Begrazing in bosreservaten door wilde hoefdieren: een onderbelicht aspect?

In een aantal bosreservaten is een verkennend onderzoek uitgevoerd naar de mate van begrazing van de verjonging en de invloed daarvan op de spontane bosontwikkeling. Dit om na te gaan of het relevant is de graasdruk een plaats te geven in het reguliere, langjarige onderzoeksprogramma naar spontane processen en natuurlijke dynamiek in onbeheerde bosse

Effect of triamcinolone acetonide injections on hemiplegic shoulder pain: a randomized clinical trial.

Background and Purpose - Hemiplegic shoulder pain is not uncommon after stroke. Its origin is still unknown, and although many different methods of treatment are applied, none have yet been proved to be effective. We sought to study the efficacy of 3 injections of intra-articular triamcinolone acetonide on pain and arm function in stroke patients with hemiplegic shoulder pain. Methods - In a multicenter, randomized, placebo-controlled clinical trial, patients with hemiplegic shoulder pain received either 3 intra-articular injections of 40 mg triamcinolone acetonide or 1 mL physiological saline solution (placebo). Primary outcomes were pain measured according to 3 visual analogue scales (score range, 0 to 10), and arm function was measured by means of the Action Research Arm test and the Fugl-Meyer assessment scale; secondary outcomes were passive external rotation of the shoulder and general functioning measured according to Barthel Index and the Rehabilitation Activities Profile. Results - In the triamcinolone group (n=18), the median decrease in pain, 3 weeks after the last injection, was 2.3 (interquartile range, 0.3 to 4.3) versus 0.2 (interquartile range, -0.5 to 2.2) in the placebo group. This result was not statistically significant. The change in the other outcome measures did not differ significantly between the 2 treatment groups. Twenty-five patients reported side effects. Conclusions - In the 37 participants included in this study, triamcinolone injections seemed to decrease hemiplegic shoulder pain and to accelerate recovery, but this effect was not statistically significant. Therefore, on the basis of the results of this study, these injections cannot be recommended for the treatment of patients with hemiplegic shoulder pain

Kinematic alterations in the ipsilateral shoulder of patients with hemiplegia due to stroke

Objective: To evaluate the assumption that shoulder kinematic patterns of the ipsilateral, nonparetic shoulder in hemiplegia are similar to kinematics recorded in a healthy population. Design: Case control study of a convenience sample of ten patients with hemiplegia due to stroke in the subacute phase compared with a control group of similar age. Three-dimensional positions of the scapula and humerus were measured and expressed in Euler angles as a function of active arm elevation in the frontal and sagittal plane and during passive humeral internal/external rotation at an elevation angle of 90 degrees in the frontal and sagittal plane. Results: Compared with controls, in the ipsilateral shoulder of patients, we found both a statistically significant diminished scapular protraction during elevation in the sagittal plane (35 ± 5 vs. 51 ± 8 degrees at 110 degrees of humeral elevation) and humeral external rotation during arm elevation in the frontal plane (51 ± 7 vs. 69 ± 14 degrees at 110 degrees of humeral elevation). Maximal passive humeral external rotation was found to be impaired in the frontal (64 ± 13 vs. 98 ± 14 degrees) and sagittal planes (65 ± 11 vs. 94 ± 12 degrees). In addition, there was significantly diminished anterior spinal tilt during humeral internal rotation (-5 ± 10 vs. -20 ± 9 degrees) and diminished posterior spinal tilt during external rotation in the frontal plane (-14 ± 8 vs. -3 ± 6 degrees). Maximal thoracohumeral elevation in patients was significantly impaired (126 ± 12 vs. 138 ± 8 degrees). Conclusion: Clear kinematic changes in the ipsilateral shoulder in patients with hemiplegia were found, indicating underlying alterations in muscle contraction patterns. The cause remains speculative. These results suggest that the ipsilateral shoulder should not be considered to function normally beforehand. Copyright © 2005 by Lippincott Williams & Wilkins

Proprioception of the shoulder after stroke

Niessen MH, Veeger DH, Koppe PA, Konijnenbelt MH, van Dieën J, Janssen TW. Proprioception of the shoulder after stroke. Objective: To investigate position sense and kinesthesia of the shoulders of stroke patients. Design: Case-control study. Setting: A rehabilitation center. Participants: A total of 22 inpatients with stroke and 10 healthy control subjects. Interventions: Not applicable. Main Outcome Measures: Angular displacement (in degrees) for threshold to detection of passive motion (TDPM) tests and absolute error (in degrees) for passive reproduction of joint position tests. Results: For patients, the TDPM for internal and external rotation was significantly higher for both the contralateral (paretic) side (internal, 7.92°±7.19°; external, 8.46°±8.87°) and the ipsilateral (nonparetic) side (internal, 4.86°±5.03°; external, 6.09°±9.15°) compared with the control group (internal, 1.83°±1.09°; external, 1.71°±.85°). Also, for internal rotation, TDPM was significantly higher for patients on the contralateral side compared with the ipsilateral side. For passive reproduction of joint position tests, no differences were found. Conclusions: Both the contralateral and ipsilateral shoulders of stroke patients showed impaired TDPM. Passive reproduction of joint position does not seem to be affected as a result of a stroke. The control of the muscle spindles and central integration or processing problems of the afferent signals provided by muscle spindles might cause these effects. © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Relationship among shoulder proprioception, kinematics, and pain after stroke

Niessen MH, Veeger DH, Meskers CG, Koppe PA, Konijnenbelt MH, Janssen TW. Relationship among shoulder proprioception, kinematics, and pain after stroke. Objective: To identify a possible relationship among chronic poststroke shoulder pain (PSSP), scapular resting pose, and shoulder proprioception. Design: Case-control study. Setting: Rehabilitation center. Participants: A total of 21 inpatients with stroke and 10 healthy control subjects. Interventions: Not applicable. Main Outcome Measures: Orientations of both the contralateral and ipsilateral (ie, paretic and nonparetic) shoulders during rest in degrees, angular displacement (degrees) for threshold to detection of passive motion (TDPM) tests, and absolute error (degrees) for passive reproduction of joint position (PRJP) tests. Results: The contralateral shoulder of patients with PSSP showed more scapular lateral rotation and larger TDPM and PRJP scores than both patients without PSSP and control subjects. Additionally, the contralateral shoulder of patients with deteriorated proprioception showed more scapular lateral rotation than control subjects, whereas their ipsilateral shoulder showed more scapular lateral rotation than both control subjects and patients with good proprioception. Conclusions: A clear relation among affected shoulder kinematics, affected proprioception, and PSSP was found. In determining the risk of developing PSSP, attention should be paid to a patients shoulder proprioception and kinematics. If both are altered after stroke, this could worsen the initial pathology or cause secondary pathologies and thus initiate a vicious circle of repetitive soft tissue damage leading to chronic PSSP. Additionally, more attention should be paid to the ipsilateral (ie, nonparetic) shoulder because it could be used in determining the risk of developing PSSP in the contralateral (ie, paretic) shoulder. © 2009 American Congress of Rehabilitation Medicine

Intrinsic properties of the knee extensor muscles after subacute stroke

Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke. Objective: To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke. Design: Case-control study. Setting: Rehabilitation center research laboratory. Participants: Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12). Interventions: Not applicable. Main Outcome Measures: Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery. Results: No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001). Conclusions: The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation. © 2010 American Congress of Rehabilitation Medicine

Effects of electric stimulation-assisted cycling training in people with chronic stroke

Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, Gerrits KH. Effects of electric stimulation-assisted cycling training in people with chronic stroke. Objective: To evaluate whether leg cycling training in subjects with chronic stroke can improve cycling performance, aerobic capacity, muscle strength, and functional performance and to determine if electric stimulation (ES) to the contralateral (paretic) leg during cycling has additional effects over cycling without ES. Design: A randomized controlled trial, with a partial double-blind design. Setting: A rehabilitation center. Participants: Twelve stroke patients (range, 18-70y), more than 5 months poststroke, with lower-extremity hemiparesis. Intervention: Subjects were randomly assigned to groups that performed cycling exercise, one with ES evoking muscle contractions and a control group with ES not evoking muscle contractions. Subjects, blinded for group assignment, trained twice a week for 6 weeks. Main Outcome Measures: Changes in aerobic capacity and maximal power output, functional performance, and lower-limb muscle strength. Results: Aerobic capacity and maximal power output significantly increased by 13.8%±19.1% and 38.1%±19.8%, but muscle strength was not significantly enhanced after training. Functional performance improved (ie, scores on the Berg Balance Scale increased by 6.9%±5.8% (P=.000) and the six-minute walk test improved by 14.5%±14.1% (P=.035). There was no significant effect on the Rivermead Mobility Index (P=.165). Training-induced changes were not significantly different between the 2 groups. Changes in cycling performance and aerobic capacity were not significantly related to changes in functional performance. Conclusions: This study showed that a short cycling training program on a semirecumbent cycle ergometer can markedly improve cycling performance, aerobic capacity, and functional performance of people with chronic stroke. The use of ES had no additional effects in this specific group of subjects with chronic stroke. © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke

Gerrits KH, Beltman MJ, Koppe PA, Konijnenbelt H, Elich PD, de Haan A, Janssen TW. Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke. Objective: (1) To examine the isometric strength, speed, and fatigue resistance of the knee extensors of the paretic limb and nonparetic limb in patients with stroke and compare these with able-bodied subjects. (2) To relate the contractile properties with different indices of functional performance. Design: Case-control study. Setting: Rehabilitation center research laboratory. Participants: Eighteen stroke patients and 10 able-bodied controls. Interventions: Not applicable. Main Outcome Measures: Maximal voluntary torque (MVT), maximal rate of torque development, time to maximal rate of torque development, half relaxation time (1/2RT), and fatigue index. Scores on the Functional Ambulation Category scale, Berg Balance Scale, and Rivermead Mobility Index as well as distance walked during the six-minute walk test were obtained. Results: MVT of the paretic leg was lower than of the nonparetic leg (P<.05), and both limbs had lower MVT than controls (P<.05). Both the paretic and the nonparetic leg showed longer 1/2RT compared with controls (P<.05). The fatigue index was reduced in the paretic leg (P<.05) but not in the nonparetic leg compared with controls. MVT and fatigue index of the paretic leg were related to indices of functional performance (r=0.49-0.64; P<.05). Conclusions: Apart from bilateral weakness, knee extensors in patients with stroke showed a lower rate of torque development and relaxation (both paretic and nonparetic leg) and lower fatigue resistance (paretic leg only) than controls, which in part may be a consequence of changes within the muscles. Strength and fatigue resistance relate to functional performance, indicating that these muscle properties should be addressed during rehabilitation. However, future research is needed to elucidate the efficacy of exercise programs. © 2009 American Congress of Rehabilitation Medicine

Relation between shoulder proprioception, kinematics and pain after stroke

Purpose: To identify a possible relationship between chronic Post-Stroke Shoulder Pain (PSSP), scapular resting pose and shoulder proprioception. Methods: A total of 21 inpatients with stroke and 10 healthy control subjects were included and kinematics and proprioception of both shoulders were measured. Results: The contralateral (i.e. paretic) shoulder of patients with PSSP showed more scapular lateral rotation and larger errors on proprioception tests compared to both patients without PSSP and control subjects. Additionally, the contralateral shoulder of patients with deteriorated proprioception showed more scapular lateral rotation compared to control subjects whereas their ipsilateral (i.e. unaffected) shoulder showed more scapular lateral rotation when compared to both control subjects and patients with good proprioception. Conclusions: A clear relation between affected shoulder kinematics, affected proprioception and PSSP was found. In determining the risk of developing PSSP, attention should be paid to a patients shoulder proprioception and kinematics. If both are altered after stroke, this could worsen the initial pathology or cause secondary pathologies and thus initiate a vicious circle of repetitive soft tissue damage leading to chronic PSSP. Additionally, more attention should be paid to the ipsilateralshoulder since it could be used in determining the risk of developing PSSP in the contralateral shoulder