Effects of two different exercise programs on chronic fatigue in lupus patients.

OBJECTIVES: Fatigue is a major complaint of patients with systemic lupus erythemasosus (SLE). While several studies have demonstrated the benefits of exercise, the effects of supervised training were never compared to those of home training. METHODS: Forty-five SLE patients suffering from fatigue, as defined by Krupp's fatigue severity scale (FSS) ≥ 3.7, were randomized in 3 groups: supervised training group (STG), home training group (HTG), and control group (CG). Primary outcome was the change in FSS at month 3. In parallel, we measured the physical working capacity measured at 75% of the predicted maximal heart rate (PWC75%/kg) and the modified Borg's scale to assess perception of exertion. RESULTS: Both STG and HTG, but not the CG, statistically improved their FSS at month 3. By contrast, the PWC75%/kg and the Borg's scale did not improve in none of the groups. Surprinsingly, compliance was similar and low (±50%) in both exercise groups. Moreover, less compliant patients improved their fatigue as much as more compliant patients. CONCLUSIONS: Patients included in the STG and the HTG similarly improved their fatigue, irrespectively of their level of compliance, raising the possibility that the beneficial effect on fatigue was not only exercise-related

Biased visuospatial perception in complex regional pain syndrome

Complex regional pain syndrome (CRPS) is a chronic pain condition associating sensory, motor, trophic and autonomic symptoms in one limb. Cognitive difficulties have also been reported, affecting the patients' ability to mentally represent, perceive and use their affected limb. However, the nature of these deficits is still a matter of debate. Recent studies suggest that cognitive deficits are limited to body-related information and body perception, while not extending to external space. Here we challenge that statement, by using temporal order judgment (TOJ) tasks with tactile (i.e. body) or visual (i.e. extra-body) stimuli in patients with upper-limb CRPS. TOJ tasks allow characterizing cognitive biases to the advantage of one of the two sides of space. While the tactile TOJ tasks did not show any significant results, significant cognitive biases were observed in the visual TOJ tasks, affecting mostly the perception of visual stimuli occurring in the immediate vicinity of the affected limb. Our results clearly demonstrate the presence of visuospatial deficits in CRPS, corroborating the cortical contribution to the CRPS pathophysiology, and supporting the utility of developing rehabilitation techniques modifying visuospatial abilities to treat chronic pain.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Does CRPS impair visuo-motor coordination in peripersonal space?

Complex Regional Pain Syndrome (CRPS) is not only characterized by sensory, motor and vegetative symptoms, but also by cognitive changes in terms of body perception and representation (Legrain et al., 2012). However, CRPS patients’ performance at standard neglect tests is inconsistent (Kolb et al., 2012) and so far, we cannot conclude that these cognitive changes extend to stimuli presented in the space outside the body (i.e. peripersonal). Therefore, we used a line bisection task in a virtual reality environment in order to test whether upper-limb patients present an impaired perception and exploration of the peripersonal space around the affected hand. We hypothesized that these impairments would also be mediated by the vision of the affected hand and the feeling of where this hand is located (proprioception). To test these hypotheses, CRPS participants were asked to move a robotic handle with their unaffected hand in order to bisect the middle of lines projected on different positions on a horizontal semi-reflective mirror screen. Throughout the different testing conditions, they were asked to perform the task either in the workspace corresponding to their affected or unaffected body side, to put their affected hand inside or outside the workspace and to perform the task either while seeing or not their hands. Results showed that CRPS patients had a general bisecting bias towards the left side of space. This bias was more important when lines were projected further from the starting point in the unaffected body side

Validation of the ABILHAND questionnaire as a measure of manual ability in patients with rheumatoid arthritis

OBJECTIVE: Hand and upper limb involvement is common in patients with rheumatoid arthritis (RA). However, its impact on manual activities of daily life has not been fully evaluated. A measure of manual ability was developed, through the Rasch measurement model, by adapting and validating the ABILHAND questionnaire, which measures the patient's perceived difficulty in performing everyday manual activities. METHODS: 112 patients with RA were evaluated. The following tests were performed: the ABILHAND questionnaire, the Health Assessment Questionnaire (HAQ), the Jamar grip and key pinch strength tests, the Box and Block dexterity test and the Purdue pegboard dexterity test. In total, 35 patients were reassessed to determine the test-retest reliability of the ABILHAND, and 6 patients were studied before and after therapy with tumour necrosis factor (TNF) blockers to address sensitivity to change. RESULTS: The Rasch refinement of the ABILHAND led to a selection of 27 items rated on a 3-point scale. The resulting ability scale was targeted to the ability of the patients. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. Grip and key pinch strength and manual and digital dexterity on both hands were significantly, though moderately, correlated with the ABILHAND measures. Manual ability was also significantly related to the number of affected hands, disease duration, tender and swollen joint counts on upper limbs, disease activity and the HAQ. Sensitivity to change was demonstrated in patients treated with TNF blockers, commensurate with their clinical improvement. CONCLUSION: The ABILHAND questionnaire is a clinically valid person-centred measure of manual ability that could be useful in longitudinal RA studies

Robot-assisted line bisection in patients with Complex Regional Pain Syndrome.

Complex Regional Pain Syndrome (CRPS) is characterized by pain, motor and inflammatory symptoms usually affecting one limb. Cognitive difficulties have been reported to affect patients' ability to represent, perceive and use their affected limb. It is debated whether these difficulties result from deficits in controlling goal-directed movements in space or from a learned strategy to protect the affected limb. In order to dissociate the two hypotheses, patients with upper-limb CRPS were asked to move with their unaffected hand towards visual targets projected at different positions on a horizontal semi-reflexive mirror. By means of a robotic handle placed below the screen, they were asked to move a cursor, to reach and cross lines at their estimated midpoint. In some of the stimulation series, the affected hand was placed below the mirror so that some lines appeared projected onto that hand. Vision of the hands and the robotic handle was preserved or prevented by opening or closing a shutter below the mirror. Lines were displayed on the mirror according to which part of the body was affected (ispi- vs. contralateral) and the actual position of the affected hand (inside vs. outside the workspace). Comparatively to control participants, CRPS patients generally biased their estimation by bisecting the lines towards their left side, irrelative of which part of the body was affected and the position of the affected hand, both in ipsi- and contralateral space, with only a few exceptions. Our results are in line with previous studies having described a visuospatial deficit in CRPS patients and discard the explanation of observed symptoms in terms of learned nonuse strategies, as only the unaffected hand was used to perform the task. It is suggested that CRPS patients can display difficulties to perform tasks requesting visuo-motor coordination, reflecting the complex cortical reorganization occurring in CRPS

Does CRPS Impair The Perception of Somatosensory and Non-somatosensory Stimuli?

Background: Complex regional pain syndrome (CRPS) is a chronic pain condition associating sensory, motor, trophic and autonomic symptoms in one limb. Cognitive difficulties have also been reported, affecting the patients’ ability to mentally represent, perceive and use their affected limb. However, the nature of these deficits is still a matter of debate. Recent studies suggested that cognitive deficits are limited to body-related information and body perception, while not extending to external space. Aims: Here we challenge that statement, by using temporal order judgment (TOJ) tasks with tactile (i.e. body) or visual (i.e. extra-body) stimuli in patients with upper-limb CRPS. Methods: TOJ tasks allow characterizing cognitive biases to the advantage of one of the two sides of space. Participants report which of two stimuli they perceive as presented first. In the tactile TOJ task, pairs of vibrotactile stimuli were presented, one stimulus applied to either hand. Patients performed the task with their arms either in a crossed or an uncrossed posture. In the visual TOJ task, pairs of visual stimuli were presented, one stimulus in either side of space, either close or far from the patients’ hands. Results: While the tactile TOJ task did not show any significant results, significant cognitive biases were observed in the visual TOJ task, affecting mostly the perception of visual stimuli occurring in the immediate vicinity of the affected limb. Conclusion & implications: Our results clearly demonstrate the presence of visuospatial deficits in CRPS, supporting the utility of developing rehabilitation techniques modifying visuospatial abilities to treat chronic pain

Does complex regional pain syndrome impair the perception of somatosensory and non-somatosensory stimuli?

Complex regional pain syndrome (CRPS) is a chronic pain condition associating sensory, motor, trophic and autonomic symptoms in one limb. Probably as a consequence of structural and functional changes at the cortical level, cognitive difficulties have also been reported, affecting the patients’ ability to mentally represent, perceive and use their affected limb. However, the nature of these deficits is still a matter of debate. Recent studies suggest that cognitive deficits are limited to body-related information and body perception, while not extending to external space. We challenged that statement, by using temporal order judgment (TOJ) tasks with tactile (i.e. body) or visual (i.e. extra-body) stimuli in patients with upper-limb CRPS. TOJ tasks allow characterizing cognitive biases to the advantage of one of the two sides of space. While the tactile TOJ tasks did not show any significant results, significant cognitive biases were observed in the visual TOJ tasks, affecting mostly the perception of visual stimuli occurring in the immediate vicinity of the affected limb. Our results clearly demonstrate the presence of visuospatial deficits in CRPS, corroborating the cortical contribution to the CRPS pathophysiology, and supporting the utility of developing rehabilitation techniques modifying visuospatial abilities to treat chronic pain

Does CRPS impair visuo-motor coordination in peripersonal space?

Complex Regional Pain Syndrome (CRPS) is an affection characterized by chronic pain, motor and vegetative symptoms, but also by cognitive symptoms affecting body perception and representation. In addition, neglect-like deficits were clinically described. However, CRPS patients’ performances at standard neglect tests are inconsistent and so far, we cannot conclude that these cognitive changes extend to stimuli presented in the space outside the body (i.e. peripersonal). Therefore, we used a line bisection task in a virtual reality environment in order to test whether upper-limb patients, in comparison to a matched control group, present an impaired perception and exploration of the peripersonal space around the affected hand. We hypothesized that these impairments would also be mediated by the vision of the affected hand and the feeling of where this hand is located (proprioception). To test these hypotheses, CRPS participants were asked to move a robotic handle with their unaffected hand in order to bisect the middle of lines projected on different positions on a horizontal semi-reflective mirror screen. Throughout the different testing conditions, they were asked to perform the task either in the workspace corresponding to their affected or unaffected body side, to put their affected hand inside or outside the workspace and to perform the task either while seeing or not their hands. Results showed that CRPS patients had a general bisecting bias towards the left side of space that were significantly bigger than deviations in the control participants, who only showed a tendency to bisect lines to the left. Our results are in line with previous studies stating a visuospatial deficit in the upper-limb CRPS population. General leftward biases are known as pseudoneglect, even in healthy population. We hypothesize that such an initially common visuospatial deviation could be exaggerated in CRPS patients due to a global attentional deficit