Mental practice-based rehabilitation training to improve arm function and daily activity performance in stroke patients: a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Over 50% of patients with upper limb paresis resulting from stroke face long-term impaired arm function and ensuing disability in daily life. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. This study aims to evaluate a new therapy for improving arm function in sub-acute stroke patients based on mental practice theories and functional task-oriented training, and to study the predictors for a positive treatment result. It is hypothesized that a six-week, mental practice-based training program (additional to regular therapy) targeting the specific upper extremity skills important to the individual patient will significantly improve both arm function and daily activity performance, as well as being cost effective.</p> <p>Methods/design</p> <p>One hundred and sixty sub-acute stroke patients with upper limb paresis (MRC grade 1–3) will participate in a single-blinded, multi-centre RCT. The experimental group will undertake a six-week, individually tailored therapy regime focused on improving arm function using mental practice. The control group will perform bimanual upper extremity exercises in addition to regular therapy. Total contact time and training intensity will be similar for both groups. Measurements will be taken at therapy onset, after its cessation and during the follow-up period (after 6 and 12 months). Primary outcome measures will assess upper extremity functioning on the ICF level of daily life activity (Wolf Motor Function Test, Frenchay Arm Test, accelerometry), while secondary outcome measures cover the ICF impairment level (Brunnstrom-Fu-Meyer test). Level of societal participation (IPA) and quality of life (EuroQol; SS-Qol) will also be tested. Costs will be based on a cost questionnaire, and statistical analyses on MAN(C)OVA and GEE (generalized estimated equations).</p> <p>Discussion</p> <p>The results of this study will provide evidence on the effectiveness of this mental practice-based rehabilitation training, as well as the cost-effectiveness.</p> <p>Trial registration</p> <p>Current Controlled Trials [ISRCTN33487341)</p

Validation of the Dutch version of the Brief Negative Symptom Scale

Contains fulltext : 225925.pdf (publisher's version ) (Open Access)PURPOSE: The Brief Negative Symptom Scale (BNSS) was developed to measure negative symptoms of schizophrenia. However, the Dutch translation of this instrument, called the "Korte Schaal voor Negatieve Symptomen" (KSNS), has not yet been validated. This study investigates the validity and reliability of this Dutch version of the instrument. PATIENTS AND METHODS: The Psychotic Symptom Rating Scale (PSYRATS), Calgary Depression Scale for Schizophrenia (CDSS), the Health of the Nation Scale (HoNOS) and the KSNS were used for routine outcome monitoring to measure symptoms in 28 patients with a psychotic disorder who were being treated on a long-stay ward. RESULTS: The internal consistency of the KSNS is fair to good. The inter-rater reliability is excellent. The concurrent validity is moderate but acceptable. The correlations between the KSNS and scales for depression and positive symptoms were not significant, which indicate good divergent validity. CONCLUSION: Despite the small sample size of the current study, we conclude that the BNSS, called the KSNS in Dutch, appears to be a reliable and valid tool for investigating negative symptoms in detail in patients with psychotic disorders.5 p

Voorspellende waarde van lichte verstandelijke beperking en PTSS voor behandelresultaten van patiënten met ernstige psychiatrische aandoeningen

Item does not contain fulltextAchtergrond: Weinig is bekend over de invloed van lichte verstandelijke beperking (lvb) of posttraumatische stressstoornis (ptss) op behandelresultaten van patiënten met ernstige psychiatrische aandoeningen (epa). Doel: Onderzoeken of resultaten op screeningslijsten voor lvb en ptss geassocieerd zijn met verminderd mentaal en sociaal functioneren van patiënten met epa. Methode: De Screener voor intelligentie en licht verstandelijke beperking (scil) werd gebruikt om lvb op te sporen, de Trauma Screening Questionnaire (tsq) om ptss te detecteren. Het verband tussen deze screeners met somscores op de Health of the Nation Outcome Scales (honos) werd onderzocht bij 628 patiënten bij ggz Oost Brabant. Resultaten: Van 628 patiënten werd een of meer honos-metingen verkregen. Bij 352 (56%) patiënten werd een scil en bij 334 (53%) een tsq verkregen. De grootste verbetering op de honos was er bij patiënten die niet voldeden aan criteria voor lvb en ptss. De verbetering was minder bij patiënten met een ptss en bij patiënten met een iq tussen 70-85 geschat met de scil. De verbetering bleek niet significant bij patiënten met een iq onder 70 geschat met de scil. Conclusie: Standaardscreening op lvb en ptss is van belang om deze problematiek eerder te herkennen en passender behandelinterventies te kunnen aanbieden.10 p

Screening for intellectual disabilities and borderline intelligence in Dutch outpatients with severe mental illness

Item does not contain fulltextBackground: The reliability and validity of the Screener for Intelligence and Learning Disabilities (SCIL) are unknown in a population of outpatients with severe mental illness. The prevalence of mild or borderline intellectual disabilities (MBID); an umbrella term for people with borderline intellectual functioning (BIF) and mild intellectual disability (MID) in this population is also unknown. Methods: A total of 625 patients were screened with the SCIL, 201 of which also had IQ test results. Results: Cronbach’s alpha of the SCIL was 0.73. The AUC value for detecting MBID was 0.81, and also 0.81 for detecting MID, with percentages of correctly classified subjects (when using the advised cut-off scores) being 73% and 79%, respectively. The SCIL results suggested that 40% of the patients were suspected of MBID and 20% of MID. Conclusion: The SCIL seems to be an appropriate screening tool for MBID. It is important to screen for MBID because a substantial proportion of outpatients with severe mental illness appear to be functioning at this level. It is necessary to adapt treatment for these patients.7 p