Somatosensory and nociceptive changes in chronic post-stroke shoulder pain

Preliminary results from a cross-sectional study that investigated the relation between the presence of post-stroke shoulder pain and somatosensory and nociceptive changes are presented. The main finding is that both abnormal somatosensation and nociception are more frequently observed in stroke patients with pain as compared to pain-free stroke patients and healthy controls

Cortical processing of electrocutaneous stimuli in chronic stroke patients: a relationship with post-stroke shoulder pain.

Cerebral stroke is often associated with changes in cognitive-evaluative and somatosensory functions which may play a role in the development and maintenance of post-stroke pain

e-Research and Jurisdiction

As part of their daily activities, those involved in e-research will often transfer information, including background materials, research results and software, across state and national borders. The act of transferring information across state and national borders raises a number of jurisdictional issues. This chapter will discuss key issues regarding intellectual property, privacy and dispute resolution as they arise from eresearchers transferring information across state and national borders, and how these issues may contractually be resolved

Experienced emotional burden in caregivers: psychometric properties of the Involvement Evaluation Questionnaire in caregivers of brain injured patients

Objective: To examine the psychometric properties (internal consistency, discriminant validity, and responsiveness) of the Involvement Evaluation Questionnaire for Brain Injury measuring emotional burden in caregivers of patients with chronic acquired brain injury. Design: Inception cohort study. Subjects: Caregivers of chronic acquired brain injury patients. Main measures: Besides the Involvement Evaluation Questionnaire for Brain Injury, the Family Assessment Device and the General Health Questionnaire were used. Methods: Ninety-eight caregivers filled out all questionnaires, of which 41 caregivers did this twice, before and after the persons they cared for had started a residential community reintegration programme. Cronbach's alpha and Intra class Correlation Coefficient were calculated for internal consistency. Pearson correlation coefficients were used for discriminant validity and Intra class Correlation Coefficient and Cohen's d were calculated to determine responsiveness. Results: The internal consistency of the Involvement Evaluation Questionnaire for Brain Injury was good (alpha = 0.73-0.84; Intra class Correlation Coefficient = 0.69-0.76). As expected, low correlations were found between the Involvement Evaluation Questionnaire for Brain Injury and either the General Health Questionnaire (r = 0.11-0.40) or the Family Assessment Device subscales (r = -0.29-0.19). Regarding responsiveness of the Involvement Evaluation Questionnaire for Brain Injury, a moderate effect size was found (Cohen's d = 0.36) while the Intra class Correlation Coefficient was good (0.80). Conclusions: The Involvement Evaluation Questionnaire for Brain Injury measures the experienced emotional burden in caregivers of patients with chronic acquired brain injury and seems to be a promising new instrument with good internal consistency, discriminant validity and responsiveness

Somatosensory abnormalities at baseline and follow-up in patients developing post-stroke shoulder pain

Post-stroke shoulder pain (PSSP) is traditionally regarded as a peripheral nociceptive pain. However, treatment aimed at peripheral pain mechanisms is often unsatisfactory and pain is persistent in a significant amount of patients. In addition, several signs of central sensitization (allodynia, generalized hyperalgesia) have been observed in patients with chronic PSSP, suggesting that central pain processing may be altered in these patients. To better understand the role of peripheral and central mechanisms in the development of PSSP we investigated pain complaints and somatosensory functions at baseline and two consecutive follow-up time frames

Clinical management of Duchenne muscular dystrophy in the Netherlands: barriers to and proposals for the implementation of the international clinical practice guidelines

Background: In order to successfully implement the international clinical care guidelines for Duchenne muscular dystrophy (DMD) in the Netherlands, it is essential to know what barriers are experienced by healthcare practitioners regarding guideline adherence and organization of care. In the Netherlands, academic medical centers provide follow up visits and work together with peripheral hospitals, rehabilitation centers, centers for home ventilation and primary care centers for treatment.Objective: To investigate perceived barriers to international clinical DMD guideline adherence and identify potential areas of improvement for implementation in the Dutch 'shared care' organization.Methods: Semi-structured in-depth interviews with healthcare practitioners of academic medical hospitals and questionnaires for healthcare practitioners of rehabilitation centers, based on the framework of Cabana.Results: The analyses identified 4 barriers for non-adherence to the DMD guideline: (i) lack of familiarity/awareness, (ii) lack of agreement with specific guideline, (iii) lack of outcome expectancy, (iv) external barriers.Conclusions: A heterogeneous set of barriers is present. Therefore, a multifaceted intervention strategy is proposed to overcome these barriers, including a clear division of roles, allowing for local (Dutch) adaptations per specialism by local consensus groups, and the facilitation of easy communication with experts/opinion leaders as well as between care professionals.Neurological Motor Disorder

Central adaptation of postural organization to peripheral sensorimotor impairments: clinical experiments in persons with lower limb amputation and in persons with hereditary motor and sensory neuropat

Contains fulltext : mmubn000001_155178547.pdf (publisher's version ) (Open Access)Promotores : A. Thomassen, G. Lankhorst en T. Mulder187 p

The reflex sympathetic dystrophy syndrome : a review with a special reference to chronic pain and motor impairments

Contains fulltext : 21340.PDF (publisher's version ) (Open Access