Ribbers, G.M.

Melodic intonation therapy: Present controversies and future opportunities (Article)

2012-01-01T00:00:00Z

Melodic Intonation Therapy: present controversies and future opportunities. This article describes the state of the art of Melodic Intonation Therapy (MIT), a structured aphasia therapy program using the melodic aspects of language (intonation, rhythm, and stress) to improve language production. MIT was developed in the 1970s and is still used worldwide. Nevertheless, we argue that many questions crucial for the clinical application of MIT are still unanswered. First, a review of MIT effect studies is presented showing that evidence from well-designed group studies is still lacking. It is also unclear which aspects of MIT contribute most to its therapeutic effect and which underlying neural mechanisms are involved. Two cases are presented illustrating unsolved questions concerning MIT in clinical practice, such as candidacy and the best timing of this therapy.

Aphasia rehabilitation: More than treating the language disorder (Article)

2012-01-01T00:00:00Z

Aphasia rehabilitation: more than treating the language disorder. This supplement focuses on the neurorehabilitation of language disorders. It offers a broad survey of this field, with state-of-the-art contributions from various disciplines. In doing so, it aims to show that treating the devastating consequences of neurological language disorders requires a prolonged interdisciplinary effort.

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.

Memory complaints in chronic stroke patients are predicted by memory self-efficacy rather than memory capacity (Article)

2011-05-01T00:00:00Z

Background: Memory self-efficacy (MSE) is the belief about one's mastery of memory functioning. In healthy elderly, memory complaints are related to MSE rather than to objectively measured memory capacity. MSE has scarcely been studied in patients that suffered a stroke. The aim of this study was twofold: (1) to examine whether memory capacity and MSE can predict the presence of memory complaints in stroke patients, and (2) to study which variables are the best predictors of MSE. Methods: In a cross-sectional study, 136 stroke patients (>18 months after onset) were recruited from April 2008 to November 2009. MSE was measured using the Metamemory in Adulthood questionnaire. Depression, coping and personality were measured using validated questionnaires, and memory performance was measured using the Rivermead Behavioural Memory Test (RBMT) and the Auditory Verbal Learning Test (AVLT). Patients were divided into a 'complaints' and a 'no complaints' group. Results: A lower MSE score was an independent predictor of having memory complaints (adjusted odds ratio: 0.422; p = 0.000), adjusted for age and depression. The RBMT and AVLT scores did not predict the presence of memory complaints (p > 0.263). Presence of memory complaints and depression were the strongest predictors of MSE (B = -1.748, p = 0.000; B = -0.054, p = 0.000), followed by word fluency, not having a partner and side of stroke (B = 0.038, p = 0.012; B = -0.517, p = 0.082; B = -0.479, p = 0.088). Conclusions: Memory complaints are predicted by MSE rather than memory capacity. MSE memory training might be an effective training strategy for reducing memory complaints in selected chronic stroke patients. Copyright

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.

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.

The effects of high custom made shoes on gait characteristics and patient satisfaction in hemiplegic gait (Article)

2011-01-01T00:00:00Z

To determine the effects of a temporary high custom made orthopaedic shoe on functional mobility, walking speed, and gait characteristics in hemiplegic stroke patients. In addition, interference of attentional demands and patient satisfaction were studied.

A case study of melodic intonation therapy (MIT) in the subacute stage of aphasia: Early re-reactivation of left hemisphere structures (Article)

2010-12-01T00:00:00Z

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.

Measuring verbal and non-verbal communication in aphasia: Reliability, validity, and sensitivity to change of the scenario test (Article)

2010-07-01T00:00:00Z

Background: This study explores the psychometric qualities of the Scenario Test, a new test to assess daily-life communication in severe aphasia. The test is innovative in that it: (1) examines the effectiveness of verbal and non-verbal communication; and (2) assesses patients' communication in an interactive setting, with a supportive communication partner.Aims: To determine the reliability, validity, and sensitivity to change of the Scenario Test and discuss its clinical value.Methods & Procedures: The Scenario Test was administered to 122 persons with aphasia after stroke and to 25 non-aphasic controls. Analyses were performed for the entire group of persons with aphasia, as well as for a subgroup of persons unable to communicate verbally (n 43). Reliability (internal consistency, testretest reliability, inter-judge, and intra-judge reliability) and validity (internal validity, convergent validity, known-groups validity) and sensitivity to change were examined using standard psychometric methods.Outcomes & Results: The Scenario Test showed high levels of reliability. Internal consistency (Cronbach's α 0.96; item-rest correlations 0.580.82) and testretest reliability (ICC 0.98) were high. Agreement between judges in total scores was good, as indicated by the high inter- and intra-judge reliability (ICC 0.861.00). Agreement in scores on the individual items was also good (square-weighted κ values 0.610.92). The test demonstrated good levels of validity. A principal component analysis for categorical data identified two dimensions, interpreted as general communication and communicative creativity. Correlations with three other instruments measuring communication in aphasia, that is, Spontaneous Speech interview from the Aachen Aphasia Test (AAT), AmsterdamNijmegen Everyday Language Test (ANELT), and Communicative Effectiveness Index (CETI), were moderate to strong (0.500.85) suggesting good convergent validity. Group differences were observed between persons with aphasia and non-aphasic controls, as well as between persons with aphasia unable to use speech to convey information and those able to communicate verbally; this indicates good known-groups validity. The test was sensitive to changes in performance, measured over a period of 6 months.Conclusions & Implications: The data support the reliability and validity of the Scenario Test as an instrument for examining daily-life communication in aphasia. The test focuses on multimodal communication; its psychometric qualities enable future studies on the effect of Alternative and Augmentative Communication (AAC) training in aphasia.

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.

Metamemory and memory test performance in stroke patients (Article)

2009-10-01T00:00:00Z

Memory Self-Efficacy (MSE) has been shown to be related to memory performance and social participation in a healthy elderly population. This relation is unclear in stroke. As about 30% of all stroke survivors report memory complaints, there is an urgent need for effective treatment strategies. Before implementing MSE as a potential target in memory training, it should be examined whether the association between MSE and memory performance demonstrated in healthy elderly people also applies in stroke patients. This study therefore explored the predictive value of MSE on two kinds of memory tests in stroke patients; adjusted and unadjusted for age, gender, education and location of stroke. In 57 stroke patients, the Metamemory in Adulthood Questionnaire (MIA), an everyday memory test (RBMT) and a more traditional memory test (AVLT) were completed. The results show that MSE significantly predicts memory test performance on both memory tests (RBMT: =.34; p =.01 AVLT: =.28; p =.04). When adjusted for gender, age, education and location of stroke, the predictive value of MSE remained significant for the AVLT (RBMT: =.23; p =.07; AVLT: =.23; p =.05). The results support the hypothesis that MSE predicts test performance in stroke patients and, by consequence, enables improving memory performance in post-acute memory rehabilitation after stroke.

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.

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.

A prospective study on coping strategies and quality of life in patients after stroke, assessing prognostic relationships and estimates of cost-effectiveness (Article)

2009-03-01T00:00:00Z

Objective: To examine the prognostic value of coping strategies of patients after stroke at time of discharge on quality of life approximately one year later. In addition, we estimated the maximum cost of improving quality of life by enhancing coping strategies using strict assumptions. Methods: Eighty patients with a stroke completed several questionnaires, at discharge to home and 9-12 months later (follow-up). Questionnaires measured quality of life, coping strategies Tenacious Goal Pursuit and Flexible Goal Adjustment. First, a regression analysis was carried out predicting quality of life at follow-up from coping strategies at discharge. Secondly, a maximum in terms of acceptable cost was calculated for several possible effect sizes. Results: Both coping strategies at discharge were positively associated with quality of life at follow-up. With regards to cost-effectiveness, a medium effect size would result in an increase in quality of life of approximately 10%. The maximum acceptable cost of an intervention for a single patient is therefore set at €2500, assuming a benefit of one year and a cost per quality adjusted life year of €25,000. Conclusion: Coping strategies at discharge are predictive of quality of life one year later. The costs of improving quality of life are thought to be within the limits that determine a cost-effective intervention.

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

MAAS (Multi-axial Aphasia System): Realistic goal setting in aphasia rehabilitation (Article)

2008-12-01T00:00:00Z

Treatment success in aphasia is influenced by various factors. Clinical decisions, including patient selection and decisions on frequency and content, are often guided by a clinician's implicit opinions. The Multi-axial Aphasia System (MAAS) was developed to structure linguistic, somatic, neuropsychological, psychosocial and socio-economic information on five separate axes, enabling an explicit and interdisciplinary process of clinical decision-making. The objectives of this study were to investigate the potentialities of MAAS in predicting the outcome of cognitive-linguistic treatment. A group of 58 aphasic patients were investigated prospectively. All received cognitive-linguistic treatment during a randomized, controlled study on the efficacy of lexical semantic treatment. An interdisciplinary aphasia team rated the pretreatment MAAS profiles of all patients. The team was blinded for treatment allocation and outcome. A multiple linear regression analysis was performed with the posttreatment verbal communication score as the variable to be predicted and the overall MAAS rating, age and type of treatment as predictor variables. In a second multiple regression analysis, the ratings for each of the five MAAS axes were used as candidate predictors. The team's overall rating contributed significantly to the prediction of verbal communicative ability after linguistic treatment. Of the five MAAS axes, the neuropsychological axis contributed to the prediction. An interdisciplinary approach to aphasia assessment may contribute to realistic goal setting in aphasia rehabilitation. The results of this study stress the importance of neuropsychological assessment of aphasic patients before treatment.

Memory self-efficacy and psychosocial factors in stroke (Article)

2008-09-01T00:00:00Z

Objective: To explore whether Memory Self-efficacy is related to depression, neuroticism and coping in patients after stroke, as it is in healthy elderly subjects. Design: A cross-sectional design. The relation between Memory Self-efficacy and psychosocial factors was analysed using a Mann-Whitney U test and non-parametric Spearman correlations. Patients: Seventeen male and 6 female patients after stroke from an inpatient rehabilitation setting were included. Methods: Memory Self-efficacy, depression, neuroticism and coping were assessed with validated questionnaires. Patients with severe aphasia, subarachnoidal haemorrhage or subdural haematomas were excluded. Results: As in healthy elderly subjects, higher depression ratings are significantly related to lower Memory Self-efficacy ratings (Z=-2.13; p=0.033). Lower Memory Self-efficacy seems related to higher neuroticism ratings and a more passive coping style score (Z=-1.54; p=0.123; Z=-1.42; p=0.155, respectively). The Spearman correlations confirm these finding (p<0.10). Conclusion: This study replicated the relationships between Memory Self-efficacy and depression and neuroticism found in a healthy population, in an inpatient stroke population. Future research on Memory Self-efficacy in patients after stroke should focus on other potential determinants such as awareness and, ultimately, on the effectiveness and efficacy of interventions aimed at Memory Self-efficacy to improve participation and quality of life. © 2008 The Authors. Journal Compilation

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.

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.

A computerised communication aid in severe aphasia: An exploratory study (Article)

2007-11-01T00:00:00Z

Purpose. To investigate the efficacy of TouchSpeak (TS), a handheld computerised communication aid for aphasia. Method. A pre-post one-group design was used with a referred sample of 34 patients with a severe aphasia and a need for alternative and augmentative communication (AAC). The participants were trained to use TS in two self-chosen communicative situations. The ability to navigate the hierarchical vocabulary and overall communicative ability were assessed. Participants rated their communicative success with and without TS. Three years after completion of the training, participants were interviewed about their present use of TS. Results. In total, 76% used TS outside the clinic in two trained communicative situations. Overall communicative ability improved, as tested in untrained scenarios. Quality of communication with TS was rated higher than without TS. Fifty per cent obtained their own TS after the training and after 3 years 6% still used TS. Conclusions. Aphasic communication can be supported effectively by TS. Patients with a severe aphasia are able to master a hierarchical computerised vocabulary and to use it in daily life for specific communicative situations. In addition, TS may also have a generalised effect on overall communicative ability. For most patients, the supportive role of TS is temporary.

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.

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.

Traumatic brain injury rehabilitation in the Netherlands: Dilemmas and challenges (Article)

2007-07-01T00:00:00Z

Traumatic brain injury (TBI) is the number one cause of mortality and morbidity in young adults in modern Western societies. This article discusses TBI rehabilitation in the Netherlands. Facts and figures on rehabilitation as well as on the epidemiology of TBI and its silent epidemic in the Netherlands are presented. The Dutch healthcare system is described, and strengths and weaknesses of TBI rehabilitation are discussed.

High-tech AAC and severe aphasia: Candidacy for TouchSpeak (TS) (Article)

2007-05-01T00:00:00Z

Background: Increasingly, computerised communication aids are used by people with severe, chronic aphasia. Although the candidacy for these devices is relatively unknown, it has been hypothesised that cognitive deficits have a negative impact on the functional use of Augmentative and Alternative Communication (AAC). Deficits of executive functioning are assumed to be particularly important, but other functions, such as memory and semantic processing, may also be relevant. In a previous study (van de Sandt-Koenderman, Wiegers, Wielaert, Duivenvoorden, & Ribbers, in press) we reported the functional effect of TouchSpeak (TS), a computerised communication aid, in a group of stroke patients with severe aphasia. The successful participants showed different levels of proficiency. Some were able to use the system independently and creatively in many situations, some used it independently for trained situations, and others remained partner dependent in using TS. Aims: To find factors associated with the functional success of TS in people with severe aphasia, focusing on memory, executive functioning, semantic processing, and communication skills. Methods & Procedures: The data of 30 patients with severe aphasia were analysed retrospectively. All were trained to use TS in two self-chosen communicative situations. Four outcome levels were differentiated: no use, dependent use, independent use, and extensive use of TS. Pre-training assessment included memory, executive functioning, semantic processing, and communication skills. The four outcome groups were compared regarding age, time post onset, gender, and aphasia type. The role of the cognitive variables was analysed with univariate ANCOVAs with contrast analysis, with correction for age, gender, aphasia type, or time post onset in case of significant differences between the groups on these variables. Outcomes & Results: Seven participants were classified as extensive users of TS, five were independent TS users, and five were partner dependent. In 13 cases there was no functional use of TS. Extensive users were younger than the other outcome groups. Independent of this age effect, there was an effect of semantic processing; the no-use group scored significantly lower on semantics than all other groups. Conclusions: Only a minority of patients with severe aphasia may be expected to become independent, flexible users of high-tech AAC. The finding that functional success was related to semantic processing is clinically important. Prospective studies are needed to support the predictive value of semantic processing for high-tech AAC use. The importance of intact executive functioning is not supported in this study. The broad concept of "executive functioning" needs to be studied in more detail in relation to aphasia.

Coping strategies as determinants of quality of life in stroke patients: A longitudinal study (Article)

2007-05-01T00:00:00Z

Background: Quality of life (QoL) is reduced for stroke patients and coping strategies have been suggested as determinants of QoL. Thus far the relationship between coping and QoL has only been examined in small-scale cross-sectional designs. Therefore, the current study set out to examine this relationship in a longitudinal setting. Methods: Stroke patients who were discharged home were interviewed at 4 different time points; just before discharge (T1), and 2 months (T2), 5 months (T3) and 9-12 months after discharge (T4). QoL was measured by the EQ-5D index score and the SF-36 utility score and coping expressed in terms of tenacious goal pursuit and flexible goal adjustment. Modified Rankin scale was assessed as a measure of general functioning. Results: Eighty stroke patients were included. Coping was not predictive of QoL at T1 and T2 but rather at T3 and T4. At T4 both coping strategies determined the levels of QoL as measured with the EQ-5D index score; higher levels of tenacious goal pursuit as well as flexible goal adjustment were associated with higher levels of QoL. This regression model explained 44% of the variance. Conclusions: Coping is a powerful determinant of QoL, but only more than 5 months after discharge; before this time QoL is mainly determined by general functioning. Both coping strategies were important determinants of QoL. Copyright

Complex regional pain syndrome 1 : a study on pain and motor impairments (Doctoral Thesis)

2001-10-24T00:00:00Z

This thesis, is compiled of publications on reflex sympathetic dystrophy (RSD) or Complex Regional Pain Syndrome type 1 (CRPS 1), as it was renamed by the committee on taxonomy of the International Association for the Study of Pain (IASP). It is a puzzling syndrome both from a clinical point of view as well as in the perspective of basic pain science. Therapies rendered may vary and include physical therapy, occupational therapy, physical immobilization, surgical or chemical sympathectomies, pharmacotherapy and psychological treatment. A well accepted treatment algorithm is lacking and treatment regimens hardly seem driven by the progress made in basic pain science. The leading thread of this thesis is the concept of CRPS 1 as a neuropathic pain syndrome of unknown etiology involving multiple and timedependent mechanisms. It is discussed that besides the affected extremity also spinal and suprapinal structures may become involved. The scope of the publications varies from clinical studies on pain management performed in the context of an interdisciplinary rehabilitation team, to experimental studies on motor impairments and immunology. The clinical and experimental work was at least partly performed before the introduction of the t= complex regional pain syndrome 1. It is for this reason that the reader may encounter the t= reflex sympathetic dystrophy in some chapters.