Activities and participation of children and adolescents after mild traumatic brain injury and the effectiveness of an early intervention (Brains Ahead!): Study protocol for a cohort study with a nested randomised controlled trial

Background: Approximately 20% of children and adolescents who have sustained mild traumatic brain injuries ma

Predicting outcome in patients with chronic stroke: findings of a 3-year follow-up study

This thesis is based on the findings of the FuPro-Stroke study (the Stroke section of the Functional Prognostification and disability study on neurological disorders), which is a multicentre, prospective cohort study among patients with stroke, who were included during inpatient rehabilitation. The aim of the research reported on in the present thesis was to investigate the long-term prognosis of chronic stroke outcome up to 3 years after onset. Poor mobility status is a key concern in chronic stroke patients, especially since it may lead to ADL dependence and affect social reintegration. We found that mobility at one-year post stroke could be predicted by functional status, sitting balance, time between stroke onset and measurement, and age. We also investigated determinants that could predict decline in mobility status in chronic stroke patients. Inactivity in terms of instrumental activities of daily living (IADL), cognitive problems, fatigue and depressive symptoms at one year post stroke were the main predictors for deterioration in mobility. Community ambulation is an important outcome for stroke patients and we found that this variable was closely related to gait speed. The optimal cut-off point for community ambulation was 0.66 m/s. Balance, endurance and the use of an assistive walking device were determinants that confounded the relation between community ambulation and gait speed. The effectiveness of training programmes focusing on lower limb strengthening, cardio-respiratory fitness or gait-oriented tasks, in terms of the outcome of gait, gait-related activities and health-related quality of life (HRQoL) after stroke were also investigated. Twenty-one high quality RCTs were included, five of which focused on lower limb strengthening, two on cardio-respiratory fitness training and 14 on gait-oriented training. After conducting a meta-analysis we suggested that gait-oriented training is the most successful method to improve walking competency after stroke. Depression and fatigue are both well-known sequels after stroke. At three years post stroke, 19% of the patients showed depressive symptoms. Depression was best predicted by one-year IADL activity and fatigue. It was also shown that 68%, 74% and 58% of the patients experienced fatigue at 6, 12 and 36 months post stroke, respectively. Fatigue was significantly related to IADL and HRQoL, but not to ADL. Depression and motor impairment were important confounders in the relationship between fatigue and IADL and HRQoL. Since the number of stroke patients is rising and it is a chronic disease, it is important that appropriate care is provided to suit the needs of all these patients. We suggest in our study that 33% of the patients perceived at least one unmet care demand at three years after stroke. Younger age, motor impairment, fatigue and depressive symptoms were significantly related to the presence of unmet demands. These results suggest that our health care system is as yet not fully meeting the demands of patients with chronic stroke. Our advise is that the focus of care and research should be on improving our understanding of the course of functional recovery by monitoring patients over time, introducing innovative intervention strategies and exploring the underlying mechanisms of functional improvement after stroke

Systematic Review of Cardiopulmonary Exercise Testing Post Stroke: Are We Adhering to Practice Recommendations?

Objective: To systematically review the use of cardiopulmonary exercise testing in people who have survived a stroke. The following questions are addressed: (i) What are the testing procedures used? (ii) What are the patient, safety and outcomes characteristics in the cardiopulmonary exercise testing procedures? (iii) Which criteria are used to determine maximum oxygen uptake (V

Republished research: Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial

Study question What is the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home? Summary answer Task oriented circuit training started in the first six months is as effective as individually tailored physiotherapy for patients with moderate to mild stroke and allows patients to exercise more intensively with a lower ratio of staff to patients. What is known and what this paper adds in patients with stroke, group circuit training is safe and has good results in terms of walking distance and walking speed. Previous trials, however, have been conducted in patients with chronic stroke, were small, and failed to follow up adequately. Though significant treatment effects favouring task specific circuit training were found for walking distance, walking speed, and stair walking, the differences between groups were small and the sustainability of effects was limited

Exercise therapy for fatigue in multiple sclerosis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The aim of the present review will be to evaluate the effectiveness of exercise therapy in patients with MS on perceived fatigue, measured with self‐reported fatigue questionnaires, and compared to any other type of intervention. We will consider the potential harm of exercise therapy in this population

Soccer injuries and recovery in dutch male amateur soccer players: Results of a prospective cohort study

OBJECTIVE:: To describe characteristics of outdoor soccer injury and recovery among Dutch soccer players. DESIGN:: Prospective cohort study. SETTING:: The 2009-2010 competitive season (33 weeks). PARTICIPANTS:: Four hundred fifty-six Dutch male soccer players of 23 amateur teams. MAIN OUTCOME MEASURES:: Coaches recorded individual exposure to all soccer activities. Paramedics or sports trainers collected information on the occurrence (eg, location, type, circumstances) and consequences (eg, absenteeism, medical treatment) of injuries. RESULTS:: In total, 424 time-loss injuries were sustained by 60% (n = 274) of the players, with 23% (n = 105) having more than 1 injury. This corresponds to an overall density of 9.6 (8.7-10.5) injuries per 1000 player hours; 3.9 (3.3-4.7) in training sessions and 20.4 (18.1-23.1) in soccer matches. Almost 30% (n = 123) of the injuries lasted for more than 1 month, 14% (n = 58) were reinjuries (causing longer absence than new injuries), and 54% (n = 230) of the injuries were given medical treatment. The most common diagnoses were muscle/tendon (38%) or joint/ligament injuries (23%) of the lower extremities. After regaining the ability to fully take part in soccer training or matches, 27.4% of the players (n = 116) still reported complaints. CONCLUSIONS:: Two recommendations based on the above-mentioned results are (1) prevention should primarily focus on these most common diagnoses and (2) players resuming soccer activities after an injury should be given special attention to resolve the remaining complaints and to prevent reinjuries. Copyright © 2014 by Lippincott Williams & Wilkins