Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: a systematic review

Contains fulltext : 110141.pdf (publisher's version ) (Open Access)BACKGROUND: Loss of arm-hand performance due to a hemiparesis as a result of stroke or cerebral palsy (CP), leads to large problems in daily life of these patients. Assessment of arm-hand performance is important in both clinical practice and research. To gain more insight in e.g. effectiveness of common therapies for different patient populations with similar clinical characteristics, consensus regarding the choice and use of outcome measures is paramount. To guide this choice, an overview of available instruments is necessary. The aim of this systematic review is to identify, evaluate and categorize instruments, reported to be valid and reliable, assessing arm-hand performance at the ICF activity level in patients with stroke or cerebral palsy. METHODS: A systematic literature search was performed to identify articles containing instruments assessing arm-hand skilled performance in patients with stroke or cerebral palsy. Instruments were identified and divided into the categories capacity, perceived performance and actual performance. A second search was performed to obtain information on their content and psychometrics. RESULTS: Regarding capacity, perceived performance and actual performance, 18, 9 and 3 instruments were included respectively. Only 3 of all included instruments were used and tested in both patient populations. The content of the instruments differed widely regarding the ICF levels measured, assessment of the amount of use versus the quality of use, the inclusion of unimanual and/or bimanual tasks and the inclusion of basic and/or extended tasks. CONCLUSIONS: Although many instruments assess capacity and perceived performance, a dearth exists of instruments assessing actual performance. In addition, instruments appropriate for more than one patient population are sparse. For actual performance, new instruments have to be developed, with specific focus on the usability in different patient populations and the assessment of quality of use as well as amount of use. Also, consensus about the choice and use of instruments within and across populations is needed

Fish Food in the Deep Sea: Revisiting the Role of Large Food-Falls

The carcasses of large pelagic vertebrates that sink to the seafloor represent a bounty of food to the deep-sea benthos, but natural food-falls have been rarely observed. Here were report on the first observations of three large ‘fish-falls’ on the deep-sea floor: a whale shark (Rhincodon typus) and three mobulid rays (genus Mobula). These observations come from industrial remotely operated vehicle video surveys of the seafloor on the Angola continental margin. The carcasses supported moderate communities of scavenging fish (up to 50 individuals per carcass), mostly from the family Zoarcidae, which appeared to be resident on or around the remains. Based on a global dataset of scavenging rates, we estimate that the elasmobranch carcasses provided food for mobile scavengers over extended time periods from weeks to months. No evidence of whale-fall type communities was observed on or around the carcasses, with the exception of putative sulphide-oxidising bacterial mats that outlined one of the mobulid carcasses. Using best estimates of carcass mass, we calculate that the carcasses reported here represent an average supply of carbon to the local seafloor of 0.4 mg m−2d−1, equivalent to ~4% of the normal particulate organic carbon flux. Rapid flux of high-quality labile organic carbon in fish carcasses increases the transfer efficiency of the biological pump of carbon from the surface oceans to the deep sea. We postulate that these food-falls are the result of a local concentration of large marine vertebrates, linked to the high surface primary productivity in the study area

Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial

Background: Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS).Objective: To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue.Methods: A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue subscale of Checklist Individual Strength - CIS20r) and participation (Impact on Participation and Autonomy scale - IPA).Results: Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the groups = -0.81; 95% confidence interval (CI), -3.71 to 2.11) or for four out of five IPA domains. An overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference between the groups = 0.19; 95% CI, 0.03 to 0.35).Conclusion: The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition