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Kooi-van Es M, Erasmus CE, Voet NBM, van den Engel-Hoek L, van der Wees PJ. Best practice recommendations for speech-language pathology in children with neuromuscular disorders: A Delphi-based consensus study. Int J Speech Lang Pathol 2024; 26:45-58. [PMID: 36896919 DOI: 10.1080/17549507.2023.2181224] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Speech-language pathology (SLP) is considered an essential intervention due to the high prevalence of dysphagia and dysarthria in paediatric neuromuscular disorders (pNMD). Evidence-based guidelines for SLP in pNMD are missing and children could be deprived the best of care. This study aimed to achieve consensus and present best practice recommendations on SLP intervention in pNMD. METHOD A modified Delphi technique was used with a panel of experienced Dutch speech-language pathologists. In two online survey rounds and a face-to-face consensus meeting, the SLP experts proposed intervention items for cases of four types of pNMD (congenital myopathy, Duchenne muscular dystrophy, myotonic dystrophy type 1, and spinal muscular atrophy type 2), covering symptoms of dysphagia, dysarthria, drooling, and oral hygiene problems. They rated the level of agreement. RESULT Intervention items that achieved consensus were incorporated into best practice recommendations. These recommendations cover six core intervention components (wait and see, explanation and advice, training and treatment, aids and adjustments, referral to other disciplines, and monitoring) suitable for the described symptoms. CONCLUSION Insight into treatment options is essential to facilitate speech-language pathologists in clinical decision-making. The current study led to best practice recommendations for speech-language pathologists working within the field of pNMD.
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Affiliation(s)
- Mieke Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Radboud, University Medical Centre, Department of Pediatric Neurology, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nicoline B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands, and
| | | | - Philip J van der Wees
- Department of Rehabilitation and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Altmann VC, Saris C, Voet NBM. [An new application of gait analysis: guidance in finding the underlying health condition]. Ned Tijdschr Geneeskd 2023; 167. [PMID: 36928409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Instrumented gait analysis was developed to assist in clinical decision-making to optimise treatment to improve walking in patients with complex gait problems. In this clinical lesson, two cases are presented in which instrumented gait analysis was used for a different goal. It was used to assist in finding the correct neurological or orthopaedic diagnosis in patients in whom symptoms occurred during walking. In both patients, an accurate diagnosis could not be found based on the symptoms they reported, despite a thorough analysis by the neurologist. Instead, the symptoms were caused by the compensations patients used to optimise walking and not directly by the health condition itself. Through instrumented gait analysis, the direct impact of a health condition on the gait pattern can be distinguished from compensations. It can be an asset in finding the correct diagnosis, especially in patients with complex gait problems or multiple health conditions.
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Voet NBM, Saris CGJ, Thijssen DHJ, Bastiaans V, Sluijs DE, Janssen MMHP. Surface Electromyography Thresholds as a Measure for Performance Fatigability During Incremental Cycling in Patients With Neuromuscular Disorders. Front Physiol 2022; 13:821584. [PMID: 35370798 PMCID: PMC8969223 DOI: 10.3389/fphys.2022.821584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
In healthy persons, there is an excellent relation between the timing of the (two) surface electromyography (sEMG) thresholds and the (two) ventilatory thresholds during exercise. The primary aim of this study was to determine the relative timing of both sEMG and ventilatory thresholds in patients with neuromuscular disorders compared with healthy subjects during a maximal ergospirometry cycling test. We hypothesized that in patients with neuromuscular disorders, the sEMG thresholds would occur relatively earlier in time than the ventilatory thresholds, compared to healthy subjects, because performance fatigability occurs more rapidly. In total, 24 healthy controls and 32 patients with a neuromuscular disorder performed a cardiopulmonary exercise test on a bicycle using a 10-min ramp protocol, during which we collected ergospirometry data: power at both ventilatory and sEMG thresholds, and sEMG data of lower leg muscles. In line with our hypothesis, normalized values for all thresholds were lower for patients than healthy subjects. These differences were significant for the first ventilatory (p = 0.008) and sEMG threshold (p < 0.001) but not for the second sEMG (p = 0.053) and ventilatory threshold (p = 0.238). Most parameters for test–retest reliability of all thresholds did not show any fixed bias, except for the second ventilatory threshold. The feasibility of the sEMG thresholds was lower than the ventilatory thresholds, particularly of the first sEMG threshold. As expected, the sEMG thresholds, particularly the first threshold, occurred relatively earlier in time than the ventilatory thresholds in patients compared with healthy subjects. A possible explanation could be (a combination of) a difference in fiber type composition, disuse, and limited muscle-specific force in patients with neuromuscular disorders. sEMG measurements during submaximal dynamic exercises are needed to generalize the measurements to daily life activities for future use in prescribing and evaluating rehabilitation interventions.
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Affiliation(s)
- Nicoline B. M. Voet
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
- Klimmendaal, Rehabilitation Center, Arnhem, Netherlands
- *Correspondence: Nicoline B. M. Voet,
| | - Christiaan G. J. Saris
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Dick H. J. Thijssen
- Department of Physiology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Vincent Bastiaans
- Sports Medicine Center, HAN Seneca, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - David E. Sluijs
- Sports Medicine Center, HAN Seneca, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Mariska M. H. P. Janssen
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
- Klimmendaal, Rehabilitation Center, Arnhem, Netherlands
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Kooi-van Es M, Erasmus CE, de Swart BJM, Voet NBM, van der Wees PJ, de Groot IJM, van den Engel-Hoek L. Dysphagia and Dysarthria in Children with Neuromuscular Diseases, a Prevalence Study. J Neuromuscul Dis 2021; 7:287-295. [PMID: 32176651 PMCID: PMC7369072 DOI: 10.3233/jnd-190436] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/13/2023]
Abstract
BACKGROUND Dysphagia and dysarthria are frequently described in pediatric neuromuscular diseases (pNMD). The consequences can be substantial: failure to thrive, malnutrition, aspiration pneumonia, or communication problems. Early detection and identification of risk factors and etiology support preventing complications and morbidity, including impact on quality of life. Information about the prevalence of dysphagia and dysarthria in pNMD is scarce. OBJECTIVE To describe the pooled prevalence of dysphagia and dysarthria in pNMD in the Netherlands. In addition, we describe the prevalence of dysphagia and dysarthria each, and the prevalence of chewing (oral) and swallowing problems per diagnostic group, based on their anatomic origin. METHODS Data were collected from 295 children (mean age 11;0 years, range 2;6-18;0) with pNMD in 12 hospitals and rehabilitation centers in the Netherlands. A speech language therapist established whether dysphagia and dysarthria were present or not. RESULTS In almost all the 14 diagnostic groups of pNMD, dysphagia and dysarthria were present. Pooled overall prevalence of dysphagia and dysarthria was 47.2% and 31.5%, respectively. Of 114 children with dysphagia, 90.0% had chewing problems, 43.0% showed swallowing problems and 33.3% showed both chewing and swallowing problems. CONCLUSIONS The overall pooled prevalence of dysphagia and dysarthria was high in the population of pNMD. It can be argued that periodic monitoring of dysphagia and dysarthria and early referral to a speech language therapist should be a necessity from the start of the diagnosis in the whole pNMD population.
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Affiliation(s)
- Mieke Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Radboud University Medical Centre, Department of Pediatric Neurology - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Bert J M de Swart
- Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Nicoline B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Department of Rehabilitation and IQ Healthcare, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
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Tosserams A, Nijkrake MJ, Voet NBM, Bloem BR, Nonnekes J. Why People With Parkinson's Disease Experience Near-Drowning-and How to Prevent It. Mov Disord Clin Pract 2020; 7:573-574. [PMID: 32626809 PMCID: PMC7328419 DOI: 10.1002/mdc3.12989] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/18/2022] Open
Abstract
View Supplementary Video S1 View Supplementary Video S2 View Supplementary Video S3
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Affiliation(s)
- Anouk Tosserams
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands.,Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands
| | - Maarten J Nijkrake
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands
| | - Nicoline B M Voet
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands.,Klimmendaal, Rehabilitation Center Arnhem The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands.,Department of Rehabilitation Sint Maartenskliniek Nijmegen The Netherlands
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Es MKV, Erasmus CE, Houwen S, de Groot IJM, Voet NBM, van den Engel-Hoek L. Early detection of dysphagia and dysarthria in children with neuromuscular disorders: Diagnostic accuracy of a Screeninglist for Physicians. J Pediatr Rehabil Med 2020; 13:17-23. [PMID: 32176663 DOI: 10.3233/prm-180569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Regardless of age or disease stage, children with neuromuscular disorders (NMD) are at risk of developing dysphagia and/or dysarthria. It is important to screen these children regularly in order to detect and treat problems as soon as possible. To date, there are no standardized tools for screening for dysphagia and dysarthria in children with NMD (pNMD). Thus, children are not always referred for assessment by a speech language therapist (SLT). A new screening instrument for dysphagia and dysarthria has been developed, the Screeninglist Physician of the Diagnostic list for Dysphagia and Dysarthria in pediatric NMD (DDD-pNMD). The diagnostic accuracy was estimated in this study. METHODS Sensitivity and specificity were assessed in 131 children aged 2.0-18.0 years by comparing the outcome of the Screeninglist Physician with the diagnosis of dysphagia and/or dysarthria established by an SLT. RESULTS The sensitivity of the Screeninglist Physician was 88% and its specificity was 63%. The AUC was 0.83. The prevalence of dysphagia and/or dysarthria was 53%. CONCLUSION The Screeninglist Physician of the DDD-pNMD is the first valid screening tool for physicians to identify children with NMD with possible dysphagia and/or dysarthria, thereby enabling timely referral to an SLT.
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Affiliation(s)
- M Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, The Netherlands
| | - C E Erasmus
- Radboud University Medical Centre, Department of Pediatric Neurology - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - S Houwen
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
| | - I J M de Groot
- Radboud University Medical Center, Nijmegen, Department of Rehabilitation, Nijmegen, The Netherlands
| | - N B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Nijmegen, Department of Rehabilitation, Nijmegen, The Netherlands
| | - L van den Engel-Hoek
- Radboud University Medical Center, Nijmegen, Department of Rehabilitation, Nijmegen, The Netherlands
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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: 15] [Impact Index Per Article: 3.0] [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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Morello J, Nevedomskaya E, Pacchiarotta T, Schoemaker B, Derks R, Voet NBM, Meissner A, Deelder AM, van Engelen BGM, Mayboroda OA. Effect of Suboptimal Sampling and Handling Conditions on Urinary Metabolic Profiles. Chromatographia 2014. [DOI: 10.1007/s10337-014-2778-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Janssen BH, Voet NBM, Nabuurs CI, Kan HE, de Rooy JWJ, Geurts AC, Padberg GW, van Engelen BGM, Heerschap A. Distinct disease phases in muscles of facioscapulohumeral dystrophy patients identified by MR detected fat infiltration. PLoS One 2014; 9:e85416. [PMID: 24454861 PMCID: PMC3891814 DOI: 10.1371/journal.pone.0085416] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/26/2013] [Indexed: 11/18/2022] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is an untreatable disease, characterized by asymmetric progressive weakness of skeletal muscle with fatty infiltration. Although the main genetic defect has been uncovered, the downstream mechanisms causing FSHD are not understood. The objective of this study was to determine natural disease state and progression in muscles of FSHD patients and to establish diagnostic biomarkers by quantitative MRI of fat infiltration and phosphorylated metabolites. MRI was performed at 3T with dedicated coils on legs of 41 patients (28 men/13 women, age 34-76 years), of which eleven were re-examined after four months of usual care. Muscular fat fraction was determined with multi spin-echo and T1 weighted MRI, edema by TIRM and phosphorylated metabolites by 3D (31)P MR spectroscopic imaging. Fat fractions were compared to clinical severity, muscle force, age, edema and phosphocreatine (PCr)/ATP. Longitudinal intramuscular fat fraction variation was analyzed by linear regression. Increased intramuscular fat correlated with age (p<0.05), FSHD severity score (p<0.0001), inversely with muscle strength (p<0.0001), and also occurred sub-clinically. Muscles were nearly dichotomously divided in those with high and with low fat fraction, with only 13% having an intermediate fat fraction. The intramuscular fat fraction along the muscle's length, increased from proximal to distal. This fat gradient was the steepest for intermediate fat infiltrated muscles (0.07±0.01/cm, p<0.001). Leg muscles in this intermediate phase showed a decreased PCr/ATP (p<0.05) and the fastest increase in fatty infiltration over time (0.18±0.15/year, p<0.001), which correlated with initial edema (p<0.01), if present. Thus, in the MR assessment of fat infiltration as biomarker for diseased muscles, the intramuscular fat distribution needs to be taken into account. Our results indicate that healthy individual leg muscles become diseased by entering a progressive phase with distal fat infiltration and altered energy metabolite levels. Fat replacement then relatively rapidly spreads over the whole muscle.
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Affiliation(s)
- Barbara H. Janssen
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Nicoline B. M. Voet
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christine I. Nabuurs
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hermien E. Kan
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacky W. J. de Rooy
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander C. Geurts
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - George W. Padberg
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Arend Heerschap
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
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de Groot IJM, Voet NBM, van Middendorp H, Knoop HJA, Rahbek J, van Engelen BGM. 184th ENMC International Workshop: pain and fatigue in neuromuscular disorders: 20-22 May 2011, Naarden, The Netherlands. Neuromuscul Disord 2013; 23:1028-32. [PMID: 23932382 PMCID: PMC3878599 DOI: 10.1016/j.nmd.2013.06.370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/13/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Imelda J M de Groot
- Radboud University Nijmegen - Medical Centre, Nijmegen Centre of Evidence Based Medicine, Dept. of Rehabilitation, Nijmegen, The Netherlands.
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Abstract
BACKGROUND Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004. OBJECTIVES To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012). SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease.We did not use the reporting of specific outcomes as a study selection criterion. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies. MAIN RESULTS We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1.In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial, there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported. AUTHORS' CONCLUSIONS Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.
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Affiliation(s)
- Nicoline B M Voet
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Medical Centre, Nijmegen, Netherlands.
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Voet NBM, Bleijenberg G, Padberg GW, van Engelen BGM, Geurts ACH. Effect of aerobic exercise training and cognitive behavioural therapy on reduction of chronic fatigue in patients with facioscapulohumeral dystrophy: protocol of the FACTS-2-FSHD trial. BMC Neurol 2010; 10:56. [PMID: 20591139 PMCID: PMC2906431 DOI: 10.1186/1471-2377-10-56] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [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: 06/15/2010] [Accepted: 06/30/2010] [Indexed: 11/15/2022] Open
Abstract
Background In facioscapulohumeral dystrophy (FSHD) muscle function is impaired and declines over time. Currently there is no effective treatment available to slow down this decline. We have previously reported that loss of muscle strength contributes to chronic fatigue through a decreased level of physical activity, while fatigue and physical inactivity both determine loss of societal participation. To decrease chronic fatigue, two distinctly different therapeutic approaches can be proposed: aerobic exercise training (AET) to improve physical capacity and cognitive behavioural therapy (CBT) to stimulate an active life-style yet avoiding excessive physical strain. The primary aim of the FACTS-2-FSHD (acronym for Fitness And Cognitive behavioural TherapieS/for Fatigue and ACTivitieS in FSHD) trial is to study the effect of AET and CBT on the reduction of chronic fatigue as assessed with the Checklist Individual Strength subscale fatigue (CIS-fatigue) in patients with FSHD. Additionally, possible working mechanisms and the effects on various secondary outcome measures at all levels of the International Classification of Functioning, Disability and Health (ICF) are evaluated. Methods/Design A multi-centre, assessor-blinded, randomized controlled trial is conducted. A sample of 75 FSHD patients with severe chronic fatigue (CIS-fatigue ≥ 35) will be recruited and randomized to one of three groups: (1) AET + usual care, (2) CBT + usual care or (3) usual care alone, which consists of no therapy at all or occasional (conventional) physical therapy. After an intervention period of 16 weeks and a follow-up of 3 months, the third (control) group will as yet be randomized to either AET or CBT (approximately 7 months after inclusion). Outcomes will be assessed at baseline, immediately post intervention and at 3 and 6 months follow up. Discussion The FACTS-2-FSHD study is the first theory-based randomized clinical trial which evaluates the effect and the maintenance of effects of AET and CBT on the reduction of chronic fatigue in patients with FSHD. The interventions are based on a theoretical model of chronic fatigue in patients with FSHD. The study will provide a unique set of data with which the relationships between outcome measures at all levels of the ICF could be assessed. Trial registration Dutch Trial Register, NTR1447.
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Affiliation(s)
- Nicoline B M Voet
- Nijmegen Centre for Evidence Based Practice; Department of Rehabilitation, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Theelen T, Meulendijks CFM, Geurts DEM, van Leeuwen A, Voet NBM, Deutman AF. Impact factors on intraocular pressure measurements in healthy subjects. Br J Ophthalmol 2004; 88:1510-1. [PMID: 15548801 PMCID: PMC1772426 DOI: 10.1136/bjo.2004.049924] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate whether intraocular pressure (IOP) calculation by applanation tonometry is determined more essentially by the subject's neck position or by neck constriction. METHODS 23 right eyes of 23 healthy subjects (12 male, 11 female) were included. IOP was measured by applanation tonometry with the TonoPen on sitting participants under four different conditions: with open collar upright (A) or with the head in the headrest of a slit lamp (B), with a tight necktie upright (C) or in slit lamp position (D). All measurements with neck constriction were performed 3 minutes after placing the necktie. RESULTS Mean IOP was 16.9 (SD 2.3) mm Hg (range 11-21 mm Hg) (A), 18.1 (SD 2.2) mm Hg (range 14-22 mm Hg) (B), 17.9 (SD 2.9) mm Hg (range 12-25 mm Hg) (C) and 18.7 (SD 2.7) mm Hg (range 13-24 mm Hg) (D). Mean IOP increased by 1.3 (SD 2.6) mm Hg (p = 0.028, paired t test, range +0.2 to +2.4 mm Hg) if subjects changed position from A to B. There was no statistically significant difference between measurements with or without neck constriction. CONCLUSION Applanation tonometry may be inaccurate if performed in slit lamp position. In contrast, tight neckties do not significantly affect IOP evaluation in healthy subjects.
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Affiliation(s)
- T Theelen
- Department of Ophthalmology, University Medical Centre Nijmegen, Philips van Leijdenlaan 15, 6525 EX Nijmegen, Netherlands.
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