Chia-Ling Chen - Academia.edu (original) (raw)

Papers by Chia-Ling Chen

Research paper thumbnail of Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: A randomized controlled trial

Annals of Physical and Rehabilitation Medicine, 2018

Introduction/Background Intermittent theta burst stimulation (iTBS) is a form of repetitive trans... more Introduction/Background Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. Material and method This was a double-blind randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the iTBS or sham group. All patients received 10 daily sessions of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were implemented before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was used to compare treatment effects between groups. Results The iTBS group showed greater improvement in the MAS and FMA than the sham group (Á 2 = 0.151-0.233; P < 0.05), as well as in the ARAT and BBT (Á 2 = 0.161-0.460; P < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in the changes in the MAL. Conclusion The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke generally have a low potential for fine motor recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function.

Research paper thumbnail of Clinical analysis of 1048 children with developmental delay

Chang Gung medical journal, 2002

Children with developmental delay (DD) have a variety of problems in developmental functions. The... more Children with developmental delay (DD) have a variety of problems in developmental functions. The purposes of this study were to analyze the underlying diseases and risk factors in children with different functional delays. We collected data on 1048 children who underwent assessments of developmental function, related diseases, and risk factors. All children were classified into 6 functional delay groups: cognitive, speech, motor, pervasive, global, and non-specific DDs. Differences in related diseases and risk factors of the 6 functional delay groups were determined. Most children had global (51.2%), speech (21.9%), and motor (13.9%) delays. Approximately 62.8% of children were associated with biological factors (19% with genetic defects or congenital anomalies, 16.5% with central nervous system lesions, 13.9% with prematurity/low birth body weight, and 13.4% with neonatal insult). We could not identify the risk factors in 36.6% of the children. Most children with motor delay had b...

Research paper thumbnail of Responsiveness and Validity of Three Outcome Measures of Motor Function After Stroke Rehabilitation

Stroke, 2009

Background and Purpose— This study investigated and compared the responsiveness and validity of t... more Background and Purpose— This study investigated and compared the responsiveness and validity of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), and the Wolf Motor Function Test (WMFT) for patients after stroke rehabilitation. Methods— A total of 57 patients with stroke received 1 of 3 rehabilitation treatments for 3 weeks. At pretreatment and posttreatment, the 3 outcome measures, as well as the Functional Independence Measure (FIM) as the external criterion, were administered. The standardized response mean (SRM) and the Wilcoxon signed rank test were used to examine the responsiveness. Construct validity and predictive validity were examined by the Spearman correlation coefficient (ρ). Results— The responsiveness of the FMA, ARAT, and WMFT functional ability scores was large (SRM=0.95–1.42), whereas the WMFT performance time score was small (SRM=0.38). The responsiveness of the FMA was significantly larger than those of the ARAT and the WMFT-TIME, but not the...

Research paper thumbnail of Effects of Object Use on Reaching and Postural Balance: A Comparison of Patients with Unilateral Stroke and Healthy Controls

American Journal of Physical Medicine & Rehabilitation, 2007

To evaluate whether the functional use of certain task objects while standing influences reaching... more To evaluate whether the functional use of certain task objects while standing influences reaching performance and postural balance in persons with left or right cerebral vascular accidents, and also in healthy individuals. Thirty-five stroke patients (20 patients with left and 15 patients with right cerebral vascular accidents) and 31 healthy controls (15 using the left and 16 the right arm) performed two experimental reaching tasks (task object present vs. absent) using the less affected arm while standing. For the object-present task, subjects held a glass and moved it forward as far as possible. For the object-absent task, subjects simply reached forward as far as possible. We measured reaching performance using kinematic analysis and assessed postural control using derivatives of the center of pressure, including forward displacement, mediolateral shift, and average velocity. Object presence did not significantly improve overall reaching performance in any group. However, for patients with left cerebral vascular accidents and controls (using either the left or the right arm), there were significant effects of object presence on the average velocity of the center of pressure. For patients with right cerebral vascular accidents, there were significant effects of task object on the forward distance and average velocity of the center of pressure. The positive findings regarding center-of-pressure derivatives suggest that a functional use of objects during a standing reaching task can decrease postural sway, as represented by the average velocity of the center of pressure, in individuals with and without stroke. Patients with right cerebral vascular accidents may benefit considerably more from functional object use during a standing reaching task, apparently because such tasks can facilitate greater forward displacement of the center of pressure.

Research paper thumbnail of Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy

Research in Developmental Disabilities, 2011

This study compared home-based constraint-induced therapy (CIT) with a dose-matched home-based co... more This study compared home-based constraint-induced therapy (CIT) with a dose-matched home-based control intervention for children with cerebral palsy (CP). The differences in unilateral and bilateral motor performance, daily functions, and quality of parental well-being (i.e., the stress level of their parents) were evaluated. The study included 21 children with CP (age range, 48–119 months) who were randomly assigned to the

Research paper thumbnail of Dual-task performance involving hand dexterity and cognitive tasks and daily functioning in people with schizophrenia: a pilot study

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

This study investigated separate and concurrent performance on cognitive and hand dexterity tasks... more This study investigated separate and concurrent performance on cognitive and hand dexterity tasks and the relationship to daily functioning in 16 people with schizophrenia and 16 healthy control participants. Participants performed the Purdue Pegboard Test and the Serial Seven Subtraction Test under single- and dual-task conditions and completed two daily functioning evaluations. The hand dexterity of all participants declined in the dual-task condition, but the discrepancy between single-task and dual-task hand dexterity was greater in the schizophrenia group than in the control group (p < .03, d > .70, for all). The extent of discrepancy in hand dexterity was negatively correlated with daily functioning in the schizophrenia group (rs = -.3 to -.5, ps = .04-.26). Ability to perform dual tasks may be an indicator of daily functioning in people with schizophrenia. Use of dual-task training may be considered as a therapeutic activity with these clients.

Research paper thumbnail of Speech-associated labiomandibular movement in Mandarin-speaking children with quadriplegic cerebral palsy: A kinematic study

Research paper thumbnail of Rasch Validation and Predictive Validity of the Action Research Arm Test in Patients Receiving Stroke Rehabilitation

Objective: To validate the internal construct and predictive validity of the Action Research Arm ... more Objective: To validate the internal construct and predictive validity of the Action Research Arm Test (ARAT).

Research paper thumbnail of A Randomized Controlled Trial of Modified Constraint-Induced Movement Therapy for Elderly Stroke Survivors: Changes in Motor Impairment, Daily Functioning, and Quality of Life

Archives of Physical Medicine and Rehabilitation, 2007

Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A randomized controlled trial of modified constrai... more Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life.

Research paper thumbnail of Factors associated with motor speech control in children with spastic cerebral palsy

Chang Gung medical journal

Speech production is often impaired in children with cerebral palsy (CP). This study investigated... more Speech production is often impaired in children with cerebral palsy (CP). This study investigated the factors associated with motor speech control in children with spastic cerebral palsy. Thirty-three children with spastic CP who were able to speak were identified for this study. They were classified into two groups: group A (spastic diplegia or hemiplegia, n = 17) and group B (spastic quadriplegia, n = 16). Each child received various assessments, namely cognition, language, modified Verbal Motor Production Assessment for Children (VMPAC), speech intelligibility, CP subtype, and Gross Motor Function Classification System (GMFCS). Group A showed better cognition and language function, higher modified VMPAC scores and better GMFCS levels than group B (p < 0.05). However, the two groups did not significantly differ in speech intelligibility. Linear regression indicated that all modified VMPAC scores were negatively related to CP subtype (adjusted r2 = 0.51~0.63, p < 0.001). The ...

Research paper thumbnail of Potential predictors of functional outcomes after home-based constraint-induced therapy for children with cerebral palsy

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based const... more OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based constraint-induced therapy (CIT) in children with cerebral palsy (CP). METHOD. Forty-three children (aged 4-12 yr) with CP were treated with individualized CIT at home for 4 wk. Potential predictors were age, sex, affected hand, and upper-extremity motor capacity measured by the Peabody Developmental Motor Scale, 2nd edition (PDMS-2). Outcomes were the Pediatric Motor Activity Log (PMAL) Amount of Hand Use and Quality of Hand Use subscales and the Functional Independence Measure for Children (WeeFIM). RESULTS. A higher PDMS-2 Visual-Motor Integration subscale score predicted a better WeeFIM score after home-based CIT (adjusted R² = .35). Younger age predicted better performance on the PMAL Amount of Hand Use and Quality of Hand Use subscales (adjusted R² = .06-.08) after home-based CIT. CONCLUSION. The potential predictors may allow occupational therapy practitioners to target those children ...

Research paper thumbnail of Acoustic study in Mandarin-speaking children: developmental changes in vowel production

Chang Gung medical journal

Acoustic analysis had been well incorporated into clinical evaluation and management of children ... more Acoustic analysis had been well incorporated into clinical evaluation and management of children with speech disorders for many years. The aim of this study is to investigate developmental changes in vowel production in Mandarin-speaking children using acoustic study analysis. A total of 22 children from 5-12 years old were analyzed in this study. Each child read a list of speech materials consisting of 6 dissyllabic words in Mandarin phonemes and the speech samples were recorded. The digitized acoustic recordings were submitted for acoustic analysis. The acoustic parameters in this study include the first and second formant frequencies (F1 and F2) of /a/, /i/ and /u/ and the vowel space. We used the Wilcoxon rank sum test and Spearman's rho correlation test for statistical analysis. The F1 values of the vowel /i/ were significantly lower in boys than those in girls (p = 0.013) by Wilcoxon ranksum test. The F1 value of the vowel /i/ was negatively correlated with children's ...

Research paper thumbnail of Comparison of developmental pattern change in preschool children with spastic diplegic and quadriplegic cerebral palsy

Chang Gung medical journal

This study compares the longitudinal change of developmental patterns in preschool children with ... more This study compares the longitudinal change of developmental patterns in preschool children with spastic diplegic (SD) and spastic quadriplegic (SQ) cerebral palsy (CP). Sixty children with spastic CP, aged 1-5 years (3.2 +/- 1.2 years), were classified into 2 groups: SD (n = 29) and SQ (n = 31). Gross Motor Function Classification System (GMFCS) levels were classified during the initial assessments. Developmental profiles, including development quotients (DQs) of gross motor, fine motor, expressive language, concept comprehension, situation comprehension, self help, personal social and general development, were evaluated on initial and final assessments and an average of one year later. The DQ change index (%) was calculated as 100% x (final DQ - initial DQ)/initial DQ. Children with SQ had lower DQs in all developmental functions than those with SD on both assessments (p < 0.01). The DQ distributions of developmental profiles were different in SD and SQ groups, although both gr...

Research paper thumbnail of Potential predictors of changes in gross motor function during various tasks for children with cerebral palsy: A follow-up study

Very few studies have investigated predictors of change in various gross motor outcomes in ambula... more Very few studies have investigated predictors of change in various gross motor outcomes in ambulatory children with cerebral palsy (CP). The aim of this study was to identify potential predictors for change in gross motor outcomes measured during various tasks in children with CP. A group of 45 children (age, 6-15 years) with CP and 7 potential predictors were identified, including age, gender, CP subtypes, gross motor function classification system (GMFCS) levels, abdominal muscle endurance, and muscles strength of knee extensor and knee flexor measured by isokinetic dynanometer. Motor outcome was assessed by means of the gross motor composite (GMC) of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), including four gross motor subtests: running speed and agility (RSA), balance (BAL), bilateral coordination (BCO), and strength (STR). The outcomes were measured at baseline and 12-week later (follow-up). The regression analyses showed that knee extensor strength was a robust predictor of change in BAL, BCO, and GMC (adjusted R(2) = 0.07-0.19, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Additionally, abdominal muscle strength was a negative predictor for the changes in the RSA (adjusted R(2) = 0.08, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). However, STR model revealed no significant predictors. These findings suggest that ambulatory children with greater knee muscle strength may benefit more from therapy than those with lower strength. The knee muscle strength can be used as a biomarker to predict the changes in the gross motor functions.

Research paper thumbnail of Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy

Research in Developmental Disabilities, 2013

Research paper thumbnail of Arm and Trunk Movement Kinematics During Seated Reaching Within and Beyond Arm's Length in People With Stroke: A Validity Study

Physical Therapy, 2014

Background. Kinematic analysis is commonly used to objectively measure upper extremity movement p... more Background. Kinematic analysis is commonly used to objectively measure upper extremity movement performance after stroke. However, the concurrent validity and predictive validity of arm-trunk kinematics during reaching within and beyond arm's length have not been studied.

Research paper thumbnail of Developmental Profiles of Preschool Children With Spastic Diplegic and Quadriplegic Cerebral Palsy

The Kaohsiung Journal of Medical Sciences, 2010

Cerebral palsy (CP) is a disorder of movement and posture control with multiple impairments. The ... more Cerebral palsy (CP) is a disorder of movement and posture control with multiple impairments. The clinical manifestations of CP vary among children. The aim of this study was to compare the developmental profiles of preschool children with either of two types of CP: spastic diplegic (SD) CP and spastic quadriplegic (SQ) CP. Relationships between the children's various developmental functions were also investigated. We recruited 137 children with spastic CP, aged 1-5 years (mean age = 3.7 ± 2.1 years), and we classified them into two groups: SD (n = 59) and SQ (n = 78). The comparison group comprised 18 children with typical development. Developmental functions were assessed in all the children, using the Chinese Child Development Inventory with the updated norms. This scale addressed eight functional domains: gross motor ability, fine motor ability, expressive language ability, concept comprehension ability, situation comprehension ability, self-help ability, personal-social skills, and general development. A development quotient (DQ) was determined for each domain as a percentage of the developmental age divided by the chronological age. The developmental profiles of the CP subtypes were found to differ. Children with SQ were found to have lower DQs than those with SD (p < 0.01). There was also a difference in the distribution of DQs between the SD and SQ groups, although the lowest DQ in both groups was for the gross motor domain. An uneven delay in the development of gross motor function was found in both groups of children with CP. Motor functions, including gross motor and fine motor functions, were significantly related to self-help ability. Complex and significant correlations among developmental functions were also identified in children with CP. The findings in the present study may allow clinicians to anticipate the developmental profile of children with CP on the basis of whether they have the SD or SQ subtype. This, in turn, is likely to facilitate individual assessment, goal setting, and the planning of interventions in children with CP.

Research paper thumbnail of Developmental Profiles and Temperament Patterns in Children With Spastic Cerebral Palsy: Relationships With Subtypes and Severity

Journal of the Formosan Medical Association, 2011

Background/Purpose: Elucidating developmental profiles and temperament patterns in children with ... more Background/Purpose: Elucidating developmental profiles and temperament patterns in children with cerebral palsy (CP) could help clinicians elaborate more flexible strategies for treating these children. This study investigated the developmental profiles and temperament patterns in children with spastic CP (sCP) of different subtypes and severities. Methods: One hundred and five children, aged 3-6 years, with sCP and 66 children with typical development (TD) were analyzed. Children with sCP were classified into spastic diplegia (SD; n = 60), and spastic quadriplegia (SQ; n = 45) groups. Motor severity was classified via the Gross Motor Function Classification System (GMFCS). Development quotients (DQs) of eight domains and temperament scores of nine dimensions were evaluated. Results: The SQ group had lower DQs in all developmental functions than the SD group (p < 0.01). The DQ distributions of developmental profiles showed the same trend in SD and SQ groups, and both groups displayed lowest DQs in the gross motor domain. The SQ group was less adaptable and approachable than the TD group (p < 0.05), and both sCP groups had lower attention span and persistence and a higher threshold of responsiveness than the TD group (p < 0.05). Correlation analysis showed that GMFCS levels were highly related to all developmental functions (r < −0.54, p < 0.01) and weakly related to some temperament dimensions in children with sCP. Conclusion: The subtype and severity of sCP were associated with developmental profiles in children with sCP. Temperament patterns were different between SD and SQ groups, but only weakly related to motor deficit. These data could allow clinicians to anticipate the developmental profiles and temperament patterns and plan appropriate therapeutic strategies for children with sCP.

Research paper thumbnail of Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study

Clinical Rehabilitation, 2013

To determine the effect of therapist-based constraint-induced therapy at home on motor performanc... more To determine the effect of therapist-based constraint-induced therapy at home on motor performance, daily function and reaching control for children with cerebral palsy. A single-blinded, randomized controlled trial. Forty-seven children (23 boys; 24 girls) with unilateral cerebral palsy, aged 6-12 years, were randomized to constraint-induced therapy (n = 24) or traditional rehabilitation (n = 23). Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained. Traditional rehabilitation involved functional unilateral and bilateral arm training. Both groups received individualized therapist-based interventions at home for 3.5-4 hours/day, two days a week for four weeks. Motor performance and daily function were measured by the Peabody Developmental Motor Scale, Second Edition and the Pediatric Motor Activity Log. Reaching control was assessed by the kinematics of reaction time, movement time, movement unit and peak velocity. There were larger effects in favour of constraint-induced therapy on motor performance, daily function, and some aspects of reaching control compared with traditional rehabilitation. Children receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale, Second Edition - Grasping (pretest mean ± SD, 39.9 ± 3.1; posttest, 44.1 ± 2.8; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), Pediatric Motor Activity Log (pretest, 1.8 ± 0.3; posttest, 2.5 ± 0.3; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and shorter reaction time, normalized movement time (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and higher peak velocity (P = 0.004) of reaching movement. Constraint-induced therapy induced better grasping performance, daily function, and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation.

Research paper thumbnail of Leg Muscle Activation Patterns of Sit-to-Stand Movement in Stroke Patients

American Journal of Physical Medicine & Rehabilitation, 2004

To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients d... more To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients during the movement of rising from a chair and to determine the differences of leg muscle activation patterns between stroke fallers and nonfallers. Subjects stood up from an armless chair at a comfortable, self-paced speed. Leg muscle activation time and patterns during the sit-to-stand movement were analyzed using multichannel surface electromyography and a force platform. The differences between stroke fallers and nonfallers were compared. The mean onset time of muscle activity in the affected limbs of stroke fallers was markedly delayed for the tibialis anterior muscle and earlier for the soleus muscle. The muscle activation patterns in the affected side of the stroke fallers exhibited a wide range of variation. Seventy percent of our stroke fallers exhibited no or merely low-amplitude activity in their tibialis anterior muscle when the patients were rising from a chair. Half of the stroke fallers exhibited premature or excessive activation of their soleus muscle when the rising activity was initiated. Stroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling.

Research paper thumbnail of Intermittent theta burst stimulation enhances upper limb motor function in patients with chronic stroke: A randomized controlled trial

Annals of Physical and Rehabilitation Medicine, 2018

Introduction/Background Intermittent theta burst stimulation (iTBS) is a form of repetitive trans... more Introduction/Background Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial stimulation to enhance upper limb (UL) motor recovery. However, only limited studies have examined its efficacy in patients with chronic stroke and therefore it remains controversial. Material and method This was a double-blind randomized controlled trial that enrolled patients from a rehabilitation department. Twenty-two patients with first-ever chronic and unilateral cerebral stroke, aged 30-70 years, were randomly assigned to the iTBS or sham group. All patients received 10 daily sessions of either iTBS or sham stimulation over the ipsilesional primary motor cortex in addition to conventional neurorehabilitation. Outcome measures were implemented before and immediately after the intervention period: Modified Ashworth Scale (MAS), Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block test (BBT), and Motor Activity Log (MAL). Analysis of covariance was used to compare treatment effects between groups. Results The iTBS group showed greater improvement in the MAS and FMA than the sham group (Á 2 = 0.151-0.233; P < 0.05), as well as in the ARAT and BBT (Á 2 = 0.161-0.460; P < 0.05) with large effect size. Both groups showed an improvement in the BBT, and there were no significant between-group differences in the changes in the MAL. Conclusion The iTBS induced greater gains in spasticity decrease and UL function improvement, especially in fine motor function, than sham TBS. This is a promising finding because patients with chronic stroke generally have a low potential for fine motor recovery. Overall, iTBS may be a beneficial adjunct therapy to neurorehabilitation for enhancing UL function.

Research paper thumbnail of Clinical analysis of 1048 children with developmental delay

Chang Gung medical journal, 2002

Children with developmental delay (DD) have a variety of problems in developmental functions. The... more Children with developmental delay (DD) have a variety of problems in developmental functions. The purposes of this study were to analyze the underlying diseases and risk factors in children with different functional delays. We collected data on 1048 children who underwent assessments of developmental function, related diseases, and risk factors. All children were classified into 6 functional delay groups: cognitive, speech, motor, pervasive, global, and non-specific DDs. Differences in related diseases and risk factors of the 6 functional delay groups were determined. Most children had global (51.2%), speech (21.9%), and motor (13.9%) delays. Approximately 62.8% of children were associated with biological factors (19% with genetic defects or congenital anomalies, 16.5% with central nervous system lesions, 13.9% with prematurity/low birth body weight, and 13.4% with neonatal insult). We could not identify the risk factors in 36.6% of the children. Most children with motor delay had b...

Research paper thumbnail of Responsiveness and Validity of Three Outcome Measures of Motor Function After Stroke Rehabilitation

Stroke, 2009

Background and Purpose— This study investigated and compared the responsiveness and validity of t... more Background and Purpose— This study investigated and compared the responsiveness and validity of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), and the Wolf Motor Function Test (WMFT) for patients after stroke rehabilitation. Methods— A total of 57 patients with stroke received 1 of 3 rehabilitation treatments for 3 weeks. At pretreatment and posttreatment, the 3 outcome measures, as well as the Functional Independence Measure (FIM) as the external criterion, were administered. The standardized response mean (SRM) and the Wilcoxon signed rank test were used to examine the responsiveness. Construct validity and predictive validity were examined by the Spearman correlation coefficient (ρ). Results— The responsiveness of the FMA, ARAT, and WMFT functional ability scores was large (SRM=0.95–1.42), whereas the WMFT performance time score was small (SRM=0.38). The responsiveness of the FMA was significantly larger than those of the ARAT and the WMFT-TIME, but not the...

Research paper thumbnail of Effects of Object Use on Reaching and Postural Balance: A Comparison of Patients with Unilateral Stroke and Healthy Controls

American Journal of Physical Medicine & Rehabilitation, 2007

To evaluate whether the functional use of certain task objects while standing influences reaching... more To evaluate whether the functional use of certain task objects while standing influences reaching performance and postural balance in persons with left or right cerebral vascular accidents, and also in healthy individuals. Thirty-five stroke patients (20 patients with left and 15 patients with right cerebral vascular accidents) and 31 healthy controls (15 using the left and 16 the right arm) performed two experimental reaching tasks (task object present vs. absent) using the less affected arm while standing. For the object-present task, subjects held a glass and moved it forward as far as possible. For the object-absent task, subjects simply reached forward as far as possible. We measured reaching performance using kinematic analysis and assessed postural control using derivatives of the center of pressure, including forward displacement, mediolateral shift, and average velocity. Object presence did not significantly improve overall reaching performance in any group. However, for patients with left cerebral vascular accidents and controls (using either the left or the right arm), there were significant effects of object presence on the average velocity of the center of pressure. For patients with right cerebral vascular accidents, there were significant effects of task object on the forward distance and average velocity of the center of pressure. The positive findings regarding center-of-pressure derivatives suggest that a functional use of objects during a standing reaching task can decrease postural sway, as represented by the average velocity of the center of pressure, in individuals with and without stroke. Patients with right cerebral vascular accidents may benefit considerably more from functional object use during a standing reaching task, apparently because such tasks can facilitate greater forward displacement of the center of pressure.

Research paper thumbnail of Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy

Research in Developmental Disabilities, 2011

This study compared home-based constraint-induced therapy (CIT) with a dose-matched home-based co... more This study compared home-based constraint-induced therapy (CIT) with a dose-matched home-based control intervention for children with cerebral palsy (CP). The differences in unilateral and bilateral motor performance, daily functions, and quality of parental well-being (i.e., the stress level of their parents) were evaluated. The study included 21 children with CP (age range, 48–119 months) who were randomly assigned to the

Research paper thumbnail of Dual-task performance involving hand dexterity and cognitive tasks and daily functioning in people with schizophrenia: a pilot study

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

This study investigated separate and concurrent performance on cognitive and hand dexterity tasks... more This study investigated separate and concurrent performance on cognitive and hand dexterity tasks and the relationship to daily functioning in 16 people with schizophrenia and 16 healthy control participants. Participants performed the Purdue Pegboard Test and the Serial Seven Subtraction Test under single- and dual-task conditions and completed two daily functioning evaluations. The hand dexterity of all participants declined in the dual-task condition, but the discrepancy between single-task and dual-task hand dexterity was greater in the schizophrenia group than in the control group (p < .03, d > .70, for all). The extent of discrepancy in hand dexterity was negatively correlated with daily functioning in the schizophrenia group (rs = -.3 to -.5, ps = .04-.26). Ability to perform dual tasks may be an indicator of daily functioning in people with schizophrenia. Use of dual-task training may be considered as a therapeutic activity with these clients.

Research paper thumbnail of Speech-associated labiomandibular movement in Mandarin-speaking children with quadriplegic cerebral palsy: A kinematic study

Research paper thumbnail of Rasch Validation and Predictive Validity of the Action Research Arm Test in Patients Receiving Stroke Rehabilitation

Objective: To validate the internal construct and predictive validity of the Action Research Arm ... more Objective: To validate the internal construct and predictive validity of the Action Research Arm Test (ARAT).

Research paper thumbnail of A Randomized Controlled Trial of Modified Constraint-Induced Movement Therapy for Elderly Stroke Survivors: Changes in Motor Impairment, Daily Functioning, and Quality of Life

Archives of Physical Medicine and Rehabilitation, 2007

Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A randomized controlled trial of modified constrai... more Wu C-Y, Chen C-L, Tsai W-C, Lin K-C, Chou S-H. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life.

Research paper thumbnail of Factors associated with motor speech control in children with spastic cerebral palsy

Chang Gung medical journal

Speech production is often impaired in children with cerebral palsy (CP). This study investigated... more Speech production is often impaired in children with cerebral palsy (CP). This study investigated the factors associated with motor speech control in children with spastic cerebral palsy. Thirty-three children with spastic CP who were able to speak were identified for this study. They were classified into two groups: group A (spastic diplegia or hemiplegia, n = 17) and group B (spastic quadriplegia, n = 16). Each child received various assessments, namely cognition, language, modified Verbal Motor Production Assessment for Children (VMPAC), speech intelligibility, CP subtype, and Gross Motor Function Classification System (GMFCS). Group A showed better cognition and language function, higher modified VMPAC scores and better GMFCS levels than group B (p < 0.05). However, the two groups did not significantly differ in speech intelligibility. Linear regression indicated that all modified VMPAC scores were negatively related to CP subtype (adjusted r2 = 0.51~0.63, p < 0.001). The ...

Research paper thumbnail of Potential predictors of functional outcomes after home-based constraint-induced therapy for children with cerebral palsy

The American journal of occupational therapy : official publication of the American Occupational Therapy Association

OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based const... more OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based constraint-induced therapy (CIT) in children with cerebral palsy (CP). METHOD. Forty-three children (aged 4-12 yr) with CP were treated with individualized CIT at home for 4 wk. Potential predictors were age, sex, affected hand, and upper-extremity motor capacity measured by the Peabody Developmental Motor Scale, 2nd edition (PDMS-2). Outcomes were the Pediatric Motor Activity Log (PMAL) Amount of Hand Use and Quality of Hand Use subscales and the Functional Independence Measure for Children (WeeFIM). RESULTS. A higher PDMS-2 Visual-Motor Integration subscale score predicted a better WeeFIM score after home-based CIT (adjusted R² = .35). Younger age predicted better performance on the PMAL Amount of Hand Use and Quality of Hand Use subscales (adjusted R² = .06-.08) after home-based CIT. CONCLUSION. The potential predictors may allow occupational therapy practitioners to target those children ...

Research paper thumbnail of Acoustic study in Mandarin-speaking children: developmental changes in vowel production

Chang Gung medical journal

Acoustic analysis had been well incorporated into clinical evaluation and management of children ... more Acoustic analysis had been well incorporated into clinical evaluation and management of children with speech disorders for many years. The aim of this study is to investigate developmental changes in vowel production in Mandarin-speaking children using acoustic study analysis. A total of 22 children from 5-12 years old were analyzed in this study. Each child read a list of speech materials consisting of 6 dissyllabic words in Mandarin phonemes and the speech samples were recorded. The digitized acoustic recordings were submitted for acoustic analysis. The acoustic parameters in this study include the first and second formant frequencies (F1 and F2) of /a/, /i/ and /u/ and the vowel space. We used the Wilcoxon rank sum test and Spearman's rho correlation test for statistical analysis. The F1 values of the vowel /i/ were significantly lower in boys than those in girls (p = 0.013) by Wilcoxon ranksum test. The F1 value of the vowel /i/ was negatively correlated with children's ...

Research paper thumbnail of Comparison of developmental pattern change in preschool children with spastic diplegic and quadriplegic cerebral palsy

Chang Gung medical journal

This study compares the longitudinal change of developmental patterns in preschool children with ... more This study compares the longitudinal change of developmental patterns in preschool children with spastic diplegic (SD) and spastic quadriplegic (SQ) cerebral palsy (CP). Sixty children with spastic CP, aged 1-5 years (3.2 +/- 1.2 years), were classified into 2 groups: SD (n = 29) and SQ (n = 31). Gross Motor Function Classification System (GMFCS) levels were classified during the initial assessments. Developmental profiles, including development quotients (DQs) of gross motor, fine motor, expressive language, concept comprehension, situation comprehension, self help, personal social and general development, were evaluated on initial and final assessments and an average of one year later. The DQ change index (%) was calculated as 100% x (final DQ - initial DQ)/initial DQ. Children with SQ had lower DQs in all developmental functions than those with SD on both assessments (p < 0.01). The DQ distributions of developmental profiles were different in SD and SQ groups, although both gr...

Research paper thumbnail of Potential predictors of changes in gross motor function during various tasks for children with cerebral palsy: A follow-up study

Very few studies have investigated predictors of change in various gross motor outcomes in ambula... more Very few studies have investigated predictors of change in various gross motor outcomes in ambulatory children with cerebral palsy (CP). The aim of this study was to identify potential predictors for change in gross motor outcomes measured during various tasks in children with CP. A group of 45 children (age, 6-15 years) with CP and 7 potential predictors were identified, including age, gender, CP subtypes, gross motor function classification system (GMFCS) levels, abdominal muscle endurance, and muscles strength of knee extensor and knee flexor measured by isokinetic dynanometer. Motor outcome was assessed by means of the gross motor composite (GMC) of Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), including four gross motor subtests: running speed and agility (RSA), balance (BAL), bilateral coordination (BCO), and strength (STR). The outcomes were measured at baseline and 12-week later (follow-up). The regression analyses showed that knee extensor strength was a robust predictor of change in BAL, BCO, and GMC (adjusted R(2) = 0.07-0.19, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Additionally, abdominal muscle strength was a negative predictor for the changes in the RSA (adjusted R(2) = 0.08, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). However, STR model revealed no significant predictors. These findings suggest that ambulatory children with greater knee muscle strength may benefit more from therapy than those with lower strength. The knee muscle strength can be used as a biomarker to predict the changes in the gross motor functions.

Research paper thumbnail of Validity, responsiveness, minimal detectable change, and minimal clinically important change of Pediatric Balance Scale in children with cerebral palsy

Research in Developmental Disabilities, 2013

Research paper thumbnail of Arm and Trunk Movement Kinematics During Seated Reaching Within and Beyond Arm's Length in People With Stroke: A Validity Study

Physical Therapy, 2014

Background. Kinematic analysis is commonly used to objectively measure upper extremity movement p... more Background. Kinematic analysis is commonly used to objectively measure upper extremity movement performance after stroke. However, the concurrent validity and predictive validity of arm-trunk kinematics during reaching within and beyond arm's length have not been studied.

Research paper thumbnail of Developmental Profiles of Preschool Children With Spastic Diplegic and Quadriplegic Cerebral Palsy

The Kaohsiung Journal of Medical Sciences, 2010

Cerebral palsy (CP) is a disorder of movement and posture control with multiple impairments. The ... more Cerebral palsy (CP) is a disorder of movement and posture control with multiple impairments. The clinical manifestations of CP vary among children. The aim of this study was to compare the developmental profiles of preschool children with either of two types of CP: spastic diplegic (SD) CP and spastic quadriplegic (SQ) CP. Relationships between the children's various developmental functions were also investigated. We recruited 137 children with spastic CP, aged 1-5 years (mean age = 3.7 ± 2.1 years), and we classified them into two groups: SD (n = 59) and SQ (n = 78). The comparison group comprised 18 children with typical development. Developmental functions were assessed in all the children, using the Chinese Child Development Inventory with the updated norms. This scale addressed eight functional domains: gross motor ability, fine motor ability, expressive language ability, concept comprehension ability, situation comprehension ability, self-help ability, personal-social skills, and general development. A development quotient (DQ) was determined for each domain as a percentage of the developmental age divided by the chronological age. The developmental profiles of the CP subtypes were found to differ. Children with SQ were found to have lower DQs than those with SD (p < 0.01). There was also a difference in the distribution of DQs between the SD and SQ groups, although the lowest DQ in both groups was for the gross motor domain. An uneven delay in the development of gross motor function was found in both groups of children with CP. Motor functions, including gross motor and fine motor functions, were significantly related to self-help ability. Complex and significant correlations among developmental functions were also identified in children with CP. The findings in the present study may allow clinicians to anticipate the developmental profile of children with CP on the basis of whether they have the SD or SQ subtype. This, in turn, is likely to facilitate individual assessment, goal setting, and the planning of interventions in children with CP.

Research paper thumbnail of Developmental Profiles and Temperament Patterns in Children With Spastic Cerebral Palsy: Relationships With Subtypes and Severity

Journal of the Formosan Medical Association, 2011

Background/Purpose: Elucidating developmental profiles and temperament patterns in children with ... more Background/Purpose: Elucidating developmental profiles and temperament patterns in children with cerebral palsy (CP) could help clinicians elaborate more flexible strategies for treating these children. This study investigated the developmental profiles and temperament patterns in children with spastic CP (sCP) of different subtypes and severities. Methods: One hundred and five children, aged 3-6 years, with sCP and 66 children with typical development (TD) were analyzed. Children with sCP were classified into spastic diplegia (SD; n = 60), and spastic quadriplegia (SQ; n = 45) groups. Motor severity was classified via the Gross Motor Function Classification System (GMFCS). Development quotients (DQs) of eight domains and temperament scores of nine dimensions were evaluated. Results: The SQ group had lower DQs in all developmental functions than the SD group (p < 0.01). The DQ distributions of developmental profiles showed the same trend in SD and SQ groups, and both groups displayed lowest DQs in the gross motor domain. The SQ group was less adaptable and approachable than the TD group (p < 0.05), and both sCP groups had lower attention span and persistence and a higher threshold of responsiveness than the TD group (p < 0.05). Correlation analysis showed that GMFCS levels were highly related to all developmental functions (r < −0.54, p < 0.01) and weakly related to some temperament dimensions in children with sCP. Conclusion: The subtype and severity of sCP were associated with developmental profiles in children with sCP. Temperament patterns were different between SD and SQ groups, but only weakly related to motor deficit. These data could allow clinicians to anticipate the developmental profiles and temperament patterns and plan appropriate therapeutic strategies for children with sCP.

Research paper thumbnail of Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study

Clinical Rehabilitation, 2013

To determine the effect of therapist-based constraint-induced therapy at home on motor performanc... more To determine the effect of therapist-based constraint-induced therapy at home on motor performance, daily function and reaching control for children with cerebral palsy. A single-blinded, randomized controlled trial. Forty-seven children (23 boys; 24 girls) with unilateral cerebral palsy, aged 6-12 years, were randomized to constraint-induced therapy (n = 24) or traditional rehabilitation (n = 23). Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained. Traditional rehabilitation involved functional unilateral and bilateral arm training. Both groups received individualized therapist-based interventions at home for 3.5-4 hours/day, two days a week for four weeks. Motor performance and daily function were measured by the Peabody Developmental Motor Scale, Second Edition and the Pediatric Motor Activity Log. Reaching control was assessed by the kinematics of reaction time, movement time, movement unit and peak velocity. There were larger effects in favour of constraint-induced therapy on motor performance, daily function, and some aspects of reaching control compared with traditional rehabilitation. Children receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale, Second Edition - Grasping (pretest mean ± SD, 39.9 ± 3.1; posttest, 44.1 ± 2.8; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), Pediatric Motor Activity Log (pretest, 1.8 ± 0.3; posttest, 2.5 ± 0.3; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and shorter reaction time, normalized movement time (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and higher peak velocity (P = 0.004) of reaching movement. Constraint-induced therapy induced better grasping performance, daily function, and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation.

Research paper thumbnail of Leg Muscle Activation Patterns of Sit-to-Stand Movement in Stroke Patients

American Journal of Physical Medicine & Rehabilitation, 2004

To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients d... more To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients during the movement of rising from a chair and to determine the differences of leg muscle activation patterns between stroke fallers and nonfallers. Subjects stood up from an armless chair at a comfortable, self-paced speed. Leg muscle activation time and patterns during the sit-to-stand movement were analyzed using multichannel surface electromyography and a force platform. The differences between stroke fallers and nonfallers were compared. The mean onset time of muscle activity in the affected limbs of stroke fallers was markedly delayed for the tibialis anterior muscle and earlier for the soleus muscle. The muscle activation patterns in the affected side of the stroke fallers exhibited a wide range of variation. Seventy percent of our stroke fallers exhibited no or merely low-amplitude activity in their tibialis anterior muscle when the patients were rising from a chair. Half of the stroke fallers exhibited premature or excessive activation of their soleus muscle when the rising activity was initiated. Stroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling.