Jacqueline Hochstenbach

Cognitive recovery after stroke : A 2-year follow-up

OBJECTIVES To determine (1) whether long-term improvement of cognitive function takes place after stroke and (2) which clinical factors influence cognitive recovery. DESIGN Cohort study with patients who were assessed at 2.3 and 27.7 months after stroke. SETTING Home-based stroke patients. PARTICIPANTS From a group of 229 stroke patients, 92 were approached to participate. Sixty-five (43 men, 22 women; mean age, 56.4y) agreed, and they were neuropsychologically assessed at 72.2 days after stroke. A group of 33 controls (12 men, 21 women; mean age, 52.4y) was used as a reference sample. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Orientation, memory, attention, visuospatial, visuoconstructive, language, and arithmetic abilities were assessed with an extensive neuropsychologic test battery. RESULTS Significant improvements across time were noted for all cognitive domains. The biggest improvement was found in the attentional domain; the least, in the memory domain. In addition, a small subset of patients accounted for the significant improvement in all cognitive domains; most patients showed no improvement or declined. Factors influencing recovery were side of the stroke and incidence of lowered consciousness on admission. Patients with right-side brain damage performed better than those with left-side brain damage and showed more improvement over time. Patients with lowered consciousness on admission performed worse than patients without lowered consciousness. No significant effect was found for gender, type of stroke, cortical versus subcortical lesions, having 1 stroke or multiple strokes, or the interval between the stroke and the neuropsychologic assessment. CONCLUSION There was room for improvement in all cognitive domains, although this improvement was gained by only a small number of patients. Hence, most patients must cope with serious permanent cognitive decline after stroke.

Long-Term Outcome after Stroke: A Disability-Orientated Approach.

Patients (N=165) under 75 who had suffered a stroke in the past 5 years completed a Sickness Impact Profile. Analysis of results indicated the influence of stroke on everyday functioning. Chronic psychosocial disabilities, independent of the degree of physical disability, were reported in fifty-two percent of the patients. This psychosocial dysfunction hindered the patients from re-establishing quality of life.

Differences between participants and non-participants in an RCT on physical activity and psychological interventions for older persons

Background and aims: Volunteer bias in intervention studies on successful aging has been poorly explored. This paper investigated differences between participants and non-participants of the Groningen Intervention Study on Successful Aging (GISSA) over a wide range of demographic, physical, psychological and social subject characteristics. Methods: Subjects were recruited among a longitudinal cohort study (Groningen Longitudinal Aging Study) and included 558 men and 711 women, aged 65–96 years, who were invited to participate in the GISSA. Measures were obtained by questionnaires at the moment of invitation and eight years before invitation. Participants were compared with three groups of non-participants: persons who refused to participate, those who did not respond after a reminder, and those who intended to participate but withdrew before pre-test. Results: At the moment of invitation, participants were younger, better educated, and functionally and physically more active than the three groups of non-participants. They also had better scores on the physical functioning subscale of the medical outcome scale, better ADL, iADL and vigorous ADL functions and fewer depressive symptoms, and perceived less social support in everyday and problem situations. Participants reported a less strong rate of decline in physical and psychological functioning in the eight years prior to the invitation than did the other groups. Conclusion: Due to volunteer bias, results of intervention studies on successful aging may have limited generalizability.

Adaptability and Flexibility of the Human Motor System:Implications for Neurological Rehabilitation

This article stresses the plasticity of the adult sensorimotor cortex in response to various injuries or environmental changes. The dominant role of sensory input is discussed. A number of studies are presented that show how input may lead to learning and change. Learning is discussed in relation to recovery. It is shown how concepts from the field of motor control and learning may be used for improving neurological rehabilitation. Specific attention is given to the variability of input, the meaningfulness of input, and the role of the learning context. The learning context and the application context should have essential characteristics in common, otherwise transfer of learning will be non-optimal. It is argued that learning landscapes are necessary in order to treat patients in such a way that he learned skills are transferable to situations outside the hospital.

Neuropsychology and the relearning of motor skills following stroke.

Regaining independent mobility is one of the most important goals in physical therapy with patients suffering from the consequences of stroke. Both physical therapy and occupational therapy are learning processes in which the patient has to remaster old skills or has to learn novel skills. It is argued that the (re-)learning of motor control is a process in which motor aspects continuously interact with sensory and cognitive processes. It is therefore necessary that neuropsychological knowledge should be integrated in the therapy in order to create the most optimal situation for learning. In this article the most prominent neuropsychological consequences are described and suggestions are given as to how a therapist may use this knowledge to improve the therapy.

Cognitive deficits following stroke in the basal ganglia

Objective: To examine the effect of a stroke in the basal ganglia on cognitive functioning. Design: As part of a larger prospective study on the neuropsychological and psychosocial consequences of stroke, 12 patients with a stroke confined to the basal ganglia were examined. Setting: The patients were assessed in one of the three participating hospitals. Subjects: The results of 12 patients with a stroke in the basal ganglia (mean age 55 years), were compared to 24 controls (mean age 54.3 years). Main outcome measures: Different aspects of memory, attention and concentration, visuospatial and visuoconstructive functions, language and arithmetic were assessed using neuropsychological tests. Results: The data show a significant abnormality in cognitive functioning on all cognitive domains. Conclusions: The results stress the notion that subcortical damage may lead to substantial neuropsychological disorders and have clear implications for neurological rehabilitation.

Don't bite my finger, look in the direction I am pointing

First, we thank the editor for giving us the opportunity to react on Peter Brugger’s comments on our article Born to Adapt, but not in your dreams. This will be a short reaction since Brugger’s comment is actually not a comment on our approach or on the interpretation of the results, or on our theoretical viewpoint, or on the employed methodology. Indeed, he does not question these aspects at all. It is more an additional paper focused on authors who in the past asked similar or related questions. This, of course, is useful and it creates always a sense of humility in the minds of present authors who, indeed, often have to admit that they are part of a continuous stream of thoughts and that their own thoughts do not represent a unique highlight. This point of Brugger’s paper is well taken when re-reading the end-line of our introduction. Nevertheless, the question is what Bruggers comments add to the primary message of our modest paper, on top of the above mentioned feeling of historical awareness and modesty. Our message was that although the brain is a biological system of remarkable flexibility, continuously adapting to alterations in the periphery, at the same time it shows stability in other domains. The intactness of the experienced image of the body in the amputee’s dreams reflects such stability. This is not at all a trivial finding but shows the multi-faceted character of concepts such as body image. The data of the older studies presented by Brugger are largely in accordance with the findings as presented in our article. So what can we learn? Brugger refers to eight additional studies that were focusing (among others) on body awareness during dreams. These authors, of which the oldest one, (Katz, 1921), is not in the reference list, however, are not focused exclusively on the expe