Mental practice-based rehabilitation training to improve arm function and daily activity performance in stroke patients: a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Over 50% of patients with upper limb paresis resulting from stroke face long-term impaired arm function and ensuing disability in daily life. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. This study aims to evaluate a new therapy for improving arm function in sub-acute stroke patients based on mental practice theories and functional task-oriented training, and to study the predictors for a positive treatment result. It is hypothesized that a six-week, mental practice-based training program (additional to regular therapy) targeting the specific upper extremity skills important to the individual patient will significantly improve both arm function and daily activity performance, as well as being cost effective.</p> <p>Methods/design</p> <p>One hundred and sixty sub-acute stroke patients with upper limb paresis (MRC grade 1–3) will participate in a single-blinded, multi-centre RCT. The experimental group will undertake a six-week, individually tailored therapy regime focused on improving arm function using mental practice. The control group will perform bimanual upper extremity exercises in addition to regular therapy. Total contact time and training intensity will be similar for both groups. Measurements will be taken at therapy onset, after its cessation and during the follow-up period (after 6 and 12 months). Primary outcome measures will assess upper extremity functioning on the ICF level of daily life activity (Wolf Motor Function Test, Frenchay Arm Test, accelerometry), while secondary outcome measures cover the ICF impairment level (Brunnstrom-Fu-Meyer test). Level of societal participation (IPA) and quality of life (EuroQol; SS-Qol) will also be tested. Costs will be based on a cost questionnaire, and statistical analyses on MAN(C)OVA and GEE (generalized estimated equations).</p> <p>Discussion</p> <p>The results of this study will provide evidence on the effectiveness of this mental practice-based rehabilitation training, as well as the cost-effectiveness.</p> <p>Trial registration</p> <p>Current Controlled Trials [ISRCTN33487341)</p

Concurrent validity and test-retest reliability of the Virtual Peg Insertion Test to quantify upper limb function in patients with chronic stroke

Background: Measuring arm and hand function of the affected side is vital in stroke rehabilitation. Therefore, the Virtual Peg Insertion Test (VPIT), an assessment combining virtual reality and haptic feedback during a goal-oriented task derived from the Nine Hole Peg Test (NHPT), was developed. This study aimed to evaluate (1) the concurrent validity of key outcome measures of the VPIT, namely the execution time and the number of dropped pegs, with the NHPT and Box and Block Test (BBT), and (2) the test-retest-reliability of these parameters together with the VPIT's additional kinetic and kinematic parameters in patients with chronic stroke. The three tests were administered on 31 chronic patients with stroke in one session (concurrent validity), and the VPIT was retested in a second session 3-7 days later (test-retest reliability). Spearman rank correlation coefficients (rho) were calculated for assessing concurrent validity, and intraclass correlation coefficients (ICCs) were used to determine relative reliability. Bland-Altman plots were drawn and the smallest detectable difference (SDD) was calculated to examine absolute reliability. Results: For the 31 included patients, 11 were able to perform the VPIT solely via use of their affected arm, whereas 20 patients also had to utilize support from their unaffected arm. For n = 31, the VPIT showed low correlations with the NHPT (rho = 0.31 for time (T-ex[s]); rho = 0.21 for number of dropped pegs (N-dp)) and BBT (rho = -0.23 for number of transported cubes (N-tc); rho = -0.12 for number of dropped cubes (N-dc)). The test-retest reliability for the parameters Tex[s], mean grasping force (F(g)go[N]), number of zero-crossings (N(zc[1/s)go/return) and mean collision force (F-cmean[N]) were good to high, with ICCs ranging from 0.83 to 0.94. Fair reliability could be found for F(g)return (ICC = 0.75) and trajectory error (E(traj)go[cm]) (0.70). Poor reliability was measured for E(traj)return[cm] (0.67) and N-dp (0.58). The SDDs were: T-ex = 70.2 s, N-dp = 0.4 pegs; F(g)go/return = 3.5/1.2 Newton; N(zc[1/s])go/return = 0.2/1.8 zero-crossings; E(traj)go/return = 3.5/1.2 Newton; N(zc[1/s])go/return = 0.2/1.8 zero-crossings; E(traj)go/return = 0.5/0.8 cm; F-cmean = 0.7 Newton. Conclusions: The VPIT is a promising upper limb function assessment for patients with stroke requiring other components of upper limb motor performance than the NHPT and BBT. The high intra-subject variation indicated that it is a demanding test for this stroke sample, which necessitates a thorough introduction to this assessment. Once familiar, the VPIT provides more objective and comprehensive measurements of upper limb function than conventional, non-computerized hand assessments

Tremor in multiple sclerosis

Tremor is estimated to occur in about 25 to 60 percent of patients with multiple sclerosis (MS). This symptom, which can be severely disabling and embarrassing for patients, is difficult to manage. Isoniazid in high doses, carbamazepine, propranolol and gluthetimide have been reported to provide some relief, but published evidence of effectiveness is very limited. Most trials were of small size and of short duration. Cannabinoids appear ineffective. Tremor reduction can be obtained with stereotactic thalamotomy or thalamic stimulation. However, the studies were small and information on long-term functional outcome is scarce. Physiotherapy, tremor reducing orthoses, and limb cooling can achieve some functional improvement. Tremor in MS remains a significant challenge and unmet need, requiring further basic and clinical research

Nucleo-cytoplasmic transport of proteins and RNA in plants

Merkle T. Nucleo-cytoplasmic transport of proteins and RNA in plants. Plant Cell Reports. 2011;30(2):153-176.Transport of macromolecules between the nucleus and the cytoplasm is an essential necessity in eukaryotic cells, since the nuclear envelope separates transcription from translation. In the past few years, an increasing number of components of the plant nuclear transport machinery have been characterised. This progress, although far from being completed, confirmed that the general characteristics of nuclear transport are conserved between plants and other organisms. However, plant-specific components were also identified. Interestingly, several mutants in genes encoding components of the plant nuclear transport machinery were investigated, revealing differential sensitivity of plant-specific pathways to impaired nuclear transport. These findings attracted attention towards plant-specific cargoes that are transported over the nuclear envelope, unravelling connections between nuclear transport and components of signalling and developmental pathways. The current state of research in plants is summarised in comparison to yeast and vertebrate systems, and special emphasis is given to plant nuclear transport mutants

Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design

<p>Abstract</p> <p>Background</p> <p>It is the purpose of this article to identify and review criteria that rehabilitation technology should meet in order to offer arm-hand training to stroke patients, based on recent principles of motor learning.</p> <p>Methods</p> <p>A literature search was conducted in PubMed, MEDLINE, CINAHL, and EMBASE (1997–2007).</p> <p>Results</p> <p>One hundred and eighty seven scientific papers/book references were identified as being relevant. Rehabilitation approaches for upper limb training after stroke show to have shifted in the last decade from being analytical towards being focussed on environmentally contextual skill training (task-oriented training). Training programmes for enhancing motor skills use patient and goal-tailored exercise schedules and individual feedback on exercise performance. Therapist criteria for upper limb rehabilitation technology are suggested which are used to evaluate the strengths and weaknesses of a number of current technological systems.</p> <p>Conclusion</p> <p>This review shows that technology for supporting upper limb training after stroke needs to align with the evolution in rehabilitation training approaches of the last decade. A major challenge for related technological developments is to provide engaging patient-tailored task oriented arm-hand training in natural environments with patient-tailored feedback to support (re) learning of motor skills.</p

Impact of cold storage on platelets treated with Intercept pathogen inactivation

BACKGROUND: Pathogen inactivation and cold or cryopreservation of platelets (PLTs) both significantly affect PLT function. It is not known how PLTs function when both are combined. STUDY DESIGN AND METHODS: Standard PLT concentrates (PCs) were compared to pathogen-inactivated PCs treated with amotosalen photochemical treatment (AS-PCT) when stored at room (RT, 22 degrees C), cold (4 degrees C, n = 6), or cryopreservation (-80 degrees C, n = 8) temperatures. The impact of alternative storage methods on both arms was studied in flow cytometry, light transmittance aggregometry, and hemostasis in collagen-coated microfluidic flow chambers. RESULTS Platelet aggregation of cold-stored AS-PCT PLTs was 44% +/- 11% compared to 57% +/- 14% for cold-stored standard PLTs and 58% +/- 21% for RT-stored AS-PCT PLTs. Integrin activation of cold-stored AS-PCT PLTs was 53% +/- 9% compared to 77% +/- 6% for cold-stored standard PLTs and 69% +/- 13% for RT-stored AS-PCT PLTs. Coagulation of cold-stored AS-PCT PLTs started faster under flow (836 +/- 140 sec) compared to cold-stored standard PLTs (960 +/- 192 sec) and RT-stored AS-PCT PLTs (1134 +/- 220 sec). Fibrin formation rate under flow was also highest for cold-stored AS-PCT PLTs. This was in line with thrombin generation in static conditions because cold-stored AS-PCT PLTs generated 297 +/- 47 nmol/L thrombin compared to 159 +/- 33 nmol/L for cold-stored standard PLTs and 83 +/- 25 nmol/L for RT-stored AS-PCT PLTs. So despite decreased PLT activation and aggregation, cold storage of AS-PCT PLTs promoted coagulation. PLT aggregation of cryopreserved AS-PCT PLTs (23% +/- 10%) was not significantly different from cryopreserved standard PLTs (25% +/- 8%). CONCLUSION: This study shows that cold storage of AS-PCT PLTs further affects PLT activation and aggregation but promotes (pro)coagulation. Increased procoagulation was not observed after cryopreservation

Bio-derived rheology modifying agents for cement-based materials

In recent few years, significant development has been made in concrete technology to accommodate the requirements of high-performance concrete. Rheology Modifying Agents (RMAs) (such as superplasticizers) and Viscosity Modifying Agents (VMAs) have been developed as two alternative admixtures to obtain the required workability. However, these admixtures not only increased the environmental impacts of concrete production but also increased the unit cost of concrete. Following these concerns, several studies have been focusing on exploring more sustainable approaches in concrete production such as the use of bio-based admixtures in concrete production. Throughout the literature, bio-based polysaccharides (cellulose, chitosan, etc.) were found to be highly effective as VMAs. Long chain molecules of these polysaccharides stick to the water molecules, decrease their relative motion and forms a gel, so increase the yield stress and plastic viscosity. This behaviour reduces the bleeding and segregation, which results in robust highly workable concrete. The interest in this study was motivated by the vital demand to introduce a greener and more sustainable VMA to improve the rheological properties of cement paste. To this end, bacterial cells proposed as VMAs for cement-based materials. The bacterial cells were directly incorporated into the mix of water without any additional intervention. The rheological measurements were implemented to evaluate the influence of cells on apparent viscosity and yield strength. In addition, the use of superplasticizers and fly ash on the performance of biological VMA were also investigated. Our results showed that the apparent viscosity and yield stress of the cement-paste mix were increased with the addition of the microorganisms. Moreover, bacterial cells were found to be compatible with the use of both fly ash and superplasticizers.TÜBİTAK ; BASF ; Consejo Nacional de Investigaciones Científicas y Técnica

Upper Limb Rehabilitation in People With Multiple Sclerosis

BACKGROUND: There has been an increasing research interest in upper limb rehabilitation in multiple sclerosis (MS). The current changes in the research field inquire a new literature review. OBJECTIVE: This systematic review aimed to provide an overview of the upper limb rehabilitation strategies in people with MS (PwMS). METHODS: Articles published in PubMed and Web of Knowledge were selected when written in English, published in the past 25 years, peer reviewed, that included at least 5 PwMS, and described the effects of an intervention study including rehabilitation strategies targeting the upper limbs. Included articles were screened based on title/abstract and full text by 2 independent reviewers. RESULTS: Thirty articles met the criteria and were included for data extraction. Only half of the included studies investigated the effects of a training program specially targeted toward the upper limbs, while in the other studies, a general whole body therapy was used. The therapy content and dosage varied greatly between the different included studies. Multidisciplinary and robot-based rehabilitation were the most investigated rehabilitation strategies and showed to improve upper limb capacity. Strength and endurance training improved the upper limb body functions and structures but did not influence the upper limb capacity and performance. CONCLUSIONS: The results of this systematic review indicated that different types of upper limb rehabilitation strategies can improve upper limb function in PwMS. Further research is necessary to compare directly the effects of different rehabilitation strategies and to investigate the optimal therapy dosage according to the upper limb disability level.multiple sclerosis; upper extremity; rehabilitatio