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PURPOSE:: The objective of this study was to investigate modulation in prelanding muscle responses and its associated impact force on landing from unexpected and self-initiated drops in male basketball players with a history of bilateral multiple ankle sprains (BMAS). METHODS:: Prelanding EMG responses were recorded in four lower-limb muscles, together with the impact force on landing, while 20 healthy and 19 basketball players with BMAS performed unexpected, self-initiated drops from a height of 30 cm. RESULTS:: Group differences were detected after self-initiated but not unexpected drops. Two main changes in prelanding EMG responses were observed in the injured basketball players during the self-initiated drops. First, tibialis anterior (TA) was activated significantly earlier in the injured group, whereas left tensor fascia latae appeared closer to the moment of landing (P < 0.025) than in the healthy players. Second, cocontraction indexes between left TA and peroneus longus, and left TA and medial gastrocnemius, were significantly greater in the injured than in the healthy players (P < 0.025). On landing, higher magnitude-of-impact forces were observed in the injured players on the right leg (by 23%, P = 0.012). CONCLUSION:: In basketball players with BMAS, modulation of prelanding muscle response latencies occurred in injured (ankle) and uninjured (hip) joints during self-initiated but not unexpected drops. Greater cocontraction index between the left ankle muscle pairs in preparation for landing from self-initiated drops, and a significantly higher magnitude of impact force in the right leg on landing, were observed in the injured players. [ABSTRACT FROM AUTHOR]

PRIMARY OBJECTIVE: The present study reports the results of 103 persons with acquired brain injury who were randomly assigned to one of three 20-session analogy problem-solving skill training groups, namely: online training (through computer video conferencing with interactive software); computer-assisted training (through interactive patient-directed software); therapist administered training (face-to-face therapist guided training activities); and a 'no-treatment' control group. RESEARCH DESIGN: Pre- and post-test quasi-experimental design. MAIN OUTCOME AND RESULTS: Individuals' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period. Overall, the training methods were found to be effective in improving problem solving skills regardless of the modes of delivery (except in the case of the control group). The continuous 'human touch' characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving. CONCLUSION: The statistically significantly improvement in problem solving skills in the online-group suggests that this approach could effectively improve cognitive functions of person with ABI and yield training outcomes comparable to other modes of delivery such as the face-to-face training. The conceptualization and applicability of tele-cognitive rehabilitation, its implications for persons with ABI, and future studies in this research area are also discussed. [ABSTRACT FROM AUTHOR]

PRIMARY OBJECTIVE: To evaluate the effects of different trainer-trainee interaction patterns on the self-efficacy outcomes of trainees with brain injury. RESEARCH DESIGN: A pre-test and post-test randomized clinical trial design. METHODS AND PROCEDURES: One hundred and three subjects with brain injury were recruited and 83 subjects participated in analogical problem-solving training that was delivered in three respective interaction modes: (a) direct trainer-trainee interaction, (b) self-paced computer-assisted and (c) on-line training with real-time audio-visual interaction. Quizzes on daily behavioural problem- solving and a problem-solving self-efficacy rating scale were adopted as outcome measures. The trainees in the trainer-administered group that received instructions in person with a continuous 'human touch' showed more significant improvement in their problem-solving self-efficacy than the two other groups. CONCLUSIONS: Interactive modes of cognitive skill training can be flexible enough to match the needs of individual trainees. However, human interaction is considered important in promoting self-efficacy in trainees with brain injury. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the effects of vestibular stimulation on standing balance control between Tai Chi practitioners and older subjects. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center. PARTICIPANTS: Tai Chi practitioners (n=24; age +/- standard deviation, 69.3+/-5.0y) and control subjects (n=24; age, 71.6+/-6.1y) were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects stood on a force platform with eyes closed before and after stimulation of their horizontal semicircular canals, applied by means of whole head-and-body rotation at 80 degrees /s for 60 seconds, with subjects seated in a rotational chair. Body sway during stance was measured as total sway path, peak amplitudes, and mean velocities of sway in both anteroposterior (AP) and mediolateral (ML) directions. RESULTS: After head-and-body rotation, significant within-group increases were found in all measures in both AP and ML directions during stance with eyes closed in older control subjects but not in Tai Chi practitioners along the AP direction. In fact, significantly smaller increases in total sway path, peak amplitude, and mean velocity of body sway in the AP direction were found in the Tai Chi practitioners when compared with those of control subjects. CONCLUSIONS: Our results show that long-term Tai Chi practitioners had better AP standing balance control after vestibular stimulation than older control subjects. Copyright © 2006 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine test-retest reliability of the Timed Up & Go (TUG) test, its ability to differentiate subjects with chronic stroke from healthy elderly subjects, and its associations with ankle plantarflexor spasticity, ankle muscle strength, gait performance, and distance walked in 6 minutes in subjects with chronic stroke. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center in Hong Kong, China. PARTICIPANTS: Ten healthy elderly subjects and 11 subjects with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time taken to complete the TUG test was recorded. Plantarflexor spasticity and ankle muscle strength were assessed, respectively, by the Composite Spasticity Scale and a load-cell together with electromyography. Gait parameters and walking endurance were measured respectively by walkway system (GAITRite II) and 6-minute walk test. Intraclass correlation coefficients (ICCs) were calculated as measures of reliability, and all correlation analyses were conducted using Spearman correlation coefficients. RESULTS: The TUG test showed excellent reliability (ICC>.95). Subjects with chronic stroke had significantly more spastic and weaker plantarflexors, slower walking speeds, and poorer walking endurance when compared with healthy elderly subjects (all P<.003). The strength of the affected ankle plantarflexors (rho=-.860, P<.01), gait parameters (rho range, .620-.900; P<.05), and walking endurance (rho=-.960, P<.01) correlated with TUG scores. CONCLUSIONS: The TUG scores were reliable, were able to differentiate the patients from the healthy elderly subjects, and correlated well with plantarflexor strength, gait performance, and walking endurance in subjects with chronic stroke. Copyright © 2005 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation [ABSTRACT FROM AUTHOR]

Background Pharmacotherapy is the mainstay of dyspnea management in patients with chronic obstructive pulmonary disease (COPD). Undesirable side effects have led to the application of alternative treatment strategies such as acupuncture. Our previous study showed that transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS), a noninvasive modality, can reduce dyspnea symptoms in patients with COPD, but the underlying mechanism is unknown. Primary Study Objective This study investigated the effect of acu-TENS on forced expiratory volume in one second (FEV1), dyspnea, and Β-endorphin levels in patients with COPD. Design A double-blinded randomized controlled trial Setting: Hospital outpatient clinic Participants Forty-four subjects diagnosed with COPD Intervention Participants were randomly assigned to receive either acu-TENS or placebo-TENS on Dingchuan (EX-B1) for 45 minutes. Outcome Measures FEV1, forced vital capacity (FVC), dyspnea visual analogue score (DVAS), respiratory rate (RR), and blood Β-endorphin levels were measured before and after therapeutic intervention. Results Our findings showed that the increase in FEV1 was 24.2% greater in the acu-TENS group than the placebo group (P < .0001). The decrease in RR and DVAS was also more in the acu-TENS group by 14.2% (P < .0001) and 20.7% (P = .006), respectively. The postintervention increase in Β-endorphin was significantly higher in the acu-TENS than the placebo group (18.3%) (P = .027). Furthermore, the percentage reduction in RR correlated with the increase in Β-endorphin (R = -0.477, P = .033). Conclusion An improvement in FEV1 and dyspnea score at the end of Acu-TENS treatment was associated with a concurrent increase in b-endorphin level in patients with COPD. [ABSTRACT FROM AUTHOR]

[Purpose] The evaluation of sitting balance is important for the prevention of falls in older adults, especially those who have a disability involving the lower extremities. However, no studies have been designed to assess a patient's dynamic sitting balance using a sequential protocol. The objective of this study was to investigate the psychometric properties of the sequential weight-shifting (SWS) test. [Subjects and Methods] Twenty-three older adults who were physically dependent with regard to ambulation were recruited by convenience sampling. In study 1, 10 participants performed the SWS test and repeated the procedure 1 week later. In study 2, 23 participants were assessed using the SWS test, forward and lateral reach tests in a sitting position, tests of shoulder flexor and hand grip strength, an eye-hand coordination test, mobility tests, and pulmonary function tests. The test-retest reliability of the SWS test and its correlations with the different physical dimensions were examined. [Results] The intraclass correlation coefficient (3,1) of the SWS test was 0.67. The results of the SWS test correlated significantly with forward reach in the sitting position, arm muscle strength, eye-hand coordination, mobility, and pulmonary function (all p<0.05). [Conclusion] The SWS test demonstrated satisfactory psychometric properties and can be considered a useful functional approach for the measurement of sitting balance.

Background and Purpose: Recent dual-task studies suggest that Tai Chi practitioners displayed better control of standing posture and maintained a quicker response time of postural muscle activation during a stepping down activity. Whether this effect extends to voluntary balance control, specifically the limits of excursion of the center of pressure, remains to be examined. The purpose of this study was to evaluate the cognitive-motor interference pattern by examining the effects of a concurrently performed cognitive task on attention of voluntary balance control in older adults who are long-term practitioners of Tai Chi., Methods: Ten older Tai Chi practitioners and 10 age-matched nonpractitioners performed a voluntary balance task that required them to shift their weight to reach a preset target in the forward and backward directions, with (single task, ST) and without (dual task, DT) a secondary cognitive task, which was the counting backward task. The counting backward task required the individual to compute and verbalize a series of arithmetic differences between a given pair of randomly generated numbers. The cognitive task was also performed independently (cognitive-ST). All trials were performed in a random order. Balance outcomes included reaction time, movement velocity, and maximal excursion of the center of pressure provided by the NeuroCom system. Cognitive outcome was the number of correct responses generated within the 8-second trial during the ST and DT conditions. Outcome variables were analyzed using a 2-factor, group by task, analysis of variance. DT costs for the variables were calculated as the relative difference between ST and DT conditions and were compared between the 2 groups using independent t tests., Results: Tai Chi practitioners displayed shorter reaction times (P < .001) and faster movement velocities (P < .05) of their center of pressure than older nonpractitioners for both directions; however, no difference was found between the maximal excursions of the 2 groups. Cost analyses revealed that reaction time and cognitive costs were significantly lower in the Tai Chi practitioners for both forward and backward directions (P < .05); however, similar findings for movement velocity costs were significant only in the backward direction (P < .05)., Discussion and Conclusions: Our results suggest that Tai Chi practitioners expended fewer motor and cognitive resources than older nonpractitioners during a fairly complex (dynamic) postural equilibrium task while performing a verbal working memory task. They exhibited lesser cognitive-motor interference and thus better allocation of attentional resources toward the voluntary balance control task. Given that dynamic balance is a crucial prerequisite for walking and dual-tasking ability is considered to be a significant predictor of falls in older adults, our results might point at the possible long-term benefits of Tai Chi practice to counteract age-related decline in dual-tasking ability. Findings present preliminary data for further investigation, especially related to potential benefits in fall prevention.

Background: This single-blinded, randomized controlled study investigated the effects of practicing Tai Chi on the postural control and cognitive performance of older women while dual tasking., Methods: Community-dwelling older women (n=31) were recruited from community centers. They were randomized to Tai Chi group (n=15, 12-form Yang style Tai Chi training) or a control group (n=16, general interest classes) for 16 weeks. Balance was tested in single leg stance after stepping down from a step, with and without a concurrent auditory response task (auditory Stroop test). Balance was measured by total sway path and sway area of subject's center of pressure (COP). The reaction time and the correctness of the auditory Stroop test were also measured., Results: Tai Chi subjects made fewer errors in auditory Stroop test under dual-task condition after Tai Chi training (p=0.01). They also showed significant decreases in the COP path (p<0.05) and the COP area (p<0.05) in their postural control after training in both single- and dual-task conditions. The subjects in the control group did not show any significant improvement in dual-task condition after the intervention., Conclusions: Tai Chi training improves the cognitive and postural control performance of older women when dual tasking.

This study quantified the effect of aging and the long-term practice of Tai Chi on upper limb movement control, indicated by performance outcome (temporal) and performance production (amplitude) measures, on a multiplanar stand-reaching (i.e., functional) task. Twelve Tai Chi practitioners (TCPs), 11 age-matched older nonpractitioners (ONPs), and 12 young subjects performed cued, flexion-reaching, and abduction-reaching tasks using a custom set-up. Surface EMG and acceleration data sampled from wireless sensors rendered performance outcome (reaction time, burst duration, time to peak, and movement time) and performance production (normalized EMG amplitude and peak acceleration) measures. Young subjects and TCPs demonstrated better performance outcome and performance production than ONPs. Relative-effect computations (i.e., the effect of Tai Chi expressed as a percentage of the effect of aging) showed that TCPs exhibited approximately 20-60% (flexion) and 20-100% (abduction) improvement in reaching task performance compared with ONPs. Tai Chi practitioners displayed better arm movement control than ONPs on a relatively challenging and functional stand-reaching task.

Purpose: The purpose of this study was to examine the effects of 3 months of sitting Tai Chi training on the sitting balance control and eye-hand coordination of older adults subjects., Methods: We randomly assigned 59 older adults from four residential care facilities to either sitting Tai Chi group or mobilizing exercises group as control. The sitting Tai Chi group underwent 3 months of training with a total of 36 sessions (1 hour/session, 3 sessions/week). The outcome measures included sitting balance tests (testing sequential weight shifting and forward reaching in a sitting position) and eye-hand coordination tests (reaction time, movement time and accuracy in finger pointing task)., Results: The Tai Chi practitioners showed significant improvement in their sequential weight shifting while sitting (improved by 29.0%, p ≤ 0.05) and in their maximum reaching distance from a sitting position (improved by 21.2%, p ≤ 0.05). No such improvements were found in the control group. In the eye-hand coordination test, the sitting Tai Chi practitioners had significant improvements in accuracy (improved by 17.3%, p ≤ 0.05). Also, no improvement was found in the control group., Conclusions: The results demonstrate 3-months of sitting Tai Chi training can improve sitting balance and accuracy in finger pointing task in the older adults., Implications for Rehabilitation: Traditional Tai Chi poses difficulties for older adults with poor standing balance. This pilot study showed that a 3 months sitting Tai Chi training can improve sitting balance and accuracy in the finger pointing task in the older adults. Sitting Tai Chi can be a therapy option for older adults with poor standing balance.

The purpose of this study was to establish the internal consistency and test-retest reliability of the electromyographic and accelerometric data sampled from the prime movers of the dominant arm during an antigravity, within-arm's length stand-reaching task without trunk restraint. Ten healthy young adults participated in two experimental sessions, approximately 7-10days apart. During each session, subjects performed 15 trials of both a flexion- and an abduction-reaching task. Surface EMG and acceleration using wireless sensors were sampled from the anterior and middle deltoid. Reliability was established using Cronbach's alpha, intraclass correlation coefficients (ICC 2, k) and standard error of measurements (SEM) for electromyographic reaction time, burst duration and normalized amplitude along with peak acceleration. Results indicated high degrees of inter-trial and test-retest reliability for flexion (Cronbach's α range=0.92-0.99; ICC range=0.82-0.92) as well as abduction (Cronbach's α range=0.94-0.99; ICC range=0.81-0.94) reaching. The SEM associated with response variables for flexion and abduction ranged from 1.55-3.26% and 3.33-3.95% of means, respectively. Findings from this study revealed that electromyographic and accelerometric data collected from prime movers of the arm during the relatively functional stand-reaching task were highly reproducible. Given its high reliability and portability, the proposed test could have applications in clinical and laboratory settings to quantify upper limb function., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

To examine the effect of a cognitive task on intentional vs. reactive balance control in people with hemiparetic stroke (PwHS). Community-dwelling PwHS (n = 10) and healthy, age-similar controls performed two tests, which included the Limits of Stability Test (intentional control) and the Motor Control Test (reactive control), under single-task (ST) and dual-task (DT) conditions (addition of a cognitive task). Cognitive ability was measured on a word list generation task by recording the number of words enumerated in sitting (ST; for cognition) and during the balance tasks. The difference in response time between the ST and DT, defined as the "balance cost" was obtained [(ST - DT)/ST × 100] and compared between tests and across groups. The "cognitive cost" was similarly defined and compared. For both groups, the response time under DT condition was significantly greater for intentional than the reactive balance control task, leading to a higher balance cost for this task (P < 0.05). However, the cognitive cost was significantly greater for the intentional than the reactive balance control task for only the PwHS. DT significantly affected intentional than reactive balance control for PwHS. The significant decrease in both balance and cognitive performance under DT compared with ST conditions during intentional balance control suggests sharing of attentional resources between semantic memory and intentional balance control. Decreased performance on the cognitive task only during the reactive balance test indicates possible central nervous system's prioritization of reactive balance control over cognition., (Copyright © 2014 the American Physiological Society.)

Objectives: To determine whether adding electrical stimulation of upper limb acupoints to conventional rehabilitation during acute stroke could produce greater and longer lasting motor improvements of the arm., Design: Double-blind, randomized, placebo-controlled trial., Setting: Acute stroke wards, followed by rehabilitation hospitals and subjects' residences., Participants: Seventy-three patients ≤ 46 hours post stroke onset with moderate to severe weakness in the arm contralateral to the side of stroke., Intervention: All subjects received conventional rehabilitation. Twenty-nine received additional electrical stimulation, 21 received additional placebo-electrical stimulation and 23 received conventional rehabilitation only, as control. Electrical stimulation or placebo-electrical stimulation was applied to acupoints GB20, LI15, LI11, LI10 and LI4, 60 minutes a day, five days a week, for four weeks., Measurements: Primary outcome measures were hand grip and pinch strength, with Action Research Arm Test (ARAT) as secondary outcome measure. These were assessed on the affected arm at recruitment, then 4 (W4), 12 (W12) and 24 weeks (W24) afterwards., Results: Post-hoc analysis showed that the electrical stimulation group had greater improvements than the control group in hand grip (P = 0.015) and pinch strength (P = 0.007) at W4, with the gains maintained at W12 and W24. In contrast, the placebo-electrical stimulation group did not differ from either the control or the electrical stimulation group. Between-group improvements in ARAT scores from baseline to W24 (by 16.8 in control, 27.6 in placebo-electrical stimulation group and 26.3 in electrical stimulation group) were not significant., Conclusions: Adding four weeks of electrical stimulation during acute stroke appears to produce greater and longer lasting hand grip and pinch strength improvements than administering conventional rehabilitation alone.

To compare the performance of older experienced Tai Chi practitioners and healthy controls in dual-task versus single-task paradigms, namely stepping down with and without performing an auditory response task, a cross-sectional study was conducted in the Center for East-meets-West in Rehabilitation Sciences at The Hong Kong Polytechnic University, Hong Kong. Twenty-eight Tai Chi practitioners (73.6 ± 4.2 years) and 30 healthy control subjects (72.4 ± 6.1 years) were recruited. Participants were asked to step down from a 19-cm-high platform and maintain a single-leg stance for 10 s with and without a concurrent cognitive task. The cognitive task was an auditory Stroop test in which the participants were required to respond to different tones of voices regardless of their word meanings. Postural stability after stepping down under single- and dual-task paradigms, in terms of excursion of the subject's center of pressure (COP) and cognitive performance, was measured for comparison between the two groups. Our findings demonstrated significant between-group differences in more outcome measures during dual-task than single-task performance. Thus, the auditory Stroop test showed that Tai Chi practitioners achieved not only significantly less error rate in single-task, but also significantly faster reaction time in dual-task, when compared with healthy controls similar in age and other relevant demographics. Similarly, the stepping-down task showed that Tai Chi practitioners not only displayed significantly less COP sway area in single-task, but also significantly less COP sway path than healthy controls in dual-task. These results showed that Tai Chi practitioners achieved better postural stability after stepping down as well as better performance in auditory response task than healthy controls. The improved performance that was magnified by dual motor-cognitive task performance may point to the benefits of Tai Chi being a mind-and-body exercise.

Background: Aerobic exercise can alleviate the declines in arterial compliance common in older adults. However, when combined with strength training, aerobic exercise may not reduce arterial compliance. Tai Chi practice has been found to improve muscle strength and cardiopulmonary function in older subjects, but whether or not it improves arterial compliance is not known. The primary aim of this study was to investigate whether Tai Chi practitioners have better arterial compliance and muscle strength., Design: Twenty-nine older Tai Chi practitioners (73.7 ± 4.5 years) and 36 healthy control subjects (71.4 ± 6.6 years) participated in this cross-sectional study., Methods: The participants were independent in their daily living activities. They were screened for apparent cardiovascular disease and underwent arterial compliance testing and isokinetic knee muscle strength testing at 30°/s., Results: Tai Chi practitioners showed significantly better haemodynamic parameters than the controls as indexed by larger and small artery compliance. They also demonstrated greater eccentric muscle strength in both knee extensors and flexors., Conclusion: The findings of better muscle strength without jeopardizing arterial compliance suggests that Tai Chi could be a suitable exercise for older persons to improve both cardiovascular function and muscle strength.

Objective: To determine the relationships between affected ankle dorsiflexion strength, other ankle muscle strength measurements, plantarflexor spasticity, and Timed "Up & Go" (TUG) times in people with spastic hemiplegia after stroke., Design: A cross-sectional study., Setting: A university-based rehabilitation centre., Participants: Seventy-three subjects with spastic hemiplegia., Main Outcome Measures: Functional mobility was assessed using TUG times. Plantarflexor spasticity was measured using the Composite Spasticity Scale. Affected and unaffected ankle dorsiflexion and plantarflexion strength were recorded using a load-cell mounted on a foot support with the knee bent at 50º and subjects in supine lying., Results: TUG times demonstrated strong negative correlation with affected ankle dorsiflexion strength (r = -0.67, p ≤ 0.001) and weak negative correlations with other ankle muscle strength measurements (r = -0.28 to -0.31, p ≤ 0.05), but no significant correlation with plantarflexor spasticity. A linear regression model showed that affected ankle dorsiflexion strength was independently associated with TUG times and accounted for 27.5% of the variance. The whole model explained 47.5% of the variance in TUG times., Conclusion: Affected ankle dorsiflexion strength is a crucial component in determining the TUG performance, which is thought to reflect functional mobility in subjects with spastic hemiplegia.

Background: Exercise which can improve muscle strength while not compromising arterial compliance is especially needed for older adults. Tai Chi practitioners are known to have better than average arterial compliance and muscle strength. This study was designed to establish a cause and effect relationship between Tai Chi training and both increased arterial compliance and increased muscle strength., Design: In a single blind randomized clinical trial, 31 elderly women were randomly assigned to receive either Tai Chi training or an education programme, three sessions per week for 16 weeks., Results: After training, the subjects in the Tai Chi group showed significant improvements in arterial compliance and eccentric knee extensor strength. The subjects in the control group showed no significant improvement., Conclusion: Practising Tai Chi can improve the eccentric knee extensor strength and arterial compliance of elderly women. Tai Chi maybe a good exercise choice to improve the cardiovascular health and muscle strength of the elderly.

Background: Gait deficits are exacerbated during the addition of a concurrent cognitive task in individuals with Parkinson's disease (PD). The provision of auditory and/or visual cues has been reported to facilitate gait performance in these patients., Aim: To investigate whether individuals with PD could use traffic lights as an audio-visual cueing strategy to enhance dual-task walking performance., Design: Cross-sectional comparative study., Setting: The Hong Kong Polytechnic University., Population: Fifteen PD and 13 healthy individuals., Methods: All participants were instructed to walk at their natural pace, followed by 2 randomized conditions: 1) walking while doing serial subtractions of three, starting from a random number between 60 to 100; 2) doing the same tasks with the addition of traffic lights signals as audio-visual cues. Primary outcomes included stride length, cadence and gait velocity., Results: Individuals with PD had more deterioration in all gait parameters than healthy controls for both single- and dual-task walking. With the use of traffic lights, individuals with PD showed significant increases in stride length (by 8.8%), cadence (by 9.6%), and gait velocity (by 21.0%, P=0.000)., Conclusion: Traffic lights could be used as combined preparatory and ongoing audio-visual cues to enhance dual-task walking performance in people with PD., Clinical Rehabilitation Impact: Positive findings from the present study suggest a promising treatment intervention to benefit people with PD, who often have to conduct concurrent cognitive task during walking in their daily activities.

Background: Previous studies have shown that people with Parkinson disease (PD) have difficulty performing the sit-to-stand task because of mobility and stability-related impairments. Despite its importance, literature on the quantification of dynamic stability control in people with PD during this task is limited., Objective: The study objective was to examine differences in dynamic stability control between people with PD and people who were healthy and the extent to which externally cued training could improve such control during the sit-to-stand task in people with PD., Design: This was a quasi-experimental controlled trial., Methods: The performance of 21 people with PD was compared with that of 12 older adults who dwelled in the community. People with PD were randomly assigned to 2 groups: a group that did not receive training and a group that received audiovisually cued training (3 times per week for 4 weeks) for speeding up performance on the sit-to-stand task. Outcome measures recorded at baseline and after 4 weeks included center-of-mass position, center-of-mass velocity, and stability against either backward or forward balance loss (backward or forward stability) at seat-off and movement termination., Results: Compared with people who were healthy, people with PD had greater backward stability resulting from a more anterior center-of-mass position at seat-off. This feature, combined with decreased forward stability at movement termination, increased their risk of forward balance loss at movement termination. After training, people with PD achieved greater backward stability through increased forward center-of-mass velocity at seat-off and reduced the likelihood of forward balance loss at movement termination through a posterior shift in the center-of-mass position., Limitations: The study applied stability limits derived from adults who were healthy to people with PD, and the suggested impact on the risk of balance loss and falling is based on these theoretical stability limits., Conclusions: For people with PD, postural stability against backward balance loss at task initiation was increased at the expense of possible forward balance loss at task termination. Task-specific training with preparatory audiovisual cues resulted in improved overall dynamic stability against both forward and backward balance loss.

Objectives: Application of transcutaneous electrical nerve stimulation over acupuncture points (Acu-TENS) is a noninvasive intervention that has recently been shown to alleviate dyspnea in patients with stable chronic obstructive pulmonary disease (COPD). This case report aims to explore the role of Acu-TENS in patients diagnosed with COPD during the acute exacerbation., Study Design: The study design was a case report., Setting: The study was conducted in an inpatient setting., Subject: The subject was a 74-year-old man admitted to the hospital due to acute exacerbation of COPD (AECOPD)., Intervention: Treatment consisted of application of TENS on EX-B1 (Dingchuan) for 45 minutes., Outcome Measures: Oxygen saturation, heart rate, and dyspnea score were measured before, immediately after, and 45 minutes after Acu-TENS intervention. Other than the physiologic measures, 10 mL of venous blood was taken from the cubital vein for assessment of β-endorphin level, white blood cell count, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) level before and immediately postintervention., Results: Postintervention, improved oxygen saturation, and reduction in heart rate and dyspneic sensation were observed accompanied by a raised blood β-endorphin level but the level of white blood cell count, TNF-α, and CRP remain unchanged., Conclusions: Application of 45 minutes Acu-TENS appeared to alleviate symptoms in a patient with AECOPD. The role of adjunctive Acu-TENS therapy during acute exacerbation warrants further investigation.

Background. This cross-sectional study examined the effect of aging on performing finger-pointing tasks involving choices and whether experienced older Tai Chi practitioners perform better than healthy older controls in such tasks. Methods. Thirty students and 30 healthy older controls were compared with 31 Tai Chi practitioners. All the subjects performed a rapid index finger-pointing task. The visual signal appeared randomly under 3 conditions: (1) to touch a black ball as quickly and as accurately as possible, (2) not to touch a white ball, (3) to touch only the white ball when a black and a white ball appeared simultaneously. Reaction time (RT) of anterior deltoid electromyogram, movement time (MT) from electromyogram onset to touching of the target, end-point accuracy from the center of the target, and the number of wrong movements were recorded. Results. Young students displayed significantly faster RT and MT, achieving significantly greater end-point accuracy and fewer wrong movements than older controls. Older Tai Chi practitioners had significantly faster MT than older controls. Conclusion. Finger-pointing tasks with a choice paradigm became slower and less accurate with age. Positive findings suggest that Tai Chi may slow down the aging effect on eye-hand coordination tasks involving choices that require more cognitive progressing.

To investigate whether elderly Tai Chi practitioners are better able to descend a step while performing a concurrent mental task than non-practitioners. The design includes cross-sectional study. The setting includes university-based rehabilitation center. The subjects were 16 young women, 29 elderly women, and 31 elderly women who had been practicing Tai Chi regularly for at least half a year. Pre-landing muscle response latencies in their tibialis anterior (TA) and medial gastrocnemius (MG) muscles were measured during stepping down (single task) and stepping down while performing a concurrent mental activity (dual tasking). The non-practitioners had earlier onset of muscle activity in the TA in preparation for landing than the other subjects. The response latency of the Tai Chi practitioners was not significantly different from that of the young controls. When the cognitive task was added, the pre-landing response in the TA was significantly altered in both elderly groups. Response was significantly delayed among the non-practitioners, but significantly earlier among the Tai Chi subjects. The average change in response latency was significantly greater in the non-Tai Chi group compared with the young subjects and the Tai Chi practitioners (p = 0.006). Such findings suggest that practicing Tai Chi helps the elderly maintain the same strategy as much as younger subjects during stepping down. Tai Chi practitioners seem to have a greater capacity to shift attention between mental and physical tasks than other elderly women.

Objectives: (1) To determine the relationships of ankle dorsiflexor strength, ankle plantarflexor strength, and spasticity of the ankle plantarflexors with walking endurance; (2) to determine whether affected ankle dorsiflexor strength makes an independent contribution to walking endurance; and (3) to quantify its relative contribution to the walking endurance of people with spastic hemiplegia after stroke., Design: A cross-sectional study., Setting: University-based rehabilitation center., Participants: Subjects (N=62) with spastic hemiplegia., Interventions: Not applicable., Main Outcome Measures: Walking endurance was measured by the distance covered in the six-minute walk test (6MWT). Ankle dorsiflexor and plantarflexor strength were measured using a load-cell mounted on a custom-built foot support. Plantarflexor spasticity was measured using the Composite Spasticity Scale., Results: The six-minute walk distances showed stronger positive correlation with affected dorsiflexor strength (r=.793, P≤.000) when compared with affected plantarflexor strength (r=.349, P=.005). Results of the regression model showed that after adjusting for basic demographic and stroke-related impairments, affected ankle dorsiflexor strength remained independently associated with six-minute walk distance, accounting for 48.8% of the variance., Conclusions: This is the first study, to our knowledge, to document the importance of ankle dorsiflexor strength as an independent determinant of walking endurance in stroke survivors with spastic plantarflexors. Our findings suggest that stroke rehabilitation programs aiming to improve walking endurance should include strengthening exercises for the ankle dorsiflexors., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

In a well-executed golf swing, golfers must maintain good balance and precise control of posture. Golfing also requires prolonged walking over uneven ground such as a hilly course. Therefore, repeated golf practice may enhance balance control and confidence in the golfers. The objective is to investigate whether older golfers had better balance control and confidence than non-golfing older, healthy adults. This is a cross-sectional study, conducted at a University-based rehabilitation center. Eleven golfers and 12 control subjects (all male; mean age: 66.2 ± 6.8 and 71.3 ± 6.6 years, respectively) were recruited. Two balance control tests were administered: (1) functional reach test which measured subjects' maximum forward distance in standing; (2) sensory organization test (SOT) which examined subjects' abilities to use somatosensory, visual, and vestibular inputs to control body sway during stance. The modified Activities-specific Balance Confidence (ABC) determined subject's balance confidence in daily activities. The golfers were found to achieve significantly longer distance in the functional reach test than controls. They manifested significantly better balance than controls in the visual ratio and vestibular ratio, but not the somatosensory ratio of the SOT. The golfers also reported significantly higher balance confidence score ratios. Furthermore, older adults' modified ABC score ratios showed positive correlations with functional reach, visual and vestibular ratios, but not with somatosensory ratio. Golfing is an activity which may enhance both the physical and psychological aspects of balance control. Significant correlations between these measures reveal the importance of the balance control under reduced or conflicting sensory conditions in older adults' balance confidence in their daily activities. Since cause-and-effect could not be established in the present cross-sectional study, further prospective intervention design is warranted.

Transcutaneous Electrical Nerve Stimulation over acupoints (Acu-TENS) facilitates recovery of resting heart rate after treadmill exercise in healthy subjects. Its effect on postexercise respiratory indices has not been reported. This study investigates the effect of Acu-TENS on forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in healthy subjects after a submaximal exercise. Eleven male subjects were invited to the laboratory twice, two weeks apart, to receive in random order either Acu-TENS or Placebo-TENS (no electrical output from the TENS unit) over bilateral Lieque (LU7) and Dingchuan (EX-B1) for 45 minutes, before undergoing exercise following the Bruce protocol. Exercise duration, rate of perceived exertion (RPE), and peak heart rate (PHR) were recorded. Between-group FEV1 and FVC, before, immediately after, at 15, 30, and 45minutes postexercise, were compared. While no between-group differences in PHR, RPE, and FVC were found, Acu-TENS was associated with a longer exercise duration (0.9 min (P = .026)) and a higher percentage increase in FEV1 at 15 and 45 minutes postexercise (3.3 ± 3.7% (P = .013) and 5.1 ± 7.5% (P = .047), resp.) compared to Placebo-TENS. We concluded that Acu-TENS was associated with a higher postexercise FEV1 and a prolongation of submaximal exercise.

Objectives: Cognitive declines are common in older people and can be a major health issue in an aging world. One type of body-mind exercises, t'ai chi, can be a possible means to help maintaining older adults' cognitive abilities, in addition to beneficial effects of physical exercises. The purpose of this study was to investigate whether t'ai chi practitioners had better attention and memory functions than older people with or without regular exercises., Methods: A cross-sectional study examining the relationship between t'ai chi practice and age-, gender- and education-similar older peoples' attention and memory functions. Forty-two (42) community-dwelling elderly subjects, aged 60 or older, recruited from t'ai chi clubs in Hong Kong formed the t'ai chi group. Another 49 elderly having regular exercise habits were recruited from community centers for inclusion in the exercise group. A nonexercise group (normal healthy control) consisting of 44 subjects were also recruited by random selection and through contacting local elderly centers. They were also screened by the Modified Barthel Index, Chinese Mini-mental Status Examination, Geriatric Depression Scale, and evaluated by attention tests (Color Trail Form A-1 and 2) and memory tests (including Rivermead Behavioral Memory Test and The Hong Kong List Learning Test)., Results: The main finding was that the three groups differed in attention and memory functions, and the t'ai chi group had demonstrated better performance than the other two groups in most subtests., Conclusions: As a causal relationship cannot be assumed in the present cross-sectional study, future research is required to examine how t'ai chi can improve cognitive function using a randomized control trial as well as determining whether t'ai chi practice can lead to better health status among elderly people.

Background and Purpose: Impaired walking function and spasticity are common sequelae of stroke. Prior studies have shown that a rehabilitation program combining transcutaneous electrical stimulation (TES) with task-related training (TRT) improves motor function in individuals with stroke. However, it is unclear if this approach is beneficial for individuals with long-standing stroke., Case Description: The subject of this case study was a 61-year-old man who was 7 years poststroke. He exhibited limitations of walking function, impaired strength of the ankle muscles, and severe plantarflexor spasticity., Interventions: For 4 weeks, the patient performed a 5-day/wk home program consisting of 60 minutes of TES (below motor threshold) to the acupoints in the affected lower leg, followed by 60 minutes of TRT. He documented his daily home program activities in a log, and 3 times a week he received a call from the therapist to verify his adherence. The patient also had 8 clinic visits, which focused on instruction to ensure adherence to the (TES + TRT) protocol and progression of the program., Outcomes: After the 4-week program, plantarflexor spasticity decreased and ankle dorsi- and plantarflexor strength improved. More important, there were notable improvements in gait velocity, walking endurance, and functional mobility. These gains were maintained at 4 weeks posttreatment., Discussion: This accessible home program was safe and effective for decreasing impairment and improving function in an individual with long-term, chronic stroke. The gains were maintained 4 weeks posttreatment. Details are provided for developing a home program integrating somatosensory TES and TRT.

Our recent studies showed that one session of transcutaneous electrical nerve stimulation on acupoints (Acu-TENS) improved forced expiratory volume in 1s (FEV(1)) in patients with chronic obstructive pulmonary disease (COPD). This study investigated the effect of 4-week Acu-TENS on physical and psychosocial function in these patients. Twenty-eight patients were randomly allocated to receive 4-weeks of 45-min, 5-days/week, of either Acu-TENS (over Dingchuan), Placebo-TENS (same protocol without electrical output), or Sham-TENS (over the patellae). Variables measured before and after intervention included FEV(1), forced vital capacity (FVC), 6-min walk distance (6MWD), St. George's Respiratory Questionnaire score (SGRQ), beta-endorphin and blood inflammatory marker levels. Only the Acu-TENS group attained significant improvement in FEV(1) (p=0.046), physical activity (p=0.007) and total SGRQ score (p=0.028). The increase in beta-endorphin (p=0.012) correlated positively with the improvement in FEV(1) (r=0.526, p=0.008). To conclude, 4 weeks of Acu-TENS improved the functional capacity of patients with COPD, probably due to the bronchodilation induced by beta-endorphin elevation., (Copyright 2010 Elsevier B.V. All rights reserved.)

Design: Cross-sectional study., Setting: University-based rehabilitation center., Participants: Tai Chi practitioners (n=24; age+/-SD, 68.5+/-6.6 y) and control subjects (n=20; age, 71.3+/-6.7 y) were recruited., Interventions: Not applicable., Main Outcome Measures: Measures included the following: (1) subjects' intentional weight shifting to 8 different spatial positions within their base of support using the limits of stability test, (2) the ability to leave the floor in single-leg jumping and to maintain balance on landing using force platform measurements, and (3) body awareness and movement behaviors using the Body Awareness Scale-Health (BAS-H)., Results: The findings showed that Tai Chi practitioners had a significantly better ability to lean further without losing stability and better directional control (P<0.01). They had a better ability to jump off the floor (P<0.05) and to maintain a longer single-leg stance after landing (P<.05) and better overall body awareness (P<.001). The single-leg jumps also correlated significantly with limits of stability measures of movement velocity, endpoint excursions, and maximum excursions but not with directional control. The BAS-H scores correlated significantly with the limits of stability measures except directional control. They also correlated significantly with the ability to jump off the floor and maintain stability after landing., Conclusions: When compared with healthy controls, Tai Chi practitioners had better stability limits, increased ability to perform a single-leg jump, and more stability in landing on 1 leg as well as better body awareness. Significant correlations among limits of stability measures, single-leg jumping tests, and the BAS-H scores indicate the importance of body awareness in limits of stability, single-leg jumping, and landing., (Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Kwok JC, Hui-Chan CW, Tsang WW. Effects of aging and Tai Chi on finger-pointing toward stationary and moving visual targets., Objective: To examine the aging effect on speed and accuracy in finger pointing toward stationary and moving visual targets between young and older healthy subjects and whether or not Tai Chi practitioners perform better than healthy older controls in these tasks., Design: Cross-sectional study., Setting: University-based rehabilitation center., Participants: University students (n=30) (aged 24.2+/-3.1y), were compared with healthy older control subjects (n=30) (aged 72.3+/-7.2y) and experienced (n=31) (mean years of practice, 7.1+/-6.5y) Tai Chi practitioners (aged 70.3+/-5.9y)., Interventions: Not applicable., Main Outcome Measures: Subjects pointed with the index finger of their dominant hand from a fixed starting position on a desk to a visual signal (1.2cm diameter dot) appearing on a display unit, as quickly and as accurately as possible. Outcome measures included (1) reaction time-the time from the appearance of the dot to the onset of the anterior deltoid electromyographic response; (2) movement time-the time from onset of the electromyographic response to touching of the dot; and (3) accuracy-the absolute deviation of the subject's finger-pointing location from center of the dot., Results: Young subjects achieved significantly faster reaction and movement times with significantly better accuracy than older control subjects in all finger-pointing tasks. Tai Chi practitioners attained significantly better accuracy than older controls in pointing to stationary visual signals appearing contralaterally and centrally to their pointing hand. They also demonstrated significantly better accuracy when the target was moving. Accuracy in Tai Chi practitioners was similar to young controls., Conclusions: Eye-hand coordination in finger-pointing declines with age in time and accuracy domains. However, Tai Chi practitioners attained significantly better accuracy than control subjects similar in age, sex, and physical activity level., (Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether older golfers have better static and dynamic balance control than older but nongolfing healthy adults., Methods: Eleven golfers and 12 control participants (all male; 66.2 +/- 6.8 and 71.3 +/- 6.6 yr old, respectively) were recruited. Duration of static single-leg stance was timed. Control of body sway was assessed in single-leg stance during forward and backward platform perturbations. The lunge distance normalized with respect to each participant's height was used to compare the 2 groups in a forward-lunge test., Results: Golfers maintained significantly longer duration in static single-leg stance. They achieved less anteroposterior body sway in perturbed single-leg stance and lunged significantly farther than did control participants., Conclusions: The better static and dynamic balance control exhibited by older golfers possibly reflects the effects of weight transfers from repeated golf swings during weight shift from 2-leg to predominantly 1-leg stance and from walking on uneven fairways.

Objective: To investigate whether surface electrical stimulation can increase the effectiveness of task-related exercises for improving the walking capacity of patients with chronic stroke., Design: Randomized, placebo-controlled clinical trial., Setting: Home-based programme., Subjects: One hundred and nine hemiparetic stroke survivors were assigned randomly to: (1) transcutaneous electrical nerve stimulation (TENS), (2) TENS + exercise, (3) placebo stimulation + exercise, or (4) control group., Interventions: The TENS group received 60 minutes of electrical stimulation. Both the TENS + exercise group and placebo stimulation + exercise group did 60 minutes of exercises, followed respectively by 60 minutes of electrical and placebo stimulation. Treatment was given five days a week for four weeks. The control group had no active treatment., Outcome Measures: Comfortable gait speed was measured using a GAITRite II walkway system. Walking endurance and functional mobility were measured by the distance covered during a 6-minute walk test (6MWT) and by timed up and go test scores before treatment, after two weeks and after four weeks of treatment, and at follow-up four weeks after treatment ended., Results: When compared with the other three groups, only the combined TENS + exercise group showed significantly greater absolute and percentage increases in gait velocity (by 37.1-57.5%, all P<0.01) and reduction in timed up and go scores (by -14.9 to -23.3%, P<0.01) from week 2 onwards. When compared with the control and TENS groups, only the combined TENS + exercise group covered significantly more distance in the 6MWT (by 22.2-34.7%, P<0.01) from week 2 onwards., Conclusion: TENS can improve the effectiveness of task-related exercise for increasing walking capacity in hemiparetic stroke survivors.

This study examined the effect of transcutaneous electrical nerve stimulation applied over acupoints (Acu-TENS) on forced expiratory volume, in patients with asthma, after exercise. Thirty subjects were randomly assigned to three groups. Group 1 received Acu-TENS over acupuncture points Lieque and Dingchuan for 45 min prior to a symptom-limited treadmill exercise test. Group 2 had Acu-TENS similarly applied prior to and throughout the exercise test. Group 3 mimicked Group 1 but without any electrical output from the device. Forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC) were recorded before, immediately after and at 20-min intervals post-exercise for 1h. Immediately after exercise, FEV(1) and FVC rose in Group 2 (p=0.015), but decreased in Group 1 and more so in Group 3. The differences became even more marked at 20, 40 and 60 min. Adjunctive Acu-TENS therapy appears to reduce decline of FEV(1) following exercise training in patients with asthma.

Background and Objective: Our previous findings showed that 4 weeks of intensive Tai Chi practice improved standing balance in healthy seniors. This study set out to investigate whether Tai Chi could improve standing balance in subjects with chronic stroke., Methods: One hundred thirty-six subjects >6 months after stroke were randomly assigned to a control group (n = 62) practicing general exercises or a Tai Chi group (n = 74) for 12 weeks of training. Each week, 1 hour of group practice was supplemented by 3 hours of self-practice. We used a short-form of Tai Chi consisting of 12 forms that require whole-body movements to be performed in a continuous sequence and demands concentration. A blinded assessor examined subjects at baseline, 6 weeks (mid-program), 12 weeks (end-program), and 18 weeks (follow-up). The 3 outcome measures were (1) dynamic standing balance evaluated by the center of gravity (COG) excursion during self-initiated body leaning in 4 directions, (2) standing equilibrium evaluated in sensory challenged conditions, and (3) functional mobility assessed by Timed-up-and-go score. Mixed model repeated-measures analysis of variance was used to examine between-group differences., Results: When compared with the controls, the Tai Chi group showed greater COG excursion amplitude in leaning forward, backward, and toward the affected and nonaffected sides (P < .05), as well as faster reaction time in moving the COG toward the nonaffected side (P = .014) in the end-program and follow-up assessments. The Tai Chi group also demonstrated better reliance on vestibular integration for balance control at end-program (P = .038). However, neither group improved significantly in Timed-up-and-go scores., Conclusions: Twelve weeks of short-form Tai Chi produced specific standing balance improvements in people with chronic stroke that outlasted training for 6 weeks.

Objective: To investigate whether transcutaneous electrical stimulation, when applied to acupuncture points in patients after acute stroke, decreases spasticity and/or increases muscle strength more effectively than placebo stimulation and standard rehabilitation., Design: Randomized control trial., Subjects: Sixty-two patients aged 70.0 (standard deviation 7.4) years and 9.2 (standard deviation 3.4) days post-stroke., Methods: The patients were randomly assigned to 3 groups receiving transcutaneous electrical stimulation, placebo stimulation, or standard rehabilitation alone. Stimulation was applied to 4 acupuncture points in the affected lower leg for 60 min, 5 days a week for 3 weeks. Plantarflexor spasticity, ankle muscle strength, and functional mobility were measured before treatment, weekly during treatment, and at follow-up at week 8 post-stroke., Results: No significant difference was found in the outcome measures among groups before treatment. When compared with standard rehabilitation or placebo stimulation, transcutaneous electrical stimulation to acupuncture points significantly increased the percentage of patients with normal tone, increased ankle dorsiflexor strength, and decreased antagonist co-contraction ratio (p < 0.05). The patients in the transcutaneous electrical stimulation group also tended to walk 2-4 days earlier than the patients in the other 2 groups., Conclusions: Three weeks of transcutaneous electrical stimulation to lower leg acupuncture points, given 5 times a week within 10 days post-stroke, significantly decreased ankle plantarflexor spasticity, and increased dorsiflexor strength concomitant with a decrease in antagonist co-contraction.

The aim of this study was to examine the repeatability of and relationships among spasticity, co-contraction of agonist-antagonist, and muscle strength in children with cerebral palsy (CP). Eight children with spastic diplegic CP (five males, three females; Gross Motor Function Classification System [GMFCS] Levels I-III; mean age 10y 2mo [SD 2y 9mo], range 6-13y) and nine children in a comparison group (six males, three females; mean age 8y 10mo [SD 2y 4mo], range 6y to 12y 6mo) were assessed twice to examine repeatability of Composite Spasticity Scale, soleus stretch reflexes, electromyography (EMG) co-contraction ratio, and torque recorded during maximal isometric voluntary contraction of ankle dorsiflexors and plantarflexors. Sixty-one children with spastic CP, (54 diplegic, seven hemiplegic; 32 males, 29 females; GMFCS levels I-III; mean age 10y 8mo [SD 2y 9mo], range 6-15y) were then assessed to delineate possible correlations among these measures. Intraclass correlation coefficients (0.78-0.97) showed high data repeatability in both groups. Children with spastic CP demonstrated significantly larger soleus stretch reflex/M-response areas smaller torques, but larger EMG co-contraction ratios during both voluntary dorsiflexion and plantarflexion (all p<0.05). Children with spastic CP who had larger soleus stretch reflex/M-response areas demonstrated larger plantarflexion co-contraction ratio (r = 0.28), and produced smaller plantarflexion and dorsiflexion torques (r = -0.48 and -0.27 respectively). However, no correlation was noted between soleus stretch reflex and clinical spasticity. Our findings demonstrated that hyperactive soleus stretch reflex affected torque production of ankle muscles. Moreover, the severity of spasticity may not be fully described by either stretch reflex or tone measure alone.

Purpose: To determine the clinical characteristics during acute stroke that predicted dextrous function in the paretic hand at 6 months post-stroke., Method: Fifty-seven patients within 5 days post-stroke were recruited in stroke wards. Recovery of dextrous hand function, indicated by a score of > or =35 of Action Research Arm Test, was assessed weekly in the first 4 weeks then monthly till 6 months post-stroke. The seven predictor candidates evaluated included side and site of brain infarct, stroke severity, cognition, spatial neglect, two-point discrimination (2-PD), muscle tone and muscle strength of the paretic upper extremity (UE)., Results: Site of infarct, stroke severity, 2-PD and UE muscle strength had independent association with dextrous hand function at 6 months post-stroke. Stepwise multiple logistic regressions showed that the best early predictor was 2-PD in week 1 to 3 (Odds ratio [OR] ranged from 0.51-0.83) and UE muscle strength during the first 2 months post-stroke (OR > or = 1.04). The strongest predictor was muscle strength at week 4 post-stroke, followed by combined 2-PD and muscle strength at week 2 post-stroke., Conclusions: Muscle strength and 2-PD in the paretic UE during the first month post-stroke were the best predictors of dextrous hand function recovery at 6 months.

We examined whether 4 weeks of audio-visual (AV) cued task-specific training could enhance sit-to-stand (STS) and whether the treatment effects could outlast the treatment period by 2 weeks. Fifty-two subjects with PD completed the study. They were randomly allocated to receive 4 weeks of AV cued task-specific training, conventional exercise (Ex), or no treatment (control). Each subject was assessed before, at the end of 2 and 4 weeks of treatment, and 2 weeks after treatment ended. After 2 weeks of training, the AV group significantly increased the peak horizontal velocity (by 13%, P<0.01) when compared with the Ex group. After 4 weeks of training, AV group increased both peak horizontal and vertical velocities, respectively by 18% and 51%, and reduced the time taken to complete STS by 25%. These improvements were greater than those of the Ex group, who showed 8% (nonsignificant between-group) and 20% (P<0.05 between-group) increases respectively for peak horizontal and vertical velocities, and 10% decrease in movement time (P<0.05). Worth-noting is the improvements in AV group could be carried over to 2 weeks after treatment ended. These findings provided concrete evidence for the use of AV cued task-specific training to reeducate STS in patients with PD., ((c) 2007 Movement Disorder Society.)

Proprioceptive input has been suggested to contribute to the pre-landing muscle responses associated with drop-landing, but its precise role has yet to be delineated. This study set out to examine the relationships among ankle proprioception, pre-landing muscle responses, and landing impact on drop-landing in healthy man. Fifteen healthy male basketball players aged 18 to 26 participated in this study. Passive ankle joint repositioning errors were used to examine ankle joint proprioception. Pre-landing EMG responses in the ankle muscles and the impact force on landing were recorded while the players performed self-initiated drops from a height of 30 cm. Results demonstrated that averaged ankle repositioning errors were significantly correlated with the co-contraction indexes between left tibialis anterior and medial gastrocnemius muscles (TA/MG CoI) (r=0.67, p=0.006), and showed a trend towards a relationship with the right TA/MG CoI (r=0.47, p=0.079). TA/MG CoI from both ankles were further related to the magnitude of the total impact force on landing (r=0.54 and 0.53, respectively; p<0.05). We concluded that male basketball players with less accurate ankle joint sense adopted greater co-contraction of ankle dorsiflexors and platarflexors, which was in turn associated with greater impact force at the moment of landing.

We aimed to develop an objective measurement to quantify trunk rigidity in patients with Parkinson's disease (PD), and to examine its reliability, validity and sensitivity in differentiating PD patients from control subjects. In Study 1, an isokinetic dynamometer was employed to assess trunk rigidity in 6 PD patients and 6 healthy controls. Passive trunk flexion and extension at 4 angular velocities were applied and resistive torques were recorded. Both work done and resistive peak torques to passive trunk flexion (Torque(PF)) and extension (Torque(PE)) were found to be highly reliable within a 2-day interval in PD patients and control subjects. In Study 2, trunk muscle tone was compared between 15 PD and 15 control subjects. Significantly higher muscle tone, as shown by increases in work done, and in Torque(PF) and Torque(PE )at higher movement speeds, was found in PD patients. Within each subject group, resistive trunk muscle tone was found to increase with increasing velocity of passive movement, but the extent of increase was greater in PD patients. Our results thus suggest that the objective method developed by us was reliable and could differentiate trunk rigidity in PD patients from that of healthy subjects.

Objective: To investigate the effects of functional electrical stimulation (FES) on the improvement of motor and walking ability of the lower extremities of the patients with acute stroke., Methods: Forty-six patients with stroke (including cerebral infarction and hemorrhage), aged 71 +/- 8 (45 - 84), hospitalized within 2 weeks (9 +/- 4 days) after the onset, matched with one another in the baseline measurements before treatment, were assigned randomly into 3 groups: FES group (n = 13), receiving standard rehabilitation combined with FES 30 minutes per day, 5 days per week for 3 weeks, placebo stimulation group (n = 15) receiving standard rehabilitation combined with the installment of the FES apparatus, operated in the same manner as mentioned above, however, without real electric stimulation, and control group (n = 13), receiving standard rehabilitation alone. The score of the composite spasticity scale (CSS) was measured, electromyography was conducted to measure the maximum isometric voluntary contraction (MIVC) of the ankle dorsi-flexors and plantar-flexors, and walking ability by the test of timed "Up and Go" before treatment, weekly during the 3-week treatment, and 8 weeks after the onset of stroke., Results: After 3 weeks of treatment, the percentage of CSS score of the FES group was 31% +/- 35%, significantly lower than those of the placebo and control groups (50% +/- 88% and 65% +/- 65% respectively, both P < 0.05); the ankle dorsiflexion torque of MIVC of the FES group was 9 Nm +/- 5 Nm, significantly higher than those of the placebo and control groups (5 Nm +/- 3 Nm and 4 Nm +/- 5 Nm respectively, both P < 0.05), and the electromyogram co-contraction ratio of the FES group was 8% +/- 5%, significantly lower than those of the placebo and control groups (27% +/- 26% and 28% +/- 19% respectively, both P < 0.05). The time needed to recover the walking ability after the stroke onset of the FES group was 18 +/- 8 days, shorter by 2 approximately 3 days than those of the placebo and control groups (20 +/- 7 and 21 +/- 8 days respectively). The percentage of the patients able to walk with the help of a stick 3 weeks after treatment of the FES group was 85%, significantly higher than those of the placebo and control groups (60% and 46% respectively, both P < 0.05). 84.6% of the patients of the FES group returned home, a percentage significantly higher than those of the placebo and control groups (53% and 46% respectively, both P < 0.05)., Conclusion: FES, plus standard rehabilitation, is effective in improving the motor and walking ability of the patients with acute stroke, to the degree that most patients are recovered to be able to return home.

Background: People with traumatic brain injury (TBI) must often deal with cognitive problems, including social problem-solving. The study reported herein evaluated the effectiveness of a newly developed pictorial-based analogical problem-solving skills training programme. It is hypothesized that the programme can help people with TBI to learn better problem-solving skills through systematic, theoretically driven learning strategies., Method: Based on the instrumental enrichment model and the hierarchy of daily problem-solving as suggested by Holloran and Bressler, analogical problem-solving training software was developed. Thirty subjects with TBI then attended a 20-session interactive analogical problem-solving skills training programme. Another 20 subjects with TBI and of similar demographics formed the control group. The outcome measures included session-based quizzes on analogical problem-solving, the Category Test of the Halstead Reitan Test Battery (HRTB) and the Lawton IADL Scale., Findings: The analogical problem-solving training strategies were found to be effective in improving problem-solving skills. The subjects generally demonstrated a selective improvement in their functional and overall problem-solving skills, but not in their basic problem-solving skills. The subjects in the control group showed stable problem-solving skills over a 4-week interval (no statistically significant changes). The findings indicated the therapeutic significance of the training programme., Conclusions: The results of the study suggested that innovative cognitive rehabilitation programmes can be customized to match the needs of clients with TBI. The applicability and implications of the interactive pictorial-based analogical problem-solving skill-training programme that was used in the study and possibilities for future study in this research area are also discussed.

Study Design: A cross-sectional study of the balance control in adolescents with idiopathic scoliosis. OBJECTIVE.: To investigate the relationship among somatosensory function, balance control, and adolescent idiopathic scoliosis (AIS)., Summary of Background Data: Balance control requires the contribution of somatosensory, visual, and vestibular inputs. Previous studies have shown that abnormal somatosensory evoked potentials (SSEPs) were associated with AIS., Methods: A total of 105 girls with AIS and 57 normal girls aged 11-14 years entered the study, and were evaluated with bilateral tibial nerve evoked cerebral SSEPs and standing balance control under reduced or conflicting sensory conditions (i.e., the sensory organization test). One-way analysis of variance was conducted to evaluate the effects of scoliosis and somatosensory function tested by SSEPs on the performance of sensory organization test., Results: There were 15 patients with AIS who had abnormal SSEPs. Postural sway was measured on all subjects under normal, reduced, or conflicting somatosensory, visual, and vestibular conditions. One-way analysis of variance indicated no significant effect of spinal deformity or SSEPs on the balance control when there was an increased reliance on the somatosensory, visual, and vestibular systems during stance (P > 0.05). However, in the patients with abnormal SSEPs, a significant effect was found when subjects had to rely on somatosensory input for their balance control (P = 0.023). The effect of scoliosis by itself was not found to be significant (P = 1.0)., Conclusions: The finding of significantly larger difference in bilateral SSEP latencies in patients with AIS indicated the association of abnormal SSEPs with AIS. The finding of a significant effect of SSEPs on the balance control further indicated the presence of abnormal somatosensory function in a subgroup of patients with AIS.

Objective: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on acupuncture points and neck exercise in chronic neck pain patients., Design: A randomized clinical trial., Setting: Hospital-based practice., Subjects: Two hundred and eighteen patients with chronic neck pain., Interventions: Subjects were randomized into three groups, receiving either (1) TENS over the acupuncture points plus infrared irradiation (TENS group); (2) exercise training plus infrared irradiation (exercise group); or (3) infrared irradiation alone (control); twice a week for six weeks., Outcome Measures: The values of verbal numeric pain scale, Northwick Park Neck Pain Questionnaire, and isometric neck muscle strength were assessed before, at the end of the six-week treatment, and at the six-month follow-up., Results: Results demonstrated that after the six-week treatment, significant improvement in the verbal numerical pain scale was found only in the TENS group (0.60+/-2.54, p = 0.027) and the exercise group (1.57+/-2.67, p < 0.001). Though significant reduction in Northwick Park Neck Pain Questionnaire score was found in all three groups, post-hoc tests showed that both the TENS and the exercise group produced better improvement (0.38+/-0.60% and 0.39+/-0.62% respectively) than the control group (0.23+/-0.63%). Significant improvement (p = < 0.001 to 0.03) in neck muscle strength was observed in all three groups, however, the improvement in the control group was not clinically significant and it could not be maintained at the six-month follow-up., Conclusions: After the six-week treatment, patients in the TENS and exercise group had a better and clinically relevant improvement in disability, isometric neck muscle strength, and pain. All the improvements in the intervention groups were maintained at the six-month follow-up.

Background: Deficiencies in ankle proprioception and standing balance in basketball players with multiple ankle sprains have been reported in separate studies. However, the question of how ankle proprioceptive inputs and postural control in stance are related is still unclear., Hypothesis: Ankle repositioning errors and the amount of postural sway in stance are increased in basketball players with multiple ankle sprains., Study Design: Controlled laboratory study., Methods: Twenty healthy male basketball players and 19 male basketball players who had suffered bilateral ankle sprains within the past 2 years were examined. Both groups were similar in age. Passive ankle joint repositioning errors at 5 degrees of plantar flexion were used to test for ankle joint proprioception. The Sensory Organization Test was applied with dynamic posturography to assess postural sway angle under 6 sensory conditions., Results: A significant increase in ankle repositioning errors was demonstrated in basketball players with bilateral ankle sprains (P < .05). The mean errors in the right and left ankles were increased from 1.0 degrees (standard deviation, 0.4 degrees ) and 0.8 degrees (standard deviation, 0.2 degrees ), respectively, in the healthy players to 1.4 degrees (standard deviation, 0.7 degrees ) and 1.1 degrees (standard deviation, 0.5 degrees ) in the injured group. A significant increase in the amount of postural sway in the injured subjects was also found in conditions 1, 2, and 5 of the Sensory Organization Test (P < .05). Furthermore, there were positive associations between averaged errors in repositioning both ankles and postural sway angles in conditions 1, 2, and 3 of the Sensory Organization Test (r = 0.39-0.54, P < .05)., Conclusions: Ankle repositioning errors and postural sway in stance increased in basketball players with multiple ankle sprains. A positive relationship was found between these 2 variables., Clinical Relevance: Such findings highlight the need for the rehabilitation of patients with multiple ankle sprains to include proprioceptive and balance training.