Johannes B. J. Bussmann

Mirror Therapy Improves Hand Function in Subacute Stroke: A Randomized Controlled Trial

OBJECTIVEnTo evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke.nnnDESIGNnRandomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months.nnnSETTINGnRehabilitation education and research hospital.nnnPARTICIPANTSnA total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke.nnnINTERVENTIONSnThirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks.nnnMAIN OUTCOME MEASURESnThe Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument).nnnRESULTSnThe scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS.nnnCONCLUSIONSnIn our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.

Motor Recovery and Cortical Reorganization After Mirror Therapy in Chronic Stroke Patients A Phase II Randomized Controlled Trial

Objective. To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. Methods. A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline—posttreatment and at 6 months—were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). Results. Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P < .05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P < .05). Conclusion. This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.

Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review.

OBJECTIVESnRecently, numerous studies have reported that psychological factors can influence the outcome of total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, a systematic overview is missing. The objective of this study was to examine which psychological factors influence the outcome of TKA and THA and to what extent.nnnMETHODSnData were obtained from the MEDLINE and EMBASE databases from inception to January 2011. Search terms included TKA and THA, outcome measures, and psychological aspects. Two reviewers independently selected the studies. Studies with a prospective before-after design with a minimum follow-up time of 6 weeks were included. One reviewer extracted the results and 2 reviewers independently conducted quality assessment. We distinguished between follow-up shorter and equal or longer than 1 year.nnnRESULTSnThirty-five of 1837 studies met the inclusion criteria and were included in this systematic review. In follow-ups shorter than 1 year, and for knee patients only, strong evidence was found that patients with pain catastrophizing reported more pain postoperatively. Furthermore, strong evidence was found that preoperative depression had no influence on postoperative functioning. In long-term follow-up, 1 year after TKA, strong evidence was found that lower preoperative mental health (measures with the SF-12 or SF-36) was associated with lower scores on function and pain. For THA, only limited, conflicting, or no evidence was found.nnnCONCLUSIONSnLow preoperative mental health and pain catastrophizing have an influence on outcome after TKA. With regard to the influence of other psychological factors and for hip patients, only limited, conflicting, or no evidence was found.

Recovery of Physical Functioning After Total Hip Arthroplasty: Systematic Review and Meta-Analysis of the Literature

Background After total hip arthroplasty (THA), patients today (who tend to be younger and more active than those who previously underwent this surgical procedure) have high expectations regarding functional outcome. Therefore, patients need to be well informed about recovery of physical functioning after THA. Purpose The purpose of this study was to review publications on recovery of physical functioning after THA and examine the degree of recovery with regard to 3 aspects of functioning (ie, perceived physical functioning, functional capacity to perform activities, and actual daily activity in the home situation). Data Sources Data were obtained from the MEDLINE and EMBASE databases from inception to July 2009, and references in identified articles were tracked. Study Selection Prospective studies with a before-after design were included. Patients included in the analysis had to have primary THA for osteoarthritis. Data Extraction and Synthesis Two reviewers independently checked the inclusion criteria, conducted the risk of bias assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model. Results A total of 31 studies were included. For perceived physical functioning, patients recovered from less than 50% preoperatively to about 80% of that of controls (individuals who were healthy) 6 to 8 months postsurgery. On functional capacity, patients recovered from 70% preoperatively to about 80% of that of controls 6 to 8 months postsurgery. For actual daily activity, patients recovered from 80% preoperatively to 84% of that of controls at 6 months postsurgery. Limitations Only a few studies were retrieved that investigated the recovery of physical functioning longer than 8 months after surgery. Conclusions Compared with the preoperative situation, the 3 aspects of physical functioning showed varying degrees of recovery after surgery. At 6 to 8 months postoperatively, physical functioning had generally recovered to about 80% of that of controls.

Automated estimation of initial and terminal contact timing using accelerometers; development and validation in transtibial amputees and controls

The aim of this study was to develop and validate an automated accelerometry-based system for estimating initial contact (IC) and terminal contact (TC) timing information from walking patterns of healthy control subjects and transtibial amputees that can be used in daily life with minimal interference of researchers. Subjects were instrumented with two uniaxial accelerometers just below the knee while synchronized ground reaction force (GRF) recordings were used as reference measurements. An automated multiphase algorithm was developed to estimate the time of IC and TC in the acceleration signals of five healthy subjects and two transtibial amputees walking at different walking speeds. The accuracy of the detection algorithm in ten control subjects and eight transtibial amputees indicated mean errors ranging between 0.013 and 0.034 s for the TC and IC timing, with 95% confidence interval of the individual step errors ranging between -0.062 and 0.115 s. Correlation coefficients between the estimated stance phase duration and GRF data were 0.98 and 0.97 for controls and amputees, respectively. We concluded that IC and TC can be accurately and easily measured using this system in both healthy subjects and transtibial amputees walking at different walking speeds. The system can be used in clinical situations or gait labs as well as during daily life.

Ambulatory activity monitoring: Progress in measurement of activity, posture, and specific motion patterns in daily life

Behavior is central to psychology in almost any definition. Although observable activity is a core aspect of behavior, assessment strategies have tended to focus on emotional, cognitive, or physiol...

Sensitivity of Accelerometry to Assess Balance Control During Sit-to-Stand Movement

Accelerometry has the potential to measure balance, defined as high-frequency body sway, ambulatorily in a simple and inexpensive way. The aim of this study was to determine and compare the sensitivity of accelerometric balance parameters during the sit-to-stand (STS) movement. Eleven healthy subjects (four males, 28.2 plusmn7.9 years) and 31 patients with stroke (21 males; 63.3plusmn12.8 years) were included. The healthy subjects performed STS movements in four conditions with different levels of difficulty. Data of the patients were compared 1) with healthy subjects, 2) between patient subgroups, and 3) between different phases of recovery to assess the sensitivity of accelerometry for differences in balance control. Accelerometers were attached to the trunk, and force plate measurements were simultaneously done in the healthy subjects. Main outcome measures were root mean square (rms) and area under the curve (AUC) derived from the high-frequency component of the transversal acceleration signal of the trunk. In all comparisons there was a significant difference in AUC data (p < 0.05), and AUC appeared to be more sensitive than rms. Variability in AUC was not completely or mainly the result of changes and differences in the duration of the STS movement. As a conclusion, accelerometry is a potentially valuable technique to measure balance during the STS movement.

Effect of tadalafil on blood flow, pain, and function in chronic cold Complex Regional Pain Syndrome: A randomized controlled trial

BackgroundThis double-blind, randomized, controlled trial investigated the effect of the phosphodiesterase-5 inhibitor tadalafil on the microcirculation in patients with cold Complex Regional Pain Syndrome (CRPS) in one lower extremity.MethodsTwenty-four patients received 20 mg tadalafil or placebo daily for 12 weeks. The patients also participated in a physical therapy program. The primary outcome measure was temperature difference between the CRPS side and the contralateral side, determined by measuring the skin temperature with videothermography. Secondary outcomes were: pain measured on a Visual Analogue Scale, muscle force measured with a MicroFet 2 dynamometer, and level of activity measured with an Activity Monitor (AM) and walking tests.ResultsAt the end of the study period, the temperature asymmetry was not significantly reduced in the tadalafil group compared with the placebo group, but there was a significant and clinically relevant reduction of pain in the tadalafil group. Muscle force improved in both treatment groups and the AM revealed small, non-significant improvements in time spent standing, walking, and the number of short walking periods.ConclusionTadalafil may be a promising new treatment for patients that have chronic cold CRPS due to endothelial dysfunction, and deserves further investigation.Trial RegistrationThe registration number in the Dutch Trial Register is ISRCTN60226869.

Daily Physical Activity and Heart Rate Response in People With a Unilateral Traumatic Transtibial Amputation

OBJECTIVESnTo test the hypothesis that people with a unilateral traumatic transtibial amputation are less active than people without an amputation, and to explore whether both groups have a similar heart rate response while walking.nnnDESIGNnA case-comparison study.nnnSETTINGnGeneral community.nnnPARTICIPANTSnNine subjects with a unilateral traumatic transtibial amputation and 9 matched subjects without known impairments.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnPercentage of dynamic activities in 48 hours (expressing activity level). Additionally, we examined heart rate and percentage heart rate reserve during walking (expressing heart rate response) and body motility during walking (expressing walking speed). These parameters were objectively measured at participants homes on 2 consecutive days.nnnRESULTSnSubjects with an amputation showed a lower percentage of dynamic activities (6.0% vs 11.7% in a 48-h period, P=.02). No significant differences were found between the 2 groups in heart rate (91.1 bpm vs 89.5 bpm, P=.86) and percentage heart rate reserve during walking (28.2% vs 27.5%, P=1.0). Body motility during walking was lower in the amputation group (.14 g vs .18 g, P<.01).nnnCONCLUSIONSnOur results support our hypothesis that persons with a unilateral traumatic transtibial amputation are considerably less active than persons without known impairments. The results indicate that heart rate response during walking is similar in both groups, and is probably regulated by adapting ones walking speed.

Analysis and decomposition of accelerometric signals of trunk and thigh obtained during the sit-to-stand movement

Piezoresistive accelerometer signals fre frequently used in movement analysis. However, their use and interpretation are complicated by the fact that the signal is composed of different acceleration components. The aim of the study was to obtain insight into the components of accelerometer signals from the trunk and thigh segments during four different sit-to-stand (STS) movements (self-selected, slow, fast and fullflexion). Nine subjects performed at least six trials of each type of STS movement. Accelerometer signals from the trunk and thigh in the sagittal direction were decomposed using kinematic data obtained from an opto-electronic device. Each acceleration signal was decomposed into gravitational and inertial components, and the inertial component of the trunk was subsequently decomposed into rotational and translational components. The accelerometer signals could be reliably reconstructed: mean normalised root mean square (RMS) trunk: 6.5% (range 3–12%), mean RMS thigh: 3% (range 2–5%). The accelerometric signals were highly characteristic and repeatable. The influence of the inertial component was significant, especially on the timing of the specific event of maximum trunk flexion in the accelerometer signal. The effect of inertia was larger in the trunk signal than in the thigh signal and increased with higher speeds. The study provides insight into the acceleration signal, its components and the influence of the type of STS movement and supports its use in STS movement analysis.