Clinimetrics in rehabilitation medicine: current issues in developing and applying measurement instruments 1

Clinimetrics in rehabilitation medicine, i.e. the field of developing, evaluating and applying measurement instruments, has undergone considerable progress. Despite this progress, however, several issues remain. These include: (i) selection of an instrument out of the wide range available; (ii) using an instrument in a variety of diagnostic groups; (iii) using an instrument in individual patients, as opposed to a group of patients; and (iv) the use of instruments in clinical practice. This paper reviews these issues, as well as current attempts at resolving them. Illustrative examples are given. It is concluded that solutions seem to be available, but considerable research effort is required to make these a reality. Clinimetrics in rehabilitation medicine remains a field with challenging opportunities for researc

Identification of ICF categories relevant for nursing in the situation of acute and early post-acute rehabilitation

<p>Abstract</p> <p>Background</p> <p>The recovery of patients after an acute episode of illness or injury depends both on adequate medical treatment and on the early identification of needs for rehabilitation care. The process of early beginning rehabilitation requires efficient communication both between health professionals and the patient in order to effectively address all rehabilitation goals. The currently used nursing taxonomies, however, are not intended for interdisciplinary use and thus may not contribute to efficient rehabilitation management and an optimal patient outcome. The ICF might be the missing link in this communication process. The objective of this study was to identify the categories of the International Classification of Functioning, Disability and Health (ICF) categories relevant for nursing care in the situation of acute and early post-acute rehabilitation.</p> <p>Methods</p> <p>First, in a consensus process, "Leistungserfassung in der Pflege" (LEP) nursing interventions relevant for the situation of acute and early post-acute rehabilitation were selected. Second, in an integrated two-step linking process, two nursing experts derived goals of LEP nursing interventions from their practical knowledge and selected corresponding ICF categories most relevant for patients in acute and post-acute rehabilitation (ICF Core Sets).</p> <p>Results</p> <p>Eighty-seven percent of ICF Core Set categories could be linked to goals of at least one nursing intervention variable of LEP. The ICF categories most frequently linked with LEP nursing interventions were respiration functions, experience of self and time functions and focusing attention. Thirteen percent of ICF Core Set categories could not be linked with LEP nursing interventions. The LEP nursing interventions which were linked with the highest number of different ICF-categories of all were "therapeutic intervention", "patient-nurse communication/information giving" and "mobilising".</p> <p>Conclusion</p> <p>The ICF Core Sets for the acute hospital and early post-acute rehabilitation facilities are highly relevant for rehabilitation nursing. Linking nursing interventions with ICF Core Set categories is a feasible way to analyse nursing. Using the ICF Core Sets to describe goals of nursing interventions both facilitates inter-professional communication and respects patient's needs. The ICF may thus be a useful framework to set nursing intervention goals.</p

Entropy and Complexity Analyses in Alzheimer’s Disease: An MEG Study

Alzheimer’s disease (AD) is one of the most frequent disorders among elderly population and it is considered the main cause of dementia in western countries. This irreversible brain disorder is characterized by neural loss and the appearance of neurofibrillary tangles and senile plaques. The aim of the present study was the analysis of the magnetoencephalogram (MEG) background activity from AD patients and elderly control subjects. MEG recordings from 36 AD patients and 26 controls were analyzed by means of six entropy and complexity measures: Shannon spectral entropy (SSE), approximate entropy (ApEn), sample entropy (SampEn), Higuchi’s fractal dimension (HFD), Maragos and Sun’s fractal dimension (MSFD), and Lempel-Ziv complexity (LZC). SSE is an irregularity estimator in terms of the flatness of the spectrum, whereas ApEn and SampEn are embbeding entropies that quantify the signal regularity. The complexity measures HFD and MSFD were applied to MEG signals to estimate their fractal dimension. Finally, LZC measures the number of different substrings and the rate of their recurrence along the original time series. Our results show that MEG recordings are less complex and more regular in AD patients than in control subjects. Significant differences between both groups were found in several brain regions using all these methods, with the exception of MSFD (p-value < 0.05, Welch’s t-test with Bonferroni’s correction). Using receiver operating characteristic curves with a leave-one-out cross-validation procedure, the highest accuracy was achieved with SSE: 77.42%. We conclude that entropy and complexity analyses from MEG background activity could be useful to help in AD diagnosis

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

The Electroencephalogram as a Biomarker Based on Signal Processing Using Nonlinear Techniques to Detect Dementia

Dementia being a syndrome caused by a brain disease of a chronic or progressive nature, in which the irreversible loss of intellectual abilities, learning, expressions arises; including memory, thinking, orientation, understanding and adequate communication, of organizing daily life and of leading a family, work and autonomous social life; leads to a state of total dependence; therefore, its early detection and classification is of vital importance in order to serve as clinical support for physicians in the personalization of treatment programs. The use of the electroencephalogram as a tool for obtaining information on the detection of changes in brain activities. This article reviews the types of cognitive spectrum dementia, biomarkers for the detection of dementia, analysis of mental states based on electromagnetic oscillations, signal processing given by the electroencephalogram, review of processing techniques, results obtained where it is proposed the mathematical model about neural networks, discussion and finally the conclusions

Specific patterns of cortical dysfunction in dementia and Parkinson's disease demonstrated by the acceleration spectrum entropy of the EEG

Acceleration spectrum entropy (ASE) was used to quantify EEG desynchronization, which is related to cortical activation. We investigated the ASE in control and patient groups with dementia (AD) and Parkinson's disease (PD). Both patient groups had significantly lower ASE scores corresponding with less desynchronization in all cortical regions. In the AD group, the ASE was significantly lower in the parietal region. ASE was found to be a sensitive and specific measure for differentiating patient groups with AD and PD from controls and from each other

Nonlinear EEG analysis in early Alzheimer's disease

Nonlinear EEG analysis attempts to characterize the dynamics of neural networks in the brain. Abnormalities in nonlinear EEG measures have been found repeatedly in Alzheimer's disease (AD). The present study was undertaken to investigate whether these abnormalities could already be found in the early stage of AD. In a representative sample of 49 community-dwelling elderly, Alzheimer's disease was diagnosed in 7 subjects. Correlation dimension (D2) and nonlinear prediction were measured at 16 electrodes and in two different activational states. Also, 10 surrogate data sets were generated for each EEG epoch in order to investigate the presence of nonlinear dynamics. Differences between nonlinear statistics derived from original and from surrogate data sets were expressed as Z-scores. We found lower D2 and higher predictability in the demented subjects compared to the normal subjects. The results obtained with the Z-scores pointed to changed nonlinear dynamics in frontal and temporal areas in demented subjects. However, the major differences between demented and healthy subjects are not due to nonlinearity. From this it appears that linear dynamics change first in the course of AD, followed by changes in nonlinear dynamics