Exploring Managers' Opinions on Planning and Designing Adult Day Care Centers.

OBJECTIVE: To explore managers' opinions on planning and design of location, building type, spatial layout, and interior design of adult day care centers (ADCCs). BACKGROUND: The planning and design of new ADCCs affect subsequent service users and workflows. Studies explore the factors affecting such planning and design using qualitative methods and from the perspective of users. Quantitative methods are rarely employed to explore factors affecting planning and opinions on the design of ADCCs from administrators' perspective. METHODS: Stratified sampling was used to collect data from managers of ADCCs in Taiwan. A mixed-method approach with an analytic hierarchy process was used to quantify the relative importance of factors affecting location and building type selections. Participants responded to open-ended interview questions followed by focus group interviews to examine the key points for spatial layout and interior design. RESULTS: The managers deemed support and attitudes from local residents (group weight = .208) and authorities (group weight = .187) as their first two critical location selection criteria. Regarding their opinions on the conditions of building type, those that prioritized the products and technologies of facility design were deemed the most critical (group weight = .193), followed by those that valued daylight quality (group weight = .161). Six key points of spatial layout and interior design were obtained from the focus group interviews. CONCLUSIONS: This study provides a reference for the effective planning of operations, including geographical location, building type, spatial layout, and interior refurbishment and design.

Can short-term effectiveness of anti-pronation taping predict the long-term outcomes of customized foot orthoses: developing predictors to identify characteristics of patients with plantar heel pain likely to benefit from customized foot orthoses.

BACKGROUND: Foot orthoses are widely used to manage plantar heel pain (PHP). However, the evidence concerning the effect of foot orthoses on PHP is not conclusive. The study aims to identify the characteristics of patients with PHP likely to achieve a positive outcome after customized foot orthoses and to verify the concept that patients who respond positively to anti-pronation taping would achieve a positive prognosis after wearing foot orthoses for six months. METHODS: This is a prospective observational cohort study. Seventy-four patients with PHP underwent a baseline examination and received anti-pronation taping to their painful feet. The taping effects on pain and function were assessed at the 7-day follow-up visit. Then, all patients received an intervention for their PHP with customized foot orthoses for six months. Outcome was assessed with a numeric pain rating scale, the patient-specific functional scale, the foot function index, and the global rating of perceived change. Significant reduction of pain, increase of function, and perception of a meaningful improvement were considered a positive response. RESULTS: Of 74 patients, 49 had a positive response to the customized foot orthosis treatment. Five predictors were identified: (1) the average pain intensity decreased by over 1.5 points with taping, (2) the range of ankle plantarflexion > 54 degrees, (3) the strength of ankle plantarflexors on the symptomatic side was equal to or stronger than that on the other side, (4) the range of hip internal rotation < 39 degrees, and (5) the range of hip external rotation > 45 degrees. The presence of three or more predictors increased the rate of achieving positive outcome from 66 to 89%. CONCLUSIONS: The predictors of customized foot orthosis outcome in patients with PHP are related to several physical measures of a lower extremity. Findings of the study can be used to screen and select patients with PHP for foot orthosis intervention. Moreover, patients who respond positively to anti-pronation taping would also benefit from the customized foot orthoses. However, since there was no control group in the current study, it is inappropriate to draw conclusions about the effectiveness of the foot orthoses treatment. TRIAL REGISTRATION: The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12617000119392 ).

Neonatal respiratory status predicts longitudinal respiratory health outcomes in preterm infants.

OBJECTIVES: To examine the relationship between neonatal respiratory status and longitudinal respiratory health outcomes in preterm infants with very low birth weight (VLBW, birth weight <1500 g). METHODS: A total of 109 VLBW preterm infants were prospectively assessed for respiratory status using the Toce clinical and radiographic scoring method on a postnatal day 28, and severity of bronchopulmonary dysplasia (BPD) at 36-weeks postmenstrual age (PMA), respiratory morbidity within 1 year of corrected age (CA), pulmonary function test, and six-minute walk test at 4 years of age. RESULTS: A high Toce clinical score on day 28 was associated with the occurrence of respiratory morbidity within 1 year of CA and poor pulmonary function and functional exercise performance at 4 years of age in VLBW preterm infants (all P < 0.05). BPD at 36-weeks PMA was associated with an increased risk of respiratory morbidity within 1 year of CA and its negative impact on pulmonary function and functional exercise performance at 4 years of age was most pronounced in the severe form (all P < 0.05). CONCLUSIONS: Early assessments of neonatal respiratory status including Toce clinical score and the severity of BPD are valid to identify VLBW preterm infants who are at risk of adverse longitudinal respiratory health outcomes.

Development of a clinical prediction rule to identify patients with plantar heel pain likely to benefit from biomechanical anti-pronation taping: A prospective cohort study.

OBJECTIVES: To develop a clinical prediction rule (CPR) to identify patients with plantar heel pain (PHP) likely to benefit from biomechanical anti-pronation taping (BAPT). DESIGN: A prospective cohort study. SETTING: An outpatient rehabilitation department in a general hospital. PARTICIPANTS: Seventy-five patients with PHP. MAIN OUTCOME MEASURES: After completing a series of physical examinations, all patients received BAPT and were evaluated with a numeric rating scale for pain intensity, the patient-specific functional scale and foot function index (FFI) for function, and the global rating of change for perceived improvement. RESULTS: Twenty-eight patients achieved a successful outcome. A CPR with 6 significant variables was identified by a multivariate logistic regression: FFI score less than 33.3, hip adduction angle of the most affected side was greater than the contralateral side, ankle plantarflexors and hip abductors on the most affected side were not weaker than those on the contralateral side, ankle invertors on the most affected side were weaker than the contralateral side, and having more than 2 painful sites in the low back and lower extremity regions. If 5 or more of the 6 predictors were presented, the probability of success increased from 37% to 80%. CONCLUSIONS: A CPR has been developed to identify patients with PHP likely to benefit from BAPT.

Comparison of segmental spinal movement control in adolescents with and without idiopathic scoliosis using modified pressure biofeedback unit.

BACKGROUND: Postural rehabilitation emphasizing on motor control training of segmental spinal movements has been proposed to effectively reduce the scoliotic spinal deformities in adolescent idiopathic scoliosis (AIS). However, information regarding the impairments of segmental spinal movement control involving segmental spinal stabilizers in adolescent idiopathic scoliosis remains limited. Examination of segmental spinal movement control may provide a window for investigating the features of impaired movement control specific to spinal segments that may assist in the development of physiotherapeutic management of AIS. OBJECTIVES: To compare segmental spinal movement control in adolescents with and without idiopathic scoliosis using modified pressure biofeedback unit. METHODS: Segmental spinal movement control was assessed in twenty adolescents with idiopathic scoliosis (AISG) and twenty healthy adolescents (CG) using a modified pressure biofeedback unit. Participants performed segmental spinal movements that primarily involved segmental spinal stabilizing muscles with graded and sustained muscle contraction against/off a pressure cuff from baseline to target pressures and then maintained for 1 min. Pressure data during the 1-minute maintenance phase were collected for further analysis. Pressure deviation were calculated and compared between groups. RESULTS: The AISG had significantly greater pressure deviations for all segmental spinal movements of cervical, thoracic, and lumbar spine than the CG. CONCLUSION: Pressure biofeedback unit was feasible for assessing segmental spinal movement control in AIS. AISG exhibited poorer ability to grade and sustain muscle activities for local movements of cervical, thoracic, and lumbar spine, suggesting motor control training of segmental spinal movements involving segmental spinal stabilizing muscles on frontal, sagittal, and transverse planes were required.

Effects of hippotherapy on body functions, activities and participation in children with cerebral palsy based on ICF-CY assessments.

PURPOSE: To evaluate the effects of hippotherapy on body functions, activities, and participation in children with CP of various functional levels by using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) checklist. METHODS: Fourteen children with cerebral palsy (CP) (3-8 years of age) were recruited for a 36-week study composed of baseline, intervention, and withdrawal phases (12 weeks for each phase, ABA design). Hippotherapy was implemented for 30 min once weekly for 12 consecutive weeks during the intervention phase. Body Functions (b) and Activities and Participation (d) components of the ICF-CY checklist were used as outcome measures at the initial interview and at the end of each phase. RESULTS: Over the 12 weeks of hippotherapy, significant improvements in ICF-CY qualifiers were found in neuromusculoskeletal and movement-related functions (b7), mobility (d4) and major life areas (d8) and, in particular, mobility of joint functions (b710), muscle tone functions (b735), involuntary movement reaction functions (b755), involuntary movement functions (b765), and play (d811) (all p < 0.05) when compared with baseline. CONCLUSION: This study demonstrated the beneficial effects of hippotherapy on body functions, activities, and participation in children with CP. Implications for Rehabilitation ICF-CY provides a comprehensive overview of functioning and disability and constitutes a universal language for identifying the benefits of hippotherapy in areas of functioning and disability in children with CP. In children with CP, hippotherapy encourages a more complementary approach that extends beyond their impairments and limitations in body functions, activities, and participation. The effect of hippotherapy was distinct from GMFCS levels and the majority of improvements were present in children with GMFCS levels I-III.

Effects of Computer-Aided Interlimb Force Coupling Training on Paretic Hand and Arm Motor Control following Chronic Stroke: A Randomized Controlled Trial.

OBJECTIVE: We investigated the training effects of interlimb force coupling training on paretic upper extremity outcomes in patients with chronic stroke and analyzed the relationship between motor recovery of the paretic hand, arm and functional performances on paretic upper limb. DESIGN: A randomized controlled trial with outcome assessment at baseline and after 4 weeks of intervention. SETTING: Taipei Veterans General Hospital, National Yang-Ming University. PARTICIPANTS: Thirty-three subjects with chronic stroke were recruited and randomly assigned to training (n = 16) and control groups (n = 17). INTERVENTIONS: The computer-aided interlimb force coupling training task with visual feedback included different grip force generation methods on both hands. MAIN OUTCOME MEASURES: The Barthel Index (BI), the upper extremity motor control Fugl-Meyer Assessment (FMA-UE), the Motor Assessment Score (MAS), and the Wolf Motor Function Test (WMFT). All assessments were executed by a blinded evaluator, and data management and statistical analysis were also conducted by a blinded researcher. RESULTS: The training group demonstrated greater improvement on the FMA-UE (p<.001), WMFT (p<.001), MAS (p = .004) and BI (p = .037) than the control group after 4 weeks of intervention. In addition, a moderate correlation was found between the improvement of scores for hand scales of the FMA and other portions of the FMA UE (r = .528, p = .018) or MAS (r = .596, p = .015) in the training group. CONCLUSION: Computer-aided interlimb force coupling training improves the motor recovery of a paretic hand, and facilitates motor control and enhances functional performance in the paretic upper extremity of people with chronic stroke. TRIAL REGISTRATION: ClinicalTrials.gov NCT02247674.

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy.

BACKGROUND: Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures. METHODS: In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support). RESULTS: Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions. CONCLUSIONS: These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.

Toxic effect of NaCl on ion metabolism, antioxidative enzymes and gene expression of perennial ryegrass.

Two-month old seedlings of perennial ryegrass (Lolium perenne L.) were subjected to four different levels of salinity for 7 days. The NaCl treatments reduced turf quality and normalized transpiration rates. Both chlorophyll (Chl) a and Chl b contents decreased in the grass exposed to 255 mM relative to the control. An increase in the lipid peroxidationin was observed. The activity of leaf superoxide dismutase increased while, peroxidase and catalase activities decreased in response to NaCl treatments. The expression of Chl Cu/ZnSOD, Cyt Cu/ZnSOD, FeSOD, CAT, POD, GPX and GR was up-regulated for NaCl-treated grass. Salt stress increased accumulation of Na(+) and decreased K(+)/Na(+) ratio, Mg(2+) and P content in both shoots and roots of perennial ryegrass. The findings of this study suggest that salt stress may cause toxicity to perennial ryegrass through oxidative injury and damage to Chl and cell membrane integrity.

Severity of bronchopulmonary dysplasia and increased risk of feeding desaturation and growth delay in very low birth weight preterm infants.

Oral feeding has been reported to compromise breathing among preterm infants with bronchopulmonary dysplasia (BPD) during hospitalization or shortly after discharge. However, limited information was available concerning whether preterm infants with BPD remain vulnerable to feeding and growth insufficiency after a longer term of follow-up. The purpose of this study was therefore to examine the effect of severity of BPD on pulse oxygen saturation (SpO(2)) during feeding and growth in very low birth weight (VLBW) preterm infants during infancy. Seventy-two preterm infants with VLBW and 15 term infants were prospectively examined their growth and SpO(2) during feeding at 2, 4, and 6 months of corrected age. The severity of BPD was graded in VLBW infants according to the American National Institutes of Health consensus definition. In comparison to VLBW infants with mild BPD and term infants, VLBW infants with severe BPD showed significantly lower mean levels of SpO(2) during feeding at 2-6 months corrected age (P < 0.05). Those with severe BPD further exhibited higher rates of growth delay (weight < 10th percentile) throughout the study period. Among VLBW infants, severe BPD had an adverse relation with subsequent weight measures after adjustment for medical and demographic confounding variables (beta = -904 g, P = 0.03). The consensus BPD definition is useful to identify those preterm infants who are at greater risk of feeding desaturation and growth delay during infancy and close monitoring of SpO(2) during feeding should be advised.

Associations of supported treadmill stepping with walking attainment in preterm and full-term infants.

BACKGROUND: Treadmill training in supported stepping has been used as part of rehabilitation programs for children with neurodevelopmental problems to facilitate earlier onset of walking. However, information concerning the developmental continuity between supported stepping and walking is limited. OBJECTIVE: The aims of this study were to longitudinally examine supported stepping in preterm and full-term infants and to explore the step parameters associated with walking attainment. DESIGN: A cohort study with a longitudinal follow-up design was used. METHODS: Twenty-nine preterm infants and 20 full-term infants were examined bimonthly with supported stepping on a treadmill from 7 months of age until walking attainment or 18 months of corrected age. The associations between step variables and walking outcome were examined using Cox proportional hazard regression and logistic regression. RESULTS: Walking attainment for preterm infants was later than for full-term infants (median = 12.8 versus 11 months, respectively). The percentage of alternating steps, hip-knee correlation, hip-ankle correlation, and asymmetry ratio (AR) of stance time of stepping movement from 7 to 9 months of corrected age were found to be associated with age of walking attainment in all infants. Manifestation of at least 3 of 4 step features (ie, > or = 80% alternating steps, < or = .37 hip-knee correlation, > or = .73 hip-ankle correlation, and < or = 1.40 AR of stance time) at 7 months predicted walking attainment prior to 11 months of corrected age (accuracy = 75%-77%). Failure to achieve such competencies at 7 or 9 months of corrected age was predictive of failure in walking attainment by 15 months (accuracy = 72%-98%). Limitations The limitations of this study included a small sample size and commencement of stepping assessment as early as 7 months of corrected age. CONCLUSIONS: The emergence of walking may involve cooperation of alternating pattern generation, interjoint coordination, and interlimb coordination in supported stepping in preterm and full-term infants. The identified step predictors may assist clinicians in designing appropriate treadmill training programs for those infants with delayed walking.

Gastrocnemius tightness on joint angle and work of lower extremity during gait.

BACKGROUND: Muscular tightness is a common clinical musculoskeletal disorder and is regarded as a predisposing factor for muscle injuries. In this study, a two-way mixed design ANOVA was applied to investigate the effects of the gastrocnemius tightness on the joint angle and joint work during walking. METHODS: Twenty-two patients with muscular tightness of gastrocnemius muscle (<12 degrees of ankle dorsiflexion with knee extended) and 22 age- and gender-matched subjects with normal gastrocnemius flexibility (>15 degrees of ankle dorsiflexion with knee extended) participated in this study. The joint angle and work at hip, knee, and ankle joints during the stance phase were analyzed at two preset cadences of 100 steps/min and 140 steps/min. FINDINGS: Significantly greater flexion angles at hip (P=0.025) and knee (P=0.001) were found in the tightness group at the time of maximal ankle dorsiflexion. Significantly less work generation at knee (P=0.034) and greater work absorption at ankle (P=0.024) were detected in the tightness group. INTERPRETATION: The subjects with gastrocnemius tightness revealed a compensatory gait pattern, which included the changes in the joint angles and associated work productions. The potential disturbance of the knee control and strain injuries of plantar flexors might be crucial in the clinical considerations for subjects with gastrocnemius tightness.

Development of walking in preterm and term infants: age of onset, qualitative features and sensitivity to resonance.

An increasing number of studies have examined the development of walking in preterm infants; however, the results concerning those who had no major neonatal disease were inconclusive. This study was therefore aimed to examine the age of onset, the quality of early walking movement, and the sensitivity to resonant period of the force-driven harmonic oscillator (FDHO) model in preterm infants who had no major neonatal disease and normal term infants. Twenty-nine preterm infants and 29 term infants were prospectively examined for their age of onset of independent walking and were subsequently assessed the qualitative features of walking at 18 months of corrected age using kinematic analysis. Kinematic variables examined included spatio-temporal organization, inter-joint coordination, and inter-limb coordination. The anthropometric data were used to calculate the resonant period. The results demonstrated that the preterm infants attained independent walking at significantly older ages than the term infants when corrected for prematurity. The preterm infants manifested similar walking characteristics, except for shorter stride lengths, at 18 months of corrected age compared with the term infants. Furthermore, the stride periods of both groups were accurately predicted by the resonant period of the FDHO model. We conclude that preterm birth without accompanied major neonatal disease may affect infants' age of onset and spatial organization but not their sensitivity to resonance during the early stage of walking development.

Relationship between spontaneous kicking and age of walking attainment in preterm infants with very low birth weight and full-term infants.

BACKGROUND AND PURPOSES: Although early kicking differences have been reported for preterm infants without overt cranial sonographic abnormalities, their functional importance remains unclear because no outcomes have been measured. Therefore, the first purpose of this prospective study was to examine the age of walking attainment in preterm infants who had very low birth weight (VLBW) but no overt neurosonographic abnormalities and full-term infants without known impairments or pathology. The second purpose was to examine the relationship between spontaneous kicking and age of walking attainment in these infants. SUBJECTS AND METHODS: Twenty-two preterm infants and 22 full-term infants were examined for kicking movements at 2 and 4 months corrected age and were followed up for age of walking attainment until 18 months corrected age. RESULTS: Survival analysis showed that infants with VLBW attained walking ability at older ages than full-term infants after correction for prematurity. Cox proportional-hazards regression analyses for all infants revealed that a high hip-knee correlation at 2 months corrected age, a high kick frequency at 4 months corrected age, and a short intra-kick pause together with a low variability in interlimb coordination at 2 and 4 months corrected age were all associated with a decreased rate of walking attainment. DISCUSSION AND CONCLUSION: The results indicated that preterm infants who had VLBW but no overt neurosonographic abnormalities had an increased risk of delayed walking attainment compared with full-term infants. Alterations of spontaneous kicking may predict a decreased rate of walking attainment in both preterm and full-term infants.