Inactive lifestyle in adults with bilateral spastic cerebral palsy

Objective: To quantify the level of everyday physical activity in adults with bilateral spastic cerebral palsy, and to study associations with personal and cerebral palsy-related characteristics. Participants and methods: Fifty-six adults with bilateral spastic cerebral palsy (mean age 36.4 (standard deviation (SD) 5.8) years, 62% male) participated in the study. Approximately 75% had high gross motor functioning. Level of everyday physical activity was measured with an accelerometry-based Activity Monitor and was characterized by: (i) duration of dynamic activities (composite measure, percentage of 24 h); (ii) intensity of activity (motility, in gravitational acceleration (g)); and (iii) number of periods of continuous dynamic activity. Outcomes in adults with cerebral palsy were compared with those for able-bodied age-mates. Results: Duration of dynamic activities was 8.1 (SD 3.7) % (116 min per day), and intensity of activity was 0.020 (SD 0.007) g; both outcomes were significantly lower compared with able-bodied age-mates. Of adults with cerebral palsy, 39% had at least one period of continuous dynamic activities lasting longer than 10 min per day. Gross motor functioning was significantly associated with level of everyday physical activity (Rs -0.34 to -0.48; p≤0.01). Conclusion: Adults with bilateral spastic cerebral palsy, especially those with low-level gross motor functioning, are at risk for an inactive lifestyle

Determination of pathological clonus characteristics using a haptic ankle manipulator

Clonus is a self sustained oscillatory movement of the extremities often seen after lesions of the central nervous system. There is still controversy about the origin of clonus whether it is i) an autonomous pacemaker-like oscillator, ii) a reflexive mediated feedback property or iii) a combination of both. With the use of a haptic robot we were able to initiate clonus in patients (n=7). We would conclude the underlying mechanism to be autonomous when the frequency of movement would not change with additional external damping and inertia. Results however showed distinct changes in frequency of movement, varying the peripheral conditions. Furthermore, when the clonus was suddenly stopped by a controlled increase of a huge external damper, clear bursting was observed in the triceps EMG while there was no rotation of the ankle. In conclusion, i) clonus is initiated by spinal reflexes (probably Ia or Ib afferents), ii) also during clonus the same spinal reflexes are likely to contribute to the maintenance of ankle rotation and iii) the after bursting directs to self sustained firing of neural circuitry. These conclusions implicate the existence of a reflexive controlled oscillator. Future research will be performed using detailed model simulations to test different gains between reflexive feedback and neural oscillations, e.g. from the alpha-motorneurons

Inactive lifestyle in adults with bilateral spastic cerebral palsy

Objective:To quantify the level of everyday physical activity in adults with bilateral spastic cerebral palsy, and to study associations with personal and cerebral palsy-related characteristics. Participants and methods: Fifty-six adults with bilateral spastic cerebral palsy (mean age 36.4 (standard deviation (SD) 5.8) years, 62%, male) participated in the study. Approximately 75%, had high gross motor functioning. Level of everyday physical activity was measured with an accelerometry-based Activity Monitor and was characterized by: (i) duration of dynamic activities (composite measure, percentage of 24 h); (ii) intensity of activity (motility, in gravitational acceleration (g)), and (iii) number of periods of continuous dynamic activity. Outcomes in adults with cerebral palsy were compared with those for able-bodied age-mates. Results: Duration of dynamic activities was 8.1 (SD 3.7) %. (116 min per day), and intensity of activity was 0.020 (SD 0.007) g; both outcomes were significantly lower compared with able-bodied age-mates. Of adults with cerebral palsy, 39%. had at least one period of continuous dynamic activities lasting longer than 10 min per day. Gross motor functioning was significantly associated with level of everyday physical activity (Rs -0.34 to -0.48; p <= 0.01). Conclusion: Adults with bilateral spastic cerebral palsy, especially those with low-level gross motor functioning, a re at risk for an inactive lifestyle

A multidimensional cancer rehabilitation program for cancer survivors Effectiveness on health-related quality of life

OBJECTIVE: A multidimensional rehabilitation program for cancer survivors was developed to overcome cancer-related problems and to improve quality of life. The two purposes of the study were to describe the effectiveness of the program and to obtain information about patient preferences for multi or mono dimensional rehabilitation programs. METHODS: Subjects: cancer survivors with different diagnoses, and cancer-related physical and psychosocial problems. Intervention: a 15-week rehabilitation program including individual exercise, sports, psycho-education, and information. Group-wise randomization was implemented by assigning one half of the patients to the complete program while the other half were allowed to choose which program components they considered relevant. Measures: Health-Related Quality of Life [RAND-36 and Rotterdam Symptom Check List (RSCL)], exercise capacity (symptom limited bicycle ergometry), muscle force (hand-held dynamometry), and patient preferences. Measurements were performed before (T0) and after the rehabilitation program (T1), and at a 3-month follow-up (T2). RESULTS: After the rehabilitation program, cancer survivors (n=63) displayed statistically significant improvements on health-related quality of life with effect sizes (ES) varying from 0.38 to 0.99 (RAND-36) and from -0.34 to -0.57 (RSCL), most persistent at 3-month follow-up. Furthermore, statistically significant improvements in exercise capacity and muscle force of upper and lower extremities were displayed after rehabilitation. If offered a choice, 80% of the patients prior to start and 58% of the patients after completion of the program indicated that they preferred the entire multidimensional program. CONCLUSION: A multidimensional rehabilitation program has statistically and clinically relevant beneficial effects on health-related quality of life, exercise capacity, and muscle force in cancer patients with different diagnoses. Furthermore, if offered the choice, the majority of cancer survivors seem to prefer multidimensional programs to programs with only one component

Estimation of tissue stiffness, reflex activity, optimal muscle length and slack length in stroke patients using an electromyography driven antagonistic wrist model

Interpretation: Non-invasive quantitative analysis, including estimation of optimal muscle lengths, enables to identify neural and non-neural changes in chronic stroke patients. Monitoring these changes in time is important to understand the recovery process and to optimize treatment. (C) 2016 Elsevier Ltd. All rights reserved.Pathofysiological analysis of movement disorders in relation to functio

Characterizing the protocol for early modified constraint-induced movement therapy in the EXPLICIT-stroke trial

Item does not contain fulltextConstraint-induced movement therapy (CIMT) is a commonly used rehabilitation intervention to improve upper limb function after stroke. CIMT was originally developed for patients with a chronic upper limb paresis. Although there are indications that exercise interventions should start as early as possible after stroke, only a few randomized controlled trials have been published on either CIMT or modified forms of CIMT (mCIMT) during the acute phase after stroke. The implementation of (m)CIMT in published studies is very heterogeneous in terms of content, timing and intensity of therapy. Moreover, mCIMT studies often fail to provide a detailed description of the protocol applied. The purpose of the present paper is therefore to describe the essential elements of the mCIMT protocol as developed for the EXplaining PLastICITy after stroke (EXPLICIT-stroke) study. The EXPLICIT-stroke mCIMT protocol emphasizes restoring body functions, while preventing the development of compensatory movement strategies. More specifically, the intervention aims to improve active wrist -and finger extension, which is assumed to be a key factor for upper limb function. The intervention starts within 2 weeks after stroke onset. The protocol retains two of the three key elements of the original CIMT protocol, that is, repetitive training and the constraining element. Repetitive task training is applied for 1 hour per working day, and the patients wear a mitt for at least 3 hours per day for three consecutive weeks