Stam, H.J.

Physical strain of walking relates to activity level in adults with cerebral palsy (Article)

2013-05-01T00:00:00Z

Objective: To gain insight into underlying mechanisms of inactive lifestyles among adults with spastic bilateral cerebral palsy (CP) with a focus on aerobic capacity, oxygen consumption, and physical strain during walking at preferred walking speed, as well as fatigue. Design: Cross-sectional. Setting: University hospital. Participants: Adults (N=36), aged 25 to 45 years, with spastic bilateral CP, walking with (n=6) or without (n=30) walking aids. Interventions: Not applicable. Main Outcome Measures: Physical strain during walking was defined as oxygen uptake during walking, expressed as percentage of peak aerobic capacity. Participants with spastic bilateral CP walked their preferred walking speed while oxygen uptake was measured using a portable gas analyzer. Peak aerobic capacity was measured during maximal cycle ergometry. An accelerometry-based activity monitor measured total daily walking time. Regression analyses were performed to assess the relation between aerobic capacity, oxygen uptake, and physical strain of walking on the one hand and total daily walking time on the other hand. Results: Neither aerobic capacity nor oxygen uptake during walking was related to total daily walking time (r2=.29, P=.10 and r2=.27, P=.16, respectively). Physical strain of walking at preferred walking speed was inversely related to total daily walking time (r2=.44, P<.01). Conclusions: Physical strain during walking is moderately related to total daily walking time, implying that people with high physical strain during walking at preferred walking speed likely walk less in daily life.

Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis (Article)

2013-04-11T00:00:00Z

Objectives: To systematically review the effects of energy conservation management (ECM) treatment for fatigue in multiple sclerosis (MS), and to study the effect of ECM treatment on restrictions in participation and quality of life (QoL). Data Sources: PubMed, CINAHL, Embase, and Web of Knowledge were searched to identify relevant randomized controlled trials (RCTs) and controlled clinical trials. Study Selection: To select potential studies, 2 reviewers independently applied the inclusion criteria. Data Extraction: Two reviewers independently extracted data and assessed the methodologic quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results. Data Synthesis: The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and QoL; 1 study reported short-term and midterm effects on participation, but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the (1) Fatigue Impact Scale: cognitive (mean difference [MD]=-2.91; 95% confidence interval [CI], -4.32 to -1.50), physical (MD=-2.99; 95% CI, -4.47 to -1.52), and psychosocial (MD=-6.05; 95% CI, -8.72 to -3.37); and (2) QoL: role physical (MD=17.26; 95% CI, 9.69-24.84), social function (MD=6.91; 95% CI, 1.32-12.49), and mental health (MD=5.55; 95% CI, 2.27-8.83). Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short-term or midterm. None of the studies reported long-term results. Conclusions: The systematic review results provide evidence that in the short-term, ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and in improving 3 QoL scales-role physical, social function, and mental health-in fatigued patients with MS. More RCTs that also study long-term results are needed.

Exercise self-efficacy in persons with spinal cord injury: psychometric properties of the Dutch translation of the Exercise Self-Efficacy Scale (Article)

2013-01-01T00:00:00Z

Objective: To assess the reliability and validity of the Dutch version of the Exercise Self-Efficacy Scale (ESES) in persons with spinal cord injury. This is the first independent study of ESES psychometric properties, and the first report on ESES test-retest reliability. Subjects/patients: A total of 53 Dutch persons with spinal cord injury. Methods: Subjects completed the Dutch ESES twice, with 2 weeks between (ESES_1 and ESES_2). Subjects also completed the General Self-Efficacy scale (GSE), and a questionnaire regarding demographic characteristics and lesion characteristics. Psychometric properties of the Dutch translation of the ESES were assessed and compared with those of the original English-language version. Results: The Dutch ESES was found to have good internal consistency (Cronbach's α for ESES_1 = 0.90, ESES_2 = 0.88). Test-retest reliability was adequate (intra-class correlation coefficient = 0.81, 95% confidence interval 0.70-0.89). For validity, a moderate, statistically significant correlation was found between ESES and the GSE (Spearman's ρ ESES_1 = 0.52, ESES_2 = 0.66, p < 0.01). Furthermore, the psychometric properties of the Dutch ESES were found to be similar to those of the original English version. Conclusion: The results of this study support the use of the ESES as a reliable and valid measure of exercise self-efficacy.

Reply (Article)

2012-12-01T00:00:00Z

Subjective caregiver burden of parents of adults with Duchenne muscular dystrophy (Article)

2012-04-30T00:00:00Z

Purpose: To describe subjective caregiver burden of parents of adults with Duchenne muscular dystrophy (DMD) and to identify factors associated with the level of subjective burden. Methods: In a cross-sectional study in 80 parents of 57 adult, severely disabled DMD patients' level of subjective caregiver burden was measured with the Caregiver Strain Index (CSI) and the Self Rated Burden Scale. A visual analogue scale was used to measure happiness. The expanded CSI version, the CarerQoL and open questions were used to analyse caregiving in more depth. In uni and multivariate analyses, associations of objective care characteristics, patient characteristics and caregiver characteristics with burden were explored. Results: Parents indicated substantial burden, but valued giving care as being important and rewarding. Subjective burden was associated with received support, tracheotomy, active coping by the patient and anxiety in patient and parents, together explaining 34%36% of variance. Living situation was not associated with experienced burden. Conclusions: Caring for an adult son with DMD is burdensome, but rewarding. Subjective caregiver burden of parents may be alleviated by adequate support and respite care, by avoiding tracheotomy and by intervention programs targeting anxiety and promoting active coping by the patient from childhood. Implications for Rehabilitation Parents of adult patients with Duchenne Muscular Dystrophy experience substantial subjective caregiver burden, but they also value caregiving as important and rewarding. Level of subjective caregiver burden in parents is associated with support, tracheotomy, active coping by the patient and anxiety both in patients and parents. Subjective caregiver burden might be alleviated by adequate support and respite care, by avoiding tracheotomy and by intervention programs targeting anxiety and promoting active coping.

Effectiveness of audio feedback for partial weight-bearing in and outside the hospital: A randomized controlled trial (Article)

2012-04-01T00:00:00Z

Effectiveness of audio feedback for partial weight-bearing in and outside the hospital: a randomized controlled trial. Objective: To determine the effectiveness of partial weight-bearing (PWB) training with audio feedback in patients after total hip arthroplasty (THA). Design: Randomized controlled trial. Setting: Orthopedic clinic and patients' homes. Participants: Patients (N=38) after THA with trochanteric osteotomy. Intervention: Patients were trained with (n=18) or without (n=20) audio feedback to perform PWB at a 10% body weight (BW) target load. PWB training started on day 2 or 3 postoperatively and was given once per day during the entire hospital stay. Main Outcome Measures: Mean peak load (%BW), and the percentage of steps below, equal to, and above the target load. Weight-bearing was measured using an insole pressure system on postoperative day 7 in the hospital during PWB training (condition 1 [C1]) and when patients walked unsupervised (condition 2 [C2]), and on postoperative day 21 at home (condition 3 [C3]). Results: PWB training with audio feedback resulted in better PWB (11.1% BW vs control, 21.9% BW; P=.006) at C1. The audio feedback group had more steps below the target load (21.4% vs control, 7.8%; P=.020) and fewer steps above the target load (15.6% vs control, 45.0%; P=.015). For C2 and C3, no significant differences were found between the patients receiving PWB training with and without audio feedback, for all outcome measures. Conclusions: Patients with THA who received audio feedback were able to accurately perform PWB at the prescribed target load during PWB training, but were unable to replicate the prescribed target load when they walked unsupervised in the hospital or at home.

Personal and environmental factors contributing to participation in romantic relationships and sexual activity of young adults with cerebral palsy (Article)

2012-02-11T00:00:00Z

Purpose: To study determinants of romantic relationships and sexual activity of young adults with cerebral palsy (CP), focusing on personal and environmental factors. Method: A cohort study was performed with 74 young adults (46 men; 28 women) aged 20–25 years (SD 1.4) with CP (49% unilateral CP, 76% GMFCS level I, 85% MACS level I). All participants were of normal intelligence. Romantic relationships, sexual activity (outcome measures), personal and environmental factors (associated factors) were assessed. Associations were analyzed using logistic regression analyses. Results: More females than males with CP were in a current romantic relationship. Self-esteem, sexual esteem and feelings of competence regarding self-efficacy contributed positively to having current romantic relationships. A negative parenting style contributed negatively. Age and gross motor functioning explained 20% of the variance in experience with intercourse. In addition, sexual esteem and taking initiative contributed significantly to intercourse experience. Conclusions: For young adults with CP personal factors (20–35% explained variances) seem to contribute more than environmental factors (9–12% explained variances) to current romantic relationships and sexual experiences. We advice parents and professionals to focus on self-efficacy, self-esteem and sexual self-esteem in development of young adults with CP.

Low impact of congenital hand differences on health-related quality of life (Article)

2012-02-01T00:00:00Z

Objective: To evaluate health-related quality of life (HRQoL) and its determinants in children with congenital hand differences (CHDs). Design: Survey. Setting: Outpatient clinic of a university hospital. Participants: Children (N=116; age range, 1014y) with CHDs. Interventions: Not applicable. Main Outcome Measures: HRQoL evaluated by child self-reports of the Pediatric Quality of Life Inventory and compared with reference values of healthy peers. Multivariable regression analysis was performed to investigate determinants of HRQoL. Results: All children with CHDs had scores similar to those of healthy peers, except for a lower score on social functioning in children aged 13 to 14 years. Higher ease of activity performance was related to higher HRQoL scores, and presence of comorbidity was related to lower scores on all HRQoL subdomains except for school functioning. Additionally, physical health was influenced by ethnicity, bilateral involvement, and previous surgery; emotional functioning by the number of affected digits; school functioning by age; and total HRQoL by bilateral involvement. Conclusions: Children with CHDs report similar HRQoL as healthy peers. HRQoL decreased in the presence of comorbidity but increased with higher ease of activity performance. Scores on some subdomains were improved by the number of affected digits, but were reduced by age, ethnicity, bilateral involvement, and surgery. Although HRQoL is an important health outcome, it may not be sensitive to detect changes over time or changes after treatment in children with CHDs.

A more active lifestyle in persons with a recent spinal cord injury benefits physical fitness and health (Article)

2011-12-06T00:00:00Z

Study design:A prospective cohort study. Objectives:To study the longitudinal relationship between objectively measured everyday physical activity level, and physical fitness and lipid profile in persons with a recent spinal cord injury (SCI).Setting:A rehabilitation centre in the Netherlands and the participant's home environment. Methods:Data of 30 persons with a recent SCI were collected at the start of active rehabilitation, 3 months later, at discharge from inpatient rehabilitation, and 1 year after discharge. Physical activity level (duration of dynamic activities as % of 24 h) was measured with an accelerometry-based activity monitor. Regarding physical fitness, peak oxygen uptake (VO2peak) and peak power output (POpeak) were determined with a maximal wheelchair exercise test, and upper extremity muscle strength was measured with a handheld dynamometer. Fasting blood samples were taken to determine the lipid profile. Results:An increase in physical activity level was significantly related to an increase in VO2peak and POpeak, and an increase in physical activity level favourably affected the lipid profile. A nonsignificant relation was found with muscle strength. Conclusion:Everyday physical activity seems to have an important role in the fitness and health of persons with a recent SCI. An increase in physical activity level was associated with an increase in physical fitness and with a lower risk of cardiovascular disease.Spinal Cord advance online publication, 6 December 2011; doi:10.1038/sc.2011.152.

Physical fitness, everyday physical activity, and fatigue in ambulatory adults with bilateral spastic cerebral palsy (Article)

2011-08-01T00:00:00Z

This study assessed physical fitness and its relationships with everyday physical activity (PA) and fatigue in cerebral palsy (CP). Participants were 42 adults with ambulatory bilateral spastic CP (mean age 36.4 ± 5.8 years; 69% males; 81% with good gross motor functioning). Progressive maximal aerobic cycle tests determined VO2peak(L/min). Objective levels of everyday PA were measured with accelerometry and self-reported levels of everyday PA with the Physical Activity Scale for Individuals with Physical Disabilities. Fatigue was assessed with the Fatigue Severity Scale. The average aerobic capacity of adults with CP was 77% of Dutch reference values. Participants were physically active during 124min/day (85% of Dutch reference values), and half experienced fatigue. In women, lower physical fitness was related to lower self-reported levels of PA (Rp=0.61, P=0.03), and in men to higher levels of fatigue (Rp=-0.37, P=0.05). Other relationships were not significant. Results suggest that ambulatory adults with CP have low levels of physical fitness, are less physically active than able-bodied age mates and often experience fatigue. We found little evidence for relationships between the level of physical fitness and everyday PA or fatigue.

Energy expenditure in chronic stroke patients playing Wii Sports: A pilot study (Article)

2011-07-14T00:00:00Z

Background: Stroke is one of the leading causes of long-term disability in modern western countries. Stroke survivors often have functional limitations which might lead to a vicious circle of reduced physical activity, deconditioning and further physical deterioration. Current evidence suggests that routine moderate- or vigorous-intensity physical activity is essential for maintenance and improvement of health among stroke survivors. Nevertheless, long-term participation in physical activities is low among people with disabilities. Active video games, such as Nintendo Wii Sports, might maintain interest and improve long-term participation in physical activities; however, the intensity of physical activity among chronic stroke patients while playing Wii Sports is unknown. We investigated the energy expenditure of chronic stroke patients while playing Wii Sports tennis and boxing. Methods: Ten chronic ([greater than or equal to] 6 months) stroke patients comprising a convenience sample, who were able to walk independently on level ground, were recruited from a rehabilitation centre. They were instructed to play Wii Sports tennis and boxing in random order for 15 minutes each, with a 10-minute break between games. A portable gas analyzer was used to measure oxygen uptake (VO2) during sitting and during Wii Sports game play. Energy expenditure was expressed in metabolic equivalents (METs), calculated as VO2 during Wii Sports divided by VO2 during sitting. We classified physical activity as moderate (3-6 METs) or vigorous (>6 METs) according to the American College of Sports Medicine and the American Heart Association Guidelines. Results: Among the 10 chronic stroke patients, 3 were unable to play tennis because they had problems with timing of hitting the ball, and 2 were excluded from the boxing group because of a technical problem with the portable gas analyzer. The mean ([plus/minus]SD) energy expenditure during Wii Sports game play was 3.7 ([plus/minus]0.6) METs for tennis and 4.1 ([plus/minus]0.7) METs for boxing. All 8 participants who played boxing and 6 of the 7 who played tennis attained energy expenditures >3 METs. Conclusions: With the exception of one patient in the tennis group, chronic stroke patients played Wii Sports tennis and boxing at moderate-intensity, sufficient for maintaining and improving health in this population.

Sexuality of young adults with cerebral palsy: Experienced limitations and needs (Article)

2011-06-01T00:00:00Z

Objective of this study is to describe the problems young adults with Cerebral Palsy (CP) experience in the various stages of the sexual response cycle, and the physical and emotional obstacles they experience with sexuality. In this prospective cohort study 74 young adults (46 men; 28 women) with CP and average intelligence participated, aged 20-24 years. Twenty percent of these young adults with CP experienced anorgasmia, 80% reported physical problems with sex related to CP and 45% emotional inhibition to initiate sexual contact. In 90% of the participants, sexuality had not been discussed during the rehabilitation treatment. Many adolescents reported wanting information about the impact of CP on sexuality and reproduction (35%), about interventions (26%), tools and medicines (16%) and about problems with their partner (14%). Young adults with CP can experience various problems or challenges with sexuality. For preventing sexual difficulties and treating sexual problems, health care professionals need to proactively take the initiative to inform young people with CP about sexuality.

Validation of the Physical Activity Scale for Individuals With Physical Disabilities (Article)

2011-04-20T00:00:00Z

van den Berg-Emons RJ, L'Ortye AA, Buffart LM, Nieuwenhuijsen C, Nooijen CF, Bergen MP, Stam HJ, Bussmann JB. Validation of the Physical Activity Scale for Individuals With Physical Disabilities. Objective: To determine the criterion validity of the Physical Activity Scale for Individuals With Physical Disabilities (PASIPD) by means of daily physical activity levels measured by using a validated accelerometry-based activity monitor in a large group of persons with a physical disability. Design: Cross-sectional. Setting: Participants' home environment. Participants: Ambulatory and nonambulatory persons with cerebral palsy, meningomyelocele, or spinal cord injury (N=124). Interventions: Not applicable. Main Outcome Measures: Self-reported physical activity level measured by using the PASIPD, a 2-day recall questionnaire, was correlated to objectively measured physical activity level measured by using a validated accelerometry-based activity monitor. Results: Significant Spearman correlation coefficients between the PASIPD and activity monitor outcome measures ranged from .22 to .37. The PASIPD overestimated the duration of physical activity measured by using the activity monitor (mean ± SD, 3.9±2.9 vs 1.5±0.9h/d; P<.01). Significant correlation (ρ=-.74; P<.01) was found between average number of hours of physical activity per day measured by using the 2 methods and difference in hours between methods. This indicates larger overestimation for persons with higher activity levels. Conclusions: The PASIPD correlated poorly with objective measurements using an accelerometry-based activity monitor in people with a physical disability. However, similar low correlations between objective and subjective activity measurements have been found in the general population. Users of the PASIPD should be cautious about overestimating physical activity levels.

The neuronal correlates of mirror therapy: An fMRI study on mirror induced visual illusions in patients with stroke (Article)

2011-04-01T00:00:00Z

Aim: To investigate the neuronal basis for the effects of mirror therapy in patients with stroke. Methods: 22 patients with stroke participated in this study. The authors used functional MRI to investigate neuronal activation patterns in two experiments. In the unimanual experiment, patients moved their unaffected hand, either while observing it directly (no-mirror condition) or while observing its mirror reflection (mirror condition). In the bimanual experiment, patients moved both hands, either while observing the affected hand directly (no-mirror condition) or while observing the mirror reflection of the unaffected hand in place of the affected hand (mirror condition). A two-factorial analysis with movement (activity vs rest) and mirror (mirror vs no mirror) as main factors was performed to assess neuronal activity resultant of the mirror illusion. Results: Data on 18 participants were suitable for analysis. Results showed a significant interaction effect of movementxmirror during the bimanual experiment. Activated regions were the precuneus and the posterior cingulate cortex (p<0.05 false discovery rate). Conclusion: In this first study on the neuronal correlates of the mirror illusion in patients with stroke, the authors showed that during bimanual movement, the mirror illusion increases activity in the precuneus and the posterior cingulate cortex, areas associated with awareness of the self and spatial attention. By increasing awareness of the affected limb, the mirror illusion might reduce learnt non-use. The fact that the authors did not observe mirror-related activity in areas of the motor or mirror neuron system questions popular theories that attribute the clinical effects of mirror therapy to these systems.

Growth diagrams for individual finger strength in children measured with the RIHM (Article)

2011-03-01T00:00:00Z

Background: Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength. Questions/purposes: We developed growth diagrams for individual finger strength in children. Patients and Methods: We measured thumb palmar abduction, thumb opposition, and thumb flexion in the metacarpophalangeal joint, and abduction of the index and little fingers in 101 children (4-12 years old) using a myometer. We recorded hand dominance, gender, height, and weight. All measurements were performed in a randomized order by the same researcher. We developed statistical models for drawing growth diagrams using estimated percentiles for each strength measurement. Separate models for dominant and nondominant hands of boys and girls were developed, in addition to a combined model. Results: Because there was no difference in strength between boys and girls and between dominant and non-dominant hands, both hands and genders were combined in one growth diagram for each measurement. The normative data were presented in a table format and in growth diagrams for each myometer measurement. Conclusions: These diagrams can be used for pediatric patients such as patients with congenital malformations or neuromuscular disorders who receive interventions or therapy aimed at function of the hand, fingers, or thumb. The growth diagrams facilitate distinguishing between the effects of growth and intervention on strength development.

Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: A phase II randomized controlled trial (Article)

2011-03-01T00:00:00Z

Objective. To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. Methods. A total of 40 chronic stroke patients (mean time post.onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline-posttreatment and at 6 months-were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). Results. Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P <.05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P <.05). Conclusion. This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.

Excellent test-retest and inter-rater reliability for Tardieu Scale measurements with inertial sensors in elbow flexors of stroke patients (Article)

2011-02-01T00:00:00Z

Background: Spasticity is often clinically assessed with the Tardieu Scale, using goniometry to measure the range of motion and angle of catch. However, the test-retest and inter-rater reliability of these measurements have been questioned. Inertial sensors (IS) have been developed to measure orientation in space and are suggested to be a more appropriate tool than goniometry to measure angles in Tardieu Scale measurements. Objective: To compare the test-retest and inter-rater reliability of Tardieu Scale scores measured with IS and goniometry. Methods: Two physiotherapists performed Tardieu Scale measurements in two sessions, using both goniometry and IS, to quantify spasticity in elbow flexors of 13 stroke patients. Results: For goniometry, test-retest and inter-rater reliability proved to be excellent (ICC 0.86) and fair to good (ICC 0.66), respectively. For IS, both test-retest (ICC 0.76) and inter-rater reliability (ICC 0.84) were excellent. Conclusions: Inertial sensors are reliable and accurate to use in Tardieu Scale measurements to quantify spasticity in the elbow flexors of hemiplegic stroke patients.

Corrigendum to "Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: A case series" [Physical Therapy in Sport 11 (2010) 99-103] (Article)

2011-02-01T00:00:00Z

Accelerometry-based activity spectrum in persons with chronic physical conditions (Article)

2010-12-01T00:00:00Z

Objectives (1) To give an overview of the impact of a variety of chronic physical conditions on accelerometry-based levels of everyday physical activity and to identify high-risk conditions; and (2) to compare these objectively assessed activity levels with the levels estimated by rehabilitation physicians. Interventions Not applicable. Design Cross-sectional study. Setting Participant's home environment. Participants Patients (n=461) with 18 chronic physical (sub)conditions and able-bodied subjects (n=96). Main Outcome Measures We summarized data on the level of everyday physical activity as objectively measured with an accelerometry-based activity monitor. Thirty-one rehabilitation physicians filled in a questionnaire designed to obtain their estimates of the level of physical activity in patients with the various conditions. Results Only 4 of the studied conditions had normal activity levels (<90% of the able-bodied level). Persons with transtibial amputation (vascular), spinal cord injury, and myelomeningocele (wheelchair dependent) had the lowest levels of activity, less than 40% of the able-bodied level. In general, rehabilitation physicians were aware of the inactive lifestyles, but considerably underestimated the magnitude of inactivity in the high-risk conditions. Conclusions This is the first study to provide an objectively assessed activity spectrum in a variety of chronic physical conditions. We hope this study will increase the awareness of health professionals as to which chronic physical conditions are at increased risk for an inactive lifestyle, and will contribute to adaptation of patient management accordingly.

Effects of a rehabilitation programme on daily functioning, participation, health-related quality of life, anxiety and depression in liver transplant recipients (Article)

2010-11-19T00:00:00Z

Purpose. Fatigue is a chronic problem in liver transplant recipients and may influence daily functioning and health-related quality of life (HRQoL). This study aimed to evaluate the effects of a fatigue-reducing physical rehabilitation programme on daily functioning, participation, HRQoL, anxiety and depression among liver transplant recipients. Method. Eighteen fatigued liver transplant recipients (mean age 51 years, 10 men/8 women) participated in a 12-week rehabilitation programme, which included supervised exercise training and daily physical activity counselling. We assessed pre- and post-programme health-related daily functioning, participation, HRQoL, anxiety and depression using questionnaires. Results. After the programme, patients showed improvements in daily functioning (23.6%, p = 0.007), the participation domain 'autonomy outdoors' (34.1%, p = 0.001), and the HRQoL domains 'physical functioning' (11.5%, p = 0.007) and 'vitality' (21.5%, p = 0.022). Anxiety and depression were unchanged post-programme. Conclusions. Rehabilitation using supervised exercise training and daily physical activity counselling can positively influence daily functioning, participation and HRQoL among fatigued liver transplant recipients.

Learn 2 Move 16-24: Effectiveness of an intervention to stimulate physical activity and improve physical fitness of adolescents and young adults with spastic cerebral palsy; a randomized controlled trial (Article)

2010-11-05T00:00:00Z

Background: Persons with cerebral palsy (CP) are at risk for developing an inactive lifestyle and often have poor fitness levels, which may lead to secondary health complications and diminished participation and quality of life. However, persons with CP also tend not to receive structural treatment to improve physical activity and fitness in adolescence, which is precisely the period when adult physical activity patterns are established.Methods: We aim to include 60 adolescents and young adults (16-24 years) with spastic CP. Participants will be randomly assigned to an intervention group or a control group (no treatment; current policy). The intervention will last 6 months and consist of three parts; 1) counselling on daily physical activity; 2) physical fitness training; and 3) sports advice. To evaluate the effectiveness of the intervention, all participants will be measured before, during, directly after, and at 6 months following the intervention period. Primary outcome measures will be: 1) physical activity level, which will be measured objectively with an accelerometry-based activity monitor during 72 h and subjectively with the Physical Activity Scale for Individuals with Physical Disabilities; 2) aerobic fitness, which will be measured with a maximal ramp test on a bicycle or armcrank ergometer and a 6-minute walking or wheelchair test; 3) neuromuscular fitness, which will be measured with handheld dynamometry; and 4 body composition, which will be determined by measuring body mass, height, waist circumference, fat mass and lipid profile.Conclusions: This paper outlines the design, methodology and intervention of a multicenter randomized controlled trial (LEARN 2 MOVE 16-24) aimed at examining the effectiveness of an intervention that is intended to permanently increase physical activity levels and improve fitness levels of adolescents and young adults with CP by achieving a behavioral change toward a more active lifestyle.Trial registration: Dutch Trial Register; NTR1785.

Using the manual ability classification system in young adults with cerebral palsy and normal intelligence (Article)

2010-10-15T00:00:00Z

Purpose.The study aimed to establish whether the manual ability classification system (MACS), a valid classification system for manual ability in children with cerebral palsy (CP), is applicable in young adults with CP and normal intelligence. Subjects.The participants (n=83) were young adults with CP and normal intelligence and had a mean age of 19.9 years. Method.In this study, inter observer reliability of the MACS was determined. We investigated relationships between the MACS level and patient characteristics (such as the gross motor function classification system (GMFCS) level, limb distribution of the spastic paresis and educational level) and with functional activities of the upper extremity (assessed with the Melbourne assessment, the Abilhand questionnaire and the domain self-care of the functional independence measure (FIM)). Furthermore, with a linear regression analysis it was determined whether the MACS is a significant determinant of activity limitations and participation restrictions. Results.The reliability was good (intraclass correlation coefficient 0.83). The Spearman correlation coefficients with GMFCS level, limb distribution of the spastic paresis and educational level were 0.53, 0.46, and 0.26, respectively. MACS level correlated moderately with outcome measures of functional activities (correlations ranging from -0.38 to -0.55). MACS level is, in addition to the GMFCS level, an important determinant for limitations in activities and restrictions in participation. Conclusion.We conclude that the MACS is a feasible method to classify manual ability in young adults with CP and normal intelligence with a good manual ability.

Energy Expenditure in Adults With Cerebral Palsy Playing Wii Sports (Article)

2010-10-01T00:00:00Z

Abstract OBJECTIVE: To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. DESIGN: Cross-sectional study. SETTING: University medical center. PARTICIPANTS: Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. INTERVENTION: Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. MAIN OUTCOME MEASURE: By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. RESULTS: Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. CONCLUSIONS: Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels

Recovery of the sit-to-stand movement after stroke: A longitudinal cohort study (Article)

2010-10-01T00:00:00Z

Background and Objective. To present quantitative data on sit-to-stand (STS)-related functioning and recovery during the first year after stroke. STS-related functioning was used to evaluate independent STS movement, rising speed, and actual STS performance during normal daily life. Methods. This was a prospective cohort study of 50 patients poststroke. Assessments were made at 0, 3, 6, 9, 12, 24, and 48 weeks poststroke. Actual STS performance was assessed at 0, 12, and 48 weeks. The main outcome measures were the following: ability to rise independently, rising speed (power chair stand up), number of STS movements, percentage of time walking and standing during daily life (using an activity monitor), and clinical outcomes, measured among others by the Barthel index (BI). Results. During year 1, the percentage of patients able to rise increased from 54% to 83%. Most improvements occurred during weeks 0 to 12, whereas no significant changes were observed during weeks 12 to 24. Rising speed similarly increased from 0.15 to 0.26 s-1during weeks 0 to 12 and to 0.30 s-1at week 48. Gait speed and BI also significantly increased. The number of STS movements increased significantly during weeks 0 to 12 (from 10.6 to 17.7) but not during weeks 12 to 48. Conclusions. STS-related functioning improved significantly in the first year after stroke, with the most improvement occurring during the first 12 weeks. After 12 weeks, rising speed, gait speed, and BI continue to improve.

Early active motion versus immobilization after tendon transfer for foot drop deformity: A randomized clinical trial (Article)

2010-09-01T00:00:00Z

Background: Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. Questions/purposes: To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems. Methods: We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups. Results: We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups. Conclusion: In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

Development of romantic relationships and sexual activity in young adults with cerebral palsy: A longitudinal study (Article)

2010-09-01T00:00:00Z

Objectives: To describe the development of romantic relationships and sexual activity of young adults with cerebral palsy (CP), to investigate whether this development is associated with demographic and physical characteristics, and to compare the sexual activity of this group with an age-appropriate Dutch reference population. Design: Prospective longitudinal study with 3 biannual assessments. Setting: Eight rehabilitation centers and departments in the southwestern regions of The Netherlands. Participants: Young adults (N=103; 61 men, 42 women) with CP without cognitive disabilities (age range at first assessment, 1620y; 82% Gross Motor Function Classification System level I or II). Interventions: Not applicable. Main Outcome Measures: Sexual interest, romantic relationships, and sexual activity. Results: We observed a significant increase in dating in young adults with CP during the 4-year period; however, the experience in romantic relationships did not increase largely during this period. Young adults with a lower education level began dating later than those with higher levels. Significantly more women were in current romantic relationships than men. During the 4 years, participants' sexual experience increased significantly for all sexual milestones evaluated. Level of gross motor function was associated significantly with intercourse experience. Compared with an age-appropriate Dutch reference population, young adults with CP participated at a lower level in romantic relationships and sexual activities, but had equal sexual interest at the final assessment. Conclusions: Young ambulatory adults with CP had similar sexual interests and had increasing experiences with romantic relationships and sexual activities during the transition from late adolescence to young adulthood. However, the percentage of young adults with CP in current romantic relationships was low, especially for men.

The profile of patients and current practice of treatment of upper limb muscle spasticity with botulinum toxin type A: An international survey (Article)

2010-09-01T00:00:00Z

To document the current practice in relation with the treatment of patients with upper limb spasticity with botulinum toxin type A to inform future research in this area. We designed an international, cross-sectional, noninterventional survey of current practice. Nine hundred and seventy-four patients from 122 investigational centres in 31 countries were studied. Most patients were over 40 years old and had a stroke. Improvement of active function was the most frequent treatment goal in the first 3 months after the onset of upper limb spasticity, but was less common than passive function in the chronic stage. Pain relief was a common goal in both the stages. As a rule, clinicians intended to assess the effectiveness of treatment with impairment level scales. Functional outcome measures seem to be rarely used in clinical practice. The use of these measures should be encouraged to assess whether the reduction in muscle tone translates into functional benefit to patients and their caregivers.

Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: A case series (Article)

2010-08-01T00:00:00Z

Objective: To evaluate short and mid-term results of active physical therapy in athletes with longstanding groin pain. Design: Case series. Setting: Primary care physical therapy practice. Participants: A total of 44 athletes suffering longstanding adductor-related groin pain. Intervention: A combination of passive (joint mobilization) and active (exercises) physical therapy interventions. Main outcome measurements: Return to (the same level of) sports, restriction in sports, and recurrence. Results: Directly after treatment, return to the same level and type of sport was successful in 38 athletes (86%), and without symptoms in 34 athletes (77%). At 6.5-51 months follow up, 10/38 (26%) of those that returned to sports had experienced a relapse; 22 (50%) athletes were able to participate in sports without any restrictions at the mid-term follow-up. Conclusions: For athletes with longstanding groin pain, short term results of physical therapy seem positive, whereas mid-term results are moderately positive. The risk for recurrence is high.

Functional outcome after laparoscopic and open incisional hernia repair (Article)

2010-07-01T00:00:00Z

Abstract: Background: The debate about the advantages of laparoscopic versus open incisional hernia repair is still ongoing. The primary outcomes of already published studies are mainly recurrence, pain and quality of life. Data on postoperative abdominal wall function after these corrections is still lacking. In this single center study muscle strength and transverse abdominal muscle thickness were analysed with regard to open and laparoscopic techniques. Methods: Thirty-five patients that underwent open and laparoscopic midline incisional hernia correction were included. Approximation of the rectus muscles was included in some open procedures but never in laparoscopic correction. Twelve healthy subjects without any abdominal operation functioned as a control group. Trunk flexion muscle strength of all operated patients and 12 healthy subjects was studied with the Biodex® isokinetic dynamometer and conventional abdominal muscle trainers for the rectus and oblique abdominal muscles. All patients underwent ultrasound examination of the abdominal wall for analysing transverse abdominal muscle thickness. Results: The mean torque/weight (%) for trunk flexion, measured with the Biodex®, was significantly higher in the control compared with the total patient group. Comparing trunk flexion with the Biodex® after either laparoscopic or open incisional hernia repair showed a trend in favour of the open group after adjusting for gender. The muscle strength measured by the conventional abdominal muscle trainers showed no differences between the operation groups. The transverse abdominal muscle thickness difference between rest and contraction was significantly higher in the open repair group. Conclusions: The isokinetic strength of trunk flexor muscles is reduced after an operation for incisional hernia. There is some evidence that open repair with approximation of the rectus abdominis muscles results in higher muscle strength of the rectus muscles and higher thickness differences between rest and contraction of the transverse abdominis muscles compared to laparoscopic technique.

Functional capacity and actual daily activity do not contribute to patient satisfaction after total knee arthroplasty (Article)

2010-06-18T00:00:00Z

Abstract Background: After total knee arthroplasty (TKA) only 75-89% of patients are satisfied. Because patient satisfaction is a prime goal of all orthopaedic procedures, optimization of patient satisfaction is of major importance. Factors related to patient satisfaction after TKA have been explored, but no studies have included two potentially relevant factors, i.e. the functional capacity of daily activities and actual daily activity. This present prospective study examines whether functional capacity and actual daily activity (in addition to an extensive set of potential factors) contribute to patient satisfaction six months after TKA. Methods: A total of 44 patients were extensively examined preoperatively and six months post surgery. Functional capacity was measured with three capacity tests, focusing on walking, stair climbing, and chair rising. Actual daily activity was measured in the patient's home situation by means of a 48-hour measurement with an Activity Monitor. To establish which factors were related to patient satisfaction six months post surgery, logistic regression analyses were used to calculate odds ratios. Results: Preoperative and postoperative functional capacity and actual daily activity had no relation with patient satisfaction. Preoperatively, only self-reported mental functioning was positively related to patient satisfaction. Postoperatively, based on multivariate analysis, only fulfilled expectations regarding pain and experienced pain six months post surgery were related to patient satisfaction. Conclusions: Functional capacity and actual daily activity do not contribute to patient satisfaction after TKA. Patients with a better preoperative self-reported mental functioning, and patients who experienced less pain and had fulfilled expectations regarding pain postoperatively, were more often satisfied.

Importance of peers and dating in the development of romantic relationships and sexual activity of young adults with cerebral palsy (Article)

2010-06-01T00:00:00Z

Aim: The aim of this study was to describe the peer group activities, romantic relationships, and sexual activity and their interrelations of young adults with cerebral palsy (CP). Method: A cross-sectional study was performed in 87 participants (51 males, 36 females; mean age 20y 4mo, SD 1y 3mo range age 18-22y) without cognitive disabilities. Ninety-four per cent had spastic CP and 49% unilateral CP, while 78% were classified at Gross Motor Function Classification System level I and 84% at Manual Ability Classification System level I. Peer group activities, dating, romantic relationships, and sexual activity were assessed with an interview and questionnaire. Associations were analysed using logistic regression analyses. Results: The study cohort reported having friends and participating in activities with peers; 71% had experience of dating, 23% had a current romantic relationship, and 38% had experience of intercourse. Young adults with CP had less experience in romantic and sexual relationships than an age-appropriate Dutch reference population. Peer group activities and dating favoured development of romantic relationships and sexual activity. Older age was associated with greater sexual activity. Motor functioning, education level, and gender did not correlate with romantic relationships or sexual activity. Interpretation: Being involved in peer group activities and creating a context to arrange dates seems relevant for young adults with CP to develop romantic relationships and sexual activity.

Participation and health-related quality of life in adults with spastic bilateral cerebral palsyand the role of self-efficacy (Article)

2010-06-01T00:00:00Z

Objective: To assess participation and health-related quality of life in adults with bilateral spastic cerebral palsy, and explore associations with self-efficacy. Design: Cross-sectional study. Subjects: A sample of 56 adults with bilateral spastic cerebral palsy (mean age 36.4 (standard deviation 5.8) years; 62% male). Methods: Daily activities and social participation (Life Habits 3.0), health-related quality of life (SF-36 Health Survey), demographic and clinical characteristics, and self-efficacy (General Self-Efficacy Scale (GSES-12)) were assessed. Associations were studied using multivariate logistic regression analyses. Results: At least 60% of the sample had difficulties with mobility, recreation and housing, and 44% had difficulty with personal care and employment. They perceived low health-related quality of life for physical functions, but not for mental functions. Corrected for demographic and clinical characteristics, general self-efficacy explained 49% of the variance in outcome on social participation, and the subscale Effort (GSES-12) 32% of the variance for the physical health-related quality of life and 16% of the mental healthrelated quality of life. Conclusion: A significant number of adults with bilateral spastic cerebral palsy encountered difficulties in social participation and had a low perceived health-related quality of life for physical functions. Higher general self-efficacy or a greater willingness to expend effort in achieving behaviour was related to better participation and a higher physical and mental health-related quality of life.

Isokinetic strength of the trunk Xexor muscles after surgical repair for incisional hernia (Article)

2010-06-01T00:00:00Z

Purpose The repair of incisional hernias can be accomplished by open or laparoscopic techniques. The Biodex® dynamometer measures muscle strength during isokinetic movement. The objectives of this study are to compare the strength of the trunk Xexors between patients who underwent repair for incisional hernia and a control group, and to compare trunk Xexion after two kinds of operative techniques for incisional hernias with and without approximation of the rectus abdominis muscles. Methods The trunk Xexion of 30 patients after different operative techniques for midline incisional hernias and of 12 healthy subjects was studied with the Biodex® isokinetic dynamometer. Results The mean torque/weight (N m/kg) for trunk Xexion was significantly higher in the control group compared to the patient group after incisional hernia repair. A significantly higher peak torque/weight [coefficient 24.45, 95% confidence interval (CI) -0.05; 48.94, P = 0.05] was found in the two-layered suture technique without mesh compared to the laparoscopic technique after adjusting for gender. Conclusions The isokinetic strength of the trunk Xexor muscles is reduced after an operation for incisional hernia. There is some evidence that a two-layered suture repair with approximation of the rectus abdominis muscles results in higher isokinetic strength of the trunk Xexor muscles compared to the laparoscopic technique.

Development and validation of ultrasound speckle tracking to quantify tendon displacement (Article)

2010-05-01T00:00:00Z

Ultrasound can be used to study tendon movement. However, measurement of tendon movement is mostly based on manual tracking of anatomical landmarks such as the musculo-tendinous junction, limiting the applicability to a small number of muscle-tendon units. The aim of this study was to quantify tendon displacement without anatomical landmarks using a speckle tracking algorithm optimized for tendons in long B-mode image sequences. A dedicated two-dimensional multi-kernel block-matching scheme with subpixel motion estimation was devised to handle large displacements over long sequences. The accuracy of the tracking on porcine tendons was evaluated during different displacements and velocities. Subsequently, the accuracy of tracking the flexor digitorum superficialis (FDS) of a human cadaver hand was evaluated. Finally, the in-vivo accuracy of the tendon tracking was determined by measuring the movement of the FDS at the wrist level. For the porcine experiment and the human cadaver arm experiment tracking errors were, on average, 0.08 and 0.05. mm, respectively (1.3% and 1.0%). For the in-vivo experiment the tracking error was, on average, 0.3. mm (1.6%). This study demonstrated that our dedicated speckle tracking can quantify tendon displacement at different physiological velocities without anatomical landmarks with high accuracy. The technique allows tracking over large displacements and in a wider range of tendons than by using anatomical landmarks.

The effect of experimental groin pain on abdominal muscle thickness (Article)

2010-05-01T00:00:00Z

It is not clear whether abnormal abdominal muscle behavior in athletes with longstanding groin pain is a risk factor for groin pain or is caused by groin pain itself. Therefore, this study investigated whether anticipation of experimental groin pain influences abdominal muscle behavior. METHODS: In 14 healthy athletes, abdominal muscle thickness was measured using ultrasound under conditions of anticipated groin pain and acute groin pain. Groin pain was induced using superficial electrical skin stimulation. Tasks evaluated were isometric hip adduction and active straight leg raise (ASLR) left. RESULTS: The m. transversus abdominis and m. obliquus internus showed a significant decrease in thickness during "anticipation of pain" compared with "no pain" and "pain" during both hip adduction and ASLR (P values <0.04). For m. obliquus externus, a significant increase in thickness was found only during "pain" compared with "no pain" and "anticipation of pain" for ASLR (P<0.004). DISCUSSION: If ASLR or hip adduction is associated with anticipated groin pain, abdominal muscle behavior is different from a pain-free situation and from a painful situation. These results suggest that abnormal abdominal muscle behavior found in athletes with longstanding groin pain may be caused by a pain anticipatory motor strategy. This may have implications for rehabilitation.

Prognosis of six-month functioning after moderate to severe traumatic brain injury: A systematic review of prospective cohort studies (Article)

2010-05-01T00:00:00Z

Objective: To systematically review which determinants, assessed within the first month after a moderate to severe traumatic brain injury, predict 6-month functional outcome. Methods: Databases were searched for relevant publications between 1995 and August 2008. Selection criteria were: prospective cohort studies; determinants associated with functional outcome 6 months after moderate to severe traumatic brain injury in adult patients; determinants assessed within the first month post-injury. Two reviewers independently performed the selection and quality assessment. A bestevidence synthesis was performed for prognostic factors assessed in 2 or more studies. Results: Twenty-eight studies were included, 27 of which were high quality. Most studies used the Glasgow Outcome Score at 6 months post-injury as outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome at 6 months was found for the Glasgow Coma Scale (GCS), GCS admission, motor score, midline shift on computed tomography scan, subdural haematoma and pulsatility index. Strong evidence of no association was found for gender and intraventricular haemorrhage. For other determinants, inconclusive or no evidence was found. Conclusion: GCS, GCS on admission, motor score, midline shift, subdural haematoma and pulsatility index predicted outcome 6 months after traumatic brain injury. Gender and intraventricular haemorrhage did not have predictive value.

Three cases of referred sensation in traumatic nerve injury of the hand: Implications for understanding central nervous system reorganization (Article)

2010-04-01T00:00:00Z

Objective: The aim of this observational study was to explore whether patients with traumatic peripheral nerve injury of the hand perceive referred sensations; sensations that are perceived to emanate from other areas of the body than the part being stimulated. Referred sensations have been reported following amputation, somatosensory deafferentation, local anaesthesia, stroke, brachial plexus avulsion injury, spinal cord injury and complex regional pain syndrome type 1. Design: Ten patients with ulnar or median nerve injuries underwent sensory testing of the face, upper body and legs, involving light touch with a cotton swab. Patients were asked to describe the location of the stimulated site, the sensations emanating from it and any other sensations experienced. Three patients with referred sensations were identified and followed over a period of time. Results: Clear and reproducible referred sensations were found in 3 out of 10 patients examined. Conclusion: Referred sensations were found in traumatic nerve injury, providing evidence of reorganization of the central nervous system after peripheral injury.

Resting thickness of transversus abdominis is decreased in athletes with longstanding adduction-related groin pain (Article)

2010-04-01T00:00:00Z

The purpose of the study was to compare thickness of the transversus abdominis (TA) and obliquus internus (OI) muscles between athletes with and without longstanding adduction-related groin pain (LAGP). Forty two athletes with LAGP and 23 controls were included. Thickness of TA and OI were measured with ultrasound imaging on the right side of the body during rest. Relative muscle thickness (compared to rest) was measured during the active straight leg raise (ASLR) left and right, and during isometric hip adduction. TA resting thickness was significantly smaller in injured subjects with left-sided (4.0 ± 0.82 mm; P < 0.001) or right-sided (4.3 ± 0.64 mm; P = 0.015) groin complaints compared with controls (4.9 ± 0.90 mm). No significant differences between patients and controls in TA or OI relative thickness during the ASLR and isometric hip adduction were found (all cases P ≥ 0.15). In conclusion, TA resting thickness is smaller in athletes with LAGP and may thus be a risk factor for (recurrent) groin injury. This may have implications for therapy and prevention of LAGP.

Promoting physical activity in an adolescent and a young adult with physical disabilities (Article)

2010-04-01T00:00:00Z

Background: We sought to describe the design of the Active Lifestyle and Sports Participation (ALSP) intervention for adolescents and young adults with physical disabilities, and to present the first 2 cases. Methods: A 17-year-old boy with myelomeningocele and hydrocephalus and a 23-year-old woman with unilateral cerebral palsy were enrolled into the ALSP intervention, a personalized intervention designed to improve physical activity and fitness levels. Main outcome measures were self-reported physical activity and aerobic fitness. Fitness was determined by submaximal 6-minute walk or wheel test and by maximal cycle or arm ergometer-exercise test. Participants rated satisfaction with the intervention on a Likert-type numeric scale from 1 to 10. Results: Improvements in self-reported physical activity were 51% and 75% for the male and female participant, respectively. Respective improvements in submaximal exercise were 16% and 9%. Maximal exercise increased 39% in the male participant but did not increase in the female participant. Satisfaction with the intervention was rated moderate-good to excellent. Conclusion: Data for the first 2 cases suggested that ALSP intervention seemed feasible to offer in an outpatient rehabilitation department, and the effectiveness may be promising. Future studies should determine the short- and long-term effectiveness of the intervention.

Predictive value of NT-proBNP in vascular surgery patients with COPD and normal left ventricular systolic function (Article)

2010-03-19T00:00:00Z

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is commonly used to identify a cardiac cause of dyspnoea. However, patients with chronic obstructive pulmonary disease (COPD) may also have increased plasma NT-proBNP levels because of right-sided myocardial stress caused by pulmonary hypertension. We investigated the relationship between COPD and elevated NT-proBNP levels as well as the impact of elevated NT-proBNP levels on mortality in vascular surgery patients with normal left ventricular systolic function. Prior to vascular surgery, NT-proBNP levels, pulmonary function and left ventricular ejection fraction (LVEF) were assessed in 376 patients. Only patients with a LVEF > 40 were included; n 261. Elevated NT-proBNP levels were defined as ≥500 pg/ml. Firstly, we assessed the relationship between COPD and NT-proBNP levels. Secondly, we investigated the association between elevated NT-proBNP levels and one-year mortality. COPD was independently associated with elevated NT-proBNP levels (OR 3.36, 95CI 1.308.65) with significant associations found for mild and severe COPD. Elevated NT-proBNP levels were associated with increased one-year mortality in patients with (HR 7.73, 95CI 1.6037.43) and without COPD (HR 3.44, 95CI 1.1010.73). COPD was associated with elevated NT-proBNP levels in patients with a normal LVEF undergoing vascular surgery. Elevated NT-proBNP levels independent of other well-established risk factors were associated with increased one-year mortality. NT-proBNP may be useful biomarker to risk stratify patients with COPD. © Copyright

Visual feedback and weight reduction of a grip strength dynamometer do not increase reliability in healthy children (Article)

2010-03-18T00:00:00Z

Study Design: Test-retest reliability study on grip strength in children. Introduction: Measuring grip strength in children is difficult because of the weight and size of the instrument, brief attention span, and possible lack of task understanding. Therefore, adaptations to the measurement protocols to improve reliability would be very important for research and clinical evaluation. Purpose: In this study, we compared the reliability of a grip strength dynamometer (Lode dynamometer, Lode BV, Groningen, The Netherlands) using three different protocols. Methods: Test-retest reliability of the American Society of Hand Therapists protocol in 104 healthy children (4-12 years) was compared with the reliability in 63 healthy children of a visual feedback protocol and a suspension protocol reducing weight of the instrument. Results: For the total group, intraclass correlation coefficients for the dominant and nondominant hands were 0.95-0.97 for all protocols, indicating that all three protocols were reliable. Conclusion: No statistically significant difference was found among the reliability of the different protocols, but the suspension protocol produced small but significantly higher force levels. Level of Evidence: Not applicable.

Intrinsic plus positioning of fingers due to bowstringing at the metacarpophalangeal joint (Article)

2010-02-01T00:00:00Z

Effect of wearing an activity monitor on the amount of daily manual wheelchair propulsion in persons with spinal cord injury (Article)

2010-02-01T00:00:00Z

Study design: An experimental study. Objectives: To assess the effect of reactivity related to wearing a multi-sensor activity monitor (AM) on the amount of manual wheelchair propulsion during daily life in wheelchair-bound persons with spinal cord injury (SCI). In addition, to establish the subjectively experienced burden of wearing the AM. Setting: Rehabilitation centre and home-based study. Methods: In 10 persons with SCI, during a 7-day period, the daily amount of manual wheelchair propulsion was measured by means of a rotation counter. During this period, an AM was worn for 1 day (AM day) by the participants. Experienced burden was measured by a questionnaire based on visual analogue scale scores. Results: The overall median of the number of rotations per minute was 1.38 (range 0.63-1.83). No significant difference was found in the amount of daily manual wheelchair propulsion between AM and AM days (P=0.33, median difference: -0.06 rotations per minute). Experienced burden was not different between subgroups that differed in reactivity. Conclusion: The results seem to indicate that wearing the AM of this study does not systematically influence the amount of daily manual wheelchair propulsion. Although low to moderate burden was experienced when wearing the AM, this does not seem to affect the amount of manual wheelchair propulsion.

Exercise capacity in Dutch children: New reference values for the Bruce treadmill protocol (Article)

2010-02-01T00:00:00Z

The Bruce treadmill protocol is suitable for children 4 years of age and older. Dutch reference values were established in 1987. We considered that children's exercise capacity has deteriorated due to changes in physical activity patterns and eating habits. We determined new reference values and evaluated determinants of exercise capacity. Healthy Dutch children (n=267) aged 6-13 years participated in this cross-sectional observational study. The maximal endurance time on the treadmill was the criterion of exercise capacity. Furthermore, we obtained data on anthropometry, smoking habits, socioeconomic status, ethnicity, sports participation, and school transport habits. The maximal endurance time for children aged up till 10 was lower (up to 1.6 and 1.4 min in girls and boys, respectively) than previously published. Body mass index was negatively, and intense sports participation was positively associated with endurance time (β=-0.412 and 0.789, respectively; P<0.001). In conclusion, exercise capacity seems to have deteriorated in Dutch children aged up till 10 years whereas the values from the older children are remarkably similar to those from the previous study.

Response to letter to the editor by videler et al (Article)

2010-01-01T00:00:00Z

Predictors of partial weight-bearing performance after total hip arthroplasty (Article)

2010-01-01T00:00:00Z

Abstract OBJECTIVE: To determine which patient characteristics, postoperative characteristics, and walking features influence patients' partial weight-bearing performance after total hip arthroplasty. DESIGN: A descriptive prospective study. PATIENTS: Fifty patients with total hip arthroplasty were included; partial weight-bearing was performed at a 10% body weight target load (n=33) and at a 50% body weight target load (n=17). METHODS: Patient (age, gender, body weight, upper arm muscle strength) and postoperative (pain, fatigue, anxiety) characteristics, and walking features (step frequency, total walking time, total number of steps, walking aid) were measured postoperatively on day 7 (with and without a physical therapist) and on day 21 (at home). Multilevel regression analyses were conducted to identify determinants that influence partial weight-bearing. RESULTS: Gender (female) (regression coefficient B=8.18, p=0.03) and total walking time (B=0.58, p<0.001) were positively, and pain during walking was negatively (B=-2.43, p=0.02), associated with the mean peak load. For partial weight-bearing at 10% body weight, postoperative overall anxiety (B=6.40, p=0.002) and total steps (B=0.05, p=0.02) were positively associated with the percentage of steps above the target load. For partial weight-bearing at home, postoperative overall anxiety was negatively associated with the percentage of steps above the target load (B=-5.32, p=0.001). Conclusion: Gender, pain during walking, walking time, postoperative anxiety and total number of steps influence the patient's partial weight-bearing performance.

Growth Diagrams for Individual Finger Strength in Children Measured with the RIHM (Article)

2010-01-01T00:00:00Z

Background: Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength. Questions/purposes: We developed growth diagrams for individual finger strength in children. Patients and Methods: We measured thumb palmar abduction, thumb opposition, and thumb flexion in the metacarpophalangeal joint, and abduction of the index and little fingers in 101 children (4-12 years old) using a myometer. We recorded hand dominance, gender, height, and weight. All measurements were performed in a randomized order by the same researcher. We developed statistical models for drawing growth diagrams using estimated percentiles for each strength measurement. Separate models for dominant and nondominant hands of boys and girls were developed, in addition to a combined model. Results: Because there was no difference in strength between boys and girls and between dominant and nondominant hands, both hands and genders were combined in one growth diagram for each measurement. The normative data were presented in a table format and in growth diagrams for each myometer measurement. Conclusions: These diagrams can be used for pediatric patients such as patients with congenital malformations or neuromuscular disorders who receive interventions or therapy aimed at function of the hand, fingers, or thumb. The growth diagrams facilitate distinguishing between the effects of growth and intervention on strength development.

Persistent fatigue in liver transplant recipients: A two-year follow-up study (Article)

2010-01-01T00:00:00Z

Background: Fatigue after liver transplantation (LTx) is a major problem that is associated with lower daily functioning and health-related quality of life (HRQoL). This study aimed to assess changes over time in fatigue following LTx. We also examined daily functioning and HRQoL changes over time and assessed the influence of fatigue and changes in fatigue on daily functioning and HRQoL. We determined whether sleep quality, anxiety, and depression were associated with fatigue. Methods: We identified 70 LTx recipients who had previously participated in a cross-sectional study and reassessed them after two yr to determine changes in level of fatigue, daily functioning, and HRQoL. We also assessed sleep quality, anxiety, and depression after two yr. Results: Level of fatigue and level of daily functioning were unchanged at follow-up. HRQoL domains remained stable or worsened. Fatigue was a significant predictor of daily functioning and all HRQoL domains (p < 0.01). Change in fatigue was a significant predictor of daily functioning and the HRQoL domains of " physical functioning," " vitality," and " pain" (p < 0.05). Sleep quality, anxiety, and depression were associated with fatigue severity (r = 0.35 to r = 0.60, p < 0.05). Conclusion: This longitudinal study shows that fatigue is a chronic problem after LTx and that daily functioning and HRQoL do not improve over time. This study supports the need for intervention programs to address fatigue after LTx.

No relation between pelvic belt tests and abdominal muscle thickness behavior in athletes with long-standing groin pain. measurements with ultrasound (Article)

2010-01-01T00:00:00Z

Objective: To investigate whether abdominal muscle thickness in athletes with long-standing adduction-related groin pain (LAGP) differs between subgroups with a positive or no response to a pelvic belt. The response to a pelvic belt is defined positive in case of a decrease ≥1 on a Likert pain scale (0-10) during the squeeze test (SQT) or a decrease ≥1 on the active straight leg raise (ASLR) test score (0-10). DESIGN: Cross-sectional study. SETTING: Physical therapy practice. PATIENTS: Fifty athletes with LAGP. INDEPENDENT VARIABLES: Squeeze test and ASLR test. MAIN OUTCOME MEASURES: First, the effect of a pelvic belt on pain during the SQT and the ASLR test score was evaluated. Then, thickness of m. transversus abdominis (TA) and m. obliquus internus (OI) was measured using ultrasound during rest, ASLR left and right, and SQT. RESULTS: Of the 50 participants, 25 (50%) experienced a decrease in pain during the SQT when wearing a pelvic belt and 10 (20%) improved in ASLR performance with a pelvic belt. Thickness of TA and OI at rest (both cases P >.08) and relative thickness compared with rest during tasks (in all cases P >.12) revealed no significant difference when comparing the 2 subgroups based on the belt response during the SQT or ASLR. CONCLUSIONS: Using these methods, abdominal muscle thickness behavior in athletes with LAGP did not differ between the subgroups based on a positive or no response to a pelvic belt. However, the ultrasound method used may not have been sensitive enough to reveal differences between groups.

Lifestyle, participation, and health-related quality of life in adolescents and young adults with myelomeningocele (Article)

2009-12-01T00:00:00Z

This study aimed to describe participation and health-related quality of life (HRQoL) in adolescents and young adults with myelomeningocele and to explore their relationships with lifestyle-related factors. Fifty-one individuals with a mean age of 21 years 1 month (SD 4y 6mo) years participated (26 males, 25 females; 82% hydrocephalus, 55% wheelchair-dependent). Participation was assessed using the Life Habits Questionnaire, and HRQoL was assessed using the Medical Outcomes Study 36-item Short-form Health Survey. Physical activity was measured using an accelerometry-based activity monitor, fitness (peak oxygen uptake) was measured during a maximal exercise test, and the sum of four skin-folds was assessed to indicate body fat. Relationships were studied using logistic regression analyses. Of the participants, 63% had difficulties in daily activities and 59% in social roles. Participants perceived lower physical HRQoL than a Dutch reference population. Participants with higher levels of physical activity and fitness had fewer difficulties in participating in daily activities (odds ratio [OR]=8.8, p=0.02 and OR=29.7, p=0.02 respectively) and a higher physical HRQoL (OR=4.8, p=0.02 and OR=30.2, p=0.006 respectively), but not mental HRQoL. Body fat was not related to participation or HRQoL. In conclusion, a large proportion of individuals with myelomeningocele had difficulties in participation and perceived low physical HRQoL. Higher levels of physical activity and fitness were related to fewer difficulties in participation and higher physical HRQoL. © The Authors. Journal compilation

The Authors Respond (Article)

2009-12-01T00:00:00Z

Experienced Problems of Young Adults With Cerebral Palsy: Targets for Rehabilitation Care (Article)

2009-11-01T00:00:00Z

Nieuwenhuijsen C, Donkervoort M, Nieuwstraten W, Stam HJ, Roebroeck ME; and the Transition Research Group South West Netherlands. Experienced problems of young adults with cerebral palsy: targets for rehabilitation care. Objective: To determine the problems experienced by young adults with cerebral palsy (CP) and the relationship between those problems and personal and CP-related characteristics. Design: Cross-sectional study. Setting: Rehabilitation centers in the southwest Netherlands. Participants: Young adults (N=87; aged 18-22y) with CP and normal intelligence (roughly corresponding to an intelligence quotient >70, excluding participants who attended schools for those with learning disabilities). Interventions: Not applicable. Main Outcome Measures: We used the Canadian Occupational Performance Measure in a semistructured interview to assess participants for experienced problems. We further categorized experienced problems according to the domains of the International Classification of Functioning, Disability and Health and assessed the relationship between those problems and personal and CP-related characteristics (eg, age, sex, level of gross motor functioning, manual ability, level of education) using appropriate correlation coefficients. Results: Approximately 70% of participants experienced problems in daily life, addressing the areas of self-care (59%), productivity (52%), and leisure activities (37%). More specifically, problems were most prevalent in recreation and leisure (30%), preparing meals (29%), housework (14%), and dressing (14%). Problems in functional mobility, paid or unpaid work, and socialization were considered as most important (represented by the highest mean importance score). Mobility problems were associated with lower levels of gross motor functioning (Spearman ρ=.39), and problems with self-care were associated with lower levels of manual ability (Spearman ρ=.40). Conclusions: Although frequently addressed during pediatric rehabilitation care, problems with mobility and self-care still prevail in young adults with CP. In addition, during the transition into adulthood, young adults with CP may experience problems regarding domestic life and work, which they consider important.

Palmar Abduction Measurements: Reliability and Introduction of Normative Data in Healthy Children (Article)

2009-11-01T00:00:00Z

Purpose: Previously, we studied normative and reliability data of palmar thumb abduction measurements (conventional goniometry, the Pollexograph thumb, the Pollexograph metacarpal, the Inter Metacarpal Distance, the American Society of Hand Therapists method, and the American Medical Association method) in healthy adults. Because many interventions aiming to improve palmar abduction are performed at an early age, the goal of this study was to assess normative and reliability data of these measurement methods in children. Methods: We performed measurements with the Pollexograph thumb, the Pollexograph metacarpal and Inter Metacarpal Distance in 100 healthy children to acquire normative data. A retest was performed in 63 children to assess intraobserver reliability. Results: Mean active and passive palmar abduction measured with the Pollexograph thumb was 62° (range, 40° to 76°). The range of motion of the Pollexograph metacarpal was smaller (mean 49°, range, 32° to 64°). The mean Inter Metacarpal Distance was 50 mm (range, 36-70 mm). Intraclass correlation coefficients of the Pollexograph thumb, Pollexograph metacarpal, and Inter Metacarpal Distance indicated excellent reliability (intraclass correlation coefficients between 0.85 and 0.92). Conclusions: Normative Pollexograph thumb and Pollexograph metacarpal data showed that means measured in children are comparable to values found in healthy adults. Reliability data indicated that the Pollexograph thumb, the Pollexograph metacarpal, and Inter Metacarpal Distance are also reliable measurement methods in children.

COPD and cancer mortality: The influence of statins (Article)

2009-11-01T00:00:00Z

Background: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer, independently of smoking. However, the relationship between COPD and total cancer mortality is less certain. A study was undertaken to investigate the association between COPD and total cancer mortality and to determine whether the use of statins, which have been associated with cancer risk in other settings, modified this relationship. Methods: The study included 3371 patients with peripheral arterial disease who underwent vascular surgery between 1990 and 2006; 1310 (39%) had COPD and the rest did not. The primary end point was cancer mortality (lung and extrapulmonary) over a median follow-up of 5 years. Results: COPD was associated with an increased risk of both lung cancer mortality (hazard ratio (HR) 2.06; 95% CI 1.32 to 3.20) and extrapulmonary cancer mortality (HR 1.43; 95% CI 1.06 to 1.94). The excess risk was mostly driven by patients with moderate and severe COPD. There was a trend towards a lower risk of cancer mortality among patients with COPD who used statins compared with patients with COPD who did not use statins (HR 0.57; 95% CI 0.32 to 1.01). Interestingly, the risk of extrapulmonary cancer mortality was lower among statin users with COPD (HR 0.49; 95% CI 0.24 to 0.99). Conclusions: COPD was associated with increased lung and extrapulmonary cancer mortality in this large cohort of patients with peripheral arterial disease undergoing vascular surgery. The risk of lung cancer mortality increased with progression of COPD. Statins were associated with a reduced risk of extrapulmonary cancer mortality in patients with COPD.

Platform accelerations of three different whole-body vibration devices and the transmission of vertical vibrations to the lower limbs (Article)

2009-10-01T00:00:00Z

Physical whole-body vibration (WBV) exercises become available at various levels of intensity. In a first series of measurements, we investigated 3-dimensional platform accelerations of three different WBV devices without and with three volunteers of different weight (62, 81 and 100 kg) in squat position (150° knee flexion). The devices tested were two professional devices, the PowerPlate and the Galileo-Fitness, and one home-use device, the PowerMaxx. In a second series of measurements, the transmission of vertical platform accelerations of each device to the lower limbs was tested in eight healthy volunteers in squat position (100° knee flexion). The first series showed that the platforms of two professional devices vibrated in an almost perfect vertical sine wave at frequencies between 25-50 and 5-40 Hz, respectively. The platform accelerations were slightly influenced by body weight. The PowerMaxx platform mainly vibrated in the horizontal plane at frequencies between 22 and 32 Hz, with minimal accelerations in the vertical direction. The weight of the volunteers reduced the platform accelerations in the horizontal plane but amplified those in the vertical direction about eight times. The vertical accelerations were highest in the Galileo (∼15 units of g) and the PowerPlate (∼8 units of g) and lowest in the PowerMaxx (∼2 units of g). The second series showed that the transmission of vertical accelerations at a common preset vibration frequency of 25 Hz were largest in the ankle and that transmission of acceleration reduced ∼10 times at the knee and hip. We conclude that large variation in 3-dimensional accelerations exist in commercially available devices. The results suggest that these differences in mechanical behaviour induce variations in transmissibility of vertical vibrations to the (lower) body.

Perceived barriers to and facilitators of physical activity in young adults with childhood-onset physical disabilities (Article)

2009-10-01T00:00:00Z

Objective: To explore the main barriers to and facilitators of physical activity in young adults with childhood-onset physical disabilities. Design: Qualitative study using focus groups. Participants: Sixteen persons (12 men and 4 women) aged 22.4 (standard deviation 3.4) years, of whom 50% were wheelchair-dependent, participated in the study. Eight were diagnosed with myelomeningocele, 4 with cerebral palsy, 2 with acquired brain injury and 2 with rheumatoid arthritis. Methods: Three focus group sessions of 1.5 h were conducted using a semi-structured question route to assess perceived barriers to and facilitators of physical activity. Tape recordings were transcribed verbatim and content analysed. According to the Physical Activity for People with a Physical Disability model, barriers and facilitators were subdivided into personal factors and environmental factors. Results: Participants reported several barriers related to attitude and motivation. In addition, lack of energy, existing injury or fear of developing injuries or complications, limited physical activity facilities, and lack of information and knowledge, appeared to be barriers to physical activity. Fun and social contacts were mentioned as facilitators of engaging in physical activity, as well as improved health and fitness. Conclusion: Young adults with childhood-onset physical disabilities perceived various personal and environmental factors as barriers to or facilitators of physical activity. These should be taken into account when developing interventions to promote physical activity in this population.

Predicting respiratory infection one year after inpatient rehabilitation with pulmonary function measured at discharge in persons with spinal cord injury (Article)

2009-09-01T00:00:00Z

Objective: To determine whether pulmonary function at discharge from inpatient rehabilitation can predict respiratory infection in spinal cord injury in the first year after discharge, and to determine which pulmonary function parameter predicts best. Design: Multicentre prospective cohort study. Subjects: A total of 140 persons with spinal cord injury. Methods: Pulmonary function was tested at discharge from inpatient rehabilitation. Pulmonary function parameters (expressed in absolute and percentage predicted values) were: forced vital capacity, forced expiratory volume in 1 sec, and peak expiratory flow. Respiratory infection was determined one year after discharge by a physician. Differences between the respiratory infection and non-respiratory infection groups were tested; and receiver operating characteristic curves were used to determine how accurately pulmonary function parameters could predict respiratory infection. Results: Of the 140 participants, 14 (10%) experienced respiratory infection in the first year after discharge. All pulmonary function parameters were significantly lower in persons who experienced respiratory infection than in those who did not. All pulmonary function parameters were almost equally accurate in predicting respiratory infection; only percentage predicted forced vital capacity was less accurate. Conclusion: Pulmonary function at discharge from inpatient rehabilitation can be used as a predictor of respiratory infection in the first year after discharge in spinal cord injury. No single pulmonary function parameter was a clearly superior predictor of respiratory infection.

Association between chronic obstructive pulmonary disease and chronic kidney disease in vascular surgery patients (Article)

2009-09-01T00:00:00Z

Background. Chronic obstructive pulmonary disease (COPD) is recognized as a source of systemic inflammation and is associated with the development of cardiovascular disease. However, little is known about the association between COPD and chronic kidney disease (CKD). Therefore, we investigated the relationship between COPD and CKD and the association between COPD and mortality in patients with CKD.Methods. We conducted a cohort study of 3358 vascular surgery patients between 1990 and 2006. CKD was defined according to the Modification of Diet in Renal Disease equation as an estimated glomerular filtration rate (GFR) <60 mLmin1.73 m2. In addition, the patients were divided into three categories based on the baseline estimated GFR: ≥90 mLmin1.73 m2; 60-89 mLmin1.73 m2and <60 mLmin1.73 m2. Multivariable logistic regression analysis was used to evaluate the independent association between prevalent COPD and CKD.Results. The prevalence of COPD was inversely related to kidney function. COPD was present in 47, 38 and 32 of patients with an estimated GFR <60, 60-89 and ≥90 mLmin1.73 m2, respectively. COPD was independently associated with CKD (OR 1.22; 95 CI 1.03-1.44; P = 0.03). This association was strongest in patients with moderate COPD (OR 1.33; 95 CI 1.07-1.65; P = 0.01). Both moderate and severe COPD were associated with increased long-term mortality in patients with CKD (HR 1.27; 95 CI 1.03-1.56; P = 0.03 and HR 1.61; 95 CI 1.10-2.35; P = 0.01, respectively), compared to patients without COPD.Conclusions. Our findings indicate that COPD is moderately associated with CKD in a large cohort of vascular surgery patients. In addition, moderate and severe COPD are related to increased long-term mortality in patients with CKD.

The Pollexograph®: A New Device for Palmar Abduction Measurements of the Thumb (Article)

2009-07-01T00:00:00Z

Study Design: Clinical measurement, cross sectional. Purpose: To introduce a new measurement device, the Pollexograph®, to easily measure palmar thumb abduction, and to compare its reliability with conventional goniometry. Methods: Fourteen hand therapists measured palmar abduction of the same healthy subject with the Pollexograph and a conventional goniometer. In addition, intrarater reliability of the Pollexograph was studied in 21 patients with a hypoplastic thumb. Results: Variance between measurements of the same subject measured by the hand therapist was 2-6 times smaller with the Pollexograph compared to conventional goniometry. Pollexograph intrarater reliability in hypoplastic thumb patients was excellent (intraclass correlation coefficient (ICC) = 0.98-0.99). Conclusions: A new tool to measure palmar abduction in clinical care, the Pollexograph, has been introduced. The Pollexograph reduces variability between raters when measuring the same subject compared with conventional goniometry and excellent measurement reliability in hypoplastic thumb patients. Level of evidence: Not applicable.

Community integration following moderate to severe traumatic brain injury: A longitudinal investigation (Article)

2009-06-01T00:00:00Z

Objective: To evaluate the course and identify determinants of community integration for up to 3 years following moderate to severe traumatic brain injury. Design: Prospective cohort study. Patients: A total of 119 patients with moderate to severe traumatic brain injury aged 16-67 years. Methods: The Community Integration Questionnaire' was completed at 3, 6, 12, 18, 24 and 36 months post-injury. Repeated measures analysis of variance was performed to determine changes over time in the Community Integration Questionnaire and its subscales. Bivariate and multivariate regression analyses were used to identify determinants of community integration 36 months post-injury. Results: Compared with pre-injury, mean home integration, social integration, productivity, and total questionnaire scores decreased 3 months post-injury. Patient scores showed maximal improvement during the first year post-injury. Mean home integration, productivity, and total scores increased to a lesser extent during years 1-3 post-injury. Age, Barthel Index scores, hospital discharge destination, and pre-injury community integration scores were the major determinants of community integration 36 months post-injury (R2=60%). Conclusion: After an initial decline, mean community integration scores gradually improve following moderate to severe traumatic brain injury. Understanding the course and determinants of community integration is necessary in order to determine functional prognosis following traumatic brain injury.

Pre-operative pulmonary evaluation of lung cancer patients: A review of the literature (Article)

2009-05-01T00:00:00Z

Complete anatomical resection of the primary tumour is still the standard of care in patients with early stage lung cancer. Because these patients are usually smokers who also suffer from chronic obstructive pulmonary disease, regional differences in pulmonary function due to lung tissue destruction exist. he purpose of the present article is to evaluate the currently available guidelines and to discuss novel methods for the pre-operative functional and anatomical pulmonary evaluation in lung cancer patients. espite the fact that knowledge on the pre-operative evaluation of the pulmonary function has substantially increased during the past decade, the majority of the studies are small, underpowered and, with exception of a proposed algorithm, not prospectively validated in independent cohorts.The future harmonisation of guidelines is required and novel imaging techniques should be incorporated in the pre-operative evaluation in chronic obstructive pulmonary disease patients with borderline pulmonary function. Copyright

Motor impairments and activity limitations in children with spastic cerebral palsy: A Dutch population-based study (Article)

2009-04-01T00:00:00Z

Objective: To determine the prevalence of motor impairments and activity limitations and their inter-relationships in Dutch children with spastic cerebral palsy. Patients and methods: In a population-based survey 119 children, age range 6-19 years, with spastic cerebral palsy were examined. Anthropometry, muscle tone, abnormal posture, joint range of motion, major orthopaedic impairments and gross motor functioning and manual ability were assessed or classified, in addition to limitations in mobility and self-care activities. Spearman's correlation coefficients, bivariate post hoc analyses and univariate and multivariate logistic regression analyses were used. Results: Children with spastic cerebral palsy had a lower body height and weight compared with typically developing peers. Forty percent had no range of motion deficits. Hip dislocations were rarely encountered. Motor impairments were associated with gross motor functioning and manual ability levels. Close to sixty-five percent walked independently. Children with diplegia and tetraplegia differed in activity limitations. Motor impairments and limitations in mobility and self-care activities were only modestly related in multivariate analyses. Conclusion: Distribution of cerebral palsy-related characteristics is consistent with that found in representative studies of other countries. The distinction between diplegia and tetraplegia is relevant from an activity point of view. The child's activity limitations are not a mirror of the motor impairments, which suggests multifactorial influences. An activity-oriented rehabilitation approach goes beyond treating specific impairments.

Evidence of a logarithmic relationship between motor capacity and actual performance in daily life of the paretic arm following stroke (Article)

2009-04-01T00:00:00Z

Objective: To examine the associations between actual performance in daily life and function, capacity and self-perceived performance of the paretic upper limb following stroke. Population: Seventeen individuals with stroke. Outcome measures: Correlation coefficients between actual performance (measured with the Stroke-Upper Limb Activity Monitor), function (Fugl-Meyer Assessment), capacity (Action Research Arm test) and self-perceived performance (ABILHAND questionnaire). Results: High correlations were found between actual performance and function (r=0.75; 95% confidence interval (CI):0.42-0.90),and capacity(r=3270.71;95%CI:0.35-0.89), whereas a moderate correlation was found between actual performance and self-perceived performance (r=0.64; 95% CI: 0.21-0.86). For the relationship between actual performance and both function and capacity, logarithmic regression explained more variance than did linear regression. Conclusion: The present study provides first evidence of the existence of a non-linear relationship between actual performance, function and capacity of the paretic upper limb following stroke. The results indicate that function and capacity need to reach a certain threshold-level before actual performance also starts to increase. Because of the small sample size of the present study caution is needed when generalizing these results.

Current experiences with the prosthetic upper extremity functional index in follow-up of children with upper limb reduction deficiency (Article)

2009-04-01T00:00:00Z

The aims of this study are to evaluate the (1) functioning of the children with upper limb reduction deficiency (ULRD) in our centers using the prosthetic upper extremity functional index (PUFI); (2) use of the PUFI as a standardized procedure in the assessment and monitoring of children with ULRD on an individual and a group level and as a follow-up instrument in users and nonusers; and (3) use of the Prosthetic Activities Score (PAS), a score for users in which only those activities for which the prosthesis is actually used are scored. The prospective study was performed in two outpatient clinics of rehabilitation medicine and the subjects included forty children with ULRD aged 4-18 years. The subjects were included from the outpatient clinics of the Erasmus University Medical Centre and the University Medical Centre Groningen; 23 were prosthetic users and 17 were nonusers. Main outcome measures included sum scores (0-100) for ease of performance with and without prosthesis and usefulness of the prosthesis, plus the PAS. Two scales of the PUFI were used in nonusers. The feasibility of the PUFI for patient monitoring and clinical research is evaluated. Children with ULRD perform well on daily activities with and without prosthesis, and both users and nonusers can do almost all activities. Users find prosthesis use in half of the activities beneficial. The PAS score is useful to get more valid scores on the actual ease of performance with the prosthesis and its usefulness. Younger children (<12 years) use their prosthesis more actively than older children (>12 years; 31% vs. 11%). In follow-up measurements, children tended to improve on ease of performance and perceived usefulness. Changes in individual scores seem to correlate with clinical observations. Both children, with and without prosthesis, function well. This is in accordance with our approach that not all children need to have prostheses. Standardized assessment of functional activities in children with ULRD using the PUFI is useful for clinical judgment and adequate goal setting, and for patient monitoring. Recommendations to improve the use of the PUFI include an adaptation of the PUFI scores (PAS) and a version for nonusers. In our opinion, broad (inter)national use of the PUFI will give the necessary feedback on the interpretation of PUFI results.

Mirror-Induced Visual Illusion of Hand Movements: A Functional Magnetic Resonance Imaging Study (Article)

2009-04-01T00:00:00Z

Matthys K, Smits M, Van der Geest JN, Van der Lugt A, Seurinck R, Stam HJ, Selles RW. Mirror-induced visual illusion of hand movements: a functional magnetic resonance imaging study. Objective: To identify neural networks associated with the use of a mirror to superimpose movement of 1 hand on top of a nonmoving contralateral hand (often referred to as mirror therapy or mirror-induced visual illusion). Design: A functional magnetic resonance imaging (fMRI) study of mirror-induced visual illusion of hand movements using a blocked design in a 1.5T magnetic resonance imaging scanner. Neural activation was compared in a no-mirror experiment and a mirror experiment. Both experiments consisted of blocks of finger tapping of the right hand versus rest. In the mirror experiment, movement of the left hand was simulated by mirror reflection of right hand movement. Setting: University medical center. Participants: Eighteen healthy subjects. Interventions: Not applicable. Main Outcome Measures: Differences in fMRI activation between the 2 experiments. Results: In the mirror experiment, we found supplementary activation compared with the no-mirror experiment in 2 visual areas: the right superior temporal gyrus (STG) and the right superior occipital gyrus. Conclusions: In this study, we found 2 areas uniquely associated with the mirror-induced visual illusion of hand movements: the right STG and the right superior occipital gyrus. The STG is a higher-order visual region involved in the analysis of biological stimuli and is activated by observation of biological motion. The right superior occipital gyrus is located in the secondary visual cortex within the dorsal visual stream. In the literature, the STG has been linked with the mirror neuron system. However, we did not find activation within the frontoparietal mirror neuron system to support further a link with the mirror neuron system. Future studies are needed to explore the mechanism of mirror induced visual illusions in patient populations in more detail.

Inactive lifestyle in adults with bilateral spastic cerebral palsy (Article)

2009-04-01T00:00:00Z

Objective: To quantify the level of everyday physical activity in adults with bilateral spastic cerebral palsy, and to study associations with personal and cerebral palsy-related characteristics. Participants and methods: Fifty-six adults with bilateral spastic cerebral palsy (mean age 36.4 (standard deviation (SD) 5.8) years, 62% male) participated in the study. Approximately 75% had high gross motor functioning. Level of everyday physical activity was measured with an accelerometry-based Activity Monitor and was characterized by: (i) duration of dynamic activities (composite measure, percentage of 24 h); (ii) intensity of activity (motility, in gravitational acceleration (g)); and (iii) number of periods of continuous dynamic activity. Outcomes in adults with cerebral palsy were compared with those for able-bodied age-mates. Results: Duration of dynamic activities was 8.1 (SD 3.7) % (116 min per day), and intensity of activity was 0.020 (SD 0.007) g; both outcomes were significantly lower compared with able-bodied age-mates. Of adults with cerebral palsy, 39% had at least one period of continuous dynamic activities lasting longer than 10 min per day. Gross motor functioning was significantly associated with level of everyday physical activity (Rs -0.34 to -0.48; p≤0.01). Conclusion: Adults with bilateral spastic cerebral palsy, especially those with low-level gross motor functioning, are at risk for an inactive lifestyle.

Palmar Abduction: Reliability of 6 Measurement Methods in Healthy Adults (Article)

2009-03-01T00:00:00Z

Purpose: The aim of the current study was to assess reliability of 6 palmar thumb abduction measurement methods: conventional goniometry, the Inter Metacarpal Distance, the method described by the American Medical Association, the method described by the American Society of Hand Therapists, and 2 new methods: the Pollexograph-thumb and the Pollexograph-metacarpal. Methods: An experienced hand therapist and a less-experienced examiner (trainee in plastic surgery) measured the right hands of 25 healthy subjects. Palmar abduction was measured both passively and actively. Means and ranges for palmar abduction were calculated, and intrarater and interrater reliability was expressed in intraclass correlation coefficients, standard errors of measurement, and smallest detectable differences. Results: Mean active and passive angles measured with goniometry resembled values measured with the Pollexograph-thumb method (approximately 60°). Mean angles found with the Pollexograph-metacarpal method were approximately 48°. Mean active and passive distances for the Inter Metacarpal Distance were 64 mm. Mean active and passive distances found with the American Society of Hand Therapists method were 97 to 101 mm, and mean distances found with the American Medical Association method were 67 to 70 mm for active and passive measurements. Intraclass correlation coefficients for the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance indicated good and significantly higher intrarater agreement for active and passive measurements than intraclass correlation coefficients of conventional goniometry, the American Society of Hand Therapists method, and the American Medical Association method, which showed only moderate agreement. For interrater reliability, the same measurement methods were found to be most reliable: the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance. Conclusions: We found that the Pollexograph-thumb, Pollexograph-metacarpal, and the Inter Metacarpal Distance are the most reliable measurement methods for palmar abduction.

Growth Diagrams for Grip Strength in Children (Article)

2009-01-01T00:00:00Z

Abstract: Grip strength dynamometers often are used to assess hand function in children. The use of normative grip strength data at followup is difficult because of the influence of growth and neuromuscular maturation. As an alternative, infant welfare centers throughout the world use growth diagrams to observe normative growth. The aim of this study was to develop similar growth diagrams for grip strength in children. We measured the grip strength, hand dominance, gender, height, and weight of 225 children, 4 to 12 years old. We developed separate statistical models for both hands of boys and girls for drawing growth curves. Grip strength increased with age for both hands. For the whole group, the dominant hand produced higher grip strength than the nondominant hand and boys were stronger than girls. The grip strength of boys and girls differed between 2 and 19 N for the different age groups. Because grip strength measurements are accompanied by a rather large variance, the growth diagrams (presenting a continuum in grip strength) make it possible to better observe grip strength development with time corresponding to a more exact age. Depending on the accuracy needed, the use of one combined diagram could be considered. Level of Evidence: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. (Article)

2009-01-01T00:00:00Z

About 45% of all pregnant women and 25% of all women postpartum suffer from pelvic girdle pain and/or low back pain (PLPP). It has been suggested that increased motion of the three joints in the pelvic ring is one of the causes of PLPP. However, in spite of the availability of high technology the relation between enlarged motion of the pelvic joints and pain remains unclear. This article presents 14 studies on this topic, of which 8 are of sufficient quality to draw conclusions. The conclusion is that, during the last months of pregnancy and the first 3 weeks after delivery, motion of the pelvic girdle joints is 32-68% larger in patients with PLPP than in healthy controls. The overlap in the range of symphyseal motion between PLPP patients and healthy controls is too large to use motion as a diagnostic tool in individual cases. The findings support the idea that enlarged motion is one of the factors that causes PLPP and justifies treatment with measures to reduce this motion.

Exercise testing of pre-school children using the Bruce treadmill protocol: new reference values (Article)

2009-01-01T00:00:00Z

The Bruce treadmill protocol is an often-used exercise test for children and adults. Few and mainly old normative data are available for young children. In this cross-sectional observational study we determined new reference values for the original Bruce protocol in children aged 4 and 5 years. Furthermore, we compared the original protocol with the so-called 'half Bruce' protocol. In the Netherlands this half-Bruce protocol is often used for young children because of the rather large increments in workload in the original protocol. Seventy-eight healthy Dutch children participated. The maximal endurance time was the criterion of exercise capacity. The new reference values for the original Bruce protocol are presented as reference centiles. The mean (SD) endurance time using the original protocol was 10.2 (SD 1.5) min.; this was 9.4 (1.3) min. for the half-Bruce protocol. The mean difference was 50 seconds (95% CI: 29-71 s, P < 0.001). So, for children aged 4 and 5 years the endurance times obtained with the original and half-Bruce protocol are different and should not be considered interchangeable. Our new reference values can be used as reference values for the original Bruce protocol.

Validity of the detection of wheelchair propulsion as measured with an Activity Monitor in patients with spinal cord injury (Article)

2009-01-01T00:00:00Z

Abstract. STUDY DESIGN: Validation study. OBJECTIVES: An accelerometry-based Activity Monitor (AM) has proven to be a valid instrument to quantify mobility-related activities (lying, sitting, standing, walking, cycling, general (noncyclic) movement). The aim of this study was to assess whether, additional to other activities, wheelchair propulsion (hand-rim wheelchair propulsion and handbiking) can be validly detected by the AM in patients with spinal cord injury (SCI). SETTING: Rehabilitation center. METHODS: In all, 10 patients with SCI (aged 19-63 years; five patients with poor triceps strength and five patients with good triceps strength) participated. Patients performed a series of representative daily life activities (involving wheelchair propulsion and nonwheelchair propulsion activities), according to a standard protocol, in a seminatural setting. Continuous registrations of signals from body-fixed accelerometers were made and the AM output (after automatic analysis) was compared with visual analysis of simultaneously made video recordings (reference method). Validity scores (agreement, sensitivity, specificity) between the output of the AM and the video analysis were calculated. RESULTS: Agreement, sensitivity and specificity for the detection of wheelchair propulsion were overall 92 (range, 87-96)%, 87 (76-99)% and 92 (85-98)%, respectively. Sensitivity was smaller in patients with poor triceps strength compared to patients with good triceps strength; 81 (76-89)% and 95 (89-99)%, respectively (P<0.01). Mean overestimation in duration of wheelchair propulsion by the AM was 3.9% (P<0.05). CONCLUSION: Besides already validated other activities, wheelchair propulsion (hand-rim wheelchair propulsion and handbiking) can be validly detected by the AM in patients with SCI, both with good and poor triceps strength. Therefore, the AM offers the possibility to obtain objective and detailed information on all major mobility-related activities performed by patients with SCI.

Transition to adulthood: Validation of the Rotterdam Transition Profile for young adults with cerebral palsy and normal intelligence (Article)

2009-01-01T00:00:00Z

The aim of this study was to investigate the validity of the Rotterdam Transition Profile (RTP) to describe the transition process from childhood to adulthood in young adults with cerebral palsy (CP). Participants were recruited from rehabilitation centres and hospital departments of rehabilitation. In total, 81 young adults (47 males, 34 females) with CP and normal intelligence participated (mean age 20y 5mo [SD 1y 4mo] range 18-22y; 95% spastic CP, 48% hemiplegia, 38% diplegia, 14% quadriplegia; 78% Gross Motor Function Classification System Level I, 83% Manual Ability Classification System Level I). The RTP and the Assessment of Life Habits questionnaire are used to measure transition and functioning in daily activities and participation. Almost all participants were in the transition process or had reached an independent adult lifestyle (ranging from 60-100%, housing 42%). Compared with able-bodied peers, young adults with CP lagged behind in their development in housing (25 vs 36%; p < 0.05), employment (33 vs 49%; p < 0.05), and intimate relationships (37 vs 76%; p < 0.01). Associations were found between the phase of transition and age, parents' level of education, gross motor functioning, manual ability, level of education, and level of functioning in daily activities and participation. The RTP is a valid tool to gain more insight into the transition process, at the individual as well as at group level. © The Authors. Journal compilation

The hypothesis of overwork weakness in Charcot-Marie-Tooth: A critical evaluation (Article)

2009-01-01T00:00:00Z

Objective: It has been reported that the non-dominant hand of patients with Charcot-Marie-Tooth disease is stronger than the dominant hand as a result of overwork weakness. The objective of this study was to determine if this hypothesis could be verified in our population. Design: Survey. Subjects: Twenty-eight patients with Charcot-Marie-Tooth disease type I or II from a rehabilitation department of a university hospital in the Netherlands. Methods: The strength of 3 intrinsic muscle groups of the dominant and non-dominant hand were determined using the Medical Research Council scale and the Rotterdam Intrinsic Hand Myometer. Furthermore, grip strength, pinch and key grip strength were measured. Results: We found no differences in muscle strength for the dominant and non-dominant hand, except for a stronger key grip strength of the dominant hand in patients with Charcot-Marie-Tooth disease type II. Conclusion: In our population, the dominant hand of patients with Charcot-Marie-Tooth disease type I and II was equally strong as the non-dominant hand, suggesting that there is no presence of overwork weakness in the dominant hand in our group of patients. This implies that patients with Charcot-Marie-Tooth disease do not have to limit the use of their hands in daily life in order to prevent muscle strength loss. © 2009 The Authors. Journal Compilation

Is there equity in long-term healthcare utilization after traumatic brain injury? (Article)

2009-01-01T00:00:00Z

Objective: To quantify the long-term use of various types of healthcare services in patients with traumatic brain injury and to estimate the relative contribution of predisposing characteristics, enabling factors and health-related needs to determine whether there is equity in healthcare utilization. Design: Cross-sectional study. Patients: Seventy-nine non-institutionalized moderate to severe patients with traumatic brain injury (age range 16-67 years). Methods: Healthcare use was measured at 3-5 years post-injury. The relative contribution of predisposing characteristics, enabling factors, and health-related needs to the utilization of various types of care was analysed using logistic regression to determine whether there was equity in healthcare utilization. Results: At least one healthcare service was used by 68% of the patients. Health-related needs explained most of the utilization. However, predisposing characteristics were also related to the use of other medical care and supportive care. Patients with a high internal locus of control were more likely to be users of supportive care, and patients with a high locus of control with the physician were more likely to visit medical specialists. Conclusion: The results suggest that most of our patients who needed care, received care. However, inequity could not be ruled out completely as predisposing characteristics also contributed to some types of healthcare utilization. © 2009 The Authors. Journal Compilation

Reliability of Hand Strength Measurements Using the Rotterdam Intrinsic Hand Myometer in Children (Article)

2008-12-01T00:00:00Z

Purpose: Grip strength and pinch strength measurements are often used to assess hand function. However, both measure a number of muscle groups in combination, and grip strength in particular is dominated by extrinsic hand muscles. The Rotterdam Intrinsic Hand Myometer (RIHM) was recently introduced to measure the force that individual fingers and thumb can exert in different directions. The aim of this study was to establish the reliability of these measurements with use of the RIHM in children. Methods: Sixty-three healthy children between 4 and 12 years of age participated in this study. The RIHM was used to measure thumb palmar abduction, thumb opposition, thumb flexion at the metacarpal-phalangeal (MP) joint, index finger abduction, and little finger abduction. A retest was performed with an average test-retest interval of 26 days. Results: For the thumb, palmar abduction strength had intraclass correlation coefficients (ICCs) of .98 for both hands. For both thumb opposition and flexion at the MP joint, ICCs were .97 for the dominant hands and .98 for the nondominant hands. Index finger abduction had ICCs of .94 and .95 and little finger abduction had ICCs of .90 and .92 for the dominant and nondominant hands, respectively. The smallest detectable differences for dominant and nondominant hands respectively were thumb palmar abduction, 15% and 15%; thumb opposition, 12% and 9%; thumb flexion (at the MP joint), 12% and 9%; abduction of the index finger, 17% and 17%; and little finger abduction, 26% and 26%. Conclusions: We found that the RIHM was reliable for use in children. Intraclass correlation coefficients and smallest detectable differences were comparable with those obtained with use of the RIHM in adults and with values found for pinch and grip strength in children. Because the RIHM measures more specific aspects of hand function than grip and pinch, adding the RIHM to measurement protocols may contribute to a more complete overview of a child's hand function.

Functional independence and health-related functional status following spinal cord injury: A prospective study of the association with physical capacity (Article)

2008-11-01T00:00:00Z

Objective: To determine changes in functional independence following spinal cord injury and to evaluate the association between functional independence and physical capacity. Design: Multi-centre prospective cohort study. Subjects: Patients with spinal cord injury admitted for initial rehabilitation. Methods: The motor Functional Independence Measure (FIMmotor) was determined at the start of rehabilitation (n=176), 3 months later (n=124), at discharge (n=160) and one year after discharge from inpatient rehabilitation (n=133). One year after discharge, physical and social dimensions of health-related functional status (Sickness Impact Profile 68; SIP68) were determined. On each occasion, physical capacity was established by measuring arm muscle strength, peak power output and peak oxygen uptake. Results: Multi-level random coefficient analyses revealed that FIMmotor improved during inpatient rehabilitation, but stabilized thereafter. Changes in FIMmotor were associated with peak power output. Multiple regression models showed that FIMmotor and peak power output at discharge were associated with FIMmotor one year after discharge (R2=0.85), and that peak power output at discharge was associated with the social dimension of the SIP68 (R2=0.18) one year after discharge. Conclusion: Functional independence improves during inpatient rehabilitation, and functional independence is positively associated with peak power output.

Hand Function and Activity Performance of Children with Longitudinal Radial Deficiency (Article)

2008-11-01T00:00:00Z

Background: The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two. Methods: We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined. Results: The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance. Conclusions: Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function.

Cardiovascular Disease Risk Factors and the Relationships With Physical Activity, Aerobic Fitness, and Body Fat in Adolescents and Young Adults With Myelomeningocele (Article)

2008-11-01T00:00:00Z

Buffart LM, van den Berg-Emons RJ, Burdorf A, Janssen WG, Stam HJ, Roebroeck ME. Cardiovascular disease risk factors and the relationships with physical activity, aerobic fitness, and body fat in adolescents and young adults with myelomeningocele. Objectives: To describe cardiovascular disease (CVD) risk factors in adolescents and young adults with myelomeningocele (MMC) and to explore relationships with physical activity, aerobic fitness, and body fat. Design: Cross-sectional study. Setting: Outpatient clinic. Participants: Adolescents and young adults (N=31) with MMC (58% men) age 16 through 30 years; 13 were ambulatory and 18 were nonambulatory. Interventions: Not applicable. Main Outcome Measures: We studied biologic and lifestyle-related CVD risk factors, including lipid and lipoprotein profiles, blood pressure, aerobic fitness (Vo2peak), body fat, daily physical activity, and smoking behavior. We considered subjects at increased CVD risk when 2 or more of the following risk factors clustered: systolic blood pressure, total serum cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and cigarette smoking. Relationships were studied using regression analyses. Results: Levels of TC, low-density lipoprotein cholesterol, and triglycerides were elevated in 29%, 38%, and 3% of the participants, respectively. HDL-C was reduced in 19%. Hypertension was found in 20%, and 19% were current cigarette smokers. Based on the clustering of risk factors, 42% of the participants were at increased CVD risk: 15% of ambulatory participants and 61% of nonambulatory participants (P=.03). Adjusted for sex and ambulatory status, participants with higher aerobic fitness tended to be more likely to have no CVD risk (odds ratio=13.0; P=.07). CVD risk was not associated to physical activity and body fat. Conclusions: A large proportion of the study sample was at CVD risk, indicated by clustering of risk factors. Improving aerobic fitness in young adults with MMC may contribute in reducing CVD risk; this needs to be confirmed in future studies.

A Prospective Study on Physical Activity Levels After Spinal Cord Injury During Inpatient Rehabilitation and the Year After Discharge (Article)

2008-11-01T00:00:00Z

van den Berg-Emons RJ, Bussmann JB, Haisma JA, Sluis TA, van der Woude LH, Bergen MP, Stam HJ. A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge. Objectives: To assess the change over time in the physical activity level after a spinal cord injury (SCI), to explore its determinants, and to compare the physical activity level 1 year after discharge from the rehabilitation center with the level in able-bodied persons. Design: Prospective cohort study. Measurements were obtained at the start of active rehabilitation, 3 months later, at discharge, 2 months after discharge, and 1 year after discharge. Setting: Rehabilitation center in The Netherlands and the participant's home. Participants: Persons (n=40) with SCI. Interventions: Not applicable. Main Outcome Measures: The physical activity level, as indicated by the duration of dynamic activities (ie, wheelchair driving, walking, cycling, noncyclic movement) per day, and the intensity of everyday activity; both were measured with an accelerometry-based activity monitor during 2 consecutive weekdays. Results: Random coefficient analyses showed that the duration of dynamic activities and the intensity of everyday activity increased during inpatient rehabilitation at rates of 41% and 19%, respectively (P<.01). Shortly after discharge, there was a strong decline (33%; P<.001) in the duration of dynamic activities. One year after discharge, this decline was restored to the discharge level but was low in comparison with levels in able-bodied persons. The level of lesion and completeness of lesion were determinants of the change in the physical activity level after discharge. Conclusions: The physical activity level increased during inpatient rehabilitation, but this increase did not continue after discharge, and the level 1 year after discharge was distinctly lower than the level in able-bodied persons. Subpopulations had a different change over time in the physical activity level after discharge.

Unmet needs and health care utilization in young adults with cerebral palsy (Article)

2008-10-10T00:00:00Z

Purpose. To gain insight into the unmet needs and utilization of health care of young adults with cerebral palsy (CP) and to explore relations between unmet needs, health care utilization and subject characteristics. Method. A cross-sectional study was performed in 29 young adults with CP without severe learning disabilities (IQ > 70). Subject characteristics such as age, gender, limb distribution, level of gross motor functioning, level of education and perceived participation and autonomy were measured. Outcome measures were the Southampton Needs Assessment Questionnaire, Impact on Participation and Autonomy and a questionnaire on health care utilization. Results. Young adults with CP reported unmet needs mostly on information (79%), mobility (66%) and health care (66%). About half of the participants visited a rehabilitation physician (52%) or a physical therapist (55%) in the past year. Participants with lower levels of gross motor functioning were found to have more unmet needs and visited various health care professionals more often than young adults with higher levels of gross motor functioning. However, participants with higher levels of gross motor functioning still reported several unmet needs. Conclusions. Although young adults with CP frequently receive treatment from health care professionals, they indicate unmet needs with respect to several areas such as information on diagnosis, functional mobility and formal health care. In the treatment of young adults with CP, attention should be paid to these aspects.

Impact of cardioselective β-blockers on mortality in patients with chronic obstructive pulmonary disease and atherosclerosis (Article)

2008-10-01T00:00:00Z

Rationale: β-Blocker use is associated with improved health outcomes in patients with cardiovascular disease. There is a general reluctance to prescribe β-blockers in patients with chronic obstructive pulmonary disease (COPD) because they may worsen symptoms. Objectives: We investigated the relationship between cardioselective β-blockers and mortality in patients with COPD undergoing major vascular surgery. Methods: We evaluated 3,371 consecutive patients who underwent major vascular surgery at one academic institution between 1990 and 2006. The patients were divided into those with and without COPD on the basis of symptoms and spirometry. The major endpoints were 30-day and long-term mortality after vascular surgery. Patients were defined as receiving low-dose therapy if the dosage was less than 25% of the maximum recommended therapeutic dose; dosages higher than this were defined as intensified dose. Measurements and Main Results: There were 1,205 (39%) patients with COPD of whom 462 (37%) received cardioselective β-blocking agents. β-Blocker use was associated independently with lower 30-day (odds ratio, 0.37; 95% confidence interval, 0.19-0.72) and long-term mortality in patients with COPD (hazards ratio, 0.73; 95% confidence interval, 0.60-0.88). Intensified dose was associated with both reduced 30-day and long-term mortality in patients with COPD, whereas low dose was not. Conclusions: Cardioselective β-blockers were associated with reduced mortality in patients with COPD undergoing vascular surgery. In carefully selected patients with COPD, the use of cardioselective β-blockers appears to be safe and associated with reduced mortality.

Sensitivity of accelerometry to assess balance control during sit-to-stand movement (Article)

2008-10-01T00:00:00Z

Accelerometry has the potential to measure balance, defined as high-frequency body sway, ambulatorily in a simple and inexpensive way. The aim of this study was to determine and compare the sensitivity of accelerometric balance parameters during the sit-to-stand (STS) movement. Eleven healthy subjects (four males, 28.2 ± 7.9 years) and 31 patients with stroke (21 males; 63.3 ± 12.8 years) were included. The healthy subjects performed STS movements in four conditions with different levels of difficulty. Data of the patients were compared 1) with healthy subjects, 2) between patient subgroups, and 3) between different phases of recovery to assess the sensitivity of accelerometry for differences in balance control. Accelerometers were attached to the trunk, and force plate measurements were simultaneously done in the healthy subjects. Main outcome measures were root mean square (rms) and area under the curve (AUC) derived from the high-frequency component of the transversal acceleration signal of the trunk. In all comparisons there was a significant difference in AUC data (p < 0.05), and AUC appeared to be more sensitive than rms. Variability in AUC was not completely or mainly the result of changes and differences in the duration of the STS movement. As a conclusion, accelerometry is a potentially valuable technique to measure balance during the STS movement.

Sports participation in adolescents and young adults with myelomeningocele and its role in total physical activity behaviour and fitness (Article)

2008-10-01T00:00:00Z

Objective: To assess sports participation in young adults with myelomeningocele and its association with personal, disease-related and psychosocial factors, physical activity and fitness. Design: Cross-sectional study. Subjects: Fifty-one persons (26 males) with myelomeningocele, mean age 21.1 (standard deviation 4.5) years. Methods: We assessed self-reported sports participation, ambulatory status, presence of hydrocephalus, functional independence, social support, perceived competence, exercise enjoyment, objective and self-reported physical activity, peak oxygen uptake, muscle strength and body fat. Associations were studied using regression analyses. Results: Thirty-five subjects (69%) participated in sports. Sports participation was not associated with disease-related characteristics, but was associated with social support from family, perceived athletic competence and physical appearance (p≤0.05), and tended to be associated with global self-worth (p=0.10). Sports participants had higher self-reported physical activity levels than non-participants (p≤0.05); objective results did not support this. Furthermore, sports participants tended to be less likely to have subnormal muscle strength (odds ratio = 0.26; p = 0.08) and their peak oxygen uptake was 0.19 l/ min higher, but not statistically significantly (p=0.13). Conclusion: Sports participation seems to be due to personal preferences rather than physical ability; it could benefit from improving social support and perceived competence, and is associated with higher self-reported physical activity.

Small increase of actual physical activity 6 months after total hip or knee arthroplasty (Article)

2008-09-01T00:00:00Z

Limitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning. We determined the effect of THA or TKA on patients' actual physical activity and body function (pain, stiffness), capacity to perform tasks, and self-reported physical functioning. We also assessed whether there are differences in the effect of the surgery between patients undergoing THA or TKA and whether the improvements vary between these different outcome measures. We recruited patients with long-standing end-stage osteoarthritis of the hip or knee awaiting THA or TKA. Measurements were performed before surgery and 3 and 6 months after surgery. Actual physical activity improved by 0.7%. Patients' body function, capacity, and self-reported physical functioning also improved. The effects of the surgery on these aspects of physical functioning were similar for THA and TKA. The effect on actual physical activity (8%) was smaller than on body function (80%-167%), capacity (19%-36%), and self-reported physical functioning (87%-112%). Therefore, in contrast to the large effect on pain and stiffness, patients' capacity, and their self-reported physical functioning, the improvement in actual physical activity of our patients was less than expected 6 months after surgery. Level of Evidence: Level I, prospective study. See the Guidelines for Authors for a complete description of levels of evidence.

Validity of accelerometry in assessing the duration of the sit-to-stand movement (Article)

2008-07-16T00:00:00Z

Accelerometry is frequently used in movement analysis to assess body postures and motions. Here, we assessed the validity of ambulatory accelerometric measurement of the sit-to-stand (STS) movement duration. We compared accelerometric and opto-electronic assessment of the STS movement duration under four conditions (comfortable, slow, fast movement and exaggerated trunk flexion) with six healthy subjects and six subjects with stroke who performed movements six times under each condition. Accelerometric and opto-electronic data of STS movement duration were strongly related (r = 0.98). Accelerometry showed a fixed bias of 0.07 s (95% CI 0.008, 0.141) in healthy subjects and 0.32 s (95% CI 0.223, 0.422) in stroke subjects. In healthy subjects, a significant negative proportional bias of 0.1 was detected (95% CI -0.160, -0.032). Accelerometry showed discriminative validity in comparing stroke subjects to healthy subjects, and in comparing speed conditions. Our results indicate that accelerometry can provide valid data on the STS movement duration, furthermore during its use additional information on the STS movement, such as balance control, can be recorded.

Effect of Statin Therapy on Mortality in Patients With Peripheral Arterial Disease and Comparison of Those With Versus Without Associated Chronic Obstructive Pulmonary Disease (Article)

2008-07-15T00:00:00Z

Chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) are both inflammatory conditions. Statins are commonly used in patients with PAD and have anti-inflammatory properties, which may have beneficial effects in patients with COPD. The relation between statin use and mortality was investigated in patients with PAD with and without COPD. From 1990 to 2006, we studied 3,371 vascular surgery patients. Statin use was noted at baseline and, if prescribed, converted to <25% (low dose) and ≥25% (intensified dose) of the maximum recommended therapeutic dose. The diagnosis of COPD was based on the Global Initiative for Chronic Obstructive Lung Disease guidelines using pulmonary function test. End points were short- (30-day) and long-term (10-year) mortality. A total of 330 patients with COPD (25%) used statins, and 480 patients (23%) without COPD. Statin use was independently associated with improved short- and long-term survival in patients with COPD (odds ratio 0.48, 95% confidence interval [CI] 0.23 to 1.00; hazard ratio 0.67, 95% CI 0.52 to 0.86, respectively). In patients without COPD, statins were also associated with improved short- and long-term survival (odds ratio 0.42, 95% CI 0.20 to 0.87; hazard ratio 0.76, 95% CI 0.60 to 0.95, respectively). In patients with COPD, only an intensified dose of statins was associated with improved short-term survival. However, for the long term, both low-dose and intensive statin therapy were beneficial. In conclusion, statin use was associated with improved short- and long-term survival in patients with PAD with and without COPD. Patients with COPD should be treated with an intensified dose of statins to achieve an optimal effect on both the short and long term.

Objective and continuous measurement of peripheral motor indicators of pain in hospitalized infants: a feasibility study. (Article)

2008-07-01T00:00:00Z

Measurement of pain in pre-verbal infants is complex. Until now, pain behavior has mainly been assessed intermittently using observational tools. Therefore, we determined the feasibility of long-term, objective and continuous measurement of peripheral motor parameters through body-fixed sensors to discriminate between pain and no pain in hospitalized pre-verbal infants. Two pain modes were studied: for procedural pain 10 measurements were performed before, during and after routine heel lances in 9 infants (age range infants: 5-175 days), and for post-operative pain 14 infants (age range 45-400 days) were measured for prolonged periods (mean 7h) using the validated COMFORT-behavior scale as reference method. Several peripheral motor parameters were studied: three body part activity parameters derived from acceleration sensors attached to one arm and both legs, and two muscle activity parameters derived from electromyographic (EMG) sensors attached to wrist flexor and extensor muscles. Results showed that the accelerometry-based parameters legs activity and overall extremity activity (i.e. mean of arm and legs) were significantly higher during heel lance than before or after lance (p0.001), whereas arm activity accelerometry data and wrist muscle activity EMG data showed no significant change. For the post-operative pain measurements, relationships were found between accelerometry-based overall extremity activity and COMFORT-behavior (r=0.76, p<0.001), and between EMG-based wrist flexor activity and COMFORT-behavior (r=0.55, p<0.001, for a subgroup of 7 infants). We conclude that long-term, objective and continuous measurement of peripheral motor parameters is feasible, has high potential, and is promising to assess pain in pre-verbal hospitalized infants.

Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre (Article)

2008-06-01T00:00:00Z

Objective: To determine the most important barriers to and facilitators of the level of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. Design: Qualitative study with both cross-sectional and retrospective questions. Subjects: Thirty-two persons with a spinal cord injury. Methods: Semi-structured interview with questions concerning the current situation (> 9 months after discharge) and retrospective questions concerning the period shortly after discharge (< 3 months). The interview consisted of 10 topic categories assumed to have an impact on the level of everyday physical activity and covering the main parts of the International Classification of Functioning, Disability and Health (ICF) model. Results: In the current situation, the most important barriers were problems with accessibility of stores and buildings, physical health problems and mental health problems. Shortly after discharge, the most important barriers were emotional distress, problems with self-care, and mental health problems. The most frequently mentioned facilitators were preparation in the rehabilitation centre with respect to daily activities and social activities and stimulation to be physically active. Conclusion: Persons with a spinal cord injury experience important barriers to physical activity, particularly on the ICF component Body Functions and Structure. © 2008 The Authors. Journal Compilation.

Health-related physical fitness of adolescents and young adults with myelomeningocele (Article)

2008-05-01T00:00:00Z

To assess components of health-related physical fitness in adolescents and young adults with myelomeningocele (MMC), and to study relations between aerobic capacity and other health-related physical fitness components. This cross-sectional study included 50 adolescents and young adults with MMC, aged 16–30 years (25 males). Aerobic capacity was quantified by measuring peak oxygen uptake (peakVO2) during a maximal exercise test on a cycle or arm ergometer depending on the main mode of ambulation. Muscle strength of upper and lower extremity muscles was assessed using a hand-held dynamometer. Regarding flexibility, we assessed mobility of hip, knee and ankle joints. Body composition was assessed by measuring thickness of four skin-folds. Relations were studied using linear regression analyses. Average peakVO2 was 1.48 ± 0.52 l/min, 61% of the participants had subnormal muscle strength, 61% had mobility restrictions in at least one joint and average sum of four skin-folds was 74.8 ± 38.8 mm. PeakVO2 was significantly related to gender, ambulatory status and muscle strength, explaining 55% of its variance. Adolescents and young adults with MMC have poor health-related physical fitness. Gender and ambulatory status are important determinants of peakVO2. In addition, we found a small, but significant relationship between peakVO2 and muscle strength.

Age-specific reliability of two grip-strength dynamometers when used by children (Article)

2008-05-01T00:00:00Z

Background: The Jamar dynamometer and the Martin vigorimeter, two instruments often used to assess grip strength, have good validity and reliability when employed to evaluate adults. Grip strength measurements are often performed to assess children with hand disorders. However, the reliability of these measurements when used to assess children under the age of twelve years is unknown. In addition, it is not clear whether reliability differs between younger and older children. The purpose of this study was to establish test-retest reliability for different age groups and to determine which instrument is the most reliable. Methods: One hundred and four children from a primary school were included. Subjects were divided into three groups: four to six, seven to nine, and ten to twelve years of age. The grip strength of both hands was measured with the Lode dynamometer (equivalent to the Jamar dynamometer) and with the Martin vigorimeter. The mean of three maximum voluntary contractions was recorded for all measurements. A retest was performed after a mean interval of twenty-nine days. Results: In the total group, the intraclass correlation coefficient for the Lode dynamometer was 0.97 (95% confidence interval, 0.95 to 0.98) for the dominant hand and 0.95 (95% confidence interval, 0.92 to 0.96) for the nondominant hand and the intraclass correlation coefficient for the Martin vigorimeter was 0.84 (95% confidence interval, 0.77 to 0.89) for the dominant hand and 0.86 (95% confidence interval, 0.80 to 0.90) for the nondominant hand. The intraclass correlation coefficients in the different age groups were lower than those in the total group because of a lower between-subject variation. The normalized smallest detectable difference between the test and retest values was approximately 25% for the Lode dynamometer and approximately 31% for the Martin vigorimeter. Conclusions: Both the Lode dynamometer and the Martin vigorimeter are reliable instruments with which to measure the grip strength of children under twelve years of age; however, the Lode dynamometer has better test-retest reliability. Furthermore, comparison of the smallest detectable differences showed the Lode dynamometer to be a more accurate instrument. Copyright

Actual everyday physical activity in patients with end-stage hip or knee osteoarthritis compared with healthy controls (Article)

2008-04-01T00:00:00Z

OBJECTIVE: Few data are available on the level of actual physical activity in patients with osteoarthritis (OA) of the hip and knee. The aim of this study was to measure the level of actual physical activity of patients with end-stage OA of the hip and the knee, to compare this with that of matched healthy controls, and to analyze the data in order to ascertain the factors of influence. METHOD: The actual physical activity was measured with an activity monitor (AM) in 40 hip and 44 knee OA patients, and compared with measurements obtained from healthy controls. Data were also collected on pain and psychological aspects as anxiety, depression and mental functioning. The primary outcome parameter of the actual physical activity was the percentage of movement-related activity. RESULTS: The percentage of movement-related activity did not differ between the two OA groups. It was 8.8 (4.2)% for the hip and 8.1 (3.8)% for the knee OA patients. The matched controls were significantly higher movement-related active than OA patients (about 11.0 (2.9)%). Increasing age and body mass index were negatively associated with the percentage of movement-related activity (beta=-0.29 and beta=-0.25, respectively), whereas mental functioning was positively related (beta=0.30). CONCLUSION: The impact of end-stage OA on the level of actual physical activity is equal for hip and knee OA patients. The actual physical activity for both of the OA groups was significantly and clinically relevantly lower compared to controls. However, this difference was smaller than expected and less dominant than patients' perception of limitations in daily life. Clinicians must be aware that the patients' perception of physical functioning in daily life does not always correspond to the actual physical activity.

Association between apolipoprotein-ε4 and long-term outcome after traumatic brain injury (Article)

2008-04-01T00:00:00Z

Objectives: To investigate the effect of carrying the apolipoprotein epsilon 4 (APOE-ε4) allele on global functional outcome, on activity limitations and participation restrictions, and on community integration at 3, 6, 12, 18, 24 and 36 months after traumatic brain injury. Method: The Glasgow Outcome Scale (GOS), the Sickness Impact Profile-68 (SIP-68) and the Community Integration Questionnaire (CIQ) were assessed in 79 moderate and severe traumatic brain injury patients at 3, 6, 12, 18, 24 and 36 months post injury. Repeated measures analyses of variance were performed with APOE-ε4 status and time of measurement as independent variables and the GOS, SIP-68 and CIQ as dependent variables. Analyses were adjusted for baseline age, gender and Glasgow Coma Scale. Results: Patients with the APOE-ε4 allele had a significantly better global functional outcome on the GOS than patients without the APOE-ε4 allele. No significant associations were found between APOE-ε4 status and the SIP-68 and CIQ. Discussion: In contrast to other studies, we found that carrying the APOE-ε4 allele had a protective influence on outcome. Multiple mechanisms, and in some cases competitive mechanisms, may explain the variable relation between the APOE-ε4 allele and outcome after traumatic brain injury.

Repeatability and variation of quantitative gait data in subgroups of patients with stroke (Article)

2008-04-01T00:00:00Z

We aimed to determine the repeatability and variation of quantitative gait data in patients with stroke and to compare the subgroups in terms of gait variability. Time-distance and kinematic characteristics of gait were evaluated in 90 inpatients (30 women) with hemiparesis (mean ± S.D. age 57.7 ± 12.5 years and time since stroke 5.99 ± 6.46 months). Subgroups were based on "gender", "side of paresis", "lesion type", "motor recovery level", "sensory status", "time since stroke" and "walking velocity". Repeatability was adequate to excellent in all stroke subgroups (ICC range 0.48-0.98). Walking velocity was the most repeatable gait parameter after stroke. Variation in step length was significantly higher in women than in men (CV 16% versus 9%, p < 0.05). Slow walkers (walking velocity <0.34 m/s) had a higher variation than fast walkers in step length (CV 12.5% versus 7.5%, p < 0.01), single support time (CV 11.9% versus 6.3%, p < 0.05), peak hip extensions in stance (CV 11.5% versus 3.7%, p < 0.01) and knee flexion in swing (CV 11.8% versus 6.5%, p < 0.05). In our stroke patients, their age, time since injury, lesion characteristics, impaired proprioception or level of motor recovery had no effect on gait variability. For better interpretation of quantitative gait data, clinicians should consider that variation in step length, single support time, peak hip extension in stance and knee flexion in swing differs according to walking velocity after stroke.

Mirror therapy in patients with causalgia (complex regional pain syndrome type II) following peripheral nerve injury: Two cases (Article)

2008-04-01T00:00:00Z

Objective: To describe the use of mirror therapy in 2 patients with complex regional pain syndrome type II following traumatic nerve injury. Design: Two case reports. Subjects: Two patients with complex regional pain syndrome type II. Methods: Two patients received mirror therapy with the painful hand hidden behind the mirror while the non-painful hand was positioned so that, from the perspective of the patient, the reflection of this hand was "superimposed" on the painful hand. Pain was measured with a visual analogue scale. Results: The first case had developed a severe burning and constant pain in the hand due to a neuroma. In this patient, a strong reduction in pain was found during and immediately after mirror therapy. As a result, the patient was able to perform active exercises that were previously too painful. However, despite the pain relief during and directly after the exercises, the overall level of pain did not decrease. The second patient also had severe burning pain following a glass injury. In this patient, repeated mirror therapy for a 3-month period strongly decreased pain due to causalgia. Conclusion: The presented cases demonstrate that the use of mirror therapy in patients with causalgia related to a neuroma is worthy of further exploration as a potential treatment modality in patients with causalgia.

Daily Physical Activity and Heart Rate Response in People With a Unilateral Traumatic Transtibial Amputation (Article)

2008-03-01T00:00:00Z

Bussmann JB, Schrauwen HJ, Stam HJ. Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation. Objectives: To test the hypothesis that people with a unilateral traumatic transtibial amputation are less active than people without an amputation, and to explore whether both groups have a similar heart rate response while walking. Design: A case-comparison study. Setting: General community. Participants: Nine subjects with a unilateral traumatic transtibial amputation and 9 matched subjects without known impairments. Interventions: Not applicable. Main Outcome Measures: Percentage of dynamic activities in 48 hours (expressing activity level). Additionally, we examined heart rate and percentage heart rate reserve during walking (expressing heart rate response) and body motility during walking (expressing walking speed). These parameters were objectively measured at participants' homes on 2 consecutive days. Results: Subjects with an amputation showed a lower percentage of dynamic activities (6.0% vs 11.7% in a 48-h period, P=.02). No significant differences were found between the 2 groups in heart rate (91.1bpm vs 89.5bpm, P=.86) and percentage heart rate reserve during walking (28.2% vs 27.5%, P=1.0). Body motility during walking was lower in the amputation group (.14g vs .18g, P<.01). Conclusions: Our results support our hypothesis that persons with a unilateral traumatic transtibial amputation are considerably less active than persons without known impairments. The results indicate that heart rate response during walking is similar in both groups, and is probably regulated by adapting one's walking speed.

Mirror Therapy Improves Hand Function in Subacute Stroke: A Randomized Controlled Trial (Article)

2008-03-01T00:00:00Z

Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoǧlu F, Atay MB, Stam HJ. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Objective: To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. Design: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting: Rehabilitation education and research hospital. Participants: A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke. Interventions: Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. Main Outcome Measures: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument). Results: The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS. Conclusions: In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.

Functional activities of the upper extremity of young adults with cerebral palsy: A limiting factor for participation? (Article)

2008-02-22T00:00:00Z

Purpose. To assess functional activities of the upper extremity of young adults with cerebral palsy (CP) and to determine their relations with participant characteristics and participation. Method. Assessment of functional activities of the upper extremity was performed on 103 participants (aged 16-20 years) with the Melbourne assessment and the Abilhand Questionnaire. Participation was measured with the Life Habits Questionnaire. Participant characteristics included age, gender, limb distribution of the spastic paresis, educational level and gross and fine motor function. Relations among these variables were studied by means of correlation coefficients and linear regression analysis. Results. Limitations in functional activities of the upper extremity were related to the limb distribution of the spastic paresis and were especially present in quadriplegic participants. Significant correlations between participant characteristics and measures of functional activities were present. Limitations in functional activities of the upper extremity, measured with the Abilhand Questionnaire, were an important determinant for participation, in addition to the gross motor function and educational level. Conclusion. Limitations in functional activities of the upper extremity are an important determinant for restrictions in participation in young adults with CP. It is recommended to include assessment of functional activities of the upper extremity in patients with CP.

Social, intimate and sexual relationships of adolescents wlth cerebral palsy compared with able-bodied age-mates (Article)

2008-02-01T00:00:00Z

Objective: To describe the social, intimate and sexual relationships of Dutch adolescents with cerebral palsy compared with their able-bodied age mates. Design: Cross-sectional study. Subjects: A total of 103 adolescents with cerebral palsy without severe learning problems aged 16-20 years. Methods: We used a structured interview and questionnaires to assess subject characteristics such as age, type of cerebral palsy, gross motor function and level of education. Main outcome measures on social, intimate and sexual relationships are the Life-Habits questionnaire, the Vineland Adaptive Behaviour Scale, and a structured interview developed for Dutch studies in able-bodied persons and persons with spina bifida. Experienced competence was assessed with the Dutch version of the Self-Perception Profile of Adolescents and the Physical Disability Sexual and Body Esteem Scale. These data were compared with matching reference data, mainly from able-bodied (Dutch) adolescents. Results: Approximately 30% of the subjects functioned socially below their age level. Adolescents with cerebral palsy find it difficult to develop intimate relationships and they have less sexual experience than their able-bodied age mates. Conclusion: Although adolescents with cerebral palsy do have social relationships, it is difficult for them to develop intimate relationships. They perceive various barriers, but seem to have a positive self-perception. © 2007 The Authors. Journal Compilation

Triad of physical activity, aerobic fitness and obesity in adolescents and young adults with myelomeningocele (Article)

2008-01-01T00:00:00Z

Objective: Comprehensively and objectively assess physical activity, aerobic fitness and body fat in adolescents and young adults with myelomeningocele and to investigate their relationships. Design: Cross-sectional study. Subjects: Fifty-one persons (26 males) with myelomeningocele aged 21.1 (standard deviation) 4.5) years. Methods: Physical activity was measured with an accelerometry-based activity monitor. Aerobic fitness was defined as the maximum oxygen uptake during the last minute of a maximal exercise test. Body fat was assessed using sum of 4 skin-folds and body mass index. Correlations were studied using multiple regression analyses. Results: Thirty-nine percent of the participants were inactive and another 37% were extremely inactive. Aerobic fitness was 42% lower than normative values and 35% were obese. Ambulatory status was related to daily physical activity (β = 0.541), aerobic fitness (β = 0.397) and body fat (β = -0.243). Gender was related to aerobic fitness (β = -0.529) and body fat (β = 0.610). Physical activity was related to aerobic fitness in non-ambulatory persons with myelomeningocele (β = 0.398), but not in ambulatory persons. Conclusion: Adolescents and young adults with myelomeningocele were physically inactive, had poor aerobic fitness and high body fat. Differences exist between subgroups regarding gender and ambulatory status.

Cognitive status at discharge from the hospital determines discharge destination in traumatic brain injury patients (Article)

2008-01-01T00:00:00Z

Purpose: To determine which basic and functional status characteristics of patients with a moderate or severe traumatic brain injury (TBI) are associated with discharge destination. Method: Cross-sectional study among TBI patients. The study included 111 patients aged 16-67 years with a moderate-to-severe TBI (Glasgow Coma Scale (GCS) score 3-14). Functional outcome was assessed with Barthel Index (BI), Functional Independence Measurement (FIM), Level of Cognitive Functioning Scale (LCFS), Functional Assessment Measurement (FAM), Supervision Rating Scale (SRS) and Neurobehavioural Rating Scale (NRS). Patients were interviewed at the time of being discharged from hospital. Outcome variable was discharge destination; (1) home vs. institution and (2) rehabilitation centre vs. nursing home. Results: Gender, age and length of stay were not associated with discharge destination. TBI severity, physical status, level of arousal and cognitive status were univariately associated. Multivariate analyses, however, showed that the risk of being admitted to an institution was significantly higher for those with severe TBI (adjusted OR = 14) and/or lowered cognitive status at the time of discharge from hospital (adjusted OR = 12). Conclusions: Discharge destination is associated with TBI-severity at admittance to the hospital and cognitive status at discharge from the hospital.

Sensory Evaluation of the Hands in Patients with Charcot-Marie-Tooth Disease Using Semmes-Weinstein Monofilaments (Article)

2008-01-01T00:00:00Z

In this study, the intra- and interobserver reliability of the Semmes-Weinstein monofilaments (SWMFs) was determined in the hands of 15 patients with Charcot-Marie-Tooth disease. In addition, the amount and distribution of sensory loss in the hand, and the relation between sensory loss, intrinsic muscle strength, and hand dexterity was explored in 45 patients. SWMF testing had good intra- and interobserver reliability with intraclass correlation coefficients of 0.91 and 0.86, respectively. The SWMF testing revealed normal sensory function in 43% of all six locations. The average loss of the intrinsic hand muscle strength was 57%. Poor strength was found in patients with both poor and with good sensory function. The correlation between the measurements of intrinsic muscle strength and the Sollerman test for dexterity was 0.70.

Repeatability of lower limb three-dimensional kinematics in patients with stroke (Article)

2008-01-01T00:00:00Z

The within- and between-session repeatability of time-distance and sagittal plane kinematic gait parameters were evaluated in 20 hemiparetic patients with sub-acute stroke. A test-retest design was used in which the patients were tested during two sessions within a 2 h period. Each session comprised three consecutive trials. The intraclass correlation coefficients (ICCs) for time-distance parameters ranged from 0.82 to 0.99. The within- and between-session repeatability of pelvis, hip, knee and ankle kinematic waveforms were high: the mean coefficient of multiple correlations (CMCs) ranged from 0.85 to 0.95. The within-session coefficient of variation (CV%) for time-distance parameters ranged from 3.9 to 14.1, whereas, between-session CV% ranged from 6.1 to 17.2, showing similar but higher variability. The within- and between-session CV% for sagittal plane kinematics of the paretic lower limb ranged from 3.6 to 32.4. The results indicate that time-distance parameters and sagittal plane gait kinematics of the paretic lower limb, measured by the Vicon 370 gait analysis system, are repeatable and can be used to assess treatment effects after stroke.

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury (Article)

2007-12-01T00:00:00Z

Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, de Groot S, Dallmeijer AJ, Bussmann JB. Prognostic models for physical capacity at discharge and 1 year postdischarge from rehabilitation in persons with spinal cord injury. Objective: To develop prognostic models for physical capacity at discharge and 1 year after discharge from inpatient rehabilitation in persons with spinal cord injury (SCI). Design: Inception cohort; data collected at start of rehabilitation (n=104), at discharge (n=81), and 1 year later (n=74). Setting: Eight Dutch rehabilitation centers. Participants: Patients with SCI at initial rehabilitation. Interventions: Not applicable. Main Outcome Measures: Physical capacity determined by endurance capacity (peak oxygen uptake [Vo2peak, in L/min] and power output [POpeak, in watts]) during a maximal exercise test, arm muscle strength, and respiratory function. Multiple regression models, either with or without prior outcome, evaluated subject, lifestyle, and lesion-related predictors. Results: Only start Vo2peak contributed to the prediction of discharge Vo2peak (R2=.51). Discharge Vo2peak contributed to its prediction 1 year later (R2=.75). Start POpeak, sex, age, and level of lesion contributed to discharge POpeak (R2=.73). Discharge POpeak, hours of employment before injury, and level of lesion contributed to POpeak 1 year later (R2=.81). Models without prior outcome explained less variance. Education, employment, body mass index, not smoking, and conservative stabilization of the spine positively contributed to endurance capacity. Muscle strength was well predicted (R2range, .68-.84). Without prior outcome, respiratory function was poorly predicted. Conclusions: Because prior outcome contributed to an accurate prediction, the early assessment of physical capacity is important in establishing prognoses. Although their accuracy warrants caution in their application, models could complement clinical expertise when informing patients about expected physical outcome and identifying those at risk of low physical capacity.

Prognostic factors of long-term functioning and productivity after traumatic brain injury: A systematic review of prospective cohort studies (Article)

2007-11-01T00:00:00Z

Objective: To systematically review prospective cohort studies that investigated prognostic factors associated with long-term activity limitations or participation restrictions and productivity after a traumatic brain injury. Data sources: PubMed and Psychinfo were searched from 1995 to April 2005, and references were checked. Review methods: Publications were selected if the study assessed prognostic factors for activity limitations or participation restrictions at least one year post injury; outcome was measured with another or additional measure besides the Glasgow Outcome Scale; the design was a prospective cohort study of adult traumatic brain injury patients; the article was a full-text article written in English, French, German or Dutch. Two reviewers independently assessed methodological quality. A study was considered as 'high quality' if it satisfied at least hall of the maximum available quality score. Results: Thirty-five articles reporting on 14 cohorts were included. Due to heterogeneity in prognostic factors and outcome measures, a best-evidence synthesis was performed. All cohorts were of high quality. Strong evidence for predicting disability was found for older age, pre-injury unemployment, pre-injury substance abuse, and more disability at rehabilitation discharge. Strong prognostic factors for being non-productive were pre-injury unemployment, longer post-traumatic amnesia, more disability at rehabilitation admission, and pre-injury substance abuse. Conclusion: Older age, pre-injury unemployment, pre-injury substance abuse and more disability at rehabilitation discharge are important predictors of long-term disability. Pre-injury unemployment, longer post-traumatic amnesia, more disability at rehabilitation admission and pre-injury substance abuse are important predictors of being non-productive.

Physical fitness in people with a spinal cord injury: The association with complications and duration of rehabilitation (Article)

2007-10-01T00:00:00Z

Objective: To assess the association between physical fitness and its recovery over time on the one hand, and complications and duration of phases of rehabilitation on the other. Design and setting: Prospective cohort study at eight rehabilitation centres. Subjects: People with a spinal cord injury were assessed four times: at the start of active rehabilitation (n = 110), three months later (n = 92), at discharge (n = 137) and a year after discharge from inpatient rehabilitation (n = 91). Main measures: Physical fitness was defined as aerobic capacity, determined at each occasion by the peak oxygen uptake (peak Vo2; L/min) and the peak power output (peak PO; W) during a maximal exercise test. On these occasions, spasticity, musculoskeletal and neurogenic pain were determined (1 = present; 0 = absent). During inpatient rehabilitation, complications (urinary tract infection, pulmonary infection or pressure sore) and bed rest were registered (1 = complication; 0 = no complications, and 1 = bed rest; 0 = no bed rest). Complications and bed rest occurring during the year after discharge were registered similarly. Results: Multilevel random coefficient analyses revealed associations in multivariate models (P ≤ 0.05). The peak oxygen uptake was negatively associated with complications after discharge. The recovery of peak power output over time was negatively associated with bed rest and spasticity. Both physical fitness and its recovery were negatively associated with the duration of active rehabilitation. Conclusion: Results suggest that limiting complications, spasticity or bed rest may improve fitness. A longer duration of active rehabilitation is not associated with an increase in physical fitness.

Health issues in young adults with cerebral palsy: Towards a life-span perspective (Article)

2007-10-01T00:00:00Z

Objective: To obtain better insight into the health issues of young adults with cerebral palsy. Design: Cross-sectional. Subjects: Two data sources were used: 54 adults with cerebral palsy (age range 25-36 years) and 48 physicians (members of the Netherlands Society of Physical and Rehabilitation Medicine). Methods: Adults with cerebral palsy participated in a physical examination and a semi-structured interview assessing several health issues and utilization of healthcare. Rehabilitation physicians completed a questionnaire on impairments they recognized as being related to cerebral palsy. Results: In the patient sample, pain (59%) and joint deformities (19-57%) were observed most frequently. Evidence of a decrease in the utilization of healthcare services at adult age emerged. Lower gross motor function and cognitive level appeared to be determinants of motor and speech impairments and of the utilization of 3 allied healthcare services. Rehabilitation physicians reported pain (88%), joint deformities (86%) and fatigue (76%) as being cerebral palsy-related health problems in adults. Conclusion: Based on the high prevalence of pain and joint deformities and the decrease in the utilization of healthcare services, systematic follow-up in adults with cerebral palsy seems warranted. Cerebral palsy needs to be considered as a life-long condition, requiring a life-span perspective in order to better organize optimal care.

Grip strength parameters and functional activities in young adults with unilateral cerebral palsy compared with healthy subjects (Article)

2007-10-01T00:00:00Z

Objective: To determine reliability of maximal grip strength, muscle coordination and muscle endurance. To compare these parameters in young adults with unilateral cerebral palsy and healthy subjects. To evaluate the correlation of these variables with functional activities. Subjects: Twenty-six healthy subjects and 26 young adults with unilateral cerebral palsy recruited from a cohort study in young adults with cerebral palsy. Methods: Maximal grip strength, muscle coordination and muscle endurance were measured in both hands of all subjects. In the healthy subjects test-retest reliability was established. In the young adults with cerebral palsy, the Melbourne assessment and Abilhand Questionnaire were used to determine functional activities. Results: For the dominant and non-dominant hand the intraclass correlation coefficients for the maximal grip strength were 0.93 and 0.91, for the muscle coordination 0.81 and 0.86, and for the muscle endurance 0.59 for both sides. Maximal grip strength of the involved hand of patients was reduced compared with the uninvolved hand and compared with healthy subjects. There was no difference in muscle coordination and muscle endurance between the involved and uninvolved hands. These parameters, however, were significantly reduced in both hands compared with healthy subjects. Correlations between grip strength parameters and activity limitations were relatively weak and non-linear. Conclusion: Performance of activity is not directly related to grip strength parameters. The uninvolved hand of young adults with unilateral cerebral palsy also has impaired function.

The Stroke Upper-Limb Activity Monitor: Its Sensitivity to Measure Hemiplegic Upper-Limb Activity During Daily Life (Article)

2007-09-01T00:00:00Z

de Niet M, Bussmann JB, Ribbers GM, Stam HJ. The Stroke Upper-Limb Activity Monitor: its sensitivity to measure hemiplegic upper-limb activity during daily life. Objective: To test the Stroke Upper-Limb Activity Monitor (Stroke-ULAM), which uses electrogoniometry and accelerometry to measure the amount of upper-limb usage in stroke patients in daily life conditions, for its sensitivity to discriminate between moderately recovered and well-recovered stroke patients and control subjects. Design: Cross-sectional study. Setting: At home or a rehabilitation center. Participants: Seventeen patients with stroke and 5 control subjects. Interventions: Not applicable. Main Outcome Measure: Level of usage of upper limb and the percentage of affected upper-limb activity compared with unaffected upper-limb activity (proportion). Results: The level of usage of the affected upper limb of stroke patients was lower than that of the nondominant upper limb of control subjects (electrogoniometry, 97.8°±92.3°/min vs 286.2°±46.5°/min, P<.01; accelerometry 1.0±0.5g/min vs 2.4±0.8g/min, P<.01). Stroke patients had lower proportions than control subjects in both electrogoniometry (22.6%±18.0% vs 84.6%±9.8%, P<.01) and accelerometry (39.2%±21.4% vs 93.3%±5.0%, P<.01). Well-recovered stroke patients had significantly higher proportions compared with moderately recovered patients on both electrogoniometry and accelerometry. Conclusions: The Stroke-ULAM sensitively measures actual performance, and therefore can be a valuable addition to the mostly capacity-oriented tools currently used to evaluate upper-limb function. Proportion is preferred to the level of usage.

Energy cost and physical strain of daily activities in adolescents and young adults with myelomeningocele (Article)

2007-09-01T00:00:00Z

The aim of this study was to assess the energy cost and physical strain of daily activities in adolescents and young adults with myelomeningocele (MMC) compared with peers without a disability. Eighteen participants with MMC aged between 16 and 30 years (13 males, five females; mean age 21y 4mo [SD 4y 8mo]) and 18 age- and sex-matched non-disabled participants performed several standardized activities. Energy cost was assessed by oxygen uptake expressed per unit time (all activities) and per metre (walking and wheelchair use at preferred speed). Physical strain was calculated by dividing energy cost by aerobic capacity. For all activities no difference was found in energy cost per unit time between ambulatory participants with MMC and comparison participants. Energy cost per metre walking at preferred speed in participants with MMC was 0.26ml/kg/m (SD 0.08), and in comparison participants was 0.20ml/kg/m (SD 0.03); p = 0.08. Non-ambulatory participants with MMC had lower energy cost (per unit time and per metre) during wheelchair use than comparison participants during walking (p < 0.05). For most activities, physical strain was 1.4 to 2 times higher in participants with MMC than in comparison participants (p < 0.05). In conclusion, energy cost per unit time of daily activities was not increased in participants with MMC. However, energy cost per metre during walking at preferred speed and physical strain were higher than in peers without disability.

Determinants of functioning of adolescents and young adults with cerebral palsy (Article)

2007-08-03T00:00:00Z

Purpose. To describe the level of functioning of adolescents and young adults with cerebral palsy (CP) and study determinants of their level of functioning. Method. In the CP Transition study, adolescents and young adults aged 16-20 years, diagnosed with CP without severe learning disabilities (n=103) participated. In this group we assessed subject characteristics, i.e., age, type of CP, gross motor function (GMFCS), level of education as well as outcome measures on functioning in daily activities and social participation (Life Habits questionnaire, Vineland Adaptive Behavior Scale, Functional Independence Measure). Multivariate regression analyses were performed. Results. About 20-30% of the participants encountered restrictions in daily activities (mobility, self-care, nutrition) and social participation (taking responsibility, community living, leisure activities and employment). The GMFCS level, level of education, and age proved to be important determinants of functioning in daily activities and social participation, explaining 70% and 66% of the variance in outcome respectively. Conclusion. A significant number of adolescents and young adults with CP without severe learning disabilities are restricted in daily activities and social participation. These problems are mainly attributable to restricted gross motor functioning, a low level of education and younger age.

Being restricted in participation after a traumatic brain injury is negatively associated by passive coping style of the caregiver (Article)

2007-08-01T00:00:00Z

Purpose: To examine whether the caregivers' coping style is associated with the functional outcome of the traumatic brain injury (TBI) patient 1 year post-injury. Method: A cross-sectional study among patients witha TBI, including their primary caregivers. The study included 51 patients aged 17-64 years with a moderate-to-severe TBI and 51 caregivers (23 parents and 28 partners) aged 23-67 years. The coping preferences of the caregivers were assessed at minimum 6 and maximum 12 months post-injury, by filling out the Utrecht Coping List (UCL) and were related to limitations in activity, as measured with the Frenchay Activities Index and with restrictions in participation as measured with the Sickness Impact Profile-68 of TBI patients 1 year post-injury. The patients were interviewed at their homes; the caregivers received and returned the UCL by mail. Results: The patients' age and the caregivers' coping style are independently associated with restrictions in participation 1 year post-injury. Conclusions: A passive coping style of the primary caregiver is negatively associated with the patient's functional outcome in terms of participation in society.

Effect of Sensory-Amplitude Electric Stimulation on Motor Recovery and Gait Kinematics After Stroke: A Randomized Controlled Study (Article)

2007-06-01T00:00:00Z

Yavuzer G, Öken Ö, Atay MB, Stam HJ. Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. Objective: To evaluate the effects of sensory-amplitude electric stimulation (SES) of the paretic leg on motor recovery and gait kinematics of patients with stroke. Design: Randomized, controlled, double-blind study. Setting: Rehabilitation ward and gait laboratory of a university hospital. Participants: A total of 30 consecutive inpatients with stroke (mean age, 63.2y), all within 6 months poststroke and without volitional ankle dorsiflexion were studied. Intervention: Both the SES group (n=15) and the placebo group (n=15) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks. The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks. Main Outcome Measures: Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait. Results: Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the SES group and 56% of the placebo group gained voluntary ankle dorsiflexion. The between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the between-group difference was not significant. Conclusions: In our patients with stroke, SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics.

Physical fitness, fatigue, and quality of life after liver transplantation (Article)

2007-06-01T00:00:00Z

Fatigue is often experienced after liver transplantation. The aims of this cross-sectional study were to assess physical fitness (cardiorespiratory fitness, neuromuscular fitness, body composition) in liver transplant recipients and to explore whether physical fitness is related to severity of fatigue. In addition, we explored the relationship between physical fitness and health-related quality of life. Included were 18 patients 1-5 years after transplantation (aged 48.0 ± 11.8 years) with varying severity of fatigue. Peak oxygen uptake during cycle ergometry, 6-min walk distance, isokinetic muscle strength of the knee extensors, body mass index, waist circumference, skinfold thickness, severity of fatigue, and health-related quality of life were measured. Cardiorespiratory fitness in the liver transplant recipients was on average 16-34% lower than normative values (P ≤ 0.05). Furthermore, the prevalence of obesity seemed to be higher than in the general population (17 vs. 10%). We found no deficit in neuromuscular fitness. Cardiorespiratory fitness was the only fitness component that was related with severity of fatigue (rs= -0.61 to rs= -0.50, P≥ 0.05). Particularly cardiorespiratory fitness was related with several aspects of health-related quality of life (rs= 0.48 to rs= 0.70, P ≤ 0.05). Results of our study imply that cardiorespiratory fitness and body composition are impaired in liver transplant recipients and that fitness is related with severity of fatigue (only cardiorespiratory fitness) and quality of life (particularly cardiorespiratory fitness) in this group. These findings have implications for the development of rehabilitation programs for liver transplant recipients.

Evaluation of arm and prosthetic functioning in children with a congenital transverse reduction deficiency of the upperlimb (Article)

2007-05-01T00:00:00Z

Objective: To assess upper extremity functioning of children with unilateral transverse upper limb reduction deficiency, using standardized instruments, and to investigate their validity and reliability. Design: Cross-sectional study. Subjects: Twenty subjects aged 4-12 years; 9 prosthetic users and 11 non-users. Methods: The Assisting Hand Assessment, Unilateral Below Elbow Test, Prosthetic Upper extremity Functional Index and ABILHAND-Kids were assessed in all children. Users were tested with and without their prosthesis. We compared results of users and non-users, and of users with and without their prosthesis. Validity was determined by testing hypotheses and correlations with other measures. Test-retest reliability was assessed from repeated measurements in 10 children. Results: Children with an upper limb reduction deficiency performed well on daily activities. They could use their prosthesis in 68% of the activities, but were currently using it in only 30%. Children find their prosthesis useful for specific activities, rather than for daily activities in general. The Assisting Hand Assessment and Prosthetic Upper extremity Functional Index showed best validity; test-retest reliability was good to excellent. Conclusion: The use of standardized instruments adds relevant information on functioning of children with ah upper limb reduction deficiency. We found additional support for validity and reliability of, in particular, the Assisting Hand Assessment and Prosthetic Upper extremity Functional Index.

Complications following spinal cord injury: Occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation (Article)

2007-05-01T00:00:00Z

Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143). Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.

Comparison of Instruments to Assess Hand Function in Children With Radius Deficiencies (Article)

2007-04-01T00:00:00Z

Purpose: For treatment evaluation of children with radius deficiencies (RDs), standardized assessment of hand function in performing activities is required. Instruments to measure hand function have been developed for other diagnoses. The current study aimed to find additional evidence for validity, reliability, and usefulness of these instruments for children with RDs. Methods: In this study, 20 children with RDs (aged 4-12 years) participated; 16 were boys, and 13 children were unilaterally affected. Children were assessed using the Assisting Hand Assessment, the Unilateral Below Elbow Test, the Prosthetic Upper Extremity Functional Index, and ABILHAND-Kids. Construct and convergent validity of the instruments were studied focusing on predefined hypotheses and relationships with other instruments and the therapist's global assessment. Test-retest reliability was assessed in 10 children by means of the intraclass correlation coefficients and the smallest detectable differences. Results: For children with RDs, the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index appeared to be the most valid function test and questionnaire according to the relationships found with type of RD, functional hand grips, and the therapist's global assessment of hand function. Regarding test-retest reliability, intraclass correlation coefficients ranged from 0.82 to 0.91, and smallest detectable differences were acceptably small. Conclusions: The current results contribute to the evidence that the instruments, especially the Assisting Hand Assessment and the Prosthetic Upper Extremity Functional Index, provide valid and reliable results in children with RDs. Type of study/level of evidence: Diagnostic I.

Cross-diagnostic validity of the SF-36 physical functioning scale in patients with stroke, multiple sclerosis and amyotrophic lateral sclerosis: A study using Rasch analysis (Article)

2007-03-01T00:00:00Z

Objective: The aim of this study was to investigate unidimensionality and differential item functioning of the SF-36 physical functioning scale (PF10) in patients with various neurological disorders. Patients: Patients post-stroke (n = 198), with multiple sclerosis (n = 151) and amyotrophic lateral sclerosis (n = 193) participated. Methods: Unidimensionality of the PF10 within the patient groups was investigated by performing a separate Rasch analysis for each group. Differential item functioning was investigated in a pooled Rasch analysis of the 3 groups. Results: Within each group, all items fitted the Rasch model, except the "bathing/dressing" item in the amyotrophic lateral sclerosis group. The pooled analysis showed inadequate fit to the Rasch model for one item ("walking several hundred metres"). Of the other 9 fitting items, 5 showed differential item functioning for stroke vs multiple sclerosis and amyotrophic lateral sclerosis, while no differential item functioning was found between multiple sclerosis and amyotrophic lateral sclerosis. Conclusion: All items of the PF10, except one for the amyotrophic lateral sclerosis group, form a unidimensional scale, supporting the use of a sum score as a measure of physical functioning within these diagnostic groups. When comparing the data of patients after stroke, with that of patients with multiple sclerosis and/or amyotrophic lateral sclerosis patients, adjustments for differential item functioning are required.

Analysing the favourable effects of physical exercise: Relationships between physical fitness, fatigue and functioning in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (Article)

2007-03-01T00:00:00Z

Objective: To elucidate the effects of physical exercise in severely fatigued patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and to clarify the mutual relationships between 5 domains studied in these patients: physical fitness, fatigue, objectively measured actual mobility, perceived physical functioning, and perceived mental functioning. Design: Case series. Subjects/patients: Twenty patients with Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. Methods: The patients undertook a 12-week physical exercise program. Relationships between domains were studied in the change scores, and additionally in the baseline data of patients. The percentage of significant relationships between each pair of domains was determined. Results: In the change scores, a small percentage of significant relationships was found between the physical fitness domain and the other 4 domains (2/30, 7%). A higher percentage of significant relationships was found between the domains perceived mental functioning and actual mobility (44%), perceived mental functioning and perceived physical functioning (44%), and between fatigue and perceived physical functioning (33%). Generally, similar patterns were found in the baseline data. Conclusion: Changes in fatigue, actual mobility and perceived functioning seem not to be influenced by changes in physical fitness. This study stresses the presence and importance of additional effects of a physical training program, not directly related to increasing fitness.

The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital (Article)

2007-02-01T00:00:00Z

OBJECTIVE: To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery. DESIGN: A descriptive prospective study. SETTING: Orthopedic clinic and patients' homes. PARTICIPANTS: Fifty patients who had undergone total hip arthroplasty (THA) with trochanteric osteotomy. INTERVENTION: Patients were verbally instructed by a physical therapist to perform partial weight bearing at a 10% body weight (BW) target load (n=33) or at a 50% BW target load (n=17). MAIN OUTCOME MEASURES: Mean peak load (%BW) and percentage of patients and mean percentage of steps below, equal to, and above the target load. Weight bearing was measured when patients walked with (condition 1) and without (condition 2) a physical therapist in the hospital and walked at home (condition 3). RESULTS: The mean peak load was significantly higher than the target in the 10% BW group for all 3 conditions (condition 1, 19.2% BW; condition 2, 20.0% BW; condition 3, 26.8% BW). In the 50% BW group, the mean peak load was significantly lower than the target in conditions 1 (28.1% BW) and 2 (32.5% BW). No significant difference in weight bearing was found when walking with or without a physical therapist (change in 10% BW, -0.1% BW; change in 50% BW, -3.17% BW). At home, the mean peak load was significantly larger compared with walking without a physical therapist in the hospital (change in 10% BW, -7.0% BW; change in 50% BW, -11.5% BW). CONCLUSIONS: Partial weight bearing at a specific target load was not achieved by patients with a THA when given verbal instructions. Especially when using a low target load and when walking at home with no supervision of a physical therapist, patients loaded the operated leg higher and more frequently above the target load. Other training methods (eg, biofeedback) have to be evaluated to use as training tools for partial weight bearing at specific target loads.

Comparison of total-breath and single-breath diffusing capacity in healthy volunteers and COPD patients (Article)

2007-01-01T00:00:00Z

Background: The measurement of single-breath diffusing capacity (DLCOSB) assumes that diffusing capacity per liter of alveolar volume (DLCO/VA) determined in a 750-mL gas sample represents the diffusing capacity (DLCO) of the entire lung. Fast-responding gas analyzers provide the opportunity to verify this assumption because of the possibility to measure CO and CH4fractions continuously throughout the entire expiration. Continuous gas sampling provides more information per measurement, but this information cannot be expressed in the traditional parameters. Our goals were to find new parameters to express the extra information of the continuous gas sampling, and to compare these new parameters with the traditional parameters. Methods: We compared a new method to determine DLCO with the traditional method in 62 healthy volunteers and 26 COPD patients. Traditionally, DLCOSBis determined by multiplying DLCO/VA with alveolar volume, both calculated from gas concentrations in a 750-mL gas sample. The new method calculates total-breath DLCO (DLCOTB) by integration of DLCO/VA against exhaled volume. Results: In healthy volunteers, DLCO/VA shows a slight upward slope during exhalation, while in COPD patients DLCO/VA shows a horizontal line. Total-breath total lung capacity (TLC) is larger than single-breath TLC both in healthy volunteers and in COPD patients, leading to a DLCOTBthat is significantly larger than DLCOSBin both groups (p < 0.001). Conclusion: The assumption that a 750-mL gas sample represents the entire lung seems to be correct for DLCO/VA but not for the CH4fraction in case of ventilation inhomogeneity.

Dynamometry of intrinsic hand muscles in patients with Charcot-Marie-Tooth disease (Article)

2006-12-12T00:00:00Z

BACKGROUND: Several problems are associated with manual muscle testing and dynamometry in the hands of patients with Charcot-Marie-Tooth (CMT) disease. OBJECTIVE: To evaluate the efficacy of the Rotterdam Intrinsic Hand Myometer (RIHM) to directly measure intrinsic hand muscle strength in CMT disease. METHODS: We measured hand muscle strength and hand function in 41 patients with CMT disease. RESULTS: RIHM measurement of intrinsic strength had excellent reliability. We found overlapping RIHM strength values in Medical Research Council grades 3 to 5. High grip and pinch strength could be found in patients with severe intrinsic muscle weakness. RIHM measurements were more strongly correlated with fine motor skills of the hand than grip and pinch strength. CONCLUSIONS: The Rotterdam Intrinsic Hand Myometer is a reliable instrument to measure intrinsic hand muscles strength in patients with Charcot-Marie-Tooth disease, providing more detailed information than manual muscle testing and a more direct assessment of intrinsic muscle loss than grip and pinch dynamometers.

Validity of the Pedar Mobile system for vertical force measurement during a seven-hour period (Article)

2006-12-01T00:00:00Z

Objective measurement of weight bearing during a long-term period can give insight into the postoperative loading of the lower extremity of orthopedic patients to avoid complications. This study investigated the validity of vertical ground reaction force measurements during a long-term period using the Pedar Mobile insole pressure system, by comparing it with a Kistler force platform. In addition, the validity of a new sensor drift correction algorithm to correct for offset drift in the Pedar signal was evaluated. Ground reaction force data were collected during dynamic and static conditions from five healthy subjects every hour for 7 h. A mean offset drift of 14.6% was found after 7 h. After applying the drift correction algorithm the Pedar system showed a high accuracy for the second peak in the ground reaction force-time curve (1.1 to 3.4% difference, p>0.05) and step duration (-2.0 to 4.4% difference, p>0.05). Less accuracy was found for the first peak in the ground reaction force-time curve (5.2 to 12.0% difference; p<0.05 for the first 3 h, p>0.05 for the last 4 h) and, consequently, in the vertical force impulse (5.5 to 11.0% difference, p>0.05). The Pedar Mobile system appeared to be a valid instrument to measure the vertical force during a long-term period when using the drift correction program described in this study.

Objective measurement of upper limb activity and mobility during everyday behavior using ambulatory accelerometry: the upper limb activity monitor. (Article)

2006-08-01T00:00:00Z

Ambulatory accelerometry is a technique that allows objective measurement of aspects of everyday human behavior. The aim of our research has been to develop, validate, and apply this technique, which recently resulted in an upper limb activity monitor (ULAM). The ULAM consists of body-mounted acceleration sensors connected to a waist-worn data recorder and allows valid and objective assessment of activity of both upper limbs during performance of also automatically detected mobility-related activities: lying, sitting, standing, walking, cycling, and general movement. The ULAM can be used to determine (limitations of) upper limb activity and mobility in freely moving subjects with upper limb disorders. This article provides a detailed description of its characteristics, summarizes the results of a feasibility study and four application studies in subjects having upper limb complex regional pain syndrome, discusses the most important practical, technical, and methodological issues that were encountered, and describes current and future research projects related to measuring (limitations of) upper limb activity.

Accuracy and repeatability of the Pedar Mobile system in long-term vertical force measurements (Article)

2006-01-01T00:00:00Z

Portable insole pressure systems can be used to measure the vertical force during long-term (hours) measurements to determine the patient's amount of weight bearing during daily activities in the hospital and at home. Especially for long-term measurements, the amount and duration of loading pressure insoles can have a large influence on the accuracy, as previous studies found a time-dependent behavior after a relatively short period (minutes) of constant loading. Therefore, this study assessed the accuracy and repeatability of a portable capacitive insole system (Pedar, Novel(GmbH)) to measure vertical force during long-term loading. Static loading experiments were performed during which the Pedar insoles were loaded with 5 and 10 N/cm2 for 7 h. Dynamic loading experiments were performed with one Pedar insole which was cyclically loaded with 300, 500 and 1000 N during two sessions of 1200 load cycles. The static and dynamic experiments were repeated 3 days later. Accuracy, due to offset drift, decreased in time during the start of the static experiments (percent error: -1.9% to 0.3% at hour 0; 26.3% to 34% at hour 7). The percent error for the dynamic experiments ranged from -16% to -19%, from -3% to -7% and from -8% to approximately 0% when the insole was loaded with 300, 500 and 1000 N, respectively. The amount of drift ranged from 12 to 62 N for the 500 and 1000 N loads, respectively. The mean day-to-day percentage difference for the static and dynamic experiments ranged from -2.3% to 0.5%, and from -2.9% to 3.0%, respectively. The results indicate that drift correction is necessary for accurate assessment of vertical force by the Pedar Mobile system to determine the amount of weight bearing during long-term measurements.

Upper limb activity over time in complex regional pain syndrome type 1 as objectively measured with an upper limb-activity monitor: an explorative multiple case study. (Article)

2006-01-01T00:00:00Z

BACKGROUND: An upper limb-activity monitor (ULAM) has been developed to determine activity limitations in complex regional pain syndrome type 1 (CRPS1). The ULAM is based on 24h ambulatory monitoring of body segment accelerations and enables valid and objective quantification of mobility and upper limb activity in transversal studies. AIMS: To explore upper limb activity over time in acute upper limb CRPS1 as measured with the ULAM in a longitudinal study, and to compare this to time courses of other outcome measures for activity limitations and impairments. METHODS: Four subjects were measured four times during a treatment protocol. Several ULAM outcome measures related to upper limb usage and mobility, three questionnaires (RASQ, DASH, RAND36), and six impairment outcome indicators (VAS-momentary pain, VAS-pain resulting from effort, volume, temperature, active range of motion, strength) were used. RESULTS: Objectively measured upper limb activity frequently improved; improvements of >5% were found for 63% of the ULAM outcome measures at final assessment. The ULAM outcome measures had a time course more similar to the body-part and CRPS1 specific questionnaire RASQ than the other questionnaires. The time course of impaired temperature was most often in accordance with the ULAM, and both VAS scores showed least accordance. CONCLUSIONS: Clear changes in upper limb activity over time were frequently found as objectively measured with the ULAM, and relationships among the time courses of the ULAM and other outcome measures were largely explainable. The ULAM can validly assess upper limb activity over time in CRPS1, but between-measurement variability needs careful consideration.

Correlation between a novel upper limb activity monitor and four other instruments to determine functioning in upper limb complex regional pain syndrome type I. (Article)

2005-03-01T00:00:00Z

OBJECTIVE: To determine the place of a novel Upper Limb Activity Monitor in the field of instruments measuring functioning and health in upper limb complex regional pain syndrome type I, by exploring the correlation between the Upper Limb Activity Monitor and 4 questionnaires. METHOD: Subjects (n = 30) were measured at home and correlations were calculated between the Upper Limb Activity Monitor and 4 questionnaires; Sickness Impact Profile, RAND-36 Health Survey, Disabilities of Arm Shoulder Hand Questionnaire and Radboud Skills Questionnaire. RESULTS: Of the inter-questionnaire correlations 83% were significant, whereas 46% of the correlations between the Upper Limb Activity Monitor and the questionnaires were significant. The number and strength of the correlations between the Upper Limb Activity Monitor and questionnaires was dependent on the degree to which similar aspects of functioning were measured. CONCLUSION: The Upper Limb Activity Monitor has some correlation with other instruments related to functioning and health, but generally it does not measure the same areas.

Impairments and activity limitations in subjects with chronic upper-limb complex regional pain syndrome type I. (Article)

2004-04-01T00:00:00Z

OBJECTIVE: To determine the degree of impairments and activity limitations and their interrelationship in complex regional pain syndrome type I (CRPS type I). DESIGN: Cross-sectional study interrelating impairments and objectively measured activity limitations. SETTING: Ambulatory and home environment. PARTICIPANTS: Thirty nonacute upper-limb CRPS type I subjects. INTERVENTIONS: Not applicable. Main outcome measures Sensory, motor, and autonomic impairments, as well as activity-limitation outcome measures. The latter were objectively measured with a novel upper-limb activity monitor (based on ambulatory accelerometry). RESULTS: All subjects were impaired to some degree but with a large variability with respect to magnitude. Regarding activity limitations, the involved upper limb was clearly less active (lower intensity and percentage of activity) than the noninvolved side. Impaired active range of motion (adjusted R(2) range, 18%-39%) and grip strength (adjusted R(2) range, 12%-45%) were the most important factors explaining variance in activity limitations. CONCLUSIONS: All subjects were still impaired nearly 3 years after the causative event. The involved upper limb was also clearly less active than the noninvolved side, especially when the subjects were sitting and when the dominant side was involved. The more impairments a subject had, especially motor impairments, the more activity limitations were present.

Techniques for measuring weight bearing during standing and walking (Article)

2003-08-01T00:00:00Z

OBJECTIVE: To classify and assess techniques for measuring the amount of weight bearing during standing and walking. BACKGROUND: A large variety of weight bearing measuring techniques exists. This review describes their advantages and limitations to assist clinicians and researchers in selecting a technique for their specific application in measuring weight bearing. METHODS: A literature search was performed in Pubmed-Medline, CINAHL, and EMBASE. Measurement techniques were classified in 'clinical examination', 'scales', 'biofeedback systems', 'ambulatory devices' and 'platforms', and assessed on aspects of methodological quality, application, and feasibility. RESULTS: A total of 68 related articles was evaluated. The clinical examination technique is a crude method to estimate the amount of weight bearing. Scales are useful for static measurements to evaluate symmetry in weight bearing. Biofeedback systems give more reliable, accurate and objective data on weight bearing compared to clinical examination and scales, but the high costs could limit their use in physical therapy departments. The ambulatory devices can measure weight bearing with good accuracy and reliability in the hospital and at home. Platforms have the best methodological quality, but are mostly restricted to a gait laboratory, need trained personnel, and are expensive. CONCLUSIONS: The choice of a technique largely depends upon the criteria discussed in this review; however the clinical utilisation, the research question posed, and the available budget also play a role. The new developments seen in the field of 'ambulatory devices' are aimed at extending measuring time, and improved practicality in data collection and data analysis. For these latter devices, however, mainly preliminary studies have been published about devices that are not (yet) commercially available.

Impact of upper limb complex regional pain syndrome type 1 on everyday life measured with a novel upper limb-activity monitor. (Article)

2003-01-01T00:00:00Z

Complex regional pain syndrome type 1 (CRPS1) often leads to serious activity limitations in everyday life. To date, however, limitations in patients with CRPS1 of an upper limb have not been objectively measured.Therefore, the aim of this study was to determine the long-term impact of upper limb CRPS1 on general mobility and upper limb usage during everyday life, as measured with a novel upper limb-activity monitor (ULAM). In ten female chronic CRPS1 patients and ten healthy control subjects, 24-h activity patterns were measured with the ULAM. This ULAM consists of body-fixed acceleration sensors, connected to a recorder worn around the waist. The ULAM automatically detects upper limb activity during mobility-related activities. Several outcome measures related to general mobility and upper limb usage were compared between patients and controls. The results showed that CRPSI in the dominant upper limb had modest impact on general mobility; i.e. on the percentages spent in body positions and body motions and on mean intensity of body activity. For upper limb usage outcome measures during sitting, there was a marked difference between CRPS1 patients and controls. Especially patients with dominant side involvement clearly showed less activity of their involved limb during sitting, indicated by significant differences for the mean intensity (P=0.014), percentage (P=0.004), and proportion (P=0.032) of upper limb activity. It is concluded that these ten chronic CRPS1 patients still had limitations in upper limb usage during everyday life, 3.7 years (average) after the causative event.

Ambulatory measurement of upper limb usage and mobility-related activities during normal daily life with an upper limb-activity monitor: a feasibility study. (Article)

2002-03-01T00:00:00Z

Abstract The aim of this research was to assess the ability of an upper limb-activity monitor (ULAM) to discriminate between upper limb usage and non-usage in healthy and disabled subjects during normal daily life. The ULAM was based on ambulatory accelerometry and consisted of several acceleration sensors connected to a small recorder worn around the waist. While wearing this ULAM, four healthy and four disabled subjects performed an activity protocol representing normal daily life upper limb usage or non-usage. The motility feature (derived from the raw acceleration signals) was used as a measure of the extent of upper limb usage. Agreement scores between ULAM output and videotape recordings (reference method) were calculated. ULAM data that were of special interest for rehabilitation were detected satisfactorily (overall agreement 83.9%). There were no systematic differences in the agreement percentages between healthy and disabled subjects for mobility-related activities (p = 0.345) and the different forms of upper limb usage or non-usage (p= 0.715). The ULAM can be used in future studies in subjects with upper limb disorders to discriminate between upper limb usage and non-usage during performance of mobility-related activities to determine activity limitations.

Outcome measures for complex regional pain syndrome type I: an overview in the context of the international classification of impairments, disabilities and handicaps. (Article)

2000-06-15T00:00:00Z

PURPOSE: To determine the availability of relevant and objective outcome measures concerning complex regional pain syndrome type I (CRPS I) for rehabilitation medicine. METHOD: Outcome measures were classified according to the International Classification of Impairments, Disabilities and Handicaps. For each outcome measure a description of concept, operationalization into variables and instrument was given. We performed a PUBMED MEDLINE search (1980-1998) using the following keywords: complex regional pain syndrome, reflex sympathetic dystrophy, impairment, disability, handicap, (long-term) outcome and effect/efficacy. RESULTS: Most outcome measures were concentrated on impairments, whereas measures at the level of disabilities and handicaps, the most relevant levels for rehabilitation medicine, were mentioned in very few studies. Objective outcome measures were merely found at the level of impairment. CONCLUSION: The results indicate a need for the development of relevant outcome measures at the level of disabilities and handicaps that can objectively measure treatment efficacy for CRPS I.

Outcome measures for complex regional pain syndrome type I: an overview in the context of the international classification of impairments, disabilities and handicaps (Article)

2000-06-01T00:00:00Z

Revalidatiegeneeskunde: over minderwaardigheidscomplex en complexe meerwaarde (Inaugural Lecture)

1995-03-17T00:00:00Z