Ann Van de Winckel

Cognitive and behavioural effects of music-based exercises in patients with dementia

Objective: To evaluate the effect of a musical exercise programme on mood state and cognitive function in women with dementia. Design: Randomized controlled trial. Setting: Public Psychiatric Hospital Rekem, Belgium. Patients: Twenty-five patients with dementia. Interventions: Fifteen patients attended exercise training for three months, which consisted of daily physical exercises supported by music for 30 min/session. They were compared with a group of 10 control patients, who received an equal amount of attention through daily conversation. Main measures: The effect on cognition was measured by the Mini-Mental State Examination (MMSE) and the Amsterdam Dementia Screening Test 6 (ADS 6). Behaviour was evaluated with the abbreviated Stockton Geriatric Rating Scale (BOP scale). The assessments were made before, after six weeks of intervention and immediately after the three-month experimental period. Results: The exercise group showed a significant improvement in cognition. This was documented by an increased MMSE mean score of 12.87-15.53, and by a higher median score, rising from 10 to 14 points, on the subset ‘fluency’ (ADS 6 test). The control group showed no significant improvement, either on the MMSE (mean score of 10.80 -11.00) or on the fluency subtest of the ADS 6 (median scores were 6.5-7 points). The effects on behavioural changes were not significant. Conclusion: The present study suggests a beneficial effect of cognition using a music-based exercise programme in a group of patients with moderate to severe dementia. Further studies are needed to confirm these findings.

Is There a Common Neuroanatomical Substrate of Language Deficit between Autism Spectrum Disorder and Specific Language Impairment

Discussion of an overlap between specific language impairment (SLI) and autism spectrum disorder (ASD) is on going. The most intriguing overlap between both phenotypes is the similarity in the observed language deficits described in SLI and a subgroup of ASD with co-occurring linguistic impairment, ASD-LI. Examining whether a similar neuroanatomical substrate underlies this phenotypical linguistic overlap, we studied the white matter microstructural properties of the superior longitudinal fascicle (SLF) of 19 ASD-LI adolescents (mean age 13.8 ± 1.6 years) and 21 age-matched controls and compared them with 13 SLI children (mean age 10.1 ± 0.4 years) and 12 age-matched controls. A linguistic profile assessment and a diffusion tensor imaging analysis of the SLF were performed. Linguistic testing revealed a mixed receptive-expressive disorder profile in both groups, confirming their overlap at phenotypical level. At neuroanatomical level, no significant differences in mean SLF fractional anisotropy (FA) and mean SLF apparent diffusion coefficient values between ASD-LI participants and controls were seen. By contrast, the mean SLF FA was significantly reduced in the SLI children as compared with their controls. The observation of structural SLF disturbances in SLI but not in ASD-LI suggests the existence of a different neuroanatomical substrate for the language deficits in both disorders.

Comprehensive assessment of gesture production

Background:  Only few standardized apraxia scales are available and they do not cover all domains and semantic features of gesture production. Therefore, the objective of the present study was to evaluate the reliability and validity of a newly developed test of upper limb apraxia (TULIA), which is comprehensive and still short to administer.

Passive somatosensory discrimination tasks in healthy volunteers: Differential networks involved in familiar versus unfamiliar shape and length discrimination

Somatosensory discrimination of unseen objects relies on processing of proprioceptive and tactile information to detect spatial features, such as shape or length, as acquired by exploratory finger movements. This ability can be impaired after stroke, because of somatosensory-motor deficits. Passive somatosensory discrimination tasks are therefore used in therapy to improve motor function. Whereas the neural correlates of active discrimination have been addressed repeatedly, little is known about the neural networks activated during passive discrimination of somatosensory information. In the present study, we applied functional magnetic resonance imaging (fMRI) while the right index finger of ten healthy subjects was passively moved along various shapes and lengths by an fMRI compatible robot. Comparing discriminating versus non-discriminating passive movements, we identified a bilateral parieto-frontal network, including the precuneus, superior parietal gyrus, rostral intraparietal sulcus, and supramarginal gyrus as well as the supplementary motor area (SMA), dorsal premotor (PMd), and ventral premotor (PMv) areas. Additionally, we compared the discrimination of different spatial features, i.e., discrimination of length versus familiar (rectangles or triangles) and unfamiliar geometric shapes (arbitrary quadrilaterals). Length discrimination activated mainly medially located superior parietal and PMd circuits whereas discrimination of familiar geometric shapes activated more laterally located inferior parietal and PMv regions. These differential parieto-frontal circuits provide new insights into the neural basis of extracting spatial features from somatosensory input and suggest that different passive discrimination tasks could be used for lesion-specific training following stroke.

How does brain activation differ in children with unilateral cerebral palsy compared to typically developing children, during active and passive movements, and tactile stimulation? An fMRI study.

The aim of the functional magnetic resonance imaging (fMRI) study was to investigate brain activation associated with active and passive movements, and tactile stimulation in 17 children with right-sided unilateral cerebral palsy (CP), compared to 19 typically developing children (TD). The active movements consisted of repetitive opening and closing of the hand. For passive movements, an MRI-compatible robot moved the finger up and down. Tactile stimulation was provided by manually stroking the dorsal surface of the hand with a sponge cotton cloth. In both groups, contralateral primary sensorimotor cortex activation (SM1) was seen for all tasks, as well as additional contralateral primary somatosensory cortex (S1) activation for passive movements. Ipsilateral cerebellar activity was observed in TD children during all tasks, but only during active movements in CP children. Of interest was additional ipsilateral SM1 recruitment in CP during active movements as well as ipsilateral S1 activation during passive movements and tactile stimulation. Another interesting new finding was the contralateral cerebellum activation in both groups during different tasks, also in cerebellar areas not primarily linked to the sensorimotor network. Active movements elicited significantly more brain activation in CP compared to TD children. In both groups, active movements displayed significantly more brain activation compared to passive movements and tactile stimulation.

Can quality of movement be measured? Rasch analysis and inter-rater reliability of the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES)

Objective: Clinical scales evaluating arm function after stroke are weak at detecting quality of movement. Therefore a new scale, the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), was developed, comprising 22 items pertaining to arm and hand performance. The scale was investigated for validity and unidimensionality using the Rasch measurement model, and for inter-rater reliability. Setting: Twelve hospitals and rehabilitation centres in Belgium, Germany and Switzerland. Patients: There were 396 patients (average age 63.38±12.89 years) in the Rasch study and 56 patients (average age 65.68±12.75 years) in the reliability study. Main measures: The scale was examined on its fit to the Rasch model, thereby evaluating the scale’s unidimensionality and validity. Differential item functioning was performed to test the stability of item hierarchy on several variables. Inter-rater reliability was examined with kappa values, weighted percentage agreement and intraclass correlation coefficients (ICC). Results: Based on Rasch analysis, five items were removed. The MESUPES was divided in two tests: the MESUPES-arm test (8 items) and MESUPES-hand test (9 items). Both scales fitted the Rasch model. All items were stable among the subgroups of the sample. ICCs were 0.95 (95% confidence interval (CI) 0.91 -0.97) and 0.97 (95% CI 0.95-0.98) for the total score on arm and hand test respectively. The scale was also reliable at item level (weighted kappa 0.62 -0.79, weighted percentage agreement 85.71 -98.21). Conclusion: The MESUPES-arm and MESUPES-hand meet the statistical properties of reliability, validity and unidimensionality. Both tests provide a useful clinical and research tool to qualitatively evaluate arm and hand function during recovery after stroke.

Arm and hand function in children with unilateral cerebral palsy: A one-year follow-up study

BACKGROUND In children with unilateral cerebral palsy (CP), development of arm and hand function is often compromised by the underlying motor and sensory impairments. However, knowledge about the evolution of arm and hand function in this population is limited. AIM The aims were to map the evolution of scores on upper limb measures over one year in children with unilateral CP and to identify factors that influence time trends. METHODS Eighty-one children (43 males, 38 females; mean age 9y11mo (SD 3y3mo) range 5-15 y) were tested at baseline, at 6 and 12 months. According to the International Classification of Functioning, Disability and Health, body function measurements included passive range of motion, muscle tone, manual muscle strength and grip strength. Activity measurements included the Melbourne Assessment, the Jebsen-Taylor test, the Assisting Hand Assessment and the Abilhand-Kids questionnaire. Age, gender, etiology (congenital or acquired lesions) and Manual Ability Classification System (MACS) levels were analyzed as predictive factors, using mixed models. RESULTS Scores for grip strength (p = 0.001) and manual dexterity (Jebsen-Taylor test, p < 0.0001) increased significantly over time. MACS level (p = 0.03) and etiology (p = 0.02) had a significant influence on the time evolution of the Jebsen-Taylor scores. Other assessments showed no significant changes. CONCLUSION Motor impairments, movement quality and hemiplegic hand use in bimanual tasks do not spontaneously improve over one year, except for an age-related change in grip strength. However, an improvement was observed in manual dexterity, suggesting that some children can learn more adaptive movement strategies.

Reliability of Infrared Ear Thermometry in the Prediction of Rectal Temperature in Older Inpatients

AIMS AND OBJECTIVES To assess the capability of infrared ear thermometry accurately to predict rectal temperature in older patients. BACKGROUND Infrared ear thermometry is now commonly used for predicting body temperature in older patients. However, ear thermometry has been insufficiently evaluated in geriatric patients. DESIGN Prospective, convenience sample, unblinded study. METHODS All patients (or their guardians) gave informed consent. Patients hospitalised in a geriatric unit underwent sequential ear and rectal temperatures measurements using two different models of infrared ear thermometers (ThermoScan and Genius) and a rectal probe, respectively. After a brief otoscopic examination, ear temperatures were measured twice at both ears with each thermometer, the highest of four measurements being retained for analysis. The rectal temperature was the reference standard. RESULTS Hundred patients (31 males), aged 81 (SD 7) years completed the study. The mean rectal temperature was 37.3 degrees C (SD 0.7) degrees C (range 36.3-40.7 degrees C). Eighteen patients were febrile (rectal temperature >or= 37.8 degrees C). The mean bias between rectal and ear temperatures as measured with the ThermoScan was -0.20 degrees C (SD 0.32) degrees C and the 95% limits of agreement were -0.83 degrees C and 0.42 degrees C (95% CI, -0.88-0.48 degrees C). Using the Genius, the corresponding figures were -0.56 degrees C (SD 0.39) degrees C, -1.32 degrees C and 0.20 degrees C (95% CI, -1.39-0.27 degrees C). After correction for bias, the ThermoScan predicted the level of fever with a maximum error of 0.7 degrees C (mean error 0.3 degrees C). Using the Genius, the maximum error and the mean error were 1.6 degrees C and 0.4 degrees C, respectively. CONCLUSIONS Infrared ear thermometry can predict rectal temperature in normothermic and in febrile inpatients with an acceptable level of accuracy. However, the predictive accuracy depends on both operator technique and quality of instrumentation. RELEVANCE TO CLINICAL PRACTICE Proper technique (measuring in both ears) and optimal instrumentation (model of ear thermometer) are essential for accuracy.

Does somatosensory discrimination activate different brain areas in children with unilateral cerebral palsy compared to typically developing children? An fMRI study

Aside from motor impairment, many children with unilateral cerebral palsy (CP) experience altered tactile, proprioceptive, and kinesthetic awareness. Sensory deficits are addressed in rehabilitation programs, which include somatosensory discrimination exercises. In contrast to adult stroke patients, data on brain activation, occurring during somatosensory discrimination exercises, are lacking in CP children. Therefore, this study investigated brain activation with functional magnetic resonance imaging (fMRI) during passively guided somatosensory discrimination exercises in 18 typically developing children (TD) (age, M=14 ± 1.92 years; 11 girls) and 16 CP children (age, M=15 ± 2.54 years; 8 girls). The demographic variables between both groups were not statistically different. An fMRI compatible robot guided the right index finger and performed pairs of unfamiliar geometric shapes in the air, which were judged on their equality. The control condition comprised discrimination of music fragments. Both groups exhibited significant activation (FDR, p<.05) in frontoparietal, temporal, cerebellar areas, and insula, similar to studies in adults. The frontal areas encompassed ventral premotor areas, left postcentral gyrus, and precentral gyrus; additional supplementary motor area (SMA proper) activation in TD; as well as dorsal premotor, and parietal operculum recruitment in CP. On uncorrected level, p<.001, TD children revealed more left frontal lobe, and right cerebellum activation, compared to CP children. Conversely, CP children activated the left dorsal cingulate gyrus to a greater extent than TD children. These data provide incentives to investigate the effect of somatosensory discrimination during rehabilitation in CP, on clinical outcome and brain plasticity.

Commentary on: "Assessing proprioception: A critical review of methods" by Han et al.

Commentary on: “Assessing proprioception: A critical review of methods” by Han et al. Carmen Krewer *, Ann Van de Winckel , Naveen Elangovan , Joshua E. Aman , Jurgen Konczak a a Human Sensorimotor Control Laboratory, University of Minnesota, Minneapolis, MN 55455, USA b Schon Klinik Bad Aibling, Bad Aibling 83043, Germany c Program in Physical Therapy, University of Minnesota, Minneapolis, MN 55455, USA