Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity.

Background: After mild stroke persistent balance limitations may occur, creating a risk factor for fear of falling, falls, and reduced activity levels. To investigate whether individuals in the chronic phase after mild stroke show balance and gait limitations, elevated fall risk, reduced balance confidence, and physical activity levels compared to healthy controls.

Methods: An observational case-control study was performed.

Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria.

A syndrome of paroxysmal, episodic sympathetic hyperactivity after acquired brain injury has been recognized for almost 60 years. This project sought to simplify the confused nomenclature for the condition (>31 eponyms) and simplify the nine overlapping sets of diagnostic criteria. A consensus-developed questionnaire based on a systematic review of the literature was circulated to a widely representative, international expert group utilizing a Delphi approach.

Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases.

Purpose: Patients with a neuromuscular disease (NMD) can present with dysarthria and/or dysphagia. Literature regarding prevalence rates of dysarthria and dysphagia is scarce. The purpose of this study was to determine prevalence rates, severity and co-presence of dysarthria and dysphagia in adult patients with NMD.

Living with myotonic dystrophy; what can be learned from couples? A qualitative study.

Background: Myotonic dystrophy type 1 (MD1) is one of the most prevalent neuromuscular diseases, yet very little is known about how MD1 affects the lives of couples and how they themselves manage individually and together. To better match health care to their problems, concerns and needs, it is important to understand their perspective of living with this hereditary, systemic disease.

Methods: A qualitative study was carried out with a purposive sample of five middle-aged couples, including three men and two women with MD1 and their partners.

Implementation of multidisciplinary advice to allied health care professionals regarding the management of their patients with neuromuscular diseases.

Purpose: Patients with neuromuscular diseases (NMDs) do not always receive appropriate allied health care. This is partially because of the large heterogeneity among these conditions, some of which are quite rare. Individual allied health care professionals, therefore, have relatively little opportunity to develop relevant experience with these patients.

Postural instability in Charcot-Marie-Tooth type 1A patients is strongly associated with reduced somatosensation.

In order to determine the influence of somatosensory impairments, due to the loss of large myelinated fibres, on the postural stability of Charcot-Marie-Tooth 1A (CMT) patients, a cross-sectional balance assessment was done. Nine CMT patients were compared with eight patients with a distal type of Spinal Muscular Atrophy (SMA), and 11 healthy control subjects. The balance assessment consisted of four tasks: quiet barefoot standing on a stable versus compliant surface, with eyes opened or closed.

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Context: A wide range (15-56%) of prevalences of anterior pituitary insufficiency are reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data are available on emergency-department-based cohorts of TBI patients.

Fast responses to stepping on an unexpected surface height depend on intact large-diameter nerve fibers: a study on Charcot-Marie-Tooth type 1A disease.

The contribution of reflexes from the large myelinated afferents in the control of normal and perturbed gait in humans is a highly debated issue. One way to investigate this topic is by studying normal and perturbed gait in patients lacking large myelinated fibers in the distal limb (Charcot-Marie-Tooth [CMT] type 1A disease). Such patients should have delayed and decreased reflexes if the latter depend on these large myelinated fibers.

Is visuospatial hemineglect really a determinant of postural control following stroke? An acute-phase study.

Objective: The purpose of this study was to determine the independent contribution of visuospatial hemineglect to impaired postural control in the acute phase (<2 weeks) of stroke compared with other possible clinical and biological determinants.

Methods: This study was conducted in 4 hospitals in the mid-east region of the Netherlands. A total of 78 consecutive patients with a first-ever acute supratentorial stroke was included.

Hitting a support surface at unexpected height during walking induces loading transients.

The impact phase during walking is sometimes characterised by an early loading peak, termed 'transient', followed by a brief decline in the force profile, termed 'unloading phase'. It was hypothesized that transients occur more frequently when subjects are unaware of the landing condition, and that the unloading phase represents a yield of the leg. This was tested experimentally by introducing an unexpectedly lowered or level support surface height during walking.

Predicting hand motor recovery in severe stroke: the role of motor evoked potentials in relation to early clinical assessment.

Objective: The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke.

Methods: The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl-Meyer Motor Assessment (FMA) hand score>3 points.

Supratentorial ischemic stroke: more than an upper motor neuron disorder.

The primary goal of this study was to identify secondary functional changes in the peripheral motor units of the paretic upper extremity (UE) in patients with severe ischemic stroke and to determine how these changes develop during the first weeks after stroke. An inception cohort of 27 consecutive patients with an acute ischemic supratentorial stroke and an initial UE paralysis was compared with 10 healthy control subjects. The ulnar nerve was electrically stimulated proximal to the wrist and electromyographic recordings were obtained from the abductor digiti minimi muscle.

Exercise therapy and other types of physical therapy for patients with neuromuscular diseases: a systematic review.

Objective: To summarize and critically appraise the available evidence on exercise therapy and other types of physical therapies for patients with neuromuscular diseases (NMD).

Data Sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Medline, CINAHL, EMBASE (Rehabilitation and Physical Medicine), and reference lists of reviews and articles.

Study Selection: Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and other designs were included.

Development of a tool to guide referral of patients with neuromuscular disorders to allied health services. Part two.

Purpose: The Perceived Limitations and Needs Questionnaire (PLAN-Q) was developed to guide referral for a one-off consultation by occupational therapy (OT), physical therapy (PT), and speech therapy (ST) consultation, to provide a tailor-made advice on allied health interventions. This article reports on the testing of validity and reliability of the PLAN-Q.

Methods: In the validation study, 208 patients with a broad spectrum of neuromuscular disorders completed the PLAN-Q, Medical Outcome Study short-form 36-item version (SF-36), and the Impact of Participation on Autonomy (IPA) questionnaires.

Development of a tool to guide referral of patients with neuromuscular disorders to allied health services. Part one.

Purpose: Reasons for referral of patients with chronic, slowly progressive neuromuscular disorders (NMD) to occupational therapy (OT), physical therapy (PT) and speech therapy (ST) are often unclear. One-off consultations by OT, PT and ST can help patients and physicians to decide if therapy is needed. We present a construct for a questionnaire, the Perceived Limitations in Activities and Needs Questionnaire (PLAN-Q).

Brain injury severity and autonomic dysregulation accurately predict heterotopic ossification in patients with traumatic brain injury.

Objective: To assess brain injury severity, autonomic dysregulation and systemic infection as risk factors for the occurrence of heterotopic ossification in patients with severe traumatic brain injury.

Design: Historic cohort study.

Setting: Radboud University Medical Centre.

Referral of patients with neuromuscular disease to occupational therapy, physical therapy and speech therapy: usual practice versus multidisciplinary advice.

Unlabelled: PURPOSE To compare the volume of occupational therapy (OT), physical therapy (PT) and speech therapy (ST) as currently received by patients with neuromuscular diseases with the volume of OT, PT and ST recommended by a multidisciplinary team.

Method: The use of OT, PT and ST was studied retrospectively and prospectively in a reference group (n = 106) receiving usual care and in an intervention group (n = 102) receiving advice based on multidisciplinary assessments. A cost analysis was made and the implementation of the advice was evaluated at 6 months.

Are neuroradiological or neurophysiological characteristics associated with upper-extremity hypertonia in severe ischaemia in supratentorial stroke?

Objective: The primary goal was to identify the neuroradiological and neurophysiological risk factors for upper-extremity hypertonia in patients with severe ischaemic supratentorial stroke.

Design: Inception cohort.

Patients: Forty-three consecutive patients with an acute ischaemic supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital recruited over a 1.

Are clinical characteristics associated with upper-extremity hypertonia in severe ischaemic supratentorial stroke?

Objective: The primary goal of this study was to identify clinical risk factors, in addition to muscle weakness, for upper-extremity hypertonia in patients with severe ischaemic supratentorial stroke. The secondary goal was to investigate the time course of upper-extremity hypertonia in these patients during the first 26 weeks post-stroke.

Design: Inception cohort.

Ambulatory disabilities and the use of walking aids in patients with hereditary motor and sensory neuropathy type I (HMSN I).

Purpose: To determine the level of ambulatory disability and the use of walking aids in well-ambulant Hereditary Motor and Sensory Neuropathy type I (HMSN I) patients, and to identify the related demographic, physical and psychological variables.

Methods: Seventy-five well-ambulant HMSN I patients, aged 20-58 years, were measured in a cross-sectional assessment, addressing disability of ambulation and mobility (Sickness Impact Profile), demographics, muscle strength (Medical Research Council), use of walking aids, physical activity (actometer), fatigue (Checklist Individual Strength), and quality of life (EuroQoL).

Results: Seventy-two percent of the patients perceived a significant amount of ambulatory disability.

How salient is the silent period? The role of the silent period in the prognosis of upper extremity motor recovery after severe stroke.

Transcranial magnetic stimulation (TMS) has been successful in the prediction of motor recovery in acute stroke patients with initially severe paresis or paralysis of the upper extremity. Motor evoked potentials (MEP) appear to have a high specificity but a rather low sensitivity with regard to motor recovery. The silent period (SP) has been proposed as an additional factor to the MEP for predicting motor recovery that might optimize the sensitivity of TMS.

Short-term effects of whole-body vibration on postural control in unilateral chronic stroke patients: preliminary evidence.

The short-term effects of whole-body vibration as a novel method of somatosensory stimulation on postural control were investigated in 23 chronic stroke patients. While standing on a commercial platform, patients received 30-Hz oscillations at 3 mm of amplitude in the frontal plane. Balance was assessed four times at 45-min intervals with a dual-plate force platform, while quietly standing with the eyes opened and closed and while performing a voluntary weight-shifting task with visual feedback of center-of-pressure movements.

Motor evoked potentials of the lower extremity in predicting motor recovery and ambulation after stroke: a cohort study.

Objective: To assess the prognostic value of motor evoked potentials (MEPs) in the lower extremity with respect to motor recovery and functional recovery in stroke patients.

Design: Cohort study.

Setting: The department of neurology at a university hospital.

Motor evoked potentials in predicting recovery from upper extremity paralysis after acute stroke.

Objective: The use of motor evoked potentials (MEPs) in predicting recovery after stroke still appears to be somehow equivocal. We assessed the prognostic value of MEPs with respect to arm and hand motor recovery in acute stroke patients.

Methods: This cohort study included 43 consecutive acute stroke patients with complete paralysis of the upper extremity.