Annemie Spooren

Influence of Task-Oriented Training Content on Skilled Arm-Hand Performance in Stroke: A Systematic Review

Objective. This review evaluates the underlying training components currently used in task-oriented training and assesses the effects of these components on skilled arm—hand performance in patients after a stroke. Methods. A computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro, and Cochrane) identified randomized clinical trials, published through March 2009, evaluating the effects of task-oriented training. Relevant article references listed in publications included were also screened. The methodological quality of the selected studies was assessed with the Van Tulder Checklist. For each functional outcome measure used, the effect size (bias corrected Hedges’s g) was calculated. Results. The intervention results in 528 patients (16 studies) were studied. From these, 15 components were identified to characterize task-oriented training. An average of 7.8 (standard deviation = 2.1) components were used in the included trials. There was no correlation between the number of task-oriented training components used in a study and the treatment effect size. “Distributed practice” and “feedback” were associated with the largest postintervention effect sizes. “Random practice” and “use of clear functional goals” were associated with the largest follow-up effect sizes. Conclusion. The task-oriented training was operationalized with 15 components. The number of components used in an intervention aimed at improving arm—hand performance after stroke was not associated with the posttreatment effect size. Certain components, which optimize storage of learned motor performance in the long-term memory, occurred more in studies with larger treatment effects.

Outcome of motor training programmes on arm and hand functioning in patients with cervical spinal cord injury according to different levels of the ICF: a systematic review.

OBJECTIVE To investigate the outcome of motor training programmes on arm and hand functioning in patients with cervical spinal cord injury according to different levels of the International Classification of Functioning, Disability and Health (ICF). DESIGN Systematic review. METHODS A search of the following databases: Medline, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Physiotherapy Evidence Database (PEDro) and Database of Abstracts of Reviews of Effects (DARE) from 1976 to August 2008 was performed using the following MeSH terms: Spinal Cord Injuries, Quadriplegia, Rehabilitation, Physical Education and Training, Exercise, Patient-Centered Care, Upper Extremity, Activities of Daily Living, Motor Skills, Motor Activity, Intervention Studies, Clinical Trial. The methodological quality of the selected articles was scored with the Van Tulder Checklist. Descriptive analyses were performed using the PICO principle (Patient characteristics, Intervention, Comparison, Outcome & results) along the ICF function and activity level. RESULTS Twelve studies were included in the analyses. Overall, the methodological quality of the studies was acceptable, with a mean Van Tulder score of 9.58. Interventions included motor training programmes at the level of function, activity or a combined programme. Most studies reported improvements in arm and hand functioning at the level that was trained for. CONCLUSION Motor training programmes may improve arm and hand functioning at function and/or activity level in cervical spinal cord injured patients. However, no general conclusion based on a meta-analysis can be drawn due to the wide variety of approaches.

Motor training programs of arm and hand in patients with MS according to different levels of the ICF: a systematic review

BackgroundThe upper extremity plays an important role in daily functioning of patients with Multiple Sclerosis (MS) and strongly influences their quality of life. However, an explicit overview of arm-hand training programs is lacking. The present review aims to investigate the training components and the outcome of motor training programs for arm and hand in MS.MethodsA computerized systematic literature search in 5 databases (PubMed, CINAHL, EMBASE, PEDro and Cochrane) was performed using the following Mesh terms: Multiple Sclerosis, Rehabilitation, Physical Education and Training, Exercise, Patient-Centered Care, Upper Extremity, Activities of Daily Living, Motor Skills, Motor Activity, Intervention Studies and Clinical Trial. The methodological quality of the selected articles was scored with the Van Tulder Checklist. A descriptive analyses was performed using the PICO principle, including scoring of training components with the calculation of Hedges’g effect sizes.ResultsEleven studies were eligible (mean Van Tulder-score = 10.82(SD2.96)). Most studies reported a specific improvement in arm hand performance at the ICF level that was trained at. The mean number of training components was 5.5(SD2.8) and a significant correlation (r = 0.67; p < 0.05) between the number of training components and effect sizes was found. The components ‘client-centered’ and ‘functional movement’ were most frequently used, whereas ‘distribution based practice’, ‘feedback’ and ‘random practice’ were never used. The component ‘exercise progression’ was only used in studies with single ICF body function training, with the exception of 1 study with activity level training. Studies including the component ‘client-centred’ demonstrated moderate to high effect sizes.ConclusionMotor training programs (both at the ICF body function and activity level) have shown to improve arm and hand performance in MS in which the value of the training specificity was emphasized. To optimize upper extremity training in MS the component ‘client-centred’ and ‘exercise progression’ may be important. Furthermore, given the importance attributed to the components ‘distribution based practice’, ‘feedback’ and ‘random practice’ in previous research in stroke patients, the use of these components in arm hand training should be explored in future research.

Measuring change in arm hand skilled performance in persons with a cervical spinal cord injury: responsiveness of the Van Lieshout Test

Objectives:To asses whether the Van Lieshout Test (VLT) is responsive to measure changes in arm hand skilled performance (AHSP) over time during active rehabilitation in persons with cervical spinal cord injury (C-SCI) and in different subgroups of persons with C-SCI according to lesion completeness and to lesion level.Study design:Longitudinal cohort study.Setting:Spinal Cord Injury Units in eight rehabilitation centres across the Netherlands.Methods:In the present study, data from a national SCI cohort study are used. Data from the VLT, the Grasp Release Test (GRT), the Functional Independence Measure (FIM) and the Quadriplegia Index of Function (QIF) were recorded at three moments during active rehabilitation: at the start of active rehabilitation (t1), 3 months after t1 (t2) and at discharge (t3). Data have been analysed using three responsiveness measures, that is, the standardized response mean, the effect size and comparison of test scores measured at different times.Results:The VLT is responsive for the intervals t1–3, t1–2 and t2–3. The VLT can be used to measure changes in AHSP in persons with a C-SCI with an American Spinal Injury Association Impairment Scale (AIS) A or B score or an AIS C or D score, as well as in persons with a C3–C6 lesion or a C7–T1 lesion. The responsiveness of the VLT is significantly correlated to the GRT, but not to the FIM and the QIF.Conclusion:The VLT is responsive in measuring changes in AHSP during rehabilitation in persons with C-SCI.

T-TOAT: A method of task-oriented arm training for stroke patients suitable for implementation of exercises in rehabilitation technology

Task-oriented training improves skilled arm-hand performance after stroke. Exercises for skill training are however not easy to implement in rehabilitation technology, especially for complex skills that involve object manipulation. In this paper, a skill training method, suitable for technology-supported training of arm-hand performance after stroke is presented. A sensor-based and robotic system in which the training method is used, are described.

Rehabilitation outcome of upper extremity skilled performance in persons with cervical spinal cord injuries

OBJECTIVE To investigate changes in arm hand skilled performance during and after active rehabilitation in (sub)groups of subjects with cervical spinal cord injuries. DESIGN Longitudinal multi-centre cohort study. PATIENTS Persons with cervical spinal cord injuries during (n?=?57) and after (n?=?35) rehabilitation. METHODS Patients from 8 Dutch rehabilitation centres received therapy as usual. At 3 time-points during active rehabilitation and one year after discharge arm hand skilled performance was measured using the Van Lieshout hand function test, the Grasp Release Test (for basic activities) and the Functional Independence Measure and the Quadriplegia Index of Function (for complex activities). RESULTS Arm hand skilled performance continues to improve over the entire rehabilitation period, mostly in the first stage of active rehabilitation, and especially in persons with a motor incomplete lesion. Persons with a motor incomplete lesion achieve higher arm hand skilled performance outcome than those with a motor complete lesion. After rehabilitation arm hand skilled performance does not decline. CONCLUSION Monitoring the outcome of arm hand skilled performance at the level of basic and complex activities during the whole rehabilitation phase may guide therapists in further optimizing therapy.

Robot-assisted task-oriented upper extremity skill training in cervical spinal cord injury: a feasibility study

Study design:Prospective multiple case study.Objectives:To test (1) the feasibility of haptic robot technology (Haptic Master (HM)) use to improve arm–hand function (AHF) and arm–hand skill performance (AHSP) in persons with a cervical spinal cord injury (C-SCI), (2) inventory participants’ motivation and expectation to work with the robot technology used and (3) to descriptively report the results in individual cases.Setting:Rehabilitation Centre.Methods:Five C-SCI patients were trained for 6 weeks, 3 days per week, 60 min per day. Therapists filled out the Usefulness, Satisfaction and Ease-of-use questionnaire (USE). The Intrinsic Motivational Inventory (IMI) and credibility and expectancy questionnaire (CEQ) were filled out by participants. Performance at activity level was gauged using the Van Lieshout test for AHF in Tetraplegia and the Spinal Cord Independence Measure. Function level was gauged using muscle strength testing and the International Classification for Surgery of the Hand in Tetraplegia.Results:As to the feasibility of the application of haptic robot technology, the mean USE score was 65%. Mean IMI and CEQ results were 67% and 60%, respectively. Participants were motivated to train with the HM. All participants rated credibility higher than expectations regarding the improvement. In the current patients, little progress was demonstrated at the International Classification of Functioning, Disability and Health function and the activity level.Conclusion:It is feasible to train C-SCI persons with the HM. Therapists report that working with the HM is easy to learn and easy to perform. Usability of the HM may be improved. Further research is needed to assess in which group of C-SCI and at which stage of rehabilitation HM training may be most beneficial.

Improvement of the Van Lieshout hand function test for Tetraplegia using a Rasch analysis

Study design:Cross-sectional studyObjective:The Van Lieshout hand function test for tetraplegia (VLT) measures the quality of arm–hand functioning in persons with tetraplegia. It is valid, reliable and responsive. However, it does not satisfy all the criteria for interval level measurement. The present study aims to apply the Rasch model to the VLT short form (VLT-SF) to upgrade its scale type towards interval level, and to verify if the requirements of an objective measure are satisfied in the revised version.Setting:Eight Dutch Rehabilitation centres.Methods:The VLT-SF data of 73 tetraplegic patients were Rasch-analysed (RUMM2030 software, RUMM Laboratory Pty Ltd, Perth, Australia) to verify the order of response categories, unidimensionality and reliability of the VLT-SF, and to assess its applicability regardless of (motor) lesion completeness.Results:Seven of the ten VLT-SF items showed disordered response categories. The six original response categories were therefore recoded into three or four categories. After recoding, all items satisfied the model requirement of unidimensionality. The items were relatively well-targeted on the subjects’ arm–hand skilled performance measures, leading to a good person separation index (R=0.91). The difficulty hierarchy of the VLT-SF items was invariant across patient subgroups of (motor) lesion completeness.Conclusions:Provided that response categories are recoded, VLT-SF Rasch analysis showed that the requirements of an objective measure were satisfied. This allows to compare the measurements of different patients quantitatively, and to follow their results over time.

Motivation, expectations, and usability of a driven gait orthosis in stroke patients and their therapists

Abstract Background: In the development of efficacious driven gait orthoses (DGO), it is an added value to consider patients’ and therapists’ perspectives concerning robot-assisted gait training (RAGT). A better understanding of these issues may improve the process of care and outcome. Objectives: This study aimed to examine stroke patients’ motivation and expectations of RAGT, and therapists’ expectations and perspectives on the usability of RAGT. Additionally, the differences in expectations between stroke patients and their therapists were analyzed. Methods: A cross sectional, multi-center, three-group trial was conducted. Included were (1) stroke patients who have experience with RAGT (i.e. the stroke user group), (2) stroke patients who have no experience with RAGT (i.e. the stroke non-user group), and (3) therapists who have experience with RAGT (i.e. the therapist user group). The Intrinsic Motivation Inventory (IMI), Credibility/Expectancy Questionnaire (CEQ), and Usefulness, Satisfaction and Ease of Use Questionnaire (USE) were used. Descriptive statistics and non-parametric Kruskal–Wallis tests were conducted. Results: In total, 46 subjects were assessed (stroke user group: n = 23, stroke non-user group: n = 14, therapist user group: n = 9). IMI subscale scores ranged from 42 to 88%. Mean credibility and expectancy ranged from 80 to 85% and 57 to 72%, respectively, with no significant differences between groups. USE subscale scores ranged from 61 to 72%. Conclusions: Stroke user group patients seem quite motivated to train with the DGO and both patients and therapists reasonably believe that this training could improve gait functioning. Therapists are moderately satisfied with the usability of the DGO, but there is room for improvement with respect to usefulness and ease of use.

Reference values for the transformed Van Lieshout hand function test for tetraplegia

Study design:Longitudinal cohort study.Objectives:Previously, the Van Lieshout hand function test for tetraplegia (short form)(VLT-SF) has been transformed into an interval scale (r_VLT-SF) using the Rasch analysis, thereby fulfilling the requirements of an objective measurement. The present study aims (1) to transform r_VLT-SFlogit scores (r_VLT-SFlogit) into 0–100 scores (r_VLT-SF100) in order to facilitate communication amongst its users and (2) to describe r_VLT-SF100 reference values in order to refine the prediction of upper extremity skilled performance in persons with tetraplegia.Setting:Eight Dutch rehabilitation centres.Methods:The VLT-SF data of tetraplegic patients from eight Dutch rehabilitation centres, gathered at the start of the active rehabilitation (t1), 3 months after t1 (t2) and at the time of discharge (t3), have been used. The r_VLT-SF100 total score for t1 and t3 were computed, anchored on the data for t2. Reference values (medians and interquartiles) for different subgroups were calculated at different moments during the rehabilitation.Results:Data at t1 (n=64), t2 (n=73) and t3 (n=69) were used. The r_VLT-SFlogit scores (−4.78–6.32) were transformed into r_VLT-SF100 (0–100) at t2. Reference values were established for persons with motor complete or incomplete lesions with either a high (C1–C6) or a low (C7-T1) lesion level at t1, t2 and t3. Significant differences (P<0.025) in r_VLT-SF100 were found for most subgroups and different time intervals.Conclusions:The r_VLT-SFlogit scores were converted into r_VLT-SF100 scores, and reference values of the r_VLT-SF100 have been established for different subgroups of tetraplegic patients at different stages during rehabilitation. The r_VLT-SF100 has been proven to be able to detect improvement over time.