Anne Dahl

Short- and long-term outcome of constraint-induced movement therapy after stroke: a randomized controlled feasibility trial

Objective: Constraint-induced movement therapy (CIMT) is a method to improve motor function in the upper extremity following stroke. The aim of this trial was to determine the effect and feasibility of CIMT compared with traditional rehabilitation in short and long term. Design: A randomized controlled trial. Setting: An inpatient rehabilitation clinic. Subjects: Thirty patients with unilateral hand impairment after stroke. Intervention: Six hours arm therapy for 10 consecutive weekdays, while using a restraining mitten on the unaffected hand. Main measures: The patients were assessed at baseline, post-treatment and at six-month follow-up using the Wolf Motor Function Test as primary outcome measure and the Motor Activity Log, Functional Independence Measure and Stroke Impact Scale as secondary measurements. Results: The CIMT group (n=18) showed a statistically significant shorter performance time (4.76 seconds versus 7.61 seconds, P= 0.030) and greater functional ability (3.85 versus 3.47, P= 0.037) than the control group (n=12) on the Wolf Motor Function Test at post-treatment assessment. There was a non-significant trend toward greater amount of use (2.47 versus 1.97, P= 0.097) and better quality of movement (2.45 versus 2.12, P=0.105) in the CIMT group according to the Motor Activity Log. No such differences were seen on Functional Independence Measure at the same time. At six-month follow-up the CIMT group maintained their improvement, but as the control group improved even more, there were no significant differences between the groups on any measurements. Conclusions: CIMT seems to be an effective and feasible method to improve motor function in the short term, but no long-term effect was found.

High-Intensity Aerobic Interval Training for Patients 3–9 Months After Stroke. A Feasibility Study

BACKGROUND AND PURPOSE High-intensity aerobic interval training (AIT) has shown to be beneficial in patients with cardiac and pulmonary diseases. Presumably, patients with stroke also benefit from such treatment. However, the feasibility and potential efficacy of high-intensity AIT should be investigated for patients early after stroke. METHODS This was a single-group, pre-test-post-test, intervention study. The intervention consisted of a 6-week high-intensity AIT programme, performed twice a week. The AIT comprised 4 × 4-minute intervals, at 85-95% of peak heart rate, interrupted by 3-minute active breaks. Adherence to the protocol, compliance and adverse events were registered to assess feasibility. Cardiorespiratory fitness and functional outcomes were assessed before and after the intervention and at 6 and 12 weeks follow-up. RESULTS Ten men and five women (mean age 70.0 ± 7.7; range 61-85 years) with mild to moderate stroke were included, 3-9 months after onset. One patient was diagnosed with cancer during follow-up. There were three minor events, but no serious adverse events occurred. All patients accomplished all training sessions and reached the 85% intensity level, except one patient who discontinued the last session. The mean peak oxygen uptake showed no significant improvement from pre-treatment, 28.7 ± 3.8 ml kg(-1)  min(-1), to post-treatment, 29.6 ± 3.6 ml kg(-1)  min(-1), p = 0.189, whereas the mean 6-minute walk test improved from 410.7 ± 101.4 m to 461.0 ± 99.6 m, p = 0.001, and the median (interquartile range) Rivermead Motor Assessment Scale improved from 12.0 (11.0-13.0) to 13.0 (11.0-13.0) points, p = 0.100. These improvements continued after the intervention was concluded. CONCLUSIONS This study has shown that high-intensity AIT is feasible for a selected group of stroke patients. However, the training should be accomplished in line with the American College of Sports Medicine guidelines for high-risk populations to ensure safety. The participants achieved a clinically highly significant improvement in walking distance. This intervention should be tested out in a randomized controlled trial to assess if it is superior to other interventions.

Negative evidence in L2 acquisition

This article deals with the L2 acquisition of differences between Norwegian and English passives, and presents data to show that the acquisition of these differences by Norwegian L2 acquirers of English cannot be fully explained by positive evidence, cues, conservativism or economy. Rather, it is argued, it is natural to consider whether indirect negative evidence may facilitate acquisition by inferencing. The structures in focus are impersonal passive constructions with postverbal NPs and passive constructions with intransitive verbs. These sentences are ungrammatical in English. Chomsky (1981) proposes that this is a result of passive morphology absorbing objective case in English. There is no such case to be assigned to the postverbal NP in impersonal passives. In passive constructions with intransitive verbs, the verb does not assign objective case, so that there is no case for the passive morphology to absorb. Thus, impersonal passives have to be changed into personal passives, where the NP receives nominative case, and the objective case is free to go to the passive morphology. Intransitive verbs, however, cannot be used in the passive voice at all. Both the structures discussed in this article, i.e. are grammatical in Norwegian. However, the options available in English, viz. personal passives and active sentences, are equally possible. Afarli (1992) therefore proposes that Norwegian has optional case absorption (passive morphology optionally absorbs case). On the basis on such observations, we may propose a parameter with the settings [+case absorption] for English, and [-case absorption], signifying optional case absorption, for Norwegian. This means that none of the structures that are grammatical in English can function as positive evidence for the [+case absorption] setting, since they are also grammatical in optional case absorption languages. The question is how this parameter is set.