The contribution of participation in meaningful activities on mental health during the COVID-19 lockdown in the Spanish population / Contribución de la participación en actividades significativas sobre la salud mental en población española durante el confinamiento por COVID-19

Introduction: During the lockdown caused by COVID-19 in Spain, citizens had to stop performing activities in the usual way, which could have had an impact on mental health. The aim of this study was to determine the contribution of participating in meaningful activitieson mental health in the Spanish population during the COVID-19 lockdown. Method:A cross-sectional online survey was developed and administered, where mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), participation in meaningful activities (Engage-ment in Meaningful Activities Survey) and socio-demographic data were assessed. A hierarchical-linear-regression was used to identify key correla-tions. Results:The participants (N= 311) reported low mental health (M= 16.12/36) and a lower level of resilience (M = 25.48). The results of the re-gression revealed that 32.6% of the variance of the GHQ was significantly explained by the living space, including an outdoor space, resilience and participation in meaningful activities. The loss of meaningful activities was significantly related to mental health, with a significant contribution when controlling for the other variables (β = -.12). Conclusion:Although experi-mental studies are needed to determine causality, this study highlights the relationship between participation in meaningful activities and mental health during the lockdown.(AU)

Introduction: During the lockdown caused by COVID-19 in Spain, citizens had to stop performing activities in the usual way, which could have had an impact on mental health. The aim of this study was to determine the contribution of participating in meaningful activities on mental health in the Spanish population during the COVID-19 lockdown. Method: A cross-sectional online survey was developed and administered, where mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), participation in meaningful activities (Engagement in Meaningful Activities Survey) and socio-demographic data were assessed. A hierarchical-linear-regression was used to identify key correlations. Results: The participants (N = 311) reported low mental health (M = 16.12/36) and a lower level of resilience (M = 25.48). The results of the regression revealed that 32.6% of the variance of the GHQ was significantly explained by the living space, including an outdoor space, resilience and participation in meaningful activities. The loss of meaningful activities was significantly related to mental health, with a significant contribution when controlling for the other variables (β = -.12). Conclusion: Although experimental studies are needed to determine causality, this study highlights the relationship between participation in meaningful activities and mental health during the lockdown.(AU)

Early and Intensive Motor Training for people with spinal cord injuries (the SCI-MT Trial): protocol of the process evaluation.

INTRODUCTION: People with spinal cord injury receive physical rehabilitation to promote neurological recovery. Physical rehabilitation commences as soon as possible when a person is medically stable. One key component of physical rehabilitation is motor training. There is initial evidence to suggest that motor training can enhance neurological recovery if it is provided soon after injury and in a high dosage. The Early and Intensive Motor Training Trial is a pragmatic randomised controlled trial to determine whether 10 weeks of intensive motor training enhances neurological recovery for people with spinal cord injury. This pragmatic randomised controlled trial will recruit 220 participants from 15 spinal injury units in Australia, Scotland, Italy, Norway, England, Belgium and the Netherlands. This protocol paper describes the process evaluation that will run alongside the Early and Intensive Motor Training Trial. This process evaluation will help to explain the trial results and explore the potential facilitators and barriers to the possible future rollout of the trial intervention. METHODS AND ANALYSIS: The UK Medical Research Council process evaluation framework and the Implementation Research Logic Model will be used to explain the trial outcomes and inform future implementation. Key components of the context, implementation and mechanism of impact, as well as the essential elements of the intervention and outcomes, will be identified and analysed. Qualitative and quantitative data will be collected and triangulated with the results of the Early and Intensive Motor Training Trial to strengthen the findings of this process evaluation. ETHICS AND DISSEMINATION: Ethical approval for the Early and Intensive Motor Training Trial and process evaluation has been obtained from the Human Research Ethics Committee at the Northern Sydney Local Health District (New South Wales) in Australia (project identifier: 2020/ETH02540). All participants are required to provide written consent after being informed about the trial and the process evaluation. The results of this process evaluation will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trial Registry (ACTRN12621000091808); Universal Trial Number (U1111-1264-1689).

Early and intensive motor training to enhance neurological recovery in people with spinal cord injury: trial protocol.

STUDY DESIGN: Protocol for a multi-centre randomised controlled trial (the SCI-MT trial). OBJECTIVES: To determine whether 10 weeks of intensive motor training enhances neurological recovery in people with recent spinal cord injury (SCI). SETTING: Fifteen spinal injury units in Australia, Scotland, England, Italy, Netherlands, Norway, and Belgium. METHODS: A pragmatic randomised controlled trial will be undertaken. Two hundred and twenty people with recent SCI (onset in the preceding 10 weeks, American Spinal Injuries Association Impairment Scale (AIS) A lesion with motor function more than three levels below the motor level on one or both sides, or an AIS C or D lesion) will be randomised to receive either usual care plus intensive motor training (12 h of motor training per week for 10 weeks) or usual care alone. The primary outcome is neurological recovery at 10 weeks, measured with the Total Motor Score from the International Standards for Neurological Classification of SCI. Secondary outcomes include global measures of motor function, ability to walk, quality of life, participants' perceptions about ability to perform self-selected goals, length of hospital stay and participants' impressions of therapeutic benefit at 10 weeks and 6 months. A cost-effectiveness study and process evaluation will be run alongside the trial. The first participant was randomised in June 2021 and the trial is due for completion in 2025. CONCLUSIONS: The findings of the SCI-MT Trial will guide recommendations about the type and dose of inpatient therapy that optimises neurological recovery in people with SCI. TRIAL REGISTRATION: ACTRN12621000091808 (1.2.2021).

The underpinning of meaningful activities by brain correlates: a systematic review.

Introduction: Engaging in meaningful activities contributes to health and wellbeing. Research identifies meaningfulness by analysing retrospective and subjective data such as personal experiences in activities. Objectively measuring meaningful activities by registering the brain (fNIRS, EEG, PET, fMRI) remains poorly investigated. Methods: A systematic review using PubMed, Web of Science, CINAHL, and Cochrane Library. Findings: Thirty-one studies investigating the correlations between daily activities in adults, their degree of meaningfulness for the participant, and the brain areas involved, were identified. The activities could be classified according to the degree of meaningfulness, using the attributes of meaningfulness described in the literature. Eleven study activities contained all attributes, which means that these can be assumed to be meaningful for the participant. Brain areas involved in these activities were generally related to emotional and affective processing, motivation, and reward. Conclusion: Although it is demonstrated that neural correlates of meaningful activities can be measured objectively by neurophysiological registration techniques, "meaning" as such has not yet been investigated explicitly. Further neurophysiological research for objective monitoring of meaningful activities is recommended.

Biomechanical differences between self-paced and fixed-speed treadmill walking in persons after stroke.

BACKGROUND: Using self-paced treadmills for gait analysis requires less space compared to overground gait labs while a more natural walking pattern could be preserved compared to fixed-speed treadmill walking. Although self-paced treadmills have been used in stroke related intervention studies, studies comparing self-paced to fixed-speed treadmill walking in this population are scarce. METHODS: Twenty-five persons after stroke (10 males/15 females; 53 ± 12.05 years; 40.72 ± 42.94 months post stroke) walked on a treadmill in a virtual environment (GRAIL, Motek) in two conditions (self-paced and fixed-speed). After familiarization, all participants completed two trials (3 min) at comfortable walking velocity in randomized order. A paired-sample t-test or Wilcoxon Signed Rank test was used to calculate differences between both conditions for spatiotemporal parameters. Statistical Parametric mapping was conducted using the t-tests (SPM(t)), to statistically compare the kinematic and kinetic curves. RESULTS: The self-selected walking velocity on the treadmill was higher in the self-paced condition compared to the fixed-speed condition (p < 0.001). However, most variability and symmetry measures were similar in both conditions. Only the standard deviation of the step length at the paretic side was significant higher (p = 0.007) and step length symmetry was significantly better (p = 0.032) in the self-paced condition. Detected kinematic and kinetic differences were small (< 3°, < 0.1 Nm/kg) and stride to stride variability was comparable in both conditions. CONCLUSION: Based on the results of the current study, self-paced walking can be used as an equivalent to fixed-speed treadmill walking in persons after stroke. Accordingly, this justifies the use of this more functional mode in clinical gait assessment and rehabilitation trials.

Passive mobilisation of the shoulder in subacute stroke patients with persistent arm paresis: A randomised multiple treatment trial.

Background: Performing a careful but effective mobilisation of the hemiplegic shoulder is essential for optimal muscle activation and to preserve the passive range of motion (PROM) needed to perform functional tasks. Studies concerning passive mobilisation of the post-stroke shoulder are scarce. Objectives: A randomised multiple treatment trial was conducted to compare the effects of different mobilisation techniques on shoulder PROM. Method: Eleven participants with upper limb paresis in the subacute phase after stroke underwent three different mobilisation techniques (3 × 4 weeks):(1) combined soft-tissue mobilisation in the scapular plane, (2) scapular mobilisation without glenohumeral movement, (3) angular glenohumeral mobilisation in the frontal plane. Depending on the randomisation, the order of the techniques changed. Differences in outcome measures (PROM shoulder, shoulder pain, spasticity of shoulder muscles and biceps, trunk impairment scale and Fugl-Meyer assessment) were calculated between the beginning and end of each intervention period. Results: Using combined soft-tissue mobilisation in patients in the subacute phase after stroke with persistent arm paresis resulted in an increased passive shoulder external rotation (p = 0.006). An average increase of 6.82° (± 9.20°) for shoulder external rotation was noted, whilst after the two other techniques, passive external rotation decreased (scapular mobilisation -7.27° ± 10.81°; angular mobilisation -5.45° ± 11.72°). Conclusion: These preliminary findings, suggest that combined soft-tissue mobilisation technique might improve the PROM for external shoulder rotation in subacute stroke patients with persistent arm paresis. Clinical implications: Performing a specific mobilisation technique might have positive effects on shoulder PROM. Research including larger sample sizes is necessary to confirm these findings and define the underlying mechanisms.

Correlation of Spinal Cord Injury With Development Of Spinal Arachnoid Cysts: Two Case Reports.

BACKGROUND: Spinal arachnoid cysts are rare entities, which are composed of a duplication in the arachnoid membrane and resultant cerebrospinal fluid collection, which may present with a progressive myelopathy. The most common symptoms caused by spinal cord compression are paraesthesia, neuropathic pain, paresis and gait ataxia. CLINICAL CASES: We report here 2 cases from different perspectives of a spinal arachnoid cysts in spinal cord injury. The first case was the occurrence of a spinal cord injury due to compression of a spinal arachnoid cysts causing myelopathy. The second case is a patient who had a traumatic paraplegia for which stabilizing surgery was required and who subsequently developed a spinal arachnoid cysts with neuropathic pain. Both cases required surgery with immediate improvement. However, after a few months both patients needed a revision due to recurrence. CONCLUSION: Spinal arachnoid cysts may present with a heterogeneous clinical picture. If cysts are not clinically apparent, a conservative treatment with careful observation can be a justifiable option. In patients with progressive symptoms, surgery is the gold standard of care. However, the literature describes the need for revision surgery in only 12.5% of cases. Regular follow-up is necessary because both of the patients reported here needed revision surgery.

Occurrence of speech-language disorders in the acute phase following pediatric acquired brain injury: results from the Ghent University Hospital.

AIMS: This study investigated the occurrence of speech-language disorders during the acute phase of recovery in children with acquired brain injury (ABI) with an age between 0 and 16 years. METHODS: A retrospective chart analysis was performed including 228 children (n = 118 boys, n = 110 girls) who consecutively presented with ABI over a 10-year period (2006-2016) at the children's rehabilitation center at Ghent University Hospital. Descriptive statistical analyses were applied. RESULTS: 71.1% (162/228) of the children who were admitted to the rehabilitation center presented with a speech-language disorder. Within this sample (n = 162), results demonstrated the occurrence of acquired disorders in language (48.9%), speech (35.1%), learning (33.3%), swallowing (21.5%), and early communicative functions (17.4%). The proportion of children presenting with disturbances in early communicative functions differed by ABI cause. More than half (10/18, 58.8%) of the children who presented with ABI following inflammatory processes demonstrated disorders in early communicative functions. CONCLUSIONS: Especially in young children who present with inflammatory processes as the ABI cause, speech-language pathologists (SLPs) must be aware of disorders in early speech-language development. The present findings allow the SLP to appropriately plan research, education, and clinical management.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults.

BACKGROUND: The spread of COVID-19 has affected people's daily lives, and the lockdown may have led to a disruption of daily activities and a decrease of people's mental health. AIM: To identify correlates of adults' mental health during the COVID-19 lockdown in Belgium and to assess the role of meaningful activities in particular. METHODS: A cross-sectional web survey for assessing mental health (General Health Questionnaire), resilience (Connor-Davidson Resilience Scale), meaning in activities (Engagement in Meaningful Activities Survey), and demographics was conducted during the first Belgian lockdown between April 24 and May 4, 2020. The lockdown consisted of closing schools, non-essential shops, and recreational settings, employees worked from home or were technically unemployed, and it was forbidden to undertake social activities. Every adult who had access to the internet and lived in Belgium could participate in the survey; respondents were recruited online through social media and e-mails. Hierarchical linear regression was used to identify key correlates. RESULTS: Participants (N = 1781) reported low mental health (M = 14.85/36). In total, 42.4% of the variance in mental health could be explained by variables such as gender, having children, living space, marital status, health condition, and resilience (ß = -.33). Loss of meaningful activities was strongly related to mental health (ß = -.36) and explained 9% incremental variance (R2 change = .092, p < .001) above control variables. CONCLUSIONS: The extent of performing meaningful activities during the COVID-19 lockdown in Belgium was positively related to adults' mental health. Insights from this study can be taken into account during future lockdown measures in case of pandemics.

Evidence of rehabilitation therapy in task-specific focal dystonia: a systematic review.

INTRODUCTION: Task-specific dystonias are primary focal dystonias characterized by excessive muscle contractions producing abnormal postures during selective motor activities that often involve highly skilled, repetitive movements. Based on the idea of excessive motor excitability and aberrant sensorimotor integration in the pathophysiology of task-specific dystonia, sensorimotor retraining may hold promise. The purpose of this systematic review was to investigate the available evidence about the role of rehabilitation therapy as a treatment for task-specific dystonia. EVIDENCE ACQUISITION: A systematic review was performed of studies identified through Pubmed and Embase in a structured search strategy by independent author screening. The JBI (Joanna Briggs Institute) Critical Appraisal Checklist and RoB 2 were used to evaluate their methodological quality. EVIDENCE SYNTHESIS: Twenty-one studies were included for qualitative synthesis. Most of the reports are small single group pre-/post-test study designs with a variability in the type of task-specific dystonia and the type of evaluated outcome measures. Rehabilitation interventions were grouped into six categories based upon the underlying theoretical basis of different approaches: 1) movement practice; 2) training with constraint; 3) sensory reorganization; 4) biofeedback training; 5) neuromodulation with training; and 6) compensatory strategies. CONCLUSIONS: Although it appears that a number of task-specific dystonia patients may improve with rehabilitation therapy, no definitive conclusions can be drawn. More research in this field is needed, using standardized approaches and clearly defined outcome measures in larger cohorts of task-specific dystonia patients that are clinically and diagnostically well characterized.

Dysarthria following acute ischemic stroke: Prospective evaluation of characteristics, type and severity.

BACKGROUND: Dysarthria is a common symptom following stroke and represents an important cause of functional impairment in stroke patients. A better characterization of dysarthria could facilitate differential diagnosis and optimize healthcare service distribution. AIM: To determine the speech characteristics, dysarthria type and severity in the acute phase following ischemic stroke in a comprehensive stroke centre. METHODS & PROCEDURES: First-ever ischemic stroke patients consecutively admitted to the Stroke Unit of Ghent University Hospital were included in this prospective clinical study between March 2018 and October 2019. All participants admitted to the Stroke Unit were screened for dysarthria by a speech-language pathologist within 72 h after admission. When dysarthria was identified, speech characteristics were evaluated via auditory-perceptual assessment and objective measurement of acoustic parameters. Dysarthria type was determined based on the Mayo Classification System. Severity of impairment was scored at function and activity level using the Radboud Dysarthria Assessment and the evaluation of speech intelligibility at sentence level using the Dutch Speech Intelligibility Assessment. In addition, dysarthria recovery was separately evaluated in all participants using the National Institutes of Health Stroke Scale (NIHSS) at hospital admission, day 3 ± 2 and day 7. OUTCOMES & RESULTS: A total of 67 out of 151 participants (44%; mean age = 69 years; SD = 13; 28 females) were diagnosed with dysarthria in the acute phase following stroke. Standardized assessments were possible in 72% (48/67) of participants. Imprecise articulation of consonants, harsh voice quality and audible inspiration were the most frequent observed speech characteristics. The acoustic parameters maximum phonation time and maximum loudness deviated most from normative values. Unilateral upper motor neuron (UUMN) was the main dysarthria type present in 52% (25/48) of participants. A total of 58% (28/48) and 71% (34/48) of participants had no/minimal/mild difficulties at the functional and activity levels, respectively. Speech intelligibility was mildly impaired (median = 91%; IQR = 73-97). According to the NIHSS, sub-item speech score at hospital admission, 46% (70/151) of participants had dysarthria, of which half recovered completely from their dysarthria within 1 week after stroke symptom onset. CONCLUSIONS & IMPLICATIONS: UUMN was the dominant dysarthria type, and the majority of participants had a mild dysarthria. Half the participants showed complete recovery within 1 week following symptom onset. The observed speech characteristics mainly reflect impairments in the subsystem's articulation, phonation and respiration. Objective measurements of acoustic parameters corroborate these findings. Future research should focus on longitudinal assessment to investigate recovery of symptoms and the long-term impact of dysarthria on social participation. What this paper adds What is already known on the subject There are few data concerning the presentation of dysarthria following acute ischemic stroke. Moreover, previous research did not include objective measurements of speech characteristics and dysarthria severity. There was a need to determine prospectively speech characteristics, dysarthria type and severity in a stroke population using standardized assessments. What this paper adds to existing knowledge The findings of this study show a high prevalence of dysarthria following acute ischemic stroke. This study confirms previous findings that the speech of dysarthric patients following acute ischemic stroke was mostly characterized by imprecise articulation of consonants, a harsh voice quality and audible inspiration. The results of the objective measures confirm these findings. We added evidence that UUMN is the most prevalent dysarthria type in a stroke population, and that the majority of participants had mild dysarthria. A high rate of dysarthria recovery was seen in the first week following symptom onset. What are the potential or actual clinical implications of this work? The findings of this study contribute to the limited research performed regarding post-stroke dysarthria. The results can help optimize the distribution of healthcare resources. The majority of participants have a mild dysarthria, making the identification of the specific needs of this group an important area of concern. The evaluation of impaired speech subsystems and characteristics, especially supplemented with objective measures of acoustic parameters, and the classification of the type and severity of dysarthria can be helpful to monitor early progress in the acute phase post-stroke.

The feasibility, usability and acceptability of a tablet-based aphasia therapy in the acute phase following stroke.

QUESTION: Independent practice via an application with a language exercise program for aphasia, as an add-on to conventional care can be a good solution to intensify aphasia therapy. The aim of this prospective trial was to investigate the feasibility, usability and acceptability of the newly-developed aphasia exercise program in the 'Speech Therapy App (STAPP)' in the acute phase post-stroke. METHODS: All eligible people with aphasia following stroke (<2 weeks post-stroke) admitted to the Stroke Unit of Ghent University Hospital were recruited in this prospective clinical trial between September 2018 and December 2019. After linguistic assessments and two short training sessions, participants were asked to practice independently with 'STAPP' for at least 30 min/day during hospitalization. Exercises were individually tailored and adjusted if necessary. Outcome was measured by recruitment, adherence and retention rates, usability questionnaires and a visual analogue scale for satisfaction. RESULTS: Twenty-five (mean age 65 years (SD = 17), 14 females) of 31 eligible people with aphasia were enrolled in this trial (recruitment rate = 81 %). All participants but one (23/24) practiced with the language app until the end of hospitalization (retention rate = 96 %). Ten participants practiced at least 30 min/day (adherence rate = 42 %). Participants reported they learned to work quickly with the app (92 %; agreed/totally agreed), the app was easy to use (88 %), they could work independently (79 %), practiced their language (67 %) and wanted to continue working with the app at home (79 %). Acceptability was high (median satisfaction rate 91 %; IQR = 75-100). CONCLUSION: The aphasia exercise program in 'STAPP' is feasible to use as an additional rehabilitation tool along with standard of care in the acute phase post-stroke. Further research is needed to assess the efficacy. CLINICAL TRIAL REGISTRATION-URL: https://clinicaltrials.gov/ct2/show/NCT03679637.

The use of shoulder orthoses post-stroke: effects on balance and gait. A systematic review.

INTRODUCTION: Since there is no clear conclusion concerning the use of arm slings in the prevention or reduction of shoulder subluxation or shoulder pain in stroke patients, it seems important to explore other potentially beneficial effects. Earlier research already suggested that the upper limb might play a considerable role in efficient balance and gait in stroke patients. Therefore, the aim of this systematic review was to investigate the effects of wearing an arm sling on balance and/or gait in stroke patients. This information could support the decision-making concerning the use of shoulder orthoses after stroke. EVIDENCE ACQUISITION: Four electronic databases (Pubmed/MEDLINE, Embase, Web of Science and CINAHL/EBSCO) were searched until April 8th, 2019. Search alerts were set and followed until January 2020 to assure no new eligible articles were published. Reference lists of included studies were hand searched. All studies examining the effect of wearing an upper limb orthosis on balance and gait in stroke patients were included. Two reviewers independently identified eligible studies and extracted data. The methodological quality of included trials was assessed using the QualSyst assessment tool for quantitative studies. Prospero registration number: CRD42019130282. EVIDENCE SYNTHESIS: Ten studies, examining 283 stroke patients with moderate to low level of upper limb impairment, were included in the quantitative synthesis of the results. The pooled mean time since stroke was 21.88±9.03 months. Only minor effects on balance or gait related outcome parameters could be detected in favor of wearing an arm sling. However, these changes did not exceed the minimal clinical important difference (MCID). CONCLUSIONS: So far no strong evidence is available regarding a potential benefit of wearing an arm sling on balance and gait for stroke patients. However, further research with longer intervention periods, can be useful to determine if stroke patients in the early phases after stroke or with persistent UL paresis might possibly benefit from wearing an arm sling.

Cross-Cultural Adaptation and Psychometric Evaluation of the Dutch Version of the Work Rehabilitation Questionnaire (WORQ-VL).

Purpose The Work Rehabilitation Questionnaire (WORQ) was developed to evaluate work functioning in vocational rehabilitation, but was not yet available in Dutch. The goal of this study is twofold: a description of the cross-cultural adaptation process (part 1) of the WORQ to be used in Flanders (The Dutch speaking part of Belgium, WORQ-VL) and a presentation of the first psychometric testing of the WORQ-VL (part 2). Methods For part 1, the guidelines for cross-cultural adaptation of self-report measures by Beaton et al. were used to structure the cross-cultural adaptation. For part 2, a cross-sectional study was conducted in patients with musculoskeletal disorders [sample A: hand and wrist rehabilitation (n = 21) and sample B: fibromyalgia patients (n = 93)] who completed the WORQ-VL. Internal consistency and factor structure were examined in the total sample, whereas convergent and discriminant validity of the WORQ-VL were researched in sample A. Results First results on the convergent validity and discriminant validity (small sample size) and internal consistency of the WORQ-VL are promising. The exploratory factor analysis revealed seven factors which were labeled as 'cognition', 'physical', 'mood', 'activities of daily living', 'sensory', 'emotional' and 'social'. The best evidence was found for the 'physical' subscale of the WORQ-VL: strong correlations were found with the 'physical functioning' and 'role limitations-physical' subscales of the Short-Form Health Survey, respectively r = - .84 and r = - .59, p < .01. As expected, predominantly weak correlations were found with hand grip strength, kinesiophobia, hand-related aesthetics and satisfaction (ranging between r = - .38 and r = .34, p > .05). Conclusions The WORQ-VL is a user-friendly and valuable ICF-based self-report questionnaire to evaluate work functioning. Future studies are highly needed to examine the value of the WORQ within different patient populations and settings in order to examine further the added value of this self-report measure.

The Adult Assisting Hand Assessment Stroke: Psychometric Properties of an Observation-Based Bimanual Upper Limb Performance Measurement.

OBJECTIVE: To investigate interrater and intrarater reliability, measurement error, and convergent and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke). DESIGN: Cross-sectional observational study. SETTING: A total of 7 stroke rehabilitation centers. PARTICIPANTS: Stroke survivors (reliability sample: n=30; validity sample: N=118) were included (median age 67y; interquartile range [IQR], 59-76); median time poststroke 81 days (IQR 57-117). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Ad-AHA Stroke, Action Research Arm Test (ARAT), upper extremity Fugl-Meyer Assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults poststroke. Reliability of Ad-AHA Stroke was examined using intraclass correlation coefficients (ICCs), Bland-Altman plots, and weighted kappa statistics for reliability on item level. SEM was calculated based on Ad-AHA units. Convergent validity was assessed by calculating Spearman rank correlation coefficients between Ad-AHA Stroke and ARA test and UE-FMA. Comparison of Ad-AHA Stroke scores between subgroups of patients according to hand dominance, neglect, and age evaluated discriminative validity. RESULTS: Intrarater and interrater agreement showed an ICC of 0.99 (95% confidence interval, 0.99-0.99), an SEM of 2.15 and 1.64 out of 100, respectively, and weighted kappa for item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was strong (ρ=0.9). Patients with neglect had significantly lower Ad-AHA scores compared to patients without neglect (P=.004). CONCLUSIONS: The Ad-AHA Stroke captures actual bimanual performance. Therefore, it provides an additional aspect of upper limb assessment with good to excellent reliability and low SEM for patients with subacute stroke. High convergent validity with the ARA test and UE-FMA and discriminative validity were supported.

Rehabilitation of visuospatial neglect by prism adaptation: effects of a mild treatment regime. A randomised controlled trial.

Closely examining the effects, optimal regime and time window of prism adaptation (PA) promotes guidelines for effective rehabilitation practice. The effects of short-term repetitive PA on spatial neglect manifestations were evaluated in patients with heterogeneous post-stroke delays, using a digital Visuospatial Neglect Test Battery. Subsequently, potential differences in PA effects between acute, subacute or chronic neglect were explored. A multicentre randomised controlled trial was conducted in 43 right-hemisphere neglect patients. They were treated with a mild PA regime: seven sessions of experimental or placebo prism training over 7-12 days. The outcome measures were diverse neglect variables related to peripersonal navigation, visual extinction, visuospatial memory, bisection, cancellation, drawing and visual search. The treatment effects were assessed after a short and a long time interval. Two to 24 hours after PA, conventional effects were found for drawing and centred bisection, and novel effects for peripersonal visuospatial navigation, visual extinction, and non-motor memory (with caution). No effects were found for visual search times and cancellation. The assessments after three months were still indicative of PA benefits for navigational, drawing and memory functions. PA did not prove to be more effective in acute, subacute or chronic patients. The extension of effects is theoretically framed within the debate about the levels of cognitive processing that are impacted by PA. Clinical suggestions are formulated regarding PA implementation in neglect treatment.

Anti-NMDA receptor encephalitis: still unknown and underdiagnosed by physicians and especially by psychiatrists?

Anti-NMDA receptor encephalitis is an autoimmune disorder confirmed by the presence of antibodies against the NMDA-receptor in serum or CSF. This case report describes a young woman with anti-NMDA receptor encephalitis, who presented with prominent psychiatric symptoms. There was a crucial delay in diagnosis and necessary treatment due to the fact that the clinical presentation was diagnosed and treated as a first psychotic episode. Physicians and especially psychiatrists, should consider the possibility of an autoimmune encephalitis in their differential diagnosis in every new onset psychotic episode with rapid progression, the presence of pathognomonic orofacial dyskinesia, the lack of psychiatric history, and the non-responding to psychopharmacological treatment. Early diagnosis and treatment is essential for recovery and may improve the prognosis.

A randomized controlled trial on the immediate and long-term effects of arm slings on shoulder subluxation in stroke patients.

BACKGROUND: Arm slings are often used in clinical practice to support the hemiplegic arm aiming to prevent or treat glenohumeral subluxation. Evidence supporting the corrective effect of slings on subluxation is scarce and long-term studies are lacking. AIM: The aim of this study was to determine both the immediate and long-term effect on acromiohumeral distance using the Actimove® sling and Shoulderlift and to determine the effect of slings on pain and passive range of motion of the shoulder in stroke patients with glenohumeral subluxation. DESIGN: Randomized control trial. SETTING: Hospital inpatients. POPULATION: Stroke patients. METHODS: Twenty-eight stroke patients, with severe upper limb impairments, were randomly allocated to 3 groups (Actimove, Shoulderlift, No sling). Patients wore their supportive device for 6 weeks and no sling in the control group. Immediate and postinterventional effect on acromiohumeral distance was measured using sonography. Pain (VAS), ROM (goniometry), spasticity (Modified Ashworth Scale), Fugl-Meyer Assessment and trunk stability (TIS) were also assessed before and after the intervention. RESULTS: The level of immediate correction of both slings was different at baseline and after 6 weeks (0 weeks: Shoulderlift 63%, Actimove 36%; 6 weeks: Shoulderlift 28%, Actimove 24%). Comparing the level of subluxation over time shows a distinct decrease in subluxation but only for the control group (-37.59% or 3.30 mm). Subluxation remained the same in the Actimove group (-2.77% or 0.27 mm) but increased in the Shoulderlift group (+12.44% or 1.03 mm). After 6 weeks, the Actimove group reported more pain at rest (P=0.036). ROM for abduction and external rotation decreased in 2 groups and remained un-altered in the Shoulderlift group. CONCLUSIONS: Results of immediate correction varied. Subluxation seemed to reduce in patients that did not wear a sling. CLINICAL REHABILITATION IMPACT: The (assumed) presence of subluxation may not benefit from wearing an arm sling which may itself inhibit active correction. If a sling is indicated the Shoulderlift may be preferable to the Actimove sling.

Damage to Fronto-Parietal Networks Impairs Motor Imagery Ability after Stroke: A Voxel-Based Lesion Symptom Mapping Study.

BACKGROUND: Mental practice with motor imagery has been shown to promote motor skill acquisition in healthy subjects and patients. Although lesions of the common motor imagery and motor execution neural network are expected to impair motor imagery ability, functional equivalence appears to be at least partially preserved in stroke patients. AIM: To identify brain regions that are mandatory for preserved motor imagery ability after stroke. METHOD: Thirty-seven patients with hemiplegia after a first time stroke participated. Motor imagery ability was measured using a Motor Imagery questionnaire and temporal congruence test. A voxelwise lesion symptom mapping approach was used to identify neural correlates of motor imagery in this cohort within the first year post-stroke. RESULTS: Poor motor imagery vividness was associated with lesions in the left putamen, left ventral premotor cortex and long association fibers linking parieto-occipital regions with the dorsolateral premotor and prefrontal areas. Poor temporal congruence was otherwise linked to lesions in the more rostrally located white matter of the superior corona radiata. CONCLUSION: This voxel-based lesion symptom mapping study confirms the association between white matter tract lesions and impaired motor imagery ability, thus emphasizing the importance of an intact fronto-parietal network for motor imagery. Our results further highlight the crucial role of the basal ganglia and premotor cortex when performing motor imagery tasks.