Publications by authors named "Chueh-Ho Lin"

18 Publications

  • Page 1 of 1

Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study.

J Neuroeng Rehabil 2021 Apr 26;18(1):71. Epub 2021 Apr 26.

Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 252, Wu-Hsing St., Taipei City, 110, Taiwan.

Background: Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation.

Methods: In this prospective case-control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category.

Results: Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70).

Conclusion: The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.
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http://dx.doi.org/10.1186/s12984-021-00866-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077813PMC
April 2021

Machine-Based Hand Massage Ameliorates Preoperative Anxiety in Patients Awaiting Ambulatory Surgery.

J Nurs Res 2021 Apr 12;29(3):e152. Epub 2021 Apr 12.

MS, RN, Executive Director of Community Medicine, Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, and Adjunct Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taiwan, ROC.

Background: Hand massage therapies have been used to relieve anxiety and pain in various clinical situations. The effects of machine-based hand massage on preoperative anxiety in ambulatory surgery settings have not been evaluated.

Purpose: This prospective study was designed to investigate the effect of machine-based hand massage on preoperative anxiety and vital signs in ambulatory surgery patients.

Methods: One hundred ninety-nine patients aged 18 years and older who were scheduled to receive ambulatory surgery were recruited from the Taipei Municipal Wanfang Hospital in Taipei City, Taiwan. The patients were assigned randomly to the experimental group (n = 101), which received presurgical machine-based hand massage therapy, and the control group (n = 98), which received no intervention. The patients in both groups completed the Spielberger State-Trait Anxiety Inventory short form at preintervention (baseline) and postintervention.

Results: Within-group comparisons of Spielberger State-Trait Anxiety Inventory short form scores showed significant decreases between preintervention and postintervention scores in the experimental group (44.3 ± 11.2 to 37.9 ± 8.7) and no significant change in the control group. Within-group comparisons of vital signs revealed a significant increase in mean respiration rate between baseline and postintervention in both groups (both ps < .05). Blood pressure was found to have decreased significantly only in the control group at postintervention (p < .05). No significant preintervention to postintervention change in pulse was observed in either group.

Conclusions: The findings of this study indicate that machine-based hand massage reduces anxiety significantly in patients awaiting ambulatory surgery while not significantly affecting their vital signs.
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http://dx.doi.org/10.1097/jnr.0000000000000432DOI Listing
April 2021

Effects of Arch Support Insoles on Single- and Dual-Task Gait Performance Among Community-Dwelling Older Adults.

Clin Interv Aging 2020 10;15:1325-1332. Epub 2020 Aug 10.

Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Purpose: To explore the immediate and prolonged effects of arch support insoles on single- and dual-task gait performance among community-dwelling older adults.

Methods: Twenty women performed single- and dual-task walking for 10 m at self-selected comfortable and fast paces while performing serial subtractions (cognitive interference) or carrying a tray (motor interference). Spatiotemporal gait parameters were measured and compared with measurements without arch support immediately after the insertion of the insoles and at 1-week follow-up.

Results: Some effects were noted, with small-to-medium effect sizes. During comfortable-paced single-task walking, stride length and walk ratio (step length/cadence) increased after arch support use. During comfortable-paced motor dual-task walking, arch support use increased cadence, stride length, and speed and decreased dual-task costs (DTCs) on cadence and speed. During fast-paced motor dual-task walking, cadence increased and the DTC on cadence decreased after arch support use at the 1-week follow-up. During comfortable-paced cognitive dual-task walking, cadence increased and the walk ratio decreased following arch support use. At the 1-week follow-up, DTCs on cadence reduced, but those on stride length and speed increased. During fast-paced cognitive dual-task walking, the speed and stride length demonstrated immediate decreases followed by increases at the 1-week follow-up.

Conclusion: The study results indicate that the use of arch support improves single- and motor dual-task gait performance, which may contribute to gait and balance training in older adults.
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http://dx.doi.org/10.2147/CIA.S254474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428319PMC
January 2021

Effectiveness of a Home-Based Telehealth Exercise Training Program for Patients With Cardiometabolic Multimorbidity: A Randomized Controlled Trial.

J Cardiovasc Nurs 2020 Sep/Oct;35(5):491-501

Background: Exercise training has positive effects on the management of cardiometabolic conditions. Little is known about the effectiveness of home-based telehealth exercise training programs among patients with cardiometabolic multimorbidity, which is associated with functional decline and decreased health-related quality of life.

Objective: The aim of this study was to determine the effectiveness of a 12-week home-based telehealth exercise training program designed to increase physical activity and exercise capacity and improve health-related quality of life in patients with cardiometabolic multimorbidity.

Methods: A randomized controlled trial was conducted. Fifty eligible patients with 2 or more cardiometabolic conditions from outpatient clinics of a medical center in Northern Taiwan were randomized to either an experimental group (EG; received a 12-week home-based telehealth exercise training program) or a control group (CG; maintained usual lifestyles). The home-based telehealth exercise training program consisted of 36 individualized home-based exercise training sessions and a weekly reminder for maintenance of exercise and providing patient support. Amounts of physical activity, exercise capacity, and health-related quality of life were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group.

Results: The EG had higher amounts of physical activity (β = 1333, P = .004) and moderate-intensity physical activity (β = 330, P = .04) than the CG after the intervention. The EG had increased exercise capacity (VO2peak, β = 4.43, P = .04), as well as improved health-related quality of life (physical function, β = 7.55, P = .03; and physical component summary, β = 4.42, P = .03) compared with those in the CG.

Conclusions: A 12-week home-based telehealth exercise training program is feasible and effective in increasing amounts of physical activity, elevating exercise capacity, and improving health-related quality of life in patients with cardiometabolic multimorbidity.
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http://dx.doi.org/10.1097/JCN.0000000000000693DOI Listing
June 2020

Validating the Capability for Measuring Age-Related Changes in Grip-Force Strength Using a Digital Hand-Held Dynamometer in Healthy Young and Elderly Adults.

Biomed Res Int 2020 20;2020:6936879. Epub 2020 Apr 20.

Master Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei 11031, Taiwan.

Background: Grip-force performance can be affected by aging, and hand-grip weakness is associated with functional limitations of dasily living. However, using an appropriate digital hand-held dynamometer with continuous hand-grip force data collection shows age-related changes in the quality of hand-grip force control may provide more valuable information for clinical diagnoses rather than merely recording instantaneous maximal hand-grip force in frail elderly adults or people with a disability. Therefore, the purpose of this study was to indicate the construct validity of the digital MicroFET3 dynamometer with Jamar values for maximal grip-force assessments in elderly and young adults and confirmed age-related changes in the maximal and the quality of grip-force performance using the MicroFET3 dynamometer in elderly people.

Methods: Sixty-five healthy young (23.3 ± 4.5 years) and 50 elderly (69.5 ± 5.8 years) adults were recruited and asked to perform a validity test of the grip-force maximum voluntary contraction (MVC) using both the dominant and nondominant hands with a Jamar dynamometer and a MicroFET3 dynamometer.

Results: A strong correlation of maximal grip-force measurements was found between the MicroFET3 dynamometer and Jamar standard dynamometer for both hands in all participants ( < 0.05). Although, the results showed that a lower grip force was measured in both hands by the MicroFET3 dynamometer than with the Jamar dynamometer by 49.9%~57% ( < 0.05), but confidently conversion formulae were also developed to convert MicroFET3 dynamometer values to equivalent Jamar values for both hands. Both dynamometers indicated age-related declines in the maximum grip-force performance by 36.7%~44.3% ( < 0.05). We also found that the maximal hand-grip force values generated in both hand by the elderly adults were slower and more inconsistent than those of the young adults when using the MicroFET3 dynamometer.

Conclusions: This study demonstrated that the digital MicroFET3 dynamometer has good validity when used to measure the maximal grip force of both hands, and conversion formulae were also developed to convert MicroFET3 dynamometer force values to Jamar values in both hands. Comparing with the Jamar dynamometer for measuring grip force, the MicroFET3 dynamometer not only indicated age-related declines in the maximum grip-force performance but also showed slower and more inconsistent maximal hand-grip strength generation by the elderly.
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http://dx.doi.org/10.1155/2020/6936879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191369PMC
February 2021

Bimanual coordination deficits in hands following stroke and their relationship with motor and functional performance.

J Neuroeng Rehabil 2019 08 2;16(1):101. Epub 2019 Aug 2.

Master Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan, Republic of China.

Background: Stroke can lead to movement disorders that affect interlimb coordination control of the bilateral upper extremities, especially the hands. However, few studies have investigated the influence of a stroke on bimanual force coordination control between the hands using a quantitative measurement tool, or the relationship of force coordination with paretic upper extremity motor and functional performance. We aimed to investigate these outcomes using a novel measurement device, and analyze the relationship of bimanual force coordination control deficits in both hands with motor and functional performances of the paretic upper extremity in stroke patients.

Methods: Sixteen healthy adults and 22 stroke patients were enrolled. A novel bilateral hand grip measurement device with two embedded dynamometers was used to evaluate the grip force during a bilateral hand grip-force coordination control task. The alternating time and force applied for coordination with the grip force of both hands were calculated to analyze control of bimanual grip force coordination. Motor and functional measurements included the upper-extremity portion of the Fugl-Meyer assessment (FMA-UE), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), and Barthel Index (BI).

Results: Compared with the healthy group, the alternating time from the non-paretic to the paretic hand was 27.6% shorter for stroke patients (p < 0.001). The grip force generated for coordination in the healthy group was significantly greater (30-59%) than that of the stroke group (p < 0.05), and the coefficients of variation of alternating time (p = 0.001) and force applied (p = 0.002) were significantly higher in the stroke group than the healthy group. The alternating time from the paretic to the non-paretic hand showed moderately significant correlations with the FMA-UE (r = - 0.533; p = 0.011), the WMFT (r = - 0.450; p = 0.036), and the BI (r = - 0.497; p = 0.019).

Conclusions: Stroke results in a decline in bimanual grip force generation and increases the alternating time for coordinating the two hands. A shorter alternating time is moderately to highly associated with enhanced motor and functional performances.
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http://dx.doi.org/10.1186/s12984-019-0570-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679439PMC
August 2019

Influence of aging and visual feedback on the stability of hand grip control in elderly adults.

Exp Gerontol 2019 05 26;119:74-81. Epub 2019 Jan 26.

Masters Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei 110, Taiwan, ROC.

Aging causes a gradual decrease in maximal grip strength and leads many elderly people to have to rely on visual feedback to compensate for poorer muscle strength in performing daily activities and preventing accidents. Previous studies have investigated age and visual feedback-related changes in grip strength. However, little is known about methods of determining the quality and stability of hand grip strength control in the elderly, which is important for understanding their ability to generate grip force when handling objects with and without visual feedback in daily living. Therefore, the purpose of this study was to investigate the influence of aging and visual feedback on the stability of hand grip control in both hands in elderly adults. Forty-four healthy elderly persons (age 80.5 ± 4.53 years) and 36 young adults (age 32.69 ± 16.48 years) were recruited to execute grip force stability tasks using both hands at a 2 kg target force level. To perform the grip force stability task, the participants were asked to hold the dynamometer tightly in an attempt to achieve the target force level under visual and non-visual feedback conditions. Strength performances (grip force and coefficient of variation values) and stability of strength control (deviation error, variation error and force stability index values) for hand grip force stability tasks were calculated and analyzed. Compared with the visual feedback condition, the stability of grip force control in the hands of the young and elderly groups were significantly reduced in the non-visual feedback condition by 23.5%-57.1% (p < .05). The elderly group also showed significantly worse hand grip strength performances and stability of hand strength control than the young adult group (p < .05). Aging and non-visual feedback reduced the hand grip force output and stability of grip strength control of the hands. This may reveal the difficulty with manipulating hand-held objects in the absence of visual feedback while performing activities of daily living among the elderly.
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http://dx.doi.org/10.1016/j.exger.2019.01.024DOI Listing
May 2019

Analysis of trunk rolling in Parkinson's disease patients using a mattress mobility detection system.

Comput Methods Programs Biomed 2018 Aug 2;162:157-163. Epub 2018 May 2.

School of Nursing & School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan. Electronic address:

Background And Objective: Parkinson's disease (PD) is a neurodegenerative condition characterized by motor dysfunction and various types of non-motor impairments. The reaction time and movement time are reported to become more severe delayed in worse PD patients. Most tools for evaluating motor impairment are limited by relying on subjective observations and being qualitative in design. The aim of this study was to investigate trunk rolling performance in PD patients by using a recently developed system to detect turning in bed.

Methods: The study included 20 PD patients and 42 healthy controls. A mattress mobility detection system was employed for quantitative measurements. Each test session consisted of subjects starting by lying in a supine position on a bed and rolling 10 times onto their left side and 10 times onto their right side. Strain gauges mounted under the feet of the bed recorded changes in the center of pressure (CoP).

Results: For turning back, the patients compared with the controls had significantly longer movement time (P = 0.017), longer time to peak counteraction (P = 0.001), larger ratio of peak counteraction to movement time (P = 0.006), shorter CoP displacement (P < 0.0001), slower turning speed (P = 0.000), weaker peak counteraction (P = 0.013), and smaller ratio of peak counteraction to weight (P = 0.032). Results for turning over were similar except there was no significant difference in the ratio of peak counteraction to weight.

Conclusions: The mattress mobility detection system was useful for objectively assessing trunk rolling performance of PD patients. Improved assessment of trunk function in PD patients could lead to better treatments and improved rehabilitation procedures.
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http://dx.doi.org/10.1016/j.cmpb.2018.04.029DOI Listing
August 2018

Development and clinical application of a computer-aided real-time feedback system for detecting in-bed physical activities.

Comput Methods Programs Biomed 2017 Aug 12;147:11-17. Epub 2017 Jun 12.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address:

Background And Objective: Being bedridden long-term can cause deterioration in patients' physiological function and performance, limiting daily activities and increasing the incidence of falls and other accidental injuries. Little research has been carried out in designing effective detecting systems to monitor the posture and status of bedridden patients and to provide accurate real-time feedback on posture. The purposes of this research were to develop a computer-aided system for real-time detection of physical activities in bed and to validate the system's validity and test-retest reliability in determining eight postures: motion leftward/rightward, turning over leftward/rightward, getting up leftward/rightward, and getting off the bed leftward/rightward.

Methods: The in-bed physical activity detecting system consists mainly of a clinical sickbed, signal amplifier, a data acquisition (DAQ) system, and operating software for computing and determining postural changes associated with four load cell sensing components. Thirty healthy subjects (15 males and 15 females, mean age = 27.8 ± 5.3 years) participated in the study. All subjects were asked to execute eight in-bed activities in a random order and to participate in an evaluation of the test-retest reliability of the results 14 days later. Spearman's rank correlation coefficient was used to compare the system's determinations of postural states with researchers' recordings of postural changes. The test-retest reliability of the system's ability to determine postures was analyzed using the interclass correlation coefficient ICC(3,1).

Results: The system was found to exhibit high validity and accuracy (r = 0.928, p < 0.001; accuracy rate: 87.9%) in determining in-bed displacement, turning over, sitting up, and getting off the bed. The system was particularly accurate in detecting motion rightward (90%), turning over leftward (83%), sitting up leftward or rightward (87-93%), and getting off the bed (100%). The test-retest reliability ICC(3,1) value was 0.968 (p < 0.001).

Conclusions: The system developed in this study exhibits satisfactory validity and reliability in detecting changes in-bed body postures and can be beneficial in assisting caregivers and clinical nursing staff in detecting the in-bed physical activities of bedridden patients and in developing fall prevention warning systems.
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http://dx.doi.org/10.1016/j.cmpb.2017.05.014DOI Listing
August 2017

Effectiveness of Light Therapy in Cognitively Impaired Persons: A Metaanalysis of Randomized Controlled Trials.

J Am Geriatr Soc 2017 Oct 22;65(10):2227-2234. Epub 2017 Jul 22.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Objectives: To explore the effects of light therapy on behavioral disturbances (BDs), sleep quality, and depression.

Design: Meta-analysis of randomized controlled trials.

Setting: PubMed, Cochrane Library, Medline, EMBASE, Web of Science, and clinicaltrials.gov of selected randomized controlled trials and previous systematic reviews were searched.

Participants: Cognitively impaired persons.

Measurements: Information was extracted on study characteristics, quality assessment, and outcomes. Outcome measures included BDs, sleep quality, and depression.

Results: Nine randomized controlled trials were examined. The results showed that light therapy has a moderate effect on BD (g = -0.61) and depression (g = -0.58) and a small effect on total sleep time at night (g = 0.25). Subgroup analysis indicated that a light intensity of 2,500 lux or greater has a greater effect on depression than an intensity of less than 2,500 lux (P = .03), and the low risk of bias in blinding was superior to the RCTs deemed to be of high or unclear risk of bias in blinding in terms of BD (P = .02).

Conclusion: Light therapy can relieve BD, improve sleep quality, and alleviate symptoms of depression for cognitively impaired persons.
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http://dx.doi.org/10.1111/jgs.14990DOI Listing
October 2017

Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials.

PLoS One 2017 4;12(5):e0176849. Epub 2017 May 4.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Background: Although cognitive behavioral therapy (CBT) is considered a promising adjuvant to pharmacotherapy for treating bipolar disorder (BD), its efficacy is unproven. The present review and meta-analysis evaluated the treatment outcomes of patients with BD treated with CBT plus medication and compared these data with the outcomes of those who received standard care alone.

Methods: Electronic searches from inception to July 31, 2016, were performed using PubMed, Medline OVID, Cochrane Library, EMBASE, CINAHL plus, and PsycINFO. In the extensive electronic literature search, keywords such as "bipolar disorder," "manic-depressive psychosis," "bipolar affective disorder," "bipolar depression," "cognitive therapy," "cognitive-behavioral therapy," and "psychotherapy" were transformed into MeSH terms, and only randomized controlled trials (RCTs) were included. The pooled odds ratios (ORs) of relapse rates and Hedges's g, along with 95% confidence intervals (CIs), for the mean differences in the levels of depression, mania, and psychosocial functioning were calculated. Further subgroup analyses were conducted according to the characteristics of the CBT approaches, patients, and therapists, if the data were available.

Result: A total of 19 RCTs comprising 1384 patients with type I or II BD were enrolled in our systematic review and meta-analysis. The main analysis revealed that CBT could lower the relapse rate (pooled OR = 0.506; 95% CI = 0.278 -0.921) and improve depressive symptoms (g = -0.494; 95% CI = -0.963 to -0.026), mania severity (g = -0.581; 95% CI = -1.127 to -0.035), and psychosocial functioning (g = 0.457; 95% CI = 0.106-0.809).

Conclusions: CBT is effective in decreasing the relapse rate and improving depressive symptoms, mania severity, and psychosocial functioning, with a mild-to-moderate effect size. Subgroup analyses indicated that improvements in depression or mania are more potent with a CBT treatment duration of ≥90 min per session, and the relapse rate is much lower among patients with type I BD.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176849PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417606PMC
September 2017

Evaluation of a smartphone-based assessment system in subjects with chronic ankle instability.

Comput Methods Programs Biomed 2017 Feb 11;139:191-195. Epub 2016 Nov 11.

National Yang-Ming University, Taipei, Taiwan. Electronic address:

Background: Ankle sprain is the most common sports-related injury, and approximately 80% of patients studied suffered recurrent sprains. These repeated ankle injuries could cause chronic ankle instability, a decrease in sports performance, and a decrease in postural control ability. At the present time, smartphones have become very popular and powerful devices, and smartphone applications (apps) that have been shown to have good validity have been designed to measure human body motion. However, the app focusing on ankle function assessment and rehabilitation is still not widely used and has very limited functions. The purpose of this study is to evaluate the feasibility of smartphone-based systems in the assessment of postural control ability for patients with chronic ankle instability.

Methods: Fifteen physically active adults (6 male, 9 female; aged = 23.4 ± 5.28 years; height = 167.13 ± 7.3 cm; weight = 62.06 ± 10.82 kg; BMI = 22.08 ± 2.57 kg/ m) were recruited, and these participants had at least one leg that was evaluated as scoring lower than 27 points according to the Cumberland Ankle Instability Tool (CAIT). The smartphone used in the study was ASUS Zenfone 2, and an app developed using MIT App Inventor was used to record built-in accelerometer data during the assessment process. Subjects were asked to perform single leg stance for 20 s in eyes-open and eyes-closed conditions with each leg. The smartphone was fixed in an upright position on the middle of the shin, using an exercise armband, with the screen facing forward. The average of recorded acceleration data was used to represent the postural control performance, and higher values indicated more instability. Data were analyzed with a paired t-test with SPSS 17.0, and the statistical significance was set as alpha <0.05.

Results: A significant difference was found between CAIT scores from the healthier leg and injured leg (healthier leg 23.07 ± 3.80 vs. injured leg 18.27 ± 3.92, p < 0.001). Significant differences were also found between the scores for the healthier leg and injured leg during both eyes-open and eyes-closed conditions (eyes-open: healthier leg 0.051 ± 0.018 vs. injured leg 0.072 ± 0.034, p = 0.027; eyes-closed: healthier leg 0.100 ± 0.031 vs. injured leg 0.123 ± 0.038, p = 0.001, unit: m/s). Significant differences were also found between eyes-open and eyes-closed conditions during both single leg standing with healthier leg and injured leg (healthier leg: eyes-open 0.051 ± 0.018 vs. eyes-closed 0.100 ± 0.031, p < 0.001; injured leg: eyes-open 0.072 ± 0.034 vs. eyes-closed 0.123 ± 0.038, p = 0.001, unit: m/s). The results demonstrate that the smartphone software can be used to discriminate between the different performances of the healthier leg and injured leg, and also between eyes-open and eyes-closed conditions.

Conclusion: The smartphone may have the potential to be a convenient, easy-to-use, and feasible tool for the assessment of postural control ability on subjects with chronic ankle instability.
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http://dx.doi.org/10.1016/j.cmpb.2016.11.005DOI Listing
February 2017

Validity of an ankle joint motion and position sense measurement system and its application in healthy subjects and patients with ankle sprain.

Comput Methods Programs Biomed 2016 Jul 13;131:89-96. Epub 2016 Apr 13.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan. Electronic address:

Background And Objective: Ankle motion and proprioception in multiple axis movements are crucial for daily activities. However, few studies have developed and used a multiple axis system for measuring ankle motion and proprioception. This study was designed to validate a novel ankle haptic interface system that measures the ankle range of motion (ROM) and joint position sense in multiple plane movements, investigating the proprioception deficits during joint position sense tasks for patients with ankle instability.

Methods: Eleven healthy adults (mean ± standard deviation; age, 24.7 ± 1.9 years) and thirteen patients with ankle instability were recruited in this study. All subjects were asked to perform tests to evaluate the validity of the ankle ROM measurements and underwent tests for validating the joint position sense measurements conducted during multiple axis movements of the ankle joint. Pearson correlation was used for validating the angular position measurements obtained using the developed system; the independent t test was used to investigate the differences in joint position sense task performance for people with or without ankle instability.

Results: The ROM measurements of the device were linearly correlated with the criterion standards (r = 0.99). The ankle instability and healthy groups were significantly different in direction, absolute, and variable errors of plantar flexion, dorsiflexion, inversion, and eversion (p < 0.05).

Conclusions: The results demonstrate that the novel ankle joint motion and position sense measurement system is valid and can be used for measuring the ankle ROM and joint position sense in multiple planes and indicate proprioception deficits for people with ankle instability.
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http://dx.doi.org/10.1016/j.cmpb.2016.03.026DOI Listing
July 2016

Analysis of Trunk Rolling Performances by Mattress Mobility Detection System in Poststroke Patients: A Pilot Study.

Biomed Res Int 2016 3;2016:8743051. Epub 2016 Mar 3.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 114, Taiwan.

Purpose: The purpose of this study was to investigate the correlation of kinematic variables with quality of trunk control in poststroke patients.

Methods: This cross-sectional study included stroke subjects with mild to moderate motor deficit corresponding to Brunnstrom stages 3-4. Trunk functional performance was measured using bed mobility monitor system. All tasks were repeated ten times for both directions in each subject. Outcome measurements included the movement time and displacement of center of pressure (CoP) from supine to side lying and returning.

Results: The results revealed that a significant longer turning time was observed when turning from the paretic side toward the nonparetic side compared to the other direction, with an estimated mean difference of 0.427 sec (P = 0.005). We found a significant difference in the time of rolling back to supine position between two directions. The displacement of CoP in rolling back from side lying on the nonparetic side was smaller than that from the paretic side with an estimated mean difference of -0.797 cm (P = 0.023).

Conclusions: The impaired trunk mobility was associated with increased movement time and decreased displacement of CoP in poststroke patients. Trunk rolling performance has potential in assessment of stroke patients.
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http://dx.doi.org/10.1155/2016/8743051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794586PMC
December 2016

Effects of Computer-Aided Interlimb Force Coupling Training on Paretic Hand and Arm Motor Control following Chronic Stroke: A Randomized Controlled Trial.

PLoS One 2015 20;10(7):e0131048. Epub 2015 Jul 20.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan (R.O.C.).

Objective: We investigated the training effects of interlimb force coupling training on paretic upper extremity outcomes in patients with chronic stroke and analyzed the relationship between motor recovery of the paretic hand, arm and functional performances on paretic upper limb.

Design: A randomized controlled trial with outcome assessment at baseline and after 4 weeks of intervention.

Setting: Taipei Veterans General Hospital, National Yang-Ming University.

Participants: Thirty-three subjects with chronic stroke were recruited and randomly assigned to training (n = 16) and control groups (n = 17).

Interventions: The computer-aided interlimb force coupling training task with visual feedback included different grip force generation methods on both hands.

Main Outcome Measures: The Barthel Index (BI), the upper extremity motor control Fugl-Meyer Assessment (FMA-UE), the Motor Assessment Score (MAS), and the Wolf Motor Function Test (WMFT). All assessments were executed by a blinded evaluator, and data management and statistical analysis were also conducted by a blinded researcher.

Results: The training group demonstrated greater improvement on the FMA-UE (p<.001), WMFT (p<.001), MAS (p = .004) and BI (p = .037) than the control group after 4 weeks of intervention. In addition, a moderate correlation was found between the improvement of scores for hand scales of the FMA and other portions of the FMA UE (r = .528, p = .018) or MAS (r = .596, p = .015) in the training group.

Conclusion: Computer-aided interlimb force coupling training improves the motor recovery of a paretic hand, and facilitates motor control and enhances functional performance in the paretic upper extremity of people with chronic stroke.

Trial Registration: ClinicalTrials.gov NCT02247674.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131048PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507879PMC
April 2016

Measurement of bed turning and comparison with age, gender, and body mass index in a healthy population: application of a novel mobility detection system.

Biomed Res Int 2014 29;2014:819615. Epub 2014 Apr 29.

Department of Physical Therapy and Assistive Technology, National Yang Ming University, No. 155, Sec. 2, Linong Street, Beitou, Taipei City 112, Taiwan.

We developed a mobility detection system to analyze pressure changes over time during side-turns in 29 healthy volunteers (17 males and 12 females) with a mean age of 46.1 ± 19.64 years (ranging from 23 to 86 years) in order to determine the effect of gender, age, and BMI on performance during bed postural change. Center of gravity (COG) location, peak pressure of counteraction, and time to reach peak pressure were the main outcomes used to gauge the ability to make a spontaneous side-turn. Men exhibited significantly higher side-turning force (P = 0.002) and back-turning force (P = 0.002) compared with women. Subjects with BMI ≥ 27 kg/m(2) had significantly higher side-turning force (P = 0.007) and back-turning force (P = 0.007) compared with those with BMI < 27 kg/m(2). After adjusting for other covariates, age positively correlated with back-turning time (P = 0.033) and negatively correlated with side-turning speed (P = 0.005), back-turning speed (P = 0.014), side-turning force (P = 0.010), and back-turning force (P = 0.016), respectively. Turning times negatively correlated with time to reach peak pressure (P = 0.008). Our system was effective in detecting changes in turning swiftness in the bed-ridden subject.
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http://dx.doi.org/10.1155/2014/819615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021992PMC
February 2015

Validity and reliability of a novel device for bilateral upper extremity functional measurements.

Comput Methods Programs Biomed 2014 May 15;114(3):315-23. Epub 2014 Mar 15.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan. Electronic address:

Background And Objective: This study was designed to establish the validity and reliability of a new device that measures bilateral shoulder and elbow range of motion (ROM) and grip force performance in vivo. A further aim was to investigate the control of inter-limb grip force coordination during isometric force-maintenance tasks. Validity of the ROM and grip force measurements was examined using a validated clinical goniometer and standard weights.

Subjects: Twenty-one healthy adults (six female, 15 male; mean±standard deviation age=23.05±3.51) were recruited for this study.

Design: All subjects were asked to perform tests to evaluate the validity and reliability of ROM, grip force maximum voluntary contraction (MVC) and coordination control measurements.

Results: The ROM and grip force measurements were linearly correlated with criterion standards. For reliability testing, all of the intraclass correlation coefficient values were >0.99. The inter-limb grip force coordination control task showed that the force modulation timing during dominant-to-non-dominant hand transition was longer than the non-dominant-to-dominant hand transition (p<0.05).

Conclusions: These results demonstrate that this device is valid and reliable when used to measure shoulder and elbow ROM and grip force of both hands. Isometric force-maintenance tasks also indicated changes in inter-limb grip force control.
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http://dx.doi.org/10.1016/j.cmpb.2014.02.012DOI Listing
May 2014

Influence of aging on bimanual coordination control.

Exp Gerontol 2014 May 15;53:40-7. Epub 2014 Feb 15.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address:

Degeneration in the neuromuscular system due to aging can affect daily activities that need to be controlled by bimanual coordination with both hands. However, little is known about the influence of aging on grip strength and bimanual coordination control between hands. The purpose of this study was to investigate the influence of aging on the maximum grip force output and capacity of coordination control of two hands. Ten healthy elderly and 21 young adults were recruited and asked to execute maximum grip force tests and bimanual coordination control tasks with reciprocal grasping, holding, and releasing of a dynamometer with both hands at three target force levels (10, 20 and 40% maximal voluntary contraction, MVC). Compared with the young group, the maximum grip force of the hands of the elderly group was significantly lower by 77.5% (p<0.05) and 71.1% (p<0.05) in the dominant and non-dominant hands, respectively. The elderly adults also displayed a significantly longer alternating time control in the dominant to non-dominant and non-dominant to dominant hands at the 20% MVC target force level (p<0.05). Aging reduces the maximum hand grip force output and the performance of bimanual coordination control of two hands, which may lead to difficulty with the execution of daily activities requiring both hands.
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http://dx.doi.org/10.1016/j.exger.2014.02.005DOI Listing
May 2014