Equilibri de tronc predictor de la funció motora en l'emiplègic vascular

TRUNK BALANCE AS A PREDICTOR OF MOTOR OUTCOME IN PATIENTS WITH STROKE ABSTRACTBackground: The search for predictors of functional stroke outcome has always been matter of research in Physical Medicine and Rehabilitation. Outcome prediction at an early stage enables clinicians not only to inform patients and their families, but also to set realistic therapeutic goals. A lot of prognostic studies have evaluated several factors, which either individually or in combination claim to predict functional outcome in stroke. The Trunk Control Test (TCT) proposed by Collin & Wade administered at 6 weeks post-stroke is a predictor of the walking ability at 18 weeks. The TCT reliability and validity has been demonstrated in stroke patients, as well as its positive correlation with disability at hospital discharge from in-patient rehabilitation measured with the Functional Independence Measure (FIM). In a previous study, a predictive model which only includes the FIM and the TCT measured at admission of patients to a rehabilitation ward, predicts 66.5% of the variability of the functional level at discharge (total FIM). Objective: To develop an early model to predict motor function (disability, walking ability and balance)at 6 months, taking into account the TCT and other valid predictors evaluated in the first and second week after suffering a stroke.Patients and Methods: Seventy-five consecutive patients with first stroke who were admitted to a rehabilitation hospital were studied. Sex, age, the stroke type, urinary incontinence, the National Institutes of Health Stroke Scales (NIHSS) and the TCT scores (assessed at first and second week post-stroke) as independent variables. Motor function outcome at 6 months after stroke is defined by the use the Rankin score, the motor FIM and the Berg Balance Scale (BBS).Results: Older patients, women and those with initial urinary incontinence and lower TCT and NIHSS scores showed significantly worse motor outcomes at first and six months after the stroke (Rankin, motor FIM and BBS). A multiple regression reveals that only age and the TCT (at 14 days after stroke) accounts for the 61.1% of the variance in the motor FIM score at 6 months after stroke. When the TCT is registered at 7 days after stroke, age and the TCT accounts for the 51.7% of the motor FIM variance. A cluster analysis identifies 12 patients with low outcome scores: Rankin 4-5, motor FIM Discussion and conclusions: Age, sex, urinary incontinence, TCT and NIHSS scores are related with disability, balance and walking ability six months after the stroke. It is possible to approach to the motor functional outcome at 6 months after stroke by the early use of data easily recorded as age and the TCT. In this study the TCT even overcomes the NIHSS, a comprehensive neurological measure whose ability to predicts outcome has been well documented in stroke patients. The reproducibility of this model must be cross-validated in future studies. The TCT registered at 14 days provides better prediction values compared with those obtained at 7 days after stroke. This study shows that the TCT early administered predicts motor outcome at six months after stroke.EQUILIBRI DE TRONC: PREDICTOR DE LA FUNCIÓ MOTORA EN L'HEMIPLÈGIC VASCULAR RESUMIntroducció: La cerca de factors predictors del resultat funcional després de patir un ictus és objecte constant d'investigació en Medicina Física i Rehabilitació. Un pronòstic funcional en fases inicials permet al clínic informar als pacients i a la seva familia, però també establir objectius terapèutics realistes. Molts estudis han avaluat la capacitat predictora de diferents factors individual i combinadament. El Test de Control de Tronc (TCT) registrat a les 6 setmanes de l'ictus és un predictor de la capacitat de marxa a les 18 setmanes. La fiabilitat i validesa del TCT s'ha demostrat en pacients amb ictus, així com la seva correlació positiva amb la discapacitat a l'alta hospitalaria. Un model predictiu que inclou només el TCT i el Functional Independence Measure (FIM) registrats a l'ingrés en la unitat de rehabilitació d'hospitalització aguda prediu el 66.5% de la variabilitat del FIM a l'alta.Objectius: Conèixer la relació de les variables predictores amb els resultats de funció motora global al mes i als sis mesos de l'ictus. Construir un model de predicció precoç de la funció motora (discapacitat, capacitat de marxa i equilibri) als 6 mesos, tenint en compte el TCT i altres predictors vàlids avaluats en la primera i en la segona setmana després de patir l'ictus.Pacients i Mètode: estudi longitudinal i prospectiu en 75 pacients consecutius ingressats per un primer episodi d'ictus. Les variables independents van ser: edat, sexe, tipus d'ictus, incontinencia urinària, l'escala d'ictus National Institutes of Health Stroke Scales (NIHSS) i el TCT (recollits en la primera i segona setmanes de l'ictus). Els resultats de funció motora al mes i als 6 mesos de l'ictus es van definir amb l'escala de Rankin, la subescala motora del FIM i l'escala d'equilibri Berg Balance Scale (BBS).Resultats: els pacients de més edat, les dones i els que tenen incontinència urinària inicial i puntuacions més baixes de TCT i NIHSS són els que presenten significativament pitjors resultats de funció motora tant en el primer com en el sisè mes de l'ictus (Rankin, FIM motor i BBS). Una anàlisi de regressió múltipla determina que només amb l'edat i el TCT de la segona setmana s'explica el 61.1% de la variabilitat del FIM motor als 6 mesos de l'ictus. Quan el TCT es registra en el setè dia de l'ictus, l'edat i el TCT expliquen el 51.7% de la variabilitat del FIM motor. Una anàlisi de conglomerats identifica 12 pacients amb resultats baixos de funció motora: Rankin 4-5, FIM motor Conclusions: L'edat, el sexe, la incontinència urinària, el TCT i el NIHSS inicials són factors relacionats amb la discapacitat, equilibri i capacitat de marxa 6 mesos després de l'ictus. És possible aproximar-nos al resultat funcional motor als 6 mesos després de patir l'ictus amb la utilització precoç de dades de fácil recollida com l'edat i el TCT. El TCT recollit en fases inicials prediu el resultat motor als 6 mesos de l'ictus

Using a multi-task adaptive vr system for upper limb rehabilitation in the acute phase of stroke

Nowadays, stroke has become one the main causes of adult disability leading to life-lasting effects, including motor and cognitive deficits. Here we explore the benefits of the use of virtual reality (VR) for the rehabilitation of motor deficits following stroke. We have developed the Rehabilitation Gaming System (RGS), a VR-based apparatus designed for the treatment of the upper extremities. The RGS is a multi-level adaptive system that provides a task oriented training of graded complexity that is online adjusted to the capabilities of the patients. We show results from an ongoing study that evaluates the impact of this system on the recovery of patients in the acute phase of stroke (n=14). The results suggest that the system induces a sustained improvement during treatment, with observed benefits in the performance of activities of daily living.info:eu-repo/semantics/publishedVersio

Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation

<p>Abstract</p> <p>Background</p> <p>Stroke is a frequent cause of adult disability that can lead to enduring impairments. However, given the life-long plasticity of the brain one could assume that recovery could be facilitated by the harnessing of mechanisms underlying neuronal reorganization. Currently it is not clear how this reorganization can be mobilized. Novel technology based neurorehabilitation techniques hold promise to address this issue. Here we describe a Virtual Reality (VR) based system, the Rehabilitation Gaming System (RGS) that is based on a number of hypotheses on the neuronal mechanisms underlying recovery, the structure of training and the role of individualization. We investigate the psychometrics of the RGS in stroke patients and healthy controls.</p> <p>Methods</p> <p>We describe the key components of the RGS and the psychometrics of one rehabilitation scenario called Spheroids. We performed trials with 21 acute/subacute stroke patients and 20 healthy controls to study the effect of the training parameters on task performance. This allowed us to develop a Personalized Training Module (PTM) for online adjustment of task difficulty. In addition, we studied task transfer between physical and virtual environments. Finally, we assessed the usability and acceptance of the RGS as a rehabilitation tool.</p> <p>Results</p> <p>We show that the PTM implemented in RGS allows us to effectively adjust the difficulty and the parameters of the task to the user by capturing specific features of the movements of the arms. The results reported here also show a consistent transfer of movement kinematics between physical and virtual tasks. Moreover, our usability assessment shows that the RGS is highly accepted by stroke patients as a rehabilitation tool.</p> <p>Conclusions</p> <p>We introduce a novel VR based paradigm for neurorehabilitation, RGS, which combines specific rehabilitative principles with a psychometric evaluation to provide a personalized and automated training. Our results show that the RGS effectively adjusts to the individual features of the user, allowing for an unsupervised deployment of individualized rehabilitation protocols.</p

Morphosyntactic knowledge of clitics by Portuguese heritage bilinguals

FirstView ArticleThis paper focuses on the linguistic competence of adult Portuguese–German bilinguals in their heritage language, European Portuguese (EP), which they acquired at home in early childhood in the context of German as the majority language. Based on a grammaticality judgment test, we investigate their morphosyntactic knowledge of clitics. The central questions are whether possible deviations from native monolinguals may be traced back to a) lack of contact with the formal register; b) reduced input after preschool age; and c) cross-linguistic influence. The results reveal qualitative differences between the heritage speakers and a group of monolingual controls in almost all test conditions. We conclude that although the linguistic knowledge of the heritage bilinguals investigated in this study differs from that of monolinguals, it is not “deficient” but “different” and “innovative”, because it is primarily based on the spoken variety of the language and because it promotes linguistic changes which are inherent in the speech of native monolinguals.Ações Luso-Alemãs (DAAD-CRUP); referências 50097448 e A-18/10 AI-A/09

Developing an assistive technology usability questionnaire for people with neurological diseases

Purpose This study describes the development of a questionnaire for assessing the usability of assistive technologies accessible to people with neurological diseases. Methods A Delphi study was conducted to identify relevant items for the questionnaire. After that, the content validity was addressed to identify the essential items. Once the questionnaire was designed following the results of the Delphi study and content validity, the reliability, validity, and the Rasch model of the questionnaire were examined. Results Two rounds of the Delphi study were carried out. A total of 73 participants (42 experts and 31 users) participated in round 1, and 59 people (27 experts and 32 users) in round 2. A total of 53 and 29 items were identified in rounds 1 and 2, respectively. In the content validity, we found nine items above the threshold of 0.58. Finally, ten items were included in the questionnaire. Fifty-one participants participate in the reliability and validity of the questionnaire. The internal consistency reliability of the questionnaire analyzed by Cronbach's Alpha was α = 0,895. There was moderate to considerable concordance among our questionnaire items test-retest in the Kappa coefficient and a strong association between test-retest in the Spearman's coefficient ρ = 0.818 (p<0,001). The intraclass correlation coefficient was 0,869 with a 95% confidence interval (0,781;0,923). There was a strong correlation between the total scores of the new questionnaire and other validated questionnaires analyzed with Spearman's coefficient ρ = 0.756 (p<0,001). The ten items demonstrated a satisfactory fit to the Rasch model. Conclusions The present study suggested that the new questionnaire is a reliable 10-item usability questionnaire that allows subjective and quick assessment of the usability of assistive technologies by people with neurological diseases

Malnutrition According to GLIM Criteria Is Associated with Mortality and Hospitalizations in Rehabilitation Patients with Stable Chronic Obstructive Pulmonary Disease

Malnutrition has a negative impact on patients with chronic pulmonary obstructive disease (COPD). The purpose of this study was to assess the prevalence of malnutrition, defined by the Global Leadership Initiative for Malnutrition (GLIM), in stable COPD patients referred to pulmonary rehabilitation, and to explore potential associations of malnutrition according to GLIM, and its components, with increased risk of mortality and hospitalizations in 2 years. In a post-hoc analysis of a prospective cohort of 200 rehabilitation patients with stable COPD, main outcome variables were hospital admissions, length of stay, and mortality during a 2-year follow-up. Covariates were malnutrition according to GLIM and its phenotypic criteria: unintentional weight loss, low body mass index (BMI), and low fat-free mass (FFM). Univariate and multivariate analysis were performed using logistic and proportional hazard Cox regression. Malnutrition according to GLIM showed 45% prevalence and was associated with increased mortality risk. Low age-related BMI and FFM were independently associated with mortality, which persisted after adjustment for age and lung function. Malnutrition and low BMI were also associated with increased risk of hospitalization. Malnutrition according to GLIM criteria was highly prevalent in rehabilitation patients with COPD and was associated with nearly 3 times greater mortality and hospitalization risk

Musical training as an alternative and effective method for neuro-education and neuro-rehabilitation

In the last decade, important advances in the field of cognitive science, psychology, and neuroscience have largely contributed to improve our knowledge on brain functioning. More recently, a line of research has been developed that aims at using musical training and practice as alternative tools for boosting specific perceptual, motor, cognitive, and emotional skills both in healthy population and in neurologic patients. These findings are of great hope for a better treatment of language-based learning disorders or motor impairment in chronic non-communicative diseases. In the first part of this review, we highlight several studies showing that learning to play a musical instrument can induce substantial neuroplastic changes in cortical and subcortical regions of motor, auditory and speech processing networks in healthy population. In a second part, we provide an overview of the evidence showing that musical training can be an alternative, low-cost and effective method for the treatment of language-based learning impaired populations. We then report results of the few studies showing that training with musical instruments can have positive effects on motor, emotional, and cognitive deficits observed in patients with non-communicable diseases such as stroke or Parkinson Disease. Despite inherent differences between musical training in educational and rehabilitation contexts, these results favor the idea that the structural, multimodal, and emotional properties of musical training can play an important role in developing new, creative and cost-effective intervention programs for education and rehabilitation in the next future.Financial support for the present project has been received by the Spanish government (Ministry of Economy and Competitiveness [MINECO] Grant PSI2011-29219 to AF) and from the Fyssen Foundation to CF (http://www.fondationfyssen.fr/)

Effect of specific over nonspecific VR-based rehabilitation on poststroke motor recovery: A systematic meta-analysis

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming. Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT). Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures. Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature

The Rehabilitation Gaming System: a Review

Abstract. Stroke will become one of the main burdens of disease and loss of quality of life in the near future. However, we still have not found rehabilitation approaches that can scale up so as to face this challenge. Virtual reality based therapy systems are a great promise for directly addressing this challenge. Here we review different approaches that are based on this technology, their assumptions and clinical impact. We will focus on virtual reality based rehabilitation systems that combine hypotheses on the aftermath of stroke and the neuronal mechanisms of recovery that directly aims at addressing this challenge. In particular we will analyze the, so called, Rehabilitation Gaming System (RGS) that proposes the use of non-invasive multi-modal stimulation to activate intact neuronal systems that provide direct stimulation to motor areas affected by brain lesions. The RGS is designed to engage the patients in task specific training scenarios that adapt to their performance, allowing for an individualized training of graded difficulty and complexity. Although RGS stands for a generic rehabilitative approach it has been specifically tested for the rehabilitation of motor deficits of the upper extremitie