Presence of Finger Extension and Shoulder Abduction Within 72 Hours After Stroke Predicts Functional Recovery. Early Prediction of Functional Outcome After Stroke: The EPOS Cohort Study

BACKGROUND AND PURPOSE-: The aim of the present study was to determine if outcome in terms of upper limb function at 6 months after stroke can be predicted in hospital stroke units using clinical parameters measured within 72 hours after stroke. In addition, the effect of the timing of assessment after stroke on the accuracy of prediction was investigated by measurements on days 5 and 9. METHODS-: Candidate determinants were measured in 188 stroke patients within 72 hours and at 5 and 9 days after stroke. Logistic regression analysis was used for model development to predict upper limb function at 6 months measured with the action research arm test (ARAT). RESULTS-: Patients with an upper limb motor deficit who exhibit some voluntary extension of the fingers and some abduction of the hemiplegic shoulder on day 2 have a probability of 0.98 to regain some dexterity at 6 months, whereas the probability was 0.25 for those without this voluntary motor activity. Sixty percent of patients with some early finger extension achieved full recovery at 6 months in terms of action research arm test score. Retesting the model on days 5 and 9 resulted in a gradual decline in probability from 0.25 to 0.14 for those without voluntary motor activity of shoulder abduction and finger extension, whereas the probability remained 0.98 for those with this motor activity. CONCLUSIONS-: Based on 2 simple bedside tests, finger extension and shoulder abduction, functional recovery of the hemiplegic arm at 6 months can be predicted early in a hospital stroke unit within 72 hours after stroke onset

Chloride Ingress of Carbonated Blast Furnace Slag Cement Mortars

In the Netherlands civil engineering structures, such as overpasses, bridges and tunnels are generally built using blast furnace slag cement (BFSC, CEM III/B) concrete, because of its high resistance against chloride penetration. Although the Dutch experience regarding durability performance of BFSC concrete has been remarkably good, its resistance to carbonation is known to be sensitive, especially when the used slag percentage is high. In a field investigation on a highway overpass damage was found in sheltered elements such as abutments and intermediate supports, which was attributed to chloride induced corrosion enhanced by carbonation that occurred prior to the chloride exposure. Many structures built using BFSC could be prone to this mechanism, i.e. carbonation enhanced chloride induced corrosion, negatively affecting their durability. Focus of the research was given on the influence of carbonation on the chloride penetration resistance of BFSC mortars with varying slag content. In light of the characteristics from the overpass case, it was assumed that first there is a period of carbonation during sheltered exposure, and subsequently joint leakage causes exposure to chlorides. In order to identify the influence of slag content on carbonation, chloride penetration resistance and their coupled effect, mortars with twelve cement blends in a range of 0-70% slag were evaluated based on chloride migration coefficient, accelerated carbonation and electrical resistivity. This study shows that carbonation of BFSC mortars increases the porosity, consequently decreasing the chloride penetration resistance. Binders with 50% or more slag were found to have a significantly lower resistance after carbonation. Consequently, the chloride penetration resistance of a given concrete cover strongly depends on the duration of carbonation and the resulting carbonation depth, hence influencing its lifespan. The service life was estimated using a simplified model for the chloride penetration time of a combined carbonated and uncarbonated layer. It was found that mortar with a slag content between 35 and 50% that was carbonated before chloride exposure show the lowest influence of carbonation on the chloride penetration resistance. © Springer International Publishing AG 2018. Bam; Cement and Beton Centrum; et al.; Rijkswaterstaat - Ministry of Infrastructure and the Environment; Van Hattum en Blankevoort; VolkerInfr

Impact of early applied upper limb stimulation: The EXPLICIT-stroke programme design

Main claims of the literature are that functional recovery of the paretic upper limb is mainly defined within the first month post stroke and that rehabilitation services should preferably be applied intensively and in a task-oriented way within this particular time window. EXplaining PLastICITy after stroke (acronym EXPLICIT-stroke) aims to explore the underlying mechanisms of post stroke upper limb recovery. Two randomized single blinded trials form the core of the programme, investigating the effects of early modified Constraint-Induced Movement Therapy (modified CIMT) and EMG-triggered Neuro-Muscular Stimulation (EMG-NMS) in patients with respectively a favourable or poor probability for recovery of dexterity.BioMechanical EngineeringMechanical, Maritime and Materials Engineerin

Computerised patient-specific prediction of the recovery profile of upper limb capacity within stroke services: The next step

Introduction: Predicting upper limb capacity recovery is important to set treatment goals, select therapies and plan discharge. We introduce a prediction model of the patient-specific profile of upper limb capacity recovery up to 6 months poststroke by incorporating all serially assessed clinical information from patients. Methods: Model input was recovery profile of 450 patients with a first-ever ischaemic hemispheric stroke measured using the Action Research Arm Test (ARAT). Subjects received at least three assessment sessions, starting within the first week until 6 months poststroke. We developed mixed-effects models that are able to deal with one or multiple measurements per subject, measured at non-fixed time points. The prediction accuracy of the different models was established by a fivefold cross-validation procedure. Results: A model with only ARAT time course, finger extension and shoulder abduction performed as good as models with more covariates. For the final model, cross-validation prediction errors at 6 months poststroke decreased as the number of measurements per subject increased, from a median error of 8.4 points on the ARAT (Q1-Q3:1.7-28.1) when one measurement early poststroke was used, to 2.3 (Q1-Q3:1-7.2) for seven measurements. An online version of the recovery model was developed that can be linked to data acquisition environments. Conclusio

Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design

<p>Abstract</p> <p>Background</p> <p>It is the purpose of this article to identify and review criteria that rehabilitation technology should meet in order to offer arm-hand training to stroke patients, based on recent principles of motor learning.</p> <p>Methods</p> <p>A literature search was conducted in PubMed, MEDLINE, CINAHL, and EMBASE (1997–2007).</p> <p>Results</p> <p>One hundred and eighty seven scientific papers/book references were identified as being relevant. Rehabilitation approaches for upper limb training after stroke show to have shifted in the last decade from being analytical towards being focussed on environmentally contextual skill training (task-oriented training). Training programmes for enhancing motor skills use patient and goal-tailored exercise schedules and individual feedback on exercise performance. Therapist criteria for upper limb rehabilitation technology are suggested which are used to evaluate the strengths and weaknesses of a number of current technological systems.</p> <p>Conclusion</p> <p>This review shows that technology for supporting upper limb training after stroke needs to align with the evolution in rehabilitation training approaches of the last decade. A major challenge for related technological developments is to provide engaging patient-tailored task oriented arm-hand training in natural environments with patient-tailored feedback to support (re) learning of motor skills.</p

Contact dermatitis and other skin conditions in instrumental musicians

BACKGROUND: The skin is important in the positioning and playing of a musical instrument. During practicing and performing there is a permanent more or less intense contact between the instrument and the musician's skin. Apart from aggravation of predisposed skin diseases (e.g., atopic eczema or psoriasis) due to music-making, specific dermatologic conditions may develop that are directly caused by playing a musical instrument. METHODS: To perform a systematic review on instrument-related skin diseases in musicians we searched the PubMed database without time limits. Furthermore we studied the online bibliography "Occupational diseases of performing artist. A performing arts medicine bibliography. October, 2003" and checked references of all selected articles for relevant papers. RESULTS: The most prevalent skin disorders of instrumental musicians, in particular string instrumentalists (e.g., violinists, cellists, guitarists), woodwind players (e.g., flautists, clarinetists), and brass instrumentalists (e.g., trumpeters), include a variety of allergic contact sensitizations (e.g., colophony, nickel, and exotic woods) and irritant (physical-chemical noxae) skin conditions whose clinical presentation and localization are usually specific for the instrument used (e.g., "fiddler's neck", "cellist's chest", "guitar nipple", "flautist's chin"). Apart from common callosities and "occupational marks" (e.g., "Garrod's pads") more or less severe skin injuries may occur in musical instrumentalists, in particular acute and chronic wounds including their complications. Skin infections such as herpes labialis seem to be a more common skin problem in woodwind and brass instrumentalists. CONCLUSIONS: Skin conditions may be a significant problem not only in professional instrumentalists, but also in musicians of all ages and ability. Although not life threatening they may lead to impaired performance and occupational hazard. Unfortunately, epidemiological investigations have exclusively been performed on orchestra musicians, though the prevalence of instrument-related skin conditions in other musician groups (e.g., jazz and rock musicians) is also of interest. The practicing clinician should be aware of the special dermatologic problems unique to the musical instrumentalist. Moreover awareness among musicians needs to be raised, as proper technique and conditioning may help to prevent affection of performance and occupational impairment

Hindcasting morphodynamic evolution with sand–mud interactions in the Yangtze Estuary

Previous work on morphodynamic evolution in the Yangtze Estuary (YE) is based on measured historical bathymetries. To evaluate the sensitivity of sand–mud interaction in the estuarine morpho-dynamics, a process-based morphodynamic model, Delft3D, is used to examine the morphodynamic behaviour from 1958 to 1997. Different scenarios concerning sand and mud and their combination are designed systematically. The scenarios considering multiple fractions, and especially with four fractions, improve the hindcasting evolution, suggesting the importance of including both sand and mud fractions and a sediment gradient setting of medium grain