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Nijmegen, Netherlands

Zedlitz A.M.E.E.,Radboud University Nijmegen | Fasotti L.,Radboud University Nijmegen | Fasotti L.,Sint Maartenskliniek Research | Geurts A.C.H.,Radboud University Nijmegen | Geurts A.C.H.,Donders Center for Neuroscience
Clinical Rehabilitation

Purpose: Post-stroke fatigue is a common and debilitating complaint, which has only recently received attention in clinical rehabilitation. Until now, no evidence-based treatments have been available for the condition. Therefore, a new treatment was designed to reduce post-stroke fatigue complaints: Cognitive and Graded Activity Training (COGRAT). Rationale: Following the premise that post-stroke fatigue is primarily caused by brain damage, the treatment aims to prevent fatigue and to manage existing fatigue symptoms. The purpose of the added graded activity programme is to reduce fatigue by changing cognitions and enhancing physical fitness. Theory into practice: COGRAT consists of a cognitive treatment and graded activity programme in small groups over 12 weeks. In the cognitive treatment, patients receive education on post-stroke fatigue and register their activities and fatigue to gain insight into their daily agenda and fatigability. Patients are then taught several compensation strategies. Cognitive behavioural therapy is used to diminish anxiety, facilitate behavioural change and manage fatigue symptoms. The graded activity programme consists of walking on a treadmill, strength training and home work assignments. Maximum heart rate and strength are increased from 40% at the beginning of the training to a maximum of 70%. Considerations for future improvements: COGRAT is currently being evaluated in outpatients with severe post-stroke fatigue in a multicentre randomized controlled trial. Preliminary data suggest both positive short- and long-term effects. Adaptations for other neurological patient groups suffering from fatigue are suggested. © 2011 The Author(s). Source

Weerdesteyn V.,Radboud University Nijmegen | Weerdesteyn V.,Sint Maartenskliniek Research | Laing A.C.,University of Waterloo | Robinovitch S.N.,Simon Fraser University
Gait and Posture

The mechanical efficiency of stepping to recover balance can be expressed by a biomechanical model that includes the trunk inclination angle and the angle of the leg at the instant of stepping-foot contact. The aim of the present study was to test the hypothesis that this model would accurately predict the successfulness of recovery attempts (recovery vs. falls) following large backward perturbations. Ten young participants were exposed to a series of 12 very large postural perturbations in the backward direction by means of a support-surface translation. At the instant of stepping-foot contact, we calculated the trunk inclination angle and the angle of the stepping leg with the vertical. Reaction time, step duration, step velocity and step length were also determined. A logistic regression analysis revealed that the model with leg and trunk inclination angles accurately predicted successful recovery, with a more forward tilted trunk and a further backward positioned leg increasing the probability of success. The set of spatiotemporal step variables was significantly less predictive. Over the course of the experiment, participants gradually became more successful in recovering balance, which coincided with an increase in leg but not in trunk angles. In conclusion, the body configuration at the instant of first stepping-foot contact accurately predicted successful balance recovery after a backward postural perturbation. Given the observation that participants improved their performance by increasing their leg angles, which suggests that it may be easier to improve this variable, compared to the trunk angle, by exercise interventions. © 2011 Elsevier B.V. Source

Ruiter M.B.,Sint Maartenskliniek Research | Kolk H.H.J.,Radboud University Nijmegen | Rietveld T.C.M.,Radboud University Nijmegen
Neuropsychological Rehabilitation

This study investigated whether a Dutch and adapted version of Reduced Syntax Therapy (REST) could stimulate and automatise the production of ellipses in Dutch-speaking, chronically agrammatic speakers (N = 12). Ellipses are syntactic frames in which slots for grammatical morphology tend to be lacking (e.g., everybody inside). When elliptical style is applied on a regular basis, the linguistic impairment is circumvented, at least for the greater part. We therefore hypothesised that REST increases participants' functional communication skills (i.e., communicative efficacy and efficiency). This is of relevance because not all chronically agrammatic speakers become skilled at employing ellipses independently. The results of the present study suggested that when elliptical style is applied regularly, chronically agrammatic speakers get their message across more efficiently when compared to error-strewn production of sentential style. © 2010 Psychology Press. Source

Potocanac Z.,Catholic University of Leuven | Hoogkamer W.,Catholic University of Leuven | Carpes F.P.,Federal University of Pampa | Pijnappels M.,VU University Amsterdam | And 3 more authors.
Gait and Posture

While walking, one often has to suppress and adjust a planned step in order to avoid a fall. Given that steps are preprogrammed this requires some form of motor inhibition. Motor inhibition is commonly tested in hand function and only recently attempts have been made to evaluate inhibition in the lower limbs, during step initiation. As adequate motor inhibition might play a role in avoiding falls a test to assess response inhibition during walking would be valuable. We developed a task in which subjects walked on a treadmill by stepping on projected patches of light, which could suddenly change color forcing the subjects to avoid it by shortening or lengthening their steps. The difficulty level was manipulated in 4 conditions by changing the distance available to respond. We hypothesized that larger demands on motor inhibition during walking would produce more failures and tested the performance of young adults (n= 12) in order to establish the protocol for use in older adults. The failure rate on the walking test was analyzed. Reducing the available response distance by 150 mm from the easiest condition resulted in a significant increase in failure rates from 15.6% to 65.1%. Therefore, results indicate this novel test can be used to assess the level of motor inhibition during walking. Additionally, in comparison to previous literature on obstacle avoidance, our experiment shows that changing a precise aiming movement is considerably more challenging than changing the same movement executed automatically. © 2013 Elsevier B.V. Source

DeVos M.J.,Orthopaedic Surgeon ter Gooi Hospital | Verdonschot N.,Radboud University Nijmegen | Luites J.W.H.,Sint Maartenskliniek Research | Anderson P.G.,Sint Maartenskliniek Research | Eygendaal D.,Orthopedic Surgeon Amphia Hospital
Bone and Joint Journal

We determined the short-term clinical outcome and migration within the bone of the humeral cementless component of the Instrumented Bone Preserving (IBP) total elbow replacement in a series of 16 patients. There were four men and 12 women with a mean age at operation of 63 years (40 to 81). Migration was calculated using radiostereometric analysis. There were no intra-operative complications and no revisions. At two-year followup, all patients showed a significant reduction in pain and functional improvement of the elbow (both p < 0.001). Although ten components (63%) showed movement or micromovement during the first six weeks, 14 (88%) were stable at one year postoperatively. Translation was primarily found in the proximal direction (median 0.3 mm (interquartile range (IQR) -0.09 to 0.8); the major rotational movement was an anterior tilt (median 0.7 (IQR 0.4 to 1.6)). One malaligned component continued to migrate during the second year, and one component could not be followed beyond three months because migration had caused the markers to break off the prosthesis. This study shows promising early results for the cementless humeral component of the IBP total elbow replacement. All patients had a good clinical outcome, and most components stabilised within six months of the operation. Source

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