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Objective: This study proposes a cephalometric method to determine an individual radius of the curve of Spee in cases of occlusal prosthetic rehabilitation. Methods: A retrospective study was conducted on 469 lateral cephalograms. Statistical analysis was performed. Correlations were computed using simple regression, Z tests, paired t-tests, and one-way repeated measures ANOVA. Results: Regression calculations supported a link between the radius of the curve of Spee and occlusal plane inclination, Balkwill's angle, mandibular parameters (MP), with MP = corpus – ramus + Bonwill height. Based on MP, data that are accessible even in the absence of teeth, a regression formula can be proposed to provide an individualized estimation of the radius of the Spee curve (RCS): RCS = 0.624 * MP + 26.583. Conclusion: This study proposes an individualized estimation of the RCS from only skeletal mandibular parameters: the length of the ramus, length of the corpus, and the Bonwill height. [ABSTRACT FROM AUTHOR]

Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan–Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension. Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified. [ABSTRACT FROM AUTHOR]

People post-stroke experience increased loneliness, compared to their healthy peers and loneliness may have increased during COVID due to social distancing. How social distancing affected loneliness among people after stroke is unknown. Bandura's self-efficacy theory suggests that self-efficacy may be a critical component affecting individuals' emotions, behaviors, attitudes, and interpretation of everyday situations. Additionally, previous studies indicate that self-efficacy is associated with both loneliness and social participation. This study investigates relationships among self-efficacy, social participation, and loneliness in people with stroke. Determine how social participation affects the relationship between self-efficacy and loneliness in people with stroke during the COVID-19 pandemic. 44 participants were community-dwelling individuals, ≥ 6 months post-stroke who participated in a 2-hour phone interview. A regression-based mediation analysis was conducted using these measures: Participation Strategies Self-Efficacy Scale, Activity Card Sort for social participation, and UCLA Loneliness Scale for loneliness. The total effect of self-efficacy on loneliness was significant (b = -0.36, p =.01). However, social participation fully mediated the relationship between self-efficacy and loneliness (indirect effect, b = -0.11, 95% CI [−0.24, −0.01]; direct effect, b = -0.25, 95% CI [−0.03, 0]). Self-efficacy is associated with both social participation and loneliness in people with stroke in this cross-sectional study. Mediation analysis findings suggest that interventions focused on increasing social participation may prevent or potentially alleviate loneliness in people with stroke who have low self-efficacy. [ABSTRACT FROM AUTHOR]

Balance assessments are an important component of rehabilitation. Considering the increasing use of telemedicine to meet rehabilitation needs, it is important to examine the feasibility of such assessments. This study aimed to examine the reliability and validity of the Tinetti Performance-Oriented Mobility Assessment Balance Subscale (POMA-B) when applied via synchronous and asynchronous tele-assessment. Twenty-five patients with chronic stroke were included in the study. The first physiotherapist assessed the patients on the first day in a face-to-face clinical setting. Synchronous or asynchronous tele-assessment was applied the next day. The assessments were performed in the same time zone, with an interval of one day. The synchronous tele-assessment was done online in real time by the first and second physiotherapists. A reference assessment video was sent to the patients for asynchronous tele-assessment. They were asked to make a video recording while performing the evaluation activities according to the reference video. Then the first and second physiotherapists assessed these video recordings separately. All the tests were repeated 10 days later to determine the intra-rater reliability of the tele-assessment methods. The intra-class correlation coefficients ranged from 0.96 to 0.98 for inter-rater reliability and from 0.97 to 0.98 for intra-rater reliability for both tele-assessment methods. Both asynchronous and asynchronous tele-assessment methods were medium correlated with the face-to-face versions. We demonstrated the validity and reliability of the POMA-B in chronic stroke patients with different tele-assessment methods, typically using the internet and available devices. [ABSTRACT FROM AUTHOR]

This study examined teacher behaviours, students' academic engagement, and classroom ecology in mainstream classrooms including children with intellectual disabilities, and examined the differences in academic engagement for students with and without intellectual disabilities. A mixed-method research methodology was employed. The study demonstrated that children with intellectual disabilities exhibited high level of engagement in the following situations: the classroom layout used grouping, the classroom organisation combined groups and independent learning, the learning tasks included reading aloud, copying, watching videos, and doing homework, and teachers paid attention to all students or to children with intellectual disabilities individually and walked around the classroom during lesson time. English was the discipline with most active engagement among children with intellectual disabilities, followed by music, art, science, Chinese, sports, social studies, and mathematics. Finally, academic engagement of children with and without intellectual disabilities was mostly passive. We discuss the factors related to academic engagement of children with intellectual disabilities and provide suggestions for improving their self-management skills and classroom organisation. [ABSTRACT FROM AUTHOR]

In mixed traffic condition, varying vehicle dimensions and lack of lane discipline lead to parallel movement of vehicles in the same lane or between lanes. This results in a condition where the longitudinal response of vehicles gets affected by adjacent vehicles and their configurations. Correspondingly, the adjacent vehicle configurations are significantly influenced by the lane position of subject vehicle. To accommodate this scenario, the study formulates longitudinal acceleration models from trajectory data considering the influence of subject vehicle's lane position along with adjacent vehicle characteristics. The response under different cases of subject vehicle's lane position and adjacent vehicle configurations are evaluated. The statistical analysis indicates that the following behavior varies based on lane position of subject vehicle and adjacent vehicle attributes. It is also found that disregarding these attributes can produce significantly erroneous acceleration estimates. These features can improve existing following behavior models and can enhance the realism of the microscopic modeling scheme for mixed traffic conditions. [ABSTRACT FROM AUTHOR]

A number of studies have examined historical climatological trends back to the Middle Ages. However, few have investigated these trends near important historical sites such as medieval battlefields. Most studies on medieval battles and battlefields focus almost exclusively on interpreting the written records from a literary standpoint and on knowledge of the site on which the battle took place, with rarely much consideration for other perspectives. While the written records are important, only focusing on them limits understanding and ignores the environment itself. A historical climatological perspective would contribute to the study of medieval warfare by exploring relevant long-term climatic proxies as well as mapping weather conditions around the time of the campaign and battle. As an example, this study will investigate the weather during Duke William's voyage to England in 1066. The study concludes with a discussion of the implications of these techniques for applying weather analyses to other historical events. [ABSTRACT FROM AUTHOR]

Unstable board intervention for patients with stroke improves sitting balance and trunk function. However, because patients with severe stroke are at high risk of falling, it is mostly adapted in mild cases. We aimed to examine the effect of standing unstable board intervention for the non-paralyzed lower limbs on sitting balance in patients with hemiplegia. The participants were 42 patients with stroke who were randomly assigned to a control or intervention group. In the intervention group, the non-paralyzed leg was placed on an unstable board, and the patient wore a knee-ankle-foot orthosis on the paralyzed side and practiced standing and weight-bearing exercises on the unstable board for 3 days. The outcomes were the angle of righting reaction of the neck, trunk, and both lower legs and the movement distance of the center of pressure of the righting reaction from lateral tilted sitting. In the intervention group, the righting reaction angle of the trunk to the paralyzed and non-paralyzed sides and the movement distance of the center of pressure were increased significantly after the unstable board intervention. The standing unstable board intervention for the non-paralyzed lower limb increased sensory input to the non-paralyzed side of the trunk weight-bearing on the lower limb of the paralyzed side. The increase in the righting reaction angle and the movement distance of the center of pressure contributed to improved sitting balance. [ABSTRACT FROM AUTHOR]

After stroke, the effects of focused scapulo-humeral training with simultaneous assessment of the changes in shoulder subluxation, related muscle thicknesses and upper limb performance have not been studied in the literature. This study aimed to investigate the effects of an 8-week scapulo-humeral training program in addition to conventional rehabilitation on upper extremity/trunk functions, shoulder pain, and sonographic measurements of the shoulder joint and periscapular muscles. Thirty stroke individuals were randomly separated into two groups as Group I-scapulo-humeral training (5F/10 M) and Group II – control (5F/10 M). Conventional rehabilitation program was applied to both groups, and a scapulo-humeral training exercise protocol was added for the scapulo-humeral group. All the treatments were applied for 1 hour/day, 3 days/week, 8 weeks. Clinical evaluations were made using the Fugl Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), ABILHAND, Visual Analog Scale, and Trunk Impairment Scale(TIS). Ultrasound was used to measure serratus anterior/lower trapezius muscle thicknesses, and acromion-greater tubercule/acromio-humeral distances. FMA-UE, ARAT, ABILHAND and TIS scores increased in both groups, with greater increases in most parameters in the scapulo-humeral training group. Shoulder pain decreased only in the scapulo-humeral training group. Subacromial distances were decreased on the paretic side, and muscle thicknesses increased on both sides in the scapulo-humeral training group, and in the control group, only serratus anterior muscle thickness increased on the paretic side (p < 0.05 for all). Additional scapulo-humeral exercises to conventional rehabilitation was seen to improve upper extremity/trunk performance and shoulder pain, and to increase scapula stabilizer muscle thicknesses in stroke individuals with mild-moderate upper extremity disability. [ABSTRACT FROM AUTHOR]

People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown. To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia. Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital. Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89). Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required. [ABSTRACT FROM AUTHOR]

Few studies have examined changes in skeletal muscle physiology post-stroke. This study examined changes in tissue oxygen saturation (StO2) of the vastus lateralis (VL) muscle of stroke survivors and age-matched control participants during maximal and submaximal isometric contractions of the knee extensor muscles. We hypothesized that tissue oxygen desaturation (ΔStO2) during knee extensor muscle contractions would be less in the VL in the paretic vs. the non-paretic and control legs. Ten chronic stroke survivors (>6 months post-stroke) with lower extremity muscle weakness and 10 age-matched controls completed this prospective cohort study. Maximum voluntary contractions (MVCs) of the knee extensor muscles were assessed with a Biodex dynamometer and StO2 of the VL was measured using near-infrared spectroscopy. In the paretic leg of the stroke survivors little change in StO2 of the VL was observed during an MVC (ΔStO2 = -1.7 ± 1.8%) compared to the non-paretic (ΔStO2 = -5.1 ± 6.1%; p < 0.05) and control legs (ΔStO2 = -14.4 ± 8.8%; p < 0.05 vs. paretic and non-paretic leg). These differences remained when normalizing for strength differences between the legs. Compared to controls, both the paretic and non-paretic VL showed pronounced reductions in ΔStO2 during ramp and hold contractions equal to 20%, 40%, or 60% of the MVC (p < 0.05 vs. controls at all load levels). These results indicate that oxygen desaturation in response to isometric muscle contractions is impaired in both the paretic and non-paretic leg muscle of stroke survivors compared to age-matched controls, and these differences are independent of differences in muscle strength. [ABSTRACT FROM AUTHOR]

As the prevalence of autism spectrum disorder (ASD) increases, there is a growing need to develop physical activity interventions that address the behavioral challenges experienced by individuals with ASD. Physical education teachers have employed behavioral supports that add more structure and adapt the environment for individuals with ASD, which are associated with increased engagement for individuals with ASD during PE. The purpose of this study was to quantify motor engaged behaviors (i.e. motor appropriate (MA)), motor inappropriate (MI), motor supported (MS) during skill practice in 18 individuals with ASD (ages 7-19 years) participating in an adapted tennis program (ACEing Autism) using the Academic Learning Time in Physical Education (ALT-PE) instrument. Overall, the supports provided during the program may have enabled participants with ASD to spend more time in MA and MS than MI. Indeed, the participants spent over 50% of their time in MA during the program. [ABSTRACT FROM AUTHOR]

Background: Half of all strokes are classified as mild, and most mild stroke survivors are discharged home after their initial hospitalization without any post-acute rehabilitation despite experiencing cognitive, psychosocial, motor, and mobility impairments. Objectives: To investigate the demographic and clinical characteristics of mild stroke survivors and their association with discharge location. Methods: This is a retrospective analysis of mild stroke survivors from 2015–2023 in an academic medical center. Demographic characteristics, clinical measures, and discharge locations were obtained from the electronic health record. The Social Vulnerability Index was used to measure the community vulnerability. Associations between variables and discharge location were examined using bivariate logistic regression analysis. Results: There were 2,953 mild stroke survivors included in this study. The majority of participants were White (65.46%), followed by Black (19.40%). Black stroke survivors and individuals with higher social vulnerability had a higher proportion of discharges to skilled nursing facilities (p = 0.001). Black patients and patients with high vulnerability in housing type and transportation were less likely to be discharged home. Conclusions: Mild stroke survivors have a high rate of home discharge, potentially because less severe stroke symptoms have a reduced need for intensive care. Racial disparities in discharge location were evident, with Black stroke survivors experiencing higher rates of institutionalized care and lower likelihood of being discharged home compared to White counterparts, emphasizing the importance of addressing these disparities for equitable healthcare delivery and optimal outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the effects of motor imagery (MI), action observation (AO), and action execution (AE) interventions on the autonomic nervous system (ANS) in individuals with chronic stroke. Methods: This was a single-center, randomized, case-control study. Thirty-six patients were randomly assigned to MI (n = 10), AO (n = 15), and the AE group (n = 11). Heart rate (HR)-based measurements (HR, heart rate variability (HRV)) and blood pressure were evaluated before the practice of each group. In the MI group, participants were instructed to imagine themselves walking at their own comfortable pace for 5 minutes. Meanwhile, in the AO group, participants were shown a video of a person walking for 5 minutes. Finally, in the AE group, participants were instructed to actually walk for 5 minutes. Then, all measurements were taken again. Results: A statistically significant difference was found in HR and mean RR interval within the AE group (p < 0.05). There was a statistically significant difference in the Root Mean Square of Successive Differences Between Normal Heartbeats (RMSSD) (ms) within the AO group (p < 0.05). There was a significant difference in HR and mean RR intervals (ms) between groups (p < 0.05). According to post-hoc analyses, HR was statistically significantly higher in the AE group compared to the other groups, and the mean RR interval was statistically significantly lower (p < 0.05). Conclusions: In conclusion, in patients with chronic stroke, AE and AO may affect ANS by increasing sympathetic activation. It is recommended for future studies to evaluate whether patients actually engage in imagery during the MI task. [ABSTRACT FROM AUTHOR]

Background: The stigma perceived by many post-stroke persons hinders their social lives. A scale to measure stigma is needed to identify social problems related to stigma, and to evaluate effectiveness of interventions. Objectives: This study aimed to develop a Japanese version of the Stroke Stigma Scale (SSS-J), and confirm its utility by examining reliability and validity. Methods: Eighty community-dwelling post-stroke individuals were enrolled at six sites. After translating the scale into Japanese using back translation methods, psychometric properties of the rating scale, internal scale validity, and reliability were examined to fit the Rasch model. Criterion-related validity, construct validity, and test-retest reliability were examined using total scores transformed to logit. For test-retest reliability, 30 participants completed the SSS-J twice, one week apart. Results: Rasch analysis showed that the SSS-J had the best fit with 15 items on a 3-category rating scale. Item difficulty logits were -2.01 to 2.21, person ability logits were -4.69 to 0.62 (mean, -1.41), person reliability coefficient was 0.71 (separation index, 1.58), and item reliability coefficient was 0.96 (separation index, 5.04). For criterion validity, Spearman's rank correlation coefficient with the Center for Epidemiologic Studies Depression Scale was 0.51 (p < 0.001). For construct validity, Spearman's rank correlation coefficients with each subscale of the Stroke Impact Scale ranged from -0.36 to -0.16 (p = 0.002–0.126). For test-retest reliability, the intra-class correlation coefficient was 0.64 (p < 0.001). Conclusions: The SSS-J adapted to the Rasch model was reliable and valid. This scale can be used to quantitatively measure stigma among community-dwelling post-stroke persons in Japan. [ABSTRACT FROM AUTHOR]

Background: The Patient-Reported Outcomes Measurement Information System® (PROMIS) Profile Computer Adaptive Testing (CAT) consists of seven CATs and one single item measuring most relevant aspects of health-related quality of life (HRQoL). The aim of our study was to determine construct validity and floor and ceiling effects of the PROMIS Profile CAT in Dutch people with stroke. Methods: People with stroke receiving rehabilitation completed the PROMIS Profile CAT and the EuroQol-5 dimensions (EQ5D). Construct validity was evaluated with hypotheses testing based on expected correlations between the profile domains and the domains of the EQ5D. The proportion of participants with the lowest and highest scores were calculated for each profile domain to assess floor and ceiling effects. Results: 160 participants were included (median age 61 years, 41.9% female). For the PROMIS Profile domains Physical Function, Anxiety, Depression, Sleep Disturbance, Pain Interference, and Pain Intensity > 75% of the results met our hypotheses. For Fatigue and Ability to Participate in Social Roles and Activities only 60% of hypotheses were met. No floor or ceiling effects were found, with the exception of a floor effect for Pain Intensity which probably indicates that many participants had no pain. Conclusion: Most domains of the PROMIS Profile CAT showed sufficient construct validity and no problematic floor or ceiling effects in people with stroke. These CATs and the single item Pain Intensity can be used to efficiently measure HRQoL in people with stroke. [ABSTRACT FROM AUTHOR]

This paper presents a study of visitors to the Fuxi Taihao Mausoleum and provides two sets of results derived from mixed methods research. The first is a description of motives and behaviours derived from observation and interviews with visitors. The second set reports statistical data derived from questionnaires completed by 553 informants pertaining to motives for visiting the site and perceived cultural importance. The paper covers practices relating to the belief systems associated with Fuxi and Nuwa, constructed, objective and existential authenticity, the strength of traditional Chinese cultural practices, but also the role of good site management. The study identifies the types of visitors and their understanding of authenticity. In addition, it notes that observation of faith-based activities and management care reinforce a sense of site 'authenticity'. Finally, it is suggested that longitudinal study is required to assess the impacts of long-term demographic and social change on faith-based tourist attractions and uses a directed acyclic graph to suggest future research questions. [ABSTRACT FROM AUTHOR]

During surface coal mining, large amounts of overburden waste materials, known as spoils, are excavated and dumped, creating massive heaps. The sustainable management of these areas is a global priority, but a comprehensive geotechnical characterization has not yet been achieved due to limited research on the spoils' geotechnical properties. This study conducts an advanced statistical analysis of lignite mine spoil materials from a large heap in Greece to determine suitable probability distributions. Five distributions - normal, lognormal, Weibull (2 and 3 parameters), and Gamma - were evaluated, considering the high variability of spoil material properties. The lognormal and Weibull distributions were found to best fit most geotechnical parameters, except for cohesion, which showed an uncommon distribution. In some cases, the normal distribution can be used for a simplified analysis. The findings can guide the analysis of spoil materials, as advanced numerical and stochastic methods are essential for robust geotechnical design. [ABSTRACT FROM AUTHOR]

The evaluation of impaired self-awareness (ISA) after brain injury is not widespread in Japan, and there is a lack of Japanese assessments of self-awareness. To translate the original version of the Awareness Questionnaire (AQ), an instrument for assessing ISA, into Japanese using a validated method and examine its reliability and validity in inpatients with stroke. This cross-sectional, prospective study enrolled 130 participants. The double-translation process was used to develop the Japanese version of the AQ. Data were collected from 120 patients. High intra-rater reliability was observed for the patient (Cronbach's α = 0.824) and clinician samples (Cronbach's α = 0.933). High intra- and inter-rater reliability were found for all AQ items [interclass coefficient (ICC) (1, 1) = 0.828, ICC (2, 1) = 0.852, ICC (3, 1) = 0.848]; however, the sub-item analysis revealed only moderate reliability. Validity assessment revealed a low but significant positive correlation (r = 0.209; p < 0.05) between the Japanese version of the AQ and the Japanese version of the Self-Regulation Skills Interview and a low but significant negative correlation (r = 0.197; p < 0.05) between the Japanese version of the AQ and the Mini-Mental State Examination. The Japanese version of the AQ was developed and applied to stroke patients, but the concept of post-stroke ISA may differ from ISA after traumatic brain injury, highlighting the need for a stroke-specific version of the AQ. [ABSTRACT FROM AUTHOR]

Objective: This study aims to delineate the characteristics of severe self-injurious behaviors (SIB) in a cohort of children with autism and unspecified intellectual developmental disorder (UIDD) (intellectual disability) and examine potential risk factors for developing SIB. Methods: A retrospective chart review studied characteristics of severe SIB in 30 children with autism spectrum disorder (ASD) and UIDD referred to a tertiary care center. Characteristics examined include genetic syndromes, brain MRI abnormalities, verbal ability, adaptive functioning, SIB frequency and severity, age of onset, number of psychopharmacological agents, irritability, hyperactivity, stereotypy, psychiatric and physical comorbidities, among others. Descriptive and bivariate analysis were applied to explore potential relationships between factors. Results: Children with severe SIB exhibit this behaviour with high frequency, inflicting moderate to severe injury. Most children in the study sample are non-verbal and have ASD (93.3%; n = 28) with psychiatric (96.7%; n = 29) and physical (90%; n = 27) comorbidities. Overall SIB improvement using the Clinical Global Impression, Improvement Score (CGI-I) was 3.0 (minimally improved). A minority were much or very much improved following appropriate intervention. Conclusions: The severity of SIB is much higher in this sample than previously noted in the literature. Severe SIB is associated with ADHD, early onset mood disorders, tics, avoidant restrictive food intake disorder and Obsessive-Compulsive Disorder. [ABSTRACT FROM AUTHOR]

The human body seems symmetrical but functional asymmetry can be observed for many tasks. One of the tasks observed the functional asymmetry is grip force and rate of grip force development (RGFD). To efficiently accomplish many tasks, it is important to measure those parameters in different ages and special groups. Thus, the purpose of the study was to test asymmetry of max grip force and max RGFD among adolescents with and without intellectual disability. 41 adolescents with (IQ between 50 and 70) and 41 adolescents without intellectual disability voluntarily participated to the study. Max grip force and max RGFD was measured using a force transducer with custom-made software. The statistical analysis displayed that adolescents without intellectual disability had higher max grip force and max RGFD with their both hands compared to adolescent with intellectual disability. Interestingly, whereas adolescent without intellectual disability displayed an asymmetry between the hands both for max grip force and max RGFD, adolescents with intellectual disability had asymmetry only for max grip force but not for max RGFD. Thus, adolescents with intellectual disability may have symmetrical neurological pathways. Individuals with intellectual disability should be provided with more physical activity and/or exercise opportunities including the bimanual movements with fast and ballistic actions. [ABSTRACT FROM AUTHOR]

Colloidal silica is a relatively new grouting low-carbon material used in soil improvement projects. A series of mechanical tests on a sand with different solid contents of the binder, i.e. 40, 30 and 20% solid content have been performed. Unconfined compressive strength at 7, 28 and 56 days, shear tests and permeability tests at 7 days were assessed. A statistical interpretation of these data has been performed and values were interpreted. A mathematical prediction model was suggested to estimate the mechanical strength of the grouted sand as the dilution grade varies. Furthermore, some considerations useful for geotechnical design on the evolution over time of the mechanical characteristics of the grouted sands have been carried out. Results show, from a statistical and mathematical view, that colloidal silica is a promising binder for ground improvement applications. [ABSTRACT FROM AUTHOR]

Considering various factors that influence the accuracy of the Subjective Visual Vertical (SVV) and Subjective Postural Vertical (SPV), standardization of assessment methods is needed. This retrospective study examined the contribution of Head-on-Body (HOB) position, starting roll position (SRP) and visuospatial neglect (VSN) to SVV and SPV constant errors (i.e. deviation from true vertical). Also, the contribution of HOB position and VSN presence to SVV and SPV variability (i.e. intra-individual consistency between trials) was assessed. First-ever unilateral hemispheric stroke survivors (<85 years; <100 days post-stroke) were assessed with three HOB positions (neutral, contralesional, and ipsilesional) and seven starting positions (20°Contralesional to 20° ipsilesional) of the laser bar and tilt chair. Linear mixed models were selected to evaluate the contribution of HOB, SRP, and VSN to SVV/SPV constant errors and variability. Thirty-four subjects (24 VSN-/10 VSN+) were assessed. A tilted HOB position led to significantly higher constant errors for the SVV and SPV (the latter only in the VSN- group), and an increased SVV variability. SRP only significantly contributed to the SVV constant errors and only in the VSN- group. Furthermore, the presence of VSN resulted in a significantly higher SVV and SPV variability. HOB position and the presence of SRP and VSN are important factors to consider during SVV and SPV measurements. Assessment with a neutral HOB position leads to more accurate results. HOB position and SRP influence the results of SVV and SPV differently in individuals with and without VSN, which highlights the relevance of VSN assessment. [ABSTRACT FROM AUTHOR]

Patients experience falls frequently after stroke. Preserved or acquired balance skills decrease fall risk and improve independence. Feasibility of Fullerton Advanced Balance Scale (FAB) has been shown in balance assessment in some neurological diseases except stroke. The purpose of this study was to investigate the reliability and validity of Turkish version of FAB (FAB-T) in patients with stroke (PwS). This cross-sectional study included 51 PwS (60.64 ± 7.66 years). Reliability analyses were conducted with Cronbach's alpha, intraclass correlation coefficient (ICC), and Spearman correlation analysis. Intra-rater and inter-rater reliability were assessed with three raters. FAB-T, Stroke Rehabilitation Assessment of Movement (STREAM), Brunnstrom Recovery Stages (BRS), Barthel Index (BI), and 36-Item Short Form Health Survey (SF-36) were used for convergent validity. Correlations of FAB-T with Berg Balance Scale (BBS) and Mini-Balance Evaluation Systems Test (Mini-BESTest) were measured for concurrent validity. Spearman correlation analysis was used for convergent and concurrent validity. For predictive validity patients' self-reports of falling were analyzed with ROC. Intra-rater (ICC = 0.998) and inter-rater reliability (ICCs = 0.984; 0.984; 0.990), and internal consistency (Cronbach's alpha = 0.930) were excellent. FAB-T had good correlations with STREAM (ρ = 0.677) and BI (ρ = 0.628), moderate correlations with BRS (ρ = 0.504 and ρ = 0.579) and physical function of SF-36 (ρ = 0.436). FAB-T excellently correlated with Mini-BESTest and BBS (ρ = 0.928 and ρ = 0.942). The cutoff score of FAB-T was determined to be 21.5 points, with sensitivity of 84% and specificity of 61% (AUC = 0.749). FAB-T is a reliable and valid balance assessment tool with an acceptable accuracy of fall prediction in PwS. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the construct validity of the 2-minute walk test (2MWT) to assess the exercise capacity and the criterion-concurrent validity of the 2MWT and the 6-minute walk test (6MWT) to estimate the cardiorespiratory fitness of ambulatory individuals with chronic stroke. In addition, to provide an equation to predict the distance covered in the 6MWT and another to predict the peak oxygen consumption (VO2peak) for these individuals. This is a cross-sectional and prospective study. A convenience sample with 57 individuals with chronic stroke was recruited. The 2MWT, the 6MWT and the cardiopulmonary exercise test (CPET) were performed in a laboratory. The Spearman's correlation coefficient was used to investigate the validity. To develop the equations, stepwise multiple linear regression analysis was used. A significant correlation of very high magnitude between the distance covered in the 2MWT and the 6MWT was found (rs = 0.93; p < 0.001). A significant correlation of moderate magnitude between the distance covered in the 2MWT and the VO2peak (rs = 0.53; p < 0.001) similar to the correlation between the 6MWT and the VO2peak (rs = 0.55; p < 0,001) were found. Furthermore, an equation was developed to predict the VO2peak (R2 = 0.690; p < 0.001; VO2peak = 13.532 + 0.078*distance walked in the 2MWT +4.509*sex-0.172*age), and another to predict the distance covered in the 6MWT (R2 = 0.827; p < 0.001; MWT = −1.867 + 3.008*distance walked in the 2MWT). 2MWT showed adequate construct and concurrent validity. Furthermore, it is possible to use the prediction equations developed to estimate the VO2peak or the distance covered in the 6MWT. [ABSTRACT FROM AUTHOR]

Diffusion tensor imaging (DTI) biomarkers can be used to quantify microstructural changes in the cerebral white matter (WM) following injury. This prospective single-center study aimed to evaluate whether atlas-based DTI-derived metrics obtained within 1 week after stroke can predict the motor outcome at 3 months. Forty patients with small acute stroke (2–7 days after onset) involving the corticospinal tract were included. Each patient underwent magnetic resonance imaging (MRI) within 1 week and at 3 months after stroke, and the changes based on DTI-derived metrics were compared by performing WM tract atlas-based quantitative analysis. A total of 40 patients were included, with median age 63.5 years and a majority of males (72.5%). Patients were classified into good-prognosis group (mRS 0–2, n = 27) and poor-prognosis group (mRS 3–5, n = 13) by outcome. The median (25th-75th percentile) of MD (0.7 (0.6–0.7) vs. 0.7 (0.7–0.8); p = 0.049) and AD (0.6 (0.5, 0.7) vs. 0.7 (0.6, 0.8); p = 0.023) ratios within 1 week were significantly lower in the poor-prognosis group compared to the good-prognosis group. The ROC curve of the combined DTI-derived metrics model showed comparable Youden index (65.5% vs. 58.4%–65.4%) and higher specificity (96.3% vs. 69.2%–88.5%) compared to clinical indexes. The area under the ROC curve of the combined DTI-derived metrics model is comparable to those of the clinical indexes (all p > 0.1) and higher than those of the individual DTI-derived metrics parameters. Atlas-based DTI-derived metrics at acute stage provide objective information for prognosis prediction of patients with ischemic or lacunar stroke. [ABSTRACT FROM AUTHOR]

Shared decision-making (SDM) aims to create a context in which patients and surgeons work together to explore treatment options and goals of care. The objective of the current study was to characterize demographic factors, behaviors, and perceptions of patient involvement among surgeons relative to SDM. Using a cross-sectional survey methodology, surgeon demographics, behaviors, and perceptions of patient involvement were assessed. Surgeon approaches to SDM were measured using a 100-point scale ranging from 'patient-led' (0) to 'surgeon-led' (100). Among 241 respondents, most were male (n = 123, 67.2%) and White (n = 124, 69.3%); roughly one-half of surgeons had been in practice ≥10 years (n = 120, 52.4%). Surgeon approaches to SDM ranged from 0 to 81.0, with a median rating of 50.0 (IQR: 35.5, 62.0). Reported approaches to SDM were associated with years in practice, sharing information, and perceptions of patient involvement. Surgeons in practice 10 + years most frequently utilized a 'Shared, Patient-led' approach to SDM (27.5%), while individuals with less experience more often employed a 'Shared, Surgeon-led' approach (33.3%, p = 0.031). Surgeons with a 'Patient-led' approach perceived patient involvement as most important (M = 3.82, SD = 0.16), while respondents who had a 'Surgeon-led' approach considered this less important (M = 3.57, SD = 0.38; p < 0.001). Surgeon factors including demographics, behaviors, and perceptions of patient involvement influenced SDM approaches. SDM between patients and surgeons should strive to be more dynamic and tailored to each specific patient's needs to promote optimal patient-centered care. [ABSTRACT FROM AUTHOR]

In the United States, 66 million people speak a language other than English at home. Patients with diverse language needs often face significant health disparities. Information and communication technologies have expanded the realm of modalities for patient-provider communication. However, the extent to which digital language access tools are utilized by healthcare providers is unknown. This research examines provider perspectives on language assistance techniques and the role of communication technology when serving patients with non-English language preference (NELP). Between April and July 2019, an online survey was administered to 3,033 healthcare providers (doctors, nurse practitioners, pharmacists, and dentists) in Washington State. Providers reported on their language access practices and perspectives on communication technology. Most providers reported using ad hoc language access techniques when engaging patients with NELP, such as a patient's family member or friend (75.8%), a patient's child specifically (61.9%), or a bilingual staff member (64.3%). Professional techniques, such as in-person interpretation (53.5%), phone interpretation (57%), and video remote interpretation (38.8%), were used less often. Dissatisfaction with the language access processes of healthcare providers' place of work was associated with a higher reliance on a patient's family or friend for language interpretation. Findings suggest that providers might be under-utilizing professional and digital interpreter services while relying on ad hoc techniques. Such practices reveal systemic constraints on language access that might make it difficult for providers to access timely and reliable options for professional language interpretation, despite federal regulations that mandate such services for patients with NELP. [ABSTRACT FROM AUTHOR]

The activities of daily life (ADL) of stroke patients generally improves after rehabilitation. However, some patients remain at risk of ADL deterioration in the future. So far, there have been few studies on the factors related to ADL deterioration in stroke patients. To identify the factors related to ADL deterioration in stroke patients with independent mobility after discharge. We assessed 336 stroke patients with independent mobility who were discharged from the rehabilitation center between January 2016 and December 2018. The primary outcome was ADL deterioration, defined as that ADL assessed at 2 years after discharge decreased more than 15 points compared with that assessed at discharge. Univariate and multivariate statistical analyses were conducted to screen for factors related to ADL deterioration. Overall, 62 (18.4%) patients exhibited ADL deterioration at 2 years after discharge. Age (OR = 1.114, 95%CI = 1.045–1.188, p = 0.001), vascular risk factors>3 (OR = 3.269, 95%CI = 1.189–8.986, p = 0.022) and with post-stroke depression (OR = 2.486, 95%CI = 1.011–6.114, p = 0.047) were risk factors for ADL deterioration in stroke patients. In contrast, elevated Berg Balance Scale (BBS) scores at discharge was a protective factor for ADL deterioration (OR = 0.484, 95%CI = 0.386–0.606, p < 0.001). Nearly 1 in 5 stroke patients with independent mobility experienced ADL deterioration at 2 years after discharge. Aging, vascular risk factors>3, BBS at discharge, and post-stroke depression (PSD) were identified as factors associated with ADL deterioration [ABSTRACT FROM AUTHOR]

Oropharyngeal dysphagia is a common swallowing impairment post-stroke managed by speech language pathologists (SLP). This article aims to demonstrate a local know-do gap assessment for usual dysphagia care for patients undergoing inpatient stroke rehabilitation in primary healthcare in Norway, which included an assessment of the functional level of the patients and characteristics and outcomes of treatment. In this observational study, we assessed the outcomes and interventions of patients admitted to inpatient rehabilitation following stroke. The patients received usual care from SLPs while the research team administered a dysphagia assessment protocol that included assessment of several swallowing domains including oral intake, swallowing, patient self-reported functional health status and health-related quality of life, and oral health. The treating SLPs documented the treatments provided in a treatment diary. Of 91 patients who consented, 27 were referred for SLP and 14 received treatment. During the median treatment period of 31.5 days (IQR = 8.8–57.0), patients received 7.0 treatment sessions (IQR = 3.8–13.5) of 60 minutes (IQR = 55–60). The patients who received SLP treatment demonstrated no/minor disorders (n = 7) and moderate/severe disorders (n = 7). Dysphagia treatments primarily included oromotor training and advice on bolus modification and were provided without association to dysphagia severity. Patients with moderate/severe swallowing impairments received slightly more SLP sessions over a longer time. This study identified gaps between current and best practices and opportunities to improve assessment, decision-making, and implement evidence-based practices. [ABSTRACT FROM AUTHOR]

There are studies reporting different results on whether there is an increased incidence of cardiovascular problems in autism spectrum disorder (ASD). The aim of this study was to examine carotid intima-media thickness (cIMT), an early marker of atherosclerosis in children and adolescents with ASD. This single-center case-control study was conducted in a tertiary care hospital. Eighty-five children (36 children with autism and 49 healthy controls) aged 6–18 were enrolled. After a clinical interview, Children's Global Assessment Scale (CGAS) and Autism Behavior Checklist (ABC) were filled out and laboratory measures were collected for ASD group. Anthropometric measurements (height, weight, waist and hip) of each participant were assessed. The cIMT was measured with an ultrasound probe on both sides of the neck. Age, gender, body mass index percentile and waist/hip ratio adjusted right/left common carotid arteries IMT and right/left bulb IMT were statistically significantly higher in the autism group than controls (0.45 ± 0.01 mm and 0.55 ± 0.01 mm, respectively, p < 0.001). We performed multiple linear regression analysis to determine statistically significant related factors of the cIMT in ASD. Early onset of autism symptoms were related with high carotid IMT (β = −0.496, p = 0.01). These findings suggest that atherosclerosis may begin earlier in children with ASD, which is one of the most common neurodevelopmental disorders in childhood. The cIMT measurement, which is an easy and noninvasive method in the cardiovascular assessment and follow-up can be recommended for clinical use for individuals with ASD. [ABSTRACT FROM AUTHOR]

The nature and quality of stroke survivor rehabilitation varies throughout Europe, including in Portugal, having not been widely monitored or benchmarked. This study analyses the stroke care pathway from three perspectives: healthcare system, process, and patient. The study uses data from a one-year single-center prospective cohort of first stroke patients, assessed at baseline, 3, 6, and 12 months. Care pathways and settings were described in terms of organizational model, funding, patient involvement, frequency and intensity and multidisciplinary team. Patient-level information and satisfaction were evaluated using a 10-point numeric rating scale. Kruskal – Wallis and post-hoc tests were used to compare EQ-5D-3 L, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index, Mini-Mental State Examination scores between pathways and settings. A total of 391 acute stroke patients, with a mean disability of 3.7 (mRS) and severity of 11.7 (NIHSS) participated. Six pathways and eight settings were described. A lack of compliance between guidelines and care was identified. There were significant differences in the four outcomes between the six pathways (p-values 0.007 to 0.020) suggesting inefficiency and inequalities, with an inadequate level of information and patient satisfaction. After post-hoc analysis, pathways 1 and 2 showed highest outcomes (p-values 0.001 to 0.002). Within settings, short-term units showed high scores, followed by rehabilitation center, outpatient hospital, and community clinic (p-values 0.001 to 0.040). A multilevel characterization of the post-stroke rehabilitation pathway showed a more complete perspective on stroke management which may contribute to future rehabilitation and stroke policies [ABSTRACT FROM AUTHOR]

There is insufficient evidence regarding the minimal clinically important difference (MCID) of the Mini-Balance Evaluation Systems Test (Mini-BESTest). To determine the MCID of the Mini-BESTest in patients with early subacute stroke. In this prospective cohort study, the Mini-BESTest score of 50 patients with stroke was obtained within 1 week of their admission, their Mini-BESTest and Global Rating of Change Scale (GRCS) scores were obtained at discharge. The GRCS scores were reported by both the patients and their physical therapists. We evaluated the correlation between the Mini-BESTest change scores and the GRCS by determining Spearman's rank correlation coefficient. The MCID was calculated using 0.5× standard deviation (SD) for the distribution method and the change difference and receiver operating curve (ROC) for the anchor method. The mean (SD) number of days between evaluations was 15.4 (4.8), and the Mini-BESTest score at admission was 17.7 (5.2) and 23.1 (3.5) at discharge. The correlation between the GRCS and the change in the Mini-BESTest score was 0.28 (p =.04) for the patients and 0.54 (p <.001) for the therapists. The MCID based on the distribution method was 3 points for 0.5× SD. The MCID values based on the anchor method were 2.3 for the change difference and 0.5 for the ROC in the patient-rated GRCS, and 4.2 for the change difference and 4.5 for the ROC in the physical therapist-rated GRCS. The MCID based on the anchor method was 4.2–4.5 points, and the MCID based on the distribution method was 2.3 points. [ABSTRACT FROM AUTHOR]

The understanding of human postural control has advanced with the introduction of optimization process modeling. These models, however, only provide control parameters, rather than analytical descriptors of optimization processes. Here, we use a newly developed direct (pattern) search algorithm to investigate changes in postural optimization process in poststroke individuals. This cross-sectional study investigated the optimization properties of postural stability during upright standing in poststroke individuals. Twenty-nine poststroke and 15 healthy age-matched individuals underwent posturography with a force platform while standing for 60 s for acquisition of center-of-pressure data. Poststroke individuals were grouped depending on their weight-bearing (WB) pattern and their balance capability assessed through Berg Balance Scale (BBS). The optimization properties of postural stability were computed assuming the minimization of postural sway as cost function. The asymmetric WB poststroke group showed larger convergence rate toward the local minimum of postural sway than the symmetric WB group. Additionally, the low-balance capability group exhibited smaller values for averaged local minima and global minimum of postural sway coordinates compared with high-balance capability group. Significant correlations were found for BBS and the local minima and global minimum (Pearson's r ranged 0.378–0.424, P < 0.05). In summary, the optimization properties describing postural dynamic stability, steadiness, and global reference are altered in poststroke individuals with asymmetric WB pattern and low-balance capability. [ABSTRACT FROM AUTHOR]

The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test–retest reliability. Test–retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96–0.99) and 80% of the individual items had almost perfect agreement (k= 0.81–1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke. [ABSTRACT FROM AUTHOR]

Microstructural changes in the corpus callosum (CC) are associated with more severe motor impairment in the paretic hand, poor recovery, and general disability. The purpose of this study was to determine if CC microstructure predicts bimanual motor performance in chronic stroke survivors. We examined the relationship between the fractional anisotropy (FA) across the CC, in both the sensorimotor and non-sensorimotor regions, and movement times for two self-initiated and self-paced bimanual tasks in 41 chronic stroke survivors. Using publicly available control datasets (n = 52), matched closely for imaging acquisition parameters, we also explored the effect of stroke and age on callosal microstructure. In mild-to-moderate chronic stroke survivors with relatively localized lesions to the motor areas, lower callosal FA values, suggestive of a more disorganized microstructure, were associated with slower bimanual performance. Associations were strongest for the primary motor fibers (b = −2.19 ± 1.03, p =.035), followed closely by premotor/supplementary motor (b = −2.07 ± 1.07, p =.041) and prefrontal (b = −1.92 ± 0.97, p =.05) fibers of the callosum. Secondary analysis revealed that compared to neurologically age-similar adults, chronic stroke survivors exhibited significantly lower mean FA in all regions of the CC, except the splenium. Remote widespread changes in the callosal genu and body are associated with slower performance on cooperative bimanual tasks that require precise and interdependent coordination of the hands. Measures of callosal microstructure may prove to be a useful predictor of real-world bimanual performance in chronic stroke survivors. [ABSTRACT FROM AUTHOR]

Stigma is a common psychological consequence for stroke survivors that aggravates their physical and psychological burden and hinders their rehabilitation. Currently, there are few interventions targeted at the stigma of stroke survivors. This study reports on the development of a self-help cognitive behavioral therapy (CBT) programme driven by a logical model of stigma in stroke survivors, CBT and the advice of multidomain experts. A logical model of stigma in stroke survivors was derived from a systematic search of the literature and semistructured interviews with 21 patients to identify factors influencing stigma. The item content of the programme was generated based on this logical model in combination with CBT. A modified Delphi process with an expert panel of multidomain experts was used to evaluate and refine the content of the programme. SPSS 20.0 was used for data analysis. Seventeen experts accepted the invitation to participate, and all completed two rounds of the Delphi survey. Six sections and 26 items were identified. Consensus was reached among experts that the self-help CBT programme included the following six sections: health education, understanding stigma, cognition change, skills training and self-care, self-acceptance and relapse prevention. The self-help CBT programme includes health education and psychological education. This study extends the limited body of research on stroke-related stigma interventions, and the next step is to evaluate its efficacy in trials. [ABSTRACT FROM AUTHOR]

Self-efficacy has been shown to play an important role in rehabilitation outcomes of stroke patients. The Stroke Self-Efficacy Questionnaire Brazil (SSEQ-B) is designed to assess self-efficacy of functional performance after stroke. This research sought to address the structural validity of the SSEQ-B using exploratory and confirmatory factorial analyses. This is a cross-sectional study. We performed a reliability assessment and structural validation of the SSEQ-B in 115 Brazilian stroke survivors living in Rio Grande do Sul or São Paulo. Results: Sample mean age was 62.7 ± 14.2 years. Internal consistency presents a Cronbach's Alpha (αC) of 0.829. Exploratory factorial analysis using the scree plot method revealed a bifactorial structure, consisting of activity and self-management domains. While confirmatory factorial analysis suggested a trifactorial structure, the loading ranges between factors 1 and 3 were very similar, suggesting they could be collapsed – resulting in the same factors found in the scree plot analysis. Both structures with subscales showed good construct validity. SSEQ-B is a valid and reliable measure of stroke self-efficacy. The preferred structure of the SSEQ-B is bifactorial and includes the domains activity and self-management. [ABSTRACT FROM AUTHOR]

Fatigue assessment scale (FAS), fatigue subscale of the Profile of Mood States (POMS-F), and vitality subscale of the Short Form Health Survey (SF-36-VT) are among the first and most widely used adapted tools for assessing post-stroke fatigue. To identify the minimal clinically important difference (MCID) and robust clinically important difference (RCID) of FAS, POMS-F, and SF-36-VT in stroke survivors. Participants completed the FAS, POMS-F, and SF-36-VT before and after receiving 6-week intervention including graded activity training and pacing therapy. MCID was calculated using the distribution-based and anchor-based methods. Further, accuracy, sensitivity, and specificity of calculated values using the distribution-based method were used for determining RCID. A total of 124 stroke survivors participated in this study. MCID for FAS, POMS-F, and SF-36-VT was found to be 4.86, 3.32, and −10.10 (using score change) and 3.5, 2.5, and −10.5 (using ROC analysis), respectively. Using the distribution-based method, the MCID value obtained for the FAS was in the range of 3.16 to 8.76, for the POMS-F was in the range of 1.49 to 5.63, and for the SF-36-VT was in the range of −15.43 to −5.58. ½SD for FAS, ½ SD and 1.96 SEM for POMS-F, and 1.96 SEM and SD for SF-36-VT showed the best discriminative ability to use as the RCID. The MCID and RCID were calculated for FAS, POMS-F, and SF-36-VT using different methods. The results can be used by researchers and clinicians for interpreting their findings in subjects similar to those who participated in this study. [ABSTRACT FROM AUTHOR]

People receiving hematopoietic stem cell transplantation (HSCT) endure long phases of therapy and immobility, which diminish their physical activity (PA) level leading to physical deconditioning. One of the reasons is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. Therefore, our study investigates reported physical activity counseling behavior of health care professionals (HCPs) and the patient perspective on this topic. Physicians (N = 52), nurses (N = 52) physical therapists (N = 26), and patients receiving HSCT (N = 62) participated in a nationwide cross-sectional online-survey. Patients' preferred source of information concerning PA was determined. We examined HCPs self-assessed PA counseling behavior and patients' PA recall by assessing the use of the 5As (Ask, Advice, Agree, Assist, Arrange). Analysis of survey responses was descriptive. Univariate multinomial logistic regression examined whether sociodemographic factors and patient characteristics influence the response behavior. Physicians and PA specialists were patients' preferred source of information regarding PA. A large discrepancy between HCPs' perception and the degree to which HSCT patients recall advice became apparent; profound counseling steps like making referrals were less often recalled in our patient sample. Inactive patients reported to receive less basic PA counseling by physicians. Future research should identify the requirements to increase patients' recall concerning PA counseling in the setting of HSCT. Important messages about PA need to be made more salient to those who are less active and less engaged. [ABSTRACT FROM AUTHOR]

The study sought to determine the effects of a pilot home-based science intervention on deaf and typically hearing children's conceptual understanding of science and their abilities to reason about and communicate their understanding (scientific enquiry skills). Data show that by age 5 years a science attainment gap exists between deaf children and those typically hearing yet early interventions with deaf children typically neglect the development of science. We created an intervention to support caregivers (N = 17) to incorporate the language of science into their daily routines. Participants were placed into a control or intervention group; within each group were caregivers of deaf and typically hearing children. Over a period of 13 months, caregivers completed five assessments (each at two different time points); four on their child's understanding of concepts and one on their developing scientific enquiry skills. All caregivers, irrespective of group, reported positive gains in their child's conceptual understanding. Caregivers of deaf children reported greater gains in scientific enquiry skills than those of typically hearing children. This offers preliminary evidence to suggest that longer-term interventions may provide an opportunity to narrow the attainment gap between deaf and typically hearing children. [ABSTRACT FROM AUTHOR]

To investigate the validity and reliability of using the Valedo® system to measure trunk Range of Motion (ROM) during performance of the streamlined Wolf Motor Function Test (SWMFT). Twenty chronic strokes and 20 age-matched healthy participants performed SWMFT while wearing Valedo® sensors on their trunks to capture trunk movements. A paired sample T-test was used to examine the validity of the system in distinguishing between the healthy and stroke group, and between the affected and unaffected sides in the stroke group. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between-days) with 95% CI. The Valedo® system was able to distinguish between stroke and healthy participants; stroke participants employed greater trunk range of movements than the healthy controls in all tasks (p <.01). Furthermore, the Valedo® system enabled differentiation between affected and unaffected hands of people within the stroke group. The reliability for the stroke group was good to excellent with intrarater reliability (ICC = 0.71–0.92) and interrater reliability (ICC = 0.63–0.95). The Valedo system demonstrates an acceptable level of validity and reliability for measuring trunk ROM during the Streamlined Wolf Motor Function Test (SWMFT). Future studies with a larger sample size, different levels of upper limb impairment are warranted. [ABSTRACT FROM AUTHOR]

Traditionally, a pegboard has been commonly used as a useful training and assessment tool for patients with stroke. However, training using pegboards could be monotonous and may discourage motivation in patients with stroke, as it requires only repetitive movements without feedback. We aimed to demonstrate the efficiency and usability of a novel rehabilitation instrument (Rapael Smart Pegboard; SP), which integrates computerized technology into a traditional pegboard. This single-center study with a single-group pre–post design included 19 patients with hemiplegic stroke (11 outpatients and 8 inpatients). The patients received 20 SP training sessions (30 minutes per session, 5 days per week, over 4 weeks) according to their ability and status without any therapist intervention. The primary outcome was changes in the Fugl–Meyer assessment of upper extremity (FMA), and the secondary outcomes were changes in the Box and Block test and Jebsen–Taylor Hand Function test (JHFT). Additionally, usability assessment was performed. All outcome measurements except JHFT-gross score showed significant improvements with SP training. The significant improvements in these outcomes were consistently found in the outpatient group; however, the inpatient group failed to show improvement in the distal part of FMA, total JHFT score, and time. The usability test showed high satisfaction with 4.9 out of 5 points. The SP is an effective and feasible instrument for upper limb rehabilitation. Moreover, the SP can be used as a self-training tool without the assistance of a health care practitioner. [ABSTRACT FROM AUTHOR]

Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise. [ABSTRACT FROM AUTHOR]

Functional magnetic resonance imaging (fMRI) combined with behavioral assessments was used in our study to investigate the dynamic process of motor cortical functional reorganization after infarction. Therefore, we could provide a theoretical basis and build a useful evaluation system for rehabilitation after stroke and various other cerebral injuries. Acute stroke patients with a single lesion in the middle cerebral artery supply area and age- and sex-matched healthy volunteers were recruited. A longitudinal observational study involving 20 patients with stroke was conducted using repeated fMRI. Task-based fMRI data were acquired 3 times over a period of 3 months. The behavioral assessment included dynamometer and finger-tapping tests to evaluate the strength and dexterity of each upper arm. Behavioral results: The behavioral assessments demonstrated large improvements in session 2 and session 3. fMRI results: The healthy group showed activation in the contralateral primary sensory-motor cortex (S1M1) when executing tasks with either the left or right hand. Compared with the healthy subjects, the patients demonstrated greater activation in the ipsilateral frontal and parietal cortices and supplementary motor areas (SMAs). Across all sessions, more motor activation was observed in the left infarction group. Our results show that motor cortical activation induced by moving the paretic hand changes over time. There were differences in motor functional recovery and motor cortex compensation between the dominant hemisphere and nondominant hemisphere after stroke. [ABSTRACT FROM AUTHOR]

Caring for an autistic child is associated with elevated stress, anxiety and depression. Although some data suggest that 'child' or 'carer' factors may moderate the severity of carer distress, relatively few international comparisons have been made, limiting the generalizability of previous findings. This study aimed to address this issue. A survey-based comparison was made of carers from three nations (Australia, Denmark, Greece), and the effects of demographic, child, and carer variables upon carer anxiety and depression were investigated. Only limited cross-nation consistency was found for nation, child, or carer variables and their effects upon carer anxiety or depression. The application of universal treatment models for carer anxiety and depression may be of differing value across nations. [ABSTRACT FROM AUTHOR]

The Motricity Index (MI) can predict motor function after rehabilitation, but its minimal clinically important difference (MCID) has not been established. The primary study aim was to estimate the MCID value of the MI arm score. Between 2017 and 2018, 173 participants hospitalized with confirmed ischemic stroke were recruited into an observational rehabilitation study. Participants with motor weakness as measured by the Fugl-Meyer upper-extremity (FM-UE) and MI with complete baseline and follow-up assessments at 3 months were included in this analysis. The longitudinal recovery of the MI arm score was anchored to having a poor outcome based on the FM-UE recovery (<9) longitudinally. Results reported include the area-under-curve (AUC), along with sensitivity, specificity, and optimal cut-points based on maximizing the Youden statistic. Sixty-nine patients (median [IQR] age 70 [18] years; 48% male; 54% white) were included in the final analysis. Mean ± standard deviation outcome scores at 3-months were: MI arm: 83.19 ± 22.80; FM-UE: 53.04 ± 17.26. For the primary results, the MI arm score optimal MCID cutoff for observed recovery was 13 points with a sensitivity of 80% (95% Confidence Interval (CI)(67.6%, 92.4%)) and a specificity of 69.0% (95% CI (52.1, 85.8%)), and the AUC was 0.8082 (0.7007, 0.9157). This was the first study to report the MCID of the MI arm score, as anchored to the FM-UE recovery between acute evaluation and 3-months. The estimated optimal MCID of improvement in the MI arm score was 13 points. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale in adults with stroke. A secondary analysis of the Stroke Recovery in Underserved Populations Cohort Study. The CES-D was administrated to 828 stroke patients at discharge from inpatient rehabilitation facilities and at 3- and 12-month follow-ups. Data were analyzed using classical test theory (CTT) and Rasch measurement model. Confirmatory factor analyses of the CES-D items showed excellent fit of a four-factor model (CFI = 0.98; TLI = 0.98; RMSEA = 0.05). CTT analyses revealed satisfactory reliability and validity. Rasch analyses also supported the unidimensionality of each factor (subscale). Wright maps indicated a floor effect and item gaps. A few items displayed differential item functioning: 3 items (1 depressed affect and 2 somatic symptoms) across gender, 1 item (depressed affect) across time of assessment and all # somatic symptom items across time of assessment. The four-factor structure of the CES-D was confirmed and its psychometric properties were validated, supporting the use of four subscales to characterize depressive symptomatology in adults with stroke. Supplementary assessments are needed for evaluating and comparing somatic symptoms over time. A refinement of the CES-D was recommended to better differentiate stroke survivors with subtle depressive symptoms. [ABSTRACT FROM AUTHOR]

Whether stroke patients resume domestic chores is one of the major issues associated with their quality of life. Prediction models for domestic chores resumption among stroke survivors can be useful for setting goals and planning rehabilitation. To develop prediction models for individual domestic chores resumption among mild stroke patients three months after discharge from specialized rehabilitation wards. Ninety-one stroke patients admitted to specialized rehabilitation wardswere included in the analyses. We assessed the prestroke and three months post-discharge frequencies of six domestic chore items of the Frenchay Activities Index. Demographics and candidate predictors such as paralysis severity, cognitive function, walking speed, and self-efficacy were collected at discharge. Binary logistic regression analyses were performed to build prediction models for individual domestic chores resumption after stroke. The preparing meals model included walking speed (OR = 1.05) and cognitive function (OR = 1.29) as predictors; washing up model, walking speed (OR = 1.04); washing clothes model, walking speed (OR = 1.06), and number of family members living together (OR = 0.42); light housework model, walking speed (OR = 1.06); heavy housework model, walking speed (OR = 1.03), cognitive function (OR = 1.38), and self-efficacy (OR = 1.91); and local shopping model, walking speed (OR = 1.05), age (OR = 0.94), and number of family members living together (OR = 0.61). Our models may be useful in clinical practice to streamline the setting of goals and development of therapeutic strategies for individual domestic chores resumption among mild stroke patients. [ABSTRACT FROM AUTHOR]