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Rheinfelden, Switzerland

Wondrusch C.,ZHAW Zurich University of Applied Sciences | Schuster-Amft C.,Reha Rheinfelden | Schuster-Amft C.,Bern University of Applied Sciences
Frontiers in Human Neuroscience

Background: For patients with central nervous system (CNS) lesions and sensorimotor impairments a solid motor imagery (MI) introduction is crucial to understand and use MI to improve motor performance. The study's aim was to develop and evaluate a standardized MI group introduction program (MIIP) for patients after stroke, multiple sclerosis (MS), Parkinson's disease (PD), and traumatic brain injury (TBI). Methods: Phase 1: Based on literature a MIIP was developed comprising MI theory (definition, type, mode, perspective, planning) and MI practice (performance, control). Phase 2: Development of a 27-item self-administered MIIP evaluation questionnaire, assessing MI knowledge self-evaluation of the ability to perform MI and patient satisfaction with the MIIP. Phase 3: Evaluation of MIIP and MI questionnaire by 2 independent MI experts based on predefined criteria and 2 patients using semi-structured interviews. Phase 4: Case series with a pre-post design to evaluate MIIP (3 × 30 min) using the MI questionnaire, Imaprax, Kinaesthetic and Visual Imagery Questionnaire, and Mental Chronometry. The paired t-test and the Wilcoxon signed-rank test were used to determine significant changes. Results: Data of eleven patients were analysed (5 females; age 62.3 ± 14.1 years). Declarative MI knowledge improved significantly from 5.4 ± 2.2 to 8.8 ± 2.9 (p = 0.010). Patients demonstrated good satisfaction with MIIP (mean satisfaction score: 83.2 ± 11.4%). MI ability remained on a high level but showed no significant change, except a significant decrease in the Kinaesthetic and Visual Imagery Questionnaire score. Conclusion: The presented MIIP seems to be valid and feasible for patients with CNS lesions and sensorimotor impairments resulting in improved MI knowledge. MIIP sessions can be held in groups of four or less. MI ability and Mental Chronometry remained unchanged after 3 training sessions. © 2013 Wondrusch and Schuster-Amft. Source

Stoller O.,Bern University of Applied Sciences | Waser M.,Swiss Tropical and Public Health Institute | Stammler L.,Bern University of Applied Sciences | Schuster C.,Reha Rheinfelden
Gait and Posture

Background: Neurological disorders lead to walking disabilities, which are often treated using robot-assisted gait training (RAGT) devices such as the driven gait-orthosis Lokomat. A novel integrated biofeedback system was developed to facilitate therapeutically desirable activities during walking. The aim of this study was to evaluate the feasibility to detect changes during RAGT by using this novel biofeedback approach in a clinical setting for patients with central neurological disorders. Methods: 84 subjects (50 men and 34 women, mean age of 58. ±. 13. years) were followed over 8 RAGT sessions. Outcome measures were biofeedback values as weighted averages of torques measured in the joint drives and independent parameters such as guidance force, walking speed, patient coefficient, session duration, time between sessions and total treatment time. Results: Joint segmented analysis showed significant trends for decreasing hip flexion activity (. p≤. .003) and increasing knee extension activity (. p≤. .001) during RAGT sessions with an intercorrelation of . r=. -.43 (. p≤. .001). Further associations among independent variables were not statistically significant. Conclusion: This is the first study that evaluates the Lokomat integrated biofeedback system in different neurological disorders in a clinical setting. Results suggest that this novel biofeedback approach used in this study is not able to detect progress during RAGT. These findings should be taken into account when refining existing or developing new biofeedback strategies in RAGT relating to appropriate systems to evaluate progress and support therapist feedback in clinical settings. © 2011 Elsevier B.V.. Source

Schuster C.,Reha Rheinfelden | Schuster C.,Oxford Brookes University | Wirth B.,ETH Zurich | Ettlin T.,Reha Rheinfelden | Ettlin T.,University of Basel
BMC Medical Research Methodology

Background: A combination of physical practice and motor imagery (MI) can improve motor function. It is essential to assess MI vividness in patients with sensorimotor impairments before implementing MI interventions. The study's aims were to translate the Canadian Kinaesthetic and Visual Imagery Questionnaire (KVIQ) and the French Imaprax, and to examine reliability and validity of the German versions. Methods. Questionnaires were translated according to guidelines. With examiner's help patients (diagnosis: stroke: subacute/chronic, brain tumour, Multiple Sclerosis, Parkinson's disease) were tested twice within seven days (T0, T1). KVIQ-G: Patients were shown a movement by the examiner, before executing and imagining the movement. They rated vividness of the image and intensity of the sensations on a five-point Likert-scale. Imaprax required a 3-step procedure: imagination of one of six gestures; evaluation of gesture understanding, vividness, and imagery perspective. Questionnaire data were analysed overall and for each group. Reliability parameters were calculated: intraclass correlation coefficient (ICC), Cronbach's alpha, standard error of measurement, minimal detectable change. Validity parameters included Spearman's rank correlation coefficient and factor analysis of the KVIQ-G-20. Results: Patients (N = 73, 28 females, age: 63 ± 13) showed the following at T0: KVIQ-G-20vis 41.7 ± 9, KVIQ-G-10vis 21.1 ± 5. ICC for KVIQ-G-20vis and KVIQ-G-10vis was 0.77; KVIQ-G-20kin 36.4 ± 12, KVIQ-G-10kin 18.3 ± 6. ICCs for KVIQ-G-20kin and KVIQ-G-10kin were 0.83/0.85; Imapraxvis 32.7 ± 4 and ICC 0.51. Internal consistency was estimated for KVIQ-G-20 αvis = 0.94/αkin = 0.92, KVIQ-G-10 αvis = 0.88/αkin = 0.96, Imaprax-G αvis = 0.70. Validity testing was performed with 19 of 73 patients, who chose an internal perspective: rs = 0.36 (p = 0.13). Factor analysis revealed two factors correlating with r = 0.36. Both explain 69.7% of total variance. Conclusions: KVIQ-G and Imaprax-G are reliable instruments to assess MI in patients with sensorimotor impairments confirmed by a KVIQ-G-factor analysis. KVIQ-G visual values were higher than kinaesthetic values. Patients with Multiple Sclerosis showed the lowest, subacute stroke patients the highest values. Hemiparetic patients scored lower in both KVIQ-G subscales on affected side compared to non-affected side. It is suggested to administer the Imaprax-G before the KVIQ-G to test patient's ability to distinguish between external and internal MI perspective. Duration of both questionnaires lead to an educational effect. Imaprax validity testing should be repeated. © 2012 Schuster et al.; licensee BioMed Central Ltd. Source

Schuster C.,Reha Rheinfelden | Schuster C.,Oxford Brookes University | Hilfiker R.,University of Applied Sciences and Arts Western Switzerland | Amft O.,TU Eindhoven | And 9 more authors.
BMC Medicine

Background: The literature suggests a beneficial effect of motor imagery (MI) if combined with physical practice, but detailed descriptions of MI training session (MITS) elements and temporal parameters are lacking. The aim of this review was to identify the characteristics of a successful MITS and compare these for different disciplines, MI session types, task focus, age, gender and MI modification during intervention.Methods: An extended systematic literature search using 24 databases was performed for five disciplines: Education, Medicine, Music, Psychology and Sports. References that described an MI intervention that focused on motor skills, performance or strength improvement were included. Information describing 17 MITS elements was extracted based on the PETTLEP (physical, environment, timing, task, learning, emotion, perspective) approach. Seven elements describing the MITS temporal parameters were calculated: study duration, intervention duration, MITS duration, total MITS count, MITS per week, MI trials per MITS and total MI training time.Results: Both independent reviewers found 96% congruity, which was tested on a random sample of 20% of all references. After selection, 133 studies reporting 141 MI interventions were included. The locations of the MITS and position of the participants during MI were task-specific. Participants received acoustic detailed MI instructions, which were mostly standardised and live. During MI practice, participants kept their eyes closed. MI training was performed from an internal perspective with a kinaesthetic mode. Changes in MI content, duration and dosage were reported in 31 MI interventions. Familiarisation sessions before the start of the MI intervention were mentioned in 17 reports. MI interventions focused with decreasing relevance on motor-, cognitive- and strength-focused tasks. Average study intervention lasted 34 days, with participants practicing MI on average three times per week for 17 minutes, with 34 MI trials. Average total MI time was 178 minutes including 13 MITS. Reporting rate varied between 25.5% and 95.5%.Conclusions: MITS elements of successful interventions were individual, supervised and non-directed sessions, added after physical practice. Successful design characteristics were dominant in the Psychology literature, in interventions focusing on motor and strength-related tasks, in interventions with participants aged 20 to 29 years old, and in MI interventions including participants of both genders. Systematic searching of the MI literature was constrained by the lack of a defined MeSH term. © 2011 Schuster et al; licensee BioMed Central Ltd. Source

Findling O.,Reha Rheinfelden | Findling O.,University of Bern | Schuster C.,Reha Rheinfelden | Sellner J.,TU Munich | And 2 more authors.
Gait and Posture

Objective: This study assessed the addition effect of mild traumatic brain injury (MTBI) on the balance control of patients who simultaneously suffered a whiplash associated disorder (WAD). Background: Dizziness is common in patients suffering from whiplash injury with or without a MTBI, but data is lacking about the additional balance problems and dizziness caused by MTBI. Methods: 44 patients with WAD and MTBI and 36 WAD patients without MTBI participated in the study. A dizziness handicap index (DHI) was used to quantify self-perceived handicap. Balance control was assessed using measures of trunk sway for a battery of stance and gait tests. Results: Patients with WAD and MTBI perceived significantly higher dizziness and unsteadiness (higher score in DHI Emotional category) and had greater trunk sway than WAD patients without MTBI for stance tasks and complex gait tasks (e.g. walking up and down stairs). Both groups had greater sway than controls for these tasks. Both groups of patients showed equal reductions in trunk sway with respect to controls for simple gait tasks (e.g. walking while rotating the head). Conclusions: A similar pattern of balance impairment was present in patients with whiplash injury with and without MTBI. However, the impairment was greater for stance and complex gait tasks in WAD patients with MTBI. © 2011 Elsevier B.V. Source

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