Virtual reality training for stroke rehabilitation.

OBJECTIVE: To evaluate the effectiveness of a 2-D virtual reality (2DVR) programme in the training of people with stroke on how to access and use the station facilities of the Mass Transit Railway (MTR). METHOD: A flat-screen 2DVR based training programme and a corresponding, typical psycho-educational programme with video modelling were developed for comparison through a research design that involved a randomised control group pre-test and post-test. RESULTS: Twenty and sixteen subjects respectively received 10 training sessions using the 2DVR strategy and a video-based psycho-educational programme. An additional 22 subjects formed the control group. They were assessed by using a behavioural checklist of MTR skills and a newly validated MTR self-efficacy scale. The subjects of both training groups showed a significant improvement in their knowledge, skills and self-efficacy in using the MTR (p<0.01), whereas, the MTR skills and self-efficacy of the control group remained stable over a four-week interval. CONCLUSION: Though both training programmes were effective in training the patients with stroke, they demonstrated differential improvements in MTR skills and related self-efficacy. Additional studies are recommended to identify the most effective training procedures for maintaining these skills and the best transfer ratio in the training of VR-based community living skills of people with stroke.

Development and evaluation of a pictorial-based analogical problem-solving programme for people with traumatic brain injury.

BACKGROUND: People with traumatic brain injury (TBI) must often deal with cognitive problems, including social problem-solving. The study reported herein evaluated the effectiveness of a newly developed pictorial-based analogical problem-solving skills training programme. It is hypothesized that the programme can help people with TBI to learn better problem-solving skills through systematic, theoretically driven learning strategies. METHOD: Based on the instrumental enrichment model and the hierarchy of daily problem-solving as suggested by Holloran and Bressler, analogical problem-solving training software was developed. Thirty subjects with TBI then attended a 20-session interactive analogical problem-solving skills training programme. Another 20 subjects with TBI and of similar demographics formed the control group. The outcome measures included session-based quizzes on analogical problem-solving, the Category Test of the Halstead Reitan Test Battery (HRTB) and the Lawton IADL Scale. FINDINGS: The analogical problem-solving training strategies were found to be effective in improving problem-solving skills. The subjects generally demonstrated a selective improvement in their functional and overall problem-solving skills, but not in their basic problem-solving skills. The subjects in the control group showed stable problem-solving skills over a 4-week interval (no statistically significant changes). The findings indicated the therapeutic significance of the training programme. CONCLUSIONS: The results of the study suggested that innovative cognitive rehabilitation programmes can be customized to match the needs of clients with TBI. The applicability and implications of the interactive pictorial-based analogical problem-solving skill-training programme that was used in the study and possibilities for future study in this research area are also discussed.

Prediction of functional rehabilitation outcomes in clients with stroke.

OBJECTIVES: To evaluate the validity of the Neurobehavioral Cognitive Status Examination (NCSE or Cognistat) and to determine its effects in order to estimate the functional outcomes of survivors with stroke. METHODS: The present study first studied the factor structure NCSE in 148 Chinese survivors with stroke (aged 45-91 years). They were admitted to hospital consecutively and recruited prospectively. The relationship of NCSE with Functional Independence Measures (FIM), a set of measures commonly adopted as an indicator of the outcome of rehabilitation, was studied. RESULTS: One hundred and forty-eight patients with stroke (49.3% male, 50.7% female), with a mean age of 70.38 and an average number of years of education of 3.50 years joined the study. A two-factor NCSE structure was obtained, namely verbal-spatial and integrated cognition, accounting for 62.77% of the variance. A significant relationship between NCSE factors and the functional status of clients with stroke on admission and upon discharge, as well as age, years of education and length of hospital stay were indicated. CONCLUSIONS: This study supports a systematic relationship between cognitive factors and functional outcome in Chinese patients with stroke. Similarities and differences in the NCSE factor structure between the population with stroke and general neurological populations were discussed and the utility of NCSE in stroke rehabilitation, such as its predictive validity in functional independence is suggested.

A pilot study on the effectiveness of tele-analogy-based problem-solving training for people with brain injuries.

People with brain injuries must often deal with cognitive problems, including social problem solving. The present study evaluated the effectiveness of a 20-session, online, interactive, skill-training programme on the solving of problems using analogies. It was hypothesized that the programme could help people with brain injuries learn better problem-solving skills through systematic, theoretically driven learning strategies. Fifteen Hong Kong-Chinese with brain injuries participated in this pilot study. They were randomly assigned to an online programme, a computer-assisted programme or a therapist-administered programme. The three programmes had a similar structure and contents, including basic components problem solving, reflective sessions and functional problem solving. Outcome measures included the Category Test of Halstead-Reitan Test Battery, and a daily problem-solving performance and self-efficacy checklist. The results showed that the subjects of the three programmes generally demonstrated higher post-training self-efficacy and basic problem-solving skills. The group using the online programme, however, showed better and quicker improvements in problem-solving performance, and demonstrated a general trend towards making fewer errors in complex problem-solving tasks. In conclusion, people with brain injuries can use the successful problem-solving experiences obtained in the training programmes with different delivery modes to solve daily living problems that are similar in nature. However, the generalizability of the effects of the programme is still to be determined.

Self-concepts of parents with a child of school age with a severe intellectual disability.

The self-concepts of Hong Kong Chinese parents with a child of school age with severe intellectual disability were explored. A 20-item Adult Sources of Self-Esteem Inventory (ASSEI) and open-ended questions on self-evaluation and interviewing were adopted as the major procedures to identify the source and basis of their self-conceptions. One hundred and nine parents--35 males and 74 females, aged 31 to 45--participated in this study. The results indicated that the participants showed similar life priorities as the control group (parents of non-handicapped children). However, the participants showed significantly lower concept of self than the control group in most areas of life. An exploratory factor-analytic result showed that the parents' concept of self had a one-dimensional structure, which might indicate the parents' lack variety in their life. An analysis of the contents of the open-ended responses showed that family and work were the most important domains of the concept of self. However, most of the respondents stated that poor family relationships, the health problems of their child, and work and financial problems made them 'feel bad'.

Evaluating computer-assisted memory retraining programmes for people with post-head injury amnesia.

OBJECTIVE: The present study was designed to perform theory-driven empirical work that might contribute to a better understanding of computer-assisted training effects adopting theoretically different memory retraining strategies for people who had amnesia as a result of a brain injury. RESEARCH DESIGN: A pre-test and post-test control group quasi-experimental design was adopted to test the differences in effectiveness of four different computer-assisted memory training strategies, which were hypothesized to improve different memory skills of persons with brain injury. METHOD AND PROCEDURES: Twenty-six persons with brain injury were randomly assigned to four age- and gender-matched memory training groups (self-paced, feedback, personalized, visual presentation) and they were trained using the related computer software, evaluated by the Rivermead Behavioural Memory Test (RBMT), self-efficacy scale and built-up computer performance records. MAIN OUTCOMES AND RESULTS: All the four memory training methods showed positive among the persons with brain injury as compared with a control group, although there was no statistically significant difference among the four training methods. However, clinical improvement was found in all four methods and the Feedback group showed significant improvement in self efficacy, in comparison with the other groups. CONCLUSION: This attempt to develop and evaluate different computer applications for memory retraining was made and the effectiveness of applying customized computer technology in memory rehabilitation was critically evaluated. Results of the present study showed that the unique customized therapeutic characteristics of computer-assisted memory retraining (e.g. self-paced practice, performance feedback, salient visual presentation and personalized training contents) are positive attributes of memory skill retraining outcomes.

Predicting osteoarthritic knee rehabilitation outcome by using a prediction model developed by data mining techniques.

Artificial neural networks (ANN) have been applied to assist in clinical decision-making and prediction. While we consider possible effective treatments for patients with osteoarthritic knee such as Transcutaneous Electrical Nerve Stimulation (TENS), exercise, and TENS with exercise respectively, we have to select a treatment protocol for patients such that they would gain the best improvements according to their clinical conditions. To facilitate this functionality with the existing patient assessment, we hope to apply the ANN programming techniques to develop a computerized prediction system. A preliminary validation was performed to test the validity of the newly developed prediction protocol on knee rehabilitation. We input the key clinical attributes of 62 patients who have undergone the three above-mentioned knee treatments to the protocol. The expected pain improvement of each patient as predicted by the protocol was obtained. Spearman rank-order correlation was used to identify whether there was a significant correlation between the rankings of the observed and expected pain improvement. We found that the Spearman's rho was 0.424, which is statistically significant at p < 0.001. From this preliminary analysis, we are confident that this newly developed prediction protocol will be useful when deciding which treatment regime best suits a patient.

Preliminary evidence for the basis of self-concept in Chinese people with mental illness.

METHOD: The Adult Source of Self-Esteem Inventory (ASSEI) (A.C. Elovson and J.S. Fleming, unpublished manuscript. California: California State University, 1989), open-ended questions on self-evaluation, and interviewing were adopted as the major procedures for identifying the sources and basis of the self-concepts of people with mental illness. One hundred and twenty three Hong Kong Chinese adults with mental illness participated in this study. RESULTS: From the results, the basis of the self-concepts of people with mental illness was explored and compared through probing, comparing, and contrasting their perceptions of different aspects of life. A hierarchical multidimensional self-concept model of the population with mental illness was thus suggested. This model includes five major self-concept factors, named as interpersonal relationship, social integrity, personal competency, personal quality, and external achievement. The self-concept of people with mental illness was also compared to that of people without mental illness. This paper discusses the implications of the findings for psychiatric rehabilitation practice for people with mental illness.

Comparing the self-concepts of Hong Kong Chinese adults with visible and not visible physical disability.

In the present study, the authors evaluated the self-concept levels of Hong Kong Chinese adults with visible and not visible physical disabilities. Fifty-five Hong Kong Chinese (22 men and 33 women) aged 18 to 55 (M = 39.50, SD = 10.21) participated-20 without physical disabilities (control group), 20 with visible physical disabilities, and 15 with physical disabilities that were not visible. All the participants responded to the Self-Concept Questionnaire for Hong Kong Chinese With Physical Disabilities (SCQPD; S. F. Tam & D. Watkins, 1997). The group with visible disabilities scored significantly lower in self-concept than did the control group and the group with disabilities that were not visible. There were also significant differences between specific facets of self-concept for people with visible and not visible disabilities. It was interesting to find that there was no significant difference in self-concept levels between the not visible group and the control group. The implications for rehabilitation and social services for these various groups are discussed.

Evaluating the efficacy of tele-cognitive rehabilitation for functional performance in three case studies.

Traumatic brain injury (TBI) is one of the main causes of long-term disability, and its rehabilitation is a challenge to the healthcare team. Tele-rehabilitation, through using advancements in networking and tailor-made software, has been developed and applied to the cognitive rehabilitation of persons with brain injury in the present study. Tele-cognitive rehabilitation uses customized online computer software as a treatment mode. The online treatment software is operated on an interactive tele-communication platform--for example, video conferencing with screen sharing. Through implementing the tele-cognitive rehabilitation activities, therapists can help clients to practise and thus improve their cognitive skills through using the treatment software successfully. Moreover, hypermedia programming techniques allow the therapist to adjust the software to meet the client's treatment needs, so that the treatment is appropriate to his/her functional levels and living environment. Also the software can customize immediate visual, auditory and personalized feedback to motivate the client and training can be set at the right pace for the client's needs. The present study aimed to evaluate the effectiveness and perceived efficacy of the newly developed customized tele-cognitive rehabilitation programme for three subjects with traumatic brain injury through using single-case and qualitative research design. The cognitive factors investigated in this pilot study were, respectively, Chinese word recognition, prospective memory and semantic memory. The subjects had undergone a recruitment process with stipulated screening criteria. A single case experimental design (ABA reversal/withdrawal design) consisted of a no-intervention baseline phase (A), an intervention phase (B) and a no-intervention withdrawal phase (A). There were six sessions in each phase, making a total of 18 sessions. Tele-cognitive rehabilitation software was tailor-made according to each subject's cognitive functional needs. To monitor the change in cognitive functions, variables were tapped by tailor-made assessment and qualitative questionnaires through interviews, and they were then used to explore subjects' opinions of the programme and to test the treatment efficacy of the tele-cognitive rehabilitation programme. Finally, the relationships among the three phases were analysed through visual analysis and trend line analysis by means of the split-middle method. The three persons with brain injury showed improving trends and levels of specific cognitive performance during the treatment phase. Qualitative findings were analysed and confirmed the efficacy of the treatment module. The tele-cognitive rehabilitation approach was well received by subjects. The authors suggest that further replication studies of this kind should be conducted in the future and that more subjects should be recruited to improve the generalizability of the results.