Rudolf Magnus Institute for Neuroscience

Utrecht, Netherlands

Rudolf Magnus Institute for Neuroscience

Utrecht, Netherlands
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Cieza A.,Ludwig Maximilians University of Munich | Kirchberger I.,Ludwig Maximilians University of Munich | Kirchberger I.,Swiss Paraplegic Research | Biering-Sorensen F.,Copenhagen University | And 10 more authors.
Spinal Cord | Year: 2010

Study design:A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed.Objectives:The objective of the study was to report on the results of the consensus process to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set, and a Brief ICF Core Set for individuals with spinal cord injury (SCI) in the long-term context.Setting:The consensus conference took place in Switzerland. Preparatory studies were performed worldwide.Methods:Preparatory studies included an expert survey, a systematic literature review, a qualitative study and empirical data collection involving people with SCI. Relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds.Results: The preparatory studies identified a set of 595 ICF categories at the second, third or fourth level. A total of 34 experts from 31 countries attended the consensus conference (12 physicians, 6 physical therapists, 5 occupational therapists, 6 nurses, 3 psychologists and 2 social workers). Altogether, 168 second-, third- or fourth-level categories were included in the Comprehensive ICF Core with 44 categories from body functions, 19 from body structures, 64 from activities and participation and 41 from environmental factors. The Brief Core Set included a total of 33 second-level categories with 9 on body functions, 4 on body structures, 11 on activities and participation and 9 on environmental factors.Conclusion:A formal consensus process integrating evidence and expert opinion based on the ICF led to the definition of the ICF Core Sets for individuals with SCI in the long-term context. Further validation of this first version is needed. © 2010 International Spinal Cord Society All rights reserved.


Kirchberger I.,Ludwig Maximilians University of Munich | Cieza A.,Ludwig Maximilians University of Munich | Cieza A.,Swiss Paraplegic Research | Biering-Sorensen F.,Copenhagen University | And 10 more authors.
Spinal Cord | Year: 2010

Study design:A formal decision-making and consensus process integrating evidence gathered from preparatory studies was followed.Objectives:The aim of this study was to report on the results of the consensus process to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set and a Brief ICF Core Set for individuals with spinal cord injury (SCI) in the early post-acute context.Setting:The consensus conference took place in Switzerland. Preparatory studies were performed worldwide.Methods:Preparatory studies included an expert survey, a systematic literature review, a qualitative study and empirical data collection involving people with SCI. ICF categories were identified in a formal consensus process by international experts from different backgrounds.Results:The preparatory studies identified a set of 531 ICF categories at the second, third and fourth levels. From 30 countries, 33 SCI experts attended the consensus conference (11 physicians, 6 physical therapists, 5 occupational therapists, 6 nurses, 3 psychologists and 2 social workers). Altogether 162 second-, third- or fourth-level categories were included in the Comprehensive ICF Core Sets with 63 categories from the component Body Functions, 14 from Body Structures, 53 from Activities and Participation and 32 from Environmental Factors. The Brief Core Set included a total of 25 second-level categories with 8 on Body Functions, 3 on Body Structures, 9 on Activities and Participation, and 5 on Environmental Factors.Conclusion:A formal consensus process-integrating evidence and expert opinion based on the ICF led to the ICF Core Sets for individuals with SCI in the early post-acute context. Further validation of this first version is needed. © 2010 International Spinal Cord Society All rights reserved.


De Groot S.,Rehabilitation Center Amsterdam | De Groot S.,University of Groningen | Post M.W.M.,Rudolf Magnus Institute for Neuroscience | Smit C.A.J.,Rehabilitation Center Amsterdam | Van Der Woude L.H.V.,University of Groningen
Assistive Technology Research Series | Year: 2010

The purpose of this study was to determine the construct and divergent validity of the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) in people with spinal cord injury (SCI). The construct validity was examined by relationships between PASIPD and measures of fitness (peak oxygen uptake, peak power output, muscular strength) and activities (wheelchair skills, Utrecht Activity List, mobility range and social behaviour subscales of the SIP68) in 139 persons with SCI 1 year after discharge from inpatient rehabilitation. Divergent validity was determined by comparing PASIPD scores of people with different personal (age, gender, body mass index) and lesion characteristics (paraplegia/tetraplegia, completeness, time since injury). PASIPD scores showed low correlations with fitness parameters (0.25-0.36, p<0.05) and low to moderate correlations with activities (0.36-0.51, p<0.01). Persons with a tetraplegia or longer time since injury had significantly lower PASIPD scores compared to those with a paraplegia (p<0.02; effect size: 0.17) or those with a short time since injury (p<0.03; effect size: 0.30). It can be concluded that the PASIPD showed weak to moderate relationships with fitness and activity parameters. This construct validity is comparable to self-report questionnaires from the general population. The divergent validity of the PASIPD was low. Therefore, the PASIPD should be used with caution in persons with SCI. © 2010 The authors and IOS Press. All rights reserved.


Charlifue S.,Craig Hospital | Post M.W.,Rudolf Magnus Institute for Neuroscience | Biering-Sorensen F.,Rigshospitalet | Biering-Sorensen F.,Copenhagen University | And 8 more authors.
Spinal Cord | Year: 2012

Study design: Survey of expert opinion, feedback, and development of final consensus. Objective: Present the background, purpose, development process and results for the International Spinal Cord Injury (SCI) Quality of Life (QoL) Basic Data Set. Setting: International. Methods: A committee of experts was established to select and define data elements to be included in an International SCI QoL Basic Data Set. A draft data set was developed and disseminated to appropriate organizations for comment. All suggested revisions were considered, and a final version of the QoL data set was completed. Results: The QoL data set consists of 3 variables: ratings of satisfaction with general quality of life, satisfaction with physical health, and satisfaction with psychological health. All variables are rated on a scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied). Conclusion: Collection of the International SCI QoL Basic Data Set variables should be a part of all future studies of SCI QoL to facilitate comparison of results across published studies from around the world. Additional standardized instruments to assess other aspects of QoL can be administered based on the purpose of a particular study. © 2012 International Spinal Cord Society All rights reserved.


Eriks-Hoogland I.E.,Swiss Paraplegic Research | De Groot S.,University of Groningen | Post M.W.M.,Rudolf Magnus Institute for Neuroscience | Van Der Woude L.H.V.,University of Groningen
Journal of Rehabilitation Medicine | Year: 2011

Objective: To study the correlation between limited shoulder range of motion in persons with spinal cord injury at discharge and the performance of activities, wheeling performance, transfers and participation one year later. Design: Multicentre prospective cohort study. Subjects: A total of 146 newly injured subjects with spinal cord injury. Methods: Shoulder range of motion was measured at discharge. One year later, Functional Independence Measure (FIM), transfer ability, wheelchair circuit and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) were assessed. Corrections were made for possible confounding factors (age, gender, level and completeness of injury, time since injury and shoulder pain). Results: All subjects with limited shoulder range of motion at discharge had a lower FIM motor score and were less likely (total group 5 times, and subjects with tetraplegia 10 times less likely) to be able to perform an independent transfer one year later. Subjects with limited shoulder range of motion in the total group needed more time to complete the wheelchair circuit. No significant associations with the PASIPD were found in either group. Conclusion: Persons with spinal cord injury and limited shoulder range of motion at discharge are more limited in their activities one year later than those without limited shoulder range of motion. © 2011 The Authors.


Scheel-Sailer A.,Clinic Swiss Paraplegic Center | Wyss A.,Clinic Swiss Paraplegic Center | Boldt C.,Munich University of Applied Sciences | Boldt C.,Swiss Paraplegic Research | And 4 more authors.
Spinal Cord | Year: 2013

Study design:This was a prospective cohort study.Objectives:The objective was to describe the incidence, prevalence, characteristics of pressure ulcers (PUs) and the association with specific patient characteristics in a consecutive sample of in-patients with a spinal cord injury (SCI).Setting:An acute care and rehabilitation clinic specialized in SCIs in Switzerland.Methods:The presence and characteristics of PUs for all adult patients with a SCI admitted to the clinic from 1 September 2009 to 28 February 2010 were recorded on a daily basis during their complete hospitalization. Risk factors were analyzed in univariate and multivariate logistic regression models.Results:A total of 185 patients were included in the study and observed for the entirety of their hospitalization. The prevalence of at least one PU was 49.2% in all patients, compared with 25.4% in the group of patients admitted without PUs. The incidence was 2.2 per person and year. In 91 patients, a total of 219 PUs were observed. PUs were most frequently located on the foot (36.1%), and the coccyx/sacrum (15.1%). The risk for occurrence of a PU increased with age (odds ratio (OR)=1.04) and post SCI (OR=1.03). In the multivariate analyses, the risk for PUs was lower for patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) of C or D (OR C =0.25, OR D =0.28) compared with patients with an AIS of A.Conclusion:Using a daily documentation system, PUs were detected as a frequent complication of SCIs. Completeness of injury, age and time since injury were significant risk factors for PUs. The foot was a region at high risk for PUs. © 2013 International Spinal Cord Society All rights reserved.


Post M.W.M.,Rudolf Magnus Institute for Neuroscience | Kirchberger I.,Ludwig Maximilians University of Munich | Scheuringer M.,Ludwig Maximilians University of Munich | Scheuringer M.,MSD Sharp and Dohme GmbH | And 2 more authors.
Spinal Cord | Year: 2010

Objectives:This study is part of the development of an International Classification of Functioning, Disability and Health (ICF) Core Set for spinal cord injury (SCI). Its specific objectives were to identify outcome parameters reported in published studies on individuals with SCI in the early post-acute and chronic situation, and to identify and quantify the concepts of the reported parameters using the ICF as a reference.Methods:Electronic searches of Medline, EMBASE, PsycINFO and CINAHL from 2001 to 2005 were carried out. All outcome parameters and their underlying concepts were retrieved from the included studies. These concepts were linked to categories of the ICF using standardized rules.Results:From the 6681 abstracts retrieved, 2205 were randomly selected (33.0%) and 281 studies met the inclusion criteria (12.7%). A total number of 5217 concepts were retrieved from standardized and non-standardized measures, of which 4049 (77.6%) could be linked to 175 different ICF categories: 56 out of 114 Body Functions, 19 out of 56 Body Structures, 62 out of 118 Activities and Participation and 38 out of 74 Environmental Factors categories. Second-level categories reported in 20% of all studies were pain, remunerative employment, health services, systems and policies, school education and higher education.Conclusion:The ICF provides a valuable reference to identify and quantify the concepts of measures focusing on SCI in the early post-acute and chronic situation. The findings show a great diversity in the consequences of SCI and underscore the importance of social participation and environment for people with SCI. © 2010 International Spinal Cord Society All rights reserved.


Franssen H.,Rudolf Magnus Institute for Neuroscience | Gebbink T.A.,Rudolf Magnus Institute for Neuroscience | Wokke J.H.J.,Rudolf Magnus Institute for Neuroscience | Van Den Berg L.H.,Rudolf Magnus Institute for Neuroscience | Van Schelven L.J.,University Utrecht
Journal of the Peripheral Nervous System | Year: 2010

Cold paresis may occur in multifocal motor neuropathy and lower motor neuron disease. It was proposed to reflect nerve lesions where axons are depolarized due to loss of Na/K-pump activity. In those circumstances, a further decrease in pump activity by cooling may induce extra depolarization, conduction block, and weakness. Evidence for this hypothesis is incomplete because it is unknown if cold induces depolarization in human motor axons and other factors may contribute to the symptoms. To solve these questions, we examined 10 normal subjects. At 37, 25, 20, and 15°C we assessed: excitability in the median nerve, decrement on 3-Hz stimulation, pulsed Doppler of a wrist artery, and thenar muscle strength. Cooling induced: (1) findings compatible with axonal depolarization on excitability testing (fanning-in of threshold electrotonus, steepened current threshold relation, increased refractory period, decreased super- and subexcitability), (2) decreased Doppler peak systolic velocity without causing ischemia, (3) decreased muscle strength and impaired muscle relaxation. Decrement tests and compound muscle action potential amplitude remained normal. The excitability findings induced by cooling were best explained by axonal depolarization due to the effect of temperature on Na/K-pump activity. The induced weakness may be explained not only by this mechanism but also by impaired muscle contraction. © 2010 Peripheral Nerve Society.


Straver D.C.G.,Rudolf Magnus Institute for Neuroscience | Van Den Berg L.H.,Rudolf Magnus Institute for Neuroscience | Van Doorn P.A.,Rotterdam University | Franssen H.,Rudolf Magnus Institute for Neuroscience | Franssen H.,University Utrecht
Journal of the Peripheral Nervous System | Year: 2011

Activity-induced weakness was reported in multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyneuropathy (CIDP). This was attributed to activity-dependent conduction block (CB) arising in demyelinated axons. It is not known if activity-induced weakness is common, nor if it is specific forMMNand CIDP. We, therefore, carried out an investigation by questionnaire in 64 MMN patients, 52 CIDP patients, 48 progressive spinal muscular atrophy (PSMA) patients, and 30 normal subjects. Subjects were asked if they experienced an increase in weakness when performing 10 common tasks. The percentage of tasks causing activity-induced weakness was higher in the patient groups than in the normal subjects (p < 0.001). The risk of activity-induced weakness exceeding that in normal subjects was sixfold higher for each patient group when adjusted for sex, age, and a fatigue score. With further adjustment for scores of weakness and axon loss, no significant differences were found between the patient groups. In conclusion, activity-induced weakness is frequently reported in MMN and CIDP. It is, however, not specific for these neuropathies as PSMA patients reported it to the same extent. © 2011 Peripheral Nerve Society.


Geyh S.,Swiss Paraplegic Research AG | Geyh S.,University of Lucerne | Muller R.,Swiss Paraplegic Research AG | Peter C.,Swiss Paraplegic Research AG | And 11 more authors.
American Journal of Physical Medicine and Rehabilitation | Year: 2011

Objective: The overall objective of this study was to illustrate a systematic approach for capturing the psychologic-personal perspective in International Classification of Functioning, Disability and Health-based comprehensive research on spinal cord injury (SCI) in terms of what and how to measure. The specific aims were to identify (1) relevant areas of research for capturing the psychologic-personal factors in a study that is planned and conceptualized according to the comprehensive context of the International Classification of Functioning, Disability and Health, using SCI as a case in point; (2) a set of domains relevant for SCI research from a psychologic-personal perspective; and (3) suitable measurement instruments that can be considered for the assessment of those identified domains based on a set of predefined guiding principles. Design: The psychologic-personal factor structure was developed based on an item pool of 1246 entries from secondary analyses of available data from SCI studies. The domain set for psychologic-personal factors was identified through reviewing the scientific literature in PubMed and PsycInfo. The set of measurement instruments was collected using available measurement reviews, searches in the literature, instrument databases, and further sources and was selected using guiding principles. Results: Forty specific psychologic-personal factors, subdivided into seven areas of research, were identified: (1) sociodemographic personal characteristics, (2) the position in the immediate social and physical context, (3) personal history and biography, (4) feelings, (5) thoughts and beliefs, (6) motives, and (7) patterns of experience and behavior. The psychologic-personal factors domain set contains both cross-cutting outcome domains, namely quality-of-life, life satisfaction, subjective well-being, and sociodemographic personal characteristics, life events, positive and negative affect, perceived stress, locus of control, self-efficacy, purpose in life, coping, lifestyle, and personality. For each of the identified domains, a pool of measurement instruments was listed, and the application of predefined guiding principles for measurement instrument selection was exemplified for self-efficacy. It resulted in the selection of the General Self-Efficacy Scale by Schwarzer and Jerusalem (Measures in Health Psychology: A User's Portfolio. Causal and Control Beliefs. pp. 35-37; 1995). Conclusions: The results of the current article contributed to creating a transparent protocol for the Swiss Spinal Cord Injury Cohort study, coordinated by the Swiss Paraplegic Research in Nottwil, Switzerland. This article also stresses the relevance of the comprehensive approach to SCI and the consideration of the psychologic-personal perspective in this approach. The study, therefore, hopes to encourage scientists to use the International Classification of Functioning, Disability and Health and the psychologic-personal perspective as a frame of reference for their research. Furthermore, the research reported in this article can inform the World Health Organization's future development of the personal factors classification in the International Classification of Functioning, Disability and Health. Copyright © 2011 by Lippincott Williams & Wilkins.

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