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Objective: This study aimed to develop and validate a machine learning-based short measure to assess 5 functions (the ML-5F) (activities of daily living [ADL], balance, upper extremity [UE] and lower extremity [LE] motor function, and mobility) in patients with stroke., Design: Secondary data from a previous study. A follow-up study assessed patients with stroke using the Barthel Index (BI), Postural Assessment Scale for Stroke (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) at hospital admission and discharge., Setting: A rehabilitation unit in a medical center., Participants: Patients (N=307) with stroke., Interventions: Not applicable., Main Outcome Measures: The BI, PASS, and STREAM., Results: A machine learning algorithm, Extreme Gradient Boosting, was used to select 15 items from the BI, PASS, and STREAM, and transformed the raw scores of the selected items into the scores of the ML-5F. The ML-5F demonstrated good concurrent validity (Pearson's r, 0.88-0.98) and responsiveness (standardized response mean, 0.28-1.01)., Conclusions: The ML-5F comprises only 15 items but demonstrates sufficient concurrent validity and responsiveness to assess ADL, balance, UE and LE functions, and mobility in patients with stroke. The ML-5F shows great potential as an efficient outcome measure in clinical settings., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Motivated by the analysis of complex dependent functional data such as event-related brain potentials (ERP), this paper considers a time-varying coefficient multivariate regression model with fixed-time covariates for testing global hypotheses about population mean curves. Based on a reduced-rank modeling of the time correlation of the stochastic process of pointwise test statistics, a functional generalized F-test is proposed and its asymptotic null distribution is derived. Our analytical results show that the proposed test is more powerful than functional analysis of variance testing methods and competing signal detection procedures for dependent data. Simulation studies confirm such power gain for data with patterns of dependence similar to those observed in ERPs. The new testing procedure is illustrated with an analysis of the ERP data from a study of neural correlates of impulse control., (© 2019 The International Biometric Society.)

Both luminance contrast and character size are critical factors affecting reading performance. Previous studies reported on the effect of luminance contrast on the reading-speed function, that is, the relationship between reading speed and character size. In particular, when contrast was reduced, the critical print size (CPS) was found to shift to a larger character size even though the maximum reading speed and function shape did not change [Japanese Journal of Ophthalmology 52(1) (2008) 44-47]. In the present study, the effect of luminance contrast on the reading function was quantitatively examined. Japanese phrases with a luminance contrast of 0.03-0.99 were prepared as stimuli. Observers with normal vision were asked to read aloud phrases with several character sizes. Then, the reading functions were obtained for each luminance contrast. CPS was found to increase as the luminance contrast decreased. The relationship between contrast and CPS was linear in log-log coordinates, that is, log-CPS increased as the log-contrast of the characters decreased. It was found that the contrast of the stimulus systematically affects the location of the reading function., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: We explored the cultural beliefs that influence Latino-American mothers' feeding practices with their young children and the sources they referenced in making food choices for their children., Method: We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development., Results: We identified four themes summarizing the mothers' feeding practices: (1) "Grandma knows best," (2) "I want my child(ren) to be healthy," (3) "always soup and always rice," and (4) "mealtime is family time.", Conclusion: Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers' needs., (Copyright © 2019 by the American Occupational Therapy Association, Inc.)

We explored parental feeding practices, feeding issues during the first 2 yr of life, and the relationship between feeding issues and levels of maternal distress in preterm infants. Four hundred twenty mothers (239 with preterm infants, 181 with full-term infants) participated in the study. The Behavior-Based Feeding Questionnaire for Infants With Premature History and the Parenting Stress Index-Chinese Version were used as the two outcome measures. The results indicated that preterm infants had different feeding experiences compared with their full-term counterparts. They tended to start solid food later in life and had limited experiences in food variation. Parenting stress was prevalent in parents with preterm infants and was associated with the frequency of feeding issues, especially at later ages when supplementary foods were being introduced., (Copyright © 2019 by the American Occupational Therapy Association, Inc.)

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

High-resolution X-ray diffraction experiments and atom-specific X-ray absorption experiments are applied to investigate a series of square planar complexes with the non-innocent ligand of maleonitriledithiolate (mnt), [S 2 C 2 (CN) 2 ] z- , containing M-S bonds. Four complexes of (PyH) z [M(mnt) 2 ] z- , where M = Ni or Cu, z = 2 or 1 and PyH + = C 5 NH 6 + , were studied in order to clarify whether such one-electron oxidation-reduction, [M(mnt) 2 ] 2- /[M(mnt) 2 ] 1- , is taking place at the metal or the ligand site. Combining the techniques of metal K-, L-edge and S K-edge X-ray absorption spectroscopy with high-resolution X-ray charge density studies, it is unambiguously demonstrated that the electron redox reaction is ligand based and metal based for Ni and Cu pairs, respectively. The bonding characters in terms of topological properties associated with the bond critical points are compared between the oxidized form [ML] - and the reduced form [ML] 2- . In the case of Ni complexes, the formal oxidation state of Ni remains as Ni 2+ and each mnt ligand carries a 2- charge in [Ni(mnt) 2 ] 2- , but only one of the ligands is formally oxidized in [Ni(mnt) 2 ] 1- . In contrast, in the case of Cu complexes, the mnt remains as 2- in both complexes, but the formal oxidation states of the metal are Cu 2+ and Cu 3+ . Bond characterizations and d-orbital populations will be presented. The complementary results of XAS, XRD and DFT calculations will be discussed. The conclusion on the redox reactions in these complexes can be firmly established.

The purpose of this study was to examine predictors of neurodevelopmental outcome in very low birth weight children without major impairment at 5 years of age, as well as to identify the contribution of early neurodevelopmental assessment to preterm children's later developmental outcomes. The participants in this study included 126 children who were prematurely born with very low birth weight. Outcomes of the childrens' later development were measured in tests that factored cognitive function, motor performance, and adaptive behavior. The results indicated that more than 50% of full-scale intelligence and 30% of both motor performance and adaptive behavior at the age of 5 can be explained by four predictors. The four predictors include preterm children's medical complications at birth, maternal education, early motor assessments, and cognitive assessments. Adding each test score obtained in early ages provides additional information to predict children's cognitive, motor, and adaptive behavior at 5 years of age. Manifold assessments conducted in multiple time periods strengthen the predictive values of later developmental outcomes. In addition, the findings of this study indicate that very low birth weight children tend to have lower adaptive behavior at 5 years old. With regard to our findings, we believe that having adaptive function is a reflection of a child's overall integrated abilities. Further study is warranted to increase understanding of this topic, as well as to be able to predict adaptive strengths and weakness and pinpoint limiting factors that may be useful for targeting behaviors in intervention., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Taking care of a premature infant adds an extra burden to already stressed parents. Previous studies have shown that parental stress occurs during the initial hospitalization. However, there is little information on parental stress over time, and the few existing results are conflicting. In addition, many studies have focused on maternal stress but there is little information about a father's long-term adaptation to stress. The purpose of this study was to examine the degree and type of parenting stress in the families of very low birth weight (VLBW) preterm infants over the first two years of life. We compared parenting stress in families with preterm infants with control families, while also comparing the stress in mothers to that in fathers. Furthermore, we explored the relationship between parenting stress in the preterm group with identified factors that included the infant's age, medical complications, and parents' perceived feeding issues after they had been discharged from the hospital. This was an exploratory study with a cross sectional design. Participants included a total of 505 mothers from Tainan, Taiwan; 297 with preterm children (239 mothers, 58 fathers) and 208 with full-term children (181 mothers, 27 fathers). Assessments including the Parenting Stress Index, Neonatal Medical Index and Behavior-based Feeding Questionnaire were used to measure parental distress, infants' medical complications and parents' perceived feeding issues, respectively. Results of the study, though not statistically significant, indicated the presence of increased parenting stress in parents of preterm infants as compared to parents of full-term infants. 13.1% of mothers with preterm infants demonstrated total stress levels that warranted clinical intervention. We also found that mothers of preterm infants presented different parenting stress patterns than fathers of preterm infants. Fathers of preterm infants tended to have overall higher stress scores than mothers. On the other hand, mothers of preterm infants tended to report more health related difficulties, more depression, higher social isolation and role restriction, and less support from their spouses, than reported by fathers. Moreover, as time went on, parents with preterm infants continued to experience greater parenting stress than those with full-term infants. Understanding the experiences of parents with preterm children is important for health care providers while interviewing parents for information regarding their children and designing intervention programs to improve children's outcomes., (Copyright © 2014. Published by Elsevier Ltd.)

Handedness for acquiring objects was assessed monthly from 6 to 14 months in 328 infants (182 males). A group based trajectory model identified 3 latent groups with different developmental trajectories: those with an identifiable right preference (38%) or left preference (14%) and those without an identifiable preference (48%) but with a significant trend toward right-handedness. Each group exhibited significant quadratic trends: Those with a right preference increased to asymptote at about 10 months and began decreasing thereafter; those with a left preference increased to asymptote at about 11 months; those without a preference exhibited increasing right-hand use. Since adult handedness reflects different patterns of neural organization which relate to differences in psychological functioning, the observed differences in infant handedness development may relate to differences in the development of infant neurobehavioral organization and functioning. Several methods were used to explore the relation of latent classes to more conventional ways of classifying infant handedness. Classification into handedness groups according to either a monthly z-score or a combination of 4 or fewer months for a handedness index failed to provide reliable estimates of handedness identified by the trajectory analysis. If identified trajectories of handedness development relate to the development of the infant's neurobehavioral organization, researchers who assess infant handedness only once in order to relate it to cognitive, social and emotional functioning may risk misclassifying the handedness of as many as 37-45% of infants.

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

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

Objective: The reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) has not been examined while taking into account the correlation between subscales. The reliability of the EORTC QLQ-C30 subscales is modest, thus limiting their utility in both clinical and research settings. The purpose of this study was to validate the factor structure of multiple-item subscales of the EORTC QLQ-C30 and to improve their reliability by means of an item response analysis by using the multidimensional partial credit model., Methods: A total of 2295 patients with complete data were used for the analysis. One- and nine-dimensional partial credit models were used to fit the data to validate the construct validity of the multiple-item subscales of the QLQ-C30., Results: The model comparison showed that the nine-dimensional factor structure of multiple-item subscales was satisfactory. The multidimensional partial credit model fit data of the multiple-item subscales of the QLQ-C30 reasonably well. The estimated test reliabilities of each domain obtained from the multidimensional approach were higher than those obtained from the unidimensional approach., Conclusions: The constructs represented by the multiple-item subscales of the QLQ-C30 were validated. The improved reliability of the multiple-item subscales of the QLQ-C30 under the multidimensional approach can facilitate their applications in clinical and research settings., (Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

We use longitudinal multilevel modeling to test how exposure to community violence and cognitive and behavioral factors contribute to the development of aggressive and prosocial behaviors. Specifically, we examine predictors of self-, peer-, and teacher-reported aggressive and prosocial behavior among 266 urban, African American early adolescents. We examine lagged, within-person, between-person, and protective effects across 2 years. In general, results suggest that higher levels of violence exposure and aggressive beliefs are associated with more aggressive and less prosocial peer-reported behavior, whereas greater self-efficacy to resolve conflict peacefully is associated with less aggression across reporters and more teacher-reported prosocial behavior. Greater knowledge and violence prevention skills are associated with fewer aggressive and more prosocial teacher-reported behaviors. Results also suggest that greater self-efficacy and lower impulsivity have protective effects for youth reporting higher levels of exposure to community violence, in terms of teacher-reported aggressive behavior and peer-reported prosocial behavior. Differences among reporters and models are discussed, as well as implications for intervention.

Objectives: To assess the impact of return-to-work (RTW) status on health-related quality of life (HRQOL) over a 2-year period in workers with traumatic limb injuries and to elucidate factors that may contribute to the association of RTW with HRQOL., Design: A 2-year repeated-measurements follow-up study using the generalized estimating equations approach for model fitting to account for within-subject correlations of HRQOL., Setting: One teaching hospital., Participants: Injured patients (N=966, 61% men) with a mean age of 44.7 years., Interventions: Not applicable., Main Outcome Measures: The RTW status, HRQOL (assessed by the EuroQol five-dimensional questionnaire), and activity/participation were repeatedly surveyed at 2 weeks and 1, 3, 6, 12, 18, and 24 months after injury. A series of regression models was used to examine the associations between HRQOL and RTW, with sequential adjustment for explanatory variables such as personal and environmental factors, body structure and function, activity/participation, and postinjury period., Results: Over a 2-year study period, 81.2% of the study participants had 1 or more RTW episodes; 38.2% of them successfully maintained their RTW status until the end. A significant positive association was found between RTW status and HRQOL. The association could largely be explained by the domains of activity/participation. A higher HRQOL was associated with a shorter length of hospital stay, better coping ability, frequent participation in activities of daily living, and a longer postinjury period. A reduced HRQOL, however, was observed for participants with more depressive symptoms., Conclusions: RTW showed a positive and independent influence on HRQOL in workers with limb injury. In addition, the activity/participation domains and the elapsed time since injury largely explained the association between RTW and HRQOL., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

This study examined the effectiveness of two approaches used in elementary schools to improve children's handwriting. Participants were 72 New York City public school students from the first and second grades. A nonequivalent pretest-posttest group design was used in which students engaged in handwriting activities using two approaches: intensive handwriting practice and visual-perceptual-motor activities. Handwriting speed, legibility, and visual-motor skills were examined after a 12-wk Handwriting Club using multivariate analysis of variance. The results showed that students in the intensive handwriting practice group demonstrated significant improvements in handwriting legibility compared with students in the visual-perceptual-motor activity group. No significant effects in handwriting speed and visual-motor skills were found between the students in intensive handwriting practice group and the students in visual-perceptual-motor activities group. The Handwriting Club model is a natural intervention that fits easily into existing school curriculums and can be an effective short-term intervention (response to intervention Tier II)., (Copyright © 2013 by the American Occupational Therapy Association, Inc.)

A unique structural transformation in the crystalline state assisted by coordination substitution is induced during a dehydration process. A 1D chain coordination polymer is irreversibly converted to a 3D interpenetrated network accompanied by a change in magnetic properties from a paramagnetic material to a spin crossover system.

Objectives: This study aims to explore the trajectories of return to work (RTW) and examine the predictors of different trajectories among workers following traumatic limb injury., Methods: A total of 804 participants were recruited during hospital admission for a 2-year prospective study. The RTW outcome was repeatedly assessed at 1, 3, 6, 12, 18, and 24 months after the injury. A group-based trajectory model (GBTM) was employed to identify trajectories of RTW among the participants. Comparisons of group characteristics of different trajectories were performed based on a multinomial logistic regression., Results: GBTM identified three distinct trajectories of RTW: (i) fast RTW consisted of workers with early and stable RTW status from the first month after the injury; (ii) average RTW consisted of workers who achieved and remained at a stable RTW status within 6 months; and (iii) slow RTW consisted of workers who had slow and unsustainable RTW status within the 2-year follow-up period. The estimated proportions were 21.5%, 50.7%, and 27.8%, respectively. Workers with slow and unsustainable RTW after injury were found to be older, married, less educated, employed as repair personnel/operators/laborers, seriously injured, and depressed; they were also found to feel more disturbance in daily life, have lower self-efficacy, and believe they experience a poorer quality of life., Conclusion: Following traumatic limb injury, individual workers showed three distinct RTW trajectories, each of which was associated with different categories of biopsychosocial factors. An understanding of how different factors contribute to increasing the likelihood of RTW for injured workers in each trajectory group should aid policy-making in worker-oriented vocational rehabilitation programs.

Event-related potentials (ERPs) are now widely collected in psychological research to determine the time courses of mental events. When event-related potentials from treatment conditions are compared, often there is no a priori information on when or how long the differences should occur. Testing simultaneously for differences over the entire set of time points creates a serious multiple comparison problem in which the probability of false positive errors must be controlled, while maintaining reasonable power for correct detection. In this work, we extend the factor-adjusted multiple testing procedure developed by Friguet, Kloareg, and Causeur (Journal of the American Statistical Association, 104, 1406-1415, 2009) to manage the multiplicity problem in ERP data analysis and compare its performance with that of the Benjamini and Hochberg (Journal of the Royal Statistical Society B, 57, 289-300, 1995) false discovery rate procedure, using simulations. The proposed procedure outperformed the latter in detecting more truly significant time points, in addition to reducing the variability of the false discovery rate, suggesting that corrections for mass multiple testings of ERPs can be much improved by modeling the strong local temporal dependencies.

In addition to the generally observed LIESST phenomenon, polymorph D of trans-[Fe(II)(abpt)(2)(NCS)(2)] exhibits a long-lived photo-induced metastable state through linkage isomerization accompanied with a spin crossover transition, which is stable up to 108 K.

Objective: To develop a computerized adaptive testing system of the Fugl-Meyer motor scale (CAT-FM) to efficiently and reliably assess motor function in patients with stroke., Design: First, a simulation study was used to develop and examine the psychometric properties of the CAT-FM. Second, a field study was employed to determine the administration efficiency of the CAT-FM., Setting: One medical center and 1 teaching hospital., Participants: Patients' responses (n=301) were used for the simulation study; 49 patients participated in the field study., Interventions: Not applicable., Main Outcome Measures: The 2 CAT-FM item banks (upper extremity and lower extremity) include 37 items from the original Fugl-Meyer scale. The reliability, validity, and responsiveness of the CAT-FM were determined by the simulation study., Results: Two stopping rules (reliability ≥0.9 or an increase of reliability <.01 after testing an item) were used. The simulation study showed that the CAT-FM had high reliability (≥.93 for upper-extremity and lower-extremity subscales) and concurrent validity (Pearson r≥.91 for the upper-extremity and lower-extremity subscales and motor scale). The responsiveness was moderate (standardized response mean for the upper extremity=.67, lower extremity=.79, and motor=.77) for the 226 patients who completed both assessments at 14 and 90 days after stroke. The field study found that, on average, the time needed to administer the CAT-FM was 242 seconds with 4.7 items., Conclusions: The CAT-FM is an efficient, reliable, valid, and responsive clinical tool for assessing motor function in patients with stroke., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

A potential bridging triazole-based ligand, atrz (trans-4,4'-azo-1,2,4-triazole), is chosen to serve as building sticks and incorporated with a spin crossover metal center to form a metal organic framework. Coordination polymers of iron(II) with the formula [Fe(μ-atrz)(3)]X(2)·2H(2)O (where X = ClO(4)(-) (1·2H(2)O) and BF(4)(-) (2·2H(2)O)) in a 3D framework and [Fe(μ-atrz)(μ-pyz)(NCS)(2)]·4H(2)O (3·4H(2)O) in a 2D layer structure were synthesized and structurally characterized. The magnetic measurements of 1·2H(2)O and 2·2H(2)O reveal spin transitions near room temperature; that of 3 exhibits an abrupt spin transition at ~200 K with a wide thermal hysteresis, and the spin transition behavior of these polymers are apparently correlated with the water content of the sample. Crystal structures have been determined both at high spin and at low spin states for 1·2H(2)O, 2·2H(2)O, and 3·4H(2)O. Each iron(II) center in 1·2H(2)O and 2·2H(2)O is octahedrally coordinated with six μ-atrz ligands, which in turn links the other Fe center forming a strong three-dimensional (3D) network; counteranion and water molecules are located in the voids of the lattice. The FeN(6) octahedron of 3·4H(2)O is formed with two atrz, two pyrazine (pyz) ligands, and two NCS(-) ligands, where the ligands atrz and pyz are bridged between iron centers forming a 2D layer polymer. A zigzag chain of water molecules is found between the layers, and there is a distinct correlation between the thermal hysteresis with the amount of water molecules the exist in the crystal., (© 2012 American Chemical Society)

Objective: To compare the performance of reaching for stationary and moving targets in virtual reality (VR) and physical reality in persons with Parkinson's disease (PD)., Design: A repeated-measures design in which all participants reached in physical reality and VR under 5 conditions: 1 stationary ball condition and 4 conditions with the ball moving at different speeds., Setting: University research laboratory., Participants: Persons with idiopathic PD (n=29) and age-matched controls (n=25)., Interventions: Not applicable., Main Outcome Measures: Success rates and kinematics of arm movement (movement time, amplitude of peak velocity, and percentage of movement time for acceleration phase)., Results: In both VR and physical reality, the PD group had longer movement time (P<.001) and lower peak velocity (P<.001) than the controls when reaching for stationary balls. When moving targets were provided, the PD group improved more than the controls did in movement time (P<.001) and peak velocity (P<.001), and reached a performance level similar to that of the controls. Except for the fastest moving ball condition (0.5-s target viewing time), which elicited worse performance in VR than in physical reality, most cueing conditions in VR elicited performance generally similar to those in physical reality., Conclusions: Although slower than the controls when reaching for stationary balls, persons with PD increased movement speed in response to fast moving balls in both VR and physical reality. This suggests that with an appropriate choice of cueing speed, VR is a promising tool for providing visual motion stimuli to improve movement speed in persons with PD. More research on the long-term effect of this type of VR training program is needed., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: : The aim of this study was to assess a cohort of children with very low birth weight (VLBW) with premature history at the age of 5 yrs for the proportion of deficits in growth, motor, cognitive, and adaptive functions and to compare them with children with normal birth weight (>2500 g) in these areas., Design: : This is a descriptive, exploratory study using a convenience sample. A cohort of 160 children with VLBW and 124 children with normal birth weight were examined. Standardized clinical and neuropsychologic assessments were administered. Correlation and multiple comparison procedures were used to analyze the relationships among all continuous outcome variables., Results: : There is a significant difference in overall performance between the VLBW children and children with normal birth weight. Deficits in motor, cognitive, visual perception, visual-motor, and adaptive functions were more prominent when we further examined the VLBW children with motor problems., Conclusions: : The VLBW children performed more poorly at age 5 yrs than did their counterparts. This validates the need for early screening and regular follow-up of VLBW preterm children, particularly those who have motor problems.

Objectives: To investigate the construct validity of the commonly used 8- and 12-domain versions of the Stroke-Specific Quality of Life (SS-QOL) with a first-order factor model. The better-fitted version was further evaluated by a second-order factor structure model in order to determine whether a summary score is justified., Design: Cohort study., Setting: Outpatient stroke clinic., Participants: Patients (N=388) with ischemic stroke., Intervention: Not applicable., Main Outcome Measures: The SS-QOL. We first conducted confirmatory factor analysis (CFA) to evaluate the construct validity of the first-order 8- or 12-domain versions of the SS-QOL. The better-fitted version was then validated by investigating the second-order health-related quality of life (HRQOL) factor., Results: The 12-domain version, but not the 8-domain version, had sufficient goodness of fit (χ(2)=2041.7, df=1061, χ(2)/df=1.9, comparative fit index [CFI]=0.98, Tucker-Lewis index [TLI]=0.98, and root mean square error of approximation=0.05). All items of the 12-domain version showed acceptable factor loadings (>0.40) and were retained. Furthermore, the second-order CFA fit indices of the 12 domains were acceptable (χ(2)=2630.3, df=1115, χ(2)/df=2.4, CFI=0.97, TLI=0.97, root mean square error of approximation=0.06), indicating that a summary score was justified for representing the overall status of HRQOL., Conclusions: Our results show that the construct validity of the 12-domain SS-QOL is well supported for measuring HRQOL in ischemic stroke patients. Thus, we recommend the 12-domain version of the SS-QOL for use in capturing the multiple impacts of stroke as well as overall HRQOL status on the basis of patients' perspectives., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The photo-induced superstructure of polymorph C of trans-[Fe(abpt)(2)(NCS)(2)] (abpt = 4-amino-3,5-bis(pyridin-2-yl)-1,2,4-triazole) is discovered as a commensurate modulated structure by single-crystal X-ray diffraction under irradiation. The crystal structure at 25 K before the photo-irradiation composed of two crystallographically independent iron molecules, one of which exhibits high spin (HS) state and the other at low spin (LS) state. Under green laser light (λ = 532 nm) irradiation, the LS molecule (Fe1) is found to be excited to a metastable HS state and gives rise to a commensurate tripled superstructure along the c axis. In addition, it is confirmed that this modulation persists until the HS → LS relaxation temperature beyond 52 K. Our structural findings suggest that the structural modulation and the site-selective LS → HS excitation are highly correlated.

Background: An efficient and precise measure of balance is needed to improve administration efficiency and to reduce the assessment burden for patients., Objective: The purpose of this study was to develop a computerized adaptive testing (CAT) system for assessing balance function in an efficient, reliable, and valid fashion in patients with stroke., Design: Two cross-sectional prospective studies were conducted., Setting: This study was conducted in the departments of physical medicine and rehabilitation in 6 hospitals., Patients: The participants were inpatients and outpatients who were receiving rehabilitation., Measurements: A balance item pool (41 items) was developed on the basis of predefined balance concepts, expert opinions, and field testing. The items were administered by 5 raters to 764 patients. An item response theory model was fit to the data, and the item parameters were estimated. A simulation study was used to determine the performance (eg, reliability, efficiency) of the Balance CAT. The Balance CAT and the Berg Balance Scale (BBS) then were tested on another independent sample of 56 patients to determine the concurrent validity and time needed for administration., Results: Seven items did not meet the model's expectations and were excluded from further analysis. The remaining 34 items formed the item bank of the Balance CAT. Two stopping rules (ie, reliability coefficient > 0.9 or < or = 6 items) were set for the CAT. The simulation study showed that the patients' balance scores estimated by the CAT had an average reliability value of .94. The scores obtained from the CAT were closely associated with those of the full item set (Pearson r=.98). The scores of the Balance CAT were highly correlated with those of the BBS (Pearson r=.88). The average time needed to administer the Balance CAT (83 seconds) was only 18% of that of the BBS., Limitations: The convenience sampling of both samples may limit the generalization of the results. Further psychometric investigation of the Balance CAT is needed., Conclusion: The results provide strong evidence that the Balance CAT is efficient and has reliability and validity for patients with stroke.

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

Two new polymorphs (C and D) of [t-Fe(abpt)(2)(NCS)(2)] are characterized, a commensurate modulated structure with the c axis tripled in the thermally quenched metastable high spin state at 25 K is found in polymorph C.

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

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

Two polymorphs of mononuclear six-coordinate iron(II) spin-crossover complex trans-[Fe(tzpy)(2)(NCS)(2)] (tzpy = 3-(2-pyridyl)[1,2,3]triazolo[1,5-a]pyridine) (1) were isolated and structurally characterized. According to the thermally dependent magnetic measurements, polymorph A undergoes a gradual spin transition from a paramagnetic high-spin state ((5)T(2), S = 2, HS-1) above 200 K to a diamagnetic low-spin state ((1)A(1), S = 0, LS-1) below 120 K, whereas polymorph B shows an abrupt spin transition with T(1/2) at 102 K. Molecular and crystal structures of polymorph A in the HS-1 and LS-1 states were studied at 300 and 40 K, respectively. Significant differences in Fe-N distances and coordination geometries of Fe were found between the two spin states, as expected. Light-induced excited spin state trapping (LIESST) was observed upon irradiating the crystal with 532 nm laser light at 40 K, whereupon a metastable high-spin state (HS-2) was formed; the molecular and crystal structure of this metastable state were investigated by a pump and probe method because of its relatively fast relaxation. The electronic configuration of the Fe center in the HS-1, LS-1, and LIESST (HS-2) states were further confirmed by Fe K- and L-edge absorption spectroscopy. In addition, the C[triple bond]N stretching frequency on the ligand can also be followed through the spin transition. The excitation and relaxation process concerning such metastable state were followed by the C[triple bond]N stretching frequency and magnetic susceptibility measurements in the temperature ranges 15-55 K and 5-80 K, respectively. The structure and electronic configuration of the LIESST state of polymorph A were firmly established by X-ray diffraction, X-ray absorption, infrared absorption, and magnetic measurements. A single-crystal-to-single-crystal transition through irradiation was demonstrated. The changes in structure and electronic configuration as a result of the spin transition are believed to occur concurrently.

t-{Fe(abpt)(2)[N(CN)(2)](2)} [abpt = 4-amino-3,5-bis(pyridin-2-yl)-1,2,4-triazole] is an intriguing spin-crossover system that crystallizes in two polymorphs. Polymorph A is paramagnetic; its crystal structure consists of a single molecule located at the center of inversion symmetry. Polymorph B, on the other hand, exhibits a rather complicated two-step-like spin transition; its crystal structure consists of two symmetry-independent molecules. The crystal structure of polymorph B has been derived in the different spin states: above the high-temperature step (300 K), between the two steps (90 K), below the incomplete low-temperature step (50 K), in the light-induced metastable state (15 K), in the thermally quenched metastable state (15 K), and after relaxation from the quenched state (15 K). The correlation between the structure and magnetic properties is precisely established, allowing the complicated magnetic behavior of polymorph B to be well understood. A unique order-disorder phase transition, resulting in a modulation of the metastable state structures, is detected for the first time on such spin-transition compounds. The modulation of the structure originates from a particular ordering of the dicyanamide ligand at one of the two Fe sites.

Background: The minimal clinically important difference (MCID) of the Stroke Rehabilitation Assessment of Movement (STREAM) measure is unknown, which limits the application and interpretation of change scores., Objective: To estimate the MCID of the 3 subscales (ie, lower extremity, upper extremity, and mobility subscales) of the STREAM using the method of patients' global ratings of change., Methods: Eighty-one stroke patients participated in this study. The patients' global ratings of change were used to rate their changes of limb movements and basic mobility skills on the 15-point Likert scale. The mean change scores on the 3 subscales of STREAM of the MCID group (ie, scored on +2 to +3 or -2 to -3) served as the estimates of the MCID., Results: There were 42, 38, and 43 patients in the MCID group, and the estimates of the MCID were 2.2, 1.9, and 4.8 points for the upper-extremity subscale, lower-extremity subscale, and mobility subscale, respectively., Conclusions: These findings suggest that if the mean change scores on the 3 subscales of the STREAM within a stroke group have reached 2.2, 1.9, and 4.8 points, the change scores on the 3 subscales of the STREAM can be perceived by patients as clinically important.

Objective: To provide empirical justification for selecting motor scales for stroke patients, the authors compared the psychometric properties (validity, responsiveness, test-retest reliability, and smallest real difference [SRD]) of the Fugl-Meyer Motor Scale (FM), the simplified FM (S-FM), the Stroke Rehabilitation Assessment of Movement instrument (STREAM), and the simplified STREAM (S-STREAM)., Methods: For the validity and responsiveness study, 50 inpatients were assessed with the FM and the STREAM at admission and discharge to a rehabilitation department. The scores of the S-FM and the S-STREAM were retrieved from their corresponding scales. For the test-retest reliability study, a therapist administered both scales on a different sample of 60 chronic patients on 2 occasions., Results: Only the S-STREAM had no notable floor or ceiling effects at admission and discharge. The 4 motor scales had good concurrent validity (rho >or= .91) and satisfactory predictive validity (rho = .72-.77). The scales showed responsiveness (effect size d >or= 0.34; standardized response mean >or= 0.95; P < .0001), with the S-STREAM most responsive. The test-retest agreements of the scales were excellent (intraclass correlation coefficients >or= .96). The SRD of the 4 scales was 10% of their corresponding highest score, indicating acceptable level of measurement error. The upper extremity and the lower extremity subscales of the 4 showed similar results., Conclusions: The 4 motor scales showed acceptable levels of reliability, validity, and responsiveness in stroke patients. The S-STREAM is recommended because it is short, responsive to change, and able to discriminate patients with severe or mild stroke.

Experiments in which recognition performance is measured sometimes involve only a small number of observations per subject, rendering d' analysis unreliable (Schooler & Shiffrin, 2005). Here, we introduce, in signal detection models, subject-specific random variables to account for heterogeneous hit and false alarm rates among individuals. Population d' effects for comparing groups are estimated, in this approach, by pooling information from a sample of subjects across experimental conditions. The method is validated by a simulation study and is illustrated with an analysis of the effect of neutral and emotional words on recognition performance, employing the emotional Stroop task (Lee & Shih, 2007).

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

We examined the reliability, validity, and responsiveness of the Neonatal Oral-Motor Assessment Scale (NOMAS) in healthy preterm infants. Feeding records of 147 infants (71 males, 76 females; gestational age [GA] 0.70) in the normal category for 32 to 35 weeks'PMA. Moderate correlations were found between scores on the NOMAS and feeding performance for all age groups except for PMA of >or= 36 weeks (absolute Spearman's r(s)=0.51-0.69), indicating acceptable convergent validity. The NOMAS demonstrated moderate responsiveness to changes in oral-motor skills in every 2-week period, ranging from 32 to 36 weeks'PMA (standard response mean greater than 0.5). This study demonstrated that the normal and disorganized categories of the NOMAS are useful, with acceptable psychometric properties, in assessing oral-motor function in preterm infants aged 32 to 35 weeks'PMA. Future research on infants with abnormal oral-motor skills is needed to further validate psychometric properties of the dysfunction category of the NOMAS.

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

Background: A great deal of attention has focused on understanding preterm infant feeding behaviors and on strategies to support the preterm infant during this period; however, comprehensive descriptions of the feeding behavior of preterm infants that incorporate an examination of multiple subsystem levels are lacking., Objective: To examine various physical indicators related to preterm infants' bottle-feeding performance., Methods: This was a retrospective, descriptive, exploratory study using a convenience sample. Medical records of 116 preterm infants were reviewed from the initiation of bottle-feeding until discharge from the neonatal intensive care unit. This study examined bottle-feeding performance (volume intake in milliliters per minute) as well as postmenstrual age, weight at each observed feed, oral motor skills, signs of distress, feeding techniques, feeding experience, gender, and Apgar scores at 5 minutes. Oral motor skills were measured by the Neonatal Oral Motor Assessment Scale., Results: Linear mixed-effects models were used to examine the relationship between bottle-feeding performance and the remaining variables. Postmenstrual age, weight at each observed feed, oral motor skills, feeding experience, and feeding techniques were found to be significant predictors of feeding performance at the .05 level., Conclusions: Multiple factors, both intrinsic and extrinsic, play a role in determining an infant's bottle-feeding performance. In addition to age and weight, the presently employed conventional criteria, oral motor skills, feeding practice, and feeding techniques also contribute to infants' feeding performance. Arbitrary age (34 weeks gestational age) and weight criteria (1,500 g) should not be the only indicators for oral feeding.

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

Background: The interpretation of the change scores of the Barthel Index (BI) in follow-up or outcome studies has been hampered by the fact that its minimal clinically important difference (MCID) has not been determined., Objective: This article was written to establish the MCID of the BI in stroke patients., Methods: Both anchor-based and distribution-based methods were used to establish the MCID. In the anchor-based method, 43 stroke inpatients participated in a follow-up study designed to determine the MCID of the BI using patients' global ratings of the activities of daily living function on a 15-point Likert-type scale. The mean change scores on the 20-point scale of the BI of the MCID group, based on the patients' ratings on the Likert-type scale, served as the first estimate of the MCID. In the distribution-based method, 56 chronic stroke patients participated in the test-retest reliability study to determine the MCID of the BI. One standard error of measurement (SEM) served as the second estimate for the MCID. The larger MCID value of the 2 estimates was chosen as the MCID of the BI., Results: In the anchor-based study, there were 20 patients in the MCID group, with a mean change score of 1.85 points (ie, the first MCID estimate). In the distribution-based study, the SEM based on test-retest agreement was 1.45 points (ie, the second MCID estimate). The MCID of the BI in stroke patients was estimated to be 1.85 points., Conclusion: The authors' results, within the limitations of their design, suggest that if the mean BI change score within a stroke group has reached 1.85 points in a study, the change score on the BI can be perceived by patients as important and beyond measurement error (ie, such a change score is clinically important).

Objective: To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke., Design: One repeated-measures design (at a 2-wk interval) was used to examine the test-retest reliability of the SBM and PASS, and another similar design was applied to investigate their responsiveness. Patients who participated in the responsiveness study were followed up approximately 1 year later, and the predictive validity of the SBM system and PASS were examined by assessing the patients' comprehensive activities of daily living (ADL) function., Setting: Three rehabilitation units in Taiwan., Participants: Twenty patients with chronic stroke in the reliability study; 40 and 32 patients who had recently had a stroke in the responsiveness and predictive validity studies, respectively., Interventions: Not applicable., Main Outcome Measures: Three computerized tests of the SBM (the equilibrium score of the Sensory Organization Test, scores in rhythmic weight-shifting tests, and scores in the limits of stability test) and the PASS were used. The combination of the Barthel Index and Frenchay Activities Index was used to represent the comprehensive ADL function., Results: For the SBM, all but the weight-shifting tests of the SBM had moderate to high reliability (intraclass correlation coefficient [ICC] range, .78-.91). The responsiveness of the equilibrium score and the limits of stability test were moderate (effect size [d], .63) and small (d range, .27-.33), respectively, whereas the responsiveness of the weight-shifting tests was limited (d range, .04-.29). All but the weight-shifting tests of the SBM in the second evaluation had acceptable predictive validity for comprehensive ADL function (r2 range, .15-.17). The PASS showed high reliability (ICC=.84) and small responsiveness (d=.41), and the PASS in the second evaluation had acceptable predictive validity (r2=.24)., Conclusions: The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.

Objective: To develop a Short Form of Postural Assessment Scale for Stroke patients (SFPASS) with sound psychometric properties (including reliability, validity, and responsiveness)., Methods: This study consisted of 2 parts: developing the SFPASS and cross-validation. In the 1st part, 287 people with stroke were evaluated with the PASS at 14- and 30-day post-stroke intervals. The authors reduced the number of test items that constitute the PASS by more than half (i.e., making 5-, 6-, and 7-item sets) and simplified the scoring system (i.e., collapsing the 4-level scale in the original PASS into a 3-level scale [PASS-3L]), making both 4-L and 3-L versions available. Thus, a total of 6 SFPASSs were generated. In addition, 2 external criteria, the Barthel activities of daily living index and the Fugl-Meyer motor test, were used to examine the validity of the 6 SFPASSs. The psychometric properties of the new 6 SFPASSs were compared with each other as well as with those of the original PASS to determine which scale outperformed the others. In the 2nd part of the study, the authors cross-validated the best SFPASS using another independent sample of 179 people with stroke., Results: All 6 SFPASSs demonstrated good reliability, validity, and responsiveness. However, the Bland-Altman plots showed that only the 5-item PASS-3L demonstrated no systematic trend between the difference and mean score of the 5-item PASS-3L and the original PASS. The 5-item PASS-3L also had psychometric properties similar to those of the original PASS, as demonstrated in a cross-validation sample., Conclusion: The authors' results provide strong evidence that the 5-item PASS-3L has sound psycho-metric properties in people with stroke. The 5-item PASS-3L is simple and fast to administer and is thus recommended.

The item infit and outfit mean square errors (MSE) and their t-transformed statistics are widely used to screen poorly fitting items. The t-transformed statistics, however, do not follow the standard normal distribution so that hypothesis testing of item fit based on the conventional critical values is likely to be inaccurate (Wang and Chen, 2005). The MSE statistics are effect-size measures of misfit and have an expected value of unity when the data fit the model's expectation. Unfortunately, most computer programs for item response analysis do not report confidence intervals of the item infit and outfit MSE, mainly because their sampling distributions are analytically intractable. Hence, the user is left without interval estimates of the magnitudes of misfit. In this study, we developed a FORTRAN 90 computer program in conjunction with the commercial program WINSTEPS (Linacre, 2001) that yields confidence intervals of the item infit and outfit MSE using the bootstrap method. The utility of the program is demonstrated through three illustrations of simulated data sets.