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Kimberley TJ, Prudente CN, Engineer ND, Dickie DA, Bisson TA, Van de Winckel A. Vagus Nerve Stimulation Paired With Mobility Training in Chronic Ischemic Stroke: A Case Report. Phys Ther 2023; 103:pzad097. [PMID: 37669130 DOI: 10.1093/ptj/pzad097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/28/2023] [Accepted: 07/02/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE The purpose of this case report is to describe pairing vagus nerve stimulation (VNS) with mobility training in an individual after stroke. METHODS A 53-year-old man with left hemiparesis 14.2 months after an ischemic stroke participated in a pilot study investigating the safety and feasibility of VNS paired with upper limb rehabilitation. In addition to upper limb impairment, the participant had impaired gait and wanted to improve his mobility. A single-subject design investigation of VNS paired with self-directed mobility training was conducted. Following the conclusion of the pilot study, the participant was instructed to complete daily sessions of self-activated VNS paired with walking or stationary biking. The 10-Meter Walk Test and timed distance (6-Minute Walk Test) were assessed at 4 baseline points and at 3 to 41 months after mobility training. RESULTS The participant had stable baseline values and was classified as a household ambulator with a quad cane. After VNS-paired mobility training, statistically significant improvements were observed in all measures, with the greatest improvements at 9 months exceeding the minimal detectable change: self-selected gait speed from 0.34 (standard deviation [SD] = 0.01) to 0.60 meters/second, fast gait speed from 0.37 (SD = 0.03) to 0.79 meters/second, and 6-Minute Walk Test distance from 106.91 (SD = 6.38) to 179.83 meters. The participant reported increased confidence and balance when walking. No falls or adverse events were reported. CONCLUSION The participant demonstrated improved gait speed and timed distance after VNS-paired mobility training. Randomized, blinded trials are needed to determine treatment efficacy. IMPACT This is the first documented case of VNS-paired mobility training in an individual with chronic poststroke gait impairments. VNS paired with mobility training may improve poststroke gait impairments.
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Affiliation(s)
- Teresa J Kimberley
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Departments of Physical Therapy and Rehabilitation Science, Rehabilitation Science PhD Program, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Cecília N Prudente
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- MicroTransponder Inc, Austin, Texas, USA
| | | | - David Alexander Dickie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Teresa A Bisson
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ann Van de Winckel
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
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Zhang JJ, Van de Winckel A. Editorial: Insights in interventions for rehabilitation: 2023. Front Rehabil Sci 2023; 4:1326850. [PMID: 38046522 PMCID: PMC10691531 DOI: 10.3389/fresc.2023.1326850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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Feng S, McDaniel S, Van de Winckel A. Finding functionality: Rasch analysis of the Functionality Appreciation Scale in community-dwelling adults in the US. Front Rehabil Sci 2023; 4:1222892. [PMID: 37849959 PMCID: PMC10577199 DOI: 10.3389/fresc.2023.1222892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
Introduction The Functionality Appreciation Scale (FAS) measures an individual's appreciation for the functions their body can perform, regardless of the individual's physical limitations. Prior studies reported on internal consistency, test-retest reliability, convergent validity, and exploratory or confirmatory factor analyses, but Rasch analysis has not yet been performed to evaluate the structural validity of the FAS. Methods We recruited community-dwelling adults at the Minnesota State Fair and through contact lists of participants identifying interest in research done in the Brain Body Mind Lab (University of Minnesota). Community-dwelling adults with spinal cord injury (SCI) completed the FAS over Zoom. We analyzed the FAS using Rasch Measurement Theory, which produced the following outputs: item, and person fit, targeting, unidimensionality, person separation reliability (PSR), local item dependence (LID), principal component analysis of residuals (PCAR), and differential item functioning (DIF). Results We recruited 567 participants (average age 52.15 ± 17.5 years, 63.84% women), among which 14 adults with SCI. After rescoring 3 items and deleting 1 item, the FAS had good person and item fit (except item 4). The PCAR and subsequent paired t-tests (3.53%) confirmed the unidimensionality of the scale. There was no DIF and only one item pair had LID (item 5-6). PSR was 0.75, reflecting a capacity to differentiate groups of people with high or low functionality appreciation levels. However, there was a significant ceiling effect (28.04%) and the person mean location was 3.06 ± 2.07 logits, indicating the FAS is too easy for community-dwelling adults in the US. Discussion The 6-item Rasch-based FAS demonstrated unidimensionality, good item fit (except item 4) and person fit, but the FAS will require more difficult items to be added to improve the targeting of the scale, and better reliability.
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Affiliation(s)
- Sarah Feng
- Breck School, Golden Valley, MN, United States
| | | | - Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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Van de Winckel A, Carpentier ST, Deng W, Zhang L, Philippus A, Battaglino R, Morse LR. Feasibility of using remotely delivered Spring Forest Qigong to reduce neuropathic pain in adults with spinal cord injury: a pilot study. Front Physiol 2023; 14:1222616. [PMID: 37719467 PMCID: PMC10500194 DOI: 10.3389/fphys.2023.1222616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction: Approximately 69% of 299,000 Americans with spinal cord injury (SCI) suffer debilitating chronic neuropathic pain, which is intractable to treatment. The aim of this study is to determine feasibility, as the primary objective, and estimates of efficacy of a remotely delivered Qigong intervention in adults with SCI-related neuropathic pain, as the secondary objective. Methods: We recruited adults with SCI-related neuropathic pain, with SCI ≥3 months, with complete or incomplete SCI, and highest neuropathic pain level of >3 on the Numeric Pain Rating Scale (NPRS), using nationwide volunteer sampling. Using a non-randomized controlled trial design, participants practiced Spring Forest Qigong's "Five Element Qigong Healing Movements" (online video) by combining movement to the best of their ability with kinesthetic imagery, at least 3x/week for 12 weeks. Adherence was automatically tracked through the Spring Forest Qigong website. Outcomes of neuropathic pain intensity (NPRS) were assessed weekly, and SCI-related symptoms were assessed at baseline, 6, and 12 weeks of Qigong practice and at 6-week and 1-year follow-ups. Results: We recruited 23 adults with chronic SCI (7/2021-2/2023). In total, 18 participants started the study and completed all study components, including the 6-week follow-up. Twelve participants completed the 1-year follow-up assessment. Feasibility was demonstrated through participants' willingness to participate, adherence, and acceptability of the study. Mean age of the 18 participants was 60 ± 12 years, and they were 15 ± 11 years post-SCI with the highest baseline neuropathic pain of 7.94 ± 2.33, which was reduced to 4.17 ± 3.07 after 12 weeks of Qigong practice (Cohen's d = 1.75). This pain relief remained at 6-week and 1-year follow-ups. Participants reported reduced spasm frequency (change score 1.17 ± 1.20, d = 0.98) and severity (0.72 ± 1.02, d = 0.71), reduced interference of neuropathic pain on mood (3.44 ± 2.53, d = 1.36), sleep (3.39 ± 2.40, d = 1.41), daily activities (3.17 ± 2.77, d = 1.14), greater ability to perform functional activities (6.68 ± 3.07, d = 2.18), and improved mood (2.33 ± 3.31, d = 0.70) after Qigong. Discussion: Remote Spring Forest Qigong's "Five Element Qigong Healing Movements" practice is feasible in adults with SCI-related neuropathic pain, with promising prolonged results of neuropathic pain relief and improvement in SCI-related symptoms after Qigong practice. Clinical trial registration: https://www.clinicaltrials.gov/ct2/show/NCT04917107, identifier NCT04917107.
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Sydney T. Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Angela Philippus
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ricardo Battaglino
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Leslie R. Morse
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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Van de Winckel A, Carpentier S, Deng W, Zhang L, Battaglino R, Morse L. Using remotely delivered Spring Forest Qigong™ to reduce neuropathic pain in adults with spinal cord injury: protocol of a quasi-experimental feasibility clinical trial. Pilot Feasibility Stud 2023; 9:145. [PMID: 37608389 PMCID: PMC10464017 DOI: 10.1186/s40814-023-01374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND About 69% of Americans living with spinal cord injury (SCI) suffer from long-term debilitating neuropathic pain, interfering with the quality of daily life. Neuropathic pain is refractory to many available treatments-some carrying a risk for opioid addiction-highlighting an urgent need for new treatments. In this study, we will test our hypothesis that Spring Forest Qigong™ will reduce SCI-related neuropathic pain by improving body awareness. We will determine whether remotely delivered Qigong is feasible and we will collect data on neuropathic pain, and other reported associations with pain such as spasms frequency and/or severity, functional performance, mood, and body awareness. METHODS In this quasi-experimental pilot clinical trial study, adults with SCI will practice Qigong at home with a 45-min video, at least 3 × /week for 12 weeks. The Qigong practice includes movements with guided breathing and is individualized based on functional abilities, i.e., the participants follow along with the Qigong movements to the level of their ability, with guided breathing, and perform kinesthetic imagery by focusing on the feeling in the whole body as if doing the whole-body Qigong movement while standing. The highest, average, and lowest neuropathic pain ratings perceived in the prior week will be recorded weekly until the 6-week follow-up. The other outcomes will be collected at 5 time points: at baseline, midway during the Qigong intervention (6 weeks), after the Qigong intervention (12 weeks), after a 6-week and 1-year follow-up. Rate parameters for the feasibility markers will be estimated based on the participants who achieved each benchmark. DISCUSSION The University of Minnesota (UMN)'s Institutional Review Board (IRB) approved the study (IRB #STUDY00011997). All participants will sign electronic informed consent on the secure UMN REDCap platform. The results will be presented at academic conferences and published in peer-reviewed publications. TRIAL REGISTRATION ClinicalTrial.gov registration number: NCT04917107 , (this protocol paper refers to the substudy), first registered 6/8/2021.
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, 420 Delaware St SE (MMC 388), Rm 311, Minneapolis, 55455, USA.
| | - Sydney Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
| | - Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Ricardo Battaglino
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
| | - Leslie Morse
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, USA
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Van de Winckel A, Ottiger B, Veerbeek JM, Nyffeler T, Vanbellingen T. Rasch validation of a new scale to measure dependency in arm use in daily life: the Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale. Front Neurol 2023; 14:1154322. [PMID: 37492854 PMCID: PMC10364475 DOI: 10.3389/fneur.2023.1154322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction About 77% of adults with stroke have upper limb impairments. Many scales are available to measure the impairment and activity level of the affected limb. However, an observational scale to assess dependency on others in upper limb performance during daily life activities instead of laboratory settings is lacking. Therefore, we developed a new 5-item Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale (UL-LIMOS). As next step in the psychometric analysis, we evaluated the unidimensionality and structural validity of the UL-LIMOS with Rasch Measurement Theory and we calculated a cut-off score for independent arm use in daily life activities at discharge. Methods This is a single-center cross-sectional study in adults with (sub) acute stroke. We applied Rasch Measurement Theory (RMT) to analyze the structural validation and unidimensionality of the UL-LIMOS. The outputs provide evidence of unidimensionality, item and person fit, overall fit, differential item functioning (DIF), principal component analysis of residuals (PCAR), person separation reliability (PSR), and residual item correlations (to identify local item dependence). Person mean location, floor and ceiling effects identify proper targeting. Results We recruited 407 adults with (sub) acute stroke (median age 63 years, 157 women). All items and persons fit the Rasch model. The PSR of 0.90 indicates that clinicians and researchers can reliably use the scale for individual decision-making. There were small floor (2.70%) and ceiling (13.00%) effects. The average person mean location was 1.32 ± 2.99 logits. There was no DIF. PCAR eigenvalue was 2.46 with 49.23% explained variance. Paired t-tests revealed that 0.89% of person locations were significantly different, confirming unidimensionality. One pair of items (arm and hand use and fine hand use) showed residual item correlations. The ROC's AUC was 0.90, CI95% = [0.85-0.96] with cut-off score of ≥14/20, and high sensitivity (87%, CI95% = [81%-91%]), specificity (83%, CI95% = [77%-87%]) for independent arm use in daily living at discharge. Discussion The new Rasch-based UL-LIMOS is a valid ICF-based observation performance scale at the ICF-activity level, to evaluate dependency during upper limb use in daily life in adults with stroke. Additional psychometric analyses are warranted. The UL-LIMOS would be a valuable addition to the core assessments of adults with (sub) acute stroke.
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Affiliation(s)
- Ann Van de Winckel
- Brain Body Mind Laboratory, Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Blackwood J, Carpentier S, Deng W, Van de Winckel A. Preliminary Rasch analysis of the multidimensional assessment of interoceptive awareness in adults with stroke. PLoS One 2023; 18:e0286657. [PMID: 37267348 DOI: 10.1371/journal.pone.0286657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/21/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE The Multidimensional Assessment of Interoceptive Awareness (MAIA) measures interoceptive body awareness, which includes aspects such as attention regulation, self-regulation, and body listening. Our purpose was to perform a preliminary validation of the MAIA in adults with stroke using Rasch Measurement Theory. METHODS The original MAIA has 32 items that measure interoceptive sensibility, which is an aspect of body awareness. We performed a preliminary analysis with Rasch Measurement Theory to evaluate the unidimensionality and structural validity of the scale. We investigated overall fit to assess unidimensionality, person and item fit, person separation reliability, targeting, local item dependence, and principal components analysis of residuals. RESULTS Forty-one adults with chronic stroke (average 3.8 years post-stroke, 13 women, average age 57±13 years) participated in the study. Overall fit (χ 2 = 62.26, p = 0.26) and item fit were obtained after deleting 3 items and rescoring 26 items. One participant did not fit the model (2.44%). There were no floor (0.00%) or ceiling effects (0.00%). Local item dependence was found in 42 pairs. The person separation reliability was 0.91, and the person mean location was 0.06±1.12 logits. CONCLUSIONS The preliminary structural validity of the MAIA demonstrated good targeting and reliability, as well as unidimensionality, and good item and person fit in adults with chronic stroke. A study with a larger sample size is needed to validate our findings.
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Affiliation(s)
- Jena Blackwood
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sydney Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
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Carpentier S, Deng W, Zhang L, Battaglino R, Morse L, de Winckel AV. Remotely Delivered Spring Forest Qigong™ to Reduce Neuropathic Pain in Adults With Spinal Cord Injury. Arch Phys Med Rehabil 2023. [DOI: 10.1016/j.apmr.2022.12.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Van de Winckel A, Zhang L, Hendrickson T, Lim KO, Mueller BA, Philippus A, Monden KR, Oh J, Huang Q, Sertic JVL, Ruen J, Konczak J, Evans R, Bronfort G. Identifying body awareness-related brain network changes after Spring Forest Qigong™ practice or P.Volve low-intensity exercise in adults with chronic low back pain: a feasibility Phase I Randomized Clinical Trial. medRxiv 2023:2023.02.11.23285808. [PMID: 36824785 PMCID: PMC9949220 DOI: 10.1101/2023.02.11.23285808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background Chronic low back pain (cLBP) affects the quality of life of 52 million Americans and leads to an enormous personal and economic burden. A multidisciplinary approach to cLBP management is recommended. Since medication has limited efficacy and there are mounting concerns about opioid addiction, the American College of Physicians and American Pain Society recommend non-pharmacological interventions, such as mind and body approaches (e.g., Qigong, yoga, Tai Chi) before prescribing medications. Of those, Qigong practice might be most accessible given its gentle movements and because it can be performed standing, sitting, or lying down. The three available Qigong studies in adults with cLBP showed that Qigong reduced pain more than waitlist and equally well than exercise. Yet, the duration and/or frequency of Qigong practice were low (<12 weeks or less than 3x/week). The objectives of this study were to investigate the feasibility of practicing Spring Forest Qigong™ or performing P.Volve low intensity exercises 3x/week for 12 weeks, feasibility of recruitment, data collection, delivery of the intervention as intended, as well as identify estimates of efficacy on brain function and behavioral outcomes after Qigong practice or exercise. To our knowledge, this is the first study investigating the feasibility of the potential effect of Qigong on brain function in adults with cLBP. Methods We conducted a feasibility Phase I Randomized Clinical Trial. Of the 36 adults with cLBP recruited between January 2020 and June 2021, 32 were enrolled and randomized to either 12 weeks of remote Spring Forest Qigong™ practice or remote P.Volve low-intensity exercises. Participants practiced at least 3x/week for 41min/session with online videos. Our main outcome measures were the Numeric Pain Rating Scale (highest, average, and lowest cLBP pain intensity levels in the prior week), assessed weekly and fMRI data (resting-state and task-based fMRI tasks: pain imagery, kinesthetic imagery of a Qigong movement, and robot-guided shape discrimination). We compared baseline resting-state connectivity and brain activation during fMRI tasks in adults with cLBP with data from a healthy control group (n=28) acquired in a prior study. Secondary outcomes included measures of function, disability, body awareness, kinesiophobia, balance, self-efficacy, core muscle strength, and ankle proprioceptive acuity with a custom-build device. Results Feasibility of the study design and methods was demonstrated with 30 participants completing the study (94% retention) and reporting high satisfaction with the programs; 96% adherence to P.Volve low-intensity exercises, and 128% of the required practice intensity for Spring Forest Qigong™ practice. Both groups saw promising reductions in low back pain (effect sizes Cohen's d =1.01-2.22) and in most other outcomes ( d =0.90-2.33). Markers of ankle proprioception were not significantly elevated in the cLBP group after the interventions. Brain imaging analysis showed weaker parietal operculum and insula network connectivity in adults with cLBP (n=26), compared to data from a healthy control group (n=28). The pain imagery task elicited lower brain activation of insula, parietal operculum, angular gyrus and supramarginal gyrus at baseline in adults with cLBP than in healthy adults. Adults with cLBP had lower precentral gyrus activation than healthy adults for the Qigong movement and robot task at baseline. Pre-post brain function changes showed individual variability: Six (out of 13) participants in the Qigong group showed increased activation in the parietal operculum, angular gyrus, supramarginal gyrus, and precentral gyrus during the Qigong fMRI task. Interpretation Our data indicate the feasibility and acceptability of using Spring Forest Qigong™ practice or P.Volve low-intensity exercises for cLBP relief showing promising results in terms of pain relief and associated symptoms. Our brain imaging results indicated brain function improvements after 12 weeks of Qigong practice in some participants, pointing to the need for further investigation in larger studies. Trial registration number ClinicalTrials.gov: NCT04164225 .
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Francisco GE, Engineer N, Dawson J, Kimberley TJ, Cramer S, Prudente CN, Pierce D, Tarver BW, Hinds RHA, Winckel AVD, Yozbatiran N. Vagus Nerve Stimulation Paired with Upper-Limb Rehabilitation After Stroke: Two- and Three-Year Follow-up from the Pilot Study. Arch Phys Med Rehabil 2023:S0003-9993(23)00147-8. [PMID: 37001842 DOI: 10.1016/j.apmr.2023.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To assess whether a long-term home-based intervention using Paired VNS therapy is feasible and whether the benefits of Paired VNS therapy are maintained beyond 1 year. DESIGN A long-term follow-up study. SETTING Three centers in the United States and 1 in the United Kingdom. PARTICIPANTS Adults with chronic ischemic stroke (n=15) with moderate to severe arm and hand impairment. INTERVENTIONS Participants were implanted with a VNS device followed by 6 weeks of in-clinic therapy with Paired (Active) or control VNS followed by home-based rehabilitation through day 90 (blinded phase). The control VNS group then crossed over to receive 6 weeks of in-clinic Active VNS. Participants in both groups then continued a long-term home exercise program with self-administered Active VNS. MAIN OUTCOME MEASURES Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) Functional scores were evaluated at the end of in-clinic therapy and day 90. Since both groups were subsequently receiving home-based rehabilitation with Active VNS during the long term, follow-up outcome assessments were pooled for the analyses at 6, 9, and 12 months, as previously reported. Here, we report pooled analysis of outcomes beyond 1 year. RESULTS One year after Paired VNS therapy, FMA-UE improved by an average of 9.2±8.2 points, as previously reported. Overall, the 2- and 3-year FMA-UE gain from baseline was 11.4±8.7 (P<.001) and 14.8±10.2 points (P<.001), respectively. At years 2 and 3, FMA-UE improved by an additional 2.9 (P=.03 for change vs year 1, n=14) and 4.7 (P=.02 for change vs year 1, n=14) points, respectively. At year 1, 73% (11/15) of participants were responders (FMA-UE change ≥6) and by year 3, 85.7% (12/14) were responders. At years 2 and 3, the WMFT score improved by an additional 0.21 points (P=.03 for change vs year 1, n=15) and 0.42 points (P=.01 for change vs year 1, n=13), respectively. Responder rate (WMFT change ≥0.4) was 46.6% (7/15), 73.3% (11/15), and 69.2% (9/13) at years 1, 2, and 3, respectively. Long-term significant improvements were also observed for Motor Activity Log (MAL) and Stroke Impact Scale, Hand section (SIS-Hand). There were no serious long-term adverse events from the stimulation. CONCLUSIONS Significant effects of Paired VNS therapy at 1 year were maintained at years 2 and 3, and further improvements in both impairment and function were observed in years 2 and 3. These changes were associated with improvements in measures of activity and participation.
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Deng W, Carpentier S, Blackwood J, Van de Winckel A. Rasch validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in community-dwelling adults. BMC Psychol 2023; 11:48. [PMID: 36803574 PMCID: PMC9936469 DOI: 10.1186/s40359-023-01058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/19/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND With the ongoing global COVID-19 pandemic and the recent political divide in the United States (US), there is an urgent need to address the soaring mental well-being problems and promote positive well-being. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) measures the positive aspects of mental health. Previous studies confirmed its construct validity, reliability, and unidimensionality with confirmatory factor analysis. Six studies have performed a Rasch analysis on the WEMWBS, and only one evaluated young adults in the US. The goal of our study is to use Rasch analysis to validate the WEMBS in a wider age group of community-dwelling adults in the US. METHODS We used the Rasch unidimensional measurement model 2030 software to evaluate item and person fit, targeting, person separation reliability (PSR), and differential item functioning (DIF) for sample sizes of at least 200 persons in each subgroup. RESULTS After deleting two items, the WEMBS analyzed in our 553 community-dwelling adults (average age 51.22 ± 17.18 years; 358 women) showed an excellent PSR = 0.91 as well as person and item fit, but the items are too easy for this population (person mean location = 2.17 ± 2.00). There was no DIF for sex, mental health, or practicing breathing exercises. CONCLUSIONS The WEMWBS had good item and person fit but the targeting is off when used in community-dwelling adults in the US. Adding more difficult items might improve the targeting and capture a broader range of positive mental well-being.
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Affiliation(s)
- Wei Deng
- grid.17635.360000000419368657Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN USA
| | - Sydney Carpentier
- grid.17635.360000000419368657Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN USA
| | - Jena Blackwood
- grid.17635.360000000419368657Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN USA
| | - Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, 420 Delaware St SE (MMC 388), Rm 311, Minneapolis, MN, 55455, USA.
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Van de Winckel A, Carpentier ST, Deng W, Zhang L, Philippus A, Monden KR, Battaglino R, Morse LR. Using remotely delivered Spring Forest Qigong™ to reduce neuropathic pain in adults with spinal cord injury: A non-randomized controlled trial. medRxiv 2023:2023.02.11.23285793. [PMID: 36824929 PMCID: PMC9949188 DOI: 10.1101/2023.02.11.23285793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Importance The manuscript proposes the feasibility and potential of a remote Qigong intervention to reduce neuropathic pain in adults with spinal cord injury (SCI)-related neuropathic pain. Objective We determined the feasibility and estimates of efficacy of a remotely delivered Qigong intervention in adults with SCI-related neuropathic pain. Design This is a non-randomized controlled trial with outcomes assessed at baseline-, 6- and 12-weeks of Qigong practice, and at 6-weeks and 1-year follow-up. Setting Completely remote clinical trial. Participants Adults with SCI-related neuropathic pain, with SCI ≥3 months, with complete or incomplete SCI, and highest neuropathic pain level of >3 on the Numeric Pain Rating Scale (NPRS). We used nationwide volunteer sampling.We recruited 23 adults with chronic SCI (7/2021-2/2022). Eighteen participants started the study and completed all study components, including the 6-week follow-up. Twelve participants completed the 1-year follow-up assessment. Intervention Participants practiced the Spring Forest Qigong™ "Five Element Healing Movements" with an online video by combining movement with kinesthetic imagery, at least 3x/week for 12 weeks. Main Outcomes and Measures To address the feasibility outcome and track adherence, the website automatically monitored the days and duration that the Qigong video was played. Self-report neuropathic pain intensity and SCI-related symptoms such as spasms, functional performance, mood, and body appreciation were also collected. Results Eighteen participants, 60±12 years of age, 15±11 years post-SCI had a highest baseline neuropathic pain of 7.94±2.33 on the NPRS, which was reduced to 4.17±3.07 after 12 weeks of Qigong practice (Cohen's d =1.75). This pain relief remained at 6-week and 1-year follow-ups. Participants reported reduced spasm frequency (change score 1.17±1.20, d =0.98) and severity (0.72±1.02, d =0.71), and reduced interference of neuropathic pain on mood (3.44±2.53, d =1.36), sleep (3.39±2.40, d =1.41), and daily activities (3.17±2.77, d =1.14). They had a greater ability to perform functional activities (Patient Specific Functional Scale, 6.68±3.07, d =2.18) and had improved mood (Patient Health Questionnaire-9, 2.33±3.31, d =0.70). Conclusions and Relevance Our preliminary data demonstrate the feasibility of Qigong practice in adults with SCI-related neuropathic pain and promising results of neuropathic pain relief and improvement in SCI-related symptoms after Qigong practice. Trial Registration this manuscript refers to the quasi-experimental substudy CREATION: A Clinical Trial of Qigong for Neuropathic Pain Relief in Adults with Spinal Cord Injury, NCT04917107 , https://www.clinicaltrials.gov/ct2/show/NCT04917107 .
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Van de Winckel A, Carpentier ST, Deng W, Bottale S, Zhang L, Hendrickson T, Linnman C, Lim KO, Mueller BA, Philippus A, Monden KR, Wudlick R, Battaglino R, Morse LR. Identifying Body Awareness-Related Brain Network Changes after Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults with Spinal Cord Injury: Delayed Treatment arm Phase I Randomized Controlled Trial. medRxiv 2023:2023.02.09.23285713. [PMID: 36798345 PMCID: PMC9934787 DOI: 10.1101/2023.02.09.23285713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Background Neuropathic pain after spinal cord injury (SCI) is notoriously hard to treat. Mechanisms of neuropathic pain are unclear, which makes finding effective treatments challenging. Prior studies have shown that adults with SCI have body awareness deficits. Recent imaging studies, including ours, point to the parietal operculum and insula as key areas for both pain perception and body awareness. Cognitive multisensory rehabilitation (CMR) is a physical therapy approach that helps improve body awareness for pain reduction and sensorimotor recovery. Based on our prior brain imaging work in CMR in stroke, we hypothesized that improving body awareness through restoring parietal operculum network connectivity leads to neuropathic pain relief and improved sensorimotor and daily life function in adults with SCI. Thus, the objectives of this study were to (1) determine baseline differences in resting-state and task-based functional magnetic resonance imaging (fMRI) brain function in adults with SCI compared to healthy controls and (2) identify changes in brain function and behavioral pain and pain-associated outcomes in adults with SCI after CMR. Methods Healthy adults underwent a one-time MRI scan and completed questionnaires. We recruited community-dwelling adults with SCI-related neuropathic pain, with complete or incomplete SCI >3 months, and highest neuropathic pain intensity level of >3 on the Numeric Pain Rating Scale (NPRS). Participants with SCI were randomized into two groups, according to a delayed treatment arm phase I randomized controlled trial (RCT): Group A immediately received CMR intervention, 3x/week, 45 min/session, followed by a 6-week and 1-year follow-up. Group B started with a 6-week observation period, then 6 weeks of CMR, and a 1-year follow-up. Highest, average, and lowest neuropathic pain intensity levels were assessed weekly with the NPRS as primary outcome. Other primary outcomes (fMRI resting-state and functional tasks; sensory and motor function with the INSCI AIS exam), as well as secondary outcomes (mood, function, spasms, and other SCI secondary conditions), were assessed at baseline, after the first and second 6-week period. The INSCI AIS exam and questionnaires were repeated at the 1-year follow-up. Findings Thirty-six healthy adults and 28 adults with SCI were recruited between September 2020 and August 2021, and of those, 31 healthy adults and 26 adults with SCI were enrolled in the study. All 26 participants with SCI completed the intervention and pre-post assessments. There were no study-related adverse events. Participants were 52±15 years of age, and 1-56 years post-SCI. During the observation period, group B did not show any reductions in neuropathic pain and did not have any changes in sensation or motor function (INSCI ASIA exam). However, both groups experienced a significant reduction in neuropathic pain after the 6-week CMR intervention. Their highest level of neuropathic pain of 7.81±1.33 on the NPRS at baseline was reduced to 2.88±2.92 after 6 weeks of CMR. Their change scores were 4.92±2.92 (large effect size Cohen's d =1.68) for highest neuropathic pain, 4.12±2.23 ( d =1.85) for average neuropathic pain, and 2.31±2.07 ( d =1.00) for lowest neuropathic pain. Nine participants out of 26 were pain-free after the intervention (34.62%). The results of the INSCI AIS testing also showed significant improvements in sensation, muscle strength, and function after 6 weeks of CMR. Their INSCI AIS exam increased by 8.81±5.37 points ( d =1.64) for touch sensation, 7.50±4.89 points ( d =1.53) for pin prick sensation, and 3.87±2.81 ( d =1.38) for lower limb muscle strength. Functional improvements after the intervention included improvements in balance for 17 out of 18 participants with balance problems at baseline; improved transfers for all of them and a returned ability to stand upright with minimal assistance in 12 out of 20 participants who were unable to stand at baseline. Those improvements were maintained at the 1-year follow-up. With regard to brain imaging, we confirmed that the resting-state parietal operculum and insula networks had weaker connections in adults with SCI-related neuropathic pain (n=20) compared to healthy adults (n=28). After CMR, stronger resting-state parietal operculum network connectivity was found in adults with SCI. Also, at baseline, as expected, right toe sensory stimulation elicited less brain activation in adults with SCI (n=22) compared to healthy adults (n=26). However, after CMR, there was increased brain activation in relevant sensorimotor and parietal areas related to pain and mental body representations (i.e., body awareness and visuospatial body maps) during the toe stimulation fMRI task. These brain function improvements aligned with the AIS results of improved touch sensation, including in the feet. Interpretation Adults with chronic SCI had significant neuropathic pain relief and functional improvements, attributed to the recovery of sensation and movement after CMR. The results indicate the preliminary efficacy of CMR for restoring function in adults with chronic SCI. CMR is easily implementable in current physical therapy practice. These encouraging impressive results pave the way for larger randomized clinical trials aimed at testing the efficacy of CMR to alleviate neuropathic pain in adults with SCI. Clinical Trial registration ClinicalTrials.gov Identifier: NCT04706208. Funding AIRP2-IND-30: Academic Investment Research Program (AIRP) University of Minnesota School of Medicine. National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR002494; the Biotechnology Research Center: P41EB015894, the National Institute of Neurological Disorders & Stroke Institutional Center Core Grants to Support Neuroscience Research: P30 NS076408; and theHigh-Performancee Connectome Upgrade for Human 3T MR Scanner: 1S10OD017974.
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Deng W, Carpentier S, Van de Winckel A. Physical body experiences questionnaire simplified for active aging (PBE-QAG): Rasch validation. PLoS One 2023; 18:e0280198. [PMID: 36763606 PMCID: PMC9916545 DOI: 10.1371/journal.pone.0280198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/22/2022] [Indexed: 02/11/2023] Open
Abstract
PURPOSE To validate the Physical Body Experiences Questionnaire simplified for Active aGing (PBE-QAG) with Rasch Measurement Theory. PBE-QAG measures body awareness during physical activity. METHODS Community-dwelling adults were recruited at the Minnesota State Fair, Highland Fest, and in the Brain Body Mind Lab (University of Minnesota). They completed demographic, clinical, and behavioral questionnaires and the PBE-QAG, which has 12 items, with scoring options ranging between 0 (totally true) and 4 (totally false). A lower total PBE-QAG score on reflects better body awareness. We validated the structural validity of PBE-QAG in community-dwelling older adults, and in community-dwelling adults (18-99 years of age). We also performed a pilot structural validity in community-dwelling adults with chronic stroke. We evaluated item and person fit, targeting, unidimensionality, person separation reliability, differential item functioning for demographic and clinical characteristics, principal component of residuals, and local item dependence. RESULTS We obtained unidimensionality and item fit after deleting and rescoring items in older adults (n = 133), adults (n = 530), and adults with chronic stroke (n = 36). In community-dwelling adults, 7 participants did not fit the model (1.13%). There was minimal floor (5.28%), no ceiling effect (0.00%), and no local item dependence or differential item functioning. The person mean location was -1.77±1.22 logits. CONCLUSIONS PBE-QAG demonstrated good item and person fit, but the targeting is off. Therefore, the current version of PBE-QAG is not recommended for use in community-dwelling adults. We encourage further validation of PBE-QAG by adding more difficult items. We also recommend evaluating the PBE-QAG in a larger group of adults with stroke.
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Affiliation(s)
- Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sydney Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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Van de Winckel A, Carpentier S, Deng W, Bottale S, Hendrickson T, Zhang L, Wudlick R, Linnman C, Battaglino R, Morse L. Identifying Body Awareness-Related Brain Network Changes After Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults With Spinal Cord Injury: Protocol of a Phase I Randomized Controlled Trial. Top Spinal Cord Inj Rehabil 2022; 28:33-43. [PMID: 36457363 PMCID: PMC9678218 DOI: 10.46292/sci22-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background About 69% of the 299,000 Americans living with spinal cord injury (SCI) experience long-term debilitating neuropathic pain. New treatments are needed because current treatments do not provide enough pain relief. We have found that insular-opercular brain network alterations may contribute to neuropathic pain and that restoring this network could reduce neuropathic pain. Here, we outline a study protocol using a physical therapy approach, cognitive multisensory rehabilitation (CMR), which has been shown to restore OP1/OP4 connections in adults post stroke, to test our hypothesis that CMR can normalize pain perception through restoring OP1/OP4 connectivity in adults with SCI and relieve neuropathic pain. Objectives To compare baseline brain function via resting-state and task-based functional magnetic resonance imaging in adults with SCI versus uninjured controls, and to identify changes in brain function and behavioral pain outcomes after CMR in adults with SCI. Methods In this phase I randomized controlled trial, adults with SCI will be randomized into two groups: Group A will receive 6 weeks of CMR followed by 6 weeks of standard of care (no therapy) at home. Group B will start with 6 weeks of standard of care (no therapy) at home and then receive 6 weeks of CMR. Neuroimaging and behavioral measures are collected at baseline, after the first 6 weeks (A: post therapy, B: post waitlist), and after the second 6 weeks (A: post-therapy follow-up, B: post therapy), with follow-up of both groups up to 12 months. Conclusion The successful outcome of our study will be a critical next step toward implementing CMR in clinical care to improve health in adults with SCI.
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Sydney Carpentier
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Wei Deng
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Sara Bottale
- Centro Studi di Riabilitazione Neurocognitiva - Villa Miari (Study Center for Cognitive Multisensory Rehabilitation), Santorso, Italy
| | - Timothy Hendrickson
- University of Minnesota Informatics Institute, Office of the Vice President for Research, University of Minnesota, Minneapolis, Minnesota
| | - Lin Zhang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Rob Wudlick
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Clas Linnman
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ricardo Battaglino
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Leslie Morse
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota
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Hartman J, Sharp A, Van de Winckel A, Tetreault K, Pechak C. Exploring the Characteristics of Doctor of Physical Therapy Students Intending to Work in Medically Underserved Areas. J Health Care Poor Underserved 2022; 33:1368-1382. [DOI: 10.1353/hpu.2022.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mallinson T, Kozlowski AJ, Johnston MV, Weaver J, Terhorst L, Grampurohit N, Juengst S, Ehrlich-Jones L, Heinemann AW, Melvin J, Sood P, de Winckel AV. Rasch Reporting Guideline for Rehabilitation Research (RULER): The RULER Statement. Arch Phys Med Rehabil 2022; 103:1477-1486. [PMID: 35421395 DOI: 10.1016/j.apmr.2022.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
The application of Rasch Measurement (RM) Theory to rehabilitation assessments has proliferated in recent years. RM Theory helps design and refine assessments so that items reflect a unidimensional construct, in an equal interval metric that distinguishes among persons of different abilities in a manner that is consistent with the underlying trait. Rapid growth of RM in rehabilitation assessment studies has led to inconsistent results reporting. Clear, consistent, transparent reporting of RM Theory results is important for advancing rehabilitation science and practice based on precise measures. Precise measures, in turn, provide researchers, practitioners, patients, and other stakeholders with tools for effective decision-making. The goal of this Rasch Reporting Guideline for Rehabilitation Research (RULER) is to provide peer-reviewed, evidence-based, transparent, and consistent recommendations for reporting studies that apply RM Theory in a rehabilitation context. The purpose of the guideline is to ensure that authors, reviewers, and editors have uniform expectations about how to write and evaluate research on rehabilitation outcome assessments. A task force of rehabilitation researchers, clinicians, and editors met regularly between November 2018 and August 2020 to identify the need for the guideline, develop an organizing framework, identify content areas, and develop the recommendations. This RULER statement includes the organizing framework and a checklist of 59 recommendations. The guideline is supported by an Explanation & Elaboration manuscript that provides more detail about the framework and recommendations in the checklist. A glossary of key terms and a recommended iterations table are provided in supplemental, online only materials.
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Affiliation(s)
- Trudy Mallinson
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University
| | - Allan J Kozlowski
- Department of Epidemiology and Biostatistics, Michigan State University - College of Human Medicine and Mary Free Bed Rehabilitation Hospital
| | - Mark V Johnston
- Professor Emeritus, Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin-Milwaukee
| | - Jennifer Weaver
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University; Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
| | - Namrata Grampurohit
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University
| | - Shannon Juengst
- Department of Physical Medicine and Rehabilitation, School of Health Professions, University of Texas Southwestern Medical Center
| | - Linda Ehrlich-Jones
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University and Shirley Ryan AbilityLab, Chicago, Illinois
| | - Allen W Heinemann
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University and Shirley Ryan AbilityLab, Chicago, Illinois
| | - John Melvin
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Pallavi Sood
- Department of Aging & Geriatric Research, Institute of Aging, University of Florida
| | - Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota.
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de Winckel AV, Kozlowski AJ, Johnston MV, Weaver J, Grampurohit N, Terhorst L, Juengst S, Ehrlich-Jones L, Heinemann AW, Melvin J, Sood P, Mallinson T. Reporting Guideline for RULER: Rasch Reporting Guideline for Rehabilitation Research – Explanation & Elaboration manuscript. Arch Phys Med Rehabil 2022; 103:1487-1498. [DOI: 10.1016/j.apmr.2022.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022]
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Deng W, Carpentier S, Bottale S, Hendrickson T, Zhang L, Wudlick R, Linnman C, Morse L, de Winckel AV. Proof of Concept of Using Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults with Spinal Cord Injury. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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de Winckel AV, Hendrickson T, Zhang L, Huang Q, Oh J, Ruen J, Evans R, Bronfort G. Identifying Pain Modulating Brain Mechanisms After Qigong Practice For Pain Reduction In Adults With Chronic Low Back Pain: A Proof Of Concept Study. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carpentier S, Deng W, Bottale S, Hendrickson T, Zhang L, Wudlick R, Linnman C, Morse L, de Winckel AV. Cognitive Multisensory Rehabilitation for Sensory and Motor Function in Adults with Spinal Cord Injury: Proof of Concept. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Van de Winckel A, Nawshin T, Byron C. Combining a Hudl App With Telehealth to Increase Home Exercise Program Adherence in People With Chronic Diseases Experiencing Financial Distress: Randomized Controlled Trial. JMIR Form Res 2021; 5:e22659. [PMID: 33640865 PMCID: PMC8075043 DOI: 10.2196/22659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/25/2020] [Accepted: 02/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Patients with chronic diseases often need to adhere to long-term individualized home exercise programs (HEPs). Limited adherence to long-term exercise given during physical therapy (PT) visits reduces the capacity of exercise to manage or improve symptoms related to chronic disease. In addition, a lower socioeconomic status negatively impacts exercise adherence. To mitigate this, apps that motivate people to exercise could be a viable option. Using an app through telehealth may help adults with chronic diseases to achieve long-term HEP adherence. However, because apps for rehabilitation are an emerging field, the feasibility of the app needs to be evaluated. Objective To address HEP adherence in participants with chronic diseases who are experiencing financial distress, we aim to evaluate the feasibility of and satisfaction with the Hudl Technique app and telehealth and satisfaction with PT care and to monitor HEP adherence and compliance (ie, percentage of participant-recorded videos sent) in participants using the app with telehealth compared with those using standard HEPs on paper. Methods We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial in which the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth physical therapist. The control group received HEPs on paper without feedback, as is customary in PT practice. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on their satisfaction with PT care, and the experimental group also completed a survey on their satisfaction with the app with telehealth use. Descriptive and nonparametric statistics were used for within-group and between-group comparisons and analyzed with JMP, version 13. Results Overall, 45 adults with chronic diseases who were experiencing financial distress were randomized into experimental (23/45, 51%) and control (22/45, 49%) groups, with 74% (17/23) and 86% (19/22) participants completing the 24-week HEP, respectively. The experimental group had an HEP adherence frequency of 4 (SD 2) to 5 (SD 2) times per week at 8 and 24 weeks (P=.14), whereas HEP adherence decreased in the control group from 4 (SD 2) to 3 (SD 2) times per week (P=.07), with a significant difference (P=.01) between groups at 24 weeks. Of the total participants, 68% (15/22) sent videos. They sent 68% (16/24) of the requested number of videos on average. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=.99), whereas it decreased from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. App-related adverse events were not observed. Conclusions The Hudl app/telehealth platform is feasible for delivering HEPs and maintaining HEP adherence in participants with chronic diseases who are experiencing financial distress. Trial Registration ClinicalTrials.gov NCT02659280; https://clinicaltrials.gov/ct2/show/NCT02659280
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Tanjila Nawshin
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Casey Byron
- Hennepin County Medical Center, Minneapolis, MN, United States
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Sharp A, Schmidt A, Casto C, Van de Winckel A. Lapses in Professional Behavior Identified by Students of Physical Therapy. J Allied Health 2021; 50:e53-e57. [PMID: 34061940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Professional behaviors are interpersonal skills central and necessary to perform the work of a given profession. Although covered in professional training programs, lapses in professional behaviors remain. We assessed how students of physical therapy ranked the importance of professional behaviors and shared examples of lapses in professional behaviors seen in student peers. SUBJECTS Out of 250 accredited physical therapist programs in the U.S., 135 students (age 26.2 ± 4.65 yrs) participated in our survey. METHODS We analyzed the student ranking of professional behaviors as compared to the accepted standard of behaviors. Themes were identified from descriptions of lapses in professional behavior. RESULTS The ranking of professional behaviors was not consistent with the accepted standard ranking. Analysis of student observations resulted in the identification of six themes: external professionalism, respectfulness, communication, relationship to learning, affective professionalism, and clinical decision-making. DISCUSSION Students' rankings of professional behaviors did not correspond to the rankings in the reference standard of clinicians. We have identified a perception gap between professional behaviors previously ranked by clinicians as compared to how students ranked those same behaviors. Educators may benefit from consideration of student perceptions of professional behaviors to most effectively facilitate development of professionalism.
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Affiliation(s)
- Amanda Sharp
- Div. of Physical Therapy, Dep. of Rehabilitation Medicine University of Minnesota, 420 Delaware St. SE (MMC 388), Rm 376, Minneapolis, MN 55455, USA. Tel 612-626-4691, fax 612-625-4274.
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Deng W, Van de Winckel A. Physical Body Experiences Questionnaire: a Validation with Rasch Measurement Theory. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Van de Winckel A, De Patre D, Rigoni M, Rizzello C, Zernitz M. Reliability and concurrent validity of the “Awareness of Functional Tasks with Arm and Hand in Stroke” (AFAS) scale. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Larson M, Chantigian DP, Asirvatham-Jeyaraj N, Van de Winckel A, Keller-Ross ML. Slow-Paced Breathing and Autonomic Function in People Post-stroke. Front Physiol 2020; 11:573325. [PMID: 33192570 PMCID: PMC7662434 DOI: 10.3389/fphys.2020.573325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: To determine if acute slow breathing at 6 breaths/min would improve baroreflex sensitivity (BRS) and heart rate variability (HRV), and lower blood pressure (BP) in adults after stroke. Methods: Twelve individuals completed two randomized study visits where they performed a 15-min bout of breathing exercises at 6 breaths/min (slow) and at 12 breaths/min (control). Continuous BP and heart rate (HR) were measured throughout, and BRS, BRS response to elevations in blood pressure (BRSup), BRS response to depressions in blood pressure (BRSdown), and HRV were calculated and analyzed before (pre), during, and after (post) breathing exercises. Results: BRS increased from pre to post slow breathing by 10% (p = 0.012), whereas BRSup increased from pre to during slow breathing by 30% (p = 0.04). BRSdown increased from pre to post breathing for both breathing conditions (p < 0.05). HR (control: Δ - 4 ± 4; slow: Δ - 3 ± 4 beats/min, time, p < 0.01) and systolic BP (control: Δ - 0.5 ± 5; slow: Δ - 6.3 ± 8 mmHg, time, p < 0.01) decreased after both breathing conditions. Total power, low frequency power, and standard deviation of normal inter-beat intervals (SDNN) increased during the 6-breaths/min condition (condition × time, p < 0.001), whereas high frequency increased during both breathing conditions (time effect, p = 0.009). Conclusions: This study demonstrated that in people post-stroke, slow breathing may increase BRS, particularly BRSup, more than a typical breathing space; however, paced breathing at either a slow or typical breathing rate appears to be beneficial for acutely decreasing systolic BP and HR and increasing HRV.
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Affiliation(s)
- Mia Larson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Daniel P. Chantigian
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ninitha Asirvatham-Jeyaraj
- Indian Institute of Science, Bangalore, India
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ann Van de Winckel
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Manda L. Keller-Ross
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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Dawson J, Engineer ND, Prudente CN, Pierce D, Francisco G, Yozbatiran N, Tarver WB, Casavant R, Kline DK, Cramer SC, Van de Winckel A, Kimberley TJ. Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up. Neurorehabil Neural Repair 2020; 34:609-615. [DOI: 10.1177/1545968320924361] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background. Vagus nerve stimulation (VNS) paired with rehabilitation may improve upper-limb impairment and function after ischemic stroke. Objective. To report 1-year safety, feasibility, adherence, and outcome data from a home exercise program paired with VNS using long-term follow-up data from a randomized double-blind study of rehabilitation therapy paired with Active VNS (n = 8) or Control VNS (n = 9). Methods. All people were implanted with a VNS device and underwent 6 weeks in clinic therapy with Control or Active VNS followed by home exercises through day 90. Thereafter, participants and investigators were unblinded. The Control VNS group then received 6 weeks in-clinic Active VNS (Cross-VNS group). All participants then performed an individualized home exercise program with self-administered Active VNS. Data from this phase are reported here. Outcome measures were Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (Functional and Time), Box and Block Test, Nine-Hole Peg Test, Stroke Impact Scale, and Motor Activity Log. Results. There were no VNS treatment–related serious adverse events during the long-term therapy. Two participants discontinued prior to receiving the full crossover VNS. On average, participants performed 200 ± 63 home therapy sessions, representing device use on 57.4% of home exercise days available for each participant. Pooled analysis revealed that 1 year after randomization, the FMA-UE score increased by 9.2 points (95% CI = 4.7 to 13.7; P = .001; n = 15). Other functional measures were also improved at 1 year. Conclusions. VNS combined with rehabilitation is feasible, with good long-term adherence, and may improve arm function after ischemic stroke.
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Affiliation(s)
| | | | - Cecília N. Prudente
- MicroTransponder, Inc, Austin, TX, USA
- University of Minnesota, Minneapolis, MN, USA
| | | | - Gerard Francisco
- The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | - Nuray Yozbatiran
- The University of Texas Health Science Center at Houston (UTHealth), TX, USA
| | | | | | - Danielle K. Kline
- University of Minnesota, Minneapolis, MN, USA
- Massachusetts General Hospital, Boston MA, USA
| | - Steven C. Cramer
- University of California, Los Angeles, CA, USA
- California Rehabilitation Institute, Los Angeles, CA, USA
| | | | - Teresa J. Kimberley
- University of Minnesota, Minneapolis, MN, USA
- Massachusetts General Hospital, Boston MA, USA
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Grampurohit N, Van de Winckel A, Ehrlich-Jones L. Measurement Characteristics and Clinical Utility of the ABILHAND-Kids Among Children With Neuromuscular Conditions. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Van de Winckel A, Gauthier L. A Revised Motor Activity Log Following Rasch Validation (Rasch-Based MAL-18) and Consensus Methods in Chronic Stroke and Multiple Sclerosis. Neurorehabil Neural Repair 2019; 33:787-791. [PMID: 31423899 DOI: 10.1177/1545968319868717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives. To derive a shorter version of the Motor Activity Log Quality-of-Movement Scale (MAL-28) with enhanced content and construct validity. Design. Validation cohort. Setting. Outpatient rehabilitation within an academic laboratory. Participants. Retrospective consecutive sample of 149 community-dwelling adults with chronic mild/moderate upper-extremity hemiparesis caused by stroke or multiple sclerosis (MS). Intervention. Not applicable. Methods. Participants received the MAL-28 at baseline and following upper-extremity rehabilitation. Rasch Measurement Theory informed threshold ordering of scoring categories, tests of fit, differential item functioning, targeting, response dependency, local dependency, and reliability (person separation index [PSI]). Seasoned examiners rated the content validity of each item. Test-retest reliability of the revised scale was calculated. Results. We established content and construct validity for 18 items. The resultant 18-item MAL fit the model (χ2 = 77.93; df = 72; P = .30) and targeted the population-that is, minimal floor (12.08%) or ceiling effects (0%), with acceptable reliability (PSI = 0.84) and good test-retest reliability [ICC(1, 1) = 0.86]. The hierarchy of item difficulty was independent of sex, age, affected side, diagnosis, or intervention type used, and there was local dependency in 3 pairs of items. Responses from a subsequent testing session were dependent on the responses from prior testing, indicating response dependency, for which a correction was proposed. Once response dependency was neutralized, there was a 15% greater treatment response. Conclusions. Content and construct validity are established for Rasch-based MAL-18 for chronic stages of stroke and MS. A Rasch-based conversion table enables clinical use of the MAL-18.
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Larson M, Chantigian D, Van de Winckel A, Keller‐Ross M. Breathing Exercises Modulate Heart Rate Variability in Individuals with Chronic Stroke. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.854.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mia Larson
- Rehabilitation MedicineUniversity of MinnesotaMinneapolisMN
| | - Dan Chantigian
- Rehabilitation MedicineUniversity of MinnesotaMinneapolisMN
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Van de Winckel A, Ottiger B, Bohlhalter S, Nyffeler T, Vanbellingen T. Comprehensive ADL Outcome Measurement after Stroke: Rasch Validation of the Lucerne ICF-Based Multidisciplinary Observation Scale (LIMOS). Arch Phys Med Rehabil 2019; 100:2314-2323. [PMID: 30928303 DOI: 10.1016/j.apmr.2019.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/02/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To establish Rasch validation of the Lucerne International Classification of Functioning, Disability and Health (ICF)-based Multidisciplinary Observation Scale (LIMOS) in stroke. LIMOS measures the level of assistance in daily life activities related to motor function, communication, cognition, and domestic life. Rasch Measurement Theory (RMT) transforms an ordinal scale into an interval scale and thus the Rasch-based LIMOS scale captures a more accurate improvement of functional outcomes via Rasch-transformed scores. DESIGN Cross-sectional study design. SETTING Neurorehabilitation center, Luzerne, Switzerland. PARTICIPANTS We recruited participants with stroke (N=407; age=63.2±16.0y; n=157 women) through consecutive sampling. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants were assessed with LIMOS at admission and discharge of rehabilitation. We used RMT to evaluate overall model fit, response dependency, floor and ceiling effect, reliability, and differential item functioning (DIF) for sex, age, type, and time of stroke on the 4 LIMOS subscales using the Rasch Unidimensional Measurement Model (RUMM) 2030 program. RESULTS The Rasch-based LIMOS subscales fit the Rasch model after reducing and rescoring items: motor (from 20 to 18 items), communication (5 items), cognition (from 15 to 13 items), and domestic life (5 items). There was no floor or ceiling effect. Some artificial DIF was identified. Scoring at discharge was dependent on the scoring responses at admission, which means that without applying a correction factor to the discharge scores, there was an underestimation of change in scores between admission and discharge, ranging from 0.24 to 0.97 logits (10.79%-49.24%) on the different subscales. CONCLUSIONS The Rasch-based LIMOS scale is recommended to measure functional outcome in people with acute or chronic stages of ischemic or hemorrhagic stroke.
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy, Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota.
| | | | | | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland; ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
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Van de Winckel A, Carey JR, Bisson TA, Hauschildt EC, Streib CD, Durfee WK. Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study. J Neuroeng Rehabil 2018; 15:83. [PMID: 30227864 PMCID: PMC6145321 DOI: 10.1186/s12984-018-0427-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is an effective neuromodulation adjunct to repetitive motor training in promoting motor recovery post-stroke. Finger tracking training is motor training whereby people with stroke use the impaired index finger to trace waveform-shaped lines on a monitor. Our aims were to assess the feasibility and safety of a telerehabilitation program consisting of tDCS and finger tracking training through questionnaires on ease of use, adverse symptoms, and quantitative assessments of motor function and cognition. We believe this telerehabilitation program will be safe and feasible, and may reduce patient and clinic costs. Methods Six participants with hemiplegia post-stroke [mean (SD) age was 61 (10) years; 3 women; mean (SD) time post-stroke was 5.5 (6.5) years] received five 20-min tDCS sessions and finger tracking training provided through telecommunication. Safety measurements included the Digit Span Forward Test for memory, a survey of symptoms, and the Box and Block test for motor function. We assessed feasibility by adherence to treatment and by a questionnaire on ease of equipment use. We reported descriptive statistics on all outcome measures. Results Participants completed all treatment sessions with no adverse events. Also, 83.33% of participants found the set-up easy, and all were comfortable with the devices. There was 100% adherence to the sessions and all recommended telerehabilitation. Conclusions tDCS with finger tracking training delivered through telerehabilitation was safe, feasible, and has the potential to be a cost-effective home-based therapy for post-stroke motor rehabilitation. Trial registration NCT02460809 (ClinicalTrials.gov).
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Affiliation(s)
- Ann Van de Winckel
- Division of Physical Therapy; Division of Rehabilitation Science, University of Minnesota, 420 Delaware Street SE (MMC388), Minneapolis, MN, 55455, USA.
| | - James R Carey
- Division of Physical Therapy; Division of Rehabilitation Science, University of Minnesota, 420 Delaware Street SE (MMC388), Minneapolis, MN, 55455, USA
| | - Teresa A Bisson
- Division of Physical Therapy, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Elsa C Hauschildt
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | | | - William K Durfee
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
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Van de Winckel A, Tseng YT, Chantigian D, Lorant K, Zarandi Z, Buchanan J, Zeffiro TA, Larson M, Olson-Kellogg B, Konczak J, Keller-Ross ML. Age-Related Decline of Wrist Position Sense and its Relationship to Specific Physical Training. Front Hum Neurosci 2017; 11:570. [PMID: 29209188 PMCID: PMC5702425 DOI: 10.3389/fnhum.2017.00570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/10/2017] [Indexed: 11/13/2022] Open
Abstract
Perception of limb and body positions is known as proprioception. Sensory feedback, especially from proprioceptive receptors, is essential for motor control. Aging is associated with a decline in position sense at proximal joints, but there is inconclusive evidence of distal joints being equally affected by aging. In addition, there is initial evidence that physical activity attenuates age-related decline in proprioception. Our objectives were, first, to establish wrist proprioceptive acuity in a large group of seniors and compare their perception to young adults, and second, to determine if specific types of training or regular physical activity are associated with preserved wrist proprioception. We recruited community-dwelling seniors (n = 107, mean age, 70 ± 5 years, range, 65–84 years) without cognitive decline (Mini Mental State Examination-brief version ≥13/16) and young adult students (n = 51, mean age, 20 ± 1 years, range, 19–26 years). Participants performed contralateral and ipsilateral wrist position sense matching tasks with a bimanual wrist manipulandum to a 15° flexion reference position. Systematic error or proprioceptive bias was computed as the mean difference between matched and reference position. The respective standard deviation over five trials constituted a measure of random error or proprioceptive precision. Current levels of physical activity and previous sport, musical, or dance training were obtained through a questionnaire. We employed longitudinal mixed effects linear models to calculate the effects of trial number, sex, type of matching task and age on wrist proprioceptive bias and precision. The main results were that relative proprioceptive bias was greater in older when compared to young adults (mean difference: 36% ipsilateral, 88% contralateral, p < 0.01). Proprioceptive precision for contralateral but not for ipsilateral matching was smaller in older than in young adults (mean difference: 38% contralateral, p < 0.01). Longer years of dance training were associated with smaller bias during ipsilateral matching (p < 0.01). Other types of training or physical activity levels did not affect bias or precision. Our findings demonstrate that aging is associated with a decline in proprioceptive bias in distal arm joints, but age does not negatively affect proprioceptive precision. Further, specific types of long-term dance related training may attenuate age-related decline in proprioceptive bias.
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Affiliation(s)
- Ann Van de Winckel
- Brain Plasticity Laboratory, Division of Physical Therapy and Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Yu-Ting Tseng
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | - Daniel Chantigian
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Kaitlyn Lorant
- Illinois Bone and Joint Institute, Chicago, IL, United States
| | - Zinat Zarandi
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | - Jeffrey Buchanan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | | | - Mia Larson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Becky Olson-Kellogg
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, United States
| | - Manda L Keller-Ross
- Cardiovascular Research and Rehabilitation Laboratory, Division of Physical Therapy and Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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de Winckel AV, Tseng YT, Chantigian D, Lorant K, Zarandi Z, Buchanan J, Konczak J, Zeffiro T, Olson-Kellogg B, Larson M, Keller-Ross M. Mapping Age-Related Changes in Wrist Proprioception. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.08.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Van de Winckel A, Feys H, Lincoln N, De Weerdt W. Assessment of arm function in stroke patients: Rivermead Motor Assessment arm section revised with Rasch analysis. Clin Rehabil 2016; 21:471-9. [PMID: 17613569 DOI: 10.1177/0269215507071783] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective : To investigate the construct validity and unidimensionality of the Rivermead Motor Assessment, arm section, using Rasch analysis which transforms the ordinal scale into an interval scale with hierarchical ordering of items. Setting : Twelve stroke units and rehabilitation centres across Belgium, Germany and Switzerland. Subjects : Two hundred fifty-two stroke patients, average (SD) age of 63.5 (13.22) years. Main measures : Principal component analysis on the Rasch data gave additional information on unidimensionality. Differential item functioning established the stability of items for gender, age, country, hemiplegic side, stroke type, and time since stroke. Results : Four items did not meet the requirements for the Rasch model and were removed. These were `Lying, protract shoulder with arm in elevation', `Pick up tennis ball from table, release on midthigh, return to table, release', `Same exercise with pencil' and `Pick up piece of paper from table. Release five times'. Principal component analysis of the remaining 11 items revealed two dimensions in the scale, `static and dynamic control of movement', and `coordination'. All items were stable among the subgroups of the sample. Conclusion : The Rivermead Motor Assessment, revised arm section meets the required criteria for validity and unidimensionality. It consists of 11 individual items, which yield two subtotals of overall upper limb ability of the patients. It is a valid tool to evaluate upper limb function after stroke.
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Affiliation(s)
- Ann Van de Winckel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
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Van de Winckel A, Feys H, van der Knaap S, Messerli R, Baronti F, Lehmann R, Van Hemelrijk B, Pantè F, Perfetti C, De Weerdt W. Can quality of movement be measured? Rasch analysis and inter-rater reliability of the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES). Clin Rehabil 2016; 20:871-84. [PMID: 17008339 DOI: 10.1177/0269215506072181] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Clinical scales evaluating arm function after stroke are weak at detecting quality of movement. Therefore a new scale, the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), was developed, comprising 22 items pertaining to arm and hand performance. The scale was investigated for validity and unidimensionality using the Rasch measurement model, and for inter-rater reliability. Setting: Twelve hospitals and rehabilitation centres in Belgium, Germany and Switzerland. Patients: There were 396 patients (average age 63.38±12.89 years) in the Rasch study and 56 patients (average age 65.68±12.75 years) in the reliability study. Main measures: The scale was examined on its fit to the Rasch model, thereby evaluating the scale’s unidimensionality and validity. Differential item functioning was performed to test the stability of item hierarchy on several variables. Inter-rater reliability was examined with kappa values, weighted percentage agreement and intraclass correlation coefficients (ICC). Results: Based on Rasch analysis, five items were removed. The MESUPES was divided in two tests: the MESUPES-arm test (8 items) and MESUPES-hand test (9 items). Both scales fitted the Rasch model. All items were stable among the subgroups of the sample. ICCs were 0.95 (95% confidence interval (CI) 0.91 -0.97) and 0.97 (95% CI 0.95-0.98) for the total score on arm and hand test respectively. The scale was also reliable at item level (weighted kappa 0.62 -0.79, weighted percentage agreement 85.71 -98.21). Conclusion: The MESUPES-arm and MESUPES-hand meet the statistical properties of reliability, validity and unidimensionality. Both tests provide a useful clinical and research tool to qualitatively evaluate arm and hand function during recovery after stroke.
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Affiliation(s)
- Ann Van de Winckel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium.
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Abstract
Objective: To evaluate the effect of a musical exercise programme on mood state and cognitive function in women with dementia. Design: Randomized controlled trial. Setting: Public Psychiatric Hospital Rekem, Belgium. Patients: Twenty-five patients with dementia. Interventions: Fifteen patients attended exercise training for three months, which consisted of daily physical exercises supported by music for 30 min/session. They were compared with a group of 10 control patients, who received an equal amount of attention through daily conversation. Main measures: The effect on cognition was measured by the Mini-Mental State Examination (MMSE) and the Amsterdam Dementia Screening Test 6 (ADS 6). Behaviour was evaluated with the abbreviated Stockton Geriatric Rating Scale (BOP scale). The assessments were made before, after six weeks of intervention and immediately after the three-month experimental period. Results: The exercise group showed a significant improvement in cognition. This was documented by an increased MMSE mean score of 12.87-15.53, and by a higher median score, rising from 10 to 14 points, on the subset ‘fluency’ (ADS 6 test). The control group showed no significant improvement, either on the MMSE (mean score of 10.80 -11.00) or on the fluency subtest of the ADS 6 (median scores were 6.5-7 points). The effects on behavioural changes were not significant. Conclusion: The present study suggests a beneficial effect of cognition using a music-based exercise programme in a group of patients with moderate to severe dementia. Further studies are needed to confirm these findings.
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Affiliation(s)
- Ann Van de Winckel
- Department of Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, Katholieke Universiteit Leuven, Leuven, Belgium.
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Verheyden G, Nieuwboer A, Van de Winckel A, De Weerdt W. Clinical tools to measure trunk performance after stroke: a systematic review of the literature. Clin Rehabil 2016; 21:387-94. [PMID: 17613559 DOI: 10.1177/0269215507074055] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective : To give a systematic review of clinical measurement scales used to assess trunk performance after stroke. Data sources : The databases CINAHL, Cochrane, Pedro and PubMed were searched with the terms `sitting balance' plus `stroke' and `trunk' plus `stroke' mentioned in the title or abstract. Databases were searched from inception to January 2006. Review methods : All articles were selected which reported or included a clinical measure of trunk performance used in an adult stroke population. Reference lists were searched as secondary sources of articles. Results : A total of 458 articles resulted from the database search. Thirty-two articles were eligible for inclusion. Earlier studies mentioned ordinal single items or a combination of items which are part of a larger scale used to assess sitting balance as a derived measure of trunk performance. Three clinical tools were available which specifically evaluated trunk performance after stroke; the Trunk Control Test and two Trunk Impairment Scales. Conclusion : Ordinal single items or subscales of existing larger scales lack a systematic evaluation of psychometric characteristics. Both Trunk Impairment Scales have been extensively examined. A comparative study assessing psychometric properties of the Trunk Control Test and two Trunk Impairment Scales could determine which should be the measure of choice when assessing trunk performance after stroke.
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Affiliation(s)
- Geert Verheyden
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
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Krewer C, Van de Winckel A, Elangovan N, Aman JE, Konczak J. Commentary on: "Assessing proprioception: A critical review of methods" by Han et al. J Sport Health Sci 2016; 5:91-92. [PMID: 30356516 PMCID: PMC6188602 DOI: 10.1016/j.jshs.2015.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/21/2015] [Indexed: 06/01/2023]
Affiliation(s)
- Carmen Krewer
- Human Sensorimotor Control Laboratory, University of Minnesota, Minneapolis, MN 55455, USA
- Schön Klinik Bad Aibling, Bad Aibling 83043, Germany
| | - Ann Van de Winckel
- Program in Physical Therapy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Naveen Elangovan
- Human Sensorimotor Control Laboratory, University of Minnesota, Minneapolis, MN 55455, USA
| | - Joshua E. Aman
- Human Sensorimotor Control Laboratory, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, University of Minnesota, Minneapolis, MN 55455, USA
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Van de Winckel A, Verheyden G, Wenderoth N, Peeters R, Sunaert S, Van Hecke W, De Cock P, Desloovere K, Eyssen M, Feys H. Does somatosensory discrimination activate different brain areas in children with unilateral cerebral palsy compared to typically developing children? An fMRI study. Res Dev Disabil 2013; 34:1710-1720. [PMID: 23500165 DOI: 10.1016/j.ridd.2013.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 06/01/2023]
Abstract
Aside from motor impairment, many children with unilateral cerebral palsy (CP) experience altered tactile, proprioceptive, and kinesthetic awareness. Sensory deficits are addressed in rehabilitation programs, which include somatosensory discrimination exercises. In contrast to adult stroke patients, data on brain activation, occurring during somatosensory discrimination exercises, are lacking in CP children. Therefore, this study investigated brain activation with functional magnetic resonance imaging (fMRI) during passively guided somatosensory discrimination exercises in 18 typically developing children (TD) (age, M=14 ± 1.92 years; 11 girls) and 16 CP children (age, M=15 ± 2.54 years; 8 girls). The demographic variables between both groups were not statistically different. An fMRI compatible robot guided the right index finger and performed pairs of unfamiliar geometric shapes in the air, which were judged on their equality. The control condition comprised discrimination of music fragments. Both groups exhibited significant activation (FDR, p<.05) in frontoparietal, temporal, cerebellar areas, and insula, similar to studies in adults. The frontal areas encompassed ventral premotor areas, left postcentral gyrus, and precentral gyrus; additional supplementary motor area (SMA proper) activation in TD; as well as dorsal premotor, and parietal operculum recruitment in CP. On uncorrected level, p<.001, TD children revealed more left frontal lobe, and right cerebellum activation, compared to CP children. Conversely, CP children activated the left dorsal cingulate gyrus to a greater extent than TD children. These data provide incentives to investigate the effect of somatosensory discrimination during rehabilitation in CP, on clinical outcome and brain plasticity.
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Affiliation(s)
- Ann Van de Winckel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium.
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Van de Winckel A, Klingels K, Bruyninckx F, Wenderoth N, Peeters R, Sunaert S, Van Hecke W, De Cock P, Eyssen M, De Weerdt W, Feys H. How does brain activation differ in children with unilateral cerebral palsy compared to typically developing children, during active and passive movements, and tactile stimulation? An fMRI study. Res Dev Disabil 2013; 34:183-97. [PMID: 22940170 DOI: 10.1016/j.ridd.2012.07.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 05/25/2023]
Abstract
The aim of the functional magnetic resonance imaging (fMRI) study was to investigate brain activation associated with active and passive movements, and tactile stimulation in 17 children with right-sided unilateral cerebral palsy (CP), compared to 19 typically developing children (TD). The active movements consisted of repetitive opening and closing of the hand. For passive movements, an MRI-compatible robot moved the finger up and down. Tactile stimulation was provided by manually stroking the dorsal surface of the hand with a sponge cotton cloth. In both groups, contralateral primary sensorimotor cortex activation (SM1) was seen for all tasks, as well as additional contralateral primary somatosensory cortex (S1) activation for passive movements. Ipsilateral cerebellar activity was observed in TD children during all tasks, but only during active movements in CP children. Of interest was additional ipsilateral SM1 recruitment in CP during active movements as well as ipsilateral S1 activation during passive movements and tactile stimulation. Another interesting new finding was the contralateral cerebellum activation in both groups during different tasks, also in cerebellar areas not primarily linked to the sensorimotor network. Active movements elicited significantly more brain activation in CP compared to TD children. In both groups, active movements displayed significantly more brain activation compared to passive movements and tactile stimulation.
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Affiliation(s)
- Ann Van de Winckel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium.
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Klingels K, Feys H, De Wit L, Jaspers E, Van de Winckel A, Verbeke G, De Cock P, Molenaers G. Arm and hand function in children with unilateral cerebral palsy: a one-year follow-up study. Eur J Paediatr Neurol 2012; 16:257-65. [PMID: 21940183 DOI: 10.1016/j.ejpn.2011.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 07/22/2011] [Accepted: 08/11/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND In children with unilateral cerebral palsy (CP), development of arm and hand function is often compromised by the underlying motor and sensory impairments. However, knowledge about the evolution of arm and hand function in this population is limited. AIM The aims were to map the evolution of scores on upper limb measures over one year in children with unilateral CP and to identify factors that influence time trends. METHODS Eighty-one children (43 males, 38 females; mean age 9y11mo (SD 3y3mo) range 5-15 y) were tested at baseline, at 6 and 12 months. According to the International Classification of Functioning, Disability and Health, body function measurements included passive range of motion, muscle tone, manual muscle strength and grip strength. Activity measurements included the Melbourne Assessment, the Jebsen-Taylor test, the Assisting Hand Assessment and the Abilhand-Kids questionnaire. Age, gender, etiology (congenital or acquired lesions) and Manual Ability Classification System (MACS) levels were analyzed as predictive factors, using mixed models. RESULTS Scores for grip strength (p = 0.001) and manual dexterity (Jebsen-Taylor test, p < 0.0001) increased significantly over time. MACS level (p = 0.03) and etiology (p = 0.02) had a significant influence on the time evolution of the Jebsen-Taylor scores. Other assessments showed no significant changes. CONCLUSION Motor impairments, movement quality and hemiplegic hand use in bimanual tasks do not spontaneously improve over one year, except for an age-related change in grip strength. However, an improvement was observed in manual dexterity, suggesting that some children can learn more adaptive movement strategies.
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Affiliation(s)
- Katrijn Klingels
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
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Verhoeven JS, Rommel N, Prodi E, Leemans A, Zink I, Vandewalle E, Noens I, Wagemans J, Steyaert J, Boets B, Van de Winckel A, De Cock P, Lagae L, Sunaert S. Is there a common neuroanatomical substrate of language deficit between autism spectrum disorder and specific language impairment? Cereb Cortex 2011; 22:2263-71. [PMID: 22047968 DOI: 10.1093/cercor/bhr292] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Discussion of an overlap between specific language impairment (SLI) and autism spectrum disorder (ASD) is on going. The most intriguing overlap between both phenotypes is the similarity in the observed language deficits described in SLI and a subgroup of ASD with co-occurring linguistic impairment, ASD-LI. Examining whether a similar neuroanatomical substrate underlies this phenotypical linguistic overlap, we studied the white matter microstructural properties of the superior longitudinal fascicle (SLF) of 19 ASD-LI adolescents (mean age 13.8 ± 1.6 years) and 21 age-matched controls and compared them with 13 SLI children (mean age 10.1 ± 0.4 years) and 12 age-matched controls. A linguistic profile assessment and a diffusion tensor imaging analysis of the SLF were performed. Linguistic testing revealed a mixed receptive-expressive disorder profile in both groups, confirming their overlap at phenotypical level. At neuroanatomical level, no significant differences in mean SLF fractional anisotropy (FA) and mean SLF apparent diffusion coefficient values between ASD-LI participants and controls were seen. By contrast, the mean SLF FA was significantly reduced in the SLI children as compared with their controls. The observation of structural SLF disturbances in SLI but not in ASD-LI suggests the existence of a different neuroanatomical substrate for the language deficits in both disorders.
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Affiliation(s)
- Judith S Verhoeven
- Department of Pediatrics, University Hospitals of the Catholic University of Leuven, Leuven, Belgium
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Smitz S, Van de Winckel A, Smitz MF. Reliability of infrared ear thermometry in the prediction of rectal temperature in older inpatients. J Clin Nurs 2009; 18:451-6. [DOI: 10.1111/j.1365-2702.2008.02565.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van de Winckel A, Sunaert S, Wenderoth N, Peeters R, Van Hecke P, Feys H, Horemans E, Marchal G, Swinnen SP, Perfetti C, De Weerdt W. Passive somatosensory discrimination tasks in healthy volunteers: differential networks involved in familiar versus unfamiliar shape and length discrimination. Neuroimage 2005; 26:441-53. [PMID: 15907302 DOI: 10.1016/j.neuroimage.2005.01.058] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 01/28/2005] [Accepted: 01/28/2005] [Indexed: 11/20/2022] Open
Abstract
Somatosensory discrimination of unseen objects relies on processing of proprioceptive and tactile information to detect spatial features, such as shape or length, as acquired by exploratory finger movements. This ability can be impaired after stroke, because of somatosensory-motor deficits. Passive somatosensory discrimination tasks are therefore used in therapy to improve motor function. Whereas the neural correlates of active discrimination have been addressed repeatedly, little is known about the neural networks activated during passive discrimination of somatosensory information. In the present study, we applied functional magnetic resonance imaging (fMRI) while the right index finger of ten healthy subjects was passively moved along various shapes and lengths by an fMRI compatible robot. Comparing discriminating versus non-discriminating passive movements, we identified a bilateral parieto-frontal network, including the precuneus, superior parietal gyrus, rostral intraparietal sulcus, and supramarginal gyrus as well as the supplementary motor area (SMA), dorsal premotor (PMd), and ventral premotor (PMv) areas. Additionally, we compared the discrimination of different spatial features, i.e., discrimination of length versus familiar (rectangles or triangles) and unfamiliar geometric shapes (arbitrary quadrilaterals). Length discrimination activated mainly medially located superior parietal and PMd circuits whereas discrimination of familiar geometric shapes activated more laterally located inferior parietal and PMv regions. These differential parieto-frontal circuits provide new insights into the neural basis of extracting spatial features from somatosensory input and suggest that different passive discrimination tasks could be used for lesion-specific training following stroke.
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Affiliation(s)
- Ann Van de Winckel
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium.
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