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Van Der Woude L.H.V.,University of Groningen | De Groot S.,University of Groningen | De Groot S.,Amsterdam Rehabilitation Research Center | Postema K.,University of Groningen | And 4 more authors.
Disability and Rehabilitation | Year: 2013

Background: With today's specialized medical care, life expectancy of persons with a spinal cord injury (SCI) has considerably improved. With increasing age and time since injury, many individuals with SCI, however, show a serious inactive lifestyle, associated with deconditioning and secondary health conditions (SHCs) (e.g. pressure sores, urinary and respiratory tract infections, osteoporosis, upper-extremity pain, obesity, diabetes, cardiovascular disease) and resulting in reduced participation and quality of life (QoL). Avoiding this downward spiral, is crucial. Objectives: To understand possible deconditioning and SHCs in persons aging with a SCI in the context of active lifestyle, fitness, participation and QoL and to examine interventions that enhance active lifestyle, fitness, participation and QoL and help prevent some of the SHCs. Methods: A multicentre multidisciplinary research program (Active LifestyLe Rehabilitation Interventions in aging Spinal Cord injury, ALLRISC) in the setting of the long-standing Dutch SCI-rehabilitation clinical research network. Results: ALLRISC is a four-study research program addressing inactive lifestyle, deconditioning, and SHCs and their associations in people aging with SCI. The program consists of a cross-sectional study (n = 300) and three randomized clinical trials. All studies share a focus on fitness, active lifestyle, SHCs and deconditioning and outcome measures on these and other (participation, QoL) domains. It is hypothesized that a self-management program, low-intensity wheelchair exercise and hybrid functional electrical stimulation-supported leg and handcycling are effective interventions to enhance active life style and fitness, help to prevent some of the important SHCs in chronic SCI and improve participation and QoL. Conclusion: ALLRISC aims to provide evidence-based preventive components of a rehabilitation aftercare system that preserves functioning in aging persons with SCI. Implications for Rehabilitation Rehabilitation aftercare is important to prevent secondary health complaints and deconditioning in persons aging with a spinal cord injury. Rehabilitation practice needs to develop a proper system of rehabilitation aftercare. Active lifestyle and fitness are important ingredients for a healthy perspective in persons aging with a spinal cord injury. © 2013 Informa UK, Ltd.

De Groot S.,Amsterdam Rehabilitation Research Center | De Groot S.,University of Groningen | Post M.W.,University Utrecht | Snoek G.J.,Roessingh Rehabilitation Center | And 2 more authors.
Spinal Cord | Year: 2013

Objective: To investigate: (1) the course of coronary heart disease risk factors (lipid profiles and body mass index (BMI)) in the first five years after discharge from inpatient spinal cord injury (SCI) rehabilitation and (2) the association between lifestyle (physical activity, self-care related to fitness, smoking, alcohol, body mass and low-fat diet) and coronary heart disease risk factors during that period.Design: Prospective cohort study.Participants/ methods: Individuals with SCI (N=130). Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and BMI were determined at discharge from inpatient rehabilitation and 1 and 5 years after discharge. Using multilevel regression models, the effects of lifestyle (drinking alcohol, smoking, active lifestyle and self-care) on the lipid profiles and BMI were determined. Results: After correction for lesion and personal characteristics, no changes in lipid profiles in the five years after discharge were seen, whereas the BMI increased significantly with 1.8 kg m -2. A high percentage was at risk of cardiovascular disease due to high BMI (63-75%) or HDL (66-95%). The individuals who indicated to maintain their fitness level as good as possible and the individuals with a low BMI showed better lipid profiles. Individuals with a more active lifestyle showed higher HDL levels. Individuals who avoid smoking showed a 1.5 kg m-2 higher BMI. Conclusion: Lipid profiles seem to stabilize in the years after discharge from inpatient SCI rehabilitation, whereas the BMI increased. Lifestyle factors associated with a favorable lipid profile and BMI could be identified. © 2013 International Spinal Cord Society All rights reserved.

Post M.W.,University Utrecht | Post M.W.,Swiss Paraplegic Research | Van Leeuwen C.M.,University Utrecht | Van Leeuwen C.M.,Swiss Paraplegic Research | And 3 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2012

Post MW, van Leeuwen CM, van Koppenhagen CF, de Groot S. Validity of the Life Satisfaction questions, the Life Satisfaction Questionnaire, and the Satisfaction With Life Scale in persons with spinal cord injury. Objective: To assess and compare the validity of 3 life satisfaction instruments in persons with spinal cord injury (SCI). Design: Cross-sectional study 5 years after discharge from inpatient rehabilitation. Setting: Eight rehabilitation centers with specialized SCI units. Participants: Persons (N=225) with recently acquired SCI between 18 and 65 years of age were included in a cohort study. Data were available for 145 persons 5 years after discharge. Interventions: Not applicable. Main Outcome Measures: The Life Satisfaction questions (LS Questions), the Life Satisfaction Questionnaire (LiSat-9), and the Satisfaction With Life Scale (SWLS). Results: There were no floor or ceiling effects. Cronbach α was questionable for the LS Questions (.60), satisfactory for the LiSat-9 (.75), and good for the SWLS (.83). Concurrent validity was shown by strong and significant Spearman correlations (.59-.60) between all 3 life satisfaction instruments. Correlations with measures of mental health and participation were.52 to.56 for the LS Questions,.45 to.52 for the LiSat-9, and.41 to.48 for the SWLS. Divergent validity was shown by weak and in part nonsignificant correlations between the 3 life satisfaction measures and measures of functional independence and lesion characteristics. Conclusions: Overall, the validity of all 3 life satisfaction measures was supported. Despite questionable internal consistency, the concurrent and divergent validity of the LS Questions was at least as good as the validity of the LiSat-9 and the SWLS. © 2012 American Congress of Rehabilitation Medicine.

Adriaansen J.J.E.,University Utrecht | Lindeman E.,University Utrecht | Van Der Woude L.H.V.,University of Groningen | De Groot S.,University of Groningen | And 2 more authors.
Disability and Rehabilitation | Year: 2013

Purpose: To describe the prevalence of secondary health conditions (SHCs) (urinary tract and bowel problems, pressure ulcers, spasticity, musculoskeletal and neuropathic pain, sexual dysfunction, respiratory and cardiovascular disorders) in persons with long-term spinal cord injury (SCI), and to explore the impact of SHCs on fitness, active lifestyle, participation and well-being. Methods: A time since injury (TSI)-stratified cross-sectional study among 300 persons between 28-and 65-year-old with a SCI for at least 10 years. Strata of TSI are 10-19, 20-29, and 30 or more years. All eight Dutch rehabilitation centres with a SCI unit will participate. Participants will be invited for a 1-day visit to the rehabilitation centre for an aftercare check-up by the local SCI rehabilitation physician (neurological impairment, SHCs and management), physical tests by a trained research assistant (lung function, wheelchair skills, physical capacity), and they will be asked to complete a self-report questionnaire in advance. Results: Not applicable. Conclusion: This study will provide knowledge on the health status and functioning of persons aging with SCI living in the Netherlands. This knowledge will help us to develop predictive models for the occurrence of SHCs and to formulate guidelines to improve health care for persons with long-term SCI. Implications for Rehabilitation Persons with long-term spinal cord injury may be susceptible to many types of secondary health conditions (i.e. pressure ulcers, urinary tract infections, pain and spasticity). Coordinated long-term health care is required for this population but this is currently not operational in all specialized rehabilitation centres in the Netherlands. This study aims to develop predictive models for the occurrence of secondary health conditions and to develop guidelines to improve long-term health care for persons living with a spinal cord injury in the Netherlands. © 2013 Informa UK, Ltd.

de Groot S.,Amsterdam Rehabilitation Research Center | de Groot S.,University of Groningen | Nieuwenhuizen M.G.,Amsterdam Rehabilitation Research Center
Medical Engineering and Physics | Year: 2013

The purpose of this study was to evaluate the validity and reliability of assessing activities, movement intensity (MI) and energy expenditure (EE) measured by accelerometry. 28 Able-bodied participants performed standardized tasks while an accelerometer was worn and oxygen uptake was measured. After uploading the accelerometer data to the manufacturer's website, a report was received that gave minute-by-minute MI and EE of the performed activities. Validity was assessed by comparing reported activities and EE with the actual performed activities and calculated EE from the oxygen uptake, and by testing whether MI differed between walking velocities and cycling resistances. Reliability was assessed by performing the protocol twice. Except for standing (classified predominantly (82%) as sitting), most activities were categorized mainly correctly (93-100%). A difference in MI was detected between walking speeds but not between cycling resistances. EE was overestimated for walking (ICC. =. 0.54) and underestimated for cycling (ICC. =. 0.03). Reliability of MI was high (ICC. =. 0.91) but reliability for the relative time spent in activities or the step count was weak to moderate. In conclusion, most activities were categorized correctly, MI seemed to be valid and reliable but reliability is low for relative time spent in activities and EE cannot be estimated well. © 2013 IPEM.

Kwakkel G.,VU University Amsterdam | Kwakkel G.,Amsterdam Rehabilitation Research Center | Veerbeek J.M.,VU University Amsterdam | van Wegen E.E.H.,VU University Amsterdam | Wolf S.L.,Atlanta Center for Visual and Neurocognitive Rehabilitation
The Lancet Neurology | Year: 2015

Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for the rehabilitation of patients. Original CIMT includes constraining of the non-paretic arm and task-oriented training. Modified versions also apply constraining of the non-paretic arm, but not as intensive as original CIMT. Behavioural strategies are mostly absent for both modified and original CIMT. With forced use therapy, only constraining of the non-paretic arm is applied. The original and modified types of CIMT have beneficial effects on motor function, arm-hand activities, and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas there is no evidence for the efficacy of constraint alone (as used in forced use therapy). The type of CIMT, timing, or intensity of practice do not seem to affect patient outcomes. Although the underlying mechanisms that drive modified and original CIMT are still poorly understood, findings from kinematic studies suggest that improvements are mainly based on adaptations through learning to optimise the use of intact end-effectors in patients with some voluntary motor control of wrist and finger extensors after stroke. © 2015 Elsevier Ltd.

Van Delden A.E.Q.,VU University Amsterdam | Peper C.E.,VU University Amsterdam | Nienhuys K.N.,Amsterdam Rehabilitation Research Center | Zijp N.I.,Amsterdam Rehabilitation Research Center | And 3 more authors.
Stroke | Year: 2013

Background and Purpose - Unilateral and bilateral training protocols for upper limb rehabilitation after stroke represent conceptually contrasting approaches with the same ultimate goal. In a randomized controlled trial, we compared the merits of modified constraint-induced movement therapy, modified bilateral arm training with rhythmic auditory cueing, and a dose-matched conventional treatment. Modified constraint-induced movement therapy and modified bilateral arm training with rhythmic auditory cueing targeted wrist and finger extensors, given their importance for functional recovery. We hypothesized that modified constraint-induced movement therapy and modified bilateral arm training with rhythmic auditory cueing are superior to dose-matched conventional treatment. Methods - Sixty patients, between 1 to 6 months after stroke, were randomized over 3 intervention groups. The primary outcome measure was the Action Research Arm test, which was conducted before, directly after, and 6 weeks after intervention. Results - Although all groups demonstrated significant improvement on the Action Research Arm test after intervention, which persisted at 6 weeks follow-up, no significant differences in change scores on the Action Research Arm test were found between groups postintervention and at follow-up. Conclusions - Modified constraint-induced movement therapy and modified bilateral arm training with rhythmic auditory cueing are not superior to dose-matched conventional treatment or each other in improving upper limb motor function 1 to 6 months after stroke. © 2013 American Heart Association, Inc.

Van Den Hoek J.,University of Amsterdam | Roorda L.D.,Amsterdam Rehabilitation Research Center | Boshuizen H.C.,Wageningen University | Van Hees J.,Amsterdam Rehabilitation Research Center | And 4 more authors.
Arthritis Care and Research | Year: 2013

Objective To describe long-term physical functioning and its association with somatic comorbidity and comorbid depression in patients with established rheumatoid arthritis (RA). Methods Longitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Patient-reported outcomes were collected in 1997, 1998, 1999, 2002, and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the physical component summary score of the Short Form 36 health survey. Somatic comorbidity was measured by a questionnaire including 12 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Studies Depression Scale. We distinguished 4 groups of patients based on comorbidity at baseline. Results Seventy-two percent of the patients at baseline were women. The mean ± SD age was 59.3 ± 14.8 years and the median disease duration was 5.0 years (interquartile range 2.0-14.0 years). For the total group of patients with RA, physical functioning improved over time. Patients with somatic comorbidity, comorbid depression, or both demonstrated worse physical functioning than patients without comorbidity at all data collection points. Both groups with comorbid depression had the lowest scores. Only patients with both somatic comorbidity and comorbid depression showed significantly less improvement in physical functioning over time. Conclusion Both somatic comorbidity and comorbid depression were negatively associated with physical functioning during an 11-year followup period. Furthermore, their combination seems to be especially detrimental to physical functioning over time. These results emphasize the need to take somatic comorbidity and comorbid depression into account in the screening and treatment of patients with RA. Copyright © 2013 by the American College of Rheumatology.

Van Kordelaar J.,VU University Amsterdam | Van Wegen E.E.H.,VU University Amsterdam | Nijland R.H.M.,VU University Amsterdam | Daffertshofer A.,VU University Amsterdam | And 2 more authors.
Neurorehabilitation and Neural Repair | Year: 2013

Background. During upper limb motor recovery after stroke, the greatest improvements occur typically in the first 5 weeks poststroke. It is unclear what patients learn during this early phase of recovery. Objective. To investigate the hypothesis that, early poststroke, patients learn to master the degrees of freedom in the paretic upper limb as reflected by dissociated shoulder and elbow movements during reach-to-grasp. Methods. Thirty-one patients with a first-ever ischemic stroke were included. Repeated 3-dimensional kinematic measurements were conducted at 14, 25, 38, 57, 92, and 189 days poststroke. Trunk, shoulder, elbow, and wrist rotations were measured during a reach-to-grasp task. Using principal component analysis the longitudinal changes in dissociated upper limb movements during reach-to-grasp were investigated. Twelve healthy subjects were included for comparison. Results. The main coordination pattern during reach-to-grasp in patients with stroke and healthy subjects consisted mostly of horizontal shoulder adduction and elbow extension. The standard deviation of this main pattern increased over time, with the largest increase in the first 5 weeks poststroke (F = 5.5, P <.001), but remained smaller than in healthy individuals. The standard deviation increased by 0.46 per day between 14 and 38 days and tapered off to 0.05 per day between 38 and 189 days poststroke. Conclusions. Our results suggest that restitution of motor control by dissociation of shoulder and elbow movements occurs mainly early poststroke. However, compared with healthy adults, most patients did not achieve fully dissociated upper limb movements at 26 weeks poststroke, suggesting that upper limb motor control after stroke remains adaptive. © The Author(s) 2013.

Van Kordelaar J.,VU University Amsterdam | Van Wegen E.,VU University Amsterdam | Kwakkel G.,VU University Amsterdam | Kwakkel G.,Amsterdam Rehabilitation Research Center
Archives of Physical Medicine and Rehabilitation | Year: 2014

Objective To establish the time course of recovery regarding smoothness of upper limb movements in the first 6 months poststroke. Design Cohort study with 3-dimensional kinematic measurements in weeks 1, 2, 3, 4, 5, 8, 12, and 26 poststroke. Setting Onsite 3-dimensional kinematic measurements in stroke units, rehabilitation centers, nursing homes, and patients' homes. Participants Patients (N=44; 19 women, 25 men; mean age ± SD, 58±12y) with a first-ever unilateral ischemic stroke and incomplete upper limb paresis (27 left sided, 17 right sided) were included. Interventions Not applicable. Main Outcome Measures In each measurement, an electromagnetic motion tracker acquired hand and finger trajectories during a reach-to-grasp task. Movement duration was determined, and smoothness of hand transport and grasp aperture was quantified by normalized jerk. With the use of random coefficient analysis, the effect of progress of time on smoothness of hand transport and grasp aperture was investigated. Results During the first 5 weeks poststroke, there was a significant contribution of progress of time to reductions in movement duration and normalized jerk of hand transport and grasp aperture (P<.01). Conclusions The present longitudinal 3-dimensional kinematic study showed that smoothness of paretic upper limb movements improves in the first 8 weeks poststroke. This improvement suggests that motor control normalizes in the first 8 weeks poststroke and can be mostly explained by spontaneous neurologic recovery that occurs typically in the first weeks poststroke. Future 3-dimensional kinematic studies should investigate whether therapies starting early after stroke can improve the quality of motor control beyond spontaneous neurologic recovery. © 2014 by the American Congress of Rehabilitation Medicine.

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