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Background: Aging is key to inclusion, and it should be taken into account when designing every place of human activity. However, the implementation of such guidelines often fails the human-centric aspiration as health and design domain interpretation gaps impede the suitable reading and implementation strategies. Purpose: This study aimed to understand critical factors in the place-of-aging and to examine the gap in domain interpretation affecting age-friendly housing. Methods: Using grounded theory as a base, questionnaire interviews were implemented either face-to-face or through an online process by health and design domain experts. Overall, 40 respondents (20 health and 20 design experts) evaluated the key criteria to prioritize according to their value of importance. The factor analysis resulted in the stated deviation, suggesting a necessity to redefine the attributes of the dwelling based on a people, place and process framework. Results: The systemic analysis affirmed the inter-disciplinary gap to enhancing the dwelling provision. The health domain experts consistently ranked the criteria higher or equal than the design domain except for safety and security criteria. Both domains agreed that affordability is a main concern, as elders must be able to afford their dwelling choice. Conclusion: The valuable finding of the key criteria in the study is to uphold the value of the urban health resilience implication as the core of this study.

Objective To investigate the effectiveness of functional electrical stimulation of the legs in patients with heart failure. Methods Data were obtained from PubMed, Cochrane Library, and Embase databases until August 12, 2021. We included randomized controlled trials that evaluated the effects of functional electrical stimulation applied to the legs of patients with heart failure, namely changes in cardiopulmonary function, muscle strength, and quality of life. Results In total, 14 randomized controlled trials (consisting of 518 patients) were included in our article. Pooled estimates demonstrated that functional electrical stimulation significantly improved peak oxygen consumption (peak VO2; standardized mean difference = 0.33, 95% confidence interval = 0.07–0.59, eight randomized controlled trials, n = 321), 6-min walking distance (mean difference = 48.03 m, 95% confidence interval = 28.50–67.57 m, 10 randomized controlled trials, n = 380), and Minnesota Living with Heart Failure Questionnaire quality of life score (mean difference = − 8.23, 95% confidence interval = − 12.64 to − 3.83, nine randomized controlled trials, n = 383). Muscle strength of lower extremities was not significantly improved in the functional electrical stimulation group compared with that in the control group (standardized mean difference = 0.26, 95% confidence interval = − 0.18 to 0.71, five randomized controlled trials, n = 218). Furthermore, the subgroup analysis revealed that functional electrical stimulation significantly improved peak VO2, 6-min walking distance, and Minnesota Living with Heart Failure Questionnaire quality of life score in the heart failure with reduced ejection fraction and heart failure with preserved ejection fraction subgroups. Conclusion Functional electrical stimulation can effectively improve the cardiopulmonary function and quality of life in patients with heart failure. However, functional electrical stimulation did not significantly improve muscle strength in the legs.

Background Robot-assisted gait training (RAGT) is a practical treatment that can complement conventional rehabilitation by providing high-intensity repetitive training for patients with stroke. RAGT systems are usually either of the end-effector or exoskeleton types. We developed a novel hybrid RAGT system that leverages the advantages of both types. Objective This single-blind randomized controlled trial evaluated the beneficial effects of the novel RAGT system both immediately after the intervention and at the 3-month follow-up in nonambulatory patients with subacute stroke. Methods We recruited 40 patients with subacute stroke who were equally randomized to receive conventional rehabilitation either alone or with the addition of 15 RAGT sessions. We assessed lower-extremity motor function, balance, and gait performance by using the following tools: active range of motion (AROM), manual muscle test (MMT), the Fugl–Meyer Assessment (FMA) lower-extremity subscale (FMA-LE) and total (FMA-total), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), Tinetti Performance-Oriented Mobility Assessment (POMA) balance and gait subscores, and the 3-m and 6-m walking speed and Timed Up and Go (TUG) tests. These measurements were performed before and after the intervention and at the 3-month follow-up. Results Both groups demonstrated significant within-group changes in the AROM, MMT, FMA-LE, FMA-total, PASS, BBS, POMA, TUG, and 3-m and 6-m walking speed tests before and after intervention and at the 3-month follow-up (p p = 0.014) and total (p = 0.002) assessments. Conclusion Although the novel hybrid RAGT is effective, strong evidence supporting its clinical effectiveness relative to controls in those with substantial leg dysfunction after stroke remains elusive. Trial registration The study was registered with an International Standard Randomized Controlled Trial Number, ISRCTN, ISRCTN15088682. Registered retrospectively on September 16, 2016, at https://www.isrctn.com/ISRCTN15088682

Background: With the annually increasing ratio of individuals with disabilities in an aged society, clinical clerkships for physiotherapy interns should provide more than just knowledge and skills. The cultivation of interns’ empathy and positive attitudes toward patients to meet future job requirements is essential. In this study, we explored the effect of simulation-based holistic health-care education on physiotherapy interns’ empathy, attitudes, and knowledge.Methods: A parallel-group design. Thirty physiotherapy interns in a medical institution were enrolled as participants. The experimental and control groups each had 15 participants. Both groups received standard clinical training. However, the experimental group participated in an additional simulation-based empathy enhancement program. The pretest and posttest measured the Jefferson Scale of Empathy, Kogan’s Attitudes toward Old People Scale, Attitudes Towards Elderly Scale, Knowledge about Aging scale, Knowledge of Situation of Older People, Perceptions of Working with Older People, and Care Willingness scale. Results: After the experimental group received 9 weeks intervention, the experimental group had a 6.4 points improvement on the Jefferson Scale of Empathy (p=0.001), a 7.7 points improvement on the Kogan’s Attitudes toward Old People Scale (p=0.002), a 3.5 points improvement on the Attitudes Towards Elderly Scale (p= 0.002), a 2.5 points marginal improvement on the Knowledge about Aging (p=0.055), a 4.5 points nonsignificant improvement on the Knowledge of Situation of Older People (pp=0.046), and a 0.5 points nonsignificant improvement on the CW (p=0.723),Conclusion: The simulation-based holistic health-care education intervention significantly improved physiotherapy interns’ empathy, knowledge, and attitudes.

The vastus medialis oblique (VMO) and vastus lateralis (VL) muscles at the knee joint play important roles for coordination, stability, and posture control. However, no currently available device records muscle activity while simultaneously warning users regarding abnormal muscle activity. This study used a commercialized electromyography sensors placed on the VL and VMO to monitor muscle activity while triggering warnings and vibration feedback to the muscles when an undesired ratio of VL/VMO muscular activation level set by current study was detected. The system was able to trigger alarms when the subject performed moderate-intensity activity and avoid triggering during low-intensity activity. Further research is needed of high-intensity exercises, such as running or weightlifting, to determine the effects of increased muscle activity on the judgment of the undesired ratio of VL/VMO muscular activation level using the device reported in the current study.

Background People with cognitive impairment are susceptible to fall. Previous studies regarding balance and gait enrolled patients with various severity of dementia. Quantification of the balance and gait performance of people with cognitive impairment may help identify their postural instability and fall risks. Aim We investigated the differences in balance and gait among older adults with preserved cognition, amnestic mild cognitive impairment, and mild dementia due to Alzheimer's disease. Design Prospective observational study. Setting Outpatient department of neurology or psychology. Population Older adults (aged ≥65 years) with independent gait were evaluated using the Mini-Mental State Examination and Clinical Dementia Rating scale. People with other neurological or musculoskeletal disorders were excluded. Methods Participants were classified into three groups: 30 healthy controls, 30 mild cognitive impairment and 30 mild dementia. Balance were evaluated through functional test (Berg Balance Scale, BBS) and laboratory test (posturography). Gait was assessed by wearable device. Muscle strength and mass were measured through grip force, calf circumstance, and body composition. Results The BBS (p = 0.04), posturography of fall risk index (FR, p = 0.01) and sensory integration indices in eyes open and firm surface (EOFIS, p = 0.009), eyes open and foam surface (EOFOS, p = 0.003) were substantially different among three groups. EOFIS and EOFOS indices of balance in mild dementia were significantly worse than in MCI. The gait speed (p = 0.04) and stride length (p = 0.04) were significantly different among three groups. The post-hoc analyses revealed that all above balance and gait indices in subjects with cognitive impairments were significantly worse than in healthy controls. The grip force, calf circumstance and body composition-muscle mass did not significantly differ among three groups. Conclusions It is a piece of evidence that cognitive dysfunction, even in early stage of memory decline, may have some bad impact on balance and gait regardless of the effect of musculoskeletal problems. Clinical rehabilitation impact Understanding the difference of specific indices of balance and gait among different severity of cognitive impairments and healthy controls could help to develop better balance-oriented rehabilitation programs in older adults at early-stage cognitive impairment.

The application of artificial intelligence (AI) to health has increased, including to COVID-19. This study aimed to provide a clear overview of COVID-19-related AI publication trends using longitudinal bibliometric analysis. A systematic literature search was conducted on the Web of Science for English language peer-reviewed articles related to AI application to COVID-19. A search strategy was developed to collect relevant articles and extracted bibliographic information (e.g., country, research area, sources, and author). VOSviewer (Leiden University) and Bibliometrix (R package) were used to visualize the co-occurrence networks of authors, sources, countries, institutions, global collaborations, citations, co-citations, and keywords. We included 729 research articles on the application of AI to COVID-19 published between 2020 and 2021. PLOS One (33/729, 4.52%), Chaos Solution Fractals (29/729, 3.97%), and Journal of Medical Internet Research (29/729, 3.97%) were the most common journals publishing these articles. The Republic of China (190/729, 26.06%), the USA (173/729, 23.73%), and India (92/729, 12.62%) were the most prolific countries of origin. The Huazhong University of Science and Technology, Wuhan University, and the Chinese Academy of Sciences were the most productive institutions. This is the first study to show a comprehensive picture of the global efforts to address COVID-19 using AI. The findings of this study also provide insights and research directions for academic researchers, policymakers, and healthcare practitioners who wish to collaborate in these domains in the future.

The number of migrant workers in Taiwan increases annually. The majority is from Indonesia and most of them are female caregivers. This study aims to determine the access to health services and the associated factors among Indonesian female domestic workers in Taiwan. In this cross-sectional study, data were collected from February to May 2019, using a structured questionnaire. Subsequently, multiple logistic regression was used to examine the association between socio-demographic factors and health service access. Two hundred and eighty-four domestic migrant workers were interviewed. Eighty-five percent of the respondents declared sickness at work, but only 48.8% seek health care services. Factors associated with health service access were marital status, income, and the availability of an attendant to accompany the migrant workers to the healthcare facilities. Language barrier and time flexibility were the main obstacles. Further research and an effective health service policy are needed for the domestic migrant workers to better access health care services.

Background Healthcare workers are usually the first responders during outbreaks and are instrumental in educating the populace about the prevention of different diseases and illnesses. The aim of this study was to assess the association between healthcare workers’ characteristics and knowledge, attitudes and practices toward Zika virus. Methods This was a cross-sectional study that collected data from healthcare workers at 3 medical facilities using a validated self-administered questionnaire between July 2017 – September 2017. Logistic regression models were used to examine the association between sociodemographic and knowledge, attitudes, and practices. Results A total of 190 healthcare workers were analyzed. Of these, 60, 72.6 and 64.7% had good knowledge, positive attitudes, and good practices toward Zika virus, respectively. Healthcare workers without a formal degree were less likely to have good knowledge of Zika virus (adjusted odds ratio (AOR) = 0:49; 95% confidence interval (CI) = 0.24–0.99) compared to those with a formal degree. Reduced odds for positive attitude towards Zika virus were observed in healthcare workers with low income as compared to those with high income (AOR = 0.31; 95% CI =0.13–0.75). Being younger than 40 years old was associated with poor Zika virus practices (AOR = 0:34; 95% CI = 0.15–0.79). Conclusions Significant association between healthcare workers’ sociodemographic characteristics and Zika virus knowledge, attitudes and practices were observed. Public health interventions that seek to increase Zika virus awareness should aim to train healthcare workers who are younger, without formal degree and those earning low income.

Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.

Objective: This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia. Methods: In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer’s program. Results: We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer’s program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31–0.83). Hauer’s program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none. Conclusions: High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.

Supplemental material, Supp_mat for High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis by Shu-Wei Yeh, Li-Fong Lin, Hung-Chou Chen, Li-Kai Huang, Chaur-Jong Hu, Ka-Wai Tam, Yi-Chun Kuan and Chien-Hsiung Hong in Clinical Rehabilitation

Summary: Background: With age, body composition often changes with functional limitations in elderly adults. What kind of body composition evaluation method had better correlation with physical capacity is unclear. The aim of this study was to investigate the correlation between body composition and physical capacity aged people. Methods: 56 males (mean age, 63.60 ± 7.24 years) and 64 females (mean age, 63.27 ± 7.23 years) were enrolled in this cross-sectional study during January and December 2016. Body composition was measured by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Physical performance was evaluated using the timed up-and-go, open eye single-leg stance, timed chair-rise, and 10-m walk speed tests. The association was analysed by Pearson test. Results: In elderly female participants, the fat percentage obtained using DXA was found to be associated with the single-leg stance (r = −0.306, p

Background Cardiac fibrosis (CF) plays a critical role in the pathogenesis of heart failure (HF), predisposing to contractile dysfunction, myocardial stiffness and life-threatening arrhythmias. Early detection and intervention of myocardial fibrosis, therefore, can delay or prevent the progression of HF. Current diagnostic and treatment options for CF, however, are very limited. Purpose To test the hypothesis that circulating lncRNA expression signature can be a sensitive biomarker to diagnose and correlate with the extent of CF in human heart. Methods Plasma RNA samples from healthy control (n=23) and from patients with diffuse myocardial fibrosis documented by cardiac magnetic resonance (T1 mapping technique, n=16) were analyzed by RNA sequencing (RNASeq), followed by differential expression, gene ontology/pathway and receiver operating characteristic (ROC) curve analyses. Results RNASeq revealed that 439 mRNAs were differentially expressed in the plasma from patients with CF, compared to that from controls. Gene ontology analyses showed significant enrichment of these CF-linked genes in cytoskeleton organization, innate immune response, and MAPK-Erk signaling, cellular processes known to contribute to the development of CF. Further analyses showed that 84 plasma lncRNAs were dysregulated in patients with CF; 5 of the lncRNAs (ENSGehz746.10420265401.1, ENSGehz746.10420229124.6, ENSGehz746.10420281376.1, ENSGehz746.10420273275.1 and ENSGehz746.10420179818.13) showed concordant changes with their cis-mRNA (UBB, VIM, BCL2L1, PPP3R1 and PCBP1). Hierarchical clustering analyses demonstrated that the expression signature of plasma lncRNAs could distinguish patients with CF from control patients (classification accuracy 87%). The expression levels of plasma lncRNAs ENSGehz746.10420258017.1 and ENSGehz746.10420265401.1, in particular, were markedly downregulated in patients with myocardial fibrosis. ROC curve analyses showed that low expression levels of ENSGehz746.10420258017.1 and ENSGehz746.10420265401.1 were highly sensitive and specific to detect the presence of CF in human heart (AUC 0.9 for both lncRNAs, Figure). LncRNA Predicts Cardiac Fibrosis Conclusions The present study revealed a circulating transcriptome signature that reflects the pathogenesis of CF. The expression profiles of circulating lncRNAs discriminated between patients with and without interstitial myocardial fibrosis. LncRNAs ENSGehz746.10420258017.1 and ENSGehz746.10420265401.1, in particular, are novel biomarkers with potential to facilitate clinical diagnosis of myocardial fibrosis.

Bilateral upper-limb motor imagery has been demonstrated to be a useful mental task in electroencephalography (EEG)-based brain–computer interfaces (BCIs). By contrast, few studies have examined bilateral lower-limb motor imagery, and all of them have focused on imaginary foot movements. The left–right classification accuracy reported in these studies based on the EEG mu rhythm (8–13 Hz) and beta band (13–30 Hz) remains unsatisfactory. The present study investigated the possibility of using lower-limb stepping motor imagery as the mental task and analysed the EEG difference between imaginary left-leg stepping (L-stepping) and right-leg stepping (R-stepping) movements. An experimental paradigm was designed to collect 5-s motor imagery EEG signals at nine recording sites around the vertex of the brain. Results from eight able-bodied participants indicated that the commonly used mu event-related desynchronisation (ERD) feature exhibited no significant difference between the two imaginary movements for all recording sites and all time intervals within the 5-s motor imagery period. Regarding the other commonly used feature, beta event-related synchronisation, no significant difference between the two imagery tasks was observed for most of the recording sites and time intervals. Instead, theta band (4–8 Hz) ERD significantly differed between the L- and R-stepping imagery tasks at five sites (FC4, C3, CP3, Cz, CPz) within the first 2 s after motor imagery cue onset. The findings from the present study may be a basis for further development of BCI systems for decoding left and right stepping during mental exercise where the two motions are alternately imagined.

Stroke results in paretic limb disabilities, but few studies have investigated the impacts of stroke on muscle perception deficits in multiaxis movements and related functional changes. Therefore, this study aimed to investigate stroke-related changes in muscle perceptions using a multiaxis ankle haptic interface and analyze their relationships with various functions. Sixteen stroke patients and 22 healthy participants performed active reproduction tests in multiaxis movements involving the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus, and flexor digitorum longus (FDL) of the ankle joint. The direction error (DE), absolute error (AE), and variable error (VE) were calculated. The lower extremity of Fugl-Meyer Assessment (FMA-LE), Barthel Index (BI), Postural Assessment Scale for Stroke Patients, Tinetti Performance-Oriented Mobility Assessment (POMA), and 10-m walk test (10MWT) were evaluated. VE of EDL for the paretic ankle was significantly lower than that for the nonparetic ankle (p = 0.009). AE of TA, EDL, and FDL and VE of EDL and FDL of muscle perceptions were significantly lower in healthy participants than in stroke patients (p &lt, 0.05 for both). DE of TA for the paretic ankle was moderately correlated with FMA-LE (r = −0.509) and POMA (r = −0.619) scores. AE and VE of EDL for the paretic ankle were moderately correlated with the 10MWT score (r = 0.515 vs. 0.557). AE of FDL for the paretic ankle was also moderately correlated with BI (r = −0.562). This study indicated poorer accuracy and consistency in muscle perception for paretic ankles, which correlated with lower limb functions of stroke patients.

Purpose Osteosarcopenic adiposity (OSA), which is described as the concurrent occurrence of osteopenia, sarcopenia, and adiposity, can lead to frailty and increase the risk of physical disability in elderly women. Progressive elastic band resistance exercise training (peRET) is considered a safe and feasible exercise intervention for elderly women with sarcopenic obesity. This study investigated the effects of elastic band resistance exercise on the physical capacity and body composition of elderly women with osteosarcopenic adiposity. Method A total of 15 and 12 women were randomly assigned to the experimental (12 weeks of resistance exercise) and control groups (no exercise intervention), respectively. Lean mass (measured using a dual-energy X-ray absorptiometer) and physical capacity assessments (such as timed up and go test and single leg stance tests) were conducted at baseline, 12 weeks (end of intervention), and 6 months after the intervention. Outcome differences within the study and control groups were analyzed using repeated-measures analysis of variance with a post-hoc test. The Mann–Whitney U test was used to examine differences between groups at different time points. Results After the intervention, no body composition changes in muscle mass and fat were observed between the study and control groups. Moreover, muscle mass and fat body composition did not significantly differ at different time points. The bone density was higher in the study group, with a higher T-score than their baseline values, but did not significantly differ compared with the control group. The study group exhibited more improved physical function than the control group, but the effect did not last after 6 months of follow-up. Conclusions A 12-week progressive elastic band resistance training program effectively increased the physical capacity and improved the bone density; however, without persistent training, the positive effect diminished at 6-month follow-up.

The effective self-management and treatment of long-term disability after stroke depends greatly on the health literacy of patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q) is a comprehensive and theory-based measure that captures multiple self-perceived competencies of health literacy and covers a diverse range of health contexts. However, there is no psychometric evidence on the HLS-EU-Q in the stroke population. The aim of this study was to examine the validity of the HLS-EU-Q in patients with stroke using Rasch analysis. We compared the model deviance among the one-domain, three-domain, four-domain, and 12-domain structures using likelihood ratio tests to determine the dimensionality of the HLS-EU-Q. Thereafter, we examined the unidimensionality of each domain, local independence, item fit, response categories, and differential item functioning (DIF) for the best fitting structure. A total of 311 patients with stroke participated in this study. Rasch analysis revealed that the 12-domain HLS-EU-Q demonstrated the best data–model fit. The original 4-point scales showed disordering, which can be corrected by rescaling them as 3-point scales with the two middle categories collapsed. All 47 items in the rescaled HLS-EU-Q fit the 12-domain Rasch model, demonstrated local independence, assessed the 12 unidimensional domains respectively, and had invariant difficulties between different age or education groups of the patients with stroke. We recommend using the 12-domain scores of the rescaled HLS-EU-Q to comprehensively and accurately capture the competencies to access, understand, appraise, and apply health information within the three health contexts of healthcare, disease prevention, and health promotion for patients with stroke.

We compared subjective and objective measurements of symptoms of dizziness and postural stability in patients with mild traumatic brain injury (mTBI) during the first week following the injury. We recruited 244 patients with mTBI and 105 controls. The Dizziness Handicap Inventory (DHI) and modified Clinical Test of Sensory Integration and Balance were used as the subjective and objective measures of dizziness and ability to perform daily activities, respectively. All four DHI subscores significantly differed among the three mTBI subgroups (low, middle, and high; P = 0.00). The predictor of postural stability and sensory integration in all three DHI subgroups was the eyes closed while standing on a firm surface (ECFIS) condition (P = 0.03). A significant relationship was observed between the emotional (r = 0.14, P = 0.028) and total (r = 0.13, P = 0.048) aspects of the DHI and sensory integration indices (ECFIS). Compared with the healthy controls, balance, postural stability, and sensory integration were considerably impaired in the patients with mTBIs. However, a low correlation was observed between subjective (DHI) and objective balance measurements.

Background: Gout commonly involves joint inflammation, and clinical epidemiological studies on involved tendons are scant. Rotator cuff tears are the most common cause of shoulder disability, and surgery is one of the choices often adopted to regain previous function. Purpose: To investigate the risk of receiving rotator cuff repair surgery among patients with gout and to analyze possible risk factors to design an effective prevention strategy. Study Design: Cohort study; Level of evidence, 3. Methods: The authors studied a 7-year longitudinal follow-up of patients from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). This included a cohort of patients who received a diagnosis of gout during 2004-2008 (gout cohort) and a cohort matched by propensity scores (control cohort). A 2-stage approach that used the National Health Interview Survey 2005 was used to obtain missing confounding variables from the LHID2005. The crude hazard ratio (HR) and adjusted HR were estimated between the gout and control cohorts. Results: The gout and control cohorts comprised 32,723 patients with gout and 65,446 people matched at a ratio of 1:2. The incidence of rotator cuff repair was 31 and 18 per 100,000 person-years in the gout and control cohorts, respectively. The crude HR for rotator cuff repair in the gout cohort was 1.73 (95% confidence interval [CI], 1.23-2.44; P < .01) during the 7-year follow-up period. After adjustment for covariates by use of the 2-stage approach, the propensity score calibration-adjusted HR was 1.60 (95% CI, 1.12-2.29; P < .01) in the gout cohort. Further analysis revealed that the adjusted HR was 1.73 (95% CI, 1.20-2.50; P < .001) among patients with gout who did not take hypouricemic medication and 2.70 (95% CI, 1.31-5.59; P < .01) for patients with gout aged 50 years or younger. Conclusion: Patients with gout, particularly those aged 50 years or younger and without hypouricemic medication control, are at a relatively higher risk of receiving rotator cuff repair surgery. Strict control of uric acid levels with hypouricemic medication may effectively reduce the risk of rotator cuff repair.

Although various kinds of motor imageries have been used for BCI applications, imaginary lower limb stepping movement has not been studied yet. The purpose of this study is to investigate the possibilities of using electroencephalography (EEG) signal to classify imaginary lower limb stepping movements and to design a robust motor imagery classifier based on support vector machine (SVM). A cue-based experimental paradigm is designed to record nine-channel EEG associated with imaginary left leg stepping (L-stepping) and right leg stepping (R-stepping) movements from eight healthy subjects. Features including band powers (BPs), common spatial pattern (CSP), and a filter-bank CSP (FB-CSP) were extracted from the recorded EEG. Fuzzy SVM (FSVM) is introduced to this study to classify L-stepping and R-stepping imageries. We propose a novel kernel-induced membership function to address the issue of data relative importance assignment. The FSVM with the membership function suggested in the original work of FSVM (Type-I FSVM) and the FSVM with the one we proposed (Type-II FSVM) is compared. Results indicated that the classification accuracies based on BP features are near the chance level (~50 %). Both alpha-band CSP (71.25 %) and FB-CSP (75.63 %) gave acceptable results as a simple k-NN classifier is performed. Results show that both types of FSVM performed better than the conventional SVM. Also, Type-II FSVM outperforms Type-I FSVM, especially when the alpha-CSP feature is employed, where the improvement in error reduction rate is over 15 %. The highest average L-stepping versus R-stepping classification accuracy over the eight subjects is achieved (86.25 % in single-trial analysis) by FB-CSP and FSVM-II. The high classification result suggests the feasibility of using lower limb stepping imagery to develop a BCI that can control devices or might be able to serve as a neurofeedback tool for users who need lower limb stepping imagery training for gait function improvement.

Background Multiple sclerosis is a progressive disease responsible for gait disabilities and cognitive impairment, which affect functional performance. Robot-assisted gait training is an emerging training method to facilitate body-weight–supported treadmill training in many neurologic diseases. Through this study, we aimed to determine the efficacy of robot-assisted gait training in patients with multiple sclerosis. Methods We performed a systematic review and meta-analysis of randomized controlled trials evaluating the effect of robot-assisted gait training for multiple sclerosis. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry for articles published before May 2019. The primary outcome was walking performance (gait parameters, balance, and ambulation capability). The secondary outcomes were changes in perceived fatigue, severity of spasticity, global mobility, physical and mental quality of life, severity of pain, activities of daily living, and treatment acceptance. Results We identified 10 studies (9 different trials) that included patients with multiple sclerosis undergoing robot-assisted gait training or conventional walk training. The meta-analysis showed comparable effectiveness between robot-assisted gait training and conventional walking therapy in walking performance, quality of life, pain, or activities of daily living. The robot-assisted gait training was even statistically superior to conventional walking therapy in improving perceived fatigue (pooled SMD: 0.34, 95% CI: 0.02–0.67), spasticity (pooled SMD: 0.70, 95% CI: 0.08–1.33, I² = 53%), and global mobility (borderline) after the intervention. Conclusion Our results provide the most up-to-date evidence regarding the robot-assisted gait training on multiple sclerosis. In addition to the safety and good tolerance, its efficacy on multiple sclerosis is comparable to that of conventional walking training and is even superior in improving fatigue and spasticity.

BACKGROUND Intermittent theta burst stimulation (iTBS) was widely used in stroke rehabilitation and was more efficient than repetitive transcranial magnetic stimulation in terms of inducing larger motor evoked potential and producing longer effects. To our knowledge, the outcomes are not available combining rehabilitation and iTBS for improving motor function of lower extremities in patients with stroke. AIM To evaluate the feasibility and effectiveness of intermittent theta burst stimulation aiming to stimulate bilateral leg motor cortex and promote functional improvements. DESIGN A single blind, randomized controlled pilot study. SETTING Rehabilitation ward. POPULATION Twenty patients with chronic stroke finally enrolled for analyzed. METHODS Participants were randomized into two groups to receive 10 sessions of iTBS group and sham group over a 5-week period. The iTBS was delivered over the midline of skull to stimulate bilateral leg motor cortex. The outcome measures included balance, mobility, and leg motor functions were measured before and after interventions. RESULTS Within-group differences were significant in the Berg Balance Scale for both groups (Z=-2.442, P=0.015 in iTBS group; Z=-2.094, P=0.036 in sham group), in the Fugl-Meyer Assessment (Z=-2.264, P=0.024) and Overall Stability Index of Biodex Balance System of iTBS group (Z=-2.124, P=0.034). However, no significant between-group differences were found. CONCLUSIONS There was no powerful evidence to support the effectiveness of iTBS group better than sham control group. Some essential technical issues should be considered for future studies applying iTBS to stimulate bilateral leg motor cortex. CLINICAL REHABILITATION IMPACT iTBS combined with stroke rehabilitation are probably expected to be useful to promote brain plasticity and functional performance but some technical issues should be carefully considered.