Rehabilitation

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

Nooijen, C.F.J. — 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.

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

Hurkmans, H.L.P. — 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.

Current evidence for effectiveness of interventions to treat rotator cuff tears (Article)

Huisstede, B.M.A. — 2011-06-01T00:00:00Z

Abstract: In this systematic review we assessed effectiveness of non-surgical and (post)surgical interventions for symptomatic rotator cuff tears (RotCuffTear). The Cochrane Library, PubMed, Embase, Cinahl, and Pedro were searched for relevant systematic reviews and randomized controlled trials (RCTs). Two reviewers independently selected relevant studies, extracted data and assessed the methodological quality. Three Cochrane reviews (7 RCTs) and 14 RCTs were included (3 non-surgery, 10 surgery, 8 post-surgery). For small or medium RotCufftears, moderate evidence was found in favour of surgery versus physiotherapy in mid- and long-term. In surgery, tendon-to-bone fixation with one metal suture anchor loaded with double sutures (TB) was more effective (moderate evidence) than a side-to-side repair with permanent sutures (SS) in the mid- and long-term; limited evidence for effectiveness was found in favour of debridement versus anchor replacement and suture repair of the type II SLAP tear in the long-term. Further, no evidence was found in favour of any non-surgical, surgical or post-surgical intervention. In conclusion, although surgery seems to give better results compared to non-surgery and TB is more effective than SS in rotator cuff repair (RCR), it remains hard to draw firm evidence-based conclusions for effectiveness of non-surgical or (post)surgical interventions to treat RotCuffTears. More research is clearly needed.

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

Wiegerink, D.J.H.G. — 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.

Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the CHECK cohort (Article)

Holla, J.F.M. — 2011-04-01T00:00:00Z

Objective: Reduced range of motion (ROM) is supposed to be a characteristic feature of osteoarthritis (OA). Because little is known about determinants of ROM, the objective of the present study was to explore the association between demographic, articular, and clinical factors and ROM in patients with early symptomatic knee and/or hip OA. Design: Baseline data of 598 participants of the Cohort Hip and Cohort Knee (CHECK) study were used in this cross-sectional study. Methods: Separate analyses were performed for participants with knee and participants with hip symptoms. Active knee flexion, and hip internal rotation, external rotation, flexion, adduction, and abduction were assessed using a goniometer. Participants underwent a standardised physical and radiographic examination, and completed a questionnaire. Exploratory regression analyses were performed to explore the association between ROM and demographic [i.e., age, gender, body mass index (BMI)], articular [i.e., osteophytosis, joint space narrowing (JSN)], and clinical (i.e., pain, stiffness) factors. Results: In patients with early symptomatic knee OA, osteophytosis, bony enlargement, crepitus, pain, and higher BMI were associated with lower knee flexion. JSN was associated with lower ROM in all planes of motion. In addition, osteophytosis, flattening of the femoral head, femoral buttressing, pain, morning stiffness, male gender, and higher BMI were found to be associated with lower hip ROM in two planes of motion. Conclusion: Features of articular degeneration are associated with lower knee ROM and lower hip ROM in patients with early OA. Pain, stiffness, higher BMI, and male gender are associated with lower ROM as well.

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

Michielsen, M.E. — 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.

Readiness to transfer to adult care of adolescents with chronic conditions: Exploration of associated factors (Article)

Staa, A.L. van — 2011-03-01T00:00:00Z

Purpose: To explore associations between adolescents' perception of their readiness to transfer to adult care and socio-demographic and disease-related characteristics, effect of the condition, self-management ability, and attitude toward transition. Methods: A cross-sectional study was conducted in a Dutch university hospital, where all adolescents (12-19 years) with somatic chronic conditions (n = 3,648) were invited to participate in a web-based questionnaire. Invitations were issued to those without an intellectual disability and who had been under treatment for at least 3 years. Results: In all, 30% (n = 1,087) of the adolescents responded; 954 assessed their perception of readiness for transfer. The majority (56%) felt that they were ready for transfer. Logistic regression analyses showed that 48% of the total variance in transfer readiness (TR) could be explained. Feeling more self-efficacious in skills for independent hospital visits and a greater perceived independence during consultations were found to be most strongly associated with being ready to transfer. Higher TR was associated with older age, but age did not prove to be the most important explaining variable. Adolescents with a more positive attitude toward transition and those who reported more discussions related to future transfer also felt more ready. Disease-related factors and effect of the condition including quality of life were only weakly associated with higher TR. Conclusions: Adolescents' attitude to transition and their level of self-efficacy in managing self-care seem to be the keystones to TR. This study suggests that individual transition plans and readiness assessments might prove to be beneficial. Strengthening adolescents' independence and self-management competencies, combined with early preparation and repeated discussions on transition, seem to be useful strategies to increase adolescents' readiness for transfer to adult care.

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

Molenaar, H.M. — 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.

Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study (Article)

Veerbeek, J.M. — 2011-03-01T00:00:00Z

Background. Early prognosis, adequate goal setting, and referral are important for stroke management. Objective. To investigate if independent gait 6 months poststroke can be accurately predicted within the first 72 hours poststroke, based on simple clinical bedside tests. Reassessment on days 5 and 9 was used to check whether accuracy changed over time. Methods. In 154 first-ever ischemic stroke patients unable to walk independently, 19 demographic and clinical variables were assessed within 72 hours and again on days 5 and 9 poststroke. Multivariable logistic modeling was applied to identify early prognostic factors for regaining independent gait, defined as ≥4 points on the Functional Ambulation Categories. Results. Multivariable modeling showed that patients with an independent sitting balance (Trunk Control Test-sitting; 30 seconds) and strength of the hemiparetic leg (Motricity Index leg; eg, visible contraction for all 3 items, or movement against resistance but weaker for 1 item) on day 2 poststroke had a 98% probability of achieving independent gait at 6 months. Absence of these features in the first 72 hours was associated with a probability of 27%, declining to 10% by day 9. Conclusions. Accurate prediction of independent gait performance can be made soon after stroke, using 2 simple bedside tests: "sitting balance" and "strength of the hemiparetic leg." This knowledge is useful for making early clinical decisions regarding treatment goals and discharge planning at hospital stroke units.

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

Michielsen, M.E. — 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.

Surgical Treatment of Renal Cell Cancer Liver Metastases: A Population-Based Study (Article)

Ruys, A.T. — 2011-02-25T00:00:00Z

Background: To evaluate outcomes of surgical treatment in patients with hepatic metastases from renal-cell carcinoma in the Netherlands, and to identify prognostic factors for survival after resection. Renal-cell carcinoma has an incidence of 2,000 new patients in the Netherlands each year (12.5/100,000 inhabitants). According to literature, half of these patients ultimately develop distant metastases with 20% involvement of the liver. Resection of renal-cell carcinoma liver metastases (RCCLM) is performed in only a minority of patients. Hence, little is known about outcome of resectable RCCLM. Methods: Patients were retrieved from local databases of theNetherlands Task Force for Liver Surgery (14 centers) and from the Dutch collective pathology database. Survival and prognostic factors were determined by Kaplan-Meier analysis and log rank test. Results: Thirty-three patients were identified who underwent resection (n = 29) or local ablation (n = 4) of RCCLM in the Netherlands between 1990 and 2008. These patients comprise 0.5% to 1% of the total population of patients diagnosed with RCCLM in that period. There was no operative mortality. The overall survival at 1, 3, and 5 years was 79, 47, and 43%, respectively. Metachronous metastases (n = 23, P = 0.03) and radical resection (n = 19, P < 0.001) were statistically significant prognosticators of overall survival. Size < 50 mm (n = 18, P = 0,54), solitary metastases (n = 19, P = 0.93), and presence of extrahepatic metastases (n = 11, P = 0.28) did not have a statistically significant impact on survival. Conclusions: The favorable 5-year survival rate of 43% without operative mortality as found in this nationwide study indicates that selected patients with RCCLM can benefit from surgical treatment.

Contents of physical therapy, occupational therapy, and sports therapy sessions for patients with a spinal cord injury in three Dutch rehabilitation centres (Article)

Langeveld, S.A. — 2011-02-21T00:00:00Z

Purpose. To describe the contents of interventions to improve self-care and mobility for patients with spinal cord injury (SCI) in early post-acute rehabilitation, using the Spinal Cord Injury-Interventions Classification System (SCI-ICS), and to compare these interventions between rehabilitation centres. The SCI-ICS describes therapy to improve self-care and mobility at three levels of functioning and consists of 25 categories with a total of 139 different interventions. Methods. Fifty-three physical therapists, occupational therapists and sports therapists of three Dutch SCI rehabilitation centres recorded interventions with the SCI-ICS for patients with SCI in early post-acute rehabilitation for four consecutive weeks. Results. Therapists recorded 1640 treatment sessions of 48 patients with a SCI. The mean number of treatment sessions per patient per week (8.9 overall) differed between centres (p < 0.05), unlike the mean therapy time in minutes per patient per week (259 overall). Highest frequencies for individual categories were found for 'Muscle Power', 'Walking', and 'Hand rim wheelchair propulsion'. Conclusions. We described the specific contents of therapy of patients with a SCI in three Dutch rehabilitation centres. The largest proportion of time was spent on interventions to improve muscle power, walking, and hand rim wheelchair propulsion.

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

Paulis, W. — 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.

Comparing content of therapy for people with a spinal cord injury in postacute inpatient rehabilitation in Australia, Norway, and the Netherlands (Article)

Langeveld, S.A. — 2011-02-01T00:00:00Z

Background. Research reports have described the contents of therapy in spinal cord injury (SCI) rehabilitation only as the total number of therapy hours. We developed the Spinal Cord Injury-Interventions Classification System (SCI-ICS) as a tool to classify therapy to improve mobility and self-care into 3 levels (body functions, basic activities, and complex activities) and 25 categories. Objective. The purposes of this study were: (1) to compare specific contents and amount of therapy provided, with the aim of improving mobility and self-care for people with SCI in Australia, Norway, and the Netherlands and (2) to evaluate the use of the SCI-ICS outside the Netherlands. Design. This was a prospective, descriptive study. Methods. Physical therapists, occupational therapists, and sports therapists in 6 centers recorded all therapy provided to all people with a recent SCI in inpatient rehabilitation during 4 designated weeks. Each treatment session was classified using 1 or more SCI-ICS codes. Duration of each intervention was specified. Results. Seventy-three therapists recorded 2,526 treatments of 79 people with SCI (Netherlands; 48; Australia; 20; Norway, 11). Most therapy time was spent on exercises (overall mean = 84%) and on categories at body function and basic activity level of the SCI-ICS. Therapy time significantly differed among countries for 13 of 25 categories. Mean time in minutes per treatment (Netherlands; 28; Australia; 43; Norway, 39) and in hours per patient per week (Netherlands; 4.3; Australia; 5.8; Norway, 6.2) differed significantly. Limitations. The short period and small number of patients may have influenced the results. Conclusions. Therapy in inpatient SCI rehabilitation in all 3 countries focused on mobility and self-care exercises at body function and basic activity level, but differences were present in focus on the various categories and therapy time. The SCI-ICS can be used reliably to describe therapy in different countries.

Using the new board game SeCZ TaLK to stimulate the communication on sexual health for adolescents with chronic conditions (Article)

Stege, H.A. van der — 2010-12-01T00:00:00Z

Objective: This study evaluated the feasibility and appreciation of a new educational board game (SeCZ TaLK) that stimulates communication on sexuality and intimate relationships in youth with chronic conditions. Methods: 85 adolescents with chronic conditions or disabilities piloted the board game in three rehabilitation centers/schools for the disabled, one outpatient clinic and a patient organization. They assessed their experiences through a brief questionnaire, as did 12 health care professionals and teachers who acted as facilitators. Results: Eighty-five percent of the adolescents found it is (very) important to discuss sexuality and intimate relationships; 81% felt that SeCZ TaLK enabled this. Girls were more positive about the game than boys (p < .05) and younger participants were more positive than older ones (p < .01). Youth in an outpatient clinic appreciated the game most (p < .05) compared to other settings. Professionals asserted that discussing these issues is important for their work and would recommend the game to colleagues. Conclusion: SeCZ TaLK is a promising tool for improving communication on sexuality with youth with special health care needs. Practice implications: Health care providers and teachers are recommended to use interventions such as SeCZ TaLK to stimulate communication about sexual health with adolescents with chronic conditions.

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

Berg-Emons, H.J.G. van den — 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)

Ginneken, B.T.J. van — 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.

Romantic Relationships and and Sexual Experiences of Adolescents and Young Adults with Cerebral Palsy (Doctoral Thesis)

Wiegerink, D.J.H.G. — 2010-11-17T00:00:00Z

Objectives: To describe the development of romantic relationships and sexual experiences of young adults with cerebral palsy (CP) and the physical and emotional obstacles they experience with sexuality. Regarding the ICF domains we investigated whether this development is associated with demographic and physical characteristics, peer group activities and dating and psychological and environmental factors. We compared the romantic relationships and sexual experiences of this group with an age-appropriate Dutch reference population. Design: Prospective longitudinal study with three 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, ranging from 16 to 20 years old at the first assessment, 82% Gross Motor Function Classification System level I-II. Interventions: Not applicable. Main outcome measures: sexual interest, romantic relationships and sexual activity. Results: During the four years, the sexual experience of the participants increased significantly for all the sexual milestones evaluated. 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 an equal sexual interest at the final assessment. Peer group activities and dating favored development of romantic relationships and a sexual career. Age and gross motor functioning explained 20% of the variance in experience with intercourse. In addition, self-efficacy, self-esteem, sexual esteem and perceived attractiveness contributed significantly to having current romantic relationships and to intercourse experience. Conclusions: Young ambulatory adults with CP had comparable sexual interests and they had increasing experiences with romantic relationships and sexual activities during the transition from late adolescence to young adulthood. Social participation and aspects of a positive self image were positively associated with romantic relationships and sexual experiences.

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)

Slaman, J. — 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)

Meeteren, J. van — 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.