Ching-Yi Wu

Background: Early detection of cognitive decline in older adults is essential for timely interventions to preserve independence in instrumental activities of daily living (IADLs). Existing cognitive screening tools often lack ecological validity or require extensive administration. Dual‐task paradigms combining cognitive and motor demands may provide a practical and sensitive alternative. Objective: This study aimed to validate two dual‐task measures integrating cognition and hand function as cognitive screening tools for older adults. Methods: A total of 103 community‐dwelling older adults (≥ 60 years) were recruited and categorized into cognitively healthy (CH, n = 61) and cognitively impaired (CI, n = 42) groups based on Montreal Cognitive Assessment (MoCA) scores. Two dual tasks were proposed: (1) Serial Sevens Test with the Box and Block Test (SST‐BBT) and (2) Frequency Discrimination with the Box and Block Test (FD‐BBT). Construct validity was examined using known‐groups comparisons and receiver operating characteristic (ROC) analyses. Criterion‐related validity was assessed via correlations with the Mini‐Mental State Examination, MoCA, Stroop Color and Word Test, and Lawton Instrumental Activities of Daily Living scale. Results: After controlling for age as a covariate, the SST‐BBT dual task significantly differentiated CH and CI groups ( p < 0.001), with an area under the ROC curve (AUC) of 0.768 (95% CI: 0.675–0.862). The FD‐BBT dual task also showed group differences ( p = 0.003) but demonstrated lower sensitivity and specificity (AUC = 0.713, 95% CI: 0.610–0.815). When applying the established dual‐task cutoffs, the SST‐BBT successfully discriminated performance across all criterion measures independent of age ( F s > 4.15, p s < 0.045, partial > 0.039), whereas the FD‐BBT failed to discriminate executive function. Both dual‐task measures demonstrated fair‐to‐good correlations with established cognitive and functional assessments ( r s = 0.356–0.551), supporting their criterion‐related validity. Conclusions: The SST‐BBT dual task demonstrated acceptable validity, sensitivity, and ecological relevance, supporting its potential as a practical screening tool for detecting CI in older adults. Future studies should replicate these findings in larger, more diverse samples and examine longitudinal outcomes to establish predictive validity. Trial Registration: ClinicalTrials.gov identifier: NCT0468977.6:

Aging involves declines in cognitive and physical functions, raising risks of falls, loss of independence, and poorer quality of life. Dual-task training, integrating cognitive and motor activities, has shown benefits, but direct comparisons of additional dual-task training (ADT), which embeds cognitive demands within motor tasks, and incorporated dual-task training (IDT), which requires concurrent yet independent cognitive tasks, are limited. This study compared the effects of ADT and IDT on cognitive function, physical performance, instrumental activities of daily living (IADL), and quality of life in community-dwelling older adults. Seventy-four participants (≥60 years) were randomized to ADT (n = 34) or IDT (n = 40) and completed a 12-week group program. Cognitive outcomes were measured with the Montreal Cognitive Assessment, Digit Symbol Substitution Test, Wechsler Memory Scale-III Word List, and Stroop Color Word Test; motor outcomes with the Box and Block Test, Timed Up and Go, and dual-task indices (BBT-SST, BBT-FD); functional outcomes with the Lawton IADL and Community Integration Questionnaire (CIQ). A significant group × time effect was found for BBT-SST number scores (p =0.002), with IDT yielding greater dual-task cognitive gains. Both groups improved in global cognition, processing speed, and working memory, while only IDT enhanced motor performance and motor-cognitive coordination. No significant changes were observed in TUG, dual-task cost, IADL, or CIQ. IDT showed superior benefits for dual-task cognition and coordination, suggesting greater ecological validity, more efficient resource allocation, and closer alignment with real-world demands. Future studies should investigate electroencephalography (EEG) based neural mechanisms and develop VR approaches for at-risk older adults.

BACKGROUND Non-pharmacological interventions play a critical role in dementia care, yet maintaining engagement and adherence remains challenging. Immersive virtual reality (VR) provides a promising platform for cognitive training, particularly when integrated with personally meaningful leisure activities that may enhance therapeutic resonance. OBJECTIVE This study aimed to examine the feasibility, usability, and preliminary cognitive effects of a leisure-based immersive VR cognitive training program in older adults with dementia. METHODS A single-arm pre–post pilot study was conducted with 16 older adults with mild to moderate dementia recruited from a hospital and a dementia day care center. Participants completed a 15-session VR intervention over 5 weeks, involving gardening-based activities targeting multiple cognitive domains. Feasibility outcomes included VR acceptance (QAVREE), simulator sickness (SSQ), usability (SUS), and emotional responses (OERS). Cognitive, functional, and psychosocial outcomes were assessed using the Montreal Cognitive Assessment (MoCA), Stroop test, Color Trails Test (CTT), Frontal Assessment Battery (FAB), Barthel Index, Instrumental Activities of Daily Living (IADL), Cornell Scale for Depression in Dementia (CSDD), measures of Behavioral and Psychological Symptoms of Dementia (BPSD), Dementia Quality of Life (DQoL), and the Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS). Paired t-tests were used to examine pre–post differences. RESULTS Sixteen participants completed feasibility assessments, and fifteen completed the intervention. VR acceptance significantly increased after the first session (p < .001), while simulator sickness significantly decreased (p = .009). Emotional responses indicated high levels of pleasure and alertness with minimal negative affect. Usability was rated as acceptable (SUS = 70.5 ± 12.17). A significant improvement in global cognitive function was observed (MoCA, p = .001, d = 1.03); however, no significant changes were found in domain-specific cognitive measures, activities of daily living, quality of life, or psychosocial outcomes. CONCLUSIONS Leisure-based immersive VR cognitive training appears to be feasible, acceptable, and well tolerated in older adults with dementia. These preliminary findings suggest that aligning technology with meaningful life experiences may enhance global cognitive function and engagement. Further randomized controlled trials with larger samples are warranted to confirm the long-term effectiveness and functional impact of this approach. CLINICALTRIAL ClinicalTrials.gov Identifier NCT07033468. (08/01/2024)

Stroke survivors often experience persistent upper extremity (UE) motor impairments, which significantly hinder their ability to perform daily functions. W

Background: Cognitive training is an effective approach to support cognitive function in older adults. Incorporating meaningful leisure activities, such as gardening, may enhance both engagement and training outcomes. While fully immersive virtual reality (VR) offers ecologically valid and engaging environments that can further boost motivation, limited research has explored the combination of VR-based cognitive training and leisure activities for older adults. Objective: This study aims to assess the feasibility, usability, and preliminary effectiveness of leisure-based VR cognitive training for community-dwelling older adults. Methods: A fully immersive VR cognitive training system, controlled via a head-mounted display, was developed, incorporating gardening-themed activities such as planting, fertilizing, watering, and harvesting. These tasks were designed to engage multiple cognitive domains, including memory, attention, executive function, processing speed, and visuospatial abilities. The program consisted of 16 sessions delivered over 8 weeks (twice weekly, 1 hour per session). Cognitive outcomes were assessed before and after training using the Montreal Cognitive Assessment, the digit symbol substitution test, word list immediate and delayed recall, spatial span, and the Stroop Color and Word Test. Feasibility, acceptance, and usability were evaluated using the System Usability Scale and a posttraining questionnaire. Licensed occupational therapists from both community and institutional settings assessed the training system’s usability. Results: All 41 participants (mean age 69.79, SD 5.05 y) completed the training with 100% adherence and no serious adverse events. Feasibility ratings—particularly for perceived usefulness, intention to use, and subjective norms—reflected strong acceptance. Usability ratings from older adults indicated high ease of use, enjoyment, and positive experience, while professionals rated the system as moderately usable (mean System Usability Scale score 68.01, SD 8.38). Statistically significant improvements were observed in general cognition (P=.004), processing speed (P=.049), immediate and delayed memory (P<.001), and executive function (P=.002). No significant changes were found in visuospatial memory (P=.29). Conclusions: This study provides preliminary evidence supporting the feasibility and usability of a gardening-based VR cognitive training program for older adults. Feasibility was demonstrated through full adherence, absence of major adverse events, and high participant acceptance. Usability feedback was favorable from both older adults and professionals across community and long term care settings. Additionally, improvements in multiple cognitive domains, including general cognition, processing speed, memory, and executive function, suggest potential cognitive benefits. Future randomized controlled trials with more diverse samples and extended follow-up are warranted to confirm and expand upon these findings.

Stroke, or cerebral vascular accident, is a sudden disease with complex causes, etiology, comorbidities, and a high mortality rate. Most importantly, stroke is the third leading cause for temporary to permanent disabilities, both physical and cognitive, which can affect an individual's quality of life in the long term. Approximately 80% of stroke survivors suffer from motor disabilities over one side of the body, but only 10–20% of these motor disabilities can be fully recovered from. Occupational therapists play a pivotal role in rehabilitating and supporting stroke survivors in their recovery journey, particularly in terms of overcoming obstacles in their activities of daily living. The first section of this chapter describes the etiology, symptoms, and complications of stroke, followed by the role of occupational therapists in stroke rehabilitation, the challenges faced by stroke survivors regarding community integration, and the challenges for caregivers who attend to family members who have had a stroke. The case studies at the end of this chapter describe the journeys of two clients suffering from a stroke. Firstly, during the acute phase of management after onset, and then from the subacute to chronic phases longitudinally to highlight the role of occupational therapists in the rehabilitation process.

Transcranial direct current stimulation (tDCS) is a popular approach to augment the effects of neurorehabilitation. Most studies stimulated the ipsilesional primary motor cortex (iM1); nonetheless, the success of iM1 stimulation was variable, suggesting that it may not be optimal for improving recovery. Ipsilesional premotor cortex (iPMC) may be an alternative candidate based on its likelihood of survival post-stroke and its contribution to functions. This study aimed to determine the effects of tDCS on the iPMC and iM1 with mirror therapy (MT) on motor control, muscle function, and brain activity in chronic stroke. Thirty-six participants were randomly distributed into (1) iPMC-tDCS with MT (PMC) (2), iM1-tDCS with MT (M1), and (3) sham tDCS with MT (sham). Motor control was assessed using kinematics. Muscle function was assessed using the modified Ashworth and the Medical Research Council Scales. The M1 and PMC activity was recorded using electroencephalography (EEG), and the event-related desynchronization and the laterality index (LI) were examined. Significant within-group differences were identified in the kinematic outcomes. After interventions, the PMC group showed reduced paretic upper limb muscle spasticity and improved paretic limb control with greater movement smoothness and peak velocity. The M1 group showed reduced trunk compensation with fewer trunk displacement and flexion. However, the sham group relied more on trunk compensation, demonstrating increased trunk peak velocity and smoothness. Significant between-group differences were also found in paretic limb control and trunk displacement. Post-hoc analysis revealed that the PMC group improved paretic limb control, and the M1 group showed reduced trunk displacement more than the sham group. Significant within-and between-group differences were identified in EEG outcomes. The iM1 and contralesional PMC (cPMC) activity increased from pre-to-post intervention in the M1 group. In contrast, the iM1 activity decreased, and the LI declined from pre- to post-intervention in the sham group. Significant group differences were found in the iM1 activity, with the PMC and M1 having greater iM1 activation than the sham group. Differential treatment benefits were identified between iPMC- and iM1-tDCS with MT. iPMC-tDCS with MT uniquely improved paretic upper limb control with reduced muscle spasticity while iM1-tDCS with MT mitigated trunk compensation during reaching. These findings suggest that both iPMC- and iM1-tDCS could augment the effects of stroke neurorehabilitation and may be considered in clinical applications. ClinicalTrials.gov Identifier: NCT04655209. Registered on 15th November 2020. https://clinicaltrials.gov/study/NCT04655209 .