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Background In recent meta-analyses, robot-assisted gait training for patients with multiple sclerosis (MS) have yielded limited clinical benefits compared with conventional overground gait training. Objective To investigate the effect of robot-assisted gait training for patients with MS on clinical outcomes through a systematic review and meta-analysis. Methods We searched for relevant studies in the PubMed, EMBASE, Cochrane Library, and Physiotherapy Evidence Database databases from their inception to April 7, 2022. We selected studies that (1) included participants with MS, (2) used robot-assisted gait training as the intervention, (3) included conventional overground gait training or another gait training protocol as control treatment, and (4) reported clinical outcomes. Continuous variables are expressed as standardized mean differences with 95% confidence intervals. Statistical analyses were performed using RevMan 5.4 software. Results We included 16 studies enrolling 536 participants. Significant improvement was observed in the intervention group, with low heterogeneity at the end of the intervention with regard to walking velocity (standardized mean difference [SMD]: 0.38, 95% confidence interval [CI]: [0.15, 0.60]), walking endurance (SMD: 0.26, 95% CI [0.04, 0.48]), mobility (SMD: −0.37, 95% CI [−0.60, −0.14]), balance (SMD: 0.26, 95% CI [0.04, 0.48]), and fatigue (SMD: −0.27, 95% CI [−0.49, −0.04]). The results of subgroup analyses revealed improvements in these outcomes for the intervention group using grounded exoskeletons. No significant differences were noted in all the outcomes between the groups at follow-up. Conclusions Robot-assisted gait training with grounded exoskeletons exerts a positive short-term effect and is an adequate treatment option for patients with MS.

Chien-Lin Lin,1 Ching-Ping Shen,2 Chin-Kai Lin3 1Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taiwan and School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 2National Chung-Shan Institute of Science & Technology Shi-Yuan Polyclinic, Taipei, Taiwan; 3Program of Early Intervention, Department of Early Childhood Education, National Taichung University of Education, Taichung, TaiwanCorrespondence: Chin-Kai Lin, National Taichung University of Education, 140 Min-Shen Road, Taichung, 40306, Taiwan, Tel +886 4-22183007, Fax +886 4-22183380, Email Linchinkai97@gmail.comPurpose: Few studies have tested the cognitive flexibility, specifically auditory and motor flexibility of children with ASD. This study was conducted to understand the relationship between cognitive flexibility and visual, auditory, and motor development in young children with ASD and autistic behaviors.Participants and methods: A purposive sampling approach was used to screen nineteen four- to five-year-old ASD children. Tests included the Autism Behavior Checklist-Taiwan Version and Cognitive Flexibility Test, which included visual, auditory, and motor cognitive flexibility subtests.Results: At the pre-switch and post-switch of three subtests, there were considerable variations in the number of ASD passing. According to the findings, children aged five had more visual cognitive flexibility than children aged four, but the lack of significant differences for the other flexibilities. The negative correlation of the three cognitive flexibilities with autistic behaviors was − 0.57∼-0.64.Conclusion: Children with ASD have significant difficulties in switching rule tasks characterized by visual, auditory, and motor cognitive flexibility. The results suggest that visual cognitive flexibility had an age effect. The negative correlation of the three cognitive flexibilities with autistic behaviors was moderate.Keywords: executive function, autistic behavior, preschooler, mental flexibility

Background. Knee osteoarthritis (OA) presented with knee pain and limitation of mobility is common, and it may become a chronic problem resulting in major loss of function, with related impaired activity of daily living. Current traditional therapy for knee OA includes pharmacological treatment and physiotherapy, but the efficacies are limited. An alternative noninvasive treatment low-level laser therapy (LLLT) applied to acupoints is still contradictory and the efficacy needs to be assessed. Methods and Materials. We conduct the randomized double-blind control study to investigate the efficacy of a dual-frequency LLLT (combines red light (780 nm) and near-infrared light (830 nm)) in patients suffering knee OA. Participates were randomly assigned into active laser therapy (ALT) and placebo laser therapy (PLT) groups. Subjects in the ALT group were separately treated by laser apparatus at the three acupoints (SP9, SP10, and EX-LE2) on their knee joints under continuous radiation for 15 min at the maximum intensity, three times per week for four weeks. The PLT group used laser apparatus of the same model according to similar procedures without laser light emission. Outcome Measurements including visual analog scale (VAS), pain pressure threshold (PPT), and Lequesne index were used. Results. A total of 30 subjects with two-sided knee OA in both groups completed the experiment. Statistically significant decreases were observed in the Lequesne index (5.27 ± 3.26 vs. 10.83 ± 3.83), conscious VAS 4 weeks after treatment (moving: 2.87 ± 1.13 vs. 5.67 ± 1.72; resting: 0.33 ± 0.62 vs. 2.67 ± 1.29), and the increase was noted in PPT (21.23 ± 1.82 kg vs. 13.02 ± 1.46 kg) in the ALT group compared with the PLT group. Conclusion. It appears that the knee OA pain and disability can be decreased after a dual-frequency LLLT applied to acupoints (SP9, SP10, and EX-LE2). The clinical efficacy of LLLT is highly related to the therapeutic settings of the laser apparatus; hence, more clinical trials with diffident parameter settings are needed to be further clarified.

Chien-Lin Lin1,2 Chin-Kai Lin,3 Jia-Jhen Yu4 1Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 2School of Chinese Medicine, College of Chinese Medicine, China Medical University, 3Program of Early Intervention, Department of Early Childhood Education, National Taichung University of Education, 4Occupation Therapy Unit of Rehabilitation Techniques Section, Lin Shin Medical Corporation Wuri Lin Shin Hospital, Taichung, Taiwan Introduction: This study aims to explore the impact of Parent Participation Program on the development of developmental delay children. Methods: Pretest-posttest equivalent-group experimental design study was used in this paper. A total of 30 pairs of developmental delay children aged 0–72 months and their parents participated into this study. They were divided into two groups, namely control group and experimental group, according to parents’ wishes. The objects of study in control group received 16 courses of direct rehabilitation therapy; those in experimental group received 8 courses of direct rehabilitation therapy and 8 courses of instruction and tracking of Parent Participation Program. The duration of the intervention was 8 weeks. All cases should be evaluated before and after the intervention, to analyze the difference before and after intervention and among groups. The statistical methods in this paper included descriptive analysis, Chi-square test, independent sample t-test, pair-sample t-test. Results and conclusion: The intervention of Parent Participation Occupational Program has positive impact on the development of developmental delay children in various fields. Among all the intervention results, the progress of the experimental group is 1.895 times more than that of the control group. With parent involvement, Parent Participation Occupational Therapy can promote the cognitive ability, language ability, action ability (gross and fine movement), social competence and self-care ability of children with developmental delay. Finally, the researcher presents suggestions and directions for future research in accordance with the results. Keywords: early intervention, preschool, developmental delay&nbsp

Bi-Huei Wang,1,* Chien-Lin Lin,1,2,* Te-Mao Li,2,3 Shih-Din Lin,3 Jaung-Geng Lin,2 Li-Wei Chou1,2,4 1Department of Physical Medicine and Rehabilitation, China Medical University Hospital; 2School of Chinese Medicine, College of Chinese Medicine; 3Graduate Institute of Acupuncture Science, 4Acupuncture Research Center, China Medical University, Taichung, Taiwan *These authors contributed equally to this work Background: This study investigated the clinical efficacy of electroacupuncture (EA) in inhibiting upper-extremity spasticity in chronic stroke patients, and also in mapping a unique preliminary acupoint-selection protocol. Methods: Fifteen patients were divided into two groups: patients in the control group (n=6) received minimal acupuncture (MA), and those in the experimental group (n=9) received EA. Four acupoints, which include Neiguan (PC6), Shaohai (HT3), Zeqian (Ex-UE, A32), and Shounizhu (EX-UE), were treated near the motor points of the muscles for elbow flexion, forearm pronation, and finger flexion. Both groups were treated for twelve sessions, 20 minutes per session, for 6 weeks (two sessions per week). The outcome measures in this study included angle of muscle reaction (R1), passive range of motion (R2), and dynamic component (R2–R1). Results: In the experimental group, the R2–R1 of the elbow joint was significantly decreased at 1 (P=0.0079), 3 (P=0.0013), and 6 weeks (P=0.0149) after treatment compared with pretreatment levels (P

This study aims to integrate importance-performance and gap analysis (IPGA), decision-making trial and evaluation laboratory (DEMATEL), and quality function deployment (QFD) to develop a three-tiered service-quality-improvement model in order to identify critical educational-service-quality deficiencies in hospitality, tourism, and leisure undergraduate programmes and thereafter to formulate applicable service-improvement strategies. Seven hundred and eighty-six valid questionnaires were returned. The IPGA analysis showed 12 service-quality attributes were in the area of ‘Concentrate here’. Out of the 12 attributes, four main cause attributes were found with the DEMATEL analysis. Furthermore, six service-improvement strategies were developed based on experts' in-depth interviews and QFD analysis. The effects of these improvement strategies were fully discussed in the context.

Central hyperthermia is characterized by a rapid onset, high temperature, marked temperature fluctuation, and poor response to antipyretics and antibiotics. Although poststroke central hyperthermia is common, prolonged instances are rare. We report a case of prolonged central fever after an intracranial hemorrhage. Before the accurate diagnosis and management of central fever, the patient underwent long-term antibiotic use that led to pseudomembranous colitis. Bromocriptine was used to treat the prolonged central hyperthermia, after which the fever did not exceed 39°C. A week later, the body temperature baseline was reduced to 37°C and a low-grade fever with minor temperature fluctuation occurred only a few times. No fever occurred in the month following the treatment. After the fever subsided, the patient could undergo an aggressive rehabilitation program.

In the face of ever intense competition and limited resources, it is management's primary concern to seek out accurate and effective ways for uncovering deficient service quality attributes and the real causes behind them. The purpose of this study is, therefore, to develop a two-phased service quality strategy model to identify defective service attributes and uncover their root causes by integrating the importance-performance gap analysis model, service triangle and gap analysis. A survey conducted on the guests, front-line servers and managers from nine different restaurant outlets of three similar international hotels in Taiwan is presented to empirically substantiate the suitability and practicality of this proposed model. The findings demonstrated that the model was fitted for the hotel in question to identify its defective service quality attributes, prioritize their order of improvement and consequently reveal the causes behind by analyzing the existence of the gaps among customers, managers and f...

Compression fracture of the vertebral body is common in the older patients. The possible etiology like osteoporosis or cancer metastasis should be included as a possibility in the differential diagnosis for severe back pain, to prevent delays in diagnosis and treatment. More severe fractures can cause significant pain, leading to inability to perform activities of daily living, and life-threatening in the older patient. We report a rare case of a 61-year-old man suffering from severe lower back pain and intermittent abdominal fullness. He came to our clinic, where muscle power was normal, but could not stand up or change posture because of severe back pain. Plain film and magnetic resonance imaging of lumbar spine both revealed osteoblastic lesion at L2 spine. Abdomen computed tomography showed a mass at the pancreatic body. The pancreatic cancer with osteoblastic metastasis was diagnosed. After receiving multimodality therapy such as percutaneous vertebroplasty and pain controlling, we provided effective palliation of symptoms, aggressive rehabilitation program, and better quality of life. Our case highlights the benefits of multidisciplinary cancer treatment for such patient, preventing the complications such as immobilization accompanied with adverse effects like musculoskeletal, respiratory, and cardiovascular systems. All clinicians should be informed of the clinical findings to provide patients with suitable therapies and surveys.

A slotless tubular linear generator (STLG) can be connected directly to renewable energy sources for generating electricity in a reciprocating force pattern with no extra mechanical cogging losses. This paper presents an analytical model for predicting the electromagnetic and electromechanical characteristics of a STLG, such that the preliminary operational performance of the STLG in potential applications can be conveniently evaluated. From the devised Bessel-based system model, both the unregulated and regulated generator outputs with and without power converter circuits included can then be thoroughly investigated. Experimental measurements obtained from a laboratory test-bed have also been provided to confirm the validity and adequacy of the proposed model for related performance assessments .

Background/Purpose: Accurate length-of-stay (LOS) estimates have an impact on medical costs for stroke patients. Most studies have reported only descriptive sample means or have provided linear-model-based estimates for LOS. This study calculated point and interval estimates by treating hospital discharge as an event, and utilizing the proportional hazards (PH) model to provide the estimation of hospital stay for first-ever stroke patients in a rehabilitation department of a clinical center. Methods: Pairwise analysis for correlations between age, sex, comorbidity status, modified Barthel index (MBI) and functional independence measure (FIM) was performed. These explanatory variables are used in the K-sample comparisons, the χ 2 test for association, the PH regression analysis, and log-transformed linear (LTL) regression. Results: The PH model gave a prediction on estimated mean LOS, with an absolute bias of 0.85 days, by combining MBI and FIM into a single variable, or a bias of 1.15 days and 1.16 days with MBI and FIM vari- ables, respectively. The LTL-based estimation generated a bias of 5.91 days. The PH model has relatively shorter confidence intervals than those obtained by sample-mean and LTL methods. Conclusion: We recommend using the PH model for predicting mean LOS when the PH assumption for patients with different clinical characteristics is satisfied. However, the proposed method only applies to rehabilitating stroke patients. (J Formos Med Assoc 2009;108(8):653-662)

In order to determine whether joint position exerts a powerful influence on length-tension regulation in multiarticulate wrist flexors, three wrist positions (neutral, flexion and extension) and four levels of flexor contraction [0%, 10%, 20% and 30% maximum voluntary contraction (MVC)] were manipulated. There were significant differences in H-reflex amplitudes according to wrist positions and levels of flexor contraction. H-reflex increased linearly as a function of contraction in all three wrist positions. H-reflex was consistently larger in the wrist flexion than in the wrist extension position. The strength of the relationship (omega2) indicated that wrist position had a greater effect on H-reflex than force of muscle contraction. The interaction between wrist flexors contraction and joint position was significant only in the wrist flexion position. Trend analysis showed that, in the wrist flexion position, a low level of contraction was sufficient to maximally facilitate the H-reflex; however, a quadratic component was seen at higher contraction levels. The above findings may reflect the length-tension relationship of the multiarticulate wrist flexors. Therefore, this paper will discuss the functional implications related to the larger H-reflex in flexion position and the depressed H-reflex in the wrist extension position.

Purpose To assess the p53 protein expression in pterygial tissue and to review all immunohistochemical studies on pterygium from Medline to evaluate the roles of age, gender, race, p53 antibody, cutoff levels of immunohistochemical analysis, parts of pterygium, p53 gene mutation spectrum, and primary or recurrent pterygium on the p53 staining results. Methods Immunohistochemical staining was performed on 127 pterygial specimens and 18 normal conjunctival samples. All 8 immunohistochemical studies on p53 expression in pterygium from Medline were reviewed. Results Among the 127 pterygial samples, there were 29 specimens (22.8%) positive for p53 expression. There was no significant difference between the p53-positive and p53-negative groups with respect to age or gender. Conclusion The positive rate of p53 staining in 8 immunohistochemical studies was 7.9%, 36.8%, 37.5%, 38.1%, 50%, 53.8%, 60%, and 100%, respectively. p53 protein antibody, cutoff level, race, and p53 gene mutational spectra all affect the results on the p53 staining. Different parts of pterygium and gender merit further evaluation in their role on p53 staining result.

Background: Preterm infants are at an increased risk of sucking problems, swallowing difficulty, and poor nourishment. During the neonatal period, the neurobehavioral organization of a preterm baby is poor compared with that of appropriate gestational age infants. Kinesio Taping has been widely used for edema control, joint protection, and proprioception training. With the help of augmentation of the sensory input for muscle facilitation and inhibition through tapping, the coordination of the target muscle groups can be improved. Until now, no research is available on the use of Kinesio Taping for the swallowing difficulty of infant.

Chien-Lin Lin,1,2 Yu-Fan Min,3 Li-Wei Chou,1,2,* Chin-Kai Lin,4,* 1Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 2School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 3Faith, Hope and Love, Center for Children and Adults With Disabilities, Taichung, Taiwan; 4Program of Early Intervention, Department of Early Childhood Education, National Taichung University of Education, Taichung, Taiwan*These authors contributed equally to this workBackground: The purpose of this study was to investigate the effectiveness of sensory processing strategies in improving the activity level of children with sensory integration dysfunction.Methods: The study used a matching-only pretest–posttest control group design, which requires random matching of sensory integration dysfunction to the corresponding intervention group (n = 18) and control group (n = 18). The intervention group comprised 3–6-year-old children who received an 8-week school-day intervention during implementation of the theme curriculum.Results: The 8-week treatment significantly reduced the activity level and foot-swinging episodes in children with sensory integration dysfunction, and obtained a medium-effect size. However, the level of improvement in the control group did not show any statistically significant change.Conclusion: Sensory processing strategies could improve activity levels in children with sensory integration dysfunction. However, this study was unable to exclude a developmental effect. The social validity results show that sensory processing strategies can be integrated into the theme curriculum and improve activity levels in children.Keywords: activity level, preschool inclusive classroom, sensory integration dysfunction, sensory processing strategy

Epidemiological evidence suggests that UV irradiation plays the most important role in pterygial formation. The noxious effects of UV irradiation are either directly by a UV phototoxic effect or indirectly by formation of radical oxygen species (ROS). ROS are very harmful to cells, because they injure cellular DNA, proteins, and lipids (called oxidative stress). Among numerous types of oxidative DNA damage, the formation of 8-hydroxydeoxyguanosine (8-OHdG) presents only a minor fraction of UV induced DNA damage, but it is a ubiquitous marker of oxidative stress. If pterygium is related to UV, we surmised oxidative stress exists in pterygium. To provide the molecular evidence of UV radiation, 8-OHdG was detected in pterygium. Moreover, human 8-oxoguanine glycosylase (hOGG1) is the key component responsible for the removal of 8-OHdG. To determine whether the hOGG1 was expressed in pterygium, this enzyme was also evaluated.Immunohistochemical staining using a monoclonal antibody to 8-OHdG and hOGG1 were performed on 52 pterygial specimens and 6 normal conjunctiva.There were 12 (23.1%) pterygial specimens positive for 8-OHdG staining, limited to the nuclei of the epithelial layer. No substantial staining was visible in the subepithelial fibrovascular layers. In pterygium with 8-OHdG staining, there were 4 (4/11, 36.4%) specimens with hOGG1 expression. However, in pterygium without 8-OHdG staining, there were only 3 (3/41, 7.3%) specimens with hOGG1 expression. hOGG1 expression was significantly associated with 8-OHdG positive staining. All normal controls were negative for 8-OHdG and hOGG1 staining.Our study demonstrated for the first time 8-OHdG in pterygium, which represented oxidative stress in pterygium. The increased level of 8-OHdG in pterygium is not due to decreased expression of hOGG1, while increased levels of 8-OHdG induced the expression of hOGG1.

Kuo-Wei Yu,1,* Chien-Lin Lin,1,2 Chun-Chuang Hung,3 Eric Chieh-Lung Chou,4 Yueh-Ling Hsieh,5 Te-Mao Li,2,3,* Li-Wei Chou1,2,61Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 2School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 3Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan; 4Department of Urology, China Medical University Hospital, Taichung, Taiwan; 5Department of Physical Therapy, China Medical University, Taichung, Taiwan; 6Acupuncture Research Center, China Medical University, Taichung, Taiwan*These authors contributed equally to this workBackground: Incomplete bladder emptying (IBE) is defined as having a postvoid residual (PVR) urine volume greater than 100 mL for 2 consecutive days. IBE is common in stroke patients and could necessitate indwelling or intermittent catheterization. The condition is correlated with urinary tract infections, which could impede rehabilitation progress and increase medical costs. Treatment for patients with IBE includes bladder retraining, biofeedback, medication, and botulinum toxin injection, but none of these interventions are completely effective.Methods: All patients with acute stroke who were admitted to the rehabilitation ward between August 2010 and April 2011 were included in the study and their PVR urine volume was checked. Electroacupuncture (EA; 1 Hz, 15 minutes) was performed on the acupoints Sanyinjiao (SP6), Ciliao (BL32), and Pangguangshu (BL28) of stroke patients with IBE for a total of ten treatments (five times a week for 2 weeks). Bladder diaries, which included the spontaneous voiding and PVR urine volumes, were recorded during the course of treatment.Results: The presence of IBE was not related to sex, history of diabetes mellitus, stroke type (hemorrhagic or ischemic), or stroke location (P > 0.05). Among the 49 patients in the study, nine (18%) had IBE, and seven of the stroke patients with IBE were treated with EA. Increased spontaneous voiding volume and decreased PVR urine volume were noted after ten sessions of EA.Conclusion: EA may have beneficial effects on stroke survivors with IBE, thereby making it a potential safe modality with which to improve urinary function.Keywords: acupuncture, electroacupuncture, incomplete bladder emptying, rehabilitation, stroke, urinary retention