Hilde Feys

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.

Use of Time by Stroke Patients. A Comparison of Four European Rehabilitation Centers

Background and Purpose— Differences exist between European countries in the proportion of patients who die or become dependent after stroke. The aim of the present study was to identify differences in the use of time by stroke patients in 4 rehabilitation centers in 4 European countries. Methods— In each of the 4 centers, 60 randomly selected stroke patients were observed at 10-minute intervals using behavioral mapping. Observations took place on 30 weekdays selected at random, on equal numbers of morning, afternoon, and evening sessions. A logistic generalized estimating equation model with correction for differences in case mix and multiple testing was used for the analysis. Results— Overall time available from different professions was the highest in the United Kingdom, but patients in the United Kingdom spent on average only 1 hour per day in therapy. This was significantly less than patients in Belgium and Germany, who spent ≈2 hours, and patients in Switzerland who spent ≈3 hours per day in therapy. In all centers, patients spent less than half their time in interactions and >72% of the time in nontherapeutic activities. Conclusions— Important differences in the use of time were established, which appeared dependent on management decisions rather than the number of staff available. Patients in the Swiss and German centers spent more time in therapy, possibly because of the structured organization of rehabilitation. Further studies will verify whether this has an effect on outcome.

Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke : a 5-year follow-up study of a randomized trial

Background and Purpose— Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke, with follow-ups at a maximum of 12 months. The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke. Subjects and Methods— One hundred consecutive stroke patients were randomly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group. The intervention period was 6 weeks. Assessments of the patients were made before, midway, and after intervention, and at 6 and 12 months after stroke. In this study, 62 patients were reassessed at 5 years after stroke. The Brunnström-Fugl-Meyer (BFM) test, Action Research Arm (ARA) test, and Barthel index (BI) were used as the primary outcome measures. Results— At the 5-year follow-up, there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group. The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA. No effect was found for the BI. The treatment was most effective in patients with a severe initial motor deficit. Conclusions— Adding a specific intervention for the arm during the acute phase after a stroke resulted in a clinically meaningful and long-lasting effect on motor function. The effect can be attributed to early, repetitive, and targeted stimulation.

Effect of a physical therapeutic intervention for balance problems in the elderly: A single-blind, randomized, controlled multicentre trial

Objective: To establish the effect of a short, individualized exercise programme on balance dysfunction in the elderly. Design: A single-blind, randomized, controlled, multicentre trial. Setting: Physical and recreational therapy departments from two rehabilitation centres. Participants: Ninety-four subjects of ≥75 years with functional balance problems living independently or in a residential care facility. Seventy-seven subjects completed the intervention period and four-week follow-up. At a one-year follow-up 49 subjects were evaluated on balance functioning. Interventions: Twelve sessions of an individualized balance training programme (experimental group) or 12 sessions of an individualized extra attention programme (control group) given in 4–6 weeks. Main outcome measures: Berg Balance Scale and the Dynamic Gait Index to establish balance functioning, a visual analogue scale to establish fear of falling in daily life and the Hospital Anxiety Depression Scale to verify feelings of anxiety and depression. Results: Subjects in the experimental group improved significantly more on the Berg Balance Scale and the Dynamic Gait Index than those in the control group (p ≤ 0.001, p ≤ 0.001, respectively). However the effect disappeared at a one-year follow-up on the Berg Balance Scale. No prognostic factors could be identified to determine who would benefit most from the individualized exercise programme. Results on the other response variables revealed no effect of the intervention. Conclusion: A short individualized exercise programme can improve functional balance in people aged 75 years and older. This improvement was maintained at least for one month but had worn off by one year.

Motor and Functional Recovery After Stroke A Comparison of 4 European Rehabilitation Centers

Background and Purpose— Outcome after first stroke varies significantly across Europe. This study was designed to compare motor and functional recovery after stroke between four European rehabilitation centers. Methods— Consecutive stroke patients (532 patients) were recruited. They were assessed on admission and at 2, 4, and 6 months after stroke with the Barthel Index, Rivermead Motor Assessment of Gross Function, Rivermead Motor Assessment of Leg/Trunk, Rivermead Motor Assessment of Arm, and Nottingham Extended Activities of Daily Living (except on admission). Data were analyzed using random effects ordinal logistic models adjusting for case-mix and multiple testing. Results— Patients in the UK center were more likely to stay in lower Rivermead Motor Assessment of Gross Function classes compared with patients in the German center (&Dgr;OR, 2.4; 95% CI, 1.3 to 4.3). In the Swiss center, patients were less likely to stay in lower Nottingham Extended Activities of Daily Living classes compared with patients in the UK center (&Dgr;OR, 0.7; 95% CI, 0.5 to 0.9). The latter were less likely to stay in lower Barthel Index classes compared with the patients in the German center (&Dgr;OR, 0.6; 95%CI, 0.4 to 0.8). Recovery patterns of Rivermead Motor Assessment of Leg/Trunk and Rivermead Motor Assessment of Arm were not significantly different between centers. Conclusions— Gross motor and functional recovery were better in the German and Swiss centers compared with the UK center, respectively. Personal self-care recovery was better in the UK compared with the German center. Previous studies in the same centers indicated that German and Swiss patients received more therapy per day. This was not the result of more staff but of a more efficient use of human resources. This study indicates potential for improving rehabilitation outcomes in the UK and Belgian centers.

Trunk performance after stroke: an eye catching predictor of functional outcome

Background and aim: Trunk performance is an important predictor of functional outcome after stroke. However, the percentage of explained variance varies considerably between studies. This may be explained by the stroke population examined, the different scales used to assess trunk performance and the time points used to measure outcome. The aim of this multicentre study was to examine the predictive validity of the Trunk Impairment Scale (TIS) and its subscales when predicting the Barthel Index score at 6 months after stroke. Methods: A total of 102 subjects were recruited in three European rehabilitation centres. Participants were assessed on admission (median time since stroke onset 20 days) and 6 months after stroke. Correlation analysis and forward stepwise multiple regression analysis were used to model outcome. Results: The best predictors of the Barthel Index scores at 6 months after stroke were total TIS score (partial R2 = 0.52, p<.0001) and static sitting balance subscale score (partial R2 = 0.50, p<.0001) on admission. The TIS score on admission and its static sitting balance subscale were stronger predictors of the Barthel Index score at 6 months than the Barthel Index score itself on admission. Conclusions: This study emphasises the importance of trunk performance, especially static sitting balance, when predicting functional outcome after stroke. The TIS is recommended as a prediction instrument in the rehabilitation setting when considering the prognosis of stroke patients. Future studies should address the evolution of trunk performance over time and the evaluation of treatment interventions to improve trunk performance.

Stroke Rehabilitation in Europe What Do Physiotherapists and Occupational Therapists Actually Do

Background and Purpose— Physiotherapy (PT) and occupational therapy (OT) are key components of stroke rehabilitation. Little is known about their content. This study aimed to define and compare the content of PT and OT for stroke patients between 4 European rehabilitation centers. Methods— In each center, 15 individual PT and 15 OT sessions of patients fitting predetermined criteria were videotaped. The content was recorded using a list comprising 12 therapeutic categories. A generalized estimating equation model was fitted to the relative frequency of each category resulting in odds ratios. Results— Comparison of PT and OT between centers revealed significant differences for only 2 of the 12 categories: ambulatory exercises and selective movements. Comparison of the 2 therapeutic disciplines on the pooled data of the 4 centers revealed that ambulatory exercises, transfers, exercises, and balance in standing and lying occurred significantly more often in PT sessions. Activities of daily living, domestic activities, leisure activities, and sensory, perceptual training, and cognition occurred significantly more often in OT sessions. Conclusion— This study revealed that the content of each therapeutic discipline was consistent between the 4 centers. PT and OT proved to be distinct professions with clear demarcation of roles.

Review of quantitative measurements of upper limb movements in hemiplegic cerebral palsy

This review provides an overview of results found in literature on objective measurements of upper limb movements in children with hemiplegic cerebral palsy (HCP). Seventeen articles were selected following a systematic search. Analysed tasks varied from simple reaching and gross motor functions to complex, fine motor tasks. Spatiotemporal characteristics have been extensively studied and longer movement durations, slower movement speed and reduced trajectory straightness at the affected upper limb, compared to the non-affected side or healthy children, were most frequently reported. Joint kinematics has been far less studied. The limited data confirm the clinical impression of children with HCP using less elbow extension and supination to reach for an object, which is compensated by increased trunk flexion. Increased trunk involvement was also reported during gross motor functions. Although three-dimensional (3D) movement analysis seems promising to provide additional insights in the pathological upper limb movements observed in HCP, future standardisation of the entire protocol is crucial. No consensus exists on the procedures for data collection, processing, analysing and reporting of results, or what upper limb tasks should be assessed. The International Society of Biomechanics recently proposed recommendations on the definition of upper limb joint coordinate systems and rotation sequences. These guidelines were not yet applied in these studies. Although the diverse methodological approaches used in the studies complicate the comparison of published results, some general conclusions could be drawn. A further standardisation of the protocol for 3D upper limb movement analysis will provide the foundation for comparable and repeatable results and eventually facilitate the selection and planning of treatment interventions.

Anxiety and depression in the first six months after stroke. A longitudinal multicentre study

Purpose. To document the prevalence, severity and time course of anxiety and depression in stroke rehabilitation patients in four European countries. Method. At two, four and six months post-stroke, the prevalence and severity of anxiety and depression were determined in 532 consecutively recruited patients, using the Hospital Anxiety and Depression Scale. Time course of prevalence and severity was examined, using Cochran-Q and Friedman-tests, respectively. We identified whether the numbers of anxious/depressed patients at each time point comprised the same individuals. Results. Prevalence of anxiety ranged between 22% and 25%; depression between 24% and 30%. Median severity ranged between 4 and 5. No significant differences between centres occurred (p > 0.05). Prevalence of both disorders was not significantly different over time. Severity of anxiety decreased between four and six months; severity of depression remained stable. About 40% of the patients with initial anxiety remained anxious at six months. Some 11% and 7% of those initially not anxious became anxious at four or six months after stroke, respectively. Depression showed a similar pattern. Conclusions. Despite differences in patient profiles and intensity of rehabilitation, no significant differences occurred between centres in prevalence and severity of both disorders. Anxiety was almost as common as depression and additional patients became anxious/depressed at each time point.

Reliability of a road test after stroke

OBJECTIVE To determine the reliability of the road test performed by stroke patients. DESIGN Prospective study of a 6-month predriving evaluation. SETTING Driving safety center in Belgium. PARTICIPANTS Thirty patients with sequelae of stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Results of driving performance as judged by 2 assessors from the Center for Determination of Fitness to Drive and Car Adaptations (CARA), in a car fitted with a video camera. A third assessor also evaluated all the video recordings. Interrater reliability was evaluated by comparing results from real-life performance and video recording, as judged by the CARA assessors and video judgments between CARA assessors and the third assessor. RESULTS Most subitems of the road test showed more than 80% scoring agreement between the various evaluations. Intraclass correlation coefficients (ICCs) of the items varied from -.08 to 1.0. The ICC of the overall performance was.62 when real-life scores were compared with video evaluations and.80 in video versus video comparison. CONCLUSION The reliability of assessing overall performance of stroke patients in the road test is moderately high and better when assessed using the same evidence. Yet, the reliability of some items needs further attention.