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This study aimed to develop and validate a machine learning-based short measure to assess 5 functions (the ML-5F) (activities of daily living [ADL], balance, upper extremity [UE] and lower extremity [LE] motor function, and mobility) in patients with stroke.Secondary data from a previous study. A follow-up study assessed patients with stroke using the Barthel Index (BI), Postural Assessment Scale for Stroke (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) at hospital admission and discharge.A rehabilitation unit in a medical center.Patients (N=307) with stroke.Not applicable.The BI, PASS, and STREAM.A machine learning algorithm, Extreme Gradient Boosting, was used to select 15 items from the BI, PASS, and STREAM, and transformed the raw scores of the selected items into the scores of the ML-5F. The ML-5F demonstrated good concurrent validity (Pearson's r, 0.88-0.98) and responsiveness (standardized response mean, 0.28-1.01).The ML-5F comprises only 15 items but demonstrates sufficient concurrent validity and responsiveness to assess ADL, balance, UE and LE functions, and mobility in patients with stroke. The ML-5F shows great potential as an efficient outcome measure in clinical settings.

International audience; Motivated by the analysis of complex dependent functional data such as event-related brain potentials (ERP), this paper considers a time-varying coefficient multivariate regression model with fixed-time covariates for testing global hypotheses about population mean curves. Based on a reduced-rank modeling of the time correlation of the stochastic process of pointwise test statistics, a functional generalized F-test is proposed and its asymptotic null distribution is derived. Our analytical results show that the proposed test is more powerful than functional analysis of variance testing methods and competing signal detection procedures for dependent data. Simulation studies confirm such power gain for data with patterns of dependence similar to those observed in ERPs. The new testing procedure is illustrated with an analysis of the ERP data from a study of neural correlates of impulse control.

Both luminance contrast and character size are critical factors affecting reading performance. Previous studies reported on the effect of luminance contrast on the reading-speed function, that is, the relationship between reading speed and character size. In particular, when contrast was reduced, the critical print size (CPS) was found to shift to a larger character size even though the maximum reading speed and function shape did not change [Japanese Journal of Ophthalmology 52(1) (2008) 44-47]. In the present study, the effect of luminance contrast on the reading function was quantitatively examined. Japanese phrases with a luminance contrast of 0.03-0.99 were prepared as stimuli. Observers with normal vision were asked to read aloud phrases with several character sizes. Then, the reading functions were obtained for each luminance contrast. CPS was found to increase as the luminance contrast decreased. The relationship between contrast and CPS was linear in log-log coordinates, that is, log-CPS increased as the log-contrast of the characters decreased. It was found that the contrast of the stimulus systematically affects the location of the reading function.

Date Presented 04/23/21 The Neonatal Oral–Motor Assessment Scale is a clinical tool commonly used to evaluate the oral–motor skills of neonates. This study is to examine its predictability in feeding performance using newly organized items. The results showed that in addition to the adjusted age and weight at observed feed, jaw depression and jaw initiation were the significant predictors for successful bottle feed. Discuss implications of findings and the need for standardized assessment in neonates' feeding. Primary Author and Speaker: Tsu-Hsin Howe Additional Authors and Speakers: Christine L. Kroll

OBJECTIVE. We explored the cultural beliefs that influence Latino-American mothers’ feeding practices with their young children and the sources they referenced in making food choices for their children.METHOD. We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development.RESULTS. We identified four themes summarizing the mothers’ feeding practices: (1) “Grandma knows best,” (2) “I want my child(ren) to be healthy,” (3) “always soup and always rice,” and (4) “mealtime is family time.”CONCLUSION. Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers’ needs.

We explored parental feeding practices, feeding issues during the first 2 yr of life, and the relationship between feeding issues and levels of maternal distress in preterm infants. Four hundred twenty mothers (239 with preterm infants, 181 with full-term infants) participated in the study. The Behavior-Based Feeding Questionnaire for Infants With Premature History and the Parenting Stress Index–Chinese Version were used as the two outcome measures. The results indicated that preterm infants had different feeding experiences compared with their full-term counterparts. They tended to start solid food later in life and had limited experiences in food variation. Parenting stress was prevalent in parents with preterm infants and was associated with the frequency of feeding issues, especially at later ages when supplementary foods were being introduced.

Date Presented 03/26/20 The NOMAS is a clinical tool commonly used to evaluate the oral-motor skills of neonates. This study is to examine its predictability in feeding performance using newly organized items. The results showed that in addition to the adjusted age and weight at observed feed, jaw depression and jaw initiation were the significant predictors for successful bottle feed. Participants will discuss implications of findings and the need for standardized assessment in neonate feeding. Primary Author and Speaker: Tsu-Hsin Howe Contributing Authors: Ching-Fan Sheu

To investigate practice effect and test-re-test reliability of the Five Digit Test (FDT) over four serial assessments in patients with stroke.Single-group repeated measures design.Twenty-five patients with stroke were administered the FDT in four consecutive assessments every 2 weeks. The FDT contains four parts with five indices: 'basic measures of attention and processing speed', 'selective attention', 'alternating attention', 'ability of inhibition' and 'ability of switching'.The five indices of the FDT showed trivial-to-small practice effects (Cohen's d = 0.03-0.47) and moderate-to-excellent test-re-test reliability (intra-class correlation coefficient = 0.59-0.97). Practice effects of the five indices all appeared cumulative, but one index, 'basic measures of attention and processing speed', reached a plateau after the second assessment. The minimum and maximum values of the 90% confidence interval (CI) of reliable change index modified for practice (RCIp) for this index were [-17.6, 11.2].One of five indices of the FDT reached a plateau, whose minimum and maximum values of the 90% CI RCIp are useful to determine whether the change in an individual's score is real. However, clinicians and researchers should be cautious when interpreting the test results of these four indices over repeated assessments.

The present study evaluated the effects of the three perceptual complexity factors: number of elements, colour variety, and graphical background clutter level, on older and younger adults’ target acquisition time within a computer display. Experiment 1 manipulated the total number of icons, Experiment 2 manipulated the variety of icon colours, and Experiment 3 manipulated the clutter level of the graphical background on the display. In each experiment, 12 older and 12 younger adults were asked to move a cursor to a target icon on the display as quickly and accurately as possible. Target size and distance to the cursor were also manipulated to yield different difficulties of targets. Target acquisition time and Fitts’ law slope were analysed. Results showed that target acquisition time increased for more difficult targets under all the three complexity factors. The amount of increase was more evident for the factors of colour variety and graphical background clutter than for the number of icons. Older part...

Objective The reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) has not been examined while taking into account the correlation between subscales. The reliability of the EORTC QLQ-C30 subscales is modest, thus limiting their utility in both clinical and research settings. The purpose of this study was to validate the factor structure of multiple-item subscales of the EORTC QLQ-C30 and to improve their reliability by means of an item response analysis by using the multidimensional partial credit model. Methods A total of 2295 patients with complete data were used for the analysis. One- and nine-dimensional partial credit models were used to fit the data to validate the construct validity of the multiple-item subscales of the QLQ-C30. Results The model comparison showed that the nine-dimensional factor structure of multiple-item subscales was satisfactory. The multidimensional partial credit model fit data of the multiple-item subscales of the QLQ-C30 reasonably well. The estimated test reliabilities of each domain obtained from the multidimensional approach were higher than those obtained from the unidimensional approach. Conclusions The constructs represented by the multiple-item subscales of the QLQ-C30 were validated. The improved reliability of the multiple-item subscales of the QLQ-C30 under the multidimensional approach can facilitate their applications in clinical and research settings.

Objectives To assess the impact of return-to-work (RTW) status on health-related quality of life (HRQOL) over a 2-year period in workers with traumatic limb injuries and to elucidate factors that may contribute to the association of RTW with HRQOL. Design A 2-year repeated-measurements follow-up study using the generalized estimating equations approach for model fitting to account for within-subject correlations of HRQOL. Setting One teaching hospital. Participants Injured patients (N=966, 61% men) with a mean age of 44.7 years. Interventions Not applicable. Main Outcome Measures The RTW status, HRQOL (assessed by the EuroQol five-dimensional questionnaire), and activity/participation were repeatedly surveyed at 2 weeks and 1, 3, 6, 12, 18, and 24 months after injury. A series of regression models was used to examine the associations between HRQOL and RTW, with sequential adjustment for explanatory variables such as personal and environmental factors, body structure and function, activity/participation, and postinjury period. Results Over a 2-year study period, 81.2% of the study participants had 1 or more RTW episodes; 38.2% of them successfully maintained their RTW status until the end. A significant positive association was found between RTW status and HRQOL. The association could largely be explained by the domains of activity/participation. A higher HRQOL was associated with a shorter length of hospital stay, better coping ability, frequent participation in activities of daily living, and a longer postinjury period. A reduced HRQOL, however, was observed for participants with more depressive symptoms. Conclusions RTW showed a positive and independent influence on HRQOL in workers with limb injury. In addition, the activity/participation domains and the elapsed time since injury largely explained the association between RTW and HRQOL.

A novel indicator called health-adjusted leave days (HALDs) is proposed. It integrates the opposite level of health-related quality of life (HRQoL) with the sick leave days (LDs) before return-to-work (RTW) to better measure the impact of injuries on occupational health. A total of 1,167 limb injuries were consecutively recruited in a teaching hospital from January to December 2009. The number of LDs was calculated between the date of injury and the first episode of RTW. Each subject was repeatedly assessed with EuroQol instrument (EQ-5D) before RTW. The HRQoL index is defined as 1 minus the EQ-5D utility and re-scaled to 0–1 range to reflect the impact of injuries. The expected HALD of each group is calculated by integrating the product of the proportion of non-RTW function and the mean HRQoL index function over the days followed up to 2 years for the group. We compared the expected HALDs between subgroups according to various demographic characteristics and consequences of injury. Older and female workers tended to have longer LDs than men and younger workers, with an increase in percentage change of 16.0 or 139.5 %, respectively. After adjusting for HRQoL index, the percentages for HALDs were changed to 28.7 or 186.6 %, respectively. The percentages for the less-educated workers and blue collar workers were 185.7 and 155.8 %. The expected HALDs showed statistical significant differences in all subgroup analyses. We believed that the proposed HALD could better measure the impact of injuries and is potentially useful for the clinical decision and industrial policy-making with respect to the assessment of the importance of limb injury due to a worker’s sick leaves.

Cooperative learning provides an important vehicle for active learning, as knowledge is socially constructed through interaction with others. This study investigated the effect of cooperative learning on occupational therapy (OT) theory knowledge attainment in professional-level OT students in a classroom environment. Using a pre- and post-test group design, 24 first-year, entry-level OT students participated while taking a theory course in their second semester of the program. Cooperative learning methods were implemented via in-class group assignments. The students were asked to complete two questionnaires regarding their attitudes toward group environments and their perception toward group learning before and after the semester. MANCOVA was used to examine changes in attitudes and perceived learning among groups. Students' summary sheets for each in-class assignment and course evaluations were collected for content analysis. Results indicated significant changes in students' attitude toward working in small groups regardless of their prior group experience.

International audience; Event-related potentials (ERPs) are recordings of electrical activity along the scalp time-locked to perceptual, motor and cognitive events. Because ERP signals are often rare and weak, relative to the large between-subject variability , establishing significant associations between ERPs and behavioral (or experimental) variables of interest poses major challenges for statistical analysis. Noting that ERP time dependence exhibits a block pattern suggesting strong local and long-range autocorrelation components, we propose a flexible factor modeling of dependence. An adaptive factor adjustment procedure is derived from a joint estimation of the signal and noise processes, given a prior knowledge of the noise-alone intervals. A simulation study is presented using known signals embedded in a real dependence structure extracted from authentic ERP measurements. The proposed procedure performs well compared with existing multiple testing procedures and is more powerful at discovering interesting ERP features.

Objective: The two aims of this study are (1) to examine the concurrent and discriminant validity of a newly developed virtual ball catching test and (2) to explore the ball catching performance of typically developing children in a virtual environment. Design: Three groups of children aged 60- to 140-mo-old (n = 368) participated in this study: (1) typically developing children (n = 272), (2) children with diagnoses of developmental coordination disorders (n = 33), and (3) children with premature birth history (n = 63). Results: The concurrent validity of the virtual ball catching test was good, with Pearson's correlation coefficient = 0.67 between the virtual ball catching test and the Van Waelvelde's short ball catching test in successful catching rate. The discriminant validity of the virtual ball catching test was acceptable in differentiating the performance among typically developing children, children with developmental coordination disorders, and children with preterm history. The significant main effects in age, sex, speed, and location (Ps < 0.001) as well as significant interaction effects in age × location and age × speed were found when examining the virtual ball catching performance of typically developing children. Conclusions: The virtual ball catching test demonstrates acceptable psychometric properties in assessing the ball catching performance of children aged 5―11 yrs. We propose that testing children's motor performance in a virtual environment might be a useful and promising alternative for clinical assessment. Future research on its clinical application is needed.

BackgroundFunctional limitation of the upper extremities is common in patients with stroke. An upper-extremity measure with sound psychometric properties is indispensable for clinical and research use.ObjectiveThe purpose of this study was to compare the psychometric properties of 4 clinical measures for assessing upper-extremity motor function in people with stroke: the upper-extremity subscale of the Fugl-Meyer Motor Test (UE-FM), the upper-extremity subscale of the Stroke Rehabilitation Assessment of Movement, the Action Research Arm Test (ARAT), and the Wolf Motor Function Test.DesignThis was a prospective, longitudinal study.MethodsFifty-three people with stroke were evaluated with the 4 measures at 4 time points (14, 30, 90, and 180 days after stroke). Thirty-five participants completed all of the assessments. The ceiling and floor effects, validity (concurrent validity and predictive validity), and responsiveness of each measure were examined. Interrater reliability and test-retest reliability also were examined.ResultsAll measures, except for the UE-FM, had significant floor effects or ceiling effects at one or more time points. The Spearman ρ correlation coefficient for each pair of the 4 measures was ≥.81, indicating high concurrent validity. The predictive validity of the 4 measures was satisfactory (Spearman ρ, ≥.51). The responsiveness of the 4 measures at 14 to 180 days after stroke was moderate (.52 ≤ effect size ≤ .79). The 4 measures had good interrater reliability (intraclass correlation coefficient [ICC], ≥.92) and test-retest reliability (ICC, ≥.97). Only the minimal detectable changes of the UE-FM (8% of the highest possible score) and the ARAT (6%) were satisfactory.LimitationsThe sample size was too small to conduct data analysis according to type or severity of stroke. In addition, the timed component of the Wolf Motor Function Test was not used in this study.ConclusionsAll 4 measures showed sufficient validity, responsiveness, and reliability in participants with stroke. The UE-FM for assessing impairment and the ARAT for assessing disability had satisfactory minimal detectable changes, supporting their utility in clinical settings.

The Iowa gambling task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994) was developed to simulate real-life decision making under uncertainty. The task has been widely used to examine possible neurocognitive deficits in normal and clinical populations. Busemeyer and Stout (2002) proposed the expectancy-valence (EV) model to explicitly account for individual participants’ repeated choices in the IGT. Parameters of the EV model presumably measure different psychological processes that underlie performance on the task, and their values may be used to differentiate individuals across different populations. In the present article, the EV model is extended to include both fixed effects and subject-specific random effects. The mixed-effects EV model fits the nested structure of observations in the IGT naturally and provides a unified procedure for parameter estimation and comparisons among groups of populations. We illustrate the utility of the mixed-effects approach with an analysis of gender differences using a real data set. A simulation study was conducted to verify the advantages of this approach.

Objectives To examine the reliability and validity of a Chinese version of the Pediatric Evaluation of Disability Inventory in children with cerebral palsy. Design A prospective study. Subjects Two samples: 58 children with cerebral palsy (mean age 65.4 (standard deviation 29.9) months) and 89 normally developing children (mean age 43.5 (standard deviation 20.6) months). Methods The Pediatric Evaluation of Disability Inventory was translated and cross-culturally adapted into a Chinese version. The test-retest reliability, concurrent validity and discriminative validity were examined. Results Internal consistency was high (Cronbach's alpha: 0.90-0.99). Test-retest reliability was excellent (intraclass correlation coefficient: 0.982-0.998). The concurrent validity was good, as evidenced by the high correlation between the Pediatric Evaluation of Disability Inventory and the Functional Independence Measure for Children (Spearman's rho: 0.92-0.99). Logistic regression analysis demonstrated that the Pediatric Evaluation of Disability Inventory factor scores estimated by confirmatory factor analysis differentiated the children with cerebral palsy from normally developing children. Conclusion This study demonstrated that the Chinese version of the Pediatric Evaluation of Disability Inventory has good reliability and validity and provides support for its use in Chinese-speaking children with cerebral palsy.

Objective: To examine the effect of spoon-handle size on kinematic performance in people with Parkinson's disease. Design: A counterbalanced repeated-measures design. Setting: A motor control laboratory in a university setting. Subjects: Eighteen individuals with Parkinson's disease and 18 age-matched controls. Experimental conditions: Each participant was instructed to scoop water (simulated soup) using spoons with three different-sized handles. Main measures: Kinematic variables (movement time, peak velocity and number of movement units) of arm movement, size of hand aperture and number of fingers to grasp the spoon. Results: The movement of the participants with Parkinson's disease was faster (shorter movement time) and smoother (fewer movement units) when they used spoons with a small- or medium-sized handle than when using a spoon with a large-sized handle. In contrast, the healthy controls showed no significant differences in movement kinematics between handle sizes. Moreover, the participants with Parkinson's disease had a significantly smaller hand aperture and used more fingers to hold the spoons than the controls did. Conclusions: These results suggest that, for people with Parkinson's disease, a small-to-medium-sized handle is more suitable than a large-sized built-up handle.

Objective: To help clinicians and researchers interpret change scores of the simplified Stroke Rehabilitation Assessment of Movement measure, we estimated the minimal detectable change of the 3 subscales (including upper-limb movements, lower-limb movements, and mobility) of the measure. Design and patients: The measure was tested on 102 patients with chronic stroke by a single rater twice, with a 7–14-day interval for the test-retest study, and on 54 patients with subacute stroke by 2 raters twice, with a 2-day interval for the inter-rater study. Methods: The minimal detectable change was calculated on the basis of standard error of measurement. Furthermore, the intraclass correlation coefficient was used to examine the agreement between test and retest and between different raters. Results: The minimal detectable changes were from 12.5 to 13.2 points for the 3 subscales in the test-retest study and from 16.6 to 18.5 points in the inter-rater study. The testretest agreement and the inter-rater agreement were suffi cient (intraclass correlation coefficient = 0.88–0.96). Conclusion: The minimal detectable changes of the simplified Stroke Rehabilitation Assessment of Movement measure are useful for both clinicians and researchers to determine whether the change score of an individual patient is real.

We examined the reliability, validity, and responsiveness of the Neonatal Oral-Motor Assessment Scale (NOMAS) in healthy preterm infants. Feeding records of 147 infants (71 males, 76 females; gestational age [GA]or= 36 wks), taken from the day bottle-feeding was initiated to the day the infants were discharged, were used to examine the psychometric properties of the normal and disorganized categories of the NOMAS. The infants, with or without experience of breastfeeding, were all fed by bottle, with either formula and/or breast milk. GA ranged from 24 to 35.9 weeks (mean 29.7 wks, SD 2.7) and birthweight ranged from 470 g to 2570 g (mean 1251.1g, SD 425.9). Postmenstrual age (PMA) at the starting point of bottle-feeding ranged from 29.4 to 40.1 weeks (mean 33.8 wks, SD 1.7). We found that the NOMAS had satisfactory internal consistency (Cronbach's alpha0.70) in the normal category for 32 to 35 weeks'PMA. Moderate correlations were found between scores on the NOMAS and feeding performance for all age groups except for PMA ofor= 36 weeks (absolute Spearman's r(s)=0.51-0.69), indicating acceptable convergent validity. The NOMAS demonstrated moderate responsiveness to changes in oral-motor skills in every 2-week period, ranging from 32 to 36 weeks'PMA (standard response mean greater than 0.5). This study demonstrated that the normal and disorganized categories of the NOMAS are useful, with acceptable psychometric properties, in assessing oral-motor function in preterm infants aged 32 to 35 weeks'PMA. Future research on infants with abnormal oral-motor skills is needed to further validate psychometric properties of the dysfunction category of the NOMAS.

A quality of life questionnaire is rarely adapted to an interview mode for people who mainly use spoken language in daily life. In Taiwan, the WHOQOL-BREF (Mandarin Chinese version) has been developed, as a self-administered questionnaire, but it cannot be applied to the majority of the elderly in Taiwan, who speak only Taiwanese (a dialect). This study adopted the audio player-assisted interview mode to develop a Taiwanese version of the WHOQOL-BREF specifically for Taiwanese-speaking elderly people, and followed with examinations of the reliability and validity of this version. Initially, the WHOQOL-BREF (English version) was translated into colloquial Taiwanese, and field tests confirmed the equivalence and appropriateness of the translation. A total of 228 Taiwanese-speaking elderly people were assessed using the Taiwanese interview version, of which 144 subjects were re-assessed two weeks later. Interviewers assessed each subject aided by an audio player on which all the translated WHOQOL-BREF contents were recorded. The Taiwanese interview version of the WHOQOL-BREF, except for the item related to dependence on medication, showed acceptable reliability (internal consistency, corrected item-domain correlation, and test-retest reliability) and validity (criterion-related, convergent, and discriminant validity). Confirmatory factor analyses supported the four-factor model of the Taiwanese interview version, providing evidence for construct validity. The results suggest that the Taiwanese audio player-assisted interview version of the WHOQOL-BREF was reliable and valid in assessing quality of life of elderly Taiwanese.

OBJECTIVE. This study compared bottle-feeding behaviors in preterm infants with and without bronchopulmonary dysplasia (BPD) during the initial hospitalization. METHOD. Individual sucking characteristics and feeding transitional rates were compared in 41 preterm infants (22 boys, 19 girls) with BPD and 99 infants (44 boys, 55 girls) without BPD. Observations of the first bottle feeding and observations of the last feeding before discharge were obtained from medical records of all infants retrospectively. RESULTS. On discharge, infants with BPD, unlike those without BPD, continued to have an immature sucking pattern and required longer hospital stays to attain full oral feeding (p < .001). No differences were found between the BPD and non-BPD groups in time needed for feeding and use of oral support. CONCLUSION. These results suggest that feeding transitional rate, rather than sucking pattern, may be a better discharge indicator for infants with BPD.

Chien C-W, Hu M-H, Tang P-F, Sheu C-F, Hsieh C-L. A comparison of psychometric properties of the Smart Balance Master system and the Postural Assessment Scale for Stroke in people who have had mild stroke. Objective To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke. Design One repeated-measures design (at a 2-wk interval) was used to examine the test-retest reliability of the SBM and PASS, and another similar design was applied to investigate their responsiveness. Patients who participated in the responsiveness study were followed up approximately 1 year later, and the predictive validity of the SBM system and PASS were examined by assessing the patients' comprehensive activities of daily living (ADL) function. Setting Three rehabilitation units in Taiwan. Participants Twenty patients with chronic stroke in the reliability study; 40 and 32 patients who had recently had a stroke in the responsiveness and predictive validity studies, respectively. Interventions Not applicable. Main Outcome Measures Three computerized tests of the SBM (the equilibrium score of the Sensory Organization Test, scores in rhythmic weight-shifting tests, and scores in the limits of stability test) and the PASS were used. The combination of the Barthel Index and Frenchay Activities Index was used to represent the comprehensive ADL function. Results For the SBM, all but the weight-shifting tests of the SBM had moderate to high reliability (intraclass correlation coefficient [ICC] range, .78−.91). The responsiveness of the equilibrium score and the limits of stability test were moderate (effect size [ d ], .63) and small ( d range, .27−.33), respectively, whereas the responsiveness of the weight-shifting tests was limited ( d range, .04−.29). All but the weight-shifting tests of the SBM in the second evaluation had acceptable predictive validity for comprehensive ADL function ( r 2 range, .15−.17). The PASS showed high reliability (ICC=.84) and small responsiveness ( d =.41), and the PASS in the second evaluation had acceptable predictive validity ( r 2 =.24). Conclusions The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.

STUDY DESIGN: A prospective interview study. OBJECTIVE: To determine whether items of the Frenchay Activities Index (FAI) measure Instrumental Activities of Daily Living (IADL), as a unidimensional construct, in patients with spinal cord injury (SCI). To examine whether the response categories of the FAI are useful in discerning the various ability levels of IADL. SUMMARY OF BACKGROUND DATA: No known IADL scale has been designed for SCI patients. The FAI, to our knowledge, has never been validated in patients with SCI. METHODS: A total of 233 persons with SCI participated in this study. The FAI was administered to the patients by interview at locations convenient for the participants. A Rasch analysis was used to examine the unidimensionality and appropriateness of the response categories of the FAI. RESULTS: All but 2 items ("going outside" and "reading books") of the FAI fitted the model's expectations. The results of Rasch analysis indicated that the response categories for the remaining 13 items of the FAI should be collapsed to create more suitable response categories (4 items, into dichotomies, and the remaining 9 items, into trichotomies). Thus, a revised 13-item FAI was formed by deleting the 2 misfitting items and collapsing the response categories of the items. CONCLUSIONS: This study demonstrated that the revised 13-item FAI assesses a single, unidimensional IADL for SCI patients living in the community. The revised FAI shows potential for assessment of IADL in SCI patients.

Objective: To justify the utility of the Simplified Stroke Rehabilitation Assessment of Movement Instrument (SSTREAM), we examined the discriminative, predictive and evaluative properties of the 3 subscales of the S-STREAM (i.e. upper-limb movements, lower-limb movements and mobility) in patients after stroke. Subjects: A total of 388 patients after stroke participated in this study. To examine the discriminative property, the patients were divided into 3 groups according to their Barthel Index scores. A comprehensive measure of activities of daily living was administered at 6 months after hospital discharge as an external criterion to examine the predictive property. Changes in the S-STREAM scores from the time of admission for rehabilitation, to hospital discharge, were used to examine the evaluative property. Results: All pair-wise comparisons of mean scores among the 3 groups on the 3 subscales of the S-STREAM were significant. The scores of the S-STREAM showed moderate to good correlations with the comprehensive activities of daily living scores. There were large changes in the 3 subscales of the S-STREAM. Conclusion: All 3 subscales of the S-STREAM demonstrate good discriminative, predictive and evaluative properties in patients after stroke. These findings provide strong evidence that the S-STREAM is useful in measuring motor and mobility function in patients after stroke.

The purpose of this study was to examine predictors of neurodevelopmental outcome in very low birth weight children without major impairment at 5 years of age, as well as to identify the contribution of early neurodevelopmental assessment to preterm children's later developmental outcomes. The participants in this study included 126 children who were prematurely born with very low birth weight. Outcomes of the childrens' later development were measured in tests that factored cognitive function, motor performance, and adaptive behavior. The results indicated that more than 50% of full-scale intelligence and 30% of both motor performance and adaptive behavior at the age of 5 can be explained by four predictors. The four predictors include preterm children's medical complications at birth, maternal education, early motor assessments, and cognitive assessments. Adding each test score obtained in early ages provides additional information to predict children's cognitive, motor, and adaptive behavior at 5 years of age. Manifold assessments conducted in multiple time periods strengthen the predictive values of later developmental outcomes. In addition, the findings of this study indicate that very low birth weight children tend to have lower adaptive behavior at 5 years old. With regard to our findings, we believe that having adaptive function is a reflection of a child's overall integrated abilities. Further study is warranted to increase understanding of this topic, as well as to be able to predict adaptive strengths and weakness and pinpoint limiting factors that may be useful for targeting behaviors in intervention.

Let a, b, c, with a ⩾ b ⩾ c , be positive real numbers indicating the intensities of physical stimuli in a psychophysical experiment; let P abc be the probability that b is judged to be more similar to a (“closer to”) a than to c. This paper investigates the following representation and its subcases for triadic judgments P abc = F [ u ( a ) - u ( b ) , u ( b ) - u ( c ) ] , where u is a real-valued, strictly increasing, continuous function and F is continuous, strictly decreasing in the first variable, and strictly increasing in the second variable. In addition to elucidating the connections between the representation and models of discrimination and bisection paradigms, this paper examines the mathematical consequences of Weber's law on subcases of the representation, demonstrating that the resulting analytic forms of these triadic models are very limited. The results constitute partial solutions to questions raised in Falmagne [(1985). Elements of psychophysical theory. New York: Oxford University Press] concerning the impact of Weber's law on probabilistic measurement models for triadic judgments.

Handedness is an aspect of hemispheric specialization whose pattern of expression may signal an unusual specialization that in turn, may underlie several developmental psychopathologies. It is generally believed that infant handedness is neither stable nor reliable and hence, cannot be used as an early marker of potential developmental abnormality of hemispheric specialization. We show that infant hand-use preferences for apprehending objects can be reliably assessed and may be relatively stable throughout the 7-13 month age period. However, the results also demonstrate that identifying infant handedness requires assessment using very large sample sizes with multiple assessment periods because it is likely that there may be many more than three patterns in the development of handedness during infancy.

A Rasch analysis was used to assess the unidimensionality and appropriateness of the scoring level of a 13-item self-perceived change in quality of life scale (CQOL) for stroke patients. A total of 158 patients with mild stroke completed the CQOL themselves at home. The results showed that a unidimensional CQOL can be created by deleting the three items related to speaking, vision, and thinking. The 4 scoring categories of the shortened scale were deemed appropriate from the analysis. These results provide preliminary evidence of the 10-item CQOL in assessing self-perceived change in quality of life in stroke patients. Further studies are needed to examine the test-retest reliability, criterion validity, and responsiveness of the 10-item CQOL in stroke patients.

Background and Purpose The trunk control items of the Postural Assessment Scale for Stroke Patients (PASS-TC) have been proposed for use in examining patients with stroke. The purpose of this study was to examine the discriminative and predictive validities and the evaluative properties of the PASS-TC at 14, 30, 90, and 180 days after stroke onset. Subjects and Methods A total of 269 patients with stroke participated in this prospective study. The PASS-TC was administered at the 4 time points after stroke onset. The distributions of the PASS-TC scores were used to determine the discriminative ability to distinguish between individuals at the 4 time points. A comprehensive activities of daily living (CADL) measure was administered 1 year after stroke onset as an external criterion for examining the predictive ability of the PASS-TC. Changes in PASS-TC scores between the intervals of 14 to 30, 30 to 90, and 90 to 180 days after stroke onset were used to examine the evaluative properties of the measure. Results The PASS-TC scores exhibited differences between the patients with disability and the patients without disability at the 4 time points. The scale, however, showed a notable ceiling effect at the 4 time points (>30% of the subjects), indicating a limited discriminative ability between individuals. The scores of the PASS-TC at the 4 time points were moderately correlated with the CADL scores at 1 year after stroke onset (Spearman ρ≥.5), evidence of its predictive validity. The responsiveness of the PASS-TC was moderate at 14 to 30 days after stroke (standardized response mean [SRM]=.65) and limited at 30 to 90 and 90 to 180 days after stroke (SRM=.42 and .02, respectively). Discussion and Conclusion The results provide evidence that the PASS-TC can predict CADL function at 1 year after a stroke, but the discriminative and evaluative abilities are limited over the first 6 months after a stroke. To promote the utility of the PASS-TC in stroke research, it will be necessary to reduce its ceiling effect and improve its evaluative ability.

Background and Purpose: Patients with mild cognitive impairment and subcortical cerebrovascular disease (svMCI) can be isolated using criteria modified from those of Erkinjuntti et al. for subcortical vascular dementia and have poorer outcomes (cognitive deterioration, disability, institutionalization, and mortality). The aim of this study was to test which of the core (dysexecutive syndrome with relative sparing of memory, gait disorders and extrapyramidal signs) and supporting (urinary and behavioral symptoms) clinical features are most useful to recognize patients with svMCI and discriminate them from those with amnestic MCI (aMCI). Methods: Twenty-nine svMCI and 14 aMCI patients were seen in a memory clinic. Tests and scales assessing core and supporting features that independently contributed to the discrimination between svMCI and aMCI were identified with stepwise logistic regression analysis. The accuracy of the discrimination was estimated with area under the receiver operating characteristic curve and 95% confidence intervals (CIs). Results: The most accurate scales were the extrapyramidal sign scale by Richards et al. (0.75, 95% CI 0.61–0.89), letter fluency (0.75, 95% CI 0.61–0.90), irritability of the Neuropsychiatric Inventory and urinary dependence (0.66, 95% CI 0.49–0.82 for both), and digit span forward (0.59, 95% CI 0.41–0.77). The overall accuracy of a model compounding information from main and supporting features was 0.98, 95% CI 0.94–1.0. Conclusions: All the domains that are included in the clinical criteria for svMCI independently contribute to the identification of the condition. These criteria can be useful to recognize svMCI patients in clinical settings.

Objective: To examine the psychometric properties of the sensory scale of the Fugl-Meyer Assessment (FMA-S) in stroke patients with a broad range of neurological and functional impairment at times from 14 to 180 days after stroke. Subjects: A total of 176 first stroke patients consecutively admitted to a university based medical centre. Design: This prospective, longitudinal investigation was based on data collected at 14, 30, 90 and 180 days after stroke. Main outcome measures: Reliability (inter-rater reliability and internal consistency), validity (convergent and predictive validity) and responsiveness of the FMA-S were examined. Results: The inter-rater agreement of the total score of the FMA-S was excellent, with an intraclass correlation coefficient of 0.93. The Cronbach's alphas of the FMA-S at four time points after stroke ranged from 0.94 to 0.98, indicating excellent internal consistency. However, the FMA-S showed a significant ceiling effect (more than 44.4% of the subjects achieving the highest score), poor to moderate inter-rater reliability for light touch items (weighted kappa ranging from 0.30 to 0.55), low to moderate validity (Spearman's rho ranging from 0.29 to 0.53), and low to moderate responsiveness (standardized response mean ranging from 0.27 to 0.67) at different post-stroke stages of recovery. Conclusions: The psychometric properties of the FMA-S in measuring sensory function do not support its clinical use in stroke patients. Further studies on methods to improve the psychometric properties of the FMA-S are needed.

Background and Purpose— To justify the summation of scores representing comprehensive activities of daily living (ADL) function, a Rasch analysis was performed to examine whether items of the Barthel Index (BI), assessing ADL, and items of the Frenchay Activities Index (FAI), assessing instrumental ADL, contribute jointly to a single, unidimensional construct in stroke patients living in the community. The number of scoring points of both indices was examined for their usefulness in discerning the various ability levels of ADL in these patients. Methods— A total of 245 patients at 1 year after stroke participated in this study. The BI and FAI were administered to the patient and/or the patient’s main caregiver by interview. Results— The initial Rasch analysis indicated that the middle scoring points for many items of the BI and FAI could be collapsed to allow only dichotomous response categories. All but 2 items of the FAI, social occasions and walking outside, fitted the model’s expectations rather well. These 2 items were excluded from further analysis. A factor analysis performed on the residuals of the Rasch-transformed scores recovered no dominant component. These results indicate that the combined 23 dichotomous items of the BI and FAI assess a single unidimensional ADL function. Conclusions— A clinically useful assessment of the comprehensive ADL function of patients at or later than 1 year after stroke can be obtained by combining the items of the BI and FAI (excluding 2 FAI items) and simplifying the responses into dichotomous categories. It is also demonstrated that the items of the new scale measure comprehensive ADL function as a single unidimensional construct when assessed at 1 year after stroke.

Background and Purpose— This study compared the validity, responsiveness, and interrater reliability of 3 mobility measures in stroke patients from the acute stage up to 180 days after stroke onset. The 3 measures were the Rivermead Mobility Index (RMI), a modified RMI (MRMI), and the Mobility Subscale of the Stroke Rehabilitation Assessment of Movement (STREAM). Methods— The validity and responsiveness of the 3 mobility measures were prospectively examined by monitoring 57 stroke patients with the measures and the Barthel Index at 14, 30, 90, and 180 days after stroke onset. Two individual raters used the 3 measures to evaluate a different sample of 40 patients on 2 separate occasions to determine the interrater reliability. Results— The Spearman ρ between STREAM and MRMI was ≥0.92; the intraclass correlation coefficient (ICC, a measure of agreement) between them was ≥0.89, indicating high concurrent validity of both measures. RMI showed a moderate to high relationship and agreement with STREAM and MRMI (ρ≥0.78, ICC≥0.5). Responsiveness of the 3 measures was high before 90 days after stroke onset (standardized response mean ≥0.83) and low at 90 to 180 days after stroke onset (0.2≤standardized response mean≤0.4). The score changes of the 3 measures at each stage were significant ( P ≤0.05), except for RMI and MRMI at 90 to 180 days after stroke onset. The interrater agreement of the 3 measures was high (ICC≥0.92). Conclusions— All 3 measures examined showed acceptable levels of reliability, validity, and responsiveness in stroke patients. The psychometric characteristics of STREAM were slightly superior to those of the other 2 measures among our patients. We prefer and recommend STREAM for measuring mobility disability in stroke patients.

Background and Purpose— Prediction of activities of daily living (ADL) functions at an early stage after a stroke is critical because it enables clinicians to set treatment programs and goals. The objective of this study was to assess the relationship between trunk control at an early stage and comprehensive ADL function (as assessed by combining basic ADL and instrumental ADL [IADL]) in patients at 6 months after stroke. Methods— A total of 169 stroke patients participated in this prospective study. Trunk control was measured with the use of the trunk control items of the Postural Assessment Scale for Stroke Patients (PASS-TC). In addition to the PASS-TC score, age, sex, type of stroke, side of hemiparesis, urinary incontinence, limb paresis (measured by the Fugl-Meyer motor test), balance (measured by the Fugl-Meyer balance test), and basic ADL (measured by the Barthel Index) were also selected as predictor variables. These variables were assessed at 14 days after stroke or earlier. The Barthel Index and Frenchay Activities Index (measuring IADL) were administered at 6 months after stroke. The sum of the standardized Barthel Index and standardized Frenchay Activities Index scores was used to assess comprehensive ADL function. Results— Multivariable stepwise linear regression analysis showed that PASS-TC score, age, Fugl-Meyer motor test score, and Barthel Index score (listed by the order of forward selection) were the strongest predictors of comprehensive ADL function. These results were internally validated with the use of the bootstrap resampling technique. The PASS-TC score alone accounted for 45% of the variance in predicting comprehensive ADL function. Results also indicated that the PASS-TC score had slightly more power in predicting comprehensive ADL function than either the Fugl-Meyer motor test score or Barthel Index score. Conclusions— The findings of this study provide strong evidence of the predictive value of trunk control on comprehensive ADL function in stroke patients. The results imply that early assessment and management of trunk control after stroke should be emphasized.

Infant hand-use preferences for apprehending objects were assessed three times at 7, 9, and 11 months of age for 154 infants (79 males) using a reliable and valid procedure. Two classification procedures (differing in Type I classification error rates) were used to identify an infant's preference (right, left, no preference) at each age, and these data were examined using two- and three-group latent class analysis models. These analyses revealed the importance of using a handedness classification procedure with low Type I error rates and evidence of a right-shift factor similar to that expressed in child and adult handedness. Thus, infant hand-use preferences for apprehending objects are likely a developmental precursor of adult handedness. The relation of the right-shift factor to increased susceptibility to social influences during development and the evolution of human abilities also is discussed. © 2002 John Wiley & Sons, Inc. Dev Psychobiol 40: 1–13, 2002

This paper considers a regression approach to estimating signal detection parameters for rating data. The methodology is based on the statistical modeling of ordinal data and requires only standard statistical software such as SAS (SAS/STAT User's Guide, 1999) for computation. The approach is more efficient than the current practice of extracting the parameter estimates with the use of specialized software and analyzing the estimates with the use of a standard statistical package. It greatly facilitates exploration of the effects of covariates on model parameters. The method is illustrated using a published data set from a single factor multiple-alternative perceptual task, and data from a more complex factorial design examining recognition memory rating data.

The purpose of this paper is to describe and illustrate a regression approach to the analysis of correlated binary outcomes (Liang & Zeger, 1986). Ignoring the correlations between repeated observations can lead to invalid inferences. This approach extends logistic regression to account for repeated observations in each of a series of individuals. In this paper, I present a nontechnical introduction to the generalized estimating equations (GEE) approach. A fictitious example is used to demonstrate that GEE regression correctly adjusts for the correlations between repeated binary observations. The approach is illustrated with an analysis of safer sex practices among high-risk teenagers.

Background and Purpose— The 50-item Fugl-Meyer motor scale (FM) is commonly used in outcome studies. However, the lengthy administration time of the FM keeps it from being widely accepted for routine clinical use. We aimed to develop a short form of the FM (the S-FM) with sound psychometric properties for stroke patients. Methods— The FM was administered to 279 patients. It was then simplified based on expert opinions and the results of Rasch analysis. The psychometric properties (including Rasch reliability, concurrent validity, predictive validity, and responsiveness) of the S-FM were examined and were compared with those of the FM. The concurrent validity and responsiveness of the S-FM were further validated in a sample from the Netherlands. Results— We selected 6 items for each subscale to construct a 12-item S-FM. The S-FM demonstrated high Rasch reliability, high concurrent validity with the original scale, moderate responsiveness, and moderate predictive validity with the comprehensive activities of daily living function. The S-FM also showed sufficient concurrent validity and responsiveness on the Dutch sample. Conclusions— Our results provide strong evidence that the psychometric properties of the S-FM are comparable with those of the FM. The S-FM contains only 12 items, making it a very efficient measure for assessing the motor function of stroke patients in both clinical and research settings.

We illustrate the application of BUGS, a Bayesian computer program, with two examples. The algorithm used in the program is a popular Markov chain Monte Carlo procedure called Gibbs sampling. Bayesian analysis based on simulation has been applied to a wide range of complex problems (Gilks, Richardson, & Spiegelhalter, 1996). The availability of a general purpose program like BUGS should facilitate important applications of Bayesian inference in psychological research.

In this paper, we discuss the use of Java, a programming language for the Internet, in introductory statistics courses. Monte Carlo estimation and simple linear regression are used as tutorial examples of the versatility of Java. Advantages over traditional instructional methods and other programming languages are examined.

Taking care of a premature infant adds an extra burden to already stressed parents. Previous studies have shown that parental stress occurs during the initial hospitalization. However, there is little information on parental stress over time, and the few existing results are conflicting. In addition, many studies have focused on maternal stress but there is little information about a father's long-term adaptation to stress. The purpose of this study was to examine the degree and type of parenting stress in the families of very low birth weight (VLBW) preterm infants over the first two years of life. We compared parenting stress in families with preterm infants with control families, while also comparing the stress in mothers to that in fathers. Furthermore, we explored the relationship between parenting stress in the preterm group with identified factors that included the infant's age, medical complications, and parents' perceived feeding issues after they had been discharged from the hospital. This was an exploratory study with a cross sectional design. Participants included a total of 505 mothers from Tainan, Taiwan; 297 with preterm children (239 mothers, 58 fathers) and 208 with full-term children (181 mothers, 27 fathers). Assessments including the Parenting Stress Index, Neonatal Medical Index and Behavior-based Feeding Questionnaire were used to measure parental distress, infants' medical complications and parents' perceived feeding issues, respectively. Results of the study, though not statistically significant, indicated the presence of increased parenting stress in parents of preterm infants as compared to parents of full-term infants. 13.1% of mothers with preterm infants demonstrated total stress levels that warranted clinical intervention. We also found that mothers of preterm infants presented different parenting stress patterns than fathers of preterm infants. Fathers of preterm infants tended to have overall higher stress scores than mothers. On the other hand, mothers of preterm infants tended to report more health related difficulties, more depression, higher social isolation and role restriction, and less support from their spouses, than reported by fathers. Moreover, as time went on, parents with preterm infants continued to experience greater parenting stress than those with full-term infants. Understanding the experiences of parents with preterm children is important for health care providers while interviewing parents for information regarding their children and designing intervention programs to improve children's outcomes.