Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial

Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.

Design: A randomised, controlled, assessor-blinded trial.

Setting: Rehabilitation institute.

Participants: Thirty-six chronic poststroke (15.89?±?9.01 months) hemiparetic subjects (age: 46.44?±?7.89 years, 30 men and functional ambulation classification of median level 3).

Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.

Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).

Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference?=?3.29, 95% CI?=?1.23–5.35, p?=?.003) and RVGA (mean difference?=?5.41, 95% CI?=?1.12–9.71, p?=?.015) in comparison to the control group. No considerable changes were observed on 10-MWT.

Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.     

A Note on the “One Case per Stagger Position” Character of Common Multiple-Baseline Intervention Designs

Purpose: To overcome the constraint of common multiple-baseline designs that only one case per stagger position is permitted.

Methods: Three alternative strategies for assigning more than one case to each stagger position are examined.

Results: The three recommended strategies achieve the objective while maintaining the study’s internal and statistical-conclusion validities.

Conclusions: ExPRT, a freely available Excel-based randomization-test package, can be used to assist in both the design and statistical analysis associated with each of the strategies.     

French translation and validation of a fragile X syndrome screening checklist

Background: Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability among men. This syndrome is frequently underdiagnosed in adults. The aim of this study was to develop and validate a French translation of the screening checklist Fragiele-X screeningslijst.

Method: The validation sample for the translated checklist included 22 pairs of men between the ages of 18 and 52, matched by age and degree of intellectual impairment.

Results: The translated checklist achieved coefficients of 0.92 for internal consistency, 0.90 for test-retest reliability and 0.65 for inter-rater reliability. These psychometric properties are commensurate with those of the original checklist.

Conclusion: Therefore, the translated checklist developed in this study can be considered a valid screening instrument for the detection of FXS in men with intellectual disabilities.

Abbreviations: FXS: fragile X syndrome; FMR1: fragile X mental retardation 1 (gene)     

Brief compassion focused imagery for treatment of severe head injury

Objective: To determine whether participants with severe head injury (SHI) allocated to a brief compassion focused imagery (CFI) intervention show greater change in compassion than those exposed to relaxation imagery (RI).

Method: Participants were exposed to a preparatory video to promote engagement and then randomly allocated to intervention. Pre- and post-preparatory measures were Motivation for Intervention and Fears of Compassion Scales, State-Trait Anxiety Inventory (STAI) and PANAS. Pre- and post-intervention self-report measures were the Empathy Quotient, Self-Compassion Scale, STAI and Relaxation Scale. Heart rate variability (HRV) was monitored throughout.

Results: Motivation for therapy increased after the preparatory video (z?=?3.44, p?=?0.001). Across the intervention, group differences were not found on self-report measures or HRV changes. When CFI and RI groups were pooled, improvement in relaxation (r?=?.41, p?<?0.01) and state anxiety (r?=?.29, p?<?0.05) were found across the intervention; these outcomes were not associated with changes in self-compassion or HRV.

Conclusion: Brief CFI, a central aspect of compassion focused therapy, did not produce a reliable change in people with SHI. Enhanced motivation for psychological therapy after a brief preparatory video is relevant and underlines the need to understand mechanisms of action rather than the pursuing whole protocol approaches to therapy.     

Exploring dimensions of social support and resilience when providing care at the end of life: a qualitative study

Background: Research shows that formal and informal social support can facilitate resilience in carers. There is a paucity of research exploring social support and resilience amongst recently bereaved informal carers.

Aim: To examine how the presence or absence of distinct dimensions of social support facilitate or hinder resilience in recently bereaved informal carers.

Participants: 44 bereaved carers, who had been identified by GP as ‘main carer’ of someone recently deceased (3–12 months), aged between 38 and 87 years old (mean= 67).

Methods: Thematic analysis then the Ecological Framework of Resilience as an organisational tool to develop overarching themes in the data. We used the Sherbourne and Stewart model to identify social support that was lacking as well as social support that was present.

Results: A range of social support types were identified. There was an emphasis on the importance of relationships with both health professionals and family members, including the care recipient. However, social support was not necessary for resilience if the participant had other resources.

Conclusions: Social support for carers providing end of life care is almost exclusively based around end of life care ‘work’. In comparison to other research our study suggests that relationships with family and health professionals are paramount. Multidimensional support is needed for carers to enhance their resilience.     

Estimation of skeletal muscle mass in patients with spinocerebellar ataxia type 3 and 10

Background: Neurodegenerative diseases may progress to a level in which patients present spontaneous weight loss, resulting in increased falls and functional disabilities when the disease is associated with muscle mass depletion.

Objective: Evaluate the muscle compartment in patients presenting spinocerebellar ataxia (SCA) type 3 and 10.

Methods: Forty-six patients presenting SCA type 3 and 10 were assessed and 76 volunteers were selected to the control group. In order to evaluate the muscle compartment, muscle mass anthropometric measurements were assessed and total skeletal muscle mass calculated through a predictive equation.

Results: Women with SCA3 presented greater weight loss and muscle mass reduction compared to those with SCA10 and the control group. Among the predictive measurements, calf muscle circumference showed a more significant correlation with total skeletal muscle mass (p = 0.718).

Conclusion: Patients presenting both types of ataxia did not show severe depletion in their nutritional status; however, those with SCA3 displayed greater weight loss and muscle mass reduction compared to the SCA10 group.     

Pharmacogenetics and levodopa induced motor complications

Aim: L-dopa remains the most effective symptomatic therapy for Parkinson's disease (PD) but unfortunately, its chronic use is often associated with motor complications. This review highlights the importance of pharmacogenetics in an individualised PD therapeutic approach.

Material and Methods: review of the literature was done.

Results: PD patients show remarkable heterogeneity in their response to L-dopa and this profound interindividual heterogeneity suggests that there is a genetic predisposition.

Conclusions: The impact of the genetic makeup of every individual on PD treatment appears to be of great importance in order to achieve not only the optimum therapeutic effect, but also with minimal side effects.     

Functional detection of the original generation of hippocampal cells planted on to the micro-fluidic chip with artificial neuronal network using the patch clamp recording technique: a preliminary study

Purpose: The design of pattern that limits the hippocampal cells growth is an important explore for realizing a simplified artificial neuronal network in vitro.

Materials and methods: In this study, we examined the pattern in micro-fluidic chip to stipulate the hippocampal cells adhesion, growth and the formation of a functional neuronal network in vitro. Patch clamp recording technique was used to detect the growth situation and biological function of the haippocampal cells on the micro-fluidic chip which could simulate environment in vivo.

Results: We showed that the number of neurons cultured was about 5000–6000 cells on the micro-fluidic chip, which was conductive to the hippocampal cells growth. The result of patch clamp recording technique showed the signals of sodium and potassium channels, meanwhile, it also revealed the signals of synaptic connection.

Conclusions: These findings involve placing cells in specific locations to create organized structures, and explore the spread function of synaptic on the micro-fluidic chip.     

A how-to guide to aphasia services: celebrating Professor Linda Worrall’s contribution to the field

Background: This article recognises Professor Linda Worrall’s contribution to aphasiology and discusses research themes which have grown from her work.

Aims: To review, summarise, and discuss literature relating to four themes which have emerged from the work of Professor Worrall: (1) Research capacity building; (2) Implementation of research evidence in clinical practice; (3) Meaningful outcome measurement; and (4) Improvement of psychological and emotional outcomes.

Main contribution: A review of the literature, with examples of practical applications.

Conclusions: The work of Professor Worrall has greatly influenced the field of aphasia; her legacy is the research capacity she has built in Australia and around the world.     

Rasch analysis of the upper-limb subscale of the stroke rehabilitation assessment of movement (STREAM) tool in an acute stroke cohort Rasch analysis of the upper-limb subscale of the STREAM tool in an acute stroke population

Background: Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness.

Objectives: To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population.

Methods: Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning.

Results: 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0–2), or using the response pattern (0–5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index – 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall fit (chi-square probability of fit – 22%), however, the reliability was slightly reduced (PSI – 0.806).

Conclusions: The study proposes a new scoring method for the upper-limb subscale of the STREAM outcome measure in the acute stroke population.     

Guilt after placement questionnaire: a new instrument to assess caregiver emotional functioning following nursing home placement

Objective: Guilt is a core feature of dementia caregivers’ experiences following placement. This study describes and validates a new assessment tool for monitoring caregiver adjustment after placement.

Methods: Forty-six items addressing ambivalence and guilt about placement were tested with 170 dementia caregivers (M age = 56.79, SD = 13.19; 69.4% female; 54.7% adult child).

Results: Using principal axis factor analysis, 10 items were retained that showed acceptable internal consistency (Cronbach's alpha of 0.92). Construct validity was established in a subset of the sample (n = 53) with measures of depression (r = 0.53), burden (r = 0.48), conflict with staff (r = 0.47), and well-being (r = ?0.30).

Conclusions: This scale may be used to identify caregivers at risk for adjustment problems following placement and to monitor adjustment over time.     

Functional and cognitive variables predicting successful use of chopsticks or a spoon by the paretic upper extremity in patients following stroke: a cross-sectional study

Background: The factors necessary for successful use of chopsticks or a spoon, by patients with a paretic upper extremity (UE) following stroke are unknown.

Objectives: We identified the functional capacities and interactions related to chopsticks or spoon use in patients with right hemiplegia following stroke.

Methods: Participants were 139 stroke patients with right hemiplegia who required rehabilitation, divided into the following three categories: able to use chopsticks, able to use a spoon, or unable to use a spoon. We collected sociodemographic data, medical data, physical and cognitive function data, and functional grades associated with chopsticks or spoon use by the paretic dominant UE while eating. We identified a complex interaction of variables relating to functional use of chopsticks or a spoon using a classification and regression tree analytic process.

Results: Patients with UE Brunnstrom recovery stage (BRS) >IV, and a Hasegawa Dementia Scale – Revised (HDS-R) score >16 had a 91.3% probability of being able to use chopsticks. Moreover, patients with a UE BRS of >IV, and the HDS-R score ≤16 had a 66.7% probability of being able to use a spoon. By contrast, patients with a UE BRS of ≤IV had a 90.5% probability of not being able to use a spoon.

Conclusions: The interaction of BRS as a measure of UE function and HDS-R score as a measure of cognitive function affect the ability of patients with stroke histories to functionally use the paretic UE to operate chopsticks or a spoon.     

Effects of phonomotor treatment on discourse production

Background: Aphasia is an acquired language disorder that makes it difficult for people to produce and comprehend language, with all people with aphasia (PWA) demonstrating difficulty accessing and selecting words (anomia). While aphasia treatments typically focus on a single aspect of language, such as word retrieval, the ultimate goal of aphasia therapy is to improve communication, which is best seen at the level of discourse.

Aims: This retrospective study investigated the effects of one effective anomia therapy, Phonomotor Treatment (PMT), on discourse production.

Methods & Procedures: Twenty-six PWA participated in 60 h of PMT, which focuses on building a person’s ability to recognize, produce, and manipulate phonemes in progressively longer nonword and real-word contexts. Language samples were collected prior to, immediately after, and 3 months after the treatment program. Percent Correct Information Units (CIUs) and CIUs per minute were calculated.

Outcomes & Results: Overall, PWA showed significantly improved CIUs per minute, relative to baseline, immediately after treatment and 3 months later, as well as significantly improved percent CIUs, relative to baseline, 3 months following treatment.

Conclusions: PMT, which focuses on phonological processing, can lead to widespread improvement throughout the language system, including to the functionally critical level of discourse production.     

Pain intensity,depressive symptoms,and functional limitations among older adults with serious mental illness

Objective: To examine pain-related activity interference as a mediator for the relationship between pain intensity and depressive symptoms among older adults with serious mental illness (SMI).

Method: Ordinary least-squares regressions were used to investigate the mediation analysis among older adults with SMI (n = 183) from community mental health centers. Analyses used secondary data from the HOPES intervention study.

Results: Higher pain intensity was associated with greater pain-related activity interference. Higher pain intensity and pain-related activity interference were also associated with elevated depressive symptoms. Finally, greater pain-related activity interference significantly mediated the association between higher pain intensity and elevated depressive symptoms.

Conclusions: These findings demonstrate that pain and depressive symptoms may be linked to functional limitations. Clinicians and researchers in the mental health field should better address pain-related activity interference among older adults with SMI, especially among those with higher pain intensity and elevated depressive symptoms.     

Life activity choices by people with aphasia: repeated interviews and proxy agreement

Background: Person-centered rehabilitation requires that meaningful life activities are identified on a case-by-case basis, but the discovery process can be inaccessible for clients with aphasia. Card-sorting methodology addresses core barriers and help clients communicate their preferences.

Aims: To characterize life activities that people with aphasia want to do, to estimate consistency in selections over time, and to replicate previous findings about the ability of family members and friends to identify their loved ones’ activity preferences.

Methods & Procedures: We administered the Life Interests and Values (LIV) Cards to 26 people with aphasia, asking them which of 95 depicted life activities they wanted to do more in their lives. Half the activity cards were presented again one to ten weeks later. Twenty family members or friends responded as proxies by selecting from a questionnaire with the same items.

Outcomes & Results: Participants with aphasia selected diverse activities, though as a group they identified significantly more activities from the “social” activity category than from the “home and community”, “creative and relaxing”, or “physical” categories. Across the repeated interviews, they selected identical activities on average 78% of the time. Item-to-item agreement between people with aphasia and their proxy responders was significantly lower at 69%.

Conclusions: People with aphasia have diverse activity interests and are reliable informants about their preferences. Because significant others have limited ability to predict these choices, their impressions are inadequate substitutes for direct interviews.     

Spiritual care for people with intellectual and developmental disability: An exploratory study

Background: A faith-based (pseudonym, Adam’s House – AH) and a non-faith-based care service (pseudonym, Greenleaves – GL) were explored to find out if and how spiritual support was provided for people with intellectual and developmental disabilities (IDDs).

Method: Six months were spent volunteering within each service and a mixed-methods approach was utilised including applied and ethnographic methods to explore and describe if and how spirituality was embedded within the two services.

Results: Themes found included community of value; homely functional care; and barriers to spiritual care. GL staff tended to provide what we termed “religious spiritual care” while AH staff administered both “religious” and “non-religious” spiritual-based support. This difference may be related to the type of training found only at AH which included spiritual dimensions.

Conclusion: Services could benefit from acknowledging the importance and significance of spiritual care training and education for effective and varied spiritual care for people with IDD who desire such support.     

Sensitivity to change and responsiveness of the Segmental Assessment of Trunk Control (SATCo) in children with spinal cord injury

Purpose: The purpose of this study was to assess the sensitivity and responsiveness of the Segmental Assessment of Trunk Control (SATCo) for evaluating trunk control in children with spinal cord injury (SCI) receiving activity-based locomotor training (AB-LT).

Methods: Prospective study of nine outcomes for consecutively enrolled children in outpatient AB-LT. To evaluate sensitivity to change, linear-mixed models were constructed and adjusted for covariates: age at and time since SCI. To evaluate responsiveness, standardized response means and 95% confidence intervals were estimated per outcome.

Results: SATCo scores increased significantly (p < 0.05) regardless of chronicity, initial score, and injury level. The SATCo was the most responsive measure and the only outcome demonstrating a large effect size after 3 months of therapy.

Conclusions: Children with SCI receiving AB-LT improved trunk control regardless of chronicity, initial impairment, or prior experience. SATCo sensitivity and responsiveness support its usefulness in measuring trunk control in children with SCI.     

Parental characteristics and the risk of schizophrenia in a Chinese population: a case-control study

Background: Genetic studies have provided convergent results indicating that schizophrenia is a polygenic disorder with a heritability estimate of ～60–80%. The propensity for schizophrenia is ～10 times higher in individuals with first-degree relatives with schizophrenia when compared to the general population.

Aim: To identify associations between parental characteristics and the risk of schizophrenia in a Chinese population.

Methods: Participants with a diagnosis of schizophrenia were recruited along with healthy controls (HCs) matched for age and gender from Weifang, China. Logistic regression models and generalized linear models were used to explore the associations between parental characteristics with the risk and age at onset of schizophrenia. In total, 414 cases and 639 HCs were recruited for the study.

Results: We observed an inverse association between levels of paternal and maternal education and risk of schizophrenia after controlling for potential confounders (Paternal: OR?=?1.525, 95% CI: 1.080–2.153, p?=?.017; Maternal: OR?=?1.984, 95% CI: 1.346-2.924, p?=?.001). Younger paternal and maternal childbearing age were associated with a higher risk of diagnosis of schizophrenia. We furtherly observed that individuals with earlier age at onset of schizophrenia had fewer siblings (p?=?.007) and had higher rates of parental marital disharmony (p?=?.033).

Conclusion: Our results indicate that parental years of education and age of childbearing are associated with an increased risk of schizophrenia in a Chinese population. Age of onset of schizophrenia was positively associated with a greater number of siblings and negatively associated with parental marital disharmony.     

Narrative review of the psychometric properties of language tests used in anomia treatment for primary progressive aphasia (PPA)

Background: Primary progressive aphasia (PPA) is a neurodegenerative dementia in which language decline is the first and most prominent symptom. Among several interventions for PPA, language rehabilitation has been the most frequently used.

Aims: This narrative review aimed to evaluate existing standardised language tests used in the assessment of PPA, in order to determine whether they are appropriate and psychometrically adequate to detect change over time in the treatment of anomia.

Main Contribution: The present findings highlight the scarcity of psychometrically robust instruments used to measure therapy-induced gains in PPA. Additionally, most of these instruments were not validated for use with the PPA population, which consequently might bias the results. There is a need for population-based norms for existing instruments.

Conclusions: The accurate assessment of lexico-semantic deficits in PPA should rely on objective, reliable, valid, and responsive outcome measures. Psychometric studies are needed to evaluate and eventually improve the quality of language tests used in clinical practice.