The Feasibility and Efficacy of Remote App-Guided Home Exercises for Frozen Shoulder: A Pilot Study.

Home exercise programs are beneficial in managing frozen shoulder (FS), yet adherence remains challenging. This pilot study introduces the remote app, Defrozen, designed for home exercises and assesses its feasibility and clinical outcomes in FS patients undergoing intra-articular and sub-acromial corticosteroid treatment. Over a four-week period, patients used the Defrozen-app, engaging in guided exercises. The feasibility of the intervention was assessed through several measurement scales, including adherence, the Technology Acceptance Model 2 (TAM2), the System Usability Scale (SUS), and User Satisfaction and Engagement (USE). Clinical outcomes included pain scale, Oxford Shoulder Score (OSS), Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) Score, and passive range of motion. The TAM2 results indicated high perceived usefulness (4.5/5), ease of use (4.8/5), and intention to use (4.4/5); the SUS score was high at 81.7/100, complemented by USE scores reflecting ease of learning (4.9/5) and satisfaction (4.3/5). Clinical outcomes showed significant pain reduction, improved shoulder function, reduced shoulder-related disability, and increased shoulder range of motion. These findings suggest the Defrozen-app as a promising solution for FS, significantly improving adherence and showing potential to enhance clinical outcomes. However, these clinical outcome results are preliminary and necessitate further validation through a large-scale randomized controlled trial to definitively confirm efficacy and assess long-term benefits.

Synergistic efficacy of repetitive peripheral magnetic stimulation on central intermittent theta burst stimulation for upper limb function in patients with stroke: a double-blinded, randomized controlled trial.

BACKGROUND: Non-invasive techniques such as central intermittent theta burst stimulation (iTBS) and repetitive peripheral magnetic stimulation (rPMS) have shown promise in improving motor function for patients with stroke. However, the combined efficacy of rPMS and central iTBS has not been extensively studied. This randomized controlled trial aimed to investigate the synergistic effects of rPMS and central iTBS in patients with stroke. METHOD: In this study, 28 stroke patients were randomly allocated to receive either 1200 pulses of real or sham rPMS on the radial nerve of the affected limb, followed by 1200 pulses of central iTBS on the ipsilesional hemisphere. The patients received the intervention for 10 sessions over two weeks. The primary outcome measures were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT). Secondary outcomes for activities and participation included the Functional Independence Measure-Selfcare (FIM-Selfcare) and the Stroke Impact Scale (SIS). The outcome measures were assessed before and after the intervention. RESULTS: Both groups showed significant improvement in FMA-UE and FIM-Selfcare after the intervention (p < 0.05). Only the rPMS + iTBS group had significant improvement in ARAT-Grasp and SIS-Strength and activity of daily living (p < 0.05). However, the change scores in all outcome measures did not differ between two groups. CONCLUSIONS: Overall, the study's findings suggest that rPMS may have a synergistic effect on central iTBS to improve grasp function and participation. In conclusion, these findings highlight the potential of rPMS as an adjuvant therapy for central iTBS in stroke rehabilitation. Further large-scale studies are needed to fully explore the synergistic effects of rPMS on central iTBS. TRIAL REGISTRATION: This trial was registered under ClinicalTrials.gov ID No.NCT04265365, retrospectively registered, on February 11, 2020.

Differential longitudinal effects of frequent sweetened food consumption at different exposure ages on child cognitive, language, and motor development.

BACKGROUND: Evidence reveals frequent sugar consumption worsens cognition in animal models, and similar effects on child development are probable. We aimed to investigate the influence of sweetened foods (SFs) on child developmental trajectories. METHODS: The prospective cohort recruited 3-month-old children in Taiwan from 1st April 2016 to 30th June 2017. Developmental inventories including cognitive, language, and motor domains, were measured at the age of 3-,12-, 24-, and 36 months old via in-person interviews. We constructed latent growth models with covariates to estimate the influence of SFs on child development. RESULTS: Ultimately, 4782 children (50.7% boys) were included in the statistical analysis. In the cognitive domain, consumption at one year of age significantly affected the intercept, but not the linear slope and quadratic term (intercept: estimate = -0.054, p < .001); consumption at two years of age significantly affected the intercept and quadratic term (intercept: estimate = -0.08, p < .001; quadratic term: estimate = -0.093, p = .026), but not the linear slope. In the language domain, only consumption at two years of age significantly affected the intercept (estimate = -0.054, p < .001). In the motor domain, consumption at two years of age significantly affected the linear slope and quadratic term (estimate = 0.080, p = .011 and estimate = -0.082, p = .048, respectively). CONCLUSION: We found SFs exposure at different times has different negative effects on child development. Early exposure to SFs harmed children's cognitive function. Relatively late exposure to SFs not only deteriorated children's cognitive and language abilities but also decelerated developmental velocity in cognitive and motor domains.

Predicting the Risk of Total Hip Replacement by Using A Deep Learning Algorithm on Plain Pelvic Radiographs: Diagnostic Study.

BACKGROUND: Total hip replacement (THR) is considered the gold standard of treatment for refractory degenerative hip disorders. Identifying patients who should receive THR in the short term is important. Some conservative treatments, such as intra-articular injection administered a few months before THR, may result in higher odds of arthroplasty infection. Delayed THR after functional deterioration may result in poorer outcomes and longer waiting times for those who have been flagged as needing THR. Deep learning (DL) in medical imaging applications has recently obtained significant breakthroughs. However, the use of DL in practical wayfinding, such as short-term THR prediction, is still lacking. OBJECTIVE: In this study, we will propose a DL-based assistant system for patients with pelvic radiographs to identify the need for THR within 3 months. METHODS: We developed a convolutional neural network-based DL algorithm to analyze pelvic radiographs, predict the hip region of interest (ROI), and determine whether or not THR is required. The data set was collected from August 2008 to December 2017. The images included 3013 surgical hip ROIs that had undergone THR and 1630 nonsurgical hip ROIs. The images were split, using split-sample validation, into training (n=3903, 80%), validation (n=476, 10%), and testing (n=475, 10%) sets to evaluate the algorithm performance. RESULTS: The algorithm, called SurgHipNet, yielded an area under the receiver operating characteristic curve of 0.994 (95% CI 0.990-0.998). The accuracy, sensitivity, specificity, and F1-score of the model were 0.977, 0.920, 0932, and 0.944, respectively. CONCLUSIONS: The proposed approach has demonstrated that SurgHipNet shows the ability and potential to provide efficient support in clinical decision-making; it can assist physicians in promptly determining the optimal timing for THR.

The Feasibility and Performance of Total Hip Replacement Prediction Deep Learning Algorithm with Real World Data.

(1) Background: Hip degenerative disorder is a common geriatric disease is the main causes to lead to total hip replacement (THR). The surgical timing of THR is crucial for post-operative recovery. Deep learning (DL) algorithms can be used to detect anomalies in medical images and predict the need for THR. The real world data (RWD) were used to validate the artificial intelligence and DL algorithm in medicine but there was no previous study to prove its function in THR prediction. (2) Methods: We designed a sequential two-stage hip replacement prediction deep learning algorithm to identify the possibility of THR in three months of hip joints by plain pelvic radiography (PXR). We also collected RWD to validate the performance of this algorithm. (3) Results: The RWD totally included 3766 PXRs from 2018 to 2019. The overall accuracy of the algorithm was 0.9633; sensitivity was 0.9450; specificity was 1.000 and the precision was 1.000. The negative predictive value was 0.9009, the false negative rate was 0.0550, and the F1 score was 0.9717. The area under curve was 0.972 with 95% confidence interval from 0.953 to 0.987. (4) Conclusions: In summary, this DL algorithm can provide an accurate and reliable method for detecting hip degeneration and predicting the need for further THR. RWD offered an alternative support of the algorithm and validated its function to save time and cost.

The Influence of Serious Extracranial Injury on In-Hospital Mortality in Children with Severe Traumatic Brain Injury.

(1) Background: Severe traumatic brain injury (sTBI) is the leading cause of death in children. Serious extracranial injury (SEI) commonly coexists with sTBI after the high impact of trauma. Limited studies evaluate the influence of SEI on the prognosis of pediatric sTBI. We aimed to analyze SEI's clinical characteristics and initial presentations and evaluate if SEI is predictive of higher in-hospital mortality in these sTBI children. (2) Methods: In this 11-year-observational cohort study, a total of 148 severe sTBI children were enrolled. We collected patients' initial data in the emergency department, including gender, age, mechanism of injury, coexisting SEI, motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and intracranial Rotterdam computed tomography (CT) score of the first brain CT scan, as potential mortality predictors. (3) Results: Compared to sTBI children without SEI, children with SEI were older and more presented with initial hypotension and hypothermia; the initial lab showed more prolonged prothrombin time and a higher in-hospital mortality rate. Multivariate analysis showed that motor components of mGCS, fixed pupil reaction, prolonged prothrombin time, and higher Rotterdam CT score were independent predictors of in-hospital mortality in sTBI children. SEI was not an independent predictor of mortality. (4) Conclusions: sTBI children with SEI had significantly higher in-hospital mortality than those without. SEI was not an independent predictor of mortality in our study. Brain injury intensity and its presentations, including lower mGCS, fixed pupil reaction, higher Rotterdam CT score, and severe injury-induced systemic response, presented as initial prolonged prothrombin time, were independent predictors of in-hospital mortality in these sTBI children.

Sufficiency of the BOT-2 short form to screen motor competency in preschool children with strabismus.

BACKGROUND: Strabismus is one of the most common visual disorders in children, with a reported prevalence of 2.48% in preschoolers. Additionally, up to 89.9% of preschool children with strabismus do not have normal stereopsis. Whether this lack of normal stereopsis affects the motor competency of preschool children with strabismus is unknown. The Bruininks-Oseretsky Test of Motor Proficiency Second Edition short form (BOT-2 SF) can be a useful tool for screening; however, its sufficiency as a diagnostic tool for children with various disorders is controversial. OBJECTIVE: The aims of this study were thus to examine motor competency in preschool children with strabismus by using the BOT-2 and to evaluate the usefulness of the BOT-2 SF to identify those at risk for motor competency issues. METHODS: Forty preschool children (aged 5-7 years) with strabismus were recruited, all of whom had abnormal stereopsis. The BOT-2 complete form (CF) was administered to all children. The BOT-2 CF was administered to all children. The scores of the BOT-2 SF were extracted from the relevant items of the BOT-2 CF for further analysis. RESULTS: The prevalence of children with strabismus who had below average performance in the composites of "Fine Manual Control", "Manual Coordination","Body Coordination", and "Strength and Agility" were 15%, 70%, 32.5%, and 5%, respectively, on the BOT-2 CF. Compared with these results, the sensitivity of the BOT-2 SF was 33.33% (95% CI = 7.49%-70.07%) and the specificity was 100% (95% CI = 88.78%-100%). CONCLUSION: Preschool children with strabismus had a high prevalence of impaired motor competency, especially in fine motor competency. The BOT-2 SF was not as sensitive in identifying motor difficulties in preschool children with strabismus. Therefore, the BOT-2 CF is recommended for evaluating motor proficiency in preschool children with strabismus.

Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury.

(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients' clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28-3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31-5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.

Self-care Experiences of Adolescents with Spinal Muscular Atrophy.

PURPOSE: We examined the self-care experiences of adolescents with spinal muscle atrophy (SMA) and their perceptions of the interactions between their body and the environment. METHODS: We interviewed ten adolescents with SMA aged 13-18 years regarding personal care practices. Purposive sampling was conducted in two medical centers in northern Taiwan. Data were analyzed using the Giorgi analysis method. RESULTS: Four constitutions were identified: (1) limited space for independent development, (2) multiple reconstructions of self-image to improve physical ability, (3) self-care of disease, and (4) developing activity styles to accommodate social culture. CONCLUSION: The self-care lived experiences of patients reflect dynamic changes in the body and environment. Self-existence was exhibited by adjustment, practice, and creativity of physical activity to integrate into society. Nursing staff should understand the self-care experiences and needs of adolescents with SMA to develop a database of self-care skills. This study recommended that nursing staff improve their ability to guide patients in taking care of themselves by developing body awareness self-care courses and individual care plans in response to various stages of disability to help patients delay deterioration, realize their physical potential, and promote independence and social development.

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury.

Traumatic brain injury (TBI) is the leading cause of mortality in children. There are few studies focused on school-aged children with TBI. We conducted this study to identify the early predictors of in-hospital mortality in school-aged children with severe TBI. In this 10 year observational cohort study, a total of 550 children aged 7-18 years with TBI were enrolled. Compared with mild/moderate TBI, children with severe TBI were older; more commonly had injury mechanisms of traffic accidents; and more neuroimage findings of subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), parenchymal hemorrhage, cerebral edema, and less epidural hemorrhage (EDH). The in-hospital mortality rate of children with severe TBI in our study was 23%. Multivariate analysis showed that falls, being struck by objects, motor component of Glasgow coma scale (mGCS), early coagulopathy, and SAH were independent predictors of in-hospital mortality. We concluded that school-aged children with severe TBI had a high mortality rate. Clinical characteristics including injury mechanisms of falls and being struck, a lower initial mGCS, early coagulopathy, and SAH are predictive of in-hospital mortality.

Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma.

Children with abusive head trauma tend to have worse outcomes than children with accidental head trauma. However, current predictors of poor outcomes for children with abusive head trauma are still limited. We aim to use clinical data to identify early predictors of poor outcome at discharge in children with abusive head trauma. In the 10-year observational retrospective cohort study, children aged between zero and four years with abusive or accidental head trauma were recruited. Multivariate logistic regression models were applied to evaluate factors associated with poor prognosis in children with abusive head trauma. The primary outcome was mortality or a Glasgow Coma Scale (GCS) motor component score of less than 6 at discharge. A total of 292 head trauma children were included. Among them, 59 children had abusive head trauma. In comparison to children with accidental head trauma, children with abusive head trauma were younger, had more severe head injuries, and experienced a higher frequency of post-traumatic seizures. Their radiologic findings showed common presence of subdural hemorrhage, cerebral edema, and less epidural hemorrhage. They were more in need of neurosurgical intervention. In the multivariate analysis for predictors of poor outcome in children with abusive head trauma, initial GCS ≤ 5 (versus GCS > 5 with the adjusted odds ratio (OR) = 25.7, 95% confidence interval (CI) = 1.5⁻432.8, p = 0.024) and older age (per year with the adjusted OR = 3.3, 95% CI = 1.2⁻9.5, p = 0.024) were independently associated with poor outcome. These findings demonstrate the characteristic clinical differences between children with abusive and accidental head trauma. Initial GCS ≤ 5 and older age are predictive of poor outcome at discharge in children with abusive head trauma.

Acceptance of different design exergames in elders.

For promoting the successful aging of elderly residents of Chang Gung Silver Village in Taiwan, five interactive exergames were developed to promote the well-being of the elderly. The exergames included both physical games and cognitive games, and were implemented using various computer-based technologies in the Chang Gung Silver Village. The exergames were trialed by 39 elderly residents (15 male, 24 female; mean age 79.5 ± 17.5 years) of Chang Gung Silver Village. Following the trials, the participants were requested to complete a Technology Acceptance Model 2 (TAM2) questionnaire. The results showed that the perceived playfulness and perceived usefulness of the exergames were significantly related to the users' usage behavior and intention to use for both the physical games and the cognitive games. However, a relationship between the output quality of the game and the usage behavior was apparent only in the case of the cognitive exergames. Finally, the impact of social influence on the intention to use and the usage behavior was more pronounced for the physical exergames. Overall, the results revealed that the acceptance of exergames by the elderly depends not so much on the awareness of fun in using the game, but the perceived usefulness of the related physical and cognitive abilities.

Partnership between families of children with muscular dystrophy and healthcare professionals: From parents' perspective.

PURPOSES: At present, there is still controversy between parents of children with muscular dystrophy (MD) and healthcare professionals on care issues. Partnerships can connect the affected children and their families to appropriate healthcare services, to jointly face the care environment together and thereby improve the quality of life of children with MD. Therefore, the objective of this study is to explore partnerships between families and healthcare professionals from the perspectives of parents of children with MD. METHOD: Husserl's phenomenological research was applied to explore the basic structures of parents' descriptions of MD. Through purposive sampling, we conducted in-depth interviews with parents, and analyzed the data according to the theory of Giorgi. Nineteen parents (10 mothers, nine fathers) participated in this study. The precision of the research results was tested by applying the four standards of Lincoln and Guba. RESULTS: This study identified five constituents: feasible resources and detailed care information; the provision of an integrated medical care across systems; family and home as key elements in critical care; respect and care for family care demands; and finally; feedback and support from families. CONCLUSION: This study demonstrated that partnerships were established by healthcare professionals, enhancing the care capacity of the families, developing the preventive medicine of MD, and enhancing children's potential for self-care within the families. Hospital policies should include the promotion of family partnership care. The findings can help healthcare professionals recognize the life experiences of children with MD when providing medical care.

Intra-observer reliability of Prechtl's method for the qualitative assessment of general movements in Taiwanese infants.

[Purpose] The aim of this study was to examine the intra-observer reliability for Prechtl's General Movements Assessment in Taiwanese infants. This includes the global General Movements Assessment, the Optimality List for Preterm General Movements and Writhing Movements, and the Assessment of Motor Repertoire-3 to 5 Months. [Subjects and Methods] Fifty-nine videos of 37 infants were observed and rated by one physical therapist twice. [Results] The intra-observer reliability ranged from good to very good for the global General Movements Assessment. The overall intra-observer reliabilities for the total score of the Optimality List from preterm up to postmenstrual age 46 weeks and the total score of the Assessment of Motor Repertoire for postmenstrual age 49 to 60 weeks were both good. [Conclusion] The results suggest that the intra-observer reliability of a certified physical therapist was satisfactory for Prechtl's method in Taiwanese infants.

Potential predictors for health-related quality of life in stroke patients undergoing inpatient rehabilitation.

BACKGROUND: Improving HRQOL is the desired outcome for patients with stroke undergoing inpatient rehabilitation services. This study aimed to comprehensively identify the potential health-related quality of life (HRQOL) predictors in patients with stroke undergoing inpatient rehabilitation within the first year after stroke; thus far, such an investigation has not been conducted. METHODS: We enrolled 119 patients (88 males, 31 females) with stroke, and examined 12 potential predictors: age, sex, stroke type, stroke side, duration after onset, cognition (Mini-Mental State Examination; MMSE), depression (Beck Depression Inventory-II), stroke severity (National Institutes of Health Stroke Scale; NIHSS), upper- and lower-extremity motor function scores of the Fugl-Meyer Assessment (FMA) scale, balance (Berg Balance Scale; BBS), and functional status (Functional Independence Measure). HRQOL was measured using Stroke Impact Scale (SIS) 3.0. RESULTS: NIHSS score predicted the strength domain and total SIS score (41.5% and 41.7% of the variances, respectively). BBS score was a major predictor of mobility and participation/role domains (48.6% and 10% of the variances, respectively). MMSE score predicted the memory and communication domains (22.5% and 36.3% of the variances, respectively). Upper extremity score of the FMA scale predicted the daily living/instrumental activities of daily life and hand function domains (40.3% and 20.6% of the variances, respectively). Stroke side predicted the emotion domain (11.6% of the variance). CONCLUSIONS: NIHSS, MMSE, BBS, FMA, and stroke side predicted most HRQOL domains. These findings suggest that different factors predicted various HRQOL domains in patients with stroke.

Increased risk of posterior circulation infarcts among ischemic stroke patients with cervical spondylosis.

BACKGROUND: Cervical spondylosis is one of the extrinsic factors causing vertebral artery stenosis. Several case studies have reported compression of the vertebral artery induced by cervical osteophytes that has resulted in posterior circulation infarcts (POCI). However, to the best of our knowledge, no studies have yet analyzed differences in the risk factors and stroke subtypes between ischemic stroke patients with cervical spondylosis and those without. PURPOSE: In the case-controlled study reported here, we analyzed the risk factors and stroke subtypes in ischemic stroke patients with and without cervical spondylosis. Characteristics in all the recruited patients with POCI and non-POCI were further compared to extract other risk factors that could predict the occurrence of POCI. METHODS AND PATIENTS: We filtered out ischemic stroke patients with cervical spondylosis ("Stroke+C" group) by International Classification of Diseases, Ninth Revision codes. We analyzed the data of 38 subjects in the Stroke+C group and 152 sex- and age-comparable ischemic stroke patients without cervical spondylosis ("Stroke-C" group). We recorded the demographic characteristics including sex and age, and stroke risk factors, including diabetes mellitus, hypertension, heart disease, hyperlipidemia, and smoking habits. The stroke classifications were defined by the Oxford Community Stroke Project classification. All subjects were further categorized into POCI or non-POCI groups. The ultrasound findings of the vertebral arteries (extracranial and intracranial) in the Stroke+C group were also recorded. RESULTS: More patients in the Stroke+C group tended to have POCI (34.2%) than patients in the Stroke-C group (17.5%) (odds ratio [OR] =2.41, P<0.05). Furthermore, hypertension (OR=3.41, P<0.01) and cervical spondylosis (OR=2.41, P<0.05) were two independent risk factors for POCI in ischemic stroke patients. CONCLUSION: Ischemic stroke patients with cervical spondylosis are more prone to POCI than those without cervical spondylosis. Hypertension is another identified risk factor for POCI in ischemic stroke patients. The occurrence of POCI should be highlighted for patients with cervical spondylosis.

Measurement properties of streamlined wolf motor function test in patients at subacute to chronic stages after stroke.

UNLABELLED: BACKGROUND. Previous research using the streamlined Wolf Motor Function Test (SWMFT) has focused either on the 3- to 9-month period or on the >12-month period after stroke and lacked the information for those at 9 to 12 months. Whether SWMFT scores reflect motor deficit and recovery from early to late stages after stroke remains unclear. OBJECTIVE: A retrospective study using the Functional Ability Scale (FAS) was conducted to evaluate whether all SWMFTs items measure the poststroke recovery of upper extremity (UE) motor function and if they could be used for patients within 9 to 12 months after a stroke. METHODS: Rasch analysis was conducted, and data were drawn from patients 3 months to years after a stroke. RESULTS: The continuum of UE motor function in SWMFT-FAS was supported. Subacute patients had the best motor function, followed by the 9- to 12-month group, and then chronic patients. Variation in UE motor function was large (2.35-2.72 logits), and motor abilities of these 3 groups overlapped. The 8 SWMFT items could target a broad range of UE motor function, from -8.28 to 7.80 logits. The average difficulty of these 8 items also matched the UE motor ability of the subgroup at 9 to 12 months after stroke, and individual versions of the SWMFT performed well to assess the motor ability of this group. CONCLUSIONS: The SWMFTs had sound hierarchical properties. The SWMFT-Chronic or the SWMFT-Subacute could be used to evaluate UE function of this subgroup at 9 to 12 months after stroke.

Predictors for changes in various developmental outcomes of children with cerebral palsy--a longitudinal study.

We aimed to identify predictors for the changes of various developmental outcomes in preschool children with cerebral palsy (CP). Participants were 78 children (49 boys, 29 girls) with CP (mean age: 3 years, 8 months; SD: 1 year, 7 months; range: 1 year to 5 years, 6 months). We examined eight potential predictors: age, sex, CP subtype, Gross Motor Function Classification System (GMFCS) level, selective motor control, Modified Ashworth Scale, and the spinal alignment (SA) and range of motion subscales of the Spinal Alignment and Range of Motion Measure (SAROMM). Developmental outcomes for cognition, language, self-help, and social and motor functions were measured at baseline and a 6-month follow-up with the Comprehensive Developmental Inventory for Infants and Toddlers. Regression model showed GMFCS level was a negative predictor for change of language (adjusted r(2)=0.30, p<.001), motor function (adjusted r(2)=0.26, p<.001), social function (adjusted r(2)=0.07, p=0.014), and self-help (adjusted r(2)=0.26, p<.001). Age was a negative predictor for change of cognition (adjusted r(2)=0.21, p<.001) and language functions (adjusted r(2)=0.26, p<.001). SAROMM-SA was a negative predictor for cognitive change (adjusted r(2)=0.30, p<.001). The GMFCS levels and age are robust negative predictors for change of most developmental domains in these children.

Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy.

This study examined criterion-related validity and clinimetric properties of the pediatric balance scale (PBS) in children with cerebral palsy (CP). Forty-five children with CP (age range: 19-77 months) and their parents participated in this study. At baseline and at follow up, Pearson correlation coefficients were used to determine criterion-related validity by analyzing the correlation between the PBS, including PBS-static, PBS-dynamic, and PBS-total, and criterion measures, including the Gross Motor Function Measure-66 items (GMFM-66) and Functional Independence Measures for Children (WeeFIM). Responsiveness was examined by paired t test and by standardized response mean (SRM). The minimal detectable change (MDC) was analyzed at the 90% confidence level, and the minimal clinically important differences (MCID) was estimated by anchor-based and distribution-based approaches. The PBS with GMFM-66 and WeeFIM showed fair-to-excellent concurrent validity at pretreatment and follow up and predictive validity. The SRM values of all PBS scales were 0.75. For the PBS-static, PBS-dynamic, and PBS-total, the MDC(90) values were 0.79, 0.96, and 1.59, and the MCID ranges were 1.47-2.92, 2.23-2.92, and 3.66-5.83, respectively. Improvement of at least MDC values on the PBS can be considered a true change, not measurement error. A mean change must exceed the MCID range on PBS to be considered clinically important change. Therefore, all PBS scales were moderately responsive to change. Clinicians and researchers can use these clinimetric data for PBS to determine if a change score represents a true or clinically meaningful effect at posttreatment and follow up.