Botulinum toxin A injection for post-stroke upper limb spasticity and rehabilitation practices from centers across Asian countries

Purpose

Describe real-life practice and outcomes in the management of post-stroke upper limb spasticity with botulinum toxin A (BoNT-A) in Asian settings.

Methods

Subgroup analysis of a prospective, observational study (NCT01020500) of adult patients (≥18 years) with post-stroke upper limb spasticity presenting for routine spasticity management, including treatment with BoNT-A. The primary outcome was goal attainment as assessed using goal-attainment scaling (GAS). Patients baseline clinical characteristics and BoNT-A injection parameters are also described.

Results

Overall, 51 patients from Asia were enrolled. Rates of comorbid cognitive and emotional problems were relatively low. Patients tended to have more severe distal limb spasticity and to prioritize active over passive function goals. Most (94.1%) patients in the subgroup were treated with abobotulinumtoxinA. For these patients, the median total dose was 500 units, and the most frequently injected muscles were the biceps brachii (83.3%), flexor carpi radialis (72.9%), and flexor digitorum profundus (66.7%). Overall, 74.5% achieved their primary goal and the mean GAS T score after one treatment cycle was 56.0 ± 13.0, with a change from baseline of 20.9 ± 14.3 (p < 0.001). The majority (96.1%) of Asian patients were rated as having improved.

Conclusion

In the Asian treatment setting, BoNT-A demonstrated a clinically significant effect on goal attainment for the real-life management of upper limb spasticity following stroke.

Event-Related Desynchronization During Mirror Visual Feedback: A Comparison of Older Adults and People After Stroke

Event-related desynchronization (ERD), as a proxy for mirror neuron activity, has been used as a neurophysiological marker for motor execution after mirror visual feedback (MVF). Using EEG, this study investigated ERD upon the immediate effects of single-session MVF in unimanual arm movements compared with the ERD effects occurring without a mirror, in two groups: stroke patients with left hemiplegia and their healthy counterparts. During EEG recordings, each group performed one session of mirror therapy training in three task conditions: with a mirror, with no mirror, and with a covered mirror. An asymmetry index was calculated from the subtraction of the event-related spectrum perturbations between the C3 and C4 electrodes located over the sensorimotor cortices contralateral and ipsilateral to the moved arm. Results of the effect of task versus group in contralateral and ipsilateral motor areas showed that there was a significant effect of task condition at the contralateral motor area in the high beta band (17–35 Hz) at C3. High beta ERD showed that the suppression was greater over the contralateral hemisphere than it was over the ipsilateral hemisphere in both study groups. The magnitude of low beta (12–16 Hz) ERD in patients with stroke was more suppressed in contralesional C3 under the no mirror compared to that of the covered mirror and similarly more suppressed in ipsilesional C4 ERD under the no mirror compared to that of the mirror condition. The correlation analysis revealed that the magnitude of ERSP power correlated significantly with arm severity in the low and high beta bands in patients with stroke, and a higher asymmetry index in the low beta band was associated with higher arm functioning under the no-mirror condition. There was a shift in sensorimotor ERD toward the contralateral hemisphere as induced by MVF accompanying unimanual movement in both stroke patients and healthy controls. The use of ERD in the low beta band as a neurophysiological marker to indicate the relationships between the amount of MVF-induced ERD attenuation and motor severity, and the outcome indicator for improving stroke patients’ neuroplasticity in clinical trials using MVF are warranted to be explored in the future.

Relation between rich-club organization versus brain functions and functional recovery after acute ischemic stroke

Studies have shown the brain's rich-club organization may underpin brain function and be associated with various brain disorders. In this study, we aimed to investigate the relation between poststroke brain functions and functional recovery versus the rich-club organization of the structural brain network of patients after first-time acute ischemic stroke. A cohort of 16 acute ischemic stroke patients (11 males) was recruited. Structural brain networks were measured using diffusion tensor imaging within 1 week and at 1, 3 and 6 months after stroke. Motor impairment was assessed using the Upper-Extremity Fugl-Meyer motor scale and activities of daily living using the Barthel Index at the same time points as MRI. The rich-club regions that were stable over the course of stroke recovery included the bilateral dorsolateral superior frontal gyri, right supplementary motor area, and left median cingulate and paracingulate gyri. The network properties that correlated with poststroke brain functions were mainly the ratio between communication cost ratio and density ratio of rich-club, feeder and local connections. The recovery of both motor functions and activities of daily living were correlated with higher normalized rich club coefficients and a shorter length of local connections within a week after stroke. The communication cost ratio of feeder connections, the length of rich-club and local connections, and normalized rich club coefficients were found to be potential prognostic indicators of stroke recovery. Our results provide additional support to the notion that different types of network connections play different roles in brain functions as well as functional recovery.

Effect of oral hygiene programmes on oral opportunistic pathogens during stroke rehabilitation

OBJECTIVES

This study was to assess the effectiveness of a conventional oral hygiene care programme (COHCP) and an advanced oral hygiene care programme (AOHCP) on prevalence and viable counts of oral opportunistic pathogens among patients undergoing stroke rehabilitation.

METHODS

A total of 94 patients were randomized to two groups. Subjects were block randomized to either (a) COHCP: manual toothbrushing with oral hygiene instruction (OHI); or (b) AOHCP: powered toothbrushing, mouthrinsing with chlorhexidine and OHI. Prevalence and viable counts of oral opportunistic pathogens including yeasts, aerobic and facultative anaerobic gram-negative bacilli, Staphylococcus aureus, were assessed at baseline, the end of 3 and 6 months.

RESULTS

No significant difference was observed in the prevalence of oral opportunistic pathogens within each group over the clinical trial period. A significant decrease in the viable counts of S. aureus was found over the clinical trial period within AOHCP group (p < 0.05), while the viable counts of yeasts and anaerobic gram-negative bacillus (AGNB) remained stable within each group. Regression analysis failed to detect an association between intervention and the prevalence/viable counts of oral opportunistic pathogens.

CONCLUSIONS

Neither oral healthcare programme significantly affects AGNB, yeast or S. aureus over the study period in terms of prevalence and viable counts.

Oral health-related quality of life in patients with stroke: a randomized clinical trial of oral hygiene care during outpatient rehabilitation

This study was to evaluate the effectiveness of oral hygiene care in improving oral health- and health-related quality of life (OHRQoL and HRQoL) among patients receiving outpatient stroke rehabilitation. Subjects were randomized to: (1) a conventional oral hygiene care programme (COHCP) comprising a manual toothbrush, and oral hygiene instruction, or (2) an advanced oral hygiene care programme (AOHCP) comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, and oral hygiene instruction. The interventional period lasted for 3 months, followed by a 3-month observational period. HRQoL was assessed by SF-12, and OHRQoL was assessed by Oral Health Impact Profile-14 (OHIP-14), General Oral Health Assessment Index (GOHAI), and Oral Health Transitional Scale (OHTS). Participants in AOHCP group had significantly better OHRQoL at the end of clinical trial as assessed by OHTS (p < 0.01), and at the end of observational study as assessed by GOHAI (p < 0.05) than those in the COHCP. Participants in the AOHCP group had significantly better HRQoL as assessed by physical component summary score (PCS) the end of both 3 and 6 months (both p < 0.05). This study provided the evidence that the AOHCP was more effective than the COHCP within stroke rehabilitation in improving subjective health.

A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation

OBJECTIVES

The objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation.

METHODS

Subjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored.

RESULTS

Participants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01).

CONCLUSIONS

Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding.

CLINICAL SIGNIFICANCE

This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities.

Validation of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in persons with disabilities and chronic illnesses for Chinese population

PURPOSE

The aim of this study is to test the psychometric properties and validity of the World Health Organization Assessment Schedule II Chinese Traditional Version (WHODAS II CT) in Traditional Chinese-speaking persons with disabilities and chronic illnesses.

METHOD

The WHODAS II CT has been administrated to a sample of 1020 persons with disabilities and chronic illnesses. The construct validity, internal consistency, concurrent validity and convergent validity were evaluated.

RESULTS

WHODAS II CT showed a satisfactory model fit for the second-order confirmatory factor analysis model (χ(2)/df = 3.05, root means square error of approximation = 0.053, comparative fit index = 0.912, standardized root mean square residual = 0.076), high internal consistency (Cronbach's α = 0.98), high correlation with all domains of Dartmouth Primary Care Cooperative Research Network/World Organization of National Colleges, Academies, and Academic Associations of General Practices/Family Physicians (COOP/WONCA) charts (partial correlation coefficient ranged from 0.26 to 0.74) and significance between persons with and without co-morbidity (all regression coefficients >0).

CONCLUSIONS

WHODAS II CT is a reliable and valid instrument to measure the disability in persons with disabilities and chronic illnesses among Traditional Chinese-speaking population. A further study is required to validate the short version of WHODAS II in order to enhance its applicability in usual and clinical practices. Implications for Rehabilitation This is the first study to evaluate the reliability and validity of WHODAS II in persons with disability and chronic illnesses among Traditional Chinese-speaking population. The WHODAS II CT is a valid instrument in Chinese adults with disabilities and chronic illnesses. The WHODAS II CT is recommended to be used in population-based survey to investigate the health needs of persons with disabilities and chronic illnesses as well as in the rehabilitation programs as an outcome measure.

Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke

BACKGROUND

Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke.

OBJECTIVE

To compare the rehabilitation effectiveness achieved by NMES robot-assisted wrist training and that by robot-assisted training.

METHODS

This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training.

RESULTS

The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05).

CONCLUSIONS

The NMES robot-assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.

Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischemic stroke

BACKGROUND

Blood pressure (BP) variability (BPV) is a novel risk factor for the development of atherosclerotic diseases. High BPV has recently been shown to predict all-cause and cardiovascular mortality in patients with lacunar infarct. Whether BPV has prognostic implications in patients with ischemic stroke subtypes, other than those due to small-vessel occlusion, remains uncertain.

METHODS

We prospectively followed up the clinical outcome of 632 consecutive ischemic stroke patients without atrial fibrillation. The average BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean 12 ± 6 outpatient clinic visits.

RESULTS

The average age of the population was 71 ± 11 years. After a mean of 76 ± 18 months of follow-up, 161 patients died (26%); 35% (n = 56 of 161) of these deaths were due to cardiovascular causes. Sixteen percent and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with high systolic BPV were at significantly greater risk of cardiovascular mortality (hazards ratio (HR) = 2.36; 95% confidence interval (CI) = 1.02-5.49; P < 0.05). High systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI = 1.16-2.75; P < 0.05). There was no association between systolic BPV and nonfatal recurrent stroke or nonfatal ACS. Raised diastolic BPV did not predict recurrent nonfatal stroke, nonfatal ACS, or mortality.

CONCLUSIONS

Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischemic stroke without atrial fibrillation, independent of other conventional risk factors, including average BP control.

World Congresses of the International Society of Physical and Rehabilitation Medicine 2013-2015: the way forward - from Beijing to Berlin

Scientific congresses are an important tool to support communication among scientists, enabling exchange of knowledge and discussion of research results. They can also provide specialist education and allow a forum in which to develop the goals and policies of scientific societies. The World Congresses of the International Society of Physical and Rehabilitation Medicine (ISPRM) aims at continuous improvement of congress quality. The programme development aims are: to operate at the highest possible scientific level; to guarantee continuous communication within the main areas of science in the field; and to invite experts to present topics of recent interest. The first section, the basic programme, largely comprises original papers selected from submitted abstracts. The second section covers topics of recent interest in more depth. Other sessions include recent topics arising from the ISPRM-World Health Organization (ISPRM-WHO) liaison, collaborative sessions with other societies, including national societies special interest sessions and ISPRM partners, and sessions organized by young scientists and students. These aims and programme guide the organizers of the 9th World Congress, which will be held on 19-23 June 2015 in Berlin. The concepts described here will be developed further for use in future ISPRM World Congresses.

A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression

Background

Our previous studies have demonstrated the treatment benefits of dense cranial electroacupuncture stimulation (DCEAS), a novel brain stimulation therapy in patients with major depression, postpartum depression and obsessive-compulsive disorder. The purpose of the present study was to further evaluate the effectiveness of DCEAS combined with body acupuncture and selective serotonin reuptake inhibitors (SSRIs) in patients with post-stroke depression (PSD).

Methods

In a single-blind, randomized controlled trial, 43 patients with PSD were randomly assigned to 12 sessions of DCEAS plus SSRI plus body electroacupuncture (n = 23), or sham (non-invasive cranial electroacupuncture, n-CEA) plus SSRI plus body electroacupuncture (n = 20) for 3 sessions per week over 4 weeks. Treatment outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), the Clinical Global Impression - Severity scale (CGI-S) and Barthel Index (BI), a measure used to evaluate movement ability associated with daily self-caring activity.

Results

DCEAS produced a significantly greater reduction of both HAMD-17 and CGI-S as early as week 1 and CGI-S at endpoint compared to n-CEA, but subjects of n-CEA group exhibited a significantly greater improvement on BI at week 4 than DCEAS. Incidence of adverse events was not different in the two groups.

Conclusions

These results indicate that DCEAS could be effective in reducing stroke patients’ depressive symptoms. Superficial electrical stimulation in n-CEA group may be beneficial in improving movement disability of stroke patients. A combination of DCEAS and body acupuncture can be considered a treatment option for neuropsychiatric sequelae of stroke.

Trial registration

http://www.clinicaltrials.gov, NCT01174394.

A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke

OBJECTIVE

The objective of this study was to review clinical, microbiological, and immunological aspects of oral health, as well as oral health related behaviours among patients following stroke.

DATA SOURCES

A structured search strategy was applied to three electronic databases to identify relevant papers.

STUDY SELECTION

The initial search yielded 19,927 papers, 60 potentially relevant studies (Kappa: 0.974) and 23 relevant papers (Kappa: 0.965) in accordance with the inclusion criteria. Outcomes regarding tooth condition, periodontal condition, oral hygiene status, and dental attendance were pooled for seven meta-analyses. Narrative summaries were provided for those outcomes which could not be pooled for meta-analysis.

RESULTS

The standardized differences in mean values of the parameters (fixed effect, random effect model) for patients with stroke compared to control groups were: number of teeth (-0.325, -0.271), DMFT (0.246, 0.246), oral hygiene status - plaque index (0.305, 0.356) and gingival index (0.716, 0.653), periodontal health status - clinical attachment loss (0.437, 0.490) and probing depth (0.470, 0.579). In addition, a lower chance of dental attendance was observed among patients with stroke (odds ratio: 0.493, 0.480). For those outcomes which could not be pooled for meta-analysis, it was not possible to draw any qualitative conclusion due to the equivocal results of these studies.

CONCLUSIONS

There is an increasing interest in oral health of patients with stroke. Patients with stroke had a poorer clinical oral health status across a range of parameters (tooth loss, dental caries experience, and periodontal status). Coupled with this, their dental attendance was less frequent. Further studies employing standardized assessments of oral health/oral health behaviour can confirm these oral health disparities.

CLINICAL SIGNIFICANCE

With comprehensive literature search, this systematic review and meta-analysis indicated a poorer oral health status and less frequent dental attendance behaviour among patients with stroke.

Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct

BACKGROUND AND PURPOSE

Both blood pressure (BP) and its variability (BPV) are established risk factors for development of atherosclerotic disease and are associated with an increased risk for cardiovascular and all-cause mortality. The prognostic implications of outpatient clinic visit-to-visit BPV amongst patients with lacunar infarction are nevertheless unknown.

METHODS

The clinical outcome of 281 patients with lacunar infarction was prospectively followed up. The average BP and BPV, as determined by the standard deviation of the systolic and diastolic BP, were recorded during a mean 13 ± 6 outpatient clinic visits.

RESULTS

The mean age of the population was 70 ± 10 years. After a mean 78 ± 18 months follow-up, 65 patients died (23%), 31% (20/65) due to cardiovascular causes; 14% and 7% developed recurrent stroke and acute coronary syndrome. After adjusting for age, sex, mean systolic and diastolic BP, cardiovascular risk factors and comorbidities, patients with a systolic BPV of the third tertile had significantly higher risk of all-cause mortality [hazard ratio (HR) 1.97, 95% confidence interval (CI) 1.02-3.80, P = 0.04) and cardiovascular mortality (HR 7.64, 95% CI 1.65-35.41, P < 0.01) than those with systolic BPV of the first tertile. Nevertheless, systolic BPV did not predict recurrent stroke or acute coronary syndrome. Diastolic BPV did not predict various adverse clinical outcomes.

CONCLUSIONS

Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality after lacunar infarct, independent of conventional risk factors including average BP control.

Changes in bone density and geometry of the radius in chronic stroke and related factors: a one-year prospective study

OBJECTIVES

To describe the changes in bone density and geometry of the radius after chronic stroke and the associated clinical factors.

METHODS

Twenty stroke patients (12 men and 8 women, age=42-78 years, time post-stroke=12-166 months) and 23 control participants (14 men and 9 women, age=53-77 years) were assessed at the time of enrolment and one year later. Peripheral quantitative computed tomography was used to scan the radius epiphysis (4% site) and diaphysis (33% site). Grip strength, spasticity, paretic arm disuse, physical activity, and vascular health were also evaluated.

RESULTS

During the follow-up period, only the cortical thickness and cortical bone mineral content (BMC) in the paretic radius diaphysis showed a decline that exceeded the least significant change value (p=0.002). Paretic arm disuse, lower vascular elasticity and physical activity level at initial assessment were significantly related to more decline in cortical thickness at this site (p<0.01).

CONCLUSIONS

The paretic radius diaphysis sustained significant reduction in cortical thickness and cortical BMC over time in chronic stroke, but these changes were less pronounced than those previously reported in sub-acute stroke. Strategies to modify vascular health, disuse, and physical activity may be important in improving upper limb bone health but will need further investigations.

Effect of oral hygiene interventions on opportunistic pathogens in patients after stroke

BACKGROUND

Despite the role of the oral cavity as a reservoir of opportunistic pathogens for infection in patients following stroke, the evaluation of the effects of oral hygiene interventions has been largely neglected.

METHODS

This randomized clinical trial included 102 patients undergoing hospital-based rehabilitation for stroke. Patients were randomized to one of 3 groups: oral hygiene instruction (OHI) only; OHI and 0.2% chlorhexidine mouth rinse twice daily; or OHI, 0.2% chlorhexidine mouth rinse twice daily, and assisted brushing twice weekly. Oral samples were obtained at baseline and after 3 weeks for detection of Staphylococcus aureus, aerobic and facultatively anaerobic gram-negative bacilli, and yeasts.

RESULTS

Almost three-quarters (72.8%) of the patients harbored oral anaerobic gram-negative bacilli at baseline, and more than half had detectable S aureus (56.8%) and yeasts (59.3%). Percentage frequencies and viable counts of pathogens remained relatively stable during the course of the clinical trial, and no significant differences were observed among the 3 patient groups.

CONCLUSIONS

In our study cohort, there was no significant difference in the effectiveness of the 3 different oral hygiene interventions on the prevalence or viable counts of oral opportunistic pathogens.

Changes in bone density and geometry of the upper extremities after stroke: a case report

PURPOSE

The purpose of this study was to examine changes in bone density and geometry of the forearm region and motor function of the paretic upper extremity in a person with subacute stroke. Client Description: The participant was a 48-year-old man with right hemiparesis.

INTERVENTION

Not applicable. Measures and Outcomes: The assessment of upper-extremity (UE) function and bone imaging took place at 3 months and 12 months after stroke. The participant had moderate motor impairment and severe disuse of the paretic UE 3 months after stroke. During the follow-up period, no substantial change in paretic UE function was observed. At the 12 month follow-up, the areal bone mineral density (aBMD) of the ultradistal and mid-regions of the paretic forearm, as measured by dual-energy X-ray absorptiometry, sustained a significant reduction of 7.9% and 5.9%, respectively. The non-paretic side, in contrast, had a significant 4.0% increase in aBMD of the mid-forearm and a 2.8% increase in aBMD of the total forearm. Significant findings from peripheral quantitative computed tomography were a reduction in total volumetric bone mineral density (-12.1%) and bone strength index (-20.6%) in the radius distal epiphysis on the paretic side and an increase in cortical bone mineral content (2.0%) and bone strength index (7.6%) in the radius diaphysis on the non-paretic side.

IMPLICATIONS

After a stroke that resulted in moderate to severe UE impairment, a significant decline in bone mineral density was identified in various skeletal sites in the forearm region as the participant entered the subacute and chronic stages of recovery. The results point to the potential importance of early rehabilitative intervention in preventing unfavourable bone changes in the paretic upper limb among individuals with stroke.

Spectrum of topics for World Congresses and other activities of the International Society for Physical and Rehabilitation Medicine (ISPRM): a first proposal

BACKGROUND

One of the objectives of the International Society for Physical and Rehabilitation Medicine is to improve the continuity of World Congresses. This requires the development of an abstract topic list for use in congress announcements and abstract submissions.

METHODS

An abstract topic list was developed on the basis of the definitions of human functioning and rehabilitation research, which define 5 main areas of research (biosciences in rehabilitation, biomedical rehabilitation sciences and engineering, clinical Physical and Rehabilitation Medicine (PRM) sciences, integrative rehabilitation sciences, and human functioning sciences). For the abstract topic list, these research areas were grouped according to the proposals of congress streams. In a second step, the first version of the list was systematically compared with the topics of the 2003 ISPRM World Congress.

RESULTS

The resulting comprehensive abstract topic list contains 5 chapters according to the definition of human functioning and rehabilitation research. Due to the high significance of clinical research, clinical PRM sciences were placed at the top of the list, comprising all relevant health conditions treated in PRM services. For congress announcements a short topic list was derived.

DISCUSSION

The ISPRM topic list is sustainable and covers a full range of topics. It may be useful for congresses and elsewhere in structuring research in PRM.

Oral health promotion interventions on oral yeast in hospitalised and medically compromised patients: a systematic review

Yeast are major aetiological agents of localised oral mucosal lesions, and are also leading causes of nosocomial bloodstream infections. The purpose of this systematic review was to examine the effectiveness of oral health promotion interventions on the prevalence and incidence of these opportunistic oral pathogens in hospitalised and medically compromised patients. The PubMed, ISI Web of Science and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral yeast. Chlorhexidine delivered in a variety of oral hygiene products appeared to have some effect on oral yeast, although some studies found equivocal effects. Although a wide array of other compounds have also been investigated, their clinical effectiveness remains to be substantiated. Likewise, the utility of mechanical oral hygiene interventions and other oral health promotion measures such as topical application of salivary substitute, remains unsettled. Although many chemical agents contained in oral hygiene products have proven in vitro activity against oral yeast, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remains to be confirmed by further high-quality randomised controlled trials. This is pertinent, given the recent emergence of yeast resistance to conventional antifungal agents.

An fMRI study showing the effect of acupuncture in chronic stage stroke patients with aphasia

Acupuncture is used as a treatment in stroke patients with aphasia, yet the underlying neural mechanisms are unknown. This study aims to examine the relationship between changes in language function and brain activation using functional magnetic resonance imaging in chronic stroke patients with aphasia who underwent an 8-week acupuncture protocol. Seven chronic stroke patients were identified from a stroke database of a regional acute hospital in Hong Kong between January and July 2007. Patients were treated three times a week over a period of 8 weeks. Four acupoints were stimulated on the weak side of the patient's body. No other rehabilitation was given during the study period. Changes in language function were measured by aphasia quotient (AQ) of Cantonese Aphasia Battery (CAB). Functional magnetic resonance imaging blood oxygen level dependent signals were used to demonstrate the correlation between changes in AQ and brain activation after treatment. The patients were divided into well-recovered and poorly- recovered groups based on their CAB scores at entry. The well-recovered group showed significant improvement in CAB scores after receiving acupuncture treatment. A significant correlation between changes in AQ and blood oxygen level dependent activation in the lesioned Wernicke's speech area was found. These preliminary results suggest that acupuncture may be beneficial to language recovery in chronic stroke patients.

The role of sub-cortical brain structures in emotion recognition

PRIMARY OBJECTIVE

This study investigated the role of sub-cortical brain structures in emotion recognition.

METHODS AND PROCEDURES

Fourteen patients (eight left, six right) with sub-cortical brain damage (SS) and 14 matched healthy volunteers (HV) were recruited. A brief neuropsychological battery was administered to measure working memory, visual inattention, Stroop effect and visual organization. A facial and prosodic emotion recognition battery previously developed was used.

RESULTS

SS patients were generally impaired on emotion recognition, with the exception of facial emotion discrimination and tasks involving happy expressions, relative to HV. Preliminary analyses also showed no statistical difference between patients with left- and right-sub-cortical brain damage in terms of emotion recognition.

CONCLUSIONS

The findings provide further support for the role of sub-cortical brain structures (and the damage thereof) as well as probable frontal-limbic neural networks in recognizing basic emotions.

Neural correlates of attention biases of people with major depressive disorder: a voxel-based morphometric study

BACKGROUND

Patients with major depressive disorder are found to show selective attention biases towards mood-congruent information. Although previous studies have identified various structural changes in the brains of these patients, it remains unclear whether the structural abnormalities are associated with these attention biases. In this study, we used voxel-based morphometry (VBM) to explore the structural correlates of attention biases towards depression-related stimuli.

METHOD

Seventeen female patients with major depressive disorder and 17 female healthy controls, matched on age and intelligence, underwent magnetic resonance imaging (MRI). They also performed positive-priming (PP) and negative-priming (NP) tasks involving neutral and negative words that assessed selective attention biases. The reaction time (RT) to a target word that had been attended to or ignored in a preceding trial was measured on the PP and NP tasks respectively. The structural differences between the two groups were correlated with the indexes of attention biases towards the negative words.

RESULTS

The enhanced facilitation of attention to stimuli in the PP task by the negative valence was only found in the depressed patients, not in the healthy controls. Such attention biases towards negative stimuli were found to be associated with reduced gray-matter concentration (GMC) in the right superior frontal gyrus, the right anterior cingulate gyrus and the right fusiform gyrus. No differential effect in inhibition of attention towards negative stimuli in the NP task was found between the depressed patients and the healthy controls.

CONCLUSIONS

Specific structural abnormalities in depression are associated with their attention biases towards mood-congruent information.

Selective attention biases of people with depression: positive and negative priming of depression-related information

Selective attention biases are believed to be one of the cognitive vulnerabilities to depression. This study examined two types of attention biases, namely attention facilitation and attention disinhibition, towards mood-congruent words in 40 clinically depressed outpatients and 40 never-depressed healthy controls. Measures were differential reaction time towards neutral and depressive words in the positive and negative priming paradigms that were used to assess attention facilitation and attention disinhibition, respectively. Results showed that the depressed group exhibited enhanced attention facilitation to depressive words relative to neutral words, whereas the control group did not. The differential reduction of reaction time of the depressed group to the previously presented depressive words relative to the previously presented neutral words was greater than that in the control group. On the other hand, both groups showed similar attention disinhibition to depressive words relative to neutral words. The differential increase in reaction time to previously ignored depressive words relative to the previously ignored neutral words was similar in both groups. The above results suggest that major depressive disorder is characterized by attention facilitation by mood-congruent information, but inhibition difficulties in attention to depression-related information is not specific to depressive disorder.

Agreement between patient and proxy assessments of oral health-related quality of life after stroke: an observational longitudinal study

This study aimed to assess agreement between patient and proxy assessment of patients' oral health-related quality of life (OHRQoL) during the acute stroke phase and 6 months after hospital discharge. As part of an observational longitudinal study, 161 consecutive patients hospitalized after stroke and their caregivers (CGs) were monitored during acute stroke and 6 months after hospital discharge. Patient-CG agreement of health-related quality of life as assessed by the General Oral Health Assessment Index (GOHAI) and Medical Outcomes Study 12-item Short Form (SF-12) which comprises physical (PCS-12) and mental component summaries (MCS-12) was determined by comparison and correlation analyses. Complete data were available for 65 patients and CGs. Compared with acute stroke, there were improvements in GOHAI and SF-12 scores from patient's and CG's perspective at 6-month follow-up. Caregivers overestimated the impact of stroke on MCS-12 over a period of time (P < 0.01) and underestimated the impact on GOHAI during acute stroke (P < 0.001) and on PCS-12 6 months later (P < 0.05). Patient-CG agreement was substantial to excellent during acute stroke [intra-class correlation coefficient (ICC 0.69-0.86)] and fair-to-moderate 6 months later (ICC 0.28-0.60). Agreement was adequate between patients' and CGs' assessment of patient OHRQoL during acute stroke but it was less reliable 6 months after hospital discharge. These findings suggest that proxy assessment of OHRQoL after stroke is effective in assessing stroke-related oral impairments that affect life quality without placing additional burden on stroke patients themselves to assess OHRQoL.

Oral carriage of yeasts and coliforms in stroke sufferers: a prospective longitudinal study

AIM

To investigate prospectively the qualitative and quantitative changes in oral carriage of yeasts and coliforms in southern Chinese people suffering from stroke.

MATERIALS AND METHODS

In 56 elderly people suffering from stroke in a rehabilitation unit of a general medical hospital in Hong Kong, oral microbiological sampling using a combined imprint culture, oral rinse approach and clinical assessment was made during the acute stroke phase, on hospital discharge and 6 months later.

RESULTS

The oral carriage of yeasts increased significantly during acute stroke (P<0.05), whereas coliform carriage did not. A reduction in oral carriage of yeasts was found on hospital discharge and 6 months later and in coliforms at the 6-month assessment (P<0.05). Candida albicans and Klebsiella pneumoniae were the predominant yeast and coliform respectively. Stroke-related difficulty in tooth brushing and denture wearing were associated with higher oral yeast carriage (P<0.05). We also report here for the first time that the use of aspirin was associated with lower oral yeast carriage in people suffering from stroke.

CONCLUSION

Oral yeast carriage was closely linked to the level of stroke-related functional disability that improved over time but had not totally resolved 6 months after hospital discharge. The oral reservoir of yeasts and coliforms in people suffering from stroke is noteworthy by care providers as K. pneumoniae may cause aspiration pneumonia.

Can caregivers be used in assessing oral health-related quality of life among patients hospitalized for acute medical conditions?

OBJECTIVES

To assess the agreement between patients' and caregivers' (CGs) assessment of patients' oral health-related quality of life (OHRQoL) during the acute stage of their hospitalization.

METHODS

A sample of 161 consecutive patients admitted to hospital following stroke and their CGs. Patients and CGs were interviewed independently about the impact of oral health status on the life quality of the patient employing the General Oral Health Assessment Index (GOHAI). Agreement of impact was assessed by comparison (agreement at the group level) and correlation analyses (agreement of individual patient-CG pairs).

RESULTS

The response rate was 76% with 121 pairs of patients and CGs participating. At the group level, variations in patient's own and CG GOHAI scores were found (P < 0.001). The CGs underestimated the impact of oral health on life quality, particularly with respect to aspects of psychosocial functioning compared with patients' own perceptions. However, the bias in reports was small (standardized difference = 0.43). The mean absolute difference in overall scores constituted 8% of the possible range of GOHAI scores. At the individual patient-CG pair level, the intraclass correlation coefficient for GOHAI scores was 0.73 (95% CI 0.61-0.82), indicating substantial agreement.

CONCLUSION

At the group and individual level there was adequate agreement between patients' and CGs' assessment of patients' OHRQoL during the acute stage of their hospitalization. The findings have implications in the use of CGs as proxies in assessing oral health when patients' own assessment may be difficult to obtain.

Neural activities for negative priming with affective stimuli: an fMRI study

Negative priming refers to the slowing down in reaction time to a stimulus that is either the same as, or related to, a distracting stimulus that has been ignored by people in an immediately preceding trial. It can be used as an index to examine the extent to which people are able to disengage attention or even ignore a distracting stimulus. In this fMRI study, with healthy Mandarin-speaking Chinese participants, we replicated the basic negative priming effect with affectively neutral words. Negative priming was associated with increased activities in the anterior cingulate cortex and the insula, a result that supports the inhibition account of negative priming. We observed that the negative priming effect was attenuated by negative affective words, relative to neutral words, suggesting that subjects' inhibition of negative information was compromised. Such attenuation of negative priming by negative affective words was associated with increased activities in the ventrolateral and medial frontal regions, the hippocampus, and supplementary motor areas. These observations indicate that specific frontal and subcortical regions take part in attention orientation toward negative-affect information.

A pilot study of randomized clinical controlled trial of gait training in subacute stroke patients with partial body-weight support electromechanical gait trainer and functional electrical stimulation: six-month follow-up

BACKGROUND AND PURPOSE

This study aimed to assess the effectiveness of gait training using an electromechanical gait trainer with or without functional electrical stimulation for people with subacute stroke.

METHODS

This was a nonblinded randomized controlled trial with a 6-month follow-up. Fifty-four subjects were recruited within 6 weeks after stroke onset and were randomly assigned to 1 of 3 gait intervention groups: conventional overground gait training treatment (CT, n=21), electromechanical gait trainer (GT, n=17) and, electromechanical gait trainer with functional electrical stimulation (GT-FES, n=16). All subjects were to undergo an assigned intervention program comprising a 20-minute session every weekday for 4 weeks. The outcome measures were Functional Independence Measure, Barthel Index, Motricity Index leg subscale, Elderly Mobility Scale (EMS), Berg Balance Scale, Functional Ambulatory Category (FAC), and 5-meter walking speed test. Assessments were made at baseline, at the end of the 4-week intervention program, and 6 months after the program ended.

RESULTS

By intention-to-treat and multivariate analysis, statistically significant differences showed up in EMS (Wilks' lambda=0.743, P=0.005), FAC (Wilks' lambda=0.744, P=0.005) and gait speed (Wilks' lambda=0.658, P<0.0001). Post hoc analysis (univariate 2-way ANCOVA) revealed that the GT and GT-FES groups showed significantly better improvement in comparison with the CT group at the end of the 4 weeks of training and in the 6-month follow-up.

CONCLUSIONS

For the early stage after stroke, this study indicated a higher effectiveness in poststroke gait training that used an electromechanical gait trainer compared with conventional overground gait training. The training effect was sustained through to the 6-month follow-up after the intervention.

Temporal course of vibrotactile imagery

This study examined the temporal courses of imagery processes by having participants imagining vibrotactile sensation as if perceived by the right-hand second finger. The results indicate that the imagery condition elicited a less negative going N400 and then a less positive going P600 than the control condition (perceived without imagining). This is suggestive of a sequential process of retrieving experiences from memory, generating images, and then maintaining the images. Dipole analysis further supports that N400 and P600 (or long latency P300) can be respectively regarded as part of the generic 'imagery network' and as modality-specific processes of imagery.

Cortical Reorganization for Response Regulation With Unilateral Thalamic Stroke Detected by Functional MRI

To understand neural reorganization of response regulation after stroke, a 54-year-old woman with a chronic left thalamic stroke performed a task requiring decisions about the directionality of an arrow during cerebral functional magnetic resonance imaging. Her performance was compared to 13 matched healthy control subjects. Her behavioral responses were slower but as accurate. Bilateral frontal activations were observed in the right medial frontal gyrus (BA 9), left superior frontal gyrus (BA 45), and left frontal rectus gyrus (BA 11). Activation in the right medial frontal gyrus, along with activity in close proximity to the anterior cingulate cortex, was observed, which may reflect reorganization of activity after the loss of function of the anterior cingulate cortex.

Associated factors of post-stroke depression among Hong Kong Chinese: A longitudinal study

The aim of this study was to explore associated factors of post-stroke depression (PSD) among Chinese first-time stroke patients. A 6-month prospective design was adopted with data collected by face-to-face interviews and physical assessment at two observation time points: T1, within 48 h of admission to the rehabilitation hospitals and T2, 6 months after the first interview in the subject's current place of residence. The prevalence of PSD at T1 and T2 was found to be 69% and 48% respectively. Backward linear regression showed that five variables explained 55% of the variance of PSD at T2. Participants who had a higher level of depression at T2 tended to have a higher level of functional disability, less social companionship and poorer informational support. Those who had been homemaker at pre-morbid state and those who exhibited a higher level of depressive symptoms at T1 showed a higher level of depression at T2. The results of this study suggest that PSD could be a psychological condition arising from the disabling consequences and altered family roles caused by a stroke.

Gait training of patients after stroke using an electromechanical gait trainer combined with simultaneous functional electrical stimulation

BACKGROUND AND PURPOSE

This case report describes the implementation of gait training intervention that used an electromechanical gait trainer with simultaneous functional electrical stimulation (FES) for 2 patients with acute ischemic stroke.

CASE DESCRIPTION

Two individuals with post-stroke hemiplegia of less than 6 weeks' duration participated in a 4-week gait training program as an adjunct to physical therapy received at a hospital. After the 4-week intervention, both patients were discharged from the hospital, and they returned after 6 months for a follow-up evaluation.

OUTCOMES

By the end of the 4-week intervention, both patients had shown improvements in scores on the Barthel Index, Berg Balance Scale, Functional Ambulation Categories Scale, 5-m timed walking test, and Motricity Index. In the 6-month follow-up evaluation, both patients continued to have improvements in all outcome measures.

DISCUSSION

This case report shows that, following the use of an electromechanical gait trainer simultaneously with FES, patients after acute stroke had improvements in gait performance, functional activities, balance, and motor control in the long term.

The differential effects of thalamus and basal ganglia on facial emotion recognition

This study examined if subcortical stroke was associated with impaired facial emotion recognition. Furthermore, the lateralization of the impairment and the differential profiles of facial emotion recognition deficits with localized thalamic or basal ganglia damage were also studied. Thirty-eight patients with subcortical strokes and 19 matched normal controls volunteered to participate. The participants were individually presented with morphed photographs of facial emotion expressions over multiple trials. They were requested to classify each of these morphed photographs according to Ekman's six basic emotion categories. The findings indicated that the clinical participants had impaired facial emotion recognition, though no clear lateralization pattern of impairment was observed. The patients with localized thalamic damage performed significantly worse in recognizing sadness than the controls. Longitudinal studies on patients with subcortical brain damage should be conducted to examine how cognitive reorganization post-stroke would affect emotion recognition.

A longitudinal study of the oral health condition of elderly stroke survivors on hospital discharge into the community

AIM

To investigate the oral health of elderly stroke survivors on discharge from hospital into the community after rehabilitation and six months later compared with community dwelling elderly people without stroke.

METHOD

The study took place in the rehabilitation unit of a general medical hospital in Hong Kong. It was a longitudinal study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. Verified clinical examination techniques and measures were used to assess dental caries, periodontal disease, oral hygiene, oral candidiasis, prosthetic status/need and functional disability (Barthel Index [BI]). Socio-demographic information was also collected.

RESULTS

Stroke survivors had significantly higher plaque and bleeding scores on hospital discharge and after six months compared with the control group (p<0.01). On hospital discharge, the stroke group also had a poorer periodontal condition with more 4-5mm pockets. The mean BI on hospital admission was 71 and 91 on discharge. Stroke survivors with a higher BI on discharge had lower plaque scores after six months. The tooth condition, number of functional tooth pairs, prosthetic status, presence of oral candidiasis and oral yeast carriage were similar between stroke and comparison groups.

CONCLUSIONS

Despite significant objective improvement in functional ability after stroke, elderly survivors returning to the community had significantly poorer periodontal health compared with community dwelling elderly without stroke, and the situation did not improve dramatically over six months. The protracted recovery of hand, arm and oral sensori-motor function is the most likely cause.

Prose memory in patients with idiopathic Parkinson's disease

BACKGROUND

The findings of previous studies have suggested that verbal memory impairments were observed in people suffering from Parkinson's disease (PD). Very few studies have examined the comprehensive profile of prose memory deficits that challenges people with PD.

METHODS

Prose memory of 19 patients with PD was examined. Their performance in three constructs, namely recall accuracy, temporal sequence, and distortions, during immediate, delayed and recognition trials was studied.

RESULTS

The patients with PD performed significantly worse in recall accuracy and temporal sequencing of information in the immediate recall trial. During the recognition trial, they made more false alarms than their healthy counterparts.

CONCLUSIONS

Our findings confirm that the performance of people with PD in immediate recall of a prose was impaired. However, the level of performance in subsequent learning and delayed recall trials became comparable to that of the normal controls. The deficit remaining after multiple learning trials was the significantly high false alarms committed in the recognition trial. Our findings highlight the importance of qualitative analysis, in addition to quantitative evaluation, of prose memory in PD.

Oral health-related quality of life of stroke survivors on discharge from hospital after rehabilitation

The study aimed to investigate oral health-related quality of life (OHR-QoL) of stroke survivors on hospital discharge after rehabilitation. It was a cross-sectional study involving 43 elderly survivors of mild to moderate stroke about to be discharged from hospital after rehabilitation and a comparison group of 43 community-dwelling elderly people. The Medical Outcomes Short Form 36 (SF-36) measure, the General Oral Health Assessment Index (GOHAI) and an oral health transition scale were administered prior to a dental examination. Median SF-36 subscale scores were significantly different between groups (P < 0.05). In physical function, role-physical, role-emotional and mental health domains, stroke survivors had significantly lower scores indicating poorer health. The median GOHAI score for the stroke group was 52 and 54 for the comparison group with no significant difference between groups although more stroke survivors had difficulty speaking compared with the comparison group. About 75% of stroke survivors considered their appearance to be worse, half of them felt that speech was worse and about a third had difficulty chewing hard food compared with the pre-stroke condition (P < 0.05). Most participants were partially dentate with no significant difference in DMFT scores or prosthetic status between groups (P > 0.05). Health-related quality of life in general was significantly poorer after stroke although patients were considered physically well enough to be discharged from hospital. There was some impairment of OHR-QoL. The nature of the stroke, the hospital environment including diet, coping strategies and elderly Chinese peoples' perception of health should be taken into account when interpreting measures of health status in stroke survivors.

Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke

Background and Purpose— The effectiveness of functional electrical stimulation (FES) has been investigated in chronic hemiplegia. The present study examines whether FES, given during acute stroke, was more effective in promoting motor recovery of the lower extremity and walking ability than standard rehabilitation alone.

Methods— Forty-six subjects, 70.9±8.0 years old and 9.2±4.1 days after stroke, were assigned randomly to 1 of 3 groups receiving standard rehabilitation with FES or placebo stimulation or alone (control). FES was applied 30 minutes and placebo stimulation 60 minutes, 5 days per week for 3 weeks. Outcome measurements included composite spasticity score, maximum isometric voluntary contraction of ankle dorsi-flexors and planter-flexors, and walking ability. They were recorded before treatment, weekly during the 3-week treatment, and at week 8 after stroke.

Results— No significant differences were found in the baseline measurements. After 3 weeks of treatment, there was a significant reduction in the percentage of composite spasticity score, and a significant improvement in the ankle dorsiflexion torque, accompanied by an increase in agonist electromyogram and a reduction in electromyogram cocontraction ratio in the FES group, when compared with the other 2 groups ( P <0.05). All subjects in the FES group were able to walk after treatment, and 84.6% of them returned home, in comparison with the placebo (53.3%) and control (46.2%, P <0.05) groups.

Conclusions— Fifteen sessions of FES, applied to subjects with acute stroke plus standard rehabilitation, improved their motor and walking ability to the degree that more subjects were able to return to home.

Stroke care in the home: the impact of social support on the general health of family caregivers

BACKGROUND

Throughout the stroke rehabilitation process, community care is one of the most important elements. Learning to live with and take care of a family member with a stroke is immensely complex and demanding. Without appropriate support, family caregivers are at risk of their own general health decreasing, thus becoming a patient themselves - the second patient in the family.

AIM

The aim of this study was to examine aspects of social support available to family caregivers during the first 12-week transitional period following hospital discharge.

DESIGN AND METHOD

This study adopted a cross-sectional descriptive design. Regression analysis was performed for examining the types of social support received and the general health of family caregivers. Open-ended questions were used to gain a better understanding of situation-specific supports including their availability, utilization and eventual satisfaction.

RESULTS

Findings confirm that home care for the stroke survivor is heavy and demanding. Health-related care tasks were the most stressful. Around 40% of the family caregivers reported somatic symptoms. Fewer persons in the social network of the family caregivers had provided support compared with the number of support people that caregivers thought available. Two inadequate types of support were tangible support and information support. Professional advice and feedback in relation to home care skills were particularly lacking.

CONCLUSION

Findings of this study affirmed that stroke care needs exceed the hospital boundary. Professional support to family caregivers is essential so as to sustain home care and protect the caregiver's health. This is particular important during the first 12 weeks transitional period after hospital discharge. RELEVANCE TO CLINICAL PRACTICE. This study highlighted the implications of social support to nursing practice, especially in predischarge planning and community care. Findings of this study may provide information and data for service planning and community resources co-ordination to support community stroke care.

Cognitive and emotional dysfunction after central pontine myelinolysis

The case of a 67-year-old right-handed Chinese man with Central Pontine Myelinolysis [CPM] is described to illustrate the resulting cognitive and emotional disturbances. A comparison of the data in this report with that in published studies suggests that ethnicity does not seem to have much effect on the symptoms of CPM. Possible underlying neural-pathological mechanisms are discussed. This case further substantiates the speculation that the brainstem plays a role in higher cognitive processes and emotional regulation.

Emotion recognition in patients with idiopathic Parkinson's disease

Emotion recognition (ER) was examined in 64 patients with idiopathic Parkinson's disease (PD; 56 bilateral and 8 right-sided) and 64 matched healthy volunteers. Participants were administered an ER battery, consisting of the following subscores: overall ER (OER), overall facial ER, facial emotion identification (FEI) and discrimination, overall prosodic ER, and prosodic emotion identification (PEI) and discrimination. Measures of visuospatial functions, auditory attention, and depression were also administered. After controlling for visuospatial functions, auditory attention and depression, results indicated that patients with bilateral PD had poorer performance on all ER subscores, regardless of the modality and type of experimental task involved, relative to healthy volunteers. However, patients with right-sided PD had difficulty on FEI and PEI only. Whereas none of the clinical variables examined in this study predicted any of the ER subscores, visual organization and auditory attention positively predicted OER in patients with PD. In addition, visual organization also positively predicted FEI in these patients. Implications are discussed in terms of the neural substrates underlying ER.

Frontal fluency and memory functioning among multiple sclerosis patients in Hong Kong

THE PRIMARY OBJECTIVE

The frontal fluency and memory functioning among Chinese patients with multiple sclerosis (MS) were investigated in order to identify cross-cultural differences in the impact of MS on cognitive functions. RESEARCH DESIGN, METHODS AND PROCEDURES: Cognitive profiles of 11 Chinese patients with MS were compared to that of their corresponding matched healthy volunteers. Since MS is of low prevalence in Hong Kong, the present sample is considered representative of patients with MS in the Hong Kong Island district. Frontal fluency and memory measures, namely Chinese Rey Auditory Verbal Learning Test, Aggie Figure Learning Test, Word Fluency Test (fruit/vegetable and animal categories), and Design Fluency Test were administered one-on-one to the participants to evaluate their cognitive functions along the verbal-non-verbal axis.

MAIN OUTCOMES AND RESULTS

Results indicated that patients with MS performed poorer on non-verbal, but not verbal measures in this study relative to their healthy counterparts. These deficits cannot be explained by clinical or demographic variables.

CONCLUSIONS

These findings further support the speculation of a verbal-non-verbal distinction for cognitive deficits in patients with MS in Hong Kong.

Self-regulatory learning and generalization for people with brain injury

PRIMARY OBJECTIVE

brain injury can result in the loss of previous learnt behaviours that affect an individual's daily functioning. The use of self-regulation helps the individual to relearn the lost behaviours by bringing him/her to self-conscious level through independent and reflective learning derived using a social cognitive perspective. The purpose of this paper is to report on clinical observations made with the use of self-regulation in people with brain injury during the relearning of lost functions.

METHODS AND PROCEDURES

daily tasks were used to assess the relearning ability of the subjects pre- and post-programme.

EXPERIMENTAL INTERVENTION

one-week self-regulatory training on five selected daily tasks.

MAIN OUTCOMES AND RESULTS

these provisory observations would suggest that, with specific guidance for people with different needs, such as with impaired cognitive function and depression, self-regulation is effective in enhancing their relearning.

CONCLUSION

Self-regulatory training is effective in enhancing the relearning of lost functions.

Oral perception and oral motor ability in edentulous patients with stroke and Parkinson's disease

Oral perception and oral motor ability were assessed in edentulous patients with stroke, Parkinson's disease, and an age and gender matched control group. Standard stereognosis and oral motor ability tests were performed, with and without complete dentures in situ. Statistical comparisons were made using ANOVA, Levene's test and paired t-tests. Stroke patients had significantly poorer stereognostic measures than Parkinson's disease patients and controls (P < 0.02). Stereognostic measures were better in all groups when dentures were worn. There were no differences in oral motor ability between groups. Oral stereognosis was significantly impaired in stroke patients. Oral stereognostic ability was better in all groups when dentures were worn. The oral motor ability test lacked the sensitivity to detect differences in motor ability between experimental groups. Edentulous patients with stroke should be encouraged to wear dentures during the rehabilitation phase as oral stereognosis is then less impaired.

Epidemiological study of multiple sclerosis in Hong Kong Chinese: questionnaire survey

OBJECTIVE

To study the epidemiology of multiple sclerosis in Hong Kong Chinese.

DESIGN

Cross-sectional questionnaire survey.

SETTING

Neurology and paediatric neurology departments in Hong Kong from January through June 1999.

PARTICIPANTS

All confirmed multiple sclerosis patients.

MAIN OUTCOME MEASURES

Demographic data, investigation results, Kurtzke's Expanded Disability Status Scale during the last follow-up visit, number of relapses between 1997 and 1998, and treatments used/currently in use.

RESULTS

Fifty-three Chinese multiple sclerosis patients were identified. The prevalence was thus estimated to be 0.77 per 100,000 population. This low prevalence was also noted in other multiple sclerosis studies from South-East Asia (range, 0.8-4 per 100,000 population). The female to male ratio among the Chinese multiple sclerosis sufferers was 9.6:1, a figure somewhat higher than that reported in the other studies from South-East Asia (range, 3.2-6.6:1). The Chinese multiple sclerosis patients in this study also had a high spinal cord involvement (66%) and a low presence of cerebrospinal fluid oligoclonal banding (40%). These findings were different from those in Caucasian multiple sclerosis patients.

CONCLUSION

Multiple sclerosis in Hong Kong Chinese has a low prevalence, a high female to male ratio, and a low cerebrospinal fluid oligoclonal banding presence.