Håndfunksjon, aktivitetsbegrensninger og deltagelsesrestriksjoner hos "tommeltå"-pasienter : en tverrsnittundersøkelse

Håndfunksjon, aktivitetsbegrensning og deltagelsesrestriksjoner hos "tommeltå"-pasienter. Formål: Hovedformålet med denne tverrsnittsstudien var å beskrive håndfunksjonen, aktivitetsbegrensninger og deltagelsesrestriksjoner hos pasienter som har gjennomgått en tå til tommel transplantasjon, samt å undersøke sammenhengen mellom kroppsfunksjon, aktivitet og deltagelse hos denne pasientgruppen. Teoretisk forankring: Studien ble teoretisk forankret i det biopsykososiale perspektivet på helse, som presentert av Verdens helseorganisasjon (WHO) gjennom modellen Internasjonal Klassifikasjon av Funksjon, Funksjonshemming og Helse (ICF). Den ble i tillegg teoretisk forankret i litteratur som omhandlet håndfunksjon, tommelens betydning for håndfunksjon og tå til tommel transplantasjoner. Metode: Trettito pasienter med transplantert tå til tommel, operert i tidsrommet 1984 til 2005, deltok i studien. Fjorten av pasientene hadde kun skadet tommelen, mens 18 pasienter hadde skadet mellom en og fire fingre i tillegg. Styrke i helhånds-, nøkkel- og trepunktsgrep, maksimal bevegelighet i tommelens metacarpophalangeal- (MCP-) og interphalangeal-ledd (IP- ledd), sensibilitet (Semmes-Weinstein monofilamenter), funksjonell sensibilitet (Moberg picking up test), grepsfunksjon (Sollerman grepsfunksjonstest), opplevelse av funksjon i overekstremitet (Disability of the Arm, Shoulder and Hand questionnaire, DASH) og opplevelse av aktivitetsproblemer (Canadian Occupational Performance Measure, COPM) ble kartlagt. Korrelasjonsanalyse ble gjennomført for å evaluere sammenhengene mellom kroppsfunksjon, aktivitet og deltagelse (Spearmans rho). Resultater: Håndfunksjonen i den opererte hånden var statistisk signifikant dårligere sammenlignet med den ikke opererte hånden. Resultatene gav likevel en indikasjon på at pasientene hadde god nok håndfunksjon til å mestre daglige aktiviteter. I median (min, maks) var pasientenes helhåndsgrep 37 (1,3- 66,1) kg i hånden med tommeltåen, deres fleksjon i tommeltåens MCP- ledd var 41 (5- 78) grader, de skåret 75 (40, 80) poeng på Sollerman grepsfunksjonstest, samt 40 % av utvalget hadde tilnærmet normal trykk sensibilitet i tommeltåen. Skadeomfanget hadde en betydning for enkelte av pasientenes funksjoner. Blant annet var pasientene med isolert tommelskade signifikant sterkere enn pasientene med minimum en finger ekstra skadet på samme hånd som tommeltåen (p< 0,05). Utvalget rapporterte liten grad av opplevde begrensninger i kroppsfunksjon, aktivitet og deltagelse i tilknytning til overekstremiteten og hånden. I median (min, maks) skåret de 10 (0, 70) på DASH kroppsfunksjon og 3,3 (0, 48) på DASH aktivitet. En av de sterkeste korrelasjonene mellom aktivitet/ deltagelse og kroppsfunksjon ble funnet mellom DASH aktivitetskår og styrke i helhåndsgrep (rs= -0,60). Konklusjon: En tå til tommel transplantasjon kan gi en tommel med både god styrke, bevegelighet i MCP- leddet, grepsfunksjon og sensibilitet. Til tross for noe nedsatt fysisk funksjon i tommeltåen, sammenlignet med ikke operert hånd/tommel, oppga de fleste av pasientene at de hadde lite eller ingen aktivitetsbegrensninger eller deltagelsesrestriksjoner i dagliglivet. Den sterke korrelasjonen mellom aktivitet/ deltagelse og styrke i helhåndsgrepet tyder på at håndstyrke bør inngå som en viktig del i behandling og råd om trening etter en tå til tommel transplantasjon. Det ble ellers kun funnet enkelte sterke sammenhenger mellom resultatene av kartleggingen av aktivitet/ deltagelse og håndfunksjon. Resultatene tyder på at tommeltåpasientene kunne ha nedsatt håndfunksjon uten å oppleve aktivitetsbegrensninger eller deltagelsesrestriksjoner, og omvendt. Nøkkelord: Tå til tommel transplantasjon, håndfunksjon, aktivitet, deltagelse, International Klassifikasjon av Funksjon, Funksjonshemning og Helse

Assessing distinct patterns of cognitive aging using tissue-specific brain age prediction based on diffusion tensor imaging and brain morphometry

Multimodal imaging enables sensitive measures of the architecture and integrity of the human brain, but the high-dimensional nature of advanced brain imaging features poses inherent challenges for the analyses and interpretations. Multivariate age prediction reduces the dimensionality to one biologically informative summary measure with potential for assessing deviations from normal lifespan trajectories. A number of studies documented remarkably accurate age prediction, but the differential age trajectories and the cognitive sensitivity of distinct brain tissue classes have yet to be adequately characterized. Exploring differential brain age models driven by tissue-specific classifiers provides a hitherto unexplored opportunity to disentangle independent sources of heterogeneity in brain biology. We trained machine-learning models to estimate brain age using various combinations of FreeSurfer based morphometry and diffusion tensor imaging based indices of white matter microstructure in 612 healthy controls aged 18–87 years. To compare the tissue-specific brain ages and their cognitive sensitivity, we applied each of the 11 models in an independent and cognitively well-characterized sample (n = 265, 20–88 years). Correlations between true and estimated age and mean absolute error (MAE) in our test sample were highest for the most comprehensive brain morphometry (r = 0.83, CI:0.78–0.86, MAE = 6.76 years) and white matter microstructure (r = 0.79, CI:0.74–0.83, MAE = 7.28 years) models, confirming sensitivity and generalizability. The deviance from the chronological age were sensitive to performance on several cognitive tests for various models, including spatial Stroop and symbol coding, indicating poorer performance in individuals with an over-estimated age. Tissue-specific brain age models provide sensitive measures of brain integrity, with implications for the study of a range of brain disorders

Verbal Learning and Memory Deficits across Neurological and Neuropsychiatric Disorders: Insights from an ENIGMA Mega Analysis.

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15-90. The effects of dementia, mild cognitive impairment, Parkinson's disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders

Virtual reality training for upper extremity in subacute stroke (VIRTUES): study protocol for a randomized controlled multicenter trial

Background. Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies. The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate cost-effectiveness in terms of resources required to regain some degree of dexterity.Methods/Design. Randomized controlled observer-blind trial. One hundred and twenty patients up to 12 weeks after stroke will be randomized to either a group receiving VR training or dose-matched and therapist attention-matched conventional arm training in addition to standard rehabilitation. During a period of four weeks the patients will be offered additional 4-5 training sessions a week of 45-60 minutes duration by a physiotherapist or an occupational therapist. Study outcomes: Arm motor function, dexterity and independence in daily life activities will be evaluated at baseline, post treatment and three months follow-up assessments with the Action Research Arm Test, Box and Blocks Test and the Functional Independence Measure, respectively. Patient and therapist satisfaction with the implementation of a VR rehabilitation system will also be assessed with questionnaires and interviews. Discussion. Virtual reality systems are promising tools for rehabilitation of arm motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance recovery after stroke, and at the same time demand little personnel resources to increase training intensity. The VIRTUES trial will provide further evidence of VR-based treatment strategies to clinicians, patients and health economists. Trial registrationClinicalTrials.gov NCT02079103.status: publishe

Virtual Reality Training for Upper Extremity in Subacute Stroke (VIRTUES) A multicenter RCT

Objective: To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke. Methods: In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as >=20 degrees wrist and 10 degrees finger extension or less, respectively. The training comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after intervention, and at the 3-month follow-up. Results: Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention (p = 0.714) and follow-up (p = 0.777) assessments. Patients in VR improved 12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively. Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis. Conclusions: Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation. ClinicalTrials.gov identifier: NCT02079103. Classification of evidence: This study provides Class I evidence that for patients with upper extremity motor impairment after stroke, compared to conventional training, VR training did not lead to significant differences in upper extremity function improvement.status: publishe

Virtual reality training for upper extremity in subacute stroke (VIRTUES): study protocol for a randomized controlled multicenter trial

Background: Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies. The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate cost-effectiveness in terms of resources required to regain some degree of dexterity. Methods/Design: Randomized controlled observer-blind trial. One hundred and twenty patients up to 12 weeks after stroke will be randomized to either a group receiving VR training or dose-matched and therapist attention-matched conventional arm training in addition to standard rehabilitation. During a period of four weeks the patients will be offered additional 4–5 training sessions a week of 45–60 minutes duration by a physiotherapist or an occupational therapist. Study outcomes: Arm motor function, dexterity and independence in daily life activities will be evaluated at baseline, post treatment and three months follow-up assessments with the Action Research Arm Test, Box and Blocks Test and the Functional Independence Measure, respectively. Patient and therapist satisfaction with the implementation of a VR rehabilitation system will also be assessed with questionnaires and interviews. Discussion: Virtual reality systems are promising tools for rehabilitation of arm motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance recovery after stroke, and at the same time demand little personnel resources to increase training intensity. The VIRTUES trial will provide further evidence of VR-based treatment strategies to clinicians, patients and health economists

Key Brain Network Nodes Show Differential Cognitive Relevance and Developmental Trajectories during Childhood and Adolescence

Human adolescence is a period of rapid changes in cognition and goal-directed behavior, and it constitutes a major transitional phase towards adulthood. One of the mechanisms suggested to underlie the protracted maturation of functional brain networks, is the increased network integration and segregation enhancing neural efficiency. Importantly, the increasing coordinated network interplay throughout development is mediated through functional hubs, which are highly connected brain areas suggested to be pivotal nodes for the regulation of neural activity. To elucidate brain hub development during childhood and adolescence, we estimated voxel-wise eigenvector centrality (EC) using functional magnetic resonance imaging (fMRI) data from two different psychological contexts (resting state and a working memory task), in a large cross-sectional sample (n = 754) spanning the age from 8 to 22 years, and decomposed the maps using independent component analysis (ICA). Our results reveal significant age-related centrality differences in cingulo-opercular, visual, and sensorimotor network nodes during both rest and task performance, suggesting that common neurodevelopmental processes manifest across different mental states. Supporting the functional significance of these developmental patterns, the centrality of the cingulo-opercular node was positively associated with task performance. These findings provide evidence for protracted maturation of hub properties in specific nodes of the brain connectome during the course of childhood and adolescence and suggest that cingulo-opercular centrality is a key factor supporting neurocognitive development

TVA-based modeling of short-term memory capacity, speed of processing and perceptual threshold in chronic stroke patients undergoing cognitive training: Case-control differences, reliability, and associations with cognitive performance

Attentional deficits following stroke are common and pervasive, and are important predictors for functional recovery. Attentional functions comprise a set of specific cognitive processes allowing to attend, filter and select among a continuous stream of stimuli. These mechanisms are fundamental for more complex cognitive functions such as learning, planning and cognitive control, all crucial for daily functioning. The distributed functional neuroanatomy of these processes is a likely explanation for the high prevalence of attentional impairments following stroke, and underscores the importance of a clinical implementation of computational approaches allowing for sensitive and specific modeling of attentional sub-processes. The Theory of Visual Attention (TVA) offers a theoretical, computational, neuronal and practical framework to assess the efficiency of visual selection performance and parallel processing of multiple objects. Here, in order to assess the sensitivity and reliability of TVA parameters reflecting short-term memory capacity ( K ), processing speed ( C ) and perceptual threshold ( t 0 ), we used a whole-report paradigm in a cross-sectional case-control comparison and across six repeated assessments over the course of a three-week computerized cognitive training (CCT) intervention in chronic stroke patients (&gt; 6 months since hospital admission, NIHSS ≤ 7 at hospital discharge). Cross-sectional group comparisons documented lower short-term memory capacity, lower processing speed and higher perceptual threshold in patients ( n  = 70) compared to age-matched healthy controls ( n  = 140). Further, longitudinal analyses in stroke patients during the course of CCT ( n  = 54) revealed high reliability of the TVA parameters, and higher processing speed at baseline was associated with larger cognitive improvement after the intervention. The results support the feasibility, reliability and sensitivity of TVA-based assessment of attentional functions in chronic stroke patients

Exploring the associations between physical activity level, cognitive performance, and response to computerized cognitive training among chronic stroke patients

Abstract Background Post‐stroke attentional and working memory deficits are common and represent relevant predictors of long‐term functional recovery and outcome. The individual responses to cognitive rehabilitation and interventions vary between patients and are influenced by multiple factors. Recently, a link between the level of engagement in physical activities and cognitive rehabilitation has been suggested. However, few previous studies have tested the predictive value of physical activity on cognitive performance and response to cognitive training among chronic stroke patients. There is also a lack of knowledge concerning the prognostic value of index stroke characteristics on physical activity in chronic phase. Method In this cross‐sectional and longitudinal study, including stroke survivors suffering mild‐to‐moderate strokes (n = 52, mean age = 70 years), we used Bayesian regression to test the association between cognitive performance and response to a 3‐week intervention with a commonly used computerized cognitive training (CCT) system and baseline physical activity level measured with International Physical Activity Questionnaire. We also tested the association between physical activity level in chronic phase and stroke characteristics, including stroke severity (National Institutes of Health Stroke Scale), ischemic stroke etiology (Trial of Org 10172 in Acute Stroke Treatment), and stroke location (n = 66, mean age = 68 years). For descriptive purposes, we included 104 sex‐ and age‐matched healthy controls (mean age = 69 years). Results The analyses revealed anecdotal evidence of a positive association between overall cognitive performance and daily minutes of sedentary behavior, indicating that better cognitive performance was associated with more daily hours of sitting still. We found no support for an association between cognitive performance and response to CCT with activity level. In addition, the analysis showed group differences in sedentary behavior between patients with small‐vessel disease (n = 20) and cardioembolism (n = 7), indicating more sedentary behavior in patients with small‐vessel disease. There was no further support for a predictive value of index stroke characteristics on physical activity level. Conclusion The results do not support that baseline physical activity level is a relevant predictor of the overall performance or response to CCT in this sample of chronic stroke patients. Similarly, the analyses revealed little evidence for an association between index stroke characteristics and future activity level in patients surviving mild‐to‐moderate stroke