Age-Related Differences Between Young and Old Adults: Effects of Advance Information on Task Switching.

In this study we investigated the effects of advance information on task switching in young and old adults, using two forms of advance information (memory-based and cue-based) and a no advance information task. We compared 19 healthy young and 19 healthy older adults in terms of their behavioral performance and neural correlates under these three task-switching paradigms. We observed a significant difference in mixing cost between the two age groups. There was no switch cost group difference on the memory-based and cue-based tasks, but older adults showed a larger switch cost than younger adults on the no advance information task. On evoked potential measures, there was no group effect in P3 cue-locked positivity; but there was, a frontal shift of the target-locked P3, indexed as reactive control, among older adults. We observed an increased target-locked P3 in the no-information paradigm compared with the cue-based and memory-based paradigms in both groups. Task cue facilitated advance preparation and proactive control under the cue-based paradigm in both groups. Age-related decline and difficulty in control processes required for task goal maintenance were apparent among the older adults.

Neural Correlates of Response Inhibition and Error Processing in Individuals with Mild Traumatic Brain Injury: An Event-Related Potential Study.

Individuals with a mild traumatic brain injury (mTBI) often have executive control deficits; however, the underlying neural mechanisms of such deficits are yet to be clarified. Inhibitory control and cognitive monitoring are two fundamental aspects of executive control processes. This study investigated the executive control of mTBI by using the Stop-signal task. Eighteen adults with mTBI and 18 age-, sex-, and education level-matched controls were recruited. Behavioral performance and event-related potential correlates of response inhibition and error processing were compared between groups. The mTBI group tended to have a lower probability of inhibition and a longer stop signal reaction time. N1 amplitude was greater on successful trials. Also on successful trials, N2 and P3 peaked earlier than on failed trials. The N2 amplitude of the mTBI group tended to be smaller than that of the controls. The control group had larger P3 amplitude on successful trials than on failed trials, whereas the mTBI group exhibited no P3 amplitudes difference between the two trial types. In addition, the mTBI group showed significantly longer error positivity latency than did the controls. These results suggest that inhibitory control and error processing were inefficient in the mTB group even more than three months after injury. Electrophysiological markers of cognitive dysfunction can be used as a sensitive tool for determining executive control after mTBI.

Responsiveness and minimal clinically important difference of TNO-AZL Preschool Children Quality of Life in children with cerebral palsy.

PURPOSE: To examine the responsiveness and minimal clinically important difference (MCID) of the TNO-AZL (Netherlands Organization for Applied Scientific Research Academic Medical Centre) Preschool Children Quality of Life (TAPQOL) in children with cerebral palsy (CP). METHODS: Ninety-seven children with CP (60 males, 37 females; aged 1-6 years) and their caregivers were recruited from the rehabilitation programs of Chang Gung Memorial Hospital in Taiwan for this 6-month longitudinal follow-up study. The Functional Independence Measure for Children (WeeFIM) and TAPQOL outcomes were measured at baseline and at a 6-month follow-up. Responsiveness was examined using the standardized response mean (SRM). The distribution-based and anchor-based MCID were determined. The TAPQOL outcomes include physical functioning (PF), social functioning (SF), cognitive functioning (CF), and emotional functioning (EF) domains. RESULTS: The responsiveness of the TAPQOL for all of TAPQOL domains was marked (SRM = 1.12-1.54). The anchor-based MCIDs of TAPQOL for PF, SF, CF, EF, and total domains were 1.25, 3.28, 2.93, 2.25, and 1.73, respectively, which were similar to the distribution-based MCID values of TAPQOL, except in the PF domain. The distribution-based MCIDs of TAPQOL in various domains were 2.85-3.73 when effect size (ES) was 0.2, 7.13-9.32 when ES was 0.5, and 11.40-14.91 when ES was 0.8. CONCLUSIONS: TAPQOL is markedly responsive to detect change in children with CP. The caregivers perceived the minimally important change in HRQOL of their children at a relatively low treatment efficacy. Researchers and clinicians can utilize TAPQOL data to determine whether changes in TAPQOL scores indicate clinically meaningful effects post-treatment and at the follow-up.

Responsiveness and minimal clinically important difference of Modified Ashworth Scale in patients with stroke.

BACKGROUND: Spasticity is a major problem in patients with stroke and influences their activities of daily living, participation, and quality of life. The Modified Ashworth Scale is widely used to assess spasticity. However, the responsiveness and minimal clinically important differences of the Modified Ashworth Scale in patients with stroke have not been explored. AIM: This study aims to examine the responsiveness and minimal clinically important differences of the Modified Ashworth Scale in patients with stroke. DESIGN: Longitudinal six-month follow-up study. SETTING: Rehabilitation wards of a tertiary hospital. POPULATION: One-hundred and fifteen patients with stroke were recruited. METHODS: All patients underwent the assessment of Modified Ashworth Scale for the upper extremity (flexors of the elbow, wrist, and fingers) and the lower extremity (hip adductor, knee flexor, and ankle plantar flexor) at baseline and 6-month follow-up. The average Modified Ashworth Scale scores of the upper and lower extremity muscles were obtained for analysis. Responsiveness of the Modified Ashworth Scale was determined using standardized mean response, and the minimal clinically important differences were determined using a distribution-based approach with Effect Sizes of 0.5 and 0.8 standard deviations. RESULTS: The responsiveness of the Modified Ashworth Scale in the upper and lower extremity muscles was marked (standardized response mean = 0.89-1.09). The minimal clinically important differences of the average Modified Ashworth Scale of Effect Sizes 0.5 and 0.8 standard deviations for the upper extremity muscles were 0.48 and 0.76, respectively, while those for the lower extremity muscles were 0.45 and 0.73, respectively. CONCLUSIONS: The Modified Ashworth Scale was markedly responsive in detecting the changes in muscle tone in patients with stroke. The minimal clinically important differences of the Modified Ashworth Scale reported in this study can be used by researchers and clinicians in determining whether the observed changes are clinically meaningful post-treatment or at follow-up. CLINICAL REHABILITATION IMPACT: The minimal clinically important differences of the Modified Ashworth Scale reported in this study will enable clinicians and researchers in determining whether changes in the muscle tone are true and clinically meaningful, and can be used as a reference for clinical decision-making.

The risk of stroke after bilateral salpingo-oophorectomy at hysterectomy for benign diseases: A nationwide cohort study.

OBJECTIVE: To assess the risk of stroke (and subtypes of stroke) in women after elective bilateral salpingo-oophorectomy at hysterectomy for benign diseases. STUDY DESIGN: We conducted a nationwide population-based, retrospective cohort study using claims data from Taiwan's National Health Insurance program between 1997 and 2013. Women aged 20 years or more who underwent bilateral salpingo-oophorectomy at hysterectomy for benign diseases (n = 1083) were compared with women who did not undergo bilateral salpingo-oophorectomy at hysterectomy for benign diseases (n = 3903). The follow-up period ranged from 10 to 16 years. Age-adjusted (or unadjusted) and multivariate Cox proportional hazards regression models were used to estimate the risk of stroke between the two groups. MAIN OUTCOME MEASURES: A diagnosis of stroke (and subtypes of stroke). RESULTS: We did not find a significant association between bilateral salpingo-oophorectomy and the risk of incident stroke (or subtypes of stroke) over an average follow-up of 13 years. Among women aged 50 years or more who used estrogen therapy, the risk of developing stroke was 64% lower in those who had undergone bilateral salpingo-oophorectomy (hazard ratio, 0.36; 95% confidence interval, 0.16-0.79) than in those who had undergone hysterectomy only. CONCLUSION: This study suggests that the use of estrogen after bilateral salpingo-oophorectomy at hysterectomy for benign diseases reduces the risk of stroke in women aged 50 years or more.

Longitudinal changes in health-related quality of life in preschool children with cerebral palsy of different levels of motor severity.

BACKGROUND: When setting goals for cerebral palsy (CP) interventions, health-related quality of life (HRQoL) is an important outcome. AIMS: To compare longitudinal changes in HRQoL in children with CP of different levels of motor severity. METHODS AND PROCEDURES: Seventy-three children with CP were collected and classified into three groups based on Gross Motor Function Classification System (GMFCS) levels. HRQoL was assessed by parent's proxy of the TNO-AZL Preschool Quality of Life (TAPQOL) at baseline and 6 months later. OUTCOMES AND RESULTS: Children with GMFCS level V had a lower total TAPQOL score and scores in all domains than those with level I-IV (p<0.01), except for the non-motor subdomain of physical functioning at follow-up. With regards to longitudinal changes, the children with GMFCS level V had greater improvements in physical (p=0.016) and cognitive functioning (p=0.042), but greater deterioration in emotional functioning (p=0.008) than those with levels I-II at 6 months of follow-up. CONCLUSIONS AND IMPLICATIONS: Motor severity was associated with TAPQOL scores in all domains and changes in some domains in children with CP. Clinicians should early identify children at risk of a poor HRQoL and plan timely treatment strategies to enhance the HRQoL of children with CP.

An Event-Related Potential Study on the Perception and the Recognition of Face, Facial Features, and Objects in Children With Autism Spectrum Disorders.

The study investigated whether children with autism spectrum disorders (ASD) showed atypical patterns of brain specialization for face processing, whether the response to familiar and unfamiliar faces, facial features, and objects were different from typically developing children. Event-related potentials were recorded in 5- to 8-year-old children (12 children with ASD, 12 typically developing children) using passive viewing paradigm. The fastest P1 latencies to faces and the largest P1 amplitudes to objects were observed in both participant groups. Both groups exhibited larger N170 response to faces and eyes, F(3, 66) = 46.94, p < .0001). However, earlier P1 and N170 latencies were found on left hemisphere in children with ASD, respectively, F(1, 83) = 4.32, p = .04; F(1, 83) = 6.73, p = .01, indicating an atypical face processing pattern. All children showed a significant effect of familiarity for objects and mouths, F(1, 71) = 33.97, p < .0001; F(1, 71 = 15.94, p = .0002. Children with ASD revealed smaller negative central to faces relative to typically developing children. Face processing abnormalities revealed in children with ASD very likely exist.

The role of trait impulsivity in response inhibition: event-related potentials in a stop-signal task.

The study examined the relation between self-reported impulsivity and inhibitory control in normal individuals. We compared stopping performance and neural correlates of stopping on stop-signal task between participants who scored in the top (n=12) and bottom 25% (n=12) on Impulsivity Scale from a sample of 305 male adults. Participants scoring high on impulsivity did not show impaired inhibitory control. However, it seems that the high impulsive tended to make more errors of commission and omission. Enhanced N1 amplitudes were found in successful than failed inhibition trials. The high impulsive group had smaller P3 amplitude than the low impulsive group. It appears that the high impulsive group may have a less efficient inhibitory control. Impulsivity Scale non-planning impulsiveness score and inattention score of Adult ADHD Self-Report Scale (ASRS) were negatively correlated with P3 amplitudes on successful inhibition trails, suggesting that impulsivity could have the potential influence on inhibitory control.

Validity and clinimetric properties of the Spinal Alignment and Range of Motion Measure in children with cerebral palsy.

AIM: The aim of this study was to assess the validity, responsiveness, and clinimetric properties of the Spinal Alignment and Range of Motion Measure (SAROMM) in children with cerebral palsy (CP). METHOD: Sixty-two children with CP (40 males, 22 females) with a median age of 3 years and 11 months (range 1-6y) and their caregivers participated in this study. Among the children, 56 had spastic CP while six had non-spastic CP; 53 had bilateral CP, while nine had unilateral limb involvement. Thirty-three children were classified as Gross Motor Function Classification System (GMFCS) levels I to III and 23 as levels IV or V. Fifty-six children (90%) received regular rehabilitation by means of regular physical or occupational therapy (50% once or twice per week and 40% more than two times per week) and six children (10%) received irregular rehabilitation (less than once a week). Construct validity was determined by assessing the strength of the correlation between the spinal alignment SAROMM (SAROMM-SA), the range of motion SAROMM (SAROMM-ROM), and the total SAROMM (SAROMM-total), and construct measures, including the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measures for Children (WeeFIM), at baseline and at 6-months follow-up. Responsiveness was examined using effect size. Minimal detectable change (MDC) at the 90% confidence level (MDC90) and minimal clinically important difference (MCID) were analysed. RESULTS: The SAROMM with the GMFM-66 and WeeFIM had fair to good construct validity. The effect size values of all SAROMM scales were 0.24 to 0.48. The MDC90 values and MCID range were 1.43 and 0.47 to 1.67 for the SAROMM-SA, 3.12 and 3.68 to 4.07 for the SAROMM-ROM, and 3.22 and 4.53 to 4.62 for the SAROMM-total. INTERPRETATION: The clinimetric properties of the SAROMM allow clinicians to determine whether a change in SAROMM score represents a clinically meaningful change.

Clinimetric properties of the Assessment of Preschool Children's Participation in children with cerebral palsy.

This study examines the criterion-related validity and clinimetric properties of the Assessment of Preschool Children's Participation (APCP) for children with cerebral palsy (CP). Eighty-two children with CP (age range, two to five years and 11 months) and their caregivers participated in this study. The APCP consists of diversity and intensity scores in the areas of play (PA), skill development (SD), active physical recreation (AP), social activities (SA), and total areas. Tests were administered at baseline and at six-month follow-up. Concurrent and predictive validities were identified by assessing the strength of correlations between APCP scores and criterion-related measures--the 66-item Gross Motor Function Measure (GMFM-66) and Functional Independence Measure for Children (WeeFIM). Responsiveness was measured by standardized response mean (SRM). Minimal detectable change (MDC) at the 95% confidence level (MDC95) and minimal clinically important difference (MCID) were analyzed. The APCP with GMFM-66 and WeeFIM had fair to excellent concurrent validity (r=0.39-0.85) and predictive validity (r=0.46-0.82). The SRM values of the APCP diversity and intensity scales in all areas were 0.8-1.3. The MDC95 and MCID ranges for all areas (i.e., PA, SD, AP, SA, and total areas) were 0.1-0.7 and 0.4-1.2 points for intensity scores, respectively, and 4-17% and 10-19% for diversity scores, respectively. Therefore, the APCP scale was markedly responsive to change. Clinicians and researchers can use these clinimetric APCP data to determine whether a change score represents a "true" or clinically meaningful effect at post-treatment and follow-up.

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.

Potential predictors of changes in gross motor function during various tasks for children with cerebral palsy: a follow-up study.

Very few studies have investigated predictors of change in various gross motor outcomes in ambulatory children with cerebral palsy (CP). The aim of this study was to identify potential predictors for change in gross motor outcomes measured during various tasks in children with CP. A group of 45 children (age, 6-15 years) with CP and 7 potential predictors were identified, including age, gender, CP subtypes, gross motor function classification system (GMFCS) levels, abdominal muscle endurance, and muscles strength of knee extensor and knee flexor measured by isokinetic dynanometer. Motor outcome was assessed by means of the gross motor composite (GMC) of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), including four gross motor subtests: running speed and agility (RSA), balance (BAL), bilateral coordination (BCO), and strength (STR). The outcomes were measured at baseline and 12-week later (follow-up). The regression analyses showed that knee extensor strength was a robust predictor of change in BAL, BCO, and GMC (adjusted R(2) = 0.07-0.19, P<0.05). Additionally, abdominal muscle strength was a negative predictor for the changes in the RSA (adjusted R(2) = 0.08, P<0.05). However, STR model revealed no significant predictors. These findings suggest that ambulatory children with greater knee muscle strength may benefit more from therapy than those with lower strength. The knee muscle strength can be used as a biomarker to predict the changes in the gross motor functions.

Knee muscle strength at varying angular velocities and associations with gross motor function in ambulatory children with cerebral palsy.

The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n=17) or level II (n=16) according to Gross Motor Function Classification System (GMFCS) levels. All children underwent curl-up test and isokinetic tests of the knee extensor and flexor muscle. Children with CP underwent the gross motor function assessments, including the Gross Motor Function Measure (GMFM-66) and the gross motor subtests of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The hamstring-quadriceps ratio (HQ ratio) was calculated as 100%×(isokinetic peak torque of hamstring (knee flexor)/isokinetic peak torque of quadriceps (knee extensor)). Children with GMFCS level II had lower BOTMP and GMFM-66 scores, curl-up scores, HQ ratio, and knee muscle strength, especially knee flexor, compared to those with GMFCS level I. The regression analysis showed that knee flexor torques at 60 and 90°/s are mainly related to balance (r(2)=0.167, p=0.011) and strength (r(2)=0.243, p=0.002) while knee flexor torques at 120°/s mainly contribute to running speed and agility (r(2)=0.372, p<0.001). These findings suggest that children with CP had knee strength deficits, especially knee flexor. Postural muscle (knee flexor) strength dominated gross motor function than antigravity muscle strength (knee extensor). The knee flexor strength at different angular velocities was associated with various gross motor tasks. The HQ ratio may be used as a potential biomarker to probe the therapeutic effectiveness for muscle strengthening in these children. These data may allow clinician for formulating effective muscle strengthening strategies for these children.

Handwriting performance and underlying factors in children with Attention Deficit Hyperactivity Disorder.

Preliminary evidence suggests that handwriting difficulties are common to children with Attention Deficit Hyperactivity Disorder (ADHD). However, the nature of the task-specific impairments is needed to be clarified. The aim of this study was to describe handwriting capacity in ADHD children without DCD and identify underlying factors of performance by use of outcome-oriented assessments and a digitizing tablet. Twenty-one children with ADHD (8.59±1.25 years) and 21 match controls (8.5±1.08 years) were recruited. Children with ADHD scored lower than controls on Tseng Handwriting Problem Checklist and writing composite of Basic Reading and Writing Test, indicating the ADHD group wrote less legibly. The ADHD group spent more on-paper time to copy 50 Chinese characters and exhibited more writing time during the writing process. The ADHD group scored significantly lower on tasks demanding upper limb and eye-hand coordination and visual-motor integration compared with controls. Furthermore, motor skill and visual-motor integration were positively correlated with the legibility. Motor skill was negatively correlated with writing time, in-air time, and in-air trajectory.

Inhibition control and error processing in children with attention deficit/hyperactivity disorder: an event-related potentials study.

We studied inhibitory control and error processing in a task requiring inhibition of a motor response. Behavioral and ERP indices were recorded in fourteen ADHD and fourteen healthy children aged between 6 and 10years during the Stop signal task (SST). The ADHD group made more variable in RT and showed less accuracy, more omissions and choice errors. Also, the ADHD group had a tendency toward a lower probability of inhibition and a longer Stop signal reaction time. The ADHD group also displayed a flatter response inhibition slope compared to the control group. Smaller P1 in ADHD group reflected that the ADHD group has less efficient attention than the control group. Furthermore, the ADHD group showed normal ERN, reduced Pe (retrieved from response-locked epochs), and reduced LPW (retrieved from Stop signal-locked epochs), suggesting that they might be normal in early error monitoring process related to error detection, but show abnormal in later error monitoring process associated with a conscious evaluation of the error. Behavioral and ERP data of the present study show deficient selective attention, inhibitory control, and error processing in children of ADHD.

Color combinations of visual display terminal (VDT) icon on user preferences and EEG response.

This study explored the effects of color combinations and polarity on user preferences and EEG responses using an icon design for a visual display terminal. 72 college students (M=24.5 yr., SD=2.3 yr.) were tested. The seven color combinations of top 16% with rating scores (5-point scale) over 3.60 almost always included black or white as a target or background, including white-on-black, red-on-black, yellow-on-black, blue-on-white, and black-on-white; the other two preferred color combinations were yellow-on-blue and blue-on-yellow. The eight color combinations of the bottom 16% with rating scores under 2.38 almost always included green, turquoise, or purple as a target or background. Negative image polarity (higher luminance color image shown on a lower luminance color background) was preferred over positive image polarity (lower luminance color image shown on a higher luminance color background) by the subjects. The theta and alpha band power in the right hemisphere were greater than those in the left hemisphere during the experiment. There seemed to be no linear correlation between the rating scores of subjective preferences and brain wave power of theta and alpha bands, so the possibility of using brain wave power to measure subjective preference is questionable.

Event-related brain potentials: report order and task switch on multidimensional stimuli identification.

An experiment was conducted to evaluate the effect of order of reporting stimulus dimension in multidimensional stimulus identification using a switch-task paradigm. Participants were required to identify each two-dimensional symbol by pushing the corresponding buttons on the keypad on which there were two columns representing the two dimensions, part and shape. The two orders of report were Order Part/Shape and Order Shape/Part. There was a task cue prior to each presentation of a symbol indicating the particular report order the participants should perform. The cue changed randomly. Both behavioral data and event-related potentials were recorded from 12 college students. Analysis of behavioral data showed switch cost indicated by increase in response time was greater for Order Shape/Part, a less appropriate order of reporting dimensional values, than Order Part/Shape (88 msec. vs 9 msec. for response time for the first stimulus dimension; 96 msec. vs -1 msec. for response time total). Neural activities under Order Shape/Part and Order Part/Shape were different, and it seems plausible that participants put more effort into selection and showed more related semantic activation in Order Shape/Part than in Order Part/ Shape which fits the Chinese adjective-then-noun language habit.

Event-related potential as a measure of effects of report order and training on identification of multidimensional stimuli.

This experiment investigated effects of report order and training on multidimensional stimulus identification. Subjects were required to identify each two-dimensional symbol. There were two orders of reporting the two dimensions of a stimulus. Subjects performed the task for three practice sessions. Both behavioral data and event-related potentials were recorded. Analysis showed order of report had no significant effect on behavior data. But when participants responded in Order Shape/ Part, they showed more N2 inhibition for Order Part/Shape. The P3 mean amplitude was marginally significantly greater for Order Part/Shape than Order Shape/Part. This indicated Order Part/Shape, according to natural language habits, was more appropriate and less cognitively demanding than Order Shape/Part. For the two report orders, along with reduction of reaction time, amplitude of N1 and N2 increased with practice. Amplitude of P2 decreased with practice, and no P3 habituation was found. ERP data indicated no habituation effect. Results suggested neural activity depended not only on perceptual mechanism but also on extent of learning.

Report order and identification of multidimensional stimuli: a study of event-related brain potentials.

An experiment was conducted to investigate the effect of order of report on multidimensional stimulus identification. Subjects were required to identify each two-dimensional symbol by pushing corresponding buttons on the keypad on which there were two columns representing the two dimensions. Order of report was manipulated for the dimension represented by the left or right column. Both behavioral data and event-related potentials were recorded from 14 college students. Behavioral data analysis showed that order of report had a significant effect on response times. Such results were consistent with those of previous studies. Analysis of event-related brain potentials showed significant differences in peak amplitude and mean amplitude at time windows of 120-250 msec. at Fz, F3, and F4 and of 350-750 msec. at Fz, F3, F4, Cz, and Pz. Data provided neurophysiological evidence that reporting dimensional values according to natural language habits was appropriate and less cognitively demanding.