the increase of movement rates. The use of HHSA for oscillatory activity analysis can be an effi-cient tool to provide informative interaction among different fre-quency bands.

Older Age, Low Socioeconomic Status, and Multiple Comorbidities Lower the Probability of Receiving Inpatient Rehabilitation Half a Year After Stroke.

OBJECTIVE: To determine the predictors of receiving inpatient rehabilitation during 7 to 12 months after stroke. DESIGN: Retrospective cohort study. SETTING: A nationally representative sample of 1 million National Health Insurance enrollees. PARTICIPANTS: Patients with new-onset stroke (N=13,828) were included. Studied participants were patients who received inpatient rehabilitation during 4 to 6 months after stroke. Patients who died within 1 year of the stroke event were excluded (n=488). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcome variable of interest was the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke. The characteristics of both patients and medical care providers were investigated to determine their effect on patients receiving inpatient rehabilitation. RESULTS: Older patients, patients of low socioeconomic status, patients with Charlson Comorbidity Index ≥5, and patients who received outpatient rehabilitation during 4 to 6 months after stroke have a lower rate of receiving inpatient rehabilitation than do their counterparts. In addition, receiving inpatient rehabilitation during 7 to 9 months after stroke is a strong positive predictor of receiving inpatient rehabilitation during 10 to 12 months after stroke (odds ratio, 38.556; P<.0001). CONCLUSIONS: This study revealed that older age, lower socioeconomic status, and multiple comorbidities are negative predictive factors with a cumulative predictive power for the probability of receiving inpatient rehabilitation during 7 to 12 months after stroke.

Study of Repetitive Movements Induced Oscillatory Activities in Healthy Subjects and Chronic Stroke Patients.

Repetitive movements at a constant rate require the integration of internal time counting and motor neural networks. Previous studies have proved that humans can follow short durations automatically (automatic timing) but require more cognitive efforts to track or estimate long durations. In this study, we studied sensorimotor oscillatory activities in healthy subjects and chronic stroke patients when subjects were performing repetitive finger movements. We found the movement-modulated changes in alpha and beta oscillatory activities were decreased with the increase of movement rates in finger lifting of healthy subjects and the non-paretic hands in stroke patients, whereas no difference was found in the paretic-hand movements at different movement rates in stroke patients. The significant difference in oscillatory activities between movements of non-paretic hands and paretic hands could imply the requirement of higher cognitive efforts to perform fast repetitive movements in paretic hands. The sensorimotor oscillatory response in fast repetitive movements could be a possible indicator to probe the recovery of motor function in stroke patients.

Ropivacane 0.1 % with or without fentanyl for epidural postoperative analgesia: a randomized, double-blind comparison.

Epidural analgesia is often considered optimal postoperative analgesia for certain surgical procedures. Ropivacaine is a new local anesthetic that is less toxic than its homologue, bupivacaine. Epidural infusions usually comprise a local anesthetic, an opioid, or a combination of the two to improve analgesic efficacy and reduce unwanted side effects. All 210 patients undergoing lower abdominal or lower extremity surgery received epidural analgesia infusions at 7 mL/hour, 105 with 0.1% ropivacaine and 105 with 0.1% ropivacaine plus 1 microg/mL fentanyl. Pain score and side effects (hypotension, nausea, vomiting, pruritus, paresthesia, urinary retention and motor block) were measured at 0, 0.5, 1, 3, 6, 12, and 24 hours. There was no statistical difference in patient profile between the groups. Pain relief scores were similar in the two groups in the first hour after the drugs were given. However, pain relief was significantly better in the ropivacaine/fentanyl group after the first hour and this difference lasted for the remaining time. There was no significant difference in adverse events between the two groups during 24 hours of assessment. In conclusion, the quality of analgesia was significantly improved by the addition of fentanyl 1 microg/mL to ropivacaine.

Epidural ropivacaine for postoperative analgesia in Taiwanese patients.

BACKGROUND: Ropivacaine is the latest long-acting amide local anesthetic. As it is less cardiovasculotoxic and neurotoxic than bupivacaine it is an attractive anesthetic agent used in clinical anesthesia and postoperative analgesia. This study was undertaken to seek for a suitable dosage of ropivacaine in postoperative analgesia for Taiwanese patients whose average physicality is not entirely compatible with the pharmacopeially recommended dosage for western people. METHODS: For assessment of epidural ropivacaine for postoperative analgesia 105 adult patients were enrolled and randomly allotted to three groups. Patients in Group A were given epidurally 0.15% ropivacaine, while those in Group B and Group C were given 0.125% and 0.10% ropivacaine respectively. Pain was evaluated with visual analogue scale (VAS) and modified Bromage scale, and adverse effects were recorded at the designated points of time during the postoperative 24-hour period. RESULTS: The demographic profiles were comparable among three groups. In VAS score, Group A (3.20 +/- 0.47) and B (3.11 +/- 0.41) did not differ much, while Group C (3.97 +/- 0.71) the score was signally higher than Group A and Group B (P < 0.05). Adverse effects, such as paraesthesia, nausea and urinary retention were observed more in Group A. CONCLUSIONS: From the results of this study, we are of the opinion that 0.125% ropivacaine could provide a postoperative analgesia in Taiwanese patients to their satisfaction with less adverse effects.

Traumatic bilateral concurrent patellar tendon rupture: an alterative fixation method.

A 37-year-old healthy Chinese man with traumatic bilateral concurrent patellar tendon rupture is presented. This is the 19th case reported in the literature. Sports-related activities are the most common cause of injury. The mechanism of rupture is forceful contraction of quadriceps muscle on a partially flexed knee. Previous surgical treatments have potential problems. Soft tissue anchors were used for restoration of the patellar continuity. Improved surgical techniques and excellent functional results are expected.