Revant (Netherlands)

ABSTRACT Purpose Fatigue in patients with acquired brain injury (ABI) is common. However, to better target fatigue, clear ways to categorize/interpret fatigue-severity in individual patients are lacking. This study aims to determine/categorize fatigue severity among children, adolescents, and young adults with ABI. Methods This cross-sectional study included young patients admitted to outpatient rehabilitation and their parents. To determine fatigue, the PedsQL™Multidimensional-Fatigue-Scale was used (MFS, scores 0–100, lower scores = higher fatigue, patient-/parent-reported). Based on scores from a reference population, four categories were formed: “1 = no/little fatigued” to “4 = severely-more fatigued.” Results All scores were lower than those from the reference population, with comparisons in the adolescent and young adult groups reaching statistical significance (p < .05). The proportions of patients in category 4 were: 9%/50%/58% among children/adolescents/young adults, showing that many patients were “severely-more fatigued”-than the reference population. Conclusions Measuring fatigue and categorizing fatigue severity looks promising for clinical practice and could help to better target fatigue.

ObjectiveAfter stroke, people experience difficulties with walking that lead to restrictions in participation in daily life. The purpose of this study was to examine the effect of virtual reality gait training (VRT) compared to non–virtual reality gait training (non-VRT) on participation in community-living people after stroke.MethodsIn this assessor-blinded, randomized controlled trial with 2 parallel groups, people were included between 2 weeks and 6 months after stroke and randomly assigned to the VRT group or non-VRT group. Participants assigned to the VRT group received training on the Gait Real-time Analysis Interactive Lab (GRAIL), and participants assigned to the non-VRT group received treadmill training and functional gait exercises without virtual reality. Both training interventions consisted of 12 30-minute sessions during 6 weeks. The primary outcome was participation measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) 3 months postintervention. Secondary outcomes included subjective physical functioning, functional mobility, walking ability, dynamic balance, walking activity, fatigue, anxiety and depression, falls efficacy, and quality of life.ResultsTwenty-eight participants were randomly assigned to the VRT group and 27 to the non-VRT group, of whom 25 and 22 attended 75% or more of the training sessions, respectively. No significant differences between the groups were found over time for the USER-P restrictions subscale (1.23; 95% CI = −0.76 to 3.23) or secondary outcome measures. Patients’ experiences with VRT were positive, and no serious adverse events were related to the interventions.ConclusionsThe effect of VRT was not statistically different from non-VRT in improving participation in community-living people after stroke.ImpactAlthough outcomes were not statistically different, treadmill-based VRT was a safe and well-tolerated intervention that was positively rated by people after stroke. VR training might, therefore, be a valuable addition to stroke rehabilitation.Lay SummaryVRT is feasible and was positively experienced by people after stroke. However, VRT was not more effective than non-VRT for improving walking ability and participation after stroke.

Background. Patients with an upper limb motor impairment are likely to develop wrist hyper-resistance during the first months post stroke. The time course of wrist hyper-resistance in terms of neural and biomechanical components, and their interaction with motor recovery, is poorly understood. Objective. To investigate the time course of neural and biomechanical components of wrist hyper-resistance in relation to upper limb motor recovery in the first 6 months post stroke. Methods. Neural (NC), biomechanical elastic (EC), and viscous (VC) components of wrist hyper-resistance (NeuroFlexor device), and upper limb motor recovery (Fugl-Meyer upper extremity scale [FM-UE]), were assessed in 17 patients within 3 weeks and at 5, 12, and 26 weeks post stroke. Patients were stratified according to the presence of voluntary finger extension (VFE) at baseline. Time course of wrist hyper-resistance components and assumed interaction effects were analyzed using linear mixed models. Results. On average, patients without VFE at baseline (n = 8) showed a significant increase in NC, EC, and VC, and an increase in FM-UE from 13 to 26 points within the first 6 months post stroke. A significant increase in NC within 5 weeks preceded a significant increase in EC between weeks 12 and 26. Patients with VFE at baseline (n = 9) showed, on average, no significant increase in components from baseline to 6 months whereas FM-UE scores improved from 38 to 60 points. Conclusion. Our findings suggest that the development of neural and biomechanical wrist hyper-resistance components in patients with severe baseline motor deficits is determined by lack of spontaneous neurobiological recovery early post stroke.

Abstract Background: Clinicians are currently challenged to support older adults to maintain a certain level of Functional Independence (FI). FI is defined as “functioning physically safely and independent from another person, within one’s own context”. A Core Outcome Set was developed to measure FI. The purpose of this study was to assess discriminative validity of the Core Outcome Set FI (COSFI) in a population of Dutch older adults (³ 65 years) with different levels of FI. Secondary objective was to assess to what extent the underlying domains ‘coping’, ‘empowerment’ and ‘health literacy’ contribute to the COSFI in addition to the domain ‘physical capacity’. Methods: A population of 200 community-dwelling older adults and older adults living in residential care facilities were evaluated by the COSFI. The COSFI contains measurements on the four domains of FI: physical capacity, coping, empowerment and health literacy. In line with the COSMIN Study Design checklist for Patient-reported outcome measurement instruments, predefined hypotheses regarding prediction accuracy and differences between three subgroups of FI were tested. Testing included ordinal logistic regression analysis, with main outcome prediction accuracy of the COSFI on a proxy indicator for FI. Results: Overall, the prediction accuracy of the COSFI was 68%. For older adults living at home and depending on help in (i)ADL, prediction accuracy was 58%. 60% of the preset hypotheses were confirmed. Only physical capacity measured with Short Physical Performance Battery was significantly associated with group membership. Adding health literacy with coping or empowerment to a model with physical capacity improved the model significantly (p&lt;0.01). Conclusions: The current composition of the COSFI, did not yet meet the COSMIN criteria for discriminative validity. However, with some adjustments, the COSFI potentially becomes a valuable instrument for clinical practice. Context-related factors, like the presence of a spouse, also may be a determining factor in this population. It is recommended to include context-related factors in further research on determining FI in subgroups of older people.

Introduction: Differentiating between the components of wrist hyper-resistance post stroke, i.e., pathological neuromuscular activation (“spasticity”) and non-neural biomechanical changes, is important for treatment decisions. This study aimed to assess the reliability and construct validity of an innovative measurement device that quantifies these neural and non-neural components by biomechanical modeling.Methods: Forty-six patients with chronic stroke and 30 healthy age-matched subjects were assessed with the NeuroFlexor, a motor-driven device that imposes isokinetic wrist extensions at two controlled velocities (5 and 236°/s). Test-retest reliability was evaluated using intraclass correlation coefficients (ICC) and smallest detectable changes (SDC), and construct validity by testing the difference between patients and healthy subjects and between subgroups of patients stratified by modified Ashworth scale (MAS), and the association with clinical scales.Results: Test-retest reliability was excellent for the neural (NC) and non-neural elastic (EC) components (ICC 0.93 and 0.95, respectively), and good for the viscous component (VC) (ICC 0.84), with SDCs of 10.3, 3.1, and 0.5 N, respectively. NC and EC were significantly higher in patients compared to healthy subjects (p < 0.001). Components gradually increased with MAS category. NC and EC were positively associated with the MAS (rs 0.60 and 0.52, respectively; p < 0.01), and NC with the Tardieu scale (rs 0.36, p < 0.05). NC and EC were negatively associated with the Fugl-Meyer Assessment of the upper extremity and action research arm test (rs ≤ −0.38, p < 0.05).Conclusions: The NeuroFlexor reliably quantifies neural and non-neural components of wrist hyper-resistance in chronic stroke, but is less suitable for clinical evaluation at individual level due to high SDC values. Although construct validity has been demonstrated, further investigation at component level is needed.

ABSTRACTObjective: To determine neurological outcome in children and youth with acquired brain injury (ABI) and explore associated factors.Design: Cross-sectional study, two-years post-injury. Patients: Hospital-based sample (n=112) aged 6-22 years.Methods: Neurological outcome and participation were assessed with a multidimensional neurological examination and the Child and Adolescent Scale of Participation. Logistic regression analyses were used to explore the relationships.Results: Both sensorimotor and cognitive deficits were found in 30-31%, language deficits and behavioural deficits in 10-17%. Non-traumatic injury had a negative impact on neurological outcome, specifically regarding sensorimotor and language deficits. Lower education level showed a significantly poorer neurological outcome. High levels of age-expected participation were reported, with a significant relation between deficits and participation restrictions, especially at school.Conclusion: One out of three have a poor neurological outcome, related to type of injury and lower level of education. The amount of deficits is associated with participation restrictions.

Mild traumatic brain injury in children can lead to persistent cognitive and physical symptoms which can have a negative impact on activities and participation in school and at play. Preventive treatment strategies are preferred because these symptoms are often not recognized and therefore not treated adequately. In this review clinical studies investigating interventions directed at pediatric mild traumatic brain injury are summarized, and clinical recommendations and directions for the future are provided. Results show that the literature is scarce and more high quality studies are needed. Information and education about the injury and its consequences are recommended, with additional follow-up consultation, including individualized advice and reassurance. The interventions should be family-centered and, ideally, the return to activity and participation should be graded and done step-by-step.

IntroductionOne third of patients with acute stroke have aphasia. The majority receive speech and language therapy. There is evidence for a beneficial effect of speech and language therapy on restoring communication, but it is unknown whether and how efficacy of speech and language therapy is influenced by timing of treatment. We studied whether speech and language therapy early after stroke by way of intensive cognitive-linguistic treatment is more effective than no speech and language therapy in the Rotterdam Aphasia Therapy Study-3, a multicentre randomised single-blind trial.Methods and patientsStroke patients with first-ever aphasia were randomised within 2 weeks of onset to either 4 weeks of early intensive cognitive-linguistic treatment (1 h/day) or no language treatment. Hereafter, both groups received regular speech and language therapy. Primary outcome was the score on the Amsterdam-Nijmegen Everyday Language Test, measuring everyday verbal communication, 4 weeks after randomisation. Secondary outcomes were Amsterdam-Nijmegen Everyday Language Test at 3 and 6 months. The study was powered to detect a clinically relevant difference of four points on the Amsterdam-Nijmegen Everyday Language Test.ResultsOf the 152 included patients, 80 patients were allocated to intervention. Median treatment intensity in the intervention-group was 24.5 h. The adjusted difference between groups in mean Amsterdam-Nijmegen Everyday Language Test-scores 4 weeks after randomisation was 0.39, 95% confidence interval: [−2.70 to 3.47], p = 0.805. No statistically significant differences were found at 3 and 6 months after randomisation either.ConclusionFour weeks of intensive cognitive-linguistic treatment initiated within 2 weeks of stroke is not more effective than no language treatment for the recovery of post-stroke aphasia. Our results exclude a clinically relevant effect of very early cognitive-linguistic treatment on everyday language.