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Pijpers EJ, Bloemen B, Cup EHC, Groothuis JT, Oortwijn WJ, van Engelen BGM, van der Wilt GJ. The capability approach in rehabilitation: developing capability care. Disabil Rehabil 2024:1-13. [PMID: 38625146 DOI: 10.1080/09638288.2024.2342494] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To develop a multidisciplinary outpatient rehabilitation intervention for people with neuromuscular diseases (NMD) based on the capability approach: capability care for persons with NMD. MATERIALS AND METHODS The development process is described using a framework of actions for intervention development. It has been an iterative process consisting of a design phase based on theoretical insights and project group discussions, and a refine phase involving input from relevant stakeholders. RESULTS Multidisciplinary efforts have resulted in the development of capability care for rehabilitation of persons with NMD. It can focus both on facilitating and achieving functionings (beings and doings), as well as looking for alternative functionings that fulfil the same underlying value, thereby contributing to the persons' well-being. To facilitate a conversation on broader aspects that impact on well-being, persons with NMD receive a preparation letter and healthcare professionals are provided with guiding questions and practical tools to use. CONCLUSIONS We have shown that it is possible to develop a healthcare intervention based on the capability approach. We hope that rehabilitation professionals will be encouraged to use capability care and that other medical professionals will be inspired to develop capability care in their respective fields. REGISTRATION Registered at trialregister.nl NL8946.
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Affiliation(s)
- Eirlys J Pijpers
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Bloemen
- Donders Institute for Brain, Cognition and Behaviour, Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith H C Cup
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wija J Oortwijn
- Research Institute for Medical Innovation, Science Department IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
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Karazi W, Coppers J, Maas D, Cup E, Bloemen B, Voet N, Groothuis JT, Pinós T, Marti Seves R, Quinlivan R, Løkken N, Vissing J, Bhai S, Wakelin A, Reason S, Voermans NC. Toward an Understanding of GSD5 (McArdle disease): How Do Individuals Learn to Live with the Metabolic Defect in Daily Life. J Neuromuscul Dis 2024; 11:103-116. [PMID: 38108358 PMCID: PMC10789332 DOI: 10.3233/jnd-230027] [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] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Glycogen storage disease type 5 (GSD) is an autosomal recessive inherited metabolic myopathy caused by a deficiency of the enzyme muscle glycogen phosphorylase. Individuals with GSD5 experience physical activity intolerance. OBJECTIVE This patient-led study aimed to capture the daily life experiences of GSD5, with a focus on adapting to and coping with their physical activity intolerance. METHODS An online survey was composed in close collaboration with patient organizations. It consisted of customized and validated questionnaires on demographics, general health and comorbidities, physical activity, psychosocial well-being and functioning, pain, fatigue and adapting to and coping with GSD5. RESULTS One hundred sixty-two participants (16 countries) participated. The majority, n = 86 (69%) were from the Netherlands, USA or UK. We observed a high rate of misdiagnosis prior to GSD5 diagnosis (49%), surprisingly a relatively high proportion had not been diagnosed by DNA testing which is the gold standard. Being diagnosed had a strong impact on emotional status, daily life activities and important life choices. A large proportion had not received any rehabilitation (41%) nor medical treatment (57%) before diagnosis. Engagement in vigorous and moderate physical activity was reduced. Health related quality of life was low, most likely related to low physical health. The median Fatigue Severity Score was 4.3, indicating moderate to severe fatigue. Participants themselves had found various ways to adapt to and cope with their disability. The adaptations concerned all aspect of their life, including household chores, social and physical activities, and work. In addition to lack of support, participants reported limited availability of information sources. CONCLUSION Participants have provided guidance for newly diagnosed people, including the advice to accept one's limited abilities and maintain an active lifestyle. We conclude that adequate counseling on ways of adapting and coping is expected to increase both health-related quality of life and physical activity.
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Affiliation(s)
- Walaa Karazi
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline Coppers
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daphne Maas
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Edith Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Bloemen
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Voet
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tomàs Pinós
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Ramon Marti Seves
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Salman Bhai
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
| | - Andrew Wakelin
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
| | - Stacey Reason
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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3
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Bouman K, Dittrich ATM, Groothuis JT, van Engelen BGM, Zweers-van Essen H, de Baaij-Daalmeyer A, Janssen MCH, Erasmus CE, Draaisma JMT, Voermans NC. Bone quality in LAMA2-related muscular dystrophy and SELENON-related congenital myopathy, a one-year prospective natural history study. Neuromuscul Disord 2024; 34:105-113. [PMID: 38160563 DOI: 10.1016/j.nmd.2023.11.008] [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] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
Fragility fractures are frequently reported in neuromuscular diseases and negatively influence functional prognosis, quality of life and survival. In LAMA2-related muscular dystrophy (LAMA2-MD) and SELENON(SEPN1)-related congenital myopathy (SELENON-RM) cross-sectional and prospective natural history studies on bone quality and fragility long bone fractures (LBFs) are lacking. We therefore aim to systematically assess bone quality and provide recommendations for clinical care. We performed a one-year prospective natural history study in 21 LAMA2-MD and 10 SELENON-RM patients including a standardized fracture history and bone quality assessment through dual energy Xray absorptiometry scan (DEXA-scan) and/or bone health index (BHI). Ninety percent of the LAMA2-MD and SELENON-RM patients showed low bone quality. Eight (38%) LAMA2-MD and five (50%) SELENON-RM patients had a history of fragility LBFs. During the one-year follow-up period, one LAMA2-MD patient (female, 3 years) experienced a fragility LBF of the right humerus. We found no difference in bone mineral density between baseline and one-year follow-up. Based on general international guidelines for osteoporosis, we advise adequate vitamin D and calcium intake, and standardized clinical follow-up through a DEXA-scan or BHI in all LAMA2-MD and SELENON-RM patients. On indication, patients should be referred to the pediatrics or internal medicine for consideration of additional treatments.
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Affiliation(s)
- Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Anne T M Dittrich
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heidi Zweers-van Essen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anja de Baaij-Daalmeyer
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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4
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Bouman K, van Doorn JLM, Groothuis JT, Wijkstra PJ, van Engelen BGM, Erasmus CE, Doorduin J, Voermans NC. Respiratory function in LAMA2-related muscular dystrophy and SELENON-related congenital myopathy, a 1.5-year natural history study. Eur J Paediatr Neurol 2024; 48:30-39. [PMID: 38008001 DOI: 10.1016/j.ejpn.2023.11.005] [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: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION LAMA2-related muscular dystrophy (LAMA2-MD) and SELENON(SEPN1)-related congenital myopathy (SELENON-RM) are rare neuromuscular diseases with respiratory impairment from a young age. Prospective natural history studies are needed for prevalence estimations, respiratory characterization, optimizing clinical care and selecting outcome measures for trial readiness. METHODS Our prospective 1.5-year natural history study included spirometry (forced vital capacity (FVC); difference between upright and supine vital capacity (dVC)), respiratory muscle strength tests (sniff nasal inspiratory pressure (SNIP)) (age≥5 years), and diaphragm ultrasound (thickness; thickening; echogenicity; all ages). RESULTS Twenty-six LAMA2-MD patients (M = 8, median 21 [9; 31] years) and 11 SELENON-RM patients (M = 8, 20 [10; 33] years) were included. At baseline, 17 (85 %) LAMA2-MD (FVC%: 59 % [33; 68]) and all SELENON-RM patients (FVC%: 34 % [31; 46]) had an impaired respiratory function (FVC%<80 %). Nine (35 %) LAMA2-MD and eight (73 %) SELENON-RM patients received mechanical ventilation at baseline, and two additional SELENON-RM patients started during follow-up. Contrarily to LAMA2-MD, SELENON-RM patients had severe diaphragm atrophy (diaphragm thickness z-score: 2.5 [-3.1; -2.1]) and dysfunction (diaphragm thickness ratio: 1.2 [1.0; 1.7]; dVC: 30 % [7.7; 41]). SNIP was low in both neuromuscular diseases and correlated with motor function. In SELENON-RM, respiratory function decreased during follow-up. CONCLUSION The majority of LAMA2-MD and all SELENON-RM patients had respiratory impairment. SELENON-RM patients showed lower respiratory function which was progressive, more prevalent mechanical ventilation, and more severe diaphragm atrophy and dysfunction than LAMA2-MD patients. Spirometry (FVC%, dVC) and respiratory muscle strength tests (SNIP) are useful in clinical care and as outcome measure in clinical trials. CLINICAL TRIAL NUMBER NCT04478981.
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Affiliation(s)
- Karlijn Bouman
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands.
| | - Jeroen L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University Medical Centre Groningen, Groningen, the Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, the Netherlands
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5
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Rasing NB, van de Geest-Buit WA, Chan OYA, Mul K, Lanser A, van Engelen BGM, Erasmus CE, Fischer AH, Ingels KJAO, Post B, Siemann I, Groothuis JT, Voermans NC. Treatment Approaches for Altered Facial Expression: A Systematic Review in Facioscapulohumeral Muscular Dystrophy and Other Neurological Diseases. J Neuromuscul Dis 2024; 11:535-565. [PMID: 38517799 DOI: 10.3233/jnd-230213] [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] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Background Facial weakness is a key feature of facioscapulohumeral muscular dystrophy (FSHD) and may lead to altered facial expression and subsequent psychosocial impairment. There is no cure and supportive treatments focus on optimizing physical fitness and compensation of functional disabilities. Objective We hypothesize that symptomatic treatment options and psychosocial interventions for other neurological diseases with altered facial expression could be applicable to FSHD. Therefore, the aim of this review is to collect symptomatic treatment approaches that target facial muscle function and psychosocial interventions in various neurological diseases with altered facial expression in order to discuss the applicability to FSHD. Methods A systematic search was performed. Selected studies had to include FSHD, Bell's palsy, Moebius syndrome, myotonic dystrophy type 1, or Parkinson's disease and treatment options which target altered facial expression. Data was extracted for study and patients' characteristics, outcome assessment tools, treatment, outcome of facial expression and or psychosocial functioning. Results Forty studies met the inclusion criteria, of which only three studies included FSHD patients exclusively. Most, twenty-one, studies were performed in patients with Bell's palsy. Studies included twelve different therapy categories and results were assessed with different outcomes measures. Conclusions Five therapy categories were considered applicable to FSHD: training of (non-verbal) communication compensation strategies, speech training, physical therapy, conference attendance, and smile restoration surgery. Further research is needed to establish the effect of these therapies in FSHD. We recommend to include outcome measures in these studies that cover at least cosmetic, functional, communication, and quality of life domains.
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Affiliation(s)
- Nathaniël B Rasing
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willianne A van de Geest-Buit
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - On Ying A Chan
- Information Specialist, Medical Library, Radboud University, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Lanser
- Patient Representative and Chairman FSHD Advocacy Group, Patient Organization for Muscular Disease Spierziekten Nederland, Baarn, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Paediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Agneta H Fischer
- Department of Psychology, Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ietske Siemann
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Bouman K, Groothuis JT, Doorduin J, van Alfen N, Udink Ten Cate FEA, van den Heuvel FMA, Nijveldt R, Kamsteeg EJ, Dittrich ATM, Draaisma JMT, Janssen MCH, van Engelen BGM, Erasmus CE, Voermans NC. LAMA2-Related Muscular Dystrophy Across the Life Span: A Cross-sectional Study. Neurol Genet 2023; 9:e200089. [PMID: 37476021 PMCID: PMC10356133 DOI: 10.1212/nxg.0000000000200089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/31/2023] [Indexed: 07/22/2023]
Abstract
Background and Objectives LAMA2-related muscular dystrophy (LAMA2-MD) is a rare neuromuscular disease characterized by proximal and axial muscle weakness, rigidity of the spine, scoliosis, and respiratory impairment. No curative treatment options exist, yet promising preclinical studies are ongoing. Currently, there is a paucity on natural history data, and appropriate clinical and functional outcome measures are needed. We aim for deep clinical phenotyping, establishment of a well-characterized baseline cohort for prospective follow-up and recruitment for future clinical trials, improvement of clinical care, and selection of outcome measures for reaching trial readiness. Methods We performed a cross-sectional, single-center, observational study. This study included neurologic examination and functional measurements among others the Motor Function Measure 20/32 (MFM-20/32) as primary outcome measure, accelerometry, questionnaires, muscle ultrasound, respiratory function tests, electrocardiography and echocardiography, and dual-energy X-ray absorptiometry. Results Twenty-seven patients with genetically confirmed LAMA2-MD were included (21 ± 13 years; M = 9; ambulant = 7). Axial and proximal muscle weakness was most pronounced. The mean MFM-20/32 score was 42.0% ± 29.4%, with domain 1 (standing and transfers) being severely affected and domain 3 (distal muscle function) relatively spared. Physical activity as measured through accelerometry showed very strong correlations to MFM-20/32 (Pearson correlation, -0.928, p < 0.01). Muscle ultrasound showed symmetrically increased echogenicity, with the sternocleidomastoid muscle most affected. Respiratory function was impaired in 85% of patients without prominent diaphragm dysfunction and was independent of age. Ten patients (37%) needed (non)invasive ventilatory support. Cardiac assessment revealed QRS fragmentation in 62%, abnormal left ventricular global longitudinal strain in 25%, and decreased left ventricular ejection fraction in 14% of patients. Decreased bone quality leading to fragility fractures was seen in most of the patients. Discussion LAMA2-MD has a widely variable phenotype. Based on the results of this cross-sectional study and current standards of care for congenital muscular dystrophies, we advise routine cardiorespiratory follow-up and optimization of bone quality. We propose MFM-20/32, accelerometry, and muscle ultrasound for assessing disease severity and progression. For definitive clinical recommendations and outcome measures, natural history data are needed. Clinical Trials Registration This study was registered at clinicaltrials.gov (NCT04478981, 21 July 2020). The first patient was enrolled in September 2020.
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Affiliation(s)
- Karlijn Bouman
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris E A Udink Ten Cate
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederik M A van den Heuvel
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin Nijveldt
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne T M Dittrich
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mirian C H Janssen
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- From the Department of Neurology (K.B., J.D., N.A., B.G.M.E., N.C.V.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Neurology (K.B., C.E.E.), Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital; Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour; Department of Pediatric Cardiology (F.E.A.U.C.), Amalia Children's Hospital; Department of Cardiology (F.M.A.H., R.N.); Department of Human Genetics (E.-J.K.); Department of Pediatrics (A.T.M.D., J.M.T.D.), Radboud Institute for Health Sciences, Amalia Children's Hospital; and Department of Internal Medicine (M.C.H.J.), Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Rasing NB, van de Geest-Buit W, Chan OYA, Mul K, Lanser A, Erasmus CE, Groothuis JT, Holler J, Ingels KJAO, Post B, Siemann I, Voermans NC. Psychosocial functioning in patients with altered facial expression: a scoping review in five neurological diseases. Disabil Rehabil 2023:1-20. [PMID: 37752723 DOI: 10.1080/09638288.2023.2259310] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE To perform a scoping review to investigate the psychosocial impact of having an altered facial expression in five neurological diseases. METHODS A systematic literature search was performed. Studies were on Bell's palsy, facioscapulohumeral muscular dystrophy (FSHD), Moebius syndrome, myotonic dystrophy type 1, or Parkinson's disease patients; had a focus on altered facial expression; and had any form of psychosocial outcome measure. Data extraction focused on psychosocial outcomes. RESULTS Bell's palsy, myotonic dystrophy type 1, and Parkinson's disease patients more often experienced some degree of psychosocial distress than healthy controls. In FSHD, facial weakness negatively influenced communication and was experienced as a burden. The psychosocial distress applied especially to women (Bell's palsy and Parkinson's disease), and patients with more severely altered facial expression (Bell's palsy), but not for Moebius syndrome patients. Furthermore, Parkinson's disease patients with more pronounced hypomimia were perceived more negatively by observers. Various strategies were reported to compensate for altered facial expression. CONCLUSIONS This review showed that patients with altered facial expression in four of five included neurological diseases had reduced psychosocial functioning. Future research recommendations include studies on observers' judgements of patients during social interactions and on the effectiveness of compensation strategies in enhancing psychosocial functioning.
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Affiliation(s)
- Nathaniël B Rasing
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willianne van de Geest-Buit
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - On Ying A Chan
- Medical Library, Radboud University, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Lanser
- Patient Representative and Chairman FSHD Advocacy Group, Patient Organization for Muscular Disease Spierziekten Nederland, Baarn, The Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith Holler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, and Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Post
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ietske Siemann
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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8
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Janssen RMJ, Lustenhouwer R, Cup EHC, van Alfen N, Ijspeert J, Helmich RC, Cameron IGM, Geurts ACH, van Engelen BGM, Graff MJL, Groothuis JT. Effectiveness of an outpatient rehabilitation programme in patients with neuralgic amyotrophy and scapular dyskinesia: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2023; 94:474-481. [PMID: 36697215 DOI: 10.1136/jnnp-2022-330296] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is an acute inflammation of nerves within the brachial plexus territory leading to severe pain and multifocal paresis resulting in >60% of patients having residual complaints and functional limitations correlated with scapular dyskinesia. Our primary aim was to compare the effects of multidisciplinary rehabilitation (MR), focused on motor relearning to improve scapular dyskinesia and self-management strategies for reducing pain and fatigue, with usual care (UC) on shoulder, arm and hand functional capability in patients with NA. METHODS In a non-blinded randomised controlled trial (RCT), patients with NA (aged≥18 years, scapular dyskinesia, >8 weeks after onset) were randomised to either an MR or an UC group. MR consisted of a diagnostic multidisciplinary consultation and eight sessions of physical and occupational therapy. Primary outcome was functional capability of the shoulder, arm and hand assessed with the Shoulder Rating Questionnaire-Dutch Language Version (SRQ-DLV). RESULTS We included 47 patients with NA; due to drop-out, there were 22 participants in MR and 15 in UC for primary analysis. The mean group difference adjusted for sex, age and SRQ-DLV baseline score was 8.60 (95%CI: 0.26 to 16.94, p=0.044). The proportion attaining a minimal clinically relevant SRQ-DLV improvement (≥12) was larger for the MR group (59%) than the UC group (33%) with a number needed to treat of 4. CONCLUSION This RCT shows that an MR programme focused on motor relearning to improve scapular dyskinesia, combined with self-management strategies for reducing pain and fatigue, shows more beneficial effects on shoulder, arm and hand functional capability than UC in patients with NA. TRIAL REGISTRATION NUMBER NCT03441347.
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Affiliation(s)
- Renske M J Janssen
- Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renee Lustenhouwer
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Functional Genomics, Faculty of Science, Center for Neurogenomics and Cognitive Research, Vrije Universiteit, Amsterdam, The Netherlands
| | - Edith H C Cup
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nens van Alfen
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jos Ijspeert
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rick C Helmich
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ian G M Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Maud J L Graff
- Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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9
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Bouman K, Dittrich AT, Groothuis JT, van Engelen BG, Janssen MC, Voermans NC, Draaisma JM, Erasmus CE. Bone Quality in Patients with a Congenital Myopathy: A Scoping Review. J Neuromuscul Dis 2023; 10:1-13. [PMID: 36314217 PMCID: PMC9881028 DOI: 10.3233/jnd-221543] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Congenital myopathies are rare neuromuscular disorders presenting with a wide spectrum of clinical features, including long bone fractures (LBFs) that negatively influence functional prognosis, quality of life and survival. Systematic research on bone quality in these patients is lacking. OBJECTIVE This scoping review aims to summarize all evidence on bone quality and to deduce recommendations for bone quality management in congenital myopathies. METHODS Five electronic databases (Pubmed, Embase, Cochrane, Web of Science, CINAHL) were searched. All studies on bone quality in congenital myopathies were included. Decreased bone quality was defined as low bone mineral density and/or (fragility) LBFs. Study selection and data extraction were performed by three independent reviewers. RESULTS We included 244 single cases (mean: 4.1±7.6 years; median: 0 years) diagnosed with a congenital myopathy from 35 articles. Bone quality was decreased in 93 patients (37%) (mean: 2.6±6.8 years; median: 0 years). Low bone mineral density was reported in 11 patients (4.5%) (mean: 10.9±9.7; median: 11 years). Congenital LBFs were reported in 64 patients (26%). (Fragility) LBFs later at life were described in 24 patients (9.8%) (mean: 14.9±11.0; median: 14 years). Four cases (1.6%) were reported to receive vitamin D and/or calcium supplementation or diphosphonate administration. CONCLUSION LBFs are thus frequently reported in congenital myopathies. We therefore recommend optimal bone quality management through bone mineral density assessment, vitamin D and calcium suppletion, and referral to internal medicine or pediatrics for consideration of additional therapies in order to prevent complications of low bone mineral density.
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Affiliation(s)
- Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands,
Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands,Correspondence to: Karlijn Bouman, Department of Neurology and Pediatric Neurology, Radboud university medical center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands. Tel.: +31 650193738; Fax: +31 243635135; E-mail:
| | - Anne T.M. Dittrich
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mirian C.H. Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jos M.T. Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corrie E. Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
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10
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Middelink M, Voermans NC, van Engelen BG, Janssen MC, Groothuis JT, Knuijt S, Zweers-van Essen H. Indications for Tube Feeding in Adults with Muscular Disorders: A Scoping Review. J Neuromuscul Dis 2023; 10:777-785. [PMID: 37483025 PMCID: PMC10578233 DOI: 10.3233/jnd-230014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Eating an adequate diet and maintaining a healthy body weight can be challenging for patients with muscular disorders (MD). Starting tube feeding can have a positive impact on nutritional status, functioning and quality of life. Guidelines on when to start tube feeding in adults with MD are lacking. OBJECTIVE We aim to review the scientific literature on indications to start tube feeding in adults with facioscapulohumeral dystrophy (FSHD), inclusion body myositis (IBM), muscular dystrophy type 1 (DM1), oculopharyngeal muscular dystrophy (OPMD) and congenital myopathies. METHODS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Relevant studies were identified in Pubmed, Embase and Cinahl (April 2022). The medical subject headings (MeSH) and text words used were related to FSHD, IBM, DM1, OPMD or congenital myopathies and dysphagia, enteral nutrition or malnutrition. RESULTS Of 1046 unique articles, 9 case reports and 2 retrospective case series were included. Indications to start tube feeding were dysphagia, malnutrition/weight loss and respiratory infections (due to aspiration). Percutaneous endoscopic gastrostomy (PEG) tubes were used most often and complications were respiratory failure, problems with the tube itself, accidental tube removal, cutaneous symptoms, digestive symptoms, and peritonitis. CONCLUSION Data on tube feeding in MD is scarce. Indications to start tube feeding were similar across the various MD. We call for more research in this field and suggest to include screening for dysphagia, aspiration and malnutrition in for the treatment of various MD.
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Affiliation(s)
- Marloes Middelink
- Department of Gastroenterology and Hepatology – Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mirian C.H. Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Centre for Brain Cognition and behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Centre for Brain Cognition and behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heidi Zweers-van Essen
- Department of Gastroenterology and Hepatology – Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Bouman K, Groothuis JT, Doorduin J, van Alfen N, Udink ten Cate FE, van den Heuvel FM, Nijveldt R, Kamsteeg EJ, Dittrich AT, Draaisma JM, Janssen MC, van Engelen BG, Erasmus CE, Voermans NC. SELENON-Related Myopathy Across the Life Span, a Cross-Sectional Study for Preparing Trial Readiness. J Neuromuscul Dis 2023; 10:1055-1074. [PMID: 37807786 PMCID: PMC10657684 DOI: 10.3233/jnd-221673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND SELENON(SEPN1)-related myopathy (SELENON-RM) is a rare congenital neuromuscular disease characterized by proximal and axial muscle weakness, spinal rigidity, scoliosis and respiratory impairment. No curative treatment options exist, but promising preclinical studies are ongoing. Currently, natural history data are lacking, while selection of appropriate clinical and functional outcome measures is needed to reach trial readiness. OBJECTIVE We aim to identify all Dutch and Dutch-speaking Belgian SELENON-RM patients, deep clinical phenotyping, trial readiness and optimization of clinical care. METHODS This cross-sectional, single-center, observational study comprised neurological examination, functional measurements including Motor Function Measurement 20/32 (MFM-20/32) and accelerometry, questionnaires, muscle ultrasound, respiratory function tests, electro- and echocardiography, and dual-energy X-ray absorptiometry. RESULTS Eleven patients with genetically confirmed SELENON-RM were included (20±13 (3-42) years, 73% male). Axial and proximal muscle weakness were most pronounced. The mean MFM-20/32 score was 71.2±15.1%, with domain 1 (standing and transfers) being most severely affected. Accelerometry showed a strong correlation with MFM-20/32. Questionnaires revealed impaired quality of life, pain and problematic fatigue. Muscle ultrasound showed symmetrically increased echogenicity in all muscles. Respiratory function, and particularly diaphragm function, was impaired in all patients, irrespective of the age. Cardiac assessment showed normal left ventricular systolic function in all patients but abnormal left ventricular global longitudinal strain in 43% of patients and QRS fragmentation in 80%. Further, 80% of patients showed decreased bone mineral density on dual-energy X-ray absorptiometry scan and 55% of patients retrospectively experienced fragility long bone fractures. CONCLUSIONS We recommend cardiorespiratory follow-up as a part of routine clinical care in all patients. Furthermore, we advise vitamin D supplementation and optimization of calcium intake to improve bone quality. We recommend management interventions to reduce pain and fatigue. For future clinical trials, we propose MFM-20/32, accelerometry and muscle ultrasound to capture disease severity and possibly disease progression.
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Affiliation(s)
- Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Floris E.A. Udink ten Cate
- Department of Pediatric cardiology, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Anne T.M. Dittrich
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Jos M.T. Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Mirian C.H. Janssen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Baziel G.M. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Corrie E. Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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12
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Lustenhouwer R, Cameron IG, van Alfen N, Toni I, Geurts AC, van Engelen BG, Groothuis JT, Helmich RC. Cerebral Adaptation Associated with Peripheral Nerve Recovery in Neuralgic Amyotrophy: A Randomized Controlled Trial. Neurorehabil Neural Repair 2023; 37:3-15. [PMID: 36575812 PMCID: PMC9896536 DOI: 10.1177/15459683221145149] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a common peripheral nerve disorder caused by auto-immune inflammation of nerves in the brachial plexus territory, characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Recent work has confirmed that NA patients with residual motor dysfunction have abnormal cerebral sensorimotor representations of their affected upper extremity. OBJECTIVE To determine whether abnormal cerebral sensorimotor representations associated with NA can be altered by specialized, multidisciplinary outpatient rehabilitation focused on relearning motor control. METHODS 27 NA patients with residual lateralized symptoms in the right upper extremity participated in a randomized controlled trial, comparing 17 weeks of multidisciplinary rehabilitation (n = 16) to usual care (n = 11). We used task-based functional MRI and a hand laterality judgment task, which involves motor imagery and is sensitive to altered cerebral sensorimotor representations of the upper extremity. RESULTS Change in task performance and related brain activity did not differ significantly between the multidisciplinary rehabilitation and usual care groups, whereas the multidisciplinary rehabilitation group showed significantly greater clinical improvement on the Shoulder Rating Questionnaire. Both groups, however, showed a significant improvement in task performance from baseline to follow-up, and significantly increased activity in visuomotor occipito-parietal brain areas, both specific to their affected upper extremity. CONCLUSIONS Abnormal cerebral sensorimotor representations of the upper extremity after peripheral nerve damage in NA can recover toward normality. As adaptations occurred in visuomotor brain areas, multidisciplinary rehabilitation after peripheral nerve damage may be further optimized by applying visuomotor strategies. This study is registered at ClinicalTrials.gov (NCT03441347).
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands,Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands
| | - Ian G.M. Cameron
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands,Faculty of Electrical Engineering,
Mathematics and Computer Science, University of Twente, Enschede, The
Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands
| | - Alexander C.H. Geurts
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Baziel G.M. van Engelen
- Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands,Jan T. Groothuis, Radboud university
medical center, Department of Rehabilitation, P.O. Box 9101, Nijmegen, 6500 HB,
The Netherlands.
| | - Rick C. Helmich
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands,Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
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13
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IJspeert J, Lustenhouwer R, Janssen RM, Han JJ, Hatch MN, Cameron I, Helmich RC, van Engelen B, van der Wees P, Geurts ACH, van Alfen N, Groothuis JT. Reachable workspace analysis is a potential measurement for impairment of the upper extremity in neuralgic amyotrophy. Muscle Nerve 2022; 66:282-288. [PMID: 35665519 PMCID: PMC9544162 DOI: 10.1002/mus.27651] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS Neuralgic amyotrophy (NA) is a multifocal neuropathy involving the nerves of the upper extremity, limiting functional capability and reducing range of motion. The reachable workspace (RWS) is a computerized three-dimensinal analysis system that evaluates the relative surface area (RSA) of an individual's arm reachability and has shown utility in several neuromuscular disorders. The aims of this study were to examine the ability of the RWS to quantitatively detect limitations in upper extremity active range of motion in patients with NA, and correlate these with other upper extremity functional outcome measures. METHODS Forty-seven patients with NA and 25 healthy age- and sex-matched controls were measured with the RWS. Study participants' RSAs were correlated with scores on the Shoulder Rating Questionnaire (SRQ), the Disabilities of Arm Shoulder and Hand (DASH) questionnaire, and upper extremity strength measurements using hand-held dynamometry. RESULTS Patients with NA showed significantly lower values in the affected arm for all quadrants (except for the ipsilateral lower quadrant) and total RSA compared with controls (P < 0.001). We found moderate correlations between the reachable workspace, the DASH questionnaire result (r = -0.415), and serratus anterior muscle strength (r = 0.414). DISCUSSION RWS is able to detect limitations in active range of motion of the affected arm in patients with NA, and is moderately correlated with upper extremity functional measures. RWS can demonstrate impairment of the affected upper extremity in NA and it has potential as a clinical outcome measure.
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Affiliation(s)
- Jos IJspeert
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands
| | - Renee Lustenhouwer
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Renske M Janssen
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jay J Han
- Department of Physical Medicine & Rehabilitation, University of California Irvine School of Medicine, Irvine, California
| | - Maya N Hatch
- Department of Physical Medicine & Rehabilitation, University of California Irvine School of Medicine, Irvine, California
| | - Ian Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Rick C Helmich
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip van der Wees
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands
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14
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Bouman K, Gubbels M, van den Heuvel FM, Groothuis JT, Erasmus CE, Nijveldt R, Udink ten Cate FE, Voermans NC. Cardiac involvement in two rare neuromuscular diseases: LAMA2-related muscular dystrophy and SELENON-related myopathy. Neuromuscul Disord 2022; 32:635-642. [DOI: 10.1016/j.nmd.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 01/16/2023]
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15
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Mul K, Wijayanto F, Loonen TGJ, Groot P, Vincenten SCC, Knuijt S, Groothuis JT, Maal TJJ, Heskes T, Voermans NC, Engelen BGMV. Development and validation of the patient-reported "Facial Function Scale" for facioscapulohumeral muscular dystrophy. Disabil Rehabil 2022; 45:1530-1535. [PMID: 35575310 DOI: 10.1080/09638288.2022.2066208] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Facial weakness and its functional consequences are an often underappreciated clinical feature of facioscapulohumeral muscular dystrophy (FSHD) by healthcare professionals and researchers. This is at least in part due to the fact that there are few adequate clinical outcome measures available. METHODS We developed the Facial Function Scale, a Rasch-built questionnaire on the functional disabilities relating to facial weakness in FSHD. A preliminary 33-item questionnaire was created based on semi-structured interviews with 16 FSHD patients and completed by 119 patients. For reliability studies, 73 patients completed it again after a two-week interval. Data were subjected to semi-automated Rasch analysis to select the most appropriate item set to fit model expectations. RESULTS This resulted in a 25-item unidimensional, linear-weighted questionnaire with high internal consistency (person separation index = 0.92) and test-retest reliability (patients' locations ICC = 0.98 and items' locations ICC = 0.99). Good external construct validity scores were obtained through correlation with the Communicative Participation Item Bank questionnaire, examiner-reported Facial Weakness Score and facial weakness subscale of the FSHD evaluation score (respectively r = 0.733, r = -0.566, and r = 0.441, all p < 0.001). CONCLUSIONS This study provides a linear-weighted, clinimetrically sound, patient-reported outcome measure on the functional disabilities relating to facial weakness in FSHD, to enable further research on this relevant topic.Implications for rehabilitationFacial weakness and its functional consequences are an often underappreciated clinical feature of facioscapulohumeral muscular dystrophy (FSHD), both in symptomatic treatment and in research.To enable the development and testing of therapeutic symptomatic interventions for facial weakness, clinical outcome measures are required.This study provides a linear-weighted, clinimetrically sound, patient-reported outcome measure on the functional disabilities relating to facial weakness in FSHD patients.
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Affiliation(s)
- Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Feri Wijayanto
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands.,Department of Informatics, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Tom G J Loonen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboudumc 3D-Lab, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Perry Groot
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Sanne C C Vincenten
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D-Lab, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Teeselink S, Vincenten SCC, Voermans NC, Groothuis JT, Doorduin J, Wijkstra PJ, Horlings CGC, van Engelen BGM, Mul K. Long-term follow-up of respiratory function in facioscapulohumeral muscular dystrophy. J Neurol 2022; 269:3682-3689. [PMID: 35147730 PMCID: PMC8831680 DOI: 10.1007/s00415-022-10990-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/25/2022]
Abstract
Objective To evaluate the 5-year change in respiratory function in patients with facioscapulohumeral muscular dystrophy (FSHD). Methods Genetically confirmed patients with FSHD aged ≥ 18 years were examined twice over five years. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured using hand-held spirometry with a face mask. Several clinical outcome measures were correlated to respiratory function. Results Ninety-two patients were included (57% male, age 18–75 years). At baseline, the spirometry outcomes of 41 patients showed a restrictive ventilatory pattern (FVC < 80% and FEV1/FVC ≥ 70% of predicted) and of 48 patients at follow-up. The mean FVC decreased from baseline to follow-up from 79.0 to 76.7% predicted (p = 0.021). This decrease was driven by a subgroup of 15 patients who had a deterioration of FVC of > 10% predicted. The subgroup of 15 patients was more severely affected at baseline (p = 0.002 for FSHD clinical score and 0.007 for Ricci score). They developed more frequently spinal and thorax deformities (p < 0.001 for kyphoscoliosis and 0.012 for pectus excavatum) and had a larger decline in axial muscle function (p = 0.020). Only weak correlations were found between the change in FVC% predicted and the change in clinical scores between baseline and follow-up. Interpretation Respiratory function remained stable in most patients with FSHD, but a subgroup of patients showed a pronounced deterioration. They showed more severe muscle weakness including the leg muscles at baseline (Ricci score ≥ 6), had spinal and thorax deformities and a relatively fast decline in axial muscle function at follow-up.
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Affiliation(s)
- Sjan Teeselink
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Sanne C C Vincenten
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Reinier Postlaan 4 (910), PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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17
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Bergs PMJ, Maas DM, Janssen MCH, Groothuis JT. Feasible and clinical relevant outcome measures for adults with mitochondrial disease. Mol Genet Metab 2022; 135:102-108. [PMID: 34961688 DOI: 10.1016/j.ymgme.2021.12.010] [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: 07/14/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
There is no consensus on clinical outcome measures that reflect function, activities and participation which are suitable for adults with mitochondrial diseases (MD). The aim of this study was to determine feasible and clinically relevant outcome measures for patients with MD . In 156 adult patients with MD, endurance, balance, strength and mobility tests were evaluated. All tests showed a negative deviation to healthy reference values. Balance tests were feasible and significantly correlated with clinical severity. The Åstrand cycle test was not feasible in 55%, whereas the feasibility of the 6 min walking test is unclear in patients with MD.
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Affiliation(s)
- Peggy M J Bergs
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Daphne M Maas
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Rehabilitation, Radboud university medical center, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- Radboud Center for Mitochondrial Medicine, Department of Rehabilitation, Radboud university medical center, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Jan T Groothuis
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud Center for Mitochondrial Medicine, Department of Rehabilitation, Radboud university medical center, Nijmegen, the Netherlands.
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18
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Lustenhouwer R, Cameron IGM, Wolfs E, van Alfen N, Toni I, Geurts ACH, van Engelen BGM, Groothuis JT, Helmich RC. OUP accepted manuscript. Brain Commun 2022; 4:fcac034. [PMID: 35233524 PMCID: PMC8882006 DOI: 10.1093/braincomms/fcac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/03/2021] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
Neuralgic amyotrophy is a common peripheral nerve disorder caused by autoimmune inflammation of the brachial plexus, clinically characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Despite recovery of the peripheral nerves, patients often have residual motor dysfunction of the upper extremity, leading to persistent pain related to altered biomechanics of the shoulder region. Building on clinical signs that suggest a role for cerebral mechanisms in these residual complaints, here we show and characterize cerebral alterations following neuralgic amyotrophy. Neuralgic amyotrophy patients often develop alternative motor strategies, which suggests that (mal)adaptations may occur in somatomotor and/or visuomotor brain areas. Here, we tested where changes in cerebral sensorimotor representations occur in neuralgic amyotrophy, while controlling for altered motor execution due to peripheral neuropathy. We additionally explore the relation between potential cerebral alterations in neuralgic amyotrophy and clinical symptoms. During functional MRI scanning, 39 neuralgic amyotrophy patients with persistent, lateralized symptoms in the right upper extremity and 23 matched healthy participants solved a hand laterality judgement task that can activate sensorimotor representations of the upper extremity, across somatomotor and visuomotor brain areas. Behavioural and cerebral responses confirmed the involvement of embodied, sensorimotor processes across groups. Compared with healthy participants, neuralgic amyotrophy patients were slower in hand laterality judgement and had decreased cerebral activity specific to their affected limb in two higher-order visual brain regions: the right extrastriate cortex and the parieto-occipital sulcus. Exploratory analyses revealed that across patients, extrastriate activity specific to the affected limb decreased as persistent pain increased, and affected limb-related parieto-occipital activity decreased as imagery performance of the affected limb became slower. These findings suggest that maladaptive cerebral plasticity in visuomotor areas involved in sensorimotor integration plays a role in residual motor dysfunction and subsequent persistent pain in neuralgic amyotrophy. Rehabilitation interventions that apply visuomotor strategies to improve sensorimotor integration may help to treat neuralgic amyotrophy patients.
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Ian G. M. Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Donders Centre for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO BOX 217, 7500 AE Enschede, The Netherlands
| | - Elze Wolfs
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Baziel G. M. van Engelen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Rick C. Helmich
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Correspondence to: Rick Helmich Department of Neurology, Radboud University Medical Center PO Box 9101, 6500 HB Nijmegen, The Netherlands E-mail:
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19
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Verbaarschot C, Tump D, Lutu A, Borhanazad M, Thielen J, van den Broek P, Farquhar J, Weikamp J, Raaphorst J, Groothuis JT, Desain P. A visual brain-computer interface as communication aid for patients with amyotrophic lateral sclerosis. Clin Neurophysiol 2021; 132:2404-2415. [PMID: 34454267 DOI: 10.1016/j.clinph.2021.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/07/2020] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Brain-Computer Interface (BCI) spellers that make use of code-modulated Visual Evoked Potentials (cVEP) may provide a fast and more accurate alternative to existing visual BCI spellers for patients with Amyotrophic Lateral Sclerosis (ALS). However, so far the cVEP speller has only been tested on healthy participants. METHODS We assess the brain responses, BCI performance and user experience of the cVEP speller in 20 healthy participants and 10 ALS patients. All participants performed a cued and free spelling task, and a free selection of Yes/No answers. RESULTS 27 out of 30 participants could perform the cued spelling task with an average accuracy of 79% for ALS patients, 88% for healthy older participants and 94% for healthy young participants. All 30 participants could answer Yes/No questions freely, with an average accuracy of around 90%. CONCLUSIONS With ALS patients typing on average 10 characters per minute, the cVEP speller presented in this paper outperforms other visual BCI spellers. SIGNIFICANCE These results support a general usability of cVEP signals for ALS patients, which may extend far beyond the tested speller to control e.g. an alarm, automatic door, or TV within a smart home.
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Affiliation(s)
- Ceci Verbaarschot
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands.
| | | | - Andreea Lutu
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Marzieh Borhanazad
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Jordy Thielen
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; MindAffect, Nijmegen, Netherlands
| | - Philip van den Broek
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | | | - Janneke Weikamp
- Radboud University Medical Center, Department of Rehabilitation, Nijmegen, Netherlands
| | - Joost Raaphorst
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Jan T Groothuis
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; Radboud University Medical Center, Department of Rehabilitation, Nijmegen, Netherlands
| | - Peter Desain
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands; MindAffect, Nijmegen, Netherlands
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20
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Veenhuizen Y, Satink T, Graff MJ, Geurts AC, Groothuis JT, van Engelen BG, Nijhuis-van der Sanden MW, Cup EH. Mixed methods evaluation of a self-management group programme for patients with neuromuscular disease and chronic fatigue. BMJ Open 2021; 11:e048890. [PMID: 34433601 PMCID: PMC8388284 DOI: 10.1136/bmjopen-2021-048890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To obtain insight into experiences of patients with a neuromuscular disease and chronic fatigue and their healthcare professionals regarding content and delivery of a multidisciplinary outpatient self-management group programme to improve social participation. This will inform future implementation. DESIGN A mixed method study alongside a randomised controlled trial. SETTING University hospital, rehabilitation centre and community health centre. PARTICIPANTS 29 patients with a neuromuscular disease and chronic fatigue and 13 healthcare professionals participated in this mixed methods study. INTERVENTION Multidisciplinary group programme, called Energetic, consisted of a 4 months intervention with weekly meetings and covered four modules: (1) individually tailored aerobic exercise training; (2) education about aerobic exercise; (3) self-management training in applying energy conservation strategies and (4) implementation and relapse prevention in daily life. MAIN MEASURES Quantitative data were collected by a questionnaire measuring patients' (n=25, all completed the programme) satisfaction with the perceived results, content and delivery of the programme. Qualitative data were collected by individual and focus group interviews to gain insight in the experiences of patients (n=18), next of kin (n=2) and healthcare professionals (n=13) with facilitators and barriers to programme implementation. RESULTS Patients were satisfied with the number and length of the sessions, the different modules and the therapists. Analysis of the interviews led to five themes: (1) the combination of modules makes a complete picture, (2) the programme is physically and mentally intensive, (3) the group setting is valuable, (4) small variations in delivery occur in different settings, (5) therapists are coaches. Suggestions for programme improvement include a combination of face to face and e-health, enhancement of therapists' skills in guiding group interventions and inclusion of more booster sessions to evaluate and maintain self-management competencies. CONCLUSIONS The Energetic programme could be implemented in different healthcare settings and group settings, and a combination of modules proved to be a facilitator for improving self-management. TRIAL REGISTRATION NUMBER NCT02208687.
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Affiliation(s)
- Yvonne Veenhuizen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Ton Satink
- School of Occupational Therapy, HAN University of Applied Science, Nijmegen, The Netherlands
| | - Maud Jl Graff
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- IQ Healthcare, Research Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Alexander Ch Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Baziel Gm van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- IQ Healthcare, Research Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Edith Hc Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Bouman K, Groothuis JT, Doorduin J, van Alfen N, Udink Ten Cate FEA, van den Heuvel FMA, Nijveldt R, van Tilburg WCM, Buckens SCFM, Dittrich ATM, Draaisma JMT, Janssen MCH, Kamsteeg EJ, van Kleef ESB, Koene S, Smeitink JAM, Küsters B, van Tienen FHJ, Smeets HJM, van Engelen BGM, Erasmus CE, Voermans NC. Natural history, outcome measures and trial readiness in LAMA2-related muscular dystrophy and SELENON-related myopathy in children and adults: protocol of the LAST STRONG study. BMC Neurol 2021; 21:313. [PMID: 34384384 PMCID: PMC8357962 DOI: 10.1186/s12883-021-02336-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND SELENON (SEPN1)-related myopathy (SELENON-RM) is a rare congenital myopathy characterized by slowly progressive proximal muscle weakness, early onset spine rigidity and respiratory insufficiency. A muscular dystrophy caused by mutations in the LAMA2 gene (LAMA2-related muscular dystrophy, LAMA2-MD) has a similar clinical phenotype, with either a severe, early-onset due to complete Laminin subunit α2 deficiency (merosin-deficient congenital muscular dystrophy type 1A (MDC1A)), or a mild, childhood- or adult-onset due to partial Laminin subunit α2 deficiency. For both muscle diseases, no curative treatment options exist, yet promising preclinical studies are ongoing. Currently, there is a paucity on natural history data and appropriate clinical and functional outcome measures are needed to reach trial readiness. METHODS LAST STRONG is a natural history study in Dutch-speaking patients of all ages diagnosed with SELENON-RM or LAMA2-MD, starting August 2020. Patients have four visits at our hospital over a period of 1.5 year. At all visits, they undergo standardized neurological examination, hand-held dynamometry (age ≥ 5 years), functional measurements, questionnaires (patient report and/or parent proxy; age ≥ 2 years), muscle ultrasound including diaphragm, pulmonary function tests (spirometry, maximal inspiratory and expiratory pressure, sniff nasal inspiratory pressure; age ≥ 5 years), and accelerometry for 8 days (age ≥ 2 years); at visit one and three, they undergo cardiac evaluation (electrocardiogram, echocardiography; age ≥ 2 years), spine X-ray (age ≥ 2 years), dual-energy X-ray absorptiometry (DEXA-)scan (age ≥ 2 years) and full body magnetic resonance imaging (MRI) (age ≥ 10 years). All examinations are adapted to the patient's age and functional abilities. Correlation between key parameters within and between subsequent visits will be assessed. DISCUSSION Our study will describe the natural history of patients diagnosed with SELENON-RM or LAMA2-MD, enabling us to select relevant clinical and functional outcome measures for reaching clinical trial-readiness. Moreover, our detailed description (deep phenotyping) of the clinical features will optimize clinical management and will establish a well-characterized baseline cohort for prospective follow-up. CONCLUSION Our natural history study is an essential step for reaching trial readiness in SELENON-RM and LAMA2-MD. TRIAL REGISTRATION This study has been approved by medical ethical reviewing committee Region Arnhem-Nijmegen (NL64269.091.17, 2017-3911) and is registered at ClinicalTrial.gov ( NCT04478981 ).
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Affiliation(s)
- Karlijn Bouman
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands.
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Floris E A Udink Ten Cate
- Department of Pediatric cardiology, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Robin Nijveldt
- Department of Cardiology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Stan C F M Buckens
- Department of Radiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Anne T M Dittrich
- Department of Pediatrics, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Mirian C H Janssen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Erik-Jan Kamsteeg
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Esmee S B van Kleef
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Saskia Koene
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Benno Küsters
- Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Hubert J M Smeets
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
- School for Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, the Netherlands
- School for Developmental Biology and Oncology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud university medical center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Blokhuis AM, Deenen JCW, Voermans NC, van Engelen BGM, Kievit W, Groothuis JT. The socioeconomic burden of facioscapulohumeral muscular dystrophy. J Neurol 2021; 268:4778-4788. [PMID: 34043041 PMCID: PMC8563627 DOI: 10.1007/s00415-021-10591-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/04/2021] [Revised: 03/19/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Promising genetic therapies are being investigated in facioscapulohumeral muscular dystrophy (FSHD). However, the current cost of illness is largely unknown. OBJECTIVE This study aimed at determining the socioeconomic burden of FSHD. METHODS Adult patients with FSHD from the Dutch FSHD registry were invited to complete a questionnaire on medical consumption, work productivity and health-related quality of life (HR-QoL) using the EQ-5D-5L. Associated costs were calculated from a societal perspective. A generalized linear model was fitted to the data to investigate whether level of mobility was related to annual costs of illness. RESULTS 172 patients with FSHD completed the questionnaire (response rate 65%). The per-patient annual direct medical costs of FSHD were estimated at €12,077, direct non-medical costs at €9179 and indirect costs at €5066, adding up to a total cost of illness of €26,322 per patient per year. The direct costs of illness were €21,256, approximately five times higher than the mean per-capita health expenditures in the Netherlands. Major cost-driving factors were formal home care and informal care. A decreased level of mobility was associated with higher direct costs of illness. HR-QoL was significantly reduced in patients with FSHD with a median health utility value of 0.63. CONCLUSIONS We show that FSHD is associated with substantial direct and indirect socioeconomic costs as well as a reduction in HR-QoL. These findings are important for health care decision makers and aids in allocation of research funds and evaluation of the cost-effectiveness of novel therapies.
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Affiliation(s)
- Anna M Blokhuis
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands.
| | - Johanna C W Deenen
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands
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23
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Lustenhouwer R, Cameron IGM, van Alfen N, Oorsprong TD, Toni I, van Engelen BGM, Groothuis JT, Helmich RC. Altered sensorimotor representations after recovery from peripheral nerve damage in neuralgic amyotrophy. Cortex 2020; 127:180-190. [PMID: 32203744 DOI: 10.1016/j.cortex.2020.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/01/2019] [Revised: 11/15/2019] [Accepted: 02/06/2020] [Indexed: 12/19/2022]
Abstract
Neuralgic amyotrophy is a common peripheral nerve disorder caused by acute autoimmune inflammation of the brachial plexus. Subsequent weakness of the stabilizing shoulder muscles leads to compensatory strategies and abnormal motor control of the shoulder. Despite recovery of peripheral nerves and muscle strength over time, motor dysfunction often persists. Suboptimal motor recovery has been linked to maladaptive changes in the central motor system in several nervous system disorders. We therefore hypothesized that neuralgic amyotrophy patients with persistent motor dysfunction may have altered cerebral sensorimotor representations of the affected upper limb. To test this hypothesis, 21 neuralgic amyotrophy patients (mean age 45 ± 12 years, 5 female) with persistent lateralized symptoms in the right upper limb and 20 age- and sex-matched healthy controls, all right-handed, performed a hand laterality judgement task in a cross-sectional comparison. Previous evidence has shown that to solve this task, subjects rely on sensorimotor representations of their own upper limb, using a first-person imagery perspective without actual motor execution. This enabled us to investigate altered central sensorimotor representations while controlling for altered motor output and altered somatosensory afference. We found that neuralgic amyotrophy patients were specifically less accurate for laterality judgments of their affected right limb, as compared to healthy controls. There were no significant group differences in reaction times. Both groups used a first-person imagery perspective, as evidenced by changes in reaction times as a function of participants' own arm posture. We conclude that cerebral sensorimotor representations of the affected upper limb are altered in neuralgic amyotrophy patients. This suggests that maladaptive central neuroplasticity may occur in response to peripheral nerve damage, thereby contributing to motor dysfunction. Therapies focused on altering cerebral sensorimotor representations may help to treat peripheral nerve disorders such as neuralgic amyotrophy.
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Affiliation(s)
- Renee Lustenhouwer
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Ian G M Cameron
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Nens van Alfen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Neurology, Nijmegen, the Netherlands.
| | - Talitha D Oorsprong
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Ivan Toni
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Baziel G M van Engelen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Neurology, Nijmegen, the Netherlands.
| | - Jan T Groothuis
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Rehabilitation, Nijmegen, the Netherlands.
| | - Rick C Helmich
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Neurology, Nijmegen, the Netherlands.
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IJspeert J, Kerstens HCJW, Janssen RMJ, Geurts ACH, van Alfen N, Groothuis JT. Correction to: Validity and reliability of serratus anterior hand held dynamometry. BMC Musculoskelet Disord 2019; 20:433. [PMID: 31526378 PMCID: PMC6747751 DOI: 10.1186/s12891-019-2780-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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Veenhuizen Y, Cup EHC, Jonker MA, Voet NBM, van Keulen BJ, Maas DM, Heeren A, Groothuis JT, van Engelen BGM, Geurts ACH. Self-management program improves participation in patients with neuromuscular disease: A randomized controlled trial. Neurology 2019; 93:e1720-e1731. [PMID: 31570565 DOI: 10.1212/wnl.0000000000008393] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/06/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of Energetic, a self-management group program combining aerobic training, energy conservation management, and relapse prevention to improve social participation in patients with neuromuscular disease (NMD) and chronic fatigue. METHODS In this multicenter, assessor-blinded, 2-armed randomized controlled trial with repeated measurements, 53 patients with various types of NMD and chronic fatigue were randomly allocated to Energetic, a 4-month group intervention, or to usual care. The primary endpoint was social participation assessed with the Canadian Occupational Performance Measure (COPM) performance scale immediately postintervention. Secondary outcomes included COPM satisfaction scale, 6-Minute Walk Test (6MWT), and Checklist Individual Strength-subscale fatigue. Participants were followed for 11 months postintervention. Data were analyzed with linear models that account for repeated measurements. RESULTS Directly after intervention, the mean group difference for COPM-performance was 1.7 (95% confidence interval [CI] 1.0-2.4; p < 0.0001) in favor of the intervention group (n = 29), adjusted for baseline, sex, diagnosis, and work status. This effect was retained at 11 months follow-up (0.9; 95% CI 0.0-1.7; p = 0.049). The COPM satisfaction scale and 6MWT improved more in the intervention group compared to usual care. After 3 and 11 months follow-up, most beneficial effects on social participation and functional endurance were retained. CONCLUSION Energetic led to sustainable improvements in social participation and functional endurance compared to usual care in patients with NMD and chronic fatigue.Clinicaltrials.gov IDENTIFIER: NCT02208687. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a combination of aerobic training, energy conservation management, and relapse prevention improves social participation in patients with NMD and chronic fatigue.
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Affiliation(s)
- Yvonne Veenhuizen
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands.
| | - Edith H C Cup
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Marianne A Jonker
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Nicoline B M Voet
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Bianca J van Keulen
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Daphne M Maas
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Anita Heeren
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Jan T Groothuis
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Baziel G M van Engelen
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Alexander C H Geurts
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
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IJspeert J, Kerstens HCJW, Janssen RMJ, Geurts ACH, van Alfen N, Groothuis JT. Validity and reliability of serratus anterior hand held dynamometry. BMC Musculoskelet Disord 2019; 20:360. [PMID: 31391035 PMCID: PMC6686461 DOI: 10.1186/s12891-019-2741-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/25/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Strength testing of the serratus anterior muscle with hand held dynamometry (HDD) in supine subjects has low reproducibility, and is influenced by compensatory activity of other muscles like the pectoralis major and upper trapezius. Previously, two manual maximum voluntary isometric contraction tests of the serratus anterior muscle were reported that recruited optimal surface electromyography (sEMG) activity in a sitting position. We adapted three manual muscle tests to make them suitable for HHD and investigated their validity and reliability. METHODS Twenty-one healthy adults were examined by two assessors in one supine and two seated positions. Each test was repeated twice. Construct validity was determined by evaluating force production (assessed with HHD) in relation to sEMG of the serratus anterior, upper trapezius and pectoralis major muscles, comparing the three test positions. Intra- and interrater reliability were determined by calculating intra-class correlation coefficients (ICC) smallest detectable change (SDC) and standard error of measurement (SEM). RESULTS Serratus anterior muscle sEMG activity was most isolated in a seated position with the humerus in 90° anteflexion in the scapular plane. This resulted in the lowest measured force levels in this position with a mean force of 296 N (SEM 15.8 N). Intrarater reliability yielded an ICC of 0.658 (95% CI 0.325; 0.846) and an interrater reliability of 0.277 (95% CI -0.089;0.605). SDC was 127 Newton, SEM 45.8 Newton. CONCLUSION The results indicate that validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane. Intrarater reliability is moderate and interrater reliability of this procedure is poor. However the high SDC values make it difficult to use the measurement in repeated measurements.
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Affiliation(s)
- Jos IJspeert
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans C. J. W. Kerstens
- Department of paramedical studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renske M. J. Janssen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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Lustenhouwer R, van Alfen N, Cameron IGM, Toni I, Geurts ACH, Helmich RC, van Engelen BGM, Groothuis JT. NA-CONTROL: a study protocol for a randomised controlled trial to compare specific outpatient rehabilitation that targets cerebral mechanisms through relearning motor control and uses self-management strategies to improve functional capability of the upper extremity, to usual care in patients with neuralgic amyotrophy. Trials 2019; 20:482. [PMID: 31391076 PMCID: PMC6686223 DOI: 10.1186/s13063-019-3556-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/11/2019] [Accepted: 07/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Neuralgic amyotrophy (NA) is a distinct peripheral neurological disorder of the brachial plexus with a yearly incidence of 1/1000, which is characterised by acute severe upper extremity pain. Weakness of the stabilising shoulder muscles in the acute phase leads to compensatory strategies and abnormal motor control of the shoulder - scapular dyskinesia. Despite peripheral nerve recovery, scapular dyskinesia often persists, leading to debilitating residual complaints including pain and fatigue. Evidence suggests that persistent scapular dyskinesia in NA may result from maladaptive cerebral neuroplasticity, altering motor planning. Currently there is no proven effective causative treatment for the residual symptoms in NA. Moreover, the role of cerebral mechanisms in persistent scapular dyskinesia remains unclear. Methods NA-CONTROL is a single-centre, randomised controlled trial comparing specific rehabilitation to usual care in NA. The rehabilitation programme combines relearning of motor control, targeting cerebral mechanisms, with self-management strategies. Fifty patients will be included. Patients are recruited through the Radboud university medical center Nijmegen, the Netherlands. Patients with a (suspected) diagnosis of NA, with lateralized symptoms and scapular dyskinesia in the right upper extremity, who are 18 years or older and not in the acute phase can be included. The primary outcome is the Shoulder Rating Questionnaire score, which measures functional capability of the upper extremity. Secondary clinical outcomes include measures of pain, fatigue, participation, reachable workspace, muscle strength and quality of life. In addition, motor planning is assessed with first-person motor imagery and functional magnetic resonance imaging. In a sub-study the patients are compared to 25 healthy participants, to determine the involvement of cerebral mechanisms. This will enable interpretation of cerebral changes associated with the rehabilitation programme and functional impairments in NA. Discussion NA-CONTROL is the first randomised trial to investigate the effect of specific rehabilitation on residual complaints in NA. It also is the first study into the cerebral mechanisms that might underlie persistent scapular dyskinesia in NA. It thus may aid the further development of mechanism-based interventions for disturbed motor control in NA and in other peripheral neurological disorders. Trial registration ClinicalTrials.gov, NCT03441347. Registered on 20 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3556-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Ian G M Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Rick C Helmich
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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van Groenestijn AC, Schröder CD, van Eijk RPA, Veldink JH, Kruitwagen-van Reenen ET, Groothuis JT, Grupstra HF, Tepper M, van Vliet RO, Visser-Meily JMA, van den Berg LH. Aerobic Exercise Therapy in Ambulatory Patients With ALS: A Randomized Controlled Trial. Neurorehabil Neural Repair 2019; 33:153-164. [DOI: 10.1177/1545968319826051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Weakness caused by motor neuron degeneration in amyotrophic lateral sclerosis (ALS) may result in avoidance of physical activity, resulting in deconditioning and reduced health-related quality of life (HRQoL). Objective: To study the effectiveness of aerobic exercise therapy (AET) on disease-specific and generic HRQoL in ambulatory patients with ALS. Methods: We conducted a multicenter, assessor-blinded, randomized controlled trial. Using a biphasic randomization model, ambulatory ALS patients were assigned (1:1) to AET+usual care (UC), or UC. AET consisted of a 16-week aerobic cycling exercise program. Primary outcome measures were the 40-item ALS assessment questionnaire (ALSAQ-40), and the mental component summary (MCS) and physical component summary (PCS) scores of the short-form survey (SF-36), using linear mixed effects models. Per-protocol (PP) analysis was performed for those patients who attended ≥75% of the training sessions; controls were matched (1:1) by propensity score matching. Results: Of 325 screened patients, 57 were randomized: 27 to AET+UC and 30 to UC. No significant mean slope differences between groups were observed for ALSAQ-40 (-1.07; 95% confidence interval [CI] -2.6 to 0.5, P=0.172) nor for SF-36 MCS (0.24; -0.7 to 1.1, P=0.576) or PCS (-0.51; -1.4 to 0.38, P=0.263). There were no adverse events related to the AET. PP-analyses showed significantly less deterioration in ALSAQ-40 (-1.88, -3.8 to 0.0, P=0.046) in AET+UC compared to UC. Conclusions: AET+UC was not superior to UC alone in preserving HRQoL in ambulatory ALS patient. However, the study was unfortunately underpowered, because only 10 patients completed the protocol. AET+UC may preserve disease-specific HRQoL in slow progressors. Clinical trial registration number: Netherlands National Trial Register (NTR): 1616.
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Affiliation(s)
- Annerieke C. van Groenestijn
- University Medical Center Utrecht, Netherlands
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
- University of Amsterdam, Netherlands
| | - Carin D. Schröder
- University Medical Center Utrecht, Netherlands
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
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van Hees SGM, Knuijt S, Dicke H, Groothuis JT, Raaphorst J, Satink T, Cup EHC. Meet and eat, an interdisciplinary group intervention for patients with myotonic dystrophy about healthy nutrition, meal preparation, and consumption: a feasibility study. Disabil Rehabil 2018; 42:1561-1568. [PMID: 30457347 DOI: 10.1080/09638288.2018.1528305] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: To develop and evaluate an interdisciplinary group intervention for patients with myotonic dystrophy regarding healthy nutrition, meal preparation, and consumption, called Meet and Eat.Materials and methods: A design-based approach was used, exploring experiences and needs of patients with myotonic dystrophy and their next of kin. This resulted in a 4-week interdisciplinary outpatient group intervention to increase awareness and change behavior. In a mixed-method feasibility study this intervention was evaluated with participants and facilitators.Results: Participants reported on social impact of difficulties with eating and drinking (speaking, swallowing, and social embarrassment) and a variety of complaints affecting meal preparation and consumption. Patients and family members expressed the wish to learn from others. After delivery of the intervention, self-reported outcome measures demonstrated improvement on eating and drinking issues in daily life. The qualitative evaluation showed increased awareness and appreciation of the following design principles: peer support, multidisciplinary approach, active involvement of patient with myotonic dystrophy and their next of kin by using personal goals and motivational interviewing.Conclusion: Participation in Meet and Eat seemed to increase insight in patients' condition and ways of management. However, a longer self-management life style program is recommended to change behavior.Implications for rehabilitationPatients with myotonic dystrophy experience physical, cognitive and psychosocial problems to manage healthy nutrition, meal preparation, and consumption;This multidisciplinary group intervention Meet and Eat in patients with myotonic dystrophy appears to be feasible and seems to result in increased insight and management strategies;Peer support, multidisciplinary approach, personal goals, and involvement of family were key factors;To change eating and drinking behavior, a 4-week intervention is too short.
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Affiliation(s)
- Suzanne G M van Hees
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heleen Dicke
- Department of Gastroenterology and Hepatology-Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost Raaphorst
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ton Satink
- Department of Occupational therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands.,European Master of Science in Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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30
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Tilanus TBM, Groothuis JT, Ten Broek-Pastoor JMC, Doorduin J, van Engelen BGM, Kampelmacher MJ, Raaphorst J. Respiratory Assessment of ALS Patients: A Nationwide Survey of Current Dutch Practice. J Neuromuscul Dis 2018:JND18302. [PMID: 30175982 DOI: 10.3233/jnd-18302] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Non-invasive ventilation (NIV) is an established treatment for respiratory failure in patients with amyotrophic lateral sclerosis (ALS). Several studies have shown room for improvement with regard to respiratory care for ALS patients, including latency of referral. These studies focused on the time period starting at the moment of referral to a home ventilation service (HVS) onwards. In the current study we performed a nationwide survey to gain insight in the trajectory before referral. We questioned the assessment of respiratory impairment by ALS physicians/care teams, including criteria for referral to an HVS. METHODS We requested 40 ALS care teams in the Netherlands to fill in an online questionnaire on respiratory management in ALS patients. RESULTS Thirty-two ALS care teams (80%) responded. Forced vital capacity was the most frequently used test at each outpatient visit (72%) and often served as a criterion (78%) for referral to an HVS. Other respiratory function measurements that were performed less often included peak cough flow (50%), maximum inspiratory/expiratory pressure (31% /28%) and sniff nasal inspiratory pressure (13%). Morning headache was the most frequently questioned complaint (94%), followed by daytime sleepiness (91%). Dyspnoea and orthopnoea were reported by 38% and 59% as important complaints. Out of all patients under the care of the ALS care teams, the mean estimated proportion of patients that was referred to an HVS was 69% (range 20-100%). When physicians refrained from referral, the most often cited reasons were patient's decision to withhold NIV (94%) and cognitive impairment (50%). Sixteen percent of the respondents stated bulbar impairment as a reason to refrain from referral. CONCLUSION Despite findings in previous studies on the superiority of SNIP and PCF as compared to FVC, our study shows that a majority of ALS care teams still prefers to use FVC for the assessment of respiratory dysfunction and for the timing of referral to an HVS. Another finding is that bulbar impairment is not an obstacle for referral for NIV.
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Affiliation(s)
- T B M Tilanus
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M C Ten Broek-Pastoor
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Doorduin
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Raaphorst
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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31
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van Alfen N, Doorduin J, van Rosmalen MHJ, van Eijk JJJ, Heijdra Y, Boon AJ, Gaytant MA, van den Biggelaar RJM, Sprooten RTM, Wijkstra PJ, Groothuis JT. Phrenic neuropathy and diaphragm dysfunction in neuralgic amyotrophy. Neurology 2018; 91:e843-e849. [PMID: 30054437 DOI: 10.1212/wnl.0000000000006076] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/25/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical phenotype and recovery of diaphragm dysfunction caused by neuralgic amyotrophy in a large cohort of patients, to improve accurate awareness of this entity, and to encourage adoption of a standardized approach for diagnosis and treatment. METHODS This observational cohort study recruited adult patients with neuralgic amyotrophy and symptoms of idiopathic phrenic neuropathy from the database of the Dutch expert center for neuralgic amyotrophy and the Dutch centers for home mechanical ventilation. Demographic and clinical information on diagnosis, symptoms, and recovery was obtained from chart review. We attempted to contact all patients for a follow-up interview. RESULTS Phrenic neuropathy occurs in 7.6% of patients with neuralgic amyotrophy. Unilateral diaphragmatic dysfunction and bilateral diaphragmatic dysfunction are frequently symptomatic, causing exertional dyspnea, orthopnea, disturbed sleep, and excessive fatigue. Diagnostic practices varied widely and were often not optimally targeted. The majority of patients experienced at least moderate recovery within 2 years. CONCLUSION We recommend screening every patient with neuralgic amyotrophy for diaphragm dysfunction by asking about orthopnea and by performing upright and supine vital capacity screening and diaphragm ultrasound in cases of suspected phrenic neuropathy to optimize diagnosis and care.
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Affiliation(s)
- Nens van Alfen
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands.
| | - Jonne Doorduin
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Marieke H J van Rosmalen
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Jeroen J J van Eijk
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Yvonne Heijdra
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Andrea J Boon
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Michael A Gaytant
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Ries J M van den Biggelaar
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Roy T M Sprooten
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Peter J Wijkstra
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
| | - Jan T Groothuis
- From the Department of Neurology (N.v.A., J.D., M.H.J.v.R., J.J.J.v.E.) and Department of Rehabilitation (J.T.G.), Donders Institute for Brain, Cognition and Behaviour, and Department of Pulmonary Diseases (Y.H.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; Department of Neurology (J.J.v.E.), Jeroen Bosch Hospital, Den Bosch; Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Medicine and Rehabilitation (A.J.B.), Mayo Clinic and Foundation, Rochester, MN; Department of Pulmonary Diseases (M.A.G.), Center for Home Mechanical Ventilation, University Medical Center Utrecht; Department of Pulmonary Diseases (R.J.M.v.d.B.), Center for Home Mechanical Ventilation, Erasmus Medical Center, Rotterdam; Department of Pulmonary Diseases (R.T.M.S.), Center for Home Mechanical Ventilation, Maastricht University Medical Center; and Department of Pulmonary Diseases (P.J.W.), Center for Home Mechanical Ventilation, University Medical Center Groningen, the Netherlands
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Janssen RMJ, Satink T, Ijspeert J, van Alfen N, Groothuis JT, Packer TL, Cup EHC. Reflections of patients and therapists on a multidisciplinary rehabilitation programme for persons with brachial plexus injuries. Disabil Rehabil 2018; 41:1427-1434. [PMID: 29385821 DOI: 10.1080/09638288.2018.1430175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 10/18/2022]
Abstract
PURPOSE There is lack of knowledge, evidence, and guidelines for rehabilitation interventions for persons with neuralgic amyotrophy (NA) or brachial plexus pathology. A first pilot study, evaluating the effect of an integrated rehabilitation programme, showed improvements in activity and participation levels. AIM To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation. MATERIALS AND METHODS A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach. RESULTS Patients reported (1) Time to diagnose: "Finally I'm in the right place;" (2) Awareness: "They gave me a mirror;" (3) Partnership: "There was real contact with the therapists; we made decisions together;" (4) Close collaboration: "Overlapping scopes of practice; doing the same from a different perspective;" and finally (5) Self-management: "Now I can do it myself." Therapists reported (1) "Patients knowledge and understanding is critical to success;" (2) "Activate problem solving and decision making;" (3) "Personalize your therapy; it's more than just giving exercises and information;" (4) "Constant consultation within the team; consistency in messages and approach;" and (5)" Ultimately the patient is in charge." CONCLUSIONS The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme. Implications for rehabilitation Both patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries. A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions. Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient-therapist and within the team; patient activation and self-reflection; and personalised care. Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.
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Affiliation(s)
- Renske M J Janssen
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Ton Satink
- b Department of Occupational Therapy , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | - Jos Ijspeert
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nens van Alfen
- c Department of Neurology and Clinical Neurophysiology , Donders Center for Medical Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Jan T Groothuis
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tanya L Packer
- d School of Occupational Therapy , Dalhousie University , Halifax , Canada
| | - Edith H C Cup
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
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Ramakers R, Koene S, Groothuis JT, de Laat P, Janssen MCH, Smeitink J. Erratum to: Quantification of gait in mitochondrial m.3243A > G patients: a validation study. Orphanet J Rare Dis 2017; 12:170. [PMID: 29078792 PMCID: PMC5660442 DOI: 10.1186/s13023-017-0688-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Rob Ramakers
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Saskia Koene
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jan T Groothuis
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Paul de Laat
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mirian C H Janssen
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.,Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan Smeitink
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
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Tilanus TBM, Groothuis JT, TenBroek-Pastoor JMC, Feuth TB, Heijdra YF, Slenders JPL, Doorduin J, Van Engelen BG, Kampelmacher MJ, Raaphorst J. The predictive value of respiratory function tests for non-invasive ventilation in amyotrophic lateral sclerosis. Respir Res 2017; 18:144. [PMID: 28743265 PMCID: PMC5526316 DOI: 10.1186/s12931-017-0624-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 10/11/2016] [Accepted: 07/17/2017] [Indexed: 11/24/2022] Open
Abstract
Background Non-invasive ventilation (NIV) improves survival and quality of life in amyotrophic lateral sclerosis (ALS) patients. The timing of referral to a home ventilation service (HVS), which is in part based on respiratory function tests, has shown room for improvement. It is currently unknown which respiratory function test predicts an appropriate timing of the initiation of NIV. Methods We analysed, retrospectively, serial data of five respiratory function tests: forced vital capacity (FVC), peak cough flow (PCF), maximum inspiratory and expiratory pressure (MIP and MEP) and sniff nasal inspiratory pressure (SNIP) in patients with ALS. Patients who had had at least one assessment of respiratory function and one visit at the HVS, were included. Our aim was to detect the test with the highest predictive value for the need for elective NIV in the following 3 months. We analysed time curves, currently used cut-off values for referral, and respiratory function test results between ‘NIV indication’ and ‘no-NIV indication’ patients. Results One hundred ten patients with ALS were included of whom 87 received an NIV indication; 11.5% had one assessment before receiving an NIV indication, 88.5% had two or more assessments. The NIV indication was based on complaints of hypoventilation and/or proven (nocturnal) hypercapnia. The five respiratory function tests showed a descending trend during disease progression, where SNIP showed the greatest decline within the latest 3 months before NIV indication (mean = −22%). PCF at the time of referral to the HVS significantly discriminated between the groups ‘NIV-indication’ and ‘no NIV-indication yet’ patients at the first HVS visit: 259 (±92) vs. 348 (±137) L/min, p = 0.019. PCF and SNIP showed the best predictive characteristics in terms of sensitivity. Conclusion SNIP showed the greatest decline prior to NIV indication and PCF significantly differentiated ‘NIV-indication’ from ‘no NIV-indication yet’ patients with ALS. Currently used cut-off values might be adjusted and other respiratory function tests such as SNIP and PCF may become part of routine care in patients with ALS in order to avoid non-timely initiation of (non-invasive) ventilation.
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Affiliation(s)
- T B M Tilanus
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J T Groothuis
- Department of Rehabilitation, Donders Centre for Neuroscience Nijmegen, Nijmegen, The Netherlands
| | - J M C TenBroek-Pastoor
- Department of Rehabilitation, Donders Centre for Neuroscience Nijmegen, Nijmegen, The Netherlands
| | - T B Feuth
- Department of Health Evidence, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Y F Heijdra
- Department of Pulmonary Diseases, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - J P L Slenders
- Department of Neurology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B G Van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Raaphorst
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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Ramakers R, Koene S, Groothuis JT, de Laat P, Janssen MC, Smeitink J. Quantification of gait in mitochondrial m.3243A > G patients: a validation study. Orphanet J Rare Dis 2017; 12:91. [PMID: 28506302 PMCID: PMC5432977 DOI: 10.1186/s13023-017-0644-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/23/2017] [Accepted: 05/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background More than half of the patients harbouring the m.3243A > G mutation were found to have trouble maintaining balance when walking in a recent study by our group. Others demonstrated that these patients had an abnormal gait pattern, as quantified by gait analysis. Gait analysis is an emerging method to quantify subtle changes in walking pattern, also during therapeutic interventions. Therefore, we aimed to test the reliability and reproducibility of gait analysis and select the most suitable protocol for this group of patients using a GAITRite electronic walkway. Four different protocols were tested: normal walking, dual task, post exercise and after a ten minutes of rest. Results In total 36 patients with the m.3243A > G mutation and 50 healthy controls were enrolled in this study. Overall high intra class correlation coefficients were found in all experimental conditions for both patients and healthy controls indicating good reproducibility. Marked differences in gait between patients and controls were observed and were in line with the only available exploratory study performed. There was a good correlation between both the overall NMDAS score, NMDAS subscale scores, both markers for disease severity, and specific gait parameters. Conclusions The observed reliability of the test makes GAITRite a suitable instrument for intervention studies in patients with mitochondrial disease.
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Affiliation(s)
- Rob Ramakers
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Saskia Koene
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jan T Groothuis
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Paul de Laat
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mirian Ch Janssen
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands.,Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Internal Medicine, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan Smeitink
- Radboud Center for Mitochondrial Medicine (RCMM) at the Department of Pediatrics, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, PO BOX 9101, 6500 HB, Nijmegen, The Netherlands
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van Eijk JJ, Groothuis JT, van Alfen N. Reply. Muscle Nerve 2017; 55:447. [DOI: 10.1002/mus.25449] [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] [Received: 09/26/2016] [Revised: 09/26/2016] [Accepted: 10/24/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Jeroen J.J. van Eijk
- Department of Neurology; Jeroen Bosch Hospital, 's-Hertogenbosch; The Netherlands
- Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Centre for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience; Radboud University Medical Center; Nijmegen The Netherlands
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van den Engel-Hoek L, Knuijt S, van Gerven MHJC, Lagarde MLJ, Groothuis JT, de Groot IJM, Janssen MCH. The 6-min mastication test: a unique test to assess endurance of continuous chewing, normal values, reliability, reproducibility and usability in patients with mitochondrial disease. J Oral Rehabil 2017; 44:155-162. [PMID: 28054362 DOI: 10.1111/joor.12481] [Citation(s) in RCA: 7] [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] [Accepted: 12/31/2016] [Indexed: 11/27/2022]
Abstract
In patients with mitochondrial disease, fatigue and muscle problems are the most common complaints. They also experience these complaints during mastication. To measure endurance of continuous mastication in patients with mitochondrial diseases, the 6-min mastication test (6MMT) was developed. This study included the collection of normal data for the 6MMT in a healthy population (children and adults). During 6 min of continuous mastication on a chew tube chewing cycles per minute, total amount of chewing cycles and the difference between minute 1 (M1 ) and minute 6 (M2 ) were collected in 271 healthy participants (5-80 years old). These results were compared with those of nine paediatric and 25 adult patients with a mitochondrial disease. Visual analogue scale (VAS) scores were collected directly after the test and after 5 min. A qualitative rating was made on masticatory movements. The reproducibility of the 6MMT in the healthy population with an interval of approximately 2 weeks was good. The inter-rater reliability for the observations was excellent. The patient group demonstrated lower total amount of chewing cycles or had greater differences between M1 and M6 . The 6MMT is a reliable and objective test to assess endurance of continuous chewing. It demonstrates the ability of healthy children and adults to chew during 6 min with a highly stable frequency of mastication movements. The test may give an explanation for the masticatory problems in patient groups, who are complaining of pain and fatigue during mastication.
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Affiliation(s)
- L van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Knuijt
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M H J C van Gerven
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M L J Lagarde
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J T Groothuis
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Mitochondrial Medicine, Nijmegen, The Netherlands
| | - I J M de Groot
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Mitochondrial Medicine, Nijmegen, The Netherlands
| | - M C H Janssen
- Radboud Center for Mitochondrial Medicine, Nijmegen, The Netherlands.,Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Affiliation(s)
- Jeroen J.J. van Eijk
- Department of Neurology; Jeroen Bosch Hospital's-Hertogenbosch; The Netherlands
- Department of Neurology and Clinical Neurophysiology; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
- Department of Rehabilitation; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
| | - Jan T. Groothuis
- Department of Neurology; Jeroen Bosch Hospital's-Hertogenbosch; The Netherlands
- Department of Neurology and Clinical Neurophysiology; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
- Department of Rehabilitation; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
| | - Nens van Alfen
- Department of Neurology; Jeroen Bosch Hospital's-Hertogenbosch; The Netherlands
- Department of Neurology and Clinical Neurophysiology; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
- Department of Rehabilitation; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
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Van Eijk JJJ, Groothuis JT, Van Alfen N. Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle Nerve 2016; 53:337-50. [PMID: 26662794 DOI: 10.1002/mus.25008] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 12/21/2022]
Abstract
In this review we provide a current overview of the clinical features, pathophysiology, epidemiology, and diagnostic and therapeutic strategies in neuralgic amyotrophy (NA). The disorder has several phenotypic variations, with a classic form in 70% of the patients. It is not rare, with an incidence of 1 per 1,000 individuals, but it is still often missed. Recurrences are common, yet the proposed multifactorial etiology, which includes genetic, biomechanical, and immunologic factors, limits our capacity to predict or prevent them. NA is a clinical diagnosis, and ancillary studies serve to exclude infectious or malignant causes or to assess a differential diagnosis. If patients are seen early and are still in pain, a short trial of high-dose oral corticosteroids is advised, and adequate analgesia may require opioids and non-steroidal anti-inflammatory drugs. Persistent complaints are common, and a multidisciplinary rehabilitation approach focusing on scapular coordination, energy distribution strategies, and self-management is indicated.
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Affiliation(s)
- Jeroen J J Van Eijk
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
| | - Nens Van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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Veenhuizen Y, Cup EHC, Groothuis JT, Hendriks JCM, Adang EMM, van Engelen BGM, Geurts ACH. Effectiveness and cost-effectiveness of a self-management group program to improve social participation in patients with neuromuscular disease and chronic fatigue: protocol of the Energetic study. BMC Neurol 2015; 15:58. [PMID: 25913823 PMCID: PMC4411708 DOI: 10.1186/s12883-015-0314-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/08/2015] [Indexed: 11/10/2022] Open
Abstract
Background Chronic fatigue is present in more than 60% of the patients with a neuromuscular disease and can be their most disabling symptom. In combination with other impairments, fatigue often results in low levels of physical activity and decreased social participation, leading to high societal costs. ‘Energetic’ is a self-management group program aimed at improving social participation, physical endurance and alleviating fatigue in these patients. The primary aim of this study is to evaluate the effectiveness and cost-effectiveness of the Energetic program. Methods/Design A multicentered, assessor-blinded, two-armed randomized controlled trial is conducted with evaluations at inclusion and four, seven and fifteen months later. The study includes patients with a neuromuscular disease and chronic fatigue and, when present, their caregivers. The participants are randomized (ratio 1:1) to either an intervention group, receiving the Energetic program, or a control group, receiving usual care (i.e., no specific intervention). The Energetic program covers four months and includes four modules: 1) individually tailored aerobic exercise training; 2) education about aerobic exercise; 3) self-management training in applying energy conservation strategies; and 4) implementation and relapse prevention in daily life. Two months after cessation of the program a booster session is provided. The primary outcome is the perceived performance score of the Canadian Occupational Performance Measure (COPM). Secondary outcomes include the COPM-satisfaction score, and measures of fatigue, physical endurance, activity engagement, mood, and self-efficacy. Caregiver burden is also evaluated as a secondary outcome. Health-related quality of life and medical and societal costs are assessed to estimate cost-effectiveness of the program. Discussion The Energetic study is the first randomized controlled trial to evaluate the effectiveness and cost-effectiveness of a combined physical and self-management group training program for improving social participation, physical endurance and alleviating fatigue in patients with neuromuscular diseases. It will generate new insights in (cost-)effective rehabilitation strategies for these incurable conditions. Trial registration Clinicaltrials.gov NCT02208687.
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Affiliation(s)
- Yvonne Veenhuizen
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Edith H C Cup
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Jan C M Hendriks
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Eddy M M Adang
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Baziel G M van Engelen
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands.
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Groothuis JT, van Eijk JJJ, van de Laar FA, van Alfen N. [Incidence of neuralgic amyotrophy in a primary care setting: a prospective cohort study]. Ned Tijdschr Geneeskd 2015; 160:A9957. [PMID: 27027209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the incidence of classic neuralgic amyotrophy (NA) in a primary care setting. DESIGN Prospective cohort study. METHOD During the year 2012 we registered all new cases of neck, shoulder or arm symptoms from two large primary care centres serving a population of 14,118. Prior to commencing the study, general practitioners attended a short training session on how to diagnose classic NA. After inclusion, patients in whom general practitioners suspected NA were offered a neurologic assessment for diagnostic confirmation. RESULTS Of the 492 patients identified with new onset of neck, shoulder or arm symptoms, 34 were suspected of having NA. Neurologic evaluation confirmed the diagnosis in 14 patients. For the Netherlands, this translates to an incidence of 1 in 1,000. CONCLUSION Our findings suggest that NA is 30-50 times more common than previously thought; in the Netherlands, this would mean 17,000 instead of 500 new cases each year. Lack of awareness of the disorder and its clinical presentation seems the most likely explanation for this difference. Since NA may lead to sustained symptoms and functional limitations in the chronic phase, increased attention is urgently required to improve diagnostics and treatment.
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Affiliation(s)
- Jan T Groothuis
- *Dit onderzoek werd eerder gepubliceerd in PLOS ONE (2015;10:e0128361) met als titel 'Incidence of neuralgic amyotrophy (Parsonage Turner syndrome) in a primary care setting - a prospective cohort study'. Afgedrukt met toestemming
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Ijspeert J, Janssen RMJ, Murgia A, Pisters MF, Cup EHC, Groothuis JT, van Alfen N. Efficacy of a combined physical and occupational therapy intervention in patients with subacute neuralgic amyotrophy: a pilot study. NeuroRehabilitation 2014; 33:657-65. [PMID: 24004606 DOI: 10.3233/nre-130993] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 11/15/2022]
Abstract
BACKGROUND Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical- and occupational therapy program for patients recovering from NA. OBJECTIVE Evaluation of the effectiveness of a multidisciplinary intervention program for patients with subacute NA. METHODS We performed a within subject proof-of-principle pilot study in eight patients with subacute NA. Patients followed 8 hours of physical and 8 hours of occupational therapy spread over a 16-week period. PRIMARY OUTCOME MEASURES The Canadian Occupational Performance Measure (COPM) and Shoulder Rating Questionnaire (SRQ). SECONDARY OUTCOME MEASURE Disability of Arm Shoulder and Hand (DASH). RESULTS Improvements (mean (95% CI)) were found in the performance and satisfaction scores of the COPM +2.3 (0.9-3.7) and +1.4 (0.4-2.4) points, respectively and the SRQ +14.8 (7.4-22.0) points. The majority of patients (6 out of 8) also demonstrated improvements in the DASH. CONCLUSION The proposed physical and occupational therapy program, may be effective for patients with subacute NA, as demonstrated by improvements in activity, performance and participation.
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Affiliation(s)
- Jos Ijspeert
- Department of Rehabilitation, Radboud University Medical Centre, Centre for Evidence Based Practice, Nijmegen, The Netherlands
| | - Renske M J Janssen
- Department of Rehabilitation, Radboud University Medical Centre, Centre for Evidence Based Practice, Nijmegen, The Netherlands
| | - Alessio Murgia
- Department of Human Movement Sciences, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen
| | - Martijn F Pisters
- Program in Clinical Health Sciences, Physical Therapy Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Radboud University Medical Centre, Centre for Evidence Based Practice, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Radboud University Medical Centre, Centre for Evidence Based Practice, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud University Medical Centre, Donders Centre for Neuroscience, Nijmegen, The Netherlands
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Jones H, Eijsvogels TMH, Nyakayiru J, Verheggen RJHM, Thompson A, Groothuis JT, Atkinson G, Hopman MTE, Thijssen DHJ. Within-subject correlations between evening-related changes in body temperature and melatonin in the spinal cord injured. Chronobiol Int 2013; 31:157-65. [DOI: 10.3109/07420528.2013.833516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Verheggen RJHM, Jones H, Nyakayiru J, Thompson A, Groothuis JT, Atkinson G, Hopman MTE, Thijssen DHJ. Complete absence of evening melatonin increase in tetraplegics. FASEB J 2012; 26:3059-64. [PMID: 22474242 DOI: 10.1096/fj.12-205401] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Individuals with a spinal cord injury (SCI), especially with tetraplegia, experience poor sleep quality, and this may be related to impaired control of circadian rhythmicity. Here, we examined the evening onset of melatonin secretion, an important hormone for the initiation of sleep, in people with a complete cervical (tetraplegia) and thoracic (paraplegia) SCI, and age- and sex-matched able-bodied control participants. Multiple samples of salivary melatonin were obtained during the evening hours and analyzed by ELISA methods in 10 control partcipants, 9 individuals with paraplegia, and 6 individuals with tetraplegia. Sleep quality was assessed using questionnaires. Interactive effects of group and time were found for melatonin levels (P=0.022). In the control and paraplegia groups, the mean melatonin level increased significantly from 2.59 ± 1.04 and 4.28 ± 3.28 pg/ml at 7 PM to 10.62 ± 4.59 and 13.10 ± 7.39 pg/ml at 11 PM, respectively (P<0.001). In the tetraplegia group, melatonin level was 5.25 ± 3.72 at 7 PM but only 2.41 ± 1.25 pg/ml at 11 PM (P>0.05). Decreased sleep quality was more prevalent in individuals with tetraplegia (83%) and paraplegia (75%) compared with controls (20%; P=0.02). Unlike in the control and paraplegia groups, the evening increase in melatonin concentration was completely absent in the tetraplegia group. This provides biological insight into sleep regulation in humans and provides better understanding of the poor sleep quality in people with tetraplegia.
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Affiliation(s)
- Rebecca J H M Verheggen
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Speelman AD, Groothuis JT, van Nimwegen M, van der Scheer ES, Borm GF, Bloem BR, Hopman MT, Munneke M. Cardiovascular Responses During a Submaximal Exercise Test in Patients with Parkinson's Disease. Journal of Parkinson's Disease 2012; 2:241-7. [DOI: 10.3233/jpd-2012-012111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Arlène D. Speelman
- Department of Neurology, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Physiology, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Marlies van Nimwegen
- Department of Neurology, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ellis S. van der Scheer
- Department of Neurology, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - George F. Borm
- Department of Epidemiology, Biostatistics and HTA, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Maria T.E. Hopman
- Department of Physiology, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Nijmegen Centre of Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Groothuis JT, Thijssen DHJ, Lenders JWM, Deinum J, Hopman MTE. Leg vasoconstriction during head-up tilt in patients with autonomic failure is not abolished. J Appl Physiol (1985) 2011; 110:416-22. [PMID: 21127209 DOI: 10.1152/japplphysiol.01098.2010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Maintaining blood pressure during orthostatic challenges is primarily achieved by baroreceptor-mediated activation of the sympathetic nervous system, which can be divided into preganglionic and postganglionic parts. Despite their preganglionic autonomic failure, spinal cord-injured individuals demonstrate a preserved peripheral vasoconstriction during orthostatic challenges. Whether this also applies to patients with postganglionic autonomic failure is unknown. Therefore, we assessed leg vasoconstriction during 60° head-up tilt in five patients with pure autonomic failure (PAF) and two patients with autonomic failure due to dopamine-β-hydroxylase (DBH) deficiency. Ten healthy subjects served as controls. Leg blood flow was measured using duplex ultrasound in the right superficial femoral artery. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. DBH-deficient patients were tested off and on the norepinephrine pro-drug l-threo-dihydroxyphenylserine (l-DOPS). During 60° head-up tilt, leg vascular resistance increased significantly in PAF patients [0.40 ± 0.38 (+30%) mmHg·ml−1·min−1]. The increase in leg vascular resistance was not significantly different from controls [0.88 ± 1.04 (+72%) mmHg·ml−1·min−1]. In DBH-deficient patients, leg vascular resistance increased by 0.49 ± 0.01 (+153%) and 1.52 ± 1.47 (+234%) mmHg·ml−1·min−1 off and on l-DOPS, respectively. Despite the increase in leg vascular resistance, orthostatic hypotension was present in PAF and DBH-deficient patients. Our results demonstrate that leg vasoconstriction during orthostatic challenges in patients with PAF or DBH deficiency is not abolished. This indicates that the sympathetic nervous system is not the sole or pivotal mechanism inducing leg vasoconstriction during orthostatic challenges. Additional vasoconstrictor mechanisms may compensate for the loss in sympathetic nervous system control.
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Affiliation(s)
- Jan T. Groothuis
- Departments of 1Physiology and
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Dick H. J. Thijssen
- Departments of 1Physiology and
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; and
| | - Jacques W. M. Lenders
- Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen
- Department of Medicine III, Carl Gustav Carus University Medical Center, Dresden, Germany
| | - Jaap Deinum
- Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen
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Groothuis JT, Rongen GA, Geurts AC, Smits P, Hopman MT. Effect of different sympathetic stimuli-autonomic dysreflexia and head-up tilt-on leg vascular resistance in spinal cord injury. Arch Phys Med Rehabil 2011; 91:1930-5. [PMID: 21112436 DOI: 10.1016/j.apmr.2010.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/19/2010] [Accepted: 09/01/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effect of different sympathetic stimuli, that is, exaggerated sympathetic activity and orthostatic challenges, on the increase in leg vascular resistance in persons with spinal cord injury (SCI) without and controls with supraspinal sympathetic control. DESIGN Case-control intervention study. SETTING Physiology research laboratory. PARTICIPANTS Persons with SCI (N=9; motor and sensory complete spinal cord lesion above the sixth thoracic spinal segment) and able-bodied controls (N=9). INTERVENTIONS In persons with SCI, exaggerated sympathetic activity was evoked by autonomic dysreflexia, and in controls, by using a cold pressor test (CPT). A 30° head-up tilt (HUT) was performed in both groups. MAIN OUTCOME MEASURE Leg blood flow was measured by using venous occlusion plethysmography during the different sympathetic stimuli. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. RESULTS In persons with SCI, leg vascular resistance significantly increased during autonomic dysreflexia and 30° HUT (25±20 and 24±13 arbitrary units [AU], respectively), with no difference (P=.87) between stimuli. In controls, leg vascular resistance significantly increased during CPT and 30° HUT (15±13 and 29±12AU, respectively) with no difference (P=.03) between stimuli. There were no differences (P=.22) in increase in leg vascular resistance during the different sympathetic stimuli between persons with SCI and controls. CONCLUSIONS The increase in leg vascular resistance during autonomic dysreflexia in persons with SCI is not different from that during 30° HUT, which might be caused by a limited vasoconstrictor reserve. Despite the lack of supraspinal sympathetic control in persons with SCI, the increase in leg vascular resistance during exaggerated sympathetic activity was not different from controls.
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Affiliation(s)
- Jan T Groothuis
- Department of Physiology, Radboud University Nijmegen Medical Centre, The Netherlands
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Hopman MTE, Thijssen DHJ, Esselink RAJ, Aalst M, Seeger JPH, Bloem BR, Groothuis JT. Peripheral vascular responses to an orthostatic challenge and plasma volume in Parkinson's disease patients with orthostatic hypotension. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.594.6] [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)
| | | | - Rianne AJ Esselink
- Parkinson Centre NijmegenDepartment of NeurologyRadboud University Nijmegen Medical CentreNijmegenNetherlands
| | | | | | - Bas R Bloem
- Parkinson Centre NijmegenDepartment of NeurologyRadboud University Nijmegen Medical CentreNijmegenNetherlands
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Groothuis JT, Rongen GA, Deinum J, Pickkers P, Danser AHJ, Geurts AC, Smits P, Hopman MT. Sympathetic Nonadrenergic Transmission Contributes to Autonomic Dysreflexia in Spinal Cord–Injured Individuals. Hypertension 2010; 55:636-43. [DOI: 10.1161/hypertensionaha.109.147330] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Autonomic dysreflexia is a hypertensive episode in spinal cord–injured individuals induced by exaggerated sympathetic activity and thought to be α-adrenergic mediated. α-Adrenoceptor antagonists have been a rational first choice; nevertheless, calcium channel blockers are primarily used in autonomic dysreflexia management. However, α-adrenoceptor blockade may leave a residual vasoconstrictor response to sympathetic nonadrenergic transmission unaffected. The aim was to assess the α-adrenergic contribution and, in addition, the role of supraspinal control to leg vasoconstriction during exaggerated sympathetic activity provoked by autonomic dysreflexia in spinal cord–injured individuals and by a cold pressure test in control individuals. Upper leg blood flow was measured using venous occlusion plethysmography during supine rest and during exaggerated sympathetic activity in 6 spinal cord–injured individuals and 7 able-bodied control individuals, without and with phentolamine (α-adrenoceptor antagonist) and nicardipine (calcium channel blocker) infusion into the right femoral artery. Leg vascular resistance was calculated. In spinal cord–injured individuals, phentolamine significantly reduced the leg vascular resistance increase during autonomic dysreflexia (8±5 versus 24±13 arbitrary units;
P
=0.04) in contrast to nicardipine (15±10 versus 24±13 arbitrary units;
P
=0.12). In controls, phentolamine completely abolished the leg vascular resistance increase during a cold pressure test (1±2 versus 18±14 arbitrary units;
P
=0.02). The norepinephrine increase during phentolamine infusion was larger (
P
=0.04) in control than in spinal cord–injured individuals. These results indicate that the leg vascular resistance increase during autonomic dysreflexia in spinal cord–injured individuals is not entirely α-adrenergic mediated and is partly explained by nonadrenergic transmission, which may, in healthy subjects, be suppressed by supraspinal control.
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Affiliation(s)
- Jan T. Groothuis
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Gerard A. Rongen
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jaap Deinum
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Peter Pickkers
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - A. H. Jan Danser
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Alexander C.H. Geurts
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Paul Smits
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Maria T.E. Hopman
- From the Departments of Physiology (J.T.G., M.T.E.H.), Pharmacology-Toxicology (G.A.R., P.S.), General Internal Medicine (J.D.), Intensive Care Medicine (P.P.), and Rehabilitation (A.C.H.G.), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Rehabilitation (J.T.G., A.C.H.G.), Sint Maartenskliniek, Nijmegen, The Netherlands; Division of Pharmacology, Vascular and Metabolic Diseases (A.H.J.D.), Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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Schipper P, Aansorgh B, Thijssen DH, De Groot PC, Groothuis JT, Hopman MT. Activity Levels While Playing New Generation Video Games. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000353298.02831.74] [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: 11/21/2022]
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