Participation in the Chronic Phase of Stroke

Abstract

Background: Participation is a multidimensional concept, consisting of an objective and a subjective dimension. Many studies have focused on determinants of only 1 dimension of participation post stroke. Objective: To describe participation (both objective and subjective) and to determine how physical and cognitive independence and subjective complaints (pain, fatigue, and mood) influence participation in community-dwelling stroke survivors in the Netherlands. Methods: The Utrecht Scale for Evaluation of Rehabilitation (USER) measures physical and cognitive independence and subjective complaints. USER-Participation measures 3 dimensions of participation: frequency (objective perspective), restrictions (subjective perspective), and satisfaction (subjective perspective). Spearman correlations and backward linear regression analyses were used to analyze associations between the 3 USER-Participation scores with demographics, stroke characteristics, physical and cognitive independence, and subjective complaints. Results: Of the 111 participants, 48.5% returned to work post stroke, but mostly for only 1 to 16 hours a week. Experienced participation restrictions were most prevalent in physical exercise, chores in/around the house, housekeeping, and outdoor activities. On average, participants were relatively satisfied with their participation, but dissatisfaction occurred in cognition, activities outdoors, and work/housekeeping. Regression analysis revealed that objective participation was determined by physical and cognitive independence, age, and education, whereas subjective participation was determined by physical and cognitive independence, fatigue, and mood. Conclusions: Most participants experienced participation problems, despite relatively good physical recovery. In addition to physical and cognitive factors, subjective complaints of persons with stroke should be addressed in the rehabilitation program.     

Medication Use in Alzheimer's Disease and Healthy Aging

Abstract

The purpose of this research was to determine if decreased utilization of specific medication in individuals with Alzheimer's disease (AD) reflects a global process of decreased medication usage. Participants were 1103 individuals (461 controls; 437 probable AD; 161 possible AD, and 44 Mixed Dementia), drawn from our Alzheimer's Disease Research Registry. Medication usage at entry into the registry did not differ between controls and probable AD cases. Possible AD and the mixed dementia cases took significantly more medications than controls or probable AD cases. Longitudinal analysis showed no significant changes in controls and mixed dementia cases up to 2 years, and use increased in possible and probable AD cases over time. Stratification of subjects by MMSE scores at entry showed no significant difference between groups. Medication use in probable AD patients does not differ from controls, and does not seem to be subject to systematic bias based on disease progression (as measured by MMSE scores). The presence of co-morbidity adds to medication utilization. Cognitive impairment does not appear to affect total medication use, suggesting that specific medication utilization patterns are unlikely to be the result of larger usage patterns.     

Starch digestibility modulation significantly improves glycemic variability in type 2 diabetic subjects: A pilot study

Background and aimsIn type 2 diabetes (T2D) patients, the reduction of glycemic variability and postprandial glucose excursions is essential to limit diabetes complications, beyond HbA1c level. This study aimed at determining whether increasing the content of Slowly Digestible Starch (SDS) in T2D patients’ diet could reduce postprandial hyperglycemia and glycemic variability compared with a conventional low-SDS diet.Methods and resultsFor this randomized cross-over pilot study, 8 subjects with T2D consumed a controlled diet for one week, containing starchy products high or low in SDS. Glycemic variability parameters were evaluated using a Continuous Glucose Monitoring System.Glycemic variability was significantly lower during High-SDS diet compared to Low-SDS diet for MAGE (Mean Amplitude of Glycemic Excursions, p < 0.01), SD (Standard Deviation, p < 0.05), and CV (Coefficient of Variation, p < 0.01). The TIR (Time In Range) [140–180 mg/dL[ was significantly higher during High-SDS diet (p < 0.0001) whereas TIRs ≥180 mg/dL were significantly lower during High-SDS diet. Post-meals tAUC (total Area Under the Curve) were significantly lower during High-SDS diet.ConclusionOne week of High-SDS Diet in T2D patients significantly improves glycemic variability and reduces postprandial glycemic excursions. Modulation of starch digestibility in the diet could be used as a simple nutritional tool in T2D patients to improve daily glycemic control.Registration numberin clinicaltrials.gov: NCT 03289494.     

Adaptive Sliding Transfer for Toileting

No abstract available for this article.     

Consistency of gait characteristics as determined from acceleration data collected at different trunk locations

Estimates of gait characteristics may suffer from errors due to discrepancies in accelerometer location. This is particularly problematic for gait measurements in daily life settings, where consistent sensor positioning is difficult to achieve. To address this problem, we equipped 21 healthy adults with tri-axial accelerometers (DynaPort MiniMod, McRoberts) at the mid and lower lumbar spine and anterior superior iliac spine (L2, L5 and ASIS) while continuously walking outdoors back and forth (20 times) over a distance of 20 m, including turns. We compared 35 gait characteristics between sensor locations by absolute agreement intra-class correlations (2, 1; ICC). We repeated these analyses after applying a new method for off-line sensor realignment providing a unique definition of the vertical and, by symmetry optimization, the two horizontal axes. Agreement between L2 and L5 after realignment was excellent (ICC > 0.9) for stride time and frequency, speed and their corresponding variability and good (ICC > 0.7) for stride regularity, movement intensity, gait symmetry and smoothness and for local dynamic stability. ICC values benefited from sensor realignment. Agreement between ASIS and the lumbar locations was less strong, in particular for gait characteristics like symmetry, smoothness, and local dynamic stability (ICC generally < 0.7). Unfortunately, this lumbar-ASIS agreement did not benefit consistently from sensor realignment. Our findings show that gait characteristics are robust against limited repositioning error of sensors at the lumbar spine, in particular if our off-line realignment is applied. However, larger positioning differences (from lumbar positions to ASIS) yield less consistent estimates and should hence be avoided.     

EDITORIAL

There is a growing literature that seeks to evaluate the role of “recovery capital” in the resolution of substance use disorders. In this study, a structured instrument (the Assessment of Recovery Capital), along with an assessment of social networks among 176 former illicit drug users and drinkers, is measured in three locations in England. There were relationships between recovery capital and vocational activity (training or employment), physical health, psychological health, and overall quality of life, with larger social networks associated with enhanced personal and social recovery capital. The study demonstrates high levels of personal and social well-being—manifesting in engagement in community activities and strong social networks—among persons engaged in recovery support activities that was not linked to time in recovery.     

Joint health and functional ability in children with haemophilia who receive intensive replacement therapy

Summary. Joint physical examination is an important outcome in haemophilia; however its relationship with functional ability is not well established in children with intensive replacement therapy. Boys aged 4–16 years were recruited from two European and three North American treatment centres. Joint physical structure and function was measured with the Haemophilia Joint Health Score (HJHS) while functional ability was measured with the revised Childhood Health Assessment Questionnaire (CHAQ₃₈). Two haemophilia‐specific domains were created by selecting items of the CHAQ₃₈ that cover haemophilia‐specific problems. Associations between CHAQ, HJHS, cumulative number of haemarthroses and age were assessed. A total of 226 subjects – mean 10.8 years old (SD 3.8) – participated; the majority (68%) had severe haemophilia. Most severe patients (91%) were on prophylactic treatment. Lifetime number of haemarthroses [median = 5; interquartile range (IQR) = 1–12] and total HJHS (median = 5; IQR = 1–12) correlated strongly (ρ = 0.51). Total HJHS did not correlate with age and only weakly (ρ = ?0.19) with functional ability scores (median = 0; IQR = ?0.06–0). Overall, haemarthroses were reported most frequently in the ankles. Detailed analysis of ankle joint health scores revealed moderate associations (ρ = 0.3–0.5) of strength, gait and atrophy with lower extremity tasks (e.g. stair climbing). In this population, HJHS summating six joints did not perform as well as individual joint scores, however, certain elements of ankle impairment, specifically muscle strength, atrophy and gait associated significantly with functional loss in lower extremity activities. Mild abnormalities in ankle assessment by HJHS may lead to functional loss. Therefore, ankle joints may warrant special attention in the follow up of these children.